New Member Nathan: some questions about feeding, timing, and home testing

Hello,

I am the new member, with my cat Nathan, who was just diagnosed diabetic on 5/15/2020. I would like to ask some questions and hope somebody could help me. I know there may be already answers in some old posts, but the information here is too much and I couldn't find them in a short period of time.

Here is the brief information: Nathan, male, 11 years old, 17.5 lbs. The vet did an in-house blood glocuse testing on 05/15/2020 and got some 400+ number. More detailed results of blood test and urinanalysis may come back on next Monday so I will know other numbers. The vet prescribed ProZinc, 2 units each time and twice a day.

Question 1: Is this dose too high for a starting dose? I read some posts and other said they started 0.5-1 unit. Or is it the right dose based on the 400+ number and his weight?

I understand that I need to feed him before/or the same time I give the insulin shot. I give him the shots at 7am and 7pm.

Question 2: Should I feed him only at 7am and 7pm? Can I feed him between the shots, say, 12pm or 4pm, if he asks for food?

Question 3: How many calories does he need at lease before/or the same time when I give him the shot to avoid hypoglycemia?

He is over-weight, and I would like him to lose some weight.

Question 4: Is it wise to let the over-weight cat lose some weight when treating for diabetes?

If Yes to Question 4,
Question 5: How do I calculate the daily calories he needs? Based on the desired weight? Based on a weight somewhere between the current weight and desired weight? Or based on the current weight*90% (or 85% or?)?

I plan to transit his current diet to the low-carb diet as suggested here.

Question 6: Should I not do the transition until I can do the home testing successfully? Or can I slowly change his diet to the low-carb diet from now?

I have bought the Relion Prime glucose meter and tested on us human, and compared its reading to the Bayer glucose meter we use. The Relion meter gave a lower reading than Bayer meter, around 15 lower.

Question 7: Is it normal that different meters give different readings?

We gave Nathan food and insulin shot at 7pm today. He seemed to be a bit sleepy then. We did a glucose testing on him at 11pm. The Relion reading is 188.

Question 8: is this a fairly good number?

Question 9: If I want to test his glucose before the insulin shot, should I do the testing before feeding him? or after feeding him (but before the shot)?

They are quite a lot questions and I would really appreciate somebody could help us.

Thank you.

 

Hi Nathan,

Since I’m sitting at the ER waiting for my cat, let me try to answer some of your questions.

1. I’m not a prozync expert but it seems high. I’d think you’d want to start with 1 unit two times a day and increase as needed from there. We recommend increasing and or decreasing by .25 increments. Dose is not based on weight
2. You can feed him as many times a day as you’d like but we suggest the bulk of the meals around shot times with smaller portions in between. No need to do 2 meals only in fact it’s best for cats and their pancreas to eat multiple times a day
3. There’s no calorie rule here. You just need to make sure he eats. I think prozync acts fast so you need to test feed then shoot. We always test before feeding to get the BG number without food influence
4. What’s his ideal weight did the vet say? 17.5 may not be overweight for him. I think the rule is keep them on wet food not dry and if they’re hungry you let them eat. Diabetic cats lose weight by peeing since there’s sugar in their urine so it’s harder to get them to gain then lose
5. Calories per day are usually 20 per pound. Minnie is 16 so she gets about 300 a day
6. You should wait to change his diet until you’re home testing since any change in food can affect his BG levels
7. 15-20% variance is okay and expected.
8. Did you get a reading before the shot? It’s important to always test before each shot so you know if it’s going down or up. Can you retest him at +6? 6 hours after the shot. You don’t want him too low. For me that number is 90 so anything below that I give her carby treats or food like FF grilled with gravy to get the BG level back up
I already answered the last question somewhere above

you should also post this on the prozync forum to get more eyes on it. I’m tagging @Deb & Wink who knows prozync way better than me!

http://www.felinediabetes.com/FDMB/forums/prozinc-pzi.24/

 

Here’s a useful link for you. You should set up your signature and a spreadsheet for the BG testing numbers so members can help you better:

http://www.felinediabetes.com/FDMB/threads/new-how-you-can-help-us-help-you.216696/

 

Have you asked the vet what an idea weight would be for Nathan? You might want to take a look at this website on feline nutrition. There is a section in there on how to safely get your cat to lose weight.

 

Let me give your questions a try.

• Q #1: I'm a big fan of starting this adventure on what may be a smaller than what turns out to be necessary dose. It's much easier on your nerves if the blood glucose (BG) numbers are a bit higher than seeing your cat in low numbers and having to get lots of high carb food into your cat. The other issue is if your vet is basing the dose on Nathan's BG at the vet's office, there's a good chance that the numbers are higher than what you would see at home. Many cat's experience stress at the vet's office and from being in the car and the stress artificially raises their BG. Basing the dose on an inflated number can lead to setting the dose based on an incorrect number.
• Q #2: You definitely want to feed Nathan at shot time (test/feed/shoot although many of us would feed and give a shot when our kitty's head was in their food bowl). Many vets will tell you to feed only twice a day. It's not necessary to limit food to x2/day. A lot depends on how you typically were feeding Nathan as well as how he responds to insulin. Most of us spread out our cat's food over several smaller meals up to the time insulin activity peaks. You'll need to do a few curves to figure out when this is but the quick answer is you can feed more often. You do NOT want to give Nathan any food 2 hours prior to shot time, though.
• Q #3: The number of calories doesn't have much to do with hypoglycemia. Food does influence numbers but it's more the amount of carbohydrates, not calories, that's important if you have to deal with a drop in numbers. You want to feed your cat a low carb diet (under 10% carb) but you also want to have some high carb food on hand (e.g., Fancy Feast Gravy Lovers food which is about 15% carb -- anything over 155 is considered high carb. Corn syrup, honey, maple syrup, etc. are also good to have on hand as they are very high in carbs.) There is information on how to put together a Hypo Toolkit.
• Q #4: It's fine to try to get Nathan to lose weight while he's diabetic. Weight can contribute to FD. However, most unregulated diabetic cats are hungry all the time The website Wendy referred you to has great information on feline obesity. It also has a wonderful food chart (look on the sidebar menu) to help you find a range of foods that are low in carbs.
• Q #5: See the feline nutrition website we linked.
• Q #6: If your cat has been eating a high carb diet, especially if it was a dry food diet, please be very careful if you are not home testing. Transitioning to a low carb diet can have a dramatic effect on BG numbers.
• Q #7: There is about a 20% allowable error that is inherent between meters and between tests on the same meter. If you compare the tests, if they are within 20%, they are essentially the same number.
• Q #8: 188 is a good number. However, it is a number in isolation. PLEASE, test before you shoot. It it critical to get a test every time prior to giving insulin. You need to be certain it's safe to give insulin.
• Q #9: The order is to test, feed, then shoot. The pre-shot test should not be influenced by food. With Prozinc, you have some time before the insulin kicks in (i.e., "onset") so you can shoot while Nathan is eating or immediately after.

Please keep the questions coming!

 

Thank you very much for your kind reply. I hope your cat get well soon.

 

Thank you. I will figure out how to do this.

 

Thank you very much for the information. I haven't talked to the vet about the ideal weight for him and how to get him lose the weight. Will try to talk to the vet next week.

 

Thank you very much for your kind and detailed reply. I do have more questions and will post them now.

 

Thank you all for the above answers/advice. I really appreciate. You have helped me clarify things a lot.

English is not my first language (I am in USA though) . So if I say something not clear/understandable, please ask me and I will try to elaborate/explain.

I do have some more questions and hope somebody could help me.

Question 10: The use of Relion. After I insert the testing stripe to the meter, it shows waiting for blood, which is good. However, when I am struggling with Nathan to get his blood, time elapsed and the meter turns off. I have to pull the stripe out and insert it again to make it work. Is this the only way or is there a simpler/easier way to turn the meter on again?

Question 11: How to do the home testing with an uncooperative cat? He shakes his head when I touch his ears and try to prick his ear. It seems very difficult to hold his head still to get enough blood before he shakes the blood off. This morning around 7am, I tried to get a reading before the feeding/shot, but had to give up after 30 minutes of struggling. Please share your experience with me if you had this similar situation.

Question 12: I read some articles about feeding the same food and not switching food often. What does it really mean? People here seem to feed different flavors of FF classic canned foods.

Question 13: The vet also did the fructosamin level (shown on the receipt), which should tell the average glucose level over the past two weeks. We haven't got the results back yet since it is weekend. Should we/vet determine the insulin dose more based on fructosamin level than the in-vet-office glucose reading (some mentioned that stress/travel to vet's office may artificially raise the in-vet-office reading)?

Question 14: Relationship with the vet. Due to the covid-19, other veterinary hospitals don't accept new patients now, so we have to stick with our current vet and want to have a good relationship with him. Will he feel offended and not happy if I question the insulin dose he prescribed?

Thank you again for your kind help.

 

Question 15: My husband thinks I am crazy/insane and I have compulsive disorder when I said we need to prick Nathan's ear a few time each day to get the glucose readings. He believes it is ok to just do what the vet said. Without his help, it is almost impossible for me to do the home testing on my own. How could I persuade him?

 

10. I havent had a diabetic in a LONG time I cant remember the trick we used.

11. It took two of us. Trouble hated testing. Treats were a good bribe. I gave him a treat immediately after testing. Sometimes 2
After a while Trouble figured out after a test he got a treat. It was easier but...still took both of us.

12. We fed different varieties of Fancy Feast pates. He gobbled them all. We even tried the friskies pates. he liked those as well
Any can food with 10% carbs or under is recommended.

13. I cant remember the fructosamine test...sorry.

14. A LOT of people have had Vets that get offended but the fact that you WANT to home test should show your Vet how serious you are about this and that you want to be hands on. THAT will actually make his job easier. Let him know you fully intend on doing home tests BECAUSE cat isnt under stress at home. Your vet SHOULD understand that. Let him know that your willing to send him any information you get from these tests.

15. Ahhh the 64,000 $ question. One fact is you doing all this at home means LESS dollars being spent at the vets. Sure your initial cost is high but once you get in a routine and groove. It WILL get easier.
ALSO theres that old adage: HAPPY WIFE = HAPPY LIFE.

I'm SURE others will be along to add all their thought correct some of mine (spelling included) Hang in there for more replies!
GOOD LUCK
jeanne

 

I insert the strip but not all the way in so my tester stay off. When i am ready to test, i push it all the way in. Some ppl scoop the drop of blood on one of their nail but i never tried.

Do you offer treats when you test him? Maybe try playing with his ears outside of testing time so he doesn't associate touching ears = something bad is gonna happen.

I know it's bad for dry food..or when you introduce wet food too fast ( soft poop problem ). As far as i know some ppl even recommend a wet food rotation to prevent allergies or the cat becoming bored of 1 flavor and not eating.

 

Tell him that if you can't prick Nathan's ear as much as you want, you will have to do it on him...can't help it, compulsive disorder

 

I’m tackling a few here:

10. My trick is the same as @Lalkabee

11. There’s a link here somewhere with testing tips like giving a treat, warming up the ear. There’s also something called the burrito technique for the feistier cats

13. the fructosamine test is a 3 week average, so no that’s not what you base the insulin dose on since it’s based on your daily testing BG numbers and mainly on the nadir once you figure out at what time that happens for your cat. Did you mean stress at the vet causes the numbers at the vet to be elevated? If so, yes. The numbers you get at home are the accurate readings since your cats stress level is much lower

PS - thanks for keeping my mind occupied

 

For #11, read this:
https://sites.google.com/site/michelangeloprofilefdmb/feline-diabetes/ear-testing-psychology

 

Our Health Links forum has a bunch of useful posts, including one on Hometesting Tips and Links, it includes several videos. It's very important to get your kitty to associate a nice low carb treat (freeze dried meat is good) with testing.

The fructosamine is an average, but that number would be the same if your cat was both high and low over those 2 weeks, or just an even numbers. We determine how to change doses based on how low the dose takes the cat, and the fructosamine won't tell you that. The test at the clinic may also not be good, as you said, some cats are stressed and their numbers go up at the vet. A non diabetic cat of mine was so stressed at a vet visit he tested well over 200. The next day the vet called to talk to me about the blood work and was concerned about diabetes. I had already tested him at home and got a 53, which is perfectly normal.

Testing at home is way cheaper and more convenient. If you cat is acting funny and you don't know if he's hypoing, you can test him and know immediately. If you wait for the vet, it may be too late. Most progressive vets are glad to see caregivers test at home. In the (2018) AAHA Diabetes Management Guidelines for Dogs and Cats it says "Obtaining a BGC at home is strongly recommended both for dog and cat owners, but even more so in the case of feline patients due to the chance of stress hyperglycemia in a hospital setting." My vet was happy I wanted to home test - it gave her more data. I initially shared my spreadsheet with her, and gave her a copy of the dosing protocol I wanted to follow. Once she saw the data and what I was doing, she left dosing up to me.

 

Same here.

 

Thanks again for the above kind and helpful replies. I will update information in my signature once I get the detailed test results from the vet.