Some advice needed - UK - Kizzy cat

Hello all

I am new to the board, and am really here to get answers to specific questions that I can't seem to find a definitive answer on (I may just be looking in the wrong place :lol: ). So this is my story, Kizzy's story, so I apologise in advance for the length of it :roll:

My name is Gillian and my cat, Kizzy, is diabetic. She is 15 and a half years old, and was diagnosed in Feb 2013. We are in the UK. The diagnosis was strange, to be honest. She'd been a bit lifeless on the Sunday and was taken to the vet the next day, they gave her antibiotics, as they thought she had an inflamed tooth. It perked her up for a day... So back she went, and she was kept in, while they did some tests. We lost our other cat, Koko, in August 2009 (her kidneys) and we were wondering if it was the same with Kizzy. Her symptoms were similar, but dissimilar, if that makes sense. She had some the same, some not. I basically thought she was going to die.

So the vet eventually called us back and told us the news, diabetes. I actually laughed. And laughed :lol: It was this human illness and my cat had it?! I've since found out cats can have strokes, too!! So I guess there was an all round sense of relief, too. She wasn't dying, her kidneys were fine, she was 'just' diabetic.

There is some blurriness of my memories around this time, as I remember visiting her in the vet one evening with my sister, and chuckling at the pink dressing she had covering the drip in her paw. I also remember the vet showing us how to stick her in the back of the neck. I got to have a practice shot before we took her home. But I also remember going to London with Uni for the weekend, and getting a text to say she was home, so that is where the blurriness lies, if I had the practice shot before taking her home, why was she still in the vets when I was in London?! :roll: I remember wanting to go visit her on the way to the train station, as the vets is so close to it.

Anyway, she did have to go back in for a small operation on her tooth, but it was just day surgery, so no staying at the vet again. They love her there! She lost the inflamed fang, but there was something (a root, most likely) still causing an issue, so the op was to get it cleaned out. She came home still high on drugs!

It was hard for her to adjust to the insulin shots, she would growl, she would hide behind the sofa and refuse to come out. It was not the actual shot, but the grabbing of her neck she did not like. So it took her a good couple of months to get settled. Now she actually sits still and waits for you to inject her :lol: We have all come a long way in the last 21 months!

She swapped over to the Royal Canin diabetic diet, both wet and dry food. She took to it, well, which was a surprise as she was a bit on the fussy side before diabetes.
She started off on 1 unit of insulin twice a day, and after glucose curves and blood tests, it was changed and changed. After check up blood tests every 6 months or so, it changed and changed. Guess she is the fussy cat that will forever be getting the insulin level changed :roll:

She is now down to 2 units twice a day, and this was changed just last week. We were concerned about her water intake, as it increased quite a bit. Before she was diagnosed, she did drink more than Koko did. Not that hard, though, as we hardly saw Koko drinking! However, now that we document her food and water intake, we have obviously noticed the rise. She was taking in an average of 200ml per day over the summer months, but now that she is not venturing outside so often, due to the colder weather, she is drinking over 300ml per day. We personally can't understand why she would drink more now that the hot summer months have gone. Granted our heating is on, but it's no warmer than it was over the summer!

We spoke to the vet about it, and they gave us a pee stick to test her urine. It did show there was some glucose present. So they had us take her in for a glucose curve (she hasn't had one in well over a year, since near the beginning of her diagnosis, as far as I can remember). They had us lower her insulin from 3 and a 1/4 units to 2 units. This was the Monday. We took her back on the Friday for another curve and they were satisfied that the 2 units were fine for her.
She has seemed a bit perkier, but she is still drinking the water. The vet did not seem concerned by this, and I am not sure if I should be, too. My sister is not concerned by it, but our parents are a bit. They keep asking if it's normal! I keep telling them the vet didn't say a thing about it.

When she was first diagnosed and all the changes to her diet were made, the vet told us the amount to feed her, which we (have mostly) stuck to. We do write everything down. The words were 'feed a substantial amount at insulin time' and 'the rest as snacks'. Also, 'don't let her drink too much'.
Okay. Can you see why we are (not so) concerned? They've never given us definite numbers. What is substantial? What is too much? :roll:

In December last year, the vet also put her on Loxicom, as she has arthritis in her right back leg/knee. It has helped some, but she does have bad days where she limps some, even going as far as lifting it up and hopping on 3 legs. Her back legs are obviously not helped by the diabetes, she can't really jump up onto beds/chairs anymore, but she still can climb the stairs, and jump down.

Since we lost Koko five years ago, Kizzy has been somewhat grumpy and she doesn't run around like she used to do with Koko. They'd chase each other and play fight, you'd come down in the morning to clumps of fur all over the place :lol: So she no longer has that. The vet has suggested some exercise for her, but coupled with her age and her bad leg, it's hard to get her motivated to run about. At the vet last Friday, she mentioned 'diet' but that we'd talk about it at another time. However, according to the food packaging, she is not even on enough food for her weight, and it's supposed to be calorie controlled, so if she's heavy, how is it happening? She has always been a big cat, and we never knew what she weighed before she became ill. She did lose weight during her first getting ill and getting diagnosed, so we think her weight gain is because she is 'better' and this is why the vet thinks she needs to diet... But what do I know?! :lol:

I think that is everything about her story, her background. I didn't want to just come on and ask questions and then you guys ask things that I should have said in the first place. There probably will be something, but since I am new, I have no idea!!

Really, my questions are as above, regarding her water intake. She is drinking more, but peeing more, which is what I would expect. I think there would be a major problem if she was not peeing, or not peeing enough.

Does anyone have any advice on the water intake?

I look forward to your replies, thank you

Re: Some advice needed - Kizzy cat

Hi Gillian & Kizzy,

It sounds like Kizzy's glucose levels are still not controlled and that is why she is drinking more water and peeing more. The best way to manage her diabetes is through a low carb/high protein diet, hometesting and insulin.

I did not see what insulin you are using. The insulins that work best for cats are Lantus, Levemir, PZI & Prozinc. All of these are long acting insulins. What insulin is Kizzy using?

The best diet for diabetic cats is a canned or raw food low carb/high protein food. Prescription foods are not necessary and most cats stop eating them anyway. Many of us feed our cats either Fancy Feast or Friskies canned foods. Dry foods, including prescription foods, are high in carbs. High carbs make it very difficult to control Kizzy's glucose levels.

The best way to monitor Kizzy's glucose levels are through hometesting. This means using a glucose meter to test a drop of blood taken from the ear to check the glucose levels before every shot. This is done to make sure that it is safe to give the insulin and to also determine how well the dose is working. Many of us use human glucose meters instead of the pet meters. They are less expensive to use and the strips are more readily available. The problem with checking glucose levels at the vet's office is that stress will raise a cat's glucose levels considerably and most cats are stressed when they go to the vet. It is very possible that you have missed your optimal dose and Kizzy is experiencing rebound. If your vet will not show you how to test, we can teach you. By testing before every shot, you will know if the glucose levels are high enough to give insulin and prevent your cat from becoming hypoglycemic by not shooting if it is too low.

It also sounds like Kizzy may have neuropathy. This is caused when the glucose levels are not controlled. By making the changes suggested above that will help you get it under control and reverse the symptoms. Also vitamin Methyl B12 will help with the neuropathy. You want to make sure that you use the B12 with methylcobalamin as the active ingredient and not cyanocobalamin. I know several members order it online and they can tell you the brands they recommend.

Re: Some advice needed - Kizzy cat

Welcome FDMB.

I suspect you are using Caninsulin, as vets in Europe seem obligated to start with this, then if it is proven not to be good control for the cat, may change to Levemir (detmir) or Lantus (glargine).

The dry diabetic food is fairly high carb- more than the 10%calories from carbohydrates we try to stay under. If I recall correctly, some of the low carb foods available in your area include Bozita, Smilla, and Grau, and there is an online pet supply called ZooPlus from which you may order. If you go to your first post and click on Edit, you can add "in UK" to your subject line to catch the attention of some of our other UK and European members.

See my signature link Glucometer Notes for some info on meters, testing, and what the numbers can mean. In Scotland, a human meter from Abbott should work satisfactorily. The trick is to find one with inexpensive test strips!

Hi, just a quick update.

Yes, she is on Caninsulin. I have edited the subject line, will remember that in future!

We already have a monitor, and last summer we did try to prick her ear and test it, but because she is a stubborn cat, it did not go well. Not enough blood to begin with, then the machine wouldn't accept the strip and by then Kizzy was harassed and we gave up.
It might be a different story now, as she is obviously more settled now than she was back then. She has also sort of mellowed quite a bit in the last year, too. If we try to make her do things, she will sigh at us, sort of like a teenager saying 'ugh, do I have to?' but will get on with it. So she does make us chuckle!

We have just had her at the vet (about 6am), with a nice emergency call out charge to boot! She has a urinary infection, she was basically peeing small amounts all over the kitchen, and there was some blood present. She was given a long lasting antibiotic injection, and she has some capsules to take for the next few days too.
We are wondering if the increased water intake was in part due to this? Probably not. Again, I mentioned to the vet about her intake and again, not much concern.

I have a zooplus account, so I will look at their foods. Not heard of those brands, so will look out for them. Obviously we take the vet's word as gospel :lol: so I think this site is just what we need!

I will also look into that vitamin for her legs. I would say she is not bad with it, like I said, it's just her jumping that has gone, but to be honest, it could just be laziness on her part :roll: :lol: when she walks, she does not walk on the hocks, it is her feet. Her right back leg is worse, but I put this down to the arthritis, she doesn't like us touching it, so it obviously hurts her some. So it is fun when we try to clip her claws on that foot!! She pulls her leg from us and it becomes a sort of tug of war :lol:

I will go over your posts again, in a few hours once I have had some sleep, think I've only had about 3 hours already! The joys of cats :roll:

Thanks for your replies :smile:

Hi Gillian and Kizzy

Welcome to the forum from another UK er.

It sounds like you have been doing well with Kizzy but would like to encourage you to home test. That way you can save money as you won't have to go to the vets for a curve, save Kizzy from the stress and hopefully get her even better controlled. It just takes a little practice and patience. At first my cat remi was having none of it but I was advised to warm the ear with a home made rice sock heated gently in the microwave help to get blood into the ear. Also make sure you have a nice low carb treat to give afterwards. I use the thrive freeze dried chicken treats that you can get in Pets at home, Sainsburys and I think Waitrose. I find the test strips very pricey but nowadays buy them in bulk off eBay. I use the Accu check machine that I bought in Boots.

This sticky contains all you need to know about home testing for glucose. Great links with photos of how to do etc
viewtopic.php?f=14&t=287

With regards food I agree you don't need to use a prescription one this thread has some good info about possible foods. viewtopic.php?f=28&t=64843

You can either opt for a premium type brand or if you are careful some of the supermarket brands are actually quite good. Does Kizzy have any other health issues besides her current UTI? If you do switch completely to wet low carb food you must monitor her blood glucose levels at home as it can decrease the need for insulin. Am off to find other useful threads, back in a bit.

Here a recent thread where three of us from the UK discuss foods that we have tried or want to try. We start of discussing info on lantus insulin which is not the same insulin Kizzy is on but towards the end we discuss food.

viewtopic.php?f=32&t=128413

I have also linked a thread from another UKer who is using caninsulin. You might find some of the advice helpful but just remember every cat is different

viewtopic.php?f=28&t=128711

Do you think you could start home testing and setting up a google spreadsheet document?

It'll help us give you better feedback if you add a few notes to your signature. These will show up at the bottom of each post you make and provide context for any feedback.

Go to the top left of the screen.
Click on User Control Panel.
Click on Profile
Click on Edit Signature
A text box displays.
This is where you paste the link for your spreadsheet, once it is set up.
Add any other text, such as
your name, cat's name,
city, state,country
date of Dx (diagnosis)
insulin
meter
any other pertinent issues like food issues, DKA, hepatic lipidosis, pancreatitis, allergies, IBD, etc.
Then Click on Submit to save it.

Next, 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.

Hello Gillian and Kizzy, and welcome to FDMB.
I'm in the UK too (was born in Scotland but am now down South in leafy Surrey...)

First off, regarding water intake, I do not understand why your vet is suggesting that you limit Kizzy's consumption...? What reason was given...?
Cats often don't drink as much as they actually need to (especially if also eating dry food), so a lot of folks actually try to find ways to encourage their cats to drink more (using water fountains, etc).

Regarding food, as others have said here, our experience is that a low carb wet diet works best for diabetics. But only change to a lower carb diet if/when you are comfortable with hometesting (testing Kizzy's blood glucose at home). That's because lowering the carb content of the diet can lower the blood glucose quite a bit, and the insulin dosage may need to be reduced accordingly. Too much insulin causes hypoglycemia.

We do have access to some fab diabetic-friendly cat foods now in the UK. It used to be pretty limited here but in recent years some really good quality European foods (mostly from Germany) have become available. Most of these need to be bought online, but I see you have a Zooplus account already ;-)
You may wish to have a look at this excellent Google list compiled and maintained by another UK member, Juliet:
https://docs.google.com/spreadsheet/ccc ... mWmc#gid=1
The list shows the carb contents of various foods and also where they can be bought.

Are you using Caninsulin syringes or pen? If syringes, are you buying them online? It's a heck of a lot cheaper than buying from your vet, and I think Vetuk.co.uk do their own version of U40 syringes now which cost even less. Here are links to both products so you can compare prices:
http://www.vetuk.co.uk/veterinary-suppl ... f-30-p-295
http://www.vetuk.co.uk/veterinary-suppl ... 00-p-11335

And here's a link to a nice page of pics and info about hometesting from the UK site 'Sugarpet'. I learned to hometest from this page!
http://www.sugarpet.net/bloodtst.html
My cat was tricky to test in the beginning too. But I learned that I could crumble a few treats for him and test him while he was munching on those... ;-)

Eliz

thanks once again for the replies. i will take the time to go through and read each one, and also the links provided.

the testing machine we have is an Accu one. it came with a pen type lancet that you stab yourself with, but since it makes a bit of noise, we thought this would be more stressful, so purchased needles like what the vet used to test the blood from her ear. when the vet did it, there was quite a bit of blood, think it might have surprised the vet too :lol: but obviously when we tried it, we were a bit more wary than a vet would be. it will take practice to hit the right spot, maybe.

i would most likely have to do the testing myself, unless my mum were to try and help. my sister works during the day (i'm self employed) so would not be there to help. although, it might be better just myself, to save crowding Kizzy and making her stress out. she can be a bit off, sometimes. one day she could be fine doing something, next day would be a whole different story!!

i will wait until she has finished her course of antibiotics before trying anything with her. she is better, but we are going to give the whole course, to make sure the infection is gone.

the only health issues she has are the diabetes and the arthritis in the one leg.

BJM i will add the info to my signature, as much as i can, although i am not sure what BDK or IBD are?

regarding the vet... they did not say why we should limit the water. just like 'substantial amounts of food' they never fully explain. again, at the vets on sunday i questioned the water intake and again they could not give an answer. it's times like that that you feel they are just after your money :? some of the charges are ridiculous!!

when she was diagnosed, we obviously did some research ourselves. we found a site which had a calculator for the food. you inputted the details (carbs, fat, protein, etc) and it would tell you if it was suitable for diabetics. her usual food came back as suitable. so then the vet said, here's this food now, and she should have more dry food than wet food. we'd read (just like you are saying) wet food is best. you can see why we are a bit frustrated at the vets, they tell you one thing, the internet says another. but they are supposed to know what they are talking about!!

once i have read all the links regarding food, i will be able to ask and tell more than i know right now.

during the times they have tested her blood and changed her insulin up or down, we have not seen a change in Kizzy's behaviour. the vet was surprised by this at one appointment, when they changed the dose. i think she was expecting Kizzy to be on death's door due to not enough, or too much, insulin (can't remember which atm) but i told her she was fine, doing everything as she usually did. the very first day she became ill, to me, that was her at death's door. she was not moving, she wasn't eating, drinking, we picked her up she was limp, we tried to put her down and her paws turned under, instead of sole down, they were top down, she wouldn't stand, she was just limp and almost lifeless. so i suppose these little things are now making us question whether she should have been on the doses she was on. again, we had to trust what the vet said!!

we are using the syringes. we bought them from the vet the first time, and then we found them for a quarter of the price online. seriously, ridiculous prices from the vets!!

the sugarpet site is the site i found last year, when we attempted the first home test! she is a 'on her terms' cat. she doesn't like being brushed, she will growl and spit, even sometimes take a swipe at your hand (ouch if she connects!). we will feed her some ham if we need to brush her a lot (she can get some matted bits), she is more compliant that way. she is not a fan of me cutting her claws either, i used to do it when she was sleeping, but now have my sister hold her and i do a few at a time. or we get the vet to do it, if they are needing done when she has an appointment.
if she is outside and we want her to come in (she is not left out all night now she is diabetic, but she used to do that when she was younger, a window was left open during the summer months for her (and koko) to come and go as they pleased) she will just refuse to come in, and we end up picking her up and bringing her in... after she has tried to hide in a bush, and then growled because i've picked her up, lol!!

BUT she loves attention, and sounds like a lawnmower when the purring starts! she will laze about the house, on her back, belly to the world (waiting to be rubbed!) and paws over her face. she's quite content in that respect, she just doesn't like all these things that are for her own good :roll: so i can just imagine what the home testing will be like :lol:

i will go do some reading. thanks again for the replies

DKA = diabetic ketoacidosis, a potentially fatal, expensive to treat, complication of diabetes. Results from high glucose levels, not enough insulin, and very often some sort of infection. If you cat has been diagnosed with that, especially recently, it is important to know, as getting the glucose under control quickly is critical to avoid another, potentially fatal, episode.

IBD = inflammatory bowel disease, a condition with frequent problems of vomiting, diarrhea, and inappetance. Can lead to intestinal lymphoma.

thanks for that, i'm rubbish with acronyms.

so i noticed 2 of the symptoms of DKA are increased thirst and frequent urination. Kizzy has been drinking more, and obviously peeing more, but it's not more frequent. she usually only goes 2-4 times a day. i wouldn't say that was frequent?

again, this all boils down to numbers that no one is able to definitely give - what is the allowed water intake?

at Kizzy's last blood check up in August, we got the vet to check her kidney function and it was fine. i believe i can check for dehydration with the neck fur test, i will do that, and see what happens.

so the other symptoms of DKA she does not have, it mentions vomiting and diarrhea (her poo is quite normal, no sickness), weight loss, etc. i am also going to get the pee test sticks. i believe human sticks will do for cats?? (i think we are heavily reliant on the vet here, when we could be doing these things ourselves, or maybe it is more that the vet has never mentioned we can do these things...).

also, it says that DKA can be caused by infections like UTIs, how coincidental that she has just had one...

the vet mentioned nothing like this when she was there for her UTI appointment, or in the previous 2 the week before, when her insulin was changed. surely they would mention such a thing??
i mean, they told us Kizzy should be on a DRY food diet for her diabetes and yet that is completely wrong. feeling a bit peeved at the vet right now grr_red

See my signature link Secondary Monitoring Tools for additional methods of monitoring your cat, including urine testing, another way to check for dehydration, measuring water (not really a limit on that) and food intake and elimination, and weight.