? Cat diagnosed with DM in Jun....some questions?

Hi everyone,

My cat was diagnosed with diabetes in June and it has been a battle to say the least! The vet we took him to reccomended 2 units of PZI twice a day to start. I followed the insturctions and tested his BG using a walgreens TrueMetRX tester twice a day prior to feeding.

I immediately read up on feline diabetes and attempted to switch my cat from Royal Canin dry Sataiety support food to Fancy Feast classics (mostly the seafood kind becuase thats what he will eat). After 1 week my cat Paul ended up not eating as much as he should and had a UTI and possible accute pancreatitus. We rushed him to an really good emergency vet becuase he hadn't been peeing for a while and was yowling.

$2300 and 24 hours of observation the new emergency vet saved Paul with fludis antibiotics and appetite stimulants. The new vet said to give Paul Royal Canin Glyco balance dry or wet food and give 1 unit of PZI twice daily (Plus antibiotics, appetite stimulants and nausea medicine fed by mouth). So we started feeding Paul 1/8th cup of glyco balance dry food in the morning 1 half can of fancy feast as a snack when he goes nuts and then 1/8th cup of glyco dry foood at 5pm. He wouldn't eat enough of the wet food if we gave it to him. he just licked it at that time.

On Sunday night Paul had Diaherrea and vomited up some Glyco Balance dry food we fed him. I read online this may be DKA but had no clue how to tell and couldn't afford another $1300 emergency vet visit! I read that DKA shows up in low blood glucose and in high numbers and the only way to tell is with piss tests. I tested his BG and it was around 111, down from 394mg/dl at 6pm. Paul wouldn't even eat his favortie treat and was refusing all food and water. I read some misinfo online and thought Paul was going into a hypo glycemic state so I put about 5 or 6 drops of Karo corn syrup on his gums and waited an hour to test again. An hour later it was 4am and Paul was at a 350+ reading. He finally seemed ok again and he gobbled down some glyco balance dry food and I even got him to drink some water! So I gave him 1 unit of PZI and called the Vet. The vet gave us more appetite stimulants and some diahrrea pills. The vet said that he might just be allergic to the glyco balance food and we scheduled an appointment for tommorrow to check up on him. Since the diaherrea and incident on Sunday Paul seems to be ok, he is eating the dry and wet food when we give it to him and everything seems normal...except is BG.

I have been feeding Paul 1/8th of a cup of Royal Canin dry Glyocobalance in the morning. My GF feeds him a half can of fancy feast salmon or seafood classic around noon usually and then we give him another half can around 4- 5pm. Sometimes he gets a few kibbles of glycobalance as a snack if he is driving us nuts with meowing.

Ok so now you have most of the info....Here are my questions.

Pauls BG average for the last 30 days is 254.

Question 1: Am I feeding Paul enough food? I havent weighed him since the last vet visit but he was around 16-17 LBS. If he were to eat just Fancy Feast classic how many cans per day do I give him?

Question 2: Am I doing this right? I give him food I wait 1 hour or more then I test his BG and then a few minutes later I give him his insulin shot. If his reading is 200 - 300 range I have been giving him 1 unit. if he goes up to 390 - 400 range I have been upping the dose to 1.5units. Am I taking readings at the wrong time? (Paul has been in the 300 - 400 range for a few cycles now when I test 1 hour after feeding.)

Question 3: Is there another area other than Pauls shoulder that I can inject the insulin? I want to change up the injection spot if possible and give his shoulders a break. Can I inject PZI into the skin near his hind legs?

Question 4: If Paul has a reading of 400+ and I give him the vet reccomnded 1 unit of PZI does that really do much of anything? I have read on other sites that in the 400 range he needs 2 units. I have also read that it is bad to adjust the does but how the **** do I keep him in the safe range if 1 unit doesn't do ****? He needs 1.5 sometimes and 1 unit others is this ok or am I putting Paul on that weird diabetic cycle thing?

Question 5: Why do vets reccomend Glyco Balance dry food when it is 20% carb and has all kinds of fiber and weird **** in it? I think the glyco balance food is keeping Pauls BG high and may be hurting him long term. If I move Paul to strictly wet food he doesn't eat enough and has problems. Paul has to be in starvation mode to want to eat a full can of Fancy Feast and mostly he gobbles down about 1.5 ounces and then grazes on the rest over an hour if we leave it out.

Thanks for all your help!

 

I would say about 3-4 or maybe even 5 cans of FF a day. With the high BG I would start with 4 cans and weigh Paul weekly and see if the amount should be decreased or increased.

The standard protocol is test BG before food, feed and then after Paul completed that meal inject the insulin. See my response to Comment 5 below since Paul doses not finish fast.

You can inject around the neck and and on the side of the body too all the way back to Paul's rear end.
Most of us here test our cat's blood glucose at home using a human meter. We test before each shot and periodically between shots. We record our reading and other info in a spreadsheet. See:
http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
Without specific BG reading at different times I can't tell if your suggested dosing is OK. The PZI you are using is amenable to a sliding scale like you presented.

It is best to start with 1 unit twice daily and increase/decrease as BG history says is needed. We usually increase in 1/4 unit increments. The spread sheet previously discussed provides in information needed.

The prescription diets like the Glyco are a fixed entity and just take that variable out of the equation. However, like you said, the dry is high in carbs and you really want a food that is less that 10% of calories from carbs. Since Paul is a slow eater, it may be better to wait until he finished one can before shooting.
The key to regulation is to have Paul eat consistently the same amount at the same time(s) every day. IN any event you should pull up any left over food two hours before measure BG/feed/shoot.

 

Holy crap! 4 cans of food per day?? The vet told us he doesn't need more than 1/8th of a cup of dry food twice daily. I know they have different calories but is fancy feast really that low calories wise? Am I starving my poor cat to death? Theres no way he would eat that much food ever in his life. I can barely get him to eat 1 full can in a sitting and when I pull the food up he slowly stops eating all together and thats when we run into complications. He grazes and has been a grazer his whole life If we leave the wet food out he eventually eats it all but its over the course of 1 - 3 hours.

Why do you take the test prior to eating? That seems like a recipe for hypoglycemia if I am understanding this right because paul will be coming down off the previous shot so his BG will be high right? Maybe a 300+ rating then he eats and spikes to a 400+ and then I inject him a dose based on the 300 test reading? Seems innacurate. Do cats actually go into remission with this protocol?

 

If he isn't fond of Fancy Feast, you could try the Friskies pates.

 

You can calculate roughly how many calories a day to feed using this formula.
13.6 X ideal weight in lbs. +70.

Adjust accordingly if Paul needs to gain back some weight or lose weight/is very active or is a couch potato. Also take into consideration that an unregulated diabetic cannot utilize the food they eat efficiently and may need more food until they are regulated. Each can of FF is in the neighbourhood of 90 calories. The dry food is 390 calories per cup so that is 100 calories. If he's only getting one can of FF a day, his total intake is around 200 calories right now. It's Ok for Paul to graze but he does need food on board before he gets insulin and food should be withheld for at least 2 hours prior to pre-shot testing.

Testing before food in on board is to lessen the chance of hypoglycemia. We test BG without food influence so we know kitty's true glucose level before insulin is given. That tells us whether BG is high enough that it's safe to give insulin. Yes it will be high but it would be higher if he has food on board. If you give insulin based on BG raised by food intake, then you run the risk of a hypo if kitty doesn't eat later in the cycle.

What protocol are you referring to?

 

"PreShot" tests are done when they haven't eaten for at least 2 hours so you get a results that's not influenced by food...a "true" number. Food influences the numbers

Other than those 2 tests before shooting, it's fine for him to graze.....just pick up any remaining food 2 hours before the next shot time.....the idea of only feeding twice a day is "old school"....most cats do better with multiple small meals

 

Fancy Feast Classics (have less than 10% of carbs from calories) have 81-95 calories/can. The specific amount varies with variety. For listing see:
http://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf
The rule of thumb is one 5.5 oz can (or two 3 oz cans) of food for a 8 pound cat. Since Paul is unregulated he can't completely process food and more is required to maintain weight.
One test prior to eating since food will raise BG. You want the BG before food sine you want that as reference when you measure BG between shots. You want to get the lowest BG between shots to be about 75-100. If you use a human meter (those read lower than real BG/Pet meter), the lowest BG can be lower.

Ideally you want to shoot after eating and most cats eat fast. One potential problem is that if you inject before finish eating and the cat does not eat any more the BG could go too low.
If you know Paul will eat the rest of the can you can inject when Paul finishes half the can.
Some cats have a noticeable BG spike but from 300 to 400 is higher than normally seen.

When you switch to canned, insulin needs should decrease. For some cats they go into remission with a diet change only.
Out of 17 diabetic cats I have had only one went into remission. Dulce, who I adopted as an untreated diabetic, went into remission after only two weeks on insulin.

 

Hi and welcome,
the piss test is done at home with relative ease and for cheap - I use urine dip strips that I buy at a human pharmacy (around $15 average) and test my cat's urine at any opportunity. It sounds more awful than it actually is! My cat is post DKA, it wasn't fun at all, and I have no money for the vet's either...Catching anything above the Trace level of ketones warrants vet's visit. Staying below, working on a good insulin dose and feeding your cat well with extra water mixed in food helps to stay in relative control over the situation. The recipe for ketone's development is:not enough insulin=high Bg+not enough calories+infection/inflammation/stress present. Best of luck to you!