Newly diagnosed & unregulated

Hi everyone

I'm new here and would like to connect to receive some feedback and support during the process of stabilising my lovely older cat who has been diagnosed with diabetes. We live in an area where there is not a lot of experience with diabetic cats.... the vet is lovely but I need to make sure I'm as knowledgable as possible.

My cat Mousey is 14 and started on Caninsulin (3 units x 2/24hr) about three weeks ago. Her blood sugars were in the 700's according to the vet. They did a curve on her six days ago ( 9am-5pm) and increased her insulin to 4 units x 2 / day because her BSL stayed in the 23-27 range all day. She was really stressed at the vet, and so the plan is for me to home test her BSL (I have all the gear now and will start tomorrow..dreading that).

Urine / food

• I've got her on diabetic wet food and have just about weaned her off the dry diabetic food (I know its not good).
• Her urine output when she first started on insulin, initially decreased, as did her water intake, but then increased to pre-insulin quantities within two days.
• On 4 units of insulin, her water intake is still 3 1/2 cups in 24 hrs, but her urine has halved again.

My concerns are:

1. She appears to be developing diabetic neuropathy and has become a lot weaker in the past month, lying around, not able to sit up for very long and walking a bit more unusually.
2. Is she having a Somogyi effect? I know I'll be able to get more information after my home testing.
3. Is 4 units x 2 day a high dose? She weighs about 6.9 kg and losing slowly after being overweight previously.

Thank you for any thoughts, I feel a bit isolated in all this and am especially worried as we are travelling overseas for about three weeks in four months.

 

Welcome! Mousey is beautiful!

First, please do not remove the dry food until you are home testing. Removing the dry food can cause dramatic drops in blood glucose levels, and if you're not testing and lowering the dose (4u is not unusual for a cat eating dry food, but a very large dose for a cat eating canned food only), you may inadvertantly cause a potentially deadly hypoglycemic incident. You're right that the dry food isn't good, but you don't want to take it away until you can make sure she's safe with home testing!

Ok, so now for some questions for you! What canned food are you feeding? Some of the diabetic prescription foods are ok for diabetic cats, but some are actually still too high in carbs for diabetic cats. Where are you located? Caninsulin (Vetsulin in the States) is not a good insulin for cats, but I think that vets have to first prescribe it in some countries. Usually, if you do not see good results in 4-6 weeks, the vet will give you a script for a longer acting insulin like Lantus or Levemir if you ask. These insulins work much better in cats, and are less dangerous than the lente insulins.

1. There is a supplement you can give to help with neuropathy--it's called methyl B12 (there are two types of B12 supplements, so you want to make sure it's Methyl B12). Zobaline is a methyl B12 supplement made just for cats. If it's not available where you are, post to the board and people can give you suggestions on an over the counter supplement you can use. The neuropathy will improve once you're able to get better control over her blood glucose.
2. It's impossible to tell if she's having a Somogyi effect without daily home testing--rebound hyperglycemia can take up to 72 hours to clear. You really need daily tests to give you a good picture of how the insulin is working.
3. As I mentioned before, it's not an unusual dose if the cat is still on a high carb diet. Diet is very important and dramatically impacts blood glucose levels. Removing the dry food and feeding a low carb, canned diet only will very likely reduce her need for insulin. Once you post your location, people can give you some good suggestions for canned foods!

 

Oh, gosh, she's a cutie! What is the brand of diabetic canned food you are feeding her? Please make sure you keep the dry out for her until you do start home testing. My Woody was hypoing each time I gave an injection and if not for the dry food free feeding he would have died. (My vet told me to keep it out so he could have food to keep from dying) but the wonderful people on this board is who helped me see the connection and really helped to save both my precious babies.

The other info I really can't say until we can see the numbers. We really like seeing the numbers in our spreadsheet, directions here: http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/.

Testing isn't all that hard after the learning curve. Here is a link that gives some good pointers and directions for home testing: http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/. Why not start practicing today

And then here is the link for the hypo kit, in case your kitty goes hypo (68 on alpha track 2 and 50 on human meters) Hypo info

 

Thanks Julia and Mum of two kitties! Its lovely to hear back so quickly and to know I'm not doing this alone.

Pre-diagnosis I was feeling her dry Hill's Science Diet, mature food mixed with joint mobility (now I cringe).
Post diagnosis for 2 weeks: Hill's dry diabetic food (eek, but recommended by the vet..)

Now I know better and am getting on track: Royal Canin wet diabetic food. She'll only eat < 1/4 cup however, so have been topping up with the dry food once she's eaten as much as she will of the wet. I feed her this x2 / day at 6 and 6. She grazes on about 1/2 cup of dry food total over the remaining day / night.
I have noticed she occasionally vomits (bile) around 5:30pm, so think she is getting hypo then perhaps? If she does this, I feed her a small amount of dry, while getting her wet sorted.

I live in New Zealand, and would welcome any suggestions on wet foods / supplements available here.

 

Bandit will vomit if he goes too long between meals...I feed him 4x a day and that works well! Have you tried splitting the wet meals into smaller, more frequent meals? You can add water to the food and leave it out, or put down a frozen portions for her to eat when it has the awe's. My cats are food crazy and will gnaw at the frozen food, so we use auto feeders to release it when we aren't home or sleeping.

I hope someone comes along with some food suggestions! I think there are some ziwipeak flavors that are suitable if I remember correctly?

Edit: I just checked and all of the ziwipeak canned varieties are good for diabetics!

 

Ziwi Peak is a quality food an diabetic friendly. It is in the expensive side but it is worth it if your kitty likes it.
I will repeat what the others have said--until you are home testing DO NOT switch to all wet food-
If you think a hypo episode is happening you can get the numbers up much faster with wet food than dry.... but with the amount of insulin the carbs in the dry are keeping her safer. If needed you can add a drop of kayo syrup or honey.... but again you will have a much better handle o this when you home test. The great news if because you have a new diabetic your chances or remission are a real possibility!
Many of us feed fancy feast classic variety for when you do begin home testing.
Zobeline has had great results for the neuropathy.
Many people use auto timed feeders to feed frequent meals and not have to wake up in the middle of the night
Here is a picture of the sweet spot" where most of us test although some use the paw.

 

We were on vetsulin for a short time and I much prefer lantus....
Much more gentle and my kitty is his normal happy self, he was depressed on vetsulin and the drops were fast and steep...

 

Thank you for all the great links and advice, I appreciate it.

 

Thanks very much - have must ordered some Ziwipeak, fingers crossed she likes it!

 

It could be a hypo symptom or it could be that she has fasted too long: some cats get stomach acid build-up if they don't eat frequently (Saoirse had this issue when a vet insisted she only be fed once every 12 hours. I disregarded the vet's instructions after only a couple of days because I wasn't prepared to see my cat going through painful vomiting bouts. With the Caninsulin it is vital that Mousey eats a substantial amount about 30 minutes before giving the injection so that it will have some carbs to 'work on' when it kicks in (and it kicks in hard and fast early in the cycle - peak effect typically by +3 hours after the dose). If you gave her a snack every few hours that would help if it's a stomach acid issue. Whether it's a hypo issue can only be determined with home testing of blood glucose levels. Smart move on your part to give Mousey something to eat. As has been mentioned above, wet high carb food can raise BG quicker than dry high carb but for future reference be aware that it doesn't keep numbers high for as long as the dry.

With regard to Mousey taking a while to get used to the wet food sometimes cats can become a bit nauseated at the start of insulin treatment and/or when the diet is changed. Here is a useful resource with information on nausea symptoms and treatments; maybe it will help you to spot whether Mousey is a bit queasy at the moment. If she is showing signs of nausea an easy thing to try is raising her food and water dishes so that she doesn't have to drop her head down to eat and drink. Warming the food a little can help, too.

It's great to hear that you're all geared up to start home testing. The prospect is daunting at first but it should become second nature to you both in a fairly short time. With the data it produces you'll be able to properly see how Mousey is responding to the current Caninsulin dose. It's good that you've been doing secondary monitoring of fluid intake/output but as you've seen it's a very crude method of monitoring and doesn't really show how well or badly the Caninsulin is working for Mousey.

When you start testing, be sure to get tests at preshot, +2 and +3 hours after the insulin injection to check the onset of the amorphous fraction of the Caninsulin and to see how low it is taking Mousey. It is also helpful to get tests around +7 / +8 because that's when the crystalline fraction of the Caninsulin typically reaches peak effect. Testing at +10 will give you an idea of whether the dose has worn off by then (i.e. helps build a picture of the duration of a dose).

It would also be a good idea to test around the time that Mousey has been having the vomiting bouts. Hopefully it will rule out her going too low and instead point the finger of blame for the vomiting on her going longer without food than her body can naturally cope with.

Does Mousey seem a bit better as the dose is wearing off by any chance and then return to the lethargic state a short while after the next dose? Caninsulin's quite harsh in its action and some cats don't respond well at all physiologically or psychologically to the blood glucose roller coaster it tends to produce.


Mogs
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Our experience with vetsulin was miserable... Dre was so depressed and lethargic.
But I have heard some do well???

 

Wow, thank you Mogs for your post. Great information - I'll check out the nausea link. I've decided to feed her smaller more regular amounts of food, as she likes to eat, and it makes sense. It'll be good to have the home test BSL's and then I can monitor her accurately from home. The vet is just too stressful for her.
She doesn't appear to have really lethargic times of the day, just overall more tired. I'm guessing this is due to continued high BSL's. She is a tiny bit more playful since on the 4 units. I'll know more tomorrow after testing. I'll look at getting the information onto the graphs you all seem to use..trying to figure out what all the abbreviations mean!

Thanks so much for your reply.

 

On the home page there is tons of info including what all the "lingo" means
Your doing fabulous!

 

Hmm interesting. I would say that since starting insulin, Mousey is not herself, tired and lying down a lot (falling asleep by her water bowl instead of getting back on the bed). I feel sad for her, and have been wondering if it is the beginning of the end! Perhaps it is 'just' an insulin issue?

 

It was a insulin issue for us--Drevon is normally happy bright and playful even at 16.
Incidentally he would sleep with his head on the water bowl -

When we switched to pro zinc he was happy again but the insulin did not last more than 6 hours with him-

I wish I had used lantus from the start-
The high Bg levels of course will make them "different" but when we were on vetsulin he was not just different-I cried every day thinking the worst
.
I do not give dosing advice but I have been thru this and my advice for you is that if you think your cat is not "your cat" anymore since starting vetsulin ... well I will just say I really wish I had switched right away. Good luck
Not to mention there is tons of support and experts in the lantus forum....

 

Amps is morning preshot BG reading.(at least a 2 hour fast) U is how much insulin was given. Then +1 is one hour after shot time. +2 is 2 hours past shot time, etc. then PMPS is pm shot BG reading.
With Cansulin you will need to make sure you test, then feed, then shoot 30 minutes after feeding. Also, don't give the shot if the BG reading is under 200.

That's why it's nice to have the spreadsheet set up before you begin. That way you don't have to do that. Also, in order for members to know her name, when Mousey was diagnosed, the type of insulin she's on, her dose, and the food she's eating could you add that to your signature block? You would click on your username at the top, find signature, then add the info. Thanks!!

 

That's why home testing is so necessary That way you know what the insulin is doing to her

 

Thank you, thank you. I am so glad to be a part of this helpful kind community. I have been watching her thinking I am watching a dying cat, not good. I'll look into Lantus.

 

Thank you very much for this!

 

Just to add to this... I know it seems like a lot to do but this information will be very useful for the experts to give you solid advice to keep your kitty safe and being newly diagnosed hopefully you will have tightly regulated or even remission.

 

I want to give you some encouragement in the form of pictures.
China at diagnosis...less than 8lbs (click on picture to expand)

China after about 4 months on Lantus with the help of the wonderful people here on the FDMB

 

1 more thing.... I don't know if your kitty is a morning eater but Dre is not and with lantus he does not have to eat a solid meal before his am shot--onset of lantus is not immediate so he can graze a little bit, then he will eat a good solid meal within a hour-

 

our feature super model

 

Hello Mousey, welcome. Just want to welcome you. You have received so much info already.

Since Ziwipeak cat food is manufactured in New Zealand, I would think you could purchase it easily and be a whole cheaper than what we pay in the States. We started it about 2 weeks ago. My sugar cat loves it. The other 2 aren't to sure about it yet. Maybe you could get them to add kangaroo flavor.

This a lot to learn, before long you will have a routine and Mousey will be feeling better.

 

Some cats do fine on Caninsulin, but it can really disagree with others. Have a look at the following recent thread where Sandrine describes how her kitty reacted to Caninsulin. Also, further down the thread I describe how poorly Saoirse was when being treated with Caninsulin. (She did much, much better on Lantus.)

http://www.felinediabetes.com/FDMB/...orse-symptoms-not-due-to-hypoglycemia.153310/

Staying parked at the water bowl can be a symptom of nausea.

For Mousey's safety you must make sure Mousey has a very substantial meal 20-30 minutes before every dose of Caninsulin, otherwise she won't have enough carbs in her system for when it kicks in and it could take her too low. For the time being I suggest you stick with the amount you're feeding at insulin time and give smaller meals at other times between doses (but no later than 10 hours after the previous dose - unless Mousey is at risk of hypoglycaemia) to help with the suspected stomach acid issue. You can always refine the feeding schedule later when you have gathered BG test data to show what effect Caninsulin is having on Mousey's BG levels. As is oft mentioned here, diabetes treatment is a marathon, not a sprint (even though we'd all make our kitties better yesterday if it were at all possible).

Keep a daily written journal of all of Mousey's clinical signs and behaviours. Highlight the ways she is different on Caninsulin to the way she was before treatment (and mention that she seemed better after a short time off the insulin even though her BG went higher again.) Your vet should be looking at Mousey's clinical signs as well as her BG levels when assessing whether or not Caninsulin is an effective treatment choice for her. By gathering evidence of this type you will be better placed to work with your vet to find a good insulin for Mousey; quality of life is what we're after here, and with the right insulin Mousey should get back to being a happier, healthier, more energetic girl. (FWIW, the difference between Saoirse on Caninsulin and Saoirse on Lantus was like night and day; I got my cat back. I could not in all conscience say that her life would have been worth living if she had had to stay on Caninsulin. I fought hard to get her an insulin that worked well for her.)



Mogs
.

 

Chris, thanks for that, what an amazing transformation. I can see how things can improve. China looks perfect.

 

Mogs thank you so very much for all this great information. I read the link about Caninsulin and it describes Mousey exactly...(she spends the day hiding under various beds, perfectly centred so you can't grab her).
"Before Caninsulin injection:
- OK in herself - alert and mood OK - but she tried very hard to hide from me after her meal because she knew her injection was coming.

Next 60-90 minutes:
- OK for a while but then mood deteriorated and she started getting quite lethargic.

+1.5 - +10.5 hours after injection:
- lethargic, miserable, no energy or engagement. Spent the whole time hiding behind sofa or behind floor-length curtain. Only emerged to eat then retreated back to hiding place.

+10.5 - +12 hours after injection:
- Saoirse came out from her hiding place, depression lifted, more alert, more herself."

I'll record her behaviour so it makes an easier case for changing insulin - will check to see if Lantus is available here in NZ.

 

I hope it gives you some hope that your sweet Mousey can come just as far back as China has

Yes, it is...Lantus is actually a human insulin, so it's available at any pharmacy. It IS expensive though....I have no idea how much it is in NZ, but here in the US, a 5 pack of Lantus Solostar pens is about $500....but that's also enough insulin to last most cats about 2 years. Luckily though we've found a place in Canada that ships to the US and we can get it for 1/3rd the cost.

You should be able to call around to pharmacies and find the best price

 

I'm so glad it is a help to you because my heart went out to you when I read ...

When Saoirse was on Caninsulin it did get to a point where I was thinking to myself that if this was how the rest of her life was going to be just to keep her blood glucose down for part of the time then it was no life at all for her. The vet who gave the FD diagnosis had told me the only insulin available for cats in the UK was Caninsulin. I am so grateful that I found FDMB and discovered that there were other - better - insulin formulations available. Saoirse went through a similar transformation to China when she finally got the right insulin and her blood glucose became tightly regulated on Lantus. She went back to being sociable, happy and playful.

I hope your vet will be able to help you find a treatment for Mousey that will make her feel better, not worse, because seeing our little ones like that is sheer agony.

Please keep us up to date with how things are going with you two, and be sure to post if you need a bit of cheering up or moral support: we worry about beans as well as kitties!




Mogs
.

 

Blood Glucose curve (non event)

Today was meant to be the day I did the home testing curve, but I was unable to get any blood out of her ear .
I have a lancet device, which I tried on different settings, the end one being 7 (highest), which produced a tiny speck of blood but nothing else even when I gently milked it. The vein in her ear is a tiny looking capillary. I used to be a paediatric nurse, so thought I would be able to get it done.. but no.
I warmed it first with an empty pill bottle with quite warm water in it. Mousey is not the easiest customer either - I had my husband there to help hold.
After about 5 jabs, we decided to leave her alone and feed her as was she was getting really stressed.

Does anyone have any suggestions? Does the paw pad really hurt?
Update: I have researched and see this link:
http://www.felinediabetes.com/FDMB/threads/trouble-getting-blood-sample.133749/

*FYI, I took my own fasting BSL this morning to make sure my lancette device was working properly and it seems I am pre-diabetic..! Mousey has inadvertently helped me with my own health.

** I realise my data sheet hasn't loaded properly, so will sort that out when I have some more time.

 

Thank you, again! You (all) make me feel much better - its hard: my husband is here, but I am the one who is doing all the research and she is sort of more my cat. I adore her - sweet kitty rescued in Portland OR actually, and traveled to NZ with us, (such a trooper as it was very hard on her). I know I'll get there, so much to learn, and lots of fretting at the moment, just because I want to get her sorted and regulated. I really appreciate this message board as there is so much more we can do for treatment than we would otherwise know, via the vet, lovely as they are!

 

Wow! Mousey's a globetrotting kitty!! Must have been some journey for her. Were you able to keep her with you for the duration of the trip to NZ?

Re the testing, I was surprised at just how warm Saoirse's ear needed to be before I could get a sample in the early days. Try not to lose heart when you don't get a blood droplet every time; with each poke it will encourage new capillaries to form at the test zones and gradually you'll have more successes. Are you using Vaseline or similar to help the blood sample to bead up? Another thing to try is just freehanding the poke with the lancet instead of putting it into the lancing device; it can be easier to hit the 'sweet spot' that way. Be sure to give Mousey her post-test treats, praise and fusses - even if the tests don't bear fruit sometimes.

Hang in there. It will get better - and easier.


Mogs
.

 

Looks like you've got it in Excel.....our spreadsheet is a Google document that's already formatted for our special use

If you're using a human meter, go HERE (since you're in NZ, I'm assuming your numbers are different from ours in the US and this spreadsheet will convert the numbers for you so us silly Americans can understand it....LOL)

After that page opens, click where it says "Use this Template" at the top left and your own copy will come up. Then you can start adding your numbers!

If you're using the AlphaTrak or another "pet" meter, go HERE and follow the same directions above.

 

Thank you - will give this a go!

 

Hi Mogs -
Mousey had to go in the hold for the trip back to NZ, and she was really traumatised by the experience. She hid under the covers of our bed for about a year..! Her paws and nose were bloodied as she'd tried so hard to get out. I loved her up and promised her we will never travel with her like that again.
Re testing, I didn't use vaseline as her ears aren't that furry, but I will as need every little bit of help.
Currently she is hiding under the deck where I can't see her or get to her, and has been there since 8:00am. I am very worried about her - its currently 4:10 pm now...

 

For us free hand testing is more acceptable for my kitty I can control the pressure and location better and no noise. except me talking to him

 

the salve ( a thin layer) will lessen the prick and help to form the blood "bubble"....your doing great by the way

 

If you have any problems, send me a private message and I'll set it up for you. Just click on my name and choose "Start a conversation"

Here's something I wrote up for others that needed help with testing...maybe it'll help you too! (substitute "her" for "him"...lol)

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!

 

Aw, the poor little thing!

I think your best plan is to let the vet know about these clinical signs ASAP. I hope that by the time you read this you'll have managed to get Mousey out from under the deck. It might be an idea to keep her somewhere she can't hide so successfully for the time being until you sort things out so that you can monitor her properly. Keeping fingers and paws crossed for things to improve on the blood sample front so that you can get a better idea of what's happening. The Vaseline should help bead up even a tiny blood sample.


Mogs
.

 

Success with the blood draw! Thanks for all the tips everyone.

• I switched to a warm facecloth in a plastic bag as it retained heat for longer
• Did a manual lancet prick of her ear (one side bled well, the other didn't at all)

So far the BSL's are too high even on 4 units. Will continue and see how we go over the day.

 

Thanks Mogs, she did eventually come out after eight hours.. she seems ok today. Its hard on the kitties when first starting out testing, and she is a very sensitive girl. I'm happy to see her today following around the warm spots in the sun and being quite calm.

 

Thanks for your help with the spreadsheet Chris, much appreciated, I got it to work today!
Your tips also helped, so now I am able to get some numbers - not that they're good...!

 

That makes for a very pleasant mental picture.

Well done both of you on the testing! And great that you've got your spreadsheet working, too.


Mogs
,

 

what's the Vaseline for? do you put it on your cat's ear before you poke it? I just started home testing and also having a hard time getting blood from his ear. and do you warm your cat's ear before you poke it, to warm it up? can you just use your hand to warm it up, or do you need something else? and how long to put the warmth on the ear before poking it for the blood glucose test? thanks! Spike's mom.