Vet says cat is most unregulated ever seen - Please help!!

Hi Everyone!

First time poster here. My cat Monty was diagnosed in January 2022 with diabetes after he rapidly lost weight and started becoming ravenous for food (3 years old on diagnosis). Once diagnosed, we started giving insulin (Lantus - 2 units) 2 times a day but we left him on his science diet sensitive skin and stomach food as he was extremely sick when we first got him (January 2020) (loose stool, bloody stool, etc) and this was the only food that stopped those issues. Fast forward 2 weeks later and he went into DKA and we had to bring him to the emergency vet on family day (stat holiday, regular vet was closed) and they said he was 3+ ketones and likely wouldn't make it through the night. The next morning I brought him to my regular vet (ready to put him down) as he couldn't walk straight or stand up very well - for my vet to tell me he was now at +1 ketones and he would probably pull through. This ordeal costed a total of 1800 dollars.

After this ordeal we switched his food to Big County Raw salmon and beef - which has 0 carbs to my understanding. He seemed to do well on this food digestively, with us giving 3 units of insulin when he was above 12 mmol (216 mg/dl) - however it was really random when he was actually getting the 3 units as sometimes he would be as low as 1.8 at the +12 hour mark and we had to give honey on gums - but other times under the same conditions he would continue to be at 25 mmol (450 mg/dl) as if the insulin didn't even work that time. At the time of switching we contacted the rescue that we got him from and the lady who owns it says that she has 3 diabetic cats and said in order to regulate him we needed to give 5 units of insulin morning and night (??) this was a huge dosage compared to what I saw online or what my vet told me so I kept him at 3 units when we was high enough to to give (maybe 1/3 of the time).

Fast forward to December 2022 and Monty is now lost a total of 6 pounds since being diagnosed (15.5 lbs down to 9.1 currently) and he his ravenous for food and very unregulated, and he went into DKA again the day before Christmas eve when all vets were about to be closed for 2 days. I bring him to my vet after being up all night syringe feeding him water and he stays the whole day there (another 900 dollars). Vet gives 2.5 units of insulin when he is at 28.5 mmol (513 mg/dl) and he says the insulin has zero effect (similar to what we experienced). 6 hours later he switches the insulin from Lantus over to Caninsulin and injects directly into his muscle and we see an immediate response down to 7 mmol (126.0 mg/dl). vet sends us home while saying he really should continue to stay hospitalized however they were closing and the emergency vet is 5700 dollars for 3 days of hospitalization (which we can't afford....who could??). I do an extreme tight regulation protocol as per my vets request for the next 3 days while we try to get rid of ketone buildup where I try to keep him between 9mmol (162 mg/dc) and 13 mmol (234 mg/dl) while syringe feeding him water. This was very very hard and we couldn't really do it (he was dropping too low and then bouncing right back up into the high 20's mmols ( >450 mg/dl). Despite this, we were able to pull him through this again somehow. Vet switches us to Caninsulin permanently and says that he is the type of cat that will always need intramuscular injections (which is terrible - he hates it and I have to wrap his head in a blanket while he hisses at me) and he wanted us to switch to the Purina DM wet food (which to my understanding has 6 grams of total carbs as opposed to the 0 carbs from the raw), because the vet was concerned about his low weight and wanted something with more fat content than the raw.

We made the food switch and went to IM injections with the Caninsulin and it seems to be working (I will provide glucose curve numbers once I figure out where to do that on this website) but in summary 2 units directly in the muscle will bring him down into normal range, however only for a few hours. The new food is now making his baseline glucose readings sit above 30 mmol (540 mg/dl) and oftentimes my meter will just say "Hi" which means he is above 34 mmol (612 mg/dl). So essentially every 12 hours he is extremely high, we give him 2 units at the 12 hour mark with food and he drops to normal range at +6 hours, but at +12 hours he is right back up to the high 30's (>590 mg/dl). I have sent my vet a glucose curve today to get his opinion but I am not feeling comfortable with how my vet has been handling this entire situation and want an opinion from others. Is his bouncing back and forth between 30mmol and 5 mmol every 6 hours terrible on his body? Should we switch back to raw food? Will we always have to do intramuscular injections?

I would appreciate any help as this is really affecting not only Monty but my own mental health as well having to deal with the financial impact of this (I'm only 26 and struggle to afford this), having to watch him be so uncomfortable all the time and thinking we would have to put him down twice now (I'm not sure I can handle that again).

Please help us in any way you can!!
eagles7373
New Member

Posts: 1
Joined: 22 Dec 2022, 9:14
Country: Canada

EDIT: Spreadsheet updated in Signature Box.

 

Waving from Ontario. Welcome to the best place you never thought you would ever be. There are years and years of experience (the people here have done the research and are willing to help) at your disposal.

I'll cover a few things.

DKA trumps everything.

• Ketones/Diabetic Ketoacidosis (DKA): Ketones, Diabetic Ketoacidosis (DKA), and Blood Ketone Meters

The formula for DKA = not enough insulin + not enough food + something else going on (usually infection or inflammation).

While your regular vet may have seen the need to switch to Caninsulin while treating DKA (Lantus dosage changes can take up to 5 days for the depot to fill), once DKA is out of the picture, Lantus will serve you better. Caninsulin is no longer recommended for cats. See

• (2018) AAHA Diabetes Management Guidelines for Dogs and Cats

This is what you are seeing now: Caninsulin does not last the full 12 hours in cats. You are seeing results during the first part of the cycle between caninsulin hits cats fast and hard. But it does not have the duration to last. Cats have a different metabolism than dogs.

Lantus is a depot insulin. It craves consistency so one needs to find a dose that can successfully be given every 12 hours.
This is why you were seeing with Lantus. The dose was too high and taking the cat too low (either low numbers or numbers lower than the cat's body is used to). The cat's body reacts and bounces. A bounce is

"Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles)."

I'll leave it to others to suggest dosing and feeding (I've never fed raw). And I'm supposed to be in bed.
@Wendy&Neko
@tiffmaxee
@Bron and Sheba (GA)
@Suzanne & Darcy

 

p.s. you can check for ketones at home. Ketostix are available at most pharmacies.

 

Hi and welcome to the forum.
We can definitely help you.
I have to go out for a few hours but will write when I come back.
Please make sure you are feeding lots of food. This means a good meal 1/2 hour before the insulin and several snacks during all the cycles.
I would also test daily for ketones seeing he is prone to them.
Be back a bit later

 

Waving at you from the coast of BC.

Zero carbs are not necessarily better than a few carbs. We consider anything under 10% carbs to be good. In fact, cats can do better with some carbs than none. I fed Neko raw too, the Red Dog, Blue Kat brand - and most of them were in the 3-5% carbs range.

When you describe your kitty getting to 1.8 on a dose then going really high, that tells me the dose was too high and kitty was bouncing. As described by Kel in post #2. The dose needed to be lowered, not raised. Don't listen to that person who has 3 diabetics, she is wrong, raising the dose was not the answer. And likely would have caused a hypo.

Neko also started on Caninsulin. It didn't last the full 12 hours, she was miserable after about 8-9 hours. Thankfully things got better, eventually, when we switched to Lantus. But I had to up my testing. That means testing before every shot to make sure it's safe to give insulin, and spot checks after that in the cycle (between shots), to see how low the dose is taking the kitty. Including the PM, since many cats go lower then. A before bed test is a good one. We decide how to change doses based on how low the dose is taking the cat. Thank goodness you tested before that 1.8!

 

Welcome Rachel and Monty , what a handsome boy
, there are a lot of experienced members here that will help
Please set up your signature I see you put all if this info about Monty when I go to your profile then I tapped on information
It need to be with your spreadsheet link is

I could give you the link for it but since you are going through a lot right now this will be easier for you

click on your name up top above where it says sesrch and then tap on the word signature and add this information

• Add info we need to help you:
  • Caregiver & kitty's name
  • DX: Date
  • Name of Insulin (do not include dose or frequency)
  • 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.

Do you see mine?

All of this needs to go in your signature that I see you have
Kitty Info:

• Name: Monty
• Age: 5

• Date of diagnosis: January 2022

• Name of the insulin used: Caninsulin (switched off of Lantus approx. 1 month ago)

• Type of Meter: GE Human Glucometer
• Testing Frequency: 12 hours - ion between of weekends for piece of mind

• Complications:
  • Polyuria or PU (urinating a lot)
  • Polydipsia or PD (drinking a lot)
  • Ketosis (manifests as spilling ketones in the urine)
  • Diabetic ketoacidosis or DKA (two times - February 2022 and December 2022)
  • Neuropathy (hind legs appear flat when walking sometimes)
  • Potential pancreatitis (potential tumor, no diagnostic testing done

• Has kitty ever taken corticosteroids?
  • No

• Food: What are you currently feeding kitty?
  • Purina DM Wet
  • Switched to Purina approx. 1 month ago from Big Country Raw Salmon and Beef
  • Other information:
    • Lethargic all the time - but in a good mood (always purring)

 

For the neuropathy
You can order this Methyl B-12 they ship to Canada , I have used it for years and a lot of other members use this Methyl B-12 , just open up the capsule mix it in with the wet food add some water, it's tasteless.

https://www.vitacost.com/vitacost-vitamin-b-12-methylcobalamin-5000-mcg-100-capsules-6
14.49 for 100 capsules
Give one a day

I saw that a member who lives in Ontario posted this
, no issues with customs, no duty to pay.


Once you start to get Month's BG regulated and starting the Methyl B-12 you should start seeing an improvement
Tyler had neuropathy and he's back to walking and jumping
Took about less than 2 months, but every couple of weeks I saw improvement
I'm pretty sure
Vitacost charges $9.99 US to ship to Canada.

@Rachel Eagles

 

Hello! Thank you! you're saying I can give him food all day long if he wants? My vet had said to only feed on the 12 hour marks as food in the middle of the day would cause additional spikes...I would absolutely love to feed him more as he's absolutely starving!!

 

Very interesting I have never heard of this!! thank you for the information - I will read up on this.

 

Ah thank you! In my signature now

 

Thanks for doing your signature I would put that he also had DKA in Feb 2022 also
Just tap on your name up too tap in signature and add it

 

Thank you so much for the reply! I also thought that recommendation of 5 units was way too high - glad I didn't listen. Yes I was just informed that caninsulin is not the recommended insulin for cats and that my vet likely did this just to get him out of DKA - and he should be switched back to something different now. I don;t mind more frequent testing so we can get this sorted out!!

 

Any tips on how to get him to let me go near him when he's mid-pee? This seems quite difficult to me - any advice is appreciated!

 

Thank you for your reply!! I appreciate the response RE: Caninsulin being too short acting - willing to switch him back off to something else for sure!!

 

Please don't forget to add he also had DKA in Feb 2022 it's important
@Rachel Eagles

 

Welcome. I couldn’t get to Max to test his urine either so I put plastic wrap over part of tge litter and tested that way.
Max had chronic pancreatitis and needed to eat about 3 smaller meals each cycle. Most of us have found it helps regulate tgem with mini meals.

 

Some.people slide a - dedicated - soup ladle underneath. Others put saran wrap on top of the litter.

There are some other tips here:

Tips for Catching Urine

 

He’s not on a high dose so I don’t understand your vet’s response. I’d go back to lantus asap.

 

Some Canadian vets, especially of a certain age, are more used to Caninsulin. Frankly, more people treat diabetic dogs than cats when they get that diagnosis. Caninsulin is great for dogs, so that's where their experience may be. I got the "we do Caninsulin at this clinic". Then I saw a locum vet who got us on Lantus.

 

Yes, please give him snacks during the cycle as well as the pre shot meal. A kitty that has had DKA needs one and a half times as many calories as he would normally get. So snacks throughout the cycles …..a snack is a teaspoon it two of normal low carb food. It won’t spike the BG. It is much more likely to help him stop dropping low and then bouncing up high again.

 

DKA is caused when there is not enough insulin, not enough food and an infection or inflammation in the body. So to treat DKA and to stop it reoccurring you need to address the reasons it happened. Testing daily for ketones is vital as that is the early warning system to tell you that something needs changing. Have you been testing for ketones?
Did Monty have an infection when diagnosed with DkA and did he get antibiotics?

As others have mentioned, Lantus is a much better insulin for cats. As long as he has not had any ketones in the urine lately, it would be safe to go back to Lantus. Lantus is is a depot insulin, it can take a few days for the dose to fully take effect, so it would be better to stay on an ‘in and out’ insulin such as Caninsulin ( even though I don’t like it) until ketones are no longer in the picture. Hopefully he hasn’t had any ketones lately.
INSULIN DEPOT

So if he had DKA again on 12 Dec he is still recovering from it. It is great that he sounds as if he is hungry! Many post DKA cats are nauseated and can’t eat.
This is what I would recommend you do.

• Make sure he is getting plenty to eat. Food is what helps keep ketones away. Feed one and a half times as many calories as he would normally eat.
• Don’t skip any doses of insulin. If you are unsure, stall, don’t feed and test again in 20 minutes to see if the BG is rising and post here and ask for help.
  
• Test daily for ketones and put the result into the remarks column of the spreadsheet
• Give extra fluids. If Monty will let you, add a teaspoon of warm water into every snack.
• Don’t feed for the 2 hours preshot so the pre shot BG is not food influenced.
• As Wendy suggested, you need to reduce the dose with that 1.8 reading.
• Post daily and ask questions.

 

added!

 

Thanks for the info - I just went out and bought ketone strips and will try and check tonight - I have put saran wrap down in the box as he runs away as soon as I come near him in the litter box. We have brought him into the vet a total of 3 times since he was diagnosed - 2 times being full blown dka and the third being a ketone build up but not full blown dka (October 2022). Each time he has elevated white blood cells (I think white? to be confirmed tomorrow) and has been given a 14 day antibiotic shot to clear out any infection. I will try to get a copy of his labs from the vet tomorrow to get those specific numbers inputted into the spreadsheet.

I gave him 2 units tonight of the caninsulin but did it SV rather than intramuscular.

Are we in a waiting game until I can get some ketone levels or would you recommend starting a new dosing scale with the Caninsulin for now until we can switch over to lantus? Same with the food - any thoughts on immediately switching back to raw food vs staying with the Purina DM food for now?

Thanks!!

 

Good. I would test daily if possible so we can see what’s happening with the ketones. There should be no ketones on a cats urine, so of any appear, it is an early warning that something is not right.
If ketones keep appearing when recovering from DKA the food needs increasing and the insulin dose needs increasing.

Since he has had DkA twice and ketones another time, once he is completely over the DKA it would be on idea to test each week for ketones and if he seems u well, is lethargic or off his food, check for ketones.

Wendy recommended you reduce the dose with that 1.8 BG, and I agree..
The next dose down from 2 units is 1.75U.
I would also not give the insulin IM. I would do subcutaneous.
Don’t forget to get at least one test in during every PM cycle if possible. Cats often drop lower at night.

I would recommend you get at least one ketone test done to establish he does not have ketones at the moment before swapping over to lantus.
And I would reduce the dose as mentioned above for the Caninsulin.

The main thing is that Monty eats well. He has lost a lot of weight so I would feed him as much a he wants. The number of carbs in the DM wet is fine…the only issue is it is more expensive than most other low carb foods available. Raw (which I feed all my cats) has no carbs but that is not necessary for diabetic cats. A few carbs is fine. Whatever you do I would do it slowly and make sure he gets the extra calories he needs at the moment.

 

You already got expert advice from folks here who know a ton about dka.

I just want to reinforce what was said about the food. Your vet seems way more familiar with dogs given caninsulin and the old fashioned advice to only feed x2 a day. Cats have higher metabolisms than dogs and need to eat more often. Diabetic cats also can’t process the nutrients in food well so they eat and are always hungry and will still lose weight. They also lose weight just by peeing since there’s sugar in their urine. All these are reasons to feed smaller meals throughout the day. And that’s also easier on their pancreas. Please feed him more and as much as he wants right now so he can start to put some weight back and to prevent dka again.