First pet - just diagnosed with feline diabetes! Raw food eater only - please help!

[Jennifer & Linus]

I'm also a newly diagnosed freaked out cat owner here (one of many!) My cat Linus is the first pet I've ever owned, adopted 6 years ago. He's currently approximately 8 years old (best guesstimate by the Humane Society) I put him on a raw cat food diet a few years ago (I make my own, using Lisa Pierson's raw cat food recipe), wanted to do my best to raise a healthy cat and minimize diabetes risk - and yet, my kitty was recently diagnosed a few weeks ago with diabetes, while he was at the vet for a teeth cleaning, he had moderate gingivitis. A few weeks before his teeth cleaning, I noticed he was having trouble eating, so I caved and gave him some Wellness chicken canned food for about a week before his teeth cleaning - which has some carbs, but not that much.

As Linus underwent teeth cleaning two weeks ago, the vet noticed his blood glucose level was high (380 mg/dL range), so after one blood glucose test- the vet prescribed Lantus, 2 ccs / twice a day. Since he was on Wellness food for a little over a week, I wondered if the higher glucose test came from the change in diet, as he usually eats a purely protein raw food diet regularly. It also seemed quite drastic to put my cat on insulin twice a day, based one blood test and when he was eating his not-normal food of Wellness -but what do I know? After the teeth cleaning, I've switched Linus back to raw food for the past two weeks. I've also just purchased the Relion confirm glucose meter, and just did my first blood test on him, a few minutes after he ate (when he is most relaxed and easy to manipulate). His first blood test reading came out to 442 mg /dL, which seemed high so I just gave him 2ccs of Lantus.

He's been on Lantus for two weeks now and I've been wary about giving him the insulin shots but I haven't had the blood glucose meter yet so I've been watching him carefully - he seems a bit lethargic, more than usual - but his urine volume has gone down.

I'm going to do my best to do more glucose testing as I get better at it - he's usually begging for food before mealtimes, I can't imagine trying to get blood from his ear unless his head it in his food bowl. He has always been food motivated, so I don't think he's begging because he's starved from the diabetes / insulin - he's just a beggar, even in his pre-diabetic days.

Can someone tell me how my cat - who eats raw cat food and no carbs - still has high blood glucose? Where is the glucose coming from? So confusing...

I also welcome any advice, suggestions or recommendations! I can tell there is such a wealth of experience on this diabetes board - thank you!

 

[Chris & China (GA)]

Can someone tell me how my cat - who eats raw cat food and no carbs - still has high blood glucose?

A lot of diabetes is genetic. If there was a way to find out about his parents/grandparents, etc, I'm betting you'd find more diabetes.

I don't think he's begging because he's starved from the diabetes / insulin - he's just a beggar, even in his pre-diabetic days

Actually, uncontrolled diabetic cats are basically starving and need more food. Food breaks down into glucose which is what every cell in the body needs to survive but without insulin, the glucose can't get into the cells and just stays in the bloodstream. Think of insulin like it's a key....on every cell of the body there's a lock....without the correct number of keys, no matter how much glucose is in the bloodstream, it can't get into the cells

the vet prescribed Lantus, 2 ccs / twice a day

I think you mean 2 units....2cc's would be a LOT of insulin!

He has always been food motivated

I can't imagine trying to get blood from his ear

Having him food motivated is GREAT!! You just need to find a special treat that he really loves and only gets at test times. Pick one place where you want your "testing spot" to be and take him there as many times a day as you can. Give his ears a quick rub and then he gets his treat! Pretty soon, he's going to associate that spot with the treats and not care what you're doing with his ears!

 

[Idjit's mom]

Hi Jennifer, I can't advise on dosing, but I can provide info on the ReliOn Confirm strips. Here is a link to a post regarding this issue: http://www.felinediabetes.com/FDMB/...firm-micro-and-availability-of-strips.205376/
ADW is ADWdiabetes.com. Don't feel bad about buying it, many of us use the Confirm or Micro and were caught by surprise too. There was no warning. However, there is a toll free # you can call and get a Walmart gift card for the price of the meter, $15. You provide the serial # and when you purchased it. Small compensation, but something. 1-855-776-0662. I don't know if there is a cutoff date, so do it while you can.
Always test before shooting, to be sure it is safe to do so. I was advised to remove food 2 hours before shot time, to be sure the test BG is not food influenced. It's T/F/S, test, feed, shoot.
Test in the mid cycle too, to find the nadir, when the BG is the lowest. Test at different times of the day, and at night too, as you can. A before bedtime test is good. What are your two shot times? I am assuming you work, and it may be that you will have to try to get more tests in when you have days off.
Testing: here is a link that might help TEST, and another: TEST2 One of our members, JanetNJ has a wonderful video in her signature that shows her testing her cat CC. It just plain takes patience and practice. We always use the same "station" where there is good light and we are comfortable. Always reward with a treat whether successful or not. A low carb treat like freeze dried chicken, or a piece of chicken breast. Whatever works.
Check out the information on the Home page, Getting Started and Education. Also, important Hypo information (I hope you never need it, but better safe than sorry) in the FAQs forum. I needed it and I didn't have it.

 

[Chris & China (GA)]

Here's something I wrote up for others for testing...maybe it'll help you too!

It can be really helpful to establish a routine with testing. Pick one spot that you want your "testing spot" to be (I like the kitchen counter because it's got good light and it's at a good height....it also already blocked 2 escape routes due to the wall and the backsplash) It can be anywhere though...a rug on the floor, a table, a particular spot on the couch...wherever is good for you.

Take him there as many times a day as you can and just give his ears a quick rub and then he gets a yummy (low carb) treat.Most cats aren't objecting so much with the poking..it's the fooling with their ears they don't like, but once they're desensitized to it and learn to associate a certain place with the treats, they usually start to come when they're called! Or even when they hear us opening the test kit!

You also have to remember...you're not poking him to hurt him...you're testing him to keep him safe and understand what's going on inside his body. There's just nothing better than truly understanding what's going on inside your kitty's body and with this disease, the more knowledge you have, the more power you have against it. The edges of the ears have very few pain receptors, so it really doesn't hurt them. Also, if you're nervous and tense, it's going to make your kitty nervous and tense too. As silly as it might seem, try singing! It forces you to use a different part of your brain!

It's also important to make sure his ear is warm. A small sock filled with a little rice and microwaved or a small pill bottle filled with warm water (check temp against your wrist like you would a baby bottle) works well

For new kitties, using a heavier gauge lancet is also really helpful. A 25-28 gauge lancet pokes a bigger "hole" than a 31-33 gauge lancet does, so look for "Alternate Site testing" lancets that are usually a lower number

Finding the right "treat" will be a great help too! Freeze dried chicken, bonito flakes, little pieces of baked chicken...whatever low carb treat you can find that he really enjoys will help him to associate the testing with the treat! China's Achilles heel was baked chicken, so I'd bake a piece, chop it into bite sized pieces, put some in the refrigerator and freeze the rest to use as needed. It didn't take long for her to come any time I picked up the meter!

 

[Jennifer & Linus]

Thank you so much!! This is incredibly helpful - one question for you -

Actually, uncontrolled diabetic cats are basically starving and need more food. Food breaks down into glucose which is what every cell in the body needs to survive but without insulin, the glucose can't get into the cells and just stays in the bloodstream. Think of insulin like it's a key....on every cell of the body there's a lock....without the correct number of keys, no matter how much glucose is in the bloodstream, it can't get into the cells

If my cat's blood glucose level is 442 about 10 minutes after his meal - and I am giving him 2 units of Lantus / twice a day (you're right - it's not 2ccs!) - there is a chance I may have to up his insulin, is that right?

There is a spot that's convenient for me to take his blood- that is a great idea. I'll have to try it tomorrow morning, if I can get him to stop meowing and pacing back and forth for breakfast...

 

[Jennifer & Linus]

Thank you so much! Will have to call Walmart for a small gift card - and will order some more strips from ADW....the testing protocols are quite overwhelming so Ill have to take a closer look...and do some more educating.

The hypo info - sighhh I hope I never have to know about it but I will definitely take a look....

Hi Jennifer, I can't advise on dosing, but I can provide info on the ReliOn Confirm strips. Here is a link to a post regarding this issue: http://www.felinediabetes.com/FDMB/...firm-micro-and-availability-of-strips.205376/
ADW is ADWdiabetes.com. Don't feel bad about buying it, many of us use the Confirm or Micro and were caught by surprise too. There was no warning. However, there is a toll free # you can call and get a Walmart gift card for the price of the meter, $15. You provide the serial # and when you purchased it. Small compensation, but something. 1-855-776-0662. I don't know if there is a cutoff date, so do it while you can.
Always test before shooting, to be sure it is safe to do so. I was advised to remove food 2 hours before shot time, to be sure the test BG is not food influenced. It's T/F/S, test, feed, shoot.
Test in the mid cycle too, to find the nadir, when the BG is the lowest. Test at different times of the day, and at night too, as you can. A before bedtime test is good. What are your two shot times? I am assuming you work, and it may be that you will have to try to get more tests in when you have days off.
Testing: here is a link that might help TEST, and another: TEST2 One of our members, JanetNJ has a wonderful video in her signature that shows her testing her cat CC. It just plain takes patience and practice. We always use the same "station" where there is good light and we are comfortable. Always reward with a treat whether successful or not. A low carb treat like freeze dried chicken, or a piece of chicken breast. Whatever works.
Check out the information on the Home page, Getting Started and Education. Also, important Hypo information (I hope you never need it, but better safe than sorry) in the FAQs forum. I needed it and I didn't have it.

 

[Chris & China (GA)]

there is a chance I may have to up his insulin, is that right?

Not necessarily.....Lantus dosing is based on how LOW it takes them, not the Pre-shot numbers. We test before shooting just to make sure they're high enough to get insulin at all but getting mid-cycle testing to see how low it's taking him is how the dose is adjusted.

If at all possible, get at least 1 mid-cycle on the AM cycle (between 5-7 hours after the shot)…..and always get a "before bed" test on the PM cycle. Most cats go lower at night so it's important to get a test before going to bed for the night to make sure they stay safe while you're sleeping

We have seen cats here that went from 400 to 40 and back to 400 by the next shot time. Without mid-cycle testing you might think they needed more insulin when in fact, they need less!

 

[Jennifer & Linus]

I think I understand - how high should his blood glucose be, before his meal - that is "safe" to give him insulin, post-meal?

Not necessarily.....Lantus dosing is based on how LOW it takes them, not the Pre-shot numbers. We test before shooting just to make sure they're high enough to get insulin at all but getting mid-cycle testing to see how low it's taking him is how the dose is adjusted.

If at all possible, get at least 1 mid-cycle on the AM cycle (between 5-7 hours after the shot)…..and always get a "before bed" test on the PM cycle. Most cats go lower at night so it's important to get a test before going to bed for the night to make sure they stay safe while you're sleeping

We have seen cats here that went from 400 to 40 and back to 400 by the next shot time. Without mid-cycle testing you might think they needed more insulin when in fact, they need less!

 

[Chris & China (GA)]

how high should his blood glucose be, before his meal - that is "safe" to give him insulin, post-meal?

At first we say if they're under 200, stall, don't feed and post for help. Test again in 20-30 minutes to see if he's coming up without the influence of food.

Once you have your spreadsheet going and are able to test regularly, we'll have you move to the Lantus forum. At that point, you're "stall and post" level drops to 150

As you gather more data and learn more about how he responds to both insulin and food, you gradually reduce that number. Those of us with enough experience and data will shoot anything over 50

 

[Jennifer & Linus]

Ahh got it.... I'll have to do mid-AM testing on weekends, as you are right - I work full time so it's difficult to test besides mornings and evenings...I just tested his BG and it's bedtime - and the test came out to 374.

I'm still trying to understand your previous post - could you help this newbie understand? I'll have to think about it some more too....

"We have seen cats here that went from 400 to 40 and back to 400 by the next shot time. Without mid-cycle testing you might think they needed more insulin when in fact, they need less!"

Thank you!!!!

At first we say if they're under 200, stall, don't feed and post for help. Test again in 20-30 minutes to see if he's coming up without the influence of food.

Once you have your spreadsheet going and are able to test regularly, we'll have you move to the Lantus forum. At that point, you're "stall and post" level drops to 150

As you gather more data and learn more about how he responds to both insulin and food, you gradually reduce that number. Those of us with enough experience and data will shoot anything over 50

 

[Chris & China (GA)]

I'm still trying to understand your previous post - could you help this newbie understand? I'll have to think about it some more too....

"We have seen cats here that went from 400 to 40 and back to 400 by the next shot time. Without mid-cycle testing you might think they needed more insulin when in fact, they need less!"

If a cat goes too low, their liver responds by releasing stored sugars and hormones to bring them back up quickly. We call it "bouncing". It can take up to 3 days for those hormones/sugars to clear the body.

If you don't catch it when they drop too low and were only testing Pre-shot and the only numbers you saw were 400's, you might think your cat needed more insulin.....but if he's dropping too low, he actually needs less!

There are actually several reasons for bouncing....1. they drop too low, 2. they drop too much, too quickly and 3. they drop into numbers their body just isn't used to anymore (or any combination of all 3)

Our cats are so good at hiding their illnesses....by the time most of us get the diabetes diagnosis, they've been diabetic for quite some time and their body has gotten used to living in higher numbers so even if they don't drop "too low" (under 50 on a human meter), just dropping from (for example) 400 to 250 could trigger a "bounce" because the liver perceives that 250 as being "too low".

 

[Crista & Ming]

Hi Jennifer! You're in the right place. I'm new as well and I'm still learning. Ask lots of questions and breathe. (I'm still learning to do that. )

You might want to also explore and post on the Lantus forum and read all the stickys over there. It's a lot of information so take your time, read them, re-read them, and ask questions and then re-read them again. I also find it helpful to read other member's posts and view their kitties' spreadsheets. It gave me perspective and also gave me a good idea of what to expect or what to do in regards to testing and what numbers I might see.

Like @Chris & China said, diabetes can also be hereditary. I also fed my cat only wet food and was transitioning towards raw only. But things happened that were completely out of my control (many many episodes of pancreatitis) and it's unfortunate but sometimes, it's just out of our hands what kind of diseases our kitties end up with.

 

[Jennifer & Linus]

Thanks for the welcome Crista & Ming!! I'm glad I'm not the only newbie here....and breathing is really difficult for me too!

My cat Linus' AMPS was 329 today so in my mind - that's data enough to show that he does have diabetes (I was skeptical!) I needed the numbers to show me... I gave him 2.5 units of Lantus this morning - will continue to monitor him, and it seems like the Lantus board might be a good place for him. Lots of reading to do in the meantime...

Hi Jennifer! You're in the right place. I'm new as well and I'm still learning. Ask lots of questions and breathe. (I'm still learning to do that. )

You might want to also explore and post on the Lantus forum and read all the stickys over there. It's a lot of information so take your time, read them, re-read them, and ask questions and then re-read them again. I also find it helpful to read other member's posts and view their kitties' spreadsheets. It gave me perspective and also gave me a good idea of what to expect or what to do in regards to testing and what numbers I might see.

Like @Chris & China said, diabetes can also be hereditary. I also fed my cat only wet food and was transitioning towards raw only. But things happened that were completely out of my control (many many episodes of pancreatitis) and it's unfortunate but sometimes, it's just out of our hands what kind of diseases our kitties end up with.

 

[Idjit's mom]

Thanks for the welcome Crista & Ming!! I'm glad I'm not the only newbie here....and breathing is really difficult for me too!

My cat Linus' AMPS was 329 today so in my mind - that's data enough to show that he does have diabetes (I was skeptical!) I needed the numbers to show me... I gave him 2.5 units of Lantus this morning - will continue to monitor him, and it seems like the Lantus board might be a good place for him. Lots of reading to do in the meantime...

Good morning Jennifer. I hope the wheels stopped turning and you got some rest last night. I will admit there is a great deal of information here that has been recommended reading. It's actually all good, but it's going to take you a while to get through it all, and then again at some point, you are going to re-read some of it. I have read this time and time again" "It's a marathon, not a sprint".
That said, I am wondering why you increased Linus' insulin dose this morning from 2 U to 2.5. His BG was 329, now that's high, but not horrible. It's tricky changing doses at this point Jennifer, and I wouldn't recommend you doing that on your own, without much experience and without testing data at this point. A sliding scale dosing protocol does not work with this insulin. Lantus should be given in equal units, 12 hours apart. Lantus is a hormone, there isn't going to be an immediate reaction, it's a depot insulin. A small amount of the dose you give him goes right to work, the rest is stored and then acts like a timed release capsule. Read this about the depot: http://petdiabetes.wikia.com/wiki/Insulin_depot
The best thing you can do right now is to get the spreadsheet going and record every test, and every insulin dose. Then you and advising members can see the trends, the patterns of how the insulin is working in his little body. When you get enough data and if you ask the experienced members to help you with dosing, they can give informed advice. Just some information, most cats are prescribed 0.5 or 1 Unit of Lantus twice a day on diagnosis, then after consideration and some time, the dose may be altered. So, please, at this point, don't alter his dose.
Linus was already getting 2 U twice a day, and that might be too much now, but only through testing and documenting that testing are you going to know. I'm not trying to be obnoxious, I just want the best for you and Linus.

 

[Dusty Bones]

Hopefully his teeth problems were the root cause of his diabetes, bad teeth cause diabetes symptoms in cats. If you're lucky your insulin treatment will be short-lived but this is why it's more important to test before injecting. As his body heals from his teeth issues you may notice less and less insulin being required. Hope that's the case and good luck!

 

[Jennifer & Linus]

Good morning Jennifer. I hope the wheels stopped turning and you got some rest last night. I will admit there is a great deal of information here that has been recommended reading. It's actually all good, but it's going to take you a while to get through it all, and then again at some point, you are going to re-read some of it. I have read this time and time again" "It's a marathon, not a sprint".
That said, I am wondering why you increased Linus' insulin dose this morning from 2 U to 2.5. His BG was 329, now that's high, but not horrible. It's tricky changing doses at this point Jennifer, and I wouldn't recommend you doing that on your own, without much experience and without testing data at this point. A sliding scale dosing protocol does not work with this insulin. Lantus should be given in equal units, 12 hours apart. Lantus is a hormone, there isn't going to be an immediate reaction, it's a depot insulin. A small amount of the dose you give him goes right to work, the rest is stored and then acts like a timed release capsule. Read this about the depot: http://petdiabetes.wikia.com/wiki/Insulin_depot
The best thing you can do right now is to get the spreadsheet going and record every test, and every insulin dose. Then you and advising members can see the trends, the patterns of how the insulin is working in his little body. When you get enough data and if you ask the experienced members to help you with dosing, they can give informed advice. Just some information, most cats are prescribed 0.5 or 1 Unit of Lantus twice a day on diagnosis, then after consideration and some time, the dose may be altered. So, please, at this point, don't alter his dose.
Linus was already getting 2 U twice a day, and that might be too much now, but only through testing and documenting that testing are you going to know. I'm not trying to be obnoxious, I just want the best for you and Linus.

Thank you for this - after taking his first AMPS dose at 329 - that gave me enough confirmation that my vet was on the right track - sort of....he originally prescribed that I give my cat Linus 2.5 units / twice a day - and I've been giving him 2 units / twice a day because I wasn't so sure I should start out so high....I will go back to 2 units, twice a day - so I can see how his BG levels are throughout the day.

I am working from home this morning and 3 hours post breakfast - his BG went was 282 - I'm hoping to get another BG reading in two hours, so 5+ - which will at least, give me a sense of what his BG levels are, 5 hours post meal.

Unfortunately, I have to head to work but I will also be taking his BG before dinner. His poor ears! I feel bad for all the pricks....

I welcome any other thoughts or questions - am relying on you and the other experts on here for guidance!! Thank you.

 

[Jennifer & Linus]

Hopefully his teeth problems were the root cause of his diabetes, bad teeth cause diabetes symptoms in cats. If you're lucky your insulin treatment will be short-lived but this is why it's more important to test before injecting. As his body heals from his teeth issues you may notice less and less insulin being required. Hope that's the case and good luck!

fascinating - I had no idea diabetes and teeth issues might be linked....wouldn't it be great if his teeth healed and his diabetes faded away?

My vet actually told me NOT to home test for glucose - but I'm doing it anyways. It doesn't sound logical - to not test at home....

 

[Chris & China (GA)]

My vet actually told me NOT to home test for glucose - but I'm doing it anyways.

We hear this ALL the time and good for you for having such good sense and not listening!! If your child's doctor told you they had diabetes and told you not to test at home, they'd be guilty of malpractice....why do vets think it's different for our furkids???

 

[Idjit's mom]

I will go back to 2 units, twice a day - so I can see how his BG levels are throughout the day.

Good deal, I think that's wise just to continue until the Lantus folks can see more data and advise. Do get the spreadsheet up, if you need help with that, there are members here who can help. I got going on it..then hit a bump and got help with finishing the process.
Many vets tell patients not to test, but humans should and most do ALWAYS test to be sure it's safe and to see what's going on. Why not the same for our cats? We wouldn't give a child insulin w/o testing.
Re: little furry ears. Be sure to compress the pokey site (front and back) with the cotton ball, cosmetic pad, folded tissue or whatever you are using to "back" the ear when you poke. This helps prevent bruising and staunch any more bleeding. Just a little squeeze for a few seconds. We also use a pain relieving ointment, not the cream, Equate or Neosporin when we are finished with the little squeeze.
I don't know if you know about warming the ear, we use a small sock with rice, warmed in the microwave. I rub it over Idjit's face, chin and then press around the front and back edge of the ear I have selected to poke. You can use a pill bottle filled with warm water, a warm wet washcloth....
We switched ears each time, and tried to poke in a bit of a different spot. The more you test, the more capillaries develop, and it's easier to get the bleed.
Isn't learning new things fun???

 

[JoyBee&Ravan]

. Lantus should be given in equal units, 12 hours apart. Lantus is a hormone,

I agree! You should not change the dose until you get advice from the "Experts" on the Lantus Forum that have a LOT of experience. He may not even need 2 units. ( some Vets are not familiar with how Lantus insulin works & they sometimes start out with too much! )
You need to read the Yellow Sticky notes & understand how the insulin works. It's a very powerful hormone & even a tiny bit can make a difference.

As soon as you get a SS (Spread Sheet) up people can see how he responds to the insulin & advise you.

Please be careful. Read as much as you can & ask a LOT of questions. It's a lot to learn but there are many people here with experience that will help you.

Best of Luck to you & Linus

 

[Crista & Ming]

I just started on Lantus and IME, the insulin does take a few cycles to take full effect. Don't freak out about the high numbers right now (as long as you're also testing for ketones). Changing the dose can affect how much insulin is released in the body and at what rate. Trust me... I started Lantus ON FIRE (as a fellow expert on the Lantus forum described it). My vet was giving different dose every cycle and Ming was stressed beyond everything in hospital. It took a week for Ming to get back on track. I think we're on track now. Not at a perfect dose (only time will tell) but it's better. Doses will always change depending on your cat's health and needs. That "perfect" dose is perfect for a limited time and then it's back onto the next one.