Bowel Movement Problems

[margot]

Our 8 year old Maine Coon developed diabetes 7 months ago. It was difficult to find the right insulin & dosage, he is now on Glargine and well controlled. Years ago he was also treated for inflammatory bowel disease, and was o.k. for a few years after being given high dosages of antibiotics for a protracted period of time, and his stools now are relatively soft, but not of diarrhea consistency. When he was diagnosed with diabetes in December he also had quite severe diarrhea (lab results did NOT show an inflammation), and took antibiotics twice for 10 days in a row and the diarrhea returned. Recommended usage of the supplement FortiFlora keeps his stools as near to normal as possible, i.e. relatively soft, as before, thankfully. For the last few months, off and on, Finnegan places bowel movements (only) outside the box, (he never urinates outside the box) which may have started during his dosage adjustments when there sometimes were copious amounts of urine in the box, despite our monitoring and cleaning as much as we could. The box is now pristine, since the diabetes is controlled, but the behaviour of continues. Help. We are patient and do not scold, and he is not anxious in any way.

[sugarcatmom]

Hello and welcome to you and Finnegan. I also have a diabetic kitty, diagnosed over 6 years ago. My first question for you is going to be what does Finnegan eat? And do you home-test his blood glucose levels? What dose of Lantus does he get?

Fortiflora is okay, but there are better, more potent probiotics out there without the filler. Natural Factor's Ultimate Multi contains 12 billion organisms of 12 different types, compared to Fortiflora, which only has 10 million of one bacteria.

Something else to try is slippery elm bark powder (which you can get at a health food store along with the probiotics). You just need a pinch, like 1/8 of a tsp to start, mixed with wet food a couple times a day. Gradually increase up to 1/4 tsp 4 X a day if needed. It works by balancing the water content in the intestines.

[margot]

Thank you so much for the reply, and yes, indeed we are quite far along in the "managing diabetes" department. Finnegan receives six units of Lantis morning and night, always around 6:30 just before he eats. His diet is (and has been for at least six years when the irritable or inflammatory bowel disease first came up) MediCal hypoallergenic vet food, half and half soft and bits. Yes, we do glucose readings at home, every so often, and with this particular dosage (the vet thought we might increase it a tad more at one point) his low point is 13 (an absolutely huge accomplishment, it took months of getting to this point) and the last time we took an all-day curve he actually went as high as 30 by the end of it - as we all know there is a good reason that humans take short term and long term insulin - apparently the cat world has not followed suit yet. He starts off at approx. 24 in the morning but I do believe he is quite a bit higher at night although his behaviour is quite normal. Sadly the "going outside his box" issue has now accelerated to almost all of the time for bowel movements - should we come across him accidentally at the right time and redirect him to his box, he actually goes. There is not much additional advice the vets can offer at this point. I should point out another additional syndrome I have noticed. Finnegan always gets brushies every day both for tangle control and for comfort, but of late his skin is so dry that he is covered with little white dandruff flakes. I will look into the more powerful supplements - if it was not for that our cat would be on an unceasing stream of antibiotics, hardly the solution. In any event, I am reporting calmly, but this is turning into such an untractable pattern that I am becoming quite desperate.

[sugarcatmom]

Originally Posted by margot

Finnegan receives six units of Lantis morning and night, always around 6:30 just before he eats.

6 units is pretty large dose for Lantus, but that's likely due to the dry food. The Medi-Cal Hypoallergenic kibble has a whopping amount of carbohydrates in it (38% of calories - cats should be getting less than 10%) and I'd go so far as to say that it's likely the cause of Finnegan developing diabetes in the first place. I'm really glad you're home-tesing his bgs because what I'm about to say hinges on you're ability to monitor it: please ditch the kibble. It's a poor quality diet, with potato as the first ingredient, and containing brewer's yeast, which is a common allergen for cats. The irony of having yeast in a supposedly "hypoallergenic" food would be funny if it didn't show how little these "prescription" pet food companies know about feline nutrition. Whether a cat has diabetes or IBD or is perfectly healthy, they should be eating a quality protein WET food with little to no grains and low in carbohydrates. The Medi-Cal Hypoallergenic canned food isn't as bad as the dry, but you're probably paying a pretty penny for it and there are better options (none found in a vet clinic). Here are some links that are absolute must-reads on this topic. The first one is a broad overview of feline nutrition, but the second one is particularly important to your situation, discussing the relationship between carbohydrates and feline diabetes. And the third link discusses diet and IBD.

http://www.catinfo.org/
http://www.catinfo.org/felinediabetes.htm
http://www.catnutrition.org/ibd.php


Just a quick comment on the timing of your injections: it's probably a better idea to give the shot AFTER Finnegan eats rather than before. What happens if one day he isn't feeling well and he decides not to eat? Then you have all this insulin on board with nothing to counter it, setting up for a possible hypoglycemic episode.

Originally Posted by margot

as we all know there is a good reason that humans take short term and long term insulin - apparently the cat world has not followed suit yet.

That's not entirely the case, it's just that most vets don't know about it or don't recommend using 2 insulins for those new to feline diabetes (probably with good reason as it can complicate things considerably). For instance, I use an insulin called Levemir as a basal insulin (lasts 24 hrs in people but since cats have faster metabolisms, typically about 14 hrs) combined with a much faster acting bolus insulin called Humulin R to handle higher numbers caused by food spikes or whatever. I also test my cat's bg before every single injection and usually a few more times during the day, time permitting.

What dose of Lantus did you start out on? Did your vet tell you about the possibility of Somogyi rebound? That can cause high bg numbers and make it look like you need to increase the dose, when in reality the dose needs to come down. More info here: http://petdiabetes.wikia.com/wiki/Somogyi_rebound Not saying that's what is going on with Finnegan, but you are still seeing some very high numbers even with the high dose. If you were to eliminate the dry and drop the amount of insulin, there's a good chance you'll start to see some better bgs. There is a wealth of info at these 2 links on managing diabetes, if you haven't seen them already:

http://petdiabetes.wikia.com/wiki/Main_Page
http://felinediabetes.com/

Originally Posted by margot

Sadly the "going outside his box" issue has now accelerated to almost all of the time for bowel movements

Likely because he feels pretty lousy when he's pooping, and he's associated that with the litter box. Perhaps adding some additional boxes and putting them in a few different locations would help. I also have to say that it's apparent the Hypo food isn't working and it might be a good time to try something else. A novel protein wet food without added vegetable matter, like Innova Evo 95% venison, would be my suggestion (or else make your own raw food). Just make sure you're testing Finnegan so that his blood sugar doesn't go too low!

Originally Posted by margot

There is not much additional advice the vets can offer at this point.

Not surprising, since most vets don't really know a heckuva lot about feline nutrition. What little education they receive on the topic is hugely influenced by the big pet food companies that pay for their text books (Hill's, Medi-Cal, Royal Canin, Purina...). Major bias there, thus the reason they often push these so-called prescription diets on pet owners.

Originally Posted by margot

but of late his skin is so dry that he is covered with little white dandruff flakes.

The dandruff is not because his skin is too dry, but because his health is suffering and his diabetes isn't regulated. It takes a lot of energy for a body to maintain a glossy coat and supple skin, so it tends to be one of the first things to fall by the way-side when an animal is sick. That energy is needed elsewhere just to keep more vital systems functioning. The best solution is to feed Finnegan better food and work on getting his diabetes under control. Please read the links I gave you. I know it's a ton of info to absorb, so just bookmark them and come back to them frequently. It will make a difference, I promise you.

[Love4himies]

Margot, I can't help you in way of diabetic advice, but I do want to offer you a .

Sugarcatmom is a world of knowledge and I trust her more than my vet. My Puddles had horrible fur a couple years ago (I thought she was on death's door) and with Sugarcatmom's help I got her on a quality canned, now raw. Her fur is like a young adults, I can't believe what changing a diet can do.

[margot]

I cannot thank you enough. We will start with a diet change tonight, mostly his normal soft with just a bit of kibble until he is going to forget all about the kibble part. We had used "better" healthy food from the pet store (as recommended in the link) for him to begin with until the bowel syndrome started six years ago and the vet highly recommended a switch to the hypoalleergenic food. We will return to the other food - I remember Finnegan loved it.

Absolutely delighted with your insulin advice - re Levemir - my husband is a diabetic and had in fact considered just the scenario you are describing of mixing long-term and short term, but it is such a scary step to take (since, as you say, most vets are not familiar with it, or I should say, don't spend the time pursuing it). We will start on that once the diet change has been made and we know where we are at carb-load wise.

And your skin condition comment makes just total sense........thank you.......and thank you for being there in future since undoubtedly there will be many insulin questions we may have. Re the slippery elm - purchased some on the way home - am I correct that the tiny amount you recommend is to be given in addition to the probiotic?

This is what we needed. I have to tell you that I cried when I read it - one finds oneself in this spiral of trying to do one's best for the little thing and tends to listen too much to "medical advice"......when I know very well that everything should be taken with a grain of salt and that one has to do one's own research for one's own health - I am also a vegetarian and have travelled quite a long road in that regard, and thankfully am in perfect health at this stage of my life.

[margot]

Dear Sugarcatmom, and Love4himies, you could not be more correct about Sugarcatmom's large contribution to this forum.

Oh my goodness. I have to immediately report on the latest happenings taking Sugarcatmom's advice - and thank you for not only giving advice but also carefully listing all of the links that support your thoughtful comments. READ THE INFORMATION IN THE LINKS. And again, DO NOTHING WITHOUT READING THE INFORMATION IN THE LINKS. The most important factor......you must monitor your cat's blood glucose level if you decide to go on this journey, and you or your vet must do it straight away if you are changing his diet from a high carb one (reduce or eliminate kibbles and instead feed more soft food), our cat reacted immediately. There was a sentence in the links DO NOT WAIT EVEN FOR A DAY BEFORE RECHECKING THE CAT'S BLOOD IF YOU CHANGE THE CARB RATIO IN HE DIET. We started last night reducing the kibble part of his diet to half of what it was before (we weighed it) and gave him a much larger portion of his soft food to make up for it. He was fed at 6:30 and his blood glucose reading was at 22 at the time of feeding. Just as a precautionary measure we decreased his Lantis shot from 6 to 5, and checked his blood again four hours later at 10:30 p.m.(prior curves we did showed that after 4 hours he probably reaches his lowest point and the blood sugar slowly goes back up again after that) and his reading was 10.5, THE LOWEST IT HAS BEEN IN SIX MONTHS. We gave him a bit more soft food just as a precautionary measure against his possibly going any lower - and measured again an hour later just before midnight and he was still at 10.7even though the body had the extra bit of food to deal with. A wonderful AND IMMEDIATE result.
This is the next morning and we cut his kibbles in half again (very small portion now), increased his soft food a bit more, and decreased his insulin from 5 to 4 units. I am home today and will monitor in four hours. By the way, he just finished all of his soft and is leaving the kibble for last - cutting kibbles out altogether will not be any problem at all. I will change the MediCal Hypoallergenic food (you are so right about the high potato content in the kibbles, totally counterindicated for a diabetic cat) to one of the low carb soft foods indicated in the links, I'll purchase it today.

[sugarcatmom]

Fantastic!!!! I am soooo thrilled to hear this, it totally makes my day. I was just on my out but wanted to see if you had a Finnegan update, now I'm happy that I checked. Keep up the good work! And let me know how things progress. If you have questions about anything at all, just ask, I'm happy to help if I can.

[margot]

Dear Sugarcat Mom,

I wanted to wait until Sunday to give a further (unbelievable) report on Finnegan's condition, we devoted the last three days to transforming all of our lives. We made relatively frequent spot checks for blood glucose levels, clearly totally necessary since at one point we actually had to deal with a low, totally unexpected. Finnegan's diet is now almost completely changed over - we totally stopped the MeDiCal Hypoallergenic kibble portion of his food early on, and gradually switched his Hypoallergenic soft food over to Wellness soft food, tonight he will get his first meal enitirely his new food, rather than the mixture of old and new. Here is the unbelievable news on two fronts:

HIS LANTIS DOSAGE IS DOWN TO 2 UNITS MORNING AND NIGHT FROM THE 6 UNITS MORNING AND NIGHT HE WAS ON only four days ago. His low point on his blood glucose curve is a healthy 10.5 on the new dosage.

HE HAS NORMAL BOWEL MOVEMENTS, NO DIARRHEA WHATSOVER, AND IS DEPOSITING THEM WITHOUT PROMPTING IN HIS LITTERBOX. I am still adding the probiotic, which I assume can't do any harm long-term.

A total life transformation within three days......we are elated, delighted, and speechless and Finnegan has also picked up again all of his normal behaviours, he is grooming, he is playing, his fur is beginning to look better, and his eyes are clear and green.

Come Monday his new life will begin, and we would like to enlist your further help regarding short-term/long-term insulin. Of course we will wait a couple of weeks or so since there may be further changes, but whatever dosage Finnegan ultimately arrives at, we want to take the next step of avoiding this endless curve up and down created by short-term insulin only, and want to introduce an additional step re adding long-term, which likely means Levemir. I understand you have some experience in this regard and we would appreciate your advice as to how to approach this combination approach.

[sugarcatmom]

Originally Posted by margot

HIS LANTIS DOSAGE IS DOWN TO 2 UNITS MORNING AND NIGHT FROM THE 6 UNITS MORNING AND NIGHT HE WAS ON only four days ago. His low point on his blood glucose curve is a healthy 10.5 on the new dosage.

HE HAS NORMAL BOWEL MOVEMENTS, NO DIARRHEA WHATSOVER, AND IS DEPOSITING THEM WITHOUT PROMPTING IN HIS LITTERBOX. I am still adding the probiotic, which I assume can't do any harm long-term.

Super! It's amazing what feeding an appropriate diet can do for our cats. Too bad more vets haven't made the connection. And yes, the probiotics are fine for the long-term. You may find at some point you can try a day here and there without them to see what happens, but there's no harm in using them regularly.

Originally Posted by margot

Of course we will wait a couple of weeks or so since there may be further changes, but whatever dosage Finnegan ultimately arrives at, we want to take the next step of avoiding this endless curve up and down created by short-term insulin only, and want to introduce an additional step re adding long-term, which likely means Levemir. I understand you have some experience in this regard and we would appreciate your advice as to how to approach this combination approach.

Cool. I agree that it would be a good idea to stick with the Lantus for a little while longer. It's possible that with a bit more tweeking of the dose, you'll find the sweet spot that keeps Finnegan's blood glucose fairly level. Many cats do great on Lantus, even eventually coming off of insulin altogether. If there comes a time when you think the Lantus isn't keeping Finnegan as tightly regulated as you'd like, I'd be happy to help you through the 2-insulin process.

Just a word of warning - your vet may not be as keen on the idea. I actually had to sign a waiver at my clinic saying that if anything happened to my cat, they were not liable. This was mostly due to me using Levemir, which very few cats in the world (and none in Canada at the time), had ever been on. Since I was 3 years into my cat's diabetes treatment and was already making all the dosing decisions anyway (diabetes is a home-managed disease, after all), I felt confident in my abilities and wasn't actually asking the vet for permission on this. I did want to keep them in the loop as to what was going on though. It's still important to maintain a good relationship. As it turns out, they were quite fascinated by my progress. I sent them regular curves and all the spot check numbers which I keep a log of every day. Which reminds me, do you have a log book of some sort where you can write down Finnegan's bgs and other notes like what and how much food he ate, how much water he drank, how many times he urinated, etc? If not, I can email you the Excel spreadsheet that I use.

[Love4himies]

Ohhhh I am so happy for you and Finnegan


Isn't sugarcatmom the best!

[margot]

Thank you both so much for your good wishes, we most certainly have a new lease on life. A happy cat, no clean-ups, no stress.....wow! Feels like old times. Dear Sugarcatmom - we are quite prepared to go down this road alone, and already know that the vet will NOT be of any help once we add long-term insulin to the mixture, we just talked about this at home the other day. Just getting the vet folk used to the idea of Lantis was already somewhat outside their comfort zone! And I agree, keeping the vet informed and on side is an important step. We may actually look into perhaps switching to a more informed practice as far as feline diabetes is concerned. We will stick with Lantis alone for just a little while longer until the ultimate Lantis dosage is clear and consistent. But we know that this does not mean that the cat is controlled per se, just looking at the curve shows this very clearly. Up and down. If you don't do that to a diabetic human, why do it to a cat??

Oh you bet we monitor how often he urinates and poos ......we are in paradise......one firm bowel movement per day for the first time in seven months.........and how well he eats and drinks. But you are so right, I have to actually mark this down, and I would be grateful for the spreadsheets, thank you, it's so important to keep track. I am just finishing up the last few packages of Forti Flora and will pick up the Ultimate Multi Probiotic tomorrow - I think this is in capsule form, how much should we give him per meal? The full contents of one capsule or is that too much?

Thank you so much.

[sugarcatmom]

Originally Posted by margot

I am just finishing up the last few packages of Forti Flora and will pick up the Ultimate Multi Probiotic tomorrow - I think this is in capsule form, how much should we give him per meal? The full contents of one capsule or is that too much?

A full capsule would be too much. I'd be more inclined to start with about 1/6 of a capsule twice a day, which would provide 2 billion organisms per dose. Doesn't have to be super-precise.

I'll pm you my email address so I can send you the spreadsheet that I use. It can be quite useful for keeping track of any trends or trying to figure out what might be influencing blood glucose levels.

[margot]

I have received the spreadsheets, thank you, this will be most helpful in monitoring. Finnegan continues to improve and spotchecks have shown that his insulin dosage is keeping him as well controlled as his short-term insulin (Lantis) is able to - which still means a constant blood glucose up and down since he is at his lowest four hours after his injection (which happens at meal time), then it climbs steadily and the insulin peters out after about 7-8 hours. Starting at a reading of 22 or so, going down to 10 or 11 and winding up 7 hours later at a much higher reading again is a roller coaster for a cat, not "control". Since he gets a shot every 12 hours (and giving it more frequently would cause "stacking" and all kinds of problems) it means that for approx. 4 hours out of every 12 hour period he is uncontrolled. We will wait another week for everything to settle and would then like to take you up on your offer of sharing what you have learned about adding long-term insulin so the cat remains controlled for longer periods at a more even level.

His new food (Wellness) has done a remarkably fast job of alleviating his former bowel movement problem (very soft consistency and going outside the litter box), he now has one normal bowel movement a day, placed in the box. Thank you again for taking this journey with us, and we will check in next week.

[Khari]

Holy smokes.....I am so happy to hear the change in your cat in such a short period of time. I am not familiar with diabetes but as soon as I read you were feeding him Medi-cal Hypoallergenic I felt this may have been contributing to the problem of his IBD forsure.

My cat had soft stool/explosive diarrhea problems for YEARS. The vet pumped him with medication and said he had a sensitive stomach. The vet said I should feed him Medi-cal Hypoallergenic which I did and his diarrhea always came back. So we switched to Royal Canin Sensitivity and of course it would return on this crap as well Finally after years of being naive and my vet not looking at anything but his wallet I started doing research of my own on feline nutrition. I was going to switch both of my cats to a grain free canned food diet. I luckily stumbled across raw feeding for cats. I started Bishop on this diet in September of last year and by mid October his diarrhea was completely cleared up. His fur coat is shiny and soft (not flaky and dry like it was on the other crap I was feeding him). I have had to tweak his raw diet over the months to suit his needs but I am proud to say that his diarrhea has not returned once....The funny thing is that I am doing an elimination diet now for him because I am coming to find that he is allergic to chicken (he scratches himself crazy when fed chicken). I wish I would have done an elimination diet for his diarrhea many years ago but I had no clue that he could be allergic to certain meats or ingredients. I didn't quite understand "sensitive stomach" I just believed and trusted what my vet told me. Another vet (who supports raw feeding) thinks he has IBD??? So, this is why we are tweaking his diet to suit him

Now if I do have to feed Bishop a canned food I make sure it is grain free and his diarrhea still does not return

Good luck and I am so glad that Sugarcatmom has helped your kitty out

[margot]

Dear Khari,

Aren't we are in the same boat, what a sad story, and it exactly mirrors ours. And years is the operative word - it is only within the last two weeks - since Sugarcatmom's intervention, bless her, and the change to, in our case, Wellness food (grain-free) ,that his diarrhea problems stopped, from one day to the next. Finnegan has normal bowel movements, deposited appropriately in the middle of his litter box - apparently for admiration purposes after all these years of misery. What absolutely bowls us over is not just the eradication of the bowel movement problem that I originally write in about, but in our case it also made a huge difference with our diabetes problem. Again, the same problem that Sugarcatmom herself also experienced - vets automatically put all cats on Caninsulin which causes huge spikes in blood glucose readings - i.e. a roller coaster of high and low and is far from being the answer for all diabetic cats. We switched ours to human insulin, i.e. Lantis, and have had far better results with this, but his blood glucose readings remained high, and the curve was fairly steep, and the insulin dosage was high. Since switching the food we were able to cut the insulin dosage (morning and night) in half, and his Lantis curve shows that it is much wider and longer, and he reaches his lowest point in six hours when before he reached it in four hours. I am attaching yesterday's curve (a 12 hour one......exhausting for all concerned, but I think we have reached a pivotal point) which will be of interest to Sugarcatmom whose advice we need once again in order to take the next step. Lantis and Caninsulin and other insulins are short-term insulins only, normally given every 12 hours, but of course they don't keep the cat controlled for 12 hours and peter out long before that and the cat is high again. Ours started at 18.8, went to a low of 6.8 (you don't want to go lower) and wound up at the end of the cycle with 23. While the attached curve is probably the best one can achieve with a short-term insulin such as Lantis, what we want to do now is add a long-term insulin, namely Levemir, to the mix. Sugarcatmom has already done this. Levemir will produce a flat long curve and one still has to add some of the short-term insulin which will essentially only deal with the food for a couple of hours or so. It's all easier to calculate if the cat eats at the same time twice a day and there is no free feeding in between. Using Levemir will keep a diabetic cat at a fairly even level for 12 hours, it's hard on the body, this constant up and down. That's why human diabets on insulin are on both a short-term and a long-term insulin. So, Sugarcatmom, having been there and done this - once we start on Levemir next week we know we need to reduce his present dosage of Lantis (it's 3 units right now) because the two insulins together would push him too low during low point times. Any suggestions as to where to start dosage-wise? Let me try and attach the curve. thank you.

[sugarcatmom]

Hi margot,

Very interesting curve. You're right, it is on the steep side, but it does show that Finnie is at least responding to Lantus. How long was he on the 3 units for?

Couple things about Lantus: it is actually supposed to be a medium to long-lasting insulin for cats, although that varies quite a bit between individuals. Some cats only get about 8-9 hours duration (as appears to be the case with Finnie), some get up to 14. I would not recommend combining Lantus with Levemir, there's going to be too much overlap between the two insulins. Both have a bit of a delayed onset and could potentially peak around the same time, which would be a huge risk for hypoglycemia. There are some people that use Lantus with Humulin R, but that isn't very common. The best combo is Levemir with R.

You can get R from the pharmacy without a prescription in Canada, and a 10ml vial lasts a long time if handled properly - 2 years for Aztec and I. It's very fast-acting and has a consistently short duration. Onset is within half an hour, peak is between 2-3 hours, and it's out of the cat's system shortly after (4-6 hrs). The reason this works with Levemir is because in most cats, Lev doesn't kick in until about 2-4 hrs post shot, and it peaks anywhere from 6-12 hrs, so you don't risk having both insulins reaching their most potent point at the same time.

How much Lantus do you have left? If you want to finish out the vial and then make a switch to Levemir, that would be okay. You could try a slightly bit higher dose, like 3.5u, and see what happens after another week or 2 (a dose change with Lantus can take up to 10 days to "settle"). Try to get lots of spot checks between +4 and +8 if you can, to see how low his nadir is going. It would be ideal if that stretched out the duration without dropping his nadir down much more.

When you do go to Levemir, I would start at no more than 1 or 1.5 units for a few days, without any other boosters. You can raise the dose quickly, like every 3 days, if you aren't getting results, but it's important to get some data on how Finnie responds to Levemir before you add another variable. For example, onset is usually around 2-4 hours for Aztec, but I know of someone else who's cat reacted to Levemir within the first hour and if they had started using boosters right away, it would have surely been quite dangerous. Remember, it takes a while for high numbers to do damage, but low numbers can kill quickly.

Once you're at the point where you want to add an R booster (and not everyone needs to, that's where gathering as much data as you can before hand is necessary), I wouldn't give more than 1/2 unit. In fact, in Aztec's case, he never needs more than 1/3 of a unit of R, and 1/4 unit usually does the trick.

Some general info on Levemir for you:

• Keep it refrigerated, and an open cartridge should last for months and months. It's much less fragile than Lantus, and even with Aztec's low dose of 1.25u bid, I can usually use a cartridge to the last drop. A cartridge 5-pack lasts for more than a year for us, bringing the price down to about $10/month (darn cheap!). My understanding is that Lantus needs to be replaced every month or 2.
  
• Like Lantus, it shouldn't be diluted, or mixed with another insulin in the same syringe.
  
• It's not a good idea to use the Levemir FlexPen because you can only use whole unit doses, and where cats are concerned, dose changes should be no more than 1/2 units (preferably 1/4 units, if you have a syringe with 1/2 unit markings).
  
• As with any insulin, it's a good idea to warm it up slightly in your hands before injecting it to minimize the sting.
  
• While Levemir is sometimes considered "peakless" that isn't always the case with cats. Yes, it's action is gentler and more even than most insulins, and if you can manage to utilize the overlap potential between injections it's possible to get a nice flat curve, but you're still likely to see some peak activity. What's really interesting and a challenge to work with is that sometimes your peak is at the same time as your preshot. This means you may even be shooting insulin at low bg numbers. I don't suggest anyone do that until they've gathered lots of data though. Know thy cat!

[MadeleineI]

Diet is SO important. Did you know that in ONE month 6 people completely came off ALL their insulin when they converted to a raw diet? ONE MONTH! So I would make a totally raw diet your goal.Well done anyway!

[sugarcatmom]

Originally Posted by MadeleineI

Diet is SO important. Did you know that in ONE month 6 people completely came off ALL their insulin when they converted to a raw diet? ONE MONTH! So I would make a totally raw diet your goal.Well done anyway!

It's not so much a raw diet that helps a diabetic cat go off of insulin, but more the fact that it's low-carb. Most cats become diabetic because of a lifetime of high-carb dry food. So while raw may be the ultimate, switching to a quality grain-free canned food is just as likely to improve blood glucose levels.



I read some of your blog and agree with most everything you say, except for this comment:

A well fed cat can easily go a few days without eating.

Not entirely the case. Cats should ideally not go more than 24 hrs without eating, and most certainly not more than 48. Because of the unique feline metabolism (which doesn't down-regulate when there's a lack of caloric intake), they are prone to something called hepatic lipidosis. Fatter cats are especially at risk, but it can happen to any cat. Plus, some cats get nauseous when they don't have food for a day, which throws them into a cycle of inappetance from not eating, and not eating because of inappetance. Can be tough to break that.

And thirdly, a diminished appetite can be the first sign of illness. By the time a cat stops eating, it's possible that they're quite sick. For instance, my cat, Egypt, suddenly refused all food, even his most ultimate of treats, chicken baby food. We go to emergency that night, and he gets an ultrasound. Gall bladder was completely blocked and on the verge of bursting. There was absolutely no other sign that anything was remotely wrong and if I had ignored this crucial sign, he likely wouldn't have survived.

Sorry for the thread-jack, just something I feel strongly about.

[margot]

Dear Sugarcatmom and Madeleine1,

Thank you both for your response. Madeleine1, you are so right, clearly diet is all! The fact that our cat responded within only 12 hours to a change in carbs and switch to another food seems to indicate that it is indeed possible that a cat won't have to rely on insulin any longer within a short period of time. We will be looking into the possibility of raw food once his diabetes is properly controlled, right now we are just so glad that his years of bowel and diarrhea problems have disappeared almost overnight through the switch to Wellness canned food from the Hypoallergenic MediCal vet food he was on for so many years.

Sugarcatmom, thank you for asking the question that reminded us that Finnegan has only been on 3 units of Lantis for a relatively short period of time (down from 6 units), namely since we cut the carbs and swiched his food. We have decided to keep him on Lantis for another week, just to see if there might be any further changes in his b.g. curve. We were encouraged to see that his low point now happens after six hours rather than 4 as was the case in the past, and of course his low point was never sufficiently low anyway, and that the low numbers last for a couple of hours or so before going back up when before his low point went up immediately again. And thank you for pointing out that Levemir is really not the short-term insulin I thought it was, and his latest curve clearly shows this.

If we don't see any significant change in his next curve in another week - a good bet, but you never know - we wil switch to Levemir combined with Humolog R, starting with a few days on Levemir only to see what response he has. Frank, a diabetic, agrees that Humolog R is designed to essentially cover one meal only, and therefore the best and most short-term addition to Levemir. And thank you for passing along the cost as well, I think all of us who have had long-term health problems with our cats and are looking at our vet bills over the years would agree that an investment in the appropriate insulin and food that keeps our cats healthy and happy is a bargain!

And Sugarcatmom, I think I need to stress again that the high level information you provide to us is absolutely priceless and not available from most vet clinics, I would guess, to those of us who need it. All the research you have done over the years, and then put into practice with Aztec, the kitty with the beautiful stripes, is now helping so many others and we are grateful that you are sharing your information and experience with us.

I will check in again shortly.

[margot]

CORRECTION. This sentence appeared at the end of the 2nd paragraph:

"And thank you for pointing out that Levemir is really not the short-term insulin I thought it was, and his latest curve clearly shows this."

I meant to say that LANTUS is not short-term, and Levemir is clearly a long-term insulin.

Sorry - read thy post before you post it

[margot]

Here is an update on Finnegan. I noticed, to my amazement, that my first posting was done on July 19, in sheer and utter frustration. Within a day or two our lives turned around, and I want to thank our fairy godmother SugarcatMom who saved our mental health and all the other experienced people that wrote in with their observations. When I first wrote Finnegan was on 6 units of Lantis morning and night, but showed very high numbers and his blood glucose reading curve was very much up and down. He had ongoing diarrhea - outside the box - became more and more withdrawn, sinking fast in fact, and his beautiful Maine Coon fur was just flakey and dull despite brushings. Despite many visits to the vets there was no change in Finnegan's conditions. SugarcatMom advised us to switch from his vet presribed GastroHypoallergenic from Medical (totall the wrong food, high in carbs, and he ate both soft food and Medical kibble, the kibble was extremly high in carbs, with potatoes listed right up there). As soon as he started on his wellness food we had to reduce his insulin dosage, he responded so quickly. His diarrhea problem stopped within a couple of days. At this point, a month and a half later, Finnegan is healthy and happy, picking up all his old behaviours, wanting to play frequently, his fur is shiny and beautiful, and life is good. No diarrhea recurrence whatsoever, totally normal toilet habits. What we still have to deal with is some insulin tweaking, which we are doing with Sugarcat Mom;s help. At this point he is on 2 units of Lantis morning and night and we just took an all day curve on Sunday. The curve is flat, which means he is well controlled over the 12 hours period, without the ups and downs he has experienced. It ranged between 16 and 19 over the 12 hour period, and that is very, very even, with only using one insulin. But it is still a bit on the high side (although it feels like Nirvana compared to the numbers he used to have) and we are now increasing the dosage to 2 1/2 units of Lantis morning and evening and hope that the numbers come down and the curve remains nicely flat.

My thanks go to everyone associated with this marvellous service that you are providing to the public - I don't believe I am exaggerating if I am saying that it has saved our cat's life and his people's sanity.

[margot]

Further Update on Finnegan.........oh joy..........wondrous things do happen in life - as of a few days ago Finnegan is diabetes-free and does not require insulin any longer. The last few weeks we gave him miniscule amounts of insulin because we thought he still needed some, particularly to deal with the two feeding periods - he doesn't, as we found in doing spot checks and doing a curve. I know one of the individuals responding to my post mentioned that cats actually do achieve the impossible once they are on a proper diet, and this is the next wondrous thing that has happened to us. Thank you to all of you and particularly to our fairy godmother - you have given us back our kitty.

[Love4himies]

Wahoo!!!!

Sure would love to see some pics of your baby



So my question is why don't vet's know about cat nutrition and how to possibly reverse diabetes? It is well documented that diabetes can be reversed in humans when they loose weight and change to a healthy diet.

[catlover2]

I love reading success stories like this. Kudos to all, especially SCM for her great help.

[Khari]

Wohoo....I am so happy with the great progress for your kitty!!

How are the bowel movements now that he is on a better cat food?

[chico2]

What a wonderful post,I read it all,we already knew SCM is our cat-gury,but I think this time she literally saved Finnegans life we are very proud of of her
I have a very weak spot for Maine Coons,would love to see a pic of him,please

[margot]

Oh you guys, thank you for all your good wishes. We are so thrilled. Chico2, there is no doubt in our minds that Sugarcatmom's good advice was instrumental in Finnegan regaining his health, and she certainly saved his life. As the old saying goes, you save a life and it's yours - undoubtedly there are many fluffies walking around that belong to SCM.

Khari, his bowel movements have totally returned to normal and are being deposited in his litter box. For some reason he is not burying them anymore - maybe he is leaving them for us to admire. And I do, I do, I stand there and smile before cleaning them out. Life is good!

Love4hymies, it is indeed a sad situation if the regained health of your pet is not related in any way to the care it received from your vet. It is reprehensible that we were not told that MediCal soft food and kibble, purchased at this well established vet practice for years, upon their advice, is totally counterindicated for a diabetic cat. Never mind assistance in more sophisticated diabetes management than Caninsulin, which did nothing for our cat. Nor was there any mention of the possibility of reversal of diabetes. Needless to say, we are searching for more well informed and enlightened health care for our loved little one.

As for pictures, Finnegan (who was a rescue kittie) is indeed one of those very long, muscular Maine Coons, and his "double fur" is showing again (Maine Coons and Norwegian Forest cats have an undercoat - no doubt designed for snowy woodlands). This also provides hours of entertainment since lots of brushing and combing is necessary. We thought it would be only fitting, and celebratory for all of us, to take some new shots over the weekend, to start his new life! I will post a photo soon.

For those readers interested in blood glucose readings, since we are still in shock and disbelief, we are still doing the occasional spot checks, and will probably continue for just a little while. His before breakfast reading this morning was 4.9 and before dinner it was 6.9, quite similar to the days before. All with NO insulin. We are still keeping the diabetic chart for him originally recommended by SCM, just for the pleasure of being able to enter 0.0 of insulin. If you look at the numbers in some of my earl posts you understand why we are so elated.

Thank you again for your support - I particularly enjoyed the group hug!

[nljnky]

This is such fantastic news!!! What an awesome way to start my Sunday.
Sugarcatmom saved one of my babies from surgery, so I am also grateful to her forever.

[Khari]

[QUOTE]

Originally Posted by margot

Khari, his bowel movements have totally returned to normal and are being deposited in his litter box. For some reason he is not burying them anymore - maybe he is leaving them for us to admire. And I do, I do, I stand there and smile before cleaning them out. Life is good!

Yay I am so relieved his bowel movements are back to normal. Your case was a prime example that out of the norm bowel movements can mean something is wrong with the cat. That's why it is important for more cat owners to become aware of their cats litterbox habits. Bishop doesn't cover his business in the litterbox as well but it is a good thing b/c then I can tell the difference between his and Lexus's potty movements. She covers hers like there is no tomorrow

It is reprehensible that we were not told that MediCal soft food and kibble, purchased at this well established vet practice for years, upon their advice, is totally counterindicated for a diabetic cat. Nor was there any mention of the possibility of reversal of diabetes.

It is very sad and frustrating. This seems to be the norm at many vet offices these days. They push the vet prescribed foods so much that they are actually doing more harm then more good for our cats. Not only with cats with diabetes but many other diseases and conditions. On this other group I belong to there is a long time member who keeps on pushing vet prescribed RC foods (I think mainly the diabetic one) on the members. And because she is a long time member and has a well recognized vet and research to back up what she is saying many poeople feed this crap to their cats. Also, she pushes the lower end cat foods as well (Purina One, Friskies).....I have to bite my tongue so often. I stay on the group b/c of the other wonderful advice I have learned for my cats health. Anything she says goes in one ear and out the other. Too bad this is not the case with some other members. :sad::sad: