A Real Novice's Question - Day #1

This website is unbelievably helpful. Thank you for all the info available. There is lots to read, but I assure you I shall read it all over the next week and hopefully become as informed as so many people on this forum are. We learned yesterday that our 11 year old male Main Coon is diabetic with a glucose reading of 496. Back in November '12, I had observed Mr. Baby drinking excessive amounts of water, urinating frequently. On 11/19/12 I took him to a vet we do not normally use but was available. The vet gave Mr. Baby a CBC test where he had a glucose reading of 109. Is it possible for this condition to creep up so swiftly whereby the glucose could jump from 109 on November 19, 2012 to 496 on 3/11/13? With the November CBC results I felt comforted that the blood work seemed to indicate diabetes was not present. However, when Mr. Baby's water drinking and frequent urination persisted, I took him back on Monday, March 11 to a different vet, one we value as our "regular" vet but who is difficult to get an appointment with, and received the news of the 496 glucose reading on a new blood test.

Our vet, a well-regarded gentleman, recommended immediately placing Mr. Baby on 5 units of Pro Zinc twice a day for 1 week and then bring him in to the office in 7 days for a blood glucose curve. My present concerns are twofold:
1. The cat seems to be doing okay on 5 units twice a day. Granted this is his first day on insulin. I am watching him VERY carefully. He may be a little more sleepy than usual, but he is walking fine, purring, eating and otherwise appears okay. In reading some of the postings, it sounds like 5 units twice a day is a large amount. Thoughts?
2. Has anyone heard of a cat's glucose being a "normal" 109 in November (even though the cat seemed to be presenting some indicators of diabetes) and then 3 months later having a glucose reading of 496?

Any assistance will be dearly appreciated. Keep in mind this is my first day giving insulin to Mr. Baby (who took it so well) so my questions and concerns may appear naive.

First, every question is important so please keep asking. It is the best way to learn and to keep your kitty safe.

There are really three important parts to managing diabetes:
DIET: Lo carb wet food is best for a diabetic cat. View catinfo.org for the rationale and a superb list of many canned foods and their nutrient values. Try to find a food below 8 - 10% (lower is better) that fits your budget and that your cat will eat.
HOME TESTINg: Most of us use a human glucometre and take a drop of blood from the cat's ear. It sounds brutal at first, but most cats never even notice. The key here is treats after each test. At a minimum, you should test before each shot. I don't use your insulin and so am not certain about the testing protocol, but you will want to test a few times in between shots to see how the insulin is working in your cat. You should have a hypo kit ready in case his blood glucose drops too low.
INSULIN: If his diet is low carb wet food and you are testing at home and know that he still needs insulin even with the low carb diet, then administering insulin is the final step. If you are giving insulin without testing, you are taking a bit of a risk, especially starting at 5 units.

And to answer the question, yes, his bg could climb from November. Some incident has made his pancreas unable to keep up with his bodies demand for insulin. It is possible for the pancreas to recover so that he doesn't need insulin if it is given appropriate support.

Others will be along with details on each of the 3 parts. You might want to check the information on the PZI insulin user group on this board if you haven't already.

marceemioni said:

This website is unbelievably helpful. Thank you for all the info available. There is lots to read, but I assure you I shall read it all over the next week and hopefully become as informed as so many people on this forum are. We learned yesterday that our 11 year old male Main Coon is diabetic with a glucose reading of 496. Back in November '12, I had observed Mr. Baby drinking excessive amounts of water, urinating frequently. On 11/19/12 I took him to a vet we do not normally use but was available. The vet gave Mr. Baby a CBC test where he had a glucose reading of 109. Is it possible for this condition to creep up so swiftly whereby the glucose could jump from 109 on November 19, 2012 to 496 on 3/11/13? With the November CBC results I felt comforted that the blood work seemed to indicate diabetes was not present. However, when Mr. Baby's water drinking and frequent urination persisted, I took him back on Monday, March 11 to a different vet, one we value as our "regular" vet but who is difficult to get an appointment with, and received the news of the 496 glucose reading on a new blood test.

Our vet, a well-regarded gentleman, recommended immediately placing Mr. Baby on 5 units of Pro Zinc twice a day for 1 week and then bring him in to the office in 7 days for a blood glucose curve. My present concerns are twofold:
1. The cat seems to be doing okay on 5 units twice a day. Granted this is his first day on insulin. I am watching him VERY carefully. He may be a little more sleepy than usual, but he is walking fine, purring, eating and otherwise appears okay. In reading some of the postings, it sounds like 5 units twice a day is a large amount. Thoughts?
2. Has anyone heard of a cat's glucose being a "normal" 109 in November (even though the cat seemed to be presenting some indicators of diabetes) and then 3 months later having a glucose reading of 496?

Any assistance will be dearly appreciated. Keep in mind this is my first day giving insulin to Mr. Baby (who took it so well) so my questions and concerns may appear naive.

Click to expand...

1. Too much insulin .... nobody starts at such a high dose and cats who truly need that much insulin usually have an insulin resistance condition. Thoughts? Don't give that dose again because you cannot state that a cat is diabetic based on a single glucose number on a CBC test. Maybe if the vet had done a fructosamine test which is an average for the last two weeks for your cat's glucose, but not one number.... stress alone can spike the number or even the food you are feeding. A sore tooth or an infection can cause a high number, but diagnose feline diabetes on a single number? no.

The best advice would be to get a human blood glucose meter and start testing your cat's numbers at home. That way you will see what your cat's real numbers are. I would not give any insulin until I knew for sure that the cat had contant high BG numbers.

The other important thing is diet as has been mentioned. Be sure you are feeding low carb wet food, under 10% carbs .... refer to Dr. Lisa's food list. Many people just feed the Fancy Feast or Friskies pates, but you can see which other foods on the list.
http://catinfo.org/docs/FoodChartPublic9-22-12.pdf

Without knowing what you are feeding, it's hard to say much, but diet change could mean the difference between needing to give insulin or not. There are a great deal of cats who are diet controlled and may have needed insulin for a short time while changing the diet.

Sorry, but a vet who says to start a cat on such a high dose of insulin, and based on a single number, is not that great of a vet when it comes to feline diabetes. A busy vet does not mean a good vet.

Here are some info on hypo; it's important to know the signs and what to do if you see some of the signs.
List of Hypo symptoms
How to treat HYPOS-They can kill! Print this out!
Jojo’s HYPO TOOLKIT

Please do not give your cat any more insulin until you are testing and know for sure if the cat is really diabetic. If you find the cat does have high numbers, the starting dose would be more like 1unit twice a day.... very few diabetic cats reach a dose as high as 5units twice a day.

Just-As-Appy and Blue: Thank you so very much. Just-As-Appy, Mr. Baby eats exclusively wet food now which he loves. I removed the kibbles for snacking that he loved prior to this questionable diabetes diagnosis. After reading lots of articles and comments today on this forum, I instinctively had a funny feeling about this high dosage of 5 units twice a day based on 1 CBC test. I have decided to consult with the Animal Speciality and Emergency Center tomorrow that is located here in Los Angeles. Blue, I fear you are absolutely right about 1 CBC test. With that said, the cat was drinking excessive amounts of water, urinating many times a day and has lost 4 pounds even with a large appetite suggesting diabetes may be an accurate diagnosis. However, yes, additional testing is needed such as a fructosamine level which was NOT done. Your comments have prompted me to seek an additional opinion. Finally, two critical things I failed to mention in my early posting that may play a role in Baby's condition. Beginning in December he suffered runny diarrhea to the point where even with constant cleaning of his rear, he had mild fecal scalding. The vet thought perhaps Mr. Baby might be suffering from ulcerative colitis or some enteral infection and Mr. Baby was prescribed, over many weeks of treatment, antibiotics and a drug for possible ulcerative colitis including a steroid. Thus, I wonder if these diabetes symptoms could be prompted by the drugs he was taking especially the steroids which also might account for his "normal" glucose level in November and now this exceedingly high reading in March. For sure, I intend to follow up tomorrow with a specialist and will bring a full chronological history. Thank you both for taking time to comment. I turned to this website today when I had this funny feeling about the 5 units twice a day. I am so glad I found felinediabetes.com. It is an amazing place full of wise people. PS Thanks again! To both of you, I adore Canada, by the way.

The steroid definitely could have triggered elevated glucose levels.

Also, some cats go LOW at the vet although not many.

Many of us use the WalMart ReliOn glucometers - Confirm, Confirm Micro, etc. These are actually branded versions on the Arkray glucometers available through our shopping partner ADW (link above on page). They are inexpensive, use small drops of blood, and if you're near a Walmart, you can get strips most times of day or night.

You'll want to pick up lancets of 26-27 gauge to use for testing. Higher gauge are thinner, which make it more difficult to get the blood drop.

Neosporin ointment (not creme) with pain relief, applied a few minutes before testing then wiped off, helps reduce the annoyance of testing and helps the blood bead up.

See my signature link Secondary Monitoring Tools for info on urine ketone testing. Ketones are a by-product of fat breakdown. Too many may indicate diabetic ketoacidosis (DKA), a potentially fatal complication of untreated or inadequately treated diabetes. It is expensive to treat and cannot be done at home.

Ditto on what everyone else has said. We suggest starting at .5 or one unit of ProZinc. Out idea is that you can always slowly increase the dose based on the numbers you get through testing, but once the insulin is shot, you can't get it out of the cat.

And switching the diet (which was a great idea) can change the numbers downward. With our Oliver, he went down 100 points overnight when we switched from dry to wet. If we hadn't been testing and had given our normal dose, he would have hypoed.

We can teach you how to hometest over the Internet; we have taught hundreds of people. It is the only way to see how the insulin is working throughout the cycle, and only way to know if the dose you are giving is safe.

My cat was "diagnosed" as diabetic on Feb 27th of this year, mere weeks ago. It started with my noticing an unusual amount of urine in the litter box, fearing possible kidney issues I called my regular vet, his front desk suggested I take him elsewhere in case he was diabetic, as they did not possess the facilities to accommodate a diabetic cat.
When I made an appointment at this other vet clinic, I was not advised to bring my cat in on a fast, and in my state of mind I didn't think twice. The vet tested his BG in front of me and proclaimed him in the 400's, and frankly I was relieved that it wasn't a kidney issue and just nodded my head. The vet did not discuss diet with me, I myself had to inquire about diet adjustments, and stated that they had dry food out 24/7 and wet food in the a.m. he advised me not to change his food and to give him two units twice a day, (to the tune of around 100 bucks a month or so), I assumed this was because my cat was dangerously high, and any major adjustments might cause problematic, again, I ASSUMED this, he didn't tell me. He then advised me I would have to crate my cat once a week and take him in for testing to the tune of 30$ a pop, no mention of home testing, I walked out of there with a 300$ bill and a bottle of Prozinc.
Upon researching around the web, I found this website and read about all of the other experiences other pet owners were having, home testing, diet adjustments and I decided to get another vets opinion and it was essentially the same except she encouraged home testing, no diet adjustment.
After speaking with the people on this site I decided to purchase a relion micron, began home testing and decided to pull the dry food, luckily my guy didn't put up too much of a fuss and after several days of wet food I was seeing some significantly lower numbers, I called the initial vet and he advised me to INCREASE his insulin to three units twice a day! I came back to the board and decided with the help of Sue and others, (who sat there holding my freaked out hand this entire way), to lower his dose to .25 and see what happened, HE TANKED, he went from 191 to 37! That entire day I spent feeding my cat and sticking his ears and he was alright, but can you imagine if I had given him three units?! I would have one cat instead of two right now.
I have not given my cat insulin since, and he has been testing in the double digits for almost three days.

https://docs.google.com/spreadsheet/ccc ... 2aUE#gid=0

What the vet did wrong;
1. Diagnosed a cat after it had been eating all night long, (not fasting)
2. Did not suggest home testing
3. Did not talk about diet
4. Suggested insulin increase after diet adjustment and lower numbers



Red. Flags.

I learnt that you do not need a vet to manage your cats diabeties IF there are no other medical conditions or complications.

I think we tend to think of vets like human doctors - that we have to follow there advice and that they have all the answers.
Of course, its not true - vets are more generalists than even a Primary Care doctor, as they have not just multiple illnesses but also multiple species to deal with.
Also, we would see a specialist for eg. diet changes we wouldn't expect our regular doctor to come up with a program to suit our needs (my DH just saw a dietician for his type2 diabeties), so its no wonder that the vet just says to stay with the food he has been told is most suitable (usually an expensive, prescription diet).

Thank God for the internet! Now we can do our own research, look at the same studies the vets see and find boards like this one (I'm also in the feline hyper-T and raw food groups on yahoo) to get all the info we need.
How good it that!?

Please learn to home test - its the key element to managing this and getting Mr. Baby into regulation and maybe remission.

Denise & Honey said:

I learnt that you do not need a vet to manage your cats diabeties IF there are no other medical conditions or complications.

I think we tend to think of vets like human doctors - that we have to follow there advice and that they have all the answers.
Of course, its not true - vets are more generalists than even a Primary Care doctor, as they have not just multiple illnesses but also multiple species to deal with.
Also, we would see a specialist for eg. diet changes we wouldn't expect our regular doctor to come up with a program to suit our needs (my DH just saw a dietician for his type2 diabeties), so its no wonder that the vet just says to stay with the food he has been told is most suitable (usually an expensive, prescription diet).

Thank God for the internet! Now we can do our own research, look at the same studies the vets see and find boards like this one (I'm also in the feline hyper-T and raw food groups on yahoo) to get all the info we need.
How good it that!?

Please learn to home test - its the key element to managing this and getting Mr. Baby into regulation and maybe remission.

Click to expand...

The SCARY part about your statement is even human doctors don't always know what they are doing or have all of the answers, either.

.

Again ditto to what everyone said.

What kind/brand of wet food are you feeding him?

Did the vet mention ketones at all?

.

I agree; vet #2 sounds much more in tune with feline diabetes than the previous one. :thumbup

I noticed you're in LA. I'm down in Orange County and just wanted to extend a SoCal Welcome! :YMHUG: If you need any help with anything, especially home testing, let me know! I'm close enough I wouldn't mind an excuse to drive up to LA to help you out. ;-)

Just following up to see how mr baby is getting on?