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Dr Caroline
Dr Caroline, Veterinarian
Category: Cat
Satisfied Customers: 643
Experience:  20 yrs of cat dog practice, general practice, emergency, certified in veterinary acupuncture 2006
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Fluffy was not feeling well-diagnosed wih Diabetes-keep trying

Customer Question

Fluffy was not feeling well-diagnosed wih Diabetes-keep trying to get under control-started with one unit twice a day but when we found his kidney was being effected we changed the diet away from protein-then we had to up the dose of insulin now to 7 untils twice a day and still the diabetes is not controlled-off the charts before the shot and still in 400's before next shot-now the cat is vomiting so now we are thinking pancreatitis so now antibotics. I am wondering are we on the right track or are we missing something else to test. Fluffy was losing weight but is gaining back weight but diabetes is still not under control plus vomit every other day.
Submitted: 5 years ago.
Category: Cat
Expert:  Dr Caroline replied 5 years ago.

Hi,

 

I need more information to better assist you.

I am sorry for Fluffy.

 

When was he diagnosed with diabetes?

What diet is on on right now?

What tests are done to make sure his diabetes is under control?

When do you feed him?

When he started vomiting, was there any blood tests done?

Any urine test showing if eh had ketones or not in the urine?

What type of insulin is he on?

 

Let me know, I may have more questions for you.

 

 

Customer: replied 5 years ago.

Fluffy was diagnosed about a month ago. He takes vetsulin (porcine insulin zinc suspension) At first we gave him one shot at one unit. Changed his diet to more protein. took him in for blood test insulin curve. Needed more insulin so went to 2 untils twice a day-then waited a week. Blood tested again-Fluffy was losing weight and not feeling well so we tested his kidneys and found them in distress-changed diet to less protein and then he needed more insulin. He spent a week at the clinic and they got up to 7 units of insulin twice a day. 4 days ago he threw up-so took him back and the vet said he was doing great and gained some weight back and his kidneys were better. Took him home two days ago and he slept the whole time and was not better to me. Took him back today for another insulin curve test and it is still too high. Also the vet called and said Fluffy did not look well so he is testing for pancreatitis today. The food he eats when they changed is diet to help the kidneys was k/d prescription diet. That worked for awhile but then Fluffy wouldn't eat it so I changed it to dry food which he liked before he got sick so now he eats heartly k/d feline prescription diet. Now that the doctor sees that he vomited today he is now doing a blood test for preceatitis(spelling)!!

Hope this helps. I really feel that we are going on the wrong road since the diabetes has never been under control yet-we keep uping the dose and then waiting a week The vet told me until we reach 10 we cannot assume insulin resistance.

 

Expert:  Dr Caroline replied 5 years ago.

Hi,

 

I am sure you meant: "pancreatitis"

I am sending you a link about it:

http://www.veterinarypartner.com/Content.plx?P=A&S=0&C=0&A=577

 

 

I do not have all the blood test details that were done, and this will be a little challenging to give some advice. I can definitely make some general comments about diabetes.

 

I always like to know how the blood glucose curve are done. How long they are, and the interval between blood draws during that day. And yes, it is custom to wait a week between glucose curve. And will need to go until we have acceptable control, or we discover a resistance, which will then let us know we are not on the right track. Some cats can be regulated at home with how much they drink or urinate. When they decrease their urination, you know you are starting to be on the right track. (that is because diabetes is a disease where the drink and urinate a lot)

 

 

The fact Fluffy started to be sick, can tell me that a disease process may even be contributing to the high blood sugar. As long as you have a concurrent problem, it may be difficult to regulate his Diabetes. Some kitties are easy to regulate, other ones are not easy. here is a link to diabetes.

 

http://www.veterinarypartner.com/Content.plx?P=A&S=0&C=0&A=631

 

Lt me know if you need additional information.

if this is helpful to you, do not forget to push the accept button.

 

Dr Caroline, Veterinarian
Category: Cat
Satisfied Customers: 643
Experience: 20 yrs of cat dog practice, general practice, emergency, certified in veterinary acupuncture 2006
Dr Caroline and 4 other Cat Specialists are ready to help you
Customer: replied 5 years ago.
I pushed the accept button so you can be paid. If the diabetes cannot be controlled because there is an underlying disease-do we keep increasing the insulin? Also fluffy has had FIV since I got him over 10 years ago and has been fine-could this be something that is flaring up now? Is the food he is eating OK-If he does have pancretitis is there any threatment other than antibotics? Thanks for your help
Expert:  Dr Caroline replied 5 years ago.

Hi,

Oh no, I did not know your kitty was also FIV positive!

Depending of the specialist you ask, some will say FIV is a problem to regulate diabetes. I saw other specialist say it should have no bearing to control the diabetes. However FIV predispose cats to infections and if this happens, this for sure will make it hard to regulate.

 

The number one cause to not regulate diabetes is infection.

Pancreatitis will also make it difficult to regulate diabetes.

I also wonder what is the kidney problem caused by, what are his kidney values?

 

When you treat pancreatitis, you treat the symptoms, nothing can make the pancreas heal faster. So, you need to make sure you give fluid support, nutrition support, antiacid, antinausea medication, antibiotics if you have some infections, vitamin B injections or in the IV fluids.

 

Hope that helps.

Let me know if you need additional information.

(do not press the accept button a second time).

 

Customer: replied 5 years ago.
Hi, I just saw your second response. The blood tests came back today-should have gotten the results for you-can get them tomorrow. At first the Vet said there was no problem with the pancreas. Then he changed his mind with the new table of results he just learned how to read. He said it is slightly elevated-his kidney is not functioning 100% and his last reading for the insulin went to 200 for the first time which it has always been over 400. Also the vomiting has stopped for two days. So we decided to continue the antibiotics from yesterday because he always seems to get better when he gets low grade infections with the FIV. Also we are continuing the seven units of insulin twice a day and the diet for problem kidneys-k/m dry-he won't eat the wet food anymore. He also suggested pepcid pills-but think I will wait until the antiobitic is finished unless he starts to vomit again. I should get the actual test results so you can better see what condition he is in. Gathering what the vet said after testing him that there is nothing really new or significant with his results-a little kidney problem and maybe a slight imflammation of the pancreas but the good news so far is that his insulin level is better than ever. Seems like when we get the insulin lower he feels better and does not eat like crazy.
Expert:  Dr Caroline replied 5 years ago.

Hi,

good to know Fluffy appears better!

You can let me know tomorrow what the laboratory numbers are.

I would go with the pepcid if it is not too streddfulto give him. I t helps decrease the acidity of the stomach and may make them feel a little better.

Let me know.

Customer: replied 5 years ago.

Fluffy not feeling well this morning and not eating so I did get a liguid form of pepcid which I gave him this afternoon-tonight he was much better and even met me at the door when I came in-a good sign but he still has not eaten or if so very little-don;t know if that is because the insulin level is lower or wasn't feeling well. Will have the results tomorrow-he looked great tonight-drank some water but not enough food yet. He refuses now to eat the wet food-also no vomiting. More tomorrow-thank you so much if I need to hit the accept answer button let me know-this has been worth the monies.

Betty

Expert:  Dr Caroline replied 5 years ago.

Hi,

just saw your response.Happy to know the pepcid is helping.

Now, if kitty does not eat, you cannot give as much insulin as normal, or you will send him into an hypoglycemic crisis (low blood sugar).

When they do not eat, make sure you only give 1/2 the dose of insulin,and then you need to call your veterinarian to put them up to speed with what is going on.

One thing you may want to learn is to check his blood sugar at home.

Everybody has their trick, but I like to put vaseline on the edge of the tip of the ear, then prick the vein through the vaseline and get one drop of blood. Really easy.

He might need his sugar level taken.

I will be waiting for the blood test results.

How is his water intake? increase, like when he was normal, less

 

 

As we go on, if I see we do chat a lot, then I will ask kindly to push the accept button again. So, no worries I will let you know.

 

I wish you and Fluffy, Happy Holidays.

 

Customer: replied 5 years ago.
His water intake is like normal not like when his insulin is high. He ate a little this morning but not much but better than yesterday. I just talked with the vet and told him he was not eating and he did not say to lower the insulin-I will call him back. He is doing much better today but I do not think he is eating enough. I know when he stopped eating the wet food he really liked his usual dry food but prescription but now he seems to need another change or he is not eating because he is sick-hard to know with him. I asked the vet if there was anything else he could eat for a change-jusgt in case he has written off K/m when he was vomiting-he said senior lite cate food with less protein. I got the results today from a day ago-kidneys 72 bmu (was 70 then went to 62 and now 72) Creatins 2.7, pancreas 5.8 His insulin reading was before the shot in the morning High-off the charts-then given the shot around 10:00a.m. at 12:00 again High off the charts probably he said 400plus, then at 2:00-300 and 4:00 225 then I took him home. That was when he was not feeling well yesterday but very good last night and today physically and active for him- He is on his third day of antiobitics and I will given him the pepcid this afternoon. The vet will not be available this weekend. Thank you
Customer: replied 5 years ago.

Since I read your thought about 1/2 insulin if he does not eat-I called the vet. He reminded me he had given me an appetite pill so I just gave that to him. I asked him if over the weekend he does not eat do I still give him everything-ie antibiotics, pepcid and 14 units of insulin-he said very good question! He said if he doesn't eat tonight than cut the insulin to 3 units tonight instead of 7. I said he is feeling fine and acting good but I did not think he was eating enough today since he did not eat yesterday and he said it is normal to have ups and downs with kidney failure. So thank you so much for letting me know about cutting the dosage in half-I did not know that and he did not mention that so I was able to call him before he left for the day to see what he said-now I will go to see if I can find a new food low in protein to help stimulate him to eat as well. Drinks plenty of water. What did you think of the blood tests and insulin tests.

Betty

Expert:  Dr Caroline replied 5 years ago.

Hi Betty,

good job being able to talk to your veterinarian before he left. It is hard sometimes to catch us when we work big full days!

Ok, so Fluffy's blood sugar is going down to 225 mg/dl. We do have a response, good!

Drinking plenty good. just make sure you keep an eye on it.

I will be checking my e-mails this weekend and will be working on and off on this site, so let me know if you need help.

cheers.

 

 

Customer: replied 5 years ago.

Just after I talked with the vet and just as I was trying to get the appetite pill down his throat-he went to eat so I did not know what to do last night-I ended up giving him 5 units instead of 7 because the needle bent. This morning he is fine-ate and drank water so will give him the 7 units this morning because he drank lots of water-usually when his insulin is high-so today all is well-we are doing good. Thank you again. The vet is treating me a little different now thanks to you. Before he was being short with me but when I asked for the results he said I could call him anytime!! But I always like a second opinion with I am dealing with health issues. And you probably saved Fluffy's life because I did not know you have to cut the insulin in half when they do not eat. And I would not have know to ask that question. "On Monday will ask the vet how to test him at home- sounds like a good idea since sometimes he eats and other days not- Also forgot to tell you in the beginning when he did not eat or respond he was in the hospital 5 days and given an IV one day which seemed to jump start his kidneys-my feeling is if we can keep his insulin below the 400 plus everything else seems to be OK that is the tricky part. But today-so far so good. Do you think with his test results that he has pancreatitis and kidney failure? And is there any other medecine or food that should be given? Can his pancreatitis get better with antiobiotics?

Betty

Expert:  Dr Caroline replied 5 years ago.

Hi Betty,

 

Good news all around! Good job to be a great mom to Fluffy.

When you talk about his insulin being high, you mean his blood sugar. That is what you may be able to test at home.

 

I am not sure about the pancreatitis because the level you send me reads pancreas 5.8, and I am not sure what was measured. But, yes a lot of cats have pancreatitis and the only symptom can be not eating. Antibiotics are not treating the pancreatitis, they will help if you have an infection going on. Rarely a pancreatitis will be infected. With his diabetes and his FIV status, it is so important to do. A pancreatitis needs supportive care until the pancreas repairs itself. Continue the Pepcid for sure.

 

As for the kidneys, I do not have a urine analysis results to get a better idea of his kidneys. If this is what is going on, I would grade him a stage II, here is a link about kidney failure:

http://www.veterinarypartner.com/Content.plx?P=A&S=0&C=0&A=572

I have been following some kidney patients in grade III for over 2 years, and they are doing pretty good! As your veterinarian will follow him, they may have to do more supportive care to help his kidneys, check his blood pressure. Because he is FIV positive, I would ask your veterinarian about his kidney size, some kitties have unfortunately cancer in their kidneys (they are usually pretty big and usually can't miss it), or he may have a kidney infection (good to have him on antibiotics).

 

In resume, I really think your veterinarian is doing a great job. Make sure you let him know this. He is the one who has all the information and sees the big picture. I am mainly there to help you understand better what is going on, answer some questions, and send you some links that I think in my mind are helpful.

 

If you could push the accept button, that would be awesome.

I will be around all weekend if need be.

Let me know how are things going. Let me know if you have more information for me, and if you need more information.

 

 

 

 

Dr Caroline, Veterinarian
Category: Cat
Satisfied Customers: 643
Experience: 20 yrs of cat dog practice, general practice, emergency, certified in veterinary acupuncture 2006
Dr Caroline and 4 other Cat Specialists are ready to help you
Customer: replied 5 years ago.

That you for your advice-I clicked on the accept button. The problem with the Vet and his wife is that there attitude is that he is old. My attitude is that each moment of life counts for any creature and since I have a cat and dog that are dependent upon me for survival I will try to do my best and then let go when nature takes its course. This afternoon Fluffy is not doing well again-so don't know if that 7 units of insulin was too much, he is eating and drinking water so around 9:00p.m. will give him another round of insulin. He never has been below 200 so think it is OK but without testing this is really guessing so I am very interested in doing home testing so I can at least get the insulin dosage correct. Gave him the pepcid this afternoon and the appetite stimulant and antibiotic this morning with his insulin. Overall Fluffy is holding on but seems to get affected with the insulin shot. After finding out from you if he doesn't eat you drop the dosage in half really makes me think it is important to do home testing. What equipment do I need and exactly how do you do it?

 

(on a side note)-Fluffy is special-they had a program for ferrel cats-$45 they neuter and give all the shots but if they have leukemia or FIV they put them to sleep. After I found Fluffy on the streets I put him into this program-the vet called and said he had FIV but he was too cute to put to sleep. I was not allowed animals where I was so I asked what should I do-she said-pick him up by 5:00p.m. and he cannot be with other cats or go outside!! So Fluffy and I dodged the apartment manager for 4 years and I trained him not to meow but now he lives in a home and can make all the noise he wants(he is a talker) for the last 6 years-he was around 6 or 7 when I found him.

 

 

 

Expert:  Dr Caroline replied 5 years ago.

Hi, you basically wait to see if he eats properly or not.

If he eats OK, you do give him his 7 units.

If he does not eat, none.

If he does eat 1/2, give him between 3 and 7.

 

Happy holidays.

 

Let me know how things work out.

 

Customer: replied 5 years ago.

Thank you-just gave fluffy some food-he is eating-will see how much he eats and give him either half or full tonight-thanks-will start measuring what he eats daily to see what is normal or half for him-before just seeing the food lower in the bowl meant to me he was eating.

 

Expert:  Dr Caroline replied 5 years ago.
Awesome
Customer: replied 5 years ago.

Last night gave him 5 units since he had only eaten 1/2cup in the morning. He seemed to eat some more last night and lots of water so I gave him 6 units this morning. If he eats today will give him the 7 units if not back to 5 or less-tricky without testing.

Will have him tested tomorrow and see about home testing.

Thank you

Betty

Expert:  Dr Caroline replied 5 years ago.

All good!

Happy to hear!

Customer: replied 5 years ago.

Hi,

Took Fluffy to the vet this morning to get weighed and get a reading on the glusose levels. $167 dollars later I get the results-In the morning his sugar levels were off the charts-over 400-then he gave him 7 units and it went down to 60. I told him that was the problem I was having is what to give him at home. I asked him for a home kit to see the readings because I would not know if his levels went down to 60 and then I would give him another 7 units and kill the poor cat. He said, the level had gone back up to 120 by 4:00p.m. so he would recommend 5 units this evening. In the meantime Fluffy vomited twice this afternoon at the vets-he said it was the pancreatitis. So he did not eat. I told him he had not vomited in 5 days. He gave him a shot for vomiting and he vomited again. He advised that I give him the pepcid again and the appetite pill and then 5 units. He said he has not known of anyone able to give a reading at home, but he said he would look into it. His wife and assistant said bring the cat back in a few weeks to get another reading. Then when I brought Fluffy home his bladder let loose in his carrying case so when I got home I had to give him a bath!!! Fluffy is almost impossible to give a bath or give him the two pills he has to take per day.(antiobiotic and appetitte) His teeth are very sharp-I asked the vet for advice on how to give the pills since Fluffy has only me to care for him. He didn't know since he had difficulty with their staff of three! Forgot to tell you Fluffy is very smart and stubborn. After I got Fluffy cleaned up he ran to the food and ate quite a bit, drank a lot of water then there was a liquid I had to clean up near his bowl -drank too fast. My feeling he is that he is getting too stressed at the vets so plan on keeping him home but really feel I need to test his sugar level to know what to give him. The vet is now saying 5 units twice a day and only if he does not eat for two days lower it to 2 units. Fluffy did not loose any weight-10 and 1/2 lbs. He is alert , walks, talks and looking good otherwise. Thank you again for keeping me informed-it really helps and thanks to you, I learned about lowering the insulin levels if they do not eat. Great advice-Since Fluffy ate and has kept it down so far I will give him the 5 units this evening-not giving him the appetite pill and will wait until tomorrow to give him the pepcid and all the other pills. The vet was telling me that he had a young lady friend who had pancreatitis and went to UCSF and they inserted a tube that feeds her intestines and she has not eaten or drank any liquids for a year except fpr the tube, but her pancreas is now getting better! Learning more than I want to know. Overall Fluffy is doing good-just need advice on what amount of insulin to give Fluffy. Another question I had is if the antiobiotics help his system or the pancreas does better will he need less insulin and how would I know this if I cannot test him. Any advice you have would be greatly appreciated.

Betty

Expert:  Dr Caroline replied 5 years ago.

Hi Betty,

 

Ups and down! But still find you 2 are doing good.

Here is a link I found on the Cornell University Veterinary web site links.

 

http://www.sugarcats.net/sites/harry/bgtest.htm

 

The glucometer is bough at your local pharmacy.

 

When you test the blood sugar at home, it is not necessarily something you do everyday to know how much insulin to give. Some tips, you take it when Fluffy does not feel good, to make sure he is not too low, when you want to do a blood sugar curve to know how controlled is the diabetes (results to be interpreted by your veterinarian). It always needs to be interpreted with the time of feeding and when was the insulin given. Some clients may not do the glucose curve and base how the kitty is doing with the amount of water and urine he/she is taking. It looks like 5 units is reasonable. As long as the kitty eats, you are in good shape. Some rare pancreatitis may need a feeding tube. We used to make sure the food was by passing the pancreas, now we put some stomach or esophageal tube if needed. Some cats may also, revert to normal sugar control (yes, it may happen in some cases).

 

Let me know how things are, I will be around for the holidays.

 

 

Expert:  Dr Caroline replied 5 years ago.

This is a crash course on how to give a pill to a cat.

Let me know if this is helpful.

http://partnersah.vet.cornell.edu/pet/cats

 

Also, you can have the medication compounded in liquid with a taste the kitty like.

Ask your veterinarian. It may be helpful to you. It does costs a lot, but may save you some skin.

 

 

 

 

Customer: replied 5 years ago.

Thank you for all the information. I am giving Fluffy just the antiobiotic by pill form, and the pepcid by liguid form. I eliminated the appetite pill since he eats the same 1/2 cup per day. He drinks lots of water. I am giving him 5 units twice a day. He has not vomited since being home-still alert. I will weigh him myself. When I gave you the pancreatitis results -the Vet told me that 5.4 was the top of normal zone and he is at 5.8 so he has pancreatitis. I will take him to the Vet for a curve analysis or if he gets worse. Since I have spent over $1,000 in a short period of time for readings and he is still guessing on what dosage to give him I am going to try to minimize the Vet visits and try to minimize the stress for Fluffy. How long does pancreatitis last?

Thank you for your assistance.

Betty

Expert:  Dr Caroline replied 5 years ago.

Hi Betty,

pancreatitis can go very long (months), very short (days), or come back intermittently without you really knowing it. Pancreatitis can be life threatening, or just have vague symptoms as decreased appetite. Vague answer, but vague disease. The most important is to manage the symptoms. Fluffy is doing really well. So keep what you are doing, you understand the disease much better and so you are better armed to manage it with your veterinarian.

Customer: replied 5 years ago.

How often should I have his pancreas tested and also kidneys? Thank you again-Unless something changes will give you a few days break!!

Betty

Expert:  Dr Caroline replied 5 years ago.

Hi Betty,

his pancreas usually is not tested again unless you run into problems, or the vomiting, or other symptoms persists.

As for his kidneys, everybody is different, if he is stable, you may want to have him tested every 3 to 6 months, and I would keep an eye on his blood pressure. Your veterinarian may want to test before if he suspects something could get worse.

As for the glucose curve, you usually do it one week after changing his insulin. The most important thing is to keep the same dose, and only change if his appetite has a big change. If you change too often, you won't be able to regulate him.

 

Customer: replied 5 years ago.
Thank you for the new info. For one week fluffy has not vomited except yesterday some liquid-about a tablespoon worth-but not like all his food. He stays in one spot when he is not feeling well and moves around and goes to the TV room when he is more energetic-he is much better overall-not laying sideways and limp. He is awake and sitting up and walks around whenever he wants. He still eats about 1/2 cup food and lots of water-do not give him the appetite pill but still giving antiobotics, pepcid and insulin at 5 units twice a day. The vet called yestersday and said we could test him for his glucose level at the end of this week-he has never mentioned blood pressure at all. Will bring it up. Overall, my feeling is that he is steady and does not seem stressed or uncomfortable. He wants a lot of attention now so also a good sign-when he is low he does not want to be bothered. The vet thinks the liguid that he threw up was a result of his pancreatitis. Too bad- was hoping that would go away! Anyway so far so good. The information really helps and I read all the articles-also giving them to the vet to give out to other people to save them the time and trouble it takes to find some of the questions to ask and answers needed to be a good care provider. Thank you.
Expert:  Dr Caroline replied 5 years ago.
Looking good! Looking good!
Customer: replied 5 years ago.

Hi,

Fluffy has been doing good however we cannot get the insulin under control. We are at 6 units and it ranges very high-off the charts-700 and then goes down to 100 after the shots. We tried 7 and he went to 50 so too low. The vet said I could try another insulin but doesn't think it will work. The problem now is that fluffy is loosing weight. He is under 10 lbs now. Also he gets shakey-his legs sometimes quiver. Any suggestions

Expert:  Dr Caroline replied 5 years ago.

Hi Betty,

can you write me the details of the glucose curve, hours after insulin injections and BG (blood sugar?).

Good to stay at 6 U right now for sure.

Any fructosamine blood test?

Are you measuring the BG at home?

What time are you giving the insulin injection?

What is his meal pattern and how much?

Can you remind me which type of insulin he is on?

Any blood work lately? CBC, chemistry? urine analysis?

Any vomiting?

 

 

 

Glad to hear from you, let's see what we can do for Fluffy..

I will be out of town leaving about now, but will check my e-mails later tomorrow afternoon for sure.

Can't wait to hear from you.

 

 

Customer: replied 5 years ago.

No fluffy has not vomited so that is very good-I still give him the Pepcid with a chicken flavor so he does not foam at the mouth anymore. I give this everyday in the morning around 9:a.m. when I give him his shot-the second insulin shot is around 9:p.m. Will get the test results today because I have to take my dog in-he has a weird looking growth on his shoulder. Will get the curve results and all tests.No the vet said it is too difficult to test him at home-also asked about the blood pressure and he said not necessary and too difficult to treat if a problem-he is sort of lay back!! They keep telling me he is old. Well so am I and I do not want to be put to sleep for good!!

Will get the results-thanks for your help.

Betty

Expert:  Dr Caroline replied 5 years ago.

Hi Betty,

great to see no vomiting! Will wait for those results. I will be around on and off today and tomorrow.

I will be off for several days afterward, but should be back online Friday or Saturday.

Hope your dog does not have anything serious.

 

Customer: replied 5 years ago.

Lady, my dog, had a tick. It looked very strange. He is now wearing a tick collar. She was in a backyard that had been empty for awhile, while I was remodeling the house. He will wear the collar until I finish the project.

 

Here are Fluffys results on the last curve test:

1/22/09 9a.m shot

10:15 a.m. High-off the charts

12:15 351

2:15 157

4:25 104

 

1/23/09 8:50 am shot

9:15 a.m. High

Then I picked up fluffy

The vet said we could try another insulin but we would have to start over on the testing. The insulin he uses is Vetsulin from Intervet-Made in Germany. He gets 6 units twice a day. We tried 7 but at its low point the vet thought he went too low-think it was 50. Could try 6 1/2. He also feels that the food we have to give him for the kidneys does not help his insulin level. The food best for diabetes would help level the range but is bad for his kidneys. We decided to favor the kidneys since he felt that he has lost 70% capacity of his kidneys.

Really want to keep those insulin levels better so Fluffy will feel better-if possible.

Thank you for everything-you really help and Fluffy is really doing better today. HIs legs are less weak and shakey. I try to get him up and waking as much as possible if it is because of his laying around too much.

 

 

Expert:  Dr Caroline replied 5 years ago.

Hi,

can you tell me how is his urination volume and his water intake. Any difference compared to when he started his problem?

We will not have a total control of his sugar level the whole day. It is normal to have a high blood sugar level before the insulin injection in the morning. 700 is high, but it maybe the only thing we can do.

Good news is that he is responding to insulin.

And 6 U appears the amount he needs from the results you gave me. 7 way too much yes.

Sometimes, we check the quality of life and how much the water intake has been changed instead of looking at numbers.

Is Fluffy able to walk normally now, or still not normal for him?

What was his latest potassium level? Kidney failure can produce low blood potassium level.

Diabetes can cause some nerve disease (a polyneuropathy), and if it is the case, it will take a while to come back, and if Fluffy is getting better, looks like we are doing good.

 

Let me know.

 

 

Customer: replied 5 years ago.

He drinks a large amount of water which is the same and I have to change the cat litter frequently. He is eating OK. Sometimes he has trouble walking-like when you have been sitting for a long time-the more he walks the better he gets. He did have a shakey leg or like a nerve twitch but I have not seen that the last few days. I do not know his potassium level but I can check with the vet tomorrow. He does sit most of the day but he is alert. Hardly any exercise. Do not see any difference in the water intake still very high. Seems from the curve his insulin is high most of the day. Probably the only difference I see from the beginning is that he is not limp in his bed and is sitting up alert. No vomiting. The rest is the same to me-lots of water-sometimes he eats the cat litter near his box-which I tell him No when I see him. At first I thought it was because I had changed the cat litter to wheat and or corn-but now I am back to the granules without the clumping. I use to use clumping but now with all the liquid I am able to slow down the tracking of cat littler around the house.

Thank you, Betty

Customer: replied 5 years ago.

I quess the problem I see is his loosing weight.

Betty

Expert:  Dr Caroline replied 5 years ago.

Did we have the last total T4 results? That is the thyroid hormone level.

Any ketones in the urine?

 

 

Customer: replied 5 years ago.

on 9/18 his ketones were normal, 9/18 his T4 was 2.4 and 12/17 his potassium level was 4.8. Hope that helps.

Betty

Expert:  Dr Caroline replied 5 years ago.

Hi Betty,

great to hear from you!

 

The T4 is a little high for an old kitty, even if in the normal range. I would check it again.If over 1/2 of the normal, I would ask for a T4 ED.

Potassium is good, but it would be good to know what it is now.

Vitamin B12 can help some diabetes kitty that have polyneuropathy (walking low on hind legs). It may take 45 days to control the condition sometimes. How many days are we in?

Very important, those little ones tend to have urinary infections with no or very little symptoms. Would be good to have a urine culture done to be on the safe side.

 

As for weight loss, let's look at the categories:

1- Not good diabetes control

2- Other disease process going on

3- Not eating enough.

 

Diet is really important. a low carbohydrate diet like M/D canned (not the dry) is a good start. But high in protein.

I would like to know how his kidney values are right now. If near normal, discuss with your veterinarian, if it is better to tackle the DM because if the weight loss is from the diabetes, we won't won't have much Fluffy left soon! If M/D does not work, i can find out a list of low card diet on the market. Yes lot's of protein, but remember kidney first or diabetes? Or try to change insulin first. If high carb diet, wait for possibly high blood sugar numbers in between insulin injections.

 

As for insulin, Vetsulin will usually have its peak activity about 4 hours after injection. it is an intermediate type of insulin.

We are trying have 75% of the time the BG (blood glucose) between 80 and 300. Moderately to severe diabetic cat will not be able to stay 100% of the time in this range.

10% of kitties with diabetes can have some kidney inflammation due to their condition.

 

What is good is that Fluffy is responding to insulin! Good news!

How about another insulin? yes, you can try glargine insulin Sanofi, Adventis). It is a human insulin used for 24 hour control. In cats, twice daily is better. You need to start at the lowest dosage to avoid low blood sugar. Since this insulin is a long acting type, it might be all that is needed to control his diabetes. But diet maybe important. Also keep in mind that a small amount of cats, can get ride of diabetes. That is why i still think you should learn to get blood sugar reading at home. It is now very common to do it. When stressed, a cat's sugar will go up very, very high!

 

Let me know what you think.

 

Here are sites about testing your kitty, problem regulating kitties.

Make sure you copy the link, then add the = at the end of it. Let me know if you have problem getting into those links.

 

http://www.veterinarypartner.com/Content.plx?P=A&C=&A=605&SourceID=

 

http://www.veterinarypartner.com/Content.plx?P=A&C=&A=1605&SourceID=

 

http://www.veterinarypartner.com/Content.plx?P=A&C=&A=627&SourceID=

 

Customer: replied 5 years ago.

This is all very tricky-we first gave him food for the diabetes-protein,protein, but then his kidneys were bad so we switched to carbs-he will not eat wet food-we tried refuses to eat it. It eats the dry food for kidneys very well now. We chose kidneys over diabetes for food. We know the food does not help the diabetes and may swing the results more than normal. My gut instinct is that we are not controlling the diabetes very well and maybe the kidneys are affected. Yes I agree we should test Fluffy at home especially when it eats little that day. I can have another T4 test, Potassium and bladder infection tests next week.. I could add B12 to his diet. I never thought his diabetes was being controlled. He trives on attention by the way!!!

Are there any other tests we should do while I take him to the vet-that stresses him so I like to limit his visits. Also two weeks from now I have to put him with the vet for four days whiile I go to LA. so I could have them try a new insulin while I am gone since he will be at the vets 24/7 plus the testing we need. Also I think if he walks more it helps his stamina and legs-so I have him follow me as much as possible.

Expert:  Dr Caroline replied 5 years ago.

Hi,

I would test his kidneys and see where we are at. If we cannot change the food at all, we may have to go for a change in insulin and hope for the best.

Urine culture and MIC

T4

Maybe a f PLI to check for pancreatitis

Abdominal ultrasound

 

The B12 needs to be administered in injection. There is not good B12 absorption by the gut.

The other vitamin B can be found in good amount in kidney diets. Discuss with your veterinarian a kidney diet in can.

 

I would not change the insulin type while he is at the clinic unless they are a 24 hour clinic. If they are not at the clinic 24 hours, they may miss an hypoglycemic (low blood sugar) episode at night with devastating results.

 

Fluffy is thriving on attention? I think most of them do Smile I have 3 of my own...

 

Hope this helps. Let's get this kitty under control!

If you could accept this one, that would be appreciated.

Keep your questions coming, and keep me posted with his results.

Dr Caroline, Veterinarian
Category: Cat
Satisfied Customers: 643
Experience: 20 yrs of cat dog practice, general practice, emergency, certified in veterinary acupuncture 2006
Dr Caroline and 4 other Cat Specialists are ready to help you
Customer: replied 5 years ago.

I will have him tested while I am gone and leave the insulin alone until we get test results. For some reason Fluffy will not eat wet food, not even treats now. He stays in his bed all day or may come in at night to watch tv while laying down. Still giving him the fish flavor pepcid which seems to help since he has not been sick. If his weight loss stops then we are probably at the best we can be for his age. Still feeding the four ferrel kittens outside-now named-Molly,Polly,Dolly and Holly-found at Xmas. Someone asked me what if they are not female-I said it won't matter soon they will all be fixed. They started a free neuter program for ferrel cats but there is a 3 month waiting time-Every morning they are at the door and I fixed a rain proof plastic shelter in the back-only problem now is what do I do with my rather large dog!! It feels like animal farm now. So hopefully I can get Fluffy normalized-at least he feels Ok ,walks and talks.

Will keep you posted. If you think I should have these tests right away before I go let me know.

Betty

Expert:  Dr Caroline replied 5 years ago.

Big family now!

Make sure they are tested for FeLV and FIV!

Good to find a free kitty spay/neuter program.

As for fluffy, the faster we can get the tests going, the faster we may be able to stop his weight loss.

Good luck, I'll wait to hear from you.

Customer: replied 5 years ago.

Just had Fluffy tested while I was in LA-8:45- 250,9:45- 250, 11:00-114 4:00p.m. -370

the only problem with this curve is that I told them I was giving fluffy 6 and 1/4 units of insulin and he gave them 5 for a week before he did the curve. I told him of his mistake and he said keep fluffy at 5 units that these numbers are OK -do not know if I agree.

Fluffy lost a few more ounces. The other test results are: Ma 144,K,3.8,Ci 123, Tco2 19, Bun 86 (kidneys) ph 7.35

 

What do you think?

Betty

Expert:  Dr Caroline replied 5 years ago.

Hi Betty,

 

I was thinking about you today!

 

Can you remind me which type of Insulin you are giving him?

Customer: replied 5 years ago.
Vetsulin
Expert:  Dr Caroline replied 5 years ago.

Hi Betty,

the curve looks like the insulin is acting very quickly, and the nadir (lowest blood sugar values) is usually around 4 hours with this type of insulin. That time would have been around 1 PM. I wonder what the values would have come up , the only one we have is at about 2 hours into it. 114 mg/dl is OK. You do not want this to be less then 80 mg/dl. But we do not have that value, we do not know how low it gets. If Fluffy ate VERY well during the hospitalization, the insulin amount should not be changed. the value of 4 PM is already high. That is because the vetsulin does not act for long. But it may indicate the diabetes may be under 300 mg/dl about 14 hours a day, which is not too bad! I would not increase the insulin amount, you would risk an hypoglycemic crisis. But make sure with the hospital he did eat properly. If not, the value of the glucose curve is not great. I am not sure the weight loss at this point is due to the diabetes, it could be due to the kidneys, or other problem. I am missing the Creatinine value to fully evaluate his kidney function.

If we want a better control of his diabetes, you may think of getting the Glargine insulin, it is longer acting.

 

Let me know if you have any questions, or need additional information.

Nice to hear from you!

Customer: replied 5 years ago.
Yes he ate well at the Vet even the wet food but now he won't eat it here so not eating as well here. I was giving him 6 and 1/4/ units before. What should the range be for the insuling? Were the other test results OK-I do not know how to read them thanks.
Expert:  Dr Caroline replied 5 years ago.

Bun is high, buy it does not mean much to me without the Creatinine blood level. The rest looks OK, not sure how the PH is read, so I won't really pay much attention to it.

I am sending the link to kidney failure and the grades according to the creatinine:

 

http://www.veterinarypartner.com/Content.plx?P=A&S=0&C=0&A=572

 

If he ate very well a the hospital, I would not give more then 5 U. I think you may run the risks of getting him into a low blood sugar level if you go higher. what is his weight these days?

 

Let me know.

I need to go out for the evening, but will be around all day tomorrow!

Customer: replied 5 years ago.

What in Bun? Will get the weight on Monday but a few ounzes below 10 pounds I will get the creatinine measurement.

Thanks-more later

Expert:  Dr Caroline replied 5 years ago.

Hi the BUN is the following level you reported:

"Bun 86 (kidneys)" it can mean: dehydration, small intestine bleeding, or kidney failure. It is always important to have the creatinine to get a better view of the kidney.

The following link on lab work will get more in details about what BUN means:

http://www.vetmed.wsu.edu/ClientED/lab.aspx

I'll be checking my e-mails all week.

 

 

 

Customer: replied 5 years ago.

Fluffy's weight was 9.15 oz on 2/17/09, then it was 9.1 on 3/2/09 and at the end of the week while I was in LA was 9. 8 oz. He was eating the wet food which he will not touch now. They have not done another creatian level since 12/17/09 whe it was 2.7-Should I have them do another test on the kidneys. My main concern is his loss of weight. They suggested feline greenies for treats and a water fountain to stimulate drinking water-he drinks a lot now but interested in your suggestions for his weight. He seems to be OK with 5 units instead of 6 and 1/2 units that I was giving before of the insulin

Betty

Expert:  Dr Caroline replied 5 years ago.

 

Hi Betty,

not forgetting about you, I am leaving for the morning, and need to rush out.

talk to you later this afternoon.

 

Expert:  Dr Caroline replied 5 years ago.

Hi Betty,

 

The weight loss is worrisome; however, I am not sure if the 9 pounds 1 ounce was supposed to be 9 pounds 10 ounces. I would think we would be in a better spot by now. The BUN was pretty high, and having the Creatinine gives you a better idea of what the kidney might be doing. If he is affected by his kidney, there might be no weight increase coming up. I would actually run a full CBC and full basic chemistry to give me a better picture of how Fluffy is doing.

 

An abdominal ultrasound, a pancreas specific test might be considered as well as urine culture to make sure no kidney infection is present might be considered.

 

As for his FIV status, usually cats that tests positive for FIV may live 7 to 10 years. However, I am not sure how the diagnostic was made. When the screening test (an ELISA) comes back positive, we now send the blood for an FIV Western Blot test to confirm. You might want to check into it. If not, you may want to retest Fluffy for FIV. If positive, he may be in a spot where it does affect him. If so, some interferon might be helpful.

 

Some cats may stop being diabetic as time goes on.

 

You may want to consider changing the insulin for Glargine which is longer acting.

 

If he is still loosing weight, you may also consider a referral to an internal medicine specialist. They may be able to guide you to a better plan of attack for his case.

 

Keep me posted.

 

 

Customer: replied 5 years ago.

No, the weight was 9 pounds 1 oz. His weight increased in the hospital probably because of the wet food. He was tested for FIV when I rescued him over 10 years ago. He has never been tested since. I think I will get him some antibiotics which helps his infections with his eye and his overall health. Periodically, this helps him with the infections he gets because his immune system is down. I will check into changing his insulin. The vet charges so much money for testing-the last bill over $250 for the few tests I did. I could go to UC Davis, which is driving distance, to get a better diagnosis.

Otherwise he is in good spirits-also I could get him weighed periodically which is free. Also he hads no been sick so the vet thinks he is overf the pancreatitis.

Thank you for everything.

Betty

Expert:  Dr Caroline replied 5 years ago.

Hi, yes, these FIV guys, you need to be on top of any infections they have. Looks like you have been on top of it all this time!

The increase in weight at the clinic appears to me the insulin is working out well for him!

I wonder if this is only a waiting game right now. If his kidneys are not working well, this may contribute to all the weight loss we saw, and it takes a while for a diabetic to get the condition controlled.

Going to UC Davis might be a good idea, just to make sure there is nothing else Fluffy is affected with.

Customer: replied 5 years ago.
Thank you-will check with the vet to change the insulin-my feeling all along has been that we need to control the diabetes to help the kidneys,will get the antiobiotics, and monitor his weight-yes it is a slow process to maintain what we have left-he is not suffering and he is vey old with many conditions-so this may be where we rest our case! If anything changes I will let you know. Betty
Expert:  Dr Caroline replied 5 years ago.
Awesome, keep me posted!
Customer: replied 5 years ago.

Hi,

Fluffy was weighed a few days ago and it has remained the same 9lbs 10 oz. He eats and we have kept the insulin a 5. But since he sits all day, his back legs are very weak and he can barely walk. He doesn't seem to be in pain.The vet gave him Glacusamine(spelling) but I really think his muscle mass is shrinking. So, I have exercised him a little each day and have him walk as much as possible. But is there anything else I can do? He needs to be able to walk to be functional. We haven't changed the insulin because he feels too much testing is needed.

Expert:  Dr Caroline replied 5 years ago.

Hi Betty!

nice to hear from you.

The good news is that the weight has stabilized.

I need to step out for the afternoon, so will answer you more in details later today.

Cheers,

Caroline

Customer: replied 5 years ago.
OK
Expert:  Dr Caroline replied 5 years ago.

Hi,

good job on the weight control now. That may mean we have a good handle of the diabetes. Be careful, we do see some diabetic cat become normal again.

 

As for the hind leg weakness:

1) Decrease potassium level? Blood work would show low or normal low potassium, then I would supplement. If his BUN and creatinine is high from his kidney insufficiency, you may consider Vetoquinol product called Azodyl. The capsule can be open and contain beneficial bacterias that will lower the BUN.

2) Polyneuropathy? That would mean the diabetes is not under control. Nerves not conducting right. You will usually notice the kitty walking with his ankles down to the ground.

3) From arthritis?

-Glucosamine is what you were trying to write. Some maybe help or not in mild cases.

consider:

-Adequan injections (careful depending of how the kidney function is). Some diabetic cats will need more insulin, or some it does not change anything.

-SAME: check with your primary care veterinarian.

-Fish oil: check with your primary care veterinarian about a good source, and start slow.

-If really painful, and cannot get much antiinflammatory due to poor kidney function may try Gabapentin

-Massage, physical therapy, acupuncture

 

Let me know if you need further information or have more questions.

If this is helpful, do not forget to select the ACCEPT button, thank you.

Hope the rest of the animal family is doing well!

 

 

 

Dr Caroline, Veterinarian
Category: Cat
Satisfied Customers: 643
Experience: 20 yrs of cat dog practice, general practice, emergency, certified in veterinary acupuncture 2006
Dr Caroline and 4 other Cat Specialists are ready to help you
Customer: replied 5 years ago.

The rest of the animal family,-Lady my dog is doing great except for the ticks-had to put another collar and had another one removed. The feral cats-fixed 5 out of 9 with all the shots. Two of the fixed (Dolly)(Jesse)come for breakfast each morning. The other three, (Tommy, Jack & Jill) that were fixed ,disappeared after being released. One kitten was probably taken care of by the coyotes,(Polly) the other 3 (Holly,Molly, James)still need to be fixed-they come for breakfast every morning-

Fluffy is in trouble-just sits all day and night-his legs and back do not seem to be in any pain-he would let me know. So I think it is the-polyneuropathy-as we know the insulin curve has shown that his levels are high most of the time because the insulin does not last long. We had to stop the Glucosamine because he was sick two days-now seems OK. His back legs are lower to the ground and the feet seem to turn out. I try to walk him as much as possible-he does not complain. But his muscle mass is too low. Guess I should get another curve analysis and see what we have. So far he is able to make it to his food and litter box but probably not for long. Besides the curve analysis, anything else I should test for besides Potassium. Thank you-Fluffy is very alert.

Expert:  Dr Caroline replied 5 years ago.

Hi Betty, thank you for the kind words.

Yes, glucosamine can give digestive problems to some cats.

 

Let me know how the curve looks like and what his potassium levels are. Some polyneuropathy cats will get back to normal when the Diabetes is better under control. His kidney insufficiency can give low potassium levels too. Other condition can give this, but would be unlikely (myasthenia gravis, toxoplasmosis).

 

Bummer about the feral cats that disappeared. At least they were fixed, good job!

 

Cheers,

Caroline

 

Keep me posted.

Customer: replied 5 years ago.

Thank you-the Vet is not happy when I bring him in but will do anyway. He has infected tooth and he said Oh, well. Anyway will pursue the path of health and happiness!!

Will let you know the results.

Expert:  Dr Caroline replied 5 years ago.

:-)

 

Good luck!

Will be out for the weekend.

Caroline

 

Customer: replied 5 years ago.
Actually since I wrote you, Fluffy has become much better-do not know what happened but he now greets me at the door like he used to do-walking more on his own. Stopped the glucosamine. Everything else the same so I decided not to get the curve done while he is doing much better for some odd reason. Will be in touch when he starts to go downhill again. Thank you, Betty
Expert:  Dr Caroline replied 5 years ago.

Hi Betty,

he must have heard you talking about more veterinary visits, and said "better be feeling good soon!".

Caroline

 

Customer: replied 5 years ago.
Spoke too soon-he trew-up this morning and not hairballs-immediatelty gave him his pepsin dose-we will see probably, an up and down situation. Thanks,Betty
Customer: replied 5 years ago.

I had Fluffy groomed yesterday and the lady thought I should have one of his ears checked. The vet said the ear was not infected but Fluffy has lost a pound-now down to 8 lbs + so he suggested another curve on Monday. What other tests should I ask him to do-because the curve tests rarely show much except it is high most of the time sincce he can only do the curve during office hours. Fluffy looks good and is in high spirits. Thanks for your help.

Betty

Expert:  Dr Caroline replied 5 years ago.

Hi Betty,

sorry I have been busier then usual these last few days.

If Fluffy still has his weak hind legs, I would check his potassium levels, kidney values level (BUN, Creatinine, calcium, phosphorus).

Do a urine analysis and culture.

A fructosamine level may tell you a little bit more how good his diabetes is regulated.

If that result is really high, I would discuss to try the long acting insulin with your primary care veterinarian.

Let me know what are the glucose curve results.

 

How much does he eat?

Do you think he has a good appetite?

What does he eat right now?

 

Let me know.

 

Cheers!

 

Customer: replied 5 years ago.
He is eating Ok maybe a little less but hard to know-He eats K/D prescription diet. I will measure it for a week to see exactly how much he eats. Tomorrow he will go to the vet to get the curve done and these other tests. When I had him groomed the other day the lady thought he might have an ear infection-so now fluffy is taking drops in his ears-less dizzy when he walks but his hind legs are still week. Mostly concerned about the weight. Will let you know the test results. By the way, I as accepted by our local magazine to write articles on dogs and cats-they also want to include the articles in three other magazines in town. People here in Stockton are so cruel to the animals so I felt it they were educated maybe some would change their ways. Just placed a beautiful chocolate point Siamese with a lovely home-thank goodness since they have put over 7,000 dogs and cats to sleep last year alone. Also trapped my 6th cat to be fixed-still feeding 5, 2 left to trap and all is well. Lady, my dog, is so happy the Siamese is gone.
Expert:  Dr Caroline replied 5 years ago.

Hi Betty,

hope all the testing will go well today.

Keep an eye on how much FLuffy eats, we may have to supplement if he is not eating enough with some home made food, or look at other kidney diets. If he does not eat enough, he'll just disappear even if the diabetes is well under control.

So, keep me posted!

 

Good job on the newspaper articles! Public education is always a good thing!

 

Tell Lady also that you are doing the kitty rescue for a good cause, she might understand Smile

 

Cheers,

Caroline

Customer: replied 5 years ago.
Just found 5 kittens in my backyard this morning-think the 6th one I rescued is the mother that was why they were crying-they are now at the vets to see how old they are-a couple of eye infections etc. At least I can get them tamed but there are so few people who want kittens here so may have to transport them to San Francisco Shelter for adoption. Never a dull moment-fluffy is going in now for the curve analysis until 5:00p.m when he closes-can't keep thim overnight since they could not give him his shot after 5:00p.m.-It is due around 11:p.m. So we will see with little info. Take care
Customer: replied 5 years ago.

The Vet called me to say that Fluffy was not doing well-very depressed, not eating, dehydrated and anorexia plus the glucose level was over 600-even higher than before. He still weighed 8 lbs 10 oz.So he said he wanted to put him on IV for a few days to get the acid level balanced. He also said he did not know if he was going to increase the insulin from 5 units or not. He didn't seem too interested in doing any more tests-he basically felt he knew the kidneys were failing-I asked again so he said he would do the extra testing-can't wait for this bill!! Will keep you posted. Fluffy did not seem depressed here but he seemed more weak - he ate out of my hand last night-maybe difficult to walk when he was so weak-but he was trying to meet me at the door when I came in-so I really feel we need to get the insuling level and see why it shot up like that.

Anything else to do, please let me know.Thank you.

Betty

Expert:  Dr Caroline replied 5 years ago.

Hi Betty, sorry to hear about Fluffy.

If he talked about getting the acid down he may be talking about a DKA (Diabetic Ketoacidosis).

I would discuss again about the longer acting insulin.

http://www.veterinarypartner.com/Content.plx?P=A&C=&A=1605&SourceID=

Make sure you copy the link and add the sign = at the end.

 

Keep me posted!

 

Caroline

Customer: replied 5 years ago.

The vet has called again to say he wanted to test for Pancreatis because he wants to find out why the very high spike. He gave Flluffy an appetite stimulant and he ate-he is on IV now, his potassium was low so he put that into his IV-he suspects Pancreatis. He gave him another shot at 5 before he goes home-not ideal he said to not have a shot before 8:30 in morning-I offered to take him home to give him the late night shot but he feels it is better to leave him on the IV on a slow drip. That is all I know for now.

Betty

Expert:  Dr Caroline replied 5 years ago.

Hope things turn out good!

 

Low potassium will make them walk low on the hind leg.

 

Keep me posted with the test results and his progress.

Customer: replied 5 years ago.
Emergency-Fluffy does not have Pancreatitis, but his insuling level has not gone below 600 even with an increase of insulin to 6 units. The vet says he cannot live long with this so he is switching insulin to Lantos. He is still eating OK. Help
Customer: replied 5 years ago.
His fructosamine level is off the charts also
Expert:  Dr Caroline replied 5 years ago.

Hi Betty,

sorry to hear we do not have a good handle on the diabetes.

How bad is the fructosamine? I would need an exact number. They are always high in diabetic, but the exact number would be a better information.

 

You are probably speaking about Lanthus, which is Glargine, which is very good insulin to use in cats.

 

Keep me posted.

 

Is there any ketones in the urine?

 

Customer: replied 5 years ago.

Will get the exact number and also if there is ketones in the urine. From my understanding from the Vet he feels that Fluffy was making antibodies to the former insulin. Yesterday, when I gave him the Lanthus at 2:00p.m. he said he was going to give him a dose at 9:00p.m. I said if he is over 600 and can die why wait-so he tested him again and found he was still off the charts so he gave him 2 units at 2:00p.m.-then at 9:00p.m. another 2 units-he is still off the charts (450+)this morning and gave him another 2 units. He said he is eating very well and looks better-still has the IV. He is going to keep him so he can monitor him-he is afraid to overdose him since this is a slower acting insulin.

The fructosamine level was 641. There were not able to get an urine sample because he didn't have any due to dehydration. I always felt his insulin level was only normal a few hours a day when he did the curves and the rest of the time very high. 2-400. So hopefully this insulin kicks in and is better. Fluffy always does better when his insulin is low. What if this insulin does not work-then what or can there be any other cause of his outrageous spike? Thank you-On the good news, placed 2 of the 5 kittens, still 2 feral cats to trap(one pregnant) and 3 kittens to place. Very busy day yesterday!!

Expert:  Dr Caroline replied 5 years ago.

Hi Betty,

yeah better to go slow with this insulin. 450 we're getting there.

Fructosamine yeah way too high, good diabetic control maybe around 400.

If does not go down:

Diabetic ketoacidosis (ketones in urine),

Insulin resistance

May need to change diet to low carb and forget about the low protein diet (may be more important)

Chase another problem: infection, tumor. That FIV status does not help.

Customer: replied 5 years ago.

The insulin level is not 450-that is only how high his test equipment goes-he is as of today over 450 but since the vet says its only the second day he wants to wait until third day-he also gave him an antiobotic-he probably has insulin resistance or diabetic ketoacidosis-he said he was very acidic. He is giving 4 units. Then what? I asked him to call UC Davis for advice but he wanted to wait until tomorrow. He says he is eating ok -he wants me to take him home tomorrow-I do not feel comfortable if his insulin level is over 450-what should I suggest if he has insulin resistance or diabetic ketoacidosis? Thanks

Betty

Expert:  Dr Caroline replied 5 years ago.

Hi Betty,

I do not have enough information to tell you what is going on.

I need to know if there are ketones in the urine

I need to know when was the blood glucose (not the insluin ) level taken in relation with the insulin injection.

I do not know how the pancreatitis was excluded from the diagnostic.

The antibiotics are a good idea.

I like to put my kitties on a drip of regular insulin in a 24 hour facility to make their blood sugar level go down and then start them on their everyday insulin.

 

Hang in there.

 

 

 

Customer: replied 5 years ago.

Hi,

The vet tested him for pancreatitis and it was negative-thats all he told me. Unfortunately, he is not a 24 hour facility and he did not recommend this or I would have taken him immediately to such a facility-that was a good idea. I will see when he calls if he can test the urine now since they say he is eating like a horse and feeling better. Do not have the insuling reading yet-will know when he calls. Thanks for the info-it helps since the vet does not say much. He is being given 4 units.

Customer: replied 5 years ago.

The vet called-no ketones in the urine. Also he is up to 9 lbs 4 oz without IV. He did give him more protein food. He will test his blood glucose level later today when the insulin level should be at it lowest. He was acidictosis when he came him but the IV took care of that. He will also test his kidneys this afternoon. The really good news is that he is going to take him home for the weekend to be able to monitor him!!!!! Will see the results this afternoon on the kidneys and glucose levels. He still feels he needs a week at this 4 unit level before increasing-likes to go slow. Thanks

Betty

Customer: replied 5 years ago.

Well, good news and bad-his glucose level came a little below 450 so it looks like it is going down slowly-he will keep him on a IV this weekend, but his kidney went from 100-120 to 130 so worse-could be because of being over 600 for quite a few days or the new diet-will see more tomorrow when I get Fluffy back.

Betty

Expert:  Dr Caroline replied 5 years ago.

Hang in there Betty,

keep me posted!

Caroline

Customer: replied 5 years ago.

Fluffy is coming home tomorrow-IV brought his kidney reading to 60 from 130 but may not last-his glusose reading is 250 so he may up his dosage in another day or two. Now Fluffy was not eating today so the vet gave him an appetite stimulate then he ate so he will stay on Pepcid and an appetite stimulate with the new insulin-then we will see if his kidneys hold-that is the latest-

really need to find a home for the other three kittens-found a puppy today but found him a home-its too much in Stockton-two more cats to fix but one is already pregnant-this really has been a project on top of Fluffy and a my wild dog Lady that does not like cats-

Expert:  Dr Caroline replied 5 years ago.

Hi, OK keep me posted with Fluffy. I would recommend not increasing the insulin dose until he eats properly. How long does his Blood sugar stay under 300 mg/dl ?

 

Your rescue work is never finished!

 

Caroline

Customer: replied 5 years ago.
Fluffy came home today after paying $1,400!! Anyway, his insulin went back up to 450. So he increased the dosage to 2 and 1/2 twice a day. The new needles are so short I did not know if I got the needle in when I gave him the insulin tonight-Fluffy is long haired. Will check with the vet tomorrow about these needles. It is hard to know how long his blood sugar stayed under 250 since he only tested him during the day-yesterday afternoon it was 250 and this morning it was 450. The vet said he was eating a lot with the stimulate-I have to order the stimulate so he may not get any tomorrow-he woobles more and his back legs seem worse but he was in a cage for a week so we will see, but the vet mentioned he thought his back legs were worse. Overall, Fluffy looked a lot better and seems to be responding very well to stimulas. Also I still feel his diabetes is not under control. It seems to have been always high except the one time when I was giving him 7 units when it went down to 70- I have always felt that-it seems to be slow going down but quick to go high on the readings and stays higher a longer period of time than when it is low. Thank you for everything
Expert:  Dr Caroline replied 5 years ago.

Hi Betty,

keep me posted on Fluffy's condition. A curve will let us know later on how he is doing. Giving the insulin to where he was at 70 mg/dl was a dangerous point. You do have some apparatus, I think only available through specialty facility, where it is put under the skin and will measure the blood glucose at all time.

Customer: replied 5 years ago.
Fluffy is much worse-on Friday the vet said-wait until Tuesday to do another curve. On Saturday Fluffy was not feeling well. Sunday it was hard for him to walk. Today I took him in and his glucose was still over 450-(as high as his monitor goes) So I said lets increase the insulin to 4 units-its 2 1/2/ now and he has never been below 250 witht he new insulin. He said we can go to 3/1/2 which we gave him this morning. He is still eating but I had to put the food on the floor this morning since he could not stand-His back legs are much worse but today his front paws went out-he can only go 2 steps before he falls-all in one day--he is alert, eats but he does not drink enough water for what he eliminates. He lost 8 oz since he has been home. It is very frustrating that the vet has not been able to get his glucose level in a normal range yet and Fluffy is getting weaker because of this-any help would be greatly appreciated.Betty
Expert:  Dr Caroline replied 5 years ago.

Hi Betty,

I am sorry to hear that Chelsea is not doing well.

I think it's time to see a specialist. Being that far away is really hard to make any suggestions at this time.

A possible ketoacidotic cat may require a lot of care and follow up in the hospital until they are feeling better. When I worked in a specialty center, those kitties needed to have their blood sugar, acid levels, potassium levels and many other parameters checked several times daily. He may be anemic, very acidotic, a low potassium, or something else is going on.

 

Customer: replied 5 years ago.
Yes the vet said he was very acidotic-the 450 was not the number-his meter only goes that high so it is over 450 but we do not know how much. What bothers me the most is that his legs are giving out really fast-his front legs looked better yesterday-have moved the food closer and lowered it and the kitty little so he can function better. He did not have ketones in the urine, his potassium was a little low, he had antiobotics-will do continued spot checks to see if the level gets below 450-looks like I will have jury duty until 6/15 so difficult to take him to UC Davis- Thanks so frustrating not to be able to control his diabetes after all this time.
Expert:  Dr Caroline replied 5 years ago.

Hi Betty,

that's why kitties like this would benefit to be in the hospital with regular insulin to get that blood sugar low as fast as possible. When diabetes is not control, look for a cause: infection, pancreatitis, other, etc.

Wish I could be more helpful.

 

Customer: replied 5 years ago.

Took him for a test yesterday and he was still over 450 so we increased the insulin to 4 1/2/ units twice a day. He still is drinking lots of water and pees a great deal. He kept his weight at 8 lbs 13 oz so he had not lost any more weight-since the previous week-eating with appetite stiumlant. Do not have jury duty so maybe I can find another vet to treat him. Found homes for all 5 kittens, still have 2 feral cats to trap and fix-neighbor is now trying to trap to kill them-even the ones I already fixed-and the beat goes on!!

Betty

Expert:  Dr Caroline replied 5 years ago.

Hi Betty,

thanks for the update.

Keep me posted

Customer: replied 5 years ago.

After 2 days at higher dose, fluffy was much better and was walking around the house-my vet is ready to send me to UCDavis because I keep saying we have to get the glucose level under control. But since Fluffy is better I will wait until Friday for the update ready-it may be working now. Thanks

Betty

Expert:  Dr Caroline replied 5 years ago.

Hang in there!

Caroline

Customer: replied 5 years ago.

Fluffy still eating and drinking lots of water-needs to be pushed to walk around but he seems a lot better-found homes for 5 kittens plus chocolate siamese, have three fixed cats who eat breakfast at my front door and 2 more to get fixed. So it is calming down a bit except for my neighbor who still wants to kill them!! Take care, more on Friday.

Betty

Expert:  Dr Caroline replied 5 years ago.

OK!

Cheers,

Caroline

Customer: replied 5 years ago.

Went for Fluffy's Friday check-up -Finally we are under the vets instrument that has a 450 ceiling. Fluffy registered at 347 insulin reading. We decided to go up to 4 1/2 and 5 injections per day. But his weight was down from 5/29th at 8 lbs 14 oz to 6/5 8 obs 9 oz. What do you think we should do for the weight. I also asked for some potassium so I will give 2 tbs a day. We were are now is much better than last week and he is able to walk around the house. But he needs coaxing and lots of attention. Thanks

Betty

Expert:  Dr Caroline replied 5 years ago.

I am out of town today and tomorrow, so quick response here.

Keep the insulin, I'll get back to you tomorrow late, or Monday AM.

Good job getting the blood sugar down!

Now we need to know what the glucose curve looks like; Usually done after a whole week on the same dosage. But also may have an idea if the urination and drinking volume came down.What does it look like?

Any idea what was the last potassium reading?

Customer: replied 5 years ago.

Next Friday we can do a glucose curve but the vet only has means from 9-5 unless he keeps him overnight at his house. The potassium was low but the vet gave him potassium when he gave him the IV two weeks ago-thought he may need some but I can get an exact reading next Friday. The urination is still high and he his still drinking a lot of water. I will have to measure the water intake to see if it is going down-just concerned about the weight loss now unless you do not think the amount of weight loss is significant.

Betty

Expert:  Dr Caroline replied 5 years ago.

Hi Betty,

yes the weight loss is significant, means his diabetes is not under control or something else is going on.

Do we have the potassium level after the end of the IV fluids?

Potassium replenishment will even be better if he takes it orally.

Was he placed on antibiotics or a urine culture done?

 

 

Customer: replied 5 years ago.

I will check on his potassium level after the IV if he took it. I know he took it before the IV. Yes he was given antibiotics during his stay at the vet. I will check on the urine culture-I remember he couldn't take one before. We will do a curve on Friday-maybe thursday I will leave him at the hospital so he can take him home to get a full curve and ask him to do a urine culture. Fluffy is much better with the new insulin and we will see if his weight loss has increased from this last week. I have my neighborhood kids feed him by hand which he likes. The something else that may be going on his his kidney failure-any test we can do for that-The vet feels the kidney failure will be his downfall.

Thanks for all of your help-I really appreciate all you have and are doing for Fluffy. He is in my TV room now and loves the attention!!

Take care,

Betty

Expert:  Dr Caroline replied 5 years ago.

Hi Betty,

Awesome! Keep in mind that it may take 4 to 6 weeks to regulate diabetes if uncomplicated.

Keep me posted.

 

If this was helpful, please do not forget to select Accept.

Thank you and let me know if you have more questions.

 

 

Dr Caroline, Veterinarian
Category: Cat
Satisfied Customers: 643
Experience: 20 yrs of cat dog practice, general practice, emergency, certified in veterinary acupuncture 2006
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Customer: replied 5 years ago.
When I took fluffy in today, the vet called later to say Fluffy had lost 2 oz. and his kidney reading (can't remember the test) was off his scale of 140. He said after he gave him an IV before he was able to see the reading at 60-in other words he feels his kidneys are failing. He did say, he was eating and alert. His insulin reading was 347 in the morning at 295 in the late afternoon so he is going to raise his insulin-to date we have not had his insuling reading at a proper rate. He said his potassium was low so he will put that in his IV. What do you think?
Expert:  Dr Caroline replied 5 years ago.

Hi Betty,

I would need more details with all lab values written. BUN was measured with which technique: a stick? machine?

 

Customer: replied 5 years ago.

He said his machine did not go over 140. The only lab work I have is his glucose levels from 347 to 295. I can check his potassium but he said it was low. I have a call into his office today-he works every other Saturday. As soon as I get more info-will let you know.

Betty

Customer: replied 5 years ago.
The vet just called-he kept Fluffy at home so he could give him the IV more than 3 hours. I quess he did not start it yesterday-he said the potassium level was 2.1-the glucose level did not go lower than 300 so he has increased his dosage to 6 units 2 x a day-he did not give him the appetite stiumulant but his appetite he said was very good-he ate the whole bowl last night and surprised him. He said he will call tomorrow and give more glucose levels on Monday. The BUN level was 140 or higher since his machine does not go higher than 140.
Expert:  Dr Caroline replied 5 years ago.

Eating will help replenish his potassium level.

Was the creatinine measured?

 

Customer: replied 5 years ago.

Don't know if the creatinine was measured-will know more on Monday-the problem after 8 months if that we have not had the glucose level normal! It appears that the kidneys are getting worse probably due to high glucose levels. Anyway, what else can I do-the vet did not want to keep him alive. I said, No-because he is still walking, talking, eating and asking for attention!!!

 

Expert:  Dr Caroline replied 5 years ago.

Hi Betty,

Let's hope for the best.

Keep me posted.

Customer: replied 5 years ago.
The BUN level was still over 100 yesterday so he kept him another night to give him more IV-will pick him up today and see all the results. Hopefully the glucose level is lower-last time he tested for the Creatinine he did not have anybut will ask. The vet said he was still eating well without the appetite enhancers.
Expert:  Dr Caroline replied 5 years ago.

Good, let's see how he does!

Caroline

 

Customer: replied 5 years ago.
Picked up Fluffy today-His BUN reading was 80 from 100 after another night of IV but the vet said pick him up. He did not do a Creatinine test because I told him to watch the costs. The last time he charged $1480 for the IV and today it was $750!!! The last IV did not last long so I quess the question is how many times do we do the IV. He told me today that the lowest the glucose level was 300 at 6 units twice a day. He also told me that the high glucose level does not affect his kidneys-it just makes him pee more. He will test his glucose level next Monday-if it does not affect anything but his pee level maybe it isn't so important what his glucose level is but to think more about how we can keep his kidneys in better shape or remain stable for a longer period of time. I will be giving him the extra potassium, pepcid, insulin and no appetite stimulant. His weight is 9 lbs 8 oz-increased with the IV.
Fluffy looks great, walks, talks and loves attention but his kidneys seem to be shutting down quickly-any suggestions? Thanks
Expert:  Dr Caroline replied 5 years ago.

Hi Betty,

at this point it is hard to make other suggestions without looking at him, having more lab work.

I do not know when his blood sugar was taken in relation with his insulin injection.

 

If his diabetes is not under control, you may have:

-Underlying condition: cancer, infection, pancreatitis, FIV related condition, other

-Cushing disease

-Acromegaly

I do not know what antibiotic he received, for how long, if his kidney may have an infection.

 

If we take all of this away, you can do at home:

-Subcutaneous fluids, your veterinarian can show you how to do this

-Vitamin B injections

-Azodyl, by Vetoquinol these are bacterias that will likely decrease the BUN count

-Phosphorus is important to know, if too high, needs to be controlled

-Continue all the medications you are giving

 

But I would investigate why his response to insulin is not that great. If his blood glucose does not get in good range a part of the day, he will continue to waste away.

 

Let me know your thoughts.

 

 

 

Customer: replied 5 years ago.
Fluffy goes in to the vet tomorrow and he mentioned giving subcutaneous fluids. I will have him check the phosphorus and recommend the Vitamin B injections-he has a new sympton when he came home-his head and eye jerked like a spasm not so often now but a new sympton. Also last night he was on his way to the litter box-I picked him up to get him there faster and he could not hold his pee-the first time. He is eating very well without the appetite stimulant and wasn't drinking too much water at first but now he is drinking a lot of water again. We tested him for pancreatitis-negative. Do not know about Cushing or Acromegaly disease. Also I do not know how the FIV would affect him if it became active. We gave him antiobotics but we could give them to him again. He is walking very well and had made it to the other side of the house-still wants attention.
Expert:  Dr Caroline replied 5 years ago.

Hi Betty,

can't tell why the head jerking, but since he has kidney disease it would be a good idea to measure the blood pressure. We see a lot of cats with hypertension, then they do not act normally. Sometimes the pressure is so high the retinas detaches. If he really has FIV: toxoplasmosis, FIP, cryptococcus, other infectious disease process might be rule outs.

As for FIV, this virus does immunosupress the body and will predispose to cancer development, infections.

It is hard do make further recommendations right now since I do not see Fluffy and do not have the chart in hand.

Keep me posted.

 

Customer: replied 5 years ago.

Well, Fluffy was at his best last week with the new insulin-went to his ole sunning spots. On Monday and Tuesday we did a cruve this week. Here are the results-Monday shot at 9:a.m. 6 units -60 at 4p.m.. 173 at 9:oop.m. so we reduced from 6 units to 5 unit, 221 9a.m. so he gave 6 units, 180 at 1:oop.m. then 74 at 4:00p.m.

Then he was given some fluids on Monday night so on Tuesday his weight was 9 lbs plus some oz. The shots are given at 9a.m. and 9 p.m.Took him home and he was great on Wednesday-gave him 5 1/2/ twice a day , I was afraid to give him 6 units since 74 was a little low. Thursday and Friday, Fluffy was in bed not feeling well-almost took him to vet on Friday but thought be better to go for another curve on Monday. This morning I felt he did not look well and I did not think he ate much so I reduced the dosage to 5 units this morning. No way to test him. Rushed him to the emergency hospital at 12:30-he was flopping like a fish- at the hospital his reading was .4!! They gave him dextrose and fluids and sent him home with a reading of 120. When he got home, he ate and drank water. Then I was on my way out of the house around 3:00p.m.and I saw Fluffy twitch so I called the emergency vet again-she said bring him in-she had told me the twitching is a first sign before seizures. When I brought him back his glucose had dropped back to 25. This time she said he was not responding well to the dextrose. So for another $1400 Fluffy is staying overnight and they are trying to save Fluffy-I quess the slow acting insulin keeps on coming-the one thing I dreaded was to overdose Fluffy and it looks like I did-feel awful. When Fluffy's insulin is in range, he is fine, walks, talks and goes to his favorite spots. She said I could test him at home even though my vet said I could not do it. If Fluffy survives this onslaught, I will have her show me what to do-it is too hard on weekends to know what to do-I felt this morning I should reduce his insulin but I should have not given him anything. Since October we have been trying with the other insulin to get it straight and with this new insulin we were getting it under control and Fluffy was doing great-even his legs were better and he was walking a lot.

Expert:  Dr Caroline replied 5 years ago.

Wow! What an ordeal. I have to command you for being so patient in his care.

Yes, kitties can be tested at home. There are glucometer we like better then others to do so.

It will be easier to do a glucose curve since you need to do it every 2 hours until the blood glucose rises again.

Hnag in there.

 

Customer: replied 5 years ago.
Which glucometer do you like? Since the hospital has not called me, it looks like Flluffy is still alive. If he makes it to Monday, he will be with my regular vet. When you say it needs to be done every 2 hours, is that because it has to rise on its own without dextrose? I will call the hospital this morning to see what is going on to see if he needs any food? They probably are not going to give him anything until Monday, but I will see. Will write more after I call now. Thanks, Betty
Customer: replied 5 years ago.
Today Fluffy has beeen receiving a glucose drip. I had my vet call the hospital and they decided to stop the drip to see what happens. His reading was 300. The good news is that Fluffy is eating. So will take him tomorrow to the my regular vet to see again if we can get the diabetes under control-I will get a measuring kit so I don't OD him again. This is the third time Fluffy has survived the onslaughts -I guess 6 more to go! (3 times the vets wanted to put him down and I said, No) When his glucose is in range he is fine-his normal self. Thanks again for all of your help-
Expert:  Dr Caroline replied 5 years ago.

Yeah, 9 lives :-)

Glucometer: alpha track is the one I like in kitties. But always see what your DVM provides you with, some people maybe more familiar with other systems. Best is to go with what your primary care veterinarian is familiar with.

 

The glucose curve is done at home when the kitty is on insulin and you want to know how he responds to it.

 

Good luck!

 

Customer: replied 5 years ago.
Fluffy is coming home today with a glucometer someone else had for $100 instead of $150. Yesterday the vet gave him his first insulin after the weekend ordeal. It was over 400-he gave him 4 units-went down to 70 in one day but back up to yesterday was the largest drop in one day-do not know if that is because of his ordeal but hopefully with the meter we can get it in an acceptable range. Does insulin accumulate over time in the body-because in two days he went down to .4 or was it totally related to him eating a little amount? At least now I have a way to monitor which I could have done since last October-which would have saved me thousands! Oh well live and learn-may have to write another article!! Thanks for everything.
Expert:  Dr Caroline replied 5 years ago.

Yes, if you give too much insulin, it will get back to you after a while. It can take several days for the blood glucose to get back in the normal diabetic range after a severe hypoglycemic crisis like Fluffy just had.

 

Caroline

 

Customer: replied 5 years ago.
We have been giving him 5 units twice a day of Lantos. He has tested very high but yesterday he was at 337 instead of over 450. I gave him 5 units and 5 units last night. This morning he was at 105 so I am not going to give him any and will test him later tonight. This machine really helps and should have had this from the beginning. I would have crashed him again on a 3 day holiday! My vet kept telling me I could not do it at home. The last two days he has been great and going to his favorite sun spots. Today he was quiet in his bed so I tested him and it was at 105 before I had planned to give him 5 units. Hopefully I did not dilute the sample with the alcohol that I applied before but we will see tonight what is reading is before I give him any insulin. Thanks
Expert:  Dr Caroline replied 5 years ago.

Good job on waiting to give him his insulin.the blood glucose will be high before you give the insulin, that's normal. If the blood glucose is low, good call to not give him the insulin.

 

Customer: replied 5 years ago.
He twitched again this evening (that meant a low count last weekend)-we tried the meter again and got a reading of 293 after I removed the stick so hopefully it is accurate-ate a small amount and drank a small amount. Plan on 4 or 5 units tonight-out of strips so hopefully they deliver tomorrow since they did not deliver today as planned. Overall he is at his best,looking for sun spots and walking all around the house. Really hard to get any blood out of fluffy-maybe the puncture tool is not working -any suggestions on how to get blood out of his paw-tried on the side, massage and warm towel -could not get anything out of his ear. Thank you
Expert:  Dr Caroline replied 5 years ago.
I get it from the ear usually, however, I woudl have your veterinary office show you how to do this. A bad pinnae prick can give you and your walls more blood then you want.
Customer: replied 5 years ago.
I was able to get some more strips from the Vet today so I can still try and test him tonight. I gave up last night and this morning after pricking his paw a lot. I even had a friend bring over her tool, as she is diabetic, and help me prick him but so little blood that it will not register-I was out of strips so the vet was able to put some in his mailbox at work today so now I am ready again. Last night I gave him 3 units instead of 5 because he ate a little and drank a little water and his reading at 4:00 was 293. Also he was in great shape. This morning I had no idea so I gave him 4 because he had ate a little and lots of water and again feeling great. Today he has not eaten at all and drinking water 3 or 4 times. He is feeling fine and now is taking a nap-if I cannot get a reading tonight, I have no idea-if he doesn't eat at all I will skip the dosage-if he eats a little maybe 2 and if he eats a lot then back to 4 or 5. If I get a reading then I will be doing fine. My vet won't be back until Tuesday. My friend said she goes by how she feels as well. So if Fluffy is feeling fine, walking around and doing good I am going to keep the insulin low until I can get a reading on Tuesday. No more overdoses by Betty!! Also he has twitched a few times which happened when he was too low. The vet was very surprised that it had gone down to 110 in the morning the other day. But when I gave him no insulin he was fine yesterday. So watching his behavior is my new plan of action-any thoughts on how to get blood? The vet showed me but he couldn't get blood so he took him in another room and completed the test and he was off scale so I gave him 5 at night and 5 in the morning and then he went low that next morning when I was able to get a sample. Thank goodness for the testing.
Customer: replied 5 years ago.
No wonder he was twitching-he reading last night at 11:30p.m. was 80-so I did not give him any insulin-he ate a little out of my hand. This morning he is not feeling as well and has not eaten so far. Will try to get a blood sample but if not what should I do? The vet does not come back until Tuesday.
Expert:  Dr Caroline replied 5 years ago.

Hi Betty,

hope the rest of the weekend went OK.

When they do not eat enough, you give only 1/2 the normal dose.

However, If he is not feeling well and his blood sugar is low, I would skip the insulin.It may take several days for it to come back up high again.

You may have to keep only 2 units possibly for a whole week after his blood sugar goes back up to its maximum. The goal is to do a glucose curve after a whole week on the same dose of insulin. You cannot choose every day a new dose according to his blood glucose. the blood sugar reading should help you know if he is too low right now to give him his insulin or not.

 

Does it make sense?

Let me know.

 

So to recap, the blood sugar should be very high before you give insulin.

He eats a normal food portion

then you give the insulin

During the day the blood sugar will go down slowly and then go up again.

Time for insulin the second time of the day, the blood sugar goes back up to its maximum again.

He eats a normal meal,

you give the full dose of insulin,

and we start the cycle again.

 

 

 

 

Customer: replied 5 years ago.
What has been very confusing, if testing was easy, is that his readings that I did get were 430 down to 110 then up to 293 then back to 80 or lower(reading was at 80 at 11:30 at night) then up to 357 and this morning 290. Also his eating has really slowed down where some days he has not eaten. For example, we were giving him 6 units twice a day and the lowest it got was 80 but the next morning I OD him 3 days after we gave him the curve .4. Then we did another curve after getting out of the hospital and decided on 5 units twice a day-but his reading went to 110 which was perfect but then went up to 340-that night-the next day he went below 80 since the reading was 80 late at night so we cut back to 4 units twice a day but since he was not eating I cut it back to 3 units twice a day and his reading this morning was 290. So for one week we went from 5 units, to 4 units and now to 3 units which keeps him stable so far.Will not know tonight since after two tests I am out of a whole bottle of strips and ruined two pads by poking him about 10 times to get blood. Tomorrow the vet is open and will get him tested, but like now, he has not eaten and I am scared to give him the 3 units (total 6 today) It would be great if we could get to a set amount but just as we do the curve and feel we have the dosage then something happens or he does not eat or gets dehydrated.
Customer: replied 5 years ago.
What I think you are saying is that if 5 units is the dosage, then if he eats a little you give 2 1/2 and if he is not feeling well and not eating-none. Then if he tests high go back to the 5 units. What happened is that 5 twice a day worked for 10 days then the next morning I OD him even though I cut back to 4 the night before and 4 in the morning thinking he was not feeling well. Then we redid the the dosage to 4 units twice a day after he OD and that seemed to work until yesterday when he was too low but instead of going to 3 I should have given him half of 4 -2 units and then if he eats and feels better back to 4?
Expert:  Dr Caroline replied 5 years ago.

Hi Betty,

when you test him, make sure you write all the following details and make charts:

-Time you gave the insulin

-Time you tested for the blood glucose.

This way, it's gives a better idea of what is going on at one glance

 

I would ask your primary care veterinarain to show you how to prick the ear (need to apply vaseline first).

 

Reevaluate with your primary care veterinarian how much insulin you are giving, so you can try to stick to one dose of insulin long enough to be able to do a glucose curve.

 

If his normal dose is 5 U, if eats a little or not and his blood sugar is high, only 1/2 the dose.

 

If he is not eating well or not and his blood sugar is low to not very high, no insulin and retest before giving the insulin the next time around.

 

You need to talk about the use of the glucometer and ask about the blood glucose levels they want you to intervene at. This needs to be done with your primary care veterinarian, I cannot do this since I do not follow him and do not have all his medical chart. I can only give you some pointers.

 

Hope this helps.

 

Good luck, and keep me posted.

 

Customer: replied 5 years ago.
Went to vet yesterday and we did a BUN test-the vet said it was fine and his weight was fine which was a shock since he had not eaten very much for 3 days. But his potassium was the lowest ever, the vet said. So we doubled the dosage of potassium by doing it twice a day. He tested 110 yesterday morning so we did not give him any insulin. We gave him 3 units last night and this morning he was at 415 so we gave him another 3 units. We were afraid to go higher since he is still not eating. Also last night I noticed Fluffy was jerking again-before that meant he was too low and ready to seizure. Also this morning he was jerking-but his reading was 415-the vet thought it might be the too low potassium. I found by putting vaseline on the paw I am getting a better sample -the blood bubbles up so it reads the blood better-so it only took 5 pricks instead of 10. Also the vet gave me his meter which rings when you get enough blood. So if the testing becomes easier and I do not have to destroy his pads then I can test more often-but for now we are at once a day. For some reason, he just stopped eating-I had the vet check his teeth -they are OK and not the reason. He has eaten twice when I give him the food and he follows me around all the time so he definitely wants company. We are still giving him the appetite pill plus the pepcid. The vet feels the appetite pill helps-I am not sure. When I give him 3 units in the morning and 3 units at night then he is low the next morning so that we cannot give him any-then it goes high until 2 dosages then too low. That has been his pattern so far-The week days I feel more confident since I can call the vet but the weekends are frightening!! Now that I can see what an overdose looks like.
Expert:  Dr Caroline replied 5 years ago.

Thanks for the update,

it looks like your new veterinarian is able to help you make the right decision about feeding and insulin.

Best to direct questions to them from now on.

 

Good luck and keep me posted.

Caroline

 

Customer: replied 5 years ago.
I have the same vet-but now I have the home monitor. His readings go from 300--400 to 100 in one day but now that he is eating he goes to 600-700 so we will have to increase the dosage while he is eating. Maybe I will contact you if something else goes on besides his insulin issue-because you have been a big help to me-thanks.
Expert:  Dr Caroline replied 5 years ago.

Hi Betty,

OK looks like his blood sugar is high up.

Have you done his blood glucose every 2 hours to know when the blood glucose is at its lowest during the day?

Is he at 600-700 with or without the insulin?

Keep doing the readings! You are doing a lot of work for this little guy, I am giving you an award for trying with a A+ note.

Caroline

 

 

Customer: replied 5 years ago.
It has been so difficult to test his blood that I have been doing it in the morniing only-but yesterday I did it around 4 when it is at its lowest. The reading was too high because the vet told me to cut back to 2 units instead of the 3 so now I am keeping him at three when he does not eat and its over 400 then to 2 twice a day to keep him steady if he eats. His eating and his potassium affects his glucose reading a lot. The most he has dropped is 300 when he is not eating and received 3 units, so I consider that when I give him a shot. The reason I keep working so hard is the cat is fine when his glucose reading is fine so I hate to end his life because of my inability to keep the glucose in line. I have learned a lot since last October and what not to do. I recommend for all future cats with diabetes to 1) get a home monitor-use vaseline to get the blood drop to raise higher 2) get the right needles, 3) get a record of his eating, shots and readings 4) check his potassium-this would save someone thousands of dollars and a lot of relief to the cat. Thanks for all of your help-you did save his life when you told me not to give him insulin when he is not eating and secondly you told me that I could do the monitoring at home when my vet said I could not do it. So hopefully,after you have saved his life twice, I hope I can extend his life as long he reamins healthy and happy. The only problem I have now is getting his glucose reading in line with high swings during one day-and what to do-when I saw the 600 plus reading I wanted to give him 3 units but the vet said 2 because when the dosage gets too high there are bigger swings. But Fuffy was really sick that day and I thought it was better to get the reading lower and then try to even out the dosage-anyway really a gamble.
Expert:  Dr Caroline replied 5 years ago.

Hi Betty,

hang in there and keep me posted!

Laughing

Customer: replied 5 years ago.
So far since October, Fluffy has not had an even dosage because of the high swings in his glucose reading and his changing eating habits. So now that I am doing it I really want to give the dosage that fits the reading but the vet keeps saying we have to give an even dosage so like today it was 610 and he wants me to give him 3 units instead of 4 or 5 like we did when he was eating. The reason it goes high is that he starts eating a lot then he gets sick because it is too high and then he stops eating and 3 units is enough and sometimes when he reads at 140 he suggests not giving him any. So the vet and I are going back and forth on what to give him. With the vets dosage it usually is over 450-he said also the food contributes to this since we give him K/D for his kidneys-the other food with more protein would stabilize the readings a little better he said. So it looks like we will never get his glucose readings in the normal range for more than once a week!! Take care, will keep you posted.
Customer: replied 5 years ago.
Just to let you know Fluffy is alive and sort of well!! It has been a challenge to get Fluffy on some sort of routine dosage. We think we have it twice a day a 5 units each then he will drop to 71 glucose reading and then we give him zero-then he goes too high and we have to start all over to get some kind of balance and then he drops again. It really seems to be related to his eating and one never knows if he is going to eat. He bit me the other day while I was trying to get the pill down his throat-so the vt and my primary physician said I needed to go to Urgent Care and get an antiobotic shot-the local doctor did not think it was an emergency so he kept me waiting 3 hours and then said I did not need a shot-so now I am an expert on cat bites!!d The home testing is the only way to go-wish I could have done this since last October. I wish I did not have to test his little paws twice a day but you never know what his reading is going to be. Anyway all is well and take care. One question. I want to take him to be groomed since he is a mess-but this vet said it could crash him? What do you think-he really needs his nails clipped, cleaned and groomed.
Expert:  Dr Caroline replied 5 years ago.

Hi Betty,

not having followed Fluffy, I can't tell how he will react at the groomer.

However, you may have the veterinary office do a nail clip. Also, they may be able to groom him too at a different time. If his medical condition is that bad, he may do better with a little bit done at a time. This is something you need to talk to your primary care veterinarian about, since I have not personally examined Fluffy.

 

Good luck, and keep me posted, he's still around, means you are doing good!

Dr Caroline, Veterinarian
Category: Cat
Satisfied Customers: 643
Experience: 20 yrs of cat dog practice, general practice, emergency, certified in veterinary acupuncture 2006
Dr Caroline and 4 other Cat Specialists are ready to help you
Customer: replied 5 years ago.
The home meter is the answer and allows be to not overdose him!! He fluctuates dramatically so it is impossible to get an even dosage daily. Yes, Fluffy is doing good. I quess the vet feels he is on the edge and any little disturbance can send him over the edge-but he has to travel to get his nails done-since he bit me twice it is impossible for me to do his nails! Anyway just wanted you to know that in October Fluffy would have survived a year with all his ailments thanks to you and the other vet. I can't tell you how many times people have said, including the vet at the Emergency place, to put him down. But Fluffy is doing good so far and still does the things he used to do when he was younger. Also potassium is really helping him a lot-he starts jerking if he doesn't get enough potassium. Will let you know if there are any changes.
Expert:  Dr Caroline replied 5 years ago.

Good to know he's hanging in there.

Keep me posted.

Make sure he gets that potassium!

Customer: replied 5 years ago.
Today the vet wanted to see Fluffy-I agreed since he doesn't want him to go to the beauty parlor- I needed his nails clipped! Since he hadn't seen him in a month we agreed we would get some blood work done. He was quite impressed that he had gained wait-now 9lbs 10oz and his glucose reading was 110, his potassium was in the normal range but low but his BUN was very high 140. So he told me he could die any moment! I asked him what we could do about the BUN rate and he said IV's but probably wouldn''t last long. I really do not want to put Fluffy through anymore stress other than what I give him at home twice a day with testing, shots and medicine. But is there anything one can do to lower the BUN rate at home or any other thought. He did mention that if he drank more water-what about those running fountains? Anyway open to suggestions to lower the BUN rate if possible. Thank you. Betty
Expert:  Dr Caroline replied 5 years ago.

Hi Betty,

sorry for the long wait, I am away from the site for long periods of time due to lot's of work. As for the BUN, it would be good to know the creatinine level done at the same time as the BUN. BUN can go up for example due to:

dehydration, renal failure, gastrointestinal bleeding.

Yes, 140 mg/dl is high unfortunately.

Good job however on the diabetes!

 

-For the high BUN if due to renal failure: always make sure there are no kidney infection (need culture to make sure)

-If he is kidney failure, good to measure his blood pressure.

-Subcutaneous fluids given at home may help, it is easy to learn, most of my kidney failure patients are on fluids at home.

-Make sure he is on a kidney failure diet.

-Some supplement made by Vetoquinol may help bring the BUN down a little:

http://www.vetoquinolusa.com/pages/pro_azodyl.html

-If he is anemic, some erythropoietin can be given

-He needs Phosphorus binders if his phosphorus is high.

-the calcium level needs to be checked too.

Here is a link about kidney failure:

http://www.veterinarypartner.com/Content.plx?P=A&S=0&C=0&A=572

Hope this helps.

 

Caroline

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