Another Canadian Newbie

[Elle & Squeak (GA)]

Hello all! New to the board and new to feline diabetes - the vet called with the news on Monday. Apologies for the incoming long post!

I had taken Squeak in late last week with UTI symptoms and they took a urine sample to send out for culture. The urinalysis came back showing sugar in the urine. In addition, the BG they did in office was elevated. So, here we are. At the moment, we haven't started treatment as Squeak's UA showed that she does have a UTI, so the vet wanted to get the culture results so I can make one trip in to get antibiotics and get up to speed on how we're going to treat her.

The vet seemed a little surprised that Squeak has diabetes as the classic signs have been fairly subtle. We've been dealing with a possible food allergy since October and I've tried to make some healthy lifestyle changes to help her with that, so that could be further masking her symptoms.

- Increased drinking/urinating - I've only noticed her drinking more from the water dish in the past week and a half (since just a couple days before the UTI symptoms popped up), but I'd tried to increase her fluid intake when she started the new food due to some constipation problems. So, increased drinking and urinating could have been masked.
- We've been trying to help her lose some weight as she is overweight and had started displaying some signs of arthritis. She's lost some weight, but it's a maybe/maybe not situation on whether it was due to our (conservative) efforts or the diabetes.
- She seems to like her prescription food and eats it all, but she doesn't seem to be any more hungry than normal.

So, as you can see, kind of muddy waters as far as symptoms go - hence why my vet was kind of surprised. One thing I have noticed is the "arthritis" I mentioned. Squeak had been going along quite well with only minor stiffness, but at the beginning of this month, she was suddenly having a lot more trouble with her rear legs, especially on the stairs. The UTI popped up very quickly after, and the vet I saw (one of the others in the practice, not my regular), mentioned it could be due to diabetic neuropathy. If so, it's really the only glaring symptom I've seen. I'm going to make sure I discuss it with my regular vet when I go in because regardless of the cause, it needs to be addressed.

Anyway, that's where we are right now.

I've been doing a lot of reading to get myself prepared. My biggest concern right now is finding a glucometer. Can any Canadians recommend a good one? I've priced around just in my local area and it seems that the strips for the Freestyle Lite are the cheapest, followed by those for the Verio IQ. Are either of those good? I know that there is a pet glucometer, but I read that the strips are quite a premium above the human ones and I'd rather keep things economical (who wouldn't?). I haven't had a chance to check in the nearest city yet, but I'm sure Costco or Walmart will have better prices. I do plan to look online for better deals, but will have to buy in person for start up, since I'm going to need things fairly quickly.

The vet said she'd be putting Squeak on glargine insulin (Lantus) - where's the best place to get that? I'm in Ontario and have access to all the usual suspects, such as Costco, Walmart, Shoppers, Superstore, etc. That might not be as pressing if I get insulin from the vet at first.

The only other thing that's on my mind right now is food. Squeak is currently on a combination of 1/2 can of Hill's d/d duck per day (I just started this over the weekend after getting the okay from the vet, since she's still on a food trial amidst all this) and Hill's dry d/d duck. I do plan on getting her onto all canned food if I can, but we're going to hold static with her food for now until we get insulin under control - we don't want to be monkeying with the food at the same time as her insulin. Once I get the hang of things, then we'll look at that. I have been looking for a decent canned food to put her on, but high protein, low carb and limited ingredient is a tall order. Too bad Fancy Feast and Friskies are out, because I'd be all over that! I guess I'll just have to see what turns up for food and do my best.

To sum up, I'm here and ready to learn all I can to get Squeak on the right track. If anyone can provide any pointers, I'd appreciate them.

 

[Shenandoah]

Hi Elle and Squeak,

Welcome to the forums! It looks like you are off to a good start, already arming yourself with a lot of information! That's great.

Many of us use the Relion monitors from Walmart, so you might be able to find something like that. In addition to being cheaper than the pet-specific monitors, the numbers you'll read around this site are mostly based on human readers, which read lower on the low end. So there's less conversion to worry about.
It's good that you plan to home test. Changing diet and clearing up the UTI can both cause significant drops in blood glucose. In fact, we started in the same spot and only did two weeks on insulin before going into diet-controlled remission! So keep a close eye on things as you make the changes.

I don't know anything specifically about the Hill's food so hopefully others can advise you there, but many of us use non-prescription food which is often as good or better than prescription, and cheaper! You can find more information about food options here http://www.felinediabetes.com/diet.htm

Most vets will tell you that there is nothing you can do for diabetic neuropathy. Usually some of it improves ones you get their blood glucose under control, but they'll still have some. Some people here have also had success with the supplement Zobalene. I just started Shenandoah on it a few days ago, so I don't yet know how successful it will be for us.

Once you start Lantus be sure to check out the Lantus specific forum http://www.felinediabetes.com/FDMB/forums/lantus-glargine-levemir-detemir.9/
There's a lot of great information in the stickies at the top about how to get started, how to figure dosing, how to handle insulin, etc.

There's a lot to learn, but these forums are a great resource full of knowledgeable and friendly people. So read, and ask all your questions.

 

[Critter Mom]

Hi Elle and Squeak. Welcome to you both.

I can relate to the tricky situation regarding events prior to diagnosis that could potentially have disguised diabetes symptoms. I had a similar problem with Saoirse in that I was battling to help her lose weight using vet-prescribed kibble so I didn't pick up on the polyphagia; I just thought she was having a hard time with the miniscule daily food allowance. It was when she lost weight, started drinking water for Ireland and her coat went to bits that I knew something really wasn't right.

On meters and insulin, there are members here who use the Freestyle, and Lantus is a very good insulin for cats (gentler in action and longer-lasting in a kitty's body than some other insulins). A lot of members here buy Lantus from Marks Marine Pharmacy in Canada. Here's a relatively recent thread with more info:

http://www.felinediabetes.com/FDMB/threads/which-canada-internet-pharmacy-to-buy-lantus-from.141318/

Another thing for your shopping list: ketone test strips. Diabetics are vulnerable to developing ketones (and potentially to developing life-threatening DKA). It's simple to do a regular check at home with urine test strips (e.g. Keto-diastix).

You'll find great information on feline nutrition and suitable diet for diabetics at vet Dr Lisa Pierson's catinfo.org website. (Very well-respected resource.)

Couple of quick questions: did your vet run a fructosamine test as part of the diagnostics? What sort of range is Squeak's blood glucose (BG) running in at the moment?

More to follow shortly ...


Mogs
.

 

[Critter Mom]

Part the Second!

Here's a video of Tootsie - a diabetic kitty who was treated successfully for neuropathy with B12 methylcobalamin. (Zobaline is suitable for diabetics as the tablets don't contain sugar. I think Vitacost may also do a diabetic-friendly methyl B12 but you'd need to double-check the ingredients before ordering.) Tootsie's neuropathy is quite severe at the start of the video. In the earlier stages it may manifest as a reluctance to jump up onto surfaces (but joint pain could also be behind that). One sign of a nervous problem is the 'plantigrade stance'; a cat with neuropathy will gradually start getting more and more 'flat-footed', ending up walking on its hocks as you'll see in the video.

It is worth noting that cats whose potassium levels are low may also show symptoms of general muscle weakness.

If your vet hasn't done so already, I'd suggest asking your vet to check Squeak's B12/folate and potassium levels.

I've probably bombarded you with enough for now. Catch you both later.


Mogs
.

 

[MrWorfMen's Mom]

Hello and welcome from a fellow Canadian in Toronto, ON. Where in Ontario are you?

I have a pet meter and yes the strips are extremely expensive and only available through your vet or a pet pharmacy. I use a Freestyle Lite meter also and am quite happy with the results to date. I personally like the side loading strips for the Freestyle but that is just a personal preference. The cheapest meter/strips in Canada is this one available online only. The only caveat to that meter is making sure you order strips well before you run low as they are not available in any local stores.

I buy my insulin from Walmart and I believe Costco prices are pretty similar. I have not checked out Superstore or Shoppers. You do not need a prescription for insulin here. Make sure though that you buy the Lantus pen refills. They come in a box of 5 small 3ml vials. This will cut down if not totally eliminate any waste that happens with the larger vials because of the small doses kitties need.

The Zobaline mentioned above is not available in Canada although you may be able to order it from the US. I would check border restrictions before doing so though as some "supplements" are not allowed across the border. Your vet should be able to provide some B12 supplementation for the neuropathy if that is the problem.

You will find everyone here very supportive and ready willing and able to help you on this journey. Keep the questions coming and you will get all the assistance and support you need.

 

[Elle & Squeak (GA)]

Thanks for the welcome everyone, and for the pointers so far.

It's good that you plan to home test. Changing diet and clearing up the UTI can both cause significant drops in blood glucose. In fact, we started in the same spot and only did two weeks on insulin before going into diet-controlled remission! So keep a close eye on things as you make the changes.

It's always encouraging to read stories like this! I know every cat is different, but we can keep our fingers crossed for an outcome like yours.

Another thing for your shopping list: ketone test strips. Diabetics are vulnerable to developing ketones (and potentially to developing life-threatening DKA). It's simple to do a regular check at home with urine test strips (e.g. Keto-diastix).

You'll find great information on feline nutrition and suitable diet for diabetics at vet Dr Lisa Pierson's catinfo.org website. (Very well-respected resource.)

Couple of quick questions: did your vet run a fructosamine test as part of the diagnostics? What sort of range is Squeak's blood glucose (BG) running in at the moment?

I have some ketone test strips, so I'm all set there. I've also been using Dr. Pierson's site since the onset of Squeak's possible food allergy - it's been really helpful!

As far as I know, the vet did not do a fructosamine test, but I could be wrong. When I had her in for the UTI last week, her BG was 19.7 on the vet's AlphaTrak meter. She had previously had lab work in October and her BG was 14-something (not sure on the exact number), but the vet chalked that up to stress. Other than those two values, I know that there was sugar in her urine when they did the urinalysis.

Here's a video of Tootsie - a diabetic kitty who was treated successfully for neuropathy with B12 methylcobalamin. (Zobaline is suitable for diabetics as the tablets don't contain sugar. I think Vitacost may also do a diabetic-friendly methyl B12 but you'd need to double-check the ingredients before ordering.) Tootsie's neuropathy is quite severe at the start of the video. In the earlier stages it may manifest as a reluctance to jump up onto surfaces (but joint pain could also be behind that). One sign of a nervous problem is the 'plantigrade stance'; a cat with neuropathy will gradually start getting more and more 'flat-footed', ending up walking on its hocks as you'll see in the video.

Thanks for posting the video. My husband and I both watched it and agreed that the way Tootsie walks towards the beginning of the video is very much like what we're seeing with Squeak right now. She's not fully in plantigrade stance yet, but you can see when she walks that her hocks drop until she gets tired and sits down. It looks like the diabetic-friendly B12 may only be available in the US, but mail order is always an option. I am going to mention it to the vet and see if there's anything they have access to. I'll also mention the potassium as a possibility.

I have a pet meter and yes the strips are extremely expensive and only available through your vet or a pet pharmacy. I use a Freestyle Lite meter also and am quite happy with the results to date. I personally like the side loading strips for the Freestyle but that is just a personal preference. The cheapest meter/strips in Canada is this one available online only. The only caveat to that meter is making sure you order strips well before you run low as they are not available in any local stores.

I buy my insulin from Walmart and I believe Costco prices are pretty similar. I have not checked out Superstore or Shoppers. You do not need a prescription for insulin here. Make sure though that you buy the Lantus pen refills. They come in a box of 5 small 3ml vials. This will cut down if not totally eliminate any waste that happens with the larger vials because of the small doses kitties need.

The Zobaline mentioned above is not available in Canada although you may be able to order it from the US.

I was looking at the Freestyle Lite meter. I remember reading that people had had problems with it in the past - I gather that's not the case anymore? I've also been looking at the Accu-Chek and the Contour (my vet had one before switching to the AlphaTrak) - I think I just have to choose a meter and stick with it or I'm going to drive myself crazy, LOL.

I think I'm just going to get the insulin from the vet to start out, but I'll be sure to look for the pen refills going forward.

Thanks for the tip on the Zobaline. They will mail it to Canada, but I'm going to hunt around for some other options before I commit to that.


Not much to update yet. Tonight is our appointment with the vet to get things started. My vet did say that I should get a pet glucometer, but I think the cost of the test strips is going to make that a challenge. I know there's a difference in reference ranges between human glucometers and pet glucometers - any tips on reporting back to the vet with readings from a human glucometer when they're used to the AlphaTrak? I want to keep things as simple as possible.

I'm sure I'll have more info tonight.

 

[MrWorfMen's Mom]

I remember reading that people had had problems with it in the past - I gather that's not the case anymore?

There are some comments on the board regarding the Freestyle meters but I think they are all older messages as there was an issue of the reading low at higher ranges a few years back. When I bought mine I researched it and that no longer seemed to be a problem. Any of the meters you mentioned would be just fine. Just pick one and stick with it so you get consistency in your readings because there are differences between human meters too! All meters in Canada are allowed a variance of up to 15% plus or minus.

any tips on reporting back to the vet with readings from a human glucometer when they're used to the AlphaTrak?

If your vet was using a human meter before, he/she may already be familiar with the difference in the readings. All the documentation on this site is based on human meter readings unless specifically stated otherwise so you could just print off some info from here if need be. If you plan to run curves (readings every 2 hours for 12 hours or every 3 hours for 18 hours) at home to share with your vet, you could graph the results because the patterns for both pet and human meters are very similar and would give your vet a good representation of how well Squeak is doing.

I don't think you will be able to get the insulin from your vet unless of course they are willing to go pick it up for you or are repackaging it. Beware repackaged insulin as this can affect the efficacy of the insulin and is not recommended. Please keep us posted!

 

[Shenandoah]

It looks like the diabetic-friendly B12 may only be available in the US, but mail order is always an option. I am going to mention it to the vet and see if there's anything they have access to. I'll also mention the potassium as a possibility.

The only place I've found Zobaline in the US is direct from the company itself.
https://www.ilifelink.com/zobaline-for_diabetic_cats-3_mg_x_60_tablets.html
It says at the bottom that they ship everywhere except Germany and Poland.

The company also sometimes sells through Amazon - I've seen it offered and out of stock at various times there, but it's always coming straight from the company, not a third-party provider.

 

[Elle & Squeak (GA)]

I don't think you will be able to get the insulin from your vet unless of course they are willing to go pick it up for you or are repackaging it. Beware repackaged insulin as this can affect the efficacy of the insulin and is not recommended. Please keep us posted!

Thanks for the heads up on the repackaged insulin. My vet had a sealed bottle when I went in last night, so someone must have gone out to pick it up.

The only place I've found Zobaline in the US is direct from the company itself.
https://www.ilifelink.com/zobaline-for_diabetic_cats-3_mg_x_60_tablets.html
It says at the bottom that they ship everywhere except Germany and Poland.

The company also sometimes sells through Amazon - I've seen it offered and out of stock at various times there, but it's always coming straight from the company, not a third-party provider.

Thanks for the info. We're going to hold on the B12 for now - if we find she's not improving, then we'll reassess and see about getting some imported.


We had our initial appointment last night. Squeak's been started on 1 unit of Lantus every 12 hours - her BG at the vet was 20.2 on their AlphaTrak meter. I'm going to keep an eye on her through the weekend and report back to the vet on Monday morning. So far, so good - my vet figures 1 unit isn't going to do much, but she wanted to start out very conservatively, especially since monitoring her from the whole cat perspective is going to be difficult, given her muddled symptoms. We did talk about her legs - Squeak, of course, wouldn't walk for the vet, so I'm glad I thought to take a couple of videos on my cell phone before we left home so I had something to show her. She thinks Squeak very well could have neuropathy effecting her rear legs and we should see improvement once we get her BG under control - she did tell me that she's never had a cat not come back from neuropathy, so that's encouraging. Finally, she's been started on a 2-week course of antibiotics for her UTI. All in all, a good visit and I'm not feeling too bad about things.

I'll be picking up a Freestyle Lite meter at some point today - the local pharmacy didn't have any on hand last night, but they've requested one to be on this morning's delivery truck. Then the real fun begins - I'm sure I'll be a bit pin-cushiony before we get the hang of it, LOL.

Squeak seems none the worse for the wear after all the poking and prodding, plus the fun of my husband and I trying to get a pill down her throat this morning. She's currently laying on the back of the couch, watching the birds at the window feeder. I have her closed in the living room for the day so I can keep a close eye on her, since she'd likely been under a bed or in a closet otherwise. At least it's entertaining for her.

So, that's where things are now. Thanks again to everyone for your posts - it's been a bit of an adjustment this week, so it's nice to talk with people who've been there.