Newly diagnosed diabetes

[giotto]

Hi All - I am so glad I found this forum. My love was diagnosed with feline diabetes yesterday. This past December 30, he had full blood and urine work, and xrays. He was ok, with just a UTI that was treated with a shot. Fast forward to now, and he had been drinking more and peeing more, and also meowing more. I knew something was up, as it was different than his UTI symptoms. I was right. I don't have his lab results, but some thing 3.5 or 3 something was mentioned in his urine, and he also had sugar in his blood levels, which is how they confirmed it was diabetes. He is about 14 1/2 (rescue) and he is a shocking 18+ pounds. He was 15+ pounds last may, so he gained weight. However, the vet had him at 19+ lbs. this past December (I did not know this at the time). I have been trying to have him lose weight, so I am not sure if the 1+ lb is due to diabetes or me cutting back, or maybe both. The vet said we could put him on purina proplan DM and in one month we will retest, as there is a possibility his levels could go down so he wouldn't have to take insulin. She also mentioned there is a pill insulin now. Does this plan sound familar to anyone? I am so upset, and would appreciate any advice, experiences that any of you have had. I only want the best for my boy, and I want to do whatever I can at any cost.
Thank you so much for anything you can provide.

 

[Bron and Sheba (GA)]

Hi and welcome to the forum.
First of all I would ring the vet and ask him if ketones were found in the urine. I am concerned the 3 or 3.5 you mentioned in the urine might be ketones. If this is the case your kitty needs to start on insulin immediately. Please don’t wait a month as ketones in a diabetic cat won’t go away on their own and he could end up with the much more serious DKA which can be deadly and very expensive to treat and is preventable.

Also he does not have to be on the prescription food. What he needs is a low carb wet food, we recommend 10% or under carbs. I will give you a link to a FOOD CHART. Look for carbs under 10%. Around 5 to 7% is best.
Make sure he is eating well as this is important in diabetic cats. Ketones can form when there is not enough food and not enough insulin being given. This is why I want you to check with the vet about ketones in the urine.

if there are no ketones in the urine you could try a food trial for a couple of weeks but I would not leave it a month. And during that time I would test the urine for ketones to check they are not forming.
You do this by by buying a bottle of Ketostix from Walmart or a pharmacy and collecting a urine sample and reading the exult exactly 15 seconds after you dip it in the urine against the colours in the bottle. Thee should be no ketones.

In regards to giving oral medication…there are pros and cons for it. they are only new and so we have not seen a lot of cats on them although more are appearing. There is an increased risk of ketones forming and you would need to be testing for those. It only suits some cats. And not older cats I believe.
HERE IS A LINK TO INFORMATION

Personally I would rather have my cat on insulin, but that is my opinion.
Keep asking questions.

 

[Sienne and Gabby (GA)]

The newer pill/liquid options are only possible if your cat does not have ketones. The newer treatments for feline diabetes are described in this post. I suspect your vet was referring to Senvelgo or Bexacat.

I wholeheartedly agree with what Bron posted.

 

[giotto]

Thank you so much for your replies. I asked my vet about ketones and she said he does not have any in his blood test and his kidney and liver are fine. I believe she is talking about the oral Bexacat, but I have to check. I had already ordered the purina proplan upon diagnosis, and the wet pate is a dry matter ratio – 6.63. I am waiting for that to arrive, and I am now just feeding him his wet Blue Buffalo WU Rx food that has about a 9 dry matter ratio. I completely cut out his dry WU food that he mostly ate. He has a ravenous appetite and doesn't like that he is receiving less food (1 1/2 cans) and no dry. We still give him bits of pressure cooked chicken breasts in between, and I serve the food in 3-4 small servings througout the day. I will buy that test for keytones and give this diet a shot as I noticed in just the one day that he is peeing a little less quantity and also drinking a little less. I am praying it keeps going in that direction.
Thank you so much again, I am so grateful I found this site. Any other suggestions/comments are welcomed and appreciated.

 

[giotto]

Hi and welcome to the forum.
First of all I would ring the vet and ask him if ketones were found in the urine. I am concerned the 3 or 3.5 you mentioned in the urine might be ketones. If this is the case your kitty needs to start on insulin immediately. Please don’t wait a month as ketones in a diabetic cat won’t go away on their own and he could end up with the much more serious DKA which can be deadly and very expensive to treat and is preventable.

Also he does not have to be on the prescription food. What he needs is a low carb wet food, we recommend 10% or under carbs. I will give you a link to a FOOD CHART. Look for carbs under 10%. Around 5 to 7% is best.
Make sure he is eating well as this is important in diabetic cats. Ketones can form when there is not enough food and not enough insulin being given. This is why I want you to check with the vet about ketones in the urine.

if there are no ketones in the urine you could try a food trial for a couple of weeks but I would not leave it a month. And during that time I would test the urine for ketones to check they are not forming.
You do this by by buying a bottle of Ketostix from Walmart or a pharmacy and collecting a urine sample and reading the exult exactly 15 seconds after you dip it in the urine against the colours in the bottle. Thee should be no ketones.

In regards to giving oral medication…there are pros and cons for it. they are only new and so we have not seen a lot of cats on them although more are appearing. There is an increased risk of ketones forming and you would need to be testing for those. It only suits some cats. And not older cats I believe.
HERE IS A LINK TO INFORMATION

Personally I would rather have my cat on insulin, but that is my opinion.
Keep asking questions.[/QU

Hi and welcome to the forum.
First of all I would ring the vet and ask him if ketones were found in the urine. I am concerned the 3 or 3.5 you mentioned in the urine might be ketones. If this is the case your kitty needs to start on insulin immediately. Please don’t wait a month as ketones in a diabetic cat won’t go away on their own and he could end up with the much more serious DKA which can be deadly and very expensive to treat and is preventable.

Also he does not have to be on the prescription food. What he needs is a low carb wet food, we recommend 10% or under carbs. I will give you a link to a FOOD CHART. Look for carbs under 10%. Around 5 to 7% is best.
Make sure he is eating well as this is important in diabetic cats. Ketones can form when there is not enough food and not enough insulin being given. This is why I want you to check with the vet about ketones in the urine.

if there are no ketones in the urine you could try a food trial for a couple of weeks but I would not leave it a month. And during that time I would test the urine for ketones to check they are not forming.
You do this by by buying a bottle of Ketostix from Walmart or a pharmacy and collecting a urine sample and reading the exult exactly 15 seconds after you dip it in the urine against the colours in the bottle. Thee should be no ketones.

In regards to giving oral medication…there are pros and cons for it. they are only new and so we have not seen a lot of cats on them although more are appearing. There is an increased risk of ketones forming and you would need to be testing for those. It only suits some cats. And not older cats I believe.
HERE IS A LINK TO INFORMATION

Personally I would rather have my cat on insulin, but that is my opinion.
Keep asking questions.

Thank you for this. My cat does not have Ketones as of last Wednesday. I have been feeding him low carb (under 10) and eliminated all dry food. He did not start any insulin, as the vet wants to see if he can turn it around by diet. Have you ever heard of this? He is peeing and drinking a little less since I stopped the dry food. However, today I added a little Purina Proplan DM (not savory, but pate) to his existing wet food as the vet had recommended it and I am trying to switch him by doing it slowly. Right after he ate the mixed food, which was the 2nd time for him to have the new food being introduced, he kept going to the box and he was doing a soft stool, and he also vomited the food up (liquid version of food, not bile or foam). Is there anything I should be doing? I will buy a ketone tester and start doing that during the month as suggested. Just want to make sure I am not missing anything, and/or need to be looking for anything else during this long month of waiting. I am thinking of not using the Puring and just keeping him with the W&U blue buffalo wet food, which is 7 or 8 carbs. The Purina has meat by-products as well as some artificial flavors, which I found very disappointing. the W&U has pure chicken and all natural flavors, so I am leaning towards keeping hin on that. Thank you for any additional information you can provide it is so much appreciated.

 

[Bron and Sheba (GA)]

He has a ravenous appetite and doesn't like that he is receiving less food (1 1/2 cans) and no dry. We still give him bits of pressure cooked chicken breasts in between, and I serve the food in 3-4 small servings througout the day

Why is he getting less food?

 

[Bron and Sheba (GA)]

You wrote:
Right after he ate the mixed food, which was the 2nd time for him to have the new food being introduced, he kept going to the box and he was doing a soft stool, and he also vomited the food up (liquid version of food, not bile or foam). Is there anything I should be doing? I will buy a ketone tester and start doing that during the month as suggested. Just want to make sure I am not missing anything, and/or need to be looking for anything else during this long month of waiting. I am thinking of not using the Puring and just keeping him with the W&U blue buffalo wet food, which is 7 or 8 carbs. The Purina has meat by-products as well as some artificial flavors, which I found very disappointing. the W&U has pure chicken and all natural flavors, so I am leaning towards keeping hin on that. Thank you for any additional information you can provide it is so much appreciated.

If your current food is low carb ( 10% or under) there is no need to swap it over to another food. Sounds as if the new food could be disagreeing with him
Always swap a new food over slowly to prevent tummy upsets if there is a need to do a swap.
Keep in touch and let us know how things are going

 

[giotto]

Why is he getting less food?

Hi - Prior to his diagnosis last week, he was getting about 3/4 wet WU a day and the rest was grazing on dry WU kibble and having bits of steamed chicken as a snack. Since he is very overweight (over 17 lbs) when I eliminated his dry, I looked up how much wet he should get to reduce his weight and it was approximately 1 1/4 - 1 1/2 cans. I have been giving him this as well as steam chicken bits throughout the day when he is meowing and looking for more food. I was hoping for a very slow reduction in his weight. Please let me know if you think this is a bad idea or if I am giving too little or too much.

 

[giotto]

You wrote:
Right after he ate the mixed food, which was the 2nd time for him to have the new food being introduced, he kept going to the box and he was doing a soft stool, and he also vomited the food up (liquid version of food, not bile or foam). Is there anything I should be doing? I will buy a ketone tester and start doing that during the month as suggested. Just want to make sure I am not missing anything, and/or need to be looking for anything else during this long month of waiting. I am thinking of not using the Puring and just keeping him with the W&U blue buffalo wet food, which is 7 or 8 carbs. The Purina has meat by-products as well as some artificial flavors, which I found very disappointing. the W&U has pure chicken and all natural flavors, so I am leaning towards keeping hin on that. Thank you for any additional information you can provide it is so much appreciated.

If your current food is low carb ( 10% or under) there is no need to swap it over to another food. Sounds as if the new food could be disagreeing with him
Always swap a new food over slowly to prevent tummy upsets if there is a need to do a swap.
Keep in touch and let us know how things are going

Thank you. I was giving him 1/2 and 1/2, which he tolerated well on the first feed. The second feed he did not. Soon after he kept going to litter box and did a few small loose stools, then he threw up two times in a row the food (brown liquid, but not bile). I went back to all WU wet today, which he was doing good on, and is under 10 carb, and no artifical additives or byproducts. I am so annoyed at these RX foods. Purina proplan seems so gimmicky to me, but I struggle with the hype because I want to do the best for him. If you know of any other good wet foods low in carb that you had success with, please let me know. Thank you so much.

 

[giotto]

Why is he getting less food?

Hi again - My apologies for all these questions, I am just very nervous. I am ordering the Ketostix. Can you please let me know if there is a special one for cats? Can you please let me know the name/brand you purchase so I am sure to get the right one. Thank you!

 

[giotto]

Hello - I am posting this to all, and I apologize if I am not posting correctly. I am new to forum and I am finding it tricky to start a new topic/discussion. If anyone can please let me know the name/brand of the ketone strips they use to test their cat at home, I would very much appreciate it. I don't want to get the wrong item, and I want to test him asap.
Thank you very much for all your help.

 

[Diane Tyler's Mom GA]

If anyone can please let me know the name/brand of the ketone strips they use to test their cat at hom

@giotto
These are fine , they don't have ones that are specifically for cats

 

[Bron and Sheba (GA)]

Any low carb food that is under10% is fine. Most of us feed around 5-7% carbs.
Here is an article on how to get your kitty to lose weight safely. You don’t want it to happen quickly. It should be done slowly. You also need to keep in mind that unregulated kitties are hungry as they are not able to utilise the food properly. So you need to be weighing your kitty each week to keep a close track on what is happening.
You also need to keep in mind that reducing the amount of food and not giving insulin if it is needed, creates a risk for ketones so I would be vigilant with testing daily for ketones and do any weight loss very slowly and if in a fortnight, the BG numbers are not down to normal, I would insist on starting insulin.
WEIGHT LOSS

It would help if you could set up your signature so we can see the information about your kitty.
HELP US HELP YOU has the link to the signature.

Are you thinking of hometesting the blood glucose? It is really the only way you can keep your kitty safe and to see how well the dose of insulin is working. We can help you with hometesting if you would like.

 

[giotto]

Thank you so so much, I really appreciate it. I spoke with vet today and she said her 15 year old cat reversed its diabetes on the purina DM diet. I am trying it again, as I only used it for one day. I have been testing ketones with the kit. It looks like it is between negative and trace... the colors are hard to distinguish. Do you find that? He is eating and it seems like the volume of his pee is a little less per visit. I was going to have his urine tested at the vet next week (bring it in), which is week number 2.
If he has to go on insulin, I would hometest the blood. I was also going to evalute the oral drugs (bexcat). Do you know anyone who has a cat on that and/or if they were able to get into remission using that drug?
Thank you again. I am happy I found this forum, as I am so overwhelmed with all the info out there.

 

[Bron and Sheba (GA)]

spoke with vet today and she said her 15 year old cat reversed its diabetes on the purina DM diet. I am trying it again, as I only used it for one day

Just be aware that it is not the Purina DM that put the vets cat into remission…any low carb canned food will do that… providing the cat is able to go into remission.

I have been testing ketones with the kit. It looks like it is between negative and trace... the colors are hard to distinguish. Do you find that?

Can you post a photo of the result of the ketone test please. Make sure it is taken at 15 seconds after dipping in the urine. To post a photo, copy and paste it into the thread.
Sometimes it can be hard to tell if there is a negative or trace but if we could see that would be helpful.
If in fact there are any ketones, you would need to start insulin straight away.

he has to go on insulin, I would hometest the blood

Excellent choice!

was also going to evalute the oral drugs (bexcat). Do you know anyone who has a cat on that and/or if they were able to get into remission using that drug?

Bexcat is a relatively new drug so there is not a lot of data yet. I will link some information for you. Some cats can use it and some can’t. Older cats can’t….if he’s 14 1/2 I think that eliminates him and if they have ketones they can’t or if they have previously had insulin they can’t. And there is an increased risk of ketones when using bexcat.
Here is the link on NEW TREATMENTS FOR FELINE DIABETES

 

[giotto]

Thank you - Below is the test from 6:00 this morning. This is pretty much the color it has been on the other three, and the first one I did was on Sunday night.

 

[giotto]

He is eating as much as I give him, and has not refused any food to date. He is drinking and peeing a lot.... maybe slightly less than before he was diagnosed, but it is hard to tell as it varies. I am not trying to cut back on diet any longer for him to lose weight (he is 18 lbs). His weight is stable and based on our home scale, which we have been using for the past week by weighing ourselves a few times, then with him and subtract the two numbers. I did take away the blue buffalo WU dry food he always ate the day he was diagnosed. He eats the WU wet food (low carb), but the switch in food to all wet definitely gave him some issues, as he would be tired and not himself after eating (two separate times he threw up/had loose stool right after eating, that did not persist, so it seemed directly related to food). Just yesterday I gave him a small amount of purina DM dry food, which is "low" in carb compared to the rest, and recommended by my vet. I also mixed in the purina DM wet food with the WU wet food this morning in another attempt to get him to eat a diet of 1 can of purina DM (5.5 ounce can) and 1/4 a cup of purina DM dry food with a few bits of steamed chicken in between to snack. That combo would put him right around the maintanance calorie for a cat his size (400ish), maybe slightly less. I can give him more if it is best, but he is older, 14+, and not active, so I leaned more around the 350ish calorie range.
Any suggestions are great appreciated. Thank you very much.

 

[Bron and Sheba (GA)]

That does look like a trace to me. Sometimes it is hard to tell if it is trace or negative but that looks more trace to me.
Let me ask a couple of other people what they think.
@Bandit's Mom
@Sienne and Gabby (GA)

Make sure you get a follow up test done on the urine following the UTI to see that it was treated properly.

My concern is you are doing a food trial, have not started insulin and your kitty has had a UTI which was treated with an injection, which was probably convenient which is not the best antibiotic for a UTI, and you have what looks like a trace of ketones in the urine. The problem with ketones is they can increase quickly if the cause of them is not treated and it can develop into DKA (Diabetic ketoacidosis) which is very expensive to treat and can be deadly and is preventable by treating ketones in the early stages. I don’t want to frighten you, I just want to give you the facts.
If he was my kitty I would be ringing the vet and I would be starting insulin (after a recheck of the BGs).

Just yesterday I gave him a small amount of purina DM dry food, which is "low" in carb compared to the rest, and recommended by my vet

Just be aware the carb content of Purina DM dry cat food is 18% which is high carb. Diabetic cats need carbs 10% of under carbs.

 

[giotto]

Thank you. We are taking him to the vet this morning. His urine was tested for a UTI and he did not have one and the vet said based on his blood test last week his kidney and liver looked good. He had a UTI end of December 2023, which was treated with a shot in her office. He immediately perked up after that. I had thought it had come back several weeks ago due to the increased drinking/peeing. The vet perscribed oral antibiotic over the phone, which he would not take the pills (only managed to get three into him over three days). Therefore, I dropped urine off at the vet and they discovered the glucose in the urine and told me to bring him in, which I did the next day. It was then discovered that it is diabetes (one week ago today). The rest has been documented on here. The change of food, etc. The only reason I implemented the 1/4 Purina dry food is that he seemed really not happy on the wet and he was having stomach issues and not acting himself after eating. I spoke with vet yesterday and I asked her about the DM dry and she said it was formulated for diabetic cats. I am so confused. Thank you so much for your help.

 

[Bron and Sheba (GA)]

I’m glad you have got the UTI issue sorted out. That is good.
I know it is very hard when your vet is telling you one thing and we are telling you another.
I’m hoping @Sienne and Gabby (GA) calls in as she can tell you all about the diatetic food…it is not diabetic because they are not allowed to call it that.
Making sure your kitty eats is more important than what he eats but eventually you will want to get him onto a low carb diet so you can get him regulated.
There are low carb dry foods available if you live in the US. You can find information about them HERE in post 4

 

[giotto]

thank you so much.

 

[giotto]

Hi again - Is the under 10% carb recommendation for dry matter or as fed? I notice I am getting different numbers and those terms are being used. Thank you.

 

[Bron and Sheba (GA)]

Dry matter

 

[giotto]

thanks

 

[giotto]

Hi All - Just an update. I got back from the vet. She is a well regarded vet. The only downside is that she is always busy because everyone wants her. She took my boy in this morning w/o an appointment. We had a huge wait because she is so busy, but here is what happened:
She took his glucose - it was 320, which she said high, but she still thought we could wait to see if food would bring it down
He is 17.7 lbs, with a "tight" stomach. She felt around, took him in back for rectum exam and xrays to see why he was so bloated
He did not have a fever
she is thinking he might have had a very mild bout of pancreatitis, and she gave him a low dose of cerenia for nausea. I will be giving him 1/4 of a pill a day for 15 days. He did throw up 2 times in the last week and has signs of belly ache/nausea after eating
the xrays showed several things, but I will focus on the digestive for now. He has gas and backed-up stool, even though he had a poo early yesterday.
He is home now, eating and drinking, but no bowel movement. I put some miralax and probiotic in his food. I am hoping that kicks in
She must think it is worth the chance of giving it a few weeks to see if he can turn this around, or else she would tell me to put him on insulin or pills
Has any of your babies had pancreatitis. Does this sound at all familar?
I am so beside myself and nervous.

 

[Bron and Sheba (GA)]

She must think it is worth the chance of giving it a few weeks to see if he can turn this around, or else she would tell me to put him on insulin or pills

I disagree with your vet.
I have just read your reply to another member where you say your kitty is still weak and eating about 1/2 the food. If he has pancreatitis, even a mild case, and has trace ketones your vet really should start him on insulin. The reason I am saying this is because if a kitty is unwell with an infection or inflammation (pancreatitis is an inflammation); is not eating properly, is not getting insulin (but has been diagnosed as a diabetic), has trace ketones in the urine, and you say he is weak…then he is at a real risk of this accelerating into DKA ( diabetic ketoasidosis), which is very serious and expensive to treat. It is preventable. If he was my kitty I would be going back to the vet today and saying strongly I want him started on insulin now.
If he has traces of ketones in the urine he can’t have oral medication such as bexacat.
Tagging @Wendy&Neko
@Sienne and Gabby (GA) for comment

 

[Wendy&Neko]

How big is that Cerenia pill - they come in different sizes? For a cat his weight, he should be getting 16 mg (dosing is about 1 mg per lb). A lot of vets under dose this.

If he has pancreatitis, it is very painful and he should be getting pain meds too. More on Pancreatitis and treatment in here: A Primer On Pancreatitis. He needs to eat if he has any ketones. Please test the ketones frequently, they can go from trace to high in the space of several hours. Anything over trace needs a vet attention immediately. To help get food in him, this post might help: Suggestions on How to Stimulate Kitty's Appetite If any ketones, stay away from Bexacat, we've seen a couple sad stories here of cats with ketones on Bexacat who did not make it.

One correction to above, the %calories from carbs is As Fed in the catinfo food chart linked. but you can convert from one to the other.

 

[giotto]

She put him on a low dose of cerenia. 4mg. I felt he was sleepy on it and hesitant to eat, although he would. I did not give it to him yesterday, as I asked the vet about it and I did not hear back. He actually responded well w/o it and he was at his best last night and today... much back to normal. He definitely seems to get either a belly ache or a little nauseous if he eats a lot. he lays down for an hour or so, then is back normal looking for food. He is eating a can a day and lots of steamed chicken with probiotic. He has a few poops and two very loose ones, as I think it was the miralax. his stomach is not bloated anymore. he has a much more lax belly. I am testing ketones and they are the same. they look somewhere between negative and trace. he is still drinking and peeing more than I would like. I can't upload, so I am pasting an old article I found on treating diabetes and I would love some opinions on it. thank you so much.

"Recently, I started taking a bit of a "less is more" approach to treating diabetes in cats. Most of my feline patients resent being brought into the veterinary clinic frequently, resent being restrained for blood draws, resent having their ears pricked for at-home glucose monitoring … (you get the idea). Since I believe that the goal of medical intervention should be an improved overall quality of life, I began to ask whether my previously more aggressive treatment approach was really doing my diabetic feline patients any favors.

Turns out lots of veterinarians have been thinking the same thing, and one renowned feline expert, Gary D. Norsworthy, DVM, DABVP, has even put a name to this "less is more" attitude — the Ultra Loose Control Approach. He developed his technique primarily because too many cats were being euthanized due to the hassles and expenses associated with his previous recommendations.

Dr. Norsworthy says that his Ultra Loose Control Approach is built on the premise that

• Cats tolerate hyperglycemia with minimal/tolerable clinical signs.
• Cats do not have significant complications from diabetes such as cataracts, peripheral vascular disease, and renal disease.
• Cats tolerate hypoglycemia with no or minimal clinical signs (though this shouldn’t be overstated because severe hypoglycemia can be fatal).

When trying to simplify the care of a diabetic cat, more emphasis is put on monitoring and resolving the patient’s clinical signs (e.g., increased thirst, appetite and urination; weight loss; reduced activity levels, etc.) than on precisely controlling blood glucose levels.

The process basically boils down to feeding the cat a low carbohydrate diet (canned if at all possible) and if initial blood glucose levels are high enough, starting twice daily injections of a long-acting insulin at a low dose. Cats are rechecked approximately once a week with a single glucose measurement taken when blood sugar levels are expected to be highest (approximately 12 hours post insulin). Based on the results of this single measurement and MOST IMPORTANTLY a discussion about how the cat’s clinical signs are or are not improving, the doctor will decide whether to increase the insulin dose or leave it alone. Weekly rechecks continue until the cat’s peak blood glucose level is under 350 mg/dl and the symptoms of diabetes have resolved.

Once the cat reaches this point, rechecks can be spaced further apart. Usually this starts out to be around once monthly. Again, a single glucose measurement is taken when blood sugar levels are expected to be highest, and the vet and owner go over a detailed history of the cat’s clinical signs. If the blood glucose measurement is 300-350 (or even higher) and the cat is symptom-free, all should continue as is. If the cat has clinical signs of diabetes the insulin dose needs to be adjusted upward in the manner that was described previously. If the blood glucose level is below 250 mg/dl and the clinical signs are gone, either the insulin dose needs to be reduced or stopped entirely. These cats may be heading into a diabetic remission.

Dr. Norsworthy reports the following results with his approach:

• Approximately 30% of cats go into remission
• Hypoglycemia is rare
• Most live 3-6 years and die of non-diabetes related disease
• 80% or more are over 10 years old at the time of diagnosis
• Many are over 14 years old

Of course, achieving diabetic regulation is not quite as simple as what I’ve written here. For example, any concurrent diseases like pancreatitis, periodontal disease, and urinary tract infections also need to be addressed to maximize the chances of a cat going into remission. The details must be left up to the veterinarian involved in the case. But the general idea, that we should be focusing on how diabetic cats are doing under treatment rather than on specific lab values, could save many feline lives."

 

[Bron and Sheba (GA)]

The upload does not work. The best way to put an article or photo into the thread is to copy and paste.
I’m sure @Wendy&Neko and @Sienne and Gabby (GA) would like to comment on this old article.What year was it written?

Most of my feline patients resent being brought into the veterinary clinic frequently, resent being restrained for blood draws, resent having their ears pricked for at-home glucose monitoring … (you get the idea).

I agree most cats hate going to the vet for blood draws. They find it stressful. But I think it is a real stretch of the imagination to say cats resent having their ears pricked at home…my cat Sheba used to come running whenever she heard me at the testing kit as she loved her treat. And if you ask most caregivers, they will tell you the same thing.

Cats are rechecked approximately once a week with a single glucose measurement taken when blood sugar levels are expected to be highest (approximately 12 hours post insulin). Based on the results of this single measurement and MOST IMPORTANTLY a discussion about how the cat’s clinical signs are or are not improving, the doctor will decide whether to increase the insulin dose or leave it alone

A lot can happen in a week and checking just one single measurement is not enough. The cat could be bouncing from very low numbers earlier and to base the dose on this single measurement could be dangerous. Also anyone with experience in dosing with long acting insulins (as he suggests) knows that dosing is based on the lowest point in the cycle not the preshot..

Weekly rechecks continue until the cat’s peak blood glucose level is under 350 mg/dl and the symptoms of diabetes have resolved.
Once the cat reaches this point, rechecks can be spaced further apart. Usually this starts out to be around once monthly. Again, a single glucose measurement is taken when blood sugar levels are expected to be highest, and the vet and owner go over a detailed history of the cat’s clinical signs. If the blood glucose measurement is 300-350 (or even higher) and the cat is symptom-free, all should continue as is.

Taking weekly then monthly random singe blood glucose measurements is not the way to manage feline diabetes in my opinion, you just need to look at any of the SS on this forum to see the fluctuations in the BG levels over a day or week. And again he is checking the highest measurement instead of the lower measurement. Leaving the cat with a BG of 300-350 is leaving the cat over the near threshold and putting unnecessary pressure on the kidneys.

If the blood glucose level is below 250 mg/dl and the clinical signs are gone, either the insulin dose needs to be reduced or stopped entirely. These cats may be heading into a diabetic remission.

If you stop the insulin too soon, you run the risk of the cat not being able to hold the remission or worse forming ketones..

 

[Wendy&Neko]

The Cerenia dose he is being given is about 1/4 of what he could get for his size. You are right, it's a very low dose. For nausea, I think ondansetron is a better drug.

Regarding your post 28: Not sure if this is the article being referred to, but it is that author and about that topic: https://www.dvm360.com/view/diabetes-cats-part-1-using-ultraloose-approach-proceedings It is from October 2011, so almost 13 years old. This approach also uses Prozinc, not Lantus and considers Purina DM superior for food.

A couple points. First are some valid concerns that if people don't want to monitor regularly, they may put the cat down. I know that my vet was thrilled I wanted to treat my cat. For people who refuse to do more, maybe this gets more people to treat their cat? I suspect this may be as good as a vet can get many clients to do.

Increases are made by 1 unit at a time, a big jump for many cats, more than we do here as we don't want to bypass a good dose. Other points not mentioned in your list but from the article are more to do with running the business as to why the ultra loose approach was created:

- Owners frequently expect to report the results of their home testing, get a recommendation over the phone, and pay nothing for the consultation.
- Owners taking over the case and not returning the cat to me for its care.

This approach would not have worked for me and likely would have killed Neko. First, she was on Lantus so wouldn't have been on this anyway. But she was one of those cats that could have very high preshots (over 400) and dive down below 50 during the cycle, and back up over 300 by the next shot. Based on the ultra loose approach, and testing only preshots, I would have increased her dose when in fact she needed less insulin. Another factor, my kitty had two secondary endocrine conditions that likely would not have discovered, much less treated. Her life would have been much shorter.

 

[giotto]

Thank you all for your comments on the article. It all makes sense. I am just trying to do as much research as I can as It is overwhelming and he now has this other problem that is terrifying. He is eating about 1 big can a day of low carb food, along with a lot of steamed chicken breast. I give it to him through the whole day in small amounts. I check his ketones throughout the day. He has the nausea still, and had two bouts of diarreah, but now he isn't going. I have also been given probiotics. I might have to switch vets. I am not happy that she didn't answer my text, when her office tells me to text her after 6:00, which is when she takes texts (prior to that are office hours and she does not take questions during that time). I know she is stretched extremely thin, and she is a very well regarded vet. You can't find a negative thing about her online, which is unheard of nowadays. I just don't know what to do. I should be able to put my trust in her, but I am having a hard time. She clearly said on Wednesday that his sugar was 330 and if it was 6 or 700 should would start insulin immediatly and that we can proceed with diet for now as planned and retest everything end of month. Not sure why she is doing this and the article made me think of her.
Thank you all again.

 

[Bron and Sheba (GA)]

Is the other problem you are talking about not going to the toilet after 2 bouts of diarrhoea?
How long is it since he had his bowels opened? It could be just that he cleared himself out with the diarrhoea and it will take a bit longer than normal to go again.
You could try giving him some plain mashed pumpkin in his food. If you live in the US you can buy it in a can. Just make sure it is the plain pumpkin. Try 1/2 teaspoon mixed in with the food twice a day to start with.
I’m sorry your vet is not answering your texts after hours…is there something we can help you with ?

 

[giotto]

Thank you so much for your kindness. He finally went. It was soft, but not diarreah. I have been giving him miralax. He seems less uncomfortable now, but I was very nervous. Watching him like a hawk all night. I was not sure about the cerenia, and that was my question to the vet. He acted odd on it on Wednesday after she gave him a shot in office, and the following day after I gave him his 1/4 pill. Just a bit off... like he was more nauseaous at first. Because of this, I skipped a day and he was acting almost fully himself (minus the excess water/peeing). However, that changed yesterday, and he was acting more agitated/uncomfortable, laying under the bed, which he did prior to Wednesday vet visit, but never did prior to this drama. I gave him the pill at 4:00 am, and soon after he seemed to relax a little. He has been and still is eating and interested in food. I will be giving the pill daily now for the remaining time, which is another 13 days, unless something crazy happens.
This is rough. Especially with a vet who is good, but who is stretched way too thin.
Thank you so much.

 

[Bron and Sheba (GA)]

I’m glad the toilet problem has been solved.
You could ask the vet to give you a script for some ondansetron which is a better antinausea medication for cats then cerenia. You get that from the pharmacy.

 

[Sienne and Gabby (GA)]

If your cat's blood glucose levels were in the 600 - 700 range, you would risk your cat dying. I would want the cat hospitalized and on an insulin drip until the blood glucose levels stabilized and the cat would need to be constantly monitored. While many people are fearful of a hypoglycemic episode, excessively high blood glucose levels can also be life threatening. I have no idea what your vet is thinking.

Wendy is noting that the information that your vet is referring to is from 2011. The guidelines from the American Animal Hospital Assn were published in 2018 and updated in 2022. They have very different guidelines.

 

[giotto]

Hi All - I took my boy to the vet again today, as he was just not right and I could tell he had a belly ache every time after eating, which he was only eating chicken since yesterday. The cerenia did not agree with him either, as it made him hesitant with food. So, all in all, he was not improving, and actually eating less. She gave him an enema, as he had a lot of backup. His glucose was 360. Because he is big she can't really get a good feel of his organs, and she can't tell what is going on (inflamation, etc.). She mentioned getting a sonagram, which will have to be next week, as the person comes to her office once a week and the next time is next Tuesday. She mentioned that it could be that he had chronic pancreatitis that spurred the diabetes. Since he is getting worse, it is best not to wait out the next couple of weeks to see if diet will change anything. She thought the insulin will give his pancreas a rest and hopefully if that is what is going on, the inflamation will go down, and hopefully we can get him to convert back (remission). He is 17.5 lbs. She sent us home with Lantus, two units, two times daily after meals. Does this sound right? My husband grew up on a farm, and he is comfortable administering. We will get a tester, but we will not have one when we start it tomorrow. I am nervous, and to be honest, the vet goes through the process very fast. I had to ask her for signs of trouble, if his sugar goes too low. In fact, she did not give us that sugar to go home with. She said Lantus is a very slow reacting insulin and to watch for his drinking and peeing. If it it slows down a lot, to give him one unit. I will be testing, but I am so confused and don't feel comfortable at all. Please let me know if anyone thinks this sounds wrong. Thank you so much.

 

[Bron and Sheba (GA)]

If your kitty weighs17.5lb, that is 7.95kg.
The formula for a cat on a wet diet and doing tight regulation is weight in kg x 0.25 which equals just under 2 units for your kitty. However for a kitty on ‘start low so slow’ dosing method, the starting dose for a kitty on a wet diet would be 0.5 units on a wet lowcarb diet or 1 unit is eating any dry food. I think you should start on the start low go slow method.
Given that he is not eating all that well, I don’t think I would give him 2units. If there are no ketones in the urine, I would start with 0.5 unit twice a day. This dose can always be increased if needed.
The routine (once you get the glucose monitor is to test/feed / give the doses that order.
For now give a good meal before giving the insulin, then give him a few snacks during the cycles. A snack is a couple of teaspoons of low carb food.
Can you show me the insulin syringes the vet gave you please? You can take a photo of the syringe then cope and paste it into the thread.

make sure you have some honey or Karo at home in case of a hypo. When you go to the shops next, get some fancy feast gravy lovers canned food which is high carb for in case of a hypo. Make sure you mark those cans as high carb and keep seperate from the other low carb food.
Keep asking any questions you have. We are always here.

Here are the 2DOSING METHODS FOR LANTUS

 

[giotto]

Hi - I am really nervous about doing something other than what she told us, as she has treated him 3xs in less than 2 weeks and is privy to his behavior/other things going on. Do you think the 2 units will do something bad? She said if his pee and drinking slow down to go to one unit. We do not have the glucose meter yet, so I will not have that. I have only been testing ketones at home. My husband will be giving the shots, and he works nights. Unfortunatley his schedule was altered tonight. We were supposed to have started at 6am today, but he will not be home until 9am. Our plan was to do the shots at 6am and 6pm daily, as that works with our schedules. Should we wait until tonight and start at 6am, or should we do 9am and do the shots a little closer until we can meet the 6am/6pm schedule? I guess my questions is whether it is ok to give less than 12 hours. We are going to have to make some adjustments here and want to devise a plan that is the most consistent for him. Thank you so much.

 

[Bron and Sheba (GA)]

The shots need to be 12 hours apart … give or take 15 minutes.

I think 2 units is too much especially as you are unable to test.
Can you tell me if you are using syringes or a pen to give the insulin please?
What were the ketones test results?

 

[giotto]

Hi - No ketones. We are using syringes U 100 3/10 cc. At vet his BC was 360. She gave him an enema, and he was himself when we got home. Something is making him constipated/gas and swollen.

 

[giotto]

Hi again - Do you think we should wait until we get a BC tester? Can we get it at a store rather than order, so I can have immediately? She recommended the animal one that has these tabs that have to be calibrated. Is this correct?

 

[Bron and Sheba (GA)]

Hi again - Do you think we should wait until we get a BC tester? Can we get it at a store rather than order, so I can have immediately? She recommended the animal one that has these tabs that have to be calibrated. Is this correct?

Yes you can get a glucose monitor at a pharmacy or if you live in the USA you can get one from Walmart. I would recommend a human meter NOT a pet meter. The pet meters are very expensive to run and are no better than the human meters. The human meters do not need to be calibrated at all. Most of us here use human meters and all our dosing methods are based on the human meter numbers.
How long before you could get a meter?
Even if you could get a meter I would not recommend you give the 2 units. It is too big a dose to start with ..

good to know there are no ketones and you have the correct syringes

 

[giotto]

Thank you so so much. he was really hungry early in the morning... waking me up for food, and noshing on his Purina DM dry food, which he hasn't really touched before (new RX diet). I then tried to give him his wet food with a little steamed chicken and a packet of the Purina forti flora probiotic. He licked it a bit and only ate very little. I wanted to give his first dose today, this morning. Please let me know if you think I can give the 1 unit, and if so, how much food and wait time needed. I will then get the glucose measure today before tonight's shot. Right now, he is sleeping and seems to be back to just laying and getting up for water. He was doing this for days now, especially after eating. Like I mentioned, his BG was 360 yesterday afternoon. Do you recommend the urine strips for glucose as a backup? At least I can then check something until I get used to doing the ear testing. I am afraid I can't do that realiably on the first time today and I don't want to wait. Also, would steamed chicken, about 1/4 cup be sufficient before shot? I think I can get him to eat that. Please advise. thank you.

 

[Bron and Sheba (GA)]

I’m not sure what time it is there the morning. I live in Australia and it’s late at night here.
If you are feeding dry food, you definitely have to do the SLGS dosing method. The dry Purina DM is high carb so is not really suitable for diabetic cats. I don’t know why vets keep giving it to the caregivers.
Anyway keep feeding that (dry) until you can start testing.
We don’t use urine test strips for glucose here as we recommend blood tests but you could do them until you get the human meter….which I understand you are getting today, is that right?
And aren’t you using those glucose/ketone strips to test for ketones?
If it is not too late in the morning, you could give the first dose this morning but please make sure you get the glucose meter today.
Make sure he eats well before the shot and then offer him snacks during the cycle as well. If he will only eat the dry, let him eat that.
You can give the shot as soon as he’s eaten

Print this off and put on your fridge. HOW TO TREAT HYPOS

 

[giotto]

Hi. Thank you. He ate about a 1/4 cup of shreded steamed chicken, and he noshed a bit on the Purina DM dry just a little. The ketone test is just for ketones. It was negative. We gave 1 unit of the Lantsus. My husband is home with him, as I have to leave. He has a syringe and honey ready if he acts weird. We will buy glucose meter today and test before the dose tonight. Do we test before or after feeding him? Please let me know what number it should be and/or range, and how much to give. If still high, should I give the 2 units? I am so drained by this vet. She has zero cummunication. She starts a sentence and then is pulled away or distracted. I am so upset. Thank you so so much for being there. I can't tell you how much it is appreciated.
She also gave us Tylan powder. Did you ever use that? Apparently it is for the stomach, a gastro antibiotic.

 

[Bron and Sheba (GA)]

Do we test before or after feeding him?

This is the routine you need to follow. Test first, then feed, then give the dose of insulin.
[QUOTE="giotto, post: 3177010, member: 40230"]Please let me know what number it should be and/or range, and how much to give.[/QUOTE]
If the BG is under 200…stall, dont feed and test again in 20 minutes. You can post and ask for help. But generally until you have some BG data we suggest not giving the dose if the BG is under 200.

If still high, should I give the 2 units?

No. You need to stay with the 1 unit for 7 days to let the depot fill. If the BG drops under 90, you need to reduce the dose to 0.75 U but we can help you with that.
I am going to tag @Bandit's Mom and ask her to help you set up a spreadsheet so you can add the data. It’s important we can see this if we are to help you.
By the way if you are going to Walmart for the glucose meter, you need to buy a ReliOn meter and test strips that match and some 26 or 28 gauge lancets to prick the ears. And some cotton balls to hold behind the ear when testing.

She also gave us Tylan powder. Did you ever use that? Apparently it is for the stomach, a gastro antibiotic.

no I haven’t used it but it can be given to cats. So make sure you give the full course.

Thank you so so much for being there. I can't tell you how much it is appreciated.

We are very happy to help you as you learn how to manage this with your kitty. All you need to do is ask us.

 

[giotto]

Hi - My husband gave him the 2 units when I wasn't home as directed by vet. We will be monitoring the glucose as described and follow that plan, as we have to go back next week. She said if he starts peeing less and drinking less we can drop to 1 unit. Does that sound right?

 

[Bron and Sheba (GA)]

Hi - My husband gave him the 2 units when I wasn't home as directed by vet. We will be monitoring the glucose as described and follow that plan, as we have to go back next week. She said if he starts peeing less and drinking less we can drop to 1 unit. Does that sound right?

No.
I would not give the 2 units to him. I would have given 1/2 to 1 unit twice a day. I would go back to 1 unit at the next dose and stay there for the 7 days.
Just monitoring the peeing and the drinking is an old fashioned way of monitoring the BGs to be honest. A far better way is to test the BGs and you will know exactly where you are up to. And starting off with 2 units will not solve the issues any quicker and could cause a hypo or low numbers . We also do not increase and decrease in 1 unit increments. We go up and down in 1/4 unit increments.
Just be aware that the BGs could drop very low before you see any change in the peeing and drinking and by the time a cat is showing signs and symptoms of a hypo, their BGs are usually really low and hypos can kill. I don’t want to frighten you but you need to be aware.
Have you managed to get the glucose meter.?
You need to be aware with Lantus that the full effect of the dose is not felt until the depot is full which will be 5 to 7 days when you first start Lantus.
Here is information about the DEPOT
Did @Bandit's Mom contact you about the spreadsheet?
Also in post 13 above I linked the information for Help is Help You which has the signature and how to set it up. It’s very simple but we really need these two pieces of information (spreadsheet and signature) for us to help you.

 

[giotto]

Thank you. He acted really good after his 2 unit shot, eating and energy. I am bringing him to the vet on Tuesday, six days after him starting. His ketones are negative. All this is so new and its a lot. I appreciate all of your information. I will read up on Depot, as I never heard of that. We are getting the BG meter today. It is has been crazy.

 

[giotto]

Hi again, he is not taking the Tylan, as it has a bitter taste and his food isn't hiding it enough. Does anyone have any good ways to disguise this powder? Thank you.