Newly diagnosed

[SanchosMom]

Greetings all,

First, I cannot express how grateful I am that you are all here. I have spent the last 24 hours researching feline DM while simultaneously freaking out and these boards have been an amazing resource. Secondly, please forgive me as this is all *extremely* new to me. Anyway- let's get to it. Sancho is a 12 year old (overweight at 14.5 lbs) male who was diagnosed with diabetes yesterday morning. I started noticing symptoms of increased water consumption with increased urine output the week of November 16th. After about 9 days of this, I thought it would be best to get him checked out, though I honestly had hoped that I was overreacting. His weight has been stable and there have been no other behavioral changes, and his physical was perfect. However, they called the next day with the news of his high BG (495) during the vet's blood draw, but there were no ketones in his urine.

Anyway, the vet was ok with me switching his diet for a few weeks to start out with (she prescribed a diet of Royal Canin Glycobalance but after researching here and elsewhere, I've found what I think will be better foods).

My main questions are:
1. Is it ok that he isn't starting insulin for a few weeks? I am pleased that his vet is letting me wait to start, but I am under the impression that most cats are started within a few days of the diagnosis, and I don't want to cause any more harm. She said since there were no ketones, she was comfortable with waiting.

2. I have gathered through direct inquiry a good sized list of up-to-date, what I'm thinking are good foods for diabetic cats, with the values for protein, fat, and carbs. Is this something that people here would be interested in me posting? This includes certain varieties of Wild Calling, Natures Variety, Merrick, and Wellness.

3. During the first ~18 hours, I was gradually switching him over to the prescription food, however as of today I have initiated the switch to Tiki Cat "Puka Puka Luau" Succulent Chicken wet food. The as fed % are: carbs 0%, protein 19%, fat 2%. The dry matter % are: carbs 0%, protein 82.6%, fat 10.1 %. The % of calories are: carbs 0%, protein 77%, and fat 23%. I still don't quite understand the difference between each of those, but does this sound appropriate?

I plan to get a home test kit tonight, play around with it, click it near his ears, and then maybe try testing for the first time tomorrow, and subsequently monitor once he and I get the hang of it. I will likely go with whatever is available at my local Walmart, whether that be Relion micro or prime etc.

Thanks again so much everyone.
Alexa

 

[Julia & Bandit (GA)]

Welcome! Diabetes can seem drastic and overwhelming at first, but after a while, you get the hang of it and it becomes no big deal. Many cats can also go into remission with the right diet, insulin, and home testing, and it looks like you've already started your research and are moving in the right direction!

1. Is it ok that he isn't starting insulin for a few weeks? I am pleased that his vet is letting me wait to start, but I am under the impression that most cats are started within a few days of the diagnosis, and I don't want to cause any more harm. She said since there were no ketones, she was comfortable with waiting.

I think it's ok to wait a week or a few days while you change the diet to canned food and learn to home test, but I definitely don't think I'd recommend waiting more than a week unless you see a dramatic drop in his numbers after the diet change. The sooner you start on insulin, the better, if you know he needs it. What insulin is your vet prescribing? Lantus (one of the recommended insulins for cats, along with Levemir) can be very expensive in the US, so that week can also be used to order your insulin from an online Canadian pharmacy if you need to. In addition to a home glucose meter, I would also buy some ketone test strips, so that you can test him for ketones at home. These are good to have on hand, and you can get them at a drug store or on Amazon.

2. I have gathered through direct inquiry a good sized list of up-to-date, what I'm thinking are good foods for diabetic cats, with the values for protein, fat, and carbs. Is this something that people here would be interested in me posting? This includes certain varieties of Wild Calling, Natures Variety, Merrick, and Wellness.

I would avoid Wild Calling--while the carb content is good, it has an usually high ash/phosphorus content, and I don't think I could recommend it for any cat, let alone a senior cat (who should avoid high phosphorus foods). Merrick has some foods that are ok (the pates), but keep in mind that they changed all of their formulas a few years back so you need to make sure the protein, fat and carb info you have is current. My cat used to eat Cowboy Cookout and a few other flavors, none of which are suitable for diabetics anymore and contain lower quality meat (I was rather angry and annoyed when I was forced to change foods because of this). Wellness and Nature's Variety are both good brands that have a lot of good options. EVO and Weruva also have some good options. You can check out this food chart for current values of a lot of cat food brands. The chart does have updated values for Merricks.

I would be curious to see the numbers you got on Wild Calling, though! I was thinking of feeding that food a few years ago, and my eyes nearly bugged out of my head when I got their typical nutrient analysis. The ash content was so crazy. I'm curious if they match the ones I received.

3. During the first ~18 hours, I was gradually switching him over to the prescription food, however as of today I have initiated the switch to Tiki Cat "Puka Puka Luau" Succulent Chicken wet food. The as fed % are: carbs 0%, protein 19%, fat 2%. The dry matter % are: carbs 0%, protein 82.6%, fat 10.1 %. The % of calories are: carbs 0%, protein 77%, and fat 23%. I still don't quite understand the difference between each of those, but does this sound appropriate?

We like to convert the as-fed (also called typical nutrient) analysis values to % per 100 calories--this makes the values much easier to understand and compare between foods, which come in different sizes and have different amounts of calories per can. So in the list I provided you above, you can see that the Puka Puka Luau is 79% protein, 21% fat, and 0% carbs. This is GREAT for a diabetic cat.

 

[Julia & Bandit (GA)]

Also, @SanchosMom , I would set up a spreadsheet if you're going to start home testing right away. It's an invaluable tool that will help you keep track of his numbers and make dosing adjustments. It's a google spreadsheet, so you can share it here to get dosing advice from experienced members, and also share it with your vet if you want. If you need help understanding it (AMPS=AM preshot, PMPS=PM preshot, +1=1 hour after shot, +2=2 hours after shot, ect.), just post here and we can help clear things up for you.

There's also some hometesting tips here: http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/. One mistake I made at first was getting lancets that were too thin. My reasoning was that they would hurt less, but they ended up not giving me a big enough drop of blood and making me poke multiiple times for each test, which made things a lot harder. I would recommend picking up the larger 26-28g lancets, not the thin 29-33g ones!

 

[SanchosMom]

Thank you so much for your response, @Julia & Bandit ! My vet hasn't yet prescribed any insulin, I think she's waiting on that step until we recheck him. But she did mention glargene and pzi. I really appreciate the tip about ordering from a Canadian pharmacy, as I am concerned about the cost.

In regards to Merrick- I was very concerned about that brand because it appeared fantastic until I had come across some threads discussing the change in Cowboy Cookout. I emailed them and received a quick response with up-to-date values, and boy has Cowboy Cookout changed! The Turkey and Chicken Pates seem to be the two that are ok right now. For Wild Calling, this is the link that one of their Support Staff members had emailed me:

https://wildcalling.app.box.com/typicalcatanalysis

Thank you for informing me about the high phosphorus content. I'm trying to keep track of all the tiny things in these foods that I need to watch for, but you're right it is overwhelming!

I am most hopeful about Tiki Cat, and am crossing my fingers that Sancho takes to it (it is not a pate). The company itself seems very transparent, which I appreciate, all of their values are listed on their website for each food- something I haven't seen any other food companies do.

That spreadsheet link! I came across it a few hours ago but had lost it in all of my fervor! Thank you SO MUCH again for everything you've provided.

 

[Julia & Bandit (GA)]

@SanchosMom If he doesn't like pates, check out Weruva, too. They have alot of good non-pate foods! Bandit now eats half Weruva, half Wellness Core, and it's worked for us well since we had to switch from Merricks.

Lantus (glargine) is an excellent insulin, and it's what I've used with Bandit since he was diagnosed almost 7 years ago. He's been in remission most of that time, and is still doing great! Levemir is another good insulin that has similar remission rates. Prozinc is also a good insulin, but it's remission rates aren't quite as high, so if you have the opportunity to use Lantus or Levemir, I would start there if you can.

 

[Julia & Bandit (GA)]

Thanks for the Wild Calling info! I'll run the numbers through my spreadsheet tomorrow and see if the ash/phosphorus percentages are still super high. If they've changed the formula since 2013, it'd be good to know!

I do remember that Merricks had a few pates that were OK for diabetics (the pates) in their new formulas, but Bandit needs his foods a little lower in fat because of chronic pancreatitis/IBD issues. That's why we liked the old Merricks so much.

 

[Squalliesmom]

Thanks for the Wild Calling info! I'll run the numbers through my spreadsheet tomorrow and see if the ash/phosphorus percentages are still super high. If they've changed the formula since 2013, it'd be good to know!

I would like to know this information as well. I just heard about Wild Calling today and was excited about it due to the low carb content, but won't purchase it if it's high in phosphorus.

 

[Squalliesmom]

@Julia & Bandit, @SanchosMom I just found this from an older post, made in April this year by jmalasiuk. Like her, I do not know how to interpret the phosphorus since they are listed as percentages of the total. If either of you know how, please let me know, thanks!

...I am most hopeful about Tiki Cat...

My kitties ADORE the Tiki Cat Chicken in Consomme and the Chicken with Egg in Consomme. I really wish I could afford to feed it as a steady diet but, with four cats, it would suck my budget dry. But they still appreciate it as an occasional treat!

 

[Julia & Bandit (GA)]

@Squalliesmom @SanchosMom

Here you go! The percentages for Wild Calling:

They definitely must have changed their formula a bit--the phosphorus and ash levels are much lower (phosphorus was in the 500-800 range for all the flavors back in 2013 when I got the as-fed values). I think this food would be fine for a young or middle-aged cat, but for a senior they're still a tad high (except for the beef and the triple delight). But it's definitely not terrible, and I don't think I'll shy people away from this food any more.

I do remember speaking with the owner back in 2013 when I had called and asked for the as-fed values, and he was a very nice person and genuinely did seem to think that his food was good for cats nutrition-wise. When I followed up with him about the phosphorus/ash issue, he didn't seem to understand why that was a problem, but it looks like it's been addressed now. I think they use bone meal as a filler, because there's no other explanation for the high ash levels from looking at the ingredients, and it looks like they've reduced the percentages a bit. That's a good sign, I think?

 

[SanchosMom]

@Squalliesmom I hear you about the cost of Tiki. Sancho is my only cat right now, so luckily I think I'll be able to swing it. It's still early though, so I'll have to see how it goes once we've had a few weeks of this. If his BG lowers and is stable, I may switch to a more affordable option and continue monitoring.

Here is the link that Wild Calling sent me: https://wildcalling.app.box.com/typicalcatanalysis
Unfortunately I can't help with interpreting the phosphorus content. @Julia & Bandit do you have a specific number that you try to stay under when looking at phosphorus? Sancho isn't loving the Tiki cat, but I'm feeding it to him with some Natures Variety "Venison," which is 42% protein, 55% fat, 3% carbs. Phosphorus is listed as 0.2% (min) in the "guaranteed analysis." Should I request a more detailed number?

 

[Julia & Bandit (GA)]

@SanchosMom Yes, I try to stay under 250 mg/100kcal with Bandit. The reason for this is that most senior cats (especially diabetics and those that have eaten dry food most their lives) have some loss of kidney function, even if it hasn't shown up in their bloodwork yet (cats need to lose more than 66% of their kidney function before it's detected in senior bloodwork). Because of that, and the fact that uncontrolled diabetes is just hard on the kidneys to begin with, I think it's a good idea to feed senior cats the same diet that is recommended for cats with early stage kidney disease as a preventative measure, and help slow any progression that might already be happening. A kidney friendly diet is high quality protein (meaning highly digestible protein, like egg & muscle meats), low phosphorus (less than 250 mg/100kcal, or less than 1% of the dry matter percentage) food.

If the cat is less than 12 years old then I would say don't really worry about a kidney friendly diet unless they actually are showing evidence of early insufficiency.

 

[Anitafrnhamer]

There is a test for kidney function now, it's the SDMA. It catches kidney disease earlier than waiting for the problem to show up with elevated BUN and Creatinine.

 

[Julia & Bandit (GA)]

@SanchosMom, In your case, Sancho is still on the young end of the "senior" spectrum, so I would concentrate on a diet that helps him lose weight and maybe worry about phosphorus a year or two down the road when he's at a healthy weight. So, very high protein, low fat, low carb. Tiki cat is great, and Weruva has a lot of good choices too that fit your needs! I would avoid things that are super high in fat (>60-65%), but something with moderate to low fat would be ideal (50% or less).

If the Tiki cat and Weruva are too pricy to feed every meal, you could always feed 50%, and pick the best of an affordable, moderate fat option for the other 50%. Just keep wary of feeding too much fish, because even though they tend to be high in protein and low in fat, cats can build intolerances to fish after eating it regularly. Occasional fish is fine.

BTW, this is what Bandit looked like at age 6 and obese from eating dry food his whole life:

And this is what he looked like at age 8, after being on entirely canned food for a year:

What a difference!

 

[Julia & Bandit (GA)]

There is a test for kidney function now, it's the SDMA. It catches kidney disease earlier than waiting for the problem to show up with elevated BUN and Creatinine.

Yes--the new test can detect loss at 25-40% loss instead of 60-80%. It's not part of a typical blood panel, though, and uncontrolled diabetes can cause further damage to the kidneys, so a negative early test may need to be repeated if a cat remains unregulated over time. When I asked my vet if we should do one (because Bandit's creatinine and BUN are borderline after his recent relapse in May), he told me that a firm diagnosis of early CKD is not going to make any difference in terms of the recommended kidney-friendly diet for his age (almost 14), so there was no point wasting money on it.

 

[SanchosMom]

@Julia & Bandit Wow! What an amazing accomplishment for you and Bandit! That gives me hope for Sancho. Did you notice any changes in Bandit's behavior or personality when switching him to wet food? Sancho has been overweight for quite some time, and I was feeding him what I *thought* was an appropriate food regimen, controlled amounts at specific times of the day of a "good food", however, 2/3 of that was in fact dry food. He hadn't lost any weight, but he hadn't gained any either so I thought we were ok. This gives me a lot of hope for Sancho. Yesterday was his first 24 hours on wet food only. I noticed that he didn't seem nearly as hungry as usual. It is common for him to be meowing and excited for food about an hour or two before his meal times. Yesterday, though, he would just casually walk over when he heard me getting his meal ready. I'm not sure if the wet food, along with it being high protein, helped satiate his hunger, or if we've just developed another problem in the last 24 hours.

I picked up a BG meter yesterday, too. I tried it on myself first, just so I would know how it worked. Then I just sort of went for it with Sancho after loving him up and playing with his ears for a while. I got a blood drop from his ear, but he became too annoyed and it smeared into his fur before I could get it in the test strip. Of course I tried again an hour later on the other ear, but he decided that just wasn't going to happen.

 

[Julia & Bandit (GA)]

@Julia & Bandit Wow! What an amazing accomplishment for you and Bandit! That gives me hope for Sancho. Did you notice any changes in Bandit's behavior or personality when switching him to wet food? Sancho has been overweight for quite some time, and I was feeding him what I *thought* was an appropriate food regimen, controlled amounts at specific times of the day of a "good food", however, 2/3 of that was in fact dry food. He hadn't lost any weight, but he hadn't gained any either so I thought we were ok. This gives me a lot of hope for Sancho. Yesterday was his first 24 hours on wet food only. I noticed that he didn't seem nearly as hungry as usual. It is common for him to be meowing and excited for food about an hour or two before his meal times. Yesterday, though, he would just casually walk over when he heard me getting his meal ready. I'm not sure if the wet food, along with it being high protein, helped satiate his hunger, or if we've just developed another problem in the last 24 hours.

Oh yes, he was brighter and more active as he lost the weight. We also had to play around with his meal times since he had been free feeding before, and he's a food crazy cat. We discovered that he must eat every 6 hours (that's our magic number), to keep him from begging for food all the time. Some whining is to be expected at first, as he settles into the new routine.

I was in the same place as you--I thought I was feeding him a quality dry food (Purina), supplemented with a premium wet food (Wellness), and I couldn't understand why he was so fat, which is why he went to consult with a nutrition expert. Turns out the "expert" we consulted with was one of the creators of Hills Science Diet, and he was put on dry prescription W/D. He lost weight (about 5 lbs), but that was because he almost died being on that food and had a severe case of triaditis--and I'm fairly certain that food was what pushed him over the edge into being diabetic less than a year later. That's when I finally did some reasearch on feline nutrition and realized that carbs were probably my problem. At that point Bandit was still carrying a little extra weight and I was feeding a grain free, lower carb dry food (EVO) partially (maybe 1/2-1/4 of his diet), and Wellness canned. But when he was diagnosed with diabetes we ditched the dry food completely, and he actually ate Fancy Feast for a while and lost a little more weight on that becuase it was lower fat than the Wellness he had been eating. It seems that we hit an impass with his weight at that point--he still need to lose about 1.5-2 lbs to get to his ideal weight, and it showed in his BG--even though he was in remission, he hung out in the 80-140 range instead of the 50-120 range. That's when we switched to the (old) Cowboy Cookout and other Merricks, and it worked amazing. The extra weight just melted off him and turned to solid muscle. So the higher protein, lower fat definitely worked really well for us. We're trying to lose an extra 1-1.5 lbs right now that he gained when he was on steroids May-Sept., so he's back on a mostly (75%) Weruva, high protein, low fat diet until we get him back to his ideal weight, and then I'll start upping the Wellness Core percentages back to 50/50 with the Weruva to maintain him. Because I work during the day, I have to set the auto feeders for the cats, and if I don't use a pate style food they don't eat at the same speed and they start going after each other's lunch (which is why 25% of his food is still Wellness right now).

I picked up a BG meter yesterday, too. I tried it on myself first, just so I would know how it worked. Then I just sort of went for it with Sancho after loving him up and playing with his ears for a while. I got a blood drop from his ear, but he became too annoyed and it smeared into his fur before I could get it in the test strip. Of course I tried again an hour later on the other ear, but he decided that just wasn't going to happen.

Keep at it! It takes a little practice. Make sure you're warming the ear, and holding it firmly until you can sip up the blood. Also, make sure he gets a low carb treat after every test! this is the most important step! The first few weeks I tested Bandit, he was absolutely awful...I had to wrap him up like a kitty burrito and put him in a basket to test him. Now he comes running when he hears the meter beep on, and sits patiently while I test him, because he knows what comes after!

I also found a tiny dab of neosporin + pain relief ointment after the test made a lot of difference in the beginning because I was poking him a lot (somtimes like 5 times for one test to get blood). We don't really need it anymore but I still use it out of habit.

One other weird thing--one of his ears bleeds much better than the other, so we don't even bother testing the other ear ever. So we always test his left ear, and leave the right alone.

 

[Squalliesmom]

@Julia & Bandit Thank you for the interpretation of the phosphorus values! Sadly. I think I won't be buying it for Squallie, he is 17 and I don't want to put him at any more risk than he already is for kidney disease. Rats, lol!

@SanchosMom You can put a very thin layer of Neosporin on his ear before you poke it; this makes the blood bead up instead of dispersing throughout the hair on his ear. Squallie also has one ear that bleeds better than the other, so I use it more frequently. His ears are paper-thin and will redden up and look sore very quickly so I do alternate ears some, but not every time I poke.

 

[SanchosMom]

Thank you! I got a successful test about 30 minutes ago. It was one hour after he ate and it read at 335. Much better than the 495 at the vet's office on Monday. It has been 32 hours since he started on wet food, and 25 hours since he started on the better wet food (high protein low carb). Is it possible that as each day passes his sugars will lower even further? Or am I being too hopeful here?