Newly Diagnosed...Im so confused but not convinced

[Tiffany Smith]

Hi everyone. So my 8 yr old Nala girl was diagnosed as Diabetic about 4 weeks ago. She initially went to the vet for a urinary tract infection and the vet noticed her urine contained a high sugar content as well. So we agreed to a glucose test which resulted in a 320. Our vet consulted an outside specialist and it was recommended that she be put on a prescription diet to see if it could be managed by diet as her number wasn't high enough to cause concern for ketones. We were given the dry Purina DM. So we come home with the new food. Here is one thing I am adamant about. My kitties do not free feed. They are given the suggested daily feeding amount at specific times of the day. So with that being said, the only thing that changed for Nala was the food...amount and feeding schedule was exactly the same. About two weeks into new food, I woke up to see she had a urinary accident on herself. I took her to the vet and they did a glucose check and I was contacted and told her number was in the mid 400's. They kept her for the day, ran a glucose curve to which her numbers didn't change much, so she comes home with Prozinc insulin 2 units twice a day while staying on the same prescription food. Here we are another 2 weeks later, now a month since diagnosis, a month on script diet, and two weeks on insulin, and I have seen no change in her. She lives and sleeps by the water bowl, scarfs her food, coat looks a little better but not much. No urinary accidents since starting insulin. But here's my thing, I now know dry food isn't the best, I am educating myself and will make the change not just for Nala but for all of my kitties (I have 5), but the dry food I was feeding her has to be better than the prescription diet. It is lower in carbs than the prescription diet, and for her numbers to change so drastically and the food change being the ONLY thing that was different for her, to me it makes sense that the prescription diet is not the way to go. Im also thinking this, if her "normal" with no insulin was in the 300's, then that number could absolutely be from just the fact of our normal food (Only Natural Pet) being dry food. I might be wrong, but from what the specialist said, those numbers were not alarming yet bc it wasn't high enough to cause her to produce ketones and her hopes were to control it with diet. If I had of transitioned her to a wet diet then, Im thinking very well that her numbers would have been lower and in the normal range. I feel like feeding her the prescription diet pushed her into the dangerous range, causing the need for insulin.

So here we are today, she was dropped off this morning for the day at the vet for a scheduled glucose curve and I supplied them with the brand of canned cat food I want her on and the original dry food (both being Only Natural Pet) and told them I am taking her off the script diet. I honestly can not afford that. They can feed her what I want her on and monitor her through the day and adjust her insulin accordingly. But using my medical background and personal knowledge of diabetes and insulin resistance (of humans, I know animals are different) Im still thinking I am close enough to the beginning of this that if I transition her to the canned only diet, that her numbers will regulate and she doesn't need the insulin. I have my glucometer that I don't have to use anymore, its a One Touch, that I can check her glucose with to make sure we are on the right track, I just need to know how human readings transition into cat readings if I decide to use that instead of purchasing one specifically for cats. I have read so many threads on here before choosing to sign up and post. Every one here appears to be concerned, compassionate and willing, so Im hoping to find some validation, encouragement, what ever I need to get a handle on this bc right now I don't feel as if my vet is providing that, which makes me feel so much more overwhelmed. I am also in mid cancer treatments with another one of our kitties, so this was literally the cherry on top of a very emotionally constructed cake.

Any input would be helpful. Am I crazy for thinking we are close enough to the start of this that if the specialist thought it could be regulated with diet only, that I can still do that? Or has 2 weeks on insulin and this crap food blew that option out of the water?? ( I say crap food bc I am not big on brand names and processed foods that are full of by products and meals. I have always been super picky about what my dogs and cats eat. My husband jokes that the pets eat filet mignon while we eat hot dogs. He's being totally dramatic of course...lol)

 

[Larry and Kitties]

Welcome. It is good that you ditched the script food. Also, it is good that you want to transition to canned.
It is also good that you want to test Nala's BG vice bringing the cat to the vet. The OneTouch is a good meter and I use One OneTouch Mini and another OneTouch Ultimate. However, I uses thise test strips, much much less expensive than real OneTouch strips. https://www.amazon.com/GenUltimate-...Mini/dp/B081VRLR5M/?tag=felinediabetesfdmb-20

 

[tiffmaxee]

Welcome. Which insulin are you using? The RX dry food is higher in carbs so a canned or raw diet is best for your cat.

 

[Nan & Amber (GA)]

Hello and welcome! Sounds like you got some mediocre (some good, some bad) advice at first, but you do seem to be on the right track now.

The Only Natural dry food is almost certainly lower in carbs than the prescription dry (sigh!), but still probably higher than Nala needs. Getting her onto the canned food, and increasing its share of her diet (compared to dry) is definitely going to help.

Is she still on the 2U of Prozinc? If you start reducing her carbs, it might reduce her insulin needs, so it's great that you're going to be doing the home testing. It will help keep her safe as you figure all this out, get her to the right dose for her, and really get the situation under control. I don't think it's 'too late' for remission, certainly not after just a few weeks of crap food. Most cats go unregulated, eating who knows what, for a long time before diagnosis, and many go into remission even so.

Hang in there! All of this is a lot to deal with (esp. when dealing with other kitty health issues and other stuff), but you've made a great start!

 

[Nan & Amber (GA)]

Now, a couple of questions for you:

-- before diagnosis, did you notice the clinical signs you mentioned (hanging out by the water bowl), or did that only start after you started insulin?

-- did your vet ever do a fructosamine test, or was diagnosis only on the basis of glucose in the urine when she had the UTI?

Just curious, because 2U is a fairly large starting dose. Sometimes too much insulin can look like too little, including in the clinical signs you mention. The home testing you are starting is going to go a long way towards figuring out if that's Nala's situation, but it's good to get a full picture of how she got to where she is.

 

[Maggies Mom Debby]

All your conclusions are well thought out. Canned food, home testing are the way to go. Once you are testing, you won’t have to go the vet for a curve. You can do it yourself.

Another thought. Infection, such as a UTI, can raise glucose. Is her UTI gone?

 

[JanetNJ]

I looked up the dry food you are feeding and it looks like it’s around 17-19%. So it’s pretty much the same as the DM food carb wise, but better ingredients. Ideally you want him on foods less than 10% carb. Most people are feeding fancy feast classic or Friskies pate foods. I feed weruva foods.

Your vet did get you on a good insulin. ProZinc is good.

You may find that you have to lower the dose once he starts the lower carb food.

The bg normal range on a human meter is 50-120 and on a pet meter it's 68-150. The two types of meters are similar (as you can see) at lower ranges and farther apart at higher levels. So while a 50 on human may be a 70 on a pet meter, a 250 on a human meter might be a 300-350 on a pet meter. I have a video in my signature showing how I test my cat CC at home.

 

[Red & Rover (GA)]

Welcome.
I'll take what I can answer one-by-one.

Food

My kitties do not free feed. They are given the suggested daily feeding amount at specific times of the day.

It is best for diabetic cats to have a main meal at shot time and smaller meals throughout the cycle, picking up any food 2 hours before the next shot time.

She lives and sleeps by the water bowl, scarfs her food, coat looks a little better but not much.

Unregulated diabetic cats drink a lot of water to help flush the glucose out of their system. As Nada becomes regulated, the drinking will decrease.
They also cannot process food properly. Do keep track of her weight. She may need more food than you are feeding until she is regulated.
Her coat will improve as she gets closer to regulation.

the dry food I was feeding her has to be better than the prescription diet.

I did a rough calculation of the ONLY NATURAL PET POWERFUSION GRAIN FREE RAW INFUSED CAT FOOD - POULTRY DINNER. It comes in at 14% carbs. Grain free does not mean carb free. Beans and some vegetables are carb loaded.
Ingredients from the above food: Deboned Chicken, Turkey Meal, Chicken Meal, Garbanzo Beans, Chicken Fat (Preserved with Mixed Tocopherols), Pea Protein, Pea Fiber, Tapioca Starch, Natural Flavor, Salmon Oil, Turkey Heart, Sweet Potatoes, Chicory Root Extract, Flaxseed, Carrots

There are better raw alternatives. I never fed raw so will leave this up to others to discuss. And check out this food list put together by a vet who is concerned about carbs in cat food.

• Cat Food - Nutritional Composition, data compiled by Dr. Lisa Pierson, DVM (2017)

I know animals are different) Im still thinking I am close enough to the beginning of this that if I transition her to the canned only diet, that her numbers will regulate and she doesn't need the insulin.

Yes, cutting the carbs can make a difference of up to 100 overall. When you start cutting carbs, it is very important to home test because the 2 units may be too high. It is important to test a lot during the transition to keep your cat safe.

Testing

a scheduled glucose curve

If you are home testing, you can save money by doing curves at home. This not only saves you money, it also eliminates any vet stress and travel stress that could impact the numbers.

I just need to know how human readings transition into cat readings if I decide to use that instead of purchasing one specifically for cats.

By this, I believe you mean a cat glucometer and a human glucometer. Unfortunately, there is no correlation between the two meters. So many people have tried.
This is what we do know: The range is the same. The "take action" number on a pet meter is 68. The "take action" on a human meter is 50.
Both types of meters are acceptable and are used here on the forum. Vets used human meters before the invention of a pet meter. The strips for the pet meter are very expensive. You will be going through more strips than you can imagine, especially since you are transitioning to a lower carb diet. Since you have the One Touch, just tell the vet that the cost of the AlphaTrak strips is too high.
Just in case:

• How to treat HYPOS - THEY CAN KILL! Print this Out!!
• jojo and bunny's HYPO TOOL BOX

And I agree with what @Nan & Amber (GA) said above. Two units is a high starting dose. The usual starting dose is 1 unit with 0.25 unit increases to make sure you don't go right past the optimal dosage.

I hope I have not inundated you with too much information. And I hope you stick around. We can help you every step of the way.

 

[Diane Tyler's Mom GA]

Welcome most of us here use The Relion Prime Human meter or the Relion Premier
The Prime is 9 dollars
The test strips are 17.88 for 100 strips
You would need 26 or 28 gauge lancets
Most of us freehand, I do and think it's much easier than using a lancet device
That's just me, You can see better where you are poking
Cotton rounds to put behind your cats ear in case you poke yourself , then take the cotton round and press gently for about 20 seconds to stop the bleeding
You can pick up Neosporin ointment with pain relief if his ears get a little sore, apply
a thin layer, don't but the cream

 

[Tiffany Smith]

Now, a couple of questions for you:

-- before diagnosis, did you notice the clinical signs you mentioned (hanging out by the water bowl), or did that only start after you started insulin?

-- did your vet ever do a fructosamine test, or was diagnosis only on the basis of glucose in the urine when she had the UTI?

Just curious, because 2U is a fairly large starting dose. Sometimes too much insulin can look like too little, including in the clinical signs you mention. The home testing you are starting is going to go a long way towards figuring out if that's Nala's situation, but it's good to get a full picture of how she got to where she is.

Hi, yes, before diagnosis for about 2-3 weeks or so I did notice the hanging out around the water bowl, so I was getting concerned diabetes could be a diagnosis. Im not sure about the fructosamine test. I know that when she first called me about it that the glucose in her urine was high so she did the blood work to confirm..would that have been it? She has been on the insulin for 2 weeks now, and is at the vet as we speak for the day having her first glucose curve ran since starting insulin.

 

[Diane Tyler's Mom GA]

Always aim for the sweet spot warm the ears up first, you can put rice in a sock and put it in the microwave, test it on the inside of your wrist to be sure it's not to hot, like you would test a babies bottle. You can fill a pill bottle with warm water and roll it on the ears also

6. As the ears get used to bleeding and grow more capilares, it gets easier to get the amount of blood you need on the first try. If she won’t stand still, you can get the blood onto a clean finger nail and test from there

 

[Tiffany Smith]

All your conclusions are well thought out. Canned food, home testing are the way to go. Once you are testing, you won’t have to go the vet for a curve. You can do it yourself.

Another thought. Infection, such as a UTI, can raise glucose. Is her UTI gone?

yes, the uti has been treated and wasn't present this last checkup when she spiked.

 

[Nan & Amber (GA)]

Hi, yes, before diagnosis for about 2-3 weeks or so I did notice the hanging out around the water bowl, so I was getting concerned diabetes could be a diagnosis. Im not sure about the fructosamine test. I know that when she first called me about it that the glucose in her urine was high so she did the blood work to confirm..would that have been it? She has been on the insulin for 2 weeks now, and is at the vet as we speak for the day having her first glucose curve ran since starting insulin.

OK, that's good to know. I don't think I'd worry about the fructosamine test right now. The concern was, basically, that the UTI was the thing causing her glucose to spike temporarily, giving a false diagnosis of diabetes. The fructosamine test measures glucose levels averaged over previous weeks, so it generally doesn't get fooled by temporary spikes. But if she was hanging out by the water bowl for a while, it's likely that she's truly diabetic, and that the causality went the other way (glucose in urine leading to UTI), which is pretty common.

 

[Tiffany Smith]

I looked up the dry food you are feeding and it looks like it’s around 17-19%. So it’s pretty much the same as the DM food carb wise, but better ingredients. Ideally you want him on foods less than 10% carb. Most people are feeding fancy feast classic or Friskies pate foods. I feed weruva foods.

Your vet did get you on a good insulin. ProZinc is good.

You may find that you have to lower the does one he starts the lower carb food.

The bg normal range on a human meter is 50-120 and on a pet meter it's 68-150. The two types of meters are similar (as you can see) at lower ranges and farther apart at higher levels. So while a 50 on human may be a 70 on a pet meter, a 250 on a human meter might be a 300-350 on a pet meter. I have a video in my signature showing how I test my cat CC at home.

Thanks so much, yes I found a calculator online explaining how to calculate the carbs in foods that don't list carbs...I can't believe its not a listed thing. But I do see where although better ingredients, the carb percent is about the same. So I am all for a canned diet. Thank you for explaining the glucometer readings for me and I will def watch your video. I sent her with the lower carb food today for them to start her on and monitor her so that if an insulin adjustment is needed it can be done. Hoping for the best.

 

[Diane Tyler's Mom GA]

VIDEO: How to test your cat's blood sugarsugar
Here is a video one of our members made

 

[Tiffany Smith]

Welcome.
I'll take what I can answer one-by-one.

Food

It is best for diabetic cats to have a main meal at shot time and smaller meals throughout the cycle, picking up any food 2 hours before the next shot time.

Unregulated diabetic cats drink a lot of water to help flush the glucose out of their system. As Nada becomes regulated, the drinking will decrease.
They also cannot process food properly. Do keep track of her weight. She may need more food than you are feeding until she is regulated.
Her coat will improve as she gets closer to regulation.

I did a rough calculation of the ONLY NATURAL PET POWERFUSION GRAIN FREE RAW INFUSED CAT FOOD - POULTRY DINNER. It comes in at 14% carbs. Grain free does not mean carb free. Beans and some vegetables are carb loaded.
Ingredients from the above food: Deboned Chicken, Turkey Meal, Chicken Meal, Garbanzo Beans, Chicken Fat (Preserved with Mixed Tocopherols), Pea Protein, Pea Fiber, Tapioca Starch, Natural Flavor, Salmon Oil, Turkey Heart, Sweet Potatoes, Chicory Root Extract, Flaxseed, Carrots

There are better raw alternatives. I never fed raw so will leave this up to others to discuss. And check out this food list put together by a vet who is concerned about carbs in cat food.

• Cat Food - Nutritional Composition, data compiled by Dr. Lisa Pierson, DVM (2017)

Yes, cutting the carbs can make a difference of up to 100 overall. When you start cutting carbs, it is very important to home test because the 2 units may be too high. It is important to test a lot during the transition to keep your cat safe.

Testing

If you are home testing, you can save money by doing curves at home. This not only saves you money, it also eliminates any vet stress and travel stress that could impact the numbers.

By this, I believe you mean a cat glucometer and a human glucometer. Unfortunately, there is no correlation between the two meters. So many people have tried.
This is what we do know: The range is the same. The "take action" number on a pet meter is 68. The "take action" on a human meter is 50.
Both types of meters are acceptable and are used here on the forum. Vets used human meters before the invention of a pet meter. The strips for the pet meter are very expensive. You will be going through more strips than you can imagine, especially since you are transitioning to a lower carb diet. Since you have the One Touch, just tell the vet that the cost of the AlphaTrak strips is too high.
Just in case:

• How to treat HYPOS - THEY CAN KILL! Print this Out!!
• jojo and bunny's HYPO TOOL BOX

And I agree with what @Nan & Amber (GA) said above. Two units is a high starting dose. The usual starting dose is 1 unit with 0.25 unit increases to make sure you don't go right past the optimal dosage.

I hope I have not inundated you with too much information. And I hope you stick around. We can help you every step of the way.

First off, thank you so much for taking the time to pick apart my story, I know that probably took some time. So to add in a little more info to what you replied with. My guys eat at 8am, 12 pm, 4pm, and 8pm, and again at 9:30pm before we call it a night and if they have anything left in their dishes. Nala receives her ins. shots at 8:30 am and pm. I did find a calculator that helped me to calculate the carbs in the ONP dry, and I agree although better ingredients, the carb content is still comparable to the script diet. So I will be transitioning to canned. The vet has her today for a glucose curve and instead of sending the script food I sent her with canned ONP so that they can adjust her insulin if needed. Im not sure if her weight plays a part into how much ins she gets, but she is almost 12 pounds, which doesn't sound like much but she is a short chunky little thing that looks like a softball on legs. I will def get the strips for my glucometer and try to start testing on my own. What can you tell me about lancets? Which size is recommended there? And I think my number one fear in all this is that Im not going to know how to adjust her insulin based on her numbers. The vet doesn't seem concerned right now with me doing at home checks, so that hasn't even been explained to me yet.

 

[Red & Rover (GA)]

What can you tell me about lancets? Which size is recommended there?

You want 26 or 28 gauge lancets. (The smaller the number, the bigger the lancet.)

And I think my number one fear in all this is that Im not going to know how to adjust her insulin based on her numbers.

We can help you with that. We have a spreadsheet that you can set up (if you need help, there are few people here who can do it in minutes). This forum is data driven and a spreadsheet is the first place a member would look.

• FDMB Spreadsheet Instructions
• Understanding the Spreadsheet/Grid

 

[Tiffany Smith]

Now, a couple of questions for you:

-- before diagnosis, did you notice the clinical signs you mentioned (hanging out by the water bowl), or did that only start after you started insulin?

-- did your vet ever do a fructosamine test, or was diagnosis only on the basis of glucose in the urine when she had the UTI?

Just curious, because 2U is a fairly large starting dose. Sometimes too much insulin can look like too little, including in the clinical signs you mention. The home testing you are starting is going to go a long way towards figuring out if that's Nala's situation, but it's good to get a full picture of how she got to where she is.

Ok, so Ive dug around a little more about what you said about 2 units being too much starting out. I have read that it should have started smaller, but the calculation should be based off of the cats ideal body weight in kg. Nala is 12 pounds. Her ideal body weight for her size should be no more than 9 pounds. Should she be on a lower dosage starting out? Why would the vet start her on more than she needs? Guess Im wondering how they come to the conclusion with dosage.

 

[Larry and Kitties]

Should she be on a lower dosage starting out? Why would the vet start her on more than she needs? Guess Im wondering how they come to the conclusion with dosage.

Yes, 1 unit is the standard starting dose unless there are extenuating circumstances. One circumstance would be discovering the cat is diabetic by the cat going into diabetic ketoacidosis.
Many vets are not that educated on diabetes and tend to start with too high a dose.
I have a Nala too. She came to me as an untreated diabetic. From the history it appears she became diabetic because she became diabetic. Like she was up to 16 pounds. Now she is about 9 pounds and no longer needs insulin. She is on Friskies canned.

 

[Pookie (GA)]

Welcome! This is a great place to be.

My Lola was diagnosed with FD and UTI on September 14, and had her first injection of Prozinc that evening. I found this Board on October 10. With the guidance of the advice-givers here, and a transition to a low-carb, wet food diet, Lola received her last insulin injection on October 18 and is now (anti-jinx) in diet-controlled remission.

In order to for the advice-givers here to help you, you'll need to provide them with data and the way we report that data is through the spreadsheet referenced in #17 above. (You'll see we all have spreadsheets referenced in our "signature." Click on anyone's SS and you can see that it provides daily dosing & testing information at a glance.) When you retrieve Nala from the vet's this afternoon, be sure to get as much testing information as you can from them, especially the results from today's curve and plug them into the spreadsheet. As mentioned above, doing your own curves at home will save you a TON of money and provide you with much more reliable numbers.

If you've not already been there, note the "stickies" on the Prozinc page, including Prozinc Dosing Methods.

Enid

 

[JanetNJ]

. Im not sure if her weight plays a part into how much ins she gets, but she is almost 12 pounds, which doesn't sound like much but she is a short chunky little thing that looks like a softball on legs.

She sounds cute. Cats are not dosed by weight. Each cat reacts differently... For one cat a unit might not even move the numbers and for another they drop like a rock on the same dose. We have one on here now that goes from 300's to double digits on 0.25 u.

 

[Tiffany Smith]

Yes, 1 unit is the standard starting dose unless there are extenuating circumstances. One circumstance would be discovering the cat is diabetic by the cat going into diabetic ketoacidosis.
Many vets are not that educated on diabetes and tend to start with too high a dose.
I have a Nala too. She came to me as an untreated diabetic. From the history it appears she became diabetic because she became diabetic. Like she was up to 16 pounds. Now she is about 9 pounds and no longer needs insulin. She is on Friskies canned.

One thing we have always struggled with concerning Nala is her weight ever since we had her spayed. She was spayed at 5 months and by the time she was 2-3 yrs we started noticing the weight increase. Ive had her from a kitten. If I had to guess how long she's been diabetic, I would say I really started noticing changes in her about a a month or so before diagnosis, so about 2 1/2 months ago. We fed strictly dry all this time bc she had horrible reactions to canned food when she was a kitten so our old vet diagnosed her allergic to all canned foods. So I've always been terrified to give her a can, even with raw/natural bc of that fear. Now Im wondering how true of a diagnosis that was bc the new vet (who we are with now) had given her canned Purina DM before I mentioned this old diagnosis and she didn't have any reactions, just didn't care for the food, but put her on the dry dm just incase. But she loves the other cats Friskies pates and would steal if not watched, but I discouraged out of fear she would get sick again. Now here I am feeling guilty bc all this could have been prevented and maybe she could have been on a canned diet. As well as my others. They get canned and dry. Everyone else is a healthy weight. Which brings me back around full circle to maybe we are still close enough to this possibility that I can make the transition to canned and help her into remission. The feline diabetic specialist my vet consulted with seemed absolutely sure based on her lab work 4 weeks ago before starting the Purina DM dry that she was able to be controlled by diet alone. 2 weeks into the DM Dry her numbers spiked into the 400s and the vet put her on the insulin immediately. Im not sure she consulted with the specialist at that point bc she didn't mention it. So she's been on insulin 2 weeks. And I am seeing no improvement as I mentioned in my main post. I feel like right now more harm than good is being done with insulin that may very well not even be the right dosage. Ketoacidosis wasn't mentioned when insulin was started, as she wasn't in ketoacidosis two weeks before, hence why the specialist said no insulin but diet change only. The spike in BG I feel sure is from the script food and initiated the vet to feel the need for insulin. (Sorry for the run on..lol..didnt mean to boil all that over on you) What are your thoughts being you have one in remission?

 

[Tiffany Smith]

Welcome! This is a great place to be.

My Lola was diagnosed with FD and UTI on September 14, and had her first injection of Prozinc that evening. I found this Board on October 10. With the guidance of the advice-givers here, and a transition to a low-carb, wet food diet, Lola received her last insulin injection on October 18 and is now (anti-jinx) in diet-controlled remission.

In order to for the advice-givers here to help you, you'll need to provide them with data and the way we report that data is through the spreadsheet referenced in #17 above. (You'll see we all have spreadsheets referenced in our "signature." Click on anyone's SS and you can see that it provides daily dosing & testing information at a glance.) When you retrieve Nala from the vet's this afternoon, be sure to get as much testing information as you can from them, especially the results from today's curve and plug them into the spreadsheet. As mentioned above, doing your own curves at home will save you a TON of money and provide you with much more reliable numbers.

If you've not already been there, note the "stickies" on the Prozinc page, including Prozinc Dosing Methods.

Enid

That sounds amazing! Congratulations to you guys. Im looking into the spreadsheet now, I will make sure to get the results of her glucose curve today when I pick her up and plug those in. Im also looking now into lancets and glucose strips for my glucometer that I also need to dig out from the depths of my bathroom cabinet. Im feeling a little more confident in this process. EVERYONE has been such an amazing help so far.