New member: Jacques

My 12 year-old cat Pumpkin just got diagnosed with DM.

Pumpkin had issues 2.5 years ago that ended up being root caused to entropnion (eyelid rolling into the eyeball, not fun at all). That set off a bit of a rollercoaster for her, where we started with steroids before the entropnion Dx, that failed, we tapered her, saw an oncologist, got the Dx, did a surgery. The surgery wasn't fully successful, the surgeon didn't believe me, we tried steroids again to get her to stop scratching, finally I caught a bit of hair on camera poking into the eyeball, we did a followup surgery (on the surgeon's tab, thankfully), and then tried to taper her off the steroids. The tapering worked for a bit, but her "scarf and barf" tendencies flared up to the point she was vomiting multiple times a day and not eating. She ended up in the hospital to be stabilized, we did more steroids, got the vomiting a bit under control but still elevated. We finally tried hydrolyzed protein diet and she stopped vomiting entirely. Whew.

By this point Pumpkin, who had long been a little chunky, topped out at 13 lbs about a year ago. So, I got a scale, got even more strict with portion control (this cat's appetite only turns off when she's sick), and sloowly got her down to 11.25 lbs. Double whew.

Cue an annual wellness appointment. Blood glucose level comes back elevated (had been 76 a year ago, now 163), also glucose in the urine (2+ or 500 mg/dL). Could be stress hyperglycemia, she needed dental work anyway, so we planned to follow up then.

Doctor was happy with her weight and suggested concluding her weight loss program. I upped her intake by about 30 calories of dry HP food.

No idea whether or not it was a coincidence or not, but over the next two weeks Pumpkin got very thirsty (2-3x water intake, 2-3x urine) and started losing weight. She shed 0.5 lbs in just two weeks, the fastest weight loss I've ever seen from her (I usually weigh her every 1-3 weeks).

Took her back into the vet, blood glucose levels were still high (I've asked but don't have the reading yet), and urine glucose was 3+ or 1000 mg/dL, negative for ketones.

Vet called and said high blood glucose, glucose in urine, thirst, weight loss = diabetes.

We're going to start her on insulin (I don't have the name yet, need to find where the prescription went) and try adjusting her diet. That's very nervewracking given her history, but we're going to try introducing a bit of Instinct Limited Ingredient Rabbit (novel to her, she's already had duck from a different brand) and see if there's any relapse of vomiting before trying to switch more over. Otherwise we're stuck with the high carb HP foods (the wet food is 40% carb by dry matter and my best guess for the dry food is 50%, but I'm not sure; either way it's pick your poison when it comes to carbs). I have switched more of her diet to wet food on the theory that every bit of carb reduction helps.

Anyway, that's my story still trying to figure out all the next steps.

I have a couple of questions:

- I don't know what the followup reading was, but 163 seems pretty borderline for a DM diagnosis. Reading the AAHA guidelines it does something to the effect of "when in doubt, look at the clinical signs" and we've got thirst, weight loss, lots of urination, and glucose in the urine. But, 163 also seems close to the level where you would reduce the dose, presumably to nothing in my case.

- Does the switch to Instinct Limited Ingredient make sense? Any other recommendation for serious food allergies in diabetic cats?

 

Whoops, not an oncologist, a ophthalmologist!

 

Hi Jacques and Pumpkin and welcome to the forum.
Just wanted to let you know we have seen your post and will get back to you shortly

 

Hi again……a few questions first
What do they think caused all the vomiting that she had earlier on?
If allergies, do you know what they are?
Are you saying that the current blood glucose number is 163? Were they ever higher than that?
When you say you took her back to the vet and the blood glucose was still high…do you remember what it was?
Has she had a fructosamine test done …that is a blood test which measures the blood glucose (BG) over the past few weeks and is used for diagnosing diabetes in cats. It is better than a one off blood test which can be higher because of stress of the cat.

The normal BG for a cat is 50 to 120.
However if your cat is eating dry food that is 40 to 50% carbs, 163 is not too bad. A change to a low cat Diet would probably lower the BGs.
It is great there were no ketones in the urine. That is important.
I would be asking for a fructosamine test before starting any insulin. And I would be looking at trying to find a low carb alternative for Pumpkin. If the BG is only around 163, she may only need a change of diet.

I don’t know Instinct limited ingredients….can you post a photo of it or a link?
For allergies we usually recommend a novel protein and trial and error to find something suitable.
You might like to look at feeding a raw diet where you can control the ingredients.

 

We didn't narrow it down further than a food allergy. She'd been through the wringer by the time we finally hit on hydrolyzed protein as getting her to consistently keep her food down, so we left things alone after that.

That was her reading in the CBC on 1/19. It had never been that high before.

They didn't tell me the reading. I've requested it and am waiting to hear back.

No fructosamine yet.

https://instinctpetfood.com/products/limited-ingredient-diet-rabbit-wet-cat-food/

Trial and error makes sense. I'm a bit worried about doing that while she's drinking/urinating way too much and losing weight. But, after talking to the vet we're going try a small amount of a novel protein and see if she shows signs of starting to vomit again. I never want to go back to watching her vomit every other day and lose nearly all her appetite, so I'm going to take things very slow on moving away from her current diet, even though it's unfortunately high carb.

Basically, I get that high carbs aren't ideal for diabetes and I'm working on finding something better, but it's gonna take a lot of slow and deliberate trials to make sure we don't add vomiting to everything else going on. Especially when she's urinating this much, I don't want her losing fluids out the other end too.

Sadly I don't know of any low carb hydrolyzed protein foods. If there are any I would try that in a heartbeat.

 

I would get the fructosamine test done so you have a definite diagnosis first before starting any insulin.
I would make sure you ask for one of the better insulins such as Lantus or Prozinc. Don’t let them give you vetsulin (Caninsulin) or Novolin N. They are not suitable insulins for cats. And the starting dose would be 0.5 to 1 unit twice a day depending what you are feeding.

The instinct food you sent the link for has peas and pea protein in it so it is not low lower carb but it could be around 9.5% carbs which is on the upper end of acceptable carbs for diabetic cats and would be better than what you are feeding now . I’m going to ask @Bandit's Mom to have a look at the carb content and see what she gets it as.

it is really very unsuitable and would be like feeding a child diabetic cakes, pizza and sweets as the routine diet.

 

I'm getting a carb% of 40%!!! It's 9.5% carbs on as as-fed basis (including the moisture) and 40% on a dry matter basis. This is based on Guaranteed Analysis values on the website which are only approximations. Many cat food companies will write back if you email them and ask them for the carb% of their food on a "dry matter basis"

You can use this carb calculator to get a rough estimate of carb% based on Guaranteed Analysis values on the cat food label. Look at Dry Matter Carbohydrates at the very end.
http://scheyderweb.com/cats/catfood.html

 

Thanks Bhooma!

 

40%!? I was going off of https://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf, which has an entry for "NATURE’S VARIETY INSTINCT Limited Ingredient” and then under Rabbit it says 13%. I know below 10% is the goal, but 13% is better than the 40% I’m at now and my research says that rabbit tends to cause fewer allergy issues than lamb. She’s already had duck, turkey, and chicken unfortunately.

Given Dr. Pierson’s chart shows a much lower % of carbohydrates, can I trust that over the calculation?

 

40%!? That’s definitely not the direction I was trying to go in!

I was basing my decision off of https://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf, which has an entry for "NATURE’S VARIETY INSTINCT Limited Ingredient” and then under Rabbit it says 13%. I know below 10% is the goal, but 13% is better than the 40% I’m at now. Given Pumpkin’s allergies, my research says that rabbit tends to cause fewer allergy issues than lamb. She’s already had duck, turkey, and chicken unfortunately, which are the other options from that brand. But, that’s all kind of irrelevant if this food has 40% carbs and not 13%.

Given Dr. Pierson’s chart shows a much lower % of carbohydrates, can I trust that over the calculation?

 

I did think 40% looked unusually high. But I rechecked it a couple of times and that's what the calculator threw up. The Guaranteed Analysis are only indicative ranges, but it's unusual for the carb% to vary this much between Dry Matter and Guaranteed Analysis. I looked for it in Dr. Pierson's list but under I for Instinct. Yes, you can trust Dr. Pierson's list over the calculated % using the Guaranteed Analysis. However, Dr. Pierson's list is a few years so old, so the carb% might be slightly higher or lower than 14%

You might want to look into Rawz canned foods. They offer a rabbit that's only 6.7% carbs.
https://rawznaturalpetfood.com/product/96-rabbit-recipe/

 

Per Dr. Lisa's list, NATURE'S VARIETY - Instinct - original - Rabbit and NATURE'S VARIETY - Instinct Raw - Rabbit are low carb at 6% and 3% respectively. There are a couple of other low carb rabbit options in other brands as well.

 

Thanks, I’ll take a look at that one! I also emailed Nature’s Variety customer service to see if they can give me the carbohydrate numbers. Using the calculators and the info they publish shows that their limited ingredient dry food is lower carb than their limited ingredient wet food, so I think we’re just missing some important information.

In only they would publish this stuff in the nutrition label. For all the issues with Science Diet, they’re the only brand I’ve seen so far where I can just look on their website to get carbohydrate content. It’s much too high, but points for transparency I guess!

 

Weruva publishes detailed nutritional info on its website as well. As do Young Again (only dry food) and Dr. Elsey's.

 

I got a reply from Nature's Variety. Their rabbit limited ingredient wet food is 20% carbs. Not good, but much better than the science diet z/d hydrolyzed protein. I'll keep looking at the different options.

 

I started trying to test Pumpkin today. I think I successfully poked her once with the lancet is five attempts (I got a flinch), but didn't draw blood. She's very fractious. I've managed to trim her claws, pill her, and syringe feed her when necessary, but my method has always pretty much needed to be World War III. She isn't one of those stunt cats from the instructional videos.

Will keep trying. This is going to be a bit of a long road.

 

LOL. I know what you mean. Fortunately Bandit is a saint and I've never had trouble testing or shooting her, thank God! But my other cat - I can only say I'm glad she isn't the one that became diabetic.

Try warming and massaging the ear before poking. That helps increase blood flow. Sometimes you even have to "milk" the ear after a poke to increase the size of the blood drop. Initially, you might want to use a fatter lancet (26-28G rather than 30-31G) to poke a larger hole. Are you poking freehand or using a lancing device? The clicking sound of the device startles some kitties.

Here is a post by another member with some more testing tips:
https://www.felinediabetes.com/FDMB/threads/9-9-bailey-amps-117-5-62.252712/#post-2851043

Hang in there. It gets easier with practice.

 

Always aim for the sweet spot warm the ears up first, you can put rice in a sock and put it in the microwave, test it on the inside of your wrist to be sure it's not to hot, like you would test a babies bottle. You can fill a pill bottle with warm water and roll it on the ears also.Just keep rubbing the ears with your fingers to warm them up

6. As the ears get used to bleeding and grow more capilares, it gets easier to get the amount of blood you need on the first try. If he won’t stand still, you can get the blood onto a clean finger nail and test from there.
When you do get some blood you can try milking the ear.
Get you finger and gently push up toward the blood , more will appear
You will put the cotton round behind his ear in case you poke your finger, after you are done testing you will fold the cotton round over his ear to stop the bleeding , press gently for about 20 seconds until it stops
Get 26 or 28 gauge lancets
A lot of us use the lancets to test freehand not the lancing device
I find it better to see where I'm aiming
Look at the lancet under a light and you will see one side is curved upward, that's the side you want to poke with

A video one of our members posted, she is using a pet meter ,strips too expensive plus you have to code it
A human meter is just fine, most of us use human meters ,that's what our numbers are based on
When you get your meter can you add the name of it to your signature and spreadsheet


VIDEO: How to test your cat's blood sugar

Here is another link to read
This is a link to one of our posts on home testing.

 

I used an old sock I filled with rice and I’d nuke it for about 30 seconds then held it against Minnie’s ear until it was warm to the touch. I also would hold a cotton oval against the back of the ear so I could apply pressure with the lancet better since the ear is close to paper thin. Lastly, I used a flashlight to make sure I could really see the lancet bevel and the ear. It takes practice. Don’t forget to give her a low carb treat immediately after to build up positive association. Good luck!!

 

Today's progress.

We tried the paw pad. That didn't work out. Tried the pad with a lancing pen and freehand. With the lancing pen she didn't even feel it. With freehand she did but I didn't see any blood before I couldn't keep her still any more.

Lot of breaks. Lots of treats before and after each try.

Okay, let's try the classic method. Rice sock. Check. Free-hand 26g lancet. Check. Aiming for the sweet spot. Check. Poke. Yelp. Wait, where's the blood? She's got black fur on either side of her so it's really hard to see anything. My wife to the rescue suggesting a flashlight. Of course, a bit of illumination should do the trick. We've got a drop of blood! Shove the test strip in the meter. Wow, this takes a long time to boot up. Okay, we're in business. Touch the strip to the drop of blood. Capillary on the strip is filling ... filling ... not quite all the way. Meter flashes E-5. Pumpkin reacts strongly when I try to milk the ear. Time to shut it down for the night.

Well, we're closer. Pumpkin is now snoring on her favorite infinity lounge scratcher/cat sofa.

I've been using the CVS True Metrix meter, which takes 0.5 uL samples. With how hard Pumpkin is to test, I'm thinking I could really use a 0.3 uL meter. It looks like the ReliOn Confirm is discontinued, and the FreeStyle has bad reviews on this board. Are there any recommended 0.3 uL meters?

Another option I was looking at is the ReLion Platinum. It needs 0.6 uL, but you can touch any part of the end of the strip to the sample. That could be helpful since it's hard to keep Pumpkin still to line the test strip up. I'm wondering if anyone has experience with the Platinum or with that style of meter? I'm also considering the Contour Next because it lets you add more blood within 60 seconds. Is that the kind of thing I should start a new thread on? In this forum or is there a better one for testing?

 

Another tip. Put the strip in the meter as far as it goes without turning the meter on, which is not very far but it’s enough to keep it in place. That way, the strip is already there and all you have to do when you have the blood is push it all the way in so the meter turns on. It speeds up the process considerably.

I used to hold a small flashlight in my mouth while humming and doing all of this lol. Yes, it was a balancing act I may have been a juggler in my past like ha! Some folks here use one of those hiking lights that come attached to a head band so it’s on your forehead. I think that’s what @Hendrick Cuddleclaw uses in his video. Black hair does make things a bit more difficult but lots of folks here have black cats so it’s doable! You’re doing great, keep at it and don’t give up. Every time you hit a road block post as you’ve been doing because we all have our personal tips we can share

 

Thanks! I’d figured out the half insert trick, but the hiking headlamp is a new idea. Right now my wife and I are tag teaming, but the headlamp will help when one of us is traveling.

 

I have a caddy that holds my testing supplies. Since it holds the meter it is easy to fully insert the strip and still keep holding the pierced ear with the other hand