Hello -- new member

Hello, last week my 4 year old cat was diagnosed with diabetes. I'm so overwhelmed with all of this new information but luckily was introduced to another group member who recommended that I join. My cat has always been small, skinny and had a problem with weak hind legs which vets always attributed to a possible birth defect or being the "runt" of his litter. Anyway, after starting on 1.5 units of vetsulin last week he's shown slight improvement in his lethargy but he still won't eat on his own. I am syringe feeding 25ml of wet cat food about 20-25 minutes before vetsulin twice a day. Today (and 3 days ago) he shows severe signs of weakness in his hind legs and has collapsed twice. A few days ago he was fine after about 10 minutes but today it's been nearly an hour that he can't use his hind legs. I'm calling his vet but wanted to see if anyone here has info they could pass along? Thank you in advance!

 

@Critter Mom @Panic @Deb & Wink @Red & Rover (GA) @Bron and Sheba (GA) @Chris & China (GA)

Rebecca is the sister of one of my past work colleagues and I asked her to post to get more input and insight. We’ve talked about home testing and she ordered the Walmart supplies which should arrive today so she can check Buddy’s bg levels at home. I asked her to go down to 1 unit of Vetsulin until she’s testing because of the lethargy and not knowing his levels and this happening today at +4 which is usually when Vetsulin peaks. I also asked her to get the blood work done at the vet so she can share the test results here. I was wondering about potassium and phosphorus imbalances. She has the links to the pancreatitis primer and Vetsulin intro sticky notes. This is the backstory. Ok sure she’ll appreciate any advice and guidance we can give her.

Thank you!

 

Are you ketone testing? In case the problem with the cat not eating enough is causing him to burn up his own fat and muscle tissue, and creating ketones as a waste byproduct.

 

He was tested last Friday at the vet and showed no ketones. I have not started testing at home yet but plan to. Thank you for responding

 

You might want to go to your local drugstore and pick up some ketone test strips. You test the urine.
Tips for Catching and Testing Urine are in this link >>>>>> https://docs.google.com/document/d/1quta5WLEjdO0Y_t2dAYSwN84h-LNZWxOdtVsJDKZ16A/pub

Ketone testing is different than checking the blood glucose levels.

 

@Deb & Wink another piece of the puzzle is she switched from high carb dry food to wet food now that she’s syringe feeding. My gut feeling is he’s reacting to too much insulin now. Wdyt?

 

Hi and welcome
Did you try honey or karo on his gums to see if that improved the collapse. It could be low blood sugars after the insulin dose.
I would also feed him during the first half of the cycle with snacks as well as before the shots. I think he needs more food than just the syringe feeds before the insulin dose. The dose may also be too much.

Are you giving cerenia for nausea?

 

Thank you, definitely will do! The vet did test his urine while we were there but it's been a week so probably need to test again.

 

If he will eat the dry food I would let him have it at the moment until you are testing the blood glucose.

 

Thank you. I may try that. The vet recommended mixing a tsp of sugar in 5 cc of water and slowly drip it in his mouth. I gave ondansetron for nausea yesterday which got him up and drinking water and licking food but not actually taking bites.

 

Thanks! He won't eat anything, not even dry food. That's what made us take him to the vet. He just completely stopped eating. Now with syringe feeding, wet food is my only choice.

 

@Bron and Sheba (GA) I’m also leaning towards too much insulin. I think it may be worth skipping tonight’s shot

@Rebecca SM the honey or Karo will work much faster go with that! Did he eat any baby food at all?

 

Hi Rebecca,

By way of general information, it can take up to 48 hours of treatment with ondansetron for it to build to full effect.

A couple of questions:

1. What weight is your little fella? (Name?)

2. What size dose of ondansetron has your vet prescribed, and how many times a day?

3. Was yesterday's dose of ondansetron the first and only dose he's received?


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Another one:

4. Did you manage to speak with the vet this evening, Rebecca? If yes, what advice/guidance did they give you?


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Thank you so much for the suggestion. I applied honey to his gums a few minutes ago so waiting to see what happens.

 

Still waiting on the vet to call me back. Thanks for asking. I will post update.

 

His name is Buddy and he's about 7lbs. I gave him 2mg of ondansetron last night and yes it was his first dose. With all of the complications today I was a little too worried to give him another dose until I spoke to the vet.

 

I suggested the ondansetron 1/2 of a 4mg since she had it handy. Every 8 hours may help and I’m thinking adding an apetite stimulant in a day or so

 

Do you think at 7 pounds she can go up to 4mg or stay at half a pill?

 

I think that might be potentially too high a dose, Ale, especially as Buddy's only 7lb. Trying to see if I can find the info from Plumb's. BRB...


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The 2mg ondansetron dose is too big to give q8h for a 7lb cat (and I'd want to check with a vet before even giving a 2mg dose at all for a cat that weight).

Per Plumb's 2008 edition, for a 7lb | 3.2kg cat:

* General dosing guide (for nausea/vomiting - route unspecified) 0.22mg/kg q8-12h = 0.22 x 3.2 = 0.7mg q8-12h

* Max dose (for severe pancreatitis) 0.1-1.0mg/kg by mouth (PO) q12-24h = 0.32-3.2mg PO q12-24

According to the above, the maximum dose for a cat Buddy's weight would be 3mg q12h but, as I mentioned above, I would not give that without getting a firm agreement from a vet, and a smaller dose would be needed if administering q8h.


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So translating 2mg every 12 hours is okay but not every 8 hours? Or go down to 1mg which would be 1/4 pill?

 

Also FYI, this is a new vet who seemed competent but didn’t prescribe any anti nausea or pain meds even though Buddy is exhibiting signs consistent with a pancreatitis flare up. I’m hoping Rebecca can get him to prescribe the pain med when he calls back

 

Thank you so much to everyone that responded to my post. This information has been incredibly helpful. While the vet never got back to me, Buddy is doing much better after some honey on his gums and a few more syringes of food. He's walking on his own again and his legs don't show signs of collapsing as they did earlier. I am going to try the vet tomorrow to get pain meds and discuss the insulin dosage and ondansetron. I am very thankful for everyone's help and support!

 

That’s great news Rebecca!

you guys, any thoughts on the dose for tomorrow am? I’m afraid even going down to 1 unit may be too much...?

 

As there were no ketones at the vet last week, and Buddy has had what looks like a hypo episode and Rebecca is not testing yet, I would skip the dose in the morning and try and get started with home testing to see where he is at with BGs.
The dose definitely needs lowering. 1.5 units for a small cat is too much.
I’d also start testing for ketones.
And I’d make sure to give lots of small feeds with the syringe and try and sort out the ondansetron dose so it can be given regularly and ask for some pain meds.

 

Hi Rebecca,

NB: Some sections of this post are now redundant and I have greyed out and struck through that text. (Sorry, I passed out in the middle of typing it last night.)

I'm in the UK and about to sign off (past 2:30 am here).

When you get a moment, please can you post an update about:

* whether the honey has had any positive effect on Buddy (in particular, has he got strength back in his hind legs?).

* whether he is managing to eat anything, and if so how much and of which food (dry/wet/low or high carb).

* whether you've heard back from the vet and, if yes, what advice you've received. (If you haven't, I recommend pushing till you get a response.)

* whether you gave any insulin and, if yes, what dose and how many hours have elapsed between dose administration and the time of your post.

For future reference, I'd recommend taking Buddy promptly to an ER vet if you can't get support from your own vet out of hours.

Whatever may be at the root of Buddy's current issues, it sounds like he might be at risk of getting dehydrated, which may also make him feel lousy and even more disinclined to eat (ways to check for dehydration here).

I'd also suggest asking whichever vet you see to check for ketones and also to run blood work to ascertain whether there might be other issues feeding into the hind leg problems and possible general weakness (e.g. potassium / phosphorus / other imbalance, as Ale mentioned above).

I'd also ask the vet to test for pancreatitis, if only to rule it out as a cause of the nausea/inappetence (Snap fPL on-the-spot test gives positive/negative/unclear results, Spec fPL returns a quantitative result indicative of degree of any inflammation present but it needs to be sent to an external lab for processing so has longer turnaround time).

Should Buddy test positive for pancreatitis then cornerstone treatments - pain management, fluids, nausea/hyperacidity control, appetite stimulation - are all covered here:

IDEXX Feline Pancreatiis Guidelines (a good document for discussions with vets).

Things to look out for and tell your vet about:

* Nausea symptom checklist (also look to see whether Buddy might sit hunched up in a 'tense meatloaf' position, possibly with a pinched expression on his face - may indicate pain, possibly somewhere in the digestive system).

* Water consumption/urine output/any inappropriate toileting behaviour.

* Energy / mood (especially if lethargic / depressed / withdrawn)

As Bron recommends above, I think that you need to start home testing blood glucose and monitoring for ketones immediately:

(a) For now, it would probably be safer to work on the principle that Buddy may have had a protracted symptomatic hypo last night until a vet can determine otherwise (especially as the event happened about 4 hours after insulin dose administration, around the time when the blood glucose level is typically at its lowest in cats on Vetsulin, plus Buddy seemed to recover limb function following administration of more concentrated sugars).

(b) Given the possibility that last night's event was a hypo then the 1.0IU dose of Vetsulin should be treated as too high - particularly as Buddy is having difficulty getting food on board. If it was my cat, I would want to determine where Buddy's BG levels are before giving another dose, and I would look to reduce the dose, at least for the time being.

(c) Again, given the possibility of a protracted symptomatic hypo event having occurred last night, Buddy may now be more sensitive to the effects of insulin. This is another reason to be extra-cautious about insulin dose.

(d) With Buddy not eating and some as yet unidentified underlying condition driving the inappetence, skipping insulin doses carries an increased risk of his starting to generate ketones (and his being skinny might increase that risk).

My best suggestion is to get Buddy checked over by a vet as soon as possible today, both to determine BG and ketone status and also to examine him for any possible residual effects of what may have been a protracted hypo. His ketone status is important because that has a direct bearing on insulin dosing.

Important note: If Buddy was in very low BG numbers last night, his body may produce a counter-regulatory response to the low and that can lead to a temporary rebound to significantly elevated BG levels, but there is no way of knowing when levels will drop back. I still think the dose should be reduced - at least for a time while you gather some BG readings and get a better picture of how Buddy's responding to insulin (your vets may give different advice).

The way to keep Buddy safe is to start closely monitoring his BG and ketone levels immediately, and speak to a vet about how much to reduce the dose by (plus addressing the inappetence). Without data, I can't suggest anything about insulin dose, only that the 1.0IU dose appears to be unsafe and if it was my cat I would be looking to agree a reduction with my vet.


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PS:

If Buddy needs insulin and is still struggling to eat enough for the next few days, it might be an idea to discuss with your vet temporarily feeding a food with more carbs to enable safe administration of insulin until Buddy is more stable and you have a better picture of where his BG levels are at (over several days). Also, from a ketone perspective, more calorie-dense foods are better when a cat's not eating much in the way of volume.


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Thank you all!! @Critter Mom i think we’re thinking along the same lines. I’ll check in with Rebecca on testing as I believe she got the supplies yesterday and was going to give it try today. She has all of my tips so hopefully it will go smoothly

 

Thank you again to everyone. Buddy skipped his insulin last night and this morning so that I could start by testing. I gave him 4 syringes (5ml ea) of pate food last night and another one this morning. I tested him at 2:15pm today and his bg is 95. I also recieved all of th results from his bloodwork and urinalysis last week (Feb. 5th)...anything I should be looking out for ? Thanks in advance

 

@Critter Mom @Bron and Sheba (GA) @Deb & Wink

I’m thinking Buddy may not even be diabetic. The food change may have been enough to get his numbers back into normal range. I think Rebecca should test again at pm preshot time but if she’s getting anything under 150, skip insulin?

also I’d love to have someone interpret the test results if she posts. Who can we ask?

Thank you!

 

And @tiffmaxee meant to tag you from the start!

 

Once a diabetic, always a diabetic.

Could be a combination of the food change, and the hypoglycemic episode that caused Buddy to not need insulin right now. It's a "wait and see" approach.
Ketone testing will be key right now. As well as blood glucose (BG) testing.

@Marje and Gracie
Rebecca doesn't even have a spreadsheet set up yet. Marje could help with that too.
But the test results should be entered on the "Labs" tab on the SS first. Much easier to see there.

 

It’s hard to say what is happening here. I wonder if this cat has pancreatitis that elevated the BG. He could very well be diet controlled. I would suggest treating with ondansetron or cerenia, getting him to eat lc food if possible, and start testing but not give any insulin.

 

a signature and spreadsheet would certainly help along with labs which I can read as well.

 

Sticky HOW TO CREATE A SPREADSHEET

Good to know that you can read the labs too Elise. Didn't realize that.

 

Rebecca gave him ondansetron but there was a question about the dose given he’s only 7 pounds. She called the vet clinic today but they won’t give her any prescriptions or dose advice since she saw a vet who fills in and is not on staff. Yes, BS I know

 

That’s crazy frustrating. I honestly would try 1 mg and no more. Would the current vets give her Cerenia and suggest dosing? When Tiffany was on chemo she weighed about the same and I was told to give her 1.0 mg.

 

Good to know indeed!

 

She was told she needs to bring him back in to be seen by one of the regular vets or wait for the “fill in” vet to be there again. I was thinking the same about the pancreatitis. And 1mg of ondansetron sounds like a safe way to go!

 

@Rebecca SM, @Aleluia Grugru & Minnie -

What tests did the vet run in order to make the diagnosis of diabetes?

- fructosamine?
- urine glucose?
- BG spot check at the clinic?


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If they don't trust the locum's skills and ability to update a patient's records then why do they allow them to practice out of their premises at all?


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I am trying to upload the test results but I'm using my phone....will I need to do this from my computer?

 

I think so. The upload function on the cell hasn’t been working. They may ask you to enter it into the spreadsheet but do what you can and we’ll see

 

I asked about the fructosamine and I don’t think they did. I see urine analysis at 1+(250mg/dL) and the spot check was at 307, which of course, could have been a one time thing due to a pancreatitis flare up which all signs are leading to... Rebecca mentioned he was sleeping in the tub and sink which he had never done before and the pancreatitis primer mentions that as a sign to watch for

 

Keep us posted Rebecca. I think we all agree on the 1mg ondansetron dose suggested by @tiffmaxee ao I’d start that am and pm to see if it helps and then you can try the apetite stimulant in combination. If he’s between 100 - 200 post a new thread asking for advice. If he’s still in the 90’s I’d skip the shot again.

 

95 is a normal BG number. When did you last give insulin?
What type of meter is it? A pet or human meter ?

 

It is a human meter ( relion). I haven't given insulin since Saturday morning (a few hours later was the hypo episode) His first bg reading was 95 at 2:15 pm. Now at 9:25pm his reading was 95 again. Any thoughts?

 

Honestly, I think anything under 150 is worth skipping the shot again

 

Those are normal numbers Rebecca.
DO NOT GIVE ANY INSULIN.
continue to feed frequent small meals.
Test BG twice a day before food. And try and get a test about three hours after food so we can see what the BG is then.
Post and tell us any BG results
Hopefully once the ondansetron starts to work he will eat better.

 

Skip again please. It’s looking more and more like he may be a false diabetic diagnosis

 

Agreed 100%!!!

 

Just for reference this last bg reading was at about 2 and a half hours after 20 ml of food.

 

That’s good to know thanks Rebecca.
Has anyone mentioned setting up a Spreadsheet to record the BG data?

 

I think she had issues. Maybe someone can help her?

 

Yes, someone very kindly posted instructions for me but I did something wrong with the hyperlink. I will try again!

 

I will tag @Bandit's Mom to see is she can help Rebecca set it up.

 

Bhooma (@Bandit's Mom ) would be happy to help you. She should be around soon.

 

Hi Rebecca, I will do it for you. Will only take a minute. Will send you a PM now with the details I need.

 

I see the ss. Now we wait for the you to fill in what numbers you have .

 

Thank you @Bandit's Mom and thank you for adding the signature Rebecca!

 

Elise, can you please take a look at the test results and let us know your thoughts? I don’t think they did a fructosamine test at all, right?

 

Where are the labs? Found them. No fructosamine. No UTI. Sugar in urine. That’s how I diagnosed Max.

 

Rebecca, take down the labs and remove your personal information as this is a public forum. Then repost. I’m still lookin at the labs. I will be back.

 

What does concern me is that the basophils are high. If the eosinophils were high it would signal allergies but they are low. There’s inflammation and I would call your vet and ask what this means. Usually cats have 0 basophils.

 

Can that be consistent with pancreatitis you think or something else?

 

I noticed that, but the numbers have been within normal range without any insulin since Saturday that we know of maybe even before. Could the food change alone put him back into non-diabetic range? I’d really like to see a fructosamine test to know what the 3-week average was for him

 

It’s not something I have seen with pancreatitis. It’s just a snapshot in time so should be run again and if still high looked into.

He very well could be food controlled. I agree a fructosamine could shed light. As an alternative I not give insulin and see how his bg is on low carb food. I have seen cats go OTJ rapidly with a food change.

 

Thanks for looking tiffmaxee . I noticed that about basophils. I'm thinking maybe asking for a leukemia test? Does anyone know anything about that? Also, I tested him 2 1/2 hours after 20 ml of food and it was 124.

 

Thanks not much over normal. Keep feeding lc and let’s see what happens. There was sugar in his urine so he was above normal. He may need some insulin once the transition to low carb is complete.

I did read there could be a bone marrow issue BUT my internist never rested upon one test. I would wZnt another CBC and chem 25 run and sent out to a lab to see if this a a fluke.

How is he feeling? Eating? Preening? Purring? Pooping? Playing?

 

He's moving around the house slowly, wants affection from our other cats. He tried to cuddle up with them any chance he gets. Purrs when we sit and pet him. He's able to get up on my daughter's top bunk so that's great news about his hind legs. Mostly sleeps but gets up every few hours to sniff the food bowls and drink a little water. He's not too playful but pooping/ peeing normally. It's been almost a week since he's tried sleeping in the tub or sink. The big issue is him not eating on his own. I'm feeding him 3-4 times a day between 15 and 25 ml of food through syringes. (Either Crave turkey or Salmon or Purina Beyond wild salmon) No insulin since Saturday morning since his last 3 readings have been 95/95/124. Guess I'm just waiting until I can get more bloodwork?

 

That is encouraging. Are you giving him ondansetron? He might very well be nauseous. At this point I would see if he will eat even dry on his own. Did they test for pancreatitis?

 

She’s giving ondansetron now 1mg twice a day and no pancreatitis test but Rebecca has all the info to do that next

 

They didn't test for pancreatitis, unfortunately. I only learned about it recently from alleluia grugru & minnie. Yes he's getting 1gm ondansetron every 12 hours (as of Saturday). I've offered dry food and he seems interested but doesn't actually eat. The syringe feeding is getting a lot easier. I think he almost enjoys it.

 

I’m glad you are syringe feeding.

 

Worth trying the apetite stimulant again now? She was given the one you rub on the ear, but I wonder if that would affect testing at all?

 

Yes. It’s better than the pill less side effects. It should not effect bg at all.

 

After approximately 8 hours since his last meal Buddy had a bg reading of 112. He is walking around the house, rubbing against furniture, purring and looking for affection. He is still moving slowly and not eating from the food bowls but drinking water. I am going to feed him now and take another bg reading a while after. He gets another dose of ondansetron tonight so I will also try the appetite stimulant again tonight if all continues to look good! Thanks again for everyone's advice and suggestions!

 

It sometimes took a couple of days for the ondansetron to work for Max. I would give him an appetite stimulant. You have to be careful though because if a nauseous cat eats he can develop food aversions to what he ate so don’t feed him his favorite food until you think he’s no longer nauseous.

 

How is Buddy today?

 

Thank you for asking. His energy is way up. He's been walking all over the house and wanting affection. No hiding at all and normal sleep. I tested him earlier today before his first meal and he was at 88. He still isn't eating on his own so I syringe fed him but he's drinking water on his own. I will test him again tonight. He is still on ondansetron every 12 hours . Still no insulin since Saturday morning since all of his readings have been good.

 

I wonder if something else is going on with him. Pancreatitis is a distinct possibility. Is he still enjoying the syringe feedings? That would be odd if nauseous. As long as you are able to get close to the full amount of food per day I would just give him time. Keep us posted. Thank goodness you are home resting and not giving insulin.

 

He fought a little on the syringe feeding today but he is not spitting anything out. I'm opting for smaller, more frequent feedings since I don't have to worry about him having a full feeding before the vetsulin. While I'm relieved that his readings are good, I am still concerned about him not eating on his own and wondering what caused all of this in the first place. Although I can't fully interpret his bloodwork, it's clear that some numbers were abnormally high. Now after some rocky communication with the vet I've lost confidence in their ability to help Buddy so my plan is to seek recommendations for a good local vet and get his bloodwork and urinalysis done again. I can't express how grateful I am for this group and all of the wonderful support and advice. Thanks to Aleluia Grugru & Minnie for introducing me.

 

Does Buddy show any interest in food?
How much are you syringe feeding? The rule of thumb is on 5.5 oz can day. I have a civi who is 13 or 14 and she has only been eating a little food for the last 5-10 years and and I have to syringe feed her the rest of the needed food. The amount sI have to syringe feed keeps increasing but she also shows interest in food. I have tried anti-nausea drugs and appetite stimulants but to no avail. She has multiple heath problems like cataracts and joint problems since she was 6 months old. and now has high blood calcium. I can syringe feed he food in about 5 minutes.

 

@Rebecca SM great news!! When you go to the new vet, remember to explain you want the pancreatitis tests done when you book the appointment as they may be able to quote the prices for you. I think we need that next to either confirm or rule out the pancreatitis

 

I am still in the process of finding a new place to get new bloodwork done but am happy to report that Buddy's numbers remain in the 90-100 range and yesterday he started eating on his own. His energy is almost back to normal, too. Starting the ondansetron and then proceeding with the appetite stimulant seems to have really worked. Thank you so much for all of your help!❤

 

That's wonderful news, Rebecca!

(((Buddy)))


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I cannot thank everyone enough. I dread to think what would have happened if I would have just carried on with the insulin. This group has been amazing.

 

Wonderful! If he’s doing well like this don’t get a pancreatitis test as if the episode has passed it might register normal and won’t let you know if he had it. I’d hold off on a vet visit for now and see how he does.

 

I couldn’t be happier you found us and amazing news!!! Go Buddy go, you’re a fighter like my Minnie

 

Maybe stop the stimulant in a few days to see if he continues to eat on his own?

 

That would be the first thing to eliminate.

 

Only remove one thing at a time in case he stops eating. You need to learn what works and what doesn’t. If you remove more than one thing you won’t know. Start by skipping a day of appy stimulant and see how it goes. If not good put it right back.

 

I just want to add that not everyone is willing to syringe feed daily and to do everything we recommend they do, and willing to go “I’ll do it!” when we say you have to start testing like now. So give yourself a lot of credit because you earned my friend!

 

Couldn't agree more with this advice.

And don't rush to stop the anti-nausea meds. Wait till Buddy has had a reasonable period of eating normally by himself without the need for an appy stimulant, and then taper down the dose size/frequency gradually.

FYI, should it prove that there's a chronic issue causing the nausea, unless contraindicated for the particular cat, ondansetron can be used as a daily maintenance treatment.


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Agreed! Minnie is on ondansetron x2 daily. There’s no long term contraindications as opposed to Cerenia. And adding Cerenia is also a possibility since they’re both anti-nausea but work in different ways. I add Cerenia when she has a really bad IBD flare up and the ondansetron alone is not enough. So even after you remove the anti stimulant successfully, you can keep Buddy on the ondansetron x2 a day and hopefully avoid a relapse

 

Max was on ondansetron for months at a time. I would test him by removing one dose and if his eating decreased added it right back.

 

Oh, another thing: just as it can take 24-48 hours for a particular dose of ondansetron to reach full effect, I've found that when trying to taper the dose down, the first day on the reduced dose might be OK but by day 2 or 3 the appetite might get sluggish again. In such circumstances, I have found that going straight back to the last effective dose straight away is the best approach, reason being that it can take that 24-48 hour period again to build back up to full effect.


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