Help with newly diagnosed cats and regulation.

I have two cats who were diagnosed recently a month apart (posted some info on the introduction page) so I will start here with some questions on them.

Lets start with Frank. He has been on Prozinc insulin for a a little over a month. I noticed he was drinking more water. His glucose was 565. He is 9 years, 16 pounds and would be considered overweight if you went by visuals on a body condition chart but the vet said he is a big cat and should be around 15 pounds anway. He has been up to 20 pounds before though. His vet did not instruct me to test at home and has seemed hesitant on relying on me to do an at-home blood curve. I expressed interest in testing anyway and at first Frank has been very difficult for this (bites), but with the help of my boyfriend we have gotten a few successful readings but the vet wont go by them. I have a walgreens brand human meter. I did take him in for a curve 3 weeks into his insulin and his readings were in the 400s on 1 unit 2x a day so she bumped him up to 3units 2x a day. I tested his blood sugar on Monday and it was 376 on my meter. She wanted another blood curve in around two weeks which I am going to attempt to do (with my boyfriends help) on Tuesday, instead of bringing him in, but I dont know how thats going to go over with the vet, I am waiting for her to call me to discuss it. Its also going to start robbing me blind financially over time relying on the vet.

Elvis was diagnosed 1 week ago. He is 5 years old and should be about 15 pounds, also a big cat but always very solid and muscular and I noticed muscle wasting so he went down to 13 pounds. His blood sugar was 533 at diagnosis. I took him to a different vet that is much closer because he gets stressed more easily. She started him on 2units Prozinc 2x a day and encouraged me to home test and try to get the blood curves (1st one 1-2 weeks in) so I am also going to try that on Tuesday. I tested him on Monday just to see how he would act and it read 366.

I had a cat who passed away at 16 last year that was diabetic but I left him with my dad when I moved so he is the one that dealt with that. That cat ended up going into remission and passed away to cancer. He used a mobile vet who also encouraged home testing and that cat responded well and could be tested daily. I would like to get a reading every day but so far I am not sure that will be possible with their behavior unless they start to get used to it. I am debating on taking both cats to the second vet as they seem more willing to work with me. I had always liked our first vet hospital but am starting to feel we are not on the same page.

Ok so now we will get into the food situation. I work in the pet industry and am very aware of proper nutrition as is part of my job. I am very aware at this point that wet food and scheduled feedings is the best case scenario and that is what I have wanted for him for the last 3 years. But I have failed with my own animals with this and now here we are. Yep, I let them graze on "junk" dry cat food and now I am kicking myself. The second vet told me that isnt why this happened to Elvis so young but I feel like she felt bad that this is happening. The reason for this first and foremost is because Frank has went into lipidosis twice. First about 4 years ago when I moved him from my dads to my boyfriends. He was in late-stage too. I was able to force-feed him out of it over the course of 2-3 weeks with monitoring from the vet. In May of last year he went into it again after I tried to change him to at least a limited ingredient food he apparently didnt really like (I also rescued a kitten from being eaten by a fox outside and the stress of the kitten was the last straw as the vet said). They also said his liver is on the small side. The vet told me not to change his eating habits yet for fear of lipidosis again. I diagree, I know they must be on low carb food, preferably wet, and thats probably why 3u insulin isnt helping enough but Im not the one with the vet degree. But I do agree we have to be EXTREMELY careful and strategic of messing with Franks food because if this. I have been giving him some wet food in the morning and evening at insulin time and he is still allowed to graze a bit of dry during the day. I am also switching them to Wellness Core as a start because atleast its much lower in carbs than the Purina One. I asked the company thats makes Evo a question and they told me they were discontinuing Evo, by the way. I have tried multiple times to get Elvis to eat wet food over the years. I have read all the tips and tricks and I will keep trying but he wont even taste it. He will not even eat baby food, tuna or lunchmeat or cooked chicken or anything. Wont even try it. But if you have buttered toast or a cookie in your hand he will try to steal it from you. It appears he doesn't like meat but I will keep trying. Because he is also underweight and not himself right now I dont know if I should wait a bit to try the "let him be hungry" method again. I am open to any advice here though.

Sorry that was long winded, but I wanted to be thorough and honest here.

 

Wow! That is a lot to deal with!

Hopefully some of the ProZinc people will weigh in on this, but here's my quick take:

That is way too rapid an increase (we typically increase/decrease by 0.25U in order not to miss the right dose!), and a fairly large dose for a new diabetic, as is Elvis's starting dose of 2U 2xday. I'm very glad you are starting to home test! Not only will it save you a ton of money on curves at the vet (not needed, often misleading), but it's the best way to keep your little guys safe.

On the food: it may be a long time to get a resistant cat to eat wet food. Thing is, I wouldn't even be too aggressive about it right now before you've got the home testing down. It may be that the "junk food" they are eating is necessary to keep them safe on those high doses of ProZinc! Eventually, yes, you want to get them on better food and then get them into better blood glucose numbers, but the high numbers won't kill them (quickly), while low numbers (hypoglycemia) can. Best to keep them safe from that (and from the hepatic lipidosis you've already dealt with) while you get everything else sorted.

With the testing, most cats will eventually at least tolerate the tests, and some positively look forward to test time because of the attention and treats they get. Keep working on it-- establish a routine, fine a reward they really like, designate one part of the house the testing areato help them build the associations. It will come. It's great you've already gotten a few successful tests-- that's often the biggest hurdle!

Finally, welcome! Lots of experienced and knowlegable folks here, I hope we can help you help your two boys!

 

Hi Steph,

We're glad you found FDMB, and we'll do all we can to help you.

While not the optimum, in these circumstances it may be worth looking at Young Again dry food for Frank. It is low in carbohydrates and may be something to consider in Frank's situation. Please note, though, that some cats get GI disturbances when switching to Young Again and sometimes the disturbance persists (e.g. looser stools) so if you do try it I'd suggest a super-cautious approach. Remember that you can work insulin around the needs of more pressing health issues and regulation doesn't typically happen overnight even in uncomplicated diabetics. Just to chuck an idea out, have you ever asked your vets whether supplements like milk thistle and SAM-e might help Frank's liver?

NB: Now that Elvis and Frank are receiving insulin you need to be very cautious about switching to lower carb food as it will affect insulin requirements and usually the dose needs to be reduced, and you really need to be home testing BG during the transition for safety. Please read this information by vet Dr. Lisa Pierson on safely transitioning diabetic cats to lower carb food:

catinfo.org - Feline Diabetes and Safe Diet Transition

I agree with Nan about the jump from 1IU Prozinc BID to 3IU BID; that's a huge increase. If you can learn to home test BG it will give you much better information with which to help both Frank and Elvis and it will help keep them safe on insulin.

WRT vet choice, the second vet sounds much more switched on FD-wise. On home curves, they yield much more reliable data upon which to base insulin doses (not stress-infuenced).

With Elvis being underweight, at high BG levels, and not eating enough it may make him more vulnerable to developing ketones. It is strongly recommended to regularly check diabetic kitties for urine ketones in order to protect them from developing complications (ketosis/diabetic ketoacidosis). Here is more information:

Testing your cat for ketones

Tips for collecting urine samples

If urine sample collection is tricky with two cats in the household then blood ketone meters are another option. Test strips for these meters are pricey but you don't need to test for ketones as often as you test BG levels. Ketone build-up and DKA need to be treated in a hospital setting so, in addition to keeping your kitties safer and healthier, blood ketone meters can protect your pocket, too!


Mogs
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Hello! Just got around to responding and giving some updates.

I had spoke with Frank s vet, the first one to tell her I was going to be attempting his next curve at home. She said ok but honestly seemed hesitant. The receptionist even said they prefer their own "controlled environment" for this....but regardless of the opinions on that I did it at home anyway.
Thank you guys so much for the info about the insulin amounts! Now I am kinda worried. I had read through a few other threads here where vets were using high or drastic changes in insulin and I find that crazy. I have been through a few vets over the years and I hate how it's hard to find one to trust to be knowledgeable, but so guess that happens with human doctors too. I asked her what will be the next step if his curve is too high and she said increase the dose again or try a different insulin. Do you think she is rushing this too much? I have no problem speaking with them but I am not sure how to approach telling them the internet is challenging their vet degree about too much insulin and jumping increases if they aren't willing to be open minded. Have any of you had to do that?
I used the curve system this vet did on Frank when I let them do it which was 4 draws in a day(on 1unit, all resulted in the 400's). I will give the vet the results tomorrow:
3 unit Prozinc 8:15AM with food then withheld food for the day;
9AM - 300
12PM - 305
3PM - 315
6PM - 292

Elvis readings(on 2 units) were:
9AM - 382
12PM - 269
3 PM - 198
6PM - 289

It's possible the first and last reading on Elvis may be a bit elevated as he was not super cooperative for those and so it took a little longer and he was getting mad. I dont know how quickly thay can cause bg to spike. I was going to try one more but his ears were getting kind red and irritated looking ( I gotta get better at getting it on the first try) so I won't mess with them any more today.) It went very smooth for the middle ones though.

I haven't talked to the second vet yet either so we will see. I did switch them from One to Wellness Core last week so that's about 40% carbs down to 19% which isn't ideal but at least it's somewhere to start and I can buy it at my work easily. Will look into YA if we keep having issues trying the wet.
Elvis didn't have any ketones in his urine at the vet but I will look into regulating this myself too.

So what do I do if the vets want to do another drastic change with insulin? Do I refuse to increase it more than .25 at a time? Do you adjust your own insulin based on your cats needs if it fluctuates? Should I request to restart on smaller doses and increase gradually?

 

Well I actually just decided we will try to go to the second vet I used for Elvis. The receptionist at Frank's usual vet called me back and told me the vet was refusing to speak to me about his curve numbers without charging me money. Fingers crossed we will have better results with the other vet hospital.

 

I don't blame you for wanting to switch vets. Hope things go better.


Mogs
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