diagnosed today...need advice

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taran80

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hi, my name is tara and my cat gizmo was diagnosed today with diabetes. he is 12 years old and 28 pounds. he was my parents cat prior to me taking him in and he was already large. i dont think i overfeed him but am now reviewing his current diet and plan on changing it. he is currently on 1 wet can of fancy feast elegant medleys daily and wellness indoor dry food. i plan on stopping the dry food gradually and will find a better canned food.

i had taken him into the vet yesterday for a visit and had blood work done. the vet called me today and said he has diabetes (no other issues). the vet had me make an appointment to bring him back in on saturday to show me how to give him insulin. i feel like it is all happening too fast. i just started reading and making myself knowledgeable today about diabetes. i asked the vet if i could just try changing his diet and he said we would still need to start the insulin but that i should put him on a low calorie cat food. from what i have read online so far, i need to put him on a low carb, higher protein diet but should change it gradually and be careful about how much insulin is given when changing a diet. i am confused if i should start him on insulin now or try diet alone first since it sounds like i shouldn't start both at the same time even though it sounds like the vet thinks this is ok.

which is preferred...
start insulin this saturday/stay on current diet temporarily?
start insulin this saturday/start new low carb/higher protein diet now?
start new diet and put off insulin for a few weeks?

any advice would be helpful. i will have to call tomorrow morning if i want to cancel and reschedule the appointment.

thanks!
tara
 
This is a marathon not a race - meaning: have patience and make the necessary changes in steps.

Your vet is correct about starting insulin now. You want to get his BGs under control, or at least lower, starting as soon a possible. It does take time and methodical dose increases to achieve regulation. usually this takes a few months, sometimes there is a dramatic response to a few weeks of insulin and a diet change, but that is not common.

You do want to change his diet, and help him loose weight, but weight loss needs to be slow. It is every important not to under feed a diabetic. The best diet is low card canned food. Please do not let your vet sell you "low calorie" food! That is usually a dry food that has carbs replacing fat to lower the calories thus creating a diet that is not suitable for any cat.

Does Gizmo like the Fancy Feast food? You might start by switching him to Fancy Feast (FF) classic pate types as they have the lowest carbs. He will probably need about 3-1/2 cans of FF a day (once dry is eliminated) at that weight. There are other foods, such as PetSmart Great Choice in 5.5 oz cans (also look for the classic/pate) flavors and avoid anything that have gravy in it.

Did your vet tell you what insulin he will be recommending? Did he say what Gizmo's blood sugar was?

Just keep reading and asking questions - and welcome Tara and Gizmo!

Silly me! I forgot to mention about testing his blood sugar at home. Almost everyone here does that and it makes managing diabetes safe and, I think, easier than not testing at home. We use human glucose meters. The Relion from Walmart is supposed to be good. I use a Bayer Contour meter for my guys.

And yes, you can begin switching his diet to low carb/high protein now. Some cats take a long time to ween off dry food. My Beau took over a month he was such an addict. And I am sure the "Weight Management" dry food I feed caused his weight gain AND his diabetes. He was on insulin for over two years but has been off insulin and diet controlled for over two years.
 
I think since you have not started insulin yet, you may want to take a week to go the diet change way first. Many cats are diet controlled and do not need insulin, so you may want to start home testing right away, and remove the dry food. Since your cat is already eating wet food, you should not have a problem taking the dry away.... it's funny, many people feed dry and give the wet as a treat or something special.... their cats must be all excited when their entire diet becomes the 'treat' food!

Once you are testing, you may find gizmo has better BG numbers and needs no insulin or a very small amount. Scrap the expensive vet food and just go with fancy feast or friskies pates, or some of the other low carb wet food suggested.

Why go with the expense of insulin and syringes before you know for sure if you need them? Tell your vet that you are going to do some home testing and switch diet to see how the numbers improve. You may well still need to give insulin, but it will be a much lesser amount than while gizmo is eating dry food.

For food, their bodies aren't great at extracting what they need from the food, so you will fine gizmo eats more now till his numbers are more regulated. My Oliver was eating close to 30oz a day and is now eating 6oz a day, so you may want to give gizmo more food, but spread it out into maybe several smaller meals through the day.
 
Can you confirm the vet did a fructosamine test to confirm the diabetes? If he was showing symptoms of diabetes like drinking and peeing a lot they probably did but if you just went in for a general check up they may just have done a spot check. The fructosamine test shows you the average glucose level over the last 2-3 weeks but a spot check as part of the general labs just shows what it was during the vet visit and stress can really raise glucose levels. If the vet is suggesting starting insulin without having done a fructosamine test that is extremely dangerous and you should get the test done and find another vet.

If they did the fructosamine they can probably advise how important it is to start insulin ASAP vs adjusting food before you start. The ideal would be to switch him cold turkey to a reasonable wet food he likes, start home testing and start the insulin soon with a low dose. If the fructosamine was not too elevated say in the low/mid 200's starting the wet food and testing his glucose at home for a week before setting the dose is probably ok.
 
hi, thank you for your responses. i did mention at the vet that gizmo seemed to be drinking a little more water than usual. he seems normal besides that. i asked the vet to run a blood test since he had not a checked up in more than a year. his previous tests have never showed diabetes or any other issues. based on my receipt, they did a feline wellness (calcium, cbc/mini screen/t4/wellness screen). i know they took blood but the vet didnt mention if it was a fructosamine test and he did not tell me what his blood sugar was. i didnt even know to ask as i am only learning about this, but feel like he should have told me this. i will call them this morning to find out. i did forgot to mention earlier i had been giving gizmo some goodlife cat treats daily so i will stop these as well (even though gizmo will not be very happy with me cat(2)_steam )
 
The fructosamine test is a blood test that takes time to send out to a lab, but it measures the blood glucose levels over the past few weeks and can tell you if he is diabetic. If the vet relied on just a blood test in the office, that will give him a number for that minute. And we think that blood tests in the vet's office may often be much higher than those at home. There are lots of noises, animals and people around that can cause stress and stress raises blood glucose levels.

If I were you, I would ask for a fructosamine test. I would start testing at home and change the diet. If you get high numbers at home with the diet change, and the fructosamine test comes back for diabetes, then I would start insulin. We can get your advice on the best kinds; some are better than others for cats.

Good for you for doing the research and asking questions. That is the first step in this sugar dance.
 
Welcome to the feline diabetic forum - this is an AWESOME place and truly a life saver. I'm always amazed at how uninformed some vets are on treating diabetic cats - I know that they need to know a little about a lot of diseases but there is so much known information about diabetes being uninformed is crazy. Anyway - the mantra here is start low and go slow. Start a diet change and home testing Gizmo's blood sugar - when you have some numbers then think about insulin. The best types of insulin are Lantus, Levemir, and Prozinc. Some vets still prescribe Humulin N and that is NOT a good insulin for cats (dogs yes but not cats). Lantus, Levemir, and Prozinc are 12 hour insulins - so shots are best given 12 hours apart. Its not the end of the world if you miss the mark a little bit but staying consistent is best. Do NOT let your vet talk you into starting at more than .5 or 1 unit twice a day. Just remember once you put insulin in your cat you can't take it out. So the sequence is test blood sugar for safety, feed, and give insulin. Also starting at too high an insulin dose causes a condition called rebounding - your cats blood sugar goes too low too fast then their body's defense mechanism kicks in and it causes a bounce back to high blood sugar readings. So when you start a low dose give it a few days to adjust then considering a higher dose if needed. My cats blood sugar readings were all over the place her first two weeks on insulin. Just remember you are in control of your cats health and being knowledable about is is the key. Jan
 
taran80 said:
hi, thank you for your responses. i did mention at the vet that gizmo seemed to be drinking a little more water than usual. he seems normal besides that. i asked the vet to run a blood test since he had not a checked up in more than a year. his previous tests have never showed diabetes or any other issues. based on my receipt, they did a feline wellness (calcium, cbc/mini screen/t4/wellness screen). i know they took blood but the vet didnt mention if it was a fructosamine test and he did not tell me what his blood sugar was. i didnt even know to ask as i am only learning about this, but feel like he should have told me this. i will call them this morning to find out. i did forgot to mention earlier i had been giving gizmo some goodlife cat treats daily so i will stop these as well (even though gizmo will not be very happy with me cat(2)_steam )
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A diabetes diagnosis can also be confirmed with a urinalysis (as long as it's performed within an hour or two of the cat arriving at the vet--extended stress can skew the results) in conjunction with the bloodwork you've already had done, which is less expensive than a fructosamine. If you're up for it, you could also confirm the diagnosis yourself by testing at home this week while you're changing the diet. Just pick up a home glucose meter and bottle of ketodiastix at your local pharmacy. These are urine testing strips. The Ketodiastix test for ketones (which are a dangerous complication of high blood sugar that you want to test for anyway if he is diabetic), as well as glucose in the urine. If he is showing high blood glucose on your glucose meter and there is glucose in his urine, then he is diabetic.

Do you know what his ideal weight is? You definitely want to be proactive about a weight loss plan, but like the others said you don't want him to lose weight too quickly. It's very helpful to feed an overweight diabetic canned food that is low in fat while he's losing weight, because you can feed more calories and still have him drop pounds healthily. Many premium foods, like Wellness and EVO, are very high in fat so you want to avoid them while he's losing weight. Merrick's Cowboy Cookout and Surf-N-Turf are two very good foods for weight loss and diabetes--they are super high protein, very low fat, and low carb. Here's a link to their locator so you can find someplace that sells them near you: http://www.merrickpetcare.com/locator/. If that food isn't an option for you, I would go with the Fancy Feast Classic Flavors, as they're probably the next best thing in terms of fat content. Here are the diabetic-safe flavors: http://felinediabetes.com/glutenfree.htm. Check out this page for how much you should feed: http://catinfo.org/?link=felineobesity#How_Much_Do_I_Feed. You can find the carb content and number of calories here: http://felinediabetes.com/diabetic-cat-diets.htm.

As others have mentioned, make sure your vet gives you a script for Lantus (glargine), Levemir (detemir), or Prozinc. The first two have amazing results with cats--they have an 84% remission rate in newly diagnosed cats when used in conjunction with a low carb, canned diet and dose adjustments via home testing. However, you do want to start insulin soon--there is a window on remission, and the faster you get his blood sugar under control the better and sooner are his chances of no longer needing insulin. I would say that if you don't see a vast improvement in your home testing with the diet change within a week, you will want to start insulin immediately.

Do NOT accept a script for Humulin N (NPH) for your cat. This is not a good insulin for cats and should only be used with dogs. Only about 25% of cats do well on this insulin, and even that is likely because of diet change, meaning the cat would have gone into remission regardless of insulin.

Btw, six years ago my Bandit was morbidly obese at over 20 lbs (his ideal weight is 13lbs), all from feeding him a dry diet. This is is him in 2006:

FATBANDIT.jpg


And here's his after picture:

SkinnyBandit-1.jpg


I remember how upset I was with the diabetes diagnosis, but honestly, it possibly was one of the best things for Bandit's health. It forced me to get rid of the dry food and pay close attention to his diet. Just like with people, obesity presents all sorts of serious health risks for cats. Bandit's been off insulin for almost 2 years now and for the past year he's probably healthier than he's ever been in his life. So don't be discouraged! The diabetes is just a bump in the road, and the benefits of diet change will pay off for you both a great deal in the long run.

Once you find out what insulin you'll be using please post back here so we can guide you with safe dosing. Many vets tend to overdose insulin because they are unaware of the dosing protocols for cats, which is dangerous and counterproductive to controlling your cat's diabetes.
 
When you replace those dry treats with a few pieces of boiled chicken breast, he will be VERY happy!

One of the keys to getting them used to, and even happy about, testing is giving treats afterwards. I use boiled chicken. I cut up a chicken breast into about 1" cubes and boil in plain water for about 10 minutes. Then I divide it up into the smallest plastic containers, including the broth so they don't dry out, and put them in the freezer, thawing out one ever few days. When the container is empty I give the broth in a dish or over their wet food.

I also keep freeze dried chicken treats in the fridge for when I run out of the boiled chicken. They last a long time. Actually, they are a dog treat, but my cats all love them. Prime Taste Treats and I get them at PetSmart. Here is a link so you can see the package:
http://www.petsmart.com/product/index.jsp?productId=4406466&lmdn=Product+Type
 
thanks everyone. i called the vet this morning and spoke with a different Dr, who happens to be the one we have the appointment with tomorrow morning and seemed more knowledgeable then the Dr we saw on Wednesday. i asked if they did the fructosamine test and she said no. they only did the general labs, however gizmo's blood sugar was 520 and even under the stress of going to the vet she said that is too high. she also mentioned we should possibly do a urine test and mentioned diabetic ketoacidosis. not sure why they wouldnt have just done the test fructosamine and urine at the last visit. should i insist on any of this additional testing before starting the insulin tomorrow? she said it will be ok to go ahead and start him on a low dose of Lantus of about 1 unit tomorrow. She said because it is a low dose it should be ok to modify his diet at the same time. She agreed with a low carb canned food only. i went to the store and bought relion meter/lancets/strips. i have read the instructions on this and a few other sites. not sure if i should try testing him myself for the first time tonight or will they do that tomorrow before showing me how to give the insulin? i will practice on myself first of course.

thank you for the info on ketodiastix. i will look into it. i started reading about the smart cat box for urine testing, but confused how this would work since i have another cat that would try to use it.

i will start to transition him today from the fancy feast elegant medleys to the fancy feast classics for now. i will look into the others you mentioned and the charts when i get more time. i will take away the dry foods and snacks. i think the snacks are what he will miss the most though! the boiled chicken sounds like a great idea for snacks.

tara
 
It's good that this vet sounds more knowledgeable and a blood glucose of 520 is very unlikely to be just due to stress. If I were you I'd try to do a glucose test at home today before you go to the vet so you can confirm what his current level really is as that'll help confirm the right safe starting dose.
 
Check out the stickies in the Lantus TR Forum for more information about Lantus: http://felinediabetes.com/FDMB/viewforum.php?f=9. There is a wealth of information about how Lantus should be handled, how it works, and how it should be dosed.

With the smart cat box, you would have to isolate the box so that only Gizmo has access to it until you get your sample. Some people collect a urine sample with their regular litterbox by catching the cat mid-stream with a ladle. (FYI, I have the Purina Breeze and it works pretty much the same way as the smart cat box: www.breezeforcats.com)

As long as you're home testing, I don't think starting at 1u would be a problem, but keep in mind that 1u is not a small dose--it's an average dose for cats. Most cats on a low carb, canned diet do not need much more than 1u of insulin.
 
we successfully tested gizmo's blood sugar at home tonight using a meter and it showed as 323. big difference than the vet test results of 520 from just 2 days ago. haven't had a chance to change much diet yet except gave him no snacks today. i will update after vet appointment tomorrow morning.
tara
 
had the follow up vet visit this morning at 9:30 am. Dr did urine test to confirm high blood sugar. tested negative for ketoacidosis. the Dr is starting gizmo on 1 unit of lantus once a day. i told her i thought it was supposed to be twice a day 12 hours apart and she said she thought it was fine to start at once a day and we can reevaluate it later. :? i told her i will be doing at home testing and she was ok with that but still wants me to come back to the vet office in about a week. she spent alot of time with us showing us how to give the injections. i filled the prescription at walgreens for Lantus 100 units/mL (u-100) One 10 mL Vial for about $130 :shock: and the syringes are 100 count u-100 for 30 units or less syringes walgreens brand - 0.3mL - 29 size gauge - 1/2" needle length for $19. The Lantus says i can refill only once and the syringes three times.

vet also gave gizmo a convenia antibiotic injection i think because of the small lump/possible infection gizmo had on his back. of course i just read on dr pierson's website that this may not be a good antibiotic. i hate reading things after the fact :-x

tested gizmo's blood sugar at home tonight at about 6pm and it was 279. will test again in the morning before we give our first at home injection of insulin.

thanks again everyone...this community has been a great help and full of support!

tara
 
Lantus needs to be dosed twice a day, not once. Please share this document with your vet: http://www.uq.edu.au/ccah/docs/diabetesinfo/link5.pdf. Note that it states,
When SID dosing is desired or demanded (it is important to note that better glycemic control and higher remission rates will be obtained with BID dosing. SID dosing only provides similar control and remission rates to lente BID).
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I've also attached an article concerning the correct use of Lantus for you to print out and give to your vet.



Cats' metabolisms are twice as fast as people or dogs, so insulins like Lantus that work 24 hrs in humans only work 12 hrs in cats. So if you're only giving insulin once a day, it's ineffective because your cat is spending half the day with high blood sugar. In order to properly control your cat's blood sugar, the insulin needs to be given twice a day, or you won't be able to get Gizmo regulated. The high remission rates with Lantus are only valid with the correct treatment plan is followed soon after diagnosis, so it's very important that you get on the right treatment path.
 

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Julia & Bandit said:
Lantus needs to be dosed twice a day, not once. Please share this document with your vet: http://www.uq.edu.au/ccah/docs/diabetesinfo/link5.pdf. Note that it states,
When SID dosing is desired or demanded (it is important to note that better glycemic control and higher remission rates will be obtained with BID dosing. SID dosing only provides similar control and remission rates to lente BID).
Click to expand...
I've also attached an article concerning the correct use of Lantus for you to print out and give to your vet.



Cats' metabolisms are twice as fast as people or dogs, so insulins like Lantus that work 24 hrs in humans only work 12 hrs in cats. So if you're only giving insulin once a day, it's ineffective because your cat is spending half the day with high blood sugar. In order to properly control your cat's blood sugar, the insulin needs to be given twice a day, or you won't be able to get Gizmo regulated. The high remission rates with Lantus are only valid with the correct treatment plan is followed soon after diagnosis, so it's very important that you get on the right treatment path.
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thanks, i have been worried about only giving the lantus once a day. i did bright up twice a day with the vet and she mentioned it was made for once a day in people. i told her i thought it was supposed to be twice a day in cats. she said some cats do fine on once a day and to start out at that. that visit was on saturday and she said to come back in about a week to reevaluate to see if twice a day was necessary or to increase dose.

how often is it really necessary for me to go to the vet when i am testing at home? do you all usually go to the vet, weekly, monthly, less? how do you get the lantus prescription refills if you are not going often and do speak to the vet about adjustments in units? i know i can probably figure it out and do it on my own especially with the help of these forums but dont want to isolate myself from the vet since i am just starting out with this.

gizmo's numbers have been in the 200's when i test him pre shot in the morning at 7 am and in the 200s when i test him 6-11 hours later in the evening. is the insulin working well for 24 hours if he is still testing in the 200's in the morning when he hasn't had a shot in almost 24 hours? i feel like the vet may think that. maybe i will try taking some more numbers in the late evening or middle of the night like 12-23 hours later so see what i get. he was higher for the first time this morning at 321. i created a spreadsheet that is in my signature.

he has been on 1 unit once a day for 5 days now. should i recommend to the vet to change it to 1 unit twice a day? or go up or down in units twice a day? i will probably make a appointment for sometime in the next few days.

thanks again!!!
 
taran80 said:
thanks, i have been worried about only giving the lantus once a day. i did bright up twice a day with the vet and she mentioned it was made for once a day in people. i told her i thought it was supposed to be twice a day in cats. she said some cats do fine on once a day and to start out at that. that visit was on saturday and she said to come back in about a week to reevaluate to see if twice a day was necessary or to increase dose.
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Did you print and show her the documents I provided in my message that clearly state Lantus should NOT be dosed once a day? And she insisted on continuing dosing once a day despite it? I would be hesitant to stay with a vet that ignored published veterinary articles because they were stubborn about being right.

taran80 said:
how often is it really necessary for me to go to the vet when i am testing at home? do you all usually go to the vet, weekly, monthly, less? how do you get the lantus prescription refills if you are not going often and do speak to the vet about adjustments in units? i know i can probably figure it out and do it on my own especially with the help of these forums but dont want to isolate myself from the vet since i am just starting out with this.
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If you're home testing, you only need to go to the vet if you have an emergency or every 6 months for regular checkups. I take Bandit in every 6 months. When my vet writes a prescription for Lantus, she puts 3 refills on the script. However, one pack of Lantus pens lasted nearly year for me, so I never needed more than one refill (Bandit went into remission after a year on insulin). If you get a script for the pens, you can just get the refill written when you go in for your six month check, if your cat isn't in remission by then. The pens will definitely last at least 6 months, and longer if you handle them properly. They are more economical than the vial. The vial will go bad before you even come close to using all of the insulin.

You don't need to isolate yourself from the vet to take his care into your own hands. My vet is 100% supportive of my treatment of Bandit's diabetes--she trusts that I know what I'm doing and gives me input when I ask for it. I insisted that she read the Roomp/Rand article and the Lantus dosing protocol that I provided for you above, and told her this is the way we are treating Bandit. After she read the articles, she was on board. If your vet will not examine the material you're providing her, or refuses to follow it, I would switch to a vet who will.

taran80 said:
gizmo's numbers have been in the 200's when i test him pre shot in the morning at 7 am and in the 200s when i test him 6-11 hours later in the evening. is the insulin working well for 24 hours if he is still testing in the 200's in the morning when he hasn't had a shot in almost 24 hours? i feel like the vet may think that. maybe i will try taking some more numbers in the late evening or middle of the night like 12-23 hours later so see what i get. he was higher for the first time this morning at 321. i created a spreadsheet that is in my signature.

he has been on 1 unit once a day for 5 days now. should i recommend to the vet to change it to 1 unit twice a day? or go up or down in units twice a day? i will probably make a appointment for sometime in the next few days.
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It's hard to tell how the insulin is working this early because you don't have enough data collected yet. With Lantus, you need at least three tests a day--once before each shot to make sure it's safe to give insulin, and then a mid-cycle check or two. Then once a week (when you can), you do a curve (testing every two hours for a cycle). Once you have enough data, then you make informed dose adjustments (in .25u increments) based on those numbers.

I can tell you that dosing once a day does not provide adequate control of blood sugar, and until you start giving insulin twice a day, you will not see a lot of improvement. Lantus only lasts around 12 hours in cats. This is a fact, not my opinion. PLEASE print the documents I provided and share them with your vet if you haven't already. With numbers in the 200s on 1u once a day, I would recommend you split that dose up and give .5u twice a day. Most cats start out on 1u of insulin, but with the numbers you're seeing already I would tread on the cautious side and start even lower. You can get wonderful dosing advice in the Lantus forum on how to raise and lower the dose safely and effectively.

Remember, Gizmo is YOUR cat, so all decisions on how to treat his diabetes are ultimately yours. On the one hand, you have a scientific study from a peer-reviewed veterinary journal that clearly states that Lantus should be dosed twice a day in cats, and on the other hand you have your vet saying it should be once a day, based on...what? That's a question I would ask her. Lantus can be dosed once a day in dogs, but not cats.
 
thanks, i have not shared the documents with the vet yet. i have only had 2 visits. the first one was a regular check up with blood test where diabetes was diagnosed and the follow up where gizmo a couple days later where he got his first injection where she said to give one a day and i mentioned i thought it should be 2. she did say at that visit to come back in a week and we would possibly change it to twice a day. i am going to make that appointment for sometime in the next couple of days. hopefully she will recommend the twice a day on her own, if not i will tell her that is what i will be doing and will provide the documents. i really like the vet as she seemed very supportive. she was ok with me testing as home and agreed with low carb high protein wet canned food. however, i think she thought she was being cautious by starting off by once a day and i think they see alot more dogs then cats in the office.
 
update - took gizmo to vet yesterday since it had been almost a week since starting 1 unit lantus once a day. good news Dr said she only started at once a day as trial but looked at my spreadsheet and said ok to start giving 1 unit of lantus twice a day. i took gizmo's blood sugar before leaving for vet and got 292. at the vet about an hour after i took blood sugar, Dr used alphatrak and got 281. Dr and vet tech seemed impressed that I have been testing at home and our numbers were similar. I was surprised that is was a little lower since i thought it would be elevated due to stress at the vet and i read the alphatrak usually reads a little higher anyways.

thanks!
 
I was surprised that is was a little lower since i thought it would be elevated due to stress at the vet and i read the alphatrak usually reads a little higher anyways.
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What that probably means is that in that hour, her BG actually dropped some. On your meter at that moment, you may have gotten a lower number than the vet did on her alpha track. BG can change quite a bit in an hour depending on where the kitty is in the 12 hour cycle. Gizmo might have dropped 30 or 40 points easily. And it could also be that Gizmo isn't all that stressed about vet visits. Some kitties aren't. Regardless, this early in the treatment, all of those numbers are not bad at all.

Carl
 
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