Newbie needing advice from step 1

Hi everyone! I'm glad to have found this forum and hope to meet many knowledgeable people. (p.s. both my vet and my cat are females so if the pronoun usage of "she" anywhere is unclear let me know)

My kitty Trixie was diagnosed last week with diabetes. I scheduled a vet appointment after noticing weight loss, increased thirst and increased urination. Since she was on a reduced fat diet (iVet reduced fat) for being a little chunky, at first I just thought her diet was working. I didn't want to admit to myself that there might be a problem, especially when I had a hunch about what it might be Her blood test showed she had 500 parts glucose (I'm sorry, I don't know the units of measure). My boyfriend and I went back to the vet today to learn about insulin, giving injections, coming back for a curve, etc. The Rx written was for Lantus, starting at 1 unit 2x/day. I need to start calling around tomorrow to see where the best place (price) to fill it is. So she hasn't started taking it yet.

In our initial appointment when the possibility of diabetes was first being discussed, the vet mentioned that Trixie would have to go on Purina DM (dry). I have some issues with 'prescription' cat food anyway and even more so after a day of reading from catinfo.org (Dr. Lisa Pierson's stuff) and some of the FAQs/links on here. I would prefer to feed something that my non-diabetic cat (4 y.o. bengal) can have too anyway. She made it sound like there wouldn't be a way to feed the cats the same kind of food, because it would be too high in something or other for the non-diabetic cat. I mentioned the idea of wet cat food, and the vet said that wet food was actually worse than dry because of the gravies. Well of course the gravy and sauce ones wouldn't be good for her health, but according to Dr. Pierson "any wet is better than dry" and there has to be something that would work, right? We ended up deciding to just go with regular iVet for now (so now it's okay for them to eat the same food?) I'm not really pleased with where we left the appointment on the subject of diet and I'm scared that I'll have to make a bunch more vet appointments if we try to switch cat food later so that her insulin dosage can be adjusted in tandem.

I really wanted to try and see what we could do for her diet-wise, but I feel like that conversation got shut down immediately... I didn't want to be one of those "but I read on the internet!!" patients so I didn't press it. Now I feel like I won't get a chance to revisit the issue, or that will sound like I'm trying to override her (the vet) years of education and experience just because I read some articles. I don't feel particularly comfortable challenging my vet as a layperson who did some reading over the weekend.

I understand that Trixie will need insulin, I'm not trying to avoid giving my cat insulin, I just feel like the diet portion is something we should give a serious look at up front as well. But I also don't want to harm my cat or possibly make her feel worse by putting off filling the insulin rx...

 

Be one of those "but I read on the internet" patients!

Diet is an absolutely key piece to this puzzle of treatment. You are absolutely on the right track. If you are going to be changing from a high carb dry food to a low carb wet food, you want to do this before starting insulin or at least you also want to be hometesting to see what kind of drop in the numbers the food change gives you, because changing the food WILL drop the numbers. Many of us feed OTC low carb wet foods (not gravy! ) and we use Dr Lisa's charts on the page you have already found! If your vet is just not cooperative on the food change at all, just tell her your cat won't eat the prescription food. Most stop eating it after a short time anyway.

Many cats do need at least a short time of insulin support and if your cat is in the 500s, that's pretty high, I'd probably get that script filled. 1U b.i.d. is a very common starting dose.

If you start hometesting, you shouldn't need any vet appointments, you should be able to just give the vet your numbers and adjust from those. Your vet sounds like a peach so I am guessing she is one who will poo-poo hometesting. Hometesting is the best way to know what is going on and adjust treatment properly.

Spend some time reading the stickies around the forum. There are years worth of diabetic treatment experience accumulated here.

Welcome!

 

@Melanie and Smokey thank you for your reply. Yeah, I feel like I don't have time to "shop around" for a different vet at this point. Your comment about her numbers being high makes me feel like I don't have time to address the diet issue before giving her insulin, either. You think the sooner the better on the lantus, even with the crappy cat food? I didn't buy the Purina DM, I bought the iVet dry food as a temporary compromise, I suppose, and so I could feed both my cats the same thing. iVet, if you aren't familiar, is just a veterinary exclusive brand -- it's not any better or anything special... it's just what I bought (they were previously eating iVet reduced fat).

I'm not sure how to call my vet to politely disagree with her treatment plan (not looking at the diet component closer). I don't want to sound like I think I know better than her... I am very inclined to trust the collective experience of those who have been through it, as many of you have been. I think I can learn a lot from those experiences, and if diet is stressed a lot on this board then it must be important.

No mention of home testing at the vet appointment, though that is something I'm willing to learn about. I need to be able to have that information about my cat to be the best caretaker. There is no other way to know. I have to be honest though, the very thought of extracting blood makes me extremely nauseous and panicky. It's not the sight, it's the process.

 

Hi

When my cat remi was first diagnosed I actually contacted dr Pierson and whilst I couldn't afford a consult she did kindly reply and mentioned that she wouldn't leave a diabetic cat for longer than two or three days without starting insulin and so this is what I did. I chose a food that I thought would suit my cat and started the switch that day. My plan was to change by 25% on the first couple of days! then up to 50%, etc but remi was keen to go faster and so I think the switch was made within the first few days and remi was almost on wet only by the time we started the insulin.

In the meantime I got the insulin and all the home testing stuff I required and read up all the relevant info on handling, storing and using the insulin.

But if you are transitioning at the same time that can be worked around, the advice is to just note it in your signature along with the insulin you are using.

This link will help get you started http://felinediabetes.com/FDMB/threads/sticky-lantus-levemir-new-to-the-group-please-read.18139/

 

Hey - you've had some really great already, so all I want to add at this point is - you absolutely have all the say in the world as to how to treat your kitty! Yes vets have an education, but you also can educate yourself on this topic and informed so as to work with your vet .

Have a look around the forums and read the pinned posts in the Lantus and Lev forum about protocols you can use and what others are doing in there.

Remember - your cat, your call. Hopefully with the support of you your vet

Welcome to the most useful place on the net for cats with the diabeasties (as it's known in our house!)

 

Hi, well. I must say that I am one of those person that "read on the internet" and my vet was not thrill about it. He thinks I am stubborn and ask one million questions, on the other hand he acknowledges that I am an informed stubborn, so he pays attention to my questions and even suggestions. If I had follow his instructions, maybe my cat will have passed some time ago instead of being on remission for the last couple of months.

It is important to have a good relationship with your vet, but most of the people at FDMB just use the vet for prescriptions, blood tests and other things that you cannot do at home.

In my not so long experience with diabetes, I must say that home testing is vital, it can save your cats life, diet is also a very important part (some cats rise their numbers even the food they are getting is below 10% and need to stay in the 4-5% range).

Testing at the vet can cause stress and therefore, the vet might prescribe a dose of insulin that might be too much for your cat, specially if you are changing his diet to only wet and was before on dry (whatever kind or dry that was).

I agree with the other, people know much better how to treat cat diabetes than many vets and it is not that vets are bad, but vets have a general training and see many species, dob diabetes i s different from cat diabetes, and then they also have patients with pancreatitis, CKD, heart problems, etc. etc. Then it is important that the vet is open to collaborate with you. I have read her about many vets that get quite impressed after watching people do curves at home, and documenting food change and behavior.

You can read the section convert a vet also, and look at the tips there. If your vet is not willing to cooperate, don´t worry too much, you have great caregivers here to advise about dose and food. I changed the dose of insulin lots of times, and I never told my vet about it, I even change the insulin (I don´t need a prescription here) and he was not aware about it. When I told him my cat was on remission, he asked then what pills for diabetes was he taking. I said no pills no insulin, he was in shock!

Well, welcome! And I do hope that you decide to listen to the "crazy cat ladies on the internet" because they DO know what to do.

 

You would be surprised how many of us "read it on the internet" people taught our vets something new.

A low carb/high protein diet is essential to managing feline diabetes.

Also, if your vet wrote the prescription for a vial of Lantus, ask for a prescription for the pens instead. The issue with the vials is that because the insulin is packaged in a larger container, it will become ineffective long before you can use it all. A package of pens has 5 pens in it and contains the same amount of insulin. But since they are packaged in smaller containers, you should be able to use almost every drop in each pen before the insulin becomes in effective. Also, check the Lantus website. They often include discounts on their website for the pens. That will help save some money for you. You can tell your vet that this is another thing you "read on the internet".

 

Bengals may do well on a raw diet, from what I've read in Bengal rescue. That said, I feed all my cats in the condo Friskies pates (except Mixed Grill) which run about 8% calories from carbohydrates. Per Cat Info, you may add about 20-25% cooked plain meat/poultry to canned food to boost the protein calorie percent, while decreasing the % calories from carbohydrate and fat.
If you're not using insulin yet, change the food asap; it can drop the glucose level about 100 mg/dL (divide by 18 to get mmol/L).
Also, testing at home may show levels from 100-180 mg/dL lower than at the vet; it is very important to test at home as it helps keep your cat safe.
See my signature links Glucometer Notes and Secondary Monitoring Tools for some additional information you may find helpful.

 

Just a word about food. When Squeaker was diagnosed, Purina DM wet was given. He would not eat it. I tried to give it to the local strays, they wouldn't eat it.

I put him on Little Friskies Classic Pates. He ate them very well. I also have another cat, Sydney, and that's what he eats. As a matter of fact, I had noticed that Sydney had gotten a rather wide behind and wondered how I could trim the excess off. About six weeks after starting both of them on the Little Friskies I noticed that Sydney wasn't as wide in the back end as he had been.

I think I am one who can drive the vets nuts as I do a ton of research and bring all my notes and questions with me. So don't be afraid to advocate for your cat. You are the only one who will.

Anita and Squeaker

 

I'm very interested in making the food switch ASAP. What is top priority in choosing one initially, being under 10% carbs?

Like I've said before, I don't want to delay giving Trixie the insulin she needs because I'm trying to get my vet on board with this food issue. I'm so overwhelmed... I'm about to crawl back in bed for the day. I'm not sure where to start or what I can do for my cat RIGHT NOW. I'm more confused than ever about what "step one" even IS for us. When I feel overwhelmed and anxious like this, I can't make any decisions and just decide to ignore or put off the whole thing. Can't really do that when I'm concerned about my fur baby's life.

 

Good morning extra sweet Trixie and altho' you didn't introduce yourself....my psychic ability tells me your name is likely Scarlett..?? OK, I admit I'm also on fbook feline diabetes group so recognize your intro.

Food - try either Fancy Feast 'classic' pates or Friskies pates other than 'Mixed Grill' (that's high in carbs). Turkey and Giblets, Supreme Supper, Country style dinner are all good.

You also need to get a meter and start testing for safety. Walmart - get the 'ReliOn' either 'Confirm' or 'Micro' and a box of 20 or 50 strips. Grab a box of lancets too. The kit will have a lancet pen in it too. Find a thin sock, fill it with about 1/4th cup uncooked rice for heating her ear. That will make it a bit easier to get blood - warm ears bleed better. Let's get you started testing first but do go ahead and find the best place to buy the insulin. The pens are a much better deal than the vials. The up front cost looks very heavy but that will last months!!

This get you going now? NOW BREATHE! You CAN do this! You really really can! We all arrived wearing your same shoes.

HUGS too!

 

@Squeaky and KT yep im the same one

I feel like I can handle the food, buying a meter, and price checking insulin today. Would you even worry about calling the vet to talk about the food issue? Tuesday is "surgery day" so I'm not sure when/if I'd get an answer from her anyway (though, of course, I could always talk to a tech or something).

 

MY opinion - I wouldn't even call and talk with them about it. You're likely going to get pushback so why deal with it? You don't need their approval to change anything....it's YOUR cat and YOUR money.

Suggestion - when you're checking prices, ask if you can buy just 1 Lantus solostar pen instead of the 5 pack. That's not nearly as hard a hit right off the bat. DO NOT let them sell you the 'pen needles' that go with the pens, you can't adjust doses small enough for cats. Those are great for humans but not for cats as they only change in full units. We change doses by .25 and .5 units.

 

The rx I have is for a vial... I'm okay with starting with a vial, I think, to avoid calling the vet to get her to write a new Rx right off the bat, driving to pick it up, etc. Many people have recommended the pen route though so that might be something for the future.

 

That's fine Scarlett....I think I'd avoid the call and trip too. I do agree that Trixie will very likely need to start insulin too so the quicker you get things set up, the quicker you can get that glucose in control. Testing will be critical to make the food change AND start insulin. It's not hard, it's just different. Also buy some freeze dried treats - places like PetSmart and Petco carry several different kinds. The hard ones are full of carbs, the freeze dried ones are low. Give her a treat after each pokie session. Yummy!

 

Great start. I wouldn't bother calling the vet either. I'd just tell her the next time I see her that the food wasn't working so I tried something different. If you can get some testing done along with a food change, you will be able to show the difference it made

I've used vials most of the time. Pens can be cheaper in the long run, but I think you are fine just starting off with the vial.

Good luck!

 

So what's my plan of action? Switch out her food today and start juice tomorrow? Later? Sooner?

I can go pick up a ReliOn from walmart today and test strips, but it looks like they don't have lancets in stock (I haven't really looked into it that far, I've just read people writing that you need both test strips and lancets). I have a new and unused Bayer Contor Next EZ in my home right now if that helps. I can also try to learn as much about testing as I can (watch videos, more reading) today. I'm veeerrrrrrry nervous about this part -- as mentioned above, the very thought makes me queasy. Can't even think about the word "vein" without wanting to puke.

 

You can use any brand of lancet...the Relions are cheaper, but a lancet is a lancet...they're all just something to poke with

I'd go ahead and do the food switch today and get some tests under your belt so when it's time to start the insulin, you'll be ready to keep her safe as well as gather the data on how she's doing

And you're not aiming for the vein in the ear..that hurts as well as bleeding a lot....you're going to want to poke along the edge of the ear between the vein and the outside edge.

 

Scarlett, you're not aiming for a vein, it will just be capillaries that provide the blood. MY opinion, change food and start the testing right now, get the insulin but I would test for about 3 days to see how her numbers are. That will give you a baseline to see what's happening without and with the insulin.

Lancets - most lancet's base is a universal size so other brands will work in the Relion lancet pen. There will probably be about 10 in the kit to get you started.

Believe me, I understand the 'scary' and nervous part - I was SO needle-phobic I would literally pass out just looking at a syringe. But my sweet boy needed it to live.

 

I'm going to buy the insulin asap though, the lovely pharmacist informed me prices will be going up Jan 1 as the company usually raises the rates each quarter. The vet must have been SUPER out of touch with the prices of things these days, she estimated $180 a vial... try $300.

Going out for lunch with a friend, then will start purchasing supplies.

 

@KittyPurry You'll also need to get some U100 syringes with half unit marks. Walmart carries those too altho' lots of the pharmacy people don't realize they carry them. They're behind the parm counter so you'll have to ask for them. You want 3ml shorts, 30 or 31 gauge. You MAY have to show them your prescription for the insulin to buy more than 10. You need a box of 100 - that's about $15.

 

One recommendation to protect your vial. Place it in an old prescription bottle and surround it with cotton balls or a paper towel to keep it snug in the bottle. You only need to take the top off of the pill bottle to draw the insulin. This way if the vial falls on the floor, it may not break. There are many of us on this site that have lost a vial of insulin because it fell on the floor. And for some reason, it usually happens when the vial is fairly new.

 

Check online for prescription discount cards. Many can be used for pet meds. Even though it may not save a lot of money with the cost of the insulin, every penny helps.

 

In order to avoid upsetting trixie's tummy I would add in just 25% of the new food today. Then tomorrow if all okay perhaps up that to 50% of the her daily food to wet, etc,etc. if she suffers from IBD then maybe a little slower. See what the other members think

 

Gradual food change of 20-25% at a time helps avoid food refusal, vomiting, and diarrhea.

 

I dropped off the Rx and will pick it up a little later. I will purchase a relion meter then too and the other testing supplies. When I head back out I'm also going to look for a special testing treat at petsmart.

Grabbed some fancy feast off the <10% carb list. I can start transitioning her tonight (would like to get them both eating the same -- Diego my Bengal boy isn't going to be pleased if he doesn't get some wet too). They dont get upset switching between dry foods even when I don't transition them like you're supposed to but i can go slow and mix it in. Do i go by the weight guidelines on the can for how much to feed or something else? She weighs like 8#.

What about the insulin? When will that start? Still kind of worried about not giving it to her soon enough.

 

I don't feel like I can master testing tonight... I can read but I dont know if I can stab.

 

I'm a fellow newb so don't have much in the way of advice but just wanted to offer some encouragement. My Henry was diagnosed about a month ago and his values were high as well: 465. As soon as he was diagnosed I jumped into research, found this board, and had him on an all Fancy Feast Classic diet within two days. Five days after that when we went in to learn how to administer the insulin, he was already down 100 points from the diet change alone. He was also started on Lantus 1u 2x/day (and yes, we got sticker shock too--$269!).

We did a few very sporadic home tests (which my vet was fine with but did not bring up herself) but did not begin them in earnest until Henry had his first glucose curve at the vet after a week on Lantus. His values were much higher there than what we'd been getting at home, and the vet upped him to 2u/day. (I know now from the good folks here that that was too much of an increase too soon.) I suspected his stress level at the vet's office was a major factor, but I gave him the 2u and monitored him closely. Within only two cycles at the increased dose he dropped dangerously low. I don't say that to scare you, but to point out that had I just listened to the vet and kept giving 2u, and had I not been home testing to catch that drop, we might have been in big trouble. I think vets underestimate how stressed cats get from the car ride and the office, and make dosing decisions based on elevated numbers. My vet is super nice and I too felt weird about pretty much ignoring her every step of the way, but that's what I've done and Henry is well on his way to remission. Even my husband teased me about making decisions based on what "strangers on the Internet" were telling me, but he has seen the results and become a believer. Trust your instincts, be an advocate for your cat, and know that you don't need your vet's permission to do what you think is best for Trixie (food-wise, dose-wise, or otherwise).

I know how overwhelming it is (it's still very fresh with me), but you have found an amazing resource here and you will adjust sooner than you think. Home testing was really hard at first for us too, but now we're all pros at it. Henry even comes around now when he hears me get the meter out because he knows a treat is forthcoming!

Best of luck to you and Trixie.

 

Try it on yourself first - I use the outside tip of my left hand little finger to test mine when needed. BREATHE! BIG deep breaths...and another...realize you really CAN do it. Stress transfers to her. I'm not pushing, I just know you can do it!

HUG...and BREATHE...

 

Practice on yourself. Practice on a piece of fruit. This will literally let you get the feel of it and the hand motions and timing down. And hey, you get to check your own glucose levels!
Once you've got that, it is a matter of working with your cat. Taking it step by step and with patience and calm will help a lot. Low carb treats, such as Pure Bites freeze dried chicken, may help too.

 

How are things going with you two today? Did you start the insulin? Here are some ear testing tips that you might find helpful in getting you started.

 

Thanks for asking. I was getting ready to make another post. I'm not sure when it will be appropriate for a new thread. What's a good guideline for that?

I will need some advice on her diet. Started giving her some FF wet food (chicken classic) along with some crunchies of the old dry iVet last night and this morning. She is a wet food fiend anyway, so this transition will be a piece of cake. Wet food was always treat food before, so her and Diego both think this is great. They are both currently being meal-fed at 9 and 9 -- this is not new, this was always the schedule.
About her weight: she is currently just shy of 9 lbs, but was just over 13 lbs when I took her in April. She was placed on a reduced fat diet (iVet adult reduced fat - dry) at that time because she was looking a lil chunky and her weight was high.
How much will she get to eat in a day? From the can, it says one 3 oz can per 3.5 lbs of weight. From her current weight, that would be like 2.5 cans. From what I found on Dr. Lisa's site, it says cats need something like 180-220 cals per day and 1 can of FF chicken is 91 cals.

I feel comfortable with the process of giving her insulin. I haven't given her any yet but from our practice session with saline at the vets, I know I can handle that part. If I need to do that today or tomorrow, I feel 100% okay and up to the challenge. I will be off all day tomorrow anyway with the holiday so I will be home with her and I have the ability to take Friday off if need be. I feel like I should be with her her first day on the juice, especially if I can't test her... My big concern is waiting too long to give her any insulin because I'm not ready to home test her. It seems kind of obvious that seeing what affect (if any) the change in cat food had on her would be very helpful, useful information but I'm just not there yet. If the only way to learn to lancet (and test) is on yourself, then I may be SOL because I can't get myself to do it. I tried a few times last night, even poked a little on the outside of my left pinky but not nearly hard enough. Adrenaline and nausea rush so that was the end of that.

I'm trying to just do what I can do, a little at a time, to try and keep my anxiety and panic under control. What I know I can do is feed her different food, inject insulin when I should, observe for signs hypoglycemia, and keep working on thinking about testing her. Since she was prescribed 1 unit 2x day (but hasn't started that) but I'm also currently switching out her cat food, would maybe a lower amount be a good compromise for now? Some is better than none? I looked at the SLGS protocol for Lantus last night and that seemed agreeable to me, but should I not even think about dosing lower than the vet recommended since I can't test right now?

 

I spent some time last night reading that document and examining her ears to see prepare myself. Trixie's little black ears are cute as can be, but not helping me out at all on this journey I am right handed, so I looked at her right one first. Can't see the vein at all from either side, really. I can on the left one, though. It seems like it's going to be near impossible to only poke on the 1-2 mm strip of ear on the other side of it! I don't know how hard I'll need to poke, and that and mastering the angle is REALLY freaking me out. Which side do you poke, front or back? I'm afraid to use the lancet tool because it feels like it would go right through, but it seems like maybe that would solve the "how hard" issue for me?

 

Unregulated diabetics will have a much more voracious appetite since their body is unable to process all the nutrients fully, so you may need to feed her a bit more than recommended to start with. You might be interested in reading this post on feeding kitty as much as they want (within reason). The easiest answer is to weigh her regularly. If she needs to lose weight, feed her less. If she needs to gain weight, feed her more.

Since she was relatively high to begin with, I'm hesitant in suggesting you hold off insulin for too much longer. Maybe wait a day or two longer until she's fully transitioned to the new food? 1u is a good starting dose for most cats and it would be a good idea if you were around to monitor the first day, but also the first week or so because it takes 5-7 before you see the full effect of the Lantus dose (you don't have to take off work or anything, but just try to be around as much as you can). Here are some Secondary Monitoring Tools that will help you do that until you get the testing down.

Is it the lancing tool that came with the ReliOn meter? If so, try taking off the cap or using the clear cap instead. You can also try free-hand, although I'm not sure how much better that might be for you. If you can't poke yourself, practice on an apple. Figure out the angle and the depth to get that apple juice out! When I first started testing Mikey, the lancing device was on the highest/deepest setting for the first week or so. As his ears started to "learn to bleed" and as I became better at it, I was able to lower the depth till now, where it's on the lowest setting. (I also invested in a new lancing device that worked so much better for us all around!)

As to the vein, yes, you want to avoid it, but if you hit it, it's not going to be the end of the world. It'll bleed more and is sometimes quite useful to aim for if you're having trouble getting blood. You just don't want to do it all the time. I don't really "aim" for the sweet spot with the lancing device. Instead, I aim for getting as close to the edge of his ear as possible without going over the side. 9/10, I hit the sweet spot, 1/10, I might hit the vein. Mikey doesn't notice any difference.

For front vs. back, it depends on the cat and depends on the ear. With Mikey, I test the outside of his ear. With Henry (non-diabetic), on the rare occasions I test him, I test the inside because he has black ears and longer hair on the outside. Make sure you have something firm to back wherever you decide to poke. I use only my finger now (the depth setting on the lancing pen is really handy and keeps it from going through the ear into my finger) but when I first started out, I'd wrap a bit of paper towel around my finger so not only did I have something protecting me in case of piercings but I could also quickly shift my finger over the poke to stem the bleeding after I got the blood on the test strip.

Here are a couple of pages I wrote up about ear testing that you might also find helpful:
Ear testing psychology
Taking your time

 

As you can see by looking at my sugardude Wink's avatar, he has black ears too. When I first started testing him it was very difficult to see that blood drop in his long black fur. So...... I took a safety razor and very lightly and gently shaved a tiny patch on both of his ears. That helped immensely, being able to see the bare skin and see where I was poking.

I don't need to shave Wink's ear anymore when I BG test, but it sure did help me there in the beginning.