Diabetes treatment less than successful...help!

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clare

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This is my first post and I hope I'm doing it right. If not, please steer me in the right direction. My cat is diabetic and has been to two different vets over the last few months, and on two different insulins. So far, neither vet has directed me to home test, and I've been waiting for my baby to kind of stabilize with regard to his symptoms before I insisted on it. Unfortunately, that is not happening. He continues to lose weight and his fur looks unthrifty. Initially, his appetite improved, as did his lethargy, but now it is clear that his health is still less than perfect. He is wildly hungry most of the time and will eat absolutely anything he can sink his few teeth into. He is less thirsty and urinates less than he did when first diagnosed. But he's never content and satisfied and I just feel he is starving before my eyes. I plan to take him back to the (second) vet shortly but I want to be educated on his behalf so that I can do a good job of taking care of him. Can someone help me with advice?
 
Hi and Welcome! You found the right place! You will be able to get plenty of information and help from experienced people on this site. Most here know more that the vets know about diabetic kitties!! The first thing you will need to do is get your baby on a low carb wet food. A lot of cats can get OTJ (off the juice) with a proper diet. I feed mine a combo of Fancy Feast Pate and Raw Instinct - both mixed with a little water After you get him on a proper diet you can be taught to home test.
Someone will be along soon to help you more and provide you with a list of foods that are low carb. Im not computer savvy enough to know how to hook up a link to the email.
I look forward to getting to know you and your baby better!!! Whats his name???
Terriy
 
Hello Clare, and welcome to FDMB,

You've come to the best place on the planet for help with your diabetic cat! :smile:

A handful of questions for you:
What insulin is your cat on currently? And what dose?
What are you feeding your cat at the moment? Dry? Wet?
Does he have any other health issues?
Are you willing to try to learn to test your cat's blood glucose at home? - This isn't nearly as difficult as it probably sounds, and it shouldn't hurt your cat at all. But it would be hugely beneficial in managing your cat's diabetes, and will save you money in vet's bills too.

Newly diagnosed diabetic cats are often ravenous at first. That's because their bodies can't utilize all the food they are eating, so they constantly want more. We recommend that a diabetic cat eats a wet/canned low carb diet if at all possible. Where are you from? We have members here from all over the world, and if we know where you're from we can better help you with food suggestions etc.

However, if you do switch your cat to a diet lower in carbohydrates it would be advisable to learn to 'hometest' (test his blood glucose at home) first. That's because lowering the carb content of the diet can dramatically lower blood glucose levels in some cats; and an insulin dose that may be OK prior to the switch could be too much on the reduced-carb diet.

We look forward to learning more about you and your cat.

Eliz
 
Hi Clare and welcome to the FDMB! Some people call this the best place you never expected to be.

A diagnosis of diabetes in your cat can be scary. It can be controlled and many cats can even achieve remission with proper diet and insulin. We have had members with diabetic cats that have lived ten years or more with diabetes.

The collective experience of members on this board can help you in many ways. Food choices, insulin choices, current vet journal published research, other health issues common to diabetic cats like constipation, CRF, UTI's, appetite issues and a whole host of other areas.

Elizabeth and Bertie said: However, if you do switch your cat to a diet lower in carbohydrates it would be advisable to learn to 'hometest' (test his blood glucose at home) first. That's because lowering the carb content of the diet can dramatically lower blood glucose levels in some cats; and an insulin dose that may be OK prior to the switch could be too much on the reduced-carb diet.
I wanted to emphasize this because it is very important. A switch from a higher carb food can drop the BG (blood glucose) levels 100 points or more and it can happen very quickly. Without knowing what your cats BG's are, switching foods can lead to low numbers and the potential for a hypo.

1. Where do you live? US, Canada, International? We ask because then we can tailor advice such as glucometers and food to where you live.
2. How long has your cat been on his current insulin? In other words, what date did you switch from the old insulin to the new insulin?
3. What testing is being done currently at the vet clinic? How often? We ask so we know how the insulin is being adjusted and how your cat is being monitored.
4. Do you monitor urine for ketones and or glucose? We ask because these are other ways to monitor your cat.
5. Is your cat on any other medications? We ask because some medications can impact BG (blood glucose) numbers.

With the answers to these questions and those that Elizabeth asked, we will be better able to help you.
 
Before changing the diet, please learn to home test.
This is for the cat's safety.

You may feed as much as 50% more than a non-diabetic cat would eat.

It helps to spread the food out across the day so he doesn't get too hungry.

With wet food, you can add a few tablespoons of water to increase the volume a bit and help him feel more full.

Spreading the food thinly across a plate may help slow him down a bit, also improving satiation. This helps avoid scarf 'n' barf behavior too.

In my signature link Secondary Monitoring Tools are a number of helpful assessments to gauge how he is doing. Urine ketone testing, in particular, is very important while unregulated. Ketones form as a by-product of fat breakdown for calories Too many ketones may indicate diabetic ketoacidosis (DKA), a po tentially fatal, expensive to treat, complication of diabetes.
 
I typed out a reply but it seems to have disappeared into thin air. If it's out there in the nether world and I'm repeating myself, forgive me. My cat is an orange tiger, originally named Bono, which has kind of morphed into Bonnie. He doesn't mind that he's being called a girl's name, honest. I'm not sure of his age because he was adopted as an adult, but he is at least 8 years old. He had all his teeth pulled except the canines shortly before he was diagnosed with diabetes a few months ago. Since then he has had a persistent ear infection, now on the third different antibiotic treatment.
Up til three weeks ago, he was on Lantus. Now he is on PVI, 2 units once a day. He seems slightly calmer, less freaked out about not having enough to eat. But he still looks sickly, fur unthrifty and continuing to lose weight. I feed him about a can a day, usually Friskies or 9 Lives pates, as well as treats (meat or dog treats that are dehydrated human-quality chicken) and dry food. I have 8 cats, some of which are geriatric, so I feel I have to leave dry food available all day. However, I can't always afford (the 8 cats eat it up very quickly) the Innova Evo or Instinct that was recommended and I can't lock Bonnie up separately all day. So sometimes I've been feeding Purina One Healthy Metabolism as it says it has higher protein. I've been thinking of preparing a diet of meat with supplements for all my cats...I've read that maybe it is better for them and might even be cheaper.
I am willing to test blood or urine and am sure I can do it. However, I am making a long distance move from Western NY to NC within the next three weeks. It will be costly and I have been on SS Disability for physical problems for the last few months. The move will take my last cent, so if the test kits are expensive, I might have to wait until the end of July or the beginning of August to buy them. I could also use a vet referral for NC if anyone knows of one. I'll be living in Sylva which is about 40 minutes west of Asheville but would be willing to travel some to find a good vet.
Right now I'm most concerned with getting Bonnie healthier so I don't wind up losing him. I am grateful for direction and any suggestions or knowledge you could share. Thank you.
 
I've been reading a little more from the website and plan to go out later and purchase one of the less expensive glucose meters I saw reviewed here on the site. My fear is that maybe Bonnie is on too high a dose of insulin (2 units of PZI once a day) and is thus having drops in blood sugar leading to his extreme hunger. I was relieved to read that it is probably normal for him to be eating 50% more than usual. But I would estimate that he is eating 3 times as much as he used to when he was healthy and 3 times as much as my non-diabetic cats. He eats his own food and then goes around and finishes the food of all the other cats. I gave him some fish oil from capsules I take and after drinking it he devoured the empty capsules! He will eat anything, anytime he can beg or steal it. His stomach looks huge but his body is thin, I can feel his vertebrae and I think his muscles are less prominent than they used to be. I will watch the videos and read up on the glucose testing and report back. My only concern is that he has this ongoing ear infection which produces some drainage. I will use the other ear as I don't want to create an infection in the outer part of the infected ear as well, by repeatedly poking it. Are there any other parts of the body that can be used...or would that be too painful for him? Thanks for the benefit of your experience and knowledge and for your kindness.
 
Hello there

The ear infection could well be spiking his blood sugar and exacerbating the diabetes so I hope the antibiotics work soon to clear it. Can u look at the medication to see if it has prednisone in it?

For now though its a good idea to test him to see what's going on. You can test the ear or the paw pads if you think he will let you touch his feet.

For food, unregulated cats are literally starving so I would feed him more but no dry if possible. Can you change all the cats onto wet? It would also help prevent them from having the same problem.

Wendy
 
I checked the ear ointment and in addition to an antibiotic it also has a steroid, mometasone (I looked it up). The previous two ear ointments he's been on also contained steroids and his ear infection never seems to clear up completely. Can the steroids be harmful for his diabetes and preventing him from getting stabilized? Any ideas on alternatives I could suggest to the vet?
 
Some cats are very sensitive to steroids; some are not.

Did the vet clean out the ear of any residual gunk, or ask you to do so? Sometimes removal of infectious material helps reduce the irritation.

Another possibilty is that it is a yeast infection too, not just a bacterial infection. Antibiotics don't do much in that case. A cleanser with acetic acid in it may help in that case, as well as an antifungal med.

You may need a combo plan of cleaning out the ear, drying it, and then applying the treatment. I'm surprised its an ointment as those may be difficult to get far down the ear canal.

Tip: for liquid cleanser or medicines, apply to a cotton ball, place that in the ear, and massage. If cleaning, use a dry cotton ball and repeat to remove excess moisture.
 
Steroid ear meds can significantly raise BG. Animax drove my Twigie's BG to the 400s
Did your vet take a sample from the ear and look at it under a microscope to determine that source of the problem? Bacteria? Yeast?
 
Steroids will make him hard to regulate but then so will an ear infection. As will dry food. And being diabetic and uncontrolled wont help the ear infection - its catch 22.. so you have a little work on your hands. :)

But lets take it one step at a time

1. Give your vet a call about that ear infection and take a second look at it as BJ suggested

2. Home testing - are you willing to home test? If so, we can work on getting them all onto Friskies pates and no dry. That will help immensely but you would need to home test because a food change can reduce insulin needs. Another advantage of home testing is we can change his insulin to match his needs better as we will have more data. This means we might be able to offset the impact of the ear infection and steroids. I have experienced this ear infection issue myself.



Wendy
 
I will start home testing tomorrow. The vet did not clean Bonnie's ear or advise me to do it. I've just been giving the medication as instructed as I don't want to do the wrong thing for his ear. I have an ear cleansing solution but have been hesitant to use it. I probably was wrong to use the word ointment...it comes in a tube but is liquid-y enough to run down into his ear. I will also buy a bag of low-carb dry food for now, Instinct since Innova Evo evidently had a recall. This is probably not the best time to switch 8 cats to exclusively canned food...I'm moving long-distance in two weeks and money will be tight. I don't know if I can afford enough canned food to keep everybody full and happy. They will want to eat canned food constantly. I think it might be better and cheaper to give them a diet of human-quality meat and supplements after I'm all moved. Does anybody out there do that?
I know Bonnie needs to go back to the vet but I fear I won't be able to afford it for about another month. Another of my cats just went in and had all his teeth pulled and then died the next day. And then there's the move, which will take all my $. I feel like a neglectful parent for waiting, but I'm not satisfied with this vet anyway. He never mentioned home testing or cleaned Bonnie's ear, etc., etc. Sorry for all the complaining; I'm just a little discouraged right now. Thanks again for the advice.
 
Thats what I had to give my Bailey when he had the infection but my vet told me to go and clean it every time with a q-tip first because the meds wouldnt be able to get in through the gunk otherwise!

Some people do feed cats meat but you have to add some supplements and stuff to make sure its balanced since cats in the wild would eat bones etc too to get additional nutrients that plain meat doesnt have- heres more info.. http://www.catinfo.org/?link=makingcatfood

Wendy
 
I tried home testing yesterday and did everything correctly but I couldn't get his ear to bleed. I tried massaging and stuck him 4 times but not a drop (then he started getting upset in spite of the treats, so I quit). I will try again this evening after heating his ear up with warm water. Also will clean the infected ear tonight before medicating.
 
If needed, aim directly for the vein at the edge of the ear. Just be prepared to apply pressure to stop the bleeding. You can get a droplet on a clean fingernail, then blot while testing the droplet.
 
clare said:
I tried home testing yesterday and did everything correctly but I couldn't get his ear to bleed. I tried massaging and stuck him 4 times but not a drop (then he started getting upset in spite of the treats, so I quit). I will try again this evening after heating his ear up with warm water. Also will clean the infected ear tonight before medicating.

What sized lancets are you using? If you can, it can help to poke twice close together and let the 2 tiny spots pool to one decent drop.

I know you are both discouraged, but the ears "learn to bleed" as the pokes heal.

Gayle
 
Hang in there! The beginning is always stressful. It will become a routine.

Re food transition. I am an advocate for a raw diet for felines but the transition takes time and a lot of patience. If not raw, then a grain free, low carb solution might be doable. It is so nice to see all my cats so vibrant and healthy since changing their diet - but the recipe to follow is on catinfo.org. It includes grinding bone with meat and making chunks and then a slurry of other nutrients to balance it all out according to the needs of the species. There are other raw options as well.

I would suggest that when you get settled and can relax - you could begin a transition for all your kitties off of dry food to canned. Yes, they will be hungry and yes, you will need to add feedings but it is so worth it when your cats don't get sick anymore - I haven't had any vomiting or messy stools since I transitioned mine and they are way more active. My 13 year old girl is acting like a playful kitten and no longer has matted fur.

Cats are adaptable and I can attest to it. While raw is their main meal twice a day, I do supplement with grain and soy-free, low carb canned food. In the beginning they would eat it the minute I put it down even though they just had a large plateful of raw. Now, I noticed that they are saving it for grazing. It was there, untouched when I left this morning but that plate will be licked clean when I return. They did this - adapted to the loss of the dry food and figured out how to cope (even my idiot civvie). Patience is the key. I started in March.

Please don't get discouraged - we are here to listen and help.
 
You mentioned that you are in Western NY - what town exactly. We may have a member nearby who could help show you home testing techniques in person.
 
I am in Arcade and bought ultra-thin lancets...a mistake, right? Am using a device and some lancets came with it; maybe those are larger (I'm not at home right now). I've put off trying again because I hate to make him upset or hurt him. But I'll try again when I get home shortly...I'll aim for the vein this time. Got the good Instinct dry and am feeding more canned every day. I hope I have enough money to get to NC. You guys are great; thanks for all the pointers and for your time.
 
Cats have fewer nerve endings in the ear than humans have in the fingertips, so you aren't really hurting him, more annoying him. To deal with that, pick up some generic Neosporin ointment (not cream) with pain relief, apply a dab on the ear before testing, wait a few minutes, then wipe off. It will reduce the annoyance and help the blood bead up.

You may find it easier to use 27-28 gauge lancets until the ear develops more capillaries (yes, it will).

And if you absolutely must get blood (ex possible hypo), aim for the vein itself. Just be prepared to snag a blood drop on a clean fingernail and blot any gusher for several minutes to minimize bruising. (gusher being the reason we don't normally prick the vein directly.)
 
The lancets that came with the device are probably 33g so still too small. You can certainly try them but if you don't have any luck then try and get bigger ones ..
 
Good luck on your move! When are you leaving? Did you read through the travel tips document?

For lancets with a larger size pin for pricking, you want a smaller gauge number. Look for boxes labeled "For Alternate Site Testing". As an example, the Walmart Relion brand I have are labeled 26G.

p.s. Arcade, NY! That's just a stones throw away from where I grew up in Jamestown.
 
clare said:
I am in Arcade and bought ultra-thin lancets...a mistake, right? Am using a device and some lancets came with it; maybe those are larger (I'm not at home right now). I've put off trying again because I hate to make him upset or hurt him. But I'll try again when I get home shortly...I'll aim for the vein this time. Got the good Instinct dry and am feeding more canned every day. I hope I have enough money to get to NC. You guys are great; thanks for all the pointers and for your time.

Hi Clare,
I am in WNY. Sending you a PM (private message) Look at top of page for message notification.
Right now the board is completely messed up for me. Format is all screwy. So I can barely see posts.
So key is that I am trying to send you one in a minute.

cheers.
 
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