Newly diagnosed cat.

Discussion in 'Feline Health - (The Main Forum)' started by TB25, Nov 5, 2018.

  1. TB25

    TB25 New Member

    Joined:
    Nov 5, 2018
    Hi All,

    (Copied from introduction forum)

    My name is Steve and my wife Jo and I are the minions of 5 cats, one of whom, our 8 year old black cat Hodgson, has recently been diagnosed as Diabetic. We are no stranger to managing chronic conditions in cats (we’ve had 2 long term CKD kittiesin the past) but diabetes is new to us and we are a bit lost!


    His symptoms pre diagnosis were what I now know to be classic: weight loss, rabid thirst and hunger, poor coat and lethargic. He went from a weight of 6kg to 4.5kg in a remarkably short time so we took him to our vet who confirmed the diagnosis and started him off on a 1iu dose of Prozinc 12 hours apart at feeding times, and told us to bring him back in 3 weeks. We already feed all the cats wet food so the only change we made was to switch from free feeding to scheduled. All have taken to this well. We’re in the Uk and feed him 1.5 sachets of purina gourmet Perle twice a day.


    Almost immediately after starting the insulin we saw improvement, he lost the excessive interest in water, his coat came back into condition and he started to gain weight. At his 3 week check he had gained 300g but the vet said his numbers were still a little high so to up the dose to 2iu twice a day for another 3 weeks.


    Progress continued well and other than being a little thin, he was completely back to his old self. At the next checkup he’d gained another 300g, but his bloods had increased (450) rather than decreased so vet told us to up the dose again to 3iu twice a day. At this point I began to feel a little uneasy about the approach as I could not reconcile the weight gain with the need to increase, but our vet has been brilliant in the past so I went forward on faith.


    That was three weeks ago. Fast forward to todays appointment: Hodgson is looking and acting great and gained another 350g BUT his numbers have increased again (470) so vet tells my wife to reduce his food because overweight cats are harder to balance AND tells her to up his dose to 5iu twice a day.


    Alarm bells are now ringing. Unlike the CKD cats, I’ve tried to stay off the internet with the diabetes so far, as our vet was outstanding with that condition, and my own research caused as many problems as it solved, but after a google search earlier I’ve found myself here and realised there is a world of stuff I don’t know! From the little I’ve read 10iu daily is a serious dose. If he was losing weight, demanding water or acting lethargic I can see why this action may be necessary, but if you didn’t know he was diabetic you’d just see a normal happy cat.


    So my question is: help! I’m really not sure what to do next? Im thinking testing at home might be useful? As far as I know he’s never had a curve done, as the vet said a fructose (sp?) test gives a similar indication, and he absolutely hates the ride to the vets so is stressed when he gets there which I understand can affect the BG result?

    Thanks and sorry for long message!
     
  2. Idjit's mom

    Idjit's mom Well-Known Member

    Joined:
    Apr 3, 2018
    Hi Steve and Jo, you made it. Where in the world are you located? We have members from across the globe and if you are not in US there are members who can help with testing supplies and food questions.
    Can you create a signature so that Hodgson's pertinent info is available with each post? Do as much as you can, you can update if/when things change. Here is a link for that: SIGNATURE The profile and the signature are two separate things, and you can add more info to the profile, when and if you like. If you click on my avatar of Idjit you can see my age and where I am, and there is a Profile page option. All that info is your choice to provide or not, but location on each is helpful.
    Just keep the signature info concise, it does not need to in narrative form.
     
    Elizabeth and Bertie likes this.
  3. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

    Joined:
    Sep 6, 2010
    Hi Steve and Jo, welcome!

    I'm so pleased that you are seeing an improvement in clinical signs. That is very encouraging.

    However... The insulin dose does seem to have been increased rather quickly, and with very little blood-test data to support those increases.
    And, when blood glucose levels increase as the insulin dose is increased that can indicate too much insulin rather than too little...

    Testing blood glucose at home would be THE best thing you could do. And it's not hard to learn. It would give you really important info about how your cat is responding to insulin, and would enable you to better manage his condition.
    I see you are in the UK (waving to you from Surrey!). If you look at the second link in my signature (you'll need to scroll down the content a bit) you'll find info on glucose meters that are currently popular in the UK.

    If you can learn to test regularly at home that could mean that you don't need to take your cat to the vet for blood glucose tests or for fructosamine tests.

    Which insulin has your vet prescribed? Edited to add: just seen that you are on Prozinc.

    Eliz
     
    Last edited: Nov 5, 2018
  4. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    Hi Steve from another UKer (Elizabeth says that's where you're from?)
    You've found the very best place to get help with your kitty so do spend as much time as you can reading here, especially the link Elizabeth quoted above which will give you a good overview.
    I'm concerned at the high dose of insulin you're giving so testing bg at home will certainly play a very useful - in fact essential - role in keeping your kitty safe and starting along the road to managing his diabetes better.
    Do keep asking questions, we're here to help :)
     
  5. JanetNJ

    JanetNJ Well-Known Member

    Joined:
    Jun 8, 2016
    You need to start home testing. Please don't increase the dose until you do. Your vet should not be basing the dose on just random spot checks. I have a video in my signature showing how I test my cat CC at home.
     
  6. Jeff D / Sketch

    Jeff D / Sketch Member

    Joined:
    Mar 21, 2017
    I like the "alarm bells are ringing" comment. We all get pretty in touch with our cats and seem to have an instinct regarding their health and well being. I agree with the others that home testing is your best bet! You mention that your cat is extremely stressed out going to the vet which can significantly increase BG # which could result at increasing the dose unnecessarily. I would start home test before increasing dose and do so only after performing a curve unless his numbers are way out of line.
     
    TB25 likes this.
  7. TB25

    TB25 New Member

    Joined:
    Nov 5, 2018
    Morning everybody, and thanks for your detailed responses! We’re in the south of the UK.

    He’s happily eating, playing and we think he’s looking good, so we’re going to stay at the current 3iu dose for the rest of this week whilst we assemble a test kit. On Saturday we’ll attempt to do a curve and take it from there.

    He’s a pretty chilled out cat so hopefully he’ll take it in his stride!

    Quick question: the wet food we feed him (and all our cats) is ~9% carbs, according to the excellent calculator we found in the FAQ’s. Should we be thinking of changing?
     
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  8. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

    Joined:
    Sep 6, 2010
    Hi,
    Generally, below 10% calories from carbs is best for diabetics. Many do better at levels lower than that, say 4 - 6% or lower; and these kinds of carb levels seem to increase the chance of remission. (Quite a few cats go into remission and can be diet-controlled).
    But.....care has to be taken with cats that are already on insulin...
    Reducing the carb content of the diet can reduce the blood glucose (quite a bit in some kitties) and the insulin dose may need to be reduced also so as to avoid hypoglycemia. For this reason we'd advise only lowering the carb content of the diet once you've learned to hometest and can monitor the effects of the change. You may find yourself back-pedaling on the insulin dose...

    Are you feeding the Purina Gourmet perle? For some kitties that will be absolutely fine. But just be aware that it contains 'vegetable protein extract' (usually soy or wheat protein) and a minority of diabetic cats seem to be very sensitive to this. My cat is one of those. Even a few bites of the stuff will send his blood glucose up. And there was a cat in remission here whose blood glucose scooted up to 30mmol after eating one pouch of food with this in (in his case, Felix 'as good as it looks'). ...Chances are your cat isn't one of the sensitive ones, but maybe just keep an eye on his blood glucose levels if you switch to a food that doesn't contain veg protein extract.

    Great! That sounds really positive. I'm sure you're going to manage this feline diabetes malarky just fine.
    Please do let us know how the curve goes. And post if you need any advice on the hometesting.

    Eliz
     
    TB25 likes this.
  9. Idjit's mom

    Idjit's mom Well-Known Member

    Joined:
    Apr 3, 2018
    Good morning. It would be very helpful if you would set up a signature and a spreadsheet. The signature is kitty's pertinent info that displays with each of your posts. Here is a link: SIGNATURE
    Here is a link to the section with instructions and understanding the spreadsheet: SPREADSHEET
     
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  10. TB25

    TB25 New Member

    Joined:
    Nov 5, 2018
    Thanks again all.

    Loads of reading done, YouTube vids watched, Signature and spreadsheet sorted, BG meter purchased, Practiced jabbing my thumb a bunch of times, testing commences tomorrow!
     
    Last edited: Nov 9, 2018
  11. Lilly’s Mom

    Lilly’s Mom Member

    Joined:
    Jun 11, 2018
    I'm going to add my voice to be cautious in raising the insulin that much so quickly. I was at my first vet and they kept increasing the dose until she was at 7iu twice a day. (I now know that is a really high dose....being new, I didn't know - I just did what the vet said to do. ) We are at a different vet now bc Lilly almost died due to a crash in her bg levels. I woke to find her unable to stand and barely alive. After rushing to the vet and getting IVs, the new vet started her at 1iu and now she is at 2iu and her levels are great. From just working with Lilly, I have noticed that it takes time for the insulin change to really show a consistent change in her levels. I wouldn't rush to change based on one reading. It could just be a random high reading. I love home testing. It makes me feel like I finally really know how she is doing....and she is doing ever so well. I was a bit intimidated at first but this site has been a lifesaver - literally! You will find so many very knowledgeable people here.
     
  12. TB25

    TB25 New Member

    Joined:
    Nov 5, 2018
    Ok, first day of testing in the books. Extraordinarily stressful, he hated it. He’s a very chilled cat, but he has never liked his head being stroked so this was a test for all of us.

    I had hoped to get a full curve with a sample every 2 hours, but between my cack handed attempts to get a droplet, and his struggling, he was so stressed I had to give him a break and messed it up a bit. He went and hid under the sofa which something her only does when really scared :-(.

    In the end I got 5 values over 12 hours (see spreadsheet), but missed the key ones in the mid afternoon which might have defined the nadir. The first test of the day was probably the best one, and the last very definitely the worst- he was seriously wound up then- so I’m wondering if the high 20.1 is a result of stress? Other than a few bits of boiled chicken as a bribe, His calorie intake today was identical to what he’s been eating for the last few weeks, and other than being a pissed off pussycat right now he’s still looking good and behaving normally.

    I know it’s early days, but does anyone have any thoughts?
     
  13. Idjit's mom

    Idjit's mom Well-Known Member

    Joined:
    Apr 3, 2018
    I tried to access the spreadsheet and permission needs to be given. I think you might have missed that step.. I did too when I was trying to set mine up. I got help when I was not able to manage. If you go back into the ss, you may be able to see where you give that permission. If not, let us know and someone will help.
    Re: testing. It's practice and patience. It takes two of us here to test Idjit, since I only have two arms and hands. DH holds and comforts Idjit, I do the poking and testing. Idjit has become resigned but is not an eager subject. He does, however, sit and wait for that treat after anything to do with his ears, he is all for that. There may be something else you could offer as a treat that he would be crazy about, and associate with the dreaded poke. Some members use freeze dried chicken bits, tuna water, bonito flakes, etc. Perhaps for the next few days, try testing before each shot and in the middle of the day (choosing different time slots to find that nadir). Perhaps a curve on the first poking session was just too much for Hodgson. Scritches and head rubs to him.
     
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  14. TB25

    TB25 New Member

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    Nov 5, 2018
    Hmmm- it says anyone with link can access. I’ll have a play and see what I can do. In the meantime his numbers were:

    AMPS 0700 - 17.1; 3iu prozinc
    0900 - no sample
    1000 -14.4
    1230 - 6.1
    1430 - 6.0
    1600 - no sample
    1800 - no sample
    PMPS 1900 - 20.1; 3iu prozinc

    Yep, I think I may have been too ambitious for day one. He’s getting a lot of cuddles and strokes right now!
     
  15. Jeff D / Sketch

    Jeff D / Sketch Member

    Joined:
    Mar 21, 2017
    Awe....poor guy. Great attempt! As you said a curve on the first day of testing might be a bit ambitious!. Do know that him being stressed when testing can also drive his numbers up as the fight or flight instinct kicks in. Maybe just try preshot/meal test and mid day for a week or so.
     
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  16. TB25

    TB25 New Member

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    Nov 5, 2018
    Yep, we’ve given him a break today and left him alone! We are going to try morning and evening over the next week, with mid afternoons next weekend.

    He hates travelling and His numbers at the vets were in the late 400’s, but we were seeing early to mid 300’s yesterday (albeit with a human meter) so quite a drop just from fear alone!
     
  17. Idjit's mom

    Idjit's mom Well-Known Member

    Joined:
    Apr 3, 2018
    I understand the motivation to give him a break, and he's still in relatively high numbers, but it's important to test preshot, just to ensure it's safe to shoot. When/if you can, this week, do try to get the mid cycle numbers so you can find how low the insulin takes him. Dosing is dependent on the lowest numbers in the cycle, and as Hodgson becomes more regulated you may be presented with the need to reduce his dose. Which would be great..that would indicate that the pancreas is healing. After all the ultimate goal is that the pancreas will heal and Hodgson go into remission. He would still be a diabetic, but not need insulin support. That's when we throw a party here on the board!
    I would recommend just going through the motions of testing, to try to convince him that this is the new norm. Take him to the testing station, rub his ears, maybe try the warmed rice sock or pill bottle filled with warm water, praise, hugs, kisses, pets and a treat every time.
    I tried your spreadsheet again, no go. Maybe you need to change the permissions on the spreadsheet. Go to that blue "Share" and click to open the new box. At the bottom right it will say "Advanced", click there. Choose "Anyone with the link can view" and then "done"!
     
  18. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

    Joined:
    Sep 6, 2010
    That's not a bad curve at all.... Well done, you! :bighug:

    The 12.30 and 14.30 are almost the same, so it seems 'likely' that the nadir (lowest blood glucose) happened between those points.

    The rise is quite steep after the nadir, which makes me wonder if there is some 'bouncing' going on. If the blood glucose drops too low for the cat's comfort the body can release stored glucose to push the blood glucose level up. The number that triggers bouncing doesn't have to be that low, just lower than the cat's body has become accustomed to.

    Aw, poor little bloke...
    Are you remembering to give a low carb treat for every attempted test?

    And you may be interested to see this little video on 'desensitization and counter conditioning'. The video shows a vet working with a cat on insulin injections, but the principles could apply just as well to hometesting.

    .
     
  19. TB25

    TB25 New Member

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    Nov 5, 2018
    Ok, so a bit more successful over the last few days. Managed to get a couple of PMPS tests with far less stress using some ham as a bribe. I’m working on opening up the spreadsheet but think issue is that my google space is a hosted by my business and I can’t open it out myself. I’ll sign up for a personal one over the weekend.

    Also been doing some food research and have moved him over to Butchers Classic. According to the food spreadsheet it has a similar carb % as the gourmet Perle but without the risk of the soy protein issue Eliz mentions above. Been on it for a couple of days and he’s seems to really like it, and tonight’s test was significantly lower than last night (13.3 vs 20.2) which might be a coincidence but we’ll see if that continues over this week.

    Thanks again for all the help so far- starting to feel a little bit more confident now!
     
  20. Idjit's mom

    Idjit's mom Well-Known Member

    Joined:
    Apr 3, 2018
    I'm so glad to hear you are getting more comfortable with testing, yep, it's a more complicated step in the sugar dance. But it sounds like you and Hodgson are learning to dance better.
    Sounds like a good idea to get your own personal Google account, then be able to set up that spreadsheet so you can track that data and it will be available to the advising experienced members.
    Do you have a picture of Hodgson to use as your avatar so we can see what he looks like?
     
  21. TB25

    TB25 New Member

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    Nov 5, 2018
    Avatar done! He’s one of five cats we serve!
     
  22. Idjit's mom

    Idjit's mom Well-Known Member

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    Apr 3, 2018
    He's beautiful, thank you for sharing. Sometime, when you have a few minutes, with working, dealing with FD, serving 5 cats and fitting in a life with your sweetheart, maybe post a pic of all of them? I love to see the fur kids, and our civies (non diabetic fur family members) are important too. We do have a Community/Off Topic forum where there is currently a thread about some members' beloved droolers.
     
  23. TB25

    TB25 New Member

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    Nov 5, 2018
    Seems I might have been off on the food thing. Back up to 21.5 tonight with the same amount and type of food as yesterday.
     
  24. TB25

    TB25 New Member

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    Nov 5, 2018
    Testing becoming much easier now. He doesn’t love it but far less stress. I’ve opened up the spreadsheet to all if anyone wants to see how we are doing.
     
  25. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    I can't open your SS. You need to set up "anyone with link can view". I'm not the best at giving assistance with SSs though. o_O
     
  26. majandra

    majandra Member

    Joined:
    Oct 11, 2018
    When I first started with testing, I experimented with different locations that would be easy for both of us. I found in the end that on my lap at kitchen table works great for testing. I put my feet on a chair so knees are raised, and then there isn't really anywhere she can go. I put her snack on the table next to the kit so she can see and smell it. She now comes when I call her, or sits on my chair when hungry.
    I may have to modify location to kitchen table once she starts with shots. I dont have room to shoot on my lap!
     
  27. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    Sep 6, 2010
    I'm so pleased to hear this! Well done, you. :bighug:

    I can't see it either, and I'd love to see how you're doing.

    Eliz
     
  28. TB25

    TB25 New Member

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    Nov 5, 2018
    Last edited: Nov 19, 2018 at 1:40 PM
    Reason for edit: duplicate post

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