? Rescued Cat with Diabetes.. What Questions should I ask my vet?

Hello! I run a small animal rescue out of my home. We recently took in a cat with Diabetes. He was diagnosed with Diabetes by the vet that the lady who had him before me went to (about an hour and a half away). I am taking him to my vet today for a general exam and just to get him in so that I can get his insulin through my vet. A bit of a backstory- he is about 6 years old. He was brought to the vet by his owner because of weight loss and urinating a lot more. His glucose was in the 500s. When they diagnosed him with diabetes the owner refused insulin and asked that he be euthanized. One of the employees at the vet office took him in as a foster. She has had him since November of 2016. She became unable to regularly give him his insulin so she reached out to me. He has been with us for 2 weeks, I have started testing his blood sugar this week (the girl who had him before me never tested it at home) and it is kind of all over the place. Some days he will skip meals, when he does this I don't give him his insulin. The girl said he would skip a few meals the first couple of weeks she had him because he was settling in. Well one day his sugar will be in the 50's or lower, then the next it is 275 (which seemed high to me but I have heard that isn't too bad for a diabetic cat). He is currently eating Friskies canned food- one can in the morning and one in the evening. She said he gets 5 units of insulin in the morning and 4 in the evening, but I am thinking that this is too much and that is why is sugar is all over- because when it drops way low I won't give him any that evening. So I just started yesterday giving him 3 units instead. Yesterday evening he was at 265. Do you think I should continue with three units and monitoring him? Also he is on Vetsulin which I have heard mixed reviews about... should I ask the vet about switching him to a different insulin? I am just wondering what all I should bring to my vet's attention. I am not sure how much experience that they have with diabetes... Another question that I had is when does everyone usually test the blood sugar? I have been doing it about an hour before I give him his dinner.
Sorry for the super long post! He is my first diabetic foster and I am always learning!
Thanks in advance!

 

Kudos to you for helping this kitty! We can certainly help you. It's very likely that the crazy BG numbers are the result of doses that are far too high. You did the right thing by lowering the Vetsulin dose to 3 units. Are you giving that twice a day?

You're already testing BG at home. Would you be willing to set up a spreadsheet like the one we use here? It's the first thing we look at before offering advice. There are techies on here who will do it for you if needed.
http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

Re Vetsulin: there's no need to ask your vet for a different insulin at this point. Vetsulin might work very well once you get some help here. There are people here who have used it very successfully and they can advise.

Re vet's FD experience: many vets have little/no experience treating FD or they think a cat is like a dog and go from there. This is the place to get the help you'll need because there's a huge amount of experience amassed here.

Re BG testing: the routine we recommend is:

• every AM and PM before feeding and injecting insulin (no food at least 2 hours before so the BG isn't affected by food) so you know if the planned dose is safe
• at least once near the middle of the day and before bed - to see if BG is dropping too low
• other random tests on days when you can get more in.

Another important factor is food: we recommend feeding low carb wet food only. No need for expensive prescription food - Friskies and Fancy Feast pates are fine (no sauce or gravy types - too carby). If your kitty is on kibble now, be aware that a switch to low carb wet food could result in a significant lowering of BG values. The BG has to be monitored very carefully during the transition.

I hope this helps to get you started. Keep asking any/all questions you have.

 

3 units of vetsulin is actually a prettyhigh dose.

Since you are home testing now (good job!!!) it would be great if you set up a spreadsheet (we can help with this). If it were my cat I would start over with a dose of 1 unit and collect data. Form there we can help you find the right dose.

 

Welcome to you and your kitty! FDMB is the nicest place you never wanted to be, lol. What is kitty's name, and what would you like us to call you?

I agree with Janet, I would start over at 1 unit and go from there. 3 units is likely too high and that's why his numbers are all over the place.

What type of meter are you using, human or pet-specific?

Any number under 50 is falling into the start of the hypoglycemic range and could potentially be very dangerous, especially if you are using a pet meter (hypo range begins at 65-68 on a pet meter, 50 on a human meter).

Since he is an "iffy" eater and is having some higher numbers it would probably be a good idea to get a bottle of ketone test strips and do the occasional urine test for ketones on him. The strips are relatively inexpensive and it's not difficult to test. If he won't let you test him in the litterbox as he goes, we have many tricks and tips to obtaining a sample, so just ask!

 

Welcome kitty and Caretaker (what shall we call you both? ) You've gotten some great info already from these wonderful ladies! Just thought I'd stop by to post a couple links I like to help new members get setup with .
The spreadsheet link has been provided already. The place to post it is in your Signature, here are the instructions on setting that up (all the light grey text / SS links below each of our posts) http://www.felinediabetes.com/FDMB/threads/editing-your-signature-profile-and-preferences.130340/
Since he's given a reading of 50, our "take action" number as Lucy stated above. Here is something to read ahead of time should he give a 50 or lower (human meter): http://www.felinediabetes.com/FDMB/threads/how-to-treat-hypos-they-can-kill-print-this-out.15887/

Feel free to ask us any questions. So great that you took on this kitty! We did have another Rescue member caring for a kitty here

 

Hey guys! My name is Alyssa and the kitty's name is Jasper FYI! I will work on getting a log and a spreadsheet going! My vet was actually really helpful and knowledgable about feline diabetes! He agreed we should reduce his insulin and monitor him and adjust accordingly. He liked that I was testing from home and told me to start keeping a log because it will give him more information. He said we should keep him on the vetsulin. And I should get one of the pet specific testers- I was using a human one and he said that could also be why I am getting crazy numbers. They tested him at the vet and he was 368- this was right before it was dinner and insulin time though. When I got home I tested him with my human one and it was really off so I definitely want to buy one of the pet ones... EverPaw looks like it is cheaper... Is it less accurate?
I am a little hesitant to drop him down to 1 unit just because he was at 5 units twice a day for 6 months... If you guys recommend doing that we can try it...
He told me to make sure he hasn't eaten two hours before I test him- which I read on here as well so I thought it was cool that he said that. He did say a lot of the things that I have read on here so I feel confident that he knows feline diabetes pretty well- he always does great with our other cat fosters.
My main question is which monitor to buy right now. And also if I should take him all the way down to 1 unit, or try 3 and see how he does there.
Thanks

 

I really like the idea of a do over for a few days at 1 unit..... Like a restart. Now that he's being tested the dose can be adjusted slowly to be most effective.


I use an Alphatrak meter as I like having the same meter as my vet.... But with strips costing about $50 for 50 strips it costs about $150/month. If that kind of cost is prohibitive then I'd stick with a human meter that would cost a third of that.

 

Being a rescue I am not sure we would be able to afford the Alphatrack strips...
However I want to get a better meter because mine is apparently really off... or do I need to calibrate it? If so I am not sure how to do that either D:

 

Human meters are fine to use.... Just know they run lower than pet meters. The difference is greater at higher numbers and much less at lower numbers. So while they might only be 20-30 points difference at low numbers, they may be 100-150 points off at very high numbers. Either type of meter will still tell you trends and if your cat is too high or low. The numbers to know are on human meters "Normal" is 50-120 and on a pet meter it's about 68-150.

 

Mine was REALLY off. It was 368 at the vet, but when I tested him at home it said he was 90...

 

What meter? Did you take a second test? Sometimes you can get a weird reading of the drop is too small. How much time passed since the test at the vet? Do you have a control solution you could test the meter with? Also you could try testing yourself and see if the numbers seem normal.

 

I'm going to disagree slightly with what was said above--Vetsulin is not a great insulin for cats, and not recommended as a first choice insulin. But since you you're already using it and have it on hand, I do agree that it does make sense to start over with it with proper dosing and diet, and see if he can get into remission on it. However, if you do not see good control and improvement within 8 weeks, I would change the insulin and ask for a script for Lantus or Levemir. Lantus is pricy in the US, but affordable if you order it from Canada with your vet's script.

There is a time limit on the very good remission rates with Lantus and Levemir, and the sooner you start on those insulins the better chance you have of reaching remission (80+% if started within the first 6 months of diagnosis, 90+% if started immediately after diagnosis). Vetsulin has remission rates of around 25% with diet change, but cats that don't regulate quickly on it typically wont reach remission. He's a relatively young cat, so getting him into remission would do a great deal to keep him healthy and live a long life.

How long before/after he was at the vet did you test him? Stress can inflate BG numbers, and Vetsulin causes hard and fast drops, so if he had insulin administered within a few hours prior that also could explain the low number. I typically test myself if I'm worried there's something off with the meter (and it's always been just me worrying, the meter is always correct), or immediately test again with a different strip if a number seems wonky (as mentioned some meters will throw low numbers if the blood drop was too small--I had this issue with my Relion Micro, but never with my AccuChek Aviva).

 

Just a quick FYI about the EverPaw meter.......I personally don't think it's worth investing in when a human meter will work just as well if not better.

The Ever Paw meter read higher than the AT2 pet meter (most popular pet meter) at low numbers and lower at high numbers. The difference is within allowable meter variance but for me it was a consistent difference. I would have been a lot happier if that difference had been the other way around because reading higher at low numbers could delay taking action when BG is heading too low. I also found the quality of the product questionable. The sample I tested would turn on and read a blood sample even if the strip was not securely seated in the meter. Sometimes it took several tries to get the strip to seat properly. The meter also takes a large blood sample compared to meters like the AT2 (pet) or Relion Micro or Confirm (human) from Walmart. This led to me ruining several strips even as a seasoned tester with a cat whose ears bleed very well. Having to use two or more strips for a test can quickly eat into any cost savings and I believe the strips for the Relion meters are cheaper than those for the Ever Paw meter anyway. Last but not least, I found the meter somewhat clumsy to use. That may have been personal preference but I think most folks would find it bulky.

The reading differences you experienced could easily be explained as a combination of pet vs. human meter difference plus stress Jasper was experiencing a the vet and timing with when shot was given so I wouldn't be too quick to discard the meter you are currently using. Why not test it on yourself as Julie suggested and see if it is reading within normal ranges.