1/22 New Member Kidney Disease and Diabetes diagnosis

My cat, C, will be 16 in April. He's a Maine Coone mix and was diagnosed with kidney disease 2.5 years ago. It's been well managed and he's been happy. He was diagnosed with diabetes yesterday based on a glucose value of 638. His BUN is up to 47.

His last lab work was about 6 months ago and glucose was 97 and BUN was down to 39!

He's an extremely difficult cat, is a biter when irritated and hates leaving the house and I am overwhelmed by the diagnosis and after the short conversation with the vet and reading all day need help and guidance.

Mu concerns:

1) He's been free fed almost all his life and doesn't eat more than a bite or two at a time. When we had scheduled feeding due to our other cat's health issues, he would eat his portion and immediately throw up. How on earth is it going to work with this now?

2) He isn't overweight and we were stunned by the diagnosis. It seems like it came on super suddenly and I guess it's just old age?

3) Our prior cat got to the point that she ran anytime she saw me because she was afraid I was going to do something to her, even though we tried to create positive associations with her medications.

4) I run a business, my husband travels frequently for work, and I have a small child. I feel like I'm struggling daily emotionally, physically, mentally, and financially already. Feedings/injections every 12 hours forever is daunting, plus the added monitoring.

5) We go on vacation and take lots of weekend road trips when school is out. My cat sitter can only come one time/day, which means my cat would have to go to the vet's and be boarded, which would be torture for him. The last time I had to board him, he didn't eat, refused to groom himself and stayed in the litterbox the entire week. I cannot do that to him (and that was 10 years ago when he was young, healthy and more flexible). How do you handle this? A new pet sitter isn't an option.

At his age, taking the KD into account with diabeteswhat are realistic expectations of quality of life?

 

Hello Eliza! First off, I'm a newbie too. My Billy was diagnosed Dec 28th. I've been in this forum ever since, learning and helping my Billy. A cat who has diabetes can live a long and healthy life. Many cats go into remission, though they still have to be watched and tested on occasion. Your cat C hasn't had diabetes for long if he was fine 6 months ago. I can answer some of your questions, and I'm sure more experienced members will come in as well.

1- While my Billy doesn't free feed, I do feed him many small meals through the day and night. He's eating a low-carb, wet food diet. You can even buy a timed feeder that works with wet food for when you are at work, etc. While some vets say feed them only twice a day, most human diabetics and cat diabetics do better on many small meals. One just has to pull food up for two hours before the dosing time. That way they are hungry, and you get a better blood glucose reading before administering insulin.

2- Many things can cause diabetes. Infection and steroid shots, for example.

3- There's lots of advice on how to test and give insulin on this board. Bribes work well with my cat. At test time, he gets the good treats and lots of pets. He loves plain cooked chicken and freeze dried chicken cat treats. For testing, cat's ears don't have a lot of nerves, so it might not be as bad as you fear. As for the shot, I did it when Billy was eating, and he didn't even flinch.

4- Only you can decide what you can do. It seemed overwhelming to me at first too, but you get in a schedule and you work it out. Though getting mid-cycle tests is very useful, at the least, you are testing and injecting twice a day. Takes me like five minutes each time. Yes, you have to make sure you are there and available, but it doesn't take much time. Mid cycle tests take even less time.

5- Honestly, many diabetic cat owners just take their cat with them. It's much easier these days to travel with a pet than it used to be. I was worried because I often take my Aunt to doctor's visits and to get hospital tests. How will I give Billy his insulin if she has an appointment during that time? I was worried, then I realized I could just stuff him in a cat carrier and take him with me. He wouldn't enjoy it, but he'd be all right.

 

Thank you for your detailed answers! I appreciate the reassurance. It never occurred to me to just take him when we travel....there has to be someone out there that's camped with a cat before....right? Something to think about at least.

He's never had a steroid shot and always been healthy (other than the KD diagnosis) so I think that's part of what's shocking is we were unprepared. I also feel like our vet didn't handle the phone call very well relaying the info. I'm hopeful when we meet with her she's more specific and if not, I'll find a vet to give me a second opinion. There are some days where injections and testing exactly 12 hours apart just isn't going to be possible and mid cycle testing is not going to happen either. I think I need to figure out exactly what I can handle and be prepared when I meet with the vet to determine what's reasonable and what's not. Like is 13 hours okay? Because some days that's how long it is from walking out the door to walking back in and unfortunately that's just the way it is. Its helpful to hear it doesn't add that actually giving the injections doesn't add that much time. Thank you again for your honest and detailed response!

 

There is absolutely a member that's taken their cat camping. I know there's a thread on traveling with your cat. Maybe one of the more experienced members can find it for us.

Testing before shots is imperative. You don't have to get a more expensive pet meter to do it either. My vet tried to make me get one, but I use a cheap WalMart ReliOn meter and it works great. Mid cycle tests are important, but they happen when they happen. If it's only on your days off, then it's only on your days off.

I suggest you ask your vet for ProZinc insulin. It's not a depot insulin, so it's a little more forgiving with time of doses. If they give you Lantus, for example, dosing at 11 and 13 could cause trouble. It needs much more precise dosing times than ProZinc, if I understand it correctly. Lantus is a great insulin for cats, but ProZinc is a great one too. That's what my Billy takes, and he's doing awesome. My vet told me I could go as far as an hour early or an hour late with the ProZinc. Might be a good insulin for you.

The testing and injecting will take a little getting used to. This article has a lot of good links, including tips for testing and injecting. And this is also a good place to start: New? How You Can Help Us Help You!

 

Oh, and I wanted to add that with the KD, I know your kitty's diet will be a little different than my Billy's. There's a great food chart here, that not only tells you the carb content and calories, but also has phosphorous levels. I believe you need to watch C's phosphorous and keep it as low as you can since he has KD. We've got other members who have KD and diabetic cats. They should be able to help.

 

You’re not alone in feeling overwhelmed. Many of us were blindsided by the diagnosis and feelings of “how the heck am I going to do this?”

So first thing: take a deep breath. Diabetes is not a death sentence. It might require a few adjustments, but that’s just what we do for those we love, right? I’ve dealt with multiple medical issues in my crew over the years and I’d take diabetes over just about everything else, especially kidney disease. I’ve had three diabetic cats over the years, btw, one of whom I adopted as a diabetic.

Quick questions: has anything changed in your home in the past 6 months, especially the food? What are you currently feeding?

Per your questions...
1. Free feeding: one of my diabetics was a nibbler. He also had IBD and kidney disease and a host of other medical issues and pretty much HAD to free feed. We do what we have to do and work around that reality. As has been mentioned, many cats do much better on frequent small meals anyway (large meals can overwhelm the system and spike blood glucose), so it’s not a big stretch to jump to free feeding. A cat who self regulates small meals can even be considered a bonus (so feel good about that!). Many vets have limited education on feline diabetes treatment and some of the older insulins that were used DID actually require that you had substantial food on board before injecting because the insulin hit hard and fast. Some of the newer insulin options tend to have a gentler action so large meals aren’t as important. And we all know that old habits/knowledge is sometimes hard to give up, so just know that twice-a-day restricted feeding is probably not a hard and fast requirement to successfully treat your cat.

2. Diabetes can be triggered for multiple reasons. A lifetime of high-carb dry food seems to predispose some cats to diabetes later in life, especially if they’re overweight. My Chip fell into that category, and he became diet-controlled (no insulin shots needed) quite quickly once I removed the offending carbs. I used to joke that all I had to do was wave high-carb food under his nose to spike his BG. Did you possibly change to a kidney diet recently? (They’re notoriously high in carbs)

Some cats are triggered by steroid shots or steroid-base ear drops. My Charlie fell into that category — Charlie was lean and athletic his entire life but steroids for his IBD triggered diabetes. Interestingly, carbs never affected him one bit.

Dental issues and urinary tract infections (any infection, really) can spike BG. Cats with kidney issues, and thus dilute urine, can be more prone to urinary tract infections.

General stress can also increase BG, although typically temporarily. How was your cat diagnosed? Did the vet run a fructosamine or was it just the glucose value on the lab work?

And sometimes we just don’t know why a cat becomes diabetic. It just happens.

3. I understand what you mean about cats running when they see us coming with medication in tow, despite efforts to condition them. However, cats are pretty smart and some even come to associate the insulin injections with feeling better. My cats never minded the ear pricks to test their BG — cat ears are very vascular but don’t have a lot of nerve endings so getting a blood sample doesn’t really hurt. Every cat is different, but please don’t let your past experience be a deterrent.

4. Insulin injections every 12 hours: take another deep breath. For most folks, it sounds worse than it really is. Most people fit in into their schedule, get comfortable with the process, and become pretty adept at the shots. I gave insulin injections off and on for many years and it added only a few minutes to my normal routine. And it WILL become routine, hard as that may be to believe right now. Anything new can be daunting, but hang in there. Not everyone can inject at exact 12-hour intervals every single day. Reach out for help and suggestions and we’ll help you find solutions. We do the best we can as caregivers and sometimes we have to get creative.

5. Traveling: Most cats hate change, so this is an issue you might need to get creative with. Some people take their cats along on the trip. I’ve had one or two who were more like dogs than cats and traveled well. Most of my cats hate changing environments, however, and get all nervous and tense. Even the most lovable and friendly cat in their home setting can become a freaked out flight risk in a strange setting. Every cat is different so you’ll need to weigh this carefully to keep him safe. I usually opt for a pet sitter over boarding because of what you mentioned — a stressed out cat who refuses to eat is not a good thing. It might be that you’ll have to compromise and settle on a pet sitter who gives one shot a day. Or you take the cat with you. Or you have a friend house sit. Or whatever. Again, we do the best we can, even if it’s not perfect at times.

Remember, you’re new at all of this so probably still reeling. When you ask about quality of life, I sense an undercurrent of maybe wondering whether you should put him down. I suggest you remove that thought from your head. UNLESS you need an easy out (which I don’t think you are looking for) be assured that he can live a long healthy life as a diabetic. And remember, remission is always a possibility.

 

Here's Camping with a special needs cat and Traveling with a diabetic cat

 

My cat, CC is 16. She also has ckd and hyperthyroidism. She has a good quality of life. I agree with a previous person who said ask about Prozinc as it is a bit more flexible with injection times because it’s not a deposit insulin. That’s what my CC is on. We both work full time with a young kid so sometime schedules are just not ideal. I am not home during the week to get a mid cycle test. I get a pretext before each shot and a before bed test. On the weekends and days of I get some extra. Once you Get the hang of it, provided your cat is cooperative, the test takes a minute to do. I have a link to a video showing how I test CC at home in my signature.

The syringes are so thin that they don’t really hurt. Some find injecting while the cat is eating is easiest.

You can let your cat eat throughout the day. One option is to use a timed feeder so it stops the access to food two hours prior to the preshot test.

taking your pet with you on vacation could work. I usually board but would take her with us if we could. (One of three people we travel with is extremely allergic). Or see if you can give your pet sitter a little extra for a second visit. Or maybe a vet tech at the vet office you go to could pop in for the other shot.

 

Thank you all for your kind replies! We met with the vet this afternoon and she spent quite awhile with us. And basically said do what you can. In a perfect world, all this happens precisely and we have to be realistic. Treatment shouldn't make anyone miserable. And she agreed that one shot a day by the pet sitter is probably better than the stress on him of taking him with us or boarding. His glucose was 689 in office today so she said the worse that happens is his numbers go high. Which they already are.

Again with the food, she said ideally eating twice a day but do the best we can. And the hard rule is be 100% sure he's eaten before giving the insulin.

She also said she could understand if we forgo treatment because of his age and KD and once he stops eating and being content, then we say goodbye.

We decided we'd do what we can without causing him or us undue stress. The tech came in and showed us how to give the shot and I'll be honest that my thought, was seriously that's it?!

So I just gave the first injection and it was easy as pie. I gave him some canned food, he ate, I gave a few treats and while he was eating those, I did it. And he didn't flinch!! And it really only took 2 minutes.

So we will see what happens but I'm feeling much more hopeful.

 

One thing you could have the sitter do is set up a timed pet feeder. Have some portions of food frozen in the freezer, and put the frozen food in the times feeder. It will defrost and he will have a fresh portion to eat later.

Yeah the shots aren't a big deal.