New in DM world

Hi.
I'm so sorry for the language, I'm danish so my english is quite bad. Hope you understand anyway.

Mauer, female neutered, born 2009 was diagnosed in March this year. She's always been peeing and drinking a lot so the diagnosis came as a huge shock. Only indoor with her brother from same mother, not same litter.

Right now - 10 in the morning in Denmark- she won't eat and is very nauseous and has been vomiting two times. She gets levemir at 10 and 22, gone down from four units to two. I'm in contact with her normal veterinarian who says I should watch her bloodsugar and withhold the insulin. I have metoclopramide at home but it's a struggle and gets her drooling like an idiot. I'm afraid it's me that gave her nausea trying to get her to eat before her shot. She gets royal canin diabetic dry food, not eating a lot of it, free 24/7 in her surefeeder. Then she gets canned food also at free disposal witch she eats more of - normaly! Last night she dropped to 4,8mmol she was eating and 50 minutes later she went to 5,8mmol and did not get insulin, nor did she today and her number is 14,6mmol.

We had the same problem last weekend and went to her veterinarian and got some metoclopramide injections and appetite stimulants. Monday we went for a scheduled appointment for a long bloodsugar test and a big blood test to find out what went wrong during the weekend. Bloodsugar was perfect at 329 and the other blood test was fine, except low white blood cells. Then Tuesday referred to a specialist in veterinarian medicine and he found absolutely nothing.

Mauer is tired and stressed about all the trips to the vet. I'm stressed out because I constantly worry about her. We are moving in the middle of June, getting a fenced garden for exercise and tanning in the sun.
I love that stupid cat and I'll go to the end of the world for her, I just want her well and happy.

Do you guys have any advice? Things I haven't done, tried? Some magic powers?
Anything will be appreciated!

 

If it's not clear, I home test before first shot and in the middle between the two shots of the day.

When Mauer is stable again I was thinking about going all canned food and barf.
I've been reading on catinfo.org and Mauers brother has idiopathic cystitis and a chronic constipation. The cystitis and constipation came under control with canned food, go figure....water.
However my veterinarian directly told me that without special diabetes food, Mauer would have no chance of remission. I do not blindly trust anything I'm told, no matter the authority or education and now its tried and it doesn't work.
In Denmark dry food is the way to go. Canned food is more a treat, and those who barf is crazy hippies. Veterinarian's don't recommend canned food, only for those who can't chew.
In some fb groups the recommendation is dry at free disposal with at least 40% protien 20% fat and meat meat meat and good canned food twice or more a day. I've been following this for the past few years and seen big improvements. The cats of course prefer canned so that's the main part. Dry is only for emergencies and is always 2nd choice.

 

Hi and welcome Sasha and Mauer to the forum. Your English is perfect!
First of all it is great you are home testing the blood glucose levels! That is great?
Mauer is a lucky cat to have you.

With the metoclopramide, other name maxalon, I have not seen that used with cats. Maybe others have seen it. She is probably drooling from the medication because it is bitter. Can you put it into a pocket of meat so that he can’t taste it.
The most common and successful antinausea medications used are cerenia and ondansetron (which is a human medication but is used for cats successfully). Could you ask your vet to give you cerenia or ondansetron instead, nauseated cats won’t eat, so this is something that needs to be addressed now. And it is not a good idea to give a nauseated cat an appetite stimulant. The nausea needs to be addressed first.

While she is not eating well, it would be a good idea to get a bottle of ketostix from a pharmacy so you can test the urine for ketones. Ketones can form when the cat is not eating properly and not getting enough insulin.. it is a simple test and it is important that ketones are addressed immediately if they are present as they can lead to the much more serious DKA.
Get a urine test from Mauer, and dip the test strip into the urine and read the result exactly 15 seconds later. Anything above a trace needs vet attention and even a trace needs watching closely.

As far as the food goes....dry food is the worst thing that you can give a diabetic cat. It is not only high in carbs, it has only 7%moisture, compared to 78% moisture in canned food. However if you are going to swap over to a fully canned diet You need to be aware that the BGs will drop quite a bit because of the lower carbs. If you are testing you will be able to reduce the dose of insulin to keep Mauer safe.
Can you tell us what type of insulin you are using and the dose Please.

I think the most pressing problem at the moment is you need to get some cerenia or ondansetron fro Mauer so that she can eat and you can give the insulin. This is most important. and you also need to buy some Ketostix so that you can rule out any ketones being present.
Please ask lots of questions and we will do our best to help you.
Bron

 

Hi Bron
Thank you very much for your reply! I'm so grateful!

She seems better already I think I'll get some food in her very soon.
Last weekend she had the nausea taken care of first, then the appetite stimulants. And it didn't really work. She spontaneously started to eat.
She drooled without getting anything at all. I was trying to poke her ear for testing and she barfed all over the kitchen table.

Now she seems awake and totally fine, so I really think she'll start to eat soon. If not, I'm going to the vet and getting an injection for the nausea.

I really can't see how I'll be able to get a urine sample from her. She pees once or twice a day, and if she's mad at me she pees somewhere else.

We started at caninsulin 2 units and her numbers were constantly high.
After a month we switched to levemir 2 units, after a week went up to four and then I saw improvements in the numbers!
Now getting too low, and the specialist on Tuesday directly said "don't test, you stress Mauer, you stress yourself, just don't test. Give insulin and check in a week or so"
And I was like...hell no. Thankfully I followed my intuition and kept testing. We've had two critical low numbers since, and if I'd given insulin she would have gone into insulinschok twice!

No matter what I'm skipping the morning shot otherwise the routine falls apart. We are three hours overdue and with 12h apart shots I'll have to get up in the middle of the night and not being able to see how she's doing.

 

Hi Sacha,
Levemir is a very good insulin, much better than Caninsulin. But going from 2 units to 4 units is not good at all!!
We recommend going up in1/4 unit increments so that you don’t go past the best dose and it is safe for the cat.
So if you were giving 2 units and wanted to go up you would go to 2.25 units.
And as for the specialist who said not to Test after doubling the dose and going from 2 units up to 4 units, because it is stressing both you and Mauer......He obviously does not understand feline diabetes at all,

Food is very important to a diabetic cat so try and get her to eat what you can and give the dose of insulin at the next due time. Are You offering food at other times apart from before the insulin dose?

We have an excellent spreadsheet here that you might like to set up and use. It is colour coded. I will give you the link and if you have any trouble, just tell me and I will get someone to set it up for you.
http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

Here is a sticky on Lantus and levemir and how to use it
http://www.felinediabetes.com/FDMB/...-low-go-slow-slgs-tight-regulation-tr.210110/

http://www.felinediabetes.com/FDMB/threads/the-basics-new-to-the-group-start-here.18139/


And a link for new members
http://www.felinediabetes.com/FDMB/threads/new-how-you-can-help-us-help-you.216696/

 

I knoooow, but my syringe only goes 1unit. My vet says that when I start giving her insulin again I start with 1 unit.

She has food at free disposal constantly. Before her shots I check if she has or want to eat, and after the shot I put out new fresh food and leave her to eat
Each cat have their own surefeed with microchip and their own food, and then I always have canned food in two bowls they can share.

 

About the spreadsheet (SS?) I already have my own homemade with time, date, number, dose of insulin and if and why when I skip.
For the time being I think I'm sticking to it. At least until I understand the diabetes language.

 

It's great that you're keeping track of of your cat's test data. However, we can't be of much help unless we can see the information, as well. We use a particular format -- the one that Bron linked. It would be very helpful if you followed the instructions and transferred your data to the format we use so we can provide assistance as you need it.

 

I understand why, just don't the spreadsheet or your terms and then it's not easy. Plus the fact that I completely stinks with numbers and calculation.

 

Update: we went to the emergency veterinarian, funny enough the one we saw on Tuesday so he was familiar with her case. He found it very strange that she keeps doing this and won't eat, found nothing apparent wrong with her, fine gums, no acetone, bladder half full and no pain response. She got something for the nausea. Now we're just waiting for it to kick in.
The vet told me NOT to come back tomorrow, since the vet on that shift is new and green. Fingers crossed that she eats!!!
Mauer is specially loving when she gets out of the transport box, rubbing against my legs and wanting to cuddle. So strange.

Totally weird question: do you sniff your cats head? It's the best smell in the world. The weird thing is, since she started on insulin specially levemir, her smell has gone?!
Really weird I know

Again, thank you so much!
I'll definitely look into the spreadsheet and try figuring it out.

 

I wish I could sniff my kitties head...I'm too allergic

 

Aaaaw I'm so sorry!
I really don't know what I would do if I became allergic.

 

Metoclopramide (brand names Reglan® and Maxolon®) is used in dogs, cats, and small mammals to stimulate stomach and upper small intestinal movement to prevent esophageal reflux, a condition where stomach acid backs up into the esophagus (the muscular tube connecting the throat and stomach) and throat. It is also used in the treatment or prevention of vomiting in dogs and cats.
https://vcahospitals.com/know-your-pet/metoclopramide

Metoclopramide is not that effective in cats for anti-vomiting and has be superseded by Cerinia

 

I'm holding my breath, she ate again.
I took a chance and gave her insulin 1 unit only. Her BG is 16,4mmoL now - 14,6mmoL 12h ago.

This also happened last weekend.
She gets low, I withhold her shot and she stops eating.
Is her not eating some kind of response to not getting her shot?
Does the longterm BG have anything to do with the daily BG? Since the longterm BG has fallen to normal range I've barely seen symptoms of the diabetes in itself no matter the daily BG, less peeing, more awake when she is, not sleeping so deeply, better mood, less drinking. The BG hi days I see slightly changes in mood and awareness but not much.
Is the anorexia and nausea caused by the lack of insulin, or possibly the routine?
We all know cats, they have their own minds.
How much influence does my worries have? For example this past week something was off, Mauer not eating- you know the story! Point is, her brother Miver not diabetic, but idiopathic cystitis and constipation and overall just more sensitive. He ALSO stopped eating, fluffy fur, not purring. I had a vet appointment next day, was up during the night to check on him. I had 3h of sleep then he was perfectly fine and back to normal. Was that my influence?
I know an owners moods and worries effects a rabbit's chances of recovering, but they're more sensitive and prey animals...

Am I totally wrong here?!

 

https://docs.google.com/spreadsheet...Dkw7vqXb_rLXBcBHVs1/pubhtml?gid=5&single=true

 

https://docs.google.com/spreadsheet...H2TvPunmZacoch2RevppaAoq8PqtWAERuK-EW/pubhtml

Day 11 is today

 

So I made the spreadsheet. The first is on levemir, and towards the end it all went to ****. Not eating, nauseous, vomiting - great numbers but a sick cat.

The second is on caninsulin. I think the first stable days is from levemir cause then the numbers raised and the last few days I've seen clinical symptoms of diabetes
So tired, sleeping almost all day, eating well, drinking more, peeing more and sugar in her urine

Options now are back on levemir - lower dose let it climb back down slooooowly
prozinc and see how it goes

What would you do? And what do you think?