Daniel&Ares
Member
Hi Everyone! My name is Daniel and I have a sweet 12 years old boy called Ares who was diagnosed with diabetes in June 2024. Ours is a cautionary tale, so buckle up, here it goes:
This next paragraph attempts to summarise Ares' medical history in a slightly tongue-in-cheek fashion, reading it is OPTIONAL as I will summarise the important parts after the TL;DR.
I've been asking for dental cleanings from our vet for 2-3 years as the mighty Ares was approaching the age of 10. I knew from our previous vet, that above 5-6, regular dentals are a good idea. Unfortunately, we had to leave this vet and switch to a new one after we moved because he didn't do house calls to the new area we moved to and back then, it was very difficult to take Ares to the vet. He is a big, strong boy, weighing ~9kg (not anymore) who had none of it and of course we didn't want to stress him, so we looked for a new vet who was willing to do house calls in our area. Big mistake! NEVER leave a vet if you are satisfied, no matter what. You will soon see why. Anyways, so we switched to a new vet and Ares was healthy, and as his name suggests, mighty cat. I asked for dentals many times, the vet always denied. He said that his teeth are alright. Probably that's the reason why he lost one of his upper canines 1-1.5 years ago. Again, I asked for a dental cleaning, and again: denied. No need to worry, his teeth are healthy enough and he was buffled why Ares lost his canine (completely, as in, it was not broken, it fell clean out). Fast-forward to April 2024. I wanted a complete blood panel and a dental procedure as I told the vet that the dentals are long overdue and also, I would like some lab results as Ares is now old and I believe in the power of prevention. The vet agreed to both after he briefly checked Ares' teeth. After the dentals, the vet casually informed us that his other upper canine had to be extracted as puss formed underneath it (not sure if it was an abscess). Other than that, the cat is very healthy. Then the lab results came back (which I will upload). What was immediately apparent: low white blood cell counts all over. I asked the vet what could cause this and when should we do more testing and check-ups to determine the cause. He said no need for that, he most likely has feline-AIDS/FIV, or bone-marrow disease, or leukemia. Whichever it is, not much can be done apart from taking immune supplements to improve his immune system. No need to bother the cat with more lab tests. Also, in the lab results Ares' fructosamine was already in the ~400 range if memory serves me right and his BG was 10 mmol/l. The vet said that this is not serious, pay no attention to it. After a couple of months, at the end of May / beginning of June Ares suddenly developed a ravenous appetite which we tried to satisfy, especially because he started to lose weight and drink a lot. The vet called for another blood test. Fructosamine was in the 700-800s, BG was above 23 mmol/l. "Ares has severe diabetes." - said the vet in a surprised tone (as if there wasn't any indication at all in Ares' previous blood panel...). Next day, the vet popped over to our house and with him brought aid in the form of a little vial, that said "Caninsuline" on the label. "How much insulin do you give your cat again?" - asked the vet from his mysterious friend over the phone as he entered into Ares' (and my) domain, while shaking my hand. "10 units!" It has been decided! 10 units of caninsulin it is, that will be the starting dose of Ares, the now 8.5 kg, 12 years old mighty cat who was freshly diagnosed with diabetes with a recent history of dental problems and low white blood cell count! Tremendous! "When should we go back for testing?" - I inquired. "If you really want to, you can bring him over next week and we can check his BG levels as we can't do it here on a house call." I was flabbergasted. Although I was quite uneducated on the topic back then, so I had no idea that 10u of caninsulin is a great big starting dose, I still suspected that something is off. No mention of home testing? Wants me to take Ares for a drop of blood and all of a sudden stopped doing house calls? I'm afraid this is goodbye. Back we went to our old vet the very next week.
So yeah, thinking that any vet will suffice since you will make sure that there will be regular health check ups for your cat and that will make sure you and a vet will be able to prevent the problems before they arise, so it is perfectly okay to leave your old (and good!) vet, so your cat can still have house calls? Well think again! Never leave a good vet. EVER. I learnt this the hard way as I'm more than sure that Ares would be in a much better condition and health, had we not leave our good old trusty vet for house calls. Which didn't matter in the end because we have to do regular vet visits now.
TL;DR: Never leave a good vet. Ares lost an upper canine 1-1.5 years ago. I asked for a routine blood check and dentals this April. His other upper canine needed to be extracted as puss was forming underneath it. His lab results came back, turns out he has low white blood cell counts. At this point his fructosamine and BG was elevated, vet said it's not serious. Few months later in June we had to do another blood test, since he developed a ravenous appetite and started drinking a lot, was lethargic. Results came back: fructosamine through the roof, BG is 23 mmol/l. Lo and behold, Ares has diabetes. Vet prescribed 10u of caninsulin, didn't mention home testing. I asked about when we should check his BG again and he said that if we want to, we can bring him to the office next week. After this I went back to our old vet. This is June 2024.
So, what happened between June and now? We couldn't test Ares' BG at home, turns out he is untestable, so started using a Freestyle Libre. Our new old vet switched him to 2u of Lantus at the end of July / beginning of August. As of November 2024, Ares is still unregulated, hence I registered here after lingering in the shadows, reading a lot and arriving at a conclusion that although we love our current vet to bits and know that he is very competent (probably among the most competent ones in the country where I'm located) but surprise-surprise: he might not have the most experience with FD. Why do I say this? Although the 10u of caninsulin prescribed by the other vet without regular testing was a very irresponsible move, suddenly putting Ares on 2u of Lantus based on three blood glucose tests (each a week apart), was also not well thought out in my humble opinion (although we weren't able to test him at home back then). But I didn't know any better. Another red(orange?) flag was that the vet started raising doses in 0.5 units / day by raising the AM dose first, then later the PM dose, then the AM dose again, so long and so forth. We still didn't have enough data to back this "protocol" up but at least we now had some tests done, thanks to Freestyle Libre. However, at this point the device only remained on Ares for a day or two max. Later, as you can see it from the spreadsheet, I was able to apply the devices to stay on for the whole 14 day duration. Anyways, so when we reached 4u/4u with Lantus, the vet wanted to do an IGF-1 and test for acromegaly. Which is a good point but I feel like (based on what I read here) it was premature. Results came back, Ares indeed had elevated IGF-1 but not above the acromegaly threshold (I intend to complete the spreadsheet with all his lab results btw). Regardless, the vet wanted to make sure with an MRI. At this point, I was getting a bit impatient and didn't really agree with his approach. I felt like that probably, we should much rather concentrate on Ares' teeth. Instead of putting him under anesthesia for an MRI, we should be putting him under anesthesia for dental clean ups / teeth extraction. Anyways, I didn't want to confront with our vet, so I went with the MRI. It came back negative. After that I asked that shouldn't we do the dentals? Or maybe give him antibiotics in case he might have an infection that is causing insulin resistance? The vet said that he would like to regulate the cat first and doesn't want to put him under anesthesia again so soon. Regarding the latter, I agreed. But the former? I didn't want to point it out that he might not be regulated like ever, if indeed his teeth are the problem. Catch-22. The vet told me that he is sure Ares doesn't have any abscesses as he would be in severe pain and would probably wouldn't have a good appetite. At this point, I was convinced that he might be right. Anyways, whatever is going on we agreed that he cannot be put under anesthesia so soon, so in the mean time we might as well just raise the dose more aggressively, so we did. We are at 8.5u of Lantus at the moment and the vet is thinking about switching to Levemir. I kind of support this but at this point, looking at the data, am utterly clueless (and unfortunately, it seems like that my vet is too), thus I decided to register and ask for help: Is Ares underdosed? Or maybe the opposite: could it be that he is overdosed? His teeth are in a bad condition, there is a slight inflammation of the gums but he has good appetite (albeit he drops the food sometimes), also, he has a bit more drooling and sometimes there is a slight discolouration (blood even) but probably no abscesses. If this is the case, could this cause such heavy insulin resistance and thus we should really start planning for a safe dental cleaning? Should we switch to Levemir at this point as he's been on Lantus since July/August? I wouldn't say to no avail, because although his BGs are high, he stopped losing weight (stopped at 6.5-7kg, was 8.5-9kg originally, he is a BIG cat but was indeed overweight), he has appetite but not a ravenous one like before, his coat has improved (shiny, soft and silky smooth again) and his activity is improved as well (going up and down the stairs again, patrolling in the garden, hunting for mice). As mentioned earlier, I kind of support the idea of a switch to Levemir to see how he reacts. In the meantime, I would like to ask for an IAA and a test for ketones in the blood and also planning to ask for a second opinion: the lab where they did Ares' MRI had a vet who is specialised in cat endocrinology and at a glance seemed to be more well informed regarding FD than our vet.
Some additional info: I entered the maximum values from the Freestyle Libre into the spreadsheet, except when there was a nadir, I entered the minimum in those cases as well (so cells with two values usually contain the nadir but sometimes if I felt that the difference between the min and max was so big, I entered both). The spreadsheet is almost complete but I will do some refinements, I will have to update the dosing information in the earlier phases (if I can recall them). I will also complete the lab results.
Also, as I mentioned, Ares has access to the garden (but he can't leave it and other cats can't enter anymore either as I closed the whole place off) and that's where he is doing his number 1 and 2 business so I can't really test for ketones with urine strips and can't prick his ears (hence the Libre).
Help would be very much appreciated and thank you so much for bearing with me, sorry for making the post so long!
This next paragraph attempts to summarise Ares' medical history in a slightly tongue-in-cheek fashion, reading it is OPTIONAL as I will summarise the important parts after the TL;DR.
I've been asking for dental cleanings from our vet for 2-3 years as the mighty Ares was approaching the age of 10. I knew from our previous vet, that above 5-6, regular dentals are a good idea. Unfortunately, we had to leave this vet and switch to a new one after we moved because he didn't do house calls to the new area we moved to and back then, it was very difficult to take Ares to the vet. He is a big, strong boy, weighing ~9kg (not anymore) who had none of it and of course we didn't want to stress him, so we looked for a new vet who was willing to do house calls in our area. Big mistake! NEVER leave a vet if you are satisfied, no matter what. You will soon see why. Anyways, so we switched to a new vet and Ares was healthy, and as his name suggests, mighty cat. I asked for dentals many times, the vet always denied. He said that his teeth are alright. Probably that's the reason why he lost one of his upper canines 1-1.5 years ago. Again, I asked for a dental cleaning, and again: denied. No need to worry, his teeth are healthy enough and he was buffled why Ares lost his canine (completely, as in, it was not broken, it fell clean out). Fast-forward to April 2024. I wanted a complete blood panel and a dental procedure as I told the vet that the dentals are long overdue and also, I would like some lab results as Ares is now old and I believe in the power of prevention. The vet agreed to both after he briefly checked Ares' teeth. After the dentals, the vet casually informed us that his other upper canine had to be extracted as puss formed underneath it (not sure if it was an abscess). Other than that, the cat is very healthy. Then the lab results came back (which I will upload). What was immediately apparent: low white blood cell counts all over. I asked the vet what could cause this and when should we do more testing and check-ups to determine the cause. He said no need for that, he most likely has feline-AIDS/FIV, or bone-marrow disease, or leukemia. Whichever it is, not much can be done apart from taking immune supplements to improve his immune system. No need to bother the cat with more lab tests. Also, in the lab results Ares' fructosamine was already in the ~400 range if memory serves me right and his BG was 10 mmol/l. The vet said that this is not serious, pay no attention to it. After a couple of months, at the end of May / beginning of June Ares suddenly developed a ravenous appetite which we tried to satisfy, especially because he started to lose weight and drink a lot. The vet called for another blood test. Fructosamine was in the 700-800s, BG was above 23 mmol/l. "Ares has severe diabetes." - said the vet in a surprised tone (as if there wasn't any indication at all in Ares' previous blood panel...). Next day, the vet popped over to our house and with him brought aid in the form of a little vial, that said "Caninsuline" on the label. "How much insulin do you give your cat again?" - asked the vet from his mysterious friend over the phone as he entered into Ares' (and my) domain, while shaking my hand. "10 units!" It has been decided! 10 units of caninsulin it is, that will be the starting dose of Ares, the now 8.5 kg, 12 years old mighty cat who was freshly diagnosed with diabetes with a recent history of dental problems and low white blood cell count! Tremendous! "When should we go back for testing?" - I inquired. "If you really want to, you can bring him over next week and we can check his BG levels as we can't do it here on a house call." I was flabbergasted. Although I was quite uneducated on the topic back then, so I had no idea that 10u of caninsulin is a great big starting dose, I still suspected that something is off. No mention of home testing? Wants me to take Ares for a drop of blood and all of a sudden stopped doing house calls? I'm afraid this is goodbye. Back we went to our old vet the very next week.
So yeah, thinking that any vet will suffice since you will make sure that there will be regular health check ups for your cat and that will make sure you and a vet will be able to prevent the problems before they arise, so it is perfectly okay to leave your old (and good!) vet, so your cat can still have house calls? Well think again! Never leave a good vet. EVER. I learnt this the hard way as I'm more than sure that Ares would be in a much better condition and health, had we not leave our good old trusty vet for house calls. Which didn't matter in the end because we have to do regular vet visits now.
TL;DR: Never leave a good vet. Ares lost an upper canine 1-1.5 years ago. I asked for a routine blood check and dentals this April. His other upper canine needed to be extracted as puss was forming underneath it. His lab results came back, turns out he has low white blood cell counts. At this point his fructosamine and BG was elevated, vet said it's not serious. Few months later in June we had to do another blood test, since he developed a ravenous appetite and started drinking a lot, was lethargic. Results came back: fructosamine through the roof, BG is 23 mmol/l. Lo and behold, Ares has diabetes. Vet prescribed 10u of caninsulin, didn't mention home testing. I asked about when we should check his BG again and he said that if we want to, we can bring him to the office next week. After this I went back to our old vet. This is June 2024.
So, what happened between June and now? We couldn't test Ares' BG at home, turns out he is untestable, so started using a Freestyle Libre. Our new old vet switched him to 2u of Lantus at the end of July / beginning of August. As of November 2024, Ares is still unregulated, hence I registered here after lingering in the shadows, reading a lot and arriving at a conclusion that although we love our current vet to bits and know that he is very competent (probably among the most competent ones in the country where I'm located) but surprise-surprise: he might not have the most experience with FD. Why do I say this? Although the 10u of caninsulin prescribed by the other vet without regular testing was a very irresponsible move, suddenly putting Ares on 2u of Lantus based on three blood glucose tests (each a week apart), was also not well thought out in my humble opinion (although we weren't able to test him at home back then). But I didn't know any better. Another red(orange?) flag was that the vet started raising doses in 0.5 units / day by raising the AM dose first, then later the PM dose, then the AM dose again, so long and so forth. We still didn't have enough data to back this "protocol" up but at least we now had some tests done, thanks to Freestyle Libre. However, at this point the device only remained on Ares for a day or two max. Later, as you can see it from the spreadsheet, I was able to apply the devices to stay on for the whole 14 day duration. Anyways, so when we reached 4u/4u with Lantus, the vet wanted to do an IGF-1 and test for acromegaly. Which is a good point but I feel like (based on what I read here) it was premature. Results came back, Ares indeed had elevated IGF-1 but not above the acromegaly threshold (I intend to complete the spreadsheet with all his lab results btw). Regardless, the vet wanted to make sure with an MRI. At this point, I was getting a bit impatient and didn't really agree with his approach. I felt like that probably, we should much rather concentrate on Ares' teeth. Instead of putting him under anesthesia for an MRI, we should be putting him under anesthesia for dental clean ups / teeth extraction. Anyways, I didn't want to confront with our vet, so I went with the MRI. It came back negative. After that I asked that shouldn't we do the dentals? Or maybe give him antibiotics in case he might have an infection that is causing insulin resistance? The vet said that he would like to regulate the cat first and doesn't want to put him under anesthesia again so soon. Regarding the latter, I agreed. But the former? I didn't want to point it out that he might not be regulated like ever, if indeed his teeth are the problem. Catch-22. The vet told me that he is sure Ares doesn't have any abscesses as he would be in severe pain and would probably wouldn't have a good appetite. At this point, I was convinced that he might be right. Anyways, whatever is going on we agreed that he cannot be put under anesthesia so soon, so in the mean time we might as well just raise the dose more aggressively, so we did. We are at 8.5u of Lantus at the moment and the vet is thinking about switching to Levemir. I kind of support this but at this point, looking at the data, am utterly clueless (and unfortunately, it seems like that my vet is too), thus I decided to register and ask for help: Is Ares underdosed? Or maybe the opposite: could it be that he is overdosed? His teeth are in a bad condition, there is a slight inflammation of the gums but he has good appetite (albeit he drops the food sometimes), also, he has a bit more drooling and sometimes there is a slight discolouration (blood even) but probably no abscesses. If this is the case, could this cause such heavy insulin resistance and thus we should really start planning for a safe dental cleaning? Should we switch to Levemir at this point as he's been on Lantus since July/August? I wouldn't say to no avail, because although his BGs are high, he stopped losing weight (stopped at 6.5-7kg, was 8.5-9kg originally, he is a BIG cat but was indeed overweight), he has appetite but not a ravenous one like before, his coat has improved (shiny, soft and silky smooth again) and his activity is improved as well (going up and down the stairs again, patrolling in the garden, hunting for mice). As mentioned earlier, I kind of support the idea of a switch to Levemir to see how he reacts. In the meantime, I would like to ask for an IAA and a test for ketones in the blood and also planning to ask for a second opinion: the lab where they did Ares' MRI had a vet who is specialised in cat endocrinology and at a glance seemed to be more well informed regarding FD than our vet.
Some additional info: I entered the maximum values from the Freestyle Libre into the spreadsheet, except when there was a nadir, I entered the minimum in those cases as well (so cells with two values usually contain the nadir but sometimes if I felt that the difference between the min and max was so big, I entered both). The spreadsheet is almost complete but I will do some refinements, I will have to update the dosing information in the earlier phases (if I can recall them). I will also complete the lab results.
Also, as I mentioned, Ares has access to the garden (but he can't leave it and other cats can't enter anymore either as I closed the whole place off) and that's where he is doing his number 1 and 2 business so I can't really test for ketones with urine strips and can't prick his ears (hence the Libre).
Help would be very much appreciated and thank you so much for bearing with me, sorry for making the post so long!
You provided me with plenty of evidence that acro is much sneakier than one would believe and it seems like that it's a condition that is difficult to rule out or diagnose with absolute certainty. So if the switch and the dentals don't improve things / he still requires high doses and IAA is negative, then I'll definitely retest for IGF-1. 