Hi everyone This post will be loooong. And what I'm really hoping for by posting Ming's situation is to gather input from everyone since everyone has had different experiences with their cats. I love the cat community and I think it's incredible the amount of knowledge there is amongst us all! Thank you in advance for reading and I hope the post isn't so long that it's unreadable! To start with, I've been posting on the Feline Diabetes Message Board. There's a play-by-play of what has happened during the week with Ming HERE but I will be summarizing it all in this thread anyway. (I hope it's okay to post another message board here.) When I adopted Ming in 2015 The first sign of any illness I noticed was of him coughing. I went to a small clinic where they did x-rays and found his heart was slightly enlarged but no signs of asthma or obstructions. I would go in about 2-3 times more to make sure his coughing wasn't anything serious. I eventually accepted that his coughing is probably some weird thing he does. He was sometimes prescribed pred or l-lysine but that was about it. He also had times where he would stop eating and/or vomit. We would bring him in. Do blood tests and find that no, he doesn't have pancreatitis. He'd be given steroids or antibiotics afterwards. His diet has always been wet foods that he'll eat. I would sneak in raw freeze dried whenever he would take it. He ate a lot - almost 12 oz a day, even more sometimes. He was a chubby 18-19 lbs kitty up until 2018. March 2018 - Diabetes I decided to bring Ming to another, larger vet hospital. We'll call this vet hospital, Hospital #2. We did a check up in November of 2017. All good! When Ming is sick, he drinks water or hangs out near his water bowl. We noticed he was drinking a lot of water and peeing like mad. And hungry all. the. time. But I didn't think too much of it, honestly. March 2018, he stops eating and vomits. He's hospitalized for almost a week. We come back to find out he is diabetic now. That explains the water-drinking and increased appetite. He's down to 16 lbs. Between March and September, he has about 5-6 pancreatitis flare ups - each time he is hospitalized at Hospital #2. We do two ultrasounds and just see LOTS of inflammation and at one point, necrotizing pancreatitis. He goes from 1 unit of Prozinc to 6 units in September. Hospital #2 did not advocate for home testing even when I asked if I should. We would just do fructosamine tests. I start working at a vet hospital (Hospital #3) as a vet assistant (they call it ward nurse so I do a lot of the cleaning, administering medications, and looking after hospitalized patients. Different from the technicians that does the tests and works with the vet to come up with plans for patients). Ming ate canned DM for a month after his last pancreatitis flare up before I spoke to a vet at Hospital #3 who said, yes, try the raw diet. I was able to transition Ming to raw for a good month. His poops were less massive and his coat felt much shinier and he didn't look so fat anymore. I start doing Blood Glucose curves and home testing because I've learned how at the hospital and from talking to another coworker (night nurse) that has had diabetic cats all her life. I find out 6 units is TOO much. So, with the help of the great people at FDMB, we reduce him to 4 units twice a day and went from there. October 2018 - Diabetes, Micro Abscesses on the Pancreas, Ketacidosis, and Asthma Ming does his whole spiel again: vomits and doesn't eat. I bring him to Hospital #3 where I work. Now, there are 4 vets that Ming has seen. All varying degrees of knowledge and different styles of treatment. I'll make up fun names so it's easier to follow. Vet A or Boss lady: She is a vet that takes risks and who initially saw Ming for a check up when I started working at Hospital #3. She talked to me about trying steroids even though it's a big no-no for diabetic cats. The vet at Hospital #2 always talked about wanting to avoid using steroids. Vet B or Fairy: She saw Ming when he started his pancreatitis flare up. Boss lady was off for the weekend so Fairy was the next best vet. She is more conservative compared to Boss lady but definitely has experience. Vet C or Princess: Fairy only works 3 days a week so she had to transfer Ming's case to Princess. Princess is a newer vet and from my observations, likes to stick to what her textbooks tell her. Vet D at Hospital #2 or Dr. S: He was the one that diagnosed Ming and who knows Ming the most since he's been at Hospital #2 a million times. I love him but I think his approach was more to treat Ming's symptoms and support Ming and err on the safe side. It's why he always talked to me about wanting to avoid steroids. He's great at getting Ming back to health clinically but I knew Ming's issues were never resolved. Friday, October 12, NIGHT I came home to find Ming had vomited upwards of 12 times. He would not eat. I texted Fairy to ask if she can see him the next day. She said yes, of course!! I gave Ming bupe, cerenia, and 4.6 units of insulin and monitored his BG levels all the night. He went as low as 10 mmols which was good. But he wasn't eating so I was a little afraid he would get hypoglycaemic. Saturday, October 13 Went to the vet. Fairy saw him and we did x-rays, blood test, and urine. His tests: Asthma in the lungs. Fairy sent his x-rays to the ultrasound specialist to confirm he has asthma. High lipase, something indicating acute inflammation in his blood. There were other things that were of note but I can't quite remember and some of it resolved during the week No ketones in the urine, thankfully Fairy put him on IV fluids, cerenia, and bupe and his normal dose of insulin for the night. Ming ate A LITTLE bit for me before I left for the day. During the night, the night nurse saw that Ming almost went hypo. He went as low as 4 mmols. There was some discussion and argument whether Ming received 4.6 units on the u-100 syringe or if he got some other weird dose. Sunday, October 14 Fairy was off and Princess took over Ming's case. She put him on antibiotics (ampicillin) and gave 3 units of insulin in the morning. Ming's BG stayed high in the 20s. He was only eating a little bit of dry food. He got 3.5 units that night and the same thing happened. Monday, October 15 Princess decided she wanted to "restart" his insulin dose. She was concerned about him becoming hypo. Ming was eating a little and seemed brighter, according to her. She said I could come take him home and maybe he will eat much better at home. So I brought him home. The first thing I noticed when I went to pick him up was that... no... he was NOT brighter. But the night nurse (with the diabetic cats) said maybe Ming will do better at home. Dr S NEVER let me take Ming home until he was eating like his normal self but I thought, sure, why not. Maybe Ming hates it at Hospital #3 so he won't eat. I bring him home. Not eating. He's warm. His breathing is fast and deep. He slept like a rock for a few hours to a point where I kept waking him up to make sure he was alive. I gave him 4 units of insulin despite Princess telling me she wanted him on 2 units. Night nurse even said 2 units was ridiculous and glad I gave 4 units. The lovely people at FDMB wanted me to give him his usual 4.6 units. But I was so frazzled I decided 4 units was safe from the dangers of everything. In retrospect, I wish I had given 4.6 units to help decrease Ming's BG. His BG that night stayed high in the 20s. And I tested his urine for ketones and he had them. So I brought him back to Hospital #3 right when the morning started. Tuesday, October 16 They do a urine test and yes, he has high amounts of ketones. They start him back on IVF and fast-acting insulin IM (humilin). For a good portion of the day, he stays under 15 mmols. We repeat this regimen: humilin when his BG is 18 and above. But his BG CONTINUES to be 18 and above. Even at one point, he was 32. From Tuesday to now, his BG has been in the 20-28 mmols range. We went from 2 units of Prozinc to 10 units today and humilin if his BG doesn't get lower than 18. Last night, his lowest was 17 mmols for the first time and he was on 8 units of Prozinc. I hope today, he hits lower numbers with the 10 units. Thursday, October 18 Ming has his ultrasound. He was microabscesses on his pancreas. Boss Lady takes over Ming's case and puts him on a stronger antibiotic called Zenquin. She puts him on 4 units of insulin again at night. Ming's BG stays in the 25s. He has ketones of 4 mmols in the middle of the night but by morning, he has trace ketones again. Boss Lady discusses with me about starting steroids and referring Ming to an internal medicine specialist. Boss Lady also will be sending an email to a vet that advocates for the use of steroids in diabetic cats to get her opinion. Friday, October 19 I finish my night shift and wait for Boss Lady to arrive for the day. I ask her a lot of questions and stress that I don't like Ming being so high and that he had ketones again. Boss Lady agrees 100%. We bring him up to 6 units of PZI with humilin support. He only goes as low as 17 mmols. We start him on pred (1/2 tab, I believe once every 24 hours?) Boss lady decides to try 8 units PZI for the night. Ming has ketones again. Saturday, October 20 (TODAY!) Clinically, Ming is doing good. He's eating and actually bright. Boss Lady sets me up with a time with the Internal Medicine Specialist on Monday. She decides to give Ming 10 units today. I don't know how it's going now but I'm going to go see Ming in a few hours. So that's Ming's story in a nutshell. He is a complicated case. Of course, the fast and quick increases to his insulin is concerning but Boss Lady says he needs it and I agree. Boss Lady KNOWS these quick and large increases are crazy too. But Ming isn't budging. I'm curious to know if any cat owners out there have had or heard of similar cases? Or even had a little taste of what is happening with Ming. I would love your input whether is negative or positive. Anything is valuable to me!