Gizmo's (long) Story

New poster, decided to post here since I have a lot of questions and the intro thread wasn't for questions.

So this is Gizmo’s story. I apologize in advice that it’s very long, I’m a rather neurotic long winded person when it comes to my kitties.

I have a 10-year-old neutered male, Gizmo, who will be 11 in May, and a 9-year-old spayed female, Widget who will be 10 in August.

About a year ago, Gizmo was pretty constipated due to hairballs and since he had started vomiting a bit more than his occasional “scarf and barf” I decided to take him in to the vet. After about 2 hours and giving him some fluids, an anti-nausea, an enema, an x-ray, blood work and urine (and an $850 bill which just about knocked me out for a non-emergency visit since that is more than half my monthly income) he came home, and took a nice big hairy poop and was back to his normal self. He has commonly had hairball issues since he LOVES grooming….so much that he also grooms his sister which is when he runs into trouble if I don’t catch it in time. I've gotten much better since finding the furminator and getting Widget a little more on board with me brushing her on a regular basis without it turning into a battle.

Vet called back after a few days and said upon looking closer at the X-ray they saw there were tiny stones in his bladder and kidneys and that if I did not put him on a prescription diet they would grow larger and cause blockages and kill him. Since I didn’t feel it was my place to question the authority of a medically trained professional, and from past experience I knew I had to switch both of them as I can’t feed them separate since they both refuse to eat then, I adjusted my own life to afford the food. Like, skipping some of my own medication and getting used to eating plain oatmeal or just skipping breakfast and eating ramen for lunch every day. Since he was a large boy (18 pounds) they wanted him on Royal Canin Urinary SO moderate calorie. I asked the vet how much he should eat and explained after much back and forth and hanging my head in shame that I simply could not afford to feed 2 cats an all wet prescription diet, the vet advised I could feed a blend of the wet and dry and to just “follow what the bag says”. At a follow up visit a week later I told her the bag said 1 cup per cat per day was the feeding recommendations but since I was doing half a half I was thinking of doing half a cup of dry for each cat per day and half a can of the pate wet food per day for each cat, split into 4 meals (at the time, my ex-husband and I were still living together and he worked a different shift so they could get fed at 4 set times) the vet said that sounded fine. When Gizmo would get finicky and refuse to eat it (since he routinely would get “bored” with a food” I would mix in part of a can of the morsels with gravy SO for a day or two and that would get him back on it.

(Yes I realize in hindsight how ridiculous this is and shame on the vet for even pushing that food so hard but in the moment I just felt shame and guilt for being too poor to properly take care of my cat, and being that I was just starting a divorce at the time, I felt extra guilt because I was taking the cats away from a human they loved for reasons they couldn’t understand)

Fast forward to about a year, present day. Now that I am moved into a new place, new life, new relationship, life is mostly good (unfortunately worse financial situation, but eh, still better than a lot of people so try to count my blessings) I decide it’s about time to get them in for a checkup. Gizmo has lost weight, just like the vet wanted, but I am a little worried that he is looking a bit skinny in the butt, but I kinda shrug it off as me possibly just overthinking it and realizing that I might have an unrealistic view on what a healthy weight is for a cat. And everything else about him is normal. Still jumps on top of everything, still tears around the house, still loves his water fountain. Both cats pee and drink a lot, but the vet said the urinary SO food makes them do that, so I did not think much of it, and neither have had any problems with the litter box.

The vet I see this time is a different vet (I think the vet I saw last time is no longer there, I did not get a clear answer but her picture is no longer on the wall, it’s a walk-in clinic with late non-emergency hours and 24-hour emergency hours) and she is very concerned with his weight…. he lost 4 pounds in a year, which is apparently pretty bad. Widget on the other hand had not lost nearly as much, only about a pound. Again in hindsight this should have concerned me more, but Gizmo is VERY active and Widget is VERY lazy and my human scale at home is not terribly accurate so the difference I just chalked up to their activity levels. (All this hindsight really has me feeling like the worst catmom ever)

So we run bloodwork and urine, give them their booster shots and head home. After a VERY long weekend of me over-analyzing EVERYTHING and worrying, I get the call. Gizmo is diabetic.

Vet recommends changing to an all wet Royal Canin Glycobalance diet and advises that Lantus is the best option but that it is $150 per pen and I have to buy 5 pens upfront but also offers Vetsulin that they sell in their office for $80 per vial that will last 2 months. She says with his temperament she thinks he is the ideal candidate to test at home and directs me towards Amazon to get the Alpha Trak 2 monitor and that I have to bring Gizmo in so we can train on how to do injections and blood testing. I let her know I need to do some research on the medications and talk to my boss on if I can get out of work early at all and figure out what I am going to do. It’s of course snowing here because Michigan is stupid so I tell her it can’t be tonight because I won’t put that stress on him tonight.

I spend the next 36 hours basically not sleeping and sneakily spending every moment between calls at work and after work researching EVERYTHING and panicking because there is NO way I can afford all this. I get mad at myself for failing to being able to support him and then I find all these resources. I read all the food info and links I find on this website. I read about how much cheaper Lantus is in Canada. I read the papers and studies and decide Lantus really is what I want to do because the science backs it up. Call the vet, and she is wary about ordering online because she said you never know how roughly the post office might handle your package, especially international, and that from Canada it could take weeks to arrive and that waiting weeks is a bad idea.

I spend another 12 hours panicking until I come across a thread that mentions you don’t need a prescription to get Lantus pens in Canada. And I live in Ann Arbor, which is not far from Detroit. The Costco in Windsor Canada is a 1 hour, 45 minute drive away or less depending on traffic. I already called them confirmed the price (seriously America – what the heck?!) and that I would not need a prescription and they even helpfully let me know that if I was coming from the states to just call them the day before and let them know so they could make sure they had enough stock since it’s a very popular request. I am still figuring out all the logistics of what I need to take with me (cooler? Ice packs? Bubble wrap? thermometers?) but that suddenly makes that part doable.

After a lot of research, I decided to pay for the more expensive Alpha Trak, because I have zero experience with this. If the Lantus does not put him into remission quickly and I need to, that’s a minimal cost to change to a cheaper tracker and learn the math and stuff at that point. With everything else going on, I figure if that is where I just bite the bullet, then that’s where I do it.

Then food. I literally put together a 3 page document, cited sources and everything gearing up for a battle with my vet on this. I must admit, I am still a little lost on exactly what my plan is. I don’t even know if they needed the Urinary SO diet because I looked at his urinalysis from last year and the one done this last weekend and both time there were no crystals in the urine. From the blood work just done it specifically notes that it appears his kidney function is fine. I’ve been reading Dr. Pierson’s cat food chart and I’m really confused because I saw several posts saying Friskies classic pate is now too high in carbs, but the list is only showing 5% for the carbs. They used to love Weruva BFF cans as a treat before the prescription food days and I’m debating doing a mix of those and a cheaper food like Friskies or 9 lives since I don’t think I can afford to feed just BFF (since I am trying to be more sensible and take better care of myself too).

I am planning on doing these transitions slowly as to not upset them too much. One of the things I found that upset me that that I was seriously underfeeding them. Luckily this new vet seems to get me a lot better and helped me figure out an actual number of kCals to be aiming for which makes a LOT more sense to me because it means I can make adjustments and just use math.

One thing I am trying to figure out is that as they have had dry food their whole life and Gizmo is very intelligent and food motivated, I don’t want him to lose that activity. During the day he would actually have puzzles and a “no bowl” feeding system where he would have to “hunt” for food since he had problems with wolfing down food and them vomit (but only with dry food, he never had the issue with wet food) What I am thinking is if I get some of those freeze dried all meat treat and just put like 1 or 2 treats in each mouse (there are 5 mice total) that would be on average 10 calories for each cat. And then have a couple of treats I put in their puzzle board and just subtract those calories from their daily calorie allotment. My concern is if 10-20 calories is enough calories to be concerning for blood levels while I am at work if he is on Lantus.

Is there anything I am missing? I feel so overwhelmed and feel like I have read everything I possibly can and yet so worried I am going mess everything up and ruin him. Our training at the vet went not as well as I hoped. I am needlephobic and I tried so hard to be brave and steady and I did so good until the vet tech couldn’t get blood from his ear and showed me how to prick his paw pad but accidently got some of his blood on me and I got woozy and almost passed out. I sat down and Gizmo just calmly got up and quite matter-of-factly jumped off the table to go jump up into my lab and snuggle up onto my chest to snuggle me and purr and then would not leave my side the rest of the visit. Like seriously, how did I ever deserve a cat this good? He’s the one who is sick and getting poked and prodded and having to go on scary car rides and yet he still thinks nothing of putting that aside to come comfort me.

So now I am just trying to figure everything out.

Some of my questions I asked the vet that I did not get clear enough answers for were:

What is “too low” of a number? The vet was kinda wishy washy on it, she said she’s had some cats that are having trouble walking at 80 and others that are fine at 45 so it’s a game of figuring it out but that 50 is probably a number to be concerned at…does that sound right?

She mentioned that if I am unsure about a number, then just skip a dose since its better to be too high than too low, but given the fact she was having trouble really describing good ranges I am a little hesitant. When they initially ran his blood his glucose was 368. During the injection training it tested at 298. What is the proverbial “no shoot” number, or how do I figure that out?

I asked the vet what to do if his number drops too low and she said “feed him” I asked if there were any special things to keep on hand like human diabetics have like glucose tabs and she said you can try rubbing karo syrup on his gums but that feeding him is better. How do I know how much to feed? Will he even eat if his number is too low?

She has me starting him on 1 unit of Lantus twice per day and that they should be 12 hours apart. She said you can fudge the numbers by 2 hours if needed, though try to not do early if you can ever avoid it and its always better to err on the side of caution and skip. She also mentioned there is a chance he could go into remission right away because he’s in such good shape, but I am not sure if that is just her trying to be optimistic and lift my spirits?

I am really sorry this is so long, I just want to do everything right by him and just feel like I have failed him despite my best efforts and I’m scared

 

Welcome! You've come to the right place! No, you aren't a bad cat mom - you did what you thought was right and what you could manage. Now I'm going to give you a r-e-a-l-l-y l-o-n-g answer!

My cat was on that a long time before his diagnosis because he was very prone to cystitis, often without an infection. At diagnosis he was switched to low carb wet food to which I add enough warm water to make a "stew" and he hasn't had a problem since. These are the food recommendations we make:

• wet food only, no kibble if at all possible
• carb level under 10% (RC Glycobalance wet is 14% and the dry is higher - both too high)
• Friskies and Fancy Feast pates are good choices if you need to keep costs down - all less than 10% carbs as fed
• for die hard kibble addicts there are two types available online, Young Again Zero Mature or Dr. Elsey's Clean Protein (free samples available if you contact the companies).

Great! Take a drive to Windsor and buy Lantus at Costco. It'll be OTC and a lot cheaper. If you go while weather is still cool you won't have to do much other than keeping it safe from breaking. It wouldn't hurt to wrap it in a small towel and put it into an insulated lunch bag with a freezer gel pack or similar.

Great meter, gives numbers very close to the vet's. Horrendously expensive test strips though - and you'll be testing quite a bit if you do things according to the tried and true Lantus dosing guidelines. Also - strips need to be ordered. Some people use the AT meter to do a curve for their vet and use a human meter day to day. Popular human meters: Walmart store brand ReliOn Micro or Confirm models, take a very tiny blood droplet, test strips around $30 for 100, readily available almost any time/day.

Slow transitions are best. If you can get your diabetic switched to low carb wet before starting insulin that's ideal because it can have a significant lowering effect on blood glucose. Best to get that sorted right at the start if you can. If not, you'll have to test BG fairly often to monitor as the food switch goes on.

A diabetic cat is always hungry and if he's underweight don't limit his intake. Split it into several meals a day. The average 5.5 oz can of low carb wet food has about 180-200 kilocalories in it.

Freeze dried meat treats are great for rewards around testing and injecting. They can also be used in those puzzle balls as a game. You can't rely on them being enough to see Gizmo through the day once he's on insulin. This is a common concern with owners of FD kitties and there are a variety of things that can help:

• testing enough and logging your data in the spreadsheet we use here to learn his patterns and be able to predict fairly well what might happen when you're away
• getting an automatic feeder that dispenses small meals every few hours while you're out ($$ with two kitties)
• having someone look in on him on a day when his early BG test results suggest he might drop lower than usual.

This WILL get easier and you'll become an expert in no time. We have tips and tricks to help. Gizmo seems to be the ideal patient too.

On an AlphaTrak 2 meter, 68 is your "take action" number. It's not a hypo number just a sign that he needs some carbs to prop him up. On a human meter the take action number is 50.

At the start when you don't have any data we'd say 200 is the no shot number if using a human meter and 250 if using an AT meter. These numbers will come down as you collect BG data and learn Gizmo's responses to Lantus.

If you have a good testing routine going and learn how he responds you'll usually be able to see a drop coming before it happens. You'd respond by giving a small snack of regular low carb food to try to steer his BGs away from the brink. If he surprises you with a low number you can try feeding high carb gravy style food, give a little syrup, etc. There are very few symptomatic hypos here among the members who are diligent in monitoring kitty's BG levels and who dose appropriately.

This is a good starting dose and giving it as close to 12/12 is best. Lantus works best when the same dose is given AM and PM as close to a 12/12 scheduleas possible. Two hours difference is too much.
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Here's a handout I made for new members:

It would help us if you set up your signature (light grey text under a post). Here's how:

• click on your name in the upper right corner of this page
• click on "signature" in the men that drops down
• type the following in the box that opens: kitty's name/age/date of diabetes diagnosis/insulin you're using /glucose meter you're using/what he eats/any other meds or health issues he has.

Another thing that will help us help you now that you've started BG testing at home is to set up a spreadsheet like the one we use here. We can all see it and look at it before offering advice: http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

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Here's the basic testing routine we recommend:

1. test every day AM and PM before feeding and injecting (no food at least 2 hours before) to see if the planned dose is safe
2. test at least once near mid cycle or at bedtime daily to see how low the BG goes
3. do extra tests on days off to fill in the response picture
4. if indicated by consistently high numbers on your spreadsheet, increase the dose by no more than 0.25 u at a time so you don't accidentally go right past a good dose
5. post here for advice whenever you're confused or unsure of what to do.

This is useful: http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/

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Here's an explanation of what we call "bouncing". It explains why a kitty's BG can go from low to sky high:

1. BG goes low OR lower than usual OR drops too quickly.
2. Kitty's body panics and thinks there's danger (OMG! My BG is too low!).
3. Complex physiologic processes take glycogen stored in the liver (I think of it as "bounce fuel"), convert it to glucose and dump it into the bloodstream to counteract the perceived dangerously low BG.
4. These processes go into overdrive in kitties who are bounce prone and keep the BG propped up varying lengths of time (AKA bouncing).
5. Bounce prone kitty repeats this until his body learns that healthy low numbers are safe. Some kitties are slow learners.

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Here are some tips on how to do urine ketone testing (VERY important if BG is high and kitty isn't eating well!):

• put the end of the test strip right in his urine stream as he's peeing
• slip a shallow, long handled spoon under his backside to catch a little pee - you don't need much
• put a double layer of plastic wrap over his favourite part of the litter box and poke some depressions in it too catch pee.

Most test strips have to be dipped and allowed to develop for 15 seconds before viewing the colour change in very good light.
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Next steps for you:

• go introduce yourself on the Lantus forum - tons of expertise there
• have a look at the yellow info stickies listed at the top of that forum's page
• learn what the Lantus depot is
• read about the two main dosing guidelines, TR and SLGS.

I told you this would be long!

 

Welcome to you and Gizmo. You have not failed Gizmo, in fact it sounds like you have been doing your homework and are on the right track to getting him healthy again. There’s a lot to learn at first, but it really will get easier, I promise! Have you started home testing him? HERE are some videos and info on home testing to help you along. Then if you can set up our spreadsheet it will really help you to see how the insulin is working. http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
Another good source for you to check out are all the yellow stickies in the Lantus forum. The info in them is invaluable.
http://www.felinediabetes.com/FDMB/forums/lantus-glargine-levemir-detemir.9/

 

I can vouch that it does get easier, I was very overwhelmed, I’ve only been a member since February and we have come a long long way, and it’s so easy now to move around in here and do the spreadsheets as they show a lot of information when you start putting in the numbers, a lot of wonderful people here, they are amazing

 

Thanks everyone I only have my mobile phone at home for internet so I will do my homework above when I get to work and have a computer to use.

I stopped after work yesterday and picked up one can each of each flavor of BFF since there is a specialty shop near my house with good prices so I can get a feel for if there are any flavors they like or dislike (and therefore can buy in bulk online cheaper), mixing it in with their current food to make a gradual transition. For the first time in MONTHS they have cleaned their plates entirely and quickly every time so that has been encouraging.

Going to hunt down Friskies after work today.

 

Brilliant answer from @Kris & Teasel do nothing new to add except welcome!

And if money is an issue, please connect with a DCIN (Diabetic Cats in Need). They have been amazing and have helped me out with test strips (exhorbitantly expensive in Canada where I live) and covered the entire cost of Silver's hospital stay. I am still blown away by that. They have a Facebook page so just look them up.

Yes I wouldn't start off with alphatrax. Most here use a human meter. Cheaper strips for sure. My vet likes Accucheck as it's close to the lab reading and you can get a free meter with the purchase of strips. Just go to the Accucheck website and download a coupon.

I feed Fancy Feast and add water to it to prevent dehydration.

This is the third Gizmo in this forum just now. Popular name. Can you post a pic so we can see his gorgeous face?

 

Hrm, weire, tried to post an update about our first blood test today to practice and it keeps flagging it as spam. Let try this again.

Went well. Had to have Josh (the boyfriend) hold his head since he kept trying to sniff the lance. Got his ear and a reading of 284. Lots of snuggles and praise after and he gave me a kiss.

Off to Canada tomorrow where Costco is holding a box for me. Thinking of starting Sunday morning but nervous about him being home Monday alone during the day while I'm at work. Been reading the Lantus forums and scaring myself I think.

Here's a picture just after we did the test tonight

 

Congratulations on your first successful test!!!

Welcome to the Vampire Club!!