New member -- needs help!

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barrybuttonsmom

barrybuttonsmom

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Hi there!

To preface things -- I work at a veterinary hospital and am studying to be a veterinarian. Please do not judge me based upon my profession or treat me any different than the other members. I love my diabetic kitty and am on here to help him just like everyone else :)

This is about to be a long intro so please buckle up for the ride.. About three weeks ago, a client brought in her diabetic cat to be euthanized due to cost and time of treatment. I ended up having her surrender him to me. So, I now have a 13 year old diabetic cat who was diagnosed back a couple months ago. He was initially started on 2u BID. Owner did not start giving it for a couple weeks. He was on 2u for only 2-3 weeks and had a fructosamine ran. DVM he is under care for thought that he had been on 2u for over a month but was not. Owner did not disclose she just started it when fructosamine was ran. It came back high for obvious reasons. Doc (still not knowing he had just started 2u) bumped him up to 3u BID. Owner was giving it for about 2-3 weeks again and decided it was time for euthanasia (11/19 I believe). Extreme polyuria/polydipsia per owner and was urinating blood. At this time, the doc assumed he was not getting the 3u as instructed. Owner insists she was giving the 3U BID and he was not improving any. Finances were a huge concern (similarly to many people amidst this pandemic, no judgement toward her!). Therefore, elected euthanasia. That is when I stepped in. Owner was feeding Purina Naturals grain-free indoor diet. Still eating that to this day with tiny amounts of fancy feast pate before insulin. He is not a big fan of wet food.

SO, once I had him surrendered to me -- his doc decreased him to 2u BID on 11/19. Did not run any BW but I ran a urine dipstick myself to ensure no ketones. Noted 4+ leukocytes and ++++ glucose spillage at that time. He also sounded quite congested and had bilateral bacterial ear infections. Treated ears with Entederm. Gave convenia injection to cover poss URI and UTI. He still is awfully congested -- sounds like he has a polyp but do not want to sedate him right now to look due to his diabetes being out of whack. He also has a couple bad teeth that need pulled but again, do not want to sedate him at this time.

Barry was on 2u BID for about 2-3 days and started experiencing episodes of intermittent blindness. Still unsure what caused this but decreased his insulin to 1.5u BID. He was managing that okay until about a week ago. Urine output suddenly increased. Water intake suddenly increased. Acting ravenous around food. I freaked out and ran full BW. Was mostly WNL but glucose was @ 471, fructosamine had come down a tiny bit. Not much though. Three days ago, his insulin dose was changed AGAIN to 2u BID. His coat looks awful. He appears to have lost weight. Acting starved. Pu/pd. Energy is awesome though. No v/d.

Well, today I had an emergency and had to be taken by ambulance. This really freaked Mr. Barry out. My mom came to my apartment to grab my laptop for me and said she saw Barry take off and run to hide. When I got home, it was about 15 minutes before his insulin. I did not find him until nearly two hours after when he was supposed to get his insulin. When I found him, he was extremely wobbly and seemed to be blind again. I gave 2u insulin + he ate and vision seemed to come back about 30 min after. He is still pretty off balance. Obviously this is not normal but, concerning?

He does NOT let me test at home. I am often referred to as the "cat wrangler" at work so, trust me on this one. He is having a freestyle libre implanted tomorrow. I plan on changing his diet once we have a libre attached or a way to check his BG without poking at home.

Could he be having a 'hypo' episode right now? Why was he wobbly when I found him? Wouldn't his BG be high if he was late on his insulin? Maybe something else going on here? I am sort of freaking the heck out. There is no rational part of my mind right now. I just think he is dying since has increased pu/pd last few days + coat started looking horrendous around that time too. No acetonic or fruity breath. No ketones in urine @ 1:30p today. Positive for glucose spillage though.

Although I work in vet med and am studying it -- feline diabetes is seeeeverely neglected when it comes to education. Please give me all the tips, tricks, pointers, and advice you possibly can. Tell me everything you would tell someone who knows nothing about feline diabetes please. I am one scared mama!!
 
Welcome to the best place you never thought you would be. The people here have lived feline diabetes 24/7 and have done the research. I'll answer what I can and leave the rest for others to chime in on.

Yes, he could be having a symptomatic hypo. Rover had one. We shoved corn syrup in his mouth and hightailed to the ER. By the time we got to the clinic, Rover was fine. The ER vet referred to it as "brain blindness." It was temporary but I've seen some cases here where the cat takes days to get its vision back. She tested his sight by dropping a cotton ball (light enough not to move the air when dropped) from above his head and just behind.

Symptomatic hypos are dangerous. Even non-symptomatic hypos are dangerous. The whole thing can change in the blink of an eye. Some very important reading for you.



Emdavv said:
He also sounded quite congested and had bilateral bacterial ear infections. Treated ears with Entederm. Gave convenia injection to cover poss URI and UTI. He still is awfully congested -- sounds like he has a polyp but do not want to sedate him right now to look due to his diabetes being out of whack.
Click to expand...
However, this could at least explain the wobbles.

Given that there are no ketones, I would not give insulin until the Libre is attached. A head's up: the Libre tends not to last the full 14 days. Most cats find a way to get it off or it comes off on its own.
It may very well be that the dose is too high. We recommend here that increases be no more than 0.25 units because you can go right past the optimal dose if you increase by whole units. Going from 2 units to 3 units is increasing the dose by 1/3.

What insulin is being given? Each insulin acts differently. Some are depot insulins. Some are in-and-out insulins.

Emdavv said:
He was managing that okay until about a week ago. Urine output suddenly increased. Water intake suddenly increased. Acting ravenous around food.
Click to expand...
Unregulated cats drink a lot of water to help flush the glucose out of their system. As he becomes regulated, this should slow down.
Also, unregulated cats cannot process food properly.
I'm pulling this explanation by @Chris & China (GA) from an old thread.
ALL food, including protein, eventually breaks down into glucose. Glucose is "food for the cells" ….but without insulin, that glucose stays in the bloodstream (which is why they have high blood glucose numbers)​
In an attempt to "dilute" the glucose from the bloodstream, they drink copious amounts of water....which leads to copious amounts of urine. (doesn't have anything to do with food but just explaining more about diabetes....why they drink so much water and pee so much)

Emdavv said:
His coat looks awful.
Click to expand...
This will improve with regulation.

Emdavv said:
That is when I stepped in. Owner was feeding Purina Naturals grain-free indoor diet. Still eating that to this day with tiny amounts of fancy feast pate before insulin. He is not a big fan of wet food.
Click to expand...

This link is full of suggestions. The other alternative once you are testing is a dry food under 10% carbs. In the US, there are only two options. Dr. Elsey's Clean Protein and Young Again. Young Again will send you a sample if asked. But do not change up the food until you are testing. Just switching to low carb food can drop a cat's numbers overall by up to 100.
Emdavv said:
Well, today I had an emergency and had to be taken by ambulance. This really freaked Mr. Barry out. My mom came to my apartment to grab my laptop for me and said she saw Barry take off and run to hide. When I got home, it was about 15 minutes before his insulin. I did not find him until nearly two hours after when he was supposed to get his insulin. When I found him, he was extremely wobbly and seemed to be blind again. I gave 2u insulin + he ate and vision seemed to come back about 30 min after. He is still pretty off balance. Obviously this is not normal but, concerning?
Click to expand...
Yes, we have seen situations where a cat's numbers tank in a stressful situation. Also remember that your relationship with him is new.
If you are giving a depot insulin such as Lantus, it does not kick in straight away. If Mr. Barry had low numbers, the Purina Naturals grain-free could have brought him up before the insulin kicked in.
Emdavv said:
He does NOT let me test at home. I am often referred to as the "cat wrangler" at work so, trust me on this one.
Click to expand...
Here are some tips. It takes time for some cats to get used to testing but it can be done. It is the only way to keep a cat safe. A fructosamine just gives the general impression of the last two weeks or so. It will not tell you whether a cat is experiencing a hypo.
Emdavv said:
Could he be having a 'hypo' episode right now? Why was he wobbly when I found him? Wouldn't his BG be high if he was late on his insulin? Maybe something else going on here?
Click to expand...
Yes, it's possible. Give him some of the dry food and no shot tonight. Better safe than sorry.
A likely sign that the insulin dose is too high is a low number at the end of a cycle.

And yes, there are other things going on.

I'm tagging a few very experienced members for you.
@tiffmaxee
@Wendy&Neko
@Bandit's Mom

We can help you every step of the way.

Emdavv said:
feline diabetes is seeeeverely neglected when it comes to education.
Click to expand...
Sadly, this is the case. No worries. We can help make you a Feline Diabetes expert in no time.
Here is a good place to start.
 
Hello and welcome! :-)

There are separate forums for each type of insulin here and there is a lot of information at the top of each forum in "stickies" - as well as here:
https://www.felinediabetes.com/FDMB/forums/health-links-faqs-about-feline-diabetes.14/

Which insulin is Barry on?

If you would like to switch to a low carb kibble while transitioning Barry to wet food (which could take a while), there are several options in the US - Young Again, Dr. Elsey's Clean Protein, Wysong Epigen 90 and Keto Kibbles. Just a change to a low carb diet might drop Barry's insulin needs. You would need to monitor his BG very closely during transition to any low carb food (dry or canned).

We are happy to answer any questions you have. I am also tagging @Bron and Sheba (GA)

Bhooma
 
Hi and welcome Emily and Barry. What a lucky fellow Barry is to have you!

I agree with @Red & Rover (GA) that Barry could well be having a hypo with the symptoms you describe.
Can you tell us what type of insulin you are using please?

I know you and Barry are getting to know each other but I think you will find with a few tips and help and encouragement from us, you will eventually be able to home test him for the BGs. A lot of people arrive here and don’t think they will be able to home test but we have very few people who are not successful.......I’m struggling even thinking of anyone.
Here is a link to how to home test....I never thought I would be able to do it but I did.
https://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/

Also another useful link
https://www.felinediabetes.com/FDMB/threads/new-how-you-can-help-us-help-you.216696/

That is good you tested for ketones.
I think once you have the freestyle meter up and running you will see how good it is to be able to see what the BG is at any given time. So much better and safer than a glucose urine test that can only tell you how much glucose is in the urine since the last pee, or a fructosamine test that is really only an average over a couple of weeks and doesn’t show the low or high numbers.
We recommend testing before every shot to see it is safe to actually give the insulin and then test again during the cycle to see how low the dose is taking Barry.

Keep asking lots of questions. It’s a steep learning curve in the beginning.
Bron:)
 
Has has blood pressure been checked? Untreated it can cause blindness and cats don have high BP not secondary to CKD. My boy did. I had it tested to get a baseline and both my vet and I were surprised it was high and he was started on amlodipine. If his sight has returned it’s likely not high bp and could have been hypo. He might be more sensitive to insulin now. Which insulin are you using? Bless you for taking him in. :bighug:
 
Emdavv said:
I ran a urine dipstick myself to ensure no ketones. Noted 4+ leukocytes
Click to expand...
For cats and dogs too, the leukocytes pad on urine dipsticks is frequently reads false positive and is not reliable. I also observed that when working at a vet and at vet tech school.

"Leukocytes: This dipstick pad detects enzymes found within neutrophils and macrophages. These pads on urine dipsticks have been developed using human leukocytes, not canine or feline cells. To cause a positive reaction these cells must degranulate (as part of an inflammatory response) or lyse (as may occur with hypotonic or alkaline urine), releasing their contents into the urine. Unfortunately, in dogs this test is not sensitive (many false-negatives), while in cats it is not specific at all (many false-positives), likely due to differences between the enzymes in our patients versus in people."

Above from:
https://www.dvm360.com/view/advanced-interpretation-urine-dipstick-proceedings
 
tiffmaxee said:
Has has blood pressure been checked? Untreated it can cause blindness and cats don have high BP not secondary to CKD. My boy did. I had it tested to get a baseline and both my vet and I were surprised it was high and he was started on amlodipine. If his sight has returned it’s likely not high bp and could have been hypo. He might be more sensitive to insulin now. Which insulin are you using? Bless you for taking him in. :bighug:
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Hi Elise I looked at her profile and information she said he's on Prozinc, I'll ask her to do her signature

@Bandit's Mom
 
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  • Hi Emily
  • when you get a chance ,It would be helpful if you can set up your signature so we don't have to ask you the same questions over again. Members will look at this first , not what you wrote in your profile
  • It appears after each post in gray, look at mine,



  • On the left, under Settings, Click on Signature. This is where you will put information that helps us give you feedback.
    • There is a limit of two lines which may include two links; you may separate pieces with commas, dashes, | etc. This is where you paste the link for your spreadsheet, once it is set up.
    • Add any other text, such as
    • Caregiver & kitty's name (optional)
    • DX: Date
    • Name of Insulin
    • Name of your meter
    • Diet: "LC wet" or "dry food" or "combo"
    • Dosing: TR or SLGS or Custom (if applicable)
    • DKA or other recent health issue (if applicable)
    • Acro, IAA, or Cushings (if applicable)
    • Spreadsheet link. Please put the signature link on the bottom line of your signature information, on its own, so it is easy to find.
    • Please do not put any information about your location in the signature for security reasons. If you wish to add your country location, please add it to your profile.
Be sure to click the 'Save Changes' button at the bottom. If you need help urgently it is important we know these things at a glance. We don’t want to waste valuable time finding out information.


tap on your avatar where it says your name ,then hit profile page ,tap on that ,then go up to the very top, upper right hand side and tap on your name ,it will bring down a drop box, tap on signature, the signature will be under settings, tap on the signature then and you can start to add what I posted above, make sure you hit save ,
Welcome to the best place you could ever be and an awesome group of people
 
Emily you mentioned on your profile page under information he's showing signs
of neuropathy in his back legs.
I will post a link for you below , a lot of members use Methyl B-12 it will help
better once you get Barry in better numbers
 
Here is the link https://www.vitacost.com/vitacost-vitamin-b-12-methylcobalamin-5000-mcg-100-capsules-6

Alot of members use this , I use it myself you can buy it on line from Vitacost
Vitamin B-12 Methylcobalamin -- 5000 mcg - 100 Capsules
It's 17.99 just be sure this is the one you buy
The only difference is the Zobaline has 200 mcgs of folic acid
So I buy the folic acid at the supermarket and crush it up and add it to the B-12
If you can't find the 200 mcg get the 400 mcg and cut it in half and crush it up
The Vitacost brand is a capsule so just open it and pour the powder on the wet food and I always add some water to the wet food.
Has no taste, no need to crush it up
The Zobaline is 33.99 for 60 pills, too expensive
I saw a big improvement I'd say 3 months, could be sooner. One capsule a day.
Once you get your kitty better regulated the B-12 methyl will help


Vitamin B-12 Methylcobalamin -- 5000 mcg - 100 Capsules

  • SKU #: 835003001804
  • Shipping Weight: 0.23 lb
  • Servings: 100
 
https://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/




We use this spreadsheet to track our kitties BG. I read you are having the
Libra put on Barry. You can still record his numbers on the SS
Just note you are using that
Most of us use human meters
Don't know how long you plan on using the Libra.
Most of us use the Relion Prime from Walmart its 9 dollars
The strips are 17.88 for 100 strips
You would want to buy lancets 26 or 28 gauge
You can test him freehand with them
They do have the lancing devices but most don't use them
Cotton rounds to put behind the ear in case you poke your
finger then use it and press his ear gently to stop the bleeding
about 20 seconds

If his ears ever look sore you can put a thin layer of Neosporin Ointment with pain relief on them, NOT The Cream
 
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Always aim for the sweet spot warm the ears up first, you can put rice in a sock and put it in the microwave, test it on the inside of your wrist to be sure it's not to hot, like you would test a babies bottle. You can fill a pill bottle with warm water and roll it on the ears also
c2b8079a-b471-4fa6-ac36-9ac1c8d6dcca-jpeg.57072
fec17d29-5ab4-44a8-912b-3a91944c3954-jpeg.57073

6. As the ears get used to bleeding and grow more capilares, it gets easier to get the amount of blood you need on the first try. If your kitty won’t stand still, you can get the blood onto a clean finger nail and test from there
 
Hello and welcome. Not much more that I can add on top of what others have said so far. We've had a number of members that were vets or vet techs, and also doctors. We all have a diabetic cat in common, and that's what counts. Welcome to the family of FDMB.
 
Diane Tyler's Mom said:
Here is the link https://www.vitacost.com/vitacost-vitamin-b-12-methylcobalamin-5000-mcg-100-capsules-6

Alot of members use this , I use it myself you can buy it on line from Vitacost
Vitamin B-12 Methylcobalamin -- 5000 mcg - 100 Capsules
It's 17.99 just be sure this is the one you buy
The only difference is the Zobaline has 200 mcgs of folic acid
So I buy the folic acid at the supermarket and crush it up and add it to the B-12
If you can't find the 200 mcg get the 400 mcg and cut it in half and crush it up
The Vitacost brand is a capsule so just open it and pour the powder on the wet food and I always add some water to the wet food.
Has no taste, no need to crush it up
The Zobaline is 33.99 for 60 pills, too expensive
I saw a big improvement I'd say 3 months, could be sooner. One capsule a day.
Once you get your kitty better regulated the B-12 methyl will help


Vitamin B-12 Methylcobalamin -- 5000 mcg - 100 Capsules

  • SKU #: 835003001804
  • Shipping Weight: 0.23 lb
  • Servings: 100
Click to expand...
Are B12 injections acceptable?
 
In Europe, specifically Germany one can buy methylcobalamin B12 as injections.
Some of the reading I've done said that when injected, it doesn't matter if its methylcobalamin or cyanocobalamin, but if its true I don't know.
I live in Denmark but I can get the B12 from Germany without a prescription.

So just maybe it's available in other countries too.
 
No judging here.
We need experienced vets. And once you gain experience with treating your own diabetic, and the research witch you'll undoubtedly have a better understanding of, than me and others. When you're done as a veterinarian, you'll probably be quite popular :D:p
 
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