New to the board (Vermont/Montreal)

Hi, I'm Jamie, one of Pippin's caretakers. Thank you for this website, it's very helpful.

My grandmother died this past spring, leaving her cat Pippin. Pippin is an indoor-outdoor neutered male cat who used to be extremely skittish, but in the past few months he's become positively hungry for attention. He's a really sweet, patient cat. He was a stray/semi-feral that my grandmother started feeding and eventually he decided to move in. We think he's probably about 11-12 years old but he could be older.

He is still living at my grandmother's house; a family member works at the house and feeds him, but he was losing a lot of weight. We took him to the vet last week and found out he has diabetes. We immediately switched him to wet food (before starting insulin) -- Friskies for a couple of days, until I could get Wellness. He loves it and is now eating Wellness Chicken or Turkey exclusively. I also bought a bag of Instincts raw medallions, but the vet advised against raw food since his immune system may be suppressed. Even with the food change, in the 4 days between the first vet visit and the second, he apparently lost more weight. :-(

On Monday, the vet started him on 1.5 u of ProZinc. I'm going to Walmart today to buy a glucometer and strips and taking him back to the vet next Monday to have a blood glucose curve done. The vet mentioned home monitoring, so I think she is open to us doing our own blood sugar testing. From what I have been reading, it sounds like the sooner we can get him regulated, the better.

The situation is a bit complicated because my cousin and his spouse are going to take Pippin to live with them in Montreal, but they can't take him for four weeks, so I am staying with him at my grandmother's house until then. (My partner and I would take him, but it seems like that would be more stressful for Pip. We also have two cats and a flatmate who's a bit allergic.)

So far administering the insulin has gone fine; he doesn't even seem to feel the needle. We're currently feeding him at 8 am and 8 pm and he usually eats all his food up right away. We've been feeding about one 12.5 oz can (sometimes a bit more) a day. I'm considering whether it would make sense to attempt tight regulation. I work from home, so I have the time and willingness. When he goes to Montreal, however, it's likely he'll go back to a 12-hour schedule for feeding and insulin because of their work hours. I think my cousin is a bit intimidated about testing blood sugar, but if I can get Pippin accustomed to it and show them how, I can probably talk them into doing it.

confused_cat Some questions I have:

1. Should I try for "tight regulation" with ProZinc, even if it's only for a month? Is it possible to continue if he has to go back to the 12 hour schedule? Maybe it's better to just stay on a 12 hour schedule for consistency?

2. I read the recommendation of tight regulation for newly-diagnosed cats, but does that still hold true if the cat probably had diabetes for a while and was undiagnosed? In other words, is he past the point where it's likely to make a difference in terms of remission?

3. The vet who sees my cats also does alternative medicine. I gave her a call to ask about food and she mentioned that she could prescribe Chinese herbs for Pippin. Has anyone tried this and was it helpful for your cat?

4. We're pretty sure that Pippin knows how to use a litterbox but given the choice he'll go outside. I figure it's probably good for him to continue his normal routine, but I'm wondering if we should try to keep him in sometimes so we can test his urine for ketones (the vet didn't mention this but it seems like a good idea.) I have no idea if he'll be willing to use the box with someone lurking around though. Thoughts?

5. Does Wellness have high enough protein/low enough carbs? Should I be looking for one of the canned foods with zero fruits and vegetables instead? Or making (cooked) homemade? Also, is it okay to give him a little bit of milk as a treat now and then?

I know that at this point we need to just start home testing and see how it goes, but I tend to go into research overdrive in these situations...

(Edited to add location)

Re: New to the board

Derp. Hopefully the photo will show up this way.

Re: New to the board

Hi Jamie! Welcome!

Wellness Chicken and Turkey flavors are great foods to feed a diabetic senior cat because they're both low in carbs and phosphorus (because senior cats commonly have undetected early stage kidney disease, low phosphorus, high quality protein (no byproducts) canned foods help reduce strain and save the kidneys from working so hard). Don't worry about the vegetables in it, because there is an insignificant amount present. From Catinfo.org:

Another example of a product with an insignificant amount of species-inappropriate ingredients is Wellness canned food. It lists several ingredients (such as carrots, broccoli, blueberries, etc.) that are high in carbohydrates but when you look at the actual carbohydrate content of the food, it is very low. What does that tell us? It tells us that those inappropriate ingredients are present in very low amounts and are listed on the label to appeal to the human who thinks that fruits and vegetables are good for cats. Cats have no need for fruits and vegetables but they are acceptable ingredients if present in low amounts.

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Yes, it's definitely a good idea to test for ketones! This can save his life. Especially when you're just getting started, and he's in higher numbers. More info on ketones: http://www.felinediabetes.com/ketones.htm, and this page is very helpful in getting you started with the strips: http://petdiabetes.wikia.com/wiki/Urine_testing_stix.

As for tight regulation, it depends on what type of insulin you're using. With Prozinc, from what I've read I believe the recommended dosing guidelines the Start Low, Go Slow approach: http://binkyspage.tripod.com/SLGS.html, and not the "Tight Regulation" approach (where you give insulin three times a day) developed by Dr. Hodgkins. The newer human analog Prozinc has a slightly longer duration of action than the old bovine PZI that Dr. Hodgkins developed the protocol for, so it's no longer valid to use. Prozinc should be dosed every 12 hours as far as I know; I've only used Lantus so I'm not very experienced with Prozinc.

The current recommendation for tight regulation for diabetic cats is with the insulins Lantus (glargine) and Levemir (detemir). The tight regulation protocol developed for those insulins has an 84% remission rate for cats diagnosed within 6 months, and a 64% remission rate overall. Because the duration of action is longer in these insulins, they are usually recommended over Prozinc. Tight regulation for Lantus and Levemir also requires shooting on a 12/12 schedule, and getting at least three tests a day (once before each shot and at least one mid-cycle test, but more are better).

There is a window on those remission rates, which means the sooner you start tight regulation with Lantus or Levemir, the sooner and more likely it will be you'll reach remission. However, given the expense of insulin, it's understandable if you want to give Prozinc a try since that's what you have now, and it's not a bad insulin. There aren't any hard studies done on it's remission rates, but given the rates of the old PZI (6-8 hr duration) and the duration of action of the new Prozinc (8-10 hrs), the remission rate is likely 50+%.

Re: New to the board

Welcome! How great that Pippin has a team - what more could a kitty need?

1. Should I try for "tight regulation" with ProZinc, even if it's only for a month? Is it possible to continue if he has to go back to the 12 hour schedule? Maybe it's better to just stay on a 12 hour schedule for consistency?

We do suggest starting low and going slow for most diabetics and yes, for ProZinc. I think it is very premature to suggest changing insulin. ProZinc works very well in many cats and since you have it, I would use it. Your starting dose is rather high, so I will be relieved when you are testing regularly. We usually suggest starting at .5 to one unit twice daily.

I would stay on the 12/12 schedule, always getting a number at preshot and getting a number around +6 whenever possible. The +6 number will telll you how low he goes with the insulin and help you adjust the dose. We suggest not shooting under 200 but to wait 20 minutes, without feeding, and retest. To make sure the numer is rising, not falling and to get a shootable number.

2. I read the recommendation of tight regulation for newly-diagnosed cats, but does that still hold true if the cat probably had diabetes for a while and was undiagnosed? In other words, is he past the point where it's likely to make a difference in terms of remission?

No one knows. Every cat is different. You should have a better take on that in a few weeks when you have data and see how the insulin is working. We do not advocate tight regulation for any ProZinc cat; it was prescribed by Dr. Hopkins on another site to which she no longer contributes and it was using PZI which, although similar, is not ProZinc. Once you have a lot of data on a cat, if he seems to need insulin more than twice daily, we have had cats that get shots three times in a cycle, but only after lots of data.

4. We're pretty sure that Pippin knows how to use a litterbox but given the choice he'll go outside. I figure it's probably good for him to continue his normal routine, but I'm wondering if we should try to keep him in sometimes so we can test his urine for ketones (the vet didn't mention this but it seems like a good idea.) I have no idea if he'll be willing to use the box with someone lurking around though. Thoughts?

Yes, it would be wise to test for ketones. For Oliver, we had to give him an empty litter box filled with aquarium gravel to get a sample. Other people use saran wrap dug into the box.

Here is a large document about ProZinc. It has many links and lots of information: http://www.felinediabetes.com/FDMB/viewtopic.php?f=24&t=32799

Keep reading and asking questions. We'd love to help you help Pippin.

Hi Julia and Sue! Thank you for your welcome and the advice. I did read that other site by Dr. Hopkins and didn't realize that it wouldn't apply to ProZinc. Very good to know.

I'm glad to hear that Wellness is good. I was wondering about kidney disease, but the vet told me he's okay on that front (for now, anyway.)

It sounds like the main thing to do is get some data on how the insulin is affecting him.

I picked up a Relion Prime at Walmart. It was $16.24 and the strips were half the price of the Relion Confirm/Micro ones -- $9 for 50. I think they just came out with this one. The strips might be smaller than others.

We did a "dry run" of testing tonight. Pippin was nervous about it, but he didn't seem bothered by the click of the lancet device, and he got a small piece of canned chicken breast as a reward. I tried to test myself but had a hard time getting a big enough drop of blood. The lancets are 26 gauge so that might be why. He's only eaten about half his food, so now I'm wishing I had gotten an actual reading.

Update: I tried to test his blood sugar at about 11pm - he was sitting next to me relaxed so it seemed like a good opportunity. I did manage to prick his ear but maybe not deep enough or far enough toward the edge (???). I was scrambling to get the strip in the meter while holding him still and couldn't get enough blood. I'll make a rice sock tomorrow and see if that works better than the washcloth/massaging with fingertips. I don't think I hurt him but I feel bad about having to hold him still.

The aquarium gravel idea is brilliant! Thank you!

You could also use a pill bottle filled with very warm water and then leave it behind the ear to have something to poke against. Your 26 gauge lancets should make a big enough hole. You can always double poke - a quick second poke in the same spot- and "milk" the ear to get the blood to move.

Lots of us did not get blood the first time. Continue to poke with confidence; you'll get it.

Pippin's Team said:

I was wondering about kidney disease, but the vet told me he's okay on that front (for now, anyway.)

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The thing with kidney disease is that it doesn't show up in blood tests until about 75% of kidney function is already gone. It can be detected earlier in a Urine Specific Gravity test, but most people don't have the vet do that test annually like they do with bloodwork with senior cats. The earlier in the disease you start feeding a kidney friendly diet (low phosphorus, high quality protein), the more you can halt it's progression. Given that kidney disease is so incredibly common in senior cats (especially ones that ate a dry diet most their lives), it's not a bad idea to feed a kidney friendly diet to senior cats even before diagnosis. While it doesn't prevent kidney disease, if they don't have kidney disease it's still a very healthy diet for a senior cat, and if they do have kidney disease you're extending the cats life by quite some time.

Pippin's Team said:

I picked up a Relion Prime at Walmart. It was $16.24 and the strips were half the price of the Relion Confirm/Micro ones -- $9 for 50. I think they just came out with this one.

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I haven't heard of the Prime, but the other Relion meters are inexpensive and great meters to use; I usually recommend them because of the price. You definitely want to get something where you can afford to test several times a day! Test strips and insulin are the only real significant costs to treating diabetes.

Pippin's Team said:

The lancets are 26 gauge so that might be why.

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26g lancets are the ones you want to use to start out with! Often (myself included) people start out with the smaller 30-33g lancets thinking they'll hurt the cat less with the pokes which will make testing easier. This is actually not the case; it's not the poking the cats don't like (they have very few nerve endings in their ears so it doesn't hurt them), it's being restrained and having something new and strange done to them, and sensing that their person is nervous or scared while they're testing them. So the more quickly and calmly you can get that drop of blood, the more the cat will tolerate the testing. It's hard first when you're learning, but once you get it down after a week or two, it is SO much easier. I remember being in tears the first week I tested Bandit, thinking he would never cooperate and that I would never be able to test him several times a day. 2 weeks later he was fine and I was doing it one handed while on the phone.

The thing with kidney disease is that it doesn't show up in blood tests until about 75% of kidney function is already gone. It can be detected earlier in a Urine Specific Gravity test, but most people don't have the vet do that test annually like they do with bloodwork with senior cats.

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Yikes.

This is actually not the case; it's not the poking the cats don't like (they have very few nerve endings in their ears so it doesn't hurt them), it's being restrained and having something new and strange done to them, and sensing that their person is nervous or scared while they're testing them. So the more quickly and calmly you can get that drop of blood, the more the cat will tolerate the testing. It's hard first when you're learning, but once you get it down after a week or two, it is SO much easier. I remember being in tears the first week I tested Bandit, thinking he would never cooperate and that I would never be able to test him several times a day. 2 weeks later he was fine and I was doing it one handed while on the phone.

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Hah, doing it one handed? That is awesome and very reassuring. Yeah, he really doesn't like being restrained. I managed to get a pre-shot reading this morning of 404 and a pre-shot reading tonight of 362. Tried to get one at +6 this afternoon but it didn't work out. The evening one didn't go too well. I poked him three times, couldn't get a good drop, then washed his ear (I put a bit too much vaseline on it in the am) and tried again until I got it. I think I haven't been pressing the lancet device tightly enough against his ear. I just tested again at 11:15 (~2.25 hours post-shot), which went better -- the reading was 289.

Pippin is really quite easy-going about it. I can't imagine my cats putting up with all the fumbling around and poking. He's still drinking a lot of water (about a cup in 24 hours, though some may have sloshed out of the bowl while he was drinking). He does go out on the prowl (he caught a couple mice this week) but is spending time inside too, which might be that he's happy to have the company. Or he's feeling bad/lethargic.

I'm worried after reading another thread that he might going too low and then bouncing back up, since the numbers are still so high. I really would like to get a +6 reading. At this point, I may just stay up to 2:30 and try to get it.

I tested the litter that I have here in some water with the ketone strips and it came up negative, so I might end up testing the urine in with the litter. I'm leaving out an empty litter box and one with a plastic bag over the the litter, hopefully he'll use one of those. I have a feeling he'll wait until after I've gone to sleep. If I don't get to it until a few hours after he urinates, is it worth testing? If not I guess I'll keep him inside tomorrow and attempt to sneak up on him. Update: he used the box with bag in it! Ketones were negative.

I found a raw patch on Pippin's belly, which I think I probably caused trying to trim out some knots. Put a little bacitracin on it... I just googled it and apparently it's toxic and bad for the kidneys. Argh! I'll see if I can wash it off. He's actually been grooming today, which is great since we think he hasn't been grooming lately and he has some bad mats (the vet shaved off some of it, but there's still patches.)

+6 test last night was 59. That's low, right? Unfortunately I failed to get a reading at +7. The AMPS was 288 which is similar to his +3 last night so I decided to only give 1 unit. I'm going to be away tonight to Saturday night. Should I have my cousin give 1 or 1.5 units? He's not going to test.

Yes, 59 is a nice low nadir. (we consider intervening with higher carb food below 40). So yes, some bouncing may be the reason for the higher preshot numbers. I like your reduction to one unit. And the preshot of 288 is nice.

I would test all you can at preshot and nadir today and tomorrow so you have data to make a better decision about when you will be gone. Is it just one shot? (you can see why we wanted data instead of starting tight regulation. You just can't predict how any one cat will react to wet low carb + insulin). Pippin is having a great reaction!

Welcome Pippin and team!

A few things-
ProZinc is a great insulin to start out with, so doing good there.

Ear tests- warm the ear up with massage, rice sock, pill bottle- just get it warm! Until the capillaries get into the area Pippin won't bleed that much or consistently, plus try the lancet on its own a time or two to see if it gives you more control. And once you get the drop- scoop it up with a finger nail rather than the test strip (this helps with restless kitties!) You can test from your nail easy that way. And I have a Relion Micro, it is a good brand. I purchase my strips from American Diabetics Wholesale- 250/$72. I never heard about the Prime, it might be new. I hope it takes a small amount of blood .

59 is a GREAT nadir but the 1.5u might be too much, causing him to bounce for the preshot times.

Food- while he is unregulated Pippin will want to eat- he is basically starving right now as his body is unable to pull the needed nutrients from the food. Once he is on insulin his food intake will go down. The trick to help level his BG's throughout the day is several small meals. Once he goes to his fur-ever home you can suggest freezing 1-2 oz of the food to leave out during the day and night so he can eat when he needs to. It will thaw in a few hours and then he will get a mid-day pick me up, or get a feeder that will pop open at a certain time during the day. He can NEVER go back to dry food- they have too much carbs and he will never get better and could just keep getting worse.

Good luck, Jamie

Hi hmjohnston!

Until the capillaries get into the area Pippin won't bleed that much or consistently, plus try the lancet on its own a time or two to see if it gives you more control.

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Yeah, that's what I've been doing. I actually put the lancet in the device but take off the cap and use it freehand. Gives me a bit more to grip. I think I may be able to switch to a smaller gauge lancet soon, he's bleeding much more easily now.

And once you get the drop- scoop it up with a finger nail rather than the test strip (this helps with restless kitties!) You can test from your nail easy that way.

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I wanted to say thanks for this tip, it has saved me from having to retest a couple of times!

I never heard about the Prime, it might be new. I hope it takes a small amount of blood

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Yes, it is new. There's a thread about it here. It takes a tiny bit more blood (0.5m vs. 0.3m) than the Micro.

Food- while he is unregulated Pippin will want to eat- he is basically starving right now as his body is unable to pull the needed nutrients from the food. Once he is on insulin his food intake will go down.

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Yeah, he was eating a ton before. Poor guy. I'm not sure at the moment whether he's eating less because he's starting to get regulated or if he's too low/too high and that's affecting his appetite. I did drop the dose. I also made another post with an update on Pippin's numbers. I'm putting food out during the day when I can or leaving out frozen, but he doesn't seem to be too into it sometimes.

Thank you for all your help!