First Post - Andrew & Cleo (Updated 7/16)

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AndrewB and Cleo

Member Since 2012
Greetings everyone, while I am not happy to have to be here, I am happy you are here for me.

My name is Andrew and I'm from Orlando, Fl. I have two cats, Lily and Cleo (both about 9 yrs old) and yesterday Cleo was diagnosed with diabetes. :shock:

I had noticed she had been drinking a lot of water the last 6 weeks and peeing a lot too. I thought it was just because it was getting warmer... Then it became apparent that she was also losing weight. She was due for her annual vet visit this week so I just thought I would get her checked out.

The vet did a full blood test and found her kidney and liver levels were a bit high and her blood glucose was 447. He told my wife (I didn't talk to him) that we needed to get some insulin and come in on Monday for training.

His proposed plan is for us to switch to Purina DM food (I wasn't clear if he meant the wet or dry). Currently both cats get Pro Plan Indoor cat. They also periodically get some wet food as a treat. On Monday he wants us to get training on how to administer insulin to her. We already have filled the prescription (it's Lantus) and have the syringes. He proposes to keep Cleo on Monday for the day to start her regulation. I imagine they will do a curve on her but I don't know for sure. (I'm sorry I am missing some details and he's not in the office today).

I spent much of last night educating myself about this problem and what to do about it. I have the following questions and really hope someone on here has some ideas:

1. I have been with this vet (Dr. Hutchinson) for a number of years and think he does a good job. However I don't know how much experience he has with treating this. What should I ask him? (I was going to ask him what starting dose of insulin he was planning) (start low, go slow right?)

2. From what I have read, trying to start regulating Cleo on Monday while simultaneously changing food seems like a bad idea. How can that possibly work? What I am inclined to tell the vet is that I want to switch her food for a week and then bring her in for testing. If that that point we need insulin I think we would have a much better idea how much to use.

3. I have read some encouraging stories about how it is possible to cause remission by a diet change alone. (I am praying this can happen for Cleo). A friend of mine suggested that a gluten free diet really helps. Apparently there is a food called Blue Buffalo (dry) and Fancy Feast Classic (wet).

I didn't sleep well last night. I went out to the couch and just held Cleo while she purred and snuggled with me. I felt guilty this happened to her but I feel better today. Life happens. Fortunately this is treatable and I will do whatever I need to help this member of my family. From what I have read here, you all feel the same way, which makes me feel better.

Thank you in advance for any advice!
 
Re: First Post - Andrew & Cleo

Hi Andrew and Cleo,

Welcome! I hope it helps to know that we were all overwhelmed and sad with the diagnosis at first. But the more you learn about this disease and how to treat it, the better Cleo and you will feel! To answer your questions:

1. I have been with this vet (Dr. Hutchinson) for a number of years and think he does a good job. However I don't know how much experience he has with treating this. What should I ask him? (I was going to ask him what starting dose of insulin he was planning) (start low, go slow right?)

Most vets get a 30 minute workshop in diabetes in vet school and little more unless they take additional workshops. When you consider they treat everything from snakes to dogs, they can't know about every disease in every species. We like it if they are willing to listen and learn. I would tell him you are planning to hometest and why.

Start low and go slow is great. Lantus is a good insulin so he gets points for that. Some more reading for you are the stickies on Lantus support group forum. They tell you exactly how to start, how to dose and how to handle the insulin: http://www.felinediabetes.com/FDMB/viewforum.php?f=9

2. From what I have read, trying to start regulating Cleo on Monday while simultaneously changing food seems like a bad idea. How can that possibly work? What I am inclined to tell the vet is that I want to switch her food for a week and then bring her in for testing. If that that point we need insulin I think we would have a much better idea how much to use.

You can start testing at home now and changing the food before starting insulin. Depending on her numbers and if they are in the higher ranges, I wouldn't wait more than a week before starting the insulin. But the wet food can make a huge difference and lower the numbers fast.

Testing at the vet is usually unreliable. Stress raises bg levels and most cats are very stressed at the vet. You are better off to test at home and fax your results to the vet.

3. I have read some encouraging stories about how it is possible to cause remission by a diet change alone. (I am praying this can happen for Cleo). A friend of mine suggested that a gluten free diet really helps. Apparently there is a food called Blue Buffalo (dry) and Fancy Feast Classic (wet).

Very few of us feed dry. Read this vet website to find out why: www.catinfood.org. Any wet under the 8-10% carb range that you can afford and that your cat will eat is fine. Here is our food chart: Janet and Binky’s chart


Keep reading and asking questions. We would love to help you help your sweet Cleo.
 
Re: First Post - Andrew & Cleo

Hi Andrew! I live in Gainesville Florida, so a couple of hours from you. I am sorry Cleo was diagnosed with diabetes, but you have found the best place possible to help her get healthy again. Sue gave you some great advice above about home testing. In addition, you might want to read the thread "Dressed down by Vet" as there is some good info related to discussing home testing with your vet. Julia, especially, posted a great link that I will recopy here: "I would bring him (your vet) the American Animal Hospital Association Guidelines for diabetes (p. 218) before you leave: http://www.aahanet.org/PublicDocuments/ ... elines.pdf. Note where it states, "Home monitoring of BG is ideal and strongly encouraged to obtain the most accurate interpretation of glucose relative to clinical signs."

My first vet also told me that home testing was not typically done and to bring my cat Ninja into his office for her first "curve" and to "get her regulated." I was relieved, because I didn't think I was really up for anything more at that point. But at the end of that first day, the vet said Ninja was so stressed that they only got one blood glucose reading from her all day; not to mention poor Ninja's stress at having to stay in a cage all day. I have since learned that any readings acquired in these types of settings are virtually useless -- as stress can send the blood glucose soaring, even in normal cats. So if you get a reading of 447 at the vet, it might really be 347 or 247 if you had tested at home without the stress of your cat being caged or restrained. In addition, the vet techs apparently didn't give Ninja any water all day because when I picked her up she was panting a little and when she got home, she drank almost a whole bowl of water. Uncontrolled diabetics drink more than normal in any case. So, not a good experience for either of us, did not produce useful data and cost a lot of money and took Ninja a long time to calm down.

I got a referral to a 2nd vet from a member of this board. My new vet is great. I do home testing now and send her the numbers periodically so we can adjust Ninja's Lantus dosage - and Ninja does not have to undergo the stress of constant vet visits -- and it is much more economical for me as well.

The injections sound intimidating (I had never even held a syringe prior to this), but that turned out to be the easy part. If you hold the needle with the markings facing up (something about the point of the needle), the cat doesn't feel it at all. It seems really strange, but true. My cat initially moved around a little when I was injecting her (looking back, like..."what are you doing to me"...just curiousity), but now she could care less -- particularly if you are feeding her at the same time. The thing that has taken time to master is the ear blood glucose testing -- but after about a month, I have that down reasonably well; at least Ninja sits and purrs now rather than running away. Some people are successful right away with the blood glucose testing, others of us take more time to master. Either way, after about 30 days, you will be an old hand at this and it will be "business as usual" - just part of your normal routine. Best of luck!!! PS: Final tip...don't roll or shake the Lantus, and keep it refrigerated. My first vet instructed me to roll the Lantus between my hands to "mix" but that is incorrect as Lantus is already mixed and you can damage it by doing this. Someone in an earlier post said to treat it like Nitroglycerin (LOL!!) which I thought was funny, but just about right. :)

Melanie
 
Re: First Post - Andrew & Cleo

Welcome to the Board Andrew (and wife) and Cleo!

A few things are needed to combat FD:
Lantus is a really great insulin to start out with, so a plus in your direction. If you get a meter and test at home you can see what BG levels Cleo has now and change her food over before giving insulin. If you start giving insulin and then change the food you need to test to make sure the insulin isn't too much for her as her BG's drop. You can wait and adjust the food first- it would be around a week as it might take Cleo's #'s a few days to drop to the new, low carb levels. Ask your vet if you can push the appt back a week in order for a food change.

This link has some good articles to print off for your vet:
viewtopic.php?f=14&t=2508

Now for the other important stuff...

The correct FOOD-
https://docs.google.com/spreadsheet/ccc ... hYXc#gid=0 (called Hobo's List)
http://binkyspage.tripod.com/canfood.html (called binky's list)

You want to look for canned food that is low carb. The two lists above are ones that we use- look for the %kcal/carbs- under 10 (5 is better) in both lists. Feed the best you can afford. Most do Fancy Feast, Friskies, 9-lives. This will also help with the UTI- dry food is, well, dry. Canned food has more moisture and when you add water to it the water content is increased- all the better to pee a lot. You do NOT need vet prescription food- it is overpriced, high carbs, and contains high quantities of liver- which most cats won't eat day in and day out. If you bought some just take it back and say your kitty stopped eating it. They should refund even if it is opened. You also should consider feeding several small meals throughout the day. Not only is a diabetic cat losing weight- the reason is because they are literally starving, unable to get the nutrients out of the food they are eating. Give more food in small meals and your cat will slow down once they start getting the nutrients out. And both cats need to be on a wet food diet if possible.

Home testing-
You need to get a glucometer to test your cat- a human one is fine and reliable to use. It reads different than the pet ones but all you really need is the consistency of the levels day in and day out. You might be able to get a free one- there is a spot just at the top of every page that says home testing kits. Here is a link to what's inside:
viewtopic.php?f=14&t=2508

If you purchase one here is a list from Consumer Reports:
viewtopic.php?f=28&t=70140

You need to look at the ones that have the cheapest strips- not the cheapest meter. The meter you will buy once, the strips you will continue to purchase over and over again. A lot of people on the board use the Relion micro/confirm meters from Wal-mart because the strips are the cheapest around- $.36 each and usually easy to get (and you can get the strips even cheaper online through the ADW site). Bayer is another popular one. Stay away from the generic kinds that have the word TRUE in the name- those are inaccurate at higher #'s or don't go above 299- and another bad one is the Freestyle Light with the butterfly on the strips- both of these have led many pet owners to believe their cats were okay when they were really in trouble. And you can do your own curves at home when you hometest- that is cheaper than doing it at the vet.

To keep up with the BG #'s there is a spread sheet (SS) that we link to our signature line. Here is the link to set up:
viewtopic.php?f=6&t=18207

Incidentals-
- I would suggest getting ketosticks (found in the diabetic supply aisle) to test your kitty for ketones that lead to DKA- this is a very serious and deadly (and EXPENSIVE) illness. For $7 you get 50 strips- the best insurance against ketones possible. If you catch it early the easier it is to treat.
- Lancets- for your first box go for the lowest gauge you can find- 26 or 28. His ears won't bleed that much at the start. There are so many u-tube videos out there that can show you how to test the ear. You can either use the lancet pen or free-hand. I free-hand as I feel like I have more control over the pointy end. After the first box is used up you can switch to 31 gauge.
- TREATS! In the videos you see the cats eager to be tested. That is because they are shamelessly bribed into sitting still because of a yummy treat that is given after testing. Freeze-dried chicken, beef, shrimp are no carb treats and there are others out there that get used as well. Give this treat ONLY a poke time- tests or shots. Your cat might not care for treats, mine never did. She just knows it comes before her food

Good luck on the sugar dance!

Edited to change broken link
 
Re: First Post - Andrew & Cleo

Wow thank you all so much for the information! Right now I am feeling a little overwhelmed (I'm sure you have all been there) but I am determined to make this work.

I have not purchased the prescription food (and I don't think I will). I just gave Cleo her first Fancy Feast Classic mixed with a little water and she loved it! I don't think that will be a problem. :)

I'll post an update after our Vet visit on Monday.

Thank you all so much!! :smile:
 
Re: First Post - Andrew & Cleo

Hi Andrew and Cleo,

I just wanted to say hello and give you some virtual encouragement! I just found the coincidence of both of us coming to the forum today with newly-diagnosed kitties named Cleo too much to pass by.

Best of luck and good wishes to you and your Cleo from me and my Cleo of the left coast!
 
Re: First Post - Andrew & Cleo

Lol yes Kathy and Cleo I was thinking just the same thing! Best wishes to you and your little furry buddy!
 
Re: First Post - Andrew & Cleo

First Shots + Vet Visit

Hey all, some good news to report.

Over the weekend I switched Cleo from dry food to wet and she took to it right away. I noticed quickly that she drastically reduced her water drinking and is using the litter box much more normally. She also is starting to go back to her usual routine. (she was hanging out near the water a lot recently)

I went to the vet this morning armed with all I have learned on this forum from all of you. I was nervous because I didn't think my vet was going to go along with a lot of what I had learned. Well, turns out my usual vet was out of the office on an emergency so I saw another vet I had never met before. Turns out the new vet is the only one in the office who believes in more holistic approaches to management. We talked quite a bit and agreed an a plan.

They did a blood test this morning at the office (he said he understood it would be higher because of stress) and were able to compare it to Cleo's test last Thursday. Last week she was a 443 today she was 430 but had eaten 90 min before.

The vet recommended a gluten free wet food diet and 1 unit on Lantus twice a day. He agreed with start slow and go low! I agreed with him that 1 unit is good place to start and would have minimal risk of overdoing it.

He was impressed I wanted to home test but was dubious about using a human meter. He said they could be off by as much as 30%. I feel that as long as it is consistent it is usable.

I like this vet and will keep going back to him for treatment. I am still hopeful that Cleo's condition was caught early enough to get remission with just diet but for now I will keep doing the insulin. By the way giving the shot was easier than I thought. I used a 31 needle and she didn't even feel it I don't think.

I'm nervous about doing the monitoring but I know it's best for her. I'll get the hang of it. :)

Thank you all for your support over the weekend. I feel a lot better now about things. Does anyone have any thoughts?
 
Hi Andrew! You will get the hang of home monitoring. Just make sure you associate it with a treat for Cleo, and personally, I would not advise poking her ear more than a couple of times before treating and letting her go. You could even start by not poking at all -- maybe warming her ear with a rice sock, clicking an empty lancet pen on her ear without a lancet in it -- just so she gets used to the clicking sound, treat and let go. Then maybe tomorrow, stepping up to: rice sock, one ear poke, treat and let go, etc. Typically when you first start, it is a little difficult to get the hang of it. The ears do not bleed as easily at first as they do with time, and you are not familiar with the meter and strips and how they "sip" blood -- so it is not at all unusual to get nothing for your efforts :cry: - but in time, it will all come together. You might want to practice the meter on yourself first (before poking Cleo) to get the hang of it. I use the Relion Micro from Walmart and you have to hold the meter almost like a pen, at a 45 degree angle to the blood drop and let it "sip" up the blood (tip of testing strip lightly touching blood at a 45 degree angle). Your meter may be different. Glad to hear things went so well today! Post back and let us know how you progress.

Melanie
 
All blood glucose meters have an accuracy range of +/- 20%. This is good enough for humans - it is good enough for cats too.

Since the accuracy is based on a percentage - this means at lower (more critical) numbers, the values are more precise. At higher numbers, the variance is higher - but - high is high - cat needs insulin and it is safe to inject it.

My vet uses a human glucometer in her cats only practice because it is economical and accurate enough to keep the cat safe.

The accuracy range can drive you crazy if you have multiple meters and do comparisons so -- save your sanity and money, and get a meter that is cost effective and takes a tiny drop of blood.

I like the Maxima AST glucometer, which I have to order online - American Diabetes Wholesale. It takes a tiny blood sample, gives a reading in 5 seconds and in not too expensive (~$.36 per test) and I don't have to go to Walmart)
 
Andrew, it sounds like not only do we have the same kitty name, but we are in very similar situations! I've just also made the swap to wet food and am starting Lantus at 1U twice a day (after a bad start at 3U - far too high). The 1U is way safer and hopefully you don't get a scare like we did!

My Cleo has been surprisingly great about glucose tests and injections, so I hope your Cleo goes easy on you too. I agree with you about her not feeling injections - my cat doesn't so much as twitch when I do the insulin injection! The ear pricks for blood tests she's not as fond of, but she loves having her ears played with and I found some freeze dried turkey treats (0 carb, all whole muscle meat) that she just loves, so she's coming on board with the ear prick tests. I definitely second the advice about associating the ear pricks with a treat.

It can be a little scary to do the blood tests at first, but you'll both get through it! I've only been at it for 3 days now and I feel like an old pro already! You may want to experiment with using the lancet manually too vs. with the pen thing. I actually find it easier to do manually because I can see exactly where the lancet is going, rather than trying to find the center of the hole on the pen and line it up with the spot on the ear I'm trying to get. I might be in the minority on this one though.

Oh, incidentally, my vet gave me the same reaction about using a human glucose meter, but a bunch of forum members chimed in on my thread and said they all use the human ones for ease/price of getting the strips and the variance is just not that bad. Really as long as you stick with one meter so you can see the trends in your cat's glucose levels, I think that's the key.

Good luck to you and your Cleo!
 
Re: First Post - Andrew & Cleo (Updated 7/19)

Hey all,

Well Cleo continues to do very well. I am really amazed how well.

I have her on Fancy Feast Classics which both her and my other cat have taken to without fuss. I was leaving dry food out before and now it's wet food twice a day and they are cool with it.

The vet has me giving her 1 unit of Lantus twice a day. I am getting better with the injections I guess. It's much easier if my wife holds her but I am training myself to give it by myself. I have found it's hard to know if the needle is actually in. I'm using a 31 needle which is so thin that I don't feel it break the skin. I assume when the syringe stops then it's in right? One morning I ended up with a needle bent at 90 degrees. There was no insulin left in it but I don't think it actually went in her. I have read that you never reshoot even if you think you didn't get it right. I think that is good policy so I didn't.

I got a 10ml bottle of insulin and now realize that I'm not going to end up using even 1/10 of it before it goes bad. I'm going to look into getting some 3ml cartridges.

Cleo is drinking much less water and the litter boxes aren't overflowing anymore so that's good. She seems to be happy and loving, and pretty much back to her old self.

I have ordered a Maxima AST meter as Phoebe_Tiggy_NortonGA suggested and it should be here very soon. I haven't tested her blood yet. I'm taking her back to the vet Monday morning for a quick test. I know it's not accurate but it should be at least consistent with what was taken last week for comparison.

Overall I am in good spirits and think both Cleo and myself will get adjusted to this new reality soon.

By the way, Cleo is on the sofa with me and snoring her head off. I love it when she snores. :)

Have a wonderful day and thanks everyone.
 
Andrew: That is great news!! Sounds like Cleo is making a lot of progress. Regarding the injections, I felt like you when I first started -- wasn't really sure if the insulin was getting in -- but yes, when the syringe stops, it is in. I assume you are pulling up the skin fold to make a tent and then injecting into the lower half (parallel to the cat's body, not shooting straight down). If you inject too high in the tent, the needle can come out the other side and you end up with a "fur shot." With time, you will gain confidence with this. My cat doesn't feel the injection at all, but I do it while she is eating - so she is distracted. And yes, the fact that Cleo's drinking and litter box are getting back to normal is a very good sign as well. It will be good when you can test her so you know exactly where she is. But all great news!!!!

On the Lantus vial, if refrigerated, it can last up to 6 months (according to experts) - though most people replace before then. They say, if it gets cloudy or has particles in it, or if you unexpectedly lose regulation in a previously regulated cat, then you should replace it. But it typically lasts significantly longer than the 28 days noted on the insert. Regardless, many people here use the pen cartridges.

Thanks for giving us an update. Happy to hear things are going so well for Cleo!!!!!!!!!
 
Andrew & Cleo (Updated 8/15) Requesting Advice

Well I'm back. Work has been killer so I haven't updated for a while.

Cleo is doing really well. I had her on 1u Lantus at first at the vet's suggestion. After a week Cleo was doing some low numbers so we cut it back to .5u. After a week of that I took her back to the vet to be tested. She was 129 so no shot that morning. The vet suggested we wait 3 days and test her again with no shots. After 3 days she was testing 151 so no shots. I also finally managed to get home testing working with a Maxtor AST.

I have been testing every other day and she was holding in the 150s for a while but now it has started creeping back up a bit. Two days ago was 168. Today I just measured 198. All my tests are prefood. I've been giving Fancy Feast classics in the morning and evening so I know she hadn't really eaten for a while today.

I'm not trying for tight regulation but I want to know if 198 is ok.

Oh by the way what the heck does OTJ mean? I know it's means off insulin but it's not in the acronyms guide. What does it stand for?

Thanks for any advice!! :-D
 
OTJ means off the juice or off insulin.

We consider a cat OTJ when they range between 40 - 120, off insulin, spending the majority of the time in double digits, for 2 weeks.

So it looks like she was close and started sneaking back up. One thing you might try is to cut the carb level if possible. So, if she is eating 7%, switch to 3%. See if that makes a difference.

I would start a new thread asking specifically for close to OTJ guidance with Lantus.
 
OTJ = off the juice (juice being insulin).

Normal BG range for a cat is 40-120 - as you are above that, it sounds to me that you stopped the insulin treatment too soon. If this were my cat, I would put her back on a small dose of insulin 0.5 and home test and monitor to see how that is working.

As you are home testing, do you keep track of the numbers? It would be helpful for us if you have this and could create a spreadsheet - viewtopic.php?f=6&t=18207
 
Hi Andrew, nice to see you back posting with an update on your Cleo! Glad to hear your Cleo is doing so much better, even if her numbers are creeping up again. I would trust the folks here with advice on what to do about those creeping numbers to keep Cleo feeling good. :mrgreen:
 
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