INFORMATION FOR AUSSIE FELINE DIABETIC CAREGIVERS Hi and welcome all Aussie caregivers and kitties to the Feline Diabetic Message Board. We are so glad you have found us! This is a fantastic worldwide community of FD caregivers who will give you help and support as you make this journey with your recently diagnosed diabetic kitty. Some of us live here in Australia. Many live in the US, Canada and the UK and we have people in many other parts of the world, so there is usually someone online at FDMB if you need to ask a question. Feline diabetes is a very treatable disease and with the right treatment and care, your kitty should live a normal life. I have collected as much information as I can which is relevant to Australia. Please feel free to add any additional information as a comment on this thread. The most important FD treatments are the same wherever you live: low carb diet, suitable insulin and home testing the blood glucose levels; but things such as food, meters, types of insulins available, medications available and names of things are often not the same as in other countries. TYPES OF INSULIN USED IN AUSTRALIAIn Australia all insulin is a prescription only medication. Most vets here in Australia use Glargine Insulin which is a gentle long acting insulin and very suitable for cats. It is given twice a day 12 hours apart. Pick a time of the day that suits you best (eg 7am and 7pm) and stick with those times to administer the insulin. In other parts of the world Glargine is called Lantus or Basaglar insulin, so when you see Lantus or Bsaglar being used on this forum, you will know it is the same as Glargine. Glargine insulin is a depot insulin, so it takes up to 6 cycles (each cycle is 12 hours) for the depot to fill and for the full effect of the insulin to be seen. The starting dose for glargine is usually around 1 unit and we recommend you go up in ¼ unit increments when increasing. You will find most vets increase in 1unit increments but by doing that you may go past the best dose for your kitty and he/she may get too much insulin. Another excellent insulin for cats, very similar to Glargine, is Levemir insulin, which is also a depot insulin and has only more recently (in the last 4 years) been used for cats here in Australia. Another type of insulin used occasionally in Australia is Caninsulin, which was developed as a dog insulin, but for many years it was given to cats, but cats have a faster metabolism than dogs so it is not generally used here now that there are more suitable longer acting insulins available. Another type of insulin I have seen used here only occasionally is Novolin N which is another insulin that drops the cat’s BG levels fast and has a shorter duration of about 8 hours and is not as suitable as the longer acting insulins. BUYING INSULIN HERE IN AUSTRALIAYour vet will most likely supply you with a cartridge of insulin in the beginning. Some people continue to buy the insulin from the vet, but it is more expensive that way. A cartridge of Lantus, for example will cost around $50 from the vet. Lantus and Levemir can also be bought from the chemist if your vet is willing to write a script. A box of 5 cartridges (pens) costs around $99 which is much cheaper. You usually can’t buy individual cartridges from the chemist, only the 5pen pack. If kept in the fridge, the opened insulin should last until the last drop. Unopened cartridges last until the expiry date if stored in the fridge. Store the cartridge of insulin in the main part of the fridge in a container or glass so it doesn’t get knocked over and do not store it in the fridge door. Lantus and Levemir DOES NOT need to be shaken or rolled to mix. Caninsulin and Novolin N are suspensions and must be mixed before use. INJECTION SITES TYPES OF SYRINGES USED IN AUSTRALIAYour vet will probably give you some suitable syringes when he puts your kitty on insulin. There are U100 syringes and U40 syringes and it will depend on the insulin prescribed as to which syringes you will need. It is very important you use the correct syringe to deliver the correct amount of insulin, so always check with your vet if you are unsure when you are buying more syringes from another source. Only use a syringe ONCE. If you use it more than once, you not only contaminate the insulin and possibly shorten the life of the insulin, the needle in the syringe gets blunt and will hurt your cat. Glargine and Levemir and Novolin N all use U100 syringes. Caninsulin uses U40 syringes. U100 Syringes can be bought from your local chemist who stocks Diabetic Supplies. I can buy a box of 100 syringes for around $30 or around $25 online (plus shipping cost). There is not the range of syringes here in Australia that there is in the US. For Glargine, Levemir and Novolin N insulins the BD Ultra-Fine Insulin Syringes 0.3ml 31G x 8mm (100 in a box) is the most popular U 100 syringe. For Caninsulin the U 40 syringes can be bought at the vets, at vetshop online and at pet pharmacies online or in person. Some vets prescribe Glargine to be administered with a SoloSTAR Pen. However, you will not be able to raise or lower the dose in ¼ unit increments which we recommend you do here on FDMB. Buying ½ unit syringes. We do not have ½ unit marked syringes available here in Australia. However, they can be ordered through a company in the UK which will deliver to you in about a week. The company website is Hyperdrug.co.uk. Here is the direct link to the page to order the 1/2 unit (Demi) U100 0.3ml syringes: https://www.hyperdrug.co.uk/BD-Micr...03ml-pack-of-100/productinfo/BDMICROFINE03ML/. SUITABLE FOOD FOR DIABETIC CATSFDMB recommends diabetic cats eat a low carbohydrate wet/canned diet that has 10% or less carbs. All dry food available in Australia is high carb as far as I am aware, sometimes as much as 35% carbs. The FDMB does not recommend dry food. Getting rid of the dry food will go a long way in helping your kitty. Dry food is bad for all cats, so if you have other cats, it would be wise to swap them all over to a low carb diet. It will not only improve their health, it will stop your diabetic kitty being able to raid the others cats’ food, which they will be tempted to do!! You may also like to consider giving your kitty a raw diet or a homemade cooked diet. Both will need supplements. More information about that is in the food link below. If you have started insulin before changing over to a low carb diet, you will need to be testing the BG levels before swapping over to low carb food. This is because taking out the dry high carb food from the diet can drop the BG levels significantly and you may need to reduce the insulin dose because of this. The only way to tell if the insulin dose needs reducing is to be testing the blood glucose levels as you do the change over from the dry to the wet food. Choose a time to do this when you can be home to monitor the BG levels. If you haven’t started the insulin, then swapping over to a low carb diet first is a safer option. However, you need to make sure your cat did not have ketones when diagnosed, because if he/she did, they will need to start the insulin immediately. Testing for ketones in the urine while swapping over, even if there were no ketones at diagnosis is a good idea. More information on ketones below. Make sure you also have some cans or pouches of medium (11%-17%) carbs and some high carb (18% and over) in your cupboard. These can be found in the link below for Australian foods. When you buy them, mark the number of carbs on the top of the tin and store in a different area to your regular food. Here is the link to the Australian low carb canned foods: http://www.felinediabetes.com/FDMB/...an-cat-food-list-suitable-for-fd-cats.216897/. Here are the links to Lisa Pierson’s 2 lists with carb and phosphorus values https://docs.google.com/spreadsheet...fEUz9YmzMGMxkmcBk6uRR0/htmlview#gid=113878384 https://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf. CAN I GIVE MY DIABETIC CAT TREATS?Yes, you can give your cat treats! Just make sure the treats you are giving are low carb treats such as small pieces of cooked or raw chicken or meat, or one of the freeze-dried treats from the list in the SUITABLE LOW CARB CANNED AND AIR/FREEZE DRIED CAT FOOD AVAILABLE IN AUSTRALIA listed above. Some cat treats available here are quite high carb so always check. TESTING THE URINE FOR KETONES AND WHY IT IS IMPORTANTKetones can develop in a newly diagnosed kitty or in a kitty already being treated for feline diabetes. Ketones develop when your kitty breaks down fat for energy and can lead to the life-threatening illness called Diabetic Ketoacidosis (DKA). It is advisable to buy a bottle of Ketostix or Keto-Diastix and test your kitty’s urine in the beginning of this journey, especially when the BG levels are higher than normal and to also test if you kitty is not eating well or appears sick and lethargic. Ketostix and Keto-Diastix are available at most chemists for around $10-$12. Ketostix just tests for ketones and Keto-Diastix tests for ketones and glucose. Anything above a trace of ketones needs the vet’s attention. If you are unable to collect a urine sample from your kitty and your kitty is prone to ketones, is recovering from DKA, or is unwell and lethargic and off his/her food you would be wise to look at buying a blood ketone meter which tests the ketones in the blood. See more information of this meter under Glucose Meters. HOME TESTING THE BLOOD GLUCOSE LEVELSTesting your kitty’s blood sugar levels can sound daunting to many people, but it is amazing how quickly both you and your kitty will adapt to the new routine. I remember when I first tried, I thought I would never succeed…but I did. It may take a few days or a couple of weeks; some lucky people can manage to do it straight away. It is not because you will be doing anything wrong, it can just take time with some kitties. The trick is to find a place to test and always use that spot. Your kitty will associate it with the treats you will give him/her when you test. Testing will not make your kitty hate you or be scared of you as some vets may say. In fact, I can guarantee you will form a close bond with your FD kitty. I only had to reach for the testing kit and make the first noise and Sheba would come running for the test….and the treat. Read the link below for more information and tips on home testing and if you have any problems at all post and ask for help: http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/. Normal BG levels in a cat Human meters…2.8- 6.6 mmol/L Alphatrak 2 meters…3.8-8.3mmol/L Numbers below 2.8 (human meter) and 3.8 (alphatrak 2 meter) are the ‘take action’ numbers and potentially hypo numbers where you will need to feed some high carb food (18% and over) and /or honey to bring the BG level up to safe numbers. You will need to test the BG level again 20 minutes after the first test to see the numbers are rising and continue to test until your kitty is staying in safe number without having to be propped up with high carb food. >> Make sure you have made up a hypo kit ready in case you may need it << Always make sure you have some high and medium carb food, extra strips, honey, the phone number of the Emergency/afterhours vet, and a copy of the "how to manage a hypo" in your toolbox. If your kitty drops low, you do not want to find you have no high carb food or honey to deal with it! Here are the links: HYPOS – THEY CAN KILL: http://www.felinediabetes.com/FDMB/threads/how-to-treat-hypos-they-can-kill-print-this-out.15887/ HYPO TOOLBOX: http://www.felinediabetes.com/FDMB/threads/jojo-and-bunnys-hypo-tool-box.2354/ Please print off both. Don’t be too alarmed if you see your kitty in high numbers in the 20s, 30s or even Hi in the beginning. While we don’t want them to be that high, it will not hurt them short term. A low number is much more dangerous than a high number. Just make sure your kitty is drinking plenty of water, eating and test for ketones when the BG level is high. WHY HOME TESTING IS IMPORTANT & WILL MY VET BE HAPPY WITH ME TESTING AT HOME?Home testing is one of the most important things you can do for your kitty to keep your kitty safe. Blood glucose levels fluctuate during the day and night and testing them will tell you when you need to increase or decrease the dose, when to give extra food and when you may need to give honey or high carb food to prevent a hypo. Testing just once a fortnight at the vet will not tell you this information accurately. Home testing will save you multiple trips to the vet, save you money and will save getting your cat stressed out with vet visits. Some vets are very supportive of home testing, and some vets are not supportive of home testing at all. The more the vet knows about FD, the more likely he will be supportive of home testing. You just need to remember that you are your kitty’s advocate and you don’t need your vet’s permission to home test. The FDMB strongly recommends you home test the BG levels. The main objective with home testing is to keep your kitty safe. TYPES OF METERS AVAILABE IN AUSTRALIAThere are two types of glucose meters in Australia. The human meter and the pet meter. Both are suitable for cats. Most of us use the human meters, which are much cheaper to run, because the test strips are much cheaper, and our dosing methods are based on the human meter. The pet meter has been available in Australia since early 2017. Up until then vets and caregivers all used human meters. In Australia some vets use pet meters and some vets use human meters. The vets that use pet meters will probably also want you to use the pet meter but be wary of the cost of the strips. When you are choosing a meter, you need to check the cost of the test strips for that meter before buying. The meters do not cost a lot, usually around $40-$50 and that usually includes a few test strips and some lancets to get you started. It is the ongoing cost of the test strips that you need to be aware of. I used to buy my human meter test strips on eBay for about $35/100 test strips. Human test strips at the chemist cost about $60/100. Pet meter test strips cost around $65/50 strips; some places are more expensive. Human Meters are available at most pharmacies in Australia. Chemist Warehouse has very good deals. A lot of meters will have the meter, lancets, lancet device, and a few strips as a package deal. One of the best meters to buy is the Abbott Freestyle Optium Neo Blood Glucose and Ketone Meter as you can test for glucose and ketones with the same meter and the initial cost is the same for the plain glucose meter as it is for the glucose and ketone Abbott Freestyle Optium Neo Meter. You just need the two types of strips to test the blood and/or the ketones. See more information about this meter below. Here are some of the reliable human meters: Abbott Freestyle Optium Neo Meter (also comes as a glucose and ketone meter combined) Accu-Chek Performa Meter Bayer Contour Next EZ Meter Abbott FreeStyle Freedom Lite Meter SENS CareSens N Contour Next Meter Abbott Freestyle Libre Glucose Monitoring System This is a relatively new human meter which is attached to the cat’s body for 14 days. To obtain a glucose reading, you just scan over the sensor with the reader to get a reading. Several FD caregivers have used it for their cats here in Australia for the first two weeks to monitor the BG levels. The cost for a sensor for 14 days is $92.50 so most people who try it, will only use it for the first 14 days, then swap over to home testing themselves with either a human or pet meter. Human Ketone Meter If you have trouble getting a urine sample from your kitty to test for ketones, an alternative is to buy a ketone meter which tests the ketones in the blood just like testing the glucose in the blood. Abbott Freestyle Optium Neo Blood Glucose and Ketone Meter combines glucose and ketone testing with the one meter. Different test strips are used for the glucose and ketone readings. The ketone strips are quite expensive, but if your kitty is recovering from DKA (Diabetic Ketoacidosis) or is prone to ketones, this is an invaluable device. Cost for the Meter is approximately $45 and the test strips for the ketones is $10/10 strips (but you can check on eBay for specials). Glucose strips for the same as for the glucose only testing Abbott meter are about $35-$45/100 strips if you buy on eBay. Pet Meters Alphatrak 2 Items you will need to start home testing the blood sugar levels Blood Glucose Meter…buy from pharmacy or online. You may be able to get a deal which has the meter, lancet device, lancets and strips. Lancets…buy at pharmacy or online for around $12/100. Buy the lancets that go with the meter/device. This is an ongoing purchase. Choose the 26 or the 28 gauge lancets as they will make the ear bleed easier. Ongoing expense. Only use the lancet once. Lancet device, if there is not one in with the meter. Most meters come with a lancet device. Only need to buy one. This holds the lancet. Test strips that go with the meter. Buy the first lot from the pharmacy so that you can see the correct ones to get, then you can buy them online or eBay. Ongoing expense. A packet of cotton wool balls to use behind the ear when you test, and to hold over the prick after testing to stop bruising. PAIN RELIEF CREAM FOR THE EARSSome people put cream on cats’ ears if they become a bit sore from testing, which may or may not happen from time to time. You may not need it. If you do, put Elma cream on the test sites after each test. It only takes a tiny dap and you can wipe it off before the next test. Elma cream can be bought over the counter at pharmacies here in Australia. Neosporin has been found to contain a toxin to cats, polymixin and should be avoided. WHY A SPREADSHEET FOR DOCUMENTING THE BLOOD SUGAR LEVELS IS A GREAT IDEASetting up a spreadsheet and documenting all the blood glucose levels is not only an excellent way for you to see how your kitty is responding to the insulin, but when you ask for help or assistance, the helpers on this board will always look at your kitty’s spreadsheet to see what the BG levels are doing. It is colour coded so you can see at a glance how your kitty is responding to the insulin. You will see there is a US spreadsheet and a ‘Rest of the World’ spreadsheet. You need to choose the ‘Rest of the World’ spreadsheet. Once you put in the numbers, they will transfer over to the US SS and show the US numbers. Your SS will still stay the same. You will also see a Remarks column at the far right of the SS. This is great for remarks about food choices you are giving, how your kitty is feeling and why you did something. Helpers always read these things before helping you and it is good information for you to look back on. Here is the link to the spreadsheet: http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/. If you have any trouble with setting it up, post and ask for help. WHY DO SOME OF THE GLUCOSE NUMBERS LOOK DIFFERENT TO MINE?FDMB is a US based board, even though we have members from all over the world, so the system that is used here is the American system of measuring the blood glucose levels which is measured in mg/dL. In Australia and the rest of the world we measure in mmol/L. While a normal cat blood sugar level tested with a human meter is 2.8-6.6mmol/L in Australia, in the US it is 50-120mg/dL. To convert your Australian blood sugar levels to US numbers, you multiply your number by 18. For example, if you have a blood glucose level of 5.5 and you wanted to convert it to US numbers: 5.5 x 18 = 99. And if you want to convert US numbers to Australian numbers you divide by 18. DO I NEED TO GET A FRUCTOSAMINE TEST DONE AT THE VET?Most vets do a fructosamine test before the diagnosis of feline diabetes as it will tell them the average of the blood glucose over the preceding couple of weeks. This helps confirm a diabetic diagnosis. Once you start testing the BG levels at home, it is not necessary to get further fructosamine tests done; and it will save you money. You will be getting daily tests in to show how your kitty is responding to the insulin while the fructosamine test will just give an average of the last couple of weeks; no high or low numbers to give an indication of how the insulin is working, just an average number. While this was useful in the past, with home testing the BG levels, the test is no longer relevant for people who home test. DO I NEED TO GET BLOOD SUGAR LEVEL CURVES DONE AT THE VET?Once you start testing the blood glucose levels at home, it is not necessary to take your kitty to the vet to have blood glucose curves done. Most kitties get stressed during a vet visit and this raises their blood glucose levels, so the curves done at the vet are not reliable and usually higher than they would normally be at home. This is of concern because the vet may raise the dose, when in fact the kitty’s blood glucose levels are lower at home, and the dose does not need raising. You can do the curve at home and show the vet, or alternatively show the vet your spreadsheet. ANTI-NAUSEA/VOMITING, and PAIN MEDICATIONS & SUBQ FLUIDS IN AUSTRALIAIn my experience, vets in Australia are not as proactive about prescribing anti-nausea medications, pain medications (with the exception of Metacam) and subQ fluids and letting caregivers administer them at home, as they are in the US. Vets will certainly use these drugs at the surgery but if you are wanting to give them at home, you may need to ask for them. Anti-nausea and vomiting medications The main anti-nausea and vomiting drug used in Australia for cats is cerenia,which can be given as an injection or orally as tablets and are prescribed and bought from the vet. Zofran (ondansetron) is another anti-nausea medication which is a human drug, and you will need to get a script from the vet and then buy it from the chemist. The Zofran comes in little wafers 4mg each and the box of them cost about $25. A lot of vets do not know about Zofran here so you may need to ask for it specifically. My vet did not know about it but was happy to prescribe it after I told him about it, and he researched it. Cerenia (can be given daily) and Zofran (can be given up to 3 times a day) can be given together as they work on different pathways if you are not having success with one of them. Pain Medications Buprenorphine is an opioid and is given to cats with severe pain. In Australia it goes under the name of Temgesic. You may see cats given bupe for pain on the forum…this is Temgesic. This may be given here in Australia for example as an injection, when a cat has pancreatitis. I have not seen it given out by the vet as an oral medication often, unless requested here. Vets are more likely to give Metacam (either as an injection after surgery or as an oral medication to take at home) as pain relief and an anti-inflammatory medication. In the US Metacam is not considered a safe medication as it is manufactured as a canine medication and the strength is different to the cat Metacam. Here in Australia, Metacam is manufactured specifically for cats and is considered safe if the guidelines on dosing and administering are strictly followed. Metacam made an amazing difference to my cat Sheba. Tramadol and Gabapentin are two other pain medications used here often in Australia. Tramadol is bitter and needs to be given in a capsule, otherwise the cat will foam at the mouth. You can buy empty capsules online to put the tablets in. SubQ Fluids In my experience SubQ fluids are not administered as frequently at home by the caregivers here in Australia, as they are in the US. They are given frequently at the surgery. However, if you have a cat with CRD or who gets frequent pancreatic flares and associated dehydration and you spoke to the vet, I am sure most vets would be happy for you to give SubQ fluids at home. My vet didn’t suggest it to me, but when I asked him about it, he was agreeable and said he had a couple of other cats who gave SubQ fluids at home as well. I bought the supplies to give the SubQ fluids from the vet initially and they were not too expensive, but they can also be bought online. However always be guided by your vet as to whether your cat is suitable to have SubQ fluids (some cats with heart problems are not suitable) and as to the amount to be given and how often. ACRO TESTING IN AUSTRALIAAcromegaly is a disease that is more common in diabetic cats than previously thought. If your kitty is not responding to insulin and has reached 6 units twice a day, your vet may want to test for Acromegaly. Treatment overseas may consist of an operation, medication or Stereotactic Radiotherapy. Previously this was not available in Australia but there is now a vet who does the operation here in Sydney. The vets name is Dr Patrick Kenny and he operates out of Small Animal Specialist Hospital Sydney, 1 Richardson Place, North Ryde, NSW 2113. Phone (02) 9889 0289. Email firstname.lastname@example.org. For getting the actual blood test done to confirm diagnosis, I spoke to a receptionist at the S.A.S. Hospital who then spoke Dr Kenny. He said the blood tests are not done here in Australia, but they send them to the Royal Vet College, London, UK. If the local vet was not comfortable with sending bloods off to the UK, Dr Kenny suggested that for people who do not live in NSW, to go to an internal medical specialist vet in their state, who could do the test and send it off. If they are unsure with what to do, ring Dr Kenny for directions. For those living in NSW, they could go to see Dr Kenny or an internal medical specialist at that practice for the initial work up and they would send off the blood to the UK. READING THE YELLOW 'STICKIES' AT THE TOP OF FORUM PAGESWhen you first learn your kitty has diabetes, you will be feeling stressed and there is so much to learn. But don’t worry, you have come to the best possible place for help and support and one of the best ways to gain a lot of wonderful information is to look at all the yellow stickies at the top of the various pages of the forum. You will find general feline diabetic information and specific information about the different types of insulin used. Please make sure you read these great sources of information. There is a Yellow Stickie on the Tight Regulation protocol and the Start Low Go Slow method for dosing the insulin. Read these and choose which one would suit you best then put it in your signature that will appear under all your posts. OTHER HEALTH CONDITIONSIf your kitty suffers from other conditions such as IBD, CRD, cancer or Hyperthyriodism, you will find many people will have a wealth of information to share with you. Just post and ask for help. They will share information and other links with you. WEAK BACK LEGS/NEUROPATHY/POTASSIUM DEFICIENCYThis condition is quite common in diabetic cats and is called diabetic neuropathy. Symptoms can include weakness in the hind legs, walking on the hocks, loss of ability to climb stairs, inability to jump, needing to rest after walking a short distance. It should improve once your cat becomes better regulated. A medication called Zobaline for cats, can be bought from lifelink, (email@example.com) which is an overseas site but reliable. Zobaline is a Methyl B12 supplement. The tablet is tasteless and can be crumbled into the food daily. If you are tempted to look for a local product just make sure that it doesn’t contain anything that will be harmful to your cat and has no sugars in it. A lot of vets have not heard of Zobaline and they do not carry the product. Potassium Deficiency can also cause weak back legs so talk to your vet if you are concerned and he may wish to do a blood test to see if a potassium supplement is needed. Do not try and manage the potassium supplement yourself, it needs to be given with vet advice. ASK LOTS OF QUESTIONSIn the beginning when it is all so new and you are maybe not sure what you should do, post and ask for assistance or ask a question. We are all very happy to help you and we all understand how stressful it is in the beginning. There are NO STUPID QUESTIONS and you will not be judged on this forum. Ask as many questions as you like.