Dalci & Co. have joined the board!

[adamj]

"Dalci", as we call her for short, is a former outdoor cat who was diagnosed with diabetes today. The initial diagnostic cost was very high (~$500 USD) and after finding out the vet would charge approximately $600 for blood glucose curves (recommended 3 in the first month) and $200 for 5 vials of insulin at Costco, we decided to not go through with care and put her to sleep. I am so very happy that I walked out of that hospital deciding to keep our cat alive for another week, 7 cans of DM food, and more than 1 hour to think about this. With your assistance, she may be able to get more than the 7 days we were hoping to "salvage" out of this bad situation.

Having been linked here by felinediabetes.com, I haven't had a lot of time to read about everything but I've gotten a good smattering of home glucose monitoring and insulin information. My girlfriend, the mama of this cat, is going out of town until Monday on a preplanned trip. I work a TON but I've volunteered to stay with the sugar cat and help regulate food intake, keep a watchful eye, and decided to really delve into what it means to have a diabetic cat.

Here are my questions:
1) Are the costs quoted by that vet realistic or high? We are in Portland, Oregon, USA.
2) For home care, what am I best doing without much consultation? Should I get a testing kit NOW, which one, and where? Or can this wait until...
3) Where can I go for affordable consultation to make sure I'm testing correctly, relatively pain-free, to set us on the right path for significantly less than $600 a test?

On felinediabetes.com, it said registering on this site that: "you become eligible for free or low cost testing supplies". Without delving into tons of the sticky topics, where how what about this?

Trying to become informed but also trying to not get overwhelmed. From an 8am vet consultation to working until 10pm, until posting now...it's been an exhausting day!

And yes, Dalci is short for Dulcinea from Don Quixote and Man of La Mancha.

"Dulcinea... Dulcinea...
I see heaven when I see thee, Dulcinea
And thy name is like a prayer
An angel whispers... Dulcinea... Dulcinea"

http://www.youtube.com/watch?v=ayz50HeFJUU

 

[Melissa and Bailey]

Welcome Adam and Dalci! You have found the right place to get help for your diabetic kitty. cat_pet_icon

The costs from your vet sound comparable to other vets- however, you can do curves at home and save yourself a ton of money.

If you look at the top right of this page, you will see a link for a free home testing kit (you pay shipping only). Alternatively, if you live near a Wal-mart, many of us use the ReliOn Confirm, a Wal-mart meter that costs $9 and has cheap test strips (the expensive part of testing).

Here is a video showing how it's done: http://www.youtube.com/watch?v=_zE12-4fVn8

I would recommend hometesting as soon as it's feasible for you - it is the best way to keep kitty safe and is much better than vet testing - cheaper and easier, doesn't stress kitty out!

A couple of questions for you - what is kitty eating? Dry or wet, low carb or not? Also, what insulin were you prescribed and what is the starting dose?

 

[adamj]

We picked up cans of Purina DM at the hospital. No insulin was prescribed but I hope I could contact the clinic and get a prescription written up and also visit Walmart tomorrow to pick up the test. It seemed, at the time, there were only two options given to us by the vet: expensive testing or euthanasia. We didn't ask about solely at-home treatment options and she may be very supportive if she knows I've done basic research and I'm somewhat competent.

Excuse my ignorance but a curve seems to be only several glucose readings spread at equal time intervals with rudimentary analysis. If home kits are so cheap, why is the cost of getting this done by the vet so expensive?

As for insulin, a once-a-day approach is highly preferred due to our work schedules; however, the difficulty with feline diabetes seems to be the inconsistency in effectiveness of different insulins for different cats. So "what works best?" seems like an inadequate question until we try something out and a twice a day approach will probably have better results.

By the way, she's 13 years old and had over 500 on her test today.

 

[Ry & Scooter]

Purina DM is ok carb-wise for diabetics, however, if you look at the ingredients, they are incredibly poor and highly liver based... lots of cats tire of liver quick. There's nothing in the DM that grocery store brands don't have, but it is far more expensive than the latter. I would suggest returning them to your vet for a refund (just say your cat won't eat it - very few cats do) and picking up something like Fancy Feast, Friskies, Special Kitty, or even on the more expensive side of things, Wellness or Merricks. Janet and Binky's food charts shows the % of calories from carbs in each type of food. You want to pick something under 10%, but under 7% is even better. You will see there are a LOT of options - just keep high fish foods to a minimum. The rest is up to kitty's preference.

Vets charge a lot for curves because they have to keep your kitty in hospitalized care and monitor them all day. They charge you for that. And they also charge you to use their "special" cat-calibrated meter (usually the Alphatrak) which is really no different from our human meters, but the meter and strips are incredibly expensive so they charge you markup to do that and whatnot. It's cheaper to buy a meter from Walmart, lancets, and strips, and do it yourself! And that way you'll get more accurate results because your cat won't be stressed out at the vet's office. Stress can significantly raise blood glucose levels and lead to your vet giving your cat a higher than normal and potentially deadly insulin dose.

Hometesting is the #1 way to keep your cat SAFE and is your key to PROPER TREATMENT & REGULATION. You will feel IN CONTROL of your cat's diabetes with hometesting and you do not have to worry about your cat not getting enough or too much insulin because you can adjust it based on the numbers you see.

You want a prescription for a long-lasting, gentle insulin. On here we mostly use Lantus, Levemir, or PZI (Prozinc). These insulins last about 12 hrs in the cat, and they gently drop the blood glucose over the cycle. Humulin N and Caninsulin are NOT ideal insulins for cats and they tend to be harsh and act fast, dropping your cat early in the cycle, and then wearing off after only 8 hours. Regulation is difficult with these harsh insulins and hypoglycemia is more likely. There is a vet-cited page here somewhere (I am sure someone else will post it) that can help convince your vet if they try to give you the inappropriate insulin. This is the only thing you need from your vet for everyday diabetes care. We can help you with the rest. You still need to have a reliable vet for things like blood tests, emergency care, etc. and things you just can't do at home.

Really - the three biggest and most important things to do are:
1. Get your cat on a low carb, canned food. Purina DM is low carb but as mentioned above, poor quality and expensive.
2. Start hometesting your cat. Switching to low carb canned can significantly reduce your cat's BG levels and you want to know these before starting insulin.
3. Start your cat on a long lasting, gentle insulin, at either 0.5 units or 1 unit and continue to home test. That way you can make safe, educated decisions about your cat's insulin needs.

A few other things you might need... you can pick up Ketostix from any Pharmacy. They are for testing your cat's urine for ketones. Diabetic ketoacidosis happens when the body cannot process glucose because of lack of insulin (or lack of regulation), and uses fat for energy instead. When the fatty acids are broken down they result in ketone acids in the blood and urine, which turns the blood acidic and severely dehydrates your cat. It can kill very fast, so it is good to test for ketones whenever possible, until your cat is regulated on insulin.

You will want to pick up some small cans of high carb (HC) gravy food in case of a hypo situation. You pour off the gravy and feed that to your cat to raise their BG levels up. I use Friskies sliced chicken dinner in gravy - it comes in 5.5oz cans but Scooter is a good eater so I feed him a bit of the actual food, and not just the gravy.

For more severe/urgent hypo situations you will want to pick up some high fructose corn syrup such as Karo. I personally use pure cane sugar syrup (golden syrup) as I use it in baking too.

You will also want some low carb treats for poke time. A lot of people use freeze dried meat treats - Purebites is one brand. Some use bonita flakes, split pea Pill Pockets, just plain boiled chicken breast, or maybe some others that I'm missing.

I probably missed a few things but others will fill in the blanks :lol:

 

[BJM]

This is manageable at home, much less expensively than your vet is quoting, since the majority of testing and doseage adjustment can be done by YOU, with some reading.

Since Dalci isn't on insulin yet, 1) diet change and 2) testing are the first order of business.

1) Ditch any and all dry food - it doesn't help the teeth and it has 30-40% of the calories from carbohydrates (ok, some prescription are around 20%, which is still too high)
Also, you can use NON-PRESCRIPTION FOOD that is easily obtainable - for example Fancy Feast Classic Pate are generally below 10% calories from carbohydrates. That'll cut your cost from $2 a can or more, to something reasonable. Binky's Page discusses food for diabetic cats and has pages about the calorie distributions. Also, Pet Food Nutritional Comparisons provides some other listings.

2) get a human glucometer and test strips here for shipping and handling costs, or from our shopping partners listed above. The WalMart ReliOn Confirm is the same thing as the Arkray Glucocard 01, which may be ordered from American Diabetes Wholesale at the shopping partners link above. It is one of the least expensive to purchase, and uses a tiny amount of blood for the testing. Although there are pet-specific glucometers, they are expensive, you can't get strips locally without going to the vet, and the strips are very expensive. There are veterinary documents which explain how to use the values from human glucometers correctly.

3) ketone testing - at a local pharmacy, pick up some urine test strips - ex Ketodiastix - so that you can watch for ketones. If these are very high, it could indicate diabetic ketoacidosis, a fatal condition if untreated and extremely expensive to treat. You use this to test fresh urine. If your cat is agreeable, you place the test strip or a soupspoon/ladle under the cat while urinating. For the spoon, you then dip the strip in the spoon. Within about 1 minute, the strip will change color IF there are any ketones. The darker it gets, the more there are. For the bashful cat, you use clean acquarium gravel in the litterbox, let the cat use it, push the gravel over, tilt the pan, and dip, within 30 minutes after use. If necessary, you can wash and re-use the gravel, although it is time-consuming!

Testing after changing the food will determine IF Dalci will continue to need insulin or if she can be diet controlled.
Testing after starting insulin will determine if it is safe to give insulin, and how to adjust the dose. As mentioned above, Lantus, Levemir, ProZinc, and PZI are all gentle insulins which will work wel for most cats. If the vet wants to use Humulin N, this suggests the vet is woefully out of date with contemporary feline diabetes care.

 

[Squeaky and KT (GA)]

...Excuse my ignorance but a curve seems to be only several glucose readings spread at equal time intervals with rudimentary analysis. If home kits are so cheap, why is the cost of getting this done by the vet so expensive?
.....

First - WELCOME to you and extra sweet Dalci! I had to giggle at this above....(we see it over and over...) - I can answer that 'Why'...."Because he likes your money!" After all, HE had to go to vet school.... Vets tend to forget that there's a whole SEA of diabetics that walk on 2 legs and are perfectly capable of testing and injecting themselves. Why they think people with animals aren't capable of doing it is beyond me!!!

HUGS!

 

[squeem3]

We picked up cans of Purina DM at the hospital.

You don't need the Purina DM or any other prescription food. As Ry and Scooter said, there isn't anything in prescription food that makes it "better" than regular canned food and the food costs a lot more. You can return the Purina DM to the vet for a refund.

Since your cat isn't on insulin yet, you can easily do a diet change.
To find low carb canned foods use Binky's charts, the Pet Food Nutritional Values list, Dr. Lynne's Wet Food list, and the list of low carb gluten free Fancy Feast

On Binky's charts, stick with foods that have a number 10 or less in the carbs colum. On the Pet Food Nutritional Values Chart, look at the %kcal from carbs column and choose foods that have a number 10 or less.

Popular brands of low carb canned foods are Fancy Feast, Wellness, Merrick, Nature's Variety Instinct, Special Kitty, Friskies. Feed your cat whatever brand of food he like to eats and you can afford.

For low carb treats, see http://www.felinediabetes.com/FDMB/viewtopic.php?f=14&t=9172

No insulin was prescribed but I hope I could contact the clinic and get a prescription written up and also visit Walmart tomorrow to pick up the test.

The sooner you start insulin, the better it will be for your cat :smile: I suggest changing the food to low carb canned right away and no more than week after that, start insulin.

Ask your vet for Lantus, Levemir, or Prozinc insulin. These are the preferred insulins to use for cats.

It seemed, at the time, there were only two options given to us by the vet: expensive testing or euthanasia.

Diabetes is a very manageable disease if you are willing to learn about it and how best to manage your cat's diabetes. There are people out there who will choose euthanasia over treatment because they simply can't be bothered to learn how to do the treatment at home.

We didn't ask about solely at-home treatment options and she may be very supportive if she knows I've done basic research and I'm somewhat competent.

Some vets discourage clients from hometesting, others are all for it. Even if your vet doesn't support it, you don't need her permission to do it. There are many published veterinary studies that promote hometesting.

Excuse my ignorance but a curve seems to be only several glucose readings spread at equal time intervals with rudimentary analysis. If home kits are so cheap, why is the cost of getting this done by the vet so expensive?

Money :roll: Many vets will charge a fourtune for simple things. Blood glucose testing done at the vet's office is often inaccurate because a stressed out cat (and many cats are) will have really high blood glucose levels. It's just a waste of $$$ for a falsely high curve.

As for insulin, a once-a-day approach is highly preferred due to our work schedules; however, the difficulty with feline diabetes seems to be the inconsistency in effectiveness of different insulins for different cats. So "what works best?" seems like an inadequate question until we try something out and a twice a day approach will probably have better results.

No insulin works once a day in cats. Cats have high metabolisms and need insulin injections twice a day. There are people here who have odd schedules and are still able to give twice a day injections.