Just diagnosed today and I'm kind of panicking

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rach and mr banks

Member Since 2023
Hello, terrified pet mama here.

Im not sure if this is the right subform for this, please let me know if I'm in the wrong area!

I haven't had time to fully read the whole website, I'm trying to slowly work my way through it but I'm having trouble absorbing the information with how panicked I'm feeling. I'm sort of overwhelmed and terrified (I may or may not have spent the day bawling). I was hoping for some piece of mind. As of right this second, I have 3 main questions that I hope someone can help with. 1) what brand of insulin do you this is best? Especially in regards to remission 2) I feel extremely overwhelmed, do you suggest any particular article or something that you suggest I prioritize reading first? I plan of reading everything I can but I wasn't sure if maybe there's something I should for sure know first. And 3) I'm going to talk a little about the situation, if you have time to spare, can you please give me advice on how serious/urgent my cats condition is and if you think my vet is being odd?

My cat is 15 yrs old. He's had asthma since he was 5 but has been pretty healthy besides that, the occasional bad tooth, and a single case of cystitis. This past week or so he started acting off (dribbling urine, having accidents in his sleep, and his back legs seemed weak) so I got him to the vet to get some blood work done. That was on the 15th. The vet called me back this evening (16th) and said he had serious/critical diabetes (358) and stage two kidney disease (BUN 52). He had glucose in his urine (3+) and ketones were also present (trace).

However, I'm honestly kind of... unsure of some of the things she said. She said that if he isn't treated within a week, he'll die. He could die anytime within the next 7 days. But then she said she doesn't have any insulin at the office and that she'll try to order it Monday. When I requested a prescription to take to a pharmacy over the weekend, she refused to give me one because "human pharmacies don't carry pet medication". Which I know isn't true - I get his asthma medication at CVS for crying out loud - in the moment I was in a full blown panic attack and breakdown; I was just told my cat, who i have been with since he was 2 weeks old, who I love dearly, would be dead in 7 days if I didn't do something immediately. So I just agreed to whatever she said - she wants me to come in Tuesday or Wednesday to get him insulin - depending on when she gets it. After I calmed down, I realized how strange it was. If he's at that severe of a risk, why is she making him wait half a week? I asked if i should contact an ER vet for an emergency insulin shot and she said no, to wait till she got the medication. I KNOW I could've gotten insulin today if I had the prescription but she wouldn't give me one. I have a suspicion that she wants me to get it from her because of the money - she didn't tell me what the brand was but she quoted me $187 for "maybe" a 2 month supply (1-2units a day). From what I've read and been told, that seems high.

Not only that, as soon as she gave me the news, my first question was about at home monitoring since I know at least for humans, that's very important for treatment... and her response was that it was not important nor at all necessary for me to monitor his blood sugar at home. And that "we aren't as strict with cat glucose levels as we are with humans". Even though I haven't had much time to research and educate myself, I don't understand how that is possible. Why wouldn't it be important for me to test his blood sugar when I'm administering INSULIN? How am I supposed to know if it's working or if his sugar is crashing?

There were several other red flags (such as finding out that he had high blood sugar and BUN over 1.5 years ago yet she told me his results were perfect) but, it's not important at the moment. Overall, I currently don't trust her with bubba. I'm going to be seeing another vet in the morning - they're technically an ER vet hospital but it's Sunday and I need a second opinion because even though i don't trust her, I'm terrified to wait after being told he could die anytime in 7 days. I'll seriously considering looking into finding him a new vet after I see what the vet tomorrow has to say.


All that said, in your experience, are these numbers actually as critical as she said?
For a little more information on bubba.
He is a domestic short hair, neutered male. He weighs about 9.5-10 lbs. He had lost weight in the last year (around 5 lbs) but there have been several big factors that could have influenced that. He recently switched to Fancy Feasts Classic Pate/Fancy Feasts Senior/Fancy Feasts Savory Centers (maybe 2weeks ago max?). He's on a low dose of prednisolone (0.4mL of a 15mL/5mg solution every other day or when symptoms occur). His glucose at the office was 358. I have a glucometer at home so, after watching videos, I tested him tonight to see if his numbers had been high due to stress. Bubba likes eating smaller meals throughout the day. So, he had a snack at around 5pm (some chicken baby food, he loves it every now and then and the vet had suggested it when he was being picky with his food so i keep a small stock of in just incase he stops eating again. I dont give it to him often, I just thought he deserved a treat since hes been acting depressed since the vet visit. The vet called 10 mins later). He was 409 at 8:30pm. He had dinner afterwards. 30 minutes after eating, he was at 391. 1 hour after eating, he was at 381. 2 hours after eating, he was 363. Side note, is that normal for a diabetic cat? For the blood sugar to actually decrease after a meal?


Thank you for reading and for any advice you can give me. Again, I apologize if I'm posting in the wrong area. I'm also sorry for such a long post, I think I might have rambled a bit haha
 
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Hi and welcome to the forum.
First of all, if your kitty is showing traces of ketones in the urine, he needs to start insulin as soon as possible.
I am very surprised your vet did not start him immediately on insulin.
Ketones can form in diabetic kitties when they are not getting enough insulin and enough food.
I am not concerned about his blood glucose numbers as such. Most diabetic kitties have BGs ranging 250 up to 500 in the beginning.
It is the ketones that I am concerned about.
I think it is a very good idea that you get a second opinion in the morning.
Ask them to put him on Lantus or biosimilar insulin and the starting dose is around 1 unit. Don’t leave without getting the insulin or the script to get it from a pharmacy.
In the meantime make sure he is eating lots of food as this will help keep ketones away.
I’ll post this but I want to address your other issues.
 
Welcome to FDMB!

First, take a few deep breaths. You found the best possible place that you never wanted to be. This is a wonderful community of caregivers who will offer both support and knowledge that will allow you to negotiate your cat's diabetes. If your vet is going to raise your anxiety to panic proportions, I would have hoped she would have been responsive to your requests and acted accordingly.

The first thing I'm going to suggest that you read are the guidelines published by the American Animal Hospital Assn for the treatment of diabetes. Their guidelines were published in 2018 and updated last year. To the extent that your vet gives you a hard time, you have information that is published by a leading veterinary professional group.

The AAHA recommends either Prozinc or glargine (or detemir) for the treatment of feline diabetes. Prozinc is formulated for animals. Glargine (or more commonly called Lantus) is a human insulin but has been widely used for treating cats. Glargine has been studied extensively by Roomp and Rand since 2009 and has a very strong research based track record for getting cats into remission. Prozinc also works well -- glargine has just been studied more. You can get generic/biosimilar glargine at most pharmacies. So, you are correct in that insulin is available at human pharmacies and vets cannot sell a human insulin. You do not want to be prescribed Vetsulin or Novolin. Their duration is too short for a cat's fast metabolism.

The presence of ketones is a warning sign. I would suggest you make a pharmacy run and pick up Ketostix. These are strips that will test your cat's urine for the presence of ketones. If the level starts to exceed trace, it could be an emergency. In order to do your best to prevent that from happening I have two suggestions.
  • First, switch your cat to a low carbohydrate, canned food diet. You have a ton of choices. This is a link to a chart with information on canned food available in the US and includes the amount of carbohydrates. You want to select foods that are less than 10% carb -- however, most members opt for foods that are in the neighborhood of 5%. Many people here use either Fancy Feast of Friskies pate style food. The FF classics are generally low in carbs. I'm not sure about the Savory Centers.
  • The other suggestion is to add some water to your cat's food. Keeping a cat hydrated is good for a number of reasons but if you're seeing ketones, it helps to dilute them.
Perhaps we have more experience than your vet when it comes to feline diabetes. 358 is definitely a blood glucose number that's in the diabetic range. However, it's not off the charts. Generally, numbers do rise after eating. However, when we eat, the pancreas begins to produce endogenous insulin to help the breakdown of food (i.e., breakdown into glucose) in order to move glucose from the blood into the cells. So, seeing a small decrease in Bubba's numbers may mean that his pancreas is still working. On the other hand, the difference you were seeing were not huge. There's about a 20% variation in any test result so the numbers were actually pretty consistent.

Unlike your vet, we strongly encourage home testing. It is the best possible way to keep Bubba safe just as you noted. It also means you don't have to be running to the vet to get your cat tested over a 12-hour period (aka a "curve"). You cat will not be stressed at home and numbers at the vet's office will be artificially higher due to stress. I'm very glad you looked at the home testing info and have started to test.

Also, BUN is not the only lab value that contributes to a diagnosis of kidney disease. In fact, BUN isn't used to stage kidney disease. Your vet needs a creatinine level and an SDMA level to stage kidney disease. The IRIS staging recommendations are linked.

Why was Bubba prescribed prednisolone? This may be steroid-induced diabetes. Any corticosteroid can cause a rise in blood glucose. It sounds like you have copies of Bubba's labs. Were his glucose levels above 120 for some time? If the prednisolone was prescribed for his asthma, typically a systemic steroid isn't prescribe. Usually, an inhaled steroid is what's used (e.g., Flovent).

There is a HUGE volume of information on this website. It is very overwhelming. I've been here a long time and I'm still finding either new information or something that I missed even in materials that I thought I was familiar with. Please ask questions. We're here to help.
 
rach and mr banks said:
All that said, in your experience, are these numbers actually as critical as she said?
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Most diabetic cats when diagnosed have high BGs (blood glucose). It can range from 200 to over 500. Once he starts on insulin he will hopefully start to get better numbers. But it can take time. But the i portent thing is to get him started on insulin with those ketones.
rach and mr banks said:
He's on a low dose of prednisolone (0.4mL of a 15mL/5mg solution every other day or when symptoms occur). His
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What is he on the prednisolone for?


rach and mr banks said:
Side note, is that normal for a diabetic cat? For the blood sugar to actually decrease after a meal?
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With meter variance (20%) the BGs of 409, 391 and 381 are very similar.
What we recommend you do is test before you feed…that is called the preshot BG, then you feed, then you give the insulin. Then you can test maybe +2 which is 2 hours after the dose or +4 which is 4 hours after the dose etc.
We have a spreadsheet which I would recommend you set up and the signature which will tell us all about your boy.
Her is the link HELP US HELP YOU
rach and mr banks said:
and stage two kidney disease (BUN 52). He
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If he does have stage 2 kidney disease I would look at feeding a low phosphorus low carb diet. You can find suitable foods here. Look for foods that have 200 mg or less mg phosphorous /100kcals AND 10% or under carbs.FOOD CHART
Weruva brand also has plenty of low phosphorus foods. Look up their website.
Fancy feast is too high in phosphorus.
In regards to food and when fed, we recommend you feed a good meal before each dose of insulin and the given 2 or 3 snacks during every cycle mainly during the first 6 hours after to dose of insulin. A snack is a teaspoon it preshot two of low carb food.

rach and mr banks said:
feel extremely overwhelmed, do you suggest any particular article or something that you suggest I prioritize reading first?
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It is normal to feel overwhelmed at first. I think the FAQ page is a good please to start HERE
rach and mr banks said:
This past week or so he started acting off (dribbling urine, having accidents in his sleep, and his back legs seemed weak) so
Click to expand...
Did the vet check his urine for an infection? If not I would ask the vet tomorrow to check it.
The back leg weakness is called diabetic neuropathy and many diabetic cats get it. It will improve once the BGs are more under control. You can also get a tablet called Zobaline from lifelink which is specifically for cats with neuropathy. Your vet will most likely not know about it.
Most vets do not know a lot about feline diabetes.

So your priority is
  • seeing the new vet tomorrow and getting your boy started on insulin.
  • Buy a bottle of Ketostix from Walmart or a pharmacy and test the urine every day for ketones…this is very important that we know what the ketones are doing.
  • Buy low carb low phosphorus food.
  • Feed plenty of food to combat the ketones.
  • Make sure he is drinking plenty of water. You can add a teaspoon of warm water to his snacks.
  • Feed 2 main meals a day and several snacks during each cycle
  • Start testing the BGs before every dose and again during the cycles
  • Set up a spreadsheet and add the BG data to it and set up your signature
  • Post here daily for help and support.
  • Ask lots of questions.
 
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What did the er vet say? Were you able to get a prescription for Lantus to Prozinc? If you’re in a hurry to get him started, Lantus would be faster since you can get it at any human pharmacy while prozinc is a pet insulin and I’m thinking it needs to be ordered from a pet pharmacy unless they can sell it to you.
 
i hopw im quoting right ...

Bron and Sheba (GA) said:
What is he on the prednisolone for?
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He's on prednisolone for his asthma. Truthfully, I don't know why his original vet who diagnosed it only gave me that option. I was very young at the time (19) and didn't ask much questions(very dumb of me). As he got older, and I switched vets, I inquired about switching to an inhaler but the general consensus has always been "he isn't experiencing any issues related to it/he is in overall good health so if it's controlling him, let's leave him on it". That was one issue I had with his vet the other day, Ive been pushing for a change since he was showing some symptoms but instead she called in more prednisolone scripts.


Bron and Sheba (GA) said:
If he does have stage 2 kidney disease I would look at feeding a low phosphorus low carb diet. You can find suitable foods here. Look for foods that have 200 mg or less mg phosphorous /100kcals AND 10% or under carbs
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If his phosphorus lab results are all normal right now, do you think it's something I need to address right away? I'm planning on discussing his kidneys with his vet once we get his diabetes at least somewhat addressed.

thank you very much for the resources though, ill definently start looking into better food options for him.

Bron and Sheba (GA) said:
Did the vet check his urine for an infection?
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Yes, a urinalysis was done and it came back all normal besides the glucose and ketones. No infections according to that. The ER vet suggested doing a culture in a week or so if he shows any other symptoms.

Thank you so much for all the information!
 
UPDATE ON BUBBA

thank you all for your input, I'll reply to everyone after I've napped since I haven't slept in about 36 hours.

I got him into the emergency vet. They immediately got me a script for 1 unit, twice a day of lantus. He may need to go back in for fluids but he looks okay for right now. I started him on insulin this afternoon. He was 340 prior to the injection. 2 hrs after, he dropped to 277. 4 hours later, he dropped to 212. He seemed a little nauseous (he was grumbling a bit and kept swallowing but no vomit or gagging) exactly 1 hr after the injection, but it only lasted about 5 minutes and he seems okay now. I called the vet and told him and he said it was probably okay and thinks it's unrelated and to just watch him. He eaten since and seems to be acting normal at the moment.

My local store didn't have ketone tests so I'll be ordering them online as soon as I have the brain power to understand the written word.
 
Well done getting the Lantus insulin and starting it. That is good news.
And great you are testing already.
Keep feeding lots of food for now.
In regards to food and kidney issues.. I would wait and get bloods retested in a couple of weeks when things have settled down a bit. Post your blood results and someone will look at them for you.
Would you like help setting up the spreadsheet?
 
Bron and Sheba (GA) said:
Well done getting the Lantus insulin and starting it. That is good news.
And great you are testing already.
Keep feeding lots of food for now.
In regards to food and kidney issues.. I would wait and get bloods retested in a couple of weeks when things have settled down a bit. Post your blood results and someone will look at them for you.
Would you like help setting up the spreadsheet?
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Yeah, I'm trying to focus on getting his diabetes handled before I tackle his kidneys. I also got a script for a steriod inhaler for him but he's still going to have to be weaned off his prednisolone over the next few weeks/month. I'm going to be trying to get that in the next few days.

Do you think his numbers after the insulin are okay? At 4 hrs he was 212 (from 340).

Oh my gosh yes, that'd be great.
 
@Bandit's Mom would you be able to help Rach with the SS please?
Yes it looks like he has had a very good response to the lantus. The thing to remember is that lantus is a depot insulin and it will take 5 to 7 days for the depot to fill and for the full effect of the dose to be felt. So keep testing the BGs and don.t increase the dose for 7 days. If the BG drops below 90 you will need to reduce the dose.
Once you are set up a bit more we will tell you about pour 2 dosing methods.
What type of glucose meter do you have?
 
Welcome @rach and mr banks
You couldn't have found a better group to join.
With the help of all the members here and me taking their advice Tyler has been in remission since 1-24-21 He was also on Lantus
Just remember to withhold food 2 hours prior to testing his AMPS ( AM Pre Shot first test in the AM and same goes for the PMPS test because you don't want his BG to be influenced by food.
I know Lantus is expensive in the US ,I don't know if you got the brand name ,next time you might need insulin most use Glargine the generic for Lantus which is much cheaper.
I can give you suggestions where to get it with a coupon

Did you get the U-100 syringes with the half unit markings , we use those so we can adjust the doses by 0.25 units. If you got the Lantus pen you can only adjust by full units so we use the syringes and insert them in the gray rubber stopper in the pen and draw out the insulin from there
If down the road you want some suggestions for a low carb/low phosphorous wet food I can give you a list ,just ask me .
You are in good hands here :cat:
 
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rach and mr banks said:
My local store didn't have ketone tests so I'll be ordering them online as soon as I have the brain power to understand the written word.
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You can get the ketostix at Walmart, Walgreen's, CVS or any pharmacy so you don't have to order them
For the diabetic neuropathy
You can order this Methyl B-12 . I have used it for years and a lot of other members use this Methyl B-12 , just open up the capsule mix it in with the wet food add some water, it's tasteless.

The Zobaline is too expensive it's like 34.00 for 60 tablets
I used it Zobaline in the beginning but got too expensive and a member here told me about the Vitacost brand

https://www.vitacost.com/vitacost-vitamin-b-12-methylcobalamin-5000-mcg-100-capsules-6
14.49 for 100 capsules
Give one a day



Once you get mr banks BG under control this will help with it also.
Tyler had diabetic neuropathy and it took about 1-2 months and he was back to jumping, running etc.
I did see an improvement every 2 weeks
You can start it now if you want to
 
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Bron and Sheba (GA) said:
@Bandit's Mom would you be able to help Rach with the SS please?
Yes it looks like he has had a very good response to the lantus. The thing to remember is that lantus is a depot insulin and it will take 5 to 7 days for the depot to fill and for the full effect of the dose to be felt. So keep testing the BGs and don.t increase the dose for 7 days. If the BG drops below 90 you will need to reduce the dose.
Once you are set up a bit more we will tell you about pour 2 dosing methods.
What type of glucose meter do you have?
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Is Glargine also a depot insulin? I would assume so since it's the generic but just to verify! That's good to know though. Thank you so much

I'm using a free style glucose meter on him at the moment.
 
rach and mr banks said:
Is Glargine also a depot insulin? I would assume so since it's the generic but just to verify! That's good to know though. Thank you so much

I'm using a free style glucose meter on him at the moment.
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Yes Glargine is also a depot insulin
The meter is fine that you are using , if you want to save money on the test strips
most of us use the Relion Premier Classic Meter
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
 
Diane Tyler's Mom said:
You can get the ketostix at Walmart, Walgreen's, CVS or any pharmacy so you don't have to order them
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right after I replied, I spoke to my mom and mentioned them. Turned out she had some since she had been considering a keto diet so she brought me her unopen bottle! I tested him last night and he showed trace amounts. It wasn't quite as pink as trace but it was definitely closer to trace than negative. But today, it's much closer to negative. I've been doing a negative strip as a control each time I test his urine and the last time they looked nearly the same. His strip was just a tinge darker.


Diane Tyler's Mom said:
You can order this Methyl B-12 . I have used it for years and a lot of other members use this Methyl B-12 , just open up the capsule mix it in with the wet food add some water, it's tasteless.
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OH I'll definitely order some in that case. His legs are too bad yet, but there is definitely some weakness. For example, when he shakes himself off, he sometimes stumbles. But he's still jumping up and down off things. He's mainly moving a bit slower and more careful with jumping. Either way, I had been planning on ordering Zobaline later next week but if that'll work, I'll try it instead! Thank you for the recommendation!
 
rach and mr banks said:
right after I replied, I spoke to my mom and mentioned them. Turned out she had some since she had been considering a keto diet so she brought me her unopen bottle! I tested him last night and he showed trace amounts. It wasn't quite as pink as trace but it was definitely closer to trace than negative. But today, it's much closer to negative. I've been doing a negative strip as a control each time I test his urine and the last time they looked nearly the same. His strip was just a tinge darker.
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Just make sure the strips aren't expired and remember what Sienne said in her post #3 , post numbers are to the right of each post
. If the level starts to exceed trace, it could be an emergency. In order to do your best to prevent that from happening I have two suggestions. Just re read her post again
 
Diane Tyler's Mom said:
Just make sure the strips aren't expired and remember what Sienne said in her post #3 , post numbers are to the right of each post
. If the level starts to exceed trace, it could be an emergency. In order to do your best to prevent that from happening I have two suggestions.
Click to expand...
I double checked, they're good until the end of 2024. She got them recently and kept them stored properly and never opened them so I think they're okay.

He's a little water fiend - always has been. He's still drinking water as usual and I have been adding a bit of water to his food just to make sure he's getting enough to flush the ketones out. He definitely wasn't above trace yesterday - it was slightly lighter than trace but not above it(between neg and trace, closer to trace. Currently, hes closer to negative.). I'll keep a close eye on it and have the info for a 24hr vet just incase he gets above trace though.
 
Do you have your hypo kit ready in case you need to bring his BG up
10% and under is low carb
11% -15 is medium carbs.

16- 24 is high carb.
from The Official Lantus, Levemir & Biosimilars Slang Dictionary MC =11=15% and HC is usually 16-24%
For your Hypo kit
Med and High Carb food and some honey



Fancy Feast Gravy Lovers Gourmet Beef Feast in Gravy 20% High Carbs

Fancy Feast Gravy Lovers Gourmet Chicken Feast in Gravy 15% Med Carbs

Fancy Feast Gravy Lovers Turkey Feast in Gravy 15% Med Carbs

Fancy Feast Gravy Lovers Chicken and Beef in Gravy 15% Med Carbs

Good idea to mark the cans with magic marker how many carbs

Or any on the food chart. Doesn't have to be Fancy Feast just an example about the med and high carb foods

https://felinediabetes.com/FDMB/threads/dr-pierson-new-food-

@rach and mr banks
 
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@rach and mr banks
If you can set up your signature that would be great , then Bhooma
@Bandit's Mom can set up your SS for you
Thanks Bhooma just in case you didn't see Bron's tag in post #12
Tap in your name up top then tap on the word signature and add this info about mr banks
  • Add info we need to help you:
    • Caregiver & kitty's name
    • DX: Date
    • Name of Insulin (do not include dose or frequency)
    • Name of your meter
    • Diet: "LC wet" or "dry food" or "combo"
    • Dosing: TR or SLGS or Custom (if applicable)
    • DKA or other recent health issue (if applicable)
    • Acro, IAA, or Cushings (if applicable)
    • Spreadsheet link. Please put the signature link on the bottom line of your signature information, on its own, so it is easy to find.
    • Please do not put any information about your location in the signature for security reasons. If you wish to add your country location, please add it to your profile.
Be sure to click the 'Save Changes' button at the bottom. If you need help urgently it is important we know these things at a glance. We don’t want to waste valuable time finding out information.


See mine about Tyler , everyone's is in gray writing
I would read this link anyway
Here is the link HELP US HELP YOU
 
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