New Member 2021-09-16 Melbourne Maya hypo now hyper. Need help

Dear Feline Diabetes forum,

It's been a hard few weeks. Maya, my lovely Burmese who is now 18 years old, was diagnosed with diabetes in July 2020, and transitioned smoothly and easily onto Lantus 1 unit twice a day with Hills MD wet food. There was no discussion of needing to monitor her BG or urine ... so I wasn't.

Then Hills stopped making MD in Australia and my vet recommended the Royal Canin Diabetic pouches. I compared the contents and was unimpressed. I read some of the literature on feeding raw food, and found 'Raw and Fresh'. I ordered her some chicken and some kangaroo raw food. She enjoyed these mostly, but still preferred the MD food. Given the advise that you might reduce or come off insulin when on raw food, I had been tapering off her insulin injections.

This coincided with a nasal infection, which led to a visit to the vet. He insisted that I put her back on insulin at the same dose as 2020, and the next day she was in a hypo crisis and I was rushing her to an emergency vet. She spent two days there getting rehydrated and having her potassium topped up. The emergency vet said to wait until her BG went to 24 mmol/L before restarting her on insulin. The local vet tested her the day after returning home and got a reading of 13 mmol/L and again insisted she restart insulin. No offer to return and test her again. That left me feeling conflicted and uncertain about how to proceed. I had ordered a glucose meter while she was in emergency, but with covid postal delays that didn't turn up until 3 days ago.

She's been home for a little over two weeks and I've spent the last 3 days trying to figure out how to take blood and get the meter to work. I'm at about a 30% success rate, but her glucose levels are swinging wildly and she's barely eating. I've taken her to the vet today and they are again keeping her overnight. This time they say she hyper.

Her back legs have gotten more wobbly, she's lethargic. and straining to poo. Having read a number of the posts on the forums, I take this to mean that she is probably low in B12, and that I need help with how to do regular blood testing at home.

I'd really appreciate any help you can offer. Not knowing what to do, especially when she is not eating well, is leaving me feeling very overwhelmed.

Thanks in advance,
Helena

 

Bump

 

There are lots of video's on YouTube on "How to test a cat's blood glucose". Watching them will help.

Here's something I wrote up for others for testing...maybe it'll help you too! (substitute "her" for "him")

It can be really helpful to establish a routine with testing. Pick one spot that you want your "testing spot" to be (I like the kitchen counter because it's got good light and it's at a good height....it also already blocked 2 escape routes due to the wall and the backsplash) It can be anywhere though...a rug on the floor, a table, a particular spot on the couch...wherever is good for you.

Take him there as many times a day as you can and just give his ears a quick rub and then he gets a yummy (low carb) treat. Most cats aren't objecting so much with the poking..it's the fooling with their ears they don't like, but once they're desensitized to it and learn to associate a certain place with the treats, they usually start to come when they're called! Or even when they hear us opening the test kit!

You also have to remember...you're not poking him to hurt him...you're testing him to keep him safe and understand what's going on inside his body. There's just nothing better than truly understanding what's going on inside your kitty's body and with this disease, the more knowledge you have, the more power you have against it. The edges of the ears have very few pain receptors, so it really doesn't hurt them. Also, if you're nervous and tense, it's going to make your kitty nervous and tense too. As silly as it might seem, try singing! It forces you to use a different part of your brain!

It's also important to make sure his ear is warm. A small sock filled with a little rice and microwaved or a small pill bottle filled with warm water (check temp against your wrist like you would a baby bottle) works well

For new kitties, using a heavier gauge lancet is also really helpful. A 25-28 gauge lancet pokes a bigger "hole" than a 31-33 gauge lancet does, so look for "Alternate Site testing" lancets that are usually a lower number

Finding the right "treat" will be a great help too! Freeze dried chicken, bonito flakes, little pieces of baked chicken...whatever low carb treat you can find that he really enjoys will help him to associate the testing with the treat! China's Achilles heel was baked chicken, so I'd bake a piece, chop it into bite sized pieces, put some in the refrigerator and freeze the rest to use as needed. It didn't take long for her to come any time I picked up the meter!

There are more testing tips here:

http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/

It sounds like she may have some diabetic neuropathy which is common in uncontrolled diabetes. Here's a video showing severe neuropathy

Any Methyl B-12 will help...it doesn't have to be the brand name "Zobaline"....just make sure you get the Methyl form of B-12 that doesn't contain any sugar or xylitol in the inert ingredients. Zobaline is 3000mcg but you can use up to 5000mcg....any that the body can't use just gets peed out.

The important part though is to get her diabetes under control. The B-12 can't really do much as long as the nerves are still being damaged due to the high blood glucose.

 

VIDEO: How to test your cat's blood sugar
A video one of our members made testing her cat

Also no need to feed prescription food
https://www.felinediabetes.com/FDMB...an-cat-food-list-suitable-for-fd-cats.216897/

 

Thanks Chris and China for sharing this info. Lots of good suggestions for managing the emotions and practicalities of doing blood tests. I'm waiting for her to come home from the animal hospital so we can build our skills together.
The treat ideas I hadn't seen before, only mention of giving treats. I'll try and find, or make some of those.
When I talked with the vet yesterday he told me that:

• she was dehydrated but has improved.
• her electrolytes were out of kilter, particularly her potassium but are improving.
• that her glucose had gone down and then had gone back up.
• that her kidney structure was showing changes and there may be an infection
• there were some changes around the pancreas.
• teeth a bit sore (she doesn't have many left at 18.5 yrs). I'm not sure why this is relevant.

They are going to put her on a long course of broad-spectrum antibiotics.
He is not sure if she has gone into remission and is advising to hold off buying or administering insulin.
Should I not be prepared for all options? Surely I should set up the process of regularly testing her once she is home, to know what is happening? Does that seem fair?

 

Thanks for this link, and to everyone involved in putting together the lists with the proportions of each type of ingredient in the different cat foods. Just an amazing resource.

I will happily stop feeding her prescription food. I'm just uncertain what food to give her instead. Limited choice in Melbourne, especially with Covid supply chain impacts. I did find the Ultimates Indulge (whitemeat tuna with fish roe & chicken breast, and two others in this line) at the supermarket, but nothing else. The tin says "intended for supplemental feeding", which makes me think that I have to give her something else as well...?! I have kangaroo mixed with organ meat in the freezer (Raw and Fresh - https://rawandfresh.com.au/?gclid=C...zd2BWO6OiYCDojd-oUaaJju01GO7GcCxoCwHkQAvD_BwE), which she did seem to like, but I don't know if that has all the supplements she needs, and if I then need to give her some other food with it.

Also, given the kidney concerns, they now say she is stage 2, whether I should be choosing a food that will protect her kidneys more...?

It is very overwhelming to get all the bits in place to support her best, and feel like I'm not causing her harm.

 

Hi Bron and Sheba,
Thanks for sharing the Australian page. It is great to know there are other fur babies and their carers in Australia.
The food list links on that page are amazing. Is it possible to download a copy, or to filter them so it is easier to identify the ones that might work for Maya?

 

I'm going to start a post for you asking if anyone from Australia can suggest foods suitable for diabetic cats with stage 2 kidney disease

 

Oh, thank you SO much Diane!
I'm rather new to the forum process...and such.

 

I've just heard from the vet that I can bring her home this afternoon.

I feeling very uncertain about what to feed her. My feelings is that as soon as she slows eating, I can't get her to eat again. So I feel like the food is really important. I have kangaroo in the freezer, and two tins of Ultimate Indule, and 4 tins of Hill's M/D diet. Any suggestions?

She'll be on analgesic and antibiotics.

 

No problem at all Maya Helena is a beauty

 

Take a look at these charts which list both carb and phosphorus levels.

Cat Food - Nutritional Composition, data compiled by Dr. Lisa Pierson, DVM (2017)

http://www.felinecrf.org/canned_food_usa.htm

https://www.felinecrf.org/canned_food_usa.htm#raw_foods

What many of us have to do is keep the phosphorus in line by adding aluminum hydroxide powder to the food. It has to be the powder. The aluminum hydroxide gels that you get from the vet are designed for both dogs and cats and contain sugars.

https://www.thrivingpets.com/shop-by-treatment/herbal-and-natural/alu-powder.html – they do ship to Australia.
Do a web search and see if Phos-Bind is available in Australia.

Tanya's CKD website is the go-to for kidney disease. Here is the link to the phosphorus binders page:
https://felinecrf.org/phosphorus_binders.htm

The most important thing right now is to get Helena eating again. Balancing diabetes and kidney disease is a juggling act. It's not perfect but it can be done.

 

Maya is home with me. So lovely to have her company again.
Vet seemed to think she was in remission. But this morning her BG is elevated. I've filled in the spreadsheet, as best as I know how. Some advice on whether to give her some insulin would be appreciated.
Helena

 

Thanks for these great resources Red and Rover. There is some great and helpful info there.
Helena

 

@Sienne and Gabby (GA)

@Bandit's Mom

@tiffmaxee

@Wendy&Neko

 

How much insulin did you give when the hypo happened? After that many cats are very sensitive to insulin. It does appear some insulin is needed. What are you feeding now with MD not available? Lower carb food will also require less insulin. How is the testing going? Are you confident you can test whenever needed?

 

Weruva makes a large selection of flavors and textures that are both low carb and low phosphorus (low phos is important for the kidneys) and they actually have the nutritional breakdown for every one of their foods on their website

 

https://weruva.com
When you click on the item go all the way to the bottom left and click on detailed nutritional info

Maya can you add to your signature the date Helena was diagnosed with diabetes July 2020 Thanks

You want to look all the way at the bottom of the Weruva page where it says Minerals/100 kcal. The phos numbers need to be below 250. . Either that, or the Dry Matter needs to be less than 1%. Look at the carbs ( as fed section) and make sure you try and stay around 5% or less

 

Unfortunately there was a problem with Weruva foods in Australia and a number of pets died. Consequently, they don't seem to be available in-store or online in Australia. Post is taking up to 10-30 days to arrive, so not a great option to order online right now.

I found in store

• Tiki Cat
  • Hanalei Luau (Protein - 76, Fat - 24, Carb - 0, Phos - 176)
  • Molokai Luau (Protein - 70, Fat - 30, Carb - 0, Phos - 170)
  • Manana Grill (Protein - 71, Fat - 29, Carb - 0, Phos - 151)

She has had one tin yesterday for dinner.
Left overs with kangaroo overnight.
1//2 a tin this morning.

I gave her 1 unit of insulin when the hypo happened.

I was getting more confident with testing, but then swapped from using a 28 gauge syringe to prick her ears to using the soft touch lancets only to find she is feeling these more and trying to leave.
She's also getting skittish at food times because I have to give her antibiotics, analgesic...



She's been sleeping since breakfast...

 

Glad you found the Tiki Cat if you are no longer feeding the MD wet please note in your signature you are feeding Tiki Cat and Kangaroo, is Kangaroo all the time?
Is she eating good for you now?




In post #16 (look to the right of the posts and you will see the numbers)

@tiffmaxee Elise asked you a few questions did you see that. Helena's BG's are still pretty high
In your post #13 you said your vet seemed to think she was in remission??
He doesn't think she needs insulin is this correct?
When was the last time she had any Lantus?

@Maya and Helena

Just to re cap what you said in your post above I copied it and posted below
You said

Given the advise that you might reduce or come off insulin when on raw food, I had been tapering off her insulin injections.

This coincided with a nasal infection, which led to a visit to the vet. He insisted that I put her back on insulin at the same dose as 2020, and the next day she was in a hypo crisis and I was rushing her to an emergency vet. She spent two days there getting rehydrated and having her potassium topped up. The emergency vet said to wait until her BG went to 24 mmol/L before restarting her on insulin. The local vet tested her the day after returning home and got a reading of 13 mmol/L and again insisted she restart insulin. No offer to return and test her again. That left me feeling conflicted and uncertain about how to proceed. I had ordered a glucose meter while she was in emergency, but with covid postal delays that didn't turn up until 3 days ago.


What antibiotics and analgesic are they that you are giving?