New here, appreciative of the support and dealing with a bit of a crisis

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bhaver

bhaver

Member Since 2019
Hi everyone,

I posted an introduction message here but will recap. Eddie is a beautiful nearly 17 year old cat. He was previously (and possibly erroneously) diagnosed with chronic kidney disease for which he was given Royal Canin Renal Support E for 2 years (very high carb). On friday, 4 days ago he was diagnosed with diabetes after we took him in because he had been drinking more water than usual. We initially thought this was his kidneys getting worse but the BUN results were normal this time. His bloodwork showed a BG of 27. Urine culture results have not yet come back. His rear legs are also very weak, this isn't new and again we believed this to be arthritis which was previously diagnosed.

We received the blood results by phone that friday and the vet said to call this week to arrange for an appointment to get started with insulin. This will happen tomorrow (Tuesday afternoon). So Eddie has not yet started on insulin.

Over the weekend Eddie has become extremely lethargic. During the day he barely moves but will occasionally get up for a bit of food and water. He wouldn't finish his Purina DM so we gave him some Blue Buffalo Indoor Mature to help transition. He does seem to prefer this food and eats more. Otherwise he just lays there sleeping or staring. As we go to bed he's slightly more alert but tends to sleep by his water and food dish and will periodically get something to eat or drink or meow for help to get up. His rear legs seem to be rapidly getting worse. The positive is that he does eat and drink and use his litter though food consumption is way down from a week ago.

I am extremely concerned with the lethargy and at 17 years old not sure what kind of quality of life I'm about to subject him to. I would love to hear your thoughts and also what I can expect once he is given some insulin doses. Assuming it comes under control, do you see changes quickly or does it take a few weeks before he will improve?

The other question I had is with respect to transitioning his food. For one I've now read that Purina DM (canned) may not be ideal and I should try Fancy Feast, and secondly is it safe/ideal to switch him directly or should I continue with a transition. I suspect he would love the fancy feast food as he used to love it as a kitten.

I'm very grateful for this forum as reading through the information and other posts is cathartic somehow. Thank you and all the best,

JP
 
Here is your post from the welcome page for continuity
http://www.felinediabetes.com/FDMB/threads/new-here-looking-for-help.212648/

Hi and welcome to you and Eddie.
You have come to the best place for help and support for your kitty.
Well done getting a meter and learning to test....the best thing you can do to keep Eddie safe!
With care and the correct treatment, you should be able to get Eddie back to his previous self. FD kitties often have a reduced appetite in the beginning but that should improve. It is important he keeps eating.

One thing I would do today is go out and buy a bottle of Ketostix and test his urine for ketones. You can buy them from a pharmacy for about $10. I am concerned he is lethargic today. It could be that he is dehydrated so try adding some warm water, about a tablespoon to his food. Also checking for ketones is a good idea. Diabetic cats, especially untreated ones are prone to ketones....and if a FD kitty is not getting enough food, enough insulin and has an infection or inflammation, he is much more likely
to get ketones which MUST be treated immmedialtey by a vet. I don't want to alarm you but to be on the safe side I would check for ketones today. Anything above a trace of ketones, go to the vet.
Not sure where you live but I see you have a world SS so I am guessing it is not the US. If you can tell us the country we can give you specific info for your country in respect to food etc.
If Eddie does NOT have ketones you might like to swap him over to a low carb diet ( 10% or under) before you start the insulin. If there are ketones present the insulin must be started. It is much easier to swap over before you start the insulin..........However if the vet thinks you need to start the insulin now, you can still swap over Gradually to a low carb diet after you start te insulin, because you are testing the BSL (blood sugar levels). Giving a low carb diet can drop the BSL significantly so please seek guidance with swapping over to the low carb diet. We are very happy to help you. Fancy feast is a fine canned food for FD kitties. The pate ones are the low carb. Definitely ditch all the dry. And there is no need to buy any of the prescription FD diet food from the vet. It is expensive and no better than low carb from the supermarket and pet store.

His rear legs will improve once you get the BSL more under control. However you can give methyl B12 tablets....Zobaline.... which a lot of us give for the neuropathy.. you can buy on amazon or lifelink. You need to buy ones that are suitable for cats and don't have any sugar in them. Check with us before buying if you get anything other than the Zobaline. It is not the same as the B injection the vet can give and you dont need the vets permission to give them.

If you can ask the vet to prescribe Lantus or Prozinc insulin, they are the best ones. Vetsulin and caninsulin are often prescribed but the two I mentioned first are much more suitable for cats and you will get better results.

Keep asking lots of questions. It is a steep learning curve in the beginning and we all understand how you are feeling at the moment.
Bron
 
Welcome! Bron gave you some excellent advice, especially the ketone check. As far as food, while Fancy Feast is a great low carb food for diabetes, it is very high in phosphorus which is not good for a cat with kidney problems. So even if you’re not sure he ever really had CKD, you may want to consider that. If you tell us what country you’re in, we can help you with a food choice.
 
Thank you for the advice and reassurance. Eddie ate all his food last night and more this morning and I could hear him drinking water through the night. I will get some test strips. We are located in Ontario Canada. We willl see the vet today and I'm hoping to get started with insulin. I will request the Lantus or Prozinc.
 
I think in Canada you can buy the Lantus without a script. I would ask for Lantus personally if you have a choice.
We have several Canadians on the board. Put Canadian in your signature so they can see.
Good luck at the vet. A good starting dose is 1 unit. Let us know how you get on
 
So Ed will be getting 2 units of Lantus tonight. He's also got an infection so we'll start him on antibiotics with his next meal. He's a bit more upbeat today so I'm happy with that. He's sitting at 7.6kg and they want to get his weight down more but we're going to move from Purina DM to Weruva Fowl Ball (or any food that fits the profile of low carb and 200-220 kcal per day). I'll update after we give the first injection.

Should I be testing his BG before and after the injection? 30 mins after? more?

Thanks!
JP
 
Great you have Lantus.
Where is his infection?
Routine for testing the BSL: test before EVERYshot to see it is safe to give the insulin, feed, then give the insulin. Then it is a good idea to test around +4 to +6 ( 4 to 6 hours after the insulin) to see how low the insulin is taking Eddie.
In the beginning if the BSL is under 11.1 (200) stall, don’t feed, and ask for help. Test 20 minutes later to see if the BSL is rising and it is safe to shoot. Once you get more data and see how Eddie reacts you will be able to shoot lower numbers.
Wereva a is a good low carb food. It is a good idea to split up his food and instead of feeding it all before the insulin, save some and feed it at say +2 and +4. Or +3 and +5.. Lantus is a long acting insulin and the onset ( when it starts to take effect ) is around +2, and the nadir is around +4 to +7 ( lowest point of BSL) usually but it can be later. Only testing will tell and every cat is different (ECID). A lot of us test more frequently especially when the numbers are dropping but what I have said above is issential to keep Eddie safe
Make sure you have some higher carb food and some honey or Karo in your cupboard at all times in case of low numbers. Don’t use dry food to bring up numbers as it is absorbed too slowly. Get some wet higher carb food. Weruva has some in the cats in the kitchen pouches.
Keep asking questions. Let us know how you go with the first injection
 
Here is a link to the Lantus page where most people who give lantus post. I would suggest you start posting over here now as you will get a lot more Lantus user eyes on you. Also read through all the yellow stickies at the top of the page for mountains of great information.
Can you adjust your signature to say Eddie is on Lantus insulin please.
I would be inclined to start him on 1.5 units of Lantus. The starting dose formula is 0.25 units per kg and with 7.6 kg comes out at 1.9 but I would go to 1.5 units and see how he goes. Better than giving too much especially until you see how he reacts to the insulin.
Did you manage to get the Ketostix?


http://www.felinediabetes.com/FDMB/forums/lantus-basaglar-glargine-and-levemir-detemir.9/
 
bhaver said:
The other question I had is with respect to transitioning his food. For one I've now read that Purina DM (canned) may not be ideal and I should try Fancy Feast, and secondly is it safe/ideal to switch him directly or should I continue with a transition. I suspect he would love the fancy feast food as he used to love it as a kitten.

JP
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Welcome! Regarding Pro Plan Veterinary Diet DM is actually listed on Dr. Pierson’s spreadsheet, with 6% calories from carbs. This is the regular canned DM. The Savory Selects DM version is 10% carbs, so that one is too high for diabetic cats.

Fancy Feast Classics pates are in the 3% range and are more affordable.

If you have regular DM canned at 6% carbs that falls in the recommended guidelines for diabetic low carb wet diet, but if your cat likes the
Fancy Feast pates, that is even lower carb.

As Bron mentioned the high to low carb food transition needs to be gradual and monitored as their glucose can drop a good amount in a matter of days when they switch.

http://www.felinediabetes.com/FDMB/threads/transitioning-your-cat-from-dry-to-wet-food.956/
 
Bron and Sheba said:
Great you have Lantus.
Where is his infection?
Routine for testing the BSL: test before EVERYshot to see it is safe to give the insulin, feed, then give the insulin. Then it is a good idea to test around +4 to +6 ( 4 to 6 hours after the insulin) to see how low the insulin is taking Eddie.
In the beginning if the BSL is under 11.1 (200) stall, don’t feed, and ask for help. Test 20 minutes later to see if the BSL is rising and it is safe to shoot. Once you get more data and see how Eddie reacts you will be able to shoot lower numbers.
Wereva a is a good low carb food. It is a good idea to split up his food and instead of feeding it all before the insulin, save some and feed it at say +2 and +4. Or +3 and +5.. Lantus is a long acting insulin and the onset ( when it starts to take effect ) is around +2, and the nadir is around +4 to +7 ( lowest point of BSL) usually but it can be later. Only testing will tell and every cat is different (ECID). A lot of us test more frequently especially when the numbers are dropping but what I have said above is issential to keep Eddie safe
Make sure you have some higher carb food and some honey or Karo in your cupboard at all times in case of low numbers. Don’t use dry food to bring up numbers as it is absorbed too slowly. Get some wet higher carb food. Weruva has some in the cats in the kitchen pouches.
Keep asking questions. Let us know how you go with the first injection
Click to expand...

The vet cultured his urine and it came back with E. Coli, and they've given us antibiotics for this. I believe this means it's a UTI.
I've updated the spreadsheet with our first few injections and the testing that I have done along the way. This morning I was very concerned because he was at a 7.5. I spoke to the vet and she said to go ahead with the injection and to check on him. We've got a ton of the Renal E food that is very high carb so will keep that ready.

The first three injections have gone pretty well (except for the fear about the low numbers). We've injected at 15, 7.5 and 6.4 (just now).

I'm thinking his lethargy this weekend was due to either the change of food or the infection. I lean towards the food because he had perked up before ever receiving antibiotics. He's also been eating pretty well since yesterday.
 
Bron and Sheba said:
Here is a link to the Lantus page where most people who give lantus post. I would suggest you start posting over here now as you will get a lot more Lantus user eyes on you. Also read through all the yellow stickies at the top of the page for mountains of great information.
Can you adjust your signature to say Eddie is on Lantus insulin please.
I would be inclined to start him on 1.5 units of Lantus. The starting dose formula is 0.25 units per kg and with 7.6 kg comes out at 1.9 but I would go to 1.5 units and see how he goes. Better than giving too much especially until you see how he reacts to the insulin.
Did you manage to get the Ketostix?


http://www.felinediabetes.com/FDMB/forums/lantus-basaglar-glargine-and-levemir-detemir.9/
Click to expand...

Yes, I'll update my signature right now. They started us with 2 units. I had some test strips and was able to test Eddie yesterday but it turns out they had expired and I tested myself and got the same result as him so I need to go out and get some fresh ones. I'll also go check out the Lantus page, thank you.
 
Please get some inbetween tests in with the preshot at 115. @bhaver
The 2 units may be too high a dose.
ETA your kitty's could drop low overnight, especially with a preshot of 115. Make sure you get a test in +2 and +4 and if still low get a +6 and keep testing until the numbers start to come back up. You can feed higher carb food if the numbers are dropping. Post and ask for help if needed.
 
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Just ran a +3 and he was at 5.8 (104) so down a bit. He's been grazing on his food a little but has been sluggish most of the evening (including before the shot) possibly his infection or legs are bothering him. Will stay on top of it.
 
What a handsome boy!

Just a couple observations, not sure if the Renal E you have is wet or dry, dry high carb will take longer to raise BG than wet because if has to be broken down in kitty’s tummy first.

If not sure Eddie has kidney issues, as previously communicated, you want to look for low carb wet that has under 300 phosphorus in addition to carbs under 10 and preferably under say 8%.

You can look on the chart or someone with a cat needing lower phosphorus may chime in.

Also, yes, would say vet is describing UTI. That will affect BG numbers, normally infection will raise them. So once that is cleared up his BG should look better.

2 units, that is a higher than normal starting dose.

I am concerned with his numbers already showing low in a few doses, a UTI, which when cleared should lower numbers and switching to low carb you almost certainly will need a reduced dose.

Not sure how diabetes was diagnosed, but with the high carb and infection combined, there may be a chance he is only borderline diabetic and hopefully can get turned around quickly with food and infection taken care of. If it was diagnosed off one high reading in vets office the combo of stress, infection and high carb diet could be enough to make even a normal cat look diabetic off one number.

May need to see what he looks like after food change and infection clears.

Also remember Lantus is cumulative and after a week when depot fills, and combined with all other factors, those current blues can turn dangerously low quickly.

I am by no means an expert, but with such a recent start, I would be tempted to back off insulin considerably until you have infection cleared and diet mostly transitioned. There are too many factors in play for my comfort, but that is me.

Hoping some more experienced members will chime in here.
 
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Julie and Honey said:
What a handsome boy!

Just a couple observations, not sure if the Renal E you have is wet or dry, dry high carb will take longer to raise BG than wet because if has to be broken down in kitty’s tummy first.

If not sure Eddie has kidney issues, as previously communicated, you want to look for low carb wet that has under 300 phosphorus in addition to carbs under 10 and preferably under say 8%.

You can look on the chart or someone with a cat needing lower phosphorus may chime in.

Also, yes, would say vet is describing UTI. That will affect BG numbers, normally infection will raise them. So once that is cleared up his BG should look better.

2 units, that is a higher than normal starting dose.

I am concerned with his numbers already showing low in a few doses, a UTI, which when cleared should lower numbers and switching to low carb you almost certainly will need a reduced dose.

Not sure how diabetes was diagnosed, but with the high carb and infection combined, there may be a chance he is only borderline diabetic and hopefully can get turned around quickly with food and infection taken care of. If it was diagnosed off one high reading in vets office the combo of stress, infection and high carb diet could be enough to make even a normal cat look diabetic off one number.

May need to see what he looks like after food change and infection clears.

Also remember Lantus is cumulative and after a week when depot fills, and combined with all other factors, those current blues can turn dangerously low quickly.

I am by no means an expert, but with such a recent start, I would be tempted to back off insulin considerably until you have infection cleared and diet mostly transitioned. There are too many factors in play for my comfort, but that is me.

Hoping some more experienced members will chime in here.
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You're describing my exact fears very well. This morning's AMPS was 8.4 and we gave his injection. He had a very good day yesterday until about 7pm where he just put his head down and became very lethargic (this was before his injection at 8:30pm). I'm hoping the lethargy is due to the food change and infection. The food in particular has been an adjustment, he's generally not eating his meals in one sitting and I don't know how to make him eat more. I have prepared a maple syrop+water mix in a dropper bottle in case things don't look well but I also have to work so my plan this morning is to head home around lunch which is +4. I will contact the vet again and ask for a follow up and raise more concerns, particularly how he's very sluggish. The diganosis was made on 1 single reading in a very high stress environment, he has always fought with vets. Prior to starting insulin I did do a test at home a day or two later and I got a 21 so it was definitely raised but as you say, this could be due to the infection.

The Renal food we have is canned, we've fed him canned nearly his entire life as I quickly discovered rapid weight gain on 'prescription dry weight loss food' :)
 
bhaver said:
You're describing my exact fears very well. This morning's AMPS was 8.4 and we gave his injection. He had a very good day yesterday until about 7pm where he just put his head down and became very lethargic (this was before his injection at 8:30pm). I'm hoping the lethargy is due to the food change and infection. The food in particular has been an adjustment, he's generally not eating his meals in one sitting and I don't know how to make him eat more. I have prepared a maple syrop+water mix in a dropper bottle in case things don't look well but I also have to work so my plan this morning is to head home around lunch which is +4. I will contact the vet again and ask for a follow up and raise more concerns, particularly how he's very sluggish. The diganosis was made on 1 single reading in a very high stress environment, he has always fought with vets. Prior to starting insulin I did do a test at home a day or two later and I got a 21 so it was definitely raised but as you say, this could be due to the infection.

The Renal food we have is canned, we've fed him canned nearly his entire life as I quickly discovered rapid weight gain on 'prescription dry weight loss food' :)
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I would say if you have to leave, check him once more if you can, if he is going down, leave a little high carb wet for him, say a spoonful or so. I am concerned that the dose this morning and everything else could drop him quickly. Some of these numbers should not be automatically shot with all the issues and you are new to this. Our primary goal is to keep your cat safe. Just because the vet tells you to do something does not mean it is what is best for the cat.

Please come home at +4 as planned and let us know.

Copying a few more experienced members to get some answers. @Wendy&Neko @Bobbie And Bubba.
 
Fancy Feast is OK for diabetic kitties, but if there is any chance he does have chronic kidney disease, I would stay away from it. It is too high in phosphorus. This food list contains many of the commercially available foods in Canada. Look for ones under 10% in carbs and ideally under 200 in phosphorus, though even under 300 will be better than Fancy Feast. The Weruva is a good option.

It would be great if you can get a check somewhere mid day today. We determine if the Lantus dose based on how low it takes the cat. Those low numbers are somewhere in the middle of the cycle. Lantus cycles typically go lowest somewhere mid cycle.

I see on your welcome post that you are going on vacation in a few weeks. If you can't find a petsitter that shoots insulin (some do), you might want to ask at the vet's office if there is someone who will come to you house and test then shoot. We would try to get enough information on your kitty before then to know what's an OK dose for while you are gone.
 
Thank you - I came home and got a +4.5 dose and it was at 8.3. He is still very sluggish but I would say slightly better. He's walked himself over into a room that gets more sun so that's a positive. If I bring the food dish over to him he usually eats a little bit.

There's so many factors it's very difficult to determine what's causing his lethargy:
1. Bladder infection
2. Change of diet (high carb 21%+ down to <8%
3. Arthritis possibly combined with neuropathy
4. Antibiotics for the UTI
5. Something else not yet diagnosed (vet wondered if this could be the case because lethargy isn't typical for the above)

The strange thing was that yesterday he was close to his normal self for about 6 hours and then suddenly he crashed again and it's persisted. He was like this on the weekend and early in the week as well.

My parents (who have 4 cats and medical background) will be taking Eddie while we're on vacation. They'll be comfortable with the monitoring and injections. They'll isolate Ed from their 4 cats because generally Ed doesn't get a long with other cats :)

Thanks again,
JP
 
Good to hear. Maybe get some guidance from experienced members on the dosing going forward.

Might just be he does not feel well with everything going on.

Glad to hear your parents can watch him, but should figure out the insulin situation before you leave.
 
Absolutely agree, I want him to be in a stable condition before we leave. There is a lot going on and that's gonna exhaust anyone. 3 days ago no one was stabbing his ears and back repeatedly!
 
Hi there and Welcome to the best place you never wanted to be.

First, Eddie is just gorgeous! I am rather partial to Maine Coons.

I read your welcome post and I wanted to address not eating the whole meal at once. As long as you can get a tbsp of food into Eddie at the shot time and his numbers is safe enough to shoot, you can give the insulin knowing that you have about 2 hours to have him eat some more before the insulin onsets. It is usually somewhere around +2.

Most of us here divide up our kitties meals into several smaller meals and space them out through out the day as eating smaller several meals a day are easier on their pancreas. I happen to give Bubba 6 small meals a day at which I divided up the amount of calories he needs to maintain his weight of 18 lbs ( he's a big cat) and give at AMPS, +3, +6 PMPS. +3 +6ish. It is a bit of an experiment in at what time you give the feedings. Those times can change once you have him more regular and you see where his nadir is. Most kitties do best getting those calories prior to the nadir in each cycle so that your aren't putting the brakes on the insulin so to speak since after the nadir the insulin starts to wan and there is a natural rise in the numbers.

Since Eddie has lost some weight, you might want to be feeding him more food to help gain back some that is of course he needs to gain back some weight. Bubba was overweight in the beginning of his diabetic DX so he didn't need more calories then.

Many of us use automatic pet feeders that you can leave food in and timed to open up through out the day and they are very handy for peeps that work outside the home or when you just can't be home for whatever reason. I use the PetSafe 5 that you can get on Amazon.

About the lethargy, with changing his food to lower carb food and now on insulin and seeing lower numbers, he could be reacting to that. When Bubba first got into lower more normal numbers he seemed lethargic too until his body got use to it. But that said, any infection could cause him to feel punky and sometimes AB cause them to feel nauseous and not wanting to eat normally. What AB are you giving him? Just some thoughts.

Keep posting and asking questions as that is how we all learn helping one another.

Tomorrow, please start another thread with the date and the AMPS. We do one new thread each day otherwise threads get very long making it hard to sift through to the problem at hand.
 
Bron and Sheba said:
Did you get some Ketostix and test for ketones? That would be my concern with lethargy, a UTI and recent diagnosis of FD.
Click to expand...
I was wondering that myself, but thought ketones were only a concern with higher BG numbers? Last couple of days have been low. Thought ketones will only show up in BG above 250? Can’t remember where I saw that.
 
Question for Bobbie and Bubba: Do you use the PetSafe 5 with wet food? The manufacturer only recommends it for dry. I use "catsicles" (frozen in ice cube trays), but if I leave them in her dish, Zoey licks them all morning until they are gone!
 
Julie and Honey said:
I was wondering that myself, but thought ketones were only a concern with higher BG numbers? Last couple of days have been low. Thought ketones will only show up in BG above 250? Can’t remember where I saw that.
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Ketones are more likely to occur in numbers over the renal threshold but if there is an infection or inflammation or stress involved they can also appear in lower numbers and should be tested for if the cat appears lethargic or unwell.
 
Bobbi's Bubba showed ketones in the 200's, so yes, also a concern for lower numbers.

And yes, you can use the Petsafe 5 with wet or even raw food. There is a spot under the rotating dish where you can put a gel pack. Or if it's going to be a few hours until it opens, put an ice cube on top. It'll melt and add water too, which is a good thing.
 
Bron and Sheba said:
Did you get some Ketostix and test for ketones? That would be my concern with lethargy, a UTI and recent diagnosis of FD.
Click to expand...

I do have some yes, as soon as I catch him going to the litter I’ll try to get a sample. His back legs are quite bad and I agree with the vet that most of that is arthritis (had it for years) but what was surprising is this evening he got himself upstairs. That’s positive however I think he was looking for quiet away from the kids and tv as he’s still quite sleepy. I have to remind myself that he is almost 17 and has spent the last few years mostly sleeping. That said you can tell when something isn’t right.

I’ll update with anything from the ketostix ASAP
 
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