New & looking for guidance

Hi we are wendy & john from the Uk, our Siamese "Cracker" 7 yrs was diagnosed with diabetes last week & we are devastated to say the least, he also suffers from Asthma.
Over the last few days we have swung like a pendulum, between trying to treat him & putting him to sleep.
This evening after finding this forum, we have made the decision to keep him & try our best to beat the diabetes.
His favourite food for many years has been Iams dry food & after much reading up we are now of the opinion that this diet may have contributed to this.
We are planning to visit our vet tomorrow & hopefully start a course of insulin, we are also looking to obtain a supply of Hills/ Royal Canin diabetes food.
What I would like to know is regarding a glucose monitor, I understand that a monitor for humans is much cheaper, but the numbering is different to a special feline monitor.
Can anyone advise me what the difference is & how do we convert this numbering.
Very grateful for any advice.

 

Welcome to the message board, the best place you never wanted to be.

There are 4 things you'll need to manage your kitty's diabetes:
- You - without your commitment, the following won't work.
- Home blood glucose monitoring with an inexpensive human glucometer such as the WalMart Relion Confirm or Target Up and Up (the pet ones will break your budget!). This saves you the cost of going to the vet for curves and done regularly, removes the need for a fructosamine test. All of our insulin guidelines use human glucometer numbers for reference.
- Low carb over the counter canned or raw diet, such as many Friskies pates. See Cat Info for more info. If already on insulin, you must be home testing before changing the diet. Food changes should be gradual to avoid GI upsets - 20-25% different food each day until switched. There are 2 low carb, dry, over the counter foods in the US - Evo Cat and Kitten dry found at pet specialty stores and Young Again 0 Carb found online.
- A long-lasting insulin such as ProZinc, Lantus, BCP PZI, or Levemir. No insulin lasts 24 hours in the cat, so giving it every 12 hours is optimal for control.

 

See Fritz the Brave for great info on feline asthma!

 

Many thanks for your prompt reply, I'm sure we will be back with more questions when we are more understanding of the situation.
I'm sure no 2 cases are the same, but do you have any idea of time scale we may be looking at to at least see some indication of recovery ?.
thank you.

 

It'll depend on whether or not you can get on a low carb food (preferably non-prescription due to the cost), and what insulin. I'd start switching to an over the counter low carb food now (ex Friskies Turkey and Giblet pate), as that can reduce the glucose levels 100-200 mg/dL. And testing at home is likely to show much lower numbers as vet stress may elevate them 100-180 mg/dL according to one study.

You will start seeing reductions in urination and hunger, first. Most of the newer insulins start around 1 unit every 12 hours. The dose is adjusted based on how LOW it goes, not on the pre-shot tests (done to make sure it is safe to give insulin)


Avoid Vetsulin and Humulin or Novolin NPH as they generally do not last 12 hours in the cat resulting in a lack of control, or having to test and dose every 8 hours.

 

We were told that his reading was very high at ' 32 ' I am not clear on how this No. relates & is shown on a human monitor.
The vet suggested 2 units per 12 hour.
Forgive me for being somewhat ignorant of the subject, we are very new to all this & the abbreviations Etc.

 

A 32 is mmol/L, which equals 576 mg/dL used in the US. That suggests you may not be in the USA?
1 mmol/L = 18 mg/dL

And yes, that is high, hence the suggestion to begin switching to a low carb food asap, as that is easier before you are using insulin.

 

You are correct we are in the Uk, approx 100 miles north of London.
We are hoping to be feeding with new food by mid day today (now 1am here).
Thank you for that conversion, I would like to know what sort of reduction in No's we are looking for from 576.
I am right in thinking we do not suddenly switch 100% to new food & gradually go fully over a period of time ?.

 

Lets have you edit your 1st post subject to put UK in it, as we do have a number of UK members who know what foods are available.

And do switch about 20-25% different food per day to avoid GI upsets and food refusals.

You'll have to start with Caninsulin insulin as it is required in the UK, unless you participate in the study being done (at one of the universities, I believe).

@Elizabeth and Bertie may have some recommendations for you, too. Here's her UK low carb food list.

 

That was the name our vet did mention, I am wondering if it might be better not to start him on insulin yet, wait until he has been on a change of food for a few days & hopefully seen a reduction in numbers ?.

 

If he is otherwise doing OK, and the vet did not mention ketones, I would do that.

 

Ok thank you, we will hold off the vet, hopefully obtain a monitor later today & change his food.
One final question if you don't mind...
do we change his food 100% straight away or start with a percentage of new & old food...& if so what percentages.

 

Thank you very much.
I can't thank you enough, has been a pleasure speaking with you.
I'm going to leave you now, as it is almost 2am over here & very weary.
Look forward to speaking again soon.
Regards.
John.

 

Sleep well.

 

The study BJ mentioned is the Diabetes Remissin Clinic at the Royal Veterinary College. http://www.rvc.ac.uk/research/resea...tre/projects/feline-diabetic-remission-clinic

 

Thanks Wendy.
It looks like the study has closed.
This may be a help, though:
"The clinic is still offering a free fructosamine service for all diabetic cats, regardless of the duration of their diabetes. Blood samples submitted using the submission form below will receive free fructosamine, cholesterol and triglycerides. Newly diagnosed cats (diagnosis within the last 6 weeks) are also eligible for follow-up samples for 4 months."
That might be a savings for you.

 

Update... have purchased a Accu-Chek aviva monitor, after struggling to get a sample our monitor told us that the reading was too high to be recorded.
Last week the vet told us the reading was 32..ie 576 on US scale.
We are now feeding diabetic food in an attempt to reduce this reading, hopefully prior to having to use insulin.

 

Hello! First and foremost, you CAN do this!!! It is all very overwhelming at first, you'll do great. I'm a newbie on this board, I want that out there right now. (So honestly, not even sure of the protocol, if I should even be commenting? Please let me know, thanks) Just to let you know, the reading of 32, here in Canada they use the same scale. So as mentioned above, just multiply what you get by 18 for "U.S." numbers. When you say "diabetic food", what type? Wet or dry, and was it bought at the vet clinic?? You'll save a lot of money, and you will get BETTER results, from something like Friskies as mentioned above. NOT the high priced vet food. These have proven to be even higher in carbs than "over the counter" (grocery, big box stores) foods. Good luck!!

 

Hi
thanks for your input, we have just this minute finally managed a blood test. we looked at various you tube video's & then was easy..phew !.
last week was 32 now 17.2 we are giving him Royal Canin diabetic wet food started last night at 25% to 75% old food, this food came from an internet site, as you say much cheaper than from a vet.
We are wondering how often to do this test & surprised how it has decreased.

 

Since they are in the UK the vet is required to first try a insulin for pets and that would be Vetsulin. When it is shown that Vetsulin is not working well the vet can then use a human insulin. Either Lantus or Levemir are the best choice.

 

Hello Wendy and John, and extra-sweet Cracker.
Waving 'Hi' to you from a very drizzly Surrey!

7 years is young to be diagnosed with diabetes.
You say that Cracker also has asthma, so I'm wondering if his diabetes is steroid induced..?
Is Cracker currently on steroids?

Well done for hometesting! What stars you are! Hometesting is the best possible tool to help you understand and manage Cracker's diabetes.

We recommend that, as a minimum, you test before each insulin shot. That is to ensure that it is 'safe' (or as safe as it can be) to actually give that shot. (Sometimes cats can surprise us with a lower-than-expected blood glucose number.) For those new to dealing with diabetes we suggest that no shot is given if the blood glucose (immediately prior to the insulin shot) is below 11.
After that, it's important to find out how low the insulin dose is dropping the cat's blood glucose. Many cats on Caninsulin may have their lowest number of the cycle at between 4 - 5 hours after the insulin shot (but every cat is different....)

Other 'spot check' tests taken throughout the cycle can also give valuable information. The number of tests you do will probably depend on the time you have available: Some people test a lot. Some people do a minimal amount of testing.

Your vet may suggest that you take Cracker into the clinic for a 'glucose curve'. However, the results are likely to be more accurate (and less stressful for Cracker) if you can do this at home. Basically, it just entails taking blood tests at intervals throughout an entire insulin cycle to see the 'pattern' of how the insulin is working in the cat's body. This is a useful exercise, as it can give you an idea of when the insulin starts working, how fast the blood glucose drops, when the lowest blood glucose of the cycle is, and how long the insulin lasts in the cat's system. But it's important to remember that a curve is just a 'snapshot' of what happens on a given day, and each day will vary to some degree.

According the chart below (from the pet diabetes wikia) a normal, non-diabetic cat will have blood glucose levels approximately between 2.7 - 7.5 on a human glucose meter.
But for a cat on insulin the range you aim for (or hope for!) will depend on a lot of factors including the type of insulin you're using, how the cat responds to that insulin, and how often you can test the blood glucose.
http://petdiabetes.wikia.com/wiki/Blood_sugar_guidelines
Some folks with cats on Caninsulin/Vetsulin try not to let their cats' blood glucose drop below 5 at the lowest point of the cycle. That's because Caninsulin can drop the blood glucose quite fast, so trying to keep it above 5 will help to give some buffer of safety.

It will be interesting to see how Cracker's change of diet affects his blood glucose levels...

I have a feeling that you are going to do just fine with Cracker's diabetes. He is lucky to have you as his caregivers.

Eliz

 

Hi
Cracker has been on a monthly steroid jab for some time, this is now stopped.
will keep you posted on levels, am contacting vet today re form of treatment for him.
many thanks.
J.

 

Update.....
We did a second BG test this morning & reading now 11.5 from 17.2 yesterday.
We have fed him 2 1/2 pouches of Royal Canin diabetic today.
Spoke to vet, we are going to take 2 hourly readings & contact her with result.
Owing to my wife being away a couple of days, we will not do this test until Friday, still not fully confident of taking blood & holding him on my own .... don't want to stress him.
I would like to know ...when people refer to 'raw chicken' does this mean 'uncooked'.
Many thanks.
J.

 

Hi John, you can feed chicken raw or cooked, but if it's cooked then it must be meat only, no bones (bones are dangerous when cooked).

That's a very encouraging drop in blood glucose numbers.
How long after the insulin shot did you get that result?

BTW, to be on the safe side: If you're not able to test much while your wife is away then I'd suggest you don't reduce the carb content of the diet any further, as this may reduce the blood glucose levels even more.

You're actually doing really well with the hometesting at this point, so please do give yourself credit for that.
And FWIW, my cat can't be held at all. So I just crumble a few (Thrive) treats for him and test him while he's munching on those....

You're doing a great job!

Eliz

 

Hi Eliz
Thanks for your response & encouragement , as of yet we have not started with insulin other than the first shot last Friday morning when the vet started
the treatment.
We were due back at the vet the evening of that day for the 2nd shot, but advised the vet that we were going to let Cracker go & didn't return.
After taking stock of the situation & several wet tissues later, we decided we could not give him up & found this site, which gave us a lot of hope.
Thank you for your comment re the chicken.
J.

 

Since you aren't using insulin yet, I would keep transitioning the food to see how going full low carb affects his glucose.

And to join in with the encouragement you have already received, y'all are doing great!

 

If he tends to eat a lot at once, it may help to divide the food into mini-meals to help spread out the glucose intake. This should help keep him from spiking really high.

 

Oh, yes. Sorry, John. I forgot that! (Note to self: Don't post when tired...and after drinking wine.... )

In that case.... If you're willing to consider a food other than the veterinary diet, there could be even lower carb foods that you could try, and that may bring the numbers down even further....

Edited to add: According to the current data on the Royal Canin website the wet diabetic food is around 12.4% calories from carbs. That's considerably lower than most dry cat foods (some of which are around 30% calories from carbs). And this could easily account for the lower blood glucose numbers you're seeing.
But there are many, many foods that have a lower carb content than the Royal Canin diabetic food. Dr Lisa Pierson of catinfo.org recommends that diabetic cats eat food that has less than 10% calories from carbs. It may well be worth you're switching to a lower carb food before starting on insulin to see how much further Cracker's blood glucose can drop from diet alone...?

If you're interested then do have a look at the links in my signature. There is a link to a list of low carb cat foods in the UK, and also a link to a thread that contains general food info for UK caregivers.

 

Update...
Cracker fed 8.30am with Royal canin Diabetic, we have just tested (10am) & back up to 20.4. from 11.5 yesterday, wondering if this is due to not eating between 1am & 8.30am & todays food not registering yet.

 

God bless Fritz the Brave!! He was a life-saving in helping me learn how to "puff" my boy Savvy!--Nora and Kali

 

New here myself, and I applaud you for making the decision not to let Cracker go. It's always a difficult and personal decision, one that is to be respected, but finding so much help and support here makes it worth the effort to give your kitty every chance to have some more happy years. I have a lot to learn for my 12-year-old girl, who is so squirmy that I didn't think I would ever be able to jab her, but have found thanks to advice from people here that if I do it while she is eating she tolerates it. I would not have known to try that otherwise. --Nora and Kali

 

Update..
After speaking with our vet, we are now planning to do a glucose graph on Sunday.
We have all the kit...new needles & monitor Etc. just need a patient pussy.

 

In addition to blood glucose testing, here are some Secondary Monitoring Tools you may find helpful.

 

Thanks for that BJM

 

Hello and welcome. A lot of great information has been bestowed on you. I just wanted to say hello and say you are doing great with all this. We all know how your head must be spinning. We are all here to help you . We are all in this together.

 

Good morning folks
We have now started our 1st glucose curve...8am uk time
Please can anyone advise if we should we do this for 12 or 24 hours.
thank you.

 

Most people do a 12 hour curve at 2 hourly intervals.
See what others think
Good luck with the curve

 

12 hour curve is all I have ever done too, because I value my sleep time. Good luck John and keep us posted.

 

Many thanks for all your advice, we have now carried out 8 tests at 2 hr intervals from 8am today uk time.
Cracker has eaten throughout the day :- cooked chicken, Royal Canin Diabetic & Hills Prescription Diet M/D.
Reading details below:-
1.. 5.4 (97) 2.. 18.4(331) 3.. 8.4(151) 4.. 8.9(160) 5.. 10.3 (185) 6..10.3(185) 7.. 11.9(214) 8.. 11.4(205)
Any comments would be greatly appreciated.

 

Hi John, I am not familiar with the meter you are using. Is it a Alpha Track? My suggestion is to copy your results and start a new thread with a title something like " Help with interpreting a Curve" or something like that . It should get new eyes on it and people with your type meter can help you decipher the curve.

 

My figures are in UK mmol's ...1 mmol/L = 18 mg/dL in US
mg shown in ( )

 

Oh, okay, I think I would still start a new thread with a new title to get attention on the curve interpretation and for the math inclined. Oh, and good job getting a curve all ready!

ETA: There will be much more experienced people that will be able to guide you about Crackers curve.

 

We have now discussed the results with our vet, she is very optimistic that we may manage with food alone.
After suggesting to her that we feed cooked chicken she feels it would be better to stay with hills prescription diabetic food & not feed chicken
( this we are purchasing from out local national pet food outlet).
Can anyone tell me please if feeding cooked chicken & fish Etc would be a problem.

 

Hi John, that is such great news that Cracker will be able to be controlled by food! I am going to give you a link for a food chart which has most brands and their carbohydrate values. It is best to keep his carbs 10% and under. The prescription diets are very expensive and many of them are way to high in carbs so many of us here feed our cats Fancy Feast Classic ( not the gravy ones as they are very high in carbs. Also 9 lives and Wellness, NO Grain. Check out the chart and stay 10% and under and I am sure you will be able to find several brands that are available in England. Cooked chicken occasionally is fine but the commercial cat food companies put in all the things necessary for our cats nutritional needs like taurine an amino acid crucial for cats. Fish is okay but should be limited to once a week because of heavy metals such as mercury. Some people make their own cat food and there are recipes online for complete feline nutrition that you can make in your kitchen that give them everything they need.

http://www.felinediabetes.com/FDMB/threads/dr-lisas-food-charts.88162/

The best of luck to you and Crackers!