? Need Some Opinions (Sorry. This is a little long)

So I need some help from this group. My 18 yr old pal Sketch passed in Oct of non diabetic issues. I treated him for two years with home testing and increasing lantus dosage (he was insulin resistant possibly from acromegaly) so I have some experience both here and with a diabetic kitty.
Here is my situation / dilemma. First I adopted a FIV cat,Oliver (2 years old) from the shelter. Oliver was a stray but in pretty decent shape and needed a home. People were reluctant because of his FIV. So he was pretty much on kibble at the shelter and I started transitioning him to wet food (some kibble, Fancy Feast gravy lovers to Fancy Feast Classic Pates). I noticed that he was urinating frequently and was concerned possibly a bladder infection so took him to the vet and his tests came back clear. He continued to exhibit the frequent urination but had great energy and all else seemed normal. I did notice an increase in appetite and what seemed like a little weight loss. Thinking it would be unlikely for him be diabetic but displaying symptoms I decided to home test him. Now, Oliver is difficult to test struggling and not liking the idea of an ear prick(Sketch although a difficult cat that only I could handle had a great deal of trust in me and would sit quietly next to me when I tested him without a flinch...same with injections) but the test revealed a 430 result! I retested him a few hours later and his numbers dropped to 340. Knowing that the flight or fight response can drive the BG test up I contacted the vet to see about a fructosamine test to see a better picture. Fructosamine test came back high indicating diabetic. So at that point I moved him to exclusively Fancy Feast Classic Pate (Chicken and Chicken and liver) supposedly 2 and 3% carb content per the food chart with hopes his numbers might drop into a normal range. But also because I think its best to adjust the diet before determining the insulin dosage. We did a follow up fructosamine test 2 weeks later that the numbers improved on but were still in the diabetic range.
At this point the the vet is recommending to start insulin (lantus) at 1/2 unit twice a day. My dilemma is after another week of the low carb diet his symptoms have all but disappeared except for a healthy appetite. He has gained back his weight to the point I have started cutting back his food a bit, tons of energy, no excessive urination or excess water consumption. I tried testing him again and he fights it so much I'm frightened I am not getting an accurate BG reading (low 300's) so I am reluctant to start the insulin (I'm not a proponent of blindly shooting w/o prior testing) for fear of him going hypo. I know a bit high is better than low.
So what say you knowledgeable folks? Should I try to work with him on testing until I feel his numbers are valid or start on the Lantus as prescribed without accurate testing? I will build a separate profile / spead sheet for Oliver soon but wanted to get opinions.

 

Hi, Jeff. I think I would work with him to get him used to the testing. Try all the old tricks like always doing it in a special spot and offer a special treat, just rub his ear and love on him first then add the testing to the routine. I would not want to give insulin blindly, as you mentioned. I would not wait too long though because the chances of remission are better the quicker you catch it and start treatment.

 

Thank you, that is my inclination as well but as you mentioned the chances of remission is better with getting started on the insulin. Kind of a dilemma indeed. I appreciate your input. As you can imagine my fear is that possibly he is going into remission from the diet change. Thinking if his BG test is being influenced by the flight or fight and his BG may be much lower (maybe even normal) than is indicated, as well as his symptoms being basically now non existent makes me very nervous to shoot him with even 1/2 unit.

 

You could always opt to do one more fructosamine. I would wait 3 weeks from the last one.

 

There are tips here also for getting cats used to testing. Treats are crucial, freeze dried chicken is a good low carb choice or even a plain cooked chicken breast cut up in small pieces an some can be frozen for later use so it does not spoil.

I started by pretend testing. Find a quiet area where it is not easy for them to get away. I use top of clothes dryer with a towel on it.

I started by putting cat on dryer, giving treat. Tell them Good kitty, scratch their head and that’s it, and let them down.

Next time gave treat, then hold ear gently, release ear and another treat.

Next time hold ear and pretend poke with lancet or device without needle, just touch ear quickly, now done and treat.

Each time you do a little more and are calm and talking softly to them and give treat, they associate is as a good experience.

After awhile, 90% of cats will come over for test and honestly won’t care.

Main thing is not to be chasing and having it be a bad experience. I started that way and had to retrain my cat that it could be a good experience.

 

In answer to the FIV and dental mentioned on other post. Thought I would answer here because dental issues, which are inherent with FIV kitties, can definitely increase sugar too. If teeth need cleaning that could help lower sugar also.

As far as other issues with FIV, I don’t have much info other than what I have read online. It is best for them to avoid stress, from what I hear. I imagine similar to humans with compromised immune systems, they stay healthier when there is not added stress, so makes sense.

FIV kitties can have pretty normal lives for quite some time. Oliver is lucky (as was Sketch) to have such a good dad.

 

Obviously, this method isn't ideal, but it may be of some help until there comes a time when you can test his blood glucose comfortably at home: Adjusting Insulin Dosages Using Urine Strip Results.

Please read the article carefully.

 

Thank you. You bring up a valid point regarding dental infection raising BG...which makes me all the more shaky about starting insulin. His breath has been poor since I adopted him from the shelter and not the typical diabetic breath. I've called the vet and left message that maybe we should do the dental cleaning/work asap to eliminate one more thing that could affect dosing or maybe even the need for insulin. Thanks

 

Good point. Plus as Julie pointed out his need of a dental cleaning could also influence his BG readings. I am going to see about the dental cleaning, work on trying to get him more comfortable with testing for the next couple or three weeks then do another fructosamine test. That should cover most the bases at this point.

 

If there is going to be a delay starting insulin, I'm wondering if a methylcobalamin supplement (Zobaline) to help prevent any peripheral neuropathy is in order.
Just putting this out there for more experienced eyes to weigh in on, also taking into account the young age of the cat.

Jeff - I hope the dental has a good effect on the numbers.

 

Age 2 is relatively young to be diabetic but it's difficult to age a stray and with teeth that potentially bad, it might be related to the FIV OR a clue that he's older than estimated (or both). Either way, I think it's a very good idea to investigate the state of his mouth/teeth. My FIV kitty was non-symptomatic for years but eventually had to have 23 teeth pulled. Bad teeth really can affect their health and well being.

Just curious, but how did they diagnose FIV? A cat who has been vaccinated for FIV will test positive, although vaccinating for FIV (not to be confused with FeLV) seems to be rare. FIV can be confirmed via a Western Blot test, although I've never had a cat come back negative if they test positive on the snap test.

If it's a quick "one and done" then a little stress from ear testing might not skew the results all that much. If you have to chase Oliver around the room for 15 minutes to catch him, then it might. My non-diabetic freaked at the vet clinic recently and raced around the room climbing walls ... her BG immediately after was 386 (next day it was in the 60s at home and 92 at the followup vet visit). ECID, of course, but neither the vet nor I had ever seen that dramatic of an impact from stress.

Tubby my acrocat would have LOWER BG when stressed. Go figure.

As @Jill & Alex (GA) suggested, you might want to get creative and try alternate methods of testing for now. You could also try testing the paw pad if that goes over better than the ear.

Good luck!

 

Yes I know the teeth can be an issue. I spoke with the vet but she didn't feel his teeth were "that bad" but he definitely does have some gingivitis (not sure I agree with just gingivitis as his breath is pretty bad) and that there are additional risks with doing dental to an unregulated diabetic FIV cat. All that said when Sketch was having trouble getting regulated I always suspected a dental/tooth issue due to his breath. I finally said lets try the dental cleaning and it turned out he had to have 8 extractions. I know that resorption isn't outwardly visible as it happens below the gum line.
His age was listed at 4 at the shelter but he is so kittenish with his play and tearing around the house I just feel he is not that old. Right know he is tugging at my shoe laces and batting a ball around.
As to his diagnosis of FIV it was through the snap test through the shelter he was in. I spoke with a friend of mine that is a vet in the bay area and he said that there is no definitive test (even the western blot test) that will differentiate the FIV vaccination from the actual disease...and that he feels is tragic because cats that have been vaccinated are often mistakenly put down. Most vets won't vaccinate for FIV currently.
His testing on the ears hasn't unfortunately been 1 and done as you put it so it could be as I suspect elevating his BG some. I mean even if he tests 320 then lets say 100 is due to the flight or fight and lets say 50 is due to dental infection then his real number is 170 and shooting him could result in a hypo event. Plus if I do start shooting and get him semi regulated and then do dental it could be like starting over with dosing.
Guess I'll sleep on it but I'm still inclined to roll the dice and do the dental first, then take a few weeks to try to get him to relax for testing and then take another fructosamine test. Then if that comes back high start shooting.
I've never paw pad tested but that might be worth a try he seems much more tolerant of his paws being rubbed. Do you prick in one of the toes or the main pad..or does it matter??
Thanks for your input! Its appreciated.

 

There is Petsmile toothpaste which can just be put on outside edge of gums, brushing not needed. Works enzymatically to help reduce tartar buildup. I think if you sign up for emails they send you a coupon. It isn’t cheap, but nice you don’t have to actually brush and there is not sugar in this one.

There is also 1-TDC, a supplement that can help with gum health. I think that is used by opening a gel capsule and adding to food. I was going to try it at some point, but never did yet. @FurBabiesMama is familiar with this product.

 

I have heard of some people using paw pad, but very few. I think you are supposed to use side of pad or toe because you don’t want the surface they walk on to be sore. Also then they are going in litter box, so not sure about how hygienic it is, risk for infection, etc.

May do better to slowly work on ear testing. Very few cats are untrainable with this method, just may take some patience.

 

I’ve been using petsmile and 1-tdc on Jackson, and I think they help. He is great and lets me brush. It’s been a months long process, though so don’t give up.

 

What was your process with Jackson to get him to allow you to brush his teeth? Also what is "1-tdc"?

 

Hi Julie, I tend to agree based on the hygienic aspect of using the ear and will continue your process of trying to get him used to having his ear poked. I may try the paw a couple times just to see if he accepts it without resistance. Thinking maybe I can get a clearer picture as to his actual BG reading if it doesn't seem stress affected. As you know he is a FIV indoor kitty so biggest worry about hygiene would be litter box. Attached pic of Oliver or "O" as I call him.

 

Was just checking out the Petsmile site for cats....love the flavor names!!! LOL Will try some and see how he reacts ....."natural london broil" and "rotisserie chicken". Will probably try the chicken...Oliver will maul you for rotisserie chcken.

 

I watched this video. Basically I gradually increased the intensity of my attention to his mouth. I started sticking my finger in his mouth while I was petting him, then letting him sniff the toothpaste, rubbing toothpaste on his gums, using gauze to rub toothpaste, using a toothbrush when he’d let me, and now, I can brush his teeth every day with Petsmile and a brush. It’s a super quick brush. I’m working on getting the molars better.
Actually, I brush all three of my cat’s teeth daily, which makes me feel like I’m a weird person, but I think it helps their overall health.

I think his mouth was bothering him more when I started. It’s been about 3-4 months and I can brush the side that seemed sore before. I think it takes months of daily or almost daily care to get them used to it.

I tried a lot of products but I settled on the Petsmile and 1tdc. His gums are still red in the back and he may need to see a veterinarian dentist. He had his teeth cleaned with no major problems identified at the shelter in March, but clearly he has mild stomatitis or some sort of inflammation of the gums.

 

Adorable! He looks like he would totally love a toothbrushing!

 

1-TDC is a supplement that was strongly recommended by the dental specialist who takes care of my girls' teeth. It is for periodontal as well as joint health... it also helps with coat and muscle stamina. You can read about it on their site: https://1tdc.com/ I get mine from Amazon. The specialist also recommended PetSmile. If you can just get it on the teeth it will work, you do not have to brush if the cat is not up to that. I have recommended both here many times and it looks like people have started trying them out!

 

I appreciate the recommendations since I had never heard of these products during many a google search about feline dental health.

 

Very handsome boy, he is lucky he found you.

 

@FurBabiesMama How to you use the 1-TDC. Apply topically or add to food? I was not sure.

 

Ideally, you squirt it on their gums, if possible. They say you can also apply to nose or paw for them to lick off - sounds way too messy to me. I squirt Willow's in her mouth, but Mia hates having anything done to her mouth so I squirt hers on a little chicken, and she eats it.