Case:Patriot

Patriot:Feline
Male Domestic Shorthair Tabby

Born	Aug-2001
Dx	Oct-2005
Oral meds	:
Regulated	June-2006
Regulated between 60 and 150
Tightly regulated
Remission	July-2006
Insulin	Levemir

Diagnosis[]

October 19, 2005. No other health problems.

Weight[]

At DX, down from 15-17 lbs. to 11 lbs.

January 5, 2006 weight was 12 lbs. 2 oz.

May 19, 2006 weight was 13 lbs. 10 oz.

Symptoms[]

Excessive peeing, drinking, weight loss, loss of appetite, lethargy, poor coat/dandruff.

Insulin - Levemir (was PZI previously)[]

Began PZI Vet (IDEXX) October 19, 2005. 1u one time a day for the first two weeks, then 1u two times a day, 12 hours apart. In retrospect, we wish vet would have had us hometest and started with two shots a day right away.

Switched to BCP PZI the evening of February 10, 2006.

Switched to Levemir the evening of May 22, 2006.

Dosing:

Levemir has a slow 3-4 hour onset. Patriot had a difficult time keeping duration. To combat this problem he began a split dose regimen. One half of his dose was given at preshot time and the other half was given 1 to 2 hours after preshot. TID was attempted when I had a week off and resulted in remission.

Patriot was also prone to a rebound reaction due to steep drops or normal non-diabetic numbers being reached. When his numbers were in the high 400's to 500's at preshot time, typically due to rebound or lack of duration, he might get a .1u or .2u dose of Humulin R to bring the number down in the first four hours before the Levemir kicked in. One goal was to get him in a 60 - 150 range so I could get his body used to normal numbers again in the hopes we could overcome the rebound tendency that is holding him back.

Home Testing[]

Yes, absolutely! I use the One Touch Ultra Smart (which ran 10-20% lower than Vet lab blood test). Patriot had a test before EVERY shot without fail, along with lots of spot checking and curves. The results are recorded in an Excel spreadsheet^[1]as well as a Word document where I can include additional information related to times and what food was fed.

Check out Patriot's profile where you can see his BG readings (scroll down in the profile to find them.)^[2]

Diet[]

Up to the time of diagnosis was fed primarily dry food with occasional wet food for a treat. At diagnosis, was prescribed dry D/M and wet M/D or D/M. Patriot loved the dry D/M and would not eat the M/D or D/M wet. With insulin and the dry food he began eating well again. BUT...

My own research indicated strongly that dry food was the equivalent of pouring gasoline on a fire (his diabetes) and that a wet food only diet consisting of less than 10% carbohydrates would improve his chances of remission. Though the vet’s argument for keeping dry out for grazing so he would have a steady flow of food over the course of a day made some sense, it made better sense to keep extra wet food out for half his cycle. One week after diagnosis all dry food was removed from the diet and replaced with low carb Fancy Feast. A month later the diet was changed to include Wellness and a raw food diet. Currently diet is half wet food and half raw food that I prepare myself.

Want to start researching diet too?^[3]^[4]

References[]

History[]

March 24, 2007: This day marks as many days off insulin as he was on insulin, about 8 1/2 months of each. Still off the juice and in non-diabetic numbers, woo hoo!

Month 12: Happy Anniversary! Remission has stuck so far, it is now October 2006 and he ranges from the 60's to 80's.

Month 9: On July 6th, after six days of TID, the last two days of which the numbers were so low he had to go back to BID, Patriot received his last shot in the morning. He is off insulin but ranging a bit higher than I like so I don't know if the remission will stick. July 15th update: Still in remission and numbers are in 80's and lower.

Month 8: We are on Levemir, and Patriot's two big problem areas are still lack of duration and steep drops that incite a rebound response. We began using a split dose routine in an effort to extend duration and soften lows and it worked! Over this month glucose went to negative on the urine dipstick. By the end of the month Patriot was tightly regulated between 60 and 150.

Months 6-7: We've had a set back and are experiencing glucose toxicity again. Much like starting over. In March it looked like we were making progress toward regulation but we have lost it. I've made a decision to try Levemir. Patriot had a vet check and blood work on May 19, 2006, and received his prescription for the insulin Levemir (thanks Dr. Miller!). Began Levemir May 22, 2006.

Month 5: BCP PZI has moved us forward more I think. He is getting intermittent lower preshot values though he drops steeply at peak. The 2.5u dose doesn't seem quite right but raising slightly past it sends his numbers plummeting through peak and rising fast through cycle end. Could be we are close to the right dose but need much more settling time. Time will tell.

Month 4: Well, we were making progress with PZI Vet but for cost reasons have switched to BCP PZI. Higher preshots have returned but, the rest of the cycle is a lovely curve. Wow! There is settling time required here. Month 5 will be interesting.

In early January 2006 dose was reduced until high flat curve achieved for 3 weeks prior to beginning dose increases again. We are still trying to break glucose toxicity and begin bringing the BG's down into regulation range. He's a tough nut to crack.

Months 1-3: Fluctuating BG’s, sometimes steep drops followed by rebound. Lack of duration and peaks 4 hours after insulin was administered. Pre-shots typically in the upper 400’s to upper 500’s. Dose was slowly increased and rebound situations increased as well.

Patriot’s Story[]

Patriot was diagnosed October 19, 2005, though symptoms may have begun occurring six months prior.

In the spring of 2005 he uncharacteristically became very fat and lost interest in physical activity, though he would lie around and play if you dangled the toy over him. Patriot and his buddy Midnight were clearly overweight and their dry food only diet was changed to Science Diet Nature’s Best in an effort to give them better ingredients. Three feral kittens joined the family in late April 2005 and the focus was on socializing the kittens. It was a constant chore to keep Patriot out of the kitten’s wet food, in hindsight he knew more about what was better for him than I did.

By late June 2005 the Litter Robots began clogging due to larger than usual urine clumps and when Patriot covertly used the kitten litter box, it became apparent that Patriot was the one urinating more. Water consumption was also up, but I thought it was due to the addition of two more cats (I kept two of the ferals).

In August of 2005 I changed dry food to Life’s Abundance in another effort to improve ingredients and promote weight loss. Both adult cats began losing weight, though Patriot lost rapidly.

By early September I was congratulating Patriot on how trim he looked. By early October I realized that Patriot seemed too thin and I could suddenly feel his spine and hip bones. His coat was scruffy and he had a lot of dandruff. I began watching him closely and realized he was ill. He began growling at the other cats, became needy, was urinating more, drinking more, and was very lethargic, sleeping much more than usual. Quite suddenly he decided to eat very little. I researched and suspected either a thyroid disorder or diabetes and I made a rush appointment with a new Vet as his old one no longer practiced. His vet visit confirmed diabetes. Patriot was only four years old, weighed in at 11 lbs. and had lost about a third of his body weight.

Within a month of treatment Patriot's coat lost its dandruff, he was eating well and looking better. Over the months, even though we struggled with high numbers he continued to improve physically, gained weight and took a run through the house at least once a day. When he became tightly regulated he turned into a frisky kitten-like creature again. Unbelievable the difference in this cat!