Hi, we're very new to this. Ollie was dx on Thursday, 2/23. We started PZ 1 unit on 2/24. He's had 3 doses so far. This afternoon I got a meter to begin checking. The meter is a cheap store brand but the pharmacist said he's had great luck with it. At 8:40 we got a BG of 90 from his ear. He ate some of his dinner (he still eating eating everything) and we checked again at 9ish. It was closer to 9:10 because it took me forever to get blood. His BG after eating was 89. I have NOT given him insulin yet because I am unsure if I should. The vet had me blindly giving insulin every 12 hours and wanted him to be fed only 2x a day. Historically that has caused problems with his IBD and everything else so we fed at 9 am, and I gave him some more at 1 pm. He did not eat again until 9 and he's really not eating well (also normally for an IBD flare which sent us to the vet to begin with). Any advice would be greatly appreciated.
I would not shoot at all anymore without first getting blood glucose tests with a home meter. It is too dangerous. For now, we will take your meter at face value which means you should not shoot one unit.
Also, it is not good to feed a diabetic cat only twice per day. Multiple smaller snacks/meals are far better and really can help stabilize BG.
What was his fructosamine test result at diagnosis? Any other labs you can share? Please let me know as much as you can, and I will check in with you in the morning. I’m Eastern time zone. Which time zone are you in? I’m really impressed with your efforts to take things under control and begin home testing to make sure he will be all right.
Thank you so much. We did not give any insulin. We tested again just now and got 118. I am so angry with the vet, I will text his regular vet in the morning. I will make sure he gets several meals. What do you mean not shooting at all until I get BG with a home meter? I am using a home meter now to get the 89 pre meal, 90 30 minutes after, and 118 at the 2 hour mark. Thank you again for your help. It is appreciated it.
Setia, I’m sure Suzanne will clarify in the morning but I’m guessing she wants you to get more of a full curve. I would keep testing every 2 hours or so until you go to bed and then again in the morning. I think we’re also kind of wondering how your vet diagnosed Ollie with diabetes. I’m not super experienced but I’ve been watching this forum for a month and you’re the first person with a “surprise” diagnosis. Often there are obvious symptoms like drinking a lot, losing weight, or walking funny (plantigrade stance). At a minimum for a diagnosis you want high blood glucose AND glucose in the urine. A high blood glucose on its own could just be a reaction to stress of the vet visit. Fructosamine gives kind of an average of the blood glucose over the past few days, so it can also be a good way to diagnose feline diabetes. Pumpkin for example was drinking 4x her normal amount of water, losing more than a quarter ounce of weight a day, had glucose in her urine, and was over 300 the first time I tested her on a human meter (pre-insulin). That’s a really obviously diabetic cat. It’ll definitely be helpful for Suzanne if you can share any lab results that led to the diagnosis (blood counts, urine analysis, etc). You can see in my spreadsheet how I transcribed Pumpkin’s lab report into my spreadsheet. And keep testing for now and updating the spreadsheet with the results.
To explain a little better, Ollie has a history of pancreas issues and IBD and I called the vet because of vomiting. Normally, my regular vet would see him and just give baytril and metronidizole and we'd call it good if his blood work was OK. On his blood work, his BG was 406. But everything else, even his pancreas was normal. They did the fructosamine after that and it was 451. He had bacteria in his urine but I do not remember what else she said, she apparently cultured that. When we got the diagnosis my husband said the pee in the litter box was more than normal but only the previous two days. Aside from that, we did not notice anything. It also is not unusual for him to drink more when he has vomiting episodes. I'll test him before bed just so we can be certain. Thank you.
@Suzanne & Darcy his Fluctosomine was 451 on Thursday. I'm EST also but have late hours. This morning his sugar is only 132 (9:20 am) after not getting insulin last night. When I look at the PZ guide, it suggests not giving insulin this low. The vet is not my normal vet--she suggested to not worry about testing and give 1 unit every 12 hours... And to only feed 2x a day. I started giving him smaller meals yesterday and we were all much happier. I'm not sure what to do. I can try to text my regular vet but he's out on personal leave. I put his labs on the lab tab of the SS. edit: Checked again 30 minutes after eating and his BG is 148. I texted his regular vet who said definitely skip insulin, check again tonight. I updated Ollie's SS.
You’re doing great Setia! With the numbers you’re seeing Ollie is going to need something to get his blood glucose into a normal range. But you’re in that uncomfortable range where you need to know how your cat reacts to the insulin to keep him safe. Keep testing every 1-2 hours for now. You changed up his eating pattern on your other vet’s unfortunate recommendation so you might still be seeing some effects from that. We want to see how Ollie’s BG levels look when he’s eating normally. I‘d also suggest starting research on foods Ollie could tolerate. A diet change might be all that’s needed, and would be way less stressful than managing insulin injections with a cat showing low numbers! Try searching for IBD on this forum. My approach was to find limited or even single ingredient (not including vitamins and minerals) foods to try and then introducing just a tablespoons or two per day to see how Pumpkin reacted. That way if she had a flareup I knew what to rule out. But see what other threads about IBD have to say, and then try to track down some samples so you have them when you’re ready. Hopefully @Suzanne & Darcy gets a chance to take a look soon. She’s much more experienced than I am, so she’ll be able to give the best advice.
I’m going to go take a hike for the rest of the day, but it looks like you’re just watching and waiting for now. Hopefully someone else will look at the thread throughout the day and I’ll take a look when I’m back this evening. One more thing to think about. If Ollie’s BG gets back into numbers that tell you to shoot by this evening, I think you’ll want to consider a lower dose. Maybe 0.5u instead of 1u. But hopefully others can chime in there. If you don’t have a syringe with half unit markings you might want to get one so you’re prepared. I found that the syringes Walgreens sells at the pharmacy counter have half unit markings. You might already have some for your own use. If you got an insulin pen that only does whole units you can just use a syringe to draw the insulin out. There are lots of videos showing how to do it. I’m not saying definitely go to 0.5u, just it would be good to be prepared.
I guess I just meant that I was unsure if you were happy with the meter that you were using. I recommend the Walmart ReliOn meters because they’re reliable and you can get 100 strips for $17.88.
I see your spreadsheet is up and running. That’s fantastic. Try to get some tests through the day (as you already have been) so we can see what’s going on. This will help to determine an appropriate dose for Ollie.
Now, as to feeding, the only times that Ollie should not be eating would be for two hours before each shot, so that we know that those pre-shot tests are not influenced by food … meaning that they are not inflated by food. That way you will know whether it is safe to shoot insulin at all or if his number is too low to shoot — or if you just need to shoot a reduced dose. Then the only other time where we don’t recommend feeding would be after his nadir, which is the lowest point in the cycle. After you have gathered a bit of data on how he does on his insulin. You will be able to hopefully pinpoint, within a couple of hours, when his typical nadir occurs. The only reason for this is that if you feed much after nadir then it can shorten the duration of the insulin. So, multiple smaller meals spread throughout the early part of the cycle is the best way to feed a diabetic cat. This is low carb wet food that I am talking about, of course. This helps to stabilize their blood glucose and give you smoother cycles without too many dramatic drops. Occasionally the carbs may need to be adjusted a little bit if your cat tends to dive down a little too much at certain points of the cycle.
Cats with high blood glucose do tend to drink a lot of water and also urinate more. This is frequently the first thing that you notice— it causes a lot of cat owners to take their cats to the vet. I am sorry if I missed this in one of your previous posts, but was he put on an antibiotic for his urinary tract infection? And if so, which antibiotic? Is he finished with the course of antibiotics now? ETA: I see in your signature that he is on Baytril. Infections will definitely raise blood glucose, any sort of inflammation, or infection can raise BG. The fructosamine test does tell us that he is diabetic. That number is the average of blood glucose over a period of a couple of weeks. So it is really the test that we want to see when determining whether a cat is diabetic, as opposed to just a regular single blood glucose test, which only tells us what the BG was at the vet at that particular moment. Stress, such as being at the vet, can definitely raise blood glucose, so we look for the fructosamine test to tell us the average blood glucose over that period of a few weeks.
If Ollie does have an infection that is being cleared, then you will need to watch carefully for his BG to come down and so his dose would also need to be adjusted down. He’s on the hydrolyzed food for his IBD. Any idea how many carbs are in that? I would have to look it up. High carb foods are not great for diabetics, as they raise BG so much, but unless you can switch Ollie to a low carb novel protein diet that works for him then you may have no choice.
Hi @Suzanne & Darcy , thank you so much for your replies. To try to answer them, the meter is fine, I think. We have been tracking his food and offering much smaller meals (which he likes!) and so far he's had meals at 9, 10, and 1. I was able to get ahold of my regular vet who is concerned about the numbers being so low he suggested not to give insulin today unless the night time BG is really high. I am going to text him those results tonight. I agree he needs to switch foods and definitely to a wet food so I will start to work on that. That will also help our other kitty as well! As far as medicine, this all started because I took him to get antibiotics and Baytril for his flare up. The vet saw BG at 406 and did fluctosamine and it was 451, so I agree it does indicate diabetes. He is currently taking Baytril (22.7 mg 1/pd) and Metronidizole (50 mg every 12 hours). My husband didn't realize the extra urine over the previous 2 days meant anything, so it may have been a lucky early catch. I was just trying to be proactive going into the weekend because he doesn't get very sick if we catch it early and seems to bounce back really well. The vet sent the urine off to be cultured since there was bacteria in it. I can scan and upload all the bloodwork if needed. As far as the hydrolyzed food, I THINK it has 40% carbs, which is high. Because he had such serious liver/gallbladder/pancreas issues we were trying to find a food that was easy to digest and met those requirements. He seemed to do great on it but I understand it may be necessary to explore novel proteins and find something that is lower in carbs to better manage his BG levels. Thank you again for all of your help and suggestions, I cannot begin to express how much peace of mind the forum has brought me and how helpful it has been.
Don’t hesitate to ask any questions. So he doesn’t take any prednisolone or budesonide for IBD? When he flares you do the Metro and Cerenia? That certainly is a high carb food. It definitely is raising his BG. If you do start insulin and you are doing a food switch from high carb to lower carb food, it would be necessary to be extra vigilant with testing as the blood glucose will definitely go down. I usually recommend that people do their food switch prior to starting insulin, but this is not always possible — and in some cases it is not even advisable if the cat has really high BG or is producing ketones and is at risk of DKA. Anyway, it is always best to make food changes slowly for cats, and doubly so for an IBD kitty as I am confident you know already. Some cats can even become diet controlled diabetics, meaning they don’t need insulin at all to manage their diabetes.
I do not know what your vet’s approach to diabetes is, but some vets like their client’s cats to be in what we call the yellow numbers (200-300) which is definitely not healthy for them. Some vets even tell their clients that their cat does not need insulin when they are in mostly blue numbers with the occasional yellow. This is not true. Normal BG levels for a cat are between 50 and 100/120 with the majority of the time in the green numbers (50-99).
If Ollie were my cat, I would be testing for a few days:fasting BG at the morning “shot time” (if you were shooting) and again another fasting BG 12 hours later before the evening “shot time.” In between, I would get a few spot checks at various points in the cycle or at least mid-cycle for now. I would chart this all on my spreadsheet. I would get some ketone urine test strips to test to make sure he’s not producing ketones and is in no danger of a DKA, which is dangerous. I used a blood ketone meter (NovaMax Plus,), but those strips are expensive and a lot of people just stalk their cat to the litter box and stick the strip in the urine stream. Of course, I started testing my cat after he was hospitalized for a week with a serious DKA that was brought on by an infection.
If you have the labs, it would be good if you could post them. Some people enter them on the labs tab of their spreadsheet and some people copy and paste a photo of the labs into their thread (since the upload icon doesn’t work.)
Historically, Ollie has had more issues with his pancreas than the IBD so we just monitor for issues and go from there. In Jan 2022 he got extremely sick and was hospitalized for 5 days for liver/pancreas/gallbladder issues. It was so bad, they suggested removing his gallbladder and going to a specialist out of state but my vet was not convinced that would "save him" because of liver and pancreas. The vet sent him home to just be with us with his regular treatment (Baytril/Metro) and he made a miraculous recovery. We put him on the HP food and he went from 8 lbs in the hospital to 13 by July. Now that was a bit too much so we were diligent about feeding amounts and he's 12 lbs. now. The HP food really really changed things since from Jan 2022 - now, he has had only one other flare, in July. We assumed this was a flare on Thursday because he vomited and would only stretch out or make a sad cat loaf. I only took him to the vet to be proactive before the weekend. The vet that diagnosed him with diabetes is not his normal vet. She's fantastic, and I like her a lot, but she wanted us to do 1u PZ every 12 hours and ONLY feed him 2x a day. I called her back Friday and tried to argue that this is too fast to switch him to 2x when he's a grazer and that because of his other health issues, I don't think it was going to work. By Saturday I was done trying to feed him 2x a day and he's had little meals since. She also did not think we needed to monitor with a BG meter. I'm a researcher and professor so that was never going to work for me. I want data. I do not know the normal vet's approach. I broke down and texted him, which I feel bad about since he's out for a family matter, and he said to withhold the morning insulin since he was only at 132. I will text him again tonight with the additional BG results and we'll decide insulin then. After doing a lot more reading, I realize that after he got the doses on Friday and Sat his eyes were kind of glassy and he was sleepy, but he's always sleep on baytril/metro. That is no longer the case, he's bright eyed and playing with the other cat more since last night. At +5.75 he's at a BG of 182. I suspect we will need insulin tonight but I truly have no idea.
This is what is on the Chewy website about the food. What % are the carbohydrates ? Answer by • May 27, 2021 This recipe contains approximately 36.28% Carbohydrates on an As-Fed basis (approximately 41.99% Carbohydrates on a Dry Matter basis).
Oh my goodness, I just looked at the ingredients for that food. There’s no meat in it. It’s hydrolyzed soy protein. I’m a little shocked. My vet wanted me to feed that or the Hill’s Z/D to my IBD cat, but so far I haven’t. I’m sure it’s less inflammatory, but I have to wonder about the health effects longer term of feeding a protein from soy that a cat’s body is not equipped to make use of. That is NOT a criticism of you. I understand all about the diarrhea, vomiting, etc. of IBD. I had one boy who was in so much pain from his IBD before he went on prednisolone that he would barely move. He walked around the house, so slowly like a two-toed sloth. It was dreadful to see. So I understand the need to feed them something that won’t make them sick — and I am always wondering what the best food is for these guys. I know that that can be different for different cats. Quite a few people here feed raw homemade diets or raw commercial diets or single novel protein diets (commercial or homemade.)
If his numbers indicate tonight and you are anxious to begin insulin, then you might want to consider a small dose like a .25 unit dose. Now let me say that a lot of vets have no clue whatsoever about small doses of insulin. They do things only in whole units. They increase in whole units and they decrease in whole units, we do not do that here and we have people whose cats only need very small amounts of insulin and you could look at their spreadsheets. Believe it or not, some cats are even on what is called a drop dose, and it really does provide just that tiny bit of insulin support that the cat needs. Our insulin dosing methods are all very well researched and documented.
Oh, I also wanted to mention this, since you said that Ollie seems to be feeling really good now (and I’m happy to hear that) … many cats who have become accustomed to having their BG in the high range only feel good when it is high. At first, when BG starts coming down into lower numbers that are closer to normal for a cat, some cats will act lethargic or hide or just act abnormally. This is because their body is not used to being in normal lower glucose numbers. It’s kind of like me without my coffee, I feel sluggish because I am used to having caffeine. But I do worry that the 1 unit dose was too much for Ollie and perhaps the BG went a little too low? But you are testing now and that puts you in control!
Yes! I hate that it is SOY protein which has other health effects in general (hormonally) in humans too. However, I can't argue with the results. He was so very ill and now he... Isn't. His fur is even like silk again today. He gets greasy feeling when he flares up since he stops washing, another sign to us we need to intervene. I love my regular vet because he humors me and understands my need to research and look everything up. We've had in depth conversation about research so I feel like he will understand using quarter or half units. We will see though! It makes sense that cats feel good in what their bodies have adjusted to so we'll definitely just keep a close eye on BG. The vet did text that we may have to switch his dose to 1 x a day so I suspect he'd be willing to dose lower to still keep him at every 12 hours. I also fixed the SS. We did give insulin 2x on Fri and 1x on Sat morning before we tested Sat night and realized his BG was 90.
I guess they didn’t do a CBC? But that bloodwork is bloodwork that I would be happy with. Apart from the high glucose and the suspected presence of rods and cocci in the urine, it looks good. It doesn’t look like he was dehydrated so you must have gotten to it in time. All the kidney values look good, good USG, pH good. Lots to be happy about.
I like the sound of your vet. Mine also knows that I am researching and want to have conversations about everything. Do you have U40 syringes with half unit markings? That is so helpful.
What is your “shot time?” It doesn’t make sense to shoot insulin only once per day really, since the duration is about 12 hours in ProZinc (some cats may get 14).
Also, I just was re-reading this. A BG of 90, in and of itself, is not a bad number. Like I said, it's within the normal healthy BG range for a cat. If you test your non-diabetic cat, I wonder what kind of fasting BG you would find? Now, with insulin we have to be more careful, naturally, since the insulin can drive them down more. But a BG of 90 in a diabetic cat is a good number and would, perhaps, warrant further testing in an hour (or sooner depending on previous tests showing the RATE of drop.) Usually, we would recommend a low carb snack of about a heaping teaspoon of wet food to help the cat keep surfing in green numbers (the HP would really shoot the number up.) If you are planning to restart insulin, do you have a hypo kit ready. This would include high carb wet food normally and karo syrup or honey... of course, lots of test strips. Let me see if I can send you some links. I hope I am not overwhelming you. If so, sorry. You seemed like the sort who can handle it.
Have you read through this Sticky note yet? And the one about ProZinc dosing methods? Anyway, there are links in there for the hypo toolkit and detailed instructions for how to handle a hypo. Always post if you have a situation that you need assistance with. https://felinediabetes.com/FDMB/thr...-the-prozinc-basics-please-start-here.164995/
I started on the other forum and then it was suggested I post here after we saw the BG of 90. I read through the PZ basics and posted here because it suggests to stall or consider waiting on insulin with any BG under 90. I need to get high carb food and karo syrup but I always have honey around. I was also really happy with his bloodwork, and his pancreas tested normal as well. I do have the u40 needs and they do have half unit markers. My regular vet wants me to test again in the morning to see where we are, so we're going to do that. I may test before bed again though (soon) but I feel so bad because I bruised his little ear and made him bleed a ton. He still doesn't seem concerned though. You will not overwhelm me, I am very very glad for the information. It's been incredibly helpful and I appreciate all of the advice
I'm not sure when. I can check today but most likely at his follow up, which is supposed to be tomorrow. His BG was only 143 again. My vet texted today he thinks he may have been sick longer than we thought and that he may have had the high glucose because of stress and sick. He said to stop insulin for now and to just keep checking him every day. We're going to still take him to the other vet tomorrow to let them pull his sugar but my regular vet wants to see him next week. I still need to finish teaching my husband how to check his sugar because I leave for conference for 5 days in 2 weeks. .
I have been thinking the same thing about how perhaps he has been sick with something and that infection/inflammation was raising his BG. After all, we had the Fructosamine test to show that his glucose was elevated for a few weeks at least. I would keep up the monitoring so that trends can be spotted and we can know for sure if he is diabetic.
How's it going with Ollie. I see he had a great 104 preshot this morning with no insulin. How's he feeling?
He's doing great! I gave him insulin last night because he was 209 and then after he ate, he was 236. This morning he was 104 so I didn't give him anything. We go back to the vet in about 45 minutes. I'm fairly sure she's going to be fussy over what we're doing but I'm not sure I care. My vet would prefer me to get the alphatrak. My husband said we should test our meter against the vets and see if it's within the realm of accurate before we spend further money on an expensive tester. I know most here use human meters. This morning he clearly felt great. He was running around trying to get the younger cat to chase him, so I'm pretty happy with how things are going so far.
Good luck at the vet. The AT will read a little higher than the human meter. Before the AT was invented all the vets used human glucometers. Many cats do tend to drop into lower numbers at night. It would be good to see sometime what Ollie os doing— on an evening when you don’t have to work the next morning so you can set an alarm and get a mid-cycle test — or can get up and maybe get a +10. Anyway, I hope all goes well today.
I just wanted to post an update and say thank you to everyone who gave advice! Ollie is doing great so far. He's been getting a little more insulin the last few days but we check his BG every morning and night and dose insulin if it's over 200-225. The vet said 200-250 is usually a good indicator. He'll go back after this week for a fructosomine test, so we'll see where are from there. Thanks again for all the amazing help! You all made this process so much less scary and I truly am grateful.
