? Likely diabetic cat, need input please!

Good evening,
Quick question or two for the group. My cat has crf, pancreatitis and possible diabetes. I'm trying to learn more about diabetes before rushing into insulin but I also don't not want to do it if I need to. Long story short, he has chronic pancreatitis,ckd. Recently not eating much. He was on prednisolone at high doses by the IM doc in June and tapered down to one dose in mid towards end of July. Transitioned to budesonide approximately two weeks ago (which seems to be when his appetite started decreasing can't say 100% certain if that or pancreas but it seems to coincide with the transition to budesonide. . His blood glucose from 3/13 - 6/16 was/ranged from 114-220. High dose of pred started and glucose was around 400 on 7/6. 7/11 bg 201, 7/19 228 (on one poll of pred). Started budesonide 7/27. Bg around 8/2 to 8/6 360. Frutcosamine level done 7/11 and doctors notes say mild elevation and was around 380 (This was in between the high dose of pred and low dose of pred). He's seeing a different place because doctor on maternity leave. Had urine test thus week which showed sugar in urine. This doctor stating to monitor urine at home and if still like this in a day or two start insulin. Are they reacting to the current levels and while on budesonide? Can panc flare cause these to escalate? Is the urine the best indicator of glucose or the frutcosamine? I feel like mo one is looking at the whole picture and not sure what to do next and am scared and not sure if I shouldn't wait or if I need to ask more questions. Help. Appreciate any input.

 

Welcome Nicole! Please don't be scared, diabetes is manageable, and you've come to the right place for good advice. More experienced people will post, but I'll mention a few things.
Diet makes a big difference in blood glucose levels. Low carb canned food is key. Most here feed Fancy Feast pates and Friskies pates. What are you feeding him?
Pain can make the glucose levels higher. So can stress, such as a vet visit.
Are you willing to home test your cat's blood glucose level? This is a must to know how to administer the proper amount of insulin. Most here use human meters. Read some of the sticky posts for more information.
Best of luck!

 

I responded on your other thread.

 

Thank you so much. He was confirmed as diabetic today and want me to start insulin. I'm very scared, especially because he isn't eating too much on his own, so I'm concerned about doing it with him not eating tons and also scared in general and wondering how I monitor at home, as I'm willing to do it, how I manage that and him not wanting to eat much etc. they think maybe having insulin will make him feel better but will it help with his appetite? Help!

 

I could have written your post about a year ago. Almost exactly the same. Gizmo is happy and doing well. Still have bouts with pancreatitis but have learned how to manage that (as well as it can be) at home.

Deep breath. Lots to learn but just keep posting and asking questions.

What insulin is being prescribed? You must be prepared before you start it (meter, strips, high carb food).

What food are you currently feeding? With FD and crf you need to feed a low carb, low phosphorus wet food. I suggest you start with the diet change and start home testing before you start insulin.

 

What insulin and what dose were prescribed?
What was his glucose level at the vet?
I'm going to tag some of the more experienced folks and ask them to help direct you.
@Bobbie And Bubba @Kris & Teasel @carfurby

 

They said glargin I think that is how you spell it. The vet had me try a diet change to a few different foods but he doesn't want to eat them, he doesn't want to eat much in general. What foods do you recommend? Also what do you mean by home testing? They had me testing hus urine at home but are really pushing me to start it in the next few days. I don't know why but they are really pushing for it actually to start tomorrow and I said I needed a night or two tomorrow digest all of it get supplies, figure out how I will do it and feedings etc

 

Welcome and good advice above. Deep breath.

There are other pros on here to help with dosing advice. But I recommend reading the Lantus (garg) sticky notes. This will give you insight on what you can expect from the insulin, how it works etc. and when you're done reading it. Read it again. Then make your way down the other stickies. Read about the two types of dosing protocols. Pick one based on your how often you can test/monitor.

The information greatly helped me as I too had all these questions when I started back in April.

It's overwhelming at first but you've come to the best place to help you manage this. Keep posting and asking questions.

 

Sometimes with the food change it takes a little bit of time, also curious what food the vet recommended, as too often they recommend dry diabetic food which is way too high in carbs.

I was sure I wouldn't be able to give Marvin his insulin shots, I am scared of needles. However I found it really easy to my surprise, and Marvin didn't feel it at all. Getting used to taking the BG test took a bit longer and lots of patiences, but became easier with time and tips and tricks from here.

Welcome, and hang in there, take it one day at a time. This place helped me greatly, and saved my Marvin....

 

What food are you feeding now? ie. what will he eat. And where to do you live? That may change what food we suggest. In general you want low carb wet food where the carbs are under 10%. This list has a list of a lot of the foods available in North America and their carb %. Since CKD is part of the picture, you also want foods that are low in phosphorus, which means Fancy Feast and Friskies are not good choices. Ideally you'd like phosphorus below 200 or as close as possible to that.

The best thing you can do to help your kitty (what is his name?) is to learn how to home test his blood sugars. It gives you control and lets you know when it's safe to give insulin.

 

I live in Arizona and my handsome boys name is Pablo. The IM vet, because he also has chronic pancreatitis, prescribed royal canin PR rabbit and another one high fiber. He hasn't been too keen on either one, but in the last day or two I have got him to eat the rabbit. He, of course, loves Fancy Feast, but that has gone out the window for now. His BG has been around 350 or so. I took him in yesterday thinking we were starting insulin but the doc wasn't in and the other two vets that were there were scared of my questions and kept him all day for no reason (other then to see how he ate). ugh. Im scared about starting insulin, most specifically because his appetite isn't that great (though the last few days have been very good for him) and his chronic panc, so I am not sure how that will go. Ive made arragements with work to be home when I start it. They want to start him at a low dose of .01 I believe and then go from there. They said they wanted to monitor him for his "curve" for a day when we start, which I don't understand and no one has explained. Sometimes I have to prompt him to eat so if they are expecting he will eat at a place where he is scared etc, it may be more unlikely unless I am in attendance. apparently he did eat yesterday while there, although they didn't test for anything, grrr. Honestly have received little to no information from vets, and feel lost confused and sad. these message boards and all you wonderful people have provided me with more information then I have possibly received vet wise (and ive been to at least 2 different vets).

 

New
I live in Arizona and my handsome boys name is Pablo. The IM vet, because he also has chronic pancreatitis, prescribed royal canin PR rabbit and another one high fiber. He hasn't been too keen on either one, but in the last day or two I have got him to eat the rabbit. He, of course, loves Fancy Feast, but that has gone out the window for now. His BG has been around 350 or so. I took him in yesterday thinking we were starting insulin but the doc wasn't in and the other two vets that were there were scared of my questions and kept him all day for no reason (other then to see how he ate). ugh. Im scared about starting insulin, most specifically because his appetite isn't that great (though the last few days have been very good for him) and his chronic panc, so I am not sure how that will go. Ive made arrangements with work to be home when I start it. They want to start him at a low dose of .01 I believe and then go from there. They said they wanted to monitor him for his "curve" for a day when we start, which I don't understand and no one has explained. Sometimes I have to prompt him to eat so if they are expecting he will eat at a place where he is scared etc, it may be more unlikely unless I am in attendance. apparently he did eat yesterday while there, although they didn't test for anything, grrr. Honestly have received little to no information from vets, and feel lost confused and sad. these message boards and all you wonderful people have provided me with more information then I have possibly received vet wise (and ive been to at least 2 different vets).

 

Where do I find the sticky notes?

 

He is being prescribed glargin (lantus). I have not yet learned to manage the panc and then add on diabetes. I find myself trying to figure out which, how, what, where, when in trying to manage all of it. How do you find is the best way that you manage for the same?

 

The Sticky Notes are the ones at the top of this forum with yellow Sticky notes beside them.

I think your first step may be to learn how to home test. If you do that, there there is no need to leave him at the vet for a "curve". Blood sugar may be elevated by stress there, and as you said, he may not eat. My cat had just 1 curve at the vet, and it was pretty much a disaster. She was very unhappy and told the vet what she though about it. It's also quite expensive and you can buy a lot of test strips for that price.

If it's the Royal Canin selected protein rabbit you are feeding, the wet food version is 15% carbs, which is too high carbs for a diabetic. We aim for something under 10%. Neko had occasional pancreatitis and I never fed her anything different for it. There are lots of other options of low carb low phosphorus food that you can buy commercially. This food chart lists a number of them. You want phosphorus ideally close to or under 200.

This post here is a good Primer on Pancreatitis.

I don't know what you mean about a dose of 0.01. We use u-100 3/10mL syringes and a typical starting dose might be 1 unit.

 

Thank you so much this is good to know! The IM vet prescribed that in hoping to help his pancreas work less (I believe because of the chronic panc). To clarify the starting dose is one unit.

 

there are quite a few people on this board who have had to deal with both FD and Pancreatitis. So you are in the right place for support and information. The one piece of advice I have is patience is key, one step at a time. You can't learn everything in a couple days, especially if any emotions involved . Home testing allows you to take control of your kitty's FD. This is important as you will be better able to manage FD, and also make sure that it is safe to give him his shot and also how to keep him safe.

Welcome Nicole

 

Thank you so much for this. Means so much! As you know it's scary and overwhelming, bit knowledge through things like this group and amazing people is power! Patience is indeed a virtue, and one I'm trying to adjust to rapidly! I feel like a bad cat mom for not knowing what to do, ask, etc, but am learning every step of the way! Thank you for your words of encouragement!

 

How is it going? Have you been able to start home testing?

 

We are officially starting insulin tomorrow at the vets. There was a mix up with the doctor and information on Monday unfortunately.....

 

I hope you have your meter and strips and hypo kit. Setting up the BG spreadsheet will help us here, help you (and Pablo).

This post may help too.

Updated Tips for New Members

 

I have home monitoring test system and strips but what is a hypo kit?

 

*** IMPORTANT DOCUMENTS ***
Print these out and keep them handy:
SYMPTOMS OF & HOW TO TREAT HYPOGLYCEMIA - what to do if your kitty experiences a hypoglycemic event
Jojo's HYPO TOOLBOX - what to have on hand in case of an emergency

 

Hypo kit is all the supplies you need to manage BGs that are low and too low in order to avoid a hypo incident. You want this as when kitty is pancreas is healing a dose that is good one day may be too much another day... there need change constantly. They are cats after all so unpredictable

Don't Get Caught Short.
Fifty test strips seems like a lot, but anyone that's ever been through a PJ party with their cat can tell you they go really fast. Try to always have an extra box (or two) on hand. Many members keep one or two boxes with the rest of their hypo supplies and switch them out periodically to keep them fresh. Some of us routinely keep 100-200 strips in reserve. You will use them.

Speaking of a hypo kit, it's a good idea to have several cans of HC and MC food, clearly labeled, stored separately from your LC food. A container of Karo or honey should also be on your list. The phone number and address of the nearest 24 hour vet is another good addition.