? Newly diagnosed, vet unhelpful, low PMPS (76)

Hi everyone!

Monty is newly diagnosed as of Friday April 5th from one blood test done in vet hospital on Tuesday April 2nd (but his symptoms fit the diagnosis- drinking/peeing a lot, lost a bunch of weight, etc.) Vet's instructions were to give 2 units of humilin if he finished all of his food twice daily. She also had me change from free feeding dry food to two meals of a high protein wet food. (She suggested Royal Canin's prescription canned food, but we are feeding Fancy Feast classic after all of your suggestions.) When I asked her about blood glucose testing before the shot, she said it would be too stressful/we shouldnt worry about "chasing numbers obsessively", and that we'd do a fructosamine test in 3 weeks during a recheck. Well, I went against medical advice after finding the Facebook group/FDMB and started testing him before shots.

Here is my spreadsheet with his numbers so far:
https://docs.google.com/spreadsheets/d/1gYSJVDIJN_Xpzm29DcH__0XHmPo4LQH9ekJTCTZnZ74/edit?usp=sharing

So I tested him tonight before his shot and he is at 76?!?! I immediately fed him his 1.5 cans of Fancy Feast, and he scarfed it down. My husband told me that Monty threw up bile earlier in the evening twice, which usually happens if he doesn't have anything in his stomach. I skipped his PM shot since the PMPS test was so low. 2 hours after feeding, and now his blood sugar is at 247. Is 247 a normal number after eating?

I'm thinking I should drop his dose down to 1 unit until we get more numbers on the chart, and perhaps we should be feeding a mid-day snack as well, so he doesn't throw up bile?

I'm so lost and honestly SO overwhelmed... and I'm absolutely LIVID at my vet. If I followed her advice and not done my own research, I could be rushing Monty to the emergency vet right now. I am definitely on board with the pre shot testing now.

I feel like I have no control over this situation, but something must be going right... Since the diagnosis/insulin/changed diet to exclusively wet food, Monty has been brighter and happier. He's less tired and grumpy. He follows us around the house from room to room looking for attention. His personality is back!!! And the peeing on the couch has stopped too!! (The reason why we visited the vet in the first place- we thought maybe it was a UTI.)

Thanks for reading this part venting part needing advice post. Any advice is much appreciated (or just some loving words because I am honestly STRUGGLING with this diagnosis, and I feel so incredibly guilty that I caused my lovely cat to get so sick by free feeding dry food, and also how did I not notice all of the behavioral changes?? He has always drank a ton of water and peed a lot since we adopted him FOUR YEARS AGO! Has he been suffering with diabetes for YEARS?!?! Okay, I'm digressing...)

Also, if anyone has any recommendations for vets in Simi Valley, CA (or nearby), please let me know!

 

Just an update.... AMPS was 435... so he is definitely not in remission like some suggested on the Facebook group.

 

Hi and Welcome to FDMB MontysMama and Monty. You are very new to this diabetes diagnosis and it can feel so overwhelming and emotional. Been there, most of us have! So, take a deep breath and know that you are already taking the right steps to help Monty feel better. There is a great deal of information here on the board that is valuable to you, and that in itself is a bit overwhelming. Like standing in the Library of Congress, with meeting rooms where various discussions are going on. Don't let that intimidate you. You said you feel like you have no control, but you have already stepped forward and taken control to keep Monty safe. I salute!

So, lets just make some starting steps to get going. Create a signature for Monty so that his information is available when you post.
1. Setting up your signature (light grey text under a post). Here's how:
click on your name in the upper right corner of this page
click on "signature" in the menu that drops down
type the following in the box that opens: kitty's name/age/date of diabetes diagnosis/insulin you're using and dosage amount /glucose meter you're using/what (s)he eats/any other meds or health issues (s)he has. You can add your name, and a geographic location (sometimes the time zone matters) Be sure to SAVE when you are finished.
2. Another thing that will help us help you now that you've started BG testing at home is to set up a spreadsheet like the one we use here. You will see how the trends and patterns emerge, and members can review his/her progress before offering suggestions or advice:
http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
http://www.felinediabetes.com/FDMB/threads/understanding-the-spreadsheet-grid.156606/

If you haven't already, read through the information in the Beginners Guide to Caninsulin (Vetsulin) at the top of this forum page.
There is also excellent beginner basic information about feline diabetes on the Home Page, the Getting Started and the Education sections on the right side of the page. Find out about what a hypoglycemic event is, and what to do if it happens. There is more information about that in the FAQs forum. Better safe than sorry.

I found the board to be an incredible resource of information and support while learning what to do, and not to do. I hope you will too.

 

We all have been where you are. We all felt the same guilt. It gets better. Feeding more often is fine as long as you don't feed two hours before pre-shot tests. I know there isn't a lot of info, but it looks like it could be a bounce. Two units is a bit high to start with a newly diagnosed kitty. Monty possibly went too low to fast and his body dumped glucose to protect itself. I think you are right in thinking it is best to go back down to one unit to start since you have switched to a lower carb food and try to get either some mid cycle tests or before bed test to see how he reacts to it. See how his numbers are for a few days and you may need to increase or decrease by .25 units based of the results.

 

Hello and welcome to FDMB.

First of all, you should not feel guilty and did NOT do this to Monty. While dry food is not recommended and is sometimes implicated in the diabetes diagnosis, dry food has been around for a long time and many cats are fed it their whole lives without developing diabetes. While it may be a factor in some instances due to the extremely high level of carbs in some brands, it is certainly not a direct or singular cause. Many of us have not picked up on the signs of diabetes immediately so don't beat yourself up. And no Monty has not been diabetic for the past 4 years. He would have lost so much weight you would have noticed long ago and probably become quite obviously ill. Focus on the future and the strides you have taken. You have done your homework and taken steps to give Monty the best care possible and that is to be commended.

Kudos for deciding to home test Monty. Home testing is the best tool we have to keep our furry friends safe and get them on the path to better health. Many vets don't advocate home testing because they don't want to overburden their human clients and feel they have to take the role of point person when dealing with diabetes. Many have few diabetic cats in their practice and don't tend to stay up to date with recommended treatment and practices.

Do you know what blood test was used to diagnose Monty? Was it a simple glucose test or was it a fructosamine test? A simple glucose test is NOT sufficient for a diagnosis to be made particularly because most cats get stressed out at the vets and that alone raises their blood glucose sometimes by 100 or even 200 points. Not only does that mean that a kitty could be mistakenly diagnosed with diabetes but also that the dose of insulin prescribed is all too often too much once kitty gets home and is relaxed in their home environment. A fructosamine test will measure a different component of the blood that provides an average of the glucose level for the previous 2 to 3 weeks (similar to the A1C for humans). This is necessary to confirm a diagnosis. If you did not get a copy of the lab work the vet did, ask for it.

You were quite right to withhold insulin the last two nights given the pre-shot test readings. I think the high pre-shot yesterday morning was likely from a bounce which is a normal physiological reaction caused by BG dropping lower than kitty is used to, dropping a lot or dropping particularly fast. Monty may have already been bouncing from the previous doses of insulin and with the reduction in dose yesterday morning his numbers dropped off nicely last night. I'm curious as to what his numbers look like today and would definitely keep the dose at a max of 1u for now provided Monty's BG readings are high enough to safely give insulin. 2u is double the usual starting dose for any cat.

While a rise from 76 to 247 would be an extremely large food bump from low carb food, that higher reading so soon after eating may have been a combination of food bump along with the start of the bounce. We recommend splitting the day's food between meal/shot times and a couple of snacks to keep BG more level through the day and night. Some of us feed 4 times per day (2 meals and 2 snacks) or even 6 times per day (2 meals and 4 snacks). If you are working, a timed feeder can be a godsend.

Keep the questions coming and we will help you keep Monty safe and on the right path.

I would suggest you repost your question about vet recommendations on the Health Forum with your general location in the title to get a wider audience and a better chance of a recommendation.

 

Thank you everyone for your kind and helpful words. Honestly, I'm already feeling A LOT better about everything. Monty has become a champ at the ear pricks and insulin shots (and I've gotten better at them too). Snacks during the day (1/4 can of fancy feast) is helping with the vomiting up bile, but he is still struggling overnights. His dinner is at 10:30 pm, and I keep waking up at 5am to the sound of him vomiting. We have two cats (and the other cat is a fatty), so IDK what I can do to help (short of waking myself up super early and giving him a snack at 5 am.) I've read about doing cat food popsicles, but I think it won't go over well with the other cat.

He was diagnosed using just the one blood test, and the vet wanted us to bring him in for a fructosamine test in 3 weeks. I definitely need to request his lab results.

We successfully did a curve yesterday. Any dosage recommendations? Or do we need more data still?

https://docs.google.com/spreadsheet...cH__0XHmPo4LQH9ekJTCTZnZ74/edit#gid=361360320

 

I am by no means an expert or seasoned, but I would want more data. Humilin N is NPH, I was using Novolin N which is the same. I definitely wouldn't want to move very fast with dose increases when you're getting semi-decent to really good ranges! But ECID. If he stops eating I would be alarmed.

There are nausea meds but if it's just because he's hungry, I'd recommend a middle of the night snack. You can get a BG quick test in, too. More data is more better.

Oh and if he is throwing up do keep an eye on his fluids!

I can't imagine a cat who would be happy without food all night!

And it's most definitely not your fault. Not at all.

Edit to add: sorry I had to cut myself off quickly to do a BG test. I'm glad you found FDMB because it's a great resource with wonderful people and information. Stay the course!

 

The 1u dose has taken Monty down a bit too low (53 on the 12th) but otherwise is getting him down to an ideal 107 on the 13th. He appears to have a nadir around +4 post shot and so those higher numbers (yellows) may be an issue with duration as Humulin often doesn't last the full 12 hours. I'd hold the course right now and gather a bit more data before making any dose changes. Whenever you can, get a mid cycle test in. If you are working but can grab a +1 or +2 post shot test before leaving for work or grab a later cycle test when you get home, it all helps form a picture. Also try to make it a habit to grab a test before bed every night. The more data you collect the easier it is to start seeing patterns and figuring out best dosing.