Should I try food control only first?

Hello! My baby Twink was diagnosed today with diabetes. The vet said her glucose level was at 226, which I've read to be pretty low in terms of diabetes. I've also read up on hypoglycemia and it scares me to death. The vet wants to start her on a low dose of insulin injections 2x a day along with changing the food. Is that usually the first step with levels on the low side? Should we not try to just adjust her diet first? I'd love to stop worrying so much and know that injections are still a good step to take. Thank you so much everyone! It's so great to know that there is support out there.

~Kira

Hello, and welcome to FDMB

Blood sugar can read high from stress --- so -- what symptoms was Tweak having that sent you to the vet?

And yes, diet change is a great idea. We highly recommend low carbohydrate (grain free) canned or raw food. (avoid foods with gravy)

Fancy Feast has some low carb flavors (and many high carb gravy flavors, so read the labels!!). Consult Janet & Binky's Food Charts for carbohydrate content and choose flavors with less than 10%.

Welcome

226 isn't too bad. Was that from a fructosamine test or a blood glucose test? A fructosamine test gives the average blood glucose levels over the past week or so. It's what confirms diabetes along with common diabetic symtpoms (flooding the litter box with sticky pee, always hungry and eating a lot but losing weight, etc). A one time blood glucose test just tells you what the blood glucose level is at that very moment. Many cats get stressed out at the vet's office so a blood glucose test tends to be inaccurately high due to vet stress.

You can start diet first. Low carb canned food or raw is best. I wouldn't stick with diet only for more than a week or so. The sooner you start insulin the better the chance your cat has of remission and the pancrease can heal. You can take this time and learn how to test your cat's blood glucose levels at home. A Human blood glucose meter is all you need. You don't need the AlphaTrack pet blood glucose meter - it's expensive and supplies are not sold in any store.

Insulin is give twice a day in cats. 1 unit twice a day is a very low safe dose to start with. Don't let the vet start your cat at a dose higher than that. Cats are not dosed by weight and very few cats need a large amount of insulin. Talk to your vet about using Lantus, Levemir, or ProZinc insulins. These are good insulins to use.

that level is pretty low for just being diagnosed in all honesty so yeah, if this were me, i'd make a diet change first, then reevaluate glucose levels in a week or two before i'd start insulin.

i'd start hometesting too so you can watch what effect the diet change has right away because if the level for whatever reason goes up instead of down, you don't want it to get high enough to cause other complications.

fwiw, most the kitties i've seen were diagnosed with levels well over 400 so see what i mean by yours being low at diagnosis?

I've just started noticing that Twink was drinking a lot of water and urinating a lot. She also lost about a pound (though I hadn't noticed that). Ever since July though she's had these 'spells' where she gets very lethargic and won't eat or drink for a few days. I push water by syringe to keep her hydrated and she starts coming around after a day or two. Then she's fine for about 4-6 weeks. She has IBD pretty badly, so if anything messes with her diet she starts vomiting and I think that triggers it sometimes. She's been on steroids for the IBD which we're going to switch her off of now that she is diabetic. So should I suggest to my vet NOT to try injections just yet? I'm planning on getting a glucometer, wouldn't that give me enough information to know that she's still in a safe range?

Learning to home test Tweak's blood sugar would be great.

Read www.catinfo.org for excellent Feline Nutrition help written by a vet who posts here as Dr. Lisa (not every day).

Changing to food good for diabetics may also help the IBD troubles.

Re: Should I try food control only first? (EDITED)

kirami said:

She's been on steroids for the IBD which we're going to switch her off of now that she is diabetic.

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Steroid use can sometimes induce diabetes. Stopping the steroids can sometimes reverse the diabetes. But talk to your vet about other treatments for the IBD that won't affect the diabetes too much.

kirami said:

So should I suggest to my vet NOT to try injections just yet? I'm planning on getting a glucometer, wouldn't that give me enough information to know that she's still in a safe range?

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You can try diet first. Monitor your cat's blood glucose levels at home to see if the diet and no steroid use is helping. Testing a few times a day should give you enough info about whether you cat needs insulin or not. Normal blood glucose range is about 60 to 150. Some non-diabetics can test as low as 40 or so. Blood glucose levels do fluctutate all day long so don't worry if you see a 40 one time and then a 132 later.

Well...

I know nothing about IBD but I wouldn't just stop giving steroids! Sometimes cats have to have steroids, so until you've researched other options, please consider keeping her on steroids. If you take her off the steroids and she gets sicker from her IBD, its all rather for not isn't it? Yes, the steroids may be causing elevated blood glucose levels but diabetes is a heck of a lot easier to treat than IBD.

I would go to Dr Lisa's page www.catinfo.org and learn more about nutrition and IBD and diabetes. Consider a telephone consultation with her if you can afford it, and look to ways to better manage both the IBD and the FD. If you can find a food that will help lower BGs and not cause an IBD flare up then great, otherwise you MAY have to consider continuing the steroids and put her on a VERY low dose of insulin. It will be a balancing act...

Jen

I would not recommend stopping the steroid since IBD is bad and diabetes can be treated. Some steroids used for IBD such as budesonide have little effect on BG.

What steroid are you using?

She is on half a pill of Prednisolone twice a day. The vet said we were going to try to switch pred for a liquid anti-nausea medication. Not sure what it's called. She also said the insulin we were going to try is some really good human kind. I'm going to make sure to have sub-Qs around in case she ends up vomiting again, so she doesn't dehydrate. It's going to be such a difficult balancing act between the IBD and diabetes. I just have SO many questions, there is so much to know!

I've had non-diabetic cats read higher than that just from stress. IBD can show up as vomiting, diarrhea, or both. You can try 1/4 tab of Pepcid A/C b.i.d about an hour before feeding time.

Just keep asking questions. We would love to help you help your kitty.

Here is a video on hometesting: Video for hometesting
Here is a list of the things you will need:

A human glucometer. Any one that sips and takes a tiny sample is fine. The meters are often free at drug stores; it’s the strips that are expensive. You can, however, buy them on ebay at less than half the price of stores. Lots of people here also like the ReliOn from Walmart. It is an inexpensive meter and its strips are the cheapest around. Try the meter out on yourself or someone else before you try it on your cat. You want to be familiar with it before you poke the cat.

Lancets and a lancet device. Usually, until the ears “learn” to bleed, a 25-26 gauge is good. Any brand will work.

Ketone strips. (Ketostix) Just like human diabetics use. You will sometimes need to test urine if the numbers are high.

Rice sack. Make this out of thinnish sock, filled with raw rice or oatmeal and then knotted. You heat this in the microwave until very warm but not hot. Then heat the ears before poking.

Also nice to have. Flashlight: so you can look at the ears and find the little capillaries that come off the vein running down the ear. Vaseline: Put a tiny smear where you want to poke. It will help the blood bead up.

And some lo carb treats to give your kitty, successful test or not Lo carb treats

I keep reading that wet food is way better than dry, but Twink is very picky and I don't think she's ever really liked wet food. I will definitely try it, but not sure what will happen. She'll probably get sick from changing the food, she'll probably get sick from lessening or stopping the pred. How am I ever supposed to navigate all these issues?

When you say less than 10% carbs, is that the column on the Binky's chart with "% of calories from carbs"?

So the lancet doesn't come with the meter?

You have to find the right balance for your cat. My suggestion would be to continue the pred, investigate other food options, get a glucometer so you can test her blood glucose values at home, and see where things go. If she's consistently over 200 then she needs insulin, just not very much. Consider at that point either lantus or levemir at something like 0.5 units twice a day.

If she didn't have the IBD issues, it would be easy enough for us to say to switch the diet, but you have to be careful that you don't make her sick. Raw or quality canned should be better for the IBD and the diabetes, may lessen or stop the need for pred, but she also has to want to eat it. It can take time to transition a cat but it 'usually' is possible to do.

Jen

Yes, it's the "% kcalories from carbs" column.

Often a lancet device and a few sample lancets come with the meter. Not always, though. You have to read the box to see what is in it. It's only about 10 lancets, though, which won't last long at all, particularly when you are just starting out - we all tend to go through a lot of supplies during the "learning stage."

Also, you don't necessarily need to use the brand of lancet device and lancets that "matches" the brand of meter. (Strips must match the brand, but lancet device and lancets can be whatever type you find works for you. Lots of us have quite an assortment, from trying various ones until we find the one we like.)

In addition, some people like to use a lancet device (I certainly do!) and others much prefer to use the lancet "freehand." There is no right or wrong there. It is whatever you find works best for you. Trying it is the only way to know.

Kirami, it can be overwhelming at first. Try not to make a ton of changes at one time otherwise you will get confused about what is having an effect.

My sister-in-law's diabetic cat hates ALL Friskies food and bizarrely, she likes the canned Purina DM, which has to be obtained through a vet and is expensive. But it does help. Do NOT feed dry Purina D/M.

If your cat absolutely will not eat wet food, there are some dry foods that are much better than others. Definitely avoid any gluten in either dry or wet food. I have a diabetic cat in remission for about two years and he is fed Taste of the Wild Dry Kibble BUT this is only a supplement for snacks as he is a barn cat and lives mainly on mice and other tasty rodents.

Just keep asking questions and go at a pace comfortable for you. I am so happy that you are going to get a glucometer for home testing.

Best,
Rebecca

Thanks everyone SO much for the advice!

So, I am calling my vet today and suggesting that we first stay on pred and change her diet only, see what that does. Then if that goes well try taking the pred out. If her numbers don't stabilize with the change diet THEN try insulin. Not sure what she'll say...

Anyone have any suggestions on a wet food that might be good for IBD as well as low carb? I'm pretty sure anything like Fancy Feast will make her really sick (it's pretty rich right?). I'm figuring on slowly switching it out with her current food? I think that will be less of a shock on her system. If she absolutely won't eat wet and needs dry, what else should I do to help her out, not sure if she'd eat chicken and rice...

If you think her tummy will be delicate, I would start with a mixture of wet and dry - more dry than wet at first, then adding more wet and taking away the dry.

If you would like to get specific food types/brands for IBD, I would start a new thread with that for a subject line. We have lots of people with kitties with IBD.