My cat was peeing and urinating a lot. I figured it was related to worsening kidney disease but a vet visit revealed she is diabetic. The vet did a fructose test after the bloodwork showed diabetic. He prescribed 2 units, told me to get an Alpha Trak meter, gave me some info on paper and shoved me out the door. While he has been my vet for 20 years, I was a bit surprised at the lack of information. Fortunately, I know how to use the internet. Stabbing the ears for blood is easy. There must not be any nerves there because the cat doesn't complain. I was pleasantly surprised at how easy taking BG measurements is. I had read about steroid induced diabetes and the vet said it was OK to reduce Gypsy's prednisone dose from 2.5mg/day to every other day. She has been a kidney cat for three years and has high blood pressure and inflammation and hence has been taking amlodipine and prednisone for about a year or so now. She had been on dry food (Halo grain free and Wellness Complete Health), but miracle of miracles she likes the Hill's m/d pork flavor! I bought a bag of flaked dried bonito at the Asian market (it's dirt cheap!) for treats and she loves it so much I add it to her wet food so that she will eat her entire meal in one sitting instead of having to wait an hour for her to eat enough. Based on calorie count, I think she's getting sufficient calories (162k) from eating one can of food per day. The diet change and reduction in prednisone may account for the sudden decrease in her BG levels from 350-550 to 80-200. It's like she's in remission! I'm not sure how to dose her; I think I need to do a BG curve taking measurements every couple of hours. When her BG is low, I've been feeding her and then giving her small dose of insulin two hours later. I probably should check BG again to make sure her BG is increasing from food and I'm not sending her into hypoglycemic state. I would like some advice on how to figure out how to determine dosage. "High is better than low", and I fear the insulin is sending her BG levels too low. Suggestions to get her onto a stable condition? Overall, the fixed schedule is a royal pain, but I'm tickled pink that insulin is working and wet food has made a huge positive effect in BG levels.
It is very possible that the diet change could be enough for her. It is for many cats. (And maybe the reduced steroids are a factor as well.) The Hill's m/d is still a little higher in carbs than is recommended. According to Dr. Pierson's cat food database (link in my signature) it is 13% carbs. It is recommended that we stay under 10% (and I think most of us like to stay lower than that, though it depends on the cat). You may want to consider trying another food like maybe something from Tiki Cat or Weruva. That may make her numbers even better. You can check the cat food database for appropriate options. It may be cheaper, and often the ingredients are better. Those 'prescription' foods are usually not the greatest. You can read all about that on catinfo.org. As far as calories, one common formula is 20 calories per pound of health body weight though that varies based on the cat's activity level. If she is happy being fed only twice a day, that is great, but if not, you do have the option of breaking her food into more meals during the day. Many of us do that. I feed my girls four times a day and leave the leftovers out for them to graze. You do not want to feed then wait two hours to give insulin.. that is too long to wait. When insulin is needed, you want to give it right after she eats a little. You may have seen people here mention two hours, but that is not two hours between eating and getting a shot. A lot of people, especially when just starting out, make sure to take away all food two hours prior to doing the pre-shot test so that the test results will not be food-impacted (so they will know the number is high enough to give the shot). Then, after the test, they feed then give the shot. Also, if a pre-shot test result is low, sometimes people will stall without feeding for about 20 minutes then test again to see if the glucose is rising on it's own before deciding if it is safe to give the shot. That can be done 2 or 3 times with ProZinc since you can give a shot within an hour of the shot time. It is possible that Gypsy does not need insulin at all. You are doing a great job of testing before each shot, but when you give insulin, you really need to get some mid-cycle tests in to see the impact of the insulin. Pre-shot tests alone do not tell you how low the insulin is taking the cat's glucose. You have had some really low pre-shot results in the mornings. Low enough that I would not have given any insulin at all. On those days, you do not know how low Gypsy went during the cycle. Often, when a cat goes lower than their body is used to, they will then go up a little higher which could factor in to your pm results being higher. There have also been several different doses being given. Consistency is so important. It is usually best to give a dose for at least a few days before making a change, to give them time to adjust and for the true impact of the dose to become evident. If you cannot give the planned dose because the pre-shot result is too low so you have to skip or reduce, that is usually an indication that the dose you have been giving is too high, so it needs to be dropped going forward. When dosing is all over the place and/or when too much insulin is given, it can create volatility and can become very difficult to figure out what is going on and how to proceed. Do you have syringes with 1/2 unit marks? Do you think you could eye a 1/4 unit dose halfway between 0 and 1/2? I think I would be tempted to try a 1/4 unit dose for at 3 or 4 days (AM and PM) while being sure to get some mid-cycle tests in. (ProZinc normally peaks between +4 and +8, so you may want to try to grab your tests in that range... if you can vary when you do it each time, you can begin to get a feel for when she goes the lowest.) If that dose ends up taking her too low during a cycle, I think I would stop insulin and see how she does on her own. If after 3 to 4 days that dose does not put her into the desired range during cycles, I would increase to 1/2 unit and try that for 3 or 4 days. You want to keep things smooth and stable and gradually ease into the desire range.
Thank you for your very helpful reply! It's difficult getting off cycle measurements as I am out of the house from 8 to 8 for work + commute. I'm at home today and getting some measurements in while I am getting some projects done. I will try to get some overnight measurements, too. I have two other cats so leaving food out is not an option unless I confine her to the bedroom. I have a SureFeed access control feeder that my 20 yo used until she passed, but Gypsy is afraid of it. Did I mention Gypsy's not the smartest cat in the clowder? She only gets food twice a day like the other two cats. It can take her an hour or so to eat all the wet food. She was a happy grazer for 14 years until the other two got fat and got put on a diet with two fixed sized meals per day. Even with the dry food meals, she would not gobble it all down at once. The frequency of drinking and peeing have definitely decreased! Her coat had gotten dry and no longer feels like dried straw, but has some oil in it. I have 1-12 U-40 syringes that don't have 1/2 markings. I feel confident getting 1/2 unit, so I'm going to start with 1/2 unit since shes is in the 100 range and I can test several times today and try to find the minimum. I'll look into different wet food (ugh) but right now I don't want to make any changes. I have the list of food that is also low in P for kidneys. I've never been impressed with prescription food and prefer quality ingredients.
You may want to get some with 1/2 unit markings. It makes it easier to change doses in smaller increments.
