New member, new diagnosis.. no change.

[M & Maisie]

Hi, thanks for having me. This is pretty overwhelming! My cat Maisie was officially diagnosed with diabetes last Tuesday (2nd March). She had her first dose of insulin that day, then went to twice a day from Wednesday (on a dose of 1 unit). We last saw the vet on Wednesday, she told me to ring for a telephone appointment in around 2 weeks to discuss how things were going. This is all completely new to me but I know things aren’t going well, there has been absolutely no change in her symptoms. She’s still drinking excessively, urinating excessively, is more hungry than normal and she’s still acting differently (when she’s not screaming at me for food/water, she’s gone from the sweetest, attention seeking cuddle cat to either hiding under my bed or lying by a source of water). She also vomited twice on Thursday, twice on Friday, once on Saturday and has had diarrhoea today. I don’t know a great deal about diabetes yet but I expected some kind of change as soon as she started having insulin, even if it was a slight decrease in thirst or something. I do plan to call the vet in the morning but I guess I just need some reassurance that I’m not overreacting or maybe to hear some stories about your experiences in your first weeks after diagnosis. It’s funny because the only thing I was worried about was how I was going to manage to do the injections but that’s the only thing that actually seems to be going ok. I don’t know, I just feel like the insulin has done absolutely nothing for her.

Just a little background on Maisie. She’s 10 (11 in July). She’s always been on the smaller side (so definitely not overweight) and she’s usually in good health with no issues other than regular periods of vomiting when she’s got a fur ball.

Any comments or advice would be greatly appreciated.

thanks so much
Michelle & Maisie

 

[SashaV]

Welcome to the best place you never wanted to be

Are you home testing?
And what insulin are you using?
I was terrified of the injections too, but that was the least of our problems

 

[M & Maisie]

Welcome to the best place you never wanted to be

Are you home testing?
And what insulin are you using?
I was terrified of the injections too, but that was the least of our problems

Hey

No, I’m not home testing, my vet said that I didn’t need to? She said some people go out and get the stuff to do it but they tend to tell people not to bother.

she’s on Caninsulin ( I had no idea, the vet never mentioned it when they gave it to me, I had to go check the bottle )

Do you think from what I said that it’s not really working or is it too early to tell? Maybe her dose needs to be adjusted ‍

 

[SashaV]

Hey

No, I’m not home testing, my vet said that I didn’t need to? She said some people go out and get the stuff to do it but they tend to tell people not to bother.

she’s on Caninsulin ( I had no idea, the vet never mentioned it when they gave it to me, I had to go check the bottle )

Do you think from what I said that it’s not really working or is it too early to tell? Maybe her dose needs to be adjusted ‍

Firstly you need to test. Caninsulin hits hard, she needs to eat 30 minutes BEFORE you give her the shot, and then it peaks around +4 - 4 hours after you gave it to her.
Where are you from?

 

[Critter Mom]

Welcome to yourself and Maisie.

You're not wrong to be concerned for your little one.

she’s still acting differently (when she’s not screaming at me for food/water, she’s gone from the sweetest, attention seeking cuddle cat to either hiding under my bed or lying by a source of water). She also vomited twice on Thursday, twice on Friday, once on Saturday and has had diarrhoea today.

she’s on Caninsulin

Caninsulin's action can be quite harsh, and its mode of action may disagree with some cats. Should this prove to be the problem, other insulins are available (preferably Lantus or Prozinc).

I also worry whether, given that she's a petite cat, she might be on too high a starting dose. Blood glucose (BG) levels can drop low and then shoot up to higher numbers when the body's protective mechanisms kick in to raise blood sugar levels. Impossible to tell what's going on without BG readings.

Also, I think that, as a general safety precaution, you should check ASAP to see whether she might be generating ketones. Ketosis and DKA are possible complications of of diabetes. You can can get urine test strips at any pharmacy. More info:

FDMB ketone primer

Tips for collecting and testing urine

Questions:

* Is Maisie eating OK at the moment?

* Which country are you in?


Mogs
.

 

[M & Maisie]

Firstly you need to test. Caninsulin hits hard, she needs to eat 30 minutes BEFORE you give her the shot, and then it peaks around +4 - 4 hours after you gave it to her.
Where are you from?

I’m in the U.K.
She’s very fussy when it comes to food (only eats dry food) and she’s a grazer so food is out at all times. The vet said I was ok to continue with this because it might stress her out changing things and for now it’s important that she eats because she’s losing weight and can’t really afford to lose more (she was 3.2kg at our first appointment on the 27th Feb, then dropped down to 3.1kg at our next app on the 2nd March and I’m fairly certain she’s lost even more weight at this point but she’s so small she doesn’t register on my scales). She said I could give her the injections while she’s eating and distracted because there’s just me and my young daughter (who is autistic) so no one to help me hold her. I found a 75% chicken dry food to try (35% protein) that I’ve been giving her with a lick-e-lix mixed in twice a day so I can give the injections. I really don’t know how else I would manage to do it without the food, specifically without the lick-e-lix treat because it’s her absolute favourite thing.

 

[M & Maisie]

Welcome to yourself and Maisie.

You're not wrong to be concerned for your little one.




Caninsulin's action can be quite harsh, and its mode of action may disagree with some cats. Should this prove to be the problem, other insulins are available (preferably Lantus or Prozinc).

I also worry whether, given that she's a petite cat, she might be on too high a starting dose. Blood glucose (BG) levels can drop low and then shoot up to higher numbers when the body's protective mechanisms kick in to raise blood sugar levels. Impossible to tell what's going on without BG readings.

Also, I think that, as a general safety precaution, you should check ASAP to see whether she might be generating ketones. Ketosis and DKA are possible complications of of diabetes. You can can get urine test strips at any pharmacy. More info:

FDMB ketone primer

Tips for collecting and testing urine

Questions:

* Is Maisie eating OK at the moment?

* Which country are you in?


Mogs
.

I’m in the U.K.
They extracted urine on our first visit and said it was very concentrated and full of glucose which obviously indicated diabetes and then they did blood tests but didn’t tell me any figures when it came back from the lab, only that it was very obvious she had diabetes. They did do her blood sugars at our second appointment before they gave her insulin for the first time, it was 28 (she had eaten about 20-30 minutes before they did it).

As for her weight. She was 3.2kg at our first appointment on the 27th Feb, she then dropped down to 3.1kg at our next appointment a few days later (2nd March) and I’m fairly certain she’s lost even more weight now. I can feel it when I stroke her and see it in her waist and back legs. I think she’ll definitely have dropped in to the 2kg’s now. Appetite wise, she’s always been a grazer. I’ve seen her at her main food bowl eating very small amounts but then to give her the insulin, I mix up a bit of dry food (that’s all she likes she’s very fussy) and a lick-e-lix treat and she eats most of it. The vet said I was ok to give her the injection while she was distracted with food because it’s just me and my daughter (who is autistic) here so I have no one to help me hold her.

 

[M & Maisie]

Welcome to yourself and Maisie.

Also, I think that, as a general safety precaution, you should check ASAP to see whether she might be generating ketones. Ketosis and DKA are possible complications of of diabetes. You can can get urine test strips at any pharmacy. More info:

FDMB ketone primer

Tips for collecting and testing urine



Mogs
.

sorry, could you please explain to me about Ketosis, DKA and what it would mean for my girl? I know absolutely nothing about either.

 

[Ale & Bobo & Minnie (GA)]

Most vets will say you don’t need to test and we’ve seen too many cases here where cats blood glucose levels change and the only way to keep them safe and avoid a hypo is to home test regularly. Caninsulin is called that because it was made for canines and dogs have a much slower metabolism than cats, which is why it’s not the best insulin for them. It hits hard and fast and then it stops working so your cat is not covered the entire 12 hours. She does need food onboard at least 30 minutes before the shot as everyone already mentioned. She’d also benefit from transitioning to wet food which is lower in carbs. Diabetic cats should eat food that has less than 10% carbs, but and this is a huge but, you shouldn’t do any food changes until you’re home testing. I, along with other members here, just helped a friend’s sister recently whose cat had a hypo because she switched from dry only to wet only and the 1.5 unit of insulin was suddenly too much since her cat’s blood glucose dropped to normal nondiabetic numbers. So, I’d suggest you strongly consider home testing and perhaps also transition to a gentler longer acting insulin that is better for cats. To answer your question though, it can take months for diabetics cats to get regulated, just a few days or a few weeks is not enough time to see any results, not really. As we all say here, feline diabetics is a marathon not a sprint.

one last thing, you can still use food as a treat or reward after the shot. Freeze dried treats are the best option for diabetic cats. Your kitty is on a high carb diet and would benefit a lot from a change, but again, not until you are home testing. Lastly, diabetic cats lose weight because they can’t process the nutrients in food well. They also burn calories just by peeing since there’s sugar in their urine. A good rule of thumb for daily calorie intake is 20 times her ideal weight. Then I’d add 20-30% to that since she needs to gain.

 

[M & Maisie]

Most vets will say you don’t need to test and we’ve seen too many cases here where cats blood glucose levels change and the only way to keep them safe and avoid a hypo is to home test regularly. Caninsulin is called that because it was made for canines and dogs have a much slower metabolism than cats, which is why it’s not the best insulin for them. It hits hard and fast and then it stops working so your cat is not covered the entire 12 hours. She does need food onboard at least 30 minutes before the shot as everyone already mentioned. She’d also benefit from transitioning to wet food which is lower in carbs. Diabetic cats should eat food that has less than 10% carbs, but and this is a huge but, you shouldn’t do any food changes until you’re home testing. I, along with other members here, just helped a friend’s sister recently whose cat had a hypo because she switched from dry only to wet only and the 1.5 unit of insulin was suddenly too much since her cat’s blood glucose dropped to normal nondiabetic numbers. So, I’d suggest you strongly consider home testing and perhaps also transition to a gentler longer acting insulin that is better for cats. To answer your question though, it can take months for diabetics cats to get regulated, just a few days or a few weeks is not enough time to see any results, not really. As we all say here, feline diabetics is a marathon not a sprint.

one last thing, you can still use food as a treat or reward after the shot. Freeze dried treats are the best option for diabetic cats. Your kitty is on a high carb diet and would benefit a lot from a change, but again, not until you are home testing. Lastly, diabetic cats lose weight because they can’t process the nutrients in food well. They also burn calories just by peeing since there’s sugar in their urine. A good rule of thumb for daily calorie intake is 20 times her ideal weight. Then I’d add 20-30% to that since she needs to gain.

thank you. I understand it will take a while to regulate and find the correct dose for her etc but I assumed I would see a minor improvement of her symptoms once insulin was on board but as I said there’s been no change, in fact I think she’s a little bit worse than she was.

I think she’s probably losing more weight because of the vomiting and diarrhoea too.

yeah I’ve read up about the best diet (that’s how I found this site actually) and I know she’s got the worst diet possible right now but she’s so fussy. I actually have another cat that loves wet food so I’ve tried for years to get her to eat wet food too, I haven’t managed to find a single one she would entertain. She will lick the gravy and that’s about it so for now the best I can do is try to move her to a better dry food unfortunately. She so skinny now at about 6.5lbs that I really don’t want to risk her not eating anything at all. Oh wow 20 times her ideal weight, I don’t even think she would eat that much right now. She’s not eating a great deal (even though she’s screaming at me for food all the time).

I asked the vet how to test the sugars (sounds silly but I have no idea where to prick to get the blood ) and she wouldn’t even tell me. She just said it didn’t need to be done and started talking about something else.

I definitely need to speak to the vet ASAP, I don’t think it can wait another 1.5 weeks. I’m really worried about her.

 

[Critter Mom]

I asked the vet how to test the sugars (sounds silly but I have no idea where to prick to get the blood ) and she wouldn’t even tell me. She just said it didn’t need to be done and started talking about something else.

Regrettably that's not an uncommon attitude among some members of the veterinary profession (the vets at the practice Saoirse was registered with at time of diagnosis was positively hostile towards it - we moved) but ultimately Maisie's your cat and it's your decision whether or not to test. We can help you learn how, to wit:

Home testing links and tips

Testing and injection tips

(Tip: Blue text on this site indicates a clickable link to another webpage.)

In addition to the learning resources above you can post for help at any time if there's anything you're finding particularly tricky.

You can monitor blood glucose using either a pet glucometer (the Alphatrak 2) or with a human glucometer. You need to use a blood glucose reference range appropriate to the type of meter you use for testing. (At FDMB we use 2.8-6.7mmol/L for human meters. It's based on studies done in diabetic cats.)

The main disadvantage of using a pet meter is that the test strips are really pricey (c. £50 for 50 strips). Ideally you'd test a minimum of four tests per day (before each dose to make sure BG is high enough to give insulin safely, one test during the day between AM and PM dose to check how low BG is taken, and a 'before bed' test a couple of hours after the PM dose), so the costs can mount up. We have a number of UK members using the GlucoNavii human meter. The meter is reliable and test strips are much better priced than the Alphatrak, e.g. a recent price check for Amazon Prime members (and you'd probably get similar prices on ebay):

GlucoNavii Meter and Starter Kit £13.99 - NB: Kit only contains 10 strips.

GlucoNavii Test Strips - £16.78 for 100 Strips (!!)

Also, here's a really good video on teaching a cat to accept injections. Maybe you could use Maisie's fave treat as a training aid?

You could apply the techniques demonstrated above to home testing too.

Not all vets are hostile to home testing. I stumbled upon quite a good UK vet practice's website the other day. It's got really good fact sheets on feline diabetes and they appear to be really up-to-date in their approach. Here's their fact sheet on monitoring of feline diabetics:

Feline diabetes monitoring fact sheet

See also this veterinary profession publication which also supports home monitoring of BG levels:

AAHA Consensus Guidelines on Management of Diabetes in Cats and Dogs

(Might help you in discussions with your vet.)


Mogs
.

 

[Critter Mom]

sorry, could you please explain to me about Ketosis, DKA and what it would mean for my girl? I know absolutely nothing about either.

Excessive ketone production is a potential complication of diabetes. It may occur when a cat's body starts breaking down fats/proteins for energy because it can't use glucose properly to fuel the body's cell metabolism. If ketone levels rise to problem levels and don't get treated promptly there may be a risk of further complications (diabetic ketoacidosis, potentially life-threatening and expensive to treat). Further info at the following link:

FDMB ketone primer

For recently diagnosed cats - particularly if they spend time over the renal threshold (14-16mmol/L on Alphatrak according to Merck, the makers of Caninsulin) - testing for ketones daily is a good general safety precaution, reason being that, should a significant problem with ketones arise, levels can build up very quickly. It's even more important to test if the cat is 'off' in any way, or if it's not eating enough. If a trace result is obtained (urine strips) then another test later in the day to double-check levels is advisable. For any result higher than trace the vet needs to be contacted ASAP for advice on how to proceed.

Tips for collecting and testing urine

According to my reading, the urine sample needs to be very fresh when testing.

I use Multistix-10SG reagent strips to for urine testing (but I'm interested in more than just ketones). I've found them quite reliable. You can pick up urine test strips from any pharmacy. For the longer term, you can usually get better prices on ebay but it's highly advisable to check the expiry date with the seller before purchasing. Ketostix (ketones) or Keto-diastix (ketones and glucose) are from the same stable so I would assume they'd be reliable too (and they're often recommended here too).

Blood beta ketone meters are also available, which work in a similar fashion to glucometers. The strips are pricey (upwards of c.£14 for 10) but you don't need to test ketones often and you can get real-time results on demand, no need to wait for a pee sample.


Mogs
.

 

[Critter Mom]

I’m in the U.K.

The other insulin currently licensed for use in cats in the UK is Prozinc. If Caninsulin is disagreeing with Maisie, it should be the next treatment choice. It's a good insulin for cats.

She so skinny now at about 6.5lbs that I really don’t want to risk her not eating anything at all. Oh wow 20 times her ideal weight, I don’t even think she would eat that much right now. She’s not eating a great deal (even though she’s screaming at me for food all the time).

Agree. Maisie needs to get her insulin and regain weight, and right now the food she will actually eat is the right food.

Is she showing any signs of nausea at all?

Nausea symptoms

If yes, please let your vet know ASAP.

I definitely need to speak to the vet ASAP, I don’t think it can wait another 1.5 weeks. I’m really worried about her.

I very much agree. While it's not uncommon for a cat starting on Caninsulin to experience some lethargy at start of treatment (which should wear off after a few days) I'm especially worried about the digestive system distress because that's definitely not normal.

With the iffy appetite, vomiting and diarrhoea in the mix, in addition to checking for ketones, I'd suggest asking the vet about testing for pancreatitis (a Spec fPL test), if only to rule it out. It's a not-uncommon fellow traveller with feline diabetes. Here's more info:

IDEXX guidelines for diagnosis and treatment of feline pancreatitis

If pancreatitis were to be an issue, the treatments outlined in the above can help a cat to eat better.

Be sure to let us know how you get on with the vets. If you can organise it, it might be handy to bring a fresh urine sample with you.


Mogs
.

 

[Critter Mom]

Just checking in to ask how Maisie is doing today. Is she feeling any better? Are you managing to get her to eat enough?


Mogs
.

 

[M & Maisie]

Just checking in to ask how Maisie is doing today. Is she feeling any better? Are you managing to get her to eat enough?


Mogs
.

Hi,
I’m so sorry, I didn’t get notifications to say I had replies.
She’s had no more vomiting for a few days but has had diarrhoea once or twice a day, has been lethargic, is still drinking huge amounts and her appetite decreased but she acts like she’s hungry (crying for food but only eating a couple of bites then leaving it).

She’s been to the vets. They tested her blood sugars, they were 26.5 ( she had had her insulin about 2 hours before this). They said her temp was fine, coat looked fine and they weren’t overly concerned about her weight right now or that she has had some diarrhoea. They decided to check her bloods for ketones, it came back that she did have ketones however the vet said it’s not at dangerous levels yet so we have a few days. She gave Maisie an anti sickness injection and an antibiotic injection (just in case she has an underlying infection somewhere) and gave her a week of antibiotic tablets (2 a day, 12 hours apart). She also upped her insulin dose to 1.5 units. She said she wants me to keep a very close eye on Maisie, if she’s not at least 30% better and if she’s not eating at least 30% more than she currently is by Friday, I need to take her back and she will be admitted for treatment.

I feel like 30% isn’t a great guide for me to go off to be honest and not the best advice to give to someone who is brand new to all of this. I told the vet I would try to weigh her food to get a more accurate number of exactly what she was eating, then I asked her what amount for Maisie’s current weight would she be happy with her eating a day (going off her 30% more advice, considering she’s only eating a couple of mouthfuls here and there throughout the day right now) Her response was- whatever it says on the packaging of the food for her weight.
I’m lost to be honest, obviously I don’t want her to have to be admitted for treatment but I’m scared that I could think she’s doing better but she’s actually not.