New and Confused

Hello,

I’m in the UK and would like some advice, please. In light of the current situation, my cats Vet appointment has been cancelled, which is completely understandable, but it’s left me with a few questions. Apologies if this is a bit long. I’ll try to give as much information as possible. Here goes...

Just over two weeks ago, my 15 year old cat, Archie, was in a terrible state. Long story short, he had gone into ketoacidosis and his outlook was bleak - the vet later informed me they didn’t think he would make it. Prior to this, he’d lost weight despite eating and was drinking excessive amounts of water, but this appeared to have levelled out for a period until he got an upper respiratory infection.

On first inspection, the vet suspected his bloods would bring back numerous complications and they were surprised when the only condition was diabetes, plus the URI and some rotten teeth, which they believe we’re a catalyst for his quick decline as his little body was trying to fight the infections. His weight at the time of admission was 3.11kg.

Archie was admitted for fluids which were given at a low level due to the fact his red blood cell count was extremely low.

Four days later, Archie was stable. He’d had six teeth removed and the vets were happy with his progress. He was allowed home with a course of antibiotics, Bisolven to help clear excess mucus and Caninsulin. His dosage for the next week would be 2UI to be given twice daily with his food.

Fast forward a week to his checkup. The vet was extremely pleased with his progress. Archie had put on 150grams, he was taking his insulin well, he was eating, ferociously - I’m feeding him a combination of Nature’s Menu Kitten food and Lily’s Kitchen with 30ml of water added to create more of a soup like consistency so he’ll eat in one sitting - plus, he was not drinking excessive amounts of water anymore! He was well hydrated, much brighter and more inquisitive. He immediately jumped off the table to have a look around the room.

As the vet was pleased, the plan was to go back on the 31st, but as mentioned before, the appointment has now been cancelled due to the restrictions now in place. This appointment was to check his glucose levels and determine if his insulin dose needed to be amended. Plus, she was going to show me how to test so I could continue to do so at home. So here are my questions/concerns. I’ll list them for ease:

1. Since the last vet visit, Archie has gained more weight but I can’t weigh accurately, I can just see he looks a little bit bigger. He is ravenous and starts yelling for his food at least two hours before his feed! Does this mean his insulin needs to be increased? His water intake hasn’t increased. He appears to be drinking on average 200ml approx per day.
2. I have ordered a glucose monitor and will order anything else I need to home test. Will the results tell me how much I need to increase or decrease his dosage, or is this something only a vet can determine?
3. The Caninsulin website states, “Consistently feed your cat the same amount of food at the same times each day to avoid unnecessary fluctuations in blood glucose. If your cat prefers to graze during the day this is fine, but continue to give equal amounts of food at set times of the day.” Does this mean I can split his food into four equal servings? If so, how would the split work time-wise if his insulin is being administered at 7.30am and 7.30pm? I think smaller portions spread throughout the day would be more suitable if that’s allowed.
   
4. Is it OK to continue to give him salmon oil in addition to his food and would there be any benefits to adding milk thistle to his food?

Finally, I don’t know what his results were from his previous visits and I’m not entirely sure of the terminology I should be using to ask the Vet. I’m finding this illness a bit overwhelming and complicated, but I know management is key and I really want to do the right thing because I know I have failed my Archie in the past by allowing his condition to deteriorate the way it did.

Any advice would be most grateful.

Thank you

Carla and Archie

 

Hi Carla and Archie and welcome to fdmb.
You have definitely come to the right place...we can help you.
I'm so sorry Archie has been so ill. It's a rough start when you have diabetes and DKA together.
I'll post this so you know you are being answered. I will be back with some answers.
Bron

 

I am so glad you are going to home test the blood glucose. That I will make a huge difference and will keep Archie safe.
Can you tell us what type of meter you have bought please?
Here is a link to home testing hints.....don't worry if you can't get into the vet, we can help with the testing.
http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/

Also if you could set up a spreadsheet to add all the BG data into it, we will be able to help you with dosing. If you have any trouble with setting it up we can do that for you..just ask! Here is the link to the SS
http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

Here is another useful link for new members. Near the bottom of the link you will see it mentions setting up your signature which is the small writing that appears at the bottom of all your posts and tells us about Archie which is so important when we help you. Your signature is found when you click on your user name at the top right of this page.
http://www.felinediabetes.com/FDMB/threads/new-how-you-can-help-us-help-you.216696/

I'll answer your question now

 

Thank you for the information. I’ll take a look at those links now.

 

I’ve ordered a Contour Next One. The Alphatrak is a bit out of my price range at the moment.

 

There is no problem in feeding the day food amount 4 times a day, when it comes to the insulin. It might be better.

 

Thank you, Ann. How would you recommend spacing the feeds?

 

It sounds as if Archie is doing well after his DKA.
It is especially good he is eating so well and seems well hydrated and active.

After a cat has DKA it is really really important that he is getting enough food, enough insulin (and water) and the infection is being treated. DKA happens when there is not enough food, not enough insulin and there is an infection or an inflammation so you can see why the food, insulin and the treating of the infection is so important. You are lucky because many DKA kitties are nauseated and don't want to eat when they get home.

1. How often are you feeding Archie.? I know you will be feeding him before all his insulin shots, but are you feeding him during the cycles? We recommend feeding cats several times a day. So feed before the shots and again around 2 hours after the shot (+2) and 4 hours after the shot (+4) for example...both am and pm cycles.
Seeing he has had DKA it is really important he eats and eats a lot...up to 1 1/2 times what he would normally eat.
You mention 150 grams? Is that a day?
He needs to eat a lot more than that. I would feed him as much as he wants at the moment.
Once you start testing we ask you don't feed for the 2 hours before you do the preshot test so that the BG is not food influenced.

2.the Contour Next meter is good. There is no need to use a pet meter. They are very expensive to run and our 2 dosing methods are based on human meters so your choice is spot on!
Yes, by testing you wil be able to tell if the dose needs to be increased or decreased. HOWEVER you will need to learn how to read and determine what to do, but we can help you there and will be very happy to guide you with that. There's is no need for the vet to be involved...especially at this time. We will be here through all this crisis..

3.with feeding the food, always give a good amount well before you give the caninsulin. With some of the other longer acting insulins the feeding schedule is a bit different around shot time, but it is a good idea to give the same amount every day consistently......but during the two cycles is good.
So for example feed before the am and pm shots, then give him some more food at say +2 when the insulin is working hard to bring down the BG and again at +4 and maybe +6... both cycles.
With him recovering from DKA you could feed pretty much any time but not the last 2 hours before the shotsbecause of what I explained earlier.

4.salmon oil shouldn't hurt him if he is used to having it. How often do you give it?
Milk thistle is very good for the liver, so should be fine.

It is overwhelming for most people in the beginning as there is so much to learn, but when you add DKA into the picture it is very stressful. It sounds as if you have managed very well so far. Don't blame yourself. He is very lucky to have you.
We can help you a lot.
There is one other thing that is really important that you need to do, and that is go out to the pharmacy today and buy a bottle of Ketostix.
After a cat has had ketones or DKA it is really important that you test for ketones in the urine daily for a while to ensure they don't reappear. All you need to do is collect a urine specimen from Archie when he visits the LB. pop a small container or big spoon under him and catch some urine. Then dip the test strip into the urine and read against the colours on the side of the bottle in exactly 15 seconds. Anything above a trace is of concern and you would need to tell the vet. Even a trace of ketones is a concern in a post DKA cat so try and test EVERY DAY for the next little while and post the result for us to see and put it into the remarks column of your SS.

So the most important things for you to do are:

• Feed 1 1/2 times as much food as you normally would during the day and night
• Learn to take the BG levels and document in the SS
• Make sure he is getting enough insulin....we can help you with that.
• Make sure he gets the full course of antibiotics.
• Add water to the food for extra fluids.
• Test daily for ketones.
• Keep asking questions...we are happy to answer them.

Bron

 

1/4 when morning insulin time, 1/4 + 6 hours later, 1/4 when evening insulin time, and 1/4 for the night. It all depends on your own hours if you at home all day. Otherwise others use Automatic timed feeders that portions the food similar during the day and night.

 

Carla I would refresh the last long post I wrote and read again as my autocorrect made several adjustments that I have corrected.

 

Hi Ann, with caninsulin I would feed most of the food in the first half of the cycle when the insulin was strongest, don't you think?. With the post DKA we want him to eat more so he can eat for most of the cycle except for the 2 hours before the insulin dose.

 

I see you have done the signature....great! Thanks.

 

Thank you, Bron. This is really helpful and daunting at the same time, mainly because I really struggle to process information with numbers . I know once I get my head around it, I’ll be OK but it’ll just take me a bit longer to make sense of it.

150grams was how much his weight had increased after one week of insulin, which was good. At the moment, I don’t think I’m feeding him enough. He is currently getting one pouch of Nature’s Menu kitten food (100g) combined with half a packet of Lily’s Kitchen (42.5g) twice a day - so, 285g per day in total. I add 30ml of water to each feed.

This is the bit where I’m struggling. So, in terms of his feeding and insulin schedule, would this be suitable:

7.15am - feed
7.45am - insulin shot
9.45am - feed
1.45pm - feed
7.15pm - feed
7.45pm - insulin shot
9.45pm - feed
1.45am - feed

Is this correct, or could I just do four hours after the shot? Also, I assume equal measures per serving? I’ll buy a timed feeder if it’s best to feed 2hrs, then 4hrs because this will be hard to manage once I get back to work.

His course of antibiotics ran out last week, but he still has Bisolven, which I sprinkle on his food twice a day. The vet didn’t say if this was to be taken consistently, but I’m going to assume that it does because after a couple of days of not taking it he started to sneeze again.

I’ll get some strips to test for ketones. Phew! We’ll get there!

 

With the salmon oil, I’ve been giving him one squirt, so around 2.5ml with his evening meal. His fur looks a bit nicer with less dandruff now.

 

I would print off this page for you to use as a reference for the first couple of weeks. It's hard for anyone to get their head around it all first time.
Also I would print off the link " How you can help is help you", and within that link, the post about hypos. If you get a really low number you will not want to have to race around and find out the info, put it on your fridge so you can grab it.

I forgot to mention that you will need some higher carb food as well as his normal food, incase of low numbers...also some honey. Mark the top of the cans with the number of carbs and put them and the honey in another part of the cupboard, away from the normal food so you don't feed that inadvertent.

There is a great thread for U.K. Caregivers. I will hunt it out and post it. You should be able to find some higher carb food in there. If not let me know and we'll look further.

I would up his food intake a bit from the 285g a day.
With the schedule you have....that looks pretty good except I would add another meal in at 11.45am and 11.45 pm. They don't have to be big meals...more snacks. Archie will love you for them!

 

Does he need it every day.....what does the dose say? I used to give salmon oil to Sheba but now I feed my cats sardines instead, so I'm not up on the salmon doses now.

 

With the food portions....I would make sure he eats well before the shots, then divide the remaining food into three portions am and pm. Do you know how many carbs the food you are feeding are?
Diabetic cats do best with 10% carbs or less.

Here is the UK information
http://www.felinediabetes.com/FDMB/...-vit-b12-and-other-need-to-know-stuff.137376/

 

The bottle says to feed once daily. If sardines are allowed, I’ll mush a few up and put them in his food instead, I’m sure he’ll appreciate the extra calories!

 

Thank you. Both foods are low, I think 0% for Lily’s Kitchen and 1.2% for Natures Menu. I’ll have a play around with the feeding times now

 

Amazing - thank you! I have a little hypo kit made up. Hoping I’ll never have to use it though.

 

He's a handsome fella, Archie

 

When you feed sardines, make sure they are the ones in mineral water not brine or tomato sauce and no added salt. Only feed the sardines once a week and a small tray/can of sardines should last Archie three times, you can freeze the sardines you don’t use straight away.

 

CarlaP
I have a little hypo kit made up. Hoping I’ll never have to use it though.

I hope you never need it either.
I had a hypo kit made and it sat there taking up space.
Thought I'd never need it either.
Boy was I wrong.
My cat bottomed out at 35 yesterday.
Knew where everything was and started using it.
Be sure to mark the top of the cans with a marker.
H for high carb
M for medium carb
L for low carb.
By doing that you don't need to fumble around wondering which is which.

Best of luck getting Archie regulated.

 

Sorry to hear about your cat. I’ll get everything labelled - thank you.

 

@CarlaP Since you are my country neighbour in UK and I am in West Coast Sweden and we share the same ocean waters - concerning a better fish, and with prime fats in it, don't you have Makarell in U.K like a fish that is naturally fished by your U.K fishermen for U.K? The Makarell at least swims in the ocean were I live and I've been out with fishing ship fishing for it myself, but we can get it fresh every day in the stores, besides Makarell filets on can. My female cat Tjejen loved Makarell and Simba and Gustav only gotten it sporadic.
It is very good fish in terms of very rich in fats in itself. It is also most probably cheaper than sardines and taste better since we fish it right outside by our own countries.
Mine however gets fished from our northern Ice Ocean plenty of quality shrimps every evening 7 days a week. They also contain protein and fats.

 

I’ll have a look into it, thank you. Unfortunately, there’s not much in the supermarkets at the moment so it may have to wait. Both my dogs are raw fed, so I could pick up some fresh mackerel or sprats if the shop is open.

 

I know, I read the U.K paper The Guardian and so many in U.K report about the empty stores. It's like during the WWII with hardly anything coming in and to eat and ration cards e.t.c.

 

How are things today Carla?

 

Hi Carla,

That Contour Next meter you have on order is a nice one.
Before it comes, get your cat used to the steps in the ear testing.

Did you want some testing tips?
These are 2 of my favorites.
Marje and Gracie's Testing and Shooting Tips

Testing
We all know the basics:

• Warm the ear with a rice sock or a warm washcloth wrapped in a plastic bag.

• Either freehand or use a lancing device; new members usually start with a larger gauge lancet such as 28g or 29g until the ear learns to bleed; then progress to a 31g or 33g which are finer.

• Be sure to poke in the "sweet spot" and not the major vein that runs along the length of the ear. Poking the vein will not only hurt, but will result in a lot of blood. The sweet spot is on the edge of the ear.

But did you also know there is a particular way for the lancet to be used? It has one side that is beveled so the sharpest part goes in first, if used correctly.

Learn to be a "Cat Whisperer" when testing. Bribes, urrr Treats I mean, are the key to a kitty's stomach. Any kind of pure meat or cheese is fine. Brushing or petting or praising your pet are nice rewards for your cat also. Sing to reduce your stress level when you are testing. A silly children's song works.
•Ear Testing Psychology•

There are lots more tips here, including videos.
Hometesting Links and Tips - includes numerous links, instructions, pictures, & videos
You can find lots of stuff in this link
Sticky INDEX: Health Links/FAQs

which can be found here:
Health Links / FAQs about Feline Diabetes

 

This is great - thank you! I’m still waiting for all the stuff to arrive but in the mean time I’ll make sure I take all this in.

Bit of good news regarding Archie. I’ve been feeding him more often for two days now and already he seems more content and sociable - he even went outside to sit in the sunshine yesterday.

 

Much better. Archie seems happier - he’s definitely enjoying eating more throughout the day. When he was eating two meals, he spent most of the day sitting by his bowl, but now he wants to go out or he’s sitting on my knee. He’s also not waking me up at 6.30am for food so I’m definitely happy!

 

Archie ventured into the garden yesterday and found a warm spot

 

Wow! Look at beautiful Archie, in the garden among all that green. Ivy and is that a rhododendron leaf in the upper right corner?
Still a bit early here in New England for many green growing things, but the bulbs are coming up nicely.

Yes, more frequent meals can make all the difference.

Is Archie getting insulin yet? You could put those insulin doses on his spreadsheet (SS).

 

Carla I am so glad Archie is more content with more food throughout the day. That is progress. And not waking you is a real plus. I’m sure he is feeling much better.
Are you testing daily for ketones? This is really important as any sign of them needs immediate action.
Can’t see any data in your spreadsheet yet. Can you add the insulin doses please even if you aren’t testing yet and also add in the remarks column when you test for ketones and the result. Thanks!
Love the photo!

 

Not too sure about the plant but he definitely seems like his old self. Yes, he’s on 2UI twice daily. I’ll get the sheet updated.

 

Not testing for ketones just yet. I’ve ordered some sticks but I expect to wait a bit longer because we’re on lockdown and deliveries are taking longer than usual.

I’ll get the sheet updated. Thank you so much for all your advice. It’s so lovely to see a glimmer of my old boy coming through.