I massively overdosed my cat, she's in the hospital

Hi everyone,

I'm brand new here and I'm so sorry this post is so long, but I am absolutely terrified right now and could use some advice. My cat was diagnosed diabetic on Saturday (6 days ago) and was put on 2.5 units of Lantus twice a day. Since day one I have been giving her 25 units instead of 2.5 twice a day, I am at a complete loss to explain how I could have made such a massive mistake. I read and re-read the dosage more than once, and up until yesterday I would have sworn I was doing the right thing. Words cannot even begin to express how much I hate myself right now for being so stupid for this long.

She did not react negatively to the overdose until 6 days later. I noticed that her appetite had decreased somewhat, so I reduced the dose to 20 units instead of the 25 I had been giving her. And then suddenly yesterday evening she finally crashed. I gave her her evening shot, left the house, and returned an hour later to find her back legs sprawled out and she had vomited all over the floor. I had already been reading about feline diabetes in the days beforehand, so I filled up a syringe with honey and gave her that. 10 minutes later she seemed normal, and I was able to get her to eat food and walk around normally. I figured I would talk to the vet the next day about home monitoring options in order to prevent it from happening again.

I went to bed, and then at 3:30 woke to the sound of her vomiting. She was in the same position, flat down with her legs sprawled out. I again administered honey, 10 minutes later she was back up, and I got her to eat more food. And then at 6:30 this morning I heard vomiting yet again. When I got out of bed I found her in the living room, lying in a pool of vomit. And then she suddenly convulsed, and rolled over onto her back while screaming. I got the honey out, and again she seemed to bounce back, but this time she wouldn't eat. I got a syringe of wet food down her throat, but she wouldn't eat on her own.

I brought her into the vet and they immediately put her on a glucose drip. But they couldn't get her numbers back up to normal. Not really surprising, as Lantus is long acting AND we weren't yet aware that I had been overdosing her. Her body temperature was also low. My vet said she should be hospitalized immediately at a facility that could look after her constantly, and she called ahead to arrange my arrival. I brought her in to the hospital around 2PM today. I brought all her medications with her (the Lantus and another antibiotic) and left them there with her. It was then that the vet noticed there was a lot more insulin missing from her vial than there should be considering that I was only medicating her for 5-6 days at that point. He called me, told me that I had been overdosing her, and it wasn't until I read the package instructions for the millionth time that I finally saw what had been there all along

They have her on 2 IV drips to keep her BG up. And even with those it's still too low. She's had seizures since being admitted, but they seem to be under control now. They are giving her round the clock care and after my visit just now I have to say that I have full faith they are doing everything that can be done for her.

She is clearly in great discomfort and not feeling well or very strong, but while I was there she also did sit up for a bit to greet me, and walked around very briefly in her cage. The vet techs said they couldn't get her to eat, but when I presented her with a bowl of dry food she not only ate it ravenously, but purred so loud while eating it they could hear her across the room. She mostly sits in an uncomfortable looking position, but her head movements seem normal and she also made eye contact with me and held it. Her pupils respond to light. Every now and then she would shiver a little bit, but when I brought it to their attention they said it could be a number of things, even her fear at being in the hospital. They are monitoring her body temperature as well and have assured me they will take steps to keep her warm should it be necessary. Everyone there seemed to think that if we can keep her near normal for the next few days until she's out of the woods she has a good chance at making a near full recovery.

My questions are these - is that realistic? I've been reading these message boards since getting home and have seen some really scary outcomes, but I also can't deny that her reactions/eating/etc while I visited gave me a lot of hope. Does anyone know of any potential long-term affects of her overdose? Does anyone have any suggestions as to what I can do on my end to make her more comfortable there until I can get her home? And do you think that, because it took her so long to react to the overdose in the first place, that she might be a particularly hardy cat? I will do whatever it takes to make her better. The guilt I feel is the most awful feeling I have ever experienced in my entire life, and I don't know how I'm going to live with myself if she's not OK.

 

((((Melinda)))) I'm so sorry!!! I know you didn't do it on purpose. You know you didn't do it on purpose. You can't beat yourself up. This is a matter of "there but for the grace of God go I." I have no advice. I certainly hope your kitty makes a full recovery!! No one here is going to judge you harshly. Please keep us posted as to how she is doing.

 

Dear Melinda,
Bring your kitty some of your unwashed softest clothes. pj's, t-shirts.
Sleeping she will sense your comforting smell.
Talk to her Melinda. Let her know how much you love her, that you are fighting for her, that she will be coming home soon and that things will get better. They understand, if not the actual words, then the sentiment in them. Talk to her.
You can apologize too if you want. But understand.....she already knows she trusts you, it was a mistake. She knows you would NEVER harm her. She trusts you with everything Melinda. Everything.
You are a human being. A good one too I bet.
Mistakes happen to everyone. This was yours.
You can spend time blaming yourself, when even she does not.
Or.....you can channel all that energy into giving her love.
Love is very very very powerful medicine Melinda.
Just love her.
As for the future....I guess it's one day at a time.
I am hoping you will be here with us and telling us of the miracle that is your baby girl for a long long time.
(((((((((Melinda))))))))))
Lori

 

Oh Melinda I am so sorry! you didn't do it on purpose, it was an accident! Everything that Lori just said, I echo all of it. Being a Mom to a sugar cat is hard, there is so much to learn, so much to figure out. My prayers are with you and your kitty but cats are very resilient! My Payne has survived DKA four times, almost dead each time, over 25 days all toll in ER .... and she is doing really well.

Say a prayer if you pray, light a candle or just do what makes you calmer, the worst is over. Visit her tomorrow and let her know how much you love her and be kind to yourself, she's gonna need you.

Nancy and Payne
((((Melinda))))

 

I am so sorry for your experiance! :YMHUG: Cedric & I will be praying for you and your baby girl! She'll get better, but I agree with taking her a piece of your unwashed clothes. Cedric LOVES rolling around on my shirts & blouses turned inside out! I gave him a shirt of mine when he was at the vet last month (I had to board him there due to vacation shortly after he was diagnosed, so he had a dental). He actually peed on it, but that was because he didn't like the shreadded paper they used for littler there. :lol:

Once she's back to normal, if she needs to go back on Lantus, talk to your vet about putting her on 1 unit twice a day to start. That's what my vet did; and that's probably what the Lantus users here would suggest also.

Hugs and prayers to you!

 

Thank you all so much. I love Sasha with all my heart, she truly is my best friend, and up until now I can honestly say that I have been an excellent cat mom. Getting the news that she was diabetic in the first place was overwhelming, and knowing that I'm the one that put her in the hospital is nearly more than I can bear. Everyone's words of comfort mean so much, thank you all very sincerely.

They said they would call me during the night if anything had turned for the worse, and my phone remained blissfully silent. I am heading over there now to visit again, and bringing some treats, one of my shirts and a pillowcase as suggested.

I've attached a photo of Sasha in better days, I am hoping I'll be able to see her like this again before too long.

 

Sasha is so beautiful.
I am praying for the both of you.

 

I am so sorry that this has happened to you both. I know how terribly scary it is when a cat becomes hypoglycemic.

My Spooky(GA) crashed on me before I ever knew about monitoring insulin doses. After a couple of days with the vet, he made a full recovery.

But, he was very insulin sensitive immediately afterward. Please, when you get Sasha home again, consider hometesting her. Also, start with a much lower dose than the prescribed 2.5 units. I have no experience with Lantus, but for Spooky, even just 1/2 of a unit (you can hardly even see it in the needle!) was enough to give him a reaction.

Cats can become very insulin sensitive after such an episode. That will be important for you to remember. Home monitoring will help you know how Sasha is doing. I cannot stress this enough

Best wishes to you both.

Lisa and Spooky(GA)

 

OMG! What an awful experience for you and your kitty! Please, don't blame yourself for the error in dosage. I think it's a little odd that your vet didn't walk you through injecting Sasha when she was first diagnosed so that you would have questioned why there was such an increase from what you did at the vet's office.

Our vet is very technical and thorough, so he wanted us to come in for Jack's first shot. He explained the vial we got and how to match it up to the syringes, what the markings on the syringes meant and had both my husband and I do a practice injection on a piece of gauze where he checked our syringe after we filled them. After practicing, he supervised as we gave Jack his first ever shot of insulin. Such a delicate situation requires a lot more instruction for people that have never had to deal with anything like this before. I would personally be a little upset with your vet that they didn't go over this thoroughly with you.

Just remember that you do love and care for your pet, otherwise you could have made the "easier" (I use that term very loosely, because I am discovering that it really isn't that difficult to care for a diabetic kitty) decision when you first found out the diagnosis. You are doing everything you can for her, and you will probably make a few other mistakes along the way.

Thanks for sharing your story with everyone here, and please keep us updated on how she is doing. It sounds like she has a great chance for recovering, and I know you'll be so happy to have her home soon. We'll be praying for you guys!

 

Adding my prayers
jeanne

 

Adding prayers for you both from my husband and I and healing purrs from our Fur Gang.

Mel, Maxwell, Musette & The Fur Gang

 

Sending my prayers to you.

Pattie

 

Many many prayers for you and your beautiful girl.

Do not beat yourself up for this. You were failed, the vet AND the pharmacy that handed you that insulin should have walked you through that dosing, shame on them for sending you off to blindly figure it out yourself. My pharmacy took out a needle and show me the dose lines and our vet had us in with Smokey to "practice" with a saline solution on how to draw and shoot the insulin correctly. It is good to know they are working so hard to get her better, but know it is their own error they are working so hard to fix, not yours.

Get better and come home to your momma little Sasha.

 

this was the first thread I rushed to see this morning.
sending more and still more prayers for (((((((Sasha and Melinda))))))
we all know how deep the love can be....we all know the power of prayer on this board.
please become a regular here when you get sasha back.

 

Thank you all so much for the love and support, I wish I had come to this forum days ago! Everyone has been so nice and helpful, and I am beyond delighted to finally be able to share some wonderful news: it looks like Sasha is going to make a full recovery! In the vet's own words, she is doing "very, very well". Her BG levels have finally stabilized in a normal range and they're going to try weaning her off the drips later today to see how she does. I went in this morning to see how she was doing, and she is still obviously uncomfortable, but was also very happy to see me. The vet let me sit in her cage (which is an enormous double-wide type) and she came over to sit next to me. I spoke with her a bit and gave her lots of attention, she was relaxed and purring and alert.

When I brought the treat can out it moved me to tears to see how enthusiastic she was about it. I fed her for a bit, and all the vet techs came over to give her some love while she was still in a good mood The said she had been becoming increasingly vocal and struggling against them with each blood draw, which is a good sign. The vet on duty also said she had never seen such a massive overdose before - normally the cats that get brought in are hospitalized after a single overdose, not 10-12 in a row like Sasha. It truly feels like a miracle, I don't know how we got so lucky. It's not often that you get a chance to correct such a critical mistake, but Sasha and I have been given that second chance. I feel so blessed and lucky. We're not out of the woods yet, but all signs point to good things to come.

lori and tom - I brought in the laundry like you suggested. I think it made us both feel better

KigerKat - when I first got the diagnosis my vet went over all the information with me. And at that time, she didn't have any needles of the size she told me to get for the Lantus. What we did instead is I used another needle with some saline solution in it to practice giving Sasha her first injection. It wasn't very much saline, and it was a larger needle, but because it wasn't insulin and the needles were different I didn't even think twice about the different amounts. My vet was actually pretty through, I still think that the blame is with me on this.

I'll update again once I visit her next, and once I get her home. Lisa and Spooky, the vet at the emergency clinic already warned me that she will be insulin sensitive after this, so we're going to discuss how to proceed afterwards but most likely she won't be getting any in the immediate future.

Again, thank you all so much for the advice and the comforting words. Hopefully once I've got Sasha regulated I can contribute to the forums in a more positive manner in the future

 

You can bet on it! This forum has been a tremendous source of information and comfort. I'll be sticking around for sure.

 

I am so glad to see that she is improving and hopefully will be able to come home soon.

I would recommend that you consider learning to hometest. This means testing her glucose levels at home before every shot to make sure it is safe to give her insulin. You can use any human glucose meter and it does not matter which brand you use. This is something your vet can teach you or there are videos that can show you. Since she will be very sensitive to insulin, by testing before every shot and also in between shots you will know how she is reacting to the dose or if a change in dose is needed.

 

after all you have been thru, and the tremendous expense this will likely be, please let me send you a newibe kit (an xtra substantial one)....see the link below.
it has all the equipement you need to start testing immediatly...as well as a few toys for ms. Sasha.
Lori
and tomtom

 

Melanie and Smokey, you do have a point. In retrospect I do wish I'd been in the office to give Sasha her first 'real' shot. But I also can't deny that had I just read the directions better all of this suffering could have been avoided.

Lisa and Witn, that's the first thing on my list! The vet said we're going to keep her off insulin for a little bit, and then re-introduce her at a much smaller level (1 unit rather than 2.5) once she's ready. I think that home testing is definitely something we need to master in order to prevent anything like this from happening again.

lori and tom - what an incredibly lovely gesture. I really don't know what to say, I'm so touched at the caring and concern I'm finding on here. It's just crazy. The cost has been considerable, no doubt about that... I called my Mom this morning to give her the good news, and told her just how much it's cost me so far. We both had the exact same reaction: "WORTH EVERY PENNY!" I won't even remember or miss that money in six months, it simply doesn't matter as long as she gets better.

I'll definitely be back to this forum, and contributing what I can. Sasha and I have some learning ahead of us, and I am just so happy I found this place.

 

So happy to seethat you got to spend some quality time with your pretty girl, and that she is doing very very well. We will be keeping all our fingers, toes and paws crossed that she will continue to improve and very soon will be back home snuggling with her mom again. Please take Lori up on her offer for an extra special newbie kit, and let us or your vet teach you to test your darling girl at home. I bet Lori can even get your kit to you before Sasha is ready to come home, so you can just take that meter in with you and explain after this accident, you are very leery of giving insulin again without testing first. If they balk on teaching you, explain that it is merely for your own peace of mind, then if they still won't teach you, come back here and we will. We've taught hundreds to do it over the internet.

Mel, Maxwell, Musette & The Fur Gang

 

Melinda, can you pm me to confirm your address, unless you already know it is correct. It came to me as 'unconfirmed' address.
Also, my post office is closed on saturday :roll: and monday being a holiday the kit will take more time than i like to always brag about. i am guessing it shall arrive thursday? it usually takes 2 to 3 days priority mail....bummer about the long weekend.
what say you?
will you possibly not be shooting until at least thursday?
i feel awful about the delay....
lori

 

Best wishes that your lovely Sasha recovers completely. What an awful mistake. Yet we've all made bad mistakes... just last night I was careless with a pillpocket with meds, and while I went to get the target cat, someone else jumped up and ate up the meds! And yours was a much more innocent mistake than mine! And you had read up and armed yourself with info... never doubt your actions saved her.

I agree with the others that a vet should make sure a new, guaranteed-overwhelmed sugarcat parent knows exactly what to do. Please let you vet know what happened so they take more care next time.

Give Sasha a kiss for us, and whisper in her ear that she is getting prayers and healing thoughts from around the whole world. she'll be home safe real soon, I just know it.

laur

 

OMG!! Just now seeing your post!! What a horrible introduction to FD! I'm sure you must feel terrible but we've all made mistakes at one point or another so don't beat yourself up. Just the other day I used the same syringe on both cats and wound up tossing a bottle of insulin....thankfully it was almost gone.


I'm soooo glad Sasha is going to be OK!! Lots of prayers on the way!

 

I am very glad to hear that Sasha is doing well. I'd read your initial post and I was very apprehensive about the outcome. I am very relieved that Sasha is recovering. It also sounds like the ER vets were very, very good to have figured out what was going on and to get Sasha the help she needed. It's not unusual for a cat to be very sensitive to insulin after an overdose.

There is a great deal of information on the use of Lantus on the Lantus board. Below are the links to the starred, sticky notes there if you think they will be helpful once Sasha is back home.

• Tight Regulation Protocol: This sticky contains the dosing protocol that we use here. There are also links to the more formal versions -- the Tilly Protocol developed by the counterpart of this group in Germany and the Queensland/Rand protocol developed by Jacqui Rand, DVM and published in one of the top vet journals.
• New to the Group: Everything you wanted to know about this forum and more. Info on our slang, FAQs, links to sites on feline nutrition and to food charts containing carb counts, how to do a curve and the components to look for, important aspects of diabetes such as ketones, DKA, and neuropathy, and most important, info on hypoglycemia.
• Handling Lantus: how to get the maximum use from your insulin and what to not do with it!
• Lantus depot/shed: This is an important concept for understanding how Lantus works.
• Becoming Data Ready: What data you need in order to be able to work toward remission or tight regulation.

 

I just saw this thread and was so happy to read that Sasha is recovering! Yippee!

 

laur+danny+cole Oh no! That sounds like something that would happen in my childhood household. We always had so many animals that getting the medication into the right animal was always a challenge I hope none of your animals suffered as a result and that everyone is doing fine.

Sienne and Gabby - those stickies are very helpful! I have a few questions about the 'handling Lantus' one that maybe someone can answer, and please tell me if I should instead post these in the Lantus forum... The bottle was pretty expensive (it was $149.99 at my local pharmacy), so I started looking at online pharmacies which I have ordered from in the past and never had a problem with. I found one in the South Pacific that will ship Lantus to me for about half the cost. Is this safe to do? On the Lantus website it says "Vials of insulin can be refrigerated or kept at room temperature (no greater than 86°F) for 28 days after first use." I was thinking that I could have several vials shipped here and then store them in the refrigerator, then toss the one in use every 28 days. Does anyone know of a reason why this would be a bad thing to do? Obviously I'd like to save money where possible, but only if it's not going to compromise the health of my kitty.

 

Hi,
I just bought the pen's at Sam's Club for $215.00 verse Rite Aide for 219.00. I had the vial which I bought in October. This has 1/2 inch left that I can't use. Kit Kat started to run high in the 300 and 400's so I think it is on the way out. So I had the vial for 8 months. I think that cost around $104.00. Pens are more expensive but hopefully will last longer. They have 5 per box.
I wanted to get from Canada but I was not sure about the mail strike and I needed the Lantus sooner than later.

 

Most of us don't use the vials. There's the potential for a great deal of waste. Most of us use the Solostar pens. A vial contains 10 ml of Lantus. You get 5, 3-ml pens in a box -- a total of 15 ml. If you drop a vial or it goes bad, you lose everything. If a vial goes bad after 2 mos, you're getting rid of a lot of insulin. You lose far less with a 3-ml pen. There are on-line pharmacies in Canada that will ship. (If you post on the Lantus board, people will tell yo where they order from.) Also, if you call around, there are often hospital pharmacies that will sell an individual pen. (A box of pens runs around $200 from a US pharmacy. Individual pens are around $45 or so.)

The pens are like mini-vials. You still use a syringe (U100 syringe that's in half unit increments) to draw off and shoot.

8 months is not recommended. The longest I've heard of anyone using a vial (or pen, for that matter) is 6 mos. I tend to swap out my pens after 28 - 30 days. My first Lantus was a vial and it was toasty after about 6 - 8 weeks.

 

i am glad that sasha is doing better and hopefully she will be back home soon. mistakes happen and it is very easy to make a mistake with insulin, especially when you are overwhelmed with the diagnosis and trying to figure out what to do and how your life will change as a result.

try not to be so hard on yourself.

rather than purchasing another viall, you may want to get the pens or cartridges instead - while the cost is higher, you get 5 in a box and will waste less than a vial. the unopened pens will last as long as the expiration date so it;s more economical to use pens.
check out your local costco - you don't have to be a member to use the pharmacy and the cost is more economical also you may be able to purchase one pen at a time.

 

Sending hugs and good wishes!!!! I just tuned in, and am so happy to read she is doing so well now. It is amazing how long she tolerated the dose, and so good that you were able to get her to the vet in time (and had honey on hand!!!!!!!!!!). Accidents happen, and thankfully some turn out ok!!! We have had people misread syringes before, or get the wrong size syringe, etc.... it happens.

:YMHUG:

 

I am just now reading your condo and I am so happy to hear that Sasha is doing better. What a scary, scary thing to happen but as everyone else said, you did not do this on purpose. The main thing now is to get Sasha better and positive energy and prayers will certainly help. Sending you lots of hugs and prayers.

 

Dear Melinda, and, of course, you too, sweet Sasha,

I'm glad your precious furry girl is doing better.

Long ago and far away, I, too, had a beautiful furry girl named Sasha...

We'll be looking forward to your Sasha's homecoming!

Welcome to the place you never wanted to be; but, will be blessed for having found.

Love and hopeful, healing hugs for you both,
Deb and Nikki -- and, Giz, forever dancing in my heart...

 

Oh this is the best news! I am so happy Sasha is on her way to a full recovery!

 

Thanks everyone for the love and support and the great advice! I just got Sasha home about 10 minutes ago. She is happily inspecting the apartment making sure I left everything the way she likes it, and purring her head off. It's the best feeling in the world. We'll be taking it easy for the rest of the weekend, cooking and watching movies together, and I've been told NO INSULIN until next week (which is fine by us!). That gives me some much-needed time to keep reading and educating myself so I can take better care of her in the future.

Many, many thanks to you all. And I look forward to seeing you all on the boards!

Much love,
Melinda and Sasha

 

Such great news to hear that she is home safe and sound!!! dancing_cat

Even after all this - waiting a week makes me a little nervous. Can you learn to home test during that time to make sure that she doesn't end up in dangerously high numbers after a few days? Also, you might want to pick up some ketostixs from your local pharmacy to test for ketones. I know she just went through a bad hypo, but the last thing we want to see is that turn into flirting with DKA.

 

:RAHCAT YAY!!!! SASHA'S HOME :RAHCAT

Now that is better than any fireworks display, family picnic or parade, a darling furry girl back home with her momma bean (as in hum(bean))

So glad to here she is home and back on duty making sure you keep everything just that she wants it... :lol:

You both have a great 4th of July! And as always if you have a question just post here, it maybe a little slow over the weekend, but someone will be wandering around to answer any and all questions.

Congrats again on having you baby back home.

Mel, Maxwell, Musette & The Fur Gang

 

Thanks everyone! I'm bringing her back into the vet on Tuesday morning to get more tests - blood sugar, red cell count/CBC, and a urinalysis and urine culture will be run at that time. The vet was very explicit about not giving her any insulin until she is seen by her regular vet. And I've already got ketone sticks on hand, I haven't used them yet but hopefully will have them mastered before too long

 

Dearest Melinda, and, especially you, sweet Sasha,

YAY!!! Color us smiling for you both!!

So what movies has Sasha decided on? I'm only asking because we know she rules...

Much love and countless celebratory homecoming hugs for you both!
Deb and Nikki -- and, Giz, forever celebrating at The Bridge...

PS: Ketostix test for ketones in urine. KetoDiastix test for sugar and ketones spilling in urine. I'm in northern NJ if that's close to you and Sasha. If I'm not close enough to show you how to home test and give you a hug, perhaps you could give us your general (no specifics necessary!) location. This Board is global, and someone might just live close enough to you and Sasha and be able to teach you ways to make both your lives safe. It's a thought, right?

PPS: We love paying it forward!

 

Very good news! Enjoy your homecoming Sasha dancing_cat

 

I just did Sasha's first Ketone test strip, that was easy! I heard her urinating in the litterbox, so I just grabbed one real fast and was able to pass it through the stream before she even knew what was up. The result was a little tricky to interpret, I'd say the color is halfway between Negative and Trace, it really could go either way.

Since she's been home there have been some strange symptoms. She's not eating very well, and for awhile she was having facial twitches where her whiskers would rapidly pull back. I watched and recorded the frequency, which at that time was running about one twitch a minute. The best way to describe it is the way cats twitch when they're dreaming. I went back to the hospital and spoke to the vet that had been taking care of Sasha. She was very concerned about this symptom, and gave me some food they had been feeding her in the hospital that she liked a lot more than the kidney-specific diet I've been giving her. She told me to make sure she eats a good meal, then watch to see if the twitching continues. If it does, I need to bring her back in for another BG check, the worry being that her sugar has again dropped too low, but the vet also said that she would be very very surprised if this were the case.

I gave her the food, and she ate some of it but not a whole lot. And the twitching does seem to have stopped, of course now I'm watching her very carefully because I'm extra paranoid They gave me a sheet with instructions on what to look for in regards to her BG falling too low, and I'm watching her like a hawk!

The other thing that's a brand new symptom is she is swallowing with some difficulty, and when she does it's like 8-10 big dramatic and uncomfortable looking swallows in a row. The emergency vet said that she's not concerned about that symptom in regards to her blood sugar, but it's definitely something for me to bring up at her visit on Tuesday with her regular vet.

 

Deb415andNikki, Sasha picked 'What's Eating Gilbert Grape', and 'Ed Wood'. She's on a Johnny Depp kick at the moment :lol:

I'm in Brooklyn, and would love to network with other diabetic cat owners in the area. It would be great to be able to help people out with their kitties when they go out of town (I promise to never ever make this same mistake again!) once I've figured out how to hometest and have got this under control.

 

Hi Melinda,

I must say that I cringe every time I hear about "kidney specific diets" being given to almost all CKD cats but especially diabetic patients.

The veterinary community is far too 'married' these high carb/low quality diets and I will beat my drums until the day I die that, in most instances of CKD, there are far better diets to be feeding. I will change "most" to "all" in the case of a client willing to make cat food vs feeding commercial foods.

I am crabby about this issue because I see so many cats end up wasting away on these low protein diets and also ending up in a diabetic state or with their current diabetes worsening.

It also makes me crazy when cats are put on these diets when they are only in the very early stages of CKD.

Please see the abstract below for a quick review of diabetic nephropathy. The gist of it is that when you feed high carb diets (all renal diets) to diabetic cats, their BG increases which then causes kidney damage.

I will copy/paste a post that I just put on VIN (Veterinary Information Network) regarding this issue:

The question that I was responding to is:

>>> Is it wise to try switching to a renal protective diet in this kitty that is in remission from his diabetes? <<<

Definitely not, in my strong opinion.

I am not fond of the word "protective" because there is nothing in the literature that supports the notion that the low protein diets will "protect" kidneys from further deterioration. Stated another way, I don't know of any study that has proven that the protein level in a maintenance diet harms kidneys.

I strongly believe that these diets are terribly overused in our profession - especially in early CKD patients - but also in advanced CKD patients. I have seen enough cats die in a state of protein malnourishment because people hang on to the use of these low protein diets with incredible tenacity....instead of feeding the cat a higher protein (and often more palatable) diet.

Keep in mind that because these diets are very low in protein, they will result in protein malnourishment and muscle wasting in any cat that decreases his intake for any reason.

In other words, if a cat eats ~6 ounces of a 22% protein diet, he will most likely meet his daily protein requirements. However, if he is now only eating ~3-4 ounces, he will end up protein malnourished.

It is easy to see how a higher protein diet...say, ~30-35% - or even higher in a severely hyporexic cat....will allow more wriggle room for a decrease in volume consumption as it pertains to meeting the daily protein needs.

Cats need a certain amount of protein per day and if he ain't gonna eat much in the way of volume....you better make every bite that he eats packed with protein.

Ok...off my general anti-renal diet soapbox.....

With regard to your case, there was an interesting webinar presented by Dr. Debra Greco a few months ago and I will summarize the gist of it. The case dealt with a vet-owned cat that was a diabetic in remission on a low carb diet. The cat had not needed insulin in a couple of years.

The vet/owner then decided that the cat need a renal diet since the cat's kidney values were creeping up above normal. The cat was put on k/d which is a high carb diet. The cat came out of remission and needed insulin again and the kidney values worsened.

Dr. Greco discussed the issue of diabetic nephropathy asserting that the high carb renal diet was doing far more harm than good. The vet/owner put the cat back on a low carb diet, non-renal diet and the cat went back into remission and the renal values actually improved.

I wish that I had more details to provide - including the lab work - but the gist of Dr. Greco's discussion was to not assume that the renal diets will 'do no harm' - especially in a fragile diabetic that will most likely fall off the remission 'cliff' if put on a high carb diet.

See this link and I will also copy/paste the part about nephropathy below in case the link does not work. (The article also includes a discussion of neuropathy.)

On a personal note, I cringe at the mention in the paper about oral hypoglycemics. I will not use these medications in diabetic cats.

http://wvc.omnibooksonline.com/data/papers/2008_T4.pdf

Managing the Difficult Diabetic Patient II: Feline
Deborah S. Greco, DVM, PhD, DACVIM

RENAL COMPLICATIONS: DIABETIC NEPHROPATHY

Diabetic nephropathy occurs in a large percentage of type 2 human diabetics. The incidence of diabetic nephropathy in cats is unknown, but recent research indicates that the incidence might approach 50–60% of diabetic cats. Diabetic nephropathy, like other diabetic complications, is associated with poor glucose regulation.

The earliest sign of diabetic nephropathy is microalbuminuria. Increases in urine protein to creatinine ratios follow microalbuminuria. Azotemia is a late consequence of diabetic nephropathy, but may be reversible with good diabetic regulation. Hyperglycemia increases GFR and RPF (renal plasma flow) and may increase binding of plasma proteins to glomerular basement membranes. Elevation of tissue polyol concentrations as a sequelae of hyperglycemia contributes to renal dysfunction. Thickening of the glomerular basement membranes and glomerular hypertension may also contribute to renal problems. Early identification of diabetic nephropathy may result in reversal of glomerular damage if glycemic control improves.

Reduction in insulin dosage and improved hyperglycemia via a low carbohydrate high protein diet with or without oral hypoglycemic agents is most successful in treating diabetic nephropathy.

Early identification of diabetic nephropathy may result in reversal of glomerular damage.

Improvement of glycemic control is the key therapeutic intervention.

Unregulated diabetes mellitus results in glomerular basement thickening, changes in GFR and eventually proteinuria and azotemia. Proper treatment of type 2 diabetes mellitus in cats using diet and oral hypoglycemics/insulin may help prevent progression of nephropathy. Diabetic nephropathy probably occurs in cats with type 2 diabetes mellitus as evidenced by increased presence of microalbuminuria. (Al Ghazlat) Poorly regulated diabetics are more likely to exhibit proteinuria than well-regulated diabetic cats. A significant relationship of systolic pressure to microalbuminuria was noted in a series of diabetic cats.

Here is a follow-up VIN post to the one above:

PS....Royal Canin's renal diet (Modified LP) is the lowest in carbs when compared to k/d or NF so if an Rx renal diet is desired, this would be my first choice - especially for a diabetic cat.

http://beta.vin.com/WebLink.plx?URL=htt ... e+RENAL+LP®+MODIFIED+(Canned

The 6 ounce Pate is 14% ME carbs and the 2.5 oz Morsels in Gravy is 21%.

Both are very low (for a cat) in protein at only 20-21% on a calorie basis.

If the protein is lowered, either the fat or carbs - or both - have to be raised. RC chooses to raise the fat and keep the carbs lower than NF or k/d.

Lisa Pierson, dvm
catinfo.org

 

Link to nephropathy article fixed above.

 

Lisa, thank you so much for your lengthy and informed reply. There is a lot of confusing and conflicting information out there as to what to feed a cat depending on what their issues are, and the trouble I'm now running into is the two issues requiring two completely different diets -- the diabetic diet should be high protein, while the kidney diet should be low protein. It's impossible to do both, so the question then is which is the more pressing concern?

Let me add here that for Sasha's entire life she has refused any kind of soft cat food, or even people food. She turns her nose up at tuna, chicken, beef, anything I have offered her. She only wants dry kibble, and it's impossible to get her to eat anything else. Of course I am willing to keep trying, and I'm also willing to try cooking for her, but my hopes are very low that she'll actually eat it.

When we checked out of the hospital this afternoon, I was given a statement of the work that had been done for Sasha, as well as a 4 page printout regarding her current state and how best to move forward with her treatment. The doctor on duty discussed her diet with me, and felt it was best to keep her on the low protein diet. Here is the diet excerpt from the papers I was given:

"Diet is a very important part of managing both diabetes and kidney disease. Studies have shown that low protein diets are very helpful in preventing progression of kidney disease. In cats that suffer from diabetes, higher protein diets low in carbohydrates have been shown to aid in regulating blood sugar. Given the combination of diseases a low protein diet to slow the progression of kidney disease would be recommended at this time. Although this may make it a bit more difficult to regulate Sasha's diabetes or make her insulin requirements higher, slowing the progression of her kidney disease will be more beneficial for her long term."

I really wish I knew what to do here, but I'm not a veterinarian. The only thing I can do is to take the advice of the experts and pray that the advice is good. I want to do what is best for my cat, and to make sure that her quality of life is as high as it can be.

Lisa, thank you again for your reply. I"ll definitely be printing this out and will bring it in for discussion when Sasha goes back to her regular vet on Tuesday. At the very least I will ask that she switch to the Royal Canin diet, she's not enjoying her Hills K/D very much. It's incredibly stressful when you want to do the right thing and aren't sure what the right thing is.

 

I know Melinda, I know.
You make the final decision, based on these 2nd opinions.
Dr. Lisa, DVM, if I'm not mistaken, works soley with cats.
Sorry if I am wrong on that.
She is well published.
Lori
and tomtom

 

I understand the difficulty the two issues propose for diet. There is the occasional post on here for cats that are both kidney cats and diabetic. It is possible to manage both. The prescription kidney diets are very very low in quality protein - to the point that it can cause a sort of malnutrition that actually does not help keep your kitty healthy longer. What you really need is a high quality protein that is easily broken down and not the generic "low protein is best". Do a search on this main forum here for CRF and you should turn up with the thread on diet.


As far as worrying about low blood sugar right now - it is much better to be able to test it at home to see instead of waiting another 30 min or hour to drive to the vet or ER vet to find out one way or the other. Low blood sugar can be managed at home *most* of the time - plus it gives you peace of mind knowing. On top of that, it is much cheaper to test at home, and more reliable than the vet tests because you don't have the stress from the vet added into the glucose readings.

 

I don't know a lot about the diet questions, but I can tell you my cat would not touch anything but dry food either, even things my other cats couldn't resist and would push each other out of the way to get to, he would just sit politely and look up at me like "yes, but where is the real food?". ohmygod_smile

I tried for months and months and tried everything I could think of to tempt him and could not get anywhere. I persevered (sp?) though, and finally out of sheer frustration I shoved some canned food in his mouth one day and that was our turning point - he decided it was actually food after all :roll: and then I was able to switch him over (in fact he would barely even touch dry food again after the :idea: went off for him, so our switchover ended up being a little rushed!).

So of course that was him and may not work for anyone else, but my point is to keep trying - you never know what might work or when they will choose to accept canned food, and it's just so much better for them in so many ways, I think it's worth keeping an iron in the fire. I had given up on trying, but with encouragement from people here, and reading the tips Dr. Lisa has (I think you can get to them from the Health Links forum, or certainly from felinediabetes.com directly), that gave me new ideas and we finally had a breakthrough.

You are doing great to be learning so much about all this stuff, we all know how overwhelming it is, and even more so when you are dealing with multiple health issues. Just keep taking it one step at a time and keep asking whatever questions you have!

 

My colleagues need to take some very serious time and sit down and carefully scrutinize the "studies" that they continue to quote.

This has become a dangerous reflexive move on the part of the members of the veterinary profession. Their constant default to the renal diets for every cat that is showing signs of CKD - both mild and severe - is robotic and often does not involve taking the individual case into account.

I see this day in and day out in my consulting work.

Diet is not a 'one size fits all' issue and the constant use of the renal diets is a clear example of this issue.

Also, please see my Tips for Transitioning Dry Food Addicts to Canned Food at catinfo.org. I am a firm believer that all cats can be switched to canned food - or at least 99.99% of them - if the human really works at it hard enough. That is not meant to throw a guilt trip on anyone. Nor is it meant to add stress to your life right now but it is my firm belief. I have dealt with a lot of VERY stubborn dry food addicts and have never failed to get one transitioned. All too often, the human gives up too quickly. As noted in my writings, it took me 3 long and VERY, VERY frustrating months to get my small herd (7 at the time) of VERY DRY FOOD ADDICTED cats off of dry food in 2002. It was not easy but it was accomplished.

That said, I fully understand that you have your hands full right now but please review my Tips paper when you feel like you have your head above water again.

 

Hi Melinda, and, of course, you too, darling Sasha,

Gizmo was the 00.01% that our dearest Dr. Lisa couldn't convert and gave special dispensation to -- and, for which, we were always beyond humbly grateful... The only actual cat food she'd eat was DM dry. Because of her diabetes, I learned to use my George Foreman Grill. She got grilled chicken (preferably boneless chicken breasts), pork chop (preferably boneless center cut), and whatever steak was on sale (usually round steak). Okay, she also had a fondness for peach yogurt... Okay, and extra-sharp cheddar cheese...

Yes, she ate better than I did... Thank God, she sent me Nikki, who's really okay eating canned cat food!

When Giz started developing kidney issues around age 17, three years after being diagnosed extra-sweet, it turned out to be a blessing she had a taste for her truly high quality high protein diet. Yes, we flirted with K/D and I can't remember the Eukeneba we tried... Just kept going back to whatever worked for Giz which was grilled whatever and DM.

Rock bottom, Sasha needs to eat. Period. Whatever works is whatever works. You can always s-l-o-w-l-y transition later...

Much love and countless hopeful, healing, non-whisker-twitching hugs for you both,
Deb and Nikki -- and, Giz, who taught me everything...

PS: Who doesn't love Johnny Depp? Seriously...

PPS: I always get lost going to Brooklyn. Quite frankly, I'm reasonably sure my car won't make it to Brooklyn or back to Jersey. There is mass transit... I'm not really good at mass transit; but, I could probably do a bus. Perhaps we can figure something out...

 

Ah...but Giz...and Clara...were never in my personal clutches.

I always picture Giz and Clara laughing at me when I say 99.99% but I still wonder what they would have done at Casa Pierson. Sorry...just have to wonder....because deep in my heart, I truly believe that it is 100%.

I can't lie....

<ducking for cover now>

 

Cedric & I are sending more hugs to u for Sasha's recovery!

 

Hi Melinda...I am very new to a diabetic cat situation also. I am learning as I go along. Please remember that what they say is true..."hindsite is 20-20" and what seems so obvious to you now was unknown before. We learn by our mistakes. I carry mistakes I made too and sometimes the guilt is overwhelming but if we learn and carry that knowledge with it, we benefit. Best wishes to you and your lovely cat....Carol

 

Hi Ms Melinda and Sweet Sasha,

I have 3 girls and all have their issues...... Slappy will not (as of now) touch any wet food either.....we watch her while she eats so my Sugar Bean does not sneek into her food (which she does every once in while :cry: ).

Sugar Bean is in REMISSION!!!

And Gumpy is the worst off.... She is CRF and very high blood pressure.... I have found that she will eat friskies special diet - good for her and Sugar Bean as she may sneek into it and she will be fine.
I also take the Friskies Classic and mix it with their food, that way Gumpy gets what is good for her and so does Bean. I know it would be best if Gumpy just at the special diet, but she likes it and will eat that better mixed. We also do the fancy feast mixed in as well.

Sure wish Sasha would give in to wet as I do with Slappy, but omg! we are goin on 3 months and I think she would starve if she did not eat the dry......I will try sticking some in her mouth tho.... who knows, she will either hate me for the day, or it might work!

I am SOOOOO glad your baby girl is doing better! I was helped by many during our first couple of weeks here, as I was not home testing yet, shooting Bean blindly. Then finaly, I "got my big girl panites on" and tested, got the testing to actually work (as I had tried 2-3 times before, and could not get the process down). We were +2 hours after shooting and my beautiful Bean girl was only 26! LORI LORI LORI stayed on the phone w/ me for 4 hours, folks here posting, etc...... WE MADE IT!!! And I promised my girl I would NEVER shoot before testing again!
And..........by testing, and adjusting her diet, MY BEAN IS IN REMISSION!!!!!! YEA BEAN... Just wanted to share my testing story and how important it is to me to test before I did any shooting.....
Now we only test 1 a week. She is wonderful! Playing again, eating good, doing her 10 min outside time. She really seems back to normal!

I wish you all the luck with the testing... as many have said here...it really is easy. Bean and I have a special chair, special loving, and special treats that we go to ONLY for pokey poke time. She knows when I get my little basket of goodies out, it is going to be just her time for at least 5 min. or when she decides to be done with after-love.

Welcome and sorry this is soo long...have a great bond day w/ Sasha - btw...she is gorgous!

 

Lisa dvm - I've been reading all the great info you have on your site. I'm pleased to say that I have been following literally every litterbox guideline you listed since day 1 with Sasha! (finally, I did something right The transitioning to wet food page was very interesting with some really good tips, and I'm going to go for it. I've known for years that wet food is better than the dry, and that's the one thing I got universal vet consensus on, but I just didn't think there was any way I could convince Sasha of the same. Once she's back to normal and fully relaxed after her terrible stay at the hospital I'm going to slooooowly start the transition. I know it doesn't have to happen overnight, thank goodness... and I still need to figure out exactly what I'm going to feed her once I've weaned her off the dry kibble. I've been reading these forums like crazy, there is a LOT of information here and it's a bit much to take in all at once. I am willing to try the higher protein diet, especially since she has been expressing her disgust with the k/d, but would like to find out what the ideal protein (easy to digest for the kidneys) might be. And please don't say mouse -- I might live in NYC and all, but I am not going to go hunting for my cat's dinner in the subways!

Deb415andNikki - I'm not extremely familiar with the geography out here, I moved to Brooklyn about 5 years ago and only take mass transit when I'm not on my bike, which makes learning about where I'm going a bit difficult for me (I always learned by driving myself and consulting maps along the way). I don't go to Jersey very often, but I do visit Jersey City on a semi-regular basis. Are you anywhere near that area?

 

Melinda, I've heard you can buy these things called "pinkies' which are frozen, skinned, mice.
Gross, perhaps. Ideal food, Yes!

 

Yeeergsh... I've seen frozen rats (skin, heads, tail, etc. all still attached) at my Petco. If we eventually start going in that direction I could do it. And if I'd need to cook them first Sasha is getting her OWN frying pan!

 

I promise to make this a quick one for once I just wanted to say thank you to everyone that has posted on this thread, this time specifically to the folks that I haven't responded individually to. There's such an overwhelming response of support and advice that I want to thank all of you. Everything has been read and appreciated and every single post has helped! Thank you all so very very much!

Sasha is resting now -- not the 'scary' resting where I check on her every minute to make sure she's still breathing, but a nice peaceful resting. The twitches are completely gone. And anytime I come into the room she perks up and seems quite alert and well. I've attached a photo I took of her just a few moments ago, we all love sharing photos of our kids

 

I fully understand this, Melinda. My Maggie was the same. She turned her pretty nose up at any wet food. She wouldn't eat any people food. In fact she and her brother would actually leave the room when we ate - I think the smell of people food bothered them. I know dry isn't good for cats, but Maggie was fed dry and honeymooned twice on it.

So get Sasha to eat. You can see if she will adapt to wet food after she gets better.

PS: I love Johnny Depp, too, but how did he come up in this thread? I'm dying to know!

PSS: Sasha is so cute in that picture!

 

She's not so bad that she'll leave the room -- she will happily put her nose on whatever it is I'm eating (I'm forever pulling her nose out of omelettes), and will occasionally lick the food (like water off blueberries). But when it comes to actually putting the food in her mouth and eating it I can't get her to do it. If I get her those cans with the shredded meat in them, she'll lick all the gravy off but leave the solid stuff behind. Maybe it won't be such a long process to wean her after all... once she's better I'm going to start the process. This should be fun

Johnny Depp was the subject of our movie night last night! I've got 2 of his films via Netflix sitting here, once I got her home from the hospital we had a lovely night in.

 

Here is the crf link that floats around here sometimes:

viewtopic.php?f=28&t=46673

It has links to food charts ordered by phosphorus content (which is hard for taxed kidneys to flush out). High meat content is usually linked to a high phosphorus content, which is also where the low protein diet comes in too. You can cross reference flavors from that chart with Janet and Binky's food charts to see which ones are lowest in carb content and within your budget.

 

Oh Melinda - so good to hear things are looking up for Sasha. Glad she is home, and the twitching has stopped and you are seeing improvement.

I read all the posts on this thread with great interest, especially Dr. Lisa's. (Thank you Dr. Lisa!!!)

Crash has been off Lantus for over two years, and has early kidney disease. Vet wanted him on KD, but I knew that was wrong for sugar cats. The search was on. I found that phos was the problem, so researched all the FF and Wellness and Proplan he was eating - all was over 200 phos. The Wellness Turkey and Wellness Chicken along with Royal Canin LP Modified is what we settled on. He needs the protein, but lower phos.

He has not lost weight, but his BG numbers have gone from 60's to 90's, but still in range, but higher than I want. He is still drinking ~8oz of water per day, and pees alot, but is still a happy cat. After reading Dr. Lisa's post, I think I will keep some of the 250's FF just in case a flavor module needs to be added to the meals. Royal Canin smells good, but not as palatable as he likes. And he now gets raw and cooked chicken and occasional eggs. Maybe you can get Sasha to enjoy some of these foods after she is convinced they taste way better than the dry food.

Give your precious girl a scritch from us, and so glad things have turned the corner for you both. Don't forget to eat some chocolate as you study!

 

Dearest Dr. Lisa,

That's because Chet and I were saving you from two black cats with extraordinary palettes...

It is 100% in my book. I lived with and loved Giz... Chet lived with and loved ClaraKitty... They were both beyond extra-sweet cats. They were both extra special -- particularly when it came to food!

You never have to duck for cover from me, dearest Lisa. I'm a pacifist. And, I'm eternally grateful that Giz, in her infinite feline wisdom, sent me Nikki who actually eats canned cat food!

Much love and countless grateful hugs for every single thing you teach us every single time you post,
Deb and Nikki -- and, Giz, no doubt sharing catnip tea with Clara whilst discussing Ralph Lauren and Calvin Klein at The Bridge... Okay, Vera Wang too...

 

On another note, let's not just focus on carbs. As I have typed many times on this board, it is *not* just about carbs.

It is also about *water*.

Feeding a water-depelted diet of dry food is very hard on the urinary tract system - including the kidneys - the most important organ when it comes to water balance and keeping us hydrated.

Cats with kidney insufficiency are better served with a diet of 78% water - not one that is only 8-10% water.

Melinda, can you get Sasha to read this?

 

Unfortunately I can't give you any advice on dry diets for cats with kidney disease, but I can give some good canned food recommendations that I used with my Gabby, who was diagnosed with renal insufficiency a few years ago. Because my other cat was diabetic, I hunted for foods that they could both eat, which meant good for Gabby's kidneys and low carb for Bandit. My vet also put Gabby on Purina NF canned food. Gabby hated it and barely ate it, even though she always loved canned food.

After some research, I discovered that there's a lot of controversy in the veterinary community over this issue. Check out the articles in the middle of this page: http://www.felinecrf.com/managd.htm. Low protein diets are successful in some cats, but diets low in protein are also low in phosphorus because of their low protein content, and it's debatable whether what's really helping cats on the low protein diets is the low phosphorus content. Some experts believe that a high quality protein/low phosphorus diet is better in treating a CRI cat. After reading about the incidents of muscle wasting that Dr. Pierson referred to in her post, I decided to go with a high protein, low phosphorus, low carb diet for Gabby. I bought her premium foods with no byproducts and low phosphorus. These were PetSmart Chicken & Beef, EVO 95% Venison and Beef flavors, Wellness Turkey, and Merrick Cowboy Cookout. The diet change pretty much stalled her kidney disease in it's tracks. She had her kidney values tested right before she passed away earlier this year (she was diagnosed with stomach cancer in July 2010), and they showed no signs of any progression of the CRI.

Of course, every cat is different, but I wanted to share my experience. I also took Gabby's quality of life into account when making my decision. She was 14 years old when she was diagnosed, and I just didn't think her body would stand up to a low protein diet. I thought that even if I was wrong on which diet was better, I'd rather have her strong and healthy for a shorter period of time than wasting away for longer. As it turned out, I 100% think I made the correct decision because the low phosphorus diet did work for her.

Of course, you also have the problem of transitioning Sasha to a canned diet, and I know how tricky that can be. My best friend's cat Calvin, has kidney disease that had progressed much further than Gabby's had, and he just refused to eat canned food. She went out and bought him EVERY canned food low in phosphorus she could find, and for months he would touch anything. Finally, she found one food he would eat (Friskies Special Diet Chicken in Gravy), and slowly got him mostly eating that food. Once the dry food finally was out, she mixed the chicken & gravy with other lower carb/low phosphorus pates that she had tried with him before and he refused. He eats the mix, but still won't eat the pates on their own. My friend is ok with that, and Calvin is doing well.

*edit--Gabby was on canned Purina NF, not Hills k/d. I got a little mixed up.

 

Sasha's never been much of a reader, she only flips through the tabloids in line at the supermarket. Her reading is much like her food - all junk.

One thing that is probably good is she has always been a very heavy water drinker. She drinks water like it's made of candy, which is also why I've stayed on top of her litterbox duties and kept it very very clean. Even catsitters have remarked on the amount of water she consumes, it's probably 2-3 times what most cats drink. As a result, for her whole life vets have made the assumption she must be diabetic and have tested her on a pretty regular basis, and they were always surprised when the tests came back negative. Well, up until a week ago, that is...

Another bit of history about Sasha - she was morbidly obese when I adopted her. A whopping 26 pounds, but through careful dieting and an iron will I slowly got her down to her current weight, 14 lbs. And if I can get a fat cat like that down to a reasonably healthy weight, I think I can eventually get her switched over to a healthier food. I'm not going to start right away, she's still got a few more scary vet visits coming up (as well as being boarded at the vet when I go on vacation later this month), and I want those to be over and done with before we start the food transition so that she only has positive associations with the food - another great tip from your article, Lisa DVM!

Julia & Bandit - thank you very much for the recommendation! Sasha is also 14 years old, and is a little wobbly to be honest. She's never been an energetic cat, even when I first got her at 4 years old, but she's definitely showing her age a lot more these past few years and I want to keep her in top shape. If I can get her feeling great at a reduced life span, I think that is way better for us both than having her stick around forever while feeling like crap the whole time

And brand names are really helpful, thank you for mentioning those - of course I will eventually do my own research, but right now I've got so much to learn just on the diabetes front that having someone say "This stuff is good!" is a big relief.
Have I mentioned how awesome all of you are? Because you are And being able to talk out these issues with everyone has given me so much hope and a much more positive outlook on the whole situation. I didn't know how I was going to deal with this before, but now I kinda feel like if I stay patient I can provide her with really good care.

 

I always leaned towards that mindset with Gabby every step of the way. While the diet change did end up working in regards to her kidneys so we were in a win/win situation with the choice I made in food, I did end up having to make that choice again. When she was diagnosed with cancer, it was a very, very difficult decision on whether or not to pursue treatment. I ended up not pursuing treatment with her, because the odds were against it getting rid of the cancer, there was a good chance of her not surviving it, and if it didn't help I didn't want her to spend months recovering from surgery when she only had months left. I wanted her happy and comfortable as long as possible. I also tried to look at it from her point of view, on what she would want if she could tell me. I know she would have wanted to live out the time she had left as comfortably as possible. Even if the surgery had given me a few more months with her, I would give up those months in a heartbeat if it meant she was unhappy the whole time. As it was, she lasted 8 months without treatment when all the vets originally thought she had no more than 3 months, so something can be said about keeping your cat as happy and comfortable as possible throughout the course of the disease.

And of course, you never know. A high protein/low phos/low carb diet could be the thing that both makes her both feel great and extends her life. That's how it would have been with Gabby the cancer not shown up.

 

Absolutely.

Quality of life always trumps quantity of years lived.

 

another inexpensive canned food option is:

friskies special diet - pates, don't get the gravy ones as those are higher in carbs.

my girls like turkey & giblets, beef & liver - these are lower in phosphorus, while still being low carb and relatively decent canned food.

 

The special diet chicken & gravy is 14% carbs, but I would say if she's being stubborn transitioning to the pates and will only eat gravy foods (as was in the case with Calvin), you can try mixing it with lower carb foods to help transition, and then gradually removing it if you can. I only mention this because you said she won't eat any people food like tuna, chicken, or beef, which makes me think you may need a gravy food to help her transition if she doesn't take to the different pates right away (all the foods I listed in my previous post were pates as well). Fortiflora is another option to help try and get her to eat the pates, and that won't mess with the carb content.

Gabby also ate the Friskies special diet Turkey & Giblets and Salmon when I went through some financial trouble and couldn't afford the premium foods for about a 4 month period. Keep in mind that Friskies does contain byproducts, so the protein quality is going to better in the premium foods. But what it comes down to is feeding the best thing that she'll eat and you can afford, so the Friskies special diet foods aren't a bad choice if that's what she wants. My friend went through about 8 different kinds of premium foods with Calvin, he will only eat the Friskies.

 

Looks like I've got a larger pool of choices than I thought I would, that's great news! Getting her switched over will be tricky for sure, but I can be sneakier than she can be and I'll figure out a way

I have yet another unrelated question for everyone here -- I tried searching on the forum for an explanation, but every search term came up with 'too many results to display'. I also tried the glossary, and no dice.

I've been looking at the spreadsheets everyone keeps, and there's a couple of things I don't understand...

1. What are AMPS and PMPS?
2. I understand the BG numbers at the top of the spreadsheet and figured out they're a color coding/legend for the BG numbers, but I'm confused by the +1 +2, etc., and why those numbers would reset themselves.
3. Does u = units? Ex: 1u = one unit of insulin, .75, etc?
4. What is a fur shot?
5. How did you figure out how to adjust your cat's dose of insulin based on these numbers? Is this something your vet told you how to do?

 

1. What are AMPS and PMPS?

AM (morning) preshot test and PM (evening) preshot test

2. I understand the BG numbers at the top of the spreadsheet and figured out they're a color coding/legend for the BG numbers, but I'm confused by the +1 +2, etc., and why those numbers would reset themselves.

+1, +2, etc., are the number of hours after the shot (+1 is one hour after the shot, +2 is 2 hours after the shot, and so forth). I'm not sure what you mean about the number resetting themselves. They restart after each shot; is that what you mean?

3. Does u = units? Ex: 1u = one unit of insulin, .75, etc?

Yes, u = units.

4. What is a fur shot?

A fur shot is when the insulin goes into the fur instead of into the cat. But you never assume that *no* insulin got into the cat, and so you don't give another shot. Wait until the next shot time.

5. How did you figure out how to adjust your cat's dose of insulin based on these numbers? Is this something your vet told you how to do?

Experience, advice from the vet, advice from people on this board; protocols for the particular insulin you are using may give some help (such protocols are usually findable in the stickies at the top of the section of the board for that particular insulin - different insulins can have very different protocols). Different people learn this from different sources.

 

1. What are AMPS and PMPS?

AM = morning
PS = preshot
PM = evening

So what this means is the morning or evening BG number prior to shot time


2. I understand the BG numbers at the top of the spreadsheet and figured out they're a color coding/legend for the BG numbers, but I'm confused by the +1 +2, etc., and why those numbers would reset themselves.

It's a clock with 12 hours - the 1 point is the AMPS and clock going 1 hour after shot, 2 hours after shot, up to 11 hours after shot, then you're at 12 o clock again and pm time.

We talk about it this and color code because people are in different time zones and this makes it easier for everyone to understand what's going on.

If I said well at 8 pm I did this and then at 10 am I did that, nobody would understand what I meant and whether those are vital times. But if I say 2 hours after getting shot, this happened, then people know what it means and how crucial it may be.

3. Does u = units? Ex: 1u = one unit of insulin, .75, etc?

yes u = unit

.75 = 3/4 unit of insulin

this is why getting syringes with 1/2 unit markings helps.

and honestly, it's a bit of a guessing game, cause my .75 may not look exactly like your .75 and yet we will call it that - the importance here - is to be consistent on your syringes with each one.

4. What is a fur shot?

anytime you screw up and don't get the insulin all the way in, some of it ends up on fur - or somehow something went wrong -it's called a fur shot - you can sometimes feel wet in the area or even smell the insulin on the fur.

5. How did you figure out how to adjust your cat's dose of insulin based on these numbers?

this is where the lantus board will come in handy, by tracking the BG's on the spreadsheet, you can start to see patterns and movement, and know what is going on and when you need to adjust dose - with guidance from the lantus board peeps!

Is this something your vet told you how to do?

nope - my vet didn't teach me any of this, all I learned I learned here.

 

Melinda check your pm's re: your newbie kit

 

Sasha is still on Lantus, right? Here is a link to the Lantus protocol: http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581. You can print this out to give to your vet to help advise you with dosing, if it's not the protocol they are already using: http://felinediabetes.com/Roomp_Rand_2008 dosing_testing protocol.pdf. This protocol has been proven to be incredibly safe and effective. The big advantage with it is that the dose is raised in quarter and half unit increments instead of whole units, so you don't miss your cats ideal dose. If you skip over the right dose for the cat to a dose that is too high, it can cause all sorts of problems. The protocol allows you to determine the best dose from the beginning.

Here's a post describing how to set up a spreadsheet and post it in your profile:http://felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207&start=0

If for some reason that does not work, follow the instructions in this post: http://felinediabetes.com/FDMB/viewtopic.php?f=6&t=46476

I'm sorry it's a little confusing to have two sets of instructions, but a lot of people were having trouble accessing the template in the first post and I want to make sure you can get started.

 

Any updates?

 

I brought her in yesterday for a follow up, she's anemic which is a brand new diagnosis.... need to keep an eye on that for the next week or so and update my vet if she doesn't start showing a little more pep.

Her BG was somewhere in the 360s (sorry, I have it written down at home, haven't started my spreadsheet yet) yesterday at the vet's office, and she received her first shot of insulin this morning since being hospitalized. We put her on 1.5u to start off with.

I have to have a BG for my vet by Friday, either by providing it myself or by bringing her back into the office. I haven't done this before so I'm a little nervous, and I really don't want to bring her back in if I can avoid it!

 

Dearest Melinda
1.5u! I am sooooo not liking that dose. Please test thru out the day. be high carb ready...not just karo or honey, but high carb food.
This is just not right...the highest should have been 1u, but even a fraction of that would have suited me.
Get that high carb food ready ok?
Call me if you need high carb choices;;;;;or quick help, altho i'll be at work most of the day.
Lori
and tomtom

 

Just realized you likely do not have your kit yet .... hopefully this afternoon or tomorow.
I have to tell you... I am a little worried.
Keep a very close eye on Sasha.
That hospital number you got yesterday could be 100 or more points higher than her non stress # at home.
And the insulin sensitivity after the overdose....

 

Oh Jeez... I really wish I knew what I were doing here. 1.5 is the number my vet told me, and she is aware of the insulin sensitivity. Can I trust her opinion anymore?

I will go home at lunch and check on her. What are some good high carb choices I can bring home? I don't have a meter yet, I'll get one at lunch as well.

 

Melinda, do you still have my number? i can pm you. i'll look on my list and name them for you if you are going shopping.
sorry to alarm you...just that vets are famous for prescribing too much insulin

 

Anything in gravy is a great HC food for a kitty, alot of the time you can just give them the gravy off it because that is where the carbs are, and it won't fill them up if you need to keep them eating.

Just remember to breathe it will all come together, baby steps for now.

Try not to be too hard on your vet, they have to know a lot about a lot of different species and all the things that can go wrong with all of them. It just isn't humanly possible to stay up to date on everything and diabetes is one of those things they probably don't see a lot of, so it may not get the same updating of information that other things that they see on a more regular basis.

Mel, Maxwell, Musette & The Fur Gang

 

I agree that 1.5 is too high after what Sasha was through. I would drop the dose down to 1u tonight. Your vet seems to be dosing too high--she started Sasha out on 2.5u when 1u is the recommended starting dose. That doesn't mean she's a bad vet, but it does mean she's not following the Lantus dosing protocol. It's possible she doesn't know the protocol, because many vets don't. I had to print it out and give it to my vet, and say, "This is what we're following for dose adjustments." Vets have to have a general knowledge base for different animals, so it can be difficult for them to know the specifics for one disease.

For high carb, grab anything with gravy. I keep Fancy Feast Gravy Lovers food on hand for high carb.

 

She may not have had the experience of actually living with a diabetic cat, monitoring it, and seeing the consequences from dosing errors. Without seeing good data, it may be difficult for a vet to understand what that is like, especially the absolute terror of seeing your cat in convulsions.

You are allowed to be assertive here and say to the vet you aren't comfortable with that dose, and that you want to be very cautious because of the recent overdose situation (or any time you have concerns about treatment, tests, etc). You are allowed to negotiate, for example, trying a lower dose first for 3-5 days, and home-testing to see the results, then sharing the data with the vet, and then adjusting the dose as needed (aka, the Tilly protocol). It may be helpful to you to read the "Convert A Vet" stickie post.

 

Well Sasha and I made it through our first home testing run, and the results were less than optimal. I had to lance her three times to get any blood out. The first two tries were with this little cap over the lance which made seeing where the needle was going impossible, so on the third attempt I removed the cap and just freehanded jabbed her. That produced some results. I put the test strip up to the blood and saw the countdown start, but then it ended with E-4. Which means nothing to me. I looked in the manual and see nothing about that code, which I'm assuming is an error of some type.

She's hiding in the closet now, but she did eat a little bit of the gravy in a can of Fancy Feast (while leaving the actual solids alone). I hate that she's in hiding, especially since we're going to have to go through this again in a couple of hours. :sad:

 

Couple of things that may help, try warming her ear up, either by rubbing it really good, you can do that while deguising it as just lots of head rubs. Or using a rice sock, baby socks work great for this, but any small sock that is fairly thinnish and cotton, fill it with about 1/4 to 1/2 cup of plain white rice or lentils, toss in the microwave for about 20 seconds. I got Musette use to it by rubbing her all over with it first, she liked the warmth.

Also make sure you are backing the ear with something fairly sturdy. I personally just use the same rice sock that I used to warm Musette's ear. Others use a makeup sponge, folded paper towel etc. Just don't want the lancet to bounce off the ear, plus it keeps you from getting poked too.

If your lancing device has a clear cap option use that option makes it easier to see where you are poking. If free-handing try going at a 45 degree angle.

Mel, Maxwell, Musette & The Fur Gang

 

Thanks MommaOfMuse! I tried warming her ear for a little bit beforehand, but she's so skittish from all the pokes and prods she's been getting at the vets that she was already trying to squirm away when I was doing that. I figured to cut that portion of it short to just try and get a reading today.

The lancing device did have the clear cap option, that's the part I had to remove in order to hit what I was actually aiming for. I think I'm going to stick with the cap-off method, it was just too difficult to guess where the needle was about to go. I backed her ear up with some folded up cotton pads to prevent from sticking the needle straight through to my skin.

I'm going to try again tonight around 7:30 to see what I can get, and dose her again at 1u. I really want to get at least one reading before tomorrow, otherwise I have to bring her back into the vet for what will probably be another inaccurate reading that'll confuse me even more. And if I fail doing that, I'll start a new thread (or find an older appropriate one) on the topic since this one has started encompassing all things Sasha-related, rather than any one specific problem I certainly don't want to be the cause behind good information getting lost under a misleading headline!

 

Melinda...you can always call for a walk thru. sometimes using the strip in a non-sipping way, or poking in just the slightly off spot can reduce blood drop.
there is a way to be set up so it all goes smoothly.

 

Couple other tips is if she is really squirmy, if you get a good blood droplet but she is squirmy, catch the droplet on the back of your thumb or fingernail and test it from that.

Musette is easy because she is a small cat...6lbs so I can stick her under my arm like a football. Maxwell on the other hand is BIG BOY, 16lbs, long and tall at first he was tough, so I would put him on a large beach towel and wrap him up like a kitty burrito, with just his head showing. And always remember the treats, something special that she only gets at test time...for my kids that is little bites of water packed sardines. And Sasha gets the treat whether you get a successful test or not, she has held up he end of the bargin for letting you try, its not her fault that it didnt work, so she is rewarded either way. Maxwell figure it out so well that he now comes when he see the test kit, even though he has been in remission for 8 months...lol. So now when I test Musette, Maxwell has to have a treat too and about half the time when I'm done testing Musette, Maxwell will crawl in my lap looking for his test too.

Mel, Maxwell, Musette & The Fur Gang

 

Thanks Lori! I'm going to try it one more time tonight and pray I get it right, if that fails I'll PM you to arrange a good time for a phone call.

MommaofMuse - Maxwell sounds so sweet! That is an adorable response for him to have, I hope that one day I can get Sasha comfortable enough with the process to have a similar reaction. I gave her treats after the attempt today, but I think I should come up with something special for test time rather than the same old Temptations I always give her.

 

Hi guys, I just read through this thread and can't believe everything you two have been through! I'm so happy Sasha has made such a nice recovery .. getting the blood out of her ear will come in time .. I know you will get it ... Again, so happy the outcome is good!!

 

'Nother tip
Pick up some neosporin ointment (not cream) with topical anesthetic in it.
Apply a very small amount before testing.
This will slightly numb the ear, plus the ointment version helps the blood bead up into a drop.
Apply a few minutes before you intend to poke (perhapsright before you warm and massage the ears)
After words, you may wipe off any residue.

A low carb treat after testing rewards the kitty and helps reduce resistance too. (Spitzer gets a piece or two of dry kibble and voluntarily comes into the bathroom for testing, though he is a bit squirmy at times)

 

My girls eat this as well. To be honest they go between the special diet flavors that are low carb and regular flavors that are low carb (around 7%). Both Margaret (sugar kitty but she's off insulin) and Julia (civie) get tested just to be on the safe side though and as long as numbers are good and they're eating, I'll stick with it. For what it's worth, they both stick their noses up at Fancy Feast but love Friskies. Both girls love gravy in their food but with the lower carb foods you don't see that as much so I make them "gravy." I think part of it is the gravy makes the food soft & mushy for them. So, I simply mix their food with water (a fork or spoon to mix it works fine) until it's mushy. It's somewhat like a thick soup and they love it. Margaret was another dry food cat and I actually got her to transition to wet food by making a "cat shake" which was recommended on this board. I blended a can of cat food in the blender with a few tbsp of water until it was creamy. I gave it to Margaret next to her dry food. She ignored it. The next time she came over she tried it and never went back to dry again. Just an idea...The funny thing is that is the only time I ever used the new blender...for cat food. :lol: Oh the things we do for our fur babies.

I'm so happy to hear Sasha is doing better!!! She's adorable.

 

Thanks to everyone for the shopping suggestions! I've got a cabinet full of wet food now, trying a different one every day