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Cat Forum / Health and Behavior / August 2006Diabetic cat becoming refractory?
Hello, I've never posted here before, and while I did try checking the archives on this, I didn't find much...but that could be due to my impatience because I never expected this. My cat was diagnosed with diabetes in March. Strasti is almost 6 years old and he's currently 18 lbb. He had 3 seizures in the three years prior to diagnosis, but I was not at all expecting the grand mal he had this past Sat. He seemed to be responding amazingly to his PZI insulin; he looked better than ever...unfortunately, he ended up in the kitty ER over the weekend, not even registering with a BG count. The vet estimated that he could've been seizuring for up to 4 hours and the facts that he came out alive & not brain-dead are amazing. He was on a dextrose drip and Valium, which my vet then oversaw when I transferred Strasti on Mon morning. Strasti came home on Tues, but I needed to return on Thurs morning because he was showing signs of hypoglycemia (at least this time he was! I saw nary a sign prior to his seizure...he *never* lets me know when he isn't feeling well.), when he was given fluids, Clamamox and Pepcid AC because he hadn't been eating. Strasti ate a bit last night...but today, he's again not interested in food. He'll sniff at it, lick my finger, but he doesn't really move from my bed (I force fed him some food this morning with his medication.). He is alert, grooming, affectionate...but lethargic. I will call the vet again if I don't see more improvement tonight. Would it make sense for me to rationalize his lethargy/exhaustion from this chaotic past week and that he has a bit of an infection? I know that I don't want to get out of bed when I feel sick...the vet said that he may be going refractory with his diabetes. Has anyone else had experience with this? Can anyone relate to anything I've written and maybe give me some advice? And, horribly enough (because I hate the mere idea of having to consider this...), when does one consider euthanasia? :-( Thank you, Christina > Hello, > [quoted text clipped - 33 lines] > Thank you, > Christina I don't have experience with this, but since he went hypoglycemic, it sounds like the diabetes might be getting better, not worse. Has he been on the same dose since March, how often has his BG been checked, have you changed his diet, and has he lost weight. > I don't have experience with this, but since he went hypoglycemic, it > sounds like the diabetes might be getting better, not worse. Has he been > on the same dose since March, how often has his BG been checked, have you > changed his diet, and has he lost weight. His dosage started at 2 units twice daily of PZI, and by early May, it had increased to 4 units twice daily...and it stayed that until his seizure. Strasti has not received any insulin since the morning of his seizure. I have checked his BG as often as I can since bringing him home and when I can get him to eat, it seems to be between 70-85. As for weight, he gained 5 lbb since starting his insulin in March, and as far as I'm aware, he hasn't lost any in the last week. I didn't change his diet prior to the seizure, but since the seizure, the goal has been to simply get him to eat, so I've been following what the kitty ER was giving him (as at least he'll eat this): baby food (turkey & chicken). I give him some pumpkin as well to get some fiber into him as he had diarrhea (his first bm since Tues, as far as I'm aware). For the most part, he'll accept both off of my fingers (but he'll walk away from a bowl). I'm also giving him Nutri-Cal, a syrup with corn syrup & all kinds of vitamins to help along his BG and make sure that he's getting something into him. My biggest concern is making sure that his BG stays as up as I can get it & that he's not vomiting his food...he's vomited just a couple of times, but I think it's due to all of the grooming he's been doing because I'm finding wads of hair in the vomit puddles and not food. Once he seems to be through with his Clavamox, then the vet will do a curve on him...he's just been through so much -- and even more with me constantly on him, poking him -- that he needs to rest some, too. :-( I worry yet about getting fluids into him, too...any advice on that? Thank you for your response; I appreciate it. :) > His dosage started at 2 units twice daily of PZI, and by early May, it > had increased to 4 units twice daily...and it stayed that until his > seizure. Strasti has not received any insulin since the morning of his > seizure. Christina, I'm glad you posted to felinediabetes. Post the insulin amounts too. We never used PZI so I don't know how it differs from Humulin, but if it is comparable at all -- that is a very high dose. Usually you start at very slow with insulin. Our cat was getting about .5ml twice a day, then eventually about 1ml twice a day. The folks at the website will know the differences. By the way, there is a cat food our ER uses to try to entice kitties to eat. It is stinkiest they've found. It's Pro Plan canned with sardines. It looks incredibly gross, but it worked for Bob. PetSmart and PetCo both have it here. Also, I don't know if they gave you any A/D, but it is a prescription food packed with nutrients for cats not eating much, and I used that with a little water and syringe-fed our cats a few times. You might ask the vet for some. Even though a couple of our sick cats turned up their noses at food, they accepted the syringe feeding pretty well. Good luck with your cat. Rhonda >> I don't have experience with this, but since he went hypoglycemic, it >> sounds like the diabetes might be getting better, not worse. Has he [quoted text clipped - 26 lines] > > Thank you for your response; I appreciate it. :) Agreed that this is a two-step process that will take some time; get him stabilized then work on the right diet and dosage of insulin to control the diabetes. When I take a sick cat to the vet, some of what I plan mention goes right out of my mind, so I jot down a little history/list as a reminder. For example, It might not mean anything that he has gained 5# since being on the insulin ... then again, it might. (I Googled up one study that found obese cats are significantly more sensitive to insulin overdose.) I've had good luck getting sick cats started eating/drinking with the broth from a turkey drumstick slow-cooked in a little bit of water, at least until the meat falls off the bone. I use that piece because it has the strongest flavor ... sort of the cat version of chicken soup. I've never found a human version of canned broth that is near concentrated enough or that doesn't have salt added. Good luck! The positive side of this emergency was that you recognized the problem in time to save your cat and now you (and your vets) know what to watch out for. Christina, Sounds to me (in my non-vet opinion) like his blood sugar is still not right. Did they do blood curves throughout the course of a day to see what was happening? Is he on insulin now at all? Sometimes if the dose is too high, they get a ricochet effect and their bodies because their bodies cannot handling the high dose. It appears on tests like the dose is not high enough and some vets wrongly increase the insulin. We had that happen with Bob, our diabetic cat. His BG was down to 32 and he landed in the ER. He also rarely showed signs other than being a little tired. The vet said this cat should be having seizures, it was so low -- she was amazed he did not look more sick. I would suggest going to an internist vet and getting this straightened out. You normally have to have a referral from your own vet, but the internists are the specialists. I believe our internist saved Bob's life. Also, please post your info on the message board at www.felinediabetes.com. They have tons of people who are experienced with cat diabetes and are very willing to help. I think of them as diabetic gurus -- they helped me with Bob. Good luck, and let us know what happens, Rhonda > Hello, > [quoted text clipped - 33 lines] > Thank you, > Christina Oops! Gotta love cut and paste -- works so well when you have your wits about you like I do not tonight... I meant: Sometimes if the dose is too high, they get a ricochet effect because their bodies cannot handle the high dose. Rhonda > Sometimes if the dose is too high, they get a ricochet effect and their > bodies because their bodies cannot handling the high dose. Rhonda, No, a curve has not been done on Strasti yet and he has not been on insulin since the morning of his seizure. One vet wanted to do the curve on Fri, but because of my taking him in on Thurs for fluids & antibiotics, the other vet decided to postpone the curve until next week, when hopefully he's eating normally and more stable. I did post my message to Feline Diabetes, as well; thank you for the suggestion. I will also ask my vet about seeing an internist. Thank you. > Hello, > [quoted text clipped - 13 lines] > Strasti on Mon morning. Strasti came home on Tues, but I needed to > return on Thurs morning because he was showing signs of hypoglycemia Christina, Are you monitoring Strasti's BG at home before you give him his insulin injections? This is very important because a diabetic cat's insulin requirements can wax and wane- this happens in about 20-30% of diabetic cats. If his insulin requirement has waned a bit but you give him his usual insulin dose, you can send him into hypoglycemia-- which is often followed by rebound hyperglycemia (a/k/a "Somogyi Overswing") which is the cat's survival mechanism for compensating for severe hypoglycemia. In the of event a Somogyi Overswing, the insulin dose should *not* be increased. Its absolutely imperative that you check his *blood* glucose before you give him insulin. Urine glucose should *never* be used to make adjustments in insulin doses. I and many others have successfully weaned diabetic cats off of insulin completely by simply changing their diet to a low to no carbohydrate diet such as Fancy Feast Seafood Filets Tuna and Ocean Feast in Aspic. Blood glucose must be monitored very closely when making any changes in his diet. Best of luck, Phil Phil, Strasti has not had any insulin in the last week, and I'll admit: I had not been vigilant in testing him regularly myself. Believe me, I beat myself up plenty over that. Even though I am concerned about maintaining some healthy level of BG for him, I need to get him eating again...I think that the Clavamox is causing the nausea and he has been getting Pepcid AC to calm his tum. I will look into the foods that you recommended; right now, I'm using what the hospital gave him to get him going again...baby food. That's all he'll take from my fingers...I think that I'll have to try a little force feeding later today. Thank you. > Phil, > [quoted text clipped - 11 lines] > > Thank you. Has the vet checked his mouth for periodontal disease? In many cases where cats stop eating the cause is found to be dental pain. You can't run a glucose curve if he's not eating since the curve is dependent on food intake and feeding schedule. If he's off the valium, speak to your vet about cyprohepadine (Periactin) 1/4 to 1/2 a 4 mg tab b.i.d. But first have his teeth checked. Good luck, Phil Yes, that was the first thing that the vets -- both of them -- have checked on Strasti. Gums are pink and healthy, teeth intact. :) And, as I began to suspect and per the advice of those here, it *was* the Clavamox causing Strasti to vomit. He vomited everything he ate yesterday morning, and an hour after it was out of his system, I tried offering him some Hill's AD. He took to it. Just a little bit...but by the end of the day, he'd had 1/2 a can of AD and some pumpkin. Both of which he kept down...and this morning, he was sitting as usual on my bed by my pillow, awaiting my awakening, and after a good nuzzle and "good morning" grooming (him cleaning my hairline), he walked me to the kitchen to check out the fridge and try to eat a little more. :) He started out by trying to bowl and then we reverted to my handfeeding him, and he got down some AD with some DM, and then some pumpkin. As he's eating so little at a time, I'm offering it to him about every 2 hours, like was done when he was in the hospital. But he's eating! :) I'm ecstatic. I'm awed by his determination. :) I will talk to the vet in the morning about the Clavamox, and then see what happens next...I'd rather not feed him the prescription food as I checked out the food list and foudn a few Fancy Feast kinds that are full of protein w/zero carbs. :) However, what do you do to supplement for fiber? Metamucil? I offer my cats pumpkin, and only Strasti (fortunately!) likes it... Thank you again, everyone, for your advice & support. I greatly appreciate it. :) As does Strasti. :) Christina > Yes, that was the first thing that the vets -- both of them -- have > checked on Strasti. Gums are pink and healthy, teeth intact. :) [quoted text clipped - 20 lines] > supplement for fiber? Metamucil? I offer my cats pumpkin, and only > Strasti (fortunately!) likes it... Christina, I'd be very cautious about fiber right now- especially since he was vomiting and might be a little dehydrated. Fiber can cause constipation if the cat isn't well hydrated. > Thank you again, everyone, for your advice & support. I greatly > appreciate it. :) As does Strasti. :) > > Christina Don't forget to mention cyprohepadine (Periactin) to your vet. Good luck, Phil My 14 year old male cat has been diabetic for about 8 months and a couple months ago had an episode of dangerously low blood sugar for which he spent 24 hours at the emergency clinic. It took him a week to get back to normal. He took no insulin during his recuperation and since then his insulin dose has been about half of what he used to take. During his recovery period he mostly slept and eating was mostly resultant from cajoling and spoon feeding him. I had the best chance of getting him to eat with baby food meats- lamb, turkey, chicken, beef - and that gets him some liquid as well as food. As I understand it, as his sugar levels fluctuate he doesn't sense hunger and thus doesn't eat and down goes that spiral. My vet suggested rubbing some Karo (light) syrup on his lips and that could counteract dangerously low sugar level but also stimulate his appetite. His diabetes is the result of long term steroid use to treat inflammatory bowel syndrome. When that flares up he doesn't want to eat and giving the regular dose of insulin will send him into shock. My vet suggested that whenever he doesn't seem to eat well it's better not to give insulin - he can deal better with high glucose than low. Also, Clavamox really upset his stomach, but a urinary tract infection seems to a common consequence to deal with. I had much better luck with Zeniquin - it treated the infection and didn't bother him. Many antibiotics seem to cause as much problem by also not making the cat want to eat. Good luck! Helen hsnixon@sbcglobal.net
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