Update - Australian cat with recently Dx diabetes now with CRF

Discussion in 'Welcome to the Group - Post an Introduction Here' started by Auscar, May 24, 2015.

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  1. Auscar

    Auscar New Member

    May 23, 2015
    My cat was diagnosed with diabetes 5 days ago and spent 2 days at the vet (specialist cat clinic - have good handouts and publications on feline diabetes but the actual vets on call don't seem that knowledgeable). He was commenced on insulin (Lantus). He is a burmilla (half burmese) and 14 years old. He has always been in excellent health, is an indoors cat and has 6 monthly check-ups and annual blood checks since age 10. His bloods 3 months ago were normal. He weighed 11.5 pounds at diagnosis (lost 1 pound prior to diagnosis).

    He is now eating 1/4 tin Hills m/d diet morning and night and 1/4 cup Royal Canin diabetic dry food (we are in Australia). That is probably about the same volume as what he ate before, just different formulation and the wet food was once a day.

    Monitoring - The vet said I could do it 4 times a day, although advised twice a day, before dosing. I have a sliding scale to adjust his insulin depending on his reading.

    Results so far:
    0700 BSL >500 Given 4 units (increased from 3.5 units) Ate 1/4 tin cat food
    1100 BSL 363
    1500 Husband couldn't get BSL and I was out
    1900 BSL 165 Given 4 units Ate 1/4 tin cat food

    0700 BSL 229 Given 4 units Ate 1/4 tin cat food
    1100 BSL 373 Ate nothing
    1500 BSL 483 Hungry after this. Ate dry food.

    I myself have been on insulin before, so know the drill for humans and am going ok with the glucose monitoring and insulin shots.

    However I am worried about 2 things:
    1. High BSL: His sugars are still very high most of the time and he doesn't seem himself. No vomiting but just weak and unsteady. Am I being too impatient with the sugars? Maybe I just need to wait longer. It seems to be a slow process.

    2. Food: Because his sugars are high, he is wanting to eat more. He is losing weight. But if he eats more, his sugars will be worse! What should I do about that? Can I feed him something like fresh meat that won't contain carbs? The tinned food looks like is full of non-natural things and I would guess that the dry food would have to be higher carbohydrate by its very nature?

    I am calling the vet daily to report his sugars. They seem to be consulting their sliding scale for dosing and are not too worried. I am taking him in tomorrow for another review. I guess I am worried too, as I have to take kids to school and work a few days a week. I have organised my parents to "cat sit" when I am not here but they won't be able to check his sugars. Just watch for signs of hypos I guess. We go overseas for a month-long holiday in 3 weeks and I have just arranged for him to board at the vet's, which he will hate. (I think they were relieved to send him home - he doesn't like the vets...).

    Thank you for any comments, I have spent quite a few hours reading the boards (such a great resource!) and am starting to get my head around things.
  2. manxcat419

    manxcat419 Well-Known Member

    Jan 14, 2015
    Hi and welcome! :)

    I see a couple of things that concern me in the way your vet has asked you to treat your cat. Lantus is not meant to be dosed on a sliding scale based on pre-shot. Because it's a depot insulin, it takes time for the depot to build up in a cat's system, so holding the same dose for several days at a time to see what will happen with it is very important. Lantus dosing should be based on the cat's nadir test results so it is important to try and catch some mid-cycle tests where possible.

    The other thing that does concern me is that the 3.5 units is a VERY high starting dose for Lantus. Based on your cat's weight of 11.5 lb, the starting dose should really be 1.25 units per shot (with 2 shots per day, 12 hours apart). This is based on the calculation of 0.25 units per kg of the cat's weight.

    There are some very good links that explain how Lantus works for cats here:-

    And to the protocols that most of us use for dosing our cats on Lantus here:-

    One more thing to bear in mind is that the prescription foods for diabetic cats are often not the best available. You can do better with a standard low carb wet food. Most of us don't usually like feeding dry food to our diabetic cats as dry food is usually too high in carbs and also tends to make diabetic cats, who are often dehydrated to begin with, more dehydrated. I'm not familiar with the foods that are available in Australia, so I'm going to tag @Vyktors Mum who is also in Australia and I hope she can give you some suggestions on what foods are good to try.

    As regards him being hungry, with his blood glucose unregulated, no matter how much he eats he's actually starving because his body can't get any fuel out of the food he's eating. A lot of us allow our cats to eat a lot more while they're not regulated to allow for this. Giving him some fresh meat, as long as it has been cooked with no additives, as a little extra to go with his regular food is fine. :)
  3. Auscar

    Auscar New Member

    May 23, 2015
    Thanks so much April, I really appreciate you taking the time to reply.
    Yes I was worried about the dose too, it seems high compared to what I have seen on the boards here. I think they probably did start him on the dose per kg you said, but they have probably adjusted it as per the sliding scale, which says to increase the dose by 0.5 units if the reading is above 12 (216).
    I've got to say, its done differently in humans. I think the vet is trying to treat 12 hour insulin the way you treat short acting insulin (with a sliding scale) and I'm not sure that is feasible really.
    I think too - he doesn't tend to graze overnight but does in the day - so he'd either need to not have food to graze on (dangerous if i am not at home) or a higher dose in the mornings.
    I have read people talking about nadir results - is that doing levels at 3, 6, 9 hours to try and catch the lowest dose?

    I'll read the links you posted.
    Thank you so much.
  4. manxcat419

    manxcat419 Well-Known Member

    Jan 14, 2015
    I'm glad I noticed your post before I logged off for the night (almost 1am here on the West Coast of the USA). It does sound as though your vet is treating the Lantus like a short acting insulin and unfortunately I don't think it's possible to get good regulation with it that way so I'm really glad you found this site as there are definitely loads of people here who can help you to get everything sorted out and under control. :) You might find that people recommend that you go back to a starting dose based on your cat's weight and then work upwards gradually from there following one of the protocols that most of us use to make sure you haven't skipped over his best dose by using the sliding scale, but I'm hoping that some others will look in on your post in the next few hours and confirm if that's the best way forward for you.

    Generally, with Lantus, we treat it in a similar way to the way it's used in humans (my step-son is also on Lantus) but we have to dose twice a day with it instead of once as it's not effective for as long in a cat's system as in a human's.

    I free feed Rosa (and all the other cats here too). They graze on wet food as much or as little as they want all the time. It's actually easier on a cat's pancreas to have multiple small meals through the day than to have one or two big meals anyway, so if your cat is happy to do that it can work very well. The only thing we suggest is that you take the food away 2 hours before shot time so that you know that your pre-shot reading isn't being influenced by a food spike (so that you know the number your shooting is safe to shoot). And yes, I wouldn't leave the house without leaving food out for him - a lot of cats will get very hungry if their numbers drop low and some can go part way towards controlling a low number themselves by eating everything they can get hold of. That's not foolproof of course and we would always recommend extra testing if you think he's heading low so that you can treat hypo range numbers before they become a real problem, but leaving some food out can definitely help cats to hang around in good numbers for longer during the day.

    That's exactly what we do - we test every few hours during the cycle to find the lowest point the cat gets to. With Lantus that's typically somewhere between +5 and +7 but it can, and does, vary even in the same cat - I've seen nadirs as early as +3 and as late as +11 with Rosa while she was on insulin.

    I'll be back on in the morning here and will look in to make sure you've got some more input - and I'll let you know if I think of anything else by then too. :)
  5. manxcat419

    manxcat419 Well-Known Member

    Jan 14, 2015
    OK, I see you haven't had any more replies so far. I'm going to cross-post this in the Lantus/Levemir sub forum and see if we can get you some more help on dosing to see if we can get you started on finding a good dose to get his levels under control. :)
  6. tiffmaxee

    tiffmaxee Well-Known Member

    Nov 15, 2013
    You have been given a lot of good information. If you go to the stickie on tech support you will find information on how to set up a spreadsheet. We use them so we can see what our cats are doing from cycle to cycle.
  7. Auscar

    Auscar New Member

    May 23, 2015
    Thanks so much, greatly appreciate it. I will try again to find the spreadsheet links, I couldn't see it earlier.
    His BSL's were high overnight still (450-500 at 11pm, 3am), despite not eating all night. This morning it was 468.
    Just got back from the vet. They have increased the dose to 5 units.

    Two other questions -
    1. They haven't done any blood tests (apart from BSL) or a urine test. Is that normal?
    2. They said not to worry about DKA unless he looks "really sick" and then bring him in. But I wonder if I should get a monitor that will test for it. The human glucometer keeps telling em to check for ketones as his reading is so high.

    His weight is the same as at diagnosis last week and he is eating wet food OK.

    Thanks again. I just don't feel as confident as I would like to that he is being managed properly. And I worry about what he's like when I'm asleep at night. (Although I wake when he does since he's been home from the vet).
  8. manxcat419

    manxcat419 Well-Known Member

    Jan 14, 2015
    Here is the link on how to create and link a spreadsheet:-

    I guess if they're absolutely sure there's nothing else wrong with him, that might be enough testing. My Rosa had a full blood work done on diagnosis to make sure there wasn't anything else going on that wasn't obvious so I'm not sure.

    You should be able to pick up Ketostix at a pharmacy - those will allow you to test his urine for ketones. And yes, if he's running in the 400s, you definitely want to test for ketones - by the time he looks sick, they're likely to be at a high level. Testing early allows you to catch them while they're still at "trace" or "small" and deal with them early.

    I still think the dosing has been started too high and raised too quickly - 5 units is a lot when he's only recently diagnosed. A lot of our cats here never get as high as 5 units. If it was me, I'd take him back down to a weight-based starting dose and work from there using one of the 2 protocols I linked for you last night. It is, of course, your choice whether or not to do that, but I think it's very possible he might be running high and flat due to too much insulin rather than not enough - that's not something we find all that often with cats that have started at a lower dose and increased gradually, but with the high starting dose and big increases it is definitely possible in this instance. A lot of us don't actually use our vets to figure out dosing etc as there are a huge number of vets who don't have the experience of feline diabetes that the people here have. To use my Rosa as an example, the vet wanted her started on 2 units twice a day and no home testing - you can see from her spreadsheet that the 2 unit dose was the one that dropped her low for the first time and started her back down the dosing scale. I dread to think what would have happened if I'd followed my vet's instructions and simply shot those 2 units blind from day 1.
  9. BJM

    BJM Well-Known Member

    Oct 6, 2010
    Understanding the spreadsheet/grid:

    The colored headings at the top are the ranges of glucose values. They are color-coded to clue you in as to meaning.

    Each day is 1 row. Each column stores different data for the day.

    From left to right, you enter
    the Date in the first column
    the AMPS (morning pre-shot test) in the 2nd column
    the Units given (turquoise column)

    Then, there are 11 columns labeled +1 through +11
    If you test at +5 (5 hours after the shot), you enter the test number in the +5 column
    If you test at +7 (7 hours after the shot), you enter the test number in the +7 column
    and so on.

    Halfway across the page is the column for PMPS (evening pre-shot)
    To the right is another turquoise column for Units given at the evening shot.

    There is second set of columns labeled +1 through +11
    If you snag a before bed test at +3, you enter the test number in the +3 column.

    We separate day and night numbers like that because many cats go lower at night.

    It is merely a grid for storing the info; no math required.
  10. tiffmaxee

    tiffmaxee Well-Known Member

    Nov 15, 2013
    I totally agree that 5 units is way too large a starting dose. Max was nearly 16 pounds when he started and he was on one unit although it probably should have been more. I think it would be best to start over with less insulin based upon your cat's weight as well. Someone more experienced can help you with that.
  11. manxcat419

    manxcat419 Well-Known Member

    Jan 14, 2015
    Thanks Elise - I'm never all that comfortable giving dosing advice as Rosa was actually fairly straightforward for dosing so even though I was sure the starting dose had been too high this time I'm really glad to have confirmation that I'm not way off track with starting over as a suggestion. :)
  12. tiffmaxee

    tiffmaxee Well-Known Member

    Nov 15, 2013
    Me neither but that dose is so high it caught my attention.
    manxcat419 likes this.
  13. Auscar

    Auscar New Member

    May 23, 2015
    Thank you, I'll get onto the spreadsheet now. His BSL was 45 before his dinner tonight - no wonder he was meowing. 3 hours prior it was 193. I didn't give him biscuits for 2 hours before his dinner as I thought it would make his numbers artificially high.
    Fun and games! Although at least, I am pleased to see that his sugar isn't still high. Poor boy.
    Thank you again everyone, your advice and assistance is greatly appreciated at this stressful time!
  14. tiffmaxee

    tiffmaxee Well-Known Member

    Nov 15, 2013
    You mention giving him biscuits. I'm not familiar with what that is but I wonder if the food you are feeding is too high in carbs. Canned low carb food pust many cats into remission.

    What did you decide to do with the dose? That 45 calls for a reduction around here. He jumped up from there which is a bounce from the low number. You don't want him to go hypo. If you haven't already, I suggest you read the stickie on how to handle low numbers.
  15. BJM

    BJM Well-Known Member

    Oct 6, 2010
  16. Vyktors Mum

    Vyktors Mum Well-Known Member

    Nov 15, 2011
    Wowsers the dosing is way too high to start off. I think you are correct that your vet is treating lantus like caninsulin. Vets can't stay on top of everything but frankly the way they are treating your kitty (what is his name?) is just flat out wrong, they do not know what they are doing with lantus. However I do give them some kudos for encouraging home testing. I hope they haven't also told you to roll or shake the insulin before dosing - this is appropriate for some types of insulin but will kill the effectiveness of lantus. You can check out the appropriate way to handle lantus in the sticky (post stuck to the top) in the lantus/levemir insulin support group forum. Lantus dosing is based on the nadir (low point in the cycle) not the preshot number so you definitely need to get those tests in the middle.

    You are going to have to take a leap of faith here, combined with your own research - which you have clearly been doing plenty of - you will know that the advice here (as soon as you get your spreadsheet set up you should start posting in the lantus/levemir insulin support group forum) is better than what your vet is offering. It is also scientifically sound, see for eg the qld university lantus study on diabetic cats (Google will find it for you). It can be hard to take the word of 'internet people' over your vet and I usually wouldn't be quite so blunt about it but your kitty is in danger with this treatment.

    Absolutely pick up the ketodiastix as suggested by April. By the time a cat is showing symptoms of diabetic ketoacidosis the situation is life threatening and not all kitty's will make it, even with the very expensive treatment that will be required. If you catch ketone readings early you can try to head it off before it happens.

    Check out Vyktors profile for low carb diabetic suitable foods available in Australia. I haven't updated it for a while so there is probably a few more (will update in the next few days) but there's enough there to get you started. BUT you need to be very careful changing foods when kitty has already started on insulin so don't start changing over until you can monitor well.

    I'm hoping that you didn't shoot that 45 :nailbiting: and I'm so glad you found us :)
  17. Auscar

    Auscar New Member

    May 23, 2015
    Hi everyone, sorry I haven't been back in, I have been sick (not helped by being up in the night to check on the cat - Oscar is his name. (And we are in Australia).
    Good news is that he is settling and his sugars and doses are coming down.
    What have I learnt? I have learnt to ask to see someone senior. I hadn't really realised I was seeing the juniors at the clinic, until the secretary commented (perhaps she detected my frazzled tone!). (And we are going to a clinic that has had vets who have published studies in this area).
    I did also realise that he hadn't had blood tests or a urine test, so he has had a urine test now (results pending but looked clear).

    The vet agreed that his sugars being so high for the whole first week was unusual. I do feel like the lantus caught up with him, as he got up to 5 units twice a day and now is on 3 units twice a day. I stopped calling the clinic so frequently and just adjusted the dose down. I also started getting up and doing his morning sugar before he was eating (which meant 5am at first). This helped know when his lowest sugar was.

    One question above was about "cat biscuits" sorry, that's what we call dry food (could be just in my family I am realising!). A bit confusing. He is on Hills m/d wet food and Royal Canin or Hills diabetic dry food, although mostly eats wet food, about a can and a half a day at present, in quarter can doses.. I have found Hills Metabolic treats for diabetic cats, which are a dry food type of treat. I am using one each time I do his sugar to reward him and that is making things SO much better. He had been hissing and growling when I did his sugar test or injection, now he is happy because he knows he gets one treat (just a single piece of dry food, perhaps twice the physical size of a normal piece of dry food).

    He has been on 3 units twice a day of Lantus for the last few days but his sugars have been a little lowish. I also checked my glucometer against the vet's one and found mine to be reading 18 lower. I think this may just be for low doses, I have read that manufacturers do that to prompt humans with low sugars to act on it
    This morning his fasting is 70.2.

    Thank you so much everyone, I am going to do that spreadsheet now. I have so appreciated the help and support here. It has been such a stressful time.
  18. BJM

    BJM Well-Known Member

    Oct 6, 2010
    Since you're in Australia, you might find it helpful to know that Dr Rand of the University of Queensland is one of the international experts on feline diabetes. If that is too far from you, it may be possible for your vets to consult with Dr Rand.
    A list of some foods that may be useful.
  19. Auscar

    Auscar New Member

    May 23, 2015
    Hi everyone, I wanted to update. Oscar is much better. His insulin requirements are continuing to decrease. He was down to 0.5 units yesterday, after a sugar of 30.6 the day before mid afternoon (6 hours after last dose) - his others had been in the 108 - 216 range on 1 unit for a few days. I was glad I noticed it - he started compulsively sniffing invisible tracks across the floor so i thought I'd check his BSL.. Scarily he hadn't gone to look for food when his sugar was so low.
    His urine test was clear for infection this week too.
    He is going well on 1/2 tin of m/d wet food twice a day and doesn't touch much dry food although I keep some there for him in case.

    His level was 92, 110 in the afternoon and 78 pre-dinner last night so I didn't give him any insulin according to the vet's protocol (reduce by 0.5 if 54-108).
    This morning he is 108 so I think I'll withhold insulin again.
    If I call the vet I'll get the after-hours cover and they'll tell me to do that according to the protocol. I suspect he probably needs 0.25, but I think I'll try and see the senior vet tomorrow to ask them.
    Might do several readings today to see what is happening.

    We are going on holidays in a week and he is boarding at the vet's. I feel so terrible about that but I don't have anyone who could do BSL measurements. (He's never had to board or been to a cattery before and he is so much happier now the diabetes is better.

    Thanks again for all the help and support. It is so nice to see him doing better.
  20. Auscar

    Auscar New Member

    May 23, 2015
    Hi everyone,
    I just wanted to update Oscar's story. i know when he was first diagnosed I liked to read the stories on here as well as advice.
    The summary is that he had really high sugars for the first few weeks and was up to 5 units Lantus at one point. In hindsight I just think it took his body a while to adapt, and his requirements came down really quickly. He was diagnosed May 20 and was down to 0.5 units once a day by June 13.
    We had a 4 week holiday booked so he stayed at the vet's for that time, they monitored his BSL twice a day and gave insulin as required.
    By the time we returnd mid-July, he was down to just having insulin every few days. This happened for about a week. The advice was to give 0.5 units if his BSL was over 108 (6.0).
    Now he has not needed any since July 19.

    He has been eating Hills m/d diet wet food with a little bit of the same brand dry food. His weight has been slowly dropping from 5.4kg (6 months ago) to 5.0kg now. He is getting sick of the food and the vet said it was OK to give him some fresh meat to keep his weight up.

    I did notice on our return that he is still drinking a lot and unfortunately the urine test showed he has kidney failure. So now he is to transition to kidney diet. I am concerned about this, as, although his BSL's are still good now, I worry about teh extra load on his pancreas.

    So I am trying to research what is the best kidney diet that won't sress out his pancreas. I have samples of Royal Canin and Hills kidney diet wet and sry food, with teh thought that I'll try to ahev him mainly on wet as I have been.

    Anyway - its great that he is off insulin, sad about the kidneys.

    My tips / things I have found
    - take my human glucometer to vet appts and check readings on mine against theirs - I found them different for low readings but the same for normal range.
    - find one nice vet. It was difficult when tehre were different emergency vets advising (this was at a clinic that specialises in cats and knows abotu feline diabetes)
    - I bought some Hills metabolic dry food treats and give one after each ear prick, this has helped A LOT.
    - I use a 25 gauge needle rather than a lancet to prick his ear, I hold his body between my legs whilst crouching on the ground to do it.

    Thanks again for all the help and supprot on here, it has been so helpful.
  21. tiffmaxee

    tiffmaxee Well-Known Member

    Nov 15, 2013
    Hi. Sorry about the kidney diagnosis. I'm in the same situation. Max was diagnosed with it last month. I've been on a mission to find food to accommodate both as he is tightly controlled with insulin. It's hard because kidney disease requires lower phosphorus and kidney diet food us high carb. So far I'm feeding a combo of Mauri kangaroo that is low carb and somewhere between .85-1.24 phosphorus and Nulo chicken and turkey which is around 1% phosphorus. Friskies SD was a good one that is still in play but has been discontinued. Soulistic (Petco Only) has some low carb low phosphorus choices as does Weruva. Ann and Tess has a list of foods attached to her ss. Dr. Pierson's list is outdated. Helen as another list a year old you can look at on Tanya's CRF that is newer. She is hoping to have her updated list done in September.
    Bron and Sheba likes this.
  22. Bron and Sheba

    Bron and Sheba Well-Known Member

    Feb 21, 2015
    Can you ask your name please?
    I live in Australia and I have a diabetic cat who also has early kidney disease.
    I give my cat home prepared diet with some Weruva canned cat food as well for carbs.
    If you are interested in trying that I can go into more detail for you. Otherwise I have found the best canned food is Weruva brand......Cats in the Kitchen is the only ones of that brand we can get here in Aus.

    Here is the site:
    This is the specific page with all the info below:

    Other things you can do is add cooked egg white to the food...that will decrease the phosphorus level of the food. So if you give 90 grams of food and you wanted to add an egg white. You would reduce the meat by however much egg white you are putting in. An egg white...large is about 40 grams. Half an egg white at a time is all mine will eat. I mash it and add to food.
    When you look at the food try and keep the level of phosphorus under 200 grams per 100 grams of food. Another way of looking at it is the dry matter....try for under or about 1%
    If you think you have found something tell us and we will have a look at it. I use cats in the kitchen fowl ball and fric a zee mostly because they both have lowish phosphorus levels and low carbs.

    The kidney food you get from the vet is high carb and will throw your cat out of remission. Far better to try and find a higher protein, low carb, low phosphorus food. Once you have found it you are set.
    Ask lots of questions and tag us if you like.
    Good luck. It is very doable!
    Last edited: Aug 7, 2015
  23. Critter Mom

    Critter Mom Well-Known Member

    Jun 16, 2014
    Hi there!

    Depending on the CKD stage your cat is at, you might have more food options available to you than the prescription CKD diets. Depending on the stage, it may not be necessary to place restrictions on the amount of protein to feed. As the other members here have already advised phosphorus is key at all stages.

    I don't know whether you'll get food help there for Australia, but if you haven't done so already I very much recommend you visit Tanya's Site: it's the best resource on the web for all things feline CKD plus a host of other health information. They also have a support group, and if you join there may well be members from Australia that might be able to point you towards suitable food choices in your area.

  24. tiffmaxee

    tiffmaxee Well-Known Member

    Nov 15, 2013

    Good advice and Helen is in the process of updating the food list which she hopes to have done in September.
    Last edited: Aug 8, 2015
    Critter Mom likes this.
  25. Anitafrnhamer

    Anitafrnhamer Member

    Jul 9, 2013
    I wanted to pass along this website. It is all the information you never wanted to know about kidney failure. At first it looks overwhelming but it is an incredible resource. One big thing about kidney failure is you now need to monitor a lot of different blood values---some of the really important ones are: BUN, Creatinine, phosphorus, and potassium.


    Another great resource are two online groups for cats in kidney failure:
    If you decide to join either/both groups (and I hope you do) please be sure to post all labs that you have.
    Critter Mom likes this.
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