treatment options for diabetes case

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kalypso

Member Since 2019
Hello all!
I am here to ask about treatment options for my friends cat named Lisa! (I help because my friend's english is not that good)
Here is history/ background info http://www.felinediabetes.com/FDMB/...r-possible-diabetes-case.214788/#post-2544172
and here is Lisa:
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Lisa has had high glucose induced by cortisone shots to cure asthma. At the beginning she had symptoms of polyuria/ polydipsia.
Now she is eating low carb wet food (mainly bozita tins, and occasionally purina dm or sensitive), her glucose is in the 300's (both vet and home testing) and she seems healthy (my friend wouldn't know something was wrong if she didn't test).
My friend is discussing treatment options with the vet, feels confused and would really like your opinions and experience!
So, options they discuss are acarbose pills, metformin pills, and insulin!
Does anyone have experience with these pills? Do they help?
Also, as my friend works, she is worried that if she gives an insulin shot in the morning, she won't be there to see if Lisa gets hypoglycemia. How do you deal with this possibility?
 

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I've never seen any cases of the pills helping. Insulin is the way to go.

The best way to deal is to do a home blood test before each shot, and start with a low dose. Only raising by 0.25 units at a time when consistent testing shows the previous dose is not enough. Also get a gentle insulin such as ProZinc or lantus. Other insulins like Novolin or vetsulin /caninsulin can hit hard and fast and need more monitoring.

What I do when I'm working full time is test and shoot early like 5:30 am, then test at 7:30 before I leave to see if there's a lot of movement with numbers. If so I leave down medium carb food. In the evening I'll test and shot again at 5:30 pm, then test before bed at 9:30-10:30 pm to get a good idea of how low the shot is taking her. On the weekend and days off I test more often to get more information.
 
Thanks for your reply!!
I translated for my friend, and to her it sounds so hard ... Mabe if the target glucose levels are higher the routine can be made easier for her? What is the target glucose range for your cat? What is the glucose value on which you would skip shooting?
Is there a way to make a compromise between strict schedule and target glucose range/cat health? Sad compromise but better than being totally scared away, I think ...
 
kalypso said:
Thanks for your reply!!
I translated for my friend, and to her it sounds so hard ... Mabe if the target glucose levels are higher the routine can be made easier for her? What is the target glucose range for your cat? What is the glucose value on which you would skip shooting?
Is there a way to make a compromise between strict schedule and target glucose range/cat health? Sad compromise but better than being totally scared away, I think ...
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What parts sound hard? It’s difficult to answer your questions because every cat is different. It also depends on the insulin you decide on. Generally speaking anything below 50 on a human meter is too low to shoot but in the beginning it’s wise to not shoot below 150 until you know how your cat responds to the insulin. The ideal range also varies but most of the time you want your cat to be between 200 max and 90 min. Again every cat is different and the only way to know is to home test so you have enough data to understand your cat’s pattern. Are you in the US? There are affordable human meters you can get to home test but you should be testing before each insulin shot at least. The only way to manage diabetes and keep your cat healthy is with insulin
 
We are in Greece, my friend is hometesting with a human meter already. What sounds hard to her is the strict schedule and the fear of hypo. She leaves for work at 9am but may return at midnight. Is it worth to start Lisa on insulin even if she will not always be able to be on schedule? How much of a reduced dose do you give when you are late and how late do you skip it? Also, can you just measure glucose, feed shoot and leave and not be in a risk for hypo?
 
kalypso said:
Thanks for your reply!!
I translated for my friend, and to her it sounds so hard ... Mabe if the target glucose levels are higher the routine can be made easier for her? What is the target glucose range for your cat? What is the glucose value on which you would skip shooting?
Is there a way to make a compromise between strict schedule and target glucose range/cat health? Sad compromise but better than being totally scared away, I think ...
Click to expand...
It might sound worse than it is. A test takes me less than a min to do, so it only takes up about 5 min of my day. I have a video in my signature showing how I test my cat CC at home.
 
kalypso said:
Thanks for your reply!!
I translated for my friend, and to her it sounds so hard ... Mabe if the target glucose levels are higher the routine can be made easier for her? What is the target glucose range for your cat? What is the glucose value on which you would skip shooting?
Is there a way to make a compromise between strict schedule and target glucose range/cat health? Sad compromise but better than being totally scared away, I think ...
Click to expand...
New people we say not to shoot of the preshot test is under 200. Normal on a human meter is 50-120 and on a pet meter it's 68-150. So that's the range we want to eventually see the cat in for at least part of the day. It may take time to get there. If you are not in the USA, divide the numbers I gave you by 18 for world numbers.


Edited to add... I see you are in Greece, and she is using a human meter, so you will need the range of about 2.8-6.7 for the normal range and no shoot below 11.1
 
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Hello...Lisa's good friend! WELCOME TO FDMB!

We all know how scary this is. Its overwhelming and scary. BUT in time your friend will get the hang of things. Honest we've all been there. This is a community dedicated to keeping our cats safe and healthy.
I use to work a VERY demanding job. I worked 12-18 hours a day. Many times had to go in to fix machines and mix chemistry in the middle of the night. So I know how your friend feels. I just did the bast I could. Sometimes shots had to be missed. Sometimes Trouble was sick and I couldnt stay home with him. Some how I got it done. You'd be surprised how you can be resourceful with time!
Knowledge is power. once Sophia decides on an insulin then things can start falling into place.
Theres always a way.
jeanne
 
kalypso said:
We are in Greece, my friend is hometesting with a human meter already. What sounds hard to her is the strict schedule and the fear of hypo. She leaves for work at 9am but may return at midnight. Is it worth to start Lisa on insulin even if she will not always be able to be on schedule? How much of a reduced dose do you give when you are late and how late do you skip it? Also, can you just measure glucose, feed shoot and leave and not be in a risk for hypo?
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That is tricky when the schedule is not consistent. Not giving a diabetic cat insulin really does put their health at risk and most likely will lead to death, so even if shots have to be late or occasionally skipped, it is better than not treating at all. ProZinc is a little more flexible with time adjustments, so you may want to ask for that one.
 
kalypso said:
Thanks for your reply!!
I translated for my friend, and to her it sounds so hard ... Mabe if the target glucose levels are higher the routine can be made easier for her? What is the target glucose range for your cat? What is the glucose value on which you would skip shooting?
Is there a way to make a compromise between strict schedule and target glucose range/cat health? Sad compromise but better than being totally scared away, I think ...
Click to expand...
At minimum she needs to test the preshot. I definitly suggest at least one mid cycle test as well.
 
kalypso said:
Thank you all for your replies!
My friend is able to hometest and values are the same as in the us.
So is it better to start Lisa on insulin even if she will miss doses than do nothing?
Can she shoot and leave for work or sleep ? Midcycle test sounds even more difficult for working people :(
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Yes it is better to start insulin even if some shots are missed or late. To not treat could lead to ketoacidosis and death, just like for diabetic people.

Yes she can work and sleep. I work and sleep. Lol. She may not get a mid cycle test during the day (I can't when I'm working), but if she can get a test right before bed that will give some information as to how effective the dose is (if it's too much or too little). If she can't, she can't. And on days off or weekends she can get a daytime number.
 
Thank you all so much for your replies!
My friends main fear is that something happens to the cat (hypo) while she is not home!!
Also, what happens when she can't be home for a dose? Does she shoot less or skip altogether, and how do you decide?
And what about food? Will she need to feed exactly the same food and quantity and at particular hours?

PS. My friend is able to hometest and is not afraid of doing the actual shot either. Lisa's glucose is in the 300's on a human meter, so it's the same values you see in the us.
 
I think a lower dose is better than NO dose. She should do as much testing and recording as she can. I feel bad she has no one to help her with this and I HOPE Lisa can stay safe. This is JUST MY OPINION. I'm NOT an expert. Hang on for more replies and suggestions
j
 
kalypso said:
My friend is seriously thinking about giving the pill. Could you explain me what are the consequences and why you don't recommend it so that I can have specific arguments?
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The pill is not enough to manage diabetes. Her cat will likely not get its diabetes under control that way and there could be other health issues that develop from unregulated diabetes like neuropathy. Diabetes requires insulin. For cats and humans alike. Have you ever heard of a human with diabetes who doesn’t take insulin? I’ll let the other morre experienced members JT tagged add more and provide evidence based arguments

adding one more @Nan & Amber (GA)
 
Here’s what I found just by doing a simple google search:

https://petdiabetes.fandom.com/wiki/Oral_medication

“80% of feline cases where they don't work, tend to make diabetes worse instead. Worse, vet literature often says that 6 to 8 weeks of oral med treatment should be tried before giving up, and it's quite possible for an untreated diabetic (or one on an ineffective treatment) to die of starvation, dehydration, or ketoacidosis within that time. The odds of oral medication leading to a successful regulation of your cat are poor, and the odds of things getting much worse during the treatment are more likely.”
 
Please urge your friend to reconsider for her cat’s sake. Also time is of the essence. I can say that one month where I waited to try to regulate Minnie with diet alone before starting her on insulin at the vet’s recommendation led to her developing neuropathy. Is there someone else who can help her with the insulin shots? Meaning, does she live with someone who can give the second shot at the 12 hour mark? Or even you, can you help?
 
kalypso said:
Thank you all so much for your replies!
My friends main fear is that something happens to the cat (hypo) while she is not home!!
Also, what happens when she can't be home for a dose? Does she shoot less or skip altogether, and how do you decide?
And what about food? Will she need to feed exactly the same food and quantity and at particular hours?

PS. My friend is able to hometest and is not afraid of doing the actual shot either. Lisa's glucose is in the 300's on a human meter, so it's the same values you see in the us.
Click to expand...

The pill is rarely effective and not a long term solution.

If she is conservative with her dosing and takes things slowly, raising in very small increments when needed, and testing when she can, she will reduce the risk of hypo. A greater risk to the cats health is not giving insulin at all.

If she can't be home for a dose, skip or ask a friend to do it (maybe you could help?). If she's only late by an hour or two she could dose late even if she has to give a little less.

Food : she should feed a low carb wet pate food. Any flavor. No food at least 2 hours prior to the preshot test, but otherwise he can eat whenever he's hungry. She could use a timed feeder to close off the food two hours before she gets home and two hours prior to the first test. She should also have some higher carb food on hand if the cat is running low or she's concerned that she MIGHT run low.
 
Thank you all for your replies! I translated to her all the relevant info on the link from prediabetes.fandom and also your replies! My friend lives with her mother who she says can't help, I live an hour away. Her main fear is hypo and not being able to follow the schedule. I told her that I read that pills can also cause hypo if I understand correctly, and that they can jeopardize the chances of a remission, and that it is ok to skip doses if she starts insulin (please tell me if I am wrong!?). But her vet also suggests pills! I really can't figure if he is also afraid of insulin or if he adapts to my friends fears. She also went to another vet for a second opinion who bullied her into buying hills dry prescription cause that is what he works with, with diabetes cats! So that would have been a big step backwards. Vets and pet owners are very uneducated about diet and very reluctant to learn. I really want to urge her into trying insulin for a while to see if it can lead to a remission! Then I hope it will at least help ease her fear of insulin. How long does it usually take in average to get into remission with insulin??
 
All vets are sadly here in the US too.

please know there’s no guarantee of remission for any cat with insulin, but it is their best shot at it. Of course adding to that is the issue of her maybe having to skip shots. Remind me what insulin did they recommend? Lantus and prozync are the ones with higher remission rates.

please let her know vets here try to shame us too, but we’re the cats’ guardians and we need to advocate for them like we would for a child. There’s no need to feed any special vet food when the only thing special about it is the price and the marketing that makes you think you should buy it. Any wet food (pate style) that has 10% or less carbs is fine.
 
Also the best shot of remission is when you start treating the diabetes with insulin within the first 6 months.

does she have any other friends who live closer who could maybe help...? The best case scenario would be having a second person who could step in and help give the insulin at the right time. Even without testing because she could then test when she got home and slower acting insulins like the two I mentioned above take usually 2 hours to start working anyway so she’d be home in time to act in case of any potential hypos
 
I wonder if your friend can explain her position like this. "I dont want to wasted percious time using the easy route. The pill seems to just delay any chance of regulation or even a decent life. If we wait for the pill to fail (which it undoubtedly will) I believe insulin is Lisa's only chance for a better life." she also HAS to be willing to make the sacrifice in getting comfortable shooting insulin. WE CAN HELP WITH THAT.
BUT its all up to your friend. We get that also.
Be safe
jeanne
 
I think she needs to take it a step at a time. Hypo is a possibility but she’s going to start with a very low dose. Whatever insulin make sure she starts at 1 unit and ask about the ones I mentioned since there’s less potential of a hypo. So at first with a small dose the numbers will stay on the high end and a hypo is unlikely. Maybe that will help her get used to it. In my opinion, it’s better to chance a hypo than watching your cat slowly deteriorate and die :( also we have a lot of tips of what to do in case of a hypo like making sure you have high carb foods and honey at hand so you’re ready to handle it. Many members here have been safely guided out of a hypo potential situation.

please tell her how we are used to vets not recommending the right treatment for diabetes. We see it here daily and sadly vets spend very little time studying feline diabetes in vet school. The folks here in this forum have spent years studying just that and many members here have achieved remission thanks to the advice in this forum. I had to fire 2 vets and I’m on a third one now. We have to do what’s best for our cats not what the vets say because at the end of the day, it’s our cat not theirs. It’s our decision. Please please please I hope she’ll listen to us :banghead::banghead::banghead:

What else can I say to help you help her? I wish I spoke Greek but I only speak Portuguese o_O
 
Thank you so much for your replies I will translate them for her!
But what happens if a cat gets a hypo while the owner is at work? Has it occurred to anyone on the forum?
 
kalypso said:
Also, her vet suggests pills, so she is also affected by his opinion.
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maybe quote some sites that talk about the oral pill. For example this is a page by Cornell University who in the Treatments section clearly says "Cats with diabetes are most often treated with injectable insulin. Oral drugs for humans (hypoglycemic medications) such as glipizide rarely work in controlling diabetes in cats." vet.cornell.edu/departments-centers-and-institutes/cornell-feline-health-center/health-information/feline-health-topics/feline-diabetes
 
kalypso said:
Thank you so much for your replies I will translate them for her!
But what happens if a cat gets a hypo while the owner is at work? Has it occurred to anyone on the forum?
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Not everything is in our control. All we can do is make our best judgement based on what the testing is showing. That's why you want to try to get a mid cycle test at night and test more on days off. In the morning I test her before I leave for work which is about two hours after her shot. If the cat is lower then normal in the morning, or shows a drop within two hours, she could leave some higher carb food out. How far away from her house does she work? can she sometimes go home during a lunch break?
 
I agree with Janet and that’s why a gentler insulin like Lantus or prozync would be best for her situation. DO NOT LET HER GO WITH VETSULIN OR CANINSULIN. That will not work with her schedule. Here are the options she has:

1. Not treat her cat with insulin and let it suffer as it develops other diabetes related illnesses, dramatic weigh loss, neuropathy where it won’t be able to jump, walk, or use the litter box and eventually die suffering through all of that

2. Give it the best possible care which is insulin and perhaps maybe risk a hypo at some point. It will be likely months before that’s even a possibility and if she follows our protocol of small increases of .25 units, the risk can be greatly reduced

diabetes is not a life threatening disease if managed with insulin, but without it it is I’m afraid. I went to the wrong vets at first and I followed their incorrect advice and 6 months were wasted that way. My cat did develop severe neuropathy and the symptoms I described above. She could barely take 2 steps without having to stop to rest. Luckily, in most cases it’s reverseable once the diabetes is regulated and with the help of b12 methyl. Minnie did recover but it took about 3 months after her diabetes was under control. You can give her my example. I was lucky she didn’t develop other issues but at least she was on insulin daily.

we have seen cats who have had hypos here and did survive, sometimes with high carb food and honey been giving and retesting until their number were safe again and other times with a trip to the ER, but there are also cats who have never had one. There are no guarantees other than that without insulin Lisa will die. Put the fear of God in her and maybe that will help!! It’s the truth anyway :(
 
My cat never came close to hypo'ing. I worked a very demanding job 12-18 hour days. And he were on a HARD insulin NPH When I couldnt be there for him, I reduced the dose. It set him back a little numbers wise but it gave me confidence to repeat the dose.

Not giving insulin is worse than worrying about a hypo situation. I'm wondering if a kitty cam would make her more confident. Put them in the rooms Lisa frequents? I know its a stretch but...no insulin has a certain outcome nobody wants.:(
 
jt and trouble (GA) said:
My cat never came close to hypo'ing. I worked a very demanding job 12-18 hour days. And he were on a HARD insulin NPH When I couldnt be there for him, I reduced the dose. It set him back a little numbers wise but it gave me confidence to repeat the dose.

Not giving insulin is worse than worrying about a hypo situation. I'm wondering if a kitty cam would make her more confident. Put them in the rooms Lisa frequents? I know its a stretch but...no insulin has a certain outcome nobody wants.:(
Click to expand...
She could get one of those cameras that can remotely shoot out treats. Lol
 
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