Feedback from Vet

[Cuddle Furry]

Opinions on ruling out more diseases? So far Oscar only has Diabetes. However, still can't get him below 300 consistently. I tried a lot of different low carb solutions and up to 7 units of Lantus. I am going to switch to Levemir but Feeling like grasping at straws. Oscar is still a happy and active Cat though so I will keep trying.

First, the insulin auto-antibody test results came back and they are normal. I still suspect the problems that you are seeing with Oscar may be associated with an underlying intestinal issue, possibly Inflammatory Bowel Disease. As we discussed before, definitive diagnosis can only be done with scoping and biopsies. Sometimes, we have seen improvement with supplementation of B12. This can be done with weekly injections at home.

If your are wanting to proceed with additional diagnostics, I would start with a repeat of bloodwork (CBC, Chem panel, thyroid) and abdominal ultrasound. If these provide no answers, then endoscopy would be the next step.

I am very happy to hear that he has gained some weight but am still concerned about the frequent vomiting.



As far as trying Levemir, I can provide you with a written prescription that you would fill at a pharmacy. I would recommend trying to find a pharmacy that will sell you just a single 3ml pen of insulin. You can use the pen or we can help you transfer the contents of the pen to a sterile vial so that you can just draw it up and use it in the same way as the Lantus. Because we don't know how Oscar will respond to the new insulin, I would recommend starting at just a 4 unit dose and monitoring his response.



For monitoring, I recommend checking glucose levels just every 3-4 days unless Oscar is having any signs of low glucose levels. I also recommend staying with an insulin dose for at least 4-5 days before making any changes as it takes a few days for the body to adjust to new dosages.



Concerning your request involving jury duty, I am unable to provide you with a letter excluding you from duty. The only thing I would be able to say is that you have a cat that requires twice daily insulin injections. If you would like me to write this up, please let me know.



Regarding your question about Naltrexone, I have no experience with this and would be uncomfortable with starting this, especially when we don't know what other underlying disease Oscar might have. Perhaps you would be interested in visiting with an Internal Medicine specialist for more advanced care? If so, I can definitely facilitate a referral to Midwest Veterinary Referral Hospital to see an Internist.



I will have a written prescription for the Levemir at the front desk. Please let me know if you have other questions or if you would like to proceed with additional testing or referral.

 

[Chris & China (GA)]

Here's your previous post...we add the link to the previous post so it's easy for people to quickly go back and see what's been going on.

You say the IAA came back normal but what about the test for acromegaly?

And just for my own curiosity, what dose did you start with? Your spreadsheet only goes back to 1/30/22. I looked back through your other posts and if you said, I didn't see it.

 

[Cuddle Furry]

acromegaly ruled out with a growth factor of 35. 1 unit starting 9/8/21.

 

[Bron and Sheba (GA)]

Hi Dave,
That is interesting acromegaly was ruled out….that a good. I’m going to tag @Wendy&Neko to comment on that. I know there can be negatives if the test is done too soon. Hopefully it’s not that.
I just read back to your last post and your comments about vomiting. If most of the vomiting is at 3 am, is the vomiting food or mostly a white liquid? It could be that he needs a meal sometime late in the evening to stop the acid tummy. My cat got that and I stopped it by feeding after midnight.
Also if he is eating too fast…then vomiting (or regurgitating really) ……very common….have you tried using a big plate so he has to eat more slowly? I’ve done that with one of my kitties and it worked. Or given smaller meals more often?

I think swapping to Levemir would be a good move. I used Levemir and loved it. I don’t think you need to reduce the dose back to 4 though as the vet suggested. Post here and we can help you with a more suitable dose. And you would hold the dose for 5 to 7 days to let the depot fill unless the BG dropped too low in which case you would reduce the dose.
I would definitely not do as the vet suggested and only monitor every 3 or 4 days when starting with Levemir. It is very important to be monitoring closely to pick up any reduction in the BG and not suddenly find yourself with a very low BG.

Also I would be more inclined to order the Levemir from Canada. You will get through a vial of it quite quickly and you can get 5x3ml vials from Canada…much more economical... Here is a link with information about buying it there https://felinediabetes.com/FDMB/threads/buying-insulin-from-canada.203498/

If you did get a pen of Levemir you do not need to transfer it to a sterile jar as the vet suggested. Here is a diagram of how you extract it from the pen easily and safely.

 

[Wendy&Neko]

The acromegaly test should be done at least 73 days after insulin is started, so sounds like you are good there cause I think you had the test done recently. The issue is that a good percent of cats tested before that were coming back with false negatives if tested too early. Out of curiosity, what was the IAA number? I like to hear what ranges cats see as "normal". The only other condition that sometimes means cats needs higher doses is called Cushing's.

To check for IBD, you do need to start with an ultrasound to see if there is bowel thickening. Unfortunately that only narrows it down, as small cell lymphoma also looks very similar on ultrasound. Your vet is right that a biopsy is needed to differentiate between the two, sometimes this can be done with endoscopy. Treatments are different between IBD and SCL, so it's good to know what you are dealing with. IBD means novel protein, SCL food doesn't matter. Don't let the lymphoma word startle you, it's a mild slow moving condition and given the right treatment, a mild chemo, over 90% of cats go into remission.

As for B12, it's best to do a blood work test first to see if the B12 needs supplementation, rather than just give an injection the cat night not need.

Levemir is a great idea at your cat's size of dose. And as Bron said, we don't go back in dose that much, usually go to a dose about 70% of the Lantus dose. The pens are great. I would never get a vet to repackage insulin! That's just not sterile enough conditions.

 

[Cuddle Furry]

Hi Team,
I got the Levermir prescription from Walmart Thursday night. I did Lantus today and Saturday will start Levermir. I have more free time on Saturday to monitor Oscar. I still test 4 times a day. Oscar had a bad 3 vomit day on Thursday. No vomit today. I have noticed he hasn't been eating as much the last 3 days. His norm is to eat up to 2 or 3 ounces of wet food at each 4 hour serving. I even fed him more at times to see if he could put back some weight. He has been eating about half that recently. Oscar glucose has been in the low 300's today. Understand not great but was getting to the mid and higher 300's. So I have been doing 7 units twice a day with Lantus. What should I start off with Saturday morning with Levermir? Thanks for everyone help.

 

[Wendy&Neko]

Some cats have a strong reaction when they switch from Lantus to Levemir, so we suggest starting at 70% of the Lantus dose. So you could start at 5 units. Note with Levemir the onset is on average at +4 and nadir on average at +8. Though there can be variability. For example, my cat onset at +5 and nadirs were typically +9 to +12. You may have to adjust your testing times. Once you've been giving Levemir a few days, it'd be good to do some curves to see how Oscar reacts to Levemir.

 

[FrostD]

I see Wendy mentioned Cushings, my only other thought would be perhaps thyroid? I see a note stating vet ruled it out, was that with bloodwork? Or perhaps some other issue with pancreas itself, or the liver?

Is he on any medication at all, other than insulin?