How much food is "enough" before Vetsulin shot

[Mocha's_mom]

Mocha is an extremely picky eater and I'm having trouble getting any consistent amount of food in his system. He went from free feeding dry high carb food his entire life to this new low carb diet that I'm trying to transition him to. On day one he had no issues eating wet food (FF chicken pate). Since then he's getting pickier and pickier and now he is refusing all wet food. I've tried FF, Friskies, Tiki Cat, Wellness, Weruva & in all different flavors and textures, and human tuna. In an act of desperation yesterday & today I've given a tiny sprinkle of kibble on top of wet food so that he will at least eat SOMETHING. Even then it's just a couple bites and he walks away. His numbers seem to be getting a little bit better but he's hardly eating much. I give him ham or turkey cold cuts after each BG reading as a little treat for being a good boy. I'm maybe giving 3-4 tiny pea sized pieces each time. So I know he's getting some calories from that. He seems to be hungry because he'll meow & wait patiently as I open up a fresh can of food but when I put it down he'll stare at it for a few minutes then walk away. My non-diabetic kitty is doing ok eating Young Again mixed with Vital Health freeze dried rabbit (she's refused all wet food from the get go so at least I got her to eat some low carb dry food). Mocha won't touch any of the low carb dry food or treats. What do I do? I've given insulin each time because I want to get a good idea of where he stands and his numbers are still high enough. But this food situation is stressing me out! I'm in tears just about every day!

 

[Librarianista]

Hi, Christina -

One of the resources here is a vet article about how to transition cats from dry to wet:
http://felinediabetes.com/TipsforTransitioningPDF12-18-09.pdf

The first day he probably thought he was getting quite the treat! But some cats take longer to transition, and we just have to deal with that.

I was not testing BG when we were on Vetsulin, so I have no idea what her numbers were actually like, so please take my story with caution. But I was happy if she ate at least 1/3 can of FF before giving her shot. I knew she’d go back to the bowl later.

 

[Mocha's_mom]

Hi, Christina -

One of the resources here is a vet article about how to transition cats from dry to wet:
http://felinediabetes.com/TipsforTransitioningPDF12-18-09.pdf

The first day he probably thought he was getting quite the treat! But some cats take longer to transition, and we just have to deal with that.

I was not testing BG when we were on Vetsulin, so I have no idea what her numbers were actually like, so please take my story with caution. But I was happy if she ate at least 1/3 can of FF before giving her shot. I knew she’d go back to the bowl later.

I feel like I've read that article a hundred times already (hoping I'd pick up something I missed the last time) LOL! Great info, but nothing is working.

I think you're right, he thought he was getting a treat the first time and gobbled it up. Now he's snubbing his nose at everything.

Do you think he's holding out for his dry kibble? I don't want to starve them into submission either so I'm at a loss. The most he's actually ever eaten at one sitting was 1/4 can FF. I don't know that he's actually even eaten an entire can in one day. That's not nearly enough calories!

Should I go back to kibble and try to make the transition slower? He's never gone hypo with the new food (or lack thereof) so I don't feel like I need to go backwards. And it seems like when Mocha is in the green is when he'll actually go to the food bowl. So maybe his body is behaving as it should and he's hungry when his glucose gets low?

 

[Sienne and Gabby (GA)]

Have you tried any of the air dried food from ZiwiPeal? This is a link to their chicken flavor. It's about 4% carb. The consistency isn't as crunchy as dry food -- it's more like jerky. The other option may be Epigen 90 dry food. It's about 8% carb.

 

[Mocha's_mom]

Have you tried any of the air dried food from ZiwiPeal? This is a link to their chicken flavor. It's about 4% carb. The consistency isn't as crunchy as dry food -- it's more like jerky. The other option may be Epigen 90 dry food. It's about 8% carb.

I haven't tried that one yet but I will!! He doesn't seem to like the freeze dried food or treats but if that one's more like jerky it's worth a try. I got the Epigen 90 and he snubbed his nose at that. So did Charlotte. The size of the food is similar to the Young Again that I bought and he doesn't like either. I even tried sprinkling FortiFlora on top and no interest. Stubborn cats!

 

[Judy & Fritz]

As a last resort, did you save some of the dry high carb food he formerly ate, or high carb treats that he liked? You can crush up a few kibbles or treats to use as a topper for the wet food and try that. At this point, he has to eat. Do you use an appetite stimulant? Is he on any meds that could have inappetance as a side effect?

Edit: Sorry, just saw that you tried the kibble. How about mixing some of the turkey cold cuts you’ve been giving him for test-time treats into his wet food?

 

[Bron and Sheba (GA)]

Another thought is…. Do you think he might be nauseated? Or do you think it is just because he wants his old food back.

 

[Mocha's_mom]

Another thought is…. Do you think he might be nauseated? Or do you think it is just because he wants his old food back.

I think he's just being stubborn and misses his old food. Plus I'm giving him a small treat of turkey or ham after every poke. So maybe that's providing enough nutrition that he doesn't get super hungry?

 

[Mocha's_mom]

As a last resort, did you save some of the dry high carb food he formerly ate, or high carb treats that he liked? You can crush up a few kibbles or treats to use as a topper for the wet food and try that. At this point, he has to eat. Do you use an appetite stimulant? Is he on any meds that could have inappetance as a side effect?

Edit: Sorry, just saw that you tried the kibble. How about mixing some of the turkey cold cuts you’ve been giving him for test-time treats into his wet food?

No meds on board and haven't tried an appetite stimulant. His numbers are still fairly high so I know he's not starving.

I tried to put some ham on top of wet food the other day and he snubbed his nose... Like "I'm not falling for that trick!"

But it's certainly worth another try.

 

[Chris & China (GA)]

But this food situation is stressing me out! I'm in tears just about every day!

How's his weight? If he's not getting enough to eat, his weight would drop. That's a pretty simple way to know if he's eating "enough".

 

[Mocha's_mom]

How's his weight? If he's not getting enough to eat, his weight would drop. That's a pretty simple way to know if he's eating "enough".

His weight is stable. 18.5lbs, same as last week at the vet. I'm going to order one of those scales similar to the vet so I can catch small changes. My hubby just picks him up and stands on the scale at home. Not the most accurate measurement. I know he needs to lose weight (he's normally around 15lbs) so I'm hoping that will come in time once we get him stable and adjusted to an all wet food low carb diet.

He's not begging for food or acting hungry so I guess that means he's ok. I'm pretty sure my ham/turkey treats are keeping him satiated.

 

[Judy & Fritz]

No meds on board and haven't tried an appetite stimulant. His numbers are still fairly high so I know he's not starving.

I tried to put some ham on top of wet food the other day and he snubbed his nose... Like "I'm not falling for that trick!"

But it's certainly worth another try.

He may be too smart for us, lol!

 

[Bron and Sheba (GA)]

You may have to transition more slowly to the wet food.
It is really important that he gets enough food otherwise you risk ketones forming.

 

[Mocha's_mom]

You may have to transition more slowly to the wet food.
It is really important that he gets enough food otherwise you risk ketones forming.

I think I'm going to need go back and "start again" to see if I can transition slowly. He's refusing all wet food now.
I've gotten him to eat Epigen90 with Fortiflora sprinkled on top so that's definitely better than his old dry kibble. I'm watching him like a hawk to make sure he eats.

 

[Judy & Fritz]

I think I'm going to need go back and "start again" to see if I can transition slowly. He's refusing all wet food now.
I've gotten him to eat Epigen90 with Fortiflora sprinkled on top so that's definitely better than his old dry kibble. I'm watching him like a hawk to make sure he eats.

Hope he eats today, I’m beginning to worry about him. But I know you’re watching him like a hawk. Do you have a ketone meter or urine ketone strips? Also, where did you find your headlamp and how many lumens is it? Thanks, Christina! Eat, Mocha, eat!!!

 

[Mocha's_mom]

I don't have a ketone meter or urine strips. I guess because he didn't present with DKA I (naively) assumed I wouldn't need them. Do you think I should have them on hand just in case? Actually I have ketostix that I use to test my own urine (I follow the keto diet) so would those work?

How will I know if I should worry about DKA?

His numbers aren't where I'd like them to be but I feel like we're still in a relatively safe zone. His polyuria & polydipsia have improved dramatically this week so that's a positive step.

Here are the magnifying glasses I got on Amazon. It comes with 5 different lens strengths but you really only need one. It doesn't say how many lumens the light is, but it does have 2 brightness levels. The 2nd brightness level is perfect for my needs.

 

[Librarianista]

I don't have a ketone meter or urine strips. I guess because he didn't present with DKA I (naively) assumed I wouldn't need them. Do you think I should have them on hand just in case? Actually I have ketostix that I use to test my own urine (I follow the keto diet) so would those work?

How will I know if I should worry about DKA?

His numbers aren't where I'd like them to be but I feel like we're still in a relatively safe zone. His polyuria & polydipsia have improved dramatically this week so that's a positive step.

Here are the magnifying glasses I got on Amazon. It comes with 5 different lens strengths but you really only need one. It doesn't say how many lumens the light is, but it does have 2 brightness levels. The 2nd brightness level is perfect for my needs.

View attachment 62182

Yes, your own ketostix would work just fine to test, following the exact same instructions. While Chloe's numbers were in the black, I was testing once a day. I don't know about for cats that aren't eating, since we ended up in the ER vet the 1 time she did that.

 

[Judy & Fritz]

I don't have a ketone meter or urine strips. I guess because he didn't present with DKA I (naively) assumed I wouldn't need them. Do you think I should have them on hand just in case? Actually I have ketostix that I use to test my own urine (I follow the keto diet) so would those work?

How will I know if I should worry about DKA?

His numbers aren't where I'd like them to be but I feel like we're still in a relatively safe zone. His polyuria & polydipsia have improved dramatically this week so that's a positive step.

Here are the magnifying glasses I got on Amazon. It comes with 5 different lens strengths but you really only need one. It doesn't say how many lumens the light is, but it does have 2 brightness levels. The 2nd brightness level is perfect for my needs.

View attachment 62182

Your Ketostix are perfect for this. Not enough food, not enough insulin (like skipping a dose) are the two things I watch out for. I test Fritz twice a week regardless, just to be on the safe side. One night last week he only ate about half his meal, refused anything else, so I gave him 1/2 dose of insulin after talking to @Bron and Sheba (GA). I tested for ketones an extra day that week. Are you familiar with how to get a urine sample? I bought the special litter, new smaller litter box, etc., but haven’t used them. I have great success using a kitchen ladle (bought for this express purpose). The ladle I bought is sold out, but this is virtually identical, just let him begin to go and stick it under him in the litter box, you can tell when the urine is filling the ladle. Just bought the magnifying glasses you did. Thanks!

 

[Mocha's_mom]

Your Ketostix are perfect for this. Not enough food, not enough insulin (like skipping a dose) are the two things I watch out for. I test Fritz twice a week regardless, just to be on the safe side. One night last week he only ate about half his meal, refused anything else, so I gave him 1/2 dose of insulin after talking to @Bron and Sheba (GA). I tested for ketones an extra day that week. Are you familiar with how to get a urine sample? I bought the special litter, new smaller litter box, etc., but haven’t used them. I have great success using a kitchen ladle (bought for this express purpose). The ladle I bought is sold out, but this is virtually identical, just let him begin to go and stick it under him in the litter box, you can tell when the urine is filling the ladle. Just bought the magnifying glasses you did. Thanks!View attachment 62187

Not sure he'd be too thrilled with me catching his urine lol! But he does tend to pee close to the side of the box so there's usually some urine on the plastic liner that I could collect. I guess in an emergency I'd use the ladle method.

 

[Judy & Fritz]

Also, if you monitor your own ketones with a meter, that will work on him as well. I just bought the Nova Max Glucose & Ketone meter and strips. Got the meter free with purchase of two boxes of ketone strips on the company’s website, then ordered glucose strips for it on Amazon. I needed a backup BG meter, anyway. https://novacares.store/novamax/

 

[Judy & Fritz]

Not sure he'd be too thrilled with me catching his urine lol! But he does tend to pee close to the side of the box so there's usually some urine on the plastic liner that I could collect. I guess in an emergency I'd use the ladle method.

I thought it would be a complete exercise in futility, but was very surprised that Fritz ignored me, and I had a pristine urine sample!

 

[Mocha's_mom]

Just a quick update - Mocha is eating wet food today! FINALLY! I don't want to jinx it. But he had a 1/4 can (maybe less) of FF turkey at 7am, shot at 8am (he was 247). Now he's about 1/2 can deep in FF chicken pate.
I've been leaving a lot of wet food out all day and night (FF, Friskies, Weruva & Tiki cat) and neither will touch it. But I'm hoping the smell will eventually get to them (Lord knows the smell is getting to me! YUCK!)
We're only a week or so in and his nadir seems to be around +4 with the Vetsulin and I'm noticing him get hungry at about +2 or +3 so that's good. Means his body is sensing a normal BG and he's eating as a result of that. Obviously he's not staying low long enough so I'm gonna try to get him some Lantus in the coming weeks.
But this is such an improvement!

 

[Judy & Fritz]

Wonderful news! SO glad to hear he’s eating! Christina, as a precaution, could you ask @Sienne and Gabby (GA) to take a look at Mocha’s chart? He has some beautiful blues, but since you’re using an AlphaTrak meter, the human meters (all I’m familiar with) would be reading quite a bit lower. Since he hasn’t been eating much until today, just to be safe, let someone experienced in Vetsulin take a look. We’re so new to this, and I always feel better having those very experienced members who can read a chart at a glance do so. @Chris & China (GA) and @Bron and Sheba (GA) can read the charts no matter what the insulin and meter. Totally your call, just looking out for you and Mocha!

 

[Chris & China (GA)]

Great news that he's eating the canned!! (said very quietly so he doesn't know that we know)

The spreadsheet looks great for a cat on Vetsulin. We don't want them going much under 100 due to how harsh it can be. If you end up continuing on the Vetsulin, you'll eventually have more data and may try to push him a little lower at nadir, but it's too soon right now.

I think Mocha would do very well on Lantus though!

 

[Sienne and Gabby (GA)]

I would like to see more numbers below renal threshold (more blues) but Vetsulin is tricky. I agree with Chris -- can you consider a switch to Lantus or Prozinc?

 

[Librarianista]

I would like to see more numbers below renal threshold (more blues) but Vetsulin is tricky. I agree with Chris -- can you consider a switch to Lantus or Prozinc?

She mentioned trying to acquire Lantus in the coming weeks I think that switch will do wonders.

 

[Judy & Fritz]

I don't have a ketone meter or urine strips. I guess because he didn't present with DKA I (naively) assumed I wouldn't need them. Do you think I should have them on hand just in case? Actually I have ketostix that I use to test my own urine (I follow the keto diet) so would those work?

How will I know if I should worry about DKA?

His numbers aren't where I'd like them to be but I feel like we're still in a relatively safe zone. His polyuria & polydipsia have improved dramatically this week so that's a positive step.

Here are the magnifying glasses I got on Amazon. It comes with 5 different lens strengths but you really only need one. It doesn't say how many lumens the light is, but it does have 2 brightness levels. The 2nd brightness level is perfect for my needs.

View attachment 62182

This magnifying glasses/LED light is AMAZING! Do you use the black headband?

 

[Mocha's_mom]

This magnifying glasses/LED light is AMAZING! Do you use the black headband?

Nah, I'm only wearing them for a minute or 2 and the nose grips help to keep them from falling off. Aren't they great! Now I can finally see what I'm doing!!

 

[Judy & Fritz]

Nah, I'm only wearing them for a minute or 2 and the nose grips help to keep them from falling off. Aren't they great! Now I can finally see what I'm doing!!

Love them! I may not have a clue what I’m doing, but I sure as heck am equipped to deal with anything, lol.

 

[Mocha's_mom]

Thank you @Sienne and Gabby (GA) @Chris & China (GA). I definitely want to get some more data to see where we're at with Vetsulin. His numbers are getting better each day which I'm hoping is because he's eating all low carb now. Based on his numbers his nadir appears to be around +4 and goes up from there. I'd definitely like him to be in the blue for longer which is where I think the Lantus is going to be a good next choice. I don't think increasing the dose of Vetsulin would make any difference because it's the duration of action that's important. How many weeks should I keep this up (meaning keep using Vetsulin) before I ask for Lantus? Do I need more data to present to the vet?

 

[Librarianista]

Ideally, the sooner you can switch to Lantus the better. Vetsulin only lasts in cats about 8 hours, which is one of the reasons it's not recommended. So it makes sense that his nadir is around +4.

Is your vet asking for the data before approving the script? I did not present any to my vet when I asked to switch. At least in my case, they suggested Vetsulin because of the price point. Lantus was offered initially, but I balked at the cost before doing any research (we also accepted the prescription food ). I feel like I would have hit remission much sooner and kept her there longer if I had just gone with Lantus and LC diet change at the onset.

I think the best piece of information you could share is the AAHA's own paper on insulins for cats: https://www.aaha.org/globalassets/02-guidelines/diabetes/diabetes-guidelines_final.pdf (pages 3-4)

 

[Mocha's_mom]

She actually hasn't even asked me for his data yet. I was supposed to bring him in for a glucose curve on Monday but I just went ahead and did my own (to save him the stress of spending the day at the vet). She hasn't even called to check to see how he's doing. Maybe she's pissed I didn't bring him in lol. I'm going to call her this afternoon. If she gives me any grief I already have another vet lined up to switch to. I'm not super thrilled that she didn't want me to check his BG at home and she told me to keep him on his high carb diet. Something tells me she doesn't deal with a lot of diabetic cats. That's why I'm anticipating some push back. Fingers crossed!!

 

[Librarianista]

Gotcha. Well hopefully she will just write the script and not fight you over it!