hi, just got diabetes diagnosis

Discussion in 'Feline Health - (The Main Forum)' started by jaykay, Sep 10, 2018.

  1. jaykay

    jaykay Member

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    Sep 10, 2018
    Put this in the Intro thread, and then read if you’ve got questions put them here. So sorry for the double post if that’s not right.

    Hi, I’m Jay and these are my cats, Jinx (ginger girl) and Jethro (black and white boy). They are littermates, now 12 years old (weren’t in this photo) and neutered. It was Jinx who last week started drinking huge amounts, miaowing like mad, and peeing everywhere.

    Vet has checked blood and urine and say diabetes, nothing else to worry about in either sample. He is ordering in insulin and syringes, which should arrive tomorrow. I am about to head out to buy low carb food.

    [​IMG][​IMG]

    A couple of questions:
    1. What food do folk in the UK feed, and
    2. What glucose monitors do folk in the UK use?
     
  2. Diana&Tom

    Diana&Tom Well-Known Member

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    Hi Jay, welcome to the board. This is definitely the very best place to come and read, research and ask questions about feline diabetes!
    So here in the UK we tend to feed a variety of foods - all wet, ie pouches or tins, and NO dry. Supermarket brands such as Whiskas are low carb but are not great quality as far as meat content is concerned. There are some supermarket brands that are good, eg Sainsbury's Delicious, and a similar one from Tesco, can't remember the name. At present I like to feed Nature's Menu which is a good choice - good prices available from online supplier Fetch www.fetch.co.uk. People here also shop at Zooplus which offers a wide range of foods. @Elizabeth and Bertie has put together a brilliant list of foods that would be good to try.

    What are you feeding at present? - just a word of caution, if you are feeding dry and then switch to wet, blood glucose would probably come down naturally (ie without insulin) anyway, so be careful and make any food switch gradually. The aim with FD is to keep BG within safe levels, not too high and not too low... you'll find a lot of queries about dosage etc here.

    As for meters, there are several available in the UK and most I think have good reports. The One Touch Ultra is a long-time favourite, and the Aviva Accu-Check Performa Nano (or similar, I can't recall the exact name). If you do a search for UK meters in the search box at the top right of your screen, it should come up with previous similar questions and answers.

    When you've got your head round food, give us some more info about yourself and your cat. And let us know what insulin is being prescribed and what the starting dose is. This is important - some vets are more clued up than others about FD and our aim is to keep your kitty as safe as possible.

    Best of luck! Keep asking questions, we are here to help.

    Diana (in Surrey)
     
  3. jaykay

    jaykay Member

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    Hi Diana, thank you for replying. Feeling a bit overwhelmed right now!

    Currently feed Whiskas tins, mainly because that’s what they like and we can get it locally (live in the middle of nowhere, north Pennines). So good to know it’s low carb, even if not great quality, but that suggests I’m not going to fix this with diet then, if they’re already eating low carb food. Will have a look round to see what we can get that’s better - and that they’ll eat. Just been made redundant (timing is great) so won’t be the premium brands, but if there are mid-range ones that are better we can manage that I’m sure.

    Will go and have a look at those meters, thank you. I’d feel happier if I were monitoring this myself, as they have to knock Jinx out to get a blood sample at the vets, which I’d rather they didn’t regularly - she’s big, and strong, and objects to being restrained by strangers!
     
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  4. jaykay

    jaykay Member

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    Update - just ordered a Bayer Contour Next, as can get it delivered on Wed, and the cost of the strips and the size of the sample seem reasonable.
    Might need to convert the levels for discussion with the vet?
     
  5. Diana&Tom

    Diana&Tom Well-Known Member

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    Whiskas is fine for the time being, Jay. You could try the cats on some of the other foods but as far as bg is concerned, Whiskas is fine. It's dry food you want to avoid at all costs. Nature's Menu is a mid range, mid price brand - I'd say it's about as good as you can get, but cats being cats, not all of them will eat it, so you may have to try a couple of alternatives if you want to switch to a slightly better quality food.

    Yes, you do have to monitor bg yourself at home, with a meter, to keep your kitty safe - we advise not to give an insulin injection at all without checking that kitty's bg is at an appropriate level to "shoot" first. There's lots more we can tell you about how to test, which includes finding the right technique (ie one that suits you). It's also important to offer treats after a test (we like low-carb pure meat Thrive, again available from online stores such as Zooplus) so our kitties learn to associate the process with a reward! But you don't have to buy special treats - things like small pieces of cooked chicken or ham are just as good.

    You could look for meters on ebay, if you feel brave enough to trawl through what's on there. Sometimes human diabetics sell their unwanted supplies. Look for a meter that uses reasonably priced test strips - some strips are dearer than others. If budget is tight there's a meter called the Code-Free which is available on Amazon I think, people here have said that's good value on an ongoing basis.

    Let us know how you get on.
     
  6. Diana&Tom

    Diana&Tom Well-Known Member

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    Ah ok we cross posted! This should be ok, you've done your research, well done!
    Not sure what you mean about converting levels??
     
  7. jaykay

    jaykay Member

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    Does the human meter give mmol/l? And is the reading what a ‘cat-specific’ meter would read from the same sample? Is it just the reference ranges that are different?
    Sorry for all the questions!
     
  8. Diana&Tom

    Diana&Tom Well-Known Member

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    Yes a UK human meter would read as we would want, ie worldwide numbers (it's just the US that use their own version). This board is mainly made up of US people who you'll notice quote their own version of numbers. It's a simple enough calculation - multiply our numbers by 18 to get the US equivalent, and divide a US number by 18 to get the "world" version. You'll very soon spot the difference.

    An animal-specific meter is slightly different and what the vet would use, but as long as you stick to one or the other that's fine. Some people like to use meters recommended by their vets but they are quite a lot more expensive.

    Sorry this is a bit rushed atm, have to pop out but back later!
     
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  9. jaykay

    jaykay Member

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    That’s great, thank you so much for all your help :)
     
  10. jaykay

    jaykay Member

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    Oh blimey, this is getting worse. She’s just peed in front of me (on the floor) and it was red, like it had blood in it.
     
  11. Diana&Tom

    Diana&Tom Well-Known Member

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    OK... this is something to talk to the vet about. Blood in the urine is a sign of urinary tract infection (UTI) and is not uncommon in unregulated diabetics. Infection is one of the things that can raise blood glucose (stress being another major cause) so needs to be checked out. The vet will probably prescribe antibiotics.
    Unfortunately diabetics are prone to issues like this so the more you can do to get the diabetes under control - eg right diet and insulin dose - the better it is for overall health.
    When you see or speak to the vet, could you ask how he/she tested for diabetes? Was it a spot check during your visit (in which case what was the number) or did he/she take a blood test and send it away for analysis? The latter would be the fructosamine test which is an average of bg levels over two or three weeks. A spot test gives the bg reading at that precise moment - this is how we check bg before giving insulin, but at the vet's it might well be elevated due to stress and infection. Not saying that diabetes isn't the correct diagnosis, but it could be that if there is an infection and it is treated, bg could drop from the number the vet got and that might affect insulin requirements.
    Sorry again if this is rather garbled... there is a lot to take in and it is a learning curve, but I have a feeling you will pick everything up quickly!
     
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  12. jaykay

    jaykay Member

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    The vets did blood there and then, sent a sample off for fructosamine test, and also tested urine. Apparently they all pointed towards diabetes (I vaguely remember that bg was 20, they said the range was 6-16), there was sugar in the urine (don’t know levels) and fructosamine test also suggested diabetes apparently, but also don’t know levels. Will ask for them when I go in tomorrow.

    I’m a biologist by training, so understand the background, and info when I get it, but I don’t have all your experience of diabetic cats.
     
    Last edited: Sep 10, 2018
  13. Diana&Tom

    Diana&Tom Well-Known Member

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    Pretty much definitely diabetes with a reading of 20 which even accounting for vet stress and/or infection, is high. Try not to worry - it could actually be a lot higher! Hopefully with the right dose of insulin you can gradually get those numbers down. It will be interesting to see what dose the vet suggests - we like to see caregivers start with 1 unit twice a day, and increase IF NECESSARY after a week or two. Some vets suggest a higher starting dose whicb isn't the best way to proceed as it could be too high and you could be skipping over the "ideal" dose. Your vet may be one of the good ones but sadly an awful lot don't have much training in FD and don't realise all the very subtle nuances of treatment... that's where this board comes in. We have members all over the world with a vast amount of hands-on experience. Do ask your vet what he/she feels about the likelihood of a UTI amd how this could be impacting on bg and how, therefore, to proceed with a starting dose of insulin.
     
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  14. jaykay

    jaykay Member

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    He was suggesting 1unit twice a day, so that’s reassuring.
     
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  15. Diana&Tom

    Diana&Tom Well-Known Member

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    Good start! Vets usually prescribe Caninsulin to begin with but this MAY not be ideal for cats as it doesn't always work for 12 hours. There are other options but you will probably have to give it a go - you may be one of the lucky ones and find it works well for you. You may like to read the recently updated document here called Beginners Guide to Caninsulin... I'll try to link it for you.
     
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  16. Diana&Tom

    Diana&Tom Well-Known Member

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  17. jaykay

    jaykay Member

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    But ‘normal’ looking this morning. Will take both samples to the vet today.
     
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  18. jaykay

    jaykay Member

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    Vet says no bacteria in sample, so ‘keep an eye on things’.
    Got Caninsulin and U40 syringes, which isn’t going to be easy to measure 1 unit accurately with. Do they do smaller ones?

    Unfortunately although the test strips have arrived, the meter isn’t getting here until tomorrow. In the normal scheme of things I’d have wanted a day’s readings without insulin, but it doesn’t seem reasonable to put off giving Jinx insulin given how distressed she is.
     
  19. Diana&Tom

    Diana&Tom Well-Known Member

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    I'm going to tag fellow UKer @Elizabeth and Bertie to help you with syringes.

    Re giving insulin without testing bg first - normally we would say don't shoot without testing but if you feel numbers are high due to clinical signs, and you can keep a close eye to observe any unusual symptoms, you could give a token dose perhaps... maybe 0.5u... I don't know what others would say. 1u may be absolutely fine but we are so accustomed to saying you must test first that it goes against the grain to say fine, go ahead. Elizabeth might comment on this too when she pops over here.
     
  20. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    Hi Jay, are you using 0.5ml syringes? There aren't smaller U40's than that.
    But, if you're still finding it too fiddly to measure then it is possible to use U40 insulin with U100 syringes. It is necessary to use a conversion chart to ensure you're measuring the right amount. But many people find it easier to measure small doses of U40 insulin that way.
    I can give you links for both of the above if that sounds useful?

    Eliz (Waving from Surrey!)
     
  21. jaykay

    jaykay Member

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    Hi Eliz,
    They’re 0.5ml syringes, I’m sure I’ll get used to them, but yes, if you have a link for the conversion chart in case I decide to go for the U100 syringes, that would be good, thank you.
     
  22. jaykay

    jaykay Member

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    And now in other news, Jethro, who is Mr Hunting-in-the-field-all-day, and only comes in at teatime, has spent all day in bed, apart from coming out to eat, and didn’t make for the great outdoors even when I left the door open, whereas normally he is dashing between my feet to get out.
    Please let it be ‘nose out of joint from all the fuss Jinx is getting’, not him getting ill too :-/
     
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  23. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    Oh dear... Any other symptoms? Any sign of injury? ...There's every chance this is just him having an off day, and timing it very badly!
    (C'mon Jethro, buck up. Jay could really do without this, ya know...)

    Just thought, Jay, regarding syringes etc... Are you using Caninsulin syringes or generic ones? The generic are much cheaper. And these from VetUK have half-unit markings also, which make it easier to measure some doses.
    https://www.vetuk.co.uk/veterinary-...nsulin-syringe-with-needle-box-of-100-p-11335

    And if you decide to try U100 syringes, the ones most of us use are BD microfine U100 0.3ml '+ demi'. I can send you some of mine if you'd like to try them.
    https://www.vetuk.co.uk/veterinary-...-0-3ml-u100-insulin-syringes-box-of-100-p-296

    And here's the link to the conversion chart for using U40 insulin with U100 syringes. But in a nutshell, U100 is 2.5 times as potent (insulin units per ml) than U40 insulin. So to measure one unit of Caninsulin in a U100 syringe you'd measure to the 2.5 unit mark.
    http://www.felinediabetes.com/insulin-conversions.htm

    Eliz
     
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  24. jaykay

    jaykay Member

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    Thank you so much
     
  25. jaykay

    jaykay Member

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    Jethro back to being a mini-panther-in-the-grass this morning, so that’s very good.

    First insulin shot for Jinx this morning (didn’t do last night, as had orchestra and didn’t want to be out all evening straight afterwards, the first time). She barely noticed it happening. Glucose meter should arrive today.
     
  26. Diana&Tom

    Diana&Tom Well-Known Member

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    Good start, well done!
     
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  27. jaykay

    jaykay Member

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    Glucometer arrived, wasted a couple of strips getting it wrong, but then did it properly and got a reading. It is pretty easy now I’ve got the hang of it (don’t quote me when we’re past the honeymoon period and Jinx is not co-operating ;))
     
    Last edited: Sep 12, 2018
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  28. Diana&Tom

    Diana&Tom Well-Known Member

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    Woo hoo, well done, that's just what we like to hear - a couple of wasted strips is par for the course but to get the hang of testing quickly is great! So now you know what to do - test before every insulin shot to make sure the number you get is "shootable", record it on your spreadsheet, and come here to ask any questions. Having the ss up and running will make it a whole lot easier for people to help.
     
  29. jaykay

    jaykay Member

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    I can't find the levels that are 'shootable', good or worrying.
     
  30. Diana&Tom

    Diana&Tom Well-Known Member

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    Well, those descriptions will vary and are all relative...

    ... we'd usually say a shootable number is no lower than 11 and I see you've got a PMPS of about that.. the issue here is that we don't know how your kitty responds to 1u Caninsulin so ideally we need to see a couple more tests, say at +2 and +4, to make sure she isn't going too low on that dose on that ps number. Caninsulin can and often does drop bg quite fast so you don't want to see too steep a drop and start entering hypo territory... not saying this will happen or is likely to, but you need to be aware of how the insulin works. Keep a copy of the beginner's guide handy and refer to it if necessary. If you're worried about the drop start a new thread and ask for urgent hypo help.

    A "good" number could be a mid cycle number showing a decent but not too steep drop before bg starts its ascent again as the insulin peters out. Or it could be a ps number that is not shootable - showing that the kitty's pancreas might be producing a little insulin of her own, or that the previous insulin dose was long lasting.

    A "worrying" number could be anything you're not expecting such as an unusual response to insulin dose, a very fast drop nearing hypo numbers, or indeed an abnormally, very high number which could indicate additional issues such as infection etc.

    There's quite a lot to take in here but once you start getting more readings and can identify a pattern, you'll see what's good and what's not so good. Meanwhile, keep an eye tonight - that pmps of 11 is borderline not shootable for a kitty newly on insulin with no data to back up response. As I said, if you see a very steep drop, post here with a new thread and ask for advice
    .
     
    Last edited: Sep 13, 2018
    Reason for edit: Sp
  31. jaykay

    jaykay Member

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    Thank you - I’d forgotten where the levels were, and it was all in the Beginners guide to Caninsulin.

    Just done a +4 test and it was higher than pre-shot. Think I was right about having done a fur shot :confused:. Oh well, first day and not all a disaster.
     
  32. Diana&Tom

    Diana&Tom Well-Known Member

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    Ok - a fur shot is quite common and becomes less frequent as you practise your shooting technique! In a way it was just as well on this occasion as I was a tad worried about the effects of shooting on that pmps number - of course we don't know the whole picture until we see some mid cycle numbers, but 11.8 is actually not bad at all. It shows that the previous dose lasted well, and that she was very probably quite a bit lower mid cycle, and rising again by pmps. The thing to be aware of is that you shoot on a rising number.

    Is this starting to fall into place? I thought from the start that you'd get a good grip of it quite quickly - the basics aren't that hard to understand but it's the individual nuances of how your cat responds that you now need to monitor, ie how she responds to insulin throughout the cycle. If testing isn't a problem for either of you, try to get some mid cycle tests today so we can see how she responds to the 1u morning shot.
     
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  33. jaykay

    jaykay Member

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    Unfortunately I’ve got a motorbike observed ride this morning, so won’t be around for the whole morning. OH knows what to look for in a hypo and what to do, but I can’t see him testing, nor Jinx letting him.
    So I’ll get what I can but it won’t be the whole set.
     
  34. Diana&Tom

    Diana&Tom Well-Known Member

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    Ok you can't be there 24/7 every day, obviously... just be aware that maybe Jinx's numbers aren't mega high and so she may utilise the insulin faster than if numbers were higher.
     
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  35. jaykay

    jaykay Member

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    Vet pleased with spreadsheet, checked my injecting technique, I gave him a printout of the ‘beginner’s guide’ so he could see what I was following. He is happy about her eating low carb wet food (good!) and wants her to stay on her current dose for a week (that’s 1iu morning and night) and see us again next week. He seems pretty good :)

    I won’t do a glucose curve today, as we’ve been to the vets and Jinx gets pretty stressed by it all, so I’ll have a go at doing one on Sunday.
     
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  36. Critter Mom

    Critter Mom Well-Known Member

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    Tip: With the urinary blood issue, as a precaution I'd suggest you have a chat with your vet about getting an SDMA test done to check Jinx's kidney status. Diabetes can affect the kidneys so it's wise to get a test done at start of treatment, if only as a baseline. No harm to get liver, thyroid and B12/folate assays done too.


    Mogs
    .
     
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  37. jaykay

    jaykay Member

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    He checked kidneys as part of the initial ‘what’s wrong with this cat’ and said that they were normal, so we have that.
    But thank you for thinking about it. Goodness knows what the urinary blood was, it was scary at the time, and hasn’t happened since!
     
  38. PussCatPrince - GA

    PussCatPrince - GA Well-Known Member

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    Evening from New Zealand.
    I just wanted to pop by and wave as I'm a Brit . Bournemouth born and bred. So was my Tyler pusscat.
     
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  39. jaykay

    jaykay Member

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    Jinx getting a bit stressed by the blood tests, so I haven’t done a curve yet. I think it’s being restrained as much as anything, though I don’t suppose she loves having her ear pricked. Her glucose numbers are not coming down any more, and she’s still drinking and peeing loads, so I’ve taken the unilateral decision to up her insulin to 1.5iu x 2 a day, from 1iu x2. I’d have said she was drinking less today....... Back to the vet on Mon, hopefully with some better blood readings by then.

    In other news, the big storm blew our chimney pot off this afternoon and it crashed down through the roof! So there’s that to sort out tomorrow too :(
     
  40. Diana&Tom

    Diana&Tom Well-Known Member

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    Ok, that's not a bad call to increase by 0.5u. I get that you don't want to do a full curve but I would suggest trying to get some early to mid-cycle tests, to see how low the extra dose drops her. The only other mid cycle number you have is probably after nadir when bg was rising again, so she may have been lower... we don't know how much lower, probably not too low, but what seems a tiny dose increase *may* make a significant difference. Lots of variables there but it would be useful to get some more tests now with the increase. You can offer some specially nice treats afterwards!

    A chimney pot coming through the roof must have been a shock! Hope there won't be any further damage.
     
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