Questions about dosing...vet NOT being helpful!!

[Emily'smom]

Hi All! I posted earlier this week in the Into Forum, as a newbie, and as the conversation has continued, I have been encouraged to post elsewhere. Here is the background: My name is Mary, mom of Emily, and 11-ish year old rescue, whom we have had for 4 years. Emily was diagnosed with diabetes in June. Emily is normally about 6.5 lbs, (with BIG fur) and can be a finicky eater with wet food. She had been eating a regular over the counter diet (supermarket food), both wet and dry. The vet put her on the so-called "prescription" wet and dry food. She is eating the prescriptive Purina DM dry, and she is getting 1/8 cup, 2x per day. She would not touch the wet food. The low-carb wet that she is eating, are various fish/seafood Fancy Feast Classics as well as Merrill Purrfect Bistro Thanksgiving Dinner. At the beginning, the vet put her on 1 unit of Lantus, 2x per day. I believe her initial number (at the vet) was in the 400's. After a few days of that my husband and I (who have no experience with diabetes in the human or animal form) could see it was way too much for her. So on our own, we cut the level down to .5 units, 2x per day. She seemed to be doing great...behaving normally, peeing normally, eating well, drinking normally. After a few weeks, we had a follow up at the vet for the full day testing. At one point in the afternoon, Emily's number dropped to 60. When we picked her up, the vet told us this number was way too low, and her suggestion was to stop giving the insulin, and just keep her on the low-carb food that she was eating, and bring her in for a recheck in 2 weeks. We were happy that perhaps we would be able to control with diet, but the low mid-afternoon number was surprising to me because I never felt she was acting "comatose" during the day, although I am not home all day, every day. In any case, when we brought her back for a single check 2 weeks after having her OFF the insulin, her numbers were back up ... she was in the mid-200's. I'm sure some of that can be attributed to stress. The vet's response to this was "well, .5 2x per day is too much, and since you can't eye up less than that, just keep her on the food and bring her back in a month for a recheck". Since that time, I can see that Emily is peeing more, is sleeping a lot, and generally once again, is not acting like herself. So, our idea is to restart the insulin, giving her .25, 2x per day. I ran this by the vet. I think she was confused by our suggestion and she said to try giving her a .5 dose ONE time per day. I don't know much about diabetes, but I didn't think that giving one dose a day is how it is done, although that certainly would be easier for me and my husband. I said to her, what about giving her .25, 2x per day and she said, "well, do what you want". UGH! So my questions, since I have lost confidence in this vet....is 60 indeed a "dangerously low level"? Can you effectively give the Lantus 1x per day? Would .25 2x per day be a good place to start? Before putting her back on the insulin, should we continue to try and tweak her diet? (I am fearful of this naturally tiny cat losing weight). Thanks in advance for any input!

 

[LizzieInTexas]

Here is the link to your other post.

http://www.felinediabetes.com/FDMB/...giving-mixed-information.181013/#post-2007309

Have you read the stickies at the top of this forum? If not, I suggest starting there.

 

[Chris/China (GA)/Garfield]

is 60 indeed a "dangerously low level"?

No, not generally....our "time to act" number is under 50 on a human meter, but it's under 68 on a pet meter and your vet may have been using the AlphaTrak pet meter. Vets also tend to want their patients to run higher than we do due to the possibility of hypo's and being liable. They don't understand that we can keep our kitties safe by home testing and that most of us are willing to do it! Our first vet wanted China to run in the 300's!!

Can you effectively give the Lantus 1x per day?

No....a cat's metabolism is too fast for once a day dosing

Would .25 2x per day be a good place to start?

Yes, if .5 dropped her to 60 on a pet meter, .25 is a good starting dose to try but I'd get her off the dry food first

Before putting her back on the insulin, should we continue to try and tweak her diet?

If you get the dry completely out of her diet, she may be able to be diet controlled!! I'd get the dry out of the picture as soon as possible (before you start the insulin is the best time to do it). The dry D/M is too high in carbs for a diabetic cat

 

[Emily'smom]

Of course we would much prefer to control this problem with diet as Chris suggests. My fear is that because she is such a tiny cat, she is a picky and finicky eater and a "grazer", if I take away her dry food, she will not eat enough wet and her weight will plummet. If she were a 20 lb cat and had weight to spare, I wouldn't be nervous about cutting out that part of her diet, because I think it would cause her to gobble up the wet. But because she eats.so.slowly, over the course of the day, and does not gobble down her wet, she may lose too much weight. Thoughts??

 

[Chris/China (GA)/Garfield]

But because she eats.so.slowly, over the course of the day, and does not gobble down her wet, she may lose too much weight. Thoughts??

A lot of us leave canned food down all day, or you can use an autofeeder like the PetSafe5
Another option if you're uncomfortable leaving wet food out is to make "food sickles" by adding water to canned food and freezing it in ice cube trays...you can leave some out (most cats won't eat it frozen) and a few hours later after it melts, it's a "fresh meal" (you can also use these in the auto feeder)

 

[LizzieInTexas]

You can grind/smash up the dry and sprinkle it on top of the wet and slowly use less and less. I would keep testing and gathering data (setup a spreadsheet) and see if you can get her transitioned over to low carb wet and then start up insulin if needed.

Gizmo was a dry kibble nibbler pre FD/pancreatitis. He transitioned very easily. It was wet or go hungry (but it never got to that). He was transitioned to wet before FD diagnosis so going strictly LC wet after diagnosis wasn't too difficult.

 

[Emily'smom]

I think my concern is if I take away the dry, I feel like she won't eat enough wet to keep her weight up, because she really is not a big eater. She is not a cat that the more you put down, the more she eats. So, if I take away the dry, I am not sure she would consume enough wet to make up the caloric difference. Does that make sense?

 

[Emily'smom]

You can grind/smash up the dry and sprinkle it on top of the wet and slowly use less and less. I would keep testing and gathering data (setup a spreadsheet) and see if you can get her transitioned over to low carb wet and then start up insulin if needed.

Gizmo was a dry kibble nibbler pre FD/pancreatitis. He transitioned very easily. It was wet or go hungry (but it never got to that). He was transitioned to wet before FD diagnosis so going strictly LC wet after diagnosis wasn't too difficult.

OK...this I can see might work and be a good idea for the transition. We did give her the tiniest bit of insulin tonight. I plan on giving her another dose in the morning...I mean, a drop or two. I will also attempt to pulverize the dry and sprinkle some on her wet and see how much she eats. I have never had to pay attention to this stuff before. I assume there is a way to determine how many calories a 6.5 lb. can should consume to maintain that weight, and a way to figure the calorie amounts she is consuming?

 

[LizzieInTexas]

Does that make sense?

Yes. You will need to monitor her weight but my guess is she will surprise you.

This is the formula I was given (here) for maintaining weight.

The cat's weight times 13 and add 70. So a 11.5 lb cat X 13=149.5 +70=226 calories/day

ETA-she is tiny. My Nikki(GA) was a tiny one too. Gizmo, not so much. Lol. He was 17#s pre FD/pancreatitis. His is now 12#'s which is good for him.

 

[LizzieInTexas]

There are other things that can be used to entice them to eat. Carla @carfurby has the list. Maybe she will post it. If not I will hunt it down tomorrow.

 

[Emily'smom]

Yes. You will need to monitor her weight but my guess is she will surprise you.

This is the formula I was given (here) for maintaining weight.

The cat's weight times 13 and add 70. So a 11.5 lb cat X 13=149.5 +70=226 calories/day

ETA-she is tiny. My Nikki(GA) was a tiny one too. Gizmo, not so much. Lol. He was 17#s pre FD/pancreatitis. His is now 12#'s which is good for him.

Thank you so much! You guys are awesome, and truly have helped more on this forum than my vet. I'm grateful. I will figure out how much she should be eating, and then will figure out between the dry/wet and try to transition her over using the crushed up dry to entice her to eat more wet. LOL! She's pretty smart, so we will see what happens. I will keep you posted!

 

[CassAndGordy(GA)]

A lot of us leave canned food down all day, or you can use an autofeeder like the PetSafe5
Another option if you're uncomfortable leaving wet food out is to make "food sickles" by adding water to canned food and freezing it in ice cube trays...you can leave some out (most cats won't eat it frozen) and a few hours later after it melts, it's a "fresh meal" (you can also use these in the auto feeder)

I freeze my wet! It stays pretty cold for a while. It could be something you keep in your back pocket.

Also, if she becomes diet controlled and that "withholding food 2 hours preshot" rule won't be in effect. You can get better feeders to keep her wet food fresher. Rex has one of those fancy microchip feeders (its been a god send) and the wet food stays wet all day. They make a kind that just opens for motion (not a chip) and it'll essentially do the same. Now, that being said, I live in Florida and my grandma keeps out place at a brisk 77° so I don't utilize that plus, dry only in mine.

(I just use one of those plastic 2-bite cupcake holders - the kind you buy pre-made at the grocery store. the plastic is bendable so you can just pop out the food. i use a big can - 12.5oz - mix a little water in and mix well - almost makes a perfect tray. And then I let the cats lick the bowl the bigger cans are trickier to find... wellness has some, but their formula changed and its harder to find now. Friskies has some - my cats dont like it, of course LOL.)

 

[LizzieInTexas]

Here is the link to the food database. You want to stay under 10% carbs.

http://catinfo.org/chart/index.php

The download pdf has the calories listed (here).

 

[LizzieInTexas]

Here is the link to helping them eat

• How to Stimulate Kitty's Appetite

 

[carfurby (GA)]

Sorry, I didn't see the tag right away. I'm glad you found the list. This is the only other thing I've seen suggested:
Purebites Duck Liver -- crushed and put on as a topper.

 

[Sienne and Gabby (GA)]

The other option with regard to a low carb dry food is Young Again Zero Carb. It's a bit pricey and while it's not really zero carbs, it's bout 5% carb. That may be a solution for you.