New Member and a bit overwhelmed

Hi everyone. I rescued a feral tomcat a little over 3 years ago, Vinnie Van Gogh, who has turned into the biggest lovebug. He was diagnosed on Friday with diabetes (probably steroid-induced) and I have spent the last 3 days overwhelmed by research. He also has asthma and I have had an impossible time getting him to use an inhaler (I have 3 cats - one of the others is also asthmatic and is fine with the inhaler so I am comfortable using it; but Vinnie fights me like crazy). Because of his resistance to the inhaler, he has been getting regular depomedrol shots for the past 2 years. I had no idea this could lead to diabetes and noticed his weight cycling up and down over the last couple of years, but the vet seemed unconcerned because his weight was never in the unhealthy range until now. His high weight in the last two years was 16.5 pounds, but he's a bit chubby at that weight. A good weight for him is about 14.5 pounds. Last week (one week after his depo shot), he went down to 12 pounds, 6 ounces, and looks like he is skin and bones. He also drinks a ton of water, eats more than my other two cats combined and he has about 4 times the urine clumps in his litter box than the other two girls have combined. (Side note: he also may have FIV - he has had two positives and two negatives and is very aggressive with my other cats so they are kept completely separate which is why I can tell the difference between his litterbox and theirs).

Bloodwork on Friday showed a glucose level of 368. His prior annual bloodwork (latest one in August) showed glucose in the high-normal range (around 200) but it turns out it was always done over a month after his latest depo shot so the steroids were no longer in his system. The vet put him on 5mg of glipizide twice daily until the steroids are out of his system. She is hoping that at that point, his glucose levels will stabilize and we can sort out the diabetes maintenance as well as figuring out how to control the asthma without steroids.

20 years ago, I had another diabetic cat. At the time, I did not ask questions and just did what the vet told me to do. It still breaks my heart and angers me that the vet told me to make dietary changes (i.e. wet food and set feeding times) WITHOUT telling me that my cat's glucose should be monitored while these changes were being made. That cat ended up with hypoglycemia at a time when my regular vet was out of town and unreachable. By the time I got him to an emergency vet, he was in really bad shape and the vet recommended that I let him go. I now try to research everything that I am told by any veterinarians to make sure I am aware of crucial information.

So back to this week. I immediately took Vinnie off of dry food completely and am giving him low-carb wet food and homemade food. His drinking and urine output has decreased by about half and he has gained a few ounces weight-wise since Friday.

So, that's the background on Vinnie and I have questions and would be very grateful for some input!

1. Glipizide. I have read bad things about this and the strain on the pancreas. The vet assures me that it is only temporary and there is nothing to be concerned about. I told her I would like to decrease the dose to 2.5mg instead of 5mg since he seems to be doing better, but she says not to do anything until we get his glucose tested again. She swears that there is no risk of hypoglycemia from glipizide which is one of the main things I am terrified of.
2. Glucose testing. I have read that glucose tests in the vet's office can be high due to stress. I am going to get my own glucose monitor so I can track it without going to the vet. Has anyone used the Nova Max Plus? It only needs a 0.3 microliter sample so I am thinking this would be a good one. Other than lancets and test strips, is there anything else I need?
3. Feeding. I know that set feeding times are generally best for diabetic cats. However, since Vinnie is still super skinny is it better to always have food available? Or is it better to do the set feeding times to encourage him to normalize which would then increase the likelihood that his body can use the food to put weight back on him?

Those are my main questions for the moment, but I am sure I will have many more...

 

Hello, and welcome to yourself and Vinnie.

Apologies in advance for the brisk tone of this reply but I'm in the UK, it's well after 3am here and I am about to sign off. I didn't want to leave your post without a reply.

That's not true. We had a Greek kitty here last year who went into hypo numbers on an oral hypoglycaemic:

https://www.felinediabetes.com/FDMB/threads/too-low-glucose-almost-hypo-sos.234110/

When a caregiver has a cat already on insulin and wants to switch it to a low carb diet, the cat's blood glucose needs to be monitored closely to make sure that it doesn't become hypoglycaemic as the carb load is reduced. The insulin dose frequently needs to be reduced in line with the carb load. I would worry that the same might be applicable for a cat on an oral hypoglycaemic. More info about transitioning safely to a low carb diet here:

https://catinfo.org/feline-diabetes/

Here are the current AAHA guidelines on treatment of diabetes in cats and dogs. Oral hypoglycaemics are not recommended:

https://www.aaha.org/globalassets/02-guidelines/diabetes/diabetes-guidelines_final.pdf

It's great that you're planning to home test. I know that there are some members who use the NovaMax Plus for ketone monitoring (I believe it can test both BG and ketone levels with the appropriate strips). If you're in the US, the most cost-effective meters are the Relion Prime and Premier (from Walmart). The strips are the most reasonably priced. Here are some links to help you get started:

Home testing links and tips

Testing and injection tips

You can post for help with anything you're finding tricky at any time.

Until you start home testing, it should be fine to leave food available at all times for Vinnie, particularly because he's underweight and unregulated cats can't fully utilise the nutrients they consume. For cats on insulin the drill is to withhold food for two hours prior to each preshot test to see whether it's safe to give the next dose. Perhaps the same approach should be used prior to giving a dose of glipizide?

WRT the glipizide treatment, has your vet said how long she considers a temporary period to be?


Mogs
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Thank you so much for staying up so late to send your reply (and the tone was not brisk in the least)!

The vet is saying that the glipizide will be for about 3 weeks (until the steroids have worn off and we have a better idea of where his true levels are). It's not sitting well with me to keep him on it that long without knowing his numbers. I ordered the Nova Max (found a box of 100 glucose test strips for the Nova Max on Amazon for only $18 which seemed really inexpensive!) But it won't be here until next week so I am going to see if I can bring him into the vet tomorrow and possibly again on Thursday for a quick level check.

In the meantime I will review all of the testing links and tips. And I will go ahead and keep food available for him until I am able to monitor him better.

Thank you again for all of your helpful answers and information!

 

Why does the vet want to keep Vinnie on glipizide and not start insulin?
We have many cats here that have had a steroid and they don’t wait until the steroid is out of the system before starting insulin
Glipizide is not a good choice at all. It makes the pancreas work harder to try and produce insulin whereas insulin supports the pancreas while it heals.
If you are hoping for remission, I would not use the glipizide.

Has the vet talked about what insulin he will use? I would ask for Lantus or prozinc as they are both good insulins for cats.

 

Bargain! That's the same price you'd pay for 100 strips for the Relion meters.

Be sure to let us know how you're getting on and post for anything you need help with. In the meantime, it would be helpful to you (and us!) if you could set up a shareable spreadsheet for Vinnie and we'll be able to give you some bit of feedback on what his BG numbers are doing. Here's what you need to get going:

How to create a spreadsheet for your cat

How to use your cat's spreadsheet

If you'd like some assistance setting up the spreadsheet, just give a shout and we'll find someone to help you.


Mogs
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Last year the FDA approved Semglee insulin which is a generic glargine (Lantus). It is a lot cheaper than Lantus and the price is comparable to Lantus bought from Canada.
https://www.goodrx.com/semglee

 

She says that his insulin needs may change drastically as the steroids leave his system so putting him on insulin could lead to hypoglycemia. There is a small chance that he won't need any insulin once the steroids are out of his system so she hasn't talked about it yet.

 

Thank you so much again! I will definitely get going on the spreadsheet.

 

Bear in mind that exactly the same thing could possibly apply with the oral hypoglycaemic. It's great that you're going to home test Vinnie daily. It will give you data to show to your vet if his numbers start trending lower. I'd suggest asking your vet how many hours after administration each glipizide dose is likely to be exerting the greatest BG lowering effect, and for how long each dose is likely to keep BG lower before wearing off. That info would help guide your testing times.

Your vet is correct in that sometimes cats with steroid-induced diabetes can go into remission very fast when the steroids are withdrawn. Even if BG initially stays in the diabetic range after the steroids have cleared the system, if the cat is switched from a higher to a lower carb diet that may then be enough to see BG levels drop back into the normal range.


Mogs
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I asked again about glipizide and hypoglycemia and the vet again swears that it is not an issue. It might be time to look for another vet as the research I've been doing says that hypoglycemia actually occurs in 15% of cats put on glipizide. We have an appointment to do a glucose test in 3 hours. Will update!

 

Article on glipizide from one of my go-to sites for pharmaceuticals used in veterinary medicine:

marvisavet.com Pharmacy Center - Glipizide

Not sure whether it might be any help to you with the vet.


Mogs
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Thank you! This also confirms that hypoglycemia is reported in about 15% of cats on glipizide, which contradicts what my vet says. I will forward this to her.

 

Just got back from the vet and he was 256 today (so down 112 from Friday's 368). Their response was "See the glipizide is working. Continue it and we will retest in a couple of weeks." My thought was "See the diet change is working. There is no way I am waiting another two weeks to test. I am going to test at home and get him off the glipizide as soon as possible." Despite their protests about me lowering the dose to 2.5mg when I saw that his urine output and drinking dropped abruptly after the diet switch, I lowered it anyway. (Many of the articles I read said that they should actually be started on 2.5mg and only if they tolerate that well, should they be bumped up to 5mg). Once I am able to monitor at home, I may stop it completely. I am wondering if the 256 reading could be higher than what it actually is since the glucose levels can increase due to stress and he shakes with stress when he goes to the vet?

They again said that cats do not get hypoglycemia from glipizide. I told them I had read a number of studies that show 15% of cats get hypoglycemia from glipizide. Their response was they have never experienced that.

 

I spoke with the vet again (I had spoken with an assistant earlier). She said that yes, there are some cases of hypoglycemia from glipizide but it is not nearly as bad as with insulin - the numbers do not drop as low or as quickly so we would have plenty of time to react should anything happen. When my glucometer comes in, they will do a demo with me, make sure it is getting the same readings as theirs, and give me a chart to fill out to track it and keep them apprised of my numbers. She is hopeful that we will be able to stop the glipizide in the next two weeks if he continues to improve. I am feeling better about them after this conversation.

 

Glad you had a better discussion with the vets.

I think you made a good call being cautious with the dosing. Neither glipizide nor insulin come with an off switch. Certainly in our experience starting low and increasing if necessary is the safer course, doubly so when the carb load is reduced.

The human meter is likely to read lower than their pet meter. The distribution of glucose in the blood differs between cats and humans and that is behind the differences. The two different meter types read closer at lower numbers but there's a wider difference at higher numbers. FYI, the feline BG reference range used here when measuring on a human meter is 50-120mg/dL.

WRT data recording, if you wish you can always send the link for your FDMB spreadsheet to the vets. Might save you having to enter data twice.

WRT testing times, the normal drill for cats on insulin is:

- fast the cat for 2 hours prior to taking the preshot reading (assuming cat is in safe range!)

- take BG reading to make sure it's high enough to give the next insulin dose.

- feed cat, wait for a while if recommended for the insulin in use, administer dose.

- test during each 12-hour cycle to ascertain how low the dose is going (usually around the time when BG is typically expected to be at its lowest - ask your vet when this is likely to be).

Perhaps you could adapt this routine to suit Vinnie?


Mogs
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Thank you! I will be sure to ask about the pet meter vs human reader issues and see if I can just send the FDMB spreadsheet to them.

Thanks also for the normal drill breakdown. I'll check with the vet to see if the cycles would be similar for the oral meds.

Anxious to get the meter in (which still hasn't shipped ) Vinnie's weight went up from 12 pounds 6 ounces to 12 pounds 12 ounces a couple of days ago, but it has since dropped again to 12 pounds 8.5 ounces. (Good weight for him is 14.5-15 pounds). He is drinking and peeing a little more than he was a couple of days ago, but still not nearly as much as he was before the diet change.

I got the lancets in and have practiced on myself and my husband. Once I get the monitor, I have two other cats and a dog that I will practice on before getting to Vinnie (being a former feral, he knows how to fight me off). Probably good to test everyone anyway! If it still hasn't shipped by tomorrow, I may just get a different kit right away that has glucose strips to tide me over until the one I ordered comes in. $23 for one test at the vet vs $20 for a kit with a handful of strips that can be delivered in a day (one of those bundles that tries to rope you in then charges a fortune for replacement strips!).

 

Okay, I'm finally comfortable testing Vinnie on my own. Yesterday we brought him to the vet for a demo and his BG was 444. Today, I did it at home and it was only 223. He seemed very stressed yesterday (when he saw the carrier, he had an asthma attack and threw up, then he was shaking while waiting for the vet). Is it normal for the BG to spike that high because of stress? I tested at around the same time today and there was no difference in medication or food or food timing. The only difference was yesterday was stressed out at the vet's office and today he was relaxing at home.

 

Minnie had a vet appointment a few weeks ago and went from 256 at home to 509 taken at the vet....

Also this is why home testing is recommended, I've read, instead of leaving kitty at the vet all day for a BG curve - stress of being there influences the numbers.

 

Thank you! I will definitely do all the testing at home from now on. Hope your Minnie is doing well!

 

Stress can definitely spike BG numbers, hence why BG levels measured at the vets are typically in a higher range than the cat would be running in at home. That said, felines being such perverse creatures at times, we have seen examples here of cats who run lower when stressed out at the vets, though I believe they're the exception, not the rule.


Mogs
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It's been 4 weeks since Vinnie's steroid shot and things were looking up. His BG was down to 208 and his weight was up to 13 pounds yesterday. Then today his BG jumped to 437, which is his all-time high. Is this normal? The vet wants him on glipizide anytime his BG is over 250 so he's been off and on it the past week. I'm wondering if the on and off is confusing his system and I'm tempted to stop it completely (especially since it's apparently only effective in 30% or fewer cats and it is so hard on the pancreas and liver; also the steroids should be out of his system in the next week or so) but will stopping it be harmful if his BG is in the 400s?

 

His BG was down to 191 today! I'm wondering if yesterday's numbers could have been off? He did bleed a lot more than most days and I got blood all over the strip. Would that affect the results and make them inaccurate?