New Member 2/12 Trying to get this all figured out

Hi group, first a big thank you! I feel so much better conquering this knowing I have you all here.

I have a female kitty, Mongoose weight is probably 7-8 lbs, DOB sometime around 2004 to 2005. Two years ago in March of 2019 she had Thyroid issues and I had her thyroid killed. After this was taken care of the kidney issues and blood sugar issues started. I changed to FF, low carb dry food, and got a fountain. BG went back to normal. A year ago the kidney issues started to get worse so I changed her dry food to a kidney diet dry food. FF is still her primary food. With this diet her BG was good and I wasn't monitoring her.

Fast forward to last week. I was gone and left her at home with the BF. I left Wed am and she was up when I was leaving at 5:45 am. Gave her FF and all was good. BF called on Friday night she was out of it, could barely stand up so was totally dehydrated and had peed herself. He didn't put FF out on Thursday am cause she wasn't up and also skipped on Thursday night and Friday am cause she wasn't up. He only went to check on her Friday evening so we aren't sure when the dehydration and incontinence started. (I've not lost my **** on him, i know it won't do any good).

To the vet Saturday am and blood work showed kidney function issues and high blood sugar. Gave her fluids and wet food, but no insulin. Picked her up Wed am, brought her home and began this journey. Spread sheet is attached.

Vet gave me Vetsulin and said go with 2 units. My syringes only have 1 unit markings. Gave her 2 at 11:00 BG was 310 on my home meter. Vet had her at 340 earlier that morning. Thank God I have a mom who has gone through this a little. 4 1/2 hrs later she was Hypo with a BG of 41. Been monitoring since, and not given any insulin as she is staying below 200.

What is your advice on where to go from here? 2 units is obviously way too much insulin. I am home tomorrow so can monitor her hourly. Work has been crazy since I was gone and I am doubting whether I can handle all of this.

 

Would you be able to add the lab work to the spreadsheet when you get a chance?

On the surface, something isn't adding up for me. As in I suspect she may not be truly diabetic, it's the other stuff influencing the numbers. For now you are doing the right thing not giving insulin. Please just continue to test AM and PM when the shot time would be, and any other blanks you can fill in would be helpful... especially the +2 to +6 window.

She may need insulin after all, I am just hesitant to recommend anything without much data and a very recent hypo (cats are generally more sensitive to insulin after a hypo).

Also when you get a chance, could you add a bit more info to your signature? This sticky has a section on what we like to see in the signature. Be sure to include the hypo date, as well as any other diagnoses.

What kidney food is she on, and roughly how much of that is she eating each day? And what kind of FF, specifically?

 

If you're suspending insulin treatment, as an important safety precaution it would be advisable to check Goose's urine for ketones daily. Some helpful links:

FDMB Ketone Primer

Tips for collecting urine samples

As part of your BG monitoring, I'd suggest doing some checks about 1 hour after Goose eats to see how food might be affecting BG levels.

Even though under 200, Goose's numbers are still in the diabetic range so I'd suggest you don't leave it very long skipping doses and that you go back to the vet to revisit treatment strategy. It might be that Goose could take a very small dose of Vetsulin (e.g. 0.25IU - you can get U40 syringes with 1/2 unit markings at ADW) but you'd need to keep a very close eye on how low the BG drops at nadir. Another potential avenue of treatment might be a switch to Lantus. It's typically gentler in action than Vetsulin and is less likely to produce such steep drops between preshot and nadir. For that reason, with adequate testing it's possible to give Lantus at lower preshot levels than Vetsulin.

There are up days and down days. We're here to help you any time you need, even if it's just with a bit of moral support.


Mogs
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Dry kidney food is the Purina pro Plan and she really hasn't touched it, FF is the savory centers. I put half a can out at 8:00 when I left this am and could tell here at 2:30 that she had eaten a little. Took the plate into her and put it next to her and she cleaned it off. Refilled and she was eating when I left. BG at 2:30 prefood was 204.

Added the labs to my spreadsheet best I could. I was mistaken the labs are from Saturday AM vet did not redo blood work Wed am before I picked her up.

 

Ok. Do you know the % carbs in the FF? I'm not so sure it's actually low carb (less than 10%).

And roughly how much of the dry does she get?

The reason I ask is you may be able to get her numbers lower simply by switching the wet food, or perhaps feeding less.of the dry if possible.

 

Can says 1.5% carbohydrate. She was on the classic pate and was getting picky and not eating it when it got the slightest bit dry. I was thinking of picking up the dry and waiting to see if she asks for it. I could also go back to the Wysong Epigean she was on last year before the kidneys flared up. Lately it doesn't appear she's eaten much dry, other days she eats the middle out and meows until I "fill" the bowl back up

 

Update: a cursory look shows the FF savory centers should be ok.

You have a few options:
- Continue to skip shots until you have a few days of midcycle, but monitor for ketones
- Start with a much smaller dose of Vetsulin, like Mogs said. 0.1-0.25U is probably good to start, but you'll really want to test in the +2 to +6 range to avoid another hypo

 

As an FYI here's a food chart that lists carbs. The cans list the Guaranteed Analysis, which is minimums and maximums. Actual carb content has to be calculated a different way, this post explains.

 

Thank You!

 

Cats, I tell ya!

Just be careful if removing the dry. That's 27% carbs, which can have a very big effect on BG. If you choose to do that, I'd do it now and not give insulin. Get about 2 to 3 days worth of a lot of testing, then see if it she maybe still needs a bit of insulin.

I'm also not sure how removing that food would affect her kidneys.

 

Picked up the dry and she hasn’t even noticed. Had to guess the half unit on my syringes. Will get half unit syringes ordered today. Was able to do a full 24 hour monitor Friday evening into Saturday evening. Her BG plummets at 2-2.5 hours post shot, still going hypo, but she has been acting normal. Then at 4 hours we are into a good range. If I take the wet food into her she devours it - breakfast in bed I guess. Which won’t be happening tomorrow when I go back to work

I’m going to call the vet in the am, but am guessing he’s going to say he doesn’t know. I live in rural western Kansas and most vets out here are big animal, cows, horses and pig vets. They do the small animal cause they have to.

 

Yeah, looking at the spreadsheet she's not really getting the duration she needs from Vetsulin. Something like ProZinc may be a better choice. BUT, one thing at a time! See how she does without the dry.

That 52 is a bit low, I'd check at +3 if you can. Might want to feed a tiny bit of the dry or a high carb food.

Technically per Vetsulin guidelines that's a 0.25U reduction, so tonight's dose would be 0.25U (or less honestly).

 

Certainly is. The 0.5IU dose is too high (probably why you're getting such early nadirs too). It's possible that you might get significant drops on a 0.25IU dose so I suggest vigilance.

If you can't monitor Goose, I'd suggest skipping those cycles and keeping a closer eye on ketone status. Did you manage to get any urine test strips to monitor for ketones? If she were to test positive for ketones at any stage - even at trace levels - I'd suggest you consider giving her a food with more carbs in order to support safer administration of insulin.


Mogs
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@FrostD -

Hi Melissa,

Per our recent discussion, Goose's spreadsheet is an example of a Vetsulin cat reaching the lowest point in the cycle much earlier than the typical expected nadir time when the dose is too high (tick mark curve).


Mogs
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@Mongoose -

Forgot to mention in my previous post that if you get numbers that low - especially that early in the cycle, doubly so if the insulin's Vetsulin/Caninsulin - the recommendation is to:

- make sure the cat eats a small amount of food (couple of teaspoonfuls) - enough to give numbers a bump but not to fill the kitty up because it may need to eat several times more.
- test again in 20-30 minutes to see if numbers are coming up and staying up
- rinse and repeat till the cat gets into a safe range (I'd look at 90-100 minimum for a Vetsulin cat) and stays up without any need for food intervention.

At numbers that low, if it were my cat in that range at that point in the cycle I'd start with medium carb food. If numbers were to dip below 50, I'd switch to high carb, possibly with honey/syrup added.


Mogs
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I can’t figure out at .25 dose with the syringes I have. I’m already guessing at the .5. And I’m not able to monitor for ketones. Haven’t caught her going for a day or two to even try and collect a sample. She is going though, but not near like she was before her attack last week.

She is due for her 12 hour here in half an hour. Should I skip? I can monitor her close tonight, and have a medium carb canned food the fancy feast with cheddar to feed. But tomorrow I can’t guarantee I will be able to check her at 2-3 hrs post shot.

 

Hiya,

Is Goose eating and drinking plenty?


Mogs
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Probably. Not the same appetite as before but is eating a can of fancy feast in. 24 hour period. I think she drank better yesterday than today. She is definitely a night eater always has been.

 

Just to make sure I understand correctly, is that just one 3oz can of FF in 24 hours? (I'm in the UK so don't know whether it also comes in bigger cans.)


Mogs
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Yep one of the 3oz cans

 

That's not much in the way of calories (90-ish per 3oz can). How much does Goose weigh?

When you get your PMPS reading can you post it here, please? (Waiting to see where Goose is at before I go to bed - nearly 2:30 am in the UK).


Mogs
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Just tested and BG 186 12:75 post shot

 

Just posted thought I had a bit ago and must not have hit post reply. ‍♀️ I can’t say a huge enough thanks for staying up so late.

BG was 186. She’s little 7-8 lbs. I’ve been taking food to her in bed trying to get her to eat more. She was an almost 2 can a day gal before

 

Am I correct in understanding that you've already given insulin this evening?


Mogs
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Updated SS with afternoon numbers.

 

No have been waiting and made her come sit on the couch and watch some NASCAR

 

Typing...

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I sure am!

 

@Mongoose wrote:

The 2 cans would more like what she should be eating (c. 20kcal/lb). It's a bit of a worry from a ketone perspective. Would you consider getting a blood beta ketone meter? The strips are a bit pricey but you'd only need to test once a day (unless readings indicate additional testing is indicated) and it removes the unpredictability problem. In your particular circumstances I think it would be a very good investment. IIRC, I've seen recommendations here for the Nova Max. The sooner you can find a way to monitor for ketones, the safer things will be.

Have you any idea why she doesn't want to eat as much now? Any signs of nausea?

Nausea symptoms and treatments

If nausea's behind the reduced appetite then there are good treatments for it. Has your vet given you any advice about appetite issues or suggested an appetite stimulant?

Also, does Goose eat a fair bit before you give the insulin? With Vetsulin the recommended drill is to give a good feed, wait 30 minutes (so digestion can get underway and provide something for the insulin to work on), give the injection (provided safe to do so), and give smaller snacks in the early part of the cycle as required to slow drops/level out BG.

I'm worried about the low calorie intake and skipping doses - especially because we don't yet know how things are on the ketone side of things at the moment - but also there's the worry that Goose might go too low again. Suggested plan:

Tonight: if Goose has eaten OK, you can monitor closely (till well past nadir if necessary) and have a well-stocked hypo kit (plenty of meter test strips, MC/HC food, honey/syrup), give insulin and start testing at +1.5 and +2.

Tomorrow daytime: IIRC you can't monitor during tomorrow's AM cycle, so I think it would be safer to skip.

What do you think yourself?


Mogs
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Mogs
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not sure why she’s not eating - it’s almost like she says I’m too tired to eat, I just want to lay here and sleep and be peaceful. She hasn’t eaten too hot tonight, did go drink but only ate a bit.

Will look into the ketone tester first thing. My new syringes shipped from chewy this evening so should have those by Tuesday to be able to shoot an accurate .5 for sure.

What’s worse - high 200 BG or too low BG?

 

Too low. Absolutely. We have a saying here: better too high for a day than too low for a minute. If BG gets too low it poses an immediate threat to life. Higher BG numbers take a fair amount of time to do damage.

Goose's numbers are fairly good at the moment, all things considered, but they are in the diabetic range for part of the time. That coupled with skipping, poor appetite of unknown cause and what sounds a bit like lethargy are why I'm particularly concerned about ketones in Goose's case.

When you get the half-unit marked syringes, I'd suggest reducing the dose below 0.5IU.

I've got to sign off now (eyes out on stalks). Wishing you both a safe night.


Mogs
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Before I (finally!) head off, here are additional thoughts and further resources...

If a cat doesn't get enough calories then, in addition to the risk of ketosis in a diabetic, there's also the risk of developing hepatic lipidosis. I'd suggest asking your vet about the appetite problem ASAP, especially with kidney issues in the mix since there are many things renal-related that can lead to poor appetite (and tiredness). A round of blood work would be a good plan if you haven't had one done recently (CBC plus appropriate chemistry panel).

Here are some helpful links:

Persuading a cat to eat

(Check the section on cat-safe baby foods - some cats will eat them when they're not so keen on their regular food, so they can provide a bit of a stopgap while the cause of the poor appetite.)

Ideas for stimulating a cat's appetite (some additional suggestions)

I'd also suggest asking your vet whether a B-complex supplement might be helpful. It can help with appetite and - if present - anaemia (although the cause of any anaemia would need to be determined and treated promptly).

Tanya's Site - B Vitamins Page


Mogs
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Mogs - thank you so much for all your feed back!!! Have a call into my vet, will see if he's any help.

This cat is going to be the death of me, forget her dying. Tested her at 10:30 before my bedtime and BG was down to 137 so I definitely didn't shoot. Heard he eating at 2:00am. This morning she was up and ready to eat at 7:00am just like "normal" and dug in. Was all excited to get a 30 min post food reading! She puked up liquid wet cat food sometime between 7-7:30, SIGH! This isn't anything new. Tested her anyways and BG was at 143, no morning shot. Saw her eating the leftovers I moved by her bed. She was very much acting like herself, walking around checking out what we were doing and looked outside. Ran home and tested at 11:15 BG was 137 she was awake and alert. And didn't pull her ears back trying to avoid testing. Going to try and go home here and test +7hrs from AMPS level.

 

@7:30 hrs post, BG was 187 and she ate when I gave her “lunch in bed again.” She’s up now drinking and eating after I show her an unopened can.

Vet agreed to reduce from the .5 so I’ll guess best I can. I won’t pull the plunger down much when I fill the syringe. If she is not above 150 or much above @ 7:30/45 should I still shoot?

 

Tested at 7:30pm so just about 36 hours post last shot of .5 and she was at 141. Yippee!!!!

 

Sorry you didn't get any reply last night. (I wasn't around; not feeling very well.)

Tip:

Sometimes when members see a lot of replies to a thread they may assume that you're getting enough help but unfortunately that's not always the case (or they might simply just not have enough time available to read through the whole thread before replying to you). To avoid this happening, if you need help with dosing, start a new thread, set the '?' icon against the title, and include in the title that you need help with Vetsulin dosing (also how urgently). It's also advisable to start a new thread when you need help with something new. Whenever starting a new thread, it's a good idea to copy/paste the URL from your previous thread so that members replying to you can easily check back over your earlier posts if they need more background info.

Any joy with the vet about the appetite issues? Any testing proposed?


Mogs
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I did that here's the link to that new thread. Guess it would make sense to link them to each other not just the new back to the old. https://felinediabetes.com/FDMB/thr...mbers-under-150-no-insulin-for-48-hrs.243214/

Nope vet just said - well with the Kidneys appetite could be a problem. And oh boy - she sure is all over the place and you were right to reduce the dose. Not oh my, good thing you tested cause if you hadn't you could have killed her with a 2unit dose three times in 24 hours.
m

 

Some vets...

Glad you got help with the dosing question (hadn't got as far as that thread).

If you've not yet visited it, I can't recommend Tanya's Site highly enough for anything related to feline CKD (a good place to start might be the pages on nausea, appetite and B vitamins linked above).

Here are some suggestions for vetty things:

* CBC - to check for any anaemia/infection/inflammation.

* Chemistry Panel - to check status of kidney function including protein level, BUN, creatinine, phosphorus, electrolytes, etc. (Worth double-checking that potassium, sodium and calcium levels are included in the test panel.)

* Given Goose's tiredness, ask for iron levels to be checked too. (Needs to be ordered in addition to a regular kidney panel over here, not sure whether same holds in US.)

* Cystocentesis with culture & sensitivity - to make sure Goose is clear of any urinary tract infection, and to check protein, pH and specific gravity values.

* Examination - including blood pressure and eye health. (Really important because untreated hypertension can worsen kidney function and increase risk of stroke or sudden blindness. For most cats it's really treatable with a once-a-day BP med, usually amlodipine).

I'd also suggest monitoring for any signs of nausea when Goose is offered food (see link above for symptom checklist). If present, even intermittently, then perhaps you could ask your vet to prescribe ondansetron and/or Cerenia (they're a big help). Feeding small, frequent meals can also help prevent build-up of stomach acid (latter can trigger vomiting when cat eats or drinks after longer fasts). This in turn may reduce nausea and get more food down. If giving a Vetsulin dose, as always a substantial feed should be given 30 minutes before insulin administration, but then you could give smaller snacks at other points between doses to keep a little something in the tummy. While it's not ideal to feed after around the +5 mark on a Vetsulin cycle, sometimes other conditions trump that consideration. In Goose's case, her being able to eat reliably would be better for her health in general, reduce her risk of throwing ketones and, if it helps resolve the vomiting problem, make insulin administration safer (and consistent administration of a safe dose in a cat requiring insulin also reduces risk of ketosis).

Again, I'd suggest asking your vet about whether it's OK to give Goose a B-complex supplement. It's very much recommended on Tanya's Site for cats with renal insufficiency. Certainly in our case it has been a significant help to Lúnasa's appetite (and in a few days' time I'll find out if it has helped her red blood cell values).


Mogs
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