New here- need advice please

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Cherylockholmes

Cherylockholmes

Member Since 2013
Hi all. I have 7 cats-- one of them, Joplin, has always been a screamer (hence the name). We got him in 2008 and he is now approx. 5 1/2 years old. At first we thought the "talking" was cute, but it got to be out of control last year to the point we brought him to the vet, had a full CBC done on him, and they discovered nothing abnormal, but noted that he was slightly hyperglycemic at 191. We were told it was behavioral and they wanted to put him on Prozac, but we decided against it. For whatever reason, over the next year things got better-- we have no idea why-- but it made it all the more noticeable when just a month ago, he started crying again, incessantly. This time it seemed related to food though, and it seemed no matter how much I fed him, he would walk around the house meowing until I fed him again. I'm giving him wet food in the morning and evenings, and the other cats get it too, as well as some grain-free kibble (because one of my cats refuses to eat wet food. ughh). Anyway, the incessant screaming got bad again to the point where we scheduled another vet appointment last week, this time with a different vet. He took a look at his mouth and couldn't believe how bad his gums were....they're so red and inflamed, and this was NOT the case a year ago when he saw the other vet. I also noticed that he lost weight. On March 1, 2013 he weighed 15 lbs. (I have a pet scale), and last week he weighed 13 lbs. He also peed outside of the litterbox on our carpet a couple weeks ago, AND the other night, peed ON ME, while I was IN BED SLEEPING. :shock: The vet gave him an antibiotic injection, a steroid injection, and suggested a blood workup and urinalysis. Well, I took him today for those tests, because I was suspecting he could be Diabetic, and his blood glucose is 340! What annoys me is the vet waited until after I paid for this very expensive blood test to tell me that the steroids can raise their blood sugar (Gee, would have been nice if you told me this PRIOR). His recommendation is to wait 10 days (to give it a full 2 weeks to get out of his system) and to test again. In the meantime, he wants me to collect urine samples (using this sand litter) every day and test for ketones with ketostix (thankfully I have some from when I was on Atkins), and feed him this Hills DM formula. (I work for an organic, all natural pet food company, so feeding this crap to him is KILLING ME :cry: ). Now I'm noticing him drinking a lot and peeing a lot, but I know that can either be Diabetes or a side effect from the steroids. My question is, will it do him serious damage to wait the 10 days to "see what happens" if his blood glucose remains this high? I don't have a meter to test it, and that's another question I wanted to ask. Recommendations on an affordable, easy to use one I can find? One part of me understands my vet not wanting to "jump the gun" and assume that this is Diabetes, but at the same time, my poor baby is losing weight, is starving all the time, and I'm afraid that the "wait and see" method will hurt him. Can someone shed some light? :YMSIGH:
 
You (and he) have a lot going on. First, did his gums improve? Is there any chance that it still hurts to eat and he is not eating? (idea: add warm water to the wet food and make it soupy so he can lick it up)

If he were mine, I'd go to Walmart tonight and get a ReliOn meter with strips and lancets (25-27 gauge). We'll give you all the info about testing. The only way to really know what is going on with his blood sugar is to test at home. Cats are stressed at the vet and stress raises levels.
 
He is definitely eating. I referee my cats when they eat to make sure they all stick to their bowls. I have even been giving him more than I normally do over the last week or so due to his constant demand for food. Yes, his gums to appear to be less inflamed than they were before the steroid injection, although still very red. Thanks for the meter suggestion. I will check it out in the morning.
 
Here's a complete shopping list
A human glucometer. Any one that sips and takes a tiny sample is fine. Some members stay away from any meter with True in the name and the Freestyle meters. Some people think they are unreliable and read lower than other meters. The meters are often free at drug stores; it’s the strips that are expensive. You can, however, buy them on ebay at less than half the price of stores. Lots of people here also like the ReliOn from Walmart. It is an inexpensive meter and its strips are the cheapest around. Try the meter out on yourself or someone else before you try it on your cat. You want to be familiar with it before you poke the cat.

Lancets and a lancet device. Usually, until the ears “learn” to bleed, a 26-28 gauge is good. Any brand will work as long as the lancets match your device.

Ketone strips. (Ketostix) Just like human diabetics use. You will sometimes need to test urine if the numbers are high.

Rice sack. Make this out of thinnish sock, filled with raw rice or oatmeal and then knotted. You heat this in the microwave until very warm but not hot. Then heat the ears before poking. You can also use a prescription bottle filled with very warm water. It provides a good surface to poke against.

Also nice to have. Flashlight: so you can look at the ears and find the little capillaries that come off the vein running down the ear. Vaseline: Put a tiny smear where you want to poke. It will help the blood bead up.

And some lo carb treats to give your kitty, successful test or not Lo carb treats

And a way to get Joplin ready:

First pick a place where you want to test. Some people use the kitchen counter, a blanket on the floor, between your legs while sitting – whatever works for you. Take the kitty there and give him/her lots of praise while you play with his/her ears. Give a treat and release. Next time, add the rice sack (thin sock filled with raw rice, heated in the microwave until very warm but not hot) or a prescription pill bottle filled with very warm water. Lots of praise, treat and release. Finally add the lancet so he/she will get used to the noise. The hope is that when you finally poke, they will be used to the process and know a treat is coming!
 
When cats are unregulated, they are literally starving. Their bodies don't utilize the food effectively. How much are you feeding? You can give him more than you might usually until his numbers go down. The watering down also makes them think they are getting more and is sometimes helpful.
 
Ahh, that makes sense. I will try that. I am giving him 2.5 ounces in the morning and 2.5 at night. Previously he was getting 1.5 ounces morning and night plus the dry food, but he hasn't been eating that because of his teeth I assume, and I don't want him eating it now anyway because of the carbs. Even though it's grain free, I'm sure it's carby from veggies. It's Pure Vita Grain Free Chicken.
 
Hello

Just to let you know steroid shots over the years was what what caused my cat to have diabetes I am sure of it, Depo Medrol. And no I would not wait 10 days to get him on insulin if his BG is truly at 340.
Yes if he is diabetic and you wait 10 days to give him insulin he could go into ketoacidosis.

Terri
 
Hello,
The question about waiting is answered by some other nice guy. What I want to share with you is that my sugar cat was stomatitis, and besides pulling out all teeth, there's no other way to solve this problem permanently.To pull all teeth away to heel stomatitis still a controversial topic in our country. He is young at that time and I made a wrong decision : I didn't let our vet pull his teeth away, instead, we use steroids to control it, once a month. He was DKA after 6 months and now he became a sugar cat, before that his glu was normal as other non-diabetic cats. I don't blame at our vet. In our country, we don't have so many cases that shows steroids will cause diabetes for sure. Anyway, I just want to say that never use steroids on your cat, and from now on, yes you may find another vet to give him insulin to lower his glu asap. Steroids will makes his glu much higher than before.
 
Well, I got the ReliOn meter, and he just tested at 208....much lower than the 340 it was at yesterday. Will continue to monitor. Thanks for the support.
 
208 is a very nice number. Just for reference, we consider a cat regulated if they are in the mid 200s at preshot and in double digits at midcycle on insulin. Generally a cat is considered in remission if they range from 40-120 off insulin. We suggest that new diabetics not shoot under 200, but wait 20 minutes without eating and retest. We like to see that the number is above 200 and rising.

You might try some very low carb foods to see if his numbers drop more. You do want to feed fish only a few times a week because of the mercury, but there are other wet foods in the 3-6% range.

Dr. Lisa’s food chart
Hobo’s Food Chart
 
Sue and Oliver (GA) said:
208 is a very nice number. Just for reference, we consider a cat regulated if they are in the mid 200s at preshot and in double digits at midcycle on insulin. Generally a cat is considered in remission if they range from 40-120 off insulin. We suggest that new diabetics not shoot under 200, but wait 20 minutes without eating and retest. We like to see that the number is above 200 and rising.

You might try some very low carb foods to see if his numbers drop more. You do want to feed fish only a few times a week because of the mercury, but there are other wet foods in the 3-6% range.

Dr. Lisa’s food chart
Hobo’s Food Chart
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Gosh, it's been so long since I've used a message board and I'm so used to Facebook, that I was looking for the "Like" button on your post- LOL :-D I was also able to get a pee sample and it showed a small amount of ketones (15). I am feeding him the DM my vet gave me, which I have about 2 weeks worth (until our next vet visit), but if he ends up needing to be on something like this long term, those lists will definitely come in handy. Thank you!
 
Test before ALL shots to make sure it is safe to give insulin.

Test around the nadir for your insulin to see how low he is going.
<40 on a human glucometer = HYPO - begin HYPO protocol immediately Instructions

40-50 at nadir = dose reduction, depending on duration of diabetes and insulin being used.
40-50 at other times - implement How to Handle Low Numbers protocol Instructions

50 - 120 = excellent control

< 240 = under the renal threshold where glucose spills into the urine. Risk of ketones.
 
BJM said:
Test before ALL shots to make sure it is safe to give insulin.

Test around the nadir for your insulin to see how low he is going.
<40 on a human glucometer = HYPO - begin HYPO protocol immediately Instructions

40-50 at nadir = dose reduction, depending on duration of diabetes and insulin being used.
40-50 at other times - implement How to Handle Low Numbers protocol Instructions

50 - 120 = excellent control

< 240 = under the renal threshold where glucose spills into the urine. Risk of ketones.
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He's not on insulin. I'm supposed to keep track of his readings for 2 weeks and then we are going to decide if he needs insulin. My question is, is it best to test his BG before breakfast in the morning?
 
My question is, is it best to test his BG before breakfast in the morning?
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Yes, for the pre-shot test, it is best to test before food is given. Yes, I realize you are not giving insulin yet so that morning and evening test is
not actually a pre-shot test. Think of it instead as a morning blood glucose test or AMBG in our shorthand. The evening BG test would be a PMBG if not giving insulin.


Food raises the BG numbers, takes about 30 minutes or so but it is good to get into a routine of test then feed.

If he goes above the renal threshold (240) several times, starting insulin before the two weeks is up would be a good idea.
 
Did you say he had trace ketones? I missed that before. They are not any thing to mess with. I'd do another test and if it is more than a trace, get him to a vet. Is he still eating well?
 
Sue and Oliver (GA) said:
Did you say he had trace ketones? I missed that before. They are not any thing to mess with. I'd do another test and if it is more than a trace, get him to a vet. Is he still eating well?
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Yes, I got a reading of "small" or the next level up from "trace" on my Ketone stick this afternoon. Yes, he is eating ravenously. I gave him an extra half a can today. Tomorrow morning I will test him before breakfast and then again tomorrow before dinner.
 
Wendy&Tiggy said:
How is he doing now?
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yesterday AMBG 243, yesterday PMBG 192. This morning AMBG 288. Still eating lots and drinking normally-- i wouldn't say anything excessive. He is very alert, playful and talkative as ever. Calling vet when they open to inquire about the levels. I haven't gotten a urine sample yet this morning..I'm watching him like a hawk so I can catch it when I can though.
 
Hmm ok, maybe there is excessive drinking. Third time at the water bowl this morning, after eating 3/4 can of wet food.....
 
PS- I feel bad for his poor ears. I realize I'm new at this and there will be a learning curve, but his little ears have scabs from various attempts at pricking. I bought the 26 gauge lancets (30 came with the kit, but I can't get anything with that) but it still takes me a lot of poking to get the right spot. Does this get easier? Poor guy is walking around with little red marks all over his ears. :YMSIGH:
 
Still eating lots and drinking normally-- i wouldn't say anything excessive
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I add water to the wet food until it is the consistency of applesauce. Wink stopped drinking any water from the water dish in about a week. I still fill them up every morning but none of may cats have touched a water dish to get a drink in almost 3 months. They are getting all their water needs from the canned food and the additional water I add.

He is very alert, playful and talkative as ever.
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Great to hear he is showing some of the 5 P's, also known as the WCR (whole cat report). A cat is not just his numbers, he is also telling you how he is feeling by his behavior. Peeing, pooping, purring, preening, playing are the 5 P's. Throw in a description of his appetite and you have a WCR!

I haven't gotten a urine sample yet this morning. I'm watching him like a hawk so I can catch it when I can though.
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I used to camp out in the hallway bathroom with Wink, a litter box for him and a good book for me. Fed him his canned food with extra water added to it until it was really soupy, probably 1 to 1 ratio of food to water. Let him eat, and after a bit he would need to go to the litter box. There are other methods if you need them. Just ask.

Ear testing tips. https://docs.google.com/document/d/13c_CPZVKz27fD_6aVbsguadJKvjSrSAkD7flgPPhEag/pub The three important points here are to warm the ear thoroughly, apply pressure after the poke to stop the ear from bruising, a dab of triple antibiotic ointment with pain relief (gel type, not the cream which soaks into the fur) helps to heal the ear but be sure to wipe off any excess so he does not get it in his eyes.

Yes, it does get easier as his ears learn to bleed. Let us know if you have more questions.

Now that you are gathering some numbers would you like to set up one of our standard spreadsheets (SS) and link it into your user control panel, profile, edit signature? That way other people can look at the SS and you could even give the link to your vet! Directions here: http://www.felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207 Ask for help if you have problems setting it up. There are people here that can do it for you.
 
Thank you so much Deb for all of that info! Had a much easier time this morning after reading that and heating the ear. But do they really not feel the prick because of no nerve endings? It sure seems like he flinches when I do it :(

This morning he is 284, same as yesterday. I spoke to my vet and he wants to wait a few more days to see if it comes down (at which point the steroid should be out of his system), and if I'm still getting these numbers, he's going to put him on a low dose of insulin. He said in the meantime, if I get a reading in the 300's or higher, to call him and he will put him on it sooner. He also wants me to get the glucose strips (I only have the ketone strips) so I'm going to do that too. Good news is his weight has held steady for the last 3 days.
 
The Secondary Monitoring Tips in my signature link give tips on doing urine testing for ketones & glucose.

The other tips provide supplemental information which help you (and your vet) monitor your cat. Ex. volume of wet litter may indicate other issues, such as renal disease, if no glucose is found.
 
BJM said:
The Secondary Monitoring Tips in my signature link give tips on doing urine testing for ketones & glucose.

The other tips provide supplemental information which help you (and your vet) monitor your cat. Ex. volume of wet litter may indicate other issues, such as renal disease, if no glucose is found.
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Thank you! I am so happy I found you all. You have been a Godsend! I have learned more over the past week than I ever thought I'd know on this topic, and even the vet has noticed I am informed (he had a surprised look on his face when I started talking about ketones, glucometers, etc.) He said 95% of his patients wouldn't go this far for their pet. That is sad, but I love my kitties and would do absolutely anything for them. They are my babies <3 My other 6 are definitely feeling a little ignored though. Extra treats for them this week! :)
 
Cherylockholmes said:
But do they really not feel the prick because of no nerve endings? It sure seems like he flinches when I do it :(
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I don't think I would buy into that myself, as my Frog definitely chastises me every time I poke him, and especially if I have to poke him more than once. I have ZERO doubt that he feels it, although in general he tolerates me doing it. (some days he is more reticent than usual, but I just put a bucket next to me (on the floor towards the direction) where he is facing..... it really makes him think hard about wanting to just run/leap out of my grasp..... most of the time he evaluates the bucket being there and just stays put.)
 
Just bought the keto/glucose strips. He came out negative for ketones, but the highest (2000) for glucose. Can someone explain to me what that means?
 
It means that his blood glucose level is over the renal threshold of 240 - 270 mg/dL, ie, too high for at least some of the time in the preceeding several hours the urine collected.
 
High urine glucose makes sense because his blood glucose is higher than the renal threshold that BJ said.

Dont worry about his ears - the red marks will fade and will get less as you get used to testing.
 
Thank you! I am so happy I found you all. You have been a Godsend! I have learned more over the past week than I ever thought I'd know on this topic, and even the vet has noticed I am informed (he had a surprised look on his face when I started talking about ketones, glucometers, etc.)
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Wow! That must have made you feel good to show your vet how informed you were about feline diabetes. Congratulations!

Welcome to the graduate school level, crash course in Treating and Management of Feline Diabetes. Your instructors so far have been Deb&Wink, Wendy&Tiggy, BJM, Barb&Mr. Frog, Sue&Oliver, Akilo, Terri1962.

He said 95% of his patients wouldn't go this far for their pet. That is sad, but I love my kitties and would do absolutely anything for them.
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Maybe he doesn't know his patients as well as he thinks he does.

They are my babies <3 My other 6 are definitely feeling a little ignored though. Extra treats for them this week!
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Yes, it's easy to need to give so much attention to your new sugarbaby at the beginning of this journey that you don't pay as much attention to the other members in your fur family. Give some extra hugs, play time to the rest of the fur family and they will be happy.

My gang of three started to appreciate their new roommate once they discovered they would be fed more frequent small meals. It was simply too hard for me to manage the diabetic kitty on one feeding schedule and my other 2 on a different feeding schedule.
 
Wendy&Tiggy said:
How is he doing now? Is his BG coming down at all?
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It did not come down, so my vet put him on .5 units of Vetsulin once a day to start conservatively. Did that for 5 days, but no difference so we are increasing him now. Good news is he has stopped losing weight and has started gaining again. At his lowest he was 11.7, but now he's back up to 12.1...not much, but at least the scale has stopped moving the other way. My question is, how soon after he's done eating and receiving his insulin should I test to see if it's having any effect. His sugar will rise about 1/2 hour after eating right? Then, how long does it take to normalize that would be the perfect time to test?

Thanks
 
I know it is hard to hear advice from strangers on the internet that is different than your vet. But because Vetsulin only last 6-8 hours in most cats, it is ridiculous to prescribe giving it once daily. It means that large dose is likely to take your cat down (and maybe very low) in the first 3 hours or so and then he will bounce back up and be high for the next 20 hours. IMHO, this is very dangerous and very bad for your cat's overall health.

Vetsulin is not one of our recommended insulins because it does not last long in cats and is not a mild insulin. Most cats do not do very well on it. Here is some info on it:

http://felinediabetes.com/FDMB/viewtopic.php?f=19&t=93937

We have had people who can get their cats regulated on Vetsulin but it takes a lot of monitoring and certainly takes dosing twice daily.
 
Sue and Oliver (GA) said:
I know it is hard to hear advice from strangers on the internet that is different than your vet. But because Vetsulin only last 6-8 hours in most cats, it is ridiculous to prescribe giving it once daily. It means that large dose is likely to take your cat down (and maybe very low) in the first 3 hours or so and then he will bounce back up and be high for the next 20 hours. IMHO, this is very dangerous and very bad for your cat's overall health.

Vetsulin is not one of our recommended insulins because it does not last long in cats and is not a mild insulin. Most cats do not do very well on it. Here is some info on it:

http://felinediabetes.com/FDMB/viewtopic.php?f=19&t=93937

We have had people who can get their cats regulated on Vetsulin but it takes a lot of monitoring and certainly takes dosing twice daily.
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Do you have another recommendation? I'm not against bringing this up with my vet and getting him on something better! Any advice as far as how long it takes for BG to return to normal after eating/receiving insulin?
 
We like Lantus, Levemir (2 human insulins that have been used with great success in felines) and ProZinc or PZI ( an insulin sold only for animals) They are all mild, giving gentle cycles for 12 hours or so with a gradual onset and gradual rise.

If you want to know what the dose does, the best way to figure it out is to take readings at 2 hours after the shot, then 3 or 4 hours after, 5/6 hours after, 7/8 hours on up to 11/12. That will give you a picture of how the insulin is working.
 
The best insulins for a cat are:

Lantus (glargine)- a long acting insulin- works about 14 hours, dosed every 12- get the script for the pens, has what is called a 'depot' effect and builds up in the body, change dose based on the nadir BG, not the PS BG
Levemir (detemir)- a long acting insulin- works about 14 hours, dosed every 12- get the script for the pens, has what is called a 'depot' effect and builds up in the body, change dose based on the nadir BG, not the PS BG
PZI/Prozinc- a shorter acting insulin- dosed every 12 hours, works about 10-12, but you don't have to worry about overlap- what you shoot is what you get. Can change dose off of the PS shot BG, but make sure you get the nadir to see how low they go
 
Sue and Oliver (GA) said:
We like Lantus, Levemir (2 human insulins that have been used with great success in felines) and ProZinc or PZI ( an insulin sold only for animals) They are all mild, giving gentle cycles for 12 hours or so with a gradual onset and gradual rise.

If you want to know what the dose does, the best way to figure it out is to take readings at 2 hours after the shot, then 3 or 4 hours after, 5/6 hours after, 7/8 hours on up to 11/12. That will give you a picture of how the insulin is working.
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I will look into those, thank you! Do you have a source for the info on Vetsulin being so short acting? Would like to have something to show to my vet.
 
Cherylockholmes said:
Sue and Oliver (GA) said:
We like Lantus, Levemir (2 human insulins that have been used with great success in felines) and ProZinc or PZI ( an insulin sold only for animals) They are all mild, giving gentle cycles for 12 hours or so with a gradual onset and gradual rise.

If you want to know what the dose does, the best way to figure it out is to take readings at 2 hours after the shot, then 3 or 4 hours after, 5/6 hours after, 7/8 hours on up to 11/12. That will give you a picture of how the insulin is working.
Click to expand...


I will look into those, thank you! Do you have a source for the info on Vetsulin being so short acting? Would like to have something to show to my vet.
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PS- This morning he tested at 325, and 4 hours after giving him 1 unit of Vetsulin, he's at 238.
 
Cherylockholmes said:
Ahh, that makes sense. I will try that. I am giving him 2.5 ounces in the morning and 2.5 at night. Previously he was getting 1.5 ounces morning and night plus the dry food, but he hasn't been eating that because of his teeth I assume, and I don't want him eating it now anyway because of the carbs. Even though it's grain free, I'm sure it's carby from veggies. It's Pure Vita Grain Free Chicken.
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I haven't read through the entire thread but wanted to tell you that unregulated cats truly are starving, so just let him eat more.

My two were up to 30oz and 24oz a day before they were regulated and then they got down to about 10oz and 5oz or so. Stay clear of any kind of dry food, and scrap the expensive and useless vet foods.
My guys ate Friskies pates and did just fine.
 
Cherylockholmes said:
Sue and Oliver (GA) said:
We like Lantus, Levemir (2 human insulins that have been used with great success in felines) and ProZinc or PZI ( an insulin sold only for animals) They are all mild, giving gentle cycles for 12 hours or so with a gradual onset and gradual rise.

If you want to know what the dose does, the best way to figure it out is to take readings at 2 hours after the shot, then 3 or 4 hours after, 5/6 hours after, 7/8 hours on up to 11/12. That will give you a picture of how the insulin is working.
Click to expand...


I will look into those, thank you! Do you have a source for the info on Vetsulin being so short acting? Would like to have something to show to my vet.
Click to expand...

Vetsulin is a lousy insulin, and I don't care that it's apparently good/new/improved/back out on the market again.
It's no good. Any insulin that's been taken off the market, then brought back again is still doubted in my mind.

You can easily prove to the vet that it does not last long by doing a curve on your cat.... the numbers don't lie so when you see an early and steep drop and then the numbers start to rise way before mid cycle, there's your proof.

My first choice for insulin is Levemir, then Lantus. I believe they are better and longer lasting than any vet insulin.
 
Cherylockholmes said:
Wendy&Tiggy said:
How is he doing now? Is his BG coming down at all?
Click to expand...

It did not come down, so my vet put him on .5 units of Vetsulin once a day to start conservatively. Did that for 5 days, but no difference so we are increasing him now. Good news is he has stopped losing weight and has started gaining again. At his lowest he was 11.7, but now he's back up to 12.1...not much, but at least the scale has stopped moving the other way. My question is, how soon after he's done eating and receiving his insulin should I test to see if it's having any effect. His sugar will rise about 1/2 hour after eating right? Then, how long does it take to normalize that would be the perfect time to test?

Thanks
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This insulin choice and the dosing tell me that this vet knows very little about treating Feline Diabetes.
Vetsulin in the US is the same as Caninsulin in Canada.... it may be good for dogs, but it's lousy for cats.

Next, there is no insulin that lasts 24hours for cats, so right there, the vet shows no knowledge on dosing.

Food affects the numbers, so you would like to remove all food during the 2 hours prior to test/shoot times, and you can feed right at shot tiime. Yes, the numbers will rise from the food, plus the insulin won't kick in for about an your or so (that vetsulin) and other insulins take a bit longer to have an effect on the numbers, closer to 3-5 hours after the shot.

Test whenever you like. If you have a free time one day between two shots, you can do a curve by testing every 2 hours. Feed just as you normally would during the curve because you want to see the effects of the insulin and the food on the numbers.

Tests that are most important are the one you get before each shot-so you know it's safe to give insulin, and a 3rd test just before you go to bed because many cats go lower in the nite.
 
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