Newly diagnosed 7 yr old mixed cat

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Jo & Nola

Jo & Nola

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Hi everybody! Let me start by saying this forum has given me the strength to question everything and really strive for my cats health and for that Im eternally grateful. I have 2 cats: Leon is male 8 yrs old and Nola, female 7. Both mixed, spayed/neutered and fully indoor cats (I live in a very populated city where cats that go outdoors die young due to poisoning, car accidents and/or other feline strays spreading diseases). I swear they must be biological brothers because they look so similar, except Leon has extra long hair and Nola has mid-length hair. I rescued both of them from being stray cats in my neighborhood when they were few weeks old (their mom abandoned them).

The last 2+ years of her life before the diagnosis she dropped a lot of weight, her eating habits changed to being extremely food motivated and drank sooo much water, that my litter expenses were ridiculous. All of these symptoms were described to the vet on 2022 when she first stopped eating out of the blue. At that point nobody ever mentioned diabetes (having no experience or knowledge on diabetes, I personally had no clue these are all clear symptoms). She was diagnosed a UTI and prescribed an urinary diet (Royal canin Urinary SO). We live in the Dominican Republic, so options for cats are extremely limited in every category (pet stores here offer 95% of their stuff for dogs). This was one of 2 brands of urinary cat food available and only in dry form it was consistent. The wet food sometimes came in and sometimes they were not available. Before this, her diet was Taste of the wild kibble (known for being full protein and grain free) at night free fed, and wet food (taste of the wild, then they stopped importing it to the country so I had to switch to Friskies wet food cans 3 times a day) : 1/4 of a 5.5 ounce wet food can every meal).

She went a few more times to the vet throughout the years for regular checkups and no flags. Then on July 26 this year she stopped eating again and I took her to the vet the 27th, when she was diagnosed as diabetic.

I thought her extreme thirst was due to the urinary food she was then eating, instead of a symptom of diabetes. And naively I thought it was a good thing that she was drinking so much water as cats are known to be dehydration prone. I now look back and it makes me so mad that even having expressed all the symptoms we still didn't caught it "in time" and now my vet is saying remission is a fallacy and its not possible for her...

I still have hope of remission, largely given by this forum. I have changed both cats to a fully wet diet, twice a day. High protein low carb: (Ive been ordering from USA's amazon tiki cat wet food). Current treatment by vet: 1 IU of Lantus Solostar Insulin (pen) and BG monitor: Abbott freestyle libre. I love this monitor because its easier for me to get 15+ readings a day without Nola's discomfort. It's costly so 'll keep using it until we have figured out her "right" dosage, I'll then switch to the lancer/strips method. On her diagnosis date she weighted 7 lbs and she's now at 9 lbs!! (24 days since diagnosis).

Please feel free to add any bit of information you think might help me, I will FOREVER be grateful. My cats are my kids, I see no difference, this diagnosis has been really tough on me. Did I cause this? was this caused by the urinary SO kibble? (I stopped even my non diabetic cat Leon from eating it, he no longer eats kibble). I want to make sure I take all the steps to not only give Nola the best life she can have but also prevent Leon from a diabetes diagnosis if possible.

Thanks again.

Jo & Nola

Notes: Initially the vet had prescribed Recomulin-N (NPH I think?) twice a day, 3 IUs in total. After reading some articles here, about studies showing Lantus & remission links I told her we were switching to Lantus. We started 1 IU per day. Wish us luck!!
 
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Welcome Jo and Nola
It would be helpful if you could set up our spreadsheet where we track our cats BG
Here is the link and will also explain how to use it, it's not that hard
https://felinediabetes.com/FDMB/threads/how-to-create-a-spreadsheet.241706/
Can you add to your signature you are from the Dominican Republic. To add it tap on your name up top then tap on signature and add it then tap save. If you need help setting it up just ask , we have a member who will help you .
You can read all about Lantus here.
Are you able to get the U-100 syringes with half unit markings for Lantus? We use these because we adjust the dose by 0.25 units at a time and these make it easier to do
https://felinediabetes.com/FDMB/forums/lantus-levemir-biosimilars.9/
Also read about the 2 dosing methods to chose from and add it to your signature and spreadsheet when you set it up

If you are using the pen to give Lantus you can only adjust by whole units

  • Full and half-unit syringe scales:
49823063143_3437e9e997_o.jpg

  • Don't reuse syringes. You'll not only run the risk of contaminating the vial/cartridge/pen, but re-using a syringe may be very uncomfortable for your cat:
So since you can only adjust the pens by whole units you need to buy U-100 syringes with half unit markings since we either increase or decrease by 0.25 units at a time
These syringes make it easier to do that
Just take the cap off the pen and use a U100 syringes and pull the insulin out of the pen! You will see a small gray rubber stopper, insert the syringe there

you can get them from Amazon without a vets script
https://www.amazon.com/UltiCare-31-Gauge-Veterinary-Insulin-Syringes/dp/B009LTE0DO
 
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Jo & Nola said:
Hi everybody! Let me start by saying this forum has given me the strength to question everything and really strive for my cats health and for that Im eternally grateful. I have 2 cats: Leon is male 8 yrs old and Nola, female 7. Both mixed, spayed/neutered and fully indoor cats (I live in a very populated city where cats that go outdoors die young due to poisoning, car accidents and/or other feline strays spreading diseases). I swear they must be biological brothers because they look so similar, except Leon has extra long hair and Nola has mid-length hair. I rescued both of them from being stray cats in my neighborhood when they were few weeks old (their mom abandoned them).

The last 2+ years of her life before the diagnosis she dropped a lot of weight, her eating habits changed to being extremely food motivated and drank sooo much water, that my litter expenses were ridiculous. All of these symptoms were described to the vet on 2022 when she first stopped eating out of the blue. At that point nobody ever mentioned diabetes (having no experience or knowledge on diabetes, I personally had no clue these are all clear symptoms). She was diagnosed a UTI and prescribed an urinary diet (Royal canin Urinary SO). We live in the Dominican Republic, so options for cats are extremely limited in every category (pet stores here offer 95% of their stuff for dogs). This was one of 2 brands of urinary cat food available and only in dry form it was consistent. The wet food sometimes came in and sometimes they were not available. Before this, her diet was Taste of the wild kibble (known for being full protein and grain free) at night free fed, and wet food (taste of the wild, then they stopped importing it to the country so I had to switch to Friskies wet food cans 3 times a day) : 1/4 of a 5.5 ounce wet food can every meal).

She went a few more times to the vet throughout the years for regular checkups and no flags. Then on July 26 this year she stopped eating again and I took her to the vet the 27th, when she was diagnosed as diabetic.

I thought her extreme thirst was due to the urinary food she was then eating, instead of a symptom of diabetes. And naively I thought it was a good thing that she was drinking so much water as cats are known to be dehydration prone. I now look back and it makes me so mad that even having expressed all the symptoms we still didn't caught it "in time" and now my vet is saying remission is a fallacy and its not possible for her...

I still have hope of remission, largely given by this forum. I have changed both cats to a fully wet diet, twice a day. High protein low carb: (Ive been ordering from USA's amazon tiki cat wet food). Treatment by vet: Recomulin N shots twice a day and monitor: Abbott freestyle libre. I love this monitor and will keep using it until we have figured out her dosage, I'll then switch to the lancer/strips method. On her diagnosis date she weighted 7 lbs and she's now at 9 lbs!! (24 days since diagnosis).

I just called the vet today to tell her we are switching to Lantus, so she recalculated and we'll start tomorrow morning with 1 IU per day. Wish us luck!! Please feel free to add any bit of information you think might help me, I will FOREVER be grateful. My cats are my kids, I see no difference, this diagnosis has been really tough on me. Did I cause this? was this caused by the urinary SO kibble? (I stopped even my non diabetic cat Leon from eating it, he no longer eats kibble). I want to make sure I take all the steps to not only give Nola the best life she can have but also prevent Leon from a diabetes diagnosis if possible.

Thanks again.
Jo
Click to expand...
@Sienne and Gabby (GA)
 
Welcome to FDMB!

Well..... Your vet is wrong. Cats can and do go into remission. The good news is that Lantus has a great track record for getting cats into remission. I'm linking the guidelines for treating diabetes from the American Animal Hospital Assn. If you look at the section on treating diabetes in cats, they point out that cats can go into remission. In fact, on p.3, they state, "In cats, diabetic remission is a reasonable goal." (You might want to share the information with your vet!)

I'd encourage you to post regularly so we can help you get started with managing your cat's diabetes. This is a link to the Lantus forum. There are sticky notes at the top of the board that will help you have a broader understanding of how Lantus works, dosing methods, etc. I'd stick with posting here on Health until you feel like you've mastered the basics.

I'm not familiar with the insulin you have been using. Please make sure that you have the appropriate syringes and you want to use a syringe not the insulin pen. Lantus is a U100 insulin. The U100 refers to the concentration of the insulin. The syringe you use should be a U100 syringe. (There are other insulin that are U40 and they require a U40 syringe.) You want to get U-100 3/10cc syringes with half unit markings.

Please let us know if you have questions. We're here to help.
 
Hi Diane Tyler's Mom, @Sienne and Gabby (GA), & @Marje, Mike, and Gracie (GA)!

Thank you for all the info, it feels me with so much hope!!! I just filled out Nola's Spreadsheet, I think I understood how to fill it out? (fingers crossed). I would love it if you could check it out and see if it makes sense to you, or let me know if I need to change something? I'm still getting used to the hours +.25, .5, .75 time increments, etc.

I put in the actual time in notes in each cell to see if what I did makes sense to you.

I'm so excited to follow SLGS&TR and to understand it better. Nola started with Lantus pen (1 IU) this Wednesday August 21st. The BG readings since that day are in the SS. I'll try to find the recommended needles ASAP so I can do the 0.25 increments as the protocol states when she gets needs it.

I also updated my signature as suggested.

Best,
Jo
 
Hi and welcome to the forum.
You are doing very well with testing!
These are the syringes you need
U100, 3/10ml, 30 or 31 gauge, 6 or 8 mm insulin syringes with 1/2 unit markings.
I’ll post below how you draw the insulin from the pen you have now.

Re the food . Please give snacks of the low carb food two or three times each cycle as well as the two main meals. A snack is a teaspoon or two.

just noticed you are only giving the insulin once a day. Cats need insulin twice a day otherwise they will spend half their time without any insulin.
 
Bron made an excellent point. Cats have a fast metabolism. While Lantus may be dosed once a day in humans, cats really need to be given a twice a day injection. Even though Lantus has a longer duration than most other insulins used for cats, it begins to wear off after about 12 hours. Its activity peaks at about 6 hours (+6 -- although the nadir can and does vary).

The other issue is that Lantus is a "depot" type of insulin. What that means is that when you give a shot, the insulin forms microcrystals that are deposited in the fat tissue. The crystals, or most of them, dissolve over the 12-hour cycle. A small amount remains and continues to work which gives Lantus is long duration and gentle action. It takes about 5 - 7 days for the depot to form and stabilize, However, if you are dosing once a day, the depot will never fully become established and you lose what makes Lantus an effective insulin for cats.

With the Start Low Go Slow (SLGS) approach to dosing, you would start Nola at 0.5u twice a day. Shots should be 12 hours apart. With the Tight Regulation protocol (TR), the starting dose of Lantus is based on your cat's weight (0.25 x cat's weight in kilograms = 0.25 x 4.08 = 1.0). You can keep your cat at the 1.0u or you can drop the dose back to 0.5u.

Again, as Bron noted, we really encourage you to use syringes rather than dispensing Lantus from the pen. The pens do not allow you to use doses that are less than 1.0u. We adjust doses by 0.25u increments. If you were to increase Nola's dose at this point, you would need to double the amount if you were using the pen. That could be risky -- doubling the dose could result in hypoglycemia. Using a syringe gives you far greater control over dosing. (The pens were developed for human diabetics and the doses for humans are way bigger than for cats.) In addition, you have to prime the pens and you end up wasting insulin every time you need to give a shot. You may need a prescription to buy syringes. in your area or with some online providers. The good news is that you can order syringes from Amazon without a prescription.
 
Hi! Fortunately I was able to find U100, 3/10ml, 31 gauge, 6 mm insulin syringes with 1/2 unit markings in the island(no prescription required for products that don't contain medication)! I'm ordering them right now. Shots twice a day does complicate daily life logistics, but if this is the best way to get her to remission, I'll do anything she needs. SLGS says 0.5 IU twice a day 12 hours apart vs TR: 1 IU once/day? Knowing she's getting 1 IU at 8:30 AM every morning now, can I safely switch her tomorrow to 0.5 IU at 8:30 AM + 0,5 IU at 8:30 PM ? And then hold this dosis for 5 to 7 days while constantly monitoring her? Note: She's been in her current Lantus treatment since Aug 21st. If I keep her at 1 IU for 5 to 7 days, then this next Tuesday we would switch dosis according to her BG readings and the corresponding protocol.

About DIABETIC KETOACIDOSIS (DKA) (my vet has never mentioned this, Im no longer surprised at this point). If we keep doing 1 IU/day (TR) your protocol says its necessary? I don't fully understand how Ill get these samples, unless I leave her litter box without litter and she just pees and makes a puddle? I have another cat, Im not sure how the logistics of this process work. Would any DKA test work? I wouldn't be able to test her immediately, as I need to order them in Amazon in the US, and that take 2 to 4 days after US delivery to get to my home.

Regarding food: They're both already on High protein low carb wet canned food: Tiki Cat wet food cans. I believe according to the charts that these are waay below 10% carbs. They're eating 6 oz a day of wet tiki cat. For the snacking that Bron mentioned, I should give her 1 teaspoon of low carb(less than 10%?) high protein food again, 2 to 3 times a day (if in TR) or 2 to 3 times every 12 hours if in SLGS? Having the right food available is surprisingly my biggest headache here in DR, so I need to plan ahead and order to Amazon US with some time. If I run out of food at any moment my plan was to cook her ground beef with offal and chicken heart, I bought some tiki cat broth she LOVES so ican put it with the homecooked meal and shell then want to eat it.

Ill be sending these (1, 2) to the vet so she's at least notified of how ill be changing dosage and hopefully when we get Nola to remission, she can no longer say to other patients that its not possible.
 
Twice a day insulin: No matter which dosing strategy you use, shots are always twice a day, 12 hours apart. No matter what the insulin is that you're using, dosing is always twice a day. If you're going to switch to SLGS, you can dose 0.5u twice a day. I am a little concerned that its may not be enough insulin but we'll have to see what Nola's numbers look like. If you opt for TR, you would give 1.0u twice a day.

Testing for ketones: Unless your cat has a history of developing ketones, you don't have to test all that frequently. At the moment, Nola is sitting in higher range numbers. Testing at least once a day would be a good idea. Most people stalk their cat to the litter box and dip the Ketostix into their cat's urine stream. The alternative is that there are meters that use a blood test for ketones (e.g., Precision Xtra or NovaMax and there are others). These meters work just like a hand held glucometer. Since you're using a Libre, Nola isn't used to your doing blood tests, though. The link you provided for test strips are fine. There are a several companies that make strips. I've never seen anyone comment that one is better than another. It's likely that a local pharmacy would carry ketone test strips. You might want to call around and find out.

Food: Giving your cat small meals several times a day is great. The issue with a home made diet is that it's not nutritionally complete. There are a number of supplements that are necessary to make sure your cat is getting all of the vitamins and minerals, etc. that are necessary. There are pre-mixes that many of us in the US use. These are powders that are mixed with water and added to the raw/partially cooked food. The two most reliable are FoodFurLife/EZComplete or Alnutrin. It looks like the EZComplete is available on Amazon.
 
Thank you for the info!! Ill make sure to buy the EZComplete when I feed them homecooked. Nola has been doing 100-199 for the last 8 hours. Im a little scared in giving her 1IU again for her PM shot thinking it might drop too low. Can I do 0.5 as PM shot? What do you suggest? When she was on the other NPG insulin her PM shot had to be reduced from 1 to 0.5 because at 12-2 Am it always dropped below 80, sometimes even 40.
 
She did amazing!! I was unnecessarily stressing out :facepalm:
I'll keep her 1 IU every 12 hrs for 5 to 7 days and recheck if I need to increase or reduce (probably increase 0.25u). Do you think I should do this at day 6 or 8th ?
 
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