Food questions for newly diagnosed elderly cat prone to UTI's and (maybe) stage 1 CKD

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EugeneR

Member Since 2023
1 of my 4 cat's was just diagnosed after we thought she had another UTI. We found sugar in the urine. Ran further tests found elevated blood glucose, and elevated fructosamine. I don't know the exact levels i'm seeing the vet in 2 days to go over them and start insulin, probably lantus. She's also hypothyroid slightly, after radioactive iodine treatment slightly overcorrect her initially hyperactive thyroid. She's a rescue that we know is at least 15 years old and probably older, and her kidney levels are slightly elevated. Stage 1 CKD maybe. My vet says it's debatable. My vet's office is a cat only practice. Lately she's been very lethargic and peeing outside of the litter box, a little stiffness/stumbling in the rear legs especially, and no longer purring. We also had her on Solensia for arthritis.

So the first thing i did when i got the call yesterday was hit google, and ran to the store to buy new low carb wet food for her. She currently at a mix of wet and dry food. One of the wet foods seemed to be relatively low carb, the other was on the higher end. I bought a bunch of new wet food, adding up the GA info on the cat looking for low carb. I wound up with a bunch of fussie cat, Tiki, & Orijen. Various flavors and textures to try that all added up to well under 10% carb (some came out negative?). Along with a bag Stella and Chewy Frozen (not freeze dried) raw-food, the rabbit flavor seemed to also be very low carb. So far i've only presented the stella and chewy frozen food and she at it all. Given her appetite has been down lately, i was pretty impressed she finished a half cup of the stella & chewy last night (it was given along side her normal wet food). And at the end of the day eating a substantial amount of anything is a good thing. She also ate one of those fish fillet treats.

Then i woke up incredibly early this morning worried for my cat and couldn't sleep, and i found this form and Dr. Pierson's website. Now i'm a bit concerned about stella and chewy, I've emailed them for a TNA on this food. I'm also concerned about carrageenan in the fussie cat. And finally I'm concerned about phosphorous. lol

Based on what i've seen, and the brands availible at my pet store, it looks like i should try and focus on feeding her tiki cat, weruva, & b.f.f. options from dr Pierson's list?


EDIT: Also i have a glucometer for myself, a Countour Next Gen. Can i use that for my kitty? or should i get a feline specific one?
 
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I just tested her blood with my meter, 378 mg/dl. She has eaten a bit today, she grazes all day long, but i'd imagine that's still pretty high?
 
Welcome to the best place you would ever want to be
As for wet food for cat that are diabetic and who have kidney disease you can try these
You can check these out from Weruva BFF like

One of our members put it together
BFF play chicken Checkmate
Protein 31%
Carbs 5%
Phosphorus 129%
BFF play chicken & turkey topsy turvy
Protein 32%
Carbs 5%
Phosphorus 129%
BFF play chicken cherish
Protein 31%
Carbs 5%
Phosphorus 135%
BFF chicken & turkey tiptoe
Protein 31%
Carbs 5%
Phosphorus 136%
BFF chicken duck & turkey take a chance
Protein 32%
Carbs 5%
Phosphorus 149%
BFF play chicken & lamb laugh out loud
Protein 31%
Carbs 5%
Phosphorus 154%
BFF play chicken & duck destiny
Protein 32%
Carbs 5%
Phosphorus 165%
BFF play chicken & beef best buds
Protein 33%
Carbs 5%
Phosphorus 171%

weruva has low carb and low phospherous wet food
With weruva foods
You want the metabolizable energy profile percentage of carbs to be less than 10%, and the phosphorus which Weruva lists in Minerals to be less than 250 mg per 100 cals. So you have to look at two different places in the Weruva charts.
https://weruva.com
Will also give the protein and fat %

When you tap on any of the Weruva food on their website tap on where it says
Detailed Nutrition Information that is on the left side it will then list the information that I listed above
 
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EugeneR said:
Also i have a glucometer for myself, a Countour Next Gen. Can i use that for my kitty? or should i get a feline specific one?
Click to expand...
Don't get a pet one the test strips are so expensive
If you have a Walmart by you
Our numbers are based on human meters anyway
If you want to get a very reasonable human for your kitty
Most of us use
Here is the link for the meter and test strips so you don't have to search for them
Relion Premier Classic Meter at Walmart for 9 dollars
https://www.walmart.com/ip/ReliOn-Premier-CLASSIC-Blood-Glucose-Monitoring-System/552134103

The tests strips are 17.88 for 100
https://www.walmart.com/ip/ReliOn-Premier-Blood-Glucose-Test-Strips-100-Count/575088197
You can order them on line ause Relion Premier Classic
 
EugeneR said:
. I don't know the exact levels i'm seeing the vet in 2 days to go over them and start insulin, probably lantus.
Click to expand...
I would get lantus also
Lantus is very expensive to n the US
you can get generic lantus from a pharmacy,most members here use the generic
You can have the vet write the script for generic lantus the 5 pens ,many members use it, The brand is much more expensive, just call around and see who might have the generic brand with the best price for 5 pens , just keep them in the fridge they are all good until the expiration date. The expiration dates would probably be 2024 or 2025 now just look when you buy them
They will probably last you a year
We use the syringes with half unit marking so we can adjust the dose by 0.25 units at a time
If you were to use the pen with the needle you can only adjust by full units

Here is some info
Check this out also
https://www.goodrx.com/insulin-glargine?dosage=five-3ml-prefilled-pens-of-100-units-ml&form=carton&label_override=insulin glargine&quantity=1




Or this one also

I see some members will call CVS, Rite Aid, Costco, Walgreen's, to get the price for 5 pens
Posted by another member
One members posted this
. I paid $175 for a box of 5 pens at Walmart pharmacy, but GoodRX coupon says you can get it for around $90 if you have a Rite Aid pharmacy near you.

A member just posted this
Allie was using the Lantus and I just switched to the generic and using the GoodRX I got 5 pens for $81.30 at Walgreens. GoodRX has a 1-800 number to assist you in using their services to get your pets prescriptions filled if the pharmacy gives you any issues.

I think I found it for you
GoodRx / Customer service

1 (855) 268-2822

You can get the syringes with half unit markings at a Walmart. Their ReliOn Brand syringes of 0.3 cc (30 unit) capacity come with half unit markings. Cost $12.58 for a box of 100
This is what the packaging looks like: either box is fine
They won't say it half unit on the box but the are . open then and look before you leave the store, can't be ordered on line , need to go into the store
:




upload_2021-9-5_23-18-9-jpeg.62508

Or any of the ones listed here
 
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Diane Tyler's Mom said:
Don't get a pet one the test strips are so expensive
Click to expand...

Thank you for the info on food and freeze dried treats.

Since i already have a human meter, no reason i can't just use the one I already have right? I'll bring it to my vet's office to compare against theirs? but i assume it's more about just building a trendline? I'll read more about the spreadsheet and how and when to test her glucose.
 
Your vet probably uses a pet meter like the alpha trak most do
The normal range for a cat on a human meter is 50-120. There is no scientific comparison between the pet and human meter
The human meter numbers are a bit lower than the pet meter numbers. There is no comparison chart but with the human meter numbers , don't try to compare them because it will drive you crazy
And yes you can use your human meter
 
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EugeneR said:
I'll read more about the spreadsheet and how and when to test her glucose.
Click to expand...
Here is a link helping us to help you link. If you noticed, our members have some basic information about their cat's in their signature. This helps us to not pester you by asking the same questions (your cat's name, insulin type, date of diagnosis, etc.) repeatedly. We also have a link to our spreadsheet in our signature. We are very numbers driven. The spreadsheet is a record of your cat's progress. By linking it in your signature, we can follow along and provide feedback should you need the help.
Tap on your name up too then tap in signature and add all the information it asks you when you tap on the blue link I gave you

You only need to withhold food is 2 hours before testing first thing in the morning AMPS (AM Pre Shot) and the same when you test first thing at night 12 hours apart PMPS (PM Pre Shot)
So the BG is not food influenced
Most of us feed the larger meals at AMPS and PMPS then small snacks about 2 or 3 teaspoons during +3 and +5 , some feed 3 smaller meals
It's easier on the pancreas.
+2 means 2 hours after giving insulin
+3. 3 hours after giving insulin and so on
Same for PMPS cycle

Lantus usually kicks in @+2
So you can test @+2. +4 and +6 @+6 is usually the lowest point during the cycle but it can vary
You want to mix up your test times like filling in pieces of a puzzle
Maybe one day test @+3, +5. +7
They usually drop lower at night so it's important to at least get another test in before you go to bed
Part of that process is getting a feel for basic concepts:
  • Onset - the length of time before insulin reaches the bloodstream & begins lowering blood glucose
  • Peak/Nadir - the lowest point in the cycle
  • Duration - the length of time insulin continues to lower blood glucose
You can read all about Lantus here, especially the 2 dosing methods to chose from, each one will tell you when you need to increase or decrease the dose
You can add that to your spreadsheet and signature also

By any chance you need help setting up your spreadsheet when you are ready we have a member who will happy to do it for you. Just ask

If you want to give it a go here is the link and it will also explain how the spreadsheet works

If it wasn't for the experienced members here giving me their advice I know my Tyler would not be in remission since 1-24-21
 
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@Diane Tyler's Mom
Thank you for all the info. I have set up my spreadsheet, if you could check and see if i'm doing it right? I've been staying up late to check her sugar 2-3 hours before going to bed, it's beginning to be a lot for me to do..

It's worrying her numbers are high, but i'm seeing the animal hospital today for a follow up, and her regular vet tomorrow. She was admitted late last week for 2 nights. She had ketones in her blood, but was not yet in dka. But was very lethargic and walking a bit drunk.

I've been struggling to find foods she'll eat that are appropriate for both diabetes and early stage ckd. She also loves her kibble, i put her on the Dr Elseys Clean protein Chicken Kibble which she is eating.

I also got a blood ketone meter to use with her.
 
@EugeneR
Hi Eugene ,your spreadsheet looks fine , one thing try to shoot the same time at night that you shoot in the morning if possible.
For example on 5-29 AM you gave insulin at 10:30 AM and then at night you gave it at 9:00PM
You shouldn't give it an hour and a half earlier than the AM shot
As soon as you test him , feed ,then give insulin it should take no longer than 15 minutes to do it

Important can you please add to your signature the meter you are using, what food you are feeding, since you are feeding some Dr Elsey's kibble you can put low carb/ Dr Elsey's kibble Ketones,Prone to UTI and CKD Stage 1 (maybe)
The first thing members look at is your signature so they don't have to keep asking you


EugeneR said:
I've been staying up late to check her sugar 2-3 hours before going to bed, it's beginning to be a lot for me to do..
Click to expand...
When you test her at night PMPS and get the BG number ,you can test @+2 , if that number has dropped sat 100 points more than you would need to get another test in to be sure the BG is coming up . . when you go to bed for the night you can leave some low carb food out for her

EugeneR said:
It's worrying her numbers are high, but i'm seeing the animal hospital today for a follow up, and her regular vet tomorrow. She was admitted late last week for 2 nights. She had ketones in her blood, but was not yet in dka. But was very lethargic and walking a bit drunk.
Click to expand...
I am going to tag s few members about this , what were the ketones
Good that you got a blood ketone meter also

Hi ladies I assume Eugene joined last Wed since today is Tues, no one responded back to him I have been trying to help him the best I can but as you all know I'm not experienced
@Bron and Sheba (GA)
@Wendy&Neko
@Suzanne & Darcy
 
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EugeneR said:
I've been struggling to find foods she'll eat that are appropriate for both diabetes and early stage ckd. She also loves her kibble, i put her on the Dr Elseys Clean protein Chicken Kibble which she is eating.
Click to expand...

@EugeneR
Have you tried
Tiki Cat Succulent Chicken
Carbs 0.338
Phosphorus 0.93. This one is like chicken shreds
259086_MAIN._AC_SS300_V1605283327_.jpg


Or this one pate
This food has a carbohydrate content of 0.63% as fed, 2.97% on a dry matter basis.
526158_MAIN._AC_SL600_V1657658483_.jpg
 
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EugeneR said:
Along with a bag Stella and Chewy Frozen (not freeze dried) raw-food, the rabbit flavor seemed to also be very low carb. So far i've only presented the stella and chewy frozen food and she at it all. Given her appetite has been down lately, i was pretty impressed she finished a half cup of the stella & chewy last night (it was given along side her normal wet food). And at the end of the day eating a substantial amount of anything is a good thing. She also ate one of those fish fillet treats.
Click to expand...
@Wendy&Neko
Hi Wendy @EugeneR has just joined probably last Wed since today is Tues and I see no one has responded to him , I'm trying to help him out, Can you please read his intro post
He said kitty is prone to UTI and maybe Stage 1 kidney disease
I don't know if the Stella and Chewy frozen taw rabbit is low carb and low phosphorus, only asking you because I think I have seen you suggest Stella and Chewy to other members but I could definitely be wrong
Plus he said
She was admitted late last week for 2 nights. She had ketones in her blood, but was not yet in dka. But was very lethargic and walking a bit drunk.
I tagged Bron also

Thank you Wendy his SS is up to date
 
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Hi Eugene and welcome to the forum.
I’m sorry I did not get the earlier tag.
Can you tell me what the reading was on the blood ketones meter please?
Is she still very lethargic and walking like a drunk?
If she had ketones in the blood…did the vet tell you this? She needs to be eating as much as possible as this will help keep the ketones away. So feed her as much as she will eat at the moment. This is very important. Give her small meals/ snacks every couple of hours.
At this point, it is more important that she eats anything …so if she will only eat dry food or the higher carb food, that is ok. She can be swapped back to low carb food later. Eating is the most important thing.
Also Looking at the spreadsheet she need an increase in the dose of insulin. If you are going to the vet today, ask about increasing the dose.
With ketones in the blood, the insulin is very important.
Are you testing for ketones at home as well?
If not I would get a bottle of Ketostix from Walmart or a pharmacy asap and start testing the urine for ketones every day.
Please let us know what the vet says today.
 
@Bron and Sheba (GA)

I was told there were some blood ketones @ the hospital, but not given specific values.

She's eating a low carb dry kibble very well, not doing very good with wet food which is the opposite of normal.

My home ketone test meter, the Fora 6, reports "Lo", i just got it on Monday.

She is not walking drunk or acting lethargic for the past few days.

(not our regular) Vet instructed me to increase dose to 1.5 IU 2x/day. I'm starting at 1.25 for a few days because that seems like a big jump to me? I was basically reprimanded for checking her blood glucose at all, and even more so for the frequency, and especially for doing so with a human monitor.

My regular vet and I have had some discussions and he's on board with me checking her if she tolerates it, and she tolerates it very well, and with using a human monitor. Seeing him this week.
 
@EugeneR
Important can you please add to your signature the meter you are using, what food you are feeding, since you are feeding some Dr Elsey's kibble you can put low carb/ Dr Elsey's kibble Ketones,Prone to UTI and CKD Stage 1 (maybe)
The first thing members look at is your signature so they don't have to keep asking you
 
EugeneR said:
not our regular) Vet instructed me to increase dose to 1.5 IU 2x/day. I'm starting at 1.25 for a few days because that seems like a big jump to me? I was basically reprimanded for checking her blood glucose at all, and even more so for the frequency, and especially for doing so with a human monitor.
Click to expand...
I'm glad you went with 1.25 units, you need to give it 5-7 days for the depot to fill up to see how it's working. I'm glad your regular vet is on board with you checking her BG and using the human meter. That other vet doesn't know what he's talking about
@EugeneR
 
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EugeneR said:
I've tried the shreds, not the pate. She has a preference for fishy foods. I've also tried the chicken and Tuna, and the tuna and mackrel.
Click to expand...
Try these they are low carb/ low phosphorus Pates

https://www.soulisticpet.com/pate
When you look for the phosphorus look where it says minerals , try to stay under 250 mg
Hen you tap on each flavor tap on where it says
COMPLETE NUTRITIONAL INFORMATION (link to page)
If possible try not to feed a lot of fish flavors because of mercury
@EugeneR
 
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We just saw her regular vet yesterday. He's telling me to give it time and wait a week before increasing her insulin again. I"m just concerned because her BG just doesn't seem to be heading in the right direction. She's pretty lethargic, and she just seems to have no quality of life and just seems miserable. I'm pretty depressed because I'm questioning if she's gonna pull through this.

I pulled out some applaws "Tuna in seaweed" and she ate that pretty enthusiastically, more so than any other wet food i've given her. She's still eating well with the Dr Elseys low carb Dry food, she nibbles all day long. I'm wondering if i should get more of the applaws and try mixing it with other wet foods to encourage her to eat them? She's still free feeding, might that have a negative impact on BG? I can't get her to eat enough with scheduled meals. I have the sureflap surefeed chip feeders for all my cats.

She's on lactulose and miralax for constipation. cyproheptadine & Mirtaz for apetite. Cerenia for nausea.

She's constantly drinking and getting her paws wet with water, causing her to constantly have cement paws, even though she's not peeing in the box, she's standing in it when she does and pees over the edge. But she poops fully in the box. I'm going to buy some corn based litter today to see if that helps. We have 3 other cats, so I'm hesitant to try pine pellets.

My wife and i are both incredibly overwhelmed and heart broken that she's feeling so poorly.
 
Does the bottle have any cloudiness or floating particles in it and have you kept it in the fridge all the time?

you do need to give the dose 5-7 days to see how it’s working before increasing. Did you read Dianne’s comment about the timing of the shots? Glargine is the generic of Lantus and it requires consistency im dosing and timing. You must give the shots 12 hours apart with no more than a 15 minute variance. This means that if you gave her the am shot at 9am, you must give the pm shot no later than 9:15 but as close to 9 as possible and the same the next morning. So your shot time in this scenario should always be 9am and 9pm. Are you doing that?

What are the ketones test results today? @Bron and Sheba (GA)
 
Ale & Bobo & Minnie (GA) said:
Glargine is the generic of Lantus and it requires consistency im dosing and timing. You must give the shots 12 hours apart with no more than a 15 minute variance. This means that if you gave her the am shot at 9am, you must give the pm shot no later than 9:15 but as close to 9 as possible and the same the next morning. So your shot time in this scenario should always be 9am and 9pm. Are you doing that?
Click to expand...
It's my post #12 ,the post numbers are to the right of each post
Also when someone replies back to you can you tap the word like to the right just so we know you read it Thanks
 
Are you able to get any tests during the pm cycle. even a before bed test would be helpful.
If you are giving dry food you need to be following the SLGS dosing method. Have a good read through it.
DOSING METHODS
EugeneR said:
She's still free feeding, might that have a negative impact on BG? I can't get her to eat enough with scheduled meals.
Click to expand...
Free-feeding is fine but take the food up for the 2 hours before you get the preshot BG as we dont want that food influenced.
I would ask the vet for some ondansetron antinausea medication for her to see if that helps with eating. It is often better than cerenia.
EugeneR said:
She's constantly drinking and getting her paws wet with water, causing her to constantly have cement paws, even though she's not peeing in the box, she's standing in it when she does and pees over the edge.
Click to expand...
She will drink a lot with those high BGs... that is normal. Let her drink all she wants.
I have a cat that likes to stand and pee. I have a lid so it goes up the side of the lid, not out over the edge.
EugeneR said:
She's pretty lethargic, and she just seems to have no quality of life and just seems miserable. I'm pretty depressed because I'm questioning if she's gonna pull through this.
Click to expand...
You are still very early in the FD journey, so give it time to work. Insulin is a hormone and doesn't work like an antibiotic. Until you reach the best dose, you wont see the BGs come down a lot. Just keep doing what you are doing, and keep asking questions. I am concerned she is lethargic though.
Try and get that ondansetron to see if that helps with eating more, test daily for ketones and put in the SS in the remarks column.
If there were ketones in the hospital it is important she gets as much food as possible and we might need to increase the dose a bit earlier than normal if there are still any ketones in the urine/blood. Try and get at least one test on every pm cycle if you can please in case we need to increase the dose a bit sooner than normal. We will need to know what is happening in the pm cycles
Ignore the vet if they are saying you should not test the BG. We hear that a lot. I find it very puzzling as both those tests are so important.
It is very important that we know what is going on with the BGs and the ketones.

Please post every day or more often if necessary, and tag me please with any ketone results.:bighug:
 
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Ale & Bobo & Minnie (GA) said:
Does the bottle have any cloudiness or floating particles in it and have you kept it in the fridge all the time?
@Bron and Sheba (GA)
Click to expand...
There are no particles or cloudiness, I did leave the insulin out overnight once. The reason i ask if it's bad, is if you look at my spreadsheet the first few days we got her home from the animal hospital, her blood gluclose levels were in the 200s. They are now in the 300s and 400s. I just tested at 491, the highest number to date. The animal hospital says they had her regulated on 1iu of lantus with a nadir of 159 @ 6 hours. In fairness they were meal feeding and I am free feeding. I understand it takes 5-7 days to build a depot, but wouldn't you expect to see glucose levels at least trending in the right direction as we get to the 7 day mark? As opposed to going from 400+ to dropping XXX points overnight because we build the depot?

Also for the sake of argument i have tried another meter, both had glucose levels within 20 points of one another.

I wonder if it's possible if the Glargine froze in my fridge? Our fridge does occasionally freeze items in the bottom drawers, the insulin has always been kept on the top of the fridge, first on a shelf for a couple days, then in the butter tray. I just put a smart thermometer in there where the insulin was, which i'll do for 24 hours, and then move it to where it currently is to see if it goes down to freezing at all.

Ale & Bobo & Minnie (GA) said:
you do need to give the dose 5-7 days to see how it’s working before increasing. Did you read Dianne’s comment about the timing of the shots? Glargine is the generic of Lantus and it requires consistency im dosing and timing. You must give the shots 12 hours apart with no more than a 15 minute variance. This means that if you gave her the am shot at 9am, you must give the pm shot no later than 9:15 but as close to 9 as possible and the same the next morning. So your shot time in this scenario should always be 9am and 9pm. Are you doing that?
@Bron and Sheba (GA)
Click to expand...

We are giving her the doses are close to 12 hours apart as possible. Due to work schedules it's not always possible to do exactly 12 hours apart, but we're trying our best. Likewise with testing glucose when we can.

Ale & Bobo & Minnie (GA) said:
What are the ketones test results today?
@Bron and Sheba (GA)
Click to expand...

So far all home blood etone tests have been negative, including the one i just pulled. I have a Fora 6 blood Ketone monitor.


Bron and Sheba (GA) said:
Are you able to get any tests during the pm cycle. even a before bed test would be helpful.
Click to expand...
I've tried my best, usually we're in bed within an hour of giving the shot which seems pretty useless since she'll have eaten, but the most recent injection in theory shouldn't really be active for at least 2 hours? I've tried staying up late a few nights to get extra readings, such as last night and tonight.

Bron and Sheba (GA) said:
If you are giving dry food you need to be following the SLGS dosing method. Have a good read through it.
Click to expand...

Is this true even if it's a low carb dry food? Aren't carbs carbs regardless of dry/wet? When we increased to 1.25 the animal hospital had instructed 1.5, which seemed like too big of jump to me, so i said i'd do 1.25 for 4-5 days and if it had an impact then go to 1.5. We did 4 days of 1 iu, and just completed 4 days at 1.25. Should i wait the full 7 days before giving a bump despite how high our numbers are?

Bron and Sheba (GA) said:
Try and get that ondansetron to see if that helps with eating more
Click to expand...

Her eating has been improving steadily, especially on the Mirtaz/Cerenia so i'm not sure it's necessary? She's really chowing down on the low carb Dr Elseys Chicken dry food, and we started mixing hydracare in her wet food. She devours the hydracare gravy, at first she ignored her wet food, now she's doing a decent job eating it too. She's lost about 2lbs in the past year, so i'm inclined to let her over eat a bit to put on some weight. I also got her to eat some applaws wet food very enthusiastically. The only issue with applaws is that it's not nutritionally complete and made for supplemental feeding, so i'm afraid to over feed it.
 
Ale & Bobo & Minnie (GA) said:
consistency im dosing and timing. You must give the shots 12 hours apart with no more than a 15 minute variance.
Click to expand...

On that note, is it more important to get a 2 hour fasting glucose test OR give the shot in a timely manner if you can only manage one? I had at least 1 instance of delaying the shot due to waiting the 2 hours to get fasting glucose Pre Shot.
 
EugeneR said:
s this true even if it's a low carb dry food? Aren't carbs carbs regardless of dry/wet? When we increased to 1.25 the animal hospital had instructed 1.5, which seemed like too big of jump to me, so i said i'd do 1.25 for 4-5 days and if it had an impact then go to 1.5. We did 4 days of 1 iu, and just completed 4 days at 1.25. Should i wait the full 7 days before giving a bump despite how high our numbers are?
Click to expand...
Any dry food and you need to do SLGS. However with ketones in the picture, we do sometimes fast track the dose.
I would go up to 1.5 units tomorrow and try to bring the BGs down a bit more. Add then hold that dose for 7 days and will will see how that goes.
I see no ketones at midnight. That is good. Keep testing daily if you can at the moment
EugeneR said:
On that note, is it more important to get a 2 hour fasting glucose test OR give the shot in a timely manner if you can only manage one? I had at least 1 instance of delaying the shot due to waiting the 2 hours to get fasting glucose Pre Shot.
Click to expand...
Unless the preshot is quite low, I think one hour is fine but try for 2 if you can.
 
I just want to point out that a nadir of 159 at the hospital means they didn’t have her regulated. What vets consider regulated is in fact not regulated at all. A regulated cat would have a nadir in the normal range which is 70-120.

SLGS is one of the 2 dosing protocols we use here and it just means you stay a bit longer with each dose before adjusting. You’d also decrease the dose if your cat goes under 90 at any given moment.

you might want to consider prozinc instead of glargine when you’re done with the bottle you have now. It’s a bit more flexible when it comes to the timing of the shots.
 
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Thanks @Ale & Bobo & Minnie (GA) and @Bron and Sheba (GA)

I've read about both protocols, i guess just with the SLGS it would seem to me if you're way off of the mark at being regulated that waiting the whole 7 days seems kind of unnecessary, and makes more sense as you get the glucose levels closer to normal. Please tell me if i'm wrong, i'm just looking at this from the stand point of: If after 4-5 days we're still in the 300s or 400s, it seems unlikely that by day 7 we'll suddenly drop 200+ Points? Please tell me if I'm wrong here, obviously i don't want to send my kitty hypo, especially over night while no one may be able to save her, I just want to get her in better numbers sooner because i'm concerned about the dangers of being this high for this long.

Ale & Bobo & Minnie (GA) said:
you might want to consider prozinc instead of glargine when you’re done with the bottle you have now. It’s a bit more flexible when it comes to the timing of the shots.
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All my shots are within an hour and i do my best to be within 15 minutes, is that really that big of a deal?


So both vets gave me a hard time about testing her glucose, my regular vet just less of a hard time. My regular is on board with testing pre-shot and at the 6 hour point, but nothing else. And he's A-OK with a human meter.

Between the 2 of them here's what I heard:

1.) i could make her ears all scabby from the constant testing. I could have defelcted that with also using the paw pads, but she won't let me do that without someone holding her down which would cause her too much stress. She hates her paws being touched.
2.) That the stress could cause her glucose to rise. She doesn't care at all when i prick her ears, as long as i catch her laying down, it's a 1 person job, and she's totally docile. If she's not laying down, the only problem is she won't stay still long enough.
3.) that i'm collecting worthless data because it takes a week for the levels to stabilize so there's no point in testing that early, apparently I was told in the ER they only test once every 6 hours.
4.) Cats don't live that long so they're blood sugar doesn't need to be regulated like a human's.

I grew up with Type 1's in my family, to think about giving insulin without checking glucose first seems... unusual.. to me

Her appetite is doing pretty good for the dry food still. Now that i'm comfortable with her eating and appetite think i should try to start transitioning her to a wet food diet? I think there was a guide here, or on catinfo.org for transitioning a dry food addict?

As expected she is still drinking and peeing a ton. The problem is this: She will squat to poo in the litter box, and even turn around properly. To Pee, ever since she started to appear sick at home, she started standing to pee, doesn't fully enter the box, her back feet are on the edge of the box, and she pees over the end. At this point i feel like we've got a behavioral problem, we just don't know what to do. Any ideas or suggestions? I've gotten the biggest open pan box i can find on chewy, and we just switched to worlds best (corn based) litter to prevent the cement paws.

She's also seems a little confused to us, when she gets up a lot of times she just stops and stands there for 5-30 seconds before going to do something, or between "tasks". Like water bowl, then she walks away towards the food bowl, stands there for a bit like she's taking a break, or forgot where she's going, before going there. Is this normal?
 
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Minnie was tested daily for over 2 years and no scabby issues with her ears. Sometimes if she pulled away I would accidentally scratch instead or pricking and there would be a lot of blood and a scab would form. I wound simply avoid that area until it was healed. If you just hold a cotton ball or oval and press against the spot for a few seconds, it will prevent any scanning from forming. Bobo was even easier to test than Minnie so his ears never scanned at all. If she’s fine with the ear testing, I’d stick to that and forget the paws. Do whatever is more comfortable for her. A trick for me because I was always afraid they’d move, was to collect the blood onto my clean nail and test from there. Once I discovered that and started doing it, I never again had an issue because once I had the droplet on my mail they could move and I could take my time testing.

I won’t even comment on the cats don’t live that long reason because it honestly makes me angry and if that’s how they feel, they should be vets at all. The longer they’re unregulated, the harder it is in their pancreas and other issues can develop because of it, the most common being neuropathy of the back legs. Minnie had a severe case of it and became unable to jump and could barely walk.

There’s absolutely no stress at home compared to the stress at the vet office. Just a bunch of BS excuses if you ask me. I think what most vets don’t want is to have to deal with us constantly asking them about the bg numbers we’re getting and that wouldn’t happen because you’d be coming to us not them. As you pointed out, a diabetic would never dream of injecting themselves without testing. It’s even more important for cats since they can’t look at you and say, “hey I think my sugar levels are going too low, can I get an HC treat please?”

it’s called Start Low Go Slow for a reason :cat: and again, it’s about giving Lantus time to work and giving you cat time to process it. I think the timing goes down to 5 days after the first week but I’ll let @Bron and Sheba (GA) correct me if I’m wrong. Feline diabetes is a marathon not a sprint. Keep that in mind. And if you follow TR, you’d be increasing every 3 days instead so maybe that’s the bet protocol for you, but sadly it doesn’t work if you’re feeding dry food.

15 minutes is okay, but an hour is not. If it’s late an hour it can act as a decrease and if your early an hour it can act as an increase.
 
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Ale & Bobo & Minnie (GA) said:
it’s called Start Low Go Slow for a reason :cat: and again, it’s about giving Lantus time to work and giving you cat time to process it. I think the timing goes down to 5 days after the first week but I’ll let @Bron and Sheba (GA) correct me if I’m wrong. Feline diabetes is a marathon not a sprint. Keep that in mind. And if you follow TR, you’d be increasing every 3 days instead so maybe that’s the bet protocol for you, but sadly it doesn’t work if you’re feeding dry food.
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With SLGS you wait 7 days between each dose increase.
You are testing enough to do TR but the stumbling block is you are feeding dry food. Even if it is low carb dry food, you can’t do TR.
 
@Bron and Sheba (GA) @Ale & Bobo & Minnie (GA) @Diane Tyler's Mom

  • We have some blood ketones tonight 0.1 mmol/L. At what point should I worry about Ketones?
  • Glucose this evening was 479.

Today was a stressful day:

1.) She had to get a bath (which she tolerates well), her paws and chest were brown/gray from constantly being wet because she dunks her whole chest into the water fountain to drink. I've got 4 different kitty fountains available, I just tried to put out a different design that will hopefully help a little. She practically gulps water.

2.) I tried changing her wet food in order to find one that she would eat. Her current wet food she nibbles at, but leaves about half of it. She ate neither of the 2 options i presented. I mixed in her hydracare with the first food, which means she also didn't drink the hydracare today either. She got 100% of her calories from dry food today. Putting her food back to normal tonight and tomorrow to try and relieve some stress which i'm sure isn't helpful for glucose or ketones.
 
EugeneR said:
We have some blood ketones tonight 0.1 mmol/L. At what point should I worry about Ketones?
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0.1 on the blood ketone meter is nothing to worry about.
EugeneR said:
tried changing her wet food in order to find one that she would eat. Her current wet food she nibbles at, but leaves about half of it. She ate neither of the 2 options i presented. I mixed in her hydracare with the first food, which means she also didn't drink the hydracare today either. She got 100% of her calories from dry food today. Putting her food back to normal tonight and tomorrow to try and relieve some stress which I'm sure isn't helpful for glucose or ketones.
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Is the dry food you are feeding her the low carb dry?
Just keep doing the swap over to wet food slowly and test daily for ketones.
I like all your notes in the remarks column...very helpful.
I can see you are swapping the dose between 1.25U and 1.5U in the last few days. I would stay with the 1.5 dose both am and pm cycles as lantus likes consistency and the 1.25 dose is not enough insulin.
The things that will keep the ketones away are food and insulin...and fluids. So we need to make sure she gets enough insulin and enough food and is drinking well. What is your kitty's name? Can you put her name in the signature please?
 
Bron and Sheba (GA) said:
Is the dry food you are feeding her the low carb dry?
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Yes the dry food is Dr Elsey's Chicken, It's on the CKD list as being low carb and moderate phosphorous.
Bron and Sheba (GA) said:
I can see you are swapping the dose between 1.25U and 1.5U in the last few days. I would stay with the 1.5 dose both am and pm cycles as lantus likes consistency and the 1.25 dose is not enough insulin.
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My normal Dr suggested a split dose for a few days in case she winds up going hypo over night. I am doing 1.5U AM/PM now.
Bron and Sheba (GA) said:
The things that will keep the ketones away are food and insulin...and fluids. So we need to make sure she gets enough insulin and enough food and is drinking well. What is your kitty's name? Can you put her name in the signature please?
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Her Name is Shenanigans
 
As far as food flavors, if she likes fish, feed her fish. Forget about making her eat a rotation of flavors and types, if she likes fish flavors and eats them consistently, feed her the fish. If she suddenly likes something else, feed her that. Forget about the potential mercury problem with feeding a lot of fish, she's over 15 years old, she's having severe health problems and a very low quality of life right now, so if the likes the fish, feed her the fish already. If she was 2 years old, yes, long term health effects from her food choice are a consideration. But she's not. She's old, she's sick, she needs to eat more importantly than she needs to eat a perfect diet.
I have four cats, two with opposing food allergies. So, since controlling who eats what is too difficult, they all eat FF Turkey, Tiny Tiger Turkey, and sometimes American Journey Turkey. Every day, every meal. And they are fine. And they start hanging out in the kitchen and running to see if it's meal time yet every single day, four times a day, running in, tripping us, running to where we put the bowls out. Do we sometimes feel bad they don't get variety? yes. But is it worth having two long-haired cats with diarrhea if we tried putting out a variety and someone got someone else's food? nope. So turkey only it is.

As for the peeing outside the box--one of our cats will pee in the box, but not poop in the box (started this when he got pancreatitis as a kitten). Poops on the floor in front of the box. So, we got plastic-backed paper, like the kind a butcher wraps up your order in, a big roll of it, and we cut sheets and leave them on the floor in front of the box where he poops. Then it's just roll them up and throw it away. We leave like 10 sheets at a time there, so it's easy to just roll up the top one and chuck it. (Actually have a bucket there, with a tight lid, they go in the bucket and get taken to the trash outside about every other day.)
Since he pees outside the box, get some very large pee pads, and put them where he pees. There is a great site for these, very good prices and choice of thickness (capacity) size, etc. https://www.poopeepads.com/ You might have to anchor the corners down with a weight, even just a rock will do, or a paperweight, whatever. Another thing that might possibly help is to get a large, really large, pan or tray to put under the litterbox, like the tray that goes in the bottom of a large dog crate, the biggest one you can find, so that the litterbox fits in it with plenty of room in front and around it to catch the cat pee, and then put the pee pads in the tray, so that you have a double layer of protection. At least then the peeing problem is manageable, cleanable, and your house is protected. Our paper-pooper has been doing his thing for over 3 years now, figuring out our system to handle it has made life so so so much easier.

https://www.poopeepads.com/
 
@Gracie85 Thanks for the link for the poopeepads!

So the only wet food i can get her to eat well so far is Applaws, i've only tried the fish flavors, however applaws is nutritionally incomplete and not for regular feeding, only supplemental. I've tried other fish flavors with limited success so far. It's difficult to find fish foods that are both low carb and low phosphorous though.
 
Unfortunately up until now she's been peeing next to the litter box. In the last 24 hours She has peed in my kitchen twice, and once in her week old expensive memory foam cat bed that I just had to throw out. No ketones today, and she ate well. Glucose is still very elevated.
 
Isolated her in the bathroom overnight incase she had any more accidents, along with a webcam to monitor her. She used the box appropriately twice. Holding off on bringing her into the ER, unless we have another accident that's different from her normal behavior of peeing over the edge of the box.

Also aggressively trying to find a wet food she'll tolerate. Put down 4 different foods this morning, each one 45 minutes apart. I had some fussie cat that i was trying to avoid because of the carageenan, but she seemed to be all over it. I'm just going to focus on a low carb wet food she'll enjoy to get her off kibble (even if it is low carb kibble) and hopefully get her glucose in check faster, then i can worry about transitioning her to a low carb low phosphorous food by mixing them and introducing a less desirable food little by little. I'm also going to pick up some friskies today, since she's turning her nose up at almost every tiki cat and weruva food i've been trying.

Also due to her possible lymphoma/ibd, i think i'm going to set an end goal of identity bison/rabbit/beef, since they seem to be around 8% carb by dry matter, and less than 1% phosphorous.
 
@Ale & Bobo & Minnie (GA) @Bron and Sheba (GA)

I've been drawing excess insulin into the syringe then squirting it back into the bottle to get to the right dose. I didn't realize i wasn't supposed to do that until i read another post here. Have i possibly ruined the insulin?

The pharmacy gave me these incredibly cheap syringes that pulled "sticky" air bubbles every single time and impossible to get all the air bubbles out of, i managed to get some BD 1/3cc syringes with .5iu markings and they draw in almost zero air bubbles. My state syringes aren't OTC, but i found a medical supply that shipped them to me online.

Also really surprised that her glucose doesn't seems to be responding well to the increased insulin doses. Is it possible she's insulin resistant? Is it possible i'm just injecting her wrong? Possible I'm testing her wrong causing wacky numbers? Possible the dose is too high and she's rebounding? Or am I just expecting too much too soon? I guess at what point in increasing her dosage are we outside of the "norm" where we have to consider that there may be some kind of user error?

@bon
 
The pee accidents are likely because she’s still unregulated. Can you wash the bed? I was washing Minnie’s bed every day then I got some that had a cover so I would put a pee in between the foam and the cover and I’d only have to wash the cover

I always did that and my insulin was always fine. I know you’re not suppose to so if I were you and you’re worried about it, just don’t do it moving forward. Can you get the Relion syringes from Walmart?

let me look at the ss. Hold on
 
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