Hello! Cat with asthma and diabetes

Hello All!

My name is Sarah and I am currently living in the UK with my husband and our 2 cats.
My cat Sushi was diagnosed with asthma 4 years ago and with diabetes 2 weeks ago, while on ketoacidosis.
I have been lost and, quite frankly, exhausted of all the vet visits and medications... I have also been feeling very lonely and judged by most people: "You should just put him out of his misery". As if that was that simple...
Anyway... I rescued Sushi 5 years ago and he was dagnosed with asthma 6 months later. I was living in Portugal and the only treatment was 2 week worth steroid injections. His muscles were becoming weaker and I thought to myself that for sure Americans had something better! Found the aerokat chamber and insisted on starting straight away. It was a massive success with the inhaled steroids. Very low dose and the odd steroid injection.
We moved to the UK in the beggining of 2014 and his asthma started to get worse... Again, he was the only cat on inhaled steroids and we adjusted his dosage and everything was fine. We started using the salbutamol inhaler in emergencies. This year, in August, he had a very severe asthma crisis because his "brother" went to the vet for his vaccine and came back with the smell. Sushi attacked the other cat for almost 24h. This nervous episode got him a few hours in the oxygen chamber and a steroid injection. The first steroid injection in almost 2 years.
That steroid injection put him in ketoacidosis and gave us the diagnosis of diabetes. He was at the vet for a few days, got better and came home. He is on the adaptation of insulin dosage and it is very uncommon here for owners to make glucose readings at home. The vet does it until an ideal insulin dose is established.
My problem is, there is great evidence that he is diabetic because of all the steroids he had to take during his life and yesterday he had another big asthma crisis. He was already very nervous from staying at the vet for a few days in the previous week and There was a bird mocking him outside...a magpie. He got so nervous that I thought he was going to die. It took me 7h to settle his breathing pattern to something manageable with intermittent salbutamol puffs. Went to the vet without him to seek advice, our vet was away and the vet that was there (he wasn't new to us, as I spend so much time there) said that he will probably need prednisolone pills (5mg) as needed on top of the inhaled steroid...2-3 days in crisis and maybe then twice a week...but adjustable as we go. He said that this would probably affect his diabetes, but not as much as an injection. And that we needed to do something because I have to be able to have normal people days and be able to leave the house without being concerned that he can die because he saw a bird.
The thing is... Is there anyone out there in a similar situation?
This appears to be very rare and I am scared... I am quite an expert in feline asthma, but diabetes and the both of them together, it is too much. I know that the inhaler is very safe with diabetes, but the pills are another story...
I am very grateful to have found this forum and I thank you all in advance for the time you may spend reading our story.
Lots of Love,
Sarah

 

My goodness, you and Sushi have had a time. What an extraordinary job you have done caring for him

Others will have more ideas about the asthma and steroids, although I do know that, yes, it can produce transitional diabetes. Because his asthma can make for variable levels, I would definitely encourage you to test at home. There are many reasons why this would be best for him: levels are often elevated at the vet because the cat is stressed; doses based on those levels can be too high once the cat goes home; you need to know what his levels are before giving each shot as the asthma can change the numbers unexpectedly. And lastly we have many members here from the Uk and all of them home test, so it is not uncommon.

What food are you feeding him? Often a higher carb food can drive the numbers up +100 points. We have UK food charts you can use to find the lower carb varieties.

If you want to home test (you don't need your vet's permission) we would be happy to teach you how. We have lots of information, videos and tips.

Let us know how we can help.

 

Hi Sue!
I am very grateful for your kind and fast response!
I thought about that...and the vet yesterday told me the same thing about the glucose vet based readings. He told me to think about making my own curves at home, but that he was only recommending that because it was me we were talking about. Because they had nobody else doing it. I understand the principle behind the curve, but I would have absolutely no idea about how to take glucose levels before his insulin shots daily and adapt his insulin accordingly.
I think that, with his asthma and steroids it is in our (mine and Sushi) best interest to start doing glucose readings at home. I think that at least that would give me some peace of mind. Should I get a pet glucose meter?
I would really appreciate your help.
He is eating wet Purina DM and some boiled chicken and white fish fillets.
From the bottom of my heart... Thank you!
<3

 

Here are a thread with more than you will ever want to know about home testing a cat:

http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/

Two things that really helped us. 1) heating the ear enough. At first, before the capillaries plump up from frequent poking, it helps a lot to warm the ear. We used a rice sack. 2) using a large enough lancet. At first the 30/31 gauge humans use can be too small. 25-28 gauge may work better

Let us know how we can help. Lots of us have tips that made the difference for us at first.

Purina DM wet is low enough carb. Many cats tire of the taste as it is liver based. And it is very expensive food with nothing "prescription" about it except the price. Here is our UK food list. We try to stay under 8-10% carbs.

http://www.felinediabetes.com/FDMB/...for-europeans-and-international-buyers.64843/

I don't know what meters are available in the UK but will ask @Elizabeth and Bertie to give you some suggestions. She is one of our UK members. You can get a pet only meter but it is expensive and so are the strips. Because of the expense, most people use human meters.

What insulin? We have guides on using each insulin as it varies depending on the kind you are using.

 

Thank you, thank you, thank you!
Caninsulin is what we are using...

 

I am not surprised. The U.K. Has a tiered system where they have to prescribe Canninsulin first. If it doesn't work, then they'll look at other insulin.

Here is the info on Canninsulin (or Vetsulin in the US).

http://www.felinediabetes.com/FDMB/threads/vetsulin-caninsulin-user-guide.302/

We have a forum but it is inactive. Very few people in the US use it but prefer milder longer lasting insulin available here. Having said that, people do have success with Canninsuilin. But post on Health for dose help, not the Vetsulin forum.

 

Thank you Sue! I already have enough to get started!

Just waiting on meter recommendation to go and buy one (and all the necessary parafernalia). I may later calibrate it with the fancy pet one that the vet has, can't I? At least it makes sense in my head... The pet meter is expensive, but the worse are the strips! Every 50 cost the same as 2 thirds of a new meter kit! I think that, regardless anything else, it is important that I start having some glucose readings. The more I investigate, the more I think that this system of measuring once a week at the vet, adapting and prescribing steroids in the meantime can't be accurate.

 

A general reference for levels: we consider a cat regulated if they are in the mid 200s at their pre shot test and in double digits at nadir (the lowest number in the cycle - with Caninsulin sometimes 4-6 hours after the shot). But not below 50 which is approaching hypo territory. If you are using metric numbers, here is a conversion chart:

http://www.joslin.org/info/conversion_table_for_blood_glucose_monitoring.html

 

Hey Sarah, I am going to give you a link to a post that was about UK meters you might find helpful.

http://www.felinediabetes.com/FDMB/...lucometer-recommendation.143347/#post-1488239

 

Thank you so much, Sue and Boobbie!
Sushi had another asthma crisis and it was imperative to finally give him the prednisolone 5mg pill... Or I am risking permanent damage to the lungs.
I really have to decide and order a meter today.
I am so so grateful for your help!

 

When you have a condition like the asthma, you treat it first and adjust the insulin.

You should be able to buy a meter at your local pharmacy - you need one that sips and uses a small sample. Bobbi's list should be a help.

 

Since he has had diabetic ketoacidosis, testing for ketones, in the urine, or in the blood (those meters are pricey, too - Nova Max Plus and Precision XTra in the US) is recommended. Urine test strips may be available at your local chemist/pharmacist, A common brand is KetoDiaStix which tests urine for both ketones and glucose. See my signature link Secondary Monitoring Tools for tips on using the urine test, as well as other assessments you may find helpful.

 

Thank you all for your help...

The information you are sharing is precious and have already a lot to sink in... I'll be working in a few hours and I will only be able to continue my reading afterwards.

I am good with the food, because I have been using your list for about a year now.
They eat some boiled chicken and white fish fillets and the wet foods I have rotating are:
- Lily's kitchen
- Thrive complete
- Schesir.

They got bored from Catz Finefood and Feringa. I have Granatapet to try next.
Sushi doesn't eat dry food now, but my other cat has it once a day. We are using Orijen.

BJM, if in suspicion of ketoacidosis again, since I am quite familiar with the slightest change in behaviour from Sushi, I will collect a sample and the test is really cheap at the vet. I can't perform it regularly, because he has to be in a closed room with the different litter tray and that drives him mad. He can't be apart from the other cat...he gets so nervous that the last time I was presented with a asthma crisis.
But I've noticed that the vet supply store has those tests as well, if needed.

Again... I can't be thankful enough for your help.

 

Welcome to my world!! But my Fudge has cancer too on top of asthma and now diabetes most likely from steriods. He is tapering off the prednisone now. The best way to manage asthma is 2 puffs of 250 mg flovent two times a day. My Fudge was diagnosed last week with diabetes and it's been a roller coaster. Others will comment about treatment for diabetes. But, I figured out how to take a blood glucose from the ear and it's very easy. Also, I have ketones strip and check Fudges urine daily for now as we manage this....

 

If you can find a blood ketone meter where you are, that can quickly confirm if ketones are present in the blood without the stress of going to the vet.

When you have a moment, could you add a few tidbits to your signature? It will help us give you feedback.

Editing your Signature

In the upper right corner of the screen, within the dark blue bar, you will see ID, Inbox, and Alerts

Click on your ID.

On the left, under Settings, Click on Signature.
This is where you will put information that helps us give you feedback. You are limited to 2 hard returns, so separate pieces by | or -.
This is where you paste the link for your spreadsheet, once it is set up.
Add any other text, such as your name | cat's name | date of Dx (diagnosis) | insulin | meter general location (city and state/province) any other pertinent issues like if there are any food issues, history of DKA, hepatic lipidosis, pancreatitis, allergies, IBD, etc.

Click the Save Changes button at the bottom.

Always click the Save Changes button at the bottom when you have changed anything.

 

Hello BJM, Holly, Sue and Bobbie!

I already made a signature, hope it is ok and I ordered the AlphaTRAK monitor.
I worked all day today without sleeping much... I am a worrier... and Sushi worries me a lot...
I will try to continue my studying tomorrow, so that I'll be ready when the monitor arrives.

Thank you all again for your care and help,

Sarah

 

Great job !!! The reason I commented on the flovent is I am part of an asthma group. They are very rigid (good) that a cat with uncontrolled asthma is recommended to be on 2 puffs of 250 mg flovent 2 x a day. Everything else should be short term med.

 

I posted the spreadsheet easily. The directions are clear and easy. I just had to shorten my signature to fit it. I suppose you can rename your spreadsheet but so new to all of this

 

Good job Sarah! You are doing great and Sushi is so lucky to have you as his bean!

 

See how much you have learned in such a short time!

While you are waiting for the meter, you could get Sushi ready for the process. Decide where you want to test - some people use the kitchen counter, some on the bed, some between their legs. Take her there, pet her, play with her ears, give her a treat and praise and let her go. (It is a good idea to find a treat she loves and use it only for testing. I am not sure what is available in the UK - my cats have liked PureBites - PureSnacks in Canada - and Bomito flakes. Some people cook a chicken breast without spices and cut it into tiny pieces, freeze and then thaw out daily)

Then repeat the process and add warming her ear. Pets, praise, treat and release. The hope is that by the time you add the poke, she will be looking forward to the treat and won't mind.

 

Hello Sarah (Waving 'Hi' to you from Surrey, UK!),

Well done for wanting to hometest.
I see that you've ordered an Alphatrak meter. But if you've interested in getting a cheaper meter as a back-up then do know that the Accuchek Aviva is popular with Brits and is usually available in pharmacies (And the test strips can be bought for around half the RRP on Ebay).

I also see that you're already feeding some low carb wet foods. There is recent list of of UK foods in my signature that may be useful for you to browse through. (Note; Granatapet is now available from Zooplus but I've not had time to update the list to include that info. Granatapet is listed under Happy Kitty Co foods...)
The other link in my signature includes info on healthy treat options for diabetic kitties.

Huge hugs to you and chin scritches to Sushi,
Eliz

 

Hey Elizabeth!
You are close to us!
Thank you for your support and care!
Yes, I thought that starting with a pet monitor would be easier for us and then maybe when we are more accostumed to it, buy the one you recommend.
I already introduced them to most of those foods in the past. The hated Grau, got bored of Feringa and Catz Finefoods. I have Granatapet to try already on the cupboard and Thrive, lily's kitchen and Schesir without rice on rotation. Schesir is a relatively good complementary food, Thrive style, that they really like (from zooplus). Sushi is in love with Purina DM, but my other cat doesn't even come close to it. I am going to reduce it soon because I am trying to make connections to the recent asthma flare up and that food checks out with the date of beginning. I am closing down on stress as well, with feliway and lots of treats on the way. Thank you for that priceless list!!
Big kiss for you and cuddles for Bertie <3

 

By the way... I have studied Fudge's spreadsheet and it looks fairly easy too understand! I thought it would be very hard...

Is there a template I can start or should I just download Holly's and change it?

Thank you!

I am just waiting for: AlphaTRAK, feliway, 5 different diabetic safe treats and lots of food! Nervous... Trying to keep it together...

 

Here is the spreadsheet info

http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

You want the World version which will convert the values for you and for people in the US.

 

I am from MA and did the US SS. It looks complicated but when I did it, it was very easy !!

 

Hi, Sarah and Sushi! Welcome to the forum! Poor baby- his asthma does sound extreme. I agree with Sue that you generally want to treat the asthma first as necessary, then worry about his BG and the diabetes. My Speckles had asthma and diabetes too. Juggling multiple health issues can be overwhelming, but don't worry because people here always want to help if they can. Please hang in there! Sending good thoughts for you and Sushi!

 

Hello Dearest Friends!
How are you all?
Just to let you know that Sushi is doing really well with his asthma, the vet said even his chest sounds much better than last week. The low dose of prednisolone was enough. She was very very happy to know that I am going to start monitoring his glucose at home! She said that even if I could only do it once a day on the peak of his caninsulin action would be a great help (they already have a curve made while he was there)! Morning and evening...perfect! She basically said that whatever work I could do with the monitor at home would be brilliant. They always suggest and have a monitor patient owners can lend to try, but nobody wanted to do it long term. People prefer to pay for them to do it, even though they know it won't be a real number, because cats are stressed.
His glucose was still high at 24, but he gained some weight and I think we are getting there! She raised his insulin to 1.5units 2x a day but doesn't want to raise more without my readings. He is slowly going back to his old self behaviour wise, started being very annoying again while demanding for attention and playing with his brother very late during the night...
I already found his favourite treat and I use it for the shots. I think it is not diabetic friendly, but he goes mad for Arm and hammer cat mints and if I use them he doesn't even remember the shot happened. I haven't been able to reintroduce his teeth brushing routine, because he has already so much going on, so at least those help with that. He also loves Origen Original treats and I know those are safe and he can eat more of them, so I am already using them on the positive conditioning to start using the monitor.
I can already see some progress! I am positive!!

From the bottom of my heart, THANK YOU!!!

 

Hello!!
First AlphaTrak use on Sushi today! He behaved really well, no fuss, even though we had to use his paw and my husband help... Little Mr HATES when we try to hold his ears.
The spreadsheet is up as well... I think this will actually work! YAY!

 

You're got it up and I can see it on my phone, too.
Good job!

 

Dearest Friends,

How are you all today?

I have a question... I haven't been restraining Sushi's food, since he only eats very small amounts each time and he is still recovering from the ketoacidosis. He is a very gentle cat and doesn't complain if there is no food there, but the vet said that we would like him to gain some weight, since he lost a lot while sick. So, and since the other cat hates Purina DM, I always have some out for Sushi to nibble on. But I feed the other cat and I pretend that I am adding new food to Sushi's bowl or offer something different at their usual feeding times.
Should I be doing something different?

Love,
Sarah

 

I'm not sure what you are asking, Sarah. If he is underweight, it is definitely fine to feed him more. Is the Purina DM wet or dry? The wet is a reasonable carb but the dry is very high.

His numbers are very high. It may be the asthma medication, but I think I would raise the dose to bring his levels down. What did the vet say?

For reference, we consider a cat regulated if they are in the mid 200s at preshot and in double digits at nadir but not below 50.

Also, with his DKA history, are you getting ketone tests? You use the strips that humans use and stick them in his urine stream (if he won't let you do that, we have other methods). Testing for ketones will give you a heads up if he starts down the DKA road again. Anytime they are in high numbers, we suggest daily ketone testing.

 

I was just asking because most of you seem to have a very strict feeding schedule and I don't.

Yes, his numbers are really high... That is really worrying me right now!

I think that it is a mix between the prednisolone and his insulin dose being too low. The vet doesn't agree on giving him the weight based dose straight away, specially with caninsulin and recommends doing increments os 0.5 a week until optimal dose. Today was actually higher at nadir with 1.5 units then on Tuesday at the vet at the same time, with only 1.0 units. Everything is the same, except that he is eating more.

He only eats WET FOOD. Purina DM, which he absolutely loves, thrive complete, lily's kitchen and rarely some boiled white fish fillet or chicken.

I definitely need help with the ketone testing. He is going to finish this cycle of prednisolone tomorrow, but he will still be on a high dose of inhaled steroids...forever. So I think I have to get used to that too. I can't afford another blood monitor for ketone testing and I can't have our 2 cats separated to collect urine, because they go crazy without each other...and drive us crazy too...
What do you mean, urine stream? You just quickly lay the little strip of paper under his "cathood" while he is peeing? Because he always pees with his back turned to the front of the litter box and I may be able to do that successfully.
Oh Boy...I am going to eat a lot of beans in the next few months... I am praying for him to have his asthma under control, like it used to be, so that we can control his diabetes...

Thank you so much Sue!!! I really appreciate your help!

 

Yes, you stick the strip while he is peeing into the stream of urine. If he won't let you, you might have to isolate him for the few minutes it takes. Oliver would not let us "watch". We cleaned a litter box and filled it with aquarium gravel. We left him in a room with it. He'd have to "christen" the clean box. Then we could swoop in and get a sample as the gravel didn't absorb it.

I would push the vet to increase by 0.5. Sitting in high numbers is not good for him. You are testing so you can watch carefully and catch any possible lows. If you weren't testing. i could understand the hesitation, but you can monitor carefully.

When they are fist diabetic and running high, we are more free with feeding. The diabetes stops their body from using the food efficiently so they are continually hungry until more regulated.

 

Thank you so much for the help, Sue!!

His numbers are all over the place! Very very high!
I am so worried!

But ok...I am doing all I can... I was working all day so I left the house before shops and vet were open and now the vet was closed...Ketone strips ordered from local pharmacy arriving on Monday (cheaper than online and the fastest I can).
I already have an appointment scheduled for Tuesday and I will pop in the vet first thing Monday morning to drop his numbers and see if the vet can give them a look asap and maybe see him earlier.
I don't think I will have to push the extra 0.5 unit, the vet will agree with me, for sure. Today was the last prednisolone pill so, we will be able to manage this better from now on.

I am feeling horrible because the vet is closed tomorrow and there is absolutely anything else I can do for now...

Again...thank you so much for your support, Sue! It means the World to me... I am feeling pretty lonely now. Not even my husband really understands, he says that, for sure the cat had higher numbers before, probably even higher, while he was on a lower dose of insulin...but since I didn't have the monitor then... It seems that I bought the monitor to be worried!

It's going to be a looooooong night...

Lots of Love,

 

You bought the meter because knowledge is power..... We have all been where you are emotionally and some of us continue to be and that said, we have each other to help, listen ,and support. You are doing great!!

 

Hello Everyone!

Bobbie, I don't know if you have an idea of the impact your kind words had on my weekend! Thank you!

The glucose levels I have are already at the vet and I am going to give him some rest today. I think I may save one day in the next few days to take every h or 2h and make a curve.
Now all I can do is wait... Wait for the vet's call and for the ketone strips...

 

By the way... Is there anything I can use to help reduce discomfort and help the healing of the tiny wounds from testing?

Thank you so much!

 

Ah, you made my day! And I am just paying it forward from all the kindness I received and still receive from this wonderful group. Pick up some Neosporin ointment with pain reliever in it for the times you have to test a lot and see redness. I was using it every poke with Bubba but just recently I switched to a finer gauge lancet (something you will be able to do eventually when his ears learn to bleed, they will develop more capillaries from all the poking ) and his ears don't seem as red. Keep up the good work and just know as time goes on, you will get more and more comfortable with it all. Just keep asking questions when you need help.

 

Thank you, Sweetie!!

Did any of the UK residents find an alternative to the Neosporin? I can't buy that here in the UK...
I wonder if it can be ordered online from a reliable seller...

 

Hmmm, not sure about that and I wasn't aware that it was unavailable to you in the UK. I am going to tag @Elizabeth and Bertie and she is she knows.

 

Thank you so much, Bobbie!!

Dear @Elizabeth and Bertie, can you help us??

 

Maybe try asking your local chemist/pharmacist, too.
Otherwise, a tiny dab of petroleum jelly, then wiped off, helps the blood bead up.
To reduce scabbing and bruising, apply firm direct pressue to the spot after testing.

 

Hello Sushi and Sarah, just wanted to pop in and say welcome to the board. I see your off to a fine start. You will do fine try not to worry, it's hard I know.

 

Hi Sarah,
No, the last time I checked I found that you can't get Neosporin here. I think that's because Neosporin has antibiotic properties (?) and the 'powers that be' take a very dim view of antibiotics being available without prescription (because of the possible increase of antibiotic resistance). Putting a little pressure on the test sight can help to minimise any bruising. Are you testing the paw rather than the ear? If it's the paw then it may be worth starting a second thread about paw testing advice.
Bertie wasn't thrilled about his ears being touched when we started testing. But I crumbled a few Thrive cat treats and tested him while he was eating those. That way he didn't even notice that he was being tested! Now, many many many tests later, he's just fine with having his ears touched.

Eliz

 

Hello Dearest Friends!

We are doing really well around here!
Insulin dose raised, Sushi responding really well to the poking and shots. Feliway working like magic! I can't poke him as much as I want now because the vetuk website is really late on my order of strips and I only have enough to test before the shots. I know...I will get an accuchek for humans from boots as well, as soon as I can afford it... It would be really reassuring...and cheaper...
I will make a curve every Sunday and pop in the vet on Mondays to drop results and Sushi's weight and the vet will call me with thoughts and changes.
Still haven't started with the ketone testing because he doesn't like that I am closer when he pees. Every time I try to restrain him in a different room with the litter tray to collect pee:
- He screams and scratches the inside of the door;
- My other cat screams and scratches on the outside of the door;
- Sushi doesn't pee, drink or eat for almost 24h;
- sushi had an asthma crisis afterwards.

So...One step at a time... I will make this work! I am working on getting a ketone blood testing monitor. My friend can get me one for free, but only in the beginning of December.

@BJM and @Elizabeth and Bertie I talked to the vet about it and she says that I should just desinfect with some diluted Hibiscrub or Iodine while applying pressure. To don't worry about that unless there is something that I don't like the look of.
@woodsywife Thank you so much for your warm welcome!

Thank you all again for everything!! I am very grateful!!

 

Sounds like you are making strides. We'll be watching for some testing results.