Feline Diabetes questions - first post

[riglee]

Hi. My cat is a 16 year old girl named Lucy. I found her in my yard in 1999 (she was born probably about May of that year) and we got to know each other outside that summer. As fall turned into winter she started staying in the garage and after she seemed content in the dog crate we set up ( with thick blanket over and a heating pad when it got really cold) we brought her in the house and got her healthy. Up until then we rarely had physical contact, just a lot of talking.

A few years ago she was diagnosed with asthma and what we tried was steroid shots (depo something) which knocked the asthma out but had to be repeated, initially in 6 months and now it seems to be 3 month or even less. It worked. She was diagnosed with diabetes earlier this year. It has been theorized that the diabetes is a direct result of the steroid. She is not and has never been overwight.

Her blood sugar was extremely high, some where in the upper 600s or low 700s (I can't find the results right now). We started her on 2 units (prozinc) but after a few weeks and another test her fructosamine count was still high (> 500). We upped the insulin to 3. I have since dropped it to 2.5 because I thought she was a bit out of sorts. Real or imagined I don't know but I was so worried about low blood sugar that I thought the best thing to do was lower it. We are going to get another fructosamine test done soon.

What I am looking for is advice on home testing, diet and other topics.

I have been feeding her Solid Gold Indigo Moon. She does not like wet canned food. She does love deli ham and really loves cooked salmon that I make in the oven.

I am going out of town for a few days. I am probably the only one that can give her insulin shots at home. For anyone else she will wither hide or try to. My dilemma is whether to leave her at home (someone will check on her, give her water and food but she would not have any insulin for 3 days) or to board her at the vet where they can give her the insulin shots (but she will be msierable there). What issues would I have by the 3 day span of no insulin and would it revert her back to super high blood sugar.

Should I do a glucose curve? If I should can I get the necessary equipment at a pharmacy or are there specific ones i shoudl use.

This is my first time writing here. Any help in answering ther questions or pointing me to the correct place wouls be most appreciated.

Thanks

 

[cookieLu1999]

Hi Riglee! While I cannot help you with diabetic answers, I am new to feline diabetes, I can say that my Phoebe is diabetic due to steroid use also. It's an unfortunate place to be. Phoebe needs her steroids to keep her gastric lymphoma in check! And Lucy needs her shots to breath!
It's an odd thing: I am a profession kitty sitter, but I don't care for diabetic kitties, I'm too afraid, and now I have a diabetic of my own. Life's weird that way, but onward we go! The pet sitting company I work for is cats only, and lots of us have a special way with cats. May I suggest taking a look for cat specialized pet sitters in your area. I would hope they could do an initial visit to determine if they would be compatible with your kitty. I hope you find a good solution for Lucy while you're away.
Good luck.

 

[Linda and Scooter & Jack]

Welcome to FDMB!
You are typical and just like the rest of us full of really good questions when we got here. A lot of your questions can be answered by clicking on the lantus/levemir page under insulin groups. There are a lot of sticky notes there that can answer your questions and even answer things you haven't asked. You and Rigley are welcome here! I will bumpthis up for more answers from more folks.

 

[BJM]

Welcome to FDMB.

We strongly encourage folks to home test the blood glucose with an inexpensive human glucometer (see my signature link Glucometer Notes), feed a species appropriate low carb canned or raw diet (see Cat Info), and lobby to get an effective, long lasting insulin for cats (ProZinc, Levemir, Lantus, or BCP PZI).

 

[phlika29]

Hi.

With regards the asthma there is actually a better treatment besides the steroid shots. You can actually give steroid from an inhaler.

There websites should give advice

http://www.felineasthma.org/medications/
http://www.fritzthebrave.com/meds/inhaled.html

http://www.trudellmed.com/animal-health/aerokat

Home testing is the best way of keeping your kitty safe and safely adjusting the dose. When are you going out of town? Could you try to get some home tests before you and teach someone else to do the shots?

Have a look at this link of home testing.

http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/

Most people buy a human meter and test strips.

@Sue and Oliver (GA) and @Elizabeth and Bertie may be able to advise on dosage

 

[Elizabeth and Bertie]

Hello and welcome, to you and to Lucy.

Kitties with steroid-induced diabetes have quite a high chance of achieving remission (ie, getting their diabetes to be diet-controlled).
Sarah (phlika29) gave you some great info about inhaled steroids. Do you think this is something that might work for you and your kitty...?

We started her on 2 units (prozinc) but after a few weeks and another test her fructosamine count was still high (> 500). We upped the insulin to 3. I have since dropped it to 2.5 because I thought she was a bit out of sorts. Real or imagined I don't know but I was so worried about low blood sugar that I thought the best thing to do was lower it.

(emphasis mine)

When you say that your kitty was "a bit out of sorts", what exactly do you mean? What symptoms was she showing? Do you think her blood glucose dropped too low?

A fructosamine test gives a sort of average of blood glucose levels from the preceding couple of weeks. What it doesn't do is show the blood glucose 'highs and lows' that happened along the way. So, whilst it is a good tool for diagnosing diabetes, it is not necessarily that helpful in determining how well the insulin is working in the cat's body.
Sometimes it can happen that a cat's blood glucose level will drop low, and then swing up high in response to that (as the body releases stored blood glucose into the bloodstream as a protection measure.). We call it rebound or 'bouncing'. A fructosamine test wouldn't pick that up.
The only way to work out the patterns of how the insulin is working in the cat's body is to test the cat's blood glucose at home.

Hometesting probably sounds a bit scary, but in fact is far simpler than it sounds, and it shouldn't hurt the kitty at all. But, like anything new, it can take a bit of getting used to, both for you and for your kitty.

Sarah gave you the link to the FDMB page of hometesting info, tips tricks and example videos. There is some great info there.
There were a number of tips that I found particulary helpful when I was learning to hometest. These are:
1. Most important: Make sure the ear is warm. Warm ears bleed so much better than cold ones.
2. It helps to apply a little pressure to the underside of the ear, opposite to where you're pricking. The lancet needs something to resist otherwise it can push the ear away rather than prick it. Some folks use a little piece of cotton wool or folded tissue. I use a fingertip (but sometimes get a blood sample from myself by doing that...)
3. Massaging immediately below the ear prick can 'milk' more blood out. (I nearly always do this.)
4. Two ear pricks close together can often get enough blood for a test where one ear prick might not.
5. A teensy weensy smidge of vaseline on the outer edge of the ear can help the blood to 'bead up' rather than disappear into the fur.

Most of us reward our kitties for tests (or attempted tests) with treats or cuddles. And I actually test my kitty while he is munching on some crumbled treats, and he doesn't really notice the test.
If a kitty doesn't like having it's ears touched it can be helpful to get it used to this by holding/massaging the ear briefly and then rewarding with a treat.
If a kitty really hates having it's ears touched then it is possible to test the paw pads rather than the ears (some folks here find the paw pad easier to test).

We recommend that the kitty's blood glucose is tested prior to each insulin shot; and that, for newcomers to diabetes (or those who have no prior hometesting data), no insulin is given if the 'preshot' blood glucose is below 200 (11).

A curve can be helpful in showing the pattern of how the insulin is working in the body.
It can enable you to work out when the insulin starts working ('onset'); when the blood glucose is at it's lowest (insulin 'peak', or blood glucose 'nadir'); and how long the insulin lasts in the cat's body ('duration'). But curves also have their limitations. The cat won't respond to insulin the same way every day. There will always be variations of some kind.

Once you get an idea of when the insulin starts working, and when the lowest blood glucose number of the cycle is likely to be, then you can target your testing more effectively.
Sue (Sue and Oliver (GA)) has written the FDMB user guide for Prozinc/PZI, which contains a lot of useful info:
Protocol for ProZinc/PZI

Do continue to ask any questions you want to. And if you don't get the answers you need than just ask again.

Eliz

 

[Mogmom and Goofus]

Hi.

With regards the asthma there is actually a better treatment besides the steroid shots. You can actually give steroid from an inhaler.

There websites should give advice

http://www.felineasthma.org/medications/
http://www.fritzthebrave.com/meds/inhaled.html

http://www.trudellmed.com/animal-health/aerokat

Home testing is the best way of keeping your kitty safe and safely adjusting the dose. When are you going out of town? Could you try to get some home tests before you and teach someone else to do the shots?

Have a look at this link of home testing.

http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/

Most people buy a human meter and test strips.

@Sue and Oliver (GA) and @Elizabeth and Bertie may be able to advise on dosage

Thank you so much for this post! As it happens, I have a cat with asthma, her name is Mouse ( long story). But the meds that we've been using haven't been helping her and she's really backsliding right now. I emailed the first link to my vet, he read it right away and made a new recommendation for meds. The med is formulated at a compounding pharmacy, so I wont get it until Monday or Tuesday, and it's kind of pricey, but I'm so excited and hopeful! Thank you again.

 

[phlika29]

Thank you so much for this post! As it happens, I have a cat with asthma, her name is Mouse ( long story). But the meds that we've been using haven't been helping her and she's really backsliding right now. I emailed the first link to my vet, he read it right away and made a new recommendation for meds. The med is formulated at a compounding pharmacy, so I wont get it until Monday or Tuesday, and it's kind of pricey, but I'm so excited and hopeful! Thank you again.

Hi

I am glad my post was useful.

Remi has been on inhaled steroids for over four years with no real problems. It is quick and efficient even if as you say a little pricey.

If you are starting out the inhaled steroid takes 10 days to build up in their system so don't taper the oral steroids until after this time. You might want to spent the first few days just slowly getting your kitty used to the spacer. I put it on the floor with treats in it. Then after a day or so I placed it briefly over his mouth and then gave a treat, etc.

The cheapest place to buy the flixotide is from inhouse pharmacy online. You need a prescription the first time but after that you are fine to just reorder. Most of the yahoo asthma group get it from this online pharmacy as well as the ventolin which you also need for emergencies.

https://www.inhousepharmacy.vu/p-398-flixotide-cfc-free-125mcg-inhaler-fluticasone.aspx

https://www.inhousepharmacy.vu/p-526-ventolin-inhaler-salbutamol.aspx

 

[Mogmom and Goofus]

We'll be starting out with the Turbuteline, it's a liquid dosed orally. We'll see how it goes!

 

[riglee]

Hello and welcome, to you and to Lucy.

Kitties with steroid-induced diabetes have quite a high chance of achieving remission (ie, getting their diabetes to be diet-controlled).
Sarah (phlika29) gave you some great info about inhaled steroids. Do you think this is something that might work for you and your kitty...?
........

Do continue to ask any questions you want to. And if you don't get the answers you need than just ask again.

Eliz

Out of sorts:
- She was sleeping a lot deeper than normal.
- She was letting our other cat, who she tolerates, walk close to her without reacting. Normally there would be a hiss or something if he invaded her space.
- She was not eating well. Small bits but not like before.
- Real or imagined I don't know. I thought she was trembling a bit. Sort of like if you think something is wrong with you your worry about it makes it even worse. Hypoglycemia had me very worried and I dodn't want to miss it.

We had another fructosamine test done yesterday. The first was well over 500 (after 3 weeks of using 2 units of ProZinc) and the most recent (yesterday) was about 300 (another 3 weeks of prozinc where I started at 3 units but dropped it to 2.5).

The symptoms I saw at 3 units do not appear at 2.5. She has energy back and her personality has come back. At 16 along with the asthma I know she doesn't have the energy she once did but she seems back to normal again.

I really love the positive thoughts about remission in steroid induced diabetes. I had read about alternatives to steroid shots before. I don't know about Lucy cooperating but if I can get her to go down that route and avoid the use of steroid injections and get her off insulin it would be fantastic. Her wheezing is starting to appear again and that usually means that in a month or so she will start to have the bad asthmatic attacks. And with spring starting all the mold and pollen outside can't help. It might be the ideal time to try inhaled steroids. When he has it bad it happens daily and it is severe. Just roughly speaking it looks like the best way to go would be "Flovent" route. The albuterol route would oly be of use in cases where I see it happening. I will pursue this with my vet.

Thanks you for all the information on inhaled steroids and glucose testing. I need to look at various food also. I thought what we have - Solid Gold Indigo Moon would be good but I don't know.