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a happy,
healthy life

2-year update

A frustrating beginning
My cat Pico Pico was diagnosed with diabetes in late January 2001 when he was 6 years old. I recognized the symptoms almost immediately as my mother was diabetic so I knew what to look for. The vet quickly confirmed the diagnosis and suggested starting Pico on 3 units of Ultralente once a day. He also put Pico on a high fibre diet and insisted that Pico had to lose weight. Pico has always been a big boy, at his December check up he weighed 19.1 pounds. Well from there my nightmare began. Because of my mother's diabetes I wasn't even remotely worried - thinking I could handle this no problem. What I didn't know then was that my vet didn't know how to treat this disease. But I trusted him and did what he told me to.

During the first month of Pico's treatment my vet never once ran a complete blood glucose curve - testing blood every 2 hours during the duration of a dose of insulin. He constantly increased Pico's insulin based on 1 blood glucose reading. He had me taking Pico for blood tests 2-3 times a day, 2-3 times a week - for which he charged me $18.00 a test. He never told me a thing about treating hypoglycemia. In less than a month Pico was up to 8 units of insulin and rather than showing signs of improvement was steadily getting worse. He was peeing and drinking up a storm.

Finding web resources and answers
But the worst part for me was that Pico's spirit was broken. I had always jokingly referred to Pico as my guard cat. He's a big guy. All of a sudden my big tough guy was hiding from me and everyone else. He was so stressed out from all the vet visits. I was devastated and thought I can't keep doing this to him. If I could see an end in sight, any signs of improvement at all, maybe it would be worth it. But with his constantly getting worse I couldn't stand to keep putting him through this. I spoke with the vet and we decided that if he didn't start improving right away that I would put him to sleep. My vet said that some cats never regulate. I came home that morning absolutely devastated. I sat down at my computer and posted my first message on the Feline Diabetes Message Board (FDMB). I called it Pouring My Heart Out and I cried with each word I wrote. Well I learned more about feline diabetes in that one morning than I ever thought possible. The amazing people on the FDMB saved my cat's life. The response I got to that initial post was overwhelming. And so consistent. People were all telling me that my cat was getting too much insulin too fast and was in rebound. I had no idea what rebound was - what people explained was that if a cat gets too much insulin and it's blood glucose drops too low or too fast, it can respond by dumping glucose that is stored in the liver.  This life-saving measure elevates the cat's blood glucose - and you see signs of high blood sugar. What you don't see is that this happened because too much insulin was given. A cat can only do this rebound process for so long and then the liver reserves will be depleted and the cat will crash in a hypoglycemic coma. The FDMB members all believed Pico needed his insulin decreased - not increased. They also suggested that  if I learned how to home test his blood glucose, we could avoid many of the stressful vet visits. They also asked if I was testing for ketones - that one question was the one that really hit home with me. I remembered my Mom had had to test for ketones and couldn't understand why my vet hadn't mentioned this to me. 

I didn't want to believe my vet didn't know what he was doing. I liked my vet and wanted to trust him. But the response to my message was so overwhelming and things people were saying was making sense. Someone recognized my e-mail address as being local and e-mailed me her phone number so I could call her. She recommended a new vet with experience treating feline diabetes and spent a good hour on the phone with me answering all my questions. My vet had been trying to get Pico into the normal blood glucose range for a non-diabetic. People from FDMB had told me that the bg range for a diabetic cat is quite different - 100-300 mg/dl. There were times during that first month when Pico had tested within the 100-300 range and my vet had continued to increase the dose. I also learned that there were other diet approaches that might work better for Pico and that losing weight during the regulation process may not be a good thing because of the risk of ketones developing. One symptom of ketones is weight loss as the body starts to feed on itself. 

Changing vets and starting new management techniques
That afternoon I went to pick Pico up and I had a long list of questions ready for my vet. To say the least I was disappointed with his response - or lack thereof. He dismissed my questions and concerns. He told me if Pico didn't look good over the weekend to increase him another unit. Also things were wrong. His vet tech who I really liked and was very good with Pico basically whispered to me that she thought I might want to try some different diet options. I told her I was considering different diet options that I had just learned about - especially a diet that is high in protein. low in carbohydrates that has been beneficial to some diabetic cats who do not have other health issues with their kidneys or liver. She then said she understood why I was so concerned about how stressed Pico was and how distraught he had been there all day. A few minutes later my vet told me how happy Pico had been there all day. I took Pico to the car and told him we weren't going back there any more. There was no way I was increasing his insulin any more until I had a second opinion. I came home and called the vet that was recommended by the FDMB member and set an appointment for the next day. And I went to Wal-Mart and bought a glucometer. 

The next day I spent more than an hour with the new vet. She answered every question I had and everything she said gelled with what I had learned on the FDMB. She taught me how to home test Pico's blood, and that weekend I ran Pico's first glucose curve. The next Monday morning I faxed the curve results to the vet and we changed everything. Pico started on Lente 1 unit twice a day and we started slowly introducing the canned Purina DM diet. Pico bored of the prescription food, so we compromised and added some variety to his diet using canned Fancy Feast. We found that home testing is absolutely invaluable. I can't say that enough. It has given me so much more of an understanding of what is going on with Pico on a regular basis. I always know when there's a problem and what the problem is. 

Progress towards a happy and healthy life
I would like to be able to tell you that Pico is wonderfully regulated now but I can't. Turns out Pico is a difficult cat to regulate. But I can tell you that he is doing great despite the fact that his bg numbers aren't. He urinates and drinks normally now. He is happy and totally non-stressed. I look for what one FDMB member calls the 4 P's - purring, playing, peeing and pooping - Pico does all of those the way he is supposed to. He's my guard cat again, just a little sweeter now - the disease or perhaps his new dependency on me for shots and all that good stuff have somehow made him more affectionate. 

In short I have my cat back. If I had continued going to the other vet and never posted on FDMB there is no doubt in my mind that Pico would be dead. I will be indebted to the wonderful people on the FDMB who saved my cat's life and who help keep me sane through it all. This disease requires a lot of patience. It takes time to find the right dose and right insulin. But while working on it you can keep your cat healthy and happy. 

Two years with diabetes
June 2003: After 2 full years of trying and 4 different insulins Pico has been regulated for the past 6 months on Caninsulin and is doing wonderfully.  All his levels came back as normal on his last blood panel and his fructosamine is in the excellent range (something my vet says is almost unheard of).  He's healthy and happy and weighs too much.  But he's doing great.

-- Contributed by Shirley

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Contributed August 2001; Updated June 2003
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