Newly diagnosed cat (Simba)

I have a 15 year old cat (Simba) who was just diagnosed with diabetes (and possibly kidney problems as well) a little over a week ago. I've been reading some threads on here but I'm still confused about a lot of stuff. I'm currently stationed in Okinawa, Japan and had to bring Simba in for emergency care at a Japanese vet because of his constipation. Blood tests were done and he had bad renal numbers and very high glucose (around 520 or so.) It's a little difficult to communicate with the vet because it has to be done through a translator but so far I've just been doing what she's told me to. They did two curves during two seperate 12-13 hour periods (two days in a row) then gave me some syringes and a vial to use at home. I've been giving him 1.5 units twice a day and will be bringing him back in tomorrow for another blood test.

I'd like to start doing home testing and need to look into getting the insulin and stuff myself. I had my mom send me a ReliOn Micro and some related testing supplies and hopefully I'll get it this week. But I'm curious about what insulin supplies I should get and where to get it from. I just learned about the pens and thought that would be pretty nice to just dial in the amount and administer it because I've been having issues with bubbles in the syringes the vet gave me but maybe I'm doing something wrong. My cat doesn't seem to mind the injections much, but I do mind waking up at the crack of dawn on weekends to give it to him...oh well, has to be done. Any suggestions for insulin delivery?

 

Re: Newly diagnosed cat

Hi and welcome to the board.

You've learned alot so far, that's great. What type of insulin did the vet give you?

Pens are great for Levemir and Lantus so the insulin lasts longer, however the pen needles that come with the pens don't work for our cats. The dosing is usually much smaller and from what my pharmacist told me, the pen needle itself is too small to possibly use on my cat.

Can you tell us what type of food your feeding? Low carb, high protein food is great for FDs, especially canned. In your case, with constipation I'd want to go with canned only and maybe some extra water mixed in to help with that.

Did you ever find out what caused the constipation. Is Simba taking anything for that? Did they mention Irritable Bowel Sydrome (or Disease) IBS/IBD or is it advanced age? Like humans, senior kitties can have difficulty with bowel movements.

Looking forward to learning more about Simba.

 

Re: Newly diagnosed cat

What insulin are you using? If it is a human insulin such as Lantus or Levemir you should be able to get that that , syringes and test strips from the same place humans get theirs. By your wording of "stationed in Okinawa, Japan" it appears that you are in the military. If that is the case I would talk to the people you normally talk to about your health. They should know where you could get the stuff if you were a diabetic. You may need prescription from the vet to get some of the supplies though.

 

Re: Newly diagnosed cat

Are the pens you are talking about the kind people use to give themselves insulin? You dial in the dose and push a button or something and the pen gives the shot? If so, those are not accurate enough in dosing for use with kitties. They're fine for people, who use larger doses (if the dose is a human dose, a half unit or even a unit off isn't going to make a huge difference, but if you are trying for a cat-sized dose, that much inaccuracy is a big problem).

They *do* sound like a helpful thing, but in fact they aren't in this situation. The "pens" that are sometimes mentioned in connection with Lantus or Levemir are small containers of insulin but are still used with syringes.

 

Re: Newly diagnosed cat

Insulin pens, such as the Lantus SoloStar and Levemir FlexPens, are used with insulin syringes for cats. Using the pen on a cat the way a Human diabetic would (with pen needle, "dialing" the dose and pushing the button) doesn't work because the pen needles are too short and you cannot measure tiny doses such as half and quarter units.

Any insulin syringe needle works with an insulin pen. You just insert the insulin syringe needle into the rubber stopper of the pen, the part where normally a pen needle is attached to. Here is a picture:



If you are using a U100 insulin such as Lantus or Levemir, it is preferred to use U100 insulin syringes that are 3/10cc with half unit markings. The half unit markings makes it easier to measure half and quarter units of insulin, which some cats need. You can use insulin syringes with whole unit markings but t's harder to measure tiny doses of insulin.

 

Re: Newly diagnosed cat

Here are the other supplies you need. The good part of this, is you should be able to get this at any regular human pharmacy and any brand you can find is fine to use:

- ketostix or ketodiastix - this is a urine test to test for ketones in the cat - should be found with other diabetic products

- neosporin or any topical antibiotic ointment/cream - typically found with first aid supplies - like band aids

- lancets - they look like push pins and are used to poke the ear to test blood - you can get ones that match the lancet device that comes with your meter, or if you want to free-hand poke - then get whatever ones you can find - with a gauge anywhere from 29 - 31. (The higher the number the thinner the needle).

Make at home - A warming sock - take one of your socks or an odd sock, fill it with about 1/4 cup of rice, oatmeal or dried beans, knot the top - then put in microwave for about 30 seconds until warm to touch - put behind cat's ear to warm the ear and help the blood pool.

What color is your cat? Especially the ears? If they are dark, then get a small flashlight (one you can hold with your mouth). It will make it easier to see (using it like a spot light) when poking.

Here are some pics of where to poke on the ear - you don't want to hit the vein, rather you want to go between the vein and edge of ear



This is what a lancet looks like and if you decide to free hand poke, then hold it at an upward 45 degree-ish angle and poke that way:



What kind of food are you using? If you're using dry food, we highly recommend changing to a low carb wet food diet. And by making this change, you may find that you will need to reduce the insulin.

Here is a link to nutrition and food information.
nutrition links


Oh and check out the link about putting together your hypo kit - cause, well you just never know when you may need it. hopefully you never will need it, but better to be prepared. Now if you can't find karo syrup - no worries, any simple sugar will do - like honey, jelly/jam, cake icing, even sugar melted in water will work.

hypo took kit

 

Re: Newly diagnosed cat

Welcome!!!! I'm so sorry you're here and i mean that in the nicest way possible!

First off, let me tell you how impressed i am with your ability to manage all this while overseas. Just being overseas in challenge enough!

Feline diabetes stinks but it's an easily managed disease and Simba can have many more happy years with great quality of life so please don't worry about that. I'm thrilled that you asked your mom to send you a ReliOn meter. It's a great meter that is easy to use and inexpensive. I just tried looking to see if there are Walmarts in Japan but it's a little unclear. Hopefully your mom can send you test strips. I think you are going to feel so much better once you can test Simba at home and not have to rely so heavily on vets that you are unable to easily communicate with.

We, here at FDMB, are an entire community here to help you. We all came here scared, confused, and feeling like the wind was just taken out of our sails. Hell, i remember crying for the first 3 days after diagnosis. I wish i found the great people here sooner.

Be proud of yourself, you're doing great!! Let me try to find you some info. to read up on....

 

Re: Newly diagnosed cat

me again -

Here's a link with a boatload of information. I know it's all very overwhelming and you're not sure where to start - read what you can and ask us lots of questions - that's how we all learned.

http://www.felinediabetes.com/FDMB/view ... =14&t=2502

Oh and i wanted to mention that your Simba sounds like a real trooper! She lucky to have you as a mom.

Keep the questions coming - Michele and Molly.

 

Re: Newly diagnosed cat

Thanks for the support guys.

About his diet... I'm usually pretty picky about what I feed him but before the diabetes stuff I didn't know about the low carb/high protein stuff. I mostly just stayed away from some fillers (like corn) and by-products. He was on dry food only until about 1.5-2 years ago when I started giving him a can a day with his dry food. Since we moved to Japan in January the selection of food has been limited and I've had to order online. He's been on Natural Balance Ultra Premium Reduced Calorie dry food for a few months now. For canned food he was getting Nutro Natural Choice Indoor Senior and getting half a can in the morning and afternoon. I had ordered some of the Natural Balance canned food (of the same variety) for when that ran out but I haven't received it yet...I think it was shipped parcel which can take forever. So in the meantime he's been eating 2 cans a day of Hill's Mature Adult Active Longevity in either turkey or chicken varieties. I really want to put him on the low carb/high protein diet that I've been reading about on diabetes pages but I don't want to change anything until I can test him at home. The vet did the curves and prescribed the insulin while he was on the Hill's canned/Natural Balance dry diet so I didn't want to risk giving him too much or too little.

I've seen some lists of foods but usually when I'm looking I'm at work and some links are blocked. The BX (base exchange, like a Walmart on base, but not as good) and Commissary only have a couple brands of canned food but I think they might have some of the food on one of the lists I saw. I need to print out the lists and go look around. Off base everything I have seen so far is all in Japanese which I can't read at all and even getting someone to translate they might not give the exact ingredient because some details could be lost in translation. I saw a link to a tripod page with a list of food and it said something about non-US food but the link was dead. Any suggestions on where to look for Japanese canned food?

Now for the constipation... He hasn't been diagnosed with anything directly related to the constipation. This was the third time in a year that he's had to go to emergency care and get an enema to clear him up. The first two times I'm not sure if they even did any blood tests like the Japanese vet did. I think the first two times he was constipated he was on Nutro canned/Blue Buffalo dry (or maybe Nutro dry the first time) and the most recent was on Hill's canned/Natural Balance dry. So I don't think it's related to a certain brand of food but it could be the (potentially...haven't done enough research on these brands) high carb diet. I'm wondering if his kidneys could be part of it though. When they did the first blood test his renal numbers were a little high. I don't have the chart with me but one was supposed to be up to 4.0 and it was at like 4.8 and the other was supposed to be up to 2.0 and it was at 2.4. After keeping him overnight with fluids/IV the numbers were within the normal range but the day after that they were back up to like 4.4/2.2 or so.

When I do start testing at home how often should I be doing it? I work normal hours 5 days a week and my wife is on a flex schedule currently but when she works it's about the same times as me. So I can only test early morning and late afternoon/evening on weekdays. If it matters I am home for a short time about 2 hours after feeding him in the morning 3 days a week.

That sucks about the pens not working for cats, I was hoping I could use that to make it easier (especially for the wife.) But what about the bubbles I get in the syringes? Could I be doing something wrong or could it be the syringes? The ones I've been using were from the vet and I think the brand name started with a T. I believe they are U100 with marks every 2 units but I'm not sure. I have no idea what type of insulin they have me using either.

 

Re: Newly diagnosed cat

Just got back from the vet. They did a blood test and his glucose was at about 430 and this was 6 hours after his injection. They were thinking maybe I was doing it wrong but how hard is it to inject insulin? His renal numbers were up too...the numbers I gave before were wrong, it wasn't 4.8 it was 48 and it was supposed to be under 40.

Should I be concerned if they reuse the insulin vial? They're only giving me a weeks worth at a time and it's diluted with saline solution so that it's easier to get the dosage right in the syringe. The syringes they're giving me are Terumo SS-10M2713. The insulin is listed as Novolin N100 on the receipt.

And to answer a couple other questions... Yes I'm in the military (Air Force), no there are no Walmarts here (closest thing is Jusco), and my cat is an orange tabby and it's easy to see the vein in his ear.

 

Re: Newly diagnosed cat

Welcome to the FDMB community. We're so glad to have another member. Feel free to ask all the questions you want. There's usually someone online 24/7 if you need help or just a listening ear.



Welcome!
Linda Lee

 

The needles u r using are fine.


I would not worry too much about bubbles. You can tap it so it comes to top and give a little squirt to remove it

Regarding insulin. N is one of the more difficult insulins to use. It is short acting. Meaning it has a duration of 6 to 10 hour. It is not long lasting like lantus or levimer. Which is one reason why u r seeing higher bgs

Anothewr can be vet stress. Cats don't like to go to vet and get stressed which can raise bgs like 100 + than at home

Since u are just starting this process can iu ask The vet to change insulin to one of the l's instead. It will be easier for u in long run



Regarding food options. If u tell us what is available to u. Brand and flavor. We can help you to figure out the carb %.

Sorry this is bad writing on a bberry. Will type more when I get to work and out of tunnel so it will send.

 

dupe deleted

 

The constipation could be IBD, irritable bowel disease, or just age. Can you get something like Miralax where you are? That would help your kitty move things along easier.

I'm not too familiar with the insulin, so others may be able to answer your questions about the vet mixing it up there and adding to the same vial.

It sounds like the resources are limited over there. If you can't get an insulin like Lantus, Levemir, ProZinc or PZI, I think the best way to help reduce the numbers is to get rid of the dry and feed the canned only. Let us know what brands they have there, Friskies, 9-Lives, Fancy Feast, if they have that at the stores, we may be able to help choose the right kinds that don't have gluten.

Test the BGs at least twice per day, before each shot. When changing food I'd check every couple of hours or every three hours for a while to see how the food and Simba react.

Terumo makes good needles, but I'd prefer the SS30M3009, the 3/10 cc, it will be easier to dose smaller doses and lines are further apart for you to read them easier. With the gauge needle it looks like you have a 27 gauge, with needles, the larger the number, the smaller the needle so the 30 gauge would actually be more comfortale for Simba.

 

Do you know the dilution ratio for the diluted N insulin? I ask because you can really confuse people if you say you are giving say 10 units of insulin when when it is diluted so you are really giving a lot less.

If you could obtain 3/10 capacity insuin syringes with 1/2 unit markings then there would be no need to use diluted insulin. A weeks supply of the dilute insulin is good since I think that the diluted insulin has a shorter shelf life than the undiluted insulin.

 

I'm supposed to be giving him 1.5 units of the insulin undiluted. The vet said to use 4 units in the syringe with it diluted (second line). I already ordered some 3/10 syringes and will ask the vet for undiluted insulin next week if I have the syringes in time. I have to see what I can do about the insulin, hopefully the vet will help me out.

Forgot to answer something earlier. Being in the military we get human stuff for free from the hospital if it's prescribed. The other option we have (at least in the US) is to go to a civilian pharmacy and have Tricare (military health insurance) cover most of the costs. There is no pharmacy on base besides the hospital and the BX has a lot less over the counter stuff than Walmart. I couldn't find ANY diabetes supplies at the BX or the commissary. There is a vet on base but they're usually really busy because they're the only US vet for all the military here (we have a lot of bases on Okinawa) and they're currently in a temporary building with no ER because they're getting a new building. I actually tried to get my cat to the vet on base a couple days prior to taking him to the ER for the constipation but they were closed for training one day and the next day we couldn't get ahold of them. Obviously the civilian vets are much more flexible.

 

hey we understand about limitations and limited choices. we will do the best we can to help you navigate with the resources you have available.

I'm wondering if the civilian pharmacy will have lantus or levimer in stock. After all there must be human diabetics in the military - no? If they carry it, then find out what you need in order to get a supply. I don't know if telling them it's for a cat, would work in your favor or not (especially if their supply is limited).

You may need a script and I'm wondering if you ask the vet to write one, if the pharmacy will accept it. They should, of course, will the vet understand what you are asking him/her to do?

If you can get one of these two insulins, we have a board on here dedicated to helping you understand and use this insulin (even without vet approval or input). Of course, it's preferred to have a vet understand what you are doing.

If the civilian pharmacy doesn't carry ketostix (again it's a diabetic thing) see if any of the local pharmacies carry it - and get it there - doesn't matter what language it's in - as long as they have it. Bayer is one of the manufacturers here for it, but I'm sure there are local ones that will work just as well.

I spent time in Thailand and their local pharmacies were great - I could find all kinds of prescription drugs there without needing a prescription to get it. They also had a British pharmacy called Boots that was well stocked with items. I even found the local pharmacists to be very helpful, even with some language challenges. I'm wondering if it may be the same where you are.

 

If you are diluting with saline it should only be diluted at the time of injection and should not be stored. At least that was what I was told years ago when Humulin stopped making their diluent. So I"d be really cautious about this. I would also not be using tumero needles as they are thicker than proper insulin needles.

I recognize you have limited resources there; hopefully we can help!

Jen

 

Hi there,
My daughter was just transferred to Kadena, she's only been there a few days, so she's just getting checked in, but she knows a ton about feline diabetes. Are you by chance a softcell user? She just got a phone but she can only talk to other softcell users at the moment and at certain times of the day, blah blah lol I am sure you know all about that. She's getting her internet and magicjack plugged in like tomorrow so she'll have that then too. Her name is Jesica and she can help you with testing, injections, food, everything.. she's been around diabetic cats and treated them for several years.

Pls send me an email at wnstnbabe at gmail dot com or find me on facebook using that address and I will get you in touch with my daughter.

Welcome to FDMB!