Case:JulieandSmokey

Smokey:Feline
Male
Click for bigger Smokey
Born	May-1992
Dx	Aug-2005
Oral meds	Benazepril, Derm Caps:
Regulated	AUG-2006
Regulated between 40 and 200
preshots average between 70-125
Remission	Not-yet
Insulin	Levemir U100

Smokey was diagonosed as a diabetic 8/22/05. He is 13 years old. I have had him since the second he was born. His Mom died giving birth so I raised him from minute 1 and bottle-fed him and his brother! He is at 16lbs 10oz. down from 23 1/2 lbs. in Feb. 2005. He is now eating Wellness Wet, Nature's Variety Prairie Wet and Fancy Feast Wet flavors with no wheat gluten BID.

Smokey was sent home from initial 5 day hospital stay on 4 units of compounded PZI (R with PZ) once a day. His BG was supposedly regulated around low-mid 200's when he came home. This was obviously not the case...we had a very bad experience with his vet and thanks to the folks at FDMB they gave me the courage to leave him and start hometesting and do what is right for my baby...and because of hometesting Smokey is alive today. He had a very bad hypo while on Humulin N for a brief time. He was down to 35 and seizing...after a trip to the ER he was fine and didn't seem to show any adverse reactions from it. He is now on BCP PZI U100 insulin. I have on occasion used Humulin R as a booster to bring down extremely high BG levels.

Until recently, Smokey was on the verge of becoming regulated thanks to alot of help from FDMB and a lot of patience. Also, removing all dry food and his regulating meal time has made all the difference in the world to his BG levels.

Further Reading

Click here for Smokey's data on the FDMB site

Click here for Smokey's current BG's

Hypo-prone

Smokey is prone to having or nearing hypoglycemic blood glucose levels, especially when shooting insulin at preshot (PS) values of about 250 and less. On four occasions in November and December 2005, at PS values of 168, 254, 200, and 174, he attained BG readings of 27 at +3.5, 42 at +4.5, 83 at +3, and 65 at +2, respectively. Smokey also went near hypo values in November 2005 at a PS of 588--67 at +5. In these cases, Smokey was given an appropriate insulin dosage given the PS value, recent dosages, and recent spot checks of nadir values. In all cases I intervened with at least wet food; in some cases with dry food and Karo syrup. As a result of the intervention or rebound or both, his subsequent PS readings were in the 400s or 500s. In most cases, the hypo events were asymptomatic but in one case he was "twitching" for a couple of days.

Extended duration

In December 2005, Smokey started to get extended duration from the BCP PZI on some cycles that produced +12 BG readings too low to shoot because of his propensity to hypoglycemia. The effects of the shots on those days lasted until about +18.

Recent events

In December 2005, Smokey had a seizure event apparently unrelated to his blood glucose level (315 at +7.5). Because of the wide swings in his BG levels, the vet has ordered him off insulin for a week, believing that his erratic reaction to insulin indicates that his diabetes may be able to be diet-controlled.

Unfortunately, after a 5 day trial of going without insulin, Smokey is not ready to be diet controlled. He varied from a low of 258 to a high of 502 without insulin. Although many of the spot checks were lower than some of his PS while on insulin, they are not low enough to go without. I am still hopeful that with time and patience we may be able to achieve diet control.

May 5, 2005 Smokey is starting on Levemir today. While he usually has a great cycle on PZI, often spending most of the cycle in non Diabetic numbers, he skyrockets to over 500 almost all of the time by +10 or +11. We are hoping that Levemir is going to provide his with a much smoother flatter cycle without all of the dramatic increases and decreases

May 22, 2006 Smokey is doing much better now that he is on Levemir! we have had a few bad days, but mostly very good..those days of preshots in the 500's seem to be a thing of the past. Levemir is giving him a very predictable, smooth cycle. We are still working on finding the correct dose that doesn't drop him too low or leave him too high..but I am confident this will be achieved soon..Smokey has dropped down into the 50's and 60's on Levemir a few times, but interestingly hasn't had any hypo symptoms like he normally had on PZI. Of greatest notice is the lack of twitching when he drops too low and rebounding sky high after he drops too low.

June 9, 2006 Smokey continues to do well on the Levemir. He has been below renal threshold all the time for the last several days. He is feeling great. He is acting like the lazy kitten he used to be..playing a bit, but not too much. After FD diagnosis he did nothing but sleep all the time..so it is nice to see him somewhat active again. He has even started a couple of fights with Sneakers my civie. This hasn't happened in over a year...as much as I hate the fights, I know it means he is feeling great. His urine has been consistently negative for glucose for the past few weeks. I am so happy with the progress we have made on Levemir. It has been a lifesaver for us.

August 5, 2006 Smokey was DX as early kidney disease...we have started him on Benazapril which is not a potent anti-hypertensive but helps CRD cats by improving blood flow and other mechanisms and also Epakitin 2x/day in his food..this is a phosphorus binder (he loves it by the way-weirdo). I have started him on fluids..a few times a week as a preventative as his CRD is very mild at this point..although it looks like we may not need to continue this..but as long as it isn't harming him I may continue..I have been advised though from the CRF board that because his Potassium level is high we should be careful giving fluids..I have switched his foods to low carb and low phosphorus..the Great news is, my vet ran a Urine Protein-Creatinine Ratio on him the other day..this apparently shows how well the kidneys are functioning..normal range is 0-0.6 Smokey was 0.2! We are thrilled! We have been consulting with another expert in the field and she agreed this is great news and that BUN may have been so high due to his high protein diet..so, it looks like we are going to be ok after all..I am very interested in being proactive and doing preventative care at this point in hopes of preventing any further damage..BG's have been a little wonky lately but he seems to be back on track. I have attached a copy of his spreadsheet to my signature as my profile is not up to date..

here are his lab results 8/4/06 Cholesterol-190 Triglycerides-120 GGT-5 ALT-89 HI (0-89) AST-31 Total bili-0 Direct bili-0 Alk Phosphatase-56 Chloride-122 Creatinine-2.4 HI BUN-57.6 HI Calcium-10.1 Albumin-3.5 Total protein-7.3 Phosphorus-4.4 Sodium-168 HI Potassium-5.4 HI NA/k-31 A/g Ratio-0.9 Globulin-3.80 Bun/Creat ratio-24.0

USG was low at 1.018 UPC-0.2 (0-0.6)

September 22, 2006 Smokey is doing fantastic! he is a pretty well regulated cat now. I can't believe we made it..it took almost a year, but we did it! He is getting 100ml fluids every 3 or 4 days for his early renal issues. He is also taking Benazapril 2.5mg SID and Derm Caps regular SID in pm meal. We will be going in to rerun labs on October 30th and will discuss the use of Calcitrol at that time. He has been taken off the Epakitin as it really doesn't seem the best choice for a binder and also, his phos level doesn't warrant the use of a binder at this point.

November 10, 2006 It is with a very sad and heavy heart that I write this. Smokey crossed over to the bridge after a 2 week struggle and multiple operations for complications from bladder stones and urinary blockages. He succumbed to a pulmonary embolism (blood clot) and was not able to fight the valiant battle anymore. He left this world the same way he came into it, in his loving Mommy's arms. I will never forget you my sweet baby boy. You were and always will be the Love of my Life..I will honor your memory and Love you forever and a day..Until we meet again my Love, Fly free my Gray Angel!

January 2006.