Figuring out what's best for Noella

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Joseph Rooks

Member Since 2015
Hi everyone. Our 18-year-old cat Noella came to live with us not long before then after my girlfriend's grandfather passed away.

She was diagnosed with diabetes a couple of months ago. We've been treating her for it without incident until a couple of weeks ago, when we had to board her (medical boarding with our vet) for a wedding I was in.

Since then things have just seemed off.

I was feeding her Royal Canin's dry prescription diabetic food with some water mixed in because she would eat that – slowly, but she would eat it. (She couldn't seem to eat the chunks in their prescription wet food so we switched to that.)

I left her food with the vet, but when I picked her up after the wedding, it was still in the bags I'd put it in to portion it out except for one bag. I went back to the vet and asked about it, and they said she wasn't showing interest in it so they gave her a different food.

She suddenly wasn't eating any of the foods we'd given her before, so I tried the Recovery food they apparently gave her at the vet with no luck.

Then I gave her some Fancy Feast Classics Chicken Feast (it was on a list of low-carb foods I found somewhere) and she loved that, so I have been feeding her that ever since and she's been eating very well.

She seems much more alert and stronger, but not everything is perfect. She's crashed after giving her insulin a couple of times.

I wasn't testing her BG levels before, so I got a kit and started testing them to try to get more information so we could provide more information to the vet as needed.

It's been a few days since I gave her insulin, because she crashed that time and she's eaten more of this Fancy Feast food than I've seen her eating of any food. I've been afraid of screwing something up while she recovers from possibly under-eating the other foods.

I'm also having a little trouble trusting my vet because even though they're friendly and have acted helpful, I've heard so many things from different people in their office that it's confused me. It's all very hard to figure out so I'm hoping I can get some support, encouragement, guidance, whatever here. Everything I have on Noella so far is in this spreadsheet on Google Docs.

Thanks to everyone who contributes around here!
 
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Hi Joseph. I'm new here and can't offer much advice, but I looked at Noellas spreadsheet. Do I understand that you have not been giving insulin? Her numbers are a bit high so it looks like she should be getting some. When you were giving it, what kind was it and how much? Also I see you're having problems with constipation and are giving Lactulose. I'm pretty sure it is high in sugar, you may want to check that. If so, then maybe switch to Miralax. Also have you checked her for ketones? It's a simple urine test performed at home with strips you can purchase at any pharmacy. I'm glad you found this site. It has been a big help to me and so many others, and I know they can help you too. Good Luck!
 
Hi Sharon, thanks for chiming in - I have given her just a couple of doses of insulin since bringing her home from the vet 2 weeks ago, and she crashed both times. I just started logging everything in this spreadsheet about one week ago.

I figure I was doing something wrong, either with bad timing or following the vet's instructions incorrectly or something.

The most recent time she crashed was on 9/16, where I have some of the trouble-spots highlighted in red on my spreadsheet (and some notes about the vet's instructions). Since then I've been pretty scared to give her anything without asking others first, but since my vet has been confusing me I wanted to post here to ask about it too.

Seeing how much she's eating of her new wet food compared to either of the Royal Canin diabetic foods (wet or dry) I fed her before makes me wonder if she was under-eating when I was feeding her those prescription foods.
 
Welcome Joseph & Noella! How long has Noella been having troubles walking? Does she seem to be in pain? Feeding Noella Fancy Feast is good, it's lower carb then most vet prescribed foods. I cant add much since I am still newish but I'm sure the others with more experience will be along to help you out.

Can you tell us what insulin Noella was on and what dose? That information will help the others out allot when it comes to giving you some advice on how to treat Noella.
 
Noella is on 1 unit of ProZinc, once per day.

After we brought her home from the vet/boarding 2 weeks ago she was a little wobbly, but still walking. Noella has only had serious trouble walking for the last few days.

Before boarding her at the vet, she was frequently walking into the room and jumping up onto the bed to be with us, and she would hop up onto her favorite couch (about 1.5 feet up) to take a nap.

Right now she's a lot like she was a few months ago, just before we first took her to the vet, got her diagnosed, and started giving her insulin – so I am hoping giving her insulin will help her recover, but I don't want to be hasty and screw something up.
 
Have you had any blood work done on Noella? Since she is 18, there may be something else going on. Kidney problems can cause them to be wobbly. Fancy Feast is high in Phosphorus which is bad for kidneys. Try a low carb low Phosphorus food.
 
Hi Joseph, I can't really provide insulin dosing help (although you could try a reduced dose if the 1u makes her crash?), but I just wanted to encourage you to hang in there. People on this forum are very knowledgeable and can help a lot.
 
There do seem to be a number of things going on. Do you do ketone tests? That would be the first thing to eliminate. Cats who aren't eating well in high ranges can go into DKA which is deadly. A ketone test will tell you if she has any ketones - if so, she needs to be at the vet. You use the same ketone strips humans use and stick them in her urine stream. If she won't let you do that, we have other ways.

If the ketones are fine, then we could help you look at some dosing options. You can give her anywhere from a drop of insulin to 0.5 units if one unit takes her too low. But sitting in the 400s is not a good idea.

Lots of people here use Miralax for constipation.

We put together a protocol for ProZinc. It is in my signature in blue.
 
Here are some other Urine Testing Tips you can try to get the ketone test

If there's no ketones, I wonder if she could be having some trouble with diabetic neuropathy? It's pretty common in our sugarcats and a lot of people here use Zobaline for Cats. It can take some time to work, but we've seen it work miracles. Here's a video of what neuropathy looks like:

I agree with Sue...looks like she needs to be on insulin, just on a smaller dose so we can get her better regulated without taking to too low. ProZinc is a U-40 insulin, but it might be helpful to get some U-100 syringes and use this Conversion Chart to be able to measure smaller doses. U-100 syringes also come with half unit markings which can be helpful

As long as her kidneys are in decent shape, the Fancy Feast is a good, low carb food that a lot of us feed, so if she likes it and is eating it well, there's no reason you need to change. If she has some kidney failure, we need to find something else low carb and low phosphorus that she'll eat. You want to stay away from all dry foods since they're high carb and that's not going to help with her diabetes.

The lactulose is fine for constipation if it's working for her...despite the name (which sounds like a sugar) it's fine for use in diabetic cats, but a lot of us have had better luck with Miralax, a taste free powder that can be mixed in with food.

What you might want to get rid of is the Pedialyte though....most of that has quite a bit of sugar in it.

It's not necessary right now, so don't worry about it, but we have our own spreadsheet on Google that we find is a very valuable tool for us here. It color codes the test results so we can identify "patterns" in the blood glucose easier to help with dose decisions. When you can, here are Instructions on getting the FDMB spreadsheet

I know there's a lot of information to absorb, but try not to get overwhelmed...we've all been where you are before and have lots of experience to help guide you while you learn all about the sugardance!
 
Our Oliver would not let us watch him pee. So we got a new litter box, filled it with aquarium gravel and left him in a room with it. He had to "christen" the box. Then we were able to swoop in and get our sample, as the gravel didn't absorb it.
 
Yup- the aquarium gravel method was the only way we could get pee to test at home with our kitty too.
If the neuropathy is bad, I would do Zobaline or another cat-safe B12 supplement at a high dose in the beginning and then reduce the dose after two weeks (they pee out any excess B12- so it doesn't become toxic- unless they have kidney disease). And/or you can ask your vet about B12 shots. We were doing both and it helped after about a week and a half.
 
Thanks everyone. Most of my stress is coming from worrying that I won't be able to figure out enough and do enough, fast enough to be helpful. I will try to process all of this and do what I can.

I am also suspicious of diabetic neuropathy since she did not have much trouble walking at all until right after I stopped giving her her insulin (due to her bottoming out and me not having enough information to feel safe giving it to her).
 
Noella is alert, happy, still as responsive as ever when we pet her, and she's eating her dinner very well. Her blood sugar is still relatively high (351 a few minutes ago) and I just fed her right before writing this.

The past week she was on kind of a loose feeding schedule because I wanted her to recover from under-eating and the vet said to make food available freely while she was recovering. She's eaten well for about a whole week so I am trying to get her on a more consistent feeding schedule now - Breakfast from 8-9 AM and dinner from 8-9 PM. Does that sound like a good idea?

I'm kind of guessing as I go here but it sounds like consistency around the feeding schedule is very important.
 
Others can give more ideas, but I think a lot of people do multiple small meals a day, some free feed, and I've always done 3 meals a day at about the same times each day. Cats like routine- so feeding at about the same time every day is a good idea if you're not free feeding.
I think you're doing great, BTW. Deep breath. Noella is a lucky girl because you clearly care a lot about doing what you can do for her. ;)
 
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Most of us feed small mini-meals because it's easier on the pancreas to deal with small meals than 2 big ones, but there are many different ways to do it.

The most common is to take the entire 12 hour's worth of food and split it into several small meals but to try to get all the food in before nadir (the lowest point in the cycle) so you're not adding carbs when the insulin is starting to wear off. This means trying to get them fed usually before +6 (6 hours after the shot)

Some cats can be fed throughout the cycle with the food being taken up at +10 so when it's shot time again, your test isn't influenced by food

Some cats do better if they only get 2 meals a day, but it's something you just have to experiment with and see what works best for Noella
 
I just tested her about an hour ago and she was at 289. Just tested again after I fed her and she wasn't interested in her food, and she's at 389 - but she didn't eat anything yet. Can somebody explain why that is / how that works / what could be happening there, because I just don't understand what might be going on inside her.

She's also drinking a lot of water this morning, which I know could be to help her get rid of some of the extra blood sugar. Is there any problem with letting her have as much water as she needs or should I limit it somehow?

Still haven't given her insulin to her since she hasn't really eaten anything this morning. She had a great appetite last night so I thought maybe I'd try today after talking to the vet, but no food, no insulin, is what I've been told in the past.
 
Were you able to get a ketone test? I am concerned that she isn't eating and is not getting insulin, with high levels. That is a recipe for DKA. Can you get a ketone test?

It is best if they have some food in their stomach when giving insulin, but ProZinc is mild so it is not imperative. I thought she was eating Fancy Feast - maybe try another flavor? Sometimes they like it mixed with a little warm water to make a gravy

If she were mine, I would give her 0.5 units (or let a few drops out if you are nervous) and test 2/5 hours after the shot to be sure she doesn't drop too low. Get some food in her
And do whatever it takes to get a ketone test
 
I eyeballed a little under 0.5 units with our U-40 syringes and gave that to her about half an hour ago. Will be keeping an eye on her.

Our vet has repeatedly said something to the effect of, "we can't really go lower than 1 unit," which doesn't sound like it makes a lot of sense but I ignored it until now because I assumed she knew something I didn't. Should I look for another vet to do a ketone test? I'm starting to feel uncomfortable with this one and I don't want their "friendliness" to get in the way of the job being done right.
 
Joseph Rooks said:
Should I look for another vet to do a ketone test?
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You can buy ketone strips from Target and replace your litter with aquarium gravel. Once your kitty pees, draw it up from the bottom of the litterbox with a syringe and use the strips to test for ketones. It's cheaper than a vet doing it.
 
Joseph you really need to get the ketone test in if at all possible, it's important. If your vet doesn't like that you are being proactive in the care of Noella then maybe it's time to have a serious chat with him/her or find a new vet. A good vet will work with you not against you.

A ketone test is simple, cheap and easy to do at home. If you have to take Noella to the vet to have the ketone test done do it but please try to get one at home first, it will save you allot of money and less stress for Noella.
 
Yeah, that would work as long as you can get the test soon after she goes (fresh pee is the best pee), but our concern is that IF she's going DKA, the sooner you get the test, the better

If anything more than "trace" shows up on the urine ketone test strip, it's a medical emergency and requires a vet to stabilize
 
What causes DKA? Do you happen to have a link that explains it in plain english? I don't have the capacity to process anything in detail right now... but I want to know what to look out for. I will get some of those strips and some gravel and try to do a test this afternoon.
 
Not enough food, plus not enough insulin, plus infection or inflammation is the "recipe" for DKA

The body starts to burn it's own fat which produces "ketones" which are poisonous when they build up in the body

You might try smelling his breath...a cat in DKA will have their breath smell like finger nail polish remover
 
Went to our local midtown Atlanta Target to try to find those strips, and they didn't have them in stock, which happens to me all the time for everything imaginable at that Target. So, I guess I will have to go to another store and try to find them this evening. :(
 
Joseph Rooks said:
Went to our local midtown Atlanta Target to try to find those strips, and they didn't have them in stock, which happens to me all the time for everything imaginable at that Target. So, I guess I will have to go to another store and try to find them this evening. :(
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Sorry! You can try calling CVS or Walgreens.
Please hang in there. We know this is stressful, but you're doing fine.
 
Just gave her a little corn syrup to help her get her blood sugar back up – When I checked it just a minute ago, it had dropped to 82 just from the roughly 1/2 unit of insulin I gave her earlier in the day. I thought she'd have an appetite by now since her appetite has been spectacular all week, but she doesn't seem hungry.
 
Joseph Rooks said:
I thought she'd have an appetite by now since her appetite has been spectacular all week, but she doesn't seem hungry.
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If the appetite issue continues, maybe you can call the vet and ask for mirtazapine or cyproheptadine. These are meds that will make her hungry. Not to scare you, but she needs to eat or else she can develop hepatic lipidosis.
 
82 is a safe number. How long since the shot is it? If you are worried about her dropping from there, just give her a little snack of her regular food and she will probably flatten out a little. We don't worry about low ranges until they drop under 50.

For general reference, we consider a cat regulated if they are in the mid 200s at the pre shot test and in double digits 5-7 hours later (usually their lowest point) but not below 50.

If she drops to 50 at some point, feed her a tablespoon of her regular food. Take another test in 20 minutes. If she is dropping lower, give her a teaspoon of the gravy off higher carb food and retest in 20 minutes. If she is in the 40s, then break out the honey.

Has she eaten again? Some tricks to try besides the water are sprinkling on Parmesan cheese, dressing with her favorite treat, warming it up until stinky and mixing it with some tuna juice.
 
Thanks for the quick input. Just re-tested her and she's down to 60 now, so I'm going to try to feed her some of her food and see if she'll eat it if it's fed to her directly. Her appetite has been awesome for several days now, so her suddenly being uninterested in food today is confusing and frustrating.
 
Sue and Oliver (GA) said:
Has she eaten again? Some tricks to try besides the water are sprinkling on Parmesan cheese, dressing with her favorite treat, warming it up until stinky and mixing it with some tuna juice.
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She took to the food with some hot water added, and some Parmesan sprinkled on top, probably ate a couple of tablespoons of it. Good trick. Now she's back around 85.

She was eating it mashed up straight out of the can through yesterday so I don't know what changed, if anything at all!
 
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warming it with warm water or by microwaving makes it "smell" better....and it's always a good idea to add a little extra water to the food anyway because it helps add extra water into their diet

Water helps keeps the kidneys healthier, so the more water, the better!

As for the Parmesan....maybe she's got some Italian in her....LOL (whatever worked, happy to hear she ate some for you!)
 
I tested her a little while ago and it came in at 82, but I took it a little close to the edge of the ear, so I re-tested two more times immediately after that and got 116 and 134. That was around three hours ago, and now it's up around 270.

Is it normal for the reading to vary that much (the 82 to 116/134) if I miss the little vein that I usually prick? I figure so since it's not practical to think it'd jump 40 mg/dl in a couple of minutes... but I'm still getting used to this so I don't know what to expect.

P.S. - You all have given me so much reassurance and peace of mind the past couple of days. Thank you. We run our own business so we're very fortunate to be able to stay home and look after the kitty, but even with all that flexibility, if there wasn't such a great community here I don't know how we'd figure anything out.
 
All meters are allowed by the FDA to have a 20% variance, plus no matter how many times you do it, every strip you use may give you a slightly different number

Even if you used the same drop of blood and could put a fresh strip into the meter and retest that same drop quickly, you can get numbers like that, so unless there's a good reason for you to doubt the first number, it's usually OK to just go with that number
 
Give yourself the credit, Joseph. You went looking for help and were willing to do the research and trust some crazy cat people on the Internet. You have learned a lot about feline diabetics in a very short time.

How long since the shot is this range of 82-134?

Are we thinking she had a pretty good cycle on 0.5 ? Has she decided she likes her food again?
 
Sue and Oliver (GA) said:
How long since the shot is this range of 82-134?
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Only three minutes. The one before the 82 was 112 and it had been going up, so I thought to retake it to be sure, and that's when it came out as 116 and then 134 – which was reassuring even if there's no guarantee the numbers are completely accurate.

Sue and Oliver (GA) said:
Are we thinking she had a pretty good cycle on 0.5 ? Has she decided she likes her food again?
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Lo and behold, I just put a fresh plate of food in front of her, no water added, no parmesan, and she's eating normally like she was before. Does high blood sugar cause cats to lose their appetites or feel nauseous… the same way the two Dr Peppers I drank earlier did? :)

Hopefully I can get her to eat normally tomorrow morning too, and then I can try the 0.5u again.

What I was able to get out of today:
  • At 11:30 AM I gave her the 0.5 u of insulin.
  • At about 4PM she got down to a low of around 60.
  • Right after that was when I finally got her to "drink" a little bit of her watered-down food.
  • At 6:43 she was at 134, then at 10:02 PM she was at 274.
 
Not a bad cycle. With ProZinc, you are looking for a smile shaped curve with the same range higher numbers at each end of the 12 hours with a lower number in the middle. She had a nice smile today! I understand your reluctance to give more insulin as you are worried she'll drop low (though her 60 today was a safe range) overnight, but your goal is to be able to give two shots every 12 hours. The problem with waiting for tomorrow morning is that she is likely to be quite high (since it will be 24 hours since her last shot)

One thing you can consider. You can use U100 needles that measure 0.5 units. We have a conversion chart that lets you use U100 needles with U40 insulin. Then, you can shot 0.2 units, 0.4 units. Here is the conversion chart:

http://www.felinediabetes.com/insulin-conversions.htm

Then you might be able to shoot 0.2 units twice daily and keep her in good ranges for 24 hours.

Glad she is eating again!
 
Can we get you started using our grid to record your glucose tests? It will help us give you better feedback and it color-codes the test values. Instructions are here.

Understanding the spreadsheet/grid:

The colored headings at the top are the ranges of glucose values. They are color-coded to clue you in as to meaning.

Each day is 1 row. Each column stores different data for the day.

From left to right, you enter
the Date in the first column
the AMPS (morning, pre-shot, test) in the 2nd column
the Units given (turquoise column)

Then, there are 11 columns labeled +1 through +11
If you test at +5 (5 hours after the shot), you enter the test number in the +5 column
If you test at +7 (7 hours after the shot), you enter the test number in the +7 column
and so on.

Halfway across the page is the column for PMPS (evening, pre-shot, test)
To the right is another turquoise column for Units given at the evening shot.

There is second set of columns labeled +1 through +11
If you snag a before bed test at +3, you enter the test number in the +3 column.

We separate day and night numbers like that because many cats go lower at night.

The nadir is the lowest glucose between shots. There is a general period when it will happen which is specific to the insulin being used and testing then helps make sure your cat doesn't go too low.

It is merely a grid for storing the info; no math required.
 
BJM said:
Can we get you started using our grid to record your glucose tests? It will help us give you better feedback and it color-codes the test values. Instructions are here.
Click to expand...

Absolutely, I'll do anything if it makes it easier to sort this out – I will make some time to figure this out tomorrow!
 
Finally found some ketone test strips at Wal-mart today... Put some gravel into her litter box and I'm going to try to get her to go in that.

I was able to get her to eat a little bit this morning. Gave her another 1/2 unit of insulin around 11AM, her blood sugar was about 230. It's about 2PM now and her blood sugar is down to about 92. I'm keeping a close eye on her and trying to get her to eat some more.

She seems pretty sleepy like she did around this time yesterday. It wasn't until later in the day that she really started eating well like she normally does.

I will try to figure out that spreadsheet this afternoon/evening so I can give better information.
 
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Did you give her 0.5 last night or not? If so, then her numbers are in very good ranges. If she drops into the 50s today, try regular low carb first and then if she is still dropping, some of the gravy off the higher carb. If you didn't give any insulin last night, then she really stayed in nice numbers with just the 0.5 for 24 hours (which is unusual)

It looks like you might be lowering the dose further. One way to do that (if you don't want to use the U100 needles and the conversion chart, is to give drops. So draw up 0.5 units of colored water. Let out the insulin, drop by drop, counting until it is gone. Then you have an idea of how many drops are in 5 units. So say, you want to give 3 drops. Pull up the insulin to 0.5 and let out drops, counting, until there are 3 left. Then shoot what is left in the syringe.
 
I worry that she's going dangerously low right now and I don't know what to do. I have been giving her corn syrup and some of her food to get it back up but it doesn't seem like it's working very well. :( (See her numbers in my spreadsheet for details...)
 
Rub some honey or syrup directly on her gums and test again. 29 is dangerously low. I think I would take her to the vet. They can give her IV glucose.
 
Joseph, I have to leave for an appointment in 15 minutes. I really would take her to the ER. But if you are going to try to help her at home, please go up to your original post and Edit. change the title to Hypo help needed with a 911 so others can help you.
 
Hi Joseph. Sue had to leave. How is Noella? Is she alert? If I read your spreadsheet right, you got a 29? How long ago? You may want to pack up your syrup and take her to the ER. If someone can go with you while you administer the syrup would be best. Is she eating high carb food?
 
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We took her to the vet immediately after we got a 29. We're laying down with her right now. It doesn't look like she's going to make it, so we're spending as much time as we can with her and preparing to let her go. The last three weeks it's been a steady decline for her, so that is probably the best thing for her now.

Thanks to everyone who encouraged me and helped me learn new things the past couple of days. I appreciate it.
 
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