Newly diagnosed....I'm freaked out

I just started posting here a day or two ago. Was waiting for my cat Lamont's diagnosis.

He was diagnosed 20 minutes ago with diabetes Mellitis. His glucose was around 540, which is very high. I'm meeting with the vet on Saturday to go over everything.

I told her I had already switched him to low carb low phosphorus food (initially Blue Buffalo, today he's starting on Wellness). This is what she said:

She claims diet has absolutely no role in feline diabetes which I just don't believe. Aside from everything I've read online, it just doesn't make sense. My cat was eating Science Diet dry food for years, plus Greenies. Because I wasn't educated about feline nutrition, I thought I was giving him a healthy diet. Now that we're in crisis-mode, I realize how unhealthy that stuff is. I've read so many people's stories online about their cats who are in remission. I TOTALLY don't agree with her there and am hoping that with his new diet and insulin he can go into remission.

She felt that home testing is a good thing, but mentioned the urine sticks.

I told her I was concerned about hypcoglycemia and since I changed his diet (Sunday he was eating a mix of Science Diet dry and Blue Buffalo mature Healthy Aging dry plus 6 Greenies, by Monday he was on no Greenies, wet Buffalo with some dry Blue Buffalo mixed in; today he's on a mix of web Blue Buffalo Wilderness Mature and Wellness No Grain Chicken), I thought it would be smarter to have his diet totally adjusted, maybe for a month before starting insulin. She said she thought that was dangerous.

Instead, she's going to start him off at the lowest possible dosage of insulin and I guess he'll start on Sunday. She'll redo his blood in a week to test it and wants me to test his urine multiple times a day.

Is there anything (aside from diet) but just insulin/testing concerns I should ask/go in armed with when I speak with her Saturday? Any specific insulin that's preferred? I'm getting the initial kit from her but plan on buying the rest online. Any suggestions, tips, links, anything are greatly appreciated.

 

Welcome.
Good insulin are the human Lantus and Levemir and the pet insulins ProZinc and BCP PZI. For those two human insulin it is best to get the 5 pack of 3 ml disposable pens via a 10 ml vial. Although per ml the vial is less expensive most cats will not use up a 10 ml vial before the insulin goes bad/becomes ineffective. The human insulin N/NPH is sometimes prescribed but only lasts 8-10 hours. Same for the pet insulin Vetsulin/Caninisulin.
Most of us here test our cats blood glucose at home using a human meter. We test before each shot and periodically between shots. We record our reading and other info in a spreadsheet. See:http://www.felinediabetes.com/FDMB/...te-a-ss-and-link-it-in-your-signature.130337/
Testing urine multiple times a day is not really possible and urine testing only shows an average over time and you can't compare the numerical values of urine and blood tests. For urine yu always want some glucose testing since yu cant tell how low it will go.

A low-carb canned is best contrary to what you vet says. No reason for a prescription food. Here is a list of commercial low-carb cannedhttp://www.felinediabetes.com/FDMB/threads/shortcut-shopping-list-all-8-or-less-updated.117688/

Here is a link to home testing blood sugarshttp://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/

 

Thank you so much, Larry. I'm not putting my cat on prescription food and do believe he'll go into remission (he actually looks pretty healthy, is no longer drinking a lot/peeing a lot and I can already see the effect of the canned low-carb food for him).

Thanks for all the links.

Question: my vet said I should only feed him twice a day and give him the insulin after he eats. Can I feed him 4 times a day (same amount of food, just broken into 4 timeslots). He's been a grazer all his life, mostly eats at around 2-3am and is doing that with the wet food. Any suggestions/links you can forward regarding that?

Again, many many thanks for all of this.

 

Diet definately makes a difference! My cat's BG dropped about 200 points after removing all dry from his diet (and that was DM dry). That drop was over three days. It went down another 30 points or so after that over the next few weeks. I think this may be more than usual but it does show that diet is important.

When Billy was diagnosed, I bought a human bg meter and tested before and during the diet change. That's how I knew he was headed in the right direction.

 

Hi there and welcome. The best place you never wanted to be. Glad you have been doing your homework and investigated all ready the importance of feline nutrition. Many of us feed our cats Fancy Feast Classics, 9-Lives Pates, and Wellness NO GRAIN. Any wet food under 10 % carbs. Here is a food chart for you to look at. Carbs are in the 3rd column from the left.
foodchart

Also, home testing very important. It is very important to understand how your kitty is reacting to the insulin and the dose. You will want to test before each shot and some additional test in between the 12 hour cycle. Another reason to home test is to keep your kitty safe. Find a place in your home where you will always perform the test and give lots of hugs before and after testing. There are many videos showing you how to test. Here is a picture of where you test on your kitty. http://s106.photobucket.com/user/chupie_2006/media/testingear/sweetspot.jpg.html

Here is another good link on Home Testing:http://www.felinediabetes.com/bg-home-test.htm

Once you learn to test you can do your own curves on him at home to save money and to get more accurate numbers as their numbers are quite elevated at the vets due to stress.

There are many meters. There is a pet meter called the Alpha Trak2 and human meters. Some use the pet meter because it is what the vets use so the numbers will match up. The meter and strips are expensive though. Most use human meters that can be purchased at any pharmacy. It typically reads a little lower than the pet meter but we have ways of compensating it. Many use Walmart's brand, Relion Micro or Relion Prime, because it only needs a tiny drop of blood. The Prime testing strips are ½ the price of the Micro.

Lancets: These are used to poke the ear to get blood. There are many different sizes (gauges). It is recommended when you are first starting out to use a 26-28 gauge. Also, it would be a good idea to pick up Neosporin WITH pain reliever to apply on the edge of the ears and don't forget to alternate ears.

About the food and feeding. Many of us feed several smaller meal a day and some feed 2 times a day. Do what is best for your cat and especially since Lamont is a grazer you will probably want to do the 3-4 times a day feeding. Just make sure that once you start testing that you don't feed within 2 hours of the test. So time it so that the test won't be food influenced. It is great that you are starting the change of food to low carbs now. This can really help influence the Blood Glucose (BG) and help you keep him safe. As a new diabetic, you don't want to shoot anything under 20

This will get you started and if you have any questions please ask, that is how we all learn. Let us know once your vet starts the insulin and what kind it is so we can help with the dosing.

 

Thank you thank you thank you!!! For all this info and sharing. It's invaluable.
A few questions:

1) Typically how long after feeding should I give an insulin shot?
2) Do I need to monitor how much insulin is given? If so, what's that based on and how do I figure out how much to give?
3) Since it's best to test at least 2 hours before the test, would be it be safe to assume that I should test before feeding--since I'm planning on doing probably 3 times a day feedings?
4) If I feed 3-4 times a day, will it influence his insulin shot? Say, if I give him breakfast/insulin at 9am and 9pm and also give him lunch at 1pm with no insulin (all equal amounts of food--say 1/3 of a can of Wellness)?
5)If I buy the human meter, say the Relion Micro or Prime and I go to the vet, is there a conversion chart so she'll know what his numbers are?
6) Typically how many times a day do people test? Is twice enough? And he's symptomatic, more?
7) Does anyone on his forum test urine?
and finally 8) Is it important to always give him the exact amount of food? If I give him a can of Wellness a day, can I add a little Weruva on top (say a 1/2 an ounce for extra flavor) for one the meals?

Thank you so much for all this. This is a scary journey but feels a lot better knowing this world of support is there!

 

I suspect I might have a similar result with Lamont--he *seems* better--his affect, he's not drinking more/peeing more/more active since he stopped eating dry. And it's only been a few days. I'm hoping anyway....

 

I hope so! Even if his bg doesn't go down as much, a wet diet is better for cats, more moisture and more/better quality protein. Also cats tend to run higher at the vet due to stress. It all adds up.

 

Thanks.

 

Depends on the type of insulin...if it's one of the good ones for cats, like Lantus, Levemir, ProZinc or BCP PZI, usually what we do is Test/Feed/Shoot all within about 5-10 minutes. If it's one of the harsher insulins, like Caninsulin/Vetsulin, it's more important that there's food on board before shooting, so you'd test/feed...and wait about 30 minutes to shoot

Your vet will probably give you a "starting dose" ....my recommendation is when you find out what insulin you're using, you ask here for what dose you should start with. Most vets start them out at too high a dose!

What we suggest is that you take all the food up 2 hours before shot times....so that when you do the "pre-shot" tests, there's no food influencing the numbers

Most cats do better with small meals instead of 2 big ones...but what we do suggest is that you try to get all the food in before nadir (the point where the blood glucose is the lowest) because after that, the insulin is wearing off and you don't want to add carbs as the insulin is wearing off too. However, every cat is different...some can be fed small meals all the way up to +10 (10 hours after the shot) but most do better if they get all their food before nadir (about +6). As you test and get more data on Lamont, you'll learn how he reacts to food and when it's going to be OK to feed

Not really but the protocols we use here on this message board are all based on human meters...and the pet meters are VERY expensive to use (the strips are about $1 EACH) so unless your vet is willing to provide you with free strips, we'd really suggest going with what you can afford! The best meter in the world is no good to you if you can't afford to test as much as you need to to keep your cat safe!

We'd like to see at least 4 tests per day...but a lot of us test more often. ALWAYS test before shooting to make sure they're high enough to have any insulin...and then if at all possible, a "mid-cycle" test (around +5 to +7) on the AM cycle and a "before bed" test on the PM cycle...of course if he drops below 50 (on a human meter) you're going to need to test more often

Mostly we all test blood glucose...Urine strips can only tell you if there's glucose getting past the kidneys and into the urine, not what his current blood glucose is. There are urine ketone tests strips a lot of us use to test for urinary ketones (very dangerous and hard to treat if they have ketones)

You want to try to be as consistent as possible, but if you want to add a little Weruva on top, just reduce the Wellness a little!

 

The answer to #1 will depend on what type of insulin he gets put on. If it is ProZinc, Lantus or Levemir, you will test, make sure it is safe to shoot feed and then immediately give the insulin. If it is Vetsulin / Caninsulin / Humulin N you will need to test, and the feed 30 -60 minutes before you shoot the insulin because food needs to be on board prior for those insulins. I am going to tag @Squalliesmom as she can tell you exactly the time frame for those insulins.
#2. Hopefully your vet won't start you on any more than .50 to 1 unit of insulin to start. You will hold that dose for at least one week unless you get a number too low ( anything under 200) then the insulin would need to be decreased. Once you know which insulin, post again and we will get you in the correct forum for guidance on dosing.
#3 Yes test before feeding you morning and evening meals that are spaced out 12 hours apart because those are the times that you are going to shoot insulin. As far as testing before the other meals, you don't have too but it could be the times you will get some more test in. We all gather our BG data on a spreadsheet and we can get you hooked up for that. I didn't mention it before because I gave you so much to take in I didn't want to overwhelm you. But here is the instructions for setting it up and if you have trouble yell and someone will help you. Look at mine in my signature and I will also give you an explanation of how it works so you can start looking it over. Don't get overwhelmed, it's pretty easy once you understand it. If you look you will see how many times I test which is often as I am trying to get him regulated and just started on a new insulin.
#5 Yes there is a difference is the vet animal meter and the human meter Take it with you to the vet and get a sample of blood using both meter on the same sample to see the difference. The important thing is that the human meter will keep your kitty safe from a hypo event. Low is low on both meters and high is high. The meter will help show you trends and keep Lamont safe.
#7 yes many of us test urine with drugstore ketone strips or you can invest in a meter, the strips are expensive but it is very accurate and will show ketones befoee the urine will.

HOW TO CREATE A SPREADSHEET
It helps us to identify the patterns we're looking for when making suggestions on dose increases. Here's some instructions on
How to create our spreadsheet

SPREAD SHEET EXPLANATION

On the spreadsheet... It's really not hard!

AMPS is the AM Pre-shot test (always test before shooting to make sure they're high enough to give insulin)...then the U column is for "Units" (how much you gave)

The +1, +2, +3, etc are for how many hours since shooting...so +2 is 2 hours after the AM shot, +9 is 9 hour after, etc.....Since we're all over the world here, saying "he was at 148 at 8pm" doesn't tell us anything...we need to know how long since his last shot

At the end of a 12 hour cycle, it's PMPS time! (PM Pre-shot) and the whole thing starts over

 

Cross post @Chris & China

 

Gee, thank you SO MUCH for all of this advice! And yes, I'm figuring I'm going to need a lot of hand-holding as this starts because I'm petrified of screwing up. A few more questions:

1) Based on what you said about feeding/nadir--If I say, test/feed/shoot at 9am, feed again at 2pm and test feed shoot at 9pm --at least at the beginning--til I gauge his reaction, I should be good?
2) What happens if I go out and am not home til 10pm one day. Is it harmful to start an hour later and if I do, should I still do the 9am test/shoot/feed?
3) What happens if I test and his number isn't high enough to get insulin? How will I know what that number is, especially if I'm using a human meter?


Thank you again for all of this! It's literally a life-saver.

 

Thank you so much for all of this! Yes, it *is* overwhelming.

Since he'll be starting all of this (probably) Sunday or Monday, should I take his food away tonight after nine? Or not feed him til 9pm? He normally eats a tiny amount at "dinnertime" --usually 7pm--and then munches out around 2-3am and finishes his food during the night. I don't want to give him too little food. How do I get him to eat everything at 9pm?

Thanks again everybody, for holding my hand through this. (will be reading the spreadsheet info later when I can absorb it all...)

 

We have all been there after our sugar cats got their DX. To answer you questions about feeding, when Chris said to keep the food prior to the nadir (the lowest point in the cycle usually about +6 hours after the insulin. There are two 12 hour cycles in a day, so there will be 2 nadirs. So there is plenty of times to keep his food our. You just want him to have not eaten any closer than 2 hours to the test time. So if you are going to give dinner at 7pm, no food after 5 pm so that the 7pm test is not influenced with food. It takes a little scheduling in the beginning. After you have you shoot times you can design the rest around that.

It will get easier and it will become second nature for you.

 

Also, I'm currently buying the Relion Gauge from Walmarts and am buying an extra box of strips and some lancets (28 gauge). Does the brand of lancet matter? Any recommendations?

Thanks again everyone!

 

Get the Relion Confirm or Micro meter...they take the smallest sample size. The Prime meter has cheaper strips, but some people get a lot of error messages with the Prime and it takes a larger sample size.

Brand of lancets doesn't matter....Look for the Relion "Alternate Site test" lancets...they're usually 25-28 gauge....the lancets that come with the little "device" are usually 31-33 gauge....and are too tiny for "new" ears....the lower the number, the better for now.

 

It's always best to space your shots every 12 hours. Sometimes life does get in the way and shots get delayed, not ideal but it happens. If you are late with a shot, the next one will be delayed as well. There are ways to get back on schedule with insulin like ProZinc and we can tell you how should you need to adjust the shot times.

As a new diabetic, your no shot number will be 200 or below. That number is designed for a human meter as are our Spread Sheets.

 

Thank you so much!

 

Thank you!!

 

Yes....that's a good schedule to start with

It's best to always keep the shots 12 hours apart....if you KNOW you're going to have a night you're going to be home late, you can adjust the shot times 15 minutes per cycle for a few days before so when you get home at 10, you're still shooting as close to 12 hours apart as possible.

To start with, if you get a number under 200, you should Stall, don't feed and post for help....the first few times someone shoots a lower number, we like to make sure someone with experience is watching over you...eventually that "no shot" number comes down

 

A thought here. If you decide on human meter, can you get one now? Then you can get a few practice tests in before insulin starts and develop Lamonts test area and start getting him use to it.

 

Woodsywife--that's exactly what I'm planning/hoping to do. Unfortunately, there isn't a Walmart near me so I'm hoping to buy one tonight online and hopefully it'll get shipped here before.

 

I hope you get it also.

 

Another total newbie question: Do I use one strip per test? (trying to figure out if I should buy a few 50 ct boxes of the confirm/micro strips--they're out of the 100 ct)

 

Yes only use a test strip once. Get the 100's you can easily use 4-6 /day. You never want to be out of them in the event of a hypo when you'd test much more.

 

I just ordered it and, unfortunately, delivery date is next Tuesday....I really hate to have to start insulin without it. Geez. My cat seems fine. Do you think it's going to make a huge difference if I start insulin a few days later? I want to make sure he's getting tested before I inject him.

 

You could get something other than a walmart meter. I think the Target up and up has been suggested here before. If you have a target near you it is inexpensive and might make a good backup in case you run out of strips for the one you just ordered. Or if you have another pharmacy near you you could see what they have. Try a search on here for meters to see what other meters people use.

 

It's impossible to know if he will be safe without testing. I would not be comfortable with shooting without testing. It's your call. Ask your vet if you could borrow a tester and some test strips. Or do you have a Target near by? There are those that use a meter from Target. Not sure of the name. There Billysmom gave you the name!

 

I just ordered the Walmart one. Do you think I should cancel it? I just found this one the FreeStyle which is in stock downstairs from me. http://www.walgreens.com/store/c/fr...cose-monitoring-system/ID=prod3423400-product

 

The freestyle lite is a good product, takes a very little blood. The strips are a lot more than the Relion strips though which is a consideration. If you can swing it, its nice to have a back up one. Then if you run out of Relion strips and they can't get sent to you fast enough you could use your Freestyle.

 

It's always good to have a back up meter anyway!! The darn things seem to know when it's most inconvenient and that's when their batteries die or they decide to stop working for some reason (or you drop it and it goes into 1000 pieces)

 

Thanks Chris & China and Bobbie & Bubba! I think the best plan is to get the second one as a backup meter and experiment with it --on me and him and get him used to it. I don't want him freaking out when I do it, which will make him not eat.

 

Hi , Lamont's Mom, and welcome to FDMB! (@Bubba and Bobbie, I'm late to the party, as usual, lol!) Yes, my kitty is on Vetsulin and I will be glad to help you if I can, if that's the insulin your vet gives you for Lamont, just sing out, anytime!

 

Thank you so much Squaliesmom! I'm meeting with the vet on Saturday so won't know til then. I'm currently worried about the food--waited til 9pm to feed him and he did his usual dinner-time thing: ate a tiny bit and left (back in the old days, i.e., last week--he used to just eat the Greenies on his dinner bowl, then eat the rest of it at around 2-3am). I'm trying to figure out how to get him to eat so he'll be eating when I give him the insulin. I know it will work itself out but... I feel like my world has been turned upside down with this! Really grateful you guys are out there with all this incredible support/advice. Thanks again!

 

If you end up on Lantus, Levemir or ProZinc, it's not as important that they eat right away, so if he's a grazer, it'll be fine!! We do like to see that they're eating fairly "normally" before shooting, but if you know Lamont well and know how he usually eats, he'll be fine!

With the harsher insulins like Vetsulin, it's a lot more important that they have food on board before it "hits" because it can hit hard and fast....the other insulins are gentler so it's not so important

Since you have a few days before starting insulin, now's the time to start getting him used to the idea of testing!

Here's something I wrote up for others for testing...maybe it'll help you too!

It can be really helpful to establish a routine with testing. Pick one spot that you want your "testing spot" to be (I like the kitchen counter because it's got good light and it's at a good height....it also already blocked 2 escape routes due to the wall and the backsplash) It can be anywhere though...a rug on the floor, a table, a particular spot on the couch...wherever is good for you. Take him there as many times a day as you can and just give his ears a quick rub and then he gets a yummy (low carb) treat. Most cats aren't objecting so much with the poking..it's the fooling with their ears they don't like, but once they're desensitized to it and learn to associate a certain place with the treats, they usually start to come when they're called! Or even when they hear us opening the test kit!

You also have to remember...you're not poking him to hurt him...you're testing him to keep him safe and understand what's going on inside his body. There's just nothing better than truly understanding what's going on inside your kitty's body and with this disease, the more knowledge you have, the more power you have against it. The edges of the ears have very few pain receptors, so it really doesn't hurt them. Also, if you're nervous and tense, it's going to make your kitty nervous and tense too. As silly as it might seem, try singing! It forces you to use a different part of your brain!

It's also important to make sure his ear is warm. A small sock filled with a little rice and microwaved or a small pill bottle filled with warm water (check temp against your wrist like you would a baby bottle) works well

Finding the right "treat" will be a great help too! Freeze dried chicken, bonito flakes, little pieces of baked chicken...whatever low carb treat you can find that he really enjoys will help him to associate the testing with the treat! China's Achilles heel was baked chicken, so I'd bake a piece, chop it into bite sized pieces, put some in the refrigerator and freeze the rest to use as needed. It didn't take long for her to come any time I picked up the meter!

 

Thank you so much for this Chris & China! I'm definitely buying the B team meter tomorrow so I can start. I've already been playing with his ears, which, luckily, he loves. Tomorrow I'll buy some freeze-dried chicken as a snack and start experimenting with the actual testing tomorrow.

 

You are going to be a great sugar moma!

 

Thank you!! PS, I worked himself up into a frenzy last night thinking, ok, I'm gonna wait for a week or so to start the insulin to give his body time to get acclimated to the wet food and get adjusted to the home monitoring.

This morning, I saw he had gone back to drinking a lot so I said to myself, nope-I'm keeping my Saturday vet appointment and, probably starting the home monitoring today.

I've also decided to get the store brand home monitor for the "b team" monitor-it's less about the actual number and about me (and him) getting comfortable with the process til the Relion arrives in a few days. It's a lot cheaper than the Freestyle lite and comes with 10 strips and 10 lancelets.
Thanks again you guys for bring there!

 

Good call to start ASAP. It's a learning curve and something that takes a while to get comfortable with. It will happen.

 

Thanks!

 

The lancets that usually come with human meters (31-33g) are thinner than what is recommended here for kitties. So if you have a problem getting blood you could try two pokes next to each other or get larger lancets (26-28g). I used the thin ones from the beginning and made them work so it may not be a problem for you. But if you have problems just wanted you to know not to get too frustrated. Lancets are cheap . I liked freehanding it. Some people like using the lancing device.

 

Actually, about to head out to get my "kit": monitoring device, Karo, extra wet food, freeze dried chicken for treats.
Will probably do my first home testing attempt later and will post.
Thanks again!

 

You've got this!!

 

I hate the amount of bad info out there among the vets. It's crazy. I spoke with ,many different vets and got many different opinions on insulin, on feeding, on diet - you name it.
All of them EXCEPT ONE said that the prescription food is necessary. Not only is it not necessary, but for my cat it made her WORSE. She dropped about 150 points with the change to canned food alone from when I adopted her, but the vet insisted on Hills DM dry food. I tried it. Within 24 hours her glucose shot up over 100 points. I fed it to her for a couple days and within one day of stopping the Hills it went back down. I had absolute proof that it was NOT good for my cat. Cats are not designed for a high carb diet. Good luck. It'll all work out!

 

Thanks smiley747. I feel the prescription diets are probably terrible--and I have no experience with them. Just looking at the ingredients is enough. After everything I've read, I think prescription dry food for a diabetic cat is an insane move. Last night I even read a paper on Hills site and THEY said there's a much better result with wet food.

I ended up choosing Wellness as his main food--the no grain chicken, because it has 4 % carbs, relatively low (for this type of food protein--at 30% ) and low phosphorous, which is good for his kidneys. I suspect a lot of vets get incentives from big companies like Hills or Purina to sell their products (just like doctors do from big pharma).

 

That's where the nutritional studies come from; the RX food companies come in and feed the vets their million dollar research which is BS.

 

@LamontsMom You've gotten a lot of great advice already, but I just wanted to second what everyone else is telling you. Diet, insulin choice, and home testing absolutely makes a huge difference in treatment! It usually means the difference between remission and a chronically ill cat that has poorly managed diabetes. If you need to bring your vet on board with your treatment, here's some stuff you can print out and bring in, and ask why her opinion is contrary to the currently recommended treatment for cats. It's possible that she hasn't seen the latest recommendations (despite them being out for 5 or more years). Or you find a new vet who is on board with your treatment choices and more up to date with treatment. I think what it usually comes down to is how receptive your vet is to new information. If she reads the guidelines and modifies her opinions on things, then you might want to stick with her. If she reads them and still insists on other treatment recommendations--well, the health of your cat isn't worth her ego, and it may be time to move on.

American Animal Hospital Assocation Diabetes Managment Guidelines: see pages 217-218 on diet. (bolded emphasis mine)

And

See also the attached file to share with your vet (outlines dosing and treatment more specifically).

 

Thanks, Julia & Bandit! This is really helpful and I suspect she'll be on board with it. If she's not (re: the home monitoring, I will thank her for her help and find another vet. I already have another recommendation waiting in line.... )

 

My thoughts on prescription diets (at risk of creating an echo chamber here!) is that the large majority of the time, there is a cheaper and better suited alternative if you look at the nutritional requirements and guidelines for the the condition you're looking to accommodate (e.g. diabetes, CKD, food intolerances/allergies, UT disease, etc.). I would say the only exceptions are the recovery formulas when (temporarily) necessary (Hills A/D, Purina CN) and the kidney diets (K/D NF) conditionally in late/end stage CKD. The only prescription diet that is even suitable for a diabetic cat is Purina DM--all of the others are too high in carbs. And even though it's a good food to feed, since it's pretty much the same thing as Fancy Feast, it's way overpriced.

Bandit used to be obese, back when he was about 5-6 years old. That's what happened from free feeding him Purina dry food. Our vet at the time was one of the creators of Hills Science Diet, so I thought we were consulting with an expert on feline nutrition. He put Bandit on Hills W/D dry, and boy did Bandit lose weight, all right--it caused a severe case of triaditis and subsequent diabetes diagnosis the following year. That's when I finally did research on feline nutrition on my own, and realized what I had been told by my vets all along about feline nutrition was not correct in the least.

I also made the mistake of feeding Purina NF to one of my cats when she was diagnosed with early stage CKD (it was called the unnecessarily scary "Chronic Renal Failure" at the time, and despite my experience with Bandit, the vet talked me into it). Boy, was that a huge mistake. She hated the food so it became a chore just to get her to eat at every meal, she lost a lot of weight and the low protein caused muscle wasting where she barely wanted to move. Based on the vet's feedback, I thought that this was the kidney disease progressing, but all her bloodwork was holding steady. I found some studies online that talked about the low protein/low phosphorus debate and decided to try changing her diet. So I switched her to a low phosphorus commercial diet instead, and her health dramatically improved. Her CKD never progressed past stage 1, and she was on the low phosphorus diet for 2 years before she passed away from stomach cancer.

 

First, Julia, I'm so sorry for your loss. And that you had to go through all of that. It's reprehensible on the part of the vets (and food companies).

I already started Lamont on Wellness No Grain Chicken, he likes it, it's 4% carbs and low in phosphorous.

So, another question: I just found another vet who, based on the receptionist (and a recommendation) feel would probably be a better fit for Lamont. He makes house calls (!!), believes in administering the fructomine test before starting insulin and most of his patients do home monitoring. He uses Pro Z as the insulin. With the current vet I have, they couldn't tell me the type of insulin (at least the receptionist couldn't) and I feel like I might be in for an argument about the home monitoring.

Should I keep the Saturday appointment, just so I can start Lamont on insulin and then continue with the next guy for everything else? Including the 1 week follow-up? Or should I switch now? I feel it's important to start Lamont on insulin asap.

 

What tests did your current vet perform to diagnose his diabetes? Was it just a blood test, or a blood test an urine test? If he is spilling glucose into his urine, and tests high at home, then it is safe to say he's diabetic and you don't need to spend money on a fructosamine. A Fructosamine gives you an average BG over the last several weeks, and can be used for diagnosis but is not necessary if you confirm the diagnosis with a urinalysis and home testing, which you plan to do anyway. After diagnosis, there is no point in doing a fructosamine if you're home testing frequently enough (at least 3x daily).

Prozinc is not a bad insulin for cats (unlike Vetsulin or Novolin), but Lantus and Levemir have better remission rates (this information is in the second study I attached in my earlier post). Prozinc is good for people who need more flexibilty with their dosing schedule, but if you can shoot regularly every 12 hours, I would strongly recommend Lantus or Levemir, as you'll have the best chance of remission with those. There is a window of remission, and the sooner you start recommended treatment (low carb canned food, lantus or levemir, and dosing based off home tests), the better your odds of reaching remission. If you end up with a script from your vet for Lantus (glargine), you can save a lot of money on it by ordering from an online Canadian pharmacy.

The fact that he encourages home monitoring is GREAT though. Bandit has seen 4 different vet practices since his diabetes diagnosis, and only his current vet has agreed with the treatment guidelines here 100%. The first one had all the right diet (low carb, canned commerical food), and insulin (Lantus) recommendations, and strongly encouraged home testing (I was told that my cat would not get better unless I learned to home test, and they even had a resident cat in the office that they used to show me how to do it and that cats accept it just fine). But she was WAY off in her dosing recommendations (she was having me give insulin once a day, and raising the dose in 1u increments). And then after the argument I got into with her about the dosing protocol (she insisted that she was correct because her two diabetic DOGS were doing great on her dosing protocol) and about Gabby and the Purina NF, I decided to find a vet that was a little easier to work with. The practice I chose didn't strongly enourage home testing, and they prescribed Prozinc and prescription diets, but they were willing to read the information I brought them and try out the new treatment guidelines with Bandit (which, to give them a bit of credit, were still very new back in 2009). Since then, they've changed all their treatment guidelines for their other cats based on their experience with me and Bandit, so I now strongly recommend them to other people in town, and my younger cat still goes to their practice. Bandit's former emergency vet hospital was a nightmare to deal with in regards to his diabetes--they weren't recommending any home testing, and they even called my regular vet practice to tell them that they thought my cat was in danger because I wouldn't start him immediately on insulin (he was in remission, and the only reason why he tested high at the hospital was stress, which is why we home test!) or feed him the dry prescription food despite his diabetes having nothing to do with why he was at the hospital (he had an accident with his tail and needed an amputation, and they happened to have one of the best surgeons in the country on call when it happened). Luckily, Bandit's regular vet was able to tell them that we had the diabetes under control, and it would be very nice if they could just focus on Bandit's tail.

When I had to switch Bandit's vet again in March because of a very serious illness his regular vet couldn't diagnose or treat (myelofibrosis), we took him to Cornell. I went in there expecting to fight with the vet once again about something with his diabetes, and he was on board with the right diabetes treatment recommendations 100% from the start, and even was able to give me advice with is dosing in areas that I didn't know about (like making dose adjustments while weaning off steroids)! It's been an absolute pleasure working with him with Bandit, and he is definitely the reason why Bandit is alive and doing so well today.

Anyway, my point is this--it's not likely you're going to find any vet that gets everything right and is perfect. It took me four vet practices and having to go to an internal medicine specialist at Cornell to find someone that got everything right. What's most important is to find someone who will work well with you, be receptive to new treatments if you have the evidence to back them up, and most importantly, has your cat's best interests in mind over everything else. So if your current vet is willing to give you what you need (a script for Lantus or Levemir and syringes (u100, 3/10cc, 8mm with 1/2 unit markings), and work with you using recommended dosing guidelines based on home testing, then you might want to keep her for now and find another vet down the road if she gives you trouble later on. If she won't give you what you need, switch to a vet who will.

 

The vet did a regular blood test that included glucose and a urine test (she said could only do one urine test --not sure if it was the urine analysis cause, frankly, it's been a lot of info to digest--because he acts out at the vet and she just got urine cause he peed out of nervousness.) I don't know what the urine showed. She then did the fructosamine.

Re: the flexibility and ProZinc: I can feed him every 12 hours nearly all of the time, but having flexibility would be a help to me (I live alone with Lamont). Also, he's a grazer and I suspect it's gonna be a long time before I can get him to eat enough to get an insulin inject in the evening. Right now, he only eats a full bowl of food (which is about a 1/4 of a 5.5 ounce can) in the morning and super late at night--like 2am or 3am. At lunchtime, he eats about a 1/6 of the bowl, same with "dinner"--which would be when he gets the 2nd shot.

That said, I want to give him the best chance for remission. He's 15. I hope it's realistic that he has a chance at remission.

I love the fact that the new guy encourages home monitoring and also like that he makes home visits which might be easier for Lamont.

What I didn't like about the current vet is she poo-poo'd home monitoring (except with home urine testing). When I told her I didn't feel comfortable just giving him insulin without knowing what his numbers were, she said it wouldn't be a problem and if he became hypoglycemic I could "tell" by his behavior and I just call the office (which seems NUTS to me. NUTS!!!!!)

So my thinking right now is, if she's willing to change her opinion about home testing, then I might stick with her, but right now, I'm thinking I'll start with her and go to the new guy for the 1 week follow-up and continue with him. He wasn't in the office today, but I might call him tomorrow to ask some of these questions, including the insulin questions--which is better for him, ProZinc, Lantus or Levemir based on his behavior, glucose, etc.)

Again, thank you SO much for all of this information. It's overwhelming but I am starting to feel like I'm getting a better understanding of things.

Next step (tomorrow afternoon: start the home testing, gulp!)

 

Well, a fructosamine does it, then! You don't need the new vet to do a second fructosamine if you already have the diagnosis from the first.

Yikes, yes, that is NUTS. Cats don't typically show symptoms of hypoglycemia until it's reached the point of being life threatening, which is why home testing is so important. It's also nearly impossible to determine the correct dose without daily testing. That's also stated in the AAHA document I linked up above, if you bring it in to her.

You need to choose the insulin that is right for you and Lamont. Lantus and Levemir have better remission rates, and if you can be home usually every 12 hours, they can still work for you if you have rare days when you can't. If you know of the change in schedule ahead of time, you can plan for it by moving the shot time up & down in 15 minutes increments. There are people here that had to shoot Lantus and Levemire off a 12 hour schedule and still was able to make it work. Or, if you feel more comfortable going with the new vet starting with Prozinc, you could always start and switch insulins after a month or two if it's not working well for Lamont. It might slow you down a bit, but I don't think it would impede things too much as long as you don't wait more than a few months to change to Lantus and Levemir if it's not working. So I guess what I'm saying is, I recommend the other two to start if you can manage it, but Prozinc is not a bad choice if you do need the flexibility and some people do have success with it.

 

Regarding your concerns about feeding...with the better insulins, it's not so important that they eat a significant amount before getting their insulin. If he's a grazer, as long as he's eating fairly normally at shot time, it should be fine

We worry when they are refusing to eat, or can't hold food down at all..... or throw up immediately after eating (although that can be "scarf and barfing" and the cure for that is to feed them slower)

 

Thank you Julia & Bandit and Chris & China!!

I feel the first vet is kind of intractable. I'm not crazy about her just prescribing a med without discussing it's merits with me (I was a caregiver for 10 years for both of my parents who were ill and I learned the hard way that you HAVE to be on top of everything, especially meds.)

I put in a call to the current vet today (she wasn't in the office) to find out what insulin she was choosing.

Do you think I should call up the 2nd guy, say the fructosamine was already done a few days ago (which it was--from blood from last Wednesday) but discuss Lantus with him and if he's willing to start Lamont on Lantus and give me an appointment to start, just go there on Monday and start him with the new guy? If would mean delaying his insulin for one or two more days (I would start insulin on Sunday with the current vet and hopefully Monday night or Tuesday with the new one--unless I can see him on Saturday as well.)

Or is it better to just start with whatever med the current vet gives and then just switch when I start with the new guy? Can I switch insulin after a week?

 

First...insulin isn't cheap, so if you can get either vet #1 to prescribe Lantus or convince vet#2 to use it instead of ProZinc, you're better off. Lantus (if you buy it in the US) is around $250 for a 10ml vial (1000 units) or around $450 for a box of 5 3ml pens (1500 total units) ProZinc runs about the same when you figure that a 10ml bottle is around $90 (but only holds 400 units)

Most of us are buying our Lantus from Canada due to the crazy prices here in the US....the last post in the "Insulin from Canadian Pharmacies" has the information about where we're buying it. Unfortunately, it will take about a week to get it

ProZinc can only be bought from your vet or a veterinary pharmacy

You wouldn't want to switch after just a week....it can take several months (no matter which insulin) before you'll really be able to tell how well it's working for Lamont.

A few days more without insulin isn't usually something to worry about....as long as Lamont has no history of ketones. A lot of times we'll suggest that people take a few days to a week transitioning their cat onto low carb food first before starting on insulin (If they have no history of ketones!)

 

Lamont started low carb Monday-ish (a mix of wet & dry Monday and Tuesday, since yesterday all wet). He's still drinking more than usual but not excessively. Thinner, but not super skinny and his affect is fine (and his fur is MUCH softer than it was a couple of days ago and looks better).
I'm going to call the first vet again (I know they think I'm a pain in the butt but hey, it's my cat) and find out about Lantus (I already mentioned ProZinc to her receptionist--I'll call in the morning and tell her that I meant Lantus. And see. I can also call the second vet and see if he's open to Lantus. After reading the attaching and doing some googling, Lantus DEFINITELY seems the way to go.
Re: the ketones. I have no idea if his urine showed ketones. Should I buy the urine strips and test it myself here? Then, depending on the insulin choice and home monitoring, I'll be able to make a good decision.

Again, THANK YOU! It's a relief to know I have a good choice of insulin that (hopefully) will bring good results.

 

Testing for ketones is always a good idea....they're much easier to deal with if caught early...and just knowing he's not throwing ketones will be a relief ...especially if you want to wait a little while to start insulin (or have to wait for shipping if you buy from Canada)

Here are some Urine Testing Tips for you to try!!

 

Thank you! How often do you have to test for Ketones if you're also monitoring the blood?

 

In a perfect world, once a day....but as we all know, it's not always a perfect world!...and a lot of it depends on the cat and how secretive they are about their litter box habits!

Once you're actually on insulin, it's still a good idea, but then we generally worry more about the high numbers....it'll depend a lot on how Lamont responds

 

I'm going to go out any buy aquarium gravel tomorrow and the strips and a collection device. You know, the more I think about it, my gut is just telling me to start Lamont on insulin by Sunday, Monday at the latest and I really want him on Lantus. I still will do the ketone testing, but I can see he's under the weather and I'm not comfortable with it. I REALLY hope this initial vet complies and gets the Lantus. I'm not up for a debate with someone. If she does, I'm just going to find someone who will write me a prescription, I'll pay the money for a starter kit and least get him on his way.

Thanks again, Chris & China!

 

You might start calling around now and see if you can find a pharmacy that will break open a box of pens and sell you just one (it's almost impossible to find one, but you might get lucky!)

We've seen Target stores be ones that tend to be willing to do it more than a lot of others, but it varies from store to store. Also hospital pharmacies and pharmacies that deal with nursing homes are other possibilities....or you might just get lucky and whatever place you call first agrees to do it!

If you can find one, you'll need one script for just 1 pen....and if you want to save the money by buying from Canada, get another script for a box of 5 Lantus Solostar pens to send to Marks

One pen is enough to last most cats several months

If you get the pens, don't listen if they tell you that you have to use the special needles that are designed to come with them. We use plain insulin syringes and draw the insulin out of the pen instead of using the "special" needles

 

So should I ask the pharmacy if I can get one Lantus Solostar pen? If they'll break open a box of 5 to sell me? I live in NYC. Hopefully, I'll find one. My vet did say she was ordering an insulin "starter kit". If it's not for Lantus, I don't want it. What type of syringes should I get? (I'm actually petrified of needles and have never given myself or anyone (!) a shot--don't even really know how to use a syringe.)

 

You'll want the vet to give you a script for 3/10 cc, 8 mm, 31g syringes with half unit markings. Walmart has them cheapest...about $14 for 100. The needles are so tiny on these...don't worry.

 

Here's what the Relion syringes look like...and if they try to tell you they don't come with half unit markings, they're wrong!

 

Thanks!! I just looked for Keto-Diastix and so far, everything is mail order, which sucks. I was hoping to walk in somewhere tomorrow and pick them up to test him.

 

Thank you!!!!

 

Walmart has these Ketone Test Strips ....they should be available at the stores but sometimes they don't carry them

Again, call around...diabetic supplies are everywhere these days....someone should have some in stock somewhere! You only need the ones that are for ketones (they make them that test for lots of other stuff too)

 

Thanks! I'll check (I was looking for Keto-Diastix--hopefully I'll have more luck with just Ketone Test Strips). There isn't a Walmart near me. I'm going to look online tonight to see if anything's in stock. If not, I'll order it online tonight.

 

Walgreens, or any pharmacy should have ketone test strips.

 

Found em! In a store that's only 6 blocks from my house. It's in CVS.

 

Hey Everybody--Again, thanks so much for your help.

I did find out from the original vet she uses Lantus, which is a good thing, she also uses the thin gauge needles (31), but vs a pen she thought the syringes and bottle were better and she's going to show me how to do it tomorrow. She's also going to walk me through the home testing (I told the receptionist if she didn't feel comfortable with me home testing, I would find another vet.)
And I did speak with my neighbor whose cat is diabetic and has been for years. She *doesn't* home test, but invited me over to show me how she shoots the insulin and that's right after the vet.
So tonight, I'm reading the manual for the glucometer and will practice on him tomorrow after the vet shows me how.
Also, this is day 4 of wet food and I see a big difference in his demeanor and coat. He's more alert, jumping higher, seems back to normal and his coat is shiny and feels silkier!

Will let you guys know how the vet meeting goes.

Thanks again.

 

Your vet probably just isn't familiar with the pens....the only difference (it's the EXACT same drug) is the pens come in 3ml sizes instead of the 10ml vial

With the vial, unless Lamont ends up being on a very high dose, you're going to end up throwing away at least half of it. Most cats end up somewhere between 1-2 units twice a day....the vials (if cared for properly) will only last about a MAX of 6 months.....on 1.5 unit twice a day, IF your vial lasts a full 6 months, you'll be throwing away about half...if it doesn't last the full 6 months, you'll throw away even more!

At about $280 for a 10ml vial, that's throwing away a lot of money! A 10ml vial holds 1000 units of insulin

The pens are just like "mini-vials" that hold 300 units each....and because you don't open each pen until you're ready to use it, all the pens will last until the expiration date on the box...usually at least 2 years away

Also...if you drop the vial, it's going to break (and take it from experience...they're easy to drop!)

Here's pictures to show your vet

 

Great news! Good to stick to your guns. Also, when the vet shows you how to test at the office, the number will be higher due to stress. You will get a lower number at home when kittie isn't stressed out.

 

Thank you SO much! I think she put in the prescription already, but she can always change it to the pen. She said she was concerned about dosing and "never heard of anyone using the pen with a cat". I will bring the print-out and say I definitely want the pen. I feel more comfortable that way anyway....

 

I am using the pen with lantus. Walmart Pharmacy will sell one pen for 84.70. Next time I need it, I will order from Mark's Marine Pharmacy from Canada, much cheaper!

 

I wish I lived near a Walmart. I'm going to demand the pen and buy the 5 pack here. It'll probably last a year or two. Then, buy from Mark's. I called every pharmacy in my area and none would break up the 5 pack.

 

PS: My vet said, "oh you don't want to use the pen, I understand they are awkward with the screw on needles". I told her I wouldn't be using a screw on needle that I would use the U100 syringes and draw from the pen. Just like the picture Chris sent to you. It taught her something new.

 

That's a bummer.

 

I know. I'll tell her about the pen/U100 syringes and she'll probably feel happier about it. (we were communicating via her receptionist).

 

How far away is a Walmart?

 

About 45 minutes to an hour. I'm ok with putting out the big amount of money initially, since it's going to last a long time. It's $365 for 5 pens in my neighborhood.

 

It might be worth the drive. Have her write it for one SoloStar pen 3 ml and the dosing, then order from Mark's next time.

 

I don't have a car right now---in NYC, mostly we use the subway, cabs or walk. I'd have to rent a car.

 

Well then it might be more trouble and just easier to get locally.

 

For sure... I'm resigned to knowing I'm just outlaying a lot of $$ right now. But to me, it's a matter of life and death for Lamont so I'll do it. At least the pens will last a long time. I don't know why they don't have a Walmart in NYC.

 

So, back from the vet. She didn't want to commit to pen. She couldn't understand what I was talking about even though I showed her the diagram, etc. She also felt it was crucial to only have him eat 2 times a day--no more. I pointed out that the AAHA guidelines say 4 times a day for diabetes and she didn't want that. She said she wants to "research" the lantus pen and start him on it on Tuesday. And suggested I get a second opinion. So I am going to the second vet--the one that just sees cats. I'm hoping it's a better experience. He uses ProZinc but they're open to doing Lantus. They said they find it's easier to use and has a better result. The vet's cat went into remission on it.

Lamont freaks out so much at the vet and part of it is dog who try to come up and smell him in his carrier. He's in a state of hysteria. The new vet will do housecalls, which, if need be is a good thing, I think.

When I go on Tuesday, any compelling reasons to say Lantus vs. ProZinc? After doing a little research, I like the flexibility with ProZinc (which also fits Lamont's personality better...) I've heard they have pretty much identical remission rates.

Again, thanks you guys for all of this!

 

Lantus can be less expensive than ProZinc

 

Just found out new vet charges $95 for ProZinc for a vial that lasts about 6 months (400 units per vial...) Which is actually cheaper than Lantus if I bought it locally (though not through Canada. I can handle that....

 

Perhaps you start a thread about Lantus vs Prozinc. There are people here who have used both.

 

That's a great idea! Thanks!