Newly Diagnosed 11 Year Old Cat

My baby, Cattywhomp, is an 11 year old short haired mixed cat. He was diagnosed with diabetes around 3 months ago. Since his diagnosis we have spent countless amounts of money trying to regulate his glucose. At our first vet we did spot testing on Saturdays every two weeks four hours after we administered his morning dose of insulin. He was started at 4 units and was gradually moved up to 14 units. On our last visit to that vet, the two doctors disagreed on whether to increase his insulin amount or to leave it the same. His reading at that time was 225. After the disagreement we decided to switch vets.

Our new vet discussed with us our options and explained that she felt a curve test would be the best way to go because she thought his sugar was dropping and then re spiking when his body was trying to recover from the drastic drop. She also said where we were administering the insulin (in the back of the neck) was not as absorbent as doing it in the side by the ribs. She dropped his insulin level to 6 units and decided that she wanted to do a curve test. We dropped Cattywhomp off to return later to hear that his levels were 355, 4-- and 525 at the three different times she tested. After some discussion of which needles we were supposed to be using and which ones we were actually given at our previous vet she suggested that we change his insulin to another type because she felt he was resistant to his current one and leave it at 6 units twice a day.

We originally began with PZI (not the compounded) and she felt he had developed a resistance to this insulin. She then prescribed another insulin that was human insulin and would run us 150.00 a 10 ml bottle. When we went to pick it up we were told that it was not 150.00 but 200.00 a bottle. We refused to pay it and I called the vet again, she called around and found it for 169.99 a bottle. I asked about another type of insulin we could use instead and she suggested the PZI Compound that would run 69.99 a bottle. My fiance and I are super tight on money especially with the continuous vet visits and insulin buying. I know that treating him is going to be expensive but I need to find a way to save money somehow. We are trying to find an insulin that is in our expense range that is still effective.

Our next step is to talk to the vet about doing curve tests at home using a human glucose meter. And then just talking to her about the numbers and her suggesting dosage changes. Either we have to spend the money on the insulin and stop the vet visits or we have to continue vet visits and find a cheaper insulin.

Please Help!! Any suggestions??

 

Welcome and yes, we can definitely try to help. Testing at home is vital. Most cats are very stressed at the vet (strange noises, other animals and all those peope who are "not the mommy"). So your numbers at howm could be significantly lower. We have free testing kits (the picture at the top of the page). It will take a few days to reach you, so you could instead go to Walmart and get a ReliOn meter and strips for under $40 and start today.

What are you feeding? We find wet low carb makes a big difference in bg levels. Our Oliver went down 100 points overnight when we switched. This vet website expalins why: www.catinfo.org. BUT don't switch over food until you are testing. If we had given Oliver his normal dose that next morning, he would have hypoed.

If you test and get some real numbers without stress and switch slowly to low carb, that could tell you alot about whether PZI works or not. The compounded brand is okay to use and is cheaper. You vet might even be able to get a free sample the first time - they used to do this.

 

Currently he is being fed Meow Mix hard food. When we originally went to the first vet they told us not to change his food until they got him regulated and that even then they wouldn't consider changing it. Though the more forums I read through the more I see that wet food, low carb is the best way to go with diabetic cats. I will try switching his food but will heed your advice and wait until we get a meter.

 

It is less likely that he will ever get regulated on dry food. Most dry foods run in the 15 -30% carb range or more. We try to stay below 8-10%. it's like a human diabetic eating donuts for every meal and taking insulin to counter that. :mrgreen:

 

Why doesn't the vet tell you that? When we said we were feeding him dry meow mix why don't they say hey, it won't ever be regulated as long as you stay on that diet. That is something we could have changed months ago.

 

Vets have to make a judgement call to see how prepared you are to take care of your cat. Some people will opt to put their cats to sleep when they hear the cat is diabetic ...others at the other end of the spectrum will home test, change to a low carb food and a good insulin and the cat will go into remission. Depends on the owners motivations and finances etc. The vet doesnt want to confuse or overwhelm you either.

At the same time many vets arent that experienced in diabetes.

But its not too late - get home testing and then change the food asap and lets see if we can get him regulated...

 

A bit on the economies of insulin glargine.

Insulin glargine (Lantus) comes as either a 10 mL vial or a 3 mL pen (in sets of 5, though sometimes you can get them sold separately).
Each mL has 100 units. Thus, 10 mL has 1,000 units; 3 mL has 300 mL.
Kept refrigerated and on a stationary shelf, Lantus may last a good 6 months.
The estimated starting dose for a cat is based on the lower of either current weight or ideal weight, in kilograms, then multiplied by 0.25.
Ex for a 9 pound cat, the estimated starting dose is 1.0 units (rounded down for safety), given every 12 hours (BID)

Cost breakdown at $180 per vial:
2 units / day: 500 days, $0.36/day
4 units / day: 250 days, $0.72/day
6 units / day: 166 days, $1.08/day

Cost breakdown at $25 per pen (for first 5 pens, with use of savings card):
2 units / day: 150 days. $0.17/day
4 units / day: 75 days. $0.34/day
6 units / day: 50 days. $0.50/day

Lantus has some research documenting remission, ie getting off insulin, as well as quite a number of cats on this board. It is harder to do with other insulins, though not impossible, if you are willing to work at it.

 

With Lantus, you can also sign up for the Lantus Savings Card. Make sure you get a prescription for the pens and not the vial in order to be able to use it. The pens will last till expiration date if not used. If used, they should last anywhere from 3-6 months refrigerated and some people have reported they can last even longer (they simply lose potency). Personally, I've been able to use all of my pens to the last drop so far. With the Lantus Savings Card, you pay only $25 per pen for up to 6 prescriptions/pens.

 

We attempted two days ago to sign up for the Lantus with the savings card. The pharmacy only sells the pens in a box of 5 and therefore in order for us to be able to use that coupon they have to break the box and sell us pen by pen as needed. We are supposed to go tomorrow to see if he will break the box but I am also going by the vet today to see what other options we have with insulin.

 

Some pharmacies are willing to break the box - maybe call around?

 

Not sure where you live, but contact your local hospital's pharmacies and ask if they will sell one pen at a time. I have heard that some of the hospitals will do that. Also call around to all local pharmacies, chain stores and mom/pop shops - you may find that the mom/pop pharmacies will do it.

Additionally, check on the supply closet forum - we have members here selling and/or giving away supplies including insulin - that too may be an option.

 

We were also considering just going with the ProZinc Compounded. We originally were on the ProZinc manufactured and he developed a resistance to it so she wanted to switch him. She suggested the Lantus originally because of it being a human insulin. What do you think about the ProZinc Compounded? She said she could get us a 10ml bottle of that for 69.99 which would last us a good two months.

 

Per a vet I spoke with at the Midwest Veterinary Conference this past spring, the compounded versions tend not to be consistent batch to batch and he advised against them.

 

So we have made some decisions on Cattywhomp's care. We have chosen to go with the PZI Compounded that the vet offers which is 69.99 a 10 ml bottle. This is going to help significantly with our financial situation. We have also chosen to do monitoring at home. Every 7-10 days we will do a curve test at the house and will call the numbers into the vet who will determine whether to raise or lower his insulin. We are also starting to change his diet. Starting tomorrow morning we will be feeding him wet can food - Friskies - twice a day. Thank you for all your help and I will keep you posted on his glucose changes.

 

Sounds like a good plan! But can I suggest instead of once a week curve you do the below? It gives you a better picture of whats going on and keeps your cat safe - especially as numbers tend to drop when they approach regualtion/remission and you dont want to shoot when too low. Shooting without testing first is like driving with a bag over your head :shock:

I usually recommend 3-4 tests a day

- ALWAYS before the shot - this is mandatory as you don't want to shoot when too low. As a newbie this too low number is 200 but is reduced over time once you have the data to know if its safe. If you dont do any other testing this is the tests that are critical.
- mid cycle - 5-7 hours after morning shot depending on your schedule. This is to see how low he is going. The low point "nadir" is what you base dose changes on since you don't want him dropping too low (under 50).
- before bed (2-3hours after Pm shot) to get an idea of what his overnight plans are. If this number is less than the pre shot test number you may want to set the alarm for a test a few hours later as this implies an active cycle.

Wendy

 

Also heres a shopping list for the meter. I am hoping you didnt buy the vets alphatrak. Its expensive for strips and the below meters are almost as good but way cheaper.

Getting started shopping list
1. Meter ie Walmart Relion Confirm or Micro.
2. Matching strips
3. Lancets - little sticks to poke the ear to get blood . new members usually start with a larger gauge lancet such as 28g or 29g until the ear learns to bleed. Optional - lancing tool.
4. Cotton balls to stem the blood
5. Neosporin or Polysporin ointment with pain relief to heal the wound
6. Mini flashlight (optional) - useful to help see the ear veins in dark cats, and to press against
7. Ketone urine test strips ie ketodiastix - Important to check ketones when blood is high
8. Sharps container - to dispose of waste syringes and lancets.
9. Treats for the cat - like freeze dried chicken
10. Karo syrup/corn syrup or honey if you dont have it at home - for hypo emergencies to bring blood sugar up fast
11. A couple of cans of fancy feast gravy lovers or other high carb gravy food- for hypo emergencies to bring blood sugar up fast


Wendy

 

All that sounds perfect!! Thank you for all your help Wendy!!

Cheryl

 

Cool. Heres some testing tips. Some cats are easier to test than others depending on how much of a bleeder they are.

https://docs.google.com/document/d/13c_CPZVKz27fD_6aVbsguadJKvjSrSAkD7flgPPhEag/pub

Before you even get the kit though you can start prepping him. A few times each day rub his ears and give him a treat after. Practice getting those ears warm and getting him used to the attention to his ears..

Wendy

 

I sent Cheryl a followup PM and she responded as below:

Wendy

 

ok does this sound right? (+3 etc means the number of hours after the shot time). Please confirm/edit. It will help us be able to advise better.

Sun sept 1
7am gave 5 IU PZI
+5.5 26 - had hypo?
7pm gave 3IU
+3.5 100

Mon sept 2
7am gave 2 IU
+1 436
+5 410
7pm gave 3 units?

gave 3 units all week

Sat sept 7
7am gave 3 IU
+3 53
+4 40 - syrup

Sun sept 8 dropped to 2.5

Mon 9th
7pm 105 - skip. stopped insulin?

Wed 11th
no insulin this day?
5.30pm 216
8pm 110

 

That last reading was on Thursday at 8 pm.

 

Ok thanks! A normal cats blood glucose is 50-130. That tells me the readings you have been getting the last few days are too high and she does need insulin although maybe not much.
Callie only gets the Friskies pates right? no dry?


I am not a PZI expert but I would be inclined to start again on a small dose - like 0.5 unit and see how that goes and work your way back up if it doesnt work or she still seems a little high than ideal. However I am hoping Sue or Carl pops in and comments since they know that insulin better than me.

Wendy

 

I'm with Wendy. Maybe .5 units. Test before each shot. If the Preshot is 200 or lower, wait 20 minutes without feeding and retest. You want to be sure he is rising, not falling and over 200. If you can get a test mid cycle, that will show you how low the insulin takes him, which helps you figure out a good dose.

 

It looks like she's trying to go off insulin, so:
1) Feed in mini-meals spread out across the day; this will keep from over-taxing her pancreas.
2) Test when you would normally do shots, plus about 2-3 hours after a meal - if the pancreas is working, feeding will cause it to kick into gear and drop the glucose the way it is supposed to do.

With those low numbers, wait until she's over 200 mg/dL and if so, give no more than 0.25 units, which you'd have to eyeball.

 

I'm with Wendy. Maybe .5 units if he is over 200. Test before each shot. If the Preshot is 200 or lower, wait 20 minutes without feeding and retest. You want to be sure he is rising, not falling and over 200. If you can get a test mid cycle, that will show you how low the insulin takes him, which helps you figure out a good dose. If he stays in the 100 -200 range, I wouldn't give any insulin

 

In case you don't have this handy someplace:

Here are some glucose reference ranges used for decision making using glucometers. Human glucometer numbers are given first. Numbers in parentheses are for non-US meters. Numbers in curly braces are estimates for an AlphaTrak.

< 40 mg/dL (2.2 mmol/L) {< 70 mg/dL for an AlphaTrak}
- Treat as if HYPO if on insulin
- At nadir (lowest point between shots) in a long term diabetic (more than a year), may earn a reduction.

< 50 mg/dL (2.8 mmol/L) {< 80 mg/dL for an AlphaTrak}
- If before nadir, steer with food, ie, give modest amounts of medium carb food to keep from going below 50 (2.8).
- At nadir, often indicates dose reduction is earned.

50 - 130 mg/dL (2.8 - 7.2 mmol/L) {80 - 160 mg/dL for an AlphaTrak}
- On insulin - great control when following a tight regulation protocol.
- Off insulin - normal numbers. (May even go as low as the upper 30s (1.7 mmol/L){60s for an AlphaTrak}; if not on insulin, this can be safe.

> 150 mg/dL (8.3 mmol/L) {> 180 mg/dL for an AlphaTrak}
- At nadir, indicates a dose increase may be needed when following a tight regulation protocol.

200 mg/dL (11.1 mmol/L) {230 mg/dL for an AlphaTrak}
- no shot level for beginners; may slowly reduce to 150 mg/dL (8.3 mmol/L) {180 mg/dL} for long-acting insulins (Lantus, Levemir, and ProZinc) as data collection shows it is safe

180 - 280 mg/dL (10 - 15.6 mmol/L) {may be 210 - 310 mg/dL for an AlphaTrak}
- Any time - The renal threshold (depending on data source and cat's renal function) where glucose spills into the urine.
- Test for ketones, glucose is too high.

>= 280 mg/dL (15.6 mmol/L) {may be >=310 mf/dL for an AlphaTrak}, if for most of the cycle between shots
- Uncontrolled diabetes and thus at risk for diabetic ketoacidosis and hepatic lipidosis
- Follow your insulin protocol for dose adjustments
- Test for ketones; if more than a trace level of ketones, go to vet ASAP.

 

Hows things going now? How are her readings?
Wendy

 

He seems to be doing well. I went by the vet last week and they said to leave him off of the insulin but to watch him closely. She said to wait ten to fourteen days and then do a glucose curve to see where he sits and if all his readings are normal then we should be good. We did a reading yesterday and it was 436 and then the second one a few hours later just said high. I believe he got into some dry food the day before and think that is what spiked his levels. We watched him all night and then made sure he has only had wet food since then and we will be testing him again tonight. If he is still high then we will probably start insulin again tonight.

 

Dry food can stay up to 48 hours in the cats system - hopefully he will come back down - it would be a shame if it set him back.

 

So we have done some testing the past two days.

9/22
Tested at 12:00 pm and got 446
Tested at 3:00 pm and got 500 - believe he consumed hard dry food before this so waiting twenty four hours before testing again to see if food will move out of his system

9/23
Tested at 5:00 pm and got 390
Tested at 8:00 pm and got 486 - administered 3 units of PZI Compounded

9/24
Tested at 6:41 am and got 66 - did not administer any insulin because of lower number
Tested at 4:48 pm and got 378 - administered 2 units of PZI Compounded

9/25
Tested at 6:45 am and got 190 - administered 2 units of PZI Compounded
Will test again this afternoon around 5 to see where he stands before deciding next dosage

I have attached his glucose spreadsheet for notes.

 

I am a little concerned about your 2 units for the 190 range. Last night you gave 2 units on a 378 and he went down to a 190 for amps. Can you sure check him today to make sure he doesn't drop too low? (you can use a sliding scale with PZI - giving less insulin in the 200 range than you do in the 350 range.)

 

My husband went home and checked his glucose at 11:45 am and he was at 165.

 

Update:

Went home yesterday and tested him at 4:48 pm and got 209. Gave him two units.

Test again in the morning and get 130 so dropped him to one unit.

 

I am completely confused on why I keep getting such odd numbers. I don't know how to regulate his levels and keep them that way. Please help.
My issue is that when he gets down in that normal range between 50-100 I don't want to give him any insulin in fear he might go into shock.


Here is my glucose spreadsheet for him:

 

Am i not reading your ss right or are you missing preshot numbers? If we don't know where he starts, then we are in the dark with what happens next. The other important reason for a preshot number is to be sure you are giving a safe dose for that number.

Have you seen the Google doc that other use on this site? It is accessible to us without directly downloading it. And it is color coded so it is easy for us and you to see trends/patterns.


http://www.felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207

 

I did what you said and created a google record of his numbers and attached it in my signature.

You are right, there are pre-test recordings missing because we didn't do them. When we originally started testing we were still newbies and didn't test the way or as often as we should have. We were doing really well last week of making sure that we tested pre-shot twice a day to see where we need to be. Once the weekend hit we fell off and shouldn't have. This morning we are back on track with checking numbers pre-shot. I agree that it is extremely important after seeing how his numbers fluctuate.

Another issue with testing is that we usually test around 6:45 in the morning and then give him insulin at 7:00 am. Then we both go to work and don't come home until 5:00 to test him again. Because of the jobs we work we just aren't able to get home to him to test him during lunch. So we are stuck testing him in the morning and then usually around 6:00 to see where he is at for his shot which he gets at 7:00 pm. Then we go to bed at 9-10 because of having to work early so we don't test him after that. Is it good enough to only test him pre-shot? I just don't know what else to do.

My concern is that he was doing fine with no insulin and his numbers were in the safe range for several weeks and now he seems to be back high.
I can see that the insulin works when we give it to him but when his numbers are in the 50-100 range like they were last night and we don't give him any insulin his sugar jumps back up again into the 300's. Do we still need to give him insulin even though his number was 83 for that night?? I just don't want to put him into shock.

 

My guess is that 2 units on whatever yesterday's amps glucose would have been was too much and took him too low. Without a pre-shot test, you can't adjust the dose before giving; and without mid-cycle tests, you can't be sure the dose is safe.

At this point, with irregular ability to test, I might stick with a nominal dose of 1 unit. monitor for urine ketones (tips in my signature link Secondary Monitoring Tools), and observe for hypoglycemia (not impossible, even with the low dose). Maybe work for stability and safety. He might have a "sputtering pancreas" which sporadically puts out some insulin on its own.


When you see a low pre-shot number, wait 30 minutes without feeding and re-test. If the glucose is rising on its own, and, of course, food will continue the increase, it may be safe to give a small dose of 0.5 units. You can see if this works on an evening when you'll be able to monitor him and see if this works for him.

 

Yesterday when I went to the store to get Cattywhomp some more food I was looking to get him different flavors because he just doesn't seem into the one's we were originally getting him. When I realized there wasn't any new ones that I could get him, I pulled out my list of foods and started going through them. I found the Fancy Feast one's that he is able to have and bought a box. When I got home I realized that they are 3 oz cans not 5.5 oz cans like the Friskies. We were feeding him two cans a day a good bit of which he wasn't really eating. One in the morning and one at night. But now that it is 3 oz cans I am not too sure how much he needs. I gave him a can last night and he gobbled it up so I gave him another half. Then this morning i gave him a can and half but about an hour later he vomited it all back up. I am not sure if he vomited because of the food or if it was something else that got him upset. What is the normal amount that he needs of the Fancy Feast?

 

In general, 2-3 cans per day, depending on whether he is too fat or too skinny.

He may have eaten the food too fast or the change may be too fast for his tummy. You might try smearing the food out so it slows his eating down or adding some warm water to make more of a gravy.(good for hydration too). Keep track of foods that cause distress- my kitties have always had trouble with the beef flavors.

 

And that is 2-3 cans of the 3 oz cans?

 

Yes.

There is an exact formula for how much to feed a cat of a certain weight. Hopefully someone else can find that - i don't have access to it. But 2-3 cans is a good startingoint.

 

sounds like scarf and barf - he ate the food so fast cos it was so yummy and threw it up immediately! spread the food on a flat plate and it will slow him down a bit until he gets used to it. You might also want to transition the food over about a week to prevent diarrhea

Fancy feast classic pates are about 85 calories a can and heres a formula for how much he needs. Its a good starting point and you can adjust if he gains or loses weight:

How much to feed? Required calories per day = [13.6 X ideal weight in lbs] + 70

Wendy

 

Hows things going? I saw the 36 this morning. Looks like 3IU is too much eh? In future you might want try and get mid cycle tests to check how low she is going before increasing the dose. As well as the preshot. Today was a good example of why. 2.5 could also be too much but without more tests you wont know that.

And remember since she dropped too low today you can expect a few days of high numbers (a bounce) so hold the dose until the bounce clears before changing dose again (unless she drops under 50 again)

Wendy