Should I Start Insulin? Water & Appetite are Normal on Wet Food

Hi Everyone,

My cat Ash is an extremely sweet cat with tons of personality, but also extremely difficult to work with.

I noticed that Ash was drinking lots of water and had switched her preference to wet food, along with an increasingly ravenous appetite. She had missed a couple jumps up to where I fed her, so I moved her food down. Unfortunately, I didn’t grasp what was going on until I saw her trying to scratch her chin and her leg was just waving in the air—i.e., diabetic neuropathy.

I switched her to all wet food (Fancy Feast pate), and I took her to the vets on 7/5/18. Her blood glucose was 400. They did a fructosamine test to confirm.

Ash is on her third day of Zobaline, and I bought a ReliOn Confirm Glucose Meter. Today is the second day of trying to get a blood reading without success. I just bought 28 gauge lancets and have been using a rice sock, but not a drop of blood and today was worse than yesterday. The problem is always the warming process, and I’ve tried three methods so far. Not a drop of blood so far!

By the time the vet called me with the results of the fructosamine test, I had noticed that her water consumption had returned to normal and her appetite was returning to normal. I did not want to start Lantus Insulin until I got a BG reading myself. Based on everything I have read on this website, I don’t know how I can manage this and afford this if I can’t do the glucose curves and monitor her blood glucose myself.

With an all wet food diet, there is no doubt her water drinking has returned to normal (full water bowls), and her eating seems about normal, and I think she’s putting on weight (she had lost 3 lbs.)

I know we want to get them on insulin ASAP, and I don’t know when I will get a blood glucose reading (hopefully soon!) I don’t want to start her on insulin and then have her go HYPO because her reading is different than it was at the vet's. At the time of the vets her water consumption and urination was extreme, and now it’s normal.

I hope she will go into remission on this wet food diet, but I know the odds of that are not very high.

Question: Is it bad to wait until I get a BG reading to start the insulin? Or should I call the vet and start it immediately? Besides her diabetic neuropathy and her not giving any blood, her demeanor and health seem better.

Thanks in advance. I could not have learned what I have already learned without this group!

P.S. Does anyone think this drop in water means anything? Has anyone else had this experience? I'm hopeful, but I don't want to be foolish.

 

I would wait on the insulin until you can get her levels at home.

Are you using the lancing device or doing it freehand? I had to put the device up to the third highest (pokes the most) setting when I started, but I've gotten better at it and now don't need to poke as deep or as many times part of the process is also 'milking' the ear, post-poke to encourage more blood to flow/bead up.

In desperation, I've poked his toe pads before, on the front feet!

 

I think you'd be OK to hold off just a little while longer, especially if the outward signs are that she's doing better.

It takes time for the high numbers to do damage but the lows can kill quickly.

The more you poke (even if you don't get a drop) the better you're going to be in the end. As you poke more and more, new capillaries will start to grow into the area (to "repair" the damage). We call it "learning to bleed" and soon you'll be able to get more than enough blood every time. (We've been at this so long I think I could just look hard at China's ear and it'd bleed for me!)

Are you testing for ketones? If not, it's really a good idea to get some urine ketone test strips just to make sure she doesn't start to develop them. If that happens, she'll need to be on insulin NOW (or if bad enough, in an ER vet)

 

Thanks for your answers so far!

I’ve watched most of the YouTube videos on BG testing and read many posts on this forum about the more difficult cats and non-bleeders. In short, I’m trying to follow all the best practices and use all of the tricks. My cat will sit on laps to no end and is so affectionate, until she is being controlled in any form—picked up or held, etc. At the vets, she does open mouth panting, and they are amazed at how upset she is. Even flea treatments are no fun.

I’ve been using the lancing device but not sure how close I’m getting to the edge because she twists and squirms. I did it freehand, and it went straight through her ear and drew my own blood, but not hers. She likes her ears rubbed, so I’ve tried warming that way, but no blood yet. She does not like any kind of heating technique (rice sock, warm water in a small container).

Twice, when I have connected with her ear nicely, she let out a howl. It’s been difficult to “milk the ear” after I have connected.

I’ve poked her paw pads a couple of times but no blood. And I just moved up to the bigger 28 gauge. I am trying to stay calm and not overdo it. Tomorrow is another day.

 

If Ash is struggling when you try and test her, try just kneeling behind her so she is between your knees but you are not restraining her. Offer her a small low carb treat while you test and it might be enough to distract her. Most cats don't like to be restrained and will struggle. Keep trying, you will be successful.

 

Hi Ross & Ash. I use that kneeling technique Bron suggests above. It works really well for Josie: she was initially a squirmer/biter/scratcher, and now she just lies right down once I kneel behind her! Re: getting her ear warmed, if it seems particularly cold, I’ve actually put my mouth right down close to the back of her ear and breathed on it before rubbing her ears, just like you do when you’re trying to warm up your hands if it’s cold outside and you forgot your mittens. Seems to work.

Re: drop in drinking water, Josie did the same thing when I switched her from high-carb canned food + dry food to all low-carb canned. I measured her water bowl intake against our civvie’s as a control, and they were the same (essentially immeasurable vs the 1/2 cup during the day that Josie had been drinking), so it seems they get almost all of what they need from the canned food (I think canned is something like 75% water?).

 

When we switched from dry to low-carb wet, the difference in water consumption was astonishing. We have two cats, only the one is diabetic. They both drink from a water fountain that I top up every morning. Before the switch I'd have to add around 48 ounces of water every day. Now I add about 4 ounces.

/ETA - I do add a can of water to each meal to make it soupy! So, that's 3oz each meal, each cat, twice a day. That's still only 16oz water as compared to 48!

 

Just wanted to add.... Don't be afraid to poke all the way through. In the beginning I also had to double poke... Twice in the same spot... To get a drop. Go in with an attitude of determination.

 

I got it! 172.

Ash likes her ears rubbed, so I decided to reduce things to the basics: ears rubbed, freehand, monitor with the sound off, and on the floor. I eliminated all the materials that I had to juggle or that would distract both her and me.

I read somewhere on this board that if you are doing it freehand to “come in at an angle and prick her ear like you are popping a balloon.”

Being on the floor behind her didn’t work, but she jumped into my lap several times. That’s where I pricked her ear like a balloon. She jumped off and scurried away, and I saw a blood drop forming. I had to grab her to get the monitor to her ear, and I thought I had missed, but when I looked at the monitor, it had a reading of 172.

Any ideas on what I do with a reading of 172 on a ReliOn Confirm six hours after eating? (I will speak to the vet on Monday.)

 

Yay! It will get easier and easier to do the testing.

Considering he has had no insulin, 172 is a pretty good number. (Keep in mind that, since you are using a human meter, the actual number is a little higher. Just wanted to remind you before you talk to the vet, in case it comes up.) If you look at the spreadsheet of someone whose cat is in remission, you will see that their numbers are usually pretty low most of the time.. often they stay below 100 the majority of the time. I am not saying that some cats don't run a little higher, I am just saying that I would not consider myself completely out of the woods if I just had one test that was 172.

So, I think that, if I was you, I would set up one of the spreadsheets and start doing tests at various times throughout the day and recording the results in the spreadsheet. You may find that the 172 is the highest number you see, and she is staying well under that most of the time. Or, you may find that she runs higher sometimes. (With that test being 6 hours since any food, it should not be food influenced at all, so you may see higher numbers closer to food times.) Whatever the case may be, you will at least have the data you need to know whether she needs insulin or not. It would also be something you could share with your vet.
http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
http://www.felinediabetes.com/FDMB/threads/understanding-the-spreadsheet-grid.156606/ (AMPS and PMPS are for shot times.. it's okay that you are not giving shots, you could use those spots for the times you would give the shots if you were having to get them, and just put 0 in the 'U' column to show that you gave no insulin.)

It would also be helpful if you set up a signature that gives basic info so that you do not have to restate it every time you post.. like the fact that you have not started insulin, what kind of meter you are using, the kind of food you feed her, etc. http://www.felinediabetes.com/FDMB/threads/editing-your-signature-profile-and-preferences.130340/

Things are looking very promising. I wish you the best!