New Member - Vet Issues

I'm Chelsi and my newly diagnosed gal is Daisy. She's 13 years young. She was diagnosed last week and the vet seems to think we've 'caught' it early. I've been reading this forum and catinfo.org for the last 4 days. I finally spoke with the vet this morning to start a 'plan of action' for treating Daisy. She is adamant we feed Daisy the Purina prescription diet for feline diabetes. I believe it is the D/M. Daisy ate it ravenously the first few feedings and now she is snubbing her nose at it. I want to switch her to the Fancy Feast or one of the other low carb/high protein canned foods which are on the list on this forum. When I mentioned this to the vet she about threw a hissy fit insisting we keep Daisy on the prescription stuff. I asked her "Why? There's nothing in it to make it a 'prescription' food and it has higher carbs than some of the foods I can get over the counter?" She countered with "Because the carbs are from fiber". I stopped talking and listening. She's not my regular vet. He has been overseas while this has been going on and this lady has been filling in for him. Anywho, the plan is to change the diet for a couple weeks and test the glucose after that to see if it goes down. She is also starting an antibiotic tomorrow for a urinary tract infection which was discovered during the testing for diabetes and hyperthyroidism. Oh yeah, she has hyperthyroidism now also. I'm pretty sure her joints are bothering her so I want to find something to give her to help with her joints. Alot of issues and I suffer from anxiety and this is sooo not helping! So that's my story so far. If you stayed for the whole thing, thanks! Sorry it was so longwinded :roll:
My question to you all is: Should I fight the vet on the diet issue and go get what I want or should I use the prescription diet?
Any other input would be greatly appreciated.
Some additional info: I live in the Twin Cities. I have 4 other cats; Shadow, Sugar, Midnight, and Mooky(All of these cats will eventually be on the same diet as Daisy). I have 2 dogs; Mikka(pronounced Meeeka)the shepherd mix and Sonnie the pittie.

 

Welcome to FDMB, Chelsie and Daisy.

Absolutely. If the cat won't eat it, what good is it? Return it, say the cat won't eat it, and say you are going with over the counter low carbohydrate food as recommended in the 2010 AAHA guidelines. Unless of course, she wants to pay for it!

An infection may raise glucose levels. Vet stress may raise glucose levels 100-180 mg/dL during the appointment and for several hours afterwards. What was the blood glucose level? Urine glucose level? Did they do a fructosamine test, too?

Have you started using insulin and if so, which one?

 

They did bloodwork and they did a urinalysis. I don't remember what the results were but I will get a printout tonight when I pick up the antibiotics. Daisy has not started insulin as my regular vet told the fill in vet he wants to see how Daisy responds to a better diet first. I don't plan on taking her back to the vet until I've had her on a different diet for 2 weeks or so. I was thinking about going to Wal Mart and getting the meter and testing her starting within the next few days so I can show the vet my own data while she's at home not stressed out.

 

That's a great idea if there are no ketones present. However pick up some urine test strips - KetoDiaStix, or generic - to monitor for glucose and ketones in the urine. These reflect what has accumulated since the previous void.

Ketones, in particular, if more than a trace, are a medical emergency. Tips on urine testing are in my signature link Secondary Monitoring Tools.

 

Hi Chelsi and sugarbaby Daisy and welcome to the FDMB. Lot's of day-to-day experience in dealing with diabetic kitties here.

Yes, fight the vet and feed poor Daisy something she will eat.

I defied the shelter staff (3 people), their in house vet, 2 other vets at the clinic the shelter uses and refused to keep my foster cat Wink on the Hill's W/d or switch him to the Hill's m/d or feed him the Purina DM.

Because I refused to feed Wink these foods, and followed the recommendations here to feed Fancy Feast classic pates or Friskies pates, Wink no longer needs insulin and he has been OTJ, off-the-juice, insulin being the juice, for 5 months now. He was at the shelter, for 4 months, unregulated, eating various high carb foods which did him no good, only kept his BG (blood glucose) numbers high.

He had severe diabetic neuropathy, huge flakes of dandruff, poor coat with hair falling out, bouts of diarrhea every month, frequent UTI's and was in poor shape. He is happy, healthy, walking more normally now, shiny sleek coat, no more bouts of diarrhea or UTI's. A totally different cat now. I would fight the shelter tooth and nail if they wanted to change his diet now.

There is nothing special about the prescription cat foods, except the high price. Many cats get tired of the taste and refuse to eat it. Fancy Feast classic pates and Friskies pates have lots of flavor varieties to please the most finicky of cats.

My recommendation is to feed your cat Daisy something she will eat. Not eating is dangerous for a cat, leading to hepatic lipidosis. Let her eat the Fancy Feast!

The DM only has 1.7% fiber. Cats don't need fiber in their diet.

 

Update: Blood Glucose levels were 258 and they saw glucose in her urine. They didn't give me a number for the glucose in her urine. They did not test for fructosamine. I asked the vet about giving Daisy something for her joints since she doesn't get around as good as she use to; she's always been a bit stiff but more so lately. The vet told me "I think your money would be better spent on treating the hyperthyroidism and diabetes than on a glucosamine." What the heck lady? I AM treating her diseases!!!! And I don't recall asking for financial advice grr_red Man this vet lady is wearing me thin!
We started antibiotics for her UTI and 5 mg methimazole twice/day for her hyperthyroidism tonight. We also started eating Fancy Feast Chunky Chicken Feast. Since I was poopooed by the vet lady regarding joint supplements, that's not being treated yet. To avoid traumatizing her too much with all the changes, I used Greenies Pill Pockets to give her pills. Hopefully this was a one time thing since I'm guessing they are not good for a diabetic. Any suggestions for giving pills other than using pill pockets? Of course, if by some miracle they are acceptable, I would continue using them. I have no problem giving pills but since she will be on the thyroid meds for the rest of her life I'd like to find a way to give it to her in a somewhat enjoyable manner.

P.S.- I sent my fiancé to get the meds from the vet after work today so I wouldn't have to deal with her. I told him do not buy food from there no matter what she says to you!

 

Hello and welcome to FDMB. Sorry you've had to deal with the back up vet and had issues. Unfortunately not uncommon.

You can use Greenies Pill Pockets, but get the Allergy Formula Duck and Pea ones as they are the best for diabetics. They only come in dog formula but you can break off a piece to wrap around a pill. Alternatively, hyperthyroid meds can come in compounded form or a transdermal gel that's rubbed in the ears.

For glucosamine, you can buy off the shelf Cosequin. It is worth getting the vet (maybe your own when he's back) to do an X-ray to confirm arthritis.

 

Well, I'm joining the conversation a bit late - but - here goes

I wouldn't bother fighting with the vet over the food issue. You can feed whatever you want in the privacy of your home.

When your regular vet is back, you can return the leftover prescription food and say your cat won't eat it.

Pill pockets do work great for meds. We buy the largest dog size package, and break off little chunks to wrap up the pill. (cheaper that way) The hyperT pills taste bad, so be careful not to get any on the outside of the pill pocket. We have to cut up the HyperT pill (tapazole).

 

I'm curious what tests the vet did to determine the hyper T - did she do blood tests that include the T-4 and Free T-4?

If not, then there is no way to be certain the cat has hyperT.

Also, 5 mg twice a day is in my opinion a high starting dose. Personally, I would halve that and start lower, or even quarter it and give 1.25 mg twice a day and see how that works. It really depends on what the T-4 and Free T-4 levels are in order to know what the best starting dose is.

Can you get a copy of the tests that were done?

Regarding the food, just ignore the vet. There is no need to fight. You are in charge of what you feed and do what you think is best. Return the prescription to the vet and just say, I'm sorry, but kitty won't touch it and I see that it has a refund guarantee, so please refund my money or apply a credit to my bill.

And if the vet suggests other food, just say thank you, I'll think about it and don't say or do anything more.

No need to fight with the vet, especially when you do need their expertise and help for the other issues.

And you can treat the arthritis with cosequin, or even get glucosamine, chrondroitin, msm vitamins as pet treats and use give her that if you want. Here is a product that I used - http://www.vitacost.com/vitacost-arthro ... ets/?cas=1

I broke up the tablet into pieces to make it easier for the cat to eat.

 

Just tell the vet your cat wont eat it and its too expensive. Discussion over.

Did you pick up the urine ketone strips yet?

Also how do you feel about home testing her blood? That way you can see what the diet change is doing and if its helping.. and its important to do if she does end up on insulin.

We can give tips and a shopping list if you like?

Wendy

 

Total T4 was 3.9 and Free T4 was 60.3

 

I don't know the carb content, but for our non-diabetic HyperT cat, we used the Vet Chews. They are easy to half or quarter do adjust dosage and you feed them as treats. They come in different flavors to match your cat's taste.
http://www.bcpvetpharm.com/products_vetchews.htm
If I have time tomorrow, I may try and call them to see what the non-medicinal content is.

 

Well that Total T4 is in the normal range, but the Free T4 is quite high, indicating hyperthyroidism.

My hyper-t cat did well on the transdermal gel version of methimazole

 

I suggested cutting down on the dose only because of my own experience with Maui. The vet instructed 5 mg BID and after giving her three pills in total - her WBC (white blood count) was almost 0. She had such a bad reaction to the dose that she almost died. It took weeks for me to nurse her back to a low - normal WBC level. I then took her for the I131 treatment.

Then my oldest had hyper T and a different vet recommended a conservative starting dose of 1.25 BID and based on what happened to Maui, I didn't want the same thing happening to Sydney, so I was happy when the vet gave the lower starting dose. If over time, it would have needed adjusting, I would have done that, but only after her body was accustomed to the pill.

 

Maybe I will reduce the dose. What if the vet gets upset that I adjusted her dose without consulting them? Also, thanks for offering a shopping list but I think I got it from another post on here. My plan for after work tomorrow is to go to Wally World and get the Relion meter, lancets, Neosporin and freeze dried treats. I'm hesitant to get the ketodiastix since I'm not sure how I can get a urine sample from Daisy. I could isolate her in a room by herself with her own litter box, but I don't really want to submit her to that sort of stress.
I did get her the GNC Ultra Mega Hip & Joint Health soft chews which contain 100 mg glucosamine, 50 mg chondroitin and 50 mg MSM per chew. I plan to give her 2 of these a day. The directions say to double the dose for the first 6 weeks for quicker results but I already feel bad giving her antibiotics for her UTI and the pill for her HyperT.
Let me know if more information is needed in my signature. Since we just got diagnosed with these diseases, I haven't gotten a hang on the jargon yet :smile:

 

Here's how to get a urine sample.. https://docs.google.com/document/d/1quta5WLEjdO0Y_t2dAYSwN84h-LNZWxOdtVsJDKZ16A/pub. If you get the ketodiastix then they show both urine glucose and ketones. Doesn't matter if you test the wrong cats urine, she should be the only one showing glucose in her pee so you will know its hers.. And hopefully no ketones.

Here's some ear testing tips too.. https://docs.google.com/document/d/13c_CPZVKz27fD_6aVbsguadJKvjSrSAkD7flgPPhEag/pub

Wendy

 

The only way to know if the methimazole dose is too high or not is if you see any symptoms and getting the t4 and free t4 tests done - with Maui, she got very sick, was lethargic, vomiting, not eating and could barely walk. I just knew she was worse than when we got the hyper t diagnosis and when I brought her back to the vet and they tested her, that's when it was confirmed and I had to take drastic measures to save her.

She also did not have diabetes when this happened.

I would suggest, watching her closely, if you see anything off, then contact the vet immediately to see what's happening. You can also call the vet tomorrow and ask her opinion on cutting the dose in half to see how that works. You can always adjust it if needed.

 

Hi Chelsi. Welcome. You've gotten a lot of feedback and might not need more, but I want to add my support too. My cat Tootoo started insulin on July 27th. The vet also told me to buy the expensive DM dry food. I did buy it, but ended up feeding Fancy Feast. I followed advice from members of this board as tightly as I possibly could, and Tootoo is doing very well now. Numbers are way down, insulin dose way down - I know the protocol used here works. Do your research, study the information given on this site, ask questions of the members, and your kitty should do fine.

Regarding the arthritis, I thought my kitty had arthritis, but the symptoms disappeared when he started insulin, so I'm assuming that what I thought was arthritis was a neuropathy connected to the diabetes.

It's my opinion that the vets are given some false information via the larger corporations that supply them with pet foods, etc. In other words, there's some money motivation behind it - not necessarily on the part of the individual veterinarian. So I think we have to really do our research and separate out the true information from the false information. The information provided on this site comes from some pretty good sources from what I've observed (but check it out yourself). More importantly, the cat's best interest is held above all else. Ok. There's my opinion. Hope it helps.

 

Today's Update - I changed my work schedule so now I'm going to try feeding Friskies Classic Pate 3 times a day to all cats. I've been feeding them Friskies twice a day for the last few days and they are all about it. Since Daisy has lost so much weight I want to try and put some meat back on her bones and I figure giving her 3 feedings a day should help. I'm hesitant to remove dry food from their diet so quickly because they have always been free fed dry food and I don't want them to think they are being punished. So I went and got Nature's Variety Instinct Grain-Free Chicken Meal Formula since it had the highest Guaranteed Analysis of Crude Protein at 49% minimum and the lowest Crude Fiber at 2.8% max. Hopefully this won't hinder Daisy's recovery from her current 3 health issues. I want her to be able to eat whenever she wants since she has gotten so skinny and I can't leave wet food out all day.
I got the Relion meter and lancet. I will try it tonight. The only Ketone strips I found were Relion and they weren't the ones suggested to me in earlier posts so I didn't get them.
I called my regular vet to discuss the HyperT medication dose and am still waiting for him to call me back.
I wish I knew how long it will take her to start acting normal. I'm wondering if the HyperT is affecting her more than the diabetes. She's just been plopping herself down on her side and laying around when she isn't eating or drinking. She always seems to lay in the coolest spots on the floor, almost as if she's hot. She's still eating as usual. She's still vocal but not as much as usual. Where's Dr. Doolittle when you need him?!
I will post an update when we attempt to use the meter and when I talk to the vet.

 

First thing: get copies of ALL the tests done on your cat; you paid for the tests and you are entitled to the results in hard copy. TELL the vet you have started a health binder for each of your cats and you want photocopies of the results.... tell them you will wait for the copies. Do NOT take no for a reply.

Next: Food. Tell miss hissy fit that food is lousy and your cat is NOT eating it. Return it for cash refund or have the amount put toward the methimazole (Tapazole) cost. Give the vet a link to Dr. Lisa's food list and have her consult it for the numbers. You are punishing your other cats by letting them stay with dry food as it's lousy for their health, but you know that already. Friskies pates are just perfect for your diabetic. Fighting the vet? Excuse me, but who is the customer, who is paying, and who owns the cat? Is the answer to any of those questions your vet's name? No, I did not think so.
Why can't you leave wet food out all day? Everyone else does. If you want to ration out the food for her, get an auto feeder.... that's what most people use for their cats. if you are worried about the food going bad, it won't. You can freeze portions and put in the feeder, and there is also a spot for an ice pack under the feeders, so you don't have to worry about spoilage.
Diabetics need to eat more frequently..... maybe 6 times a day - 3 meals and 3 snacks. If you feed only 2 times, you will contribute to uneven blood glucose numbers through the day. Testing at home with a Relion meter is a great idea because you can see how she is doing now that you have taken away any dry food. A great deal of cats are diet controlled and need no insulin once the dry is gone and the low carb wet food is fed.

HyperT: careful with the dosing; the others who have replied know what they are saying.... start low and increase if needed. Just like with insulin.... too many vets say to start at a dose that is way too high, and it harms the cats. Go low and slow with the dosing; it's safer for your cat.

You mentioned stiffness in walking. You can try cosequin and also, you can see if she would like to sleep on a heating pad in her bed. You can also start giving her B12 shots as most cats over 10yrs old benefit from weekly shots of B12.

Last, look around for a decent vet if this one continues to boss you around. You can ask others near you about their vets, and then you can make an appt for a consult..... take your cat and a list of questions, and see how you like the answers and manners of another vet. That's what I did and I was so very happy; I found an incredible office with 3 extremely caring and dedicated vets.

Gayle

 

Is it the natures variety instinct "raw", if so that's a good choice as is fairly low carb (8%)but I think the non raw is too high. Maybe take it back and switch it?

The relion ketone strips are fine... Reason I suggested the ketodiastix as it would make it a little easier to know for sure who's pee it was since the ketodiastix test for urine sugar too. The relion strips just test ketones but they will work and nobody should show ketones anyway.. And if they do then its probably her and she would need an immediate vet trip!

Wendy

 

Nice that all your kitties like the Friskies! Would Daisy eat some plain cooked chicken or turkey? The extra protein may help her to gain some weight. You could add up to 20% protein like the chicken/turkey to her food to help her out a bit.

With the combination of the unregulated diabetes and the hyper-t, she must be super hungry. My Wink would eat 10-12 ounces of food a day and he still lost weight. Just could not get him to eat enough.

How many ounces of the wet food are you giving Daisy?

It's a good idea not to take away the dry food all at once. Fewer tummy upsets and less chance of diarrhea that way. It's much better to gradually give less dry food. :mrgreen:

If your multiple cats are like mine, leaving out wet food all day long simply does not work. Two of mine are hoovers, and the food disappears in a couple of minutes flat. Wink would never get enough to eat if I left the wet food out to be free fed. That is the main reason for meal feeding, so each kitty gets a fair share of the food.

Is there anyway to give Daisy a later before bed snack without the other kitties mobbing you for some food too? Just trying to think of some suggestions to get her an extra meal or two.

 

The Nature's Instinct is kibble so I don't think it's this raw you speak of :? Daisy got about a handful of chicken breast last night. Is there a way I can cook some chicken and keep it in the fridge or freezer to feed her as needed instead of cooking it every time? She gets about 7.5 oz wet food per day plus the new dry kibble I got today. I'm going to keep a can next to me while I'm sitting watching tv or playing on my laptop so I can sneak her some while the other cats aren't looking.
I spoke with the vet. Starting with her next dose, tomorrow am, her HyperT med will go down to 2.5 mg twice a day from 5 mg twice a day.
Thanks for all your help and hanging in there with me during this initial process. :smile:

 

Hope your other kitties don't catch on to this trick too quickly. :lol: :lol: :lol: Be careful that she doesn't lick the can rim and hurt her tongue on the sharp edges. Maybe instead of a can to eat out of, keep a small covered Tupperware/plastic container nearby.

Hope the reduction in the thyroid meds helps Daisy to feel better.

 

The raw is kibble - see here http://www.naturesvariety.com/Instinct/cat/kibble/rawboost/all

 

So how do you feel about ear testing? Will you give it a go? Its good to get baseline data before you start insulin..

 

Update -
It's been a while since I posted. I guess we got comfortable since once we finally got Daisy's Thyroid medication dosage acceptable she seemed like her normal self again. The cats have been strictly on a Friskies Classic Pate diet since Daisy was first diagnosed with diabetes and hyperthyroidism. I thought this was working and I figured if something was wrong I'd be able to tell by her behavior. Boy was I wrong. Daisy became lethargic Sunday and stopped eating. I rushed her to her vet Monday morning. Her blood glucose was over 500. Poor thing. She was like a limp noodle when I took her in. I thought for sure she was a goner. The vet had to force feed her Monday night. I wasn't there when they did this so I have no idea what this means but whatever they did worked. Yesterday she started eating on her own and was sitting up, purring and begging for attention. She's still at the hospital. As of last night, they were still trying to get all the ketones out of her urine and get her blood sugar stable. I decided to work today since the vet staff were very optimistic. I will get another update this afternoon. I don't want to bring her home until she is stable. To be frank, I'm afraid to bring her home, since I failed her once already. I'm positive the vet will certainly push the D/M canned food on me since the Friskies wasn't successful, although since she will most likely be on insulin now, Friskies with the insulin may be ok? I'll post an update later tonight. Suggestions and beratings are more than welcome.

 

I wont berate you - you havent failed her. But there is some stuff you can do, to give her a fighting chance. Good regulation and remission isnt out of the question if you do this

1. Get a good insulin - Lantus, Levemir or Prozinc

2. Food - I would continue the fancy feast classics as they are low carb and you know she likes them

3. HOME TESTING. You learned the hard way that you cant tell by looking at the cat how it is doing. Its not as hard as you might think. i do it to 2 cats no problem - and even with reluctant bleeders, the vast majority get used to testing within a few weeks. We can advise on how to do this, what to buy etc. Home testing gives you a better picture of whats going on, is more reliable and cheaper than vet visits. I would advise home testing her blood PLUS home testing her pee for ketones so you dont have this issue again!

let me know if you want more home test info...

Wendy

 

It sounds like we will be starting Daisy on Lantus. The thing which has me most scared is how often and when I'm suppose to test her. There is an 8 hour period during the day when nobody is home. I feed her before work @ 4:30am, after work @ 2:30pm, and before bed @ 9pm. My better half leaves for work at 7am and could feed her before he leaves but there is no way he will do the testing. He can't look at a needle without gagging. I did test her for the first time on Sunday evening. It was quite easy, but she was very lethargic so it will be interesting to see how she tolerates it while she is alert. I'm concerned about testing for ketones as we have 5 cats in the house along with 2 dogs. This makes it difficult to have a litter box upstairs where I can keep an eye on Daisy's potty patterns since the dogs love to eat litter.
On another note, I can't get a pic of Daisy on our profile b/c I can't get a pic compressed to less than 10 kb.

 

Lantus is a good insulin.

I reckon we can fit 3 tests into your schedule nicely...

- always before the shot - this is mandatory as you don't want to shoot when too low. As a newbie this too low number is 200 but is reduced over time once you have the data to know if its safe. So say test and shoot at 4.00am and 4.00pm?
- mid cycle - 5-7 hours after the shot and is to see how low she is going. The low point "nadir" is what you base dose changes on since you don't want her dropping too low (under 50). This could be 9.00pm which is 5 hours after your pm shot.

What meter are you using and what test result did you get?

For the ketone tests - you can test the pee anyway - if you dont see any ketones then all is good. If you do see ketones I would assume its Daisy since she is the only diabetic and take her to the vet!!

Wendy

 

How to get an avatar small enough directions. See the 3rd post down in the topic, for step by step how to's

 

Vet instructions: Give 2 units, twice per day, after feeding. Don't worry about checking the blood glucose levels during the first week, as the body will be adjusting to the insulin. After the first week or so, bring Daisy in to the vet for a day so a curve can be done and her insulin will be adjusted according to how this curve turns out.

I gave her the first insulin shot last night and another before work today; both after feeding. It seemed to go okay. As far as feeding goes, she does not eat all at once. She eats a little and keeps coming back. She was in better spirits when I got her home last night. She seemed a bit restless, but alert.

 

2 units is a high starting dose for Lantus. It did sound like Daisy had ketones in her urine though. Is that correct?

How much does Daisy weigh now?

 

Yes, she did have ketones in her urine. She was 9lb11oz in August. She had visibly gained some weight since then but within the last week she's probably back down to that.

 

There are certainly circumstances where a higher starting dose is warranted. Ketones, DKA (diabetic ketoacidosis) being two of those circumstances.

The scientific protocol we use uses this formula: ideal weight or current weight if underweight, expressed in kilos times 0.25 units per kilo, rounded down to the nearest quarter unit for safety and ease of measurement. That gives us this for your cat:

9.11 pounds/ 2.2 pounds per kilo = 4.43 kilos
4.43 kilos X 0.25 Units per kilo = 1.1 Units
1.1U rounded down for safety to nearest quarter unit = 1U

The initial starting dose is double what our protocol would have set. Since Lantus is cumulative in nature, and the full dose builds up over the first few days, 5-7 days usually, I recommend that you keep a close eye on your cat for any signs of hypoglycemia. We see plenty of new members where a vet has prescribed too much insulin to start, and then the cat drops too low into dangerous territory.

Please put together a hypo toolkit and be prepared. We'd rather have you and your cat safe. Most cats don't show hypo symptoms until it's too late to help them.

Printing out a copy of these hypo instructions would be a very good idea also. You may not need them, but if you do, they can be a lifesaver. I kept a printed copy of these instructions with my hypo toolkit.

Did your vet give you a list of hypoglycemia (hypo) symptoms to watch for? If not, they are in the hypo instructions link I gave you above. Wink only got very dilated eyes whenever his BG (blood glucose) was in the 30's.

How early you see those low numbers is also a key factor. In your case, since you are not doing home blood glucose testing, you'll have to watch for the physical signs that the numbers may be dropping too low.

 

Well, I gave her her insulin shot after she ate at 4:30. When I pulled the syringe away from her, the needle was completely bent at a 90 degree angle. So I don't know if it even went into her. She wasn't wet but I could sure smell the stuff. This happened last night also. This morning it went in. I know because she meowed at me. I also didn't smell it this morning. So I've been watching her since she ate at 4:30. She's been eating and drinking a lot of water and sort of groggy. I started thinking that dose I gave her earlier never went in. So I tested her glucose about 10 minutes ago, which is 1.5 hours since she ate. It was 371. I gave her the dose again. This time, she meowed at me and I didn't smell it. I'm thinking if I smell it, it didn't go in. I keep hovering like a helicopter mom. Should I test again? If so, when? I can't afford another $1300 vet bill from ketoacidosis treatment again.

 

Please, never give another shot if you think you might have missed all or part of the shot and given what we call a fur shot. You can't really tell how much insulin you may have actually got into your cat, and we don't want a hypo.

"Better too high for a day, than too low for a moment."

Lantus usually takes 2-3 hours before it onsets, or starts to work.

How long has it been since that first shot? How long was it since you gave that second shot because you thought you had missed?

You definitely want to test again, if it's been a couple of hours since either of those shots, close together.

What gauge needles are you using? Some people have bent needle problems with the 31 gauge needles. Are you shooting, so the needle is going in parallel to the body?

 

It's been 3.5 hrs since the first shot and 1.75 since the second one. I am using the short 31 gauge needles.

 

Would you please try to get another test? Now, to see how much that shot 3.5 hours ago affected her BG. Then, another test about 30 minutes after that, to see how the second shot 1.75 hours ago affected her.

Hoping she does not drop too low tonight. Do you have your hypo toolkit ready and waiting?

 

The only thing I'm missing is the high carb canned food. 164, approx. 2 minutes ago.

 

You can always add a couple of drops of the karo/honey/maple syrup/pancake syrup to the low carb food to bring the numbers up. It wears off quickly, so you'll want to monitor closely this evening. You only want to feed in small portions, 1-2 teaspoons at a time.

You may be having your very first pajama party tonight.

Please verify that I have these times correct.
PMPS? 2 u (maybe partial fur shot)
+1.75 371 2U more insulin given
+3.5 164

 

+1.75 371 2U more insulin given
+3.75 164
+4.25 195

 

If you simply go back and edit your post, like you did to add the +4.25 reading, it does not show up on the board as a new post. So we are not aware that anything has been posted, when we scan the board for updates.

If you would please add a new post to the existing topic, that will show up as we scan the board.

Did you have a PMPS test? When you gave the first of the 2 units this evening?

 

Since you gave 2 shots this evening, you'll want to do more testing. About +6 after that first shot, and again at +4 and +6 after the second shot. You may need to use the hypo protocol to help bring the numbers up, if they drop below 50.

Unfortunately, I can't stay up with you tonight. I've got an early wake up call for Friday.

Please, if the numbers drop below 50, edit the very first post in this topic, and put that 911 icon on your very first post and change the subject line to include the words help and possible hypo.

If no one is here on the Health forum to help, you can check the Lantus TR forum. More people over there, later at night to help you out.

 

+5.25 122
I'm not sure what PMPS is.

 

PMPS =pm (evening) Preshot

How is Daisy now?

 

+6 120
+7 141

Although it's only +5.25 from the second shot, which I know was injected.

 

How is Daisy today?

 

She was fine this morning. I poked her this morning before I fed her and she was 370 so I gave her her insulin shot at the scheduled time after I fed her and came to work. Our kitchen broke last night so between playing the role of plumber tonight and monitoring Daisy, it's gonna be a busy one.

 

Thats good she is ok.

Do you think you can get some tests in today? I know your vet said not to, but honestly that can be dangerous. I have seen a few cats have hypos on here in the first week when the dose was too high. My recommended tests time are above but if your day today is to busy then just preshot tests are ok.

Wendy

 

I just wanted to let you guys know Daisy is doing ok. I've been checking her blood before her feedings and shots to make sure she isn't low. I think I will keep doing this all this upcoming week and next weekend I will try and do the curve. Hopefully, this will give her body enough time to react consistently and I will get an accurate curve. I would like to thank all of you for helping me last week. It really does put my mind at ease knowing you guys are here to help and you do seem to genuinely care.

 

Thanks for the update. We appreciate it. We worry about family members if we don't here from them in a while.

Let us know how things go over the next week.

 

I am a newbie to all this too and welcome to a VERY support group of folks here!

Both of my cats were dry food free feeders and I switched them to wet food free feeders.
The non diabetic took to the wet food like a sea lion to the ocean - it was one of those "Where has this food been the last 12 years?!" type moments.
Of course the diabetic cat took a few days to get converted and I did spend the first 2 whole weeks feeding them both 4x/day.

When my vet asked me how feeding was going and I told him this he looked at me like I was crazy and said to just put down half the food in the morning and the other half in the evening and see how they do. They both self regulated right off the bat. As he explained it to me - cats outside don't put their food in the fridge to keep for later - as long as I keep into consideration the overall environment - like a 90 degree day then they should be fine for 12 hour stretches and so far it has been true.

So maybe give free feeding a try even on the wet food.

I hope it can work because it SURE helped me get back out of a sleep deprived state.
But of course every cat is different and every cat's bean is different!

Welcome and the very best to you and your kitty from a fellow newbie

 

GReat! You dont want to shoot if she is under 200 for now. Also it would be good to get a mid cycle test (5-7 hours after shot) to see how low she is going - that way you know if the dose is too high or too low.

Wendy

 

It's time for Daisy's 5pm feeding and shot. I tested before feeding twice because the first reading was low. Each test was from each ear. The first was 121 and the second was 170. She's eating right now. Should I skip this shot and wait until her 5am shot?

 

You could wait thirty minutes and test again - assuming you didnt feed.. to see how her BG is going? Otherwise skip.

Wendy

 

I fed her right after testing. I also called the vet and he said to give her the shot as long as she's above 90. I don't feel comfortable giving her the shot with one of the tests being 120. I feel like her body is still adjusting to all of this.

 

On here, we advise newbies not to shoot under 200 unless they have a spreadsheet and data to know how the cat is going to behave. So skipping is the right idea.

However what you can do next time is test, and if she is under 200, wait 30 minutes (dont shoot or feed) to see if she has gone up naturally without the influence of food. That is also why we advise not to feed two hours before shot time - so you know for sure that food doesnt play a part in your reading.

Get a test in a few hours though so we can see what she does without the shot.

Wendy

 

Oooooh. When I feed them I leave the food out. Maybe I should have my fiancé remove their food bowls before he goes to bed at night and I can remove them when I get home from work. This way I'll know for sure she hasn't eaten anything at least 2 hours before I test her, feed her, and give her shot.

 

Might catch the occasional test when you do pick up the food, just in case there's a surprise low. It can happen.

 

I'm having a hard time figuring out the best way to make sure the insulin shot goes in Daisy. I grab her to make a "tent" but I can't get a good tent. Sometimes it goes straight through the other side. Do you guys have any suggestions for a better way to do this?

 

4 Ps for injecting:
Pull up the skin into a tent.
Gently Poke the syringe into the tent, at an angle of about 30 degrees up from horizontal.
Push the syringe plungerinto the barrel.
Pull out the syringe.

Where
horizontal = 0 degrees
perpendicular to the skin = 90 degrees
The desired angle is about 30 degrees, less than halfway tilted between 0 and 90.
(Halfway between 0 and 90 degrees is a 45 degree angle; you want less than that.)

 

Update
Daisy's doing ok. We've got the shot routine down pat. She even lets me know when it's time to eat every morning and evening. She gets sassy if I don't feed her between 4:00 and 4:30. Unfortunately, she is pulling her hair out again. I think this has to do with her thyroid disease. She hasn't been on that medication since we started the insulin since it was more important to get her insulin under control and her thyroid levels were slightly low on her last blood test. I have a feeling we're going to have to change the food or increase the insulin. I hope I'm wrong. I'm doing a curve today. The +3 reading was 506. I'll post the curve results before I go to bed tonight...

 

506 is very high- I hope you are testing for ketones. What dose is she on now of Lantus?

Wendy

 

She's still on 2 units twice a day.

 

I took Daisy to the vet last night and left her there all day today so they could do a curve on her. She's home now and happy to be. Here are the curve results:
feeding and shot time462, +2 - 410, +4 - 284, +6 - 260, +8 - 253, +10 - 278. The vet said to increase her dose from 2 units twice a day to 3 units twice a day. I fed her at 6:30 and gave her 3 units. I will check her before I go to bed which will be +2.5

 

We don't usually recommend a dose change more than 1/4 unit as you can miss the good dose. Also how does the vet know she isn't bouncing? Its a shame you don't have a spreadsheet set up - it would tell us so much more.

Did you check her for ketones? I really really hope so because you don't want DKA - its very serious, and very expensive to treat...

Wendy

 

I've been Daisy's hooman for 10 years. I was hanging out with her previous caretaker recently and found out she's 3 years older than I always thought she was. It turns out she wasn't 3 years old when I adopted her. She was 3 years OLDER THAN HER HOUSEMATES! Anyhow, I'm doing a curve today. I have been a bad caretaker for the last month or so. I have been dealing with the possibility of losing my job. I suffer from depression and do not do well in these sort of situations. I will not just go with the flow and let the chips fall where they may and not worry and stress about it. In my brain, I catastrophize the situation even though it hasn't even happened yet. If you have any knowledge of depression, you will understand. If you do not understand, please don't judge me as I judge myself every second of the day. I've been doing feedings and shots on schedule and doing random BG tests but I am sure Daisy could use more attention. Her BG levels are not going down very well. She looks like she is losing weight again. She is still drinking tons of water. She diarrheas 4-5 times during the week. I know it's her because last night while I was scooping the boxes she laid one out in the box next to me. She doesn't cover it up and it's a light tan color. It almost looks like putty. I'm debating on taking her to the vet today to get kidney and liver labs done due to this diarrhea. She still follows me around and talks to me and gets sassy. I promise I will do a better job at keeping this updated. Should I start another thread in a different board; like maybe a Lantus board?

 

The light tan/putty colored diarrhea sounds like her pancreas may not be producing enough enzymes to digest the food properly. This is called exocrine pancreatic insufficiency and is treated with replacement enzymes which aren't too costly. The proper test for this requires fasting for 8-12 hours and can be pricey. An alternative is empirical treatment, ie treating 'as if' that is the diagnosis without doing the test. Discuss this with your vet. (Mercola makes a product for pets.)

Note: enzymes are different from probiotics. Those can be helpful too, if there is an imbalance in the normal bacteria of the gut. (Ex Forti Flora)

 

I am getting concerned. I called the vet and they want Daisy to go in on Monday. Ok fine. But I want to run her symptoms by you guys. Please let me know if I'm overreacting, underreacting, and/or if you have any suggestions for my next step.
Symptoms: Eats like a pig, drinks tons of water, light tan puffy poop pile, losing more weight(super skinny), lazy(walking very slowly up the stairs)
Her BG SS is available in my signature.
Please give me some advice! Tell me to simmer down or go to the ER. Last time she was lethargic she was hospitalized for a few days and put on fast acting insulin drip and I don't want this to happen again. Her BG seems fine at the moment. I hesitate to use the 911 icon but I need some direction! Thanks in advance!!

 

Unfortunately, I can't provide much advice based on her symptoms. However, since you've displayed a 911 icon on your last post, in order to attract more people to your thread, go back to your first post in the thread and edit that one and display the icon there.

If you do that, it will show up in the list of threads with the 911 icon next to the thread. Otherwise, people would need to read the entire thread to realize that with your last post you are having an emergency issue.

Have you tested for ketones recently? What was the result?

According to http://en.wikivet.net/Diabetic_Ketoacidosis symptoms of acute ketoacidosis is depression, weakness, vomiting, diarrhea, acetone-smelling breath, slow deep breathing and early symptoms include polyphagia (excessive hunger) and weight loss.

If you have tested for ketones and there is even more then a trace amount, then you have a serious emergency on your hands and I would go to the emergency vet ASAP.

 

Here BGs are on the high side but not that bad. The eating/drinking suggests other problems like hyperthyroidism or could be something else. If no ketones and continues to eat you could wait until Monday morning.

 

I took Daisy to the vet. She was sleeping with her head hanging over the edge of the water bowl which made me very concerned about her kidneys. They drew blood, took her temp and took her blood pressure. Her blood pressure was normal and so was her temp. I wont get lab results until Monday but they ordered a T-4 total, comprehensive chem panel and complete blood count. I will continue to do a BG curve.

 

Great job on the SS - her BG isn't that bad but probably does need a slight dose increase. Does she still only get the FF classics? no dry or anything?

As regards her poops - it does sound like it could be exocrine pancreatic insufficiency like BJ said. Ask your vet about it. My Bailey has it. I don't know if i would even bother testing for it, just start the enzymes and you should know in a few days if its working..

keeping my paws crossed for her!

Wendy

 

Well, Daisy's labwork came back normal. The vet is adamant I change her diet. He doesn't want to change her insulin dose as he is afraid it will go too low when it goes down. This makes sense to me. We have to figure out why she is spiking. She is still drinking a ton of water and her BG spikes a few hours before her evening shot. Her mornings start out around 400 and steadily goes down and then spikes over 600 a few hours before her evening shot. There is nothing different during the time between the feedings and shots. Same food and same amount. She gets Friskies Pate Turkey & Giblets Dinner or Friskies Pate Mixed Grill. Any ideas?

 

The Friskies Mixed Grill is 11% carbs. The Friskies Turkey and Giblet is 8%. We recommend trying to stay under 10% carbs. For that reason, I don't feed my sugardude Wink the Mixed Grill flavor.

If you can find the Friskies Special Diet canned foods, most of those are 4-5% carbs. I found some recently at my local Petco.

The Fancy Feast classic pates (3-5% carbs) are also about half the carbs of the Friskies classic pate style foods.

Daisy is dropping into the blue numbers mid-cycle, so that is encouraging. I just don't think the 3 units is enough.

I'd like to see the numbers on the SS for the last couple of days, to see the trends after the depot has filled. Usually can take a couple of days to see an affect from the dose increase.

If you noted on your SS, which foods you feed which days, that might help us to see if Daisy is carb sensitive, and you should eliminate the Mixed Grill from her diet. Just a thought.

 

I agree with Deb I would tweak the food a little.

The vets fear is preventing Daisy from getting her blood sugar into normal cat levels (50-130). Normal cat levels will help her body heal and possible even remission. Since you are home testing you can ensure she stays safe and doesn't drop too low. However if you change her food a little to say the fancy feast classic pates, she might come down naturally without increasing the insulin so I would give that a try first

Wendy

 

Update -
Daisy was on 3 units in the am and 4 units in the pm and eating only Friskies Turkey & Giblets. Her poop issues never did improve so I recently switched foods. So I changed her food about 1.5 weeks ago. I switched to Authority Chicken pate because it seems to have lower carbs than the Friskies. I also changed her units to 3 in am and 3 in pm because of the lower carbs. I did not want to risk her going too low with the change in food. Her BG is hovering around 300 before her feedings and her poop is still light tan and "puffy" looking and reeks horribly. She will be due for a refill of her insulin in a couple weeks and I'm wondering if I should request trying a different one from the vet.
Should I give the new food more time? Is there another food I should try? I've been seriously considering trying Dr. Pierson's recipe. Also, any thoughts on changing the insulin? Any suggestions would be very appreciated.

 

Did the vet test for exocrine pancreatic insufficiency after fasting her for 12 hours?

It still sounds like EPI to me. Hows her weight?

Before changing insulin can you update your SS with more data so we can see how the insulin is working? You will need pre shot tests plus a few mid cycles for at least 3 days to really know how its working. 3 days will account for any bounces and give a good picture of her BG.

I usually recommend 3-4 tests a day to give a good idea of what the insulin is doing

- always before the shot - this is the highest point of the day for many cats
- mid cycle - 5-7 hours after morning shot depending on your schedule. This is to see how low the cat’s blood sugar is going. The low point "nadir" is what you base dose changes on since you don't want the cat dropping too low (under 50).vary this test within the 4-8 hour window.
- before bed (2-3hours after Pm shot) to get an idea of what the cat's overnight plans are. If this number is less than the pre shot test number , set the alarm for a test a few hours later as this implies an active cycle.

Wendy

 

Well it looks like I have to go back to Friskies until I can figure out which food to try next. Petsmart is constantly out of the Authority Chicken pate Adult and they are the only ones who sell it

 

Since Petsmart doesn't seem to keep their OWN brand of cat food(Authority) in stock on a regular basis, I decided to look for the Friskies Special Diet Turkey & Giblets while I was there yesterday. I found it! I was so excited :razz: The cats had some last night. I think I'll do a curve over the weekend after they've been eating it for a few days. Until then, I'm doing random BG tests.

 

FYI - The PetSmart brand is called Great Choice, not Authority - that is a name brand like Purina, Fancy Feast, Friskies, Blue, Whiskas, etc. not PetSmart's store brand.

You may want to talk with the store manager however about ordering Authority. They may do that. Additionally, if you cannot find it locally, there are many online stores that you can purchase from and ship directly to your house, including petsmart.com, wag.com, petflow.com, petfood.com, etc. - check online and their websites for coupon codes, discounts, free shipping, etc. Some of them if you sign up for their newsletter you will receive coupons, discounts etc.

 

I knew Great Choice was their brand but I assumed Authority was also since it is only sold there. I have not found it available on any websites. Some of the websites say they sell it but once I go to their website Authority isn't listed. Also, the Authority website has the PetSmart logo on the tab in my browser which led me to believe it was their brand.

 

The Friskies Special Diet T&G is what my two kitties eat. It can't be beat for the low carbs, the low phosphorus, and the higher protein content, all for the super low price!

 

It's "exclusively sold at PetSmart," according to their website. Not sure what that means.

 

Probably means they contracted with a specific manufacturer to label a generic product just for them.

 

I started the cats on the Friskies Special Diet Turkey & Giblets Tuesday night. I've been giving Daisy her usual doses. This morning her BG was 80 before I fed so I did not give her a shot. How do I determine how much insulin to give her once she goes up again?

 

If you are using Lantus, then you do not want to feed within 2 hours of shot time (unless the cat goes under 50), as you won't be able to tell if she is just plain rising or it's a spike in BGs because of the food.
You can wait 2 hours and test again, and if she is at a number you are comfortable shooting, you could give the insulin then, but post for advice first, please.

If you give her her shot 2 hours late, that means tonight's shot will be 12 hours after you give her the insulin this morning, so you would need to have flexability in your shot schedule.

 

Can you update your spreadsheet with her most recent numbers, please? That will help others to help you.

 

I'm at work and I can't update my spreadsheet from work. We can't access file-sharing sites. I had my fiance test her blood 2.5 hours after her feeding and her BG was up to 127. Obviously, I can't give her a shot from work so she is missing her morning shot today. I will test her blood when I get home and update the SS and request dosage instructions based on that.
FYI...Here is our usual schedule:
Mon - Fri(No work Sat & Sun)
4:20am Feed & give shot
4:50am Leave for work
2:30pm Arrive home from work
4:20pm Feed & give shot
8:30pm Bedtime

 

Daisy's SS has been updated. Based on her PMPS I just did, which was 187, I think I may only give her 1 unit after she's done eating.

 

Wheb you aren't comfortable with a pre-test, stall 30 min without feeding and re-test.
This let's you see if the number is rising. If it is, it may be OK to shoot if you can monitor the first few times you do that.

Please stick with 1 unit for 3 full days, unless the glucose drops below 50 mg/dL on a human meter or 80 mg/dL on a pet-specific meter. Lantus needs that time to stabilize at a new doseage.

 

As BJ says, hold this dose 3 days unless she drops under 50. Then you may want to reevaluate and see if a slight 0.25 increase is needed - see this protocol - but ask if you have questions!!

http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581

 

Based on Daisy's SS, I think I should increase her dose. What do you guys think?

 

Yes, I would probably increase to 1.25u and see how Daisy does. Hold it for a minimum of 3days/6 cycles and if you're not seeing better numbers, then you might need to increase again.

Now that you have a spreadsheet set up, if you want to join one of the Lantus sup-group forums, they'll be able to give more specific dosing advice.

 

In short, Daisy hasn't had a shot in 2 days due to her bg being <100. She is walking awkwardly on her rear haunches. And she isn't eating very much.

 

I forgot to mention. She's urinating on herself. Please help

 

Go to an emergency vet. We can't diagnose over the internet, nor can vets.

Possible diagnoses include hepatic lipidosis (can be fatal), plus it sounds like she has been ill, possibly with pancreatitis (can raise glucose), and/or exocrine pancreatic insufficiency.

These must be treated by a vet.

The last person who wanted to wait until the vets office opened in the morning lost her cat.

 

I was out of town for 2 weeks until last night. As soon as I got home, I noticed Daisy was in worse shape than my fiance lead me to believe. I took her to the EV before I even got a response on here. She's gone. Her BG was fine but her kidney's were failing and she had pancreatitis. I could not put her through any more. Thanks for all your help in the past.

 

Requiem aeternum, Daisy.

{{hugs}}