My cat, Simba, diagnosed with diabetes in shelter

My family and I rescued a light orange tabby, Simba, from a local animal shelter, who was said to be about 9 years old and diagnosed with diabetes when he was brought in to the shelter (he was seized by animal control from a cat hoarder, his original owner died). He was initially put on Royal Canin by the shelter, after the diagnosis and they started him out with 2 units of Lantus insulin, after which time they tested his fructosamine and determined his diabetes was still not controlled, so they increased it to 2.5 units. This all happened in October 2019.

We brought him home on October 24 2019 (this year), and continued him on that regemin. We took him to the vet in early November, where they tested his fructosamine again, and stated that his diabetes was now under control, and to continue with the 2.5 units of insulin and the same diet. We found that he was seeming to be always hungry, and would wake us up in the middle of the night to be fed, and even would sometimes bite us to try to get us to feed him. So at my husband's urging, I decided to research feline diabetes, and found this board. I finally got everything I needed and began testing his blood sugar, and found that it's not been high, and in fact was very low last night two hours after he got his evening dose (it registered 41 on the Relion Prime meter). I gave him some honey and some of the dry food to raise his blood sugar.

This morning, I cut back the Royal Canin dry food by 1 tablespoon (out of 4) and skipped his insulin. His blood sugar, which was 132 before his first meal, actually dropped to 86 by 10 am (2 hours after breakfast). He has been calmer, and not bitten anyone today. I have decided to cut back his dry food by another tablespoon, adding more wet food instead. He weighed 12.2 pounds at his last vet appointment, which was about the same at his previous 2, so I'm guessing that he doesn't need more calories, but was thinking that the volume of wet food should probably be a bit lower. Is there a way to figure out how many calories are in Royal Canin dry food?

 

Hi Jennifer
Here is your link from the welcome page
http://www.felinediabetes.com/FDMB/...-9-years-old-diagnosed-in-the-shelter.223294/
I am so glad you are testing the BG levels.
Simba has earned a reduction in dose with that 41 last night down to 2 units.(see ETA below)
If you get a low number like you did last night, and you give food to bring the number up, which was the correct thing to do, always test again to see that it is rising as it often bobs up and down before going back up.

You did the right thing skipping this morning.
As you have just started to test, if you get a number under 200 at preshot, stall, don't feed, post and ask for assistance. Test again 20 minutes later to see if the number is rising. Put something like 'BG xx stalling please help' in your subject line.

Have you thought about swapping to a low carb canned food diet?
That is under 10% carbs. Wet food only.
That could further reduce his need for as much insulin as well.
Here is a link to the suitable low carb food. You do not need Royal Caninsulin food.
https://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf
However you need to be aware that giving the low carb food will further drop the numbers so you need to be vigilant with the testing.

Here is a link to the hypo kit and what to do if you get low numbers. Print it off and put on your fridge soyou have it in case of an emergency. I would get some cans of higher carb food ( which you will find in the food link above as well)..many use Fancy Feast gravy lovers cans.

Keep posting his numbers and we will watch out for them.

ETA. I see you said that last night on the welcome page, because he was 69 at PMPS you gave him 'most of his insulin' and you recorded that as 2.25 units
So last night was the first time you gave the 2.25 dose, is that correct?

 

Okay, so if I test him again just before his usual meal/shot time (which is 8 pm), and he is still under 100, I post that blood sugar reading and ask for assistance? I realize now in the light of day that I should have retested him, but I think maybe I was not thinking very clearly at 11, and not expecting to see such a low number. I hope it's not that low again, but if it is, how often do I need to re-test? Every 20 minutes?

I think that when I saw that his blood sugar was below 200 this morning, I should have waited on that meal, but he gets really anxious about his breakfast (woke me up at 7:20 so he had already been waiting awhile) -- I realize I made a mistake, but maybe I should have tested him well before his meal time?
I will look into the low carb food list. If I give him low carb food, and his blood sugar is well below 100 (like say, 80), would I wait and see as above?

 

Also have a look at the two dosing methods to see which one suite you best. When you decide, could you put that in your signature please as we look at that each time we help you.
http://www.felinediabetes.com/FDMB/...-low-go-slow-slgs-tight-regulation-tr.210110/

 

What counts as "high carb" by the way?

 

The two dosing methods mentioned both assume you're just starting out with insulin. Since he has been on it for over two months already, I'm not sure how to adapt it.

 

If the preshot is under 200 not 100, you stall, post and ask for advice and test 20 mins later.
Some people get a +11 if the numbers have been low during the cycle just to get a heads up. If they get a +11, they can see if the +12 is rising or not....they can also have posted then and asked for opinions on how to proceed at +12.

With a low number during the cycle, always test again 20 minutes later to see it is rising. Then you keep testing 1/2 to 1 hour intervals until the numbers are rising on their own without food. If you get in that situation again, always post and we will help you get through it and then you will know what to do.
Here is a link on how to deal with low numbers.
http://www.felinediabetes.com/FDMB/threads/dont-panic-or-how-to-handle-low-numbers.210109/

If you are testing and get a number under say 100 or a much lower number than the last one (eg 300 and the next hour 150) always test again an hour later to check on that number.

You haven't made any mistakes at all. It is just a learning experience.
You can get a +11 as I mentioned above if you like and that will give you a heads up as to whether the Preshot is going to be low or not and you can start planning what to do
If ever in doubt, post

 

Over 15%
I'd get some around 16%, 12% ( medium carb) and 20%
Just a few cans of each and rplace as needed.

 

What is a +11? Would that be 11 hours after the previous dose? His glucose went down after his meal, even though I didn't give insulin. Is that typical? I will retest him now and see how it went. The last reading was 86 at 2 pm.

 

It doesn't matter how long you have been on insulin....
Sheba was on insulin for a year before I joined and started with TR.

 

Yes. A +11 is 11 hours after the shot.
+3 is 3 hours after the shot.
We talk here is + hours as we are all in different time zones.
I live in Australia so have no idea what time it is where you live, but if you say it is +10 I know exactly where you are up to.

Usually a cats BG has a slight bump up after a meal which is normal.
Simbas went down which could indicate that his pancreas is spluttering and trying to work again.
Also the depot of the Lantus insulin is still in play and that will still be giving him some insulin.

 

How do you keep track of which ones to buy and find them at the store? Do you print out the whole spreadsheet?

 

No need to print out the whole thing.
I picked some out, wrote down the names and carbs, then went shopping.
A lot of people choose Fancy Feast ....you can get Gravylovers which is higher carb at various levels of carbs and they are easy to buy.
When you get them home, get a texta and write the number of carbs on the top of all the cans so you know what to choose when needed.

 

Jennifer I have to go out, but should be back here in about 20 mins.

 

Did you get another test in Jennifer?

 

Yes, I tested him 2 hours after the last time, so technically, he is 20+ and his blood sugar read 70.

 

So it's going down even though he's not had any insulin in 20 hours. I'm guessing he's still using the depot that was there?

 

I am wondering, if they are below 100 for every reading, do we still give insulin? I need to get to the store to get some of that wet food.

 

He's looking very good without any insulin.
Keep testing as you are even though you are not giving any insulin.
Are you offering any food during the cycle?

With the SS can you put any documentation into the remarks column please and just the numbers in the actual SS.. we can see that he hasn't had any insulin so no need to say it in the squares.
So now he is at +20 BG 70
There will still be some insulin working in his body from the depot so let's see how he goes in the next several hours.

 

As we don't have any previous data for Simba on how he reacts to insulin, we won't give any insulin at the moment.
If he had been tested frequently and had gone down in dose from say 2 units to a drop over a period of time and was getting green numbers, it would be safe to give him the drop. But as that didn't happen, we will skip the insulin and see what he does with the numbers.

Just wanted to check....did he ever have ketones at all do you know?

 

I think as far as the two dosing methods, I would probably want to start with the low and slow method, unless his numbers spike suddenly. He is 12.57 Lbs/5.70 Kgs , which would require 1.4 units (rounded up to 1.5) per the TR method, while the SLGS method would have me starting him at 1. Given that he was on 2.5, though, I'm not sure. I gave him 2.25 last night based on his reading of 69 before the meal.

 

I don't know if he was tested for ketones. I didn't get his full records from the shelter. They only told me how much to give him and how much to feed him.

 

The only test result I have for him is:
11/26/19 FRUCTOSAMINE 276 umol/L - reference range 143.000 - 373.000 umol/L
Which is normal.

 

You don't restart with the dose of insulin when you choose a method, that guide is only for people who are starting insulin in the beginning.
You would continue on with whatever you were doing except you would follow the method. Does that make sense?
As far as current dose for Simba is, we need to wait and see what he is doing with the BGs.

Can you put the SLSG into your signature please so that peeps will know what you are following.

 

It is safe for you to go out to the store.

 

I fed him at 8 am, then a tablespoon of fancy feast at 2 PM and another tablespoon at 4 PM. He was very hungry. I had given him a treat at the times that I tested his blood, and he was begging for more.

 

Try adding some water to the food if he will eat it. It will make him feel fuller. Start with a tablespoon of warm water and make it into a gravy.

if you feed him his breakfast at 8 am I would give him a snack at 10 or 11 am and again at 1 pm/2pm. It’s better to give the food in the first half of the cycle when the insulin is strongest.
I would much rather have a hungry cat than one who doesn’t want to eat! That’s hard work.

What RC cans were you using as many of them are higher carb as well?
And what RCDry is it?

 

His blood glucose was 77 at +11

 

I am giving Royal Canin Glycobalance in both wet and dry form.

 

Lovely green number

 

The cans of R C Glucobalance are 14 carbs according to Lisa Piersons chart.
The RC dry I haven't found yet but it will be even higher in carbs than the wet.
Swapping to a low carb wet diet will be much better for Simba.

 

Thanks for the tip about adding water. Oh, and I got the name wrong, it's Glycobalance

 

Did you buy some low carb today?
If so you could start giving it to him now while he is not getting any insulin.

 

The RC Glycobalance dry is around 29% carbs!
That is like giving really high carb food every time you feed the dry.
Simba's need for insulin will reduce once you swap to low carb

 

Bron asked a few of us to pop in.

Normally, cats slowly earn reductions and we take them down to a drop before going off insulin. And we also shoot these kinds of green numbers once we have data. But because there is no data and there’s no telling how many potential dose reductions Simba earned, I would suggest we take it a cycle at a time and if he’s in green numbers, don’t shoot as long as he’s never had DKA.

If he starts to trend up, we can give him some insulin support. I would also suggest that we see if his pancreas is working by testing, feeding, and then testing three hours later to see if his pancreas brings the BG down.

I would agree with Bron that now is the time to switch him to a LC canned food and ditch the dry while he’s not getting insulin.

 

Jennifer, I see 69 BG in the +25
Looking good.
Can you note in the remarks column each time you feed please so we can see how his pancreas responds?

You mentioned that Simba has been getting really hungry and wakes you and even bites you during the cycles. . I think that could well be because he has been dropping really low during the cycles and that can make them ravenously hunger.
Without testing you would not know, but your tests so far indicate that the dose was too high. Poor Simba was probably just trying to save himself by eating.
It will be interesting to see if the intense hunger abates.

 

Yes, I got some low carb, and have stopped the dry food since he's no longer on insulin. I gave all low carb wet food, no dry food. My worry with cutting the dry food before I knew his blood sugar was that I wouldn't know how much insulin he needed. But given that his blood sugar hasn't gone over 100 since his morning test, I'm waiting to give him insulin. I realize now that I should have waited to feed him at 8, but He really, really loves food and I hate to make him wait. He gets very insistent.

 

He doesn’t need insulin with his BG at the current levels.

 

Hey @Jennifer R. So happy to see you over here from the Facebook group!

I have to wonder if Simba may be in remission. Being in the shelter could have very well raised his BG quite a bit due to the stress of a shelter environment as well as being fed the high carb kibble.

It's totally possible that the only reason he was diagnosed as diabetic in the first place was due to stress and the food.

Time will tell, but it's looking good so far! Fingers crossed that he continues to stay in those normal numbers!

 

Thanks for all the feedback. His blood sugar was still pretty good this morning, still no insulin. Giving him low carb food now. How often should I be testing his blood sugar to make sure he's still stable? He hates having his ear poked.

 

Welcome!
I don't know enough to advise you (And you have some of the smartest folks on the board already helping you) but I wanted to say how great it is that you adopted an older cat with diabetes! (Who hopefully doesn't really have it anymore.) I volunteer with cat rescue and we have a heck of a time getting people to take older cats even if they are healthy. You are a rescue group's dream come true! Wishing you & Simba all the best!

 

Simba is still looking great Jennifer!
I would test before you feed at the previously normal shot times to see what the BG is and then once during the cycles. Marje suggested testing 3 hours after you have tested and fed to see if the BG goes down as this can be a sign of the pancreas working.
Great job getting him over to a low carb diet. He’s a lucky boy to have you. Would love to see another photo of him.

 

We went into the shelter looking for a Russian Blue because of allergy concerns, but the volunteer there said she wasn't very friendly, and showed up Simba (his shelter name was Peaches), and found he didn't really trigger any of our allergies, and he was so friendly, we decided to take him home. We wanted to bring them all home, really. His adoption fee was waived because he was considered high risk for not being adopted, and they gave us a full vial of insulin and a one month supply of food, so that did help, but we were more than willing to pay for it all. Given how much Lantus is, I'm glad we didn't pay for it only to find out he really didn't need it. I will keep testing him. His glucose seems to be staying around 80 now, going down a bit after meals.

 

He has gotten so much calmer and friendlier than when we first brought him home. Here is another photo of him with my daughter. He is rather camera shy.

 

He is gorgeous Jennifer!
And his numbers are staying in normal range. Just keep doing the same.
Has his extreme hunger settled at all?

 

Yes, his extreme hunger is so much better. No more waking me up in the middle of the night, no more biting my husband, he even leaves my husband alone when he comes into the kitchen now.

 

I’m sure then, that the extreme hunger symptoms he was exhibited were from his BG dropping really low.
Sudden ravenous hunger is one of the first signs of a hypo.
I’m so glad he is feeling much better.

 

Yes, and I feel so bad that it went on so long before I finally worked up the guts to test his blood sugar. I'm also mad the vet wasn't better about telling me about the warning signs of low blood sugar other than seizures and lethargy.

 

Don’t feel bad. Vets often don’t give out much information to caregivers except the bare basics.
Keep doing what you are doing now and feeding the low carb food. If he stays in these numbers I think you could start an OTJ trial in a couple of days as the depot should have drained by then. @Marje and Gracie what do you think?
Attached is a link to OTJ trial. Scroll down to it.
He will have to stay on a low carb wet diet for life because he is still a diabetic, just a diet controlled one.
http://www.felinediabetes.com/FDMB/...ng-reductions-and-starting-otj-trials.150160/

 

What is an OTJ trial? I was a bit confused. It looks like you test at the usual pre-shot times, then if he is green, not again until the next pre-shot time (if blue test 3 hours later), and if he stays green 14 days, you can stop testing?

 

An OTJ trial is when you are seeing if you can stop the insulin (OTJ means off-the-juice, insulin being the juice). Seeing if your cat can get normal BG numbers with just the food change to low carb food. We call it remission or being diet controlled.

14 days at normal numbers, checking at normal pre-shot test time, then another test 3 hours after that. Do these tests AM and PM cycles.

 

Just keep testing as you are doing for now and we will tell you when to start the OTJ trial.
You have done a great job changing him over to the low carb diet and testing the BG and keeping the SS up to date.

Hopefully he will stay in green numbers so you can start the trial.

 

I'm still a bit confused. He hasn't been over 100 since Saturday morning. When I last gave him his insulin, he dropped down to 41. He has been going between 59 and 95, without any insulin, but when I read the OTJ trial info, it sounds like he's already doing an OTJ trial in that I'm not giving him insulin.

 

Hi Jennifer
We needed to wait a few days to see that his BGs were not effected by the depot and when that went, he could still maintain the normal numbers. and his numbers are beautiful!
I would start the OTJ trial tomorrow.
So starting tomorrow, start a new thread each day with the subject line "OTJ trial Day 1 BG xx" and we will cheer you on.
Following day new thread Day 2 etc.
Follow the instructions in the OTJ trial sheet I sent you for the testing.
Good Luck!
Go Simba!

You might like to check out Boomer on the Lantus forum, he has just completed the OTJ trial.

 

Lantus leaves a bit of a 'storage area' with remains of the insulin underneath the cat's skin. That is what we call the 'depot'. It can take time for that leftover insulin to still get into your cat. So although the numbers have been good, there may have been some insulin left behind under the skin that was still being 'used up' and helping to keep those BG readings low.

So tomorrow the last of that insulin in the 'depot' should have been used up. That is why Bron and Sheba have asked you to start the OTJ trial later, counting the days AFTER the residual insulin has been used up. It can make a difference between a successful OTJ trial and not.

If you were using one of the shorter acting insulins like Vetsulin/Caninsulin or Prozinc that don't have that 'storage area' effect, then you could have started counting the days for the OTJ trial earlier.

OK?

 

Okay, now I understand it better. I didn't see this until now, so I will have to start the OTJ trial tomorrow. I start a new job, but it's work from home, so it should be manageable.

 

I don't actually see any instructions for the actual OTJ trial, just the reductions. What am I missing?

 

I thought it said more sorry.
Take a BG test before you feed at the usual times you used to give insulin.... just as you have been doing the last few days.
If the number is blue, then test three hours later. Otherwise, if green, test again at the next 12 hour feed time. does that make sense?

Do that each day and start a new thread each day which says ‘OTJ trial Day 1 BG xx’, then day2,3 etc.

The idea is to hopefully see all green numbers. After 14 days, if still in green numbers Simba will be officially in remission!!

 

OK, so only before feeding, that will be a relief. I will start the thread once I have his spreadsheet updated. His number this morning was green, but I can't remember the exact one so I will have to go look.

 

So number this morning was in the green (under 99 mg/dl on a human meter in the USA), so only the pre-shot test needed for this morning. BUT if the pre-shot test is anything higher than that (blue or yellow or red or black on the color coded spreadsheet), you need to test at +3.

The timing of the second test at +3 is because food eaten usually starts to influence BG numbers around that +3 time you will see that. If the pancreas is working and producing enough insulin, numbers should stay in the green range, even with the food on board.

 

Okay, thanks for the explanation. That makes total sense. Should I call this day 2 or 1?

 

I'd call it day 1

 

It is done, then. Thanks! I have updated his spreadsheet with the latest numbers, 78 was his AMPS number. No high numbers yet. He is still acting rather hungry, I'm thinking this time it's from the switch to all wet food. At least he's no longer waking me up at 3, 4, and 5 am, and not until 8 am, which is when the first shot was.

 

Day 1! Yeah Simba.


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