newly diagnosed, with neuropathy

Hello everyone. It is not with joy that I become a member, I must say. My name is Ana and Gaysha, my 10 years old cat, was diagnosed with diabetes last wednesday (24th February).

I had already been to the vet with her twice before, because I noticed she was drinking too much water. At first the vet thought it could be kidney stones. Took a powder supposedly to dissolve kidney stones. Nothing happened, she kept drinking bowls of water.

Three days later, as she would not get better, took her to the vet again. She did a blood workout, to check kidney and liver function. Everything was normal. We thought it could be stress, because my life has not been easy these last months. Changed home and city twice, became from unemployed for a year and a half, where I was at home most of the day, to working 5 days a week from 9am 'till 7 pm.

Gaysha started losing weight, gradually, but it became more visible this last month. She used to be a beautiful black cat, quite big and weighting around 6,5 to 7 kg. So went home with Gaysha with some vitamins. Nothing changed until 23rd february when i got home after work and she had blood in her urine.

Took her to the vet the day after. That's when another vet (in the same vet hospital) did a glucose analysis and she had around 350 (cannot recall the exact number). The blood in her urine was obviously due to a urinary infection she had caught. She weight less than 3kg :'( I was shocked...

We scheduled her first glucose curve for the next tuesday (which would have been yesterday) and prescribed an antibiotic for the infection. On Thursday night (the 25 th february), Gaysha was too weak due to acidosis. She hardly ate anything and could barely walk. She urinated in the bed because she was too weak to get up and go to the sand box. So I phoned the vet and we scheduled the first glucose curve for friday (26 th february).

Gaysha was really really weak. I left her at the vet hospital and came back at 8 pm. I couldn't stop crying when I saw her. She could hardly walk. I must admit I thought seriously about putting her down. She stayed at the hospital overnight and when I came back to visit her on saturday at noon, she looked much better. Her eyes were wide open, she was reacting to sounds and purring and walking around in the hospital. That really relieved my heart.

Cutting it short: she stayed in the hospital from friday until monday. She had 3 glucose curves, the first without insuline, the other two with insuline to decide on the dosage. She is receiving 0,02 mL of Caninsulide twice a day. The vet prescribed her diet: Hills m/d or Royal Canin for diabetics. Gaysha likes neither. At first I thought she just had lack of appetite. But yesterday I gave her just a tiny bit of normal food (whiskas gourmet chunks) and she ate it enthusiasticly. So that took my doubts away: she is hungry, she just doesn't like the food. I've been also trying to give her, besides the dry food, canned w/d from Hills, she smells it, shows some interest, licks it once or twice and then just goes away. So I have to force feeder since monday night, which is very violent on her and very frustrating to me. I called the vet yesterday night to discuss a change of diet. I had seen on Hill’s site that there were other options for diabetic cats. I told me the other options (aside from m/d or w/d) are too high in protein. That I should stick to force feeding her until she starts eating on her own.

When I called the vet yesterday, I also referred the fact that she was too weak, that she could hardly walk. I had read on the internet about this neuropathy, which I think is the case of Gaysha. She walks like if she was drunk and falls middle way, and then just stays there for a while (it looks like she is too tired to get up). But the vet never told me anything about neuropathy, which makes me think that maybe he never heard of it.

I am emotionally exhausted. What kind of life is this one? Am I helping Gaysha or just prolonging her agony? I have to force feed her every day so that I can give her the insulin, she barely walks… About neuropathy, I have read a lot of different opinions. Some people say methyl-B12 helps, others say it doesn’t… If it goes away when glucose levels are stabilized, how long will that take? Will Gaysha live like this for months? Is this a life I want for my kitty? I am terribly confused and sad and… so many other things that I cannot put in words… I left home for work today with my heart broken. I’ve been crying all day with all of this in my head. Today when I leave work I will go and talk to the vet again. When a cat has lost so much weight, wouldn’t it be wise to give her a high protein diet to recover muscle strength?

Also, please do not miss-interpret my, I am not cold and cruel. But I was unemployed for 1 year and a half. I just started working this month. Finances were still recovering. All these hospitalizations, glucose curves, prescription diets… my money is just blowing away… everyday I come home and thing of what else can I give up to have money to support Gaysha’s treatments. I have spent more than 300 euros at the hospital (this month) and 65 euros in prescription food that she just won’t eat… 365 euros is more than I pay for rent, is more than 1/3 of my monthly salary.

I live across the ocean, by the way. In Portugal. There are a lot of things in the states that do not apply over here.
I will appreciate any help you can give me. I feel lost and alone. Thanks everyone and sorry for the long text. Will do a bit more crying on my own now.

 

I am very sorry that you guys are having such a tough time; your vets should have tested for diabetes immediately and then you wouldn't have so many complications!

Is she on insulin yet? She needs insulin twice a day and needs food, whatever kind of food until she eats, then you can work on the carbohydrate content...

Jen

 

Yes she is on insulin (called caninsulin or vetsulin in some countries) twice a day. The vet said that if we are to change her diet into something more high carb, she will need a higher dose of insulin, which we all want to avoid.

 

but if she doesn't eat she will die before you get the chance to deal with a higher dose.

feed her whatever she will eat right now. build up some strength and then we can talk insulin dose and such.

right now eating comes first, and you can work the insulin around the numbers.

surely you can get a glucose meter there in Portugal right? if so, i encourage you to do so and start testing her at home so you can see if she's improving.

 

I asked the vet about that option: buying a glucose meter and testing her at home. He said that Gaysha would start running away from me if I did that, because she would think I was going to pin her again. This is why all this information is making me confused. We always have to think that there is always some finantial interest behind everything the vet says, which is stupid and imoral and should be banned Obviously he does not want me to test Gaysha at home, if I do that at the vet, it's something else they can charge me for, isn't it? I really don't know what to think...

 

you don't have to have anyone's permission to test your cat and i'd be willing to put out there that 9 out of 10 cats don't run from us wanting to test them. and the one only does it for a few days at the most until they learn that we are helping them.

my cat actually runs TO me for testing. she knows if she sits on the couch and sits still she will get a yummy fishy treat so she comes willingly

 

Lots of vets don't think that cats will let us test them; mine is a wonderful vet but not at all supportive of hometesting when Squeak was diagnosed.

All you need is a human glucometer, test strips, a lancet device and lancets (to poke the ear) and you can test at home just like human diabetics do.

And for now, feed her whatever she will eat, or yes, she will die of complications. Modify the diet once she's more balanced out (food and insulin).

Jen

 

Ana, we all use a meter to test our cats at home. We don't care what the vets think or say about it.....it is a lifesaver. As for the vet saying she will run away from you.....that's a joke. It does not hurt them......at all. We also use Ketostix or Keto-Diastix to test the urine for ketones when the cat doesn't act right, throws up......or even looks at us funny. Majority of us also feed Fancy Feast or Friskies.....any canned food is better that dry and W/D actually is Weight Reducing diet. She needs to eat so feed her whatever she wants as long as it is canned. Neuropathy....maybe, maybe not.....she may just be weak. Have you asked the vet what other insulins in Portugal are available? Levemir or Glargine(Lantus)? One of those would be much better for her than Caninsulin.

Please, go buy a meter....if in doubt, post back what meters are available in Portugal. I never shoot insulin without getting a test first to tell me what the blood glucose level is. http://laurieulrich.com/jasper is our main site for reading and learning about neuropathy.

With your own meter there is also no need to go to the vet for a curve. You can do that at home. Having ketones she needs to be monitored closely and she needs to eat and get the insulin. Please keep reading and posting so we know how she is doing.

 

If she has ketones (which may well be the cause of her impaired movements) what do I do?

 

ketones don't really affect movement but they make a cat feel really sick, and can be life threatening. They are a biproduct of fat burning and can escalate to something called diabetic ketoacidosis. If you test her urine with a ketostix from your pharmacy (bayer makes them here), you can quickly see if she has ketones or not. With her not eating she is at risk.

 

She is eating one m/d can a day because I am force feeding her. I always make sure she eats half a can before each insulin injection because I know the risks of hypoglycemia. What would be the benefits for changing from caninsulin to those other ones? (I am a naggy 'mom', I'm sorry... this is all very new to me)

 

Ketones........

http://www.gorbzilla.com/ketones_for_dummies.htm

The Hows and Whys of Ketones

from Kathy and Cashew (GA)


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Energy Supplies of the Body

Before we discuss Diabetic Ketoacidosis let's review how ketones are used in the body. There are two basic forms of fuel the body uses to keep the body running at its most basic cellular level. The primary form of energy used is glucose. Glucose is obtained from digested foods (carbohydrates). Protein can also be converted to glucose in a process called gluconeogensis. Fat when digested is broken down into fatty acids and glycerol. Glycerol can also be converted to glucose. Fatty acids can used by the body or be converted to ketones. In addition to digested food, the body has reserves of fuel in the liver called glycogen, which can be converted to glucose when needed. There are also small stores of glycogen in muscle tissue. When necessary protein can be stripped from muscle mass to convert to glucose in times of extreme need. Likewise fatty acids can be converted to ketones by breaking down fat stored in adipose tissue and converting it into ketones in the cells of the liver.

Ketones: Do they deserve their bad reputation? When do they become a problem?

It may seem like ketones have a bad reputation since we've seen so many problems occur with DKA but ketones are actually used by the body everyday to provide energy to some primary body organs like the heart and can be used as an alternate energy source when glucose is lacking. They also help reserve the glucose supply for those organs that prefer it like the brain. They can be found at normal basal levels in blood and urine. When we talk about losing weight and burning fat, we are actually talking about using ketones. Dieters and people stranded in the wilderness rely on ketones to survive.

Ketones only become problematic when they replace glucose as the primary energy source. It's the excessive use of ketones which can cause the body's PH to lower and turn the blood acidic creating metabolic disorders such as diabetic ketoacidosis. When ketones have reached the level where they can be detected using urine test strips – that is the danger sign.

Who directs the body and tells it when to use which fuel?

Hormones in the body work like air traffic controllers signaling positive and negative instructions regarding its energy needs and fuel supplies. Insulin for example inhibits the production of ketone bodies by inhibiting the breakdown of fat (ljpolysis) in adipose tissue while in the liver it inhibits the conversion of free fatty acids into ketones. Glucagon, a pancreatic hormone stimulates the release of natural insulin which in turn inhibits ketone formation however in diabetics when there is either none or little supply of insulin to be stimulated, glucagon actually stimulates fat breakdown (lipolysis) in adipose tissue and enhances the conversion of fatty acids into ketones in the liver (ketogenesis) and can cause DKA. Stress hormones (catecholamines) such as epinephrine, norepinephrine, ACTH in addition to glucagon also stimulate ketone formation.

Why does DKA occur?

Diabetic Ketoacidosis occurs when glucose cannot reach the cellular level. The body tries to compensate by increasing the level of glucose in the blood. It does this by breaking down the glycogen reserve into glucose (glycogenolysis) and by creating new glucose from protein and glycerol (gluconeogensesis). The body will use whatever protein is available either from ingested food or it will strip muscle mass from the body. In a predator such as a cat the body will only strip so much muscle mass from its body since historically it knows that in order to eat, a cat must be able to walk and hunt thus promoting use of ketone formation more readily. Insulin deficiency promotes the acceleration of ketone production by stimulating fat breakdown (lipolysis). The body will try to answer the demand for fuel by breaking down more fat to convert to ketones to substitute for the lack of glucose. This causes a high level of ketones in the blood (hyperketonemia) and excessive polyuria causing dehydration and electrolyte loss and acidosis in the blood.

In an analogy I once used in an fdmb post, if the body cells were hungry guests at a party and were anxiously awaiting the pizza man (insulin) to deliver the pizza's (glucose) the host (liver) might start serving chinese food too (ketones) to placate the guests. The longer it takes the pizza man to deliver the pizzas the more chinese food gets used.

DKA prevention
To prevent DKA, all diabetic kitties should routinely be monitored for ketones in the urine using Ketostix. This will provide an early warning system so that if detected, intervention can be started before ketones progress to diabetic ketoacidosis.

Anorexia and/or insulin deficiency can lead to a lack of glucose at the cellular level which can lead to DKA. To prevent DKA a kitty must have a sufficient incoming glucose supply and must be given insulin in order to allow the glucose to enter the body cells. Anorexia is a typical sign of illness in a kitty and needs to be taken seriously with diabetic kitties because they need the glucose (even if they are currently at a high bg) to replenish their glycogen supplies. You also want your kitty to eat so you can give your kitty insulin. If a kitty refuses to eat or eats little but has a high bg and you hometest you can give a reduced dosage of insulin to move some of that glucose into the body cells and discourage ketone formation. If you don't hometest, it's more difficult to monitor the effect of a reduced insulin dosage and you have to weigh the odds of hypo risk versus ketone risk. The basic cause of the anorexia needs to be discovered. Most times DKA occurs when infection is present. This usually causes the kitty to be anorexia and the infection itself can cause bg levels to rise because of the body's greater demand for energy to fight the infection. A visit to the vet whenever anorexia lasts longer than a day is always a wise idea as well as increasing the frequency of ketone testing whenever a kitty is ill.

DKA Treatment
When a kitty is diagnosed with DKA the typical treatment involves a slow rehydration which will help flush out ketones and restore the pH level of the blood and replace electrolytes, and begin moving the body back to using glucose as its primary fuel. Usually a kitty is given fluids, electrolytes, glucose and small frequent amounts of regular insulin to facilitate glucose delivery to body cells. Antibiotics are usually given also since most times the cause is an underlying infection. When a kitty is back to eating and drinking with negative ketones they are on the road to recovery

 

Don't apologize for all of your questions! We are here to help!

1/2 can twice a day isn't 'bad' although I'd imagine that normally she'd eat more.

Vetsulin has 2 strikes against it in my mind:

1. not as smooth and long lasting as other insulins, so it is not as good at creating and maintaining a gentler 'curve' or more stable bgs as it hits quicker and wears off faster than lantus/glargine or levemir/determere (not sure what else is available in portugal though).

2. vetsulin has had issues lately with consistency and has been recalled, so this may or may not be contributing to general difficulties...

 

If you are feeding the cat prescription cat food from the vet I would stop that and feed her any canned wet cat food you can get her to eat. Generally they are going to like store bought canned food better and there fore eat it more willingly.
It sounds like your vet is definitely more interested in getting a repeat customer than helping you learn to help yourself and your cat.
Most of us don't have deep pockets and so we learned to test the blood and if I can do it you can too.
I started by putting a towel on the kitchen cabinet and sitting the cat on it. I gave him lots of pets and pats and took his first blood test from the ear. I actually had to prick him 3 times and he did not seem to feel it. Once I got the sample he got more cuddling and a couple of his favorite snacks. It only took about 3 sessions for him to realize that each time this happened he got petting and a treat. Now he waits for me by the cabinet and trys to reach the place on the cabinet!
Make sure that after you take the blood sample that you gently press the place you poked for about 10 seconds or so. This will make sure you don't get bruising on the ear.
Please do a search online for videos showing people testing cats BG. VERY educational and it will help you know where to lance.

 

About the food. When you talk to your vet, tell her that Gaysha will not eat the food and you want to return it. She may try to talk you out of it, but just keep saying Gaysha won't eat it and you want a refund.

 

I have a semi feral cat that spends most of her time outdoors and does not like contact with people. However, she comes for testing and that is because I have made it a positive experience for her ie she gets a treat that she never gets under other circumstances! If I can test a feral cat,do not fear, you will be able to test yours! One other trick is to make sure the cat is warm and also the ear as that makes for easier blood flow. And, no, she does not run away from me, the person who does the testing, but from everyone else. You will get the hang of this, we all do but with much trepidations in the beginning.