Adjusting to our new diagnosis

[PumaMum]

Puma is a delightful 4 year old Manx who we adopted at about 18 months. He scared us twice in the past with episodes of asthma, but hasn't had any wheezing episodes for over a year. We have 3 other cats at home, and a year ago adopted a greyhound. They are all incredibly happy together.
We noticed a couple of months ago that Puma seemed to be drinking more, and then when I came home Monday after being away for 2 weeks on a business trip I realized he had lost weight. His 18 pounds 6 ounces last December is now 14 pounds 8 ounces. I felt almost certain we were watching feline diabetes, and our local vet confirmed it with blood work normal except for a blood glucose of 410. He started Puma on 2 units PZI twice daily and wants him back next Tuesday for a glucose curve. This vet "doesn't believe" in home monitoring, when I asked about it he commented that it makes people manage their cats too closely.
With our 4 cats, we have been free feeding the Petsmart Authority brand dry pet food. Our oldest cats has had major skin problems in the past, and along the way we discovered that it's due to some sort of food allergies and she's just fine on this dry food. Also, unlike the others, she won't touch wet food. We've switched Puma to the Fancy Feast Classics wet food, and our plan is to let the others have dry food available overnight as we take him upstairs with us.

Questions -
Am I risking hypoglycemia by switching him to wet food when the 410 was driven by the higher carb content of his prior diet?
Is 2 units PZI twice a day sort of on the high side as a starting dose?
Should we be monitoring blood glucose at home? If so, what do you think is the easiest method?

Thank you, everyone!

 

[Carl & Polly & Bob (GA)]

Hi, and welcome you and Puma!

I'm 99.99% certain that you won't see anyone answer your question about whether you should monitor BG at home with a "No". ;-)
We strongly advocate home testing for several reasons.
It is the safest way to manage the illness. It reflects more accurate readings that a curve run at the vet's office because it reduces or eliminates stress, which can raise BG numbers. You have to be sure, before you give insulin that the dose is logical based on the test results. If for some reason, his BG is lower than what you would normally see, the dose could be too high. Insulin is going to lower his blood glucose levels once it is injected. If they go too low, it could be fatal, so of course you want to make sure it isn't too low already. We usually tell people to pretend your kitty were your infant child. You have no idea from just looking what his or her BG is, and you have to give a shot. Would you do that without testing first, knowing it could cause hypoglycemia? Of course you wouldn't. If you put it that way to your vet, maybe he'll "get it"? Ask if he'd do it with his child.

Terrific to hear that you've already switched to FF classics! Just that will improve Puma's numbers. And yes, your instincts are right. His numbers could already be much lower than they were before that diet change, and the 2u dose could be too much.
A starting dose of 2u is higher than we normally advise. No matter the insulin, we usually recommend a dose of 1u or less, every 12 hours. A lot of the time, the vet will base the dose on weight, and on how high the number happened to be at the time they tested his blood.

My opinion, but I would say that with the quick change in diet, you should drop back to 1u, and begin home testing immediately. Any human glucometer will work, but we usually recommend avoiding the word "True" in the brand name, just because we've seen a lot of people have problems with anything that says "True". Relion (sold at walmart) makes a couple of them - the Micro and the Confirm - that work well. We like them because the cost is lower than many others. A meter is less than $10, and the strips (which is where most of the money goes over time) can be found for about $20 for a box of 50.

The normal method of obtaining blood is by pricking the edge of the ears to get a tiny drop. If you can go to Youtube, just search for "feline diabetes testing" and you'll find tons of videos showing how it is done. The first time you try, it can be stressful or overwhelming, but after a few days, you can do it in your sleep! We find that the key to success is to bribe the cat. ;-) We usually give kitty a treat after a test, and they learn to associate the test with a reward. Many cats, including mine, hear the meter case being opened and come running to the test spot. They can put up with a teeny ear poke if it means they get a treat!

There's a ton of awesome information on this site, and a ton of people who are here to help you and Puma however we can. Just don't try to absorb too much at once. Don't hesitate to ask questions. We have all been in your shoes before and there were people here to help us out on day one too.

Carl

 

[PumaMum]

Thank you so much!
We're starting to settle in to our routine of FF classics and PZI. I picked up a True2go meter from Walgreens (which will be free with its rebate coupon) and we tested Puma's blood for the first time at 5 PM today, before his dinner. I managed to go through his ear :cry: but he didn't even notice, too busy enjoying a little bite of prosciutto. It was 193.
A couple of questions - I think he needs 3 cans of FF daily, he currently weights just over 14 lbs and in December was over 18 lbs. But he only seems to want to eat 1 can at a time. At the moment we're giving him his third can around 11 or 12 - my husband's home, so it's possible to do that. Is that approach OK? Should we be trying to get him to eat 1 1/2 cans twice a day instead?
Also, he seems to have dandruff and to be shedding. Is that his diabetes? Or are we just noticing it because we're paying attention? Or is it the summer, heat, and so on?
Tuesday he'll be at the vet for a glucose curve day, I think that after that one I'd prefer to do them at home.

 

[Carl & Polly & Bob (GA)]

Not sure what time zone you are in, but I am thinking your shot times are 5 am and pm? And he'd get a full can at those times? Well, you can split that third can as you choose between shots, as long as you do not let him eat in the 2-3 hour period leading up to his shots. I used to give Bob his snacks between five and seven hours after each shot which in our lingo would be +5 to +7.

Multiple feedings seem to work better for diabetics rather than just two meals per day.

We have had members who have had issues with the accuracy of meters with the word "true" in the name. A great idea would be for you to bring your meter to the vet on Tuesday, and do a side by side test using the same drop of blood, comparing your reading to theirs. It will verify your meter is correct, for your peace of mind.
Congrats on your first successful test
Carl

 

[squeem3]

I picked up a True2go meter from Walgreens (which will be free with its rebate coupon) and we tested Puma's blood for the first time at 5 PM today, before his dinner. I managed to go through his ear :cry: but he didn't even notice, too busy enjoying a little bite of prosciutto. It was 193.

None of the Tru-anthing meters are accurate. They read blood glucose levels too low, as much as 100 points off. Plese buy another brand of meter so you can be sure that the reading you get is as accurate as possible. Avoid the FreeStyle brand. It too is inaccurate. Wal Mart's Relion brand of meters are inexpensive and what many people here use, mainly the Micro or Ultima models since they use very little blood.

Great job of getting a reading, though :smile: 193 isn't too bad, assuming it's not too far off from what the real blood glucose level is.

A couple of questions - I think he needs 3 cans of FF daily, he currently weights just over 14 lbs and in December was over 18 lbs. But he only seems to want to eat 1 can at a time. At the moment we're giving him his third can around 11 or 12 - my husband's home, so it's possible to do that. Is that approach OK? Should we be trying to get him to eat 1 1/2 cans twice a day instead?

Let your cat dictate how much food he wants to eat. If he's only interested in one can right now, then just give him that. You can invest in a programmable timed feeder to give your cat small meals throughout the day. Diabetics seem to do best with small frequent meals every day.

18 pounds is pretty hefty for many cat. Do you know what your cat's ideal body weight should be? Weight loss is a typical diabetes symptom and can in fact be helpful to some previously overweight cats. You want to feed enough to maintain a good body weight and condition. An obese diabetic cat is harder to regulate.

lso, he seems to have dandruff and to be shedding. Is that his diabetes? Or are we just noticing it because we're paying attention? Or is it the summer, heat, and so on?

Unregualted diabetes can cause a poor fur coat. Dry summer heat doesn't help either. Try frequent brushing to remove dandruff. There are supplements out there for healthy fur coats and such but many contain sugars and other no-no ingredients for a diabetic. Look for one that is sugar and carb-free, such as omega 3 rich 100% salmon oil. OnlyNaturalPet.com has some salmon oil supplements.

Tuesday he'll be at the vet for a glucose curve day, I think that after that one I'd prefer to do them at home.

Yes, you can do your own glucose testing at home :smile: It'll be much more accurate than at the vet's office.

Keep track of your cat's blood glucose levels so you can see trends. Most people here use an online spreadsheet. The instructions are here http://felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207 There are two ways to get a spreadsheet, both are in the instructions. If one doesn't work, try the other one.

 

[hmjohnston]

I picked up a True2go meter from Walgreens (which will be free with its rebate coupon)

I, too, started out with a Tru meter. At first it wouldn't work and then we had problems in that it wouldn't read anything over 299. I got the Relion meter Micro- only $9 and strips are $36/100 at the store and you can order the strips from ADW $72/250.

we tested Puma's blood for the first time at 5 PM today, before his dinner. I managed to go through his ear :cry: but he didn't even notice, too busy enjoying a little bite of prosciutto. It was 193.

Awesome! First try and success!

I think he needs 3 cans of FF daily, he currently weights just over 14 lbs and in December was over 18 lbs. But he only seems to want to eat 1 can at a time. At the moment we're giving him his third can around 11 or 12 - my husband's home, so it's possible to do that. Is that approach OK? Should we be trying to get him to eat 1 1/2 cans twice a day instead?

My cat eats 12-15oz a day. She's got acromegaly and is growing and her diabetes is NOT under control because of it. So she is starving- like all diabetic cats that can't get the nutrients from their food. So I feed her small meals throughout the day. If you don't like leaving the canned out as is because it might dry- freeze half of it overnight and set it out to thaw. I do the ice cube trays, mixed in with a little water and sprinkle of mirilax (for her constipation) when I go out of town and use a pet sitter and they set it out with a plain water cube to help it keep moist. You can do the same thing for daily use- takes an hour or two to thaw and voila! Mid-day snack! Most diabetic cats need to eat every few hours- just like diabetic people do- it keeps their BG levels more even.

Also, he seems to have dandruff and to be shedding. Is that his diabetes? Or are we just noticing it because we're paying attention? Or is it the summer, heat, and so on?

Yes- that is diabetes (and a dry food diet). Once the insulin starts making magic happen the dandruff should reduce- although the summer doesn't help it! Sneakers always got mats anyway. The canned diet will help his skin/fur to be more silky.

Tuesday he'll be at the vet for a glucose curve day, I think that after that one I'd prefer to do them at home.

Do this at home!
It will be cheaper and not stress elevated as most cats do NOT like to go to the vet. I do a curve just about every weekend- at HOME. Bear in mind that you will test more than your vet will. Mine- a curve day was two tests for $11 each- once in the morning and once at night. That isn't a curve and if he had done one I wouldn't have been able to afford it :shock: . You can do it, just choose one cycle to test at +2, +4, +5, +6, +8, +10 from the shot- or every hour if you think Puma would stand for it. Then take the results to the vet.

Good luck!

 

[PumaMum]

Thank you, everyone, you really are awesome!
I'll pick up a new meter and check a couple of BGs this weekend. Puma had a curve at the vet today, they checked 5 points at roughly +1, +3, +5, +9, and +11 hours after 1 1/2 cans of FF and 1 U PZI. I've tried to use the spreadsheet, hopefully got it right.
The values are a bit high, but the other issue was that Puma got into the dry food the prior evening left out for other cats, and who knows how much he ate. I didn't give him any FF that evening since he wasn't hungry. And I assume he was a bit stressed at the vet. It was also expensive - $150. And the vet didn't give any feedback or instructions to my husband when he picked up Puma.

So - next steps -
I think a new vet.
Using the start low, go slow mantra, shall I keep him on 1 unit PZI, keep him away from the dry food, and try to do a curve at home on Saturday with a new Relion meter?
What is the fewest points on a curve that would be useful?

Jane (Puma's mom)
Puma's PZI SS

 

[Sue and Oliver (GA)]

Hi Jane,

You are doing great things for Puma: hometesting, changing the food and being cautious with the insulin.

I am wondering about your numbers tonight. Was the 161 after insulin or before? Where was the food in that time frame? How much insulin did you give him?

We suggest that new diabetics do not shoot under 200, but wait 20 minutes without feeding (which can raise bg levels) and retest to see if the number is sure rising and over 200. It is a little concerning that his number was going down, not up at +12 and that was with dry food in the picture?

If you shot at 161, I would suggest you get a number in a hour and see where he is headed. We just want to make sure he stays in safe numbers.