George out of remission

Discussion in 'Feline Health - (Welcome & Main Forum)' started by CLM1975, Jan 15, 2021.

  1. CLM1975

    CLM1975 Member

    Joined:
    Feb 19, 2020
    Welp, George was initially diagnosed w diabetes Feb 15, 2020 and was regulated and in remission in just 2 weeks. Yay! Except last week we found out his diabetes is back. Not yay.

    George is turning 17 this year. We first brought him in last February noticing our chonker had lost weight. When he was diagnosed, our regular vet (Dr M) was having surgery so there was a replacement (Dr P) covering. Dr P knew a lot about feline diabetes and had us put a Freestyle libre glucose monitor. Using that was huge in being able to get him into remission, having so much data was so incredibly helpful.

    George is very sensitive and responsive to insulin. Not sure if this plays in, but in July he had a UTI and we discovered he was having kidney issues. Had to go to emergency 24 hr vet who was an hour away and thankfully working together we saved him. He's on epogen for anemia, a phosphate binder and subq fluids every 3 days. Kidney values are back to normal, yay! He was going to Dr J/ER vet every month for a bit and she would check his blood glucose and he was normal on Nov 12. That was Dr J's last visit as she was retiring so I figured we should go back to our regular vet in our town.

    My old guy started really dropping weight again in December. From 13.8 lbs Nov 12 down to 10.9 lbs (so skinny ) on Jan 6 when I got him in to Dr M. Next day Dr M calls w test results, George's diabetes was back, his blood glucose was 457. (Don't know what meter used.) I still have his insulin in fridge and all the supplies, except test strips. Initially I had thought we'd put another Freestyle continuous glucose monitor on him, but Dr M wasn't comfortable with doing it as he had never done it before. Told me to start shooting 1 unit Vetsulin 2X a day. Dr M is into shooting blind, I'm not. (When I showed him my spreadsheet last Feb he was shocked and kind of didn't know how to respond.)

    My super awesome pet sitter is the vet clinic mgr and found another vet in town to apply the Freestyle. After thinking about it more, decided instead to do ear pricks. Ordered test strips online and since I live at the end of the earth took a few days. George's glucose was so high, I decided to shot him with 1 unit as Dr M recommended and start testing as soon as strips arrived. Two days of shooting 1 unit 2x a day and I knew it was too much. Not having test strips, one night I gave him some corn syrup as I was fearful he was hypo he was unusually groggy.

    I don't feel confident that Dr M knows enough about feline diabetes. Shooting George blind would have killed him last year and it would have killed him now. Someone posted about how thankful they are for this resource and I agree. I don't know how most people would know how important testing is.

    Didn't shoot any insulin after that for 3 days until test strips arrived yesterday. Relion. Pre-shot reading last night was 210, 4+ was 88. This morning he was 159 so I decided not to shoot. Should I have shot .25?

    How often should I be testing?

    I'm feeding him Fancy Feast pate and Hills Urgent care, appetite is decent. His water consumption has reduced, as well as his enormous urine output. Water consumption is hard to know whether it's kidney related or diabetes. Of course would love to see him put some weight on.

    I'm just not sure what I'm missing or should be doing. He still wants to go out on his harness in the yard, bullies his sister, cuddles and purrs with us in bed, he seems himself.

    Like everyone here, I want him to have the best quality of life possible for his twilight years.

    What else should I being doing to get him regulated?
     
  2. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    @Deb & Wink
    Hi Deb I have seen you helped Carrie in the past, hope you don't mind I tagged you :cat:
     
  3. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
  4. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    Hi....welcome back....I’m sure you’d rather not be back though,
    Are you feeding 1/2 hour before the shots?
    Are you giving George some snacks of food early in the cycle.
    I’m not a vetsulin user but I’ll tag @Critter Mom to help you.
     
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  5. CLM1975

    CLM1975 Member

    Joined:
    Feb 19, 2020
    Yes I am feeding 20 to 30 minutes before his shot. Because of his weight loss I free feed FF pate (stopped eating wet kidney diet) and Hills kidney dry food, I take his food up two to three hours before his shot.

    it's a big adjustment taking the blood glucose readings via a prick versus the Freestyle. I was having some trouble with the machine last night so I ended up pricking my finger to do a test, I'm really glad I did. It doesn't hurt one tiny bit!
     
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  6. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    I know that a cat being anemic can throw off the BG readings. But I'm not sure how much, or if it makes the BG readings higher or lower than they are for real.

    Tagging @Marje and Gracie to see if she knows, or can tag someone else that might know.

    The Fancy Feast foods are too high in phosphorus for a cat with CKD. So you might want to consider another wet food for George. Some of the Weruva canned foods are low in phosphorus and in carbs, so better for a diabetic cat with CKD. There is a facebook group for CKD cats that you might think about joining.

    With multiple health issues to deal with, it's going to be a balancing act to find a food that will work for all of George's health conditions. For now, it's important to get him to eat what he is willing to eat, to have him gain back some much needed weight. The insulin dose can be adjusted around the food needs, for the CKD.

    You asked about how often to test. Always before the shot of insulin, the pre-shot test. So you know that George's BG level to give him the insulin in the first place. Then you need to test enough to find when his nadir is, and how long the duration of the Vetsulin is. Most cats get somewhere around 8-10 hours duration on Vetsulin. So test midway in that time frame, varying the time to find when George drops to his lowest point in the cycle. You don't have to test every hour, like the Libre was doing for you. But filling in some of those blank spots on the SS will be helpful.

    Highly recommend you read the sticky (pinned) posts in the Caninsulin/Vetsulin/NPH ISG forum here.

    Some cats do ok on Vetsulin, but it's not recommended for most cats. Prozinc or the L insulins (lantus and levemir) are the recommended insulins for cats per the AAHA diabetes guidelines.
     
  7. Larry and Kitties

    Larry and Kitties Well-Known Member

    Joined:
    Dec 28, 2009
    For humans it if very dependent upon the specific meter. See:
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3692232/
    Hematocrit Interference of Blood Glucose Meters for Patient Self-Measurement
     
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  8. CLM1975

    CLM1975 Member

    Joined:
    Feb 19, 2020
    I'd much prefer he eat either the Hill's or Royal Canin CKD wet food. At first he loved the Hill's, gobbled it up no problem. Then he started getting really finicky. I ordered cases of the different varieties (bc you can't order just a can.) and now I've got $300+ worth of food he absolutely refuses to eat. At this point I just want him to eat. I do really heap on the phosphorus binder on the FF.

    Every day I'm getting better at testing, so I'm more comfortable testing more. Today he was 174 at +2 and 88 at +5. Always always test pre-shot except this week waiting for strips. With him occasionally being insulin sensitive I won't shoot without testing.

    One thing with the SS, I'm finding occasionally I'll open doc and can't edit. Is that bc someone else is viewing document? I'm using my Android phone.
     
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  9. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    The "not being able to edit" issue for the SS has been reported by many people. It seems to be linked to using your phone to update. People are usually able to update the SS in their tablet or PC. Then it starts to work again on their phones. No idea why, as I don't have a smartphone.
    There is a money back guarantee on both of those pet food product lines. Contact the place where you purchased the food, tell them your cat refuses to eat it, and see about a refund.
    From the Hill's website:
    "What is the Hill's Pet Nutrition guarantee?
    All of our products are 100% satisfaction guaranteed or your money back. If you are not satisfied for any reason, return the unused portion to your Hill's authorized retailer for a refund or replacement."

    From the Royal Canin website:
    "What is the Palatibility Guarantee?
    Our Palatability Guarantee means that, in the unlikely event your pet refuses to eat their Royal Canin diet, we can offer 100% money-back on all products, with support from our retail partners."
     
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  10. CLM1975

    CLM1975 Member

    Joined:
    Feb 19, 2020
    This morning I was determined to figure out the SS issue and started by checking the tech support forum and saw the random issue w google docs on phones is common. My Fire tablet can't access google drive, laptop crapped out years ago and haven't really needed to replace until today. Oh well. I'll keep paper records and update SS whenever it lets me. Bc of course I love looking at the data, oddly satisfying!

    I hadn't noticed that refund policy on the food! I am already offered to donate what I have, but I'm going to order a couple more different cases and return if he snubs it. Sometimes he's funny, he'll eat a bunch then just changes his mind and he won't touch.

    He's been near 300 last 4 shot times. Lowest he got yesterday was 150 at +5. (Though I didn't test again until PMPS.)

    I heard him vomit last night +1.5, got up to clean it up and check him out. He went from crouched puke position straight to his food station and really hoovered up some food.

    Just keep on keeping on....
     
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  11. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Do you think George is showing signs of nausea? Perhaps signs of pancreatitis?

    Could have been "hacking up a hairball" too. It's hairball season here, and I have to brush my civie at least a little bit every day for several months now.
     
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  12. CLM1975

    CLM1975 Member

    Joined:
    Feb 19, 2020
    He sporadically vomits, as long as it's not multiple times per day or days in a row I think it's just normal cat stuff. Before last night it had been at least a week or two. With the kidney disease his puking really picked up but those levels were normal not even 2 weeks ago and once those got better he stopped.

    We live in the sub-tropics, they no longer grow a winter coat. Tonight it's a low of 64, I'm freezing, seriously.

    If I uninstall and reinstall Sheets I'm able to update SS. Yippie!
     
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  13. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    AM dose today 1/19/21 was ??????

    Whatever the dose was, it dropped George to the nice low blues at +3 today.

    That sounds like a pain in the you know where. Hope you don't have to do that every time, in order to update the SS.

    Temp of 64 would be a heatwave here on the northeast coast of MA. 30's (fahrenheit) are normal highs here in January. Low's are down in the teens. Water in my bird bath freezes solid overnight.
     
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