Newbie Questions! Hello!

garbagecat

garbagecat

Member
Sorry for what will definitely be a long brain dump. I have several questions, but first, some background info!

4.yo male cat, Frank, was just diagnosed diabetic yesterday afternoon at the vet (lost weight, down from 10 lbs to 9.1, peeing a ton, drinking lots of water, ravenously hungry). Previously he was free-fed dry food + given Sheba Perfect Portions as a dinner treat - since yesterday afternoon after we got back from the vets, he has been exclusively getting low carb wet food:
Fancy feast classic chicken pate, 3% carb, 99 cal per can, and sheba perfect portions pate, 3% carb, 42 cal per can).

His BG at the vet yesterday right before official diagnosis was ~400 - super high but he was also VERY stressed out. No ketones in his urine. I was then prescribed 1unit of ProZinc every 12 hrs and to feed only every 12 hours. I went to the vet's office again today to learn how to give shots and ask some questions. We just gave our first shot tonight after dinner.

I've been reading all the files and am trying to make sense of our new routine. We got a ReliOn meter and have started a spreadsheet tonight: https://docs.google.com/spreadsheet...VuOzVgOrIkrG-zE3sCmw4KOFDM/edit#gid=361360320

Enter my vet frustration. She does NOT want me to home test (she thinks it will be "too confusing" and I would only "stress out" over the numbers) and she gave me Purina Pro OM (Overweight Management) canned food to start him on because she says it's "good for diabetics" - but according to the food chart this is 21% carbs.

21% carbs!!!!

I told her that I had been doing my research and I would not be feeding him this, as I wanted to feed him something lower in carbs and I bought the Fancy Feast classic chicken pate. She told me FF was junk and that "carbs aren't the only thing that matters" but couldn't provide me any additional explanation when I asked what nutritionally made the prescription food she wanted me to try better, despite it being super high in carbs.
We tested tonight for the first time with the (human) ReliOn meter right before dinner and it read 204. Had him eat his full can of FF pate (99 cal) and 1/2 Sheba Perfect Portion (20 cal) and then gave him 1 unit of ProZinc.

Super nervous about my first time giving insulin. IF you are still with me, thank you! My questions:
  1. I have heard the most important test for ProZinc is +2 hrs after shot. Is this the case? Should I always test this in addition to BG before feeding? We will try to do a curve test but it will have to wait until a weekend since we both work full time.
  2. He is SUPER hungry but my vet told me only to feed every 12 hours in order to regulate blood sugar. Is this ok? If not, what should I be doing instead? It seems like there are two sides to this question, even this website says "some feed every 12 hrs" but some seem to think he'll starve to death. It seems like as long as he gets enough calories it should be all good? (he should be 10 lbs but is only 9 currently, so shooting for ~240 cal a day?)
  3. How do I find a better vet? So far I've emailed all the ones in my area asking for their approach to treating feline diabetes because I'm really not satisfied with my vet's dismissal of home testing and carb count. I want a vet that will encourage home testing and is more knowledgable about nutrition than "Purina says this is a good food for diabetes"
  4. If I give him a low/no carb tiny treat (like a piece of freeze dried chicken) after testing his BG will this affect the way he absorbs insulin etc? I understand the pattern of every 12 hrs test, feed, if test was over 200 shoot, and then test again 2 hrs later. I do not understand how free feeding/treats outside meal time fit into this pattern with insulin.
  5. How quickly after switching from high carb dry food to low carb wet food should I expect to see a drop in BG levels? My vet would not test again today despite 24hrs of diet change. I am still so new to testing and I'm sure my at home ReliOn is less accurate than their veterinary bloodwork - if I'm interpreting this correctly his BG went from 400 at the vets to just over 200 at home the next day. Is this even possible? Or does this not make a difference? Reading this article and feeling kind of nervous: https://catinfo.org/feline-diabetes/

    Any other advice?
 
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Welcome! I've only been a member since October and am therefore probably not the best person to respond to your inquiries, but I'll give it a shot.

First of all, congrats on already testing. And YES, you should be home testing, especially if you are switching Frank's diet to low carb. I'd encourage you to make the change gradually and to test throughout that period. Changing the diet to low carb can have a significant impact on BG levels. By way of example, Lola and I found the board on October 10 and started the transition to low carb and on October 18 she had her last insulin injection. Yep, she's now in diet-controlled remission, after only 10 days on her new diet. If you look at her spreadsheet you'll see that I created a cell to compute the average of her daily readings, and you can see it coming down gradually. There's no way I would have been able to know this was happening without testing. I'd simply have been shooting blindly and letting her body make adjustments as best it could (or go into a life-threatening hypo event) instead of me adjusting the amount of insulin I was giving her.

So, to answer your questions:

#1. No. If you haven't already, please read NEW TO THE GROUP: THE PROZINC BASICS. PLEASE START HERE.. Prozinc typically starts to work at +2, but it typically reaches its most effective point (the "nadir" where the BG level is at its lowest) at mid cycle. Lola's nadir was pretty consistently at +5, but that could change from day to day and every cat is different. The +2 reading will give you an idea of how fast the insulin is starting to work, but the nadir reading will tell you how well it's working. Dosing decisions are made based on the nadir. PROZINC DOSING METHODS

But, on a day to day basis, the shots you shouldn't miss are the a.m. and p.m. PreShots because they will tell you whether it is even safe to give any insulin at that point. (The Dosing Methods sticky addresses what to do in that case.)

#2. No. I think this is a carry-over from old-school diabetes management, before there was home testing equipment, and the rationale was to ensure that the cat had sufficient food onboard to deal with the jolt of old-school insulin. Many of us free-feed (I do), some feed on a regular schedule, and some use automated feeders in an attempt to ensure that the cat eats throughout the day and night. The important things are 1) to ensure that he hasn't eaten during his 2-hour PS fast, and 2) that has eaten before you administer the insulin. (So: test, then feed, then shoot.)

It helps to understand that the old school techniques of diabetes management, before folks had easy access to home testing equipment, was to keep the insulin at a level that it brought the BG down to reasonably good levels, but high enough to keep the cat away from the dangerous hypo levels. Of course, the eliminates any hope of remission.... Twenty years ago I had my first diabetic cat, and that's the process we used -- I shot the number my vet told me based on periodic curves -- and he lived to a fine old age after 10 years of insulin injections. (But there was that one horrendous DKA episode that nearly cost him his life ... ) (Just to be fair, my vet did tell me I could test him at home way back then, but I elected not to. It worked out "okay," but I know now that he would have been safer and healthier if I had been home testing.)

#3. So your vet doesn't want you to worry your pretty little head over Frank's health? Wants you to trust her to keep Frank safe with tests that you'll pay her to administer (which likely won't be accurate because his BG levels are high due to stress from being at the vet's surrounded by strangers and other animals) and eating food that you'll buy from her. Pardon my cynicism, but I'd be steaming mad and would be vet shopping too. You might try posting in the Welcome page to see if anyone lives in your area who might have a recommendation.

#4. Low carb treats are just fine. Most of us use them as bribes/rewards to encourage cooperation at testing time. But no more Temptations (unless they're in your hypo kit) How to treat HYPOS - THEY CAN KILL! Print this Out!!

#5. I think I addressed this in my opening paragraph, but to reiterate - yes, you will see a very rapid response to a diet change. And as for the drop from 400 at the vet's to 200 at home the next day -- perfectly understandable. Vet stress is real. At her last in-clinic curve Lola had 2 readings that were so high that their equipment couldn't measure it. (I wasn't yet home testing so I don't know what her readings would normally be, but that's what made me decide that I absolutely had to be doing home testing.)

Don't discount the reliability of the ReliOn meters. They are made for humans and are subject to rigorous requirements. Because they are calibrated from human blood, not cat's, they do read differently (generally lower, but there's no algorithm to convert "human to cat" because the spread changes along the scale). Since all the guidelines here are based on readings from human meters you made a good choice. When I report BG readings to my vet I just remind her that they are based on readings from a human meter.

I know there's a lot to take in at first that it's overwhelming. I found this forum when Lola was in crisis (due to a dosing decision made at her last in-clinic curve). I spent days reading and re-reading. And even though she's in remission I still read and re-read. There's great information here and wonderful, supportive and knowledgeable members who, because its membership is international, are online almost 24-7. But, because you can't rely on their availability, you should make sure you know/save the really important bits. (For instance, I copied the "lower than normal" guidelines to the top of Lola's spreadsheet so I could handle a low number on my own if no one was available to help me.)

I'd also encourage you to print out "How to Treat Hypos" so it is immediately available, and get your hypo toolkit ready. There's enough stress with your first low number without having to rummage around trying to find guidelines and medium carb and high carb food.

Finally, make sure you have ketone testing strips and you might as well get in the habit of using them. They're available at any pharmacy and Walmart has its own. (Although my local Walgreens was sold out, presumably because of the current enthusiasm for low-carb dieting.) Ketones are very dangerous to a cat and can go from worrisome ("trace") to life-threatening (Diabetic Keto Acidosis) in the blink of an eye.
Ketones, Ketoacidosis, and Diabetic Cats: A Primer on Ketones

Again, welcome!

Enid
 
Thank you! Wow super thorough.

We will be doing a curve this weekend when we are both off work. Today we did our pre-breakfast test and it was 195 - under 200 is "no shoot" so I fed him and 30 minutes later he was up to 255. We did a complete diet change (immediately switched exclusively to low carb cans) and he's handling it pretty well, just reallllly hungry at meal time.

I do not understand how to do a curve and also free feed. Wouldn't his blood sugar go up every time he eats? How would I ensure I'm getting an accurate reading of the curve?

If he goes hypo thankfully we have a 24 hr emergency vet about 20-30 minutes away so the plan right would be to get some sugar in him and get him to the vet right away - I'm not super concerned with stabilizing him at home and waiting and seeing if I can balance him out with wet food since I'm so new to this, I'd rather just scoop him and get him to the hospital.

The vet also said there weren't ketones in his urine so I'm not sure I should be testing for these. I don't think it is a problem for him?

Though I am super frustrated with the vet. I asked yesterday if they could give me a copy of his lab work, and they said they would email. Still no email. I emailed again, still nothing. So I have what they told me in office and I can't yet view the actual results. Hopefully they get around to sending it soon
 
I'm going to tag a couple of experienced members and ask one of them to respond to you (and also to vet my post at #2). @JanetNJ @tiffmaxee @Shelley & Jess @Critter Mom

The thing about ketones is that they're almost always not there and so not a problem. But if kitty develops an infection, or goes off her food, or runs high BG ... or it's a month with an R in it ... if ketones develop they can quickly become a big stinking deal. The recommendation is that anything over "trace" means you get your cat to the e-vet. It's not a wait and see or treat at home sort of thing. I can think of 2 members since I've been on the board whose cats died, in spite of days of hospitalization, because of ketones. They're not a problem, until they are. (When Sporty was hospitalized, I visited every day after work, and every day I signed a check or a charge slip that was equal to or greater than my mortgage payment, day after day after day, so they would continue to treat him. I was lucky. He survived.) Test strips are cheap insurance, and it's good to keep them in the front of your mind.

I'm so grateful I have such a great vet. She earned my undying loyalty 20 yeas ago helping us with Sporty (who was the Cat of all Cats to me).

E
 
Wow you are awesome for really advocating for your cat. You are definitely on the right track. Prozinc usually perks about 5-7 hours after the shot , so it’s always good to get a reading during that time. I always do morning, mid day, evening preshot, and a before bed. Sometimes I get another in there. I also feed four times a day. Just no food at least 2 hours prior to the preshot test.
 
garbagecat said:
Sorry for what will definitely be a long brain dump. I have several questions, but first, some background info!

4.yo male cat, Frank, was just diagnosed diabetic yesterday afternoon at the vet (lost weight, down from 10 lbs to 9.1, peeing a ton, drinking lots of water, ravenously hungry). Previously he was free-fed dry food + given Sheba Perfect Portions as a dinner treat - since yesterday afternoon after we got back from the vets, he has been exclusively getting low carb wet food:
Fancy feast classic chicken pate, 3% carb, 99 cal per can, and sheba perfect portions pate, 3% carb, 42 cal per can).

His BG at the vet yesterday right before official diagnosis was ~400 - super high but he was also VERY stressed out. No ketones in his urine. I was then prescribed 1unit of ProZinc every 12 hrs and to feed only every 12 hours. I went to the vet's office again today to learn how to give shots and ask some questions. We just gave our first shot tonight after dinner.

I've been reading all the files and am trying to make sense of our new routine. We got a ReliOn meter and have started a spreadsheet tonight: https://docs.google.com/spreadsheet...VuOzVgOrIkrG-zE3sCmw4KOFDM/edit#gid=361360320

Enter my vet frustration. She does NOT want me to home test (she thinks it will be "too confusing" and I would only "stress out" over the numbers) and she gave me Purina Pro OM (Overweight Management) canned food to start him on because she says it's "good for diabetics" - but according to the food chart this is 21% carbs.

21% carbs!!!!

I told her that I had been doing my research and I would not be feeding him this, as I wanted to feed him something lower in carbs and I bought the Fancy Feast classic chicken pate. She told me FF was junk and that "carbs aren't the only thing that matters" but couldn't provide me any additional explanation when I asked what nutritionally made the prescription food she wanted me to try better, despite it being super high in carbs.
We tested tonight for the first time with the (human) ReliOn meter right before dinner and it read 204. Had him eat his full can of FF pate (99 cal) and 1/2 Sheba Perfect Portion (20 cal) and then gave him 1 unit of ProZinc.

Super nervous about my first time giving insulin. IF you are still with me, thank you! My questions:
  1. I have heard the most important test for ProZinc is +2 hrs after shot. Is this the case? Should I always test this in addition to BG before feeding? We will try to do a curve test but it will have to wait until a weekend since we both work full time.
  2. He is SUPER hungry but my vet told me only to feed every 12 hours in order to regulate blood sugar. Is this ok? If not, what should I be doing instead? It seems like there are two sides to this question, even this website says "some feed every 12 hrs" but some seem to think he'll starve to death. It seems like as long as he gets enough calories it should be all good? (he should be 10 lbs but is only 9 currently, so shooting for ~240 cal a day?)
  3. How do I find a better vet? So far I've emailed all the ones in my area asking for their approach to treating feline diabetes because I'm really not satisfied with my vet's dismissal of home testing and carb count. I want a vet that will encourage home testing and is more knowledgable about nutrition than "Purina says this is a good food for diabetes"
  4. If I give him a low/no carb tiny treat (like a piece of freeze dried chicken) after testing his BG will this affect the way he absorbs insulin etc? I understand the pattern of every 12 hrs test, feed, if test was over 200 shoot, and then test again 2 hrs later. I do not understand how free feeding/treats outside meal time fit into this pattern with insulin.
  5. How quickly after switching from high carb dry food to low carb wet food should I expect to see a drop in BG levels? My vet would not test again today despite 24hrs of diet change. I am still so new to testing and I'm sure my at home ReliOn is less accurate than their veterinary bloodwork - if I'm interpreting this correctly his BG went from 400 at the vets to just over 200 at home the next day. Is this even possible? Or does this not make a difference? Reading this article and feeling kind of nervous: https://catinfo.org/feline-diabetes/

    Any other advice?
Click to expand...
Oh just wanted to clarify the spreadsheet. Amps means am (morning) preshot. So that's where your test number will go. The pmps column is for your pm (evening) shot number will go.
 
If your cat has lost weight, why would you vet prescribe overweight management food for your cat? Unless your cat needs to lose a lot more weight. But switching from dry to wet food would help with weight management. Wet food has fewer calories than dry food. What your vet is suggesting for the food option for you cat seems counter intuitive to me.

garbagecat said:
I do not understand how to do a curve and also free feed. Wouldn't his blood sugar go up every time he eats? How would I ensure I'm getting an accurate reading of the curve?
Click to expand...
Curves are done by testing every 2 hours, from one pre-shot test to the next pre-shot test. It's only the pre-shot tests that we expect no food to be given, 2 hours before that test. All other tests during the 12 hour dosing cycle, we expect there to be some food influence in the BG readings.

It is better to not feed after the middle point of the insulin cycle, +6 or so. That is because the insulin will have been used up by that point, and any food given after about +6 will cause the BG levels to spike back up faster.
 
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