? General help for new diagnosis

[Setia]

Hi everyone,

I apologize if this is the wrong place. I tried to look for answers already and I'm at a loss. Ollie was diagnosed with diabetes on Thursday. He's about 7. He has a history of pancreatitis and IBD. Last Jan he almost died from an enlarged gallbladder and the trifecta of liver, pancreas, and gallbladder issues. He made a miraculous recovery and the bet switched him to Royal Canin hydrolyzed protein. The switch seemed to dramatically reduce his vomiting and general issues and he went from a severely underweight 8 lbs. to the 12 lbs. he is today.

He has always been a grazer. The vet said we needed to immediately switch to 2 meals a day, 12 hours apart for his insulin. He is on 1 unit of ProZinc every 12 hours.

Great. I have no problem with this. Ollie takes great issue though and is only eating a very small amount at a time. When I read about transitioning from grazing to meals, everything says the process can take months. I really think starving him is not going to convince him he needs to eat at the next meal, since it has not yet.

The vet had little advice but she was not my normal vet. Her concern was just that he needs 2 meals and he needs his insulin. My regular vet had an emergency and will be out for a while (possibly until early-mid March!!) and I do not want to text him under those circumstances.

So my questions are as follows:

Can we transition to 2x meals a day more slowly at first? By maybe feeding 4 meals instead of 2 to start with? Or will he figure it out when he "gets hungry enough?"

Even though he has the history of IBD/Pancreas issues, should we switch to a wet lower carb food? I suspect I know the answer to this is yet but this may be an issue we can wait for the regular vet to return for. The wet HP foods seem to be... Very low quality and have horrible reviews (not to mention almost $4 a can).

The vet suggested I needed a testing device from them, but that I did not actually have to test. I have read a lot to the contrary and spent many years having to make sure my glucose was not too low. I am very familiar with testing (humans). I assume most people test? Do you use a human monitor?

Any help or advice is appreciated. So far Ollie seems to be doing great and other than being annoyed at not having food when he wants it, he does not care about his insulin shots.

Thanks so much,
Setia

 

[Adrienne & Molly (GA)]

Hello,
When posting a question add the ? GA stands for guardian angel. Kitties that have passed away.
Wet lower food is good for cats with diabetes. I fed my Molly Fancy Feast pate. Beef, chicken. I also used a human monitor to test. I’m not familiar with pancreas issues. I can tag a couple ladies. Who can help you with that.
Should also start a spreadsheet, keep track of your BG numbers each day testing. I’ll share a couple links for you
@Wendy&Neko
@Suzanne & Darcy

https://felinediabetes.com/FDMB/threads/dr-pierson-new-food-chart.174147/
https://felinediabetes.com/FDMB/threads/how-to-create-a-spreadsheet.241706/
https://felinediabetes.com/FDMB/forums/spreadsheets-tech-support-testing-area.6/
last last link has some helpful information for you!

 

[Jacques and Pumpkin]

Welcome, Setia!

Pumpkin had very similar issues. Some kind of food allergies/IBD, switched to an HP food, the vomiting stopped, and then she got diabetes.

You're going to want to take a look at the stickied posts in this forum and in the ProZinc forum.

The advice your vet is giving you is based on older insulins that act very quickly. ProZinc is a long-acting insulin, so its effect lasts throughout the day. Feeding Ollie all at once is the exact opposite of what you want to do there. By the time the insulin kicks in, the blood sugar spike from his meal will have passed, and then the insulin might drop his blood sugar further, possibly into dangerously low hypoglycemia territory! Ollie being a grazer is already a good start.

Next, you're going to need to look into a lower carb (ideally less than 10% energy carbs) food for Ollie. Royal Canin HP is 40% carbs. This is really hard for a cat with food issues. I'm going through it right now with Pumpkin and it's very stressful. Before her HP diet, Pumpkin ended up in the hospital she was vomiting so much and refusing food.

I'm in the process of trying out different limited ingredient foods to find something that her stomach can tolerate. Every time she so much as burps my blood pressure goes up!

But, from the blood glucose testing I've been doing I can tell the insulin is basically having no effect on Pumpkin because it's just getting overwhelmed by all the carbs in her HP food. She's already lost 2 lbs, and I'm in a race against the clock to work out a better diet.

Two important things about the diet changes:

1. If you have to pick between low carbs and no vomiting, pick no vomiting. Vomiting is obviously really bad for your cat, and when they're on insulin it's even worse because vomiting leads to low blood sugar and low blood sugar is dangerous with insulin.

2. Once you have a low-carb food that Ollie can tolerate, you need to make the change gradually and monitor his blood glucose to make sure it doesn't get too low. Once you get rid of all the carbs, his body might be able to regulate its blood sugar all on its own. At that point the insulin could drop him dangerously low.

I'm sure you're going to have lots of questions. Take a look at all the stickied posts and then we can help you out with anything that's not clear.

You might also want to look at my post history. I've been asking a lot of the same questions you might have about Ollie's combination of stomach issues and diabetes.

 

[Jacques and Pumpkin]

I missed on my first read that you test your own blood glucose, so a bunch of the stuff I was saying was probably already obvious to you. Feline diabetes isn't exactly the same as human diabetes, but if something sounds really strange to you compared to managing human diabetes, there's a good chance it also doesn't make sense for cats.

 

[Setia]

First, I am so sorry I used the wrong tag. I do not see how to edit it. ...

Thank you @Adrienne & Molly (GA) for the links. I will look at them. I am very familiar with spreadsheets, so I think keeping one will be great. Thank you so much for your help.

@Jacques and Pumpkin it is so stressful. His vomiting went from every few days to hardly at all. In fact, vomiting is what sent us to the vet on Thursday only to be blindsided by a diabetes diagnosis. Ollie spent 5 days hospitalized last Jan and I'm pretty sure the vet was just sending him home to be with us. Then, surprise, he made a full recovery, we switch foods, and he gained a bunch of weight. One of the vets in the office had last seen him when he was so sick and she was shocked with how good he looks. I will check out more stickied posts and your history. It was just so frustrating to be told to switch him to 2 meals when the insulin instructions say "be consistent" but do not define what that means.

I have not started testing yet because the vet we saw said not to worry. That was a red flag since human diabetes involves SO much testing and between my own experiences and my grandma's, I assumed I would be getting a tester (either pet or human) regardless of that. I like the vet he saw a lot but my regular vet cannot come back fast enough!

Thank you again so much. It's only been a few days so I know it'll be a transition but I just felt like everything we were told to do was counter intuitive. Finding a few is so... So hard. We have been through so many and kept having to go back to taste of the wild prey. The other issue is that I'm gluten intolerant and even having gluten in pet food is a problem for me... So the entire house is gluten free. We finally seemed to be making so much progress even though HP foods are such high carb.

I will read all the links and things sent, thanks again!

 

[Wendy&Neko]

Hello and welcome to you and sweet Ollie. I've removed the GA prefix and replaced it with "?" which is what we use for questions.

If Ollie like to graze, let him graze! It'll be helpful if you can take up his food the couple hours before his shot, so that food doesn't influence his blood glucose (BG) numbers you should be testing before you shoot. And yes, human meters are fine here, and actually preferred. Their test strips are SO much cheaper, easier to get in a pinch when you run out, and our dosing methodologies are all based on human meters. When I started here, that's all people used anyway. As you will see, we are strong believers in home testing. Would your vet not test their baby before giving it insulin?

Prozinc is a good insulin for cats, so I will give your vet kudos for that.

There are lots of commercially available low carb options for cats with IBD. Pancreatitis does not need a special diet, but many cats with GI issues can also get pancreatitis. More on pancreatitis on this post: A Primer On Pancreatitis

For IBD, a good approach is a novel protein diet (a protein he hasn't eaten before) and probiotics. Visbiome is a good probiotic specifically made for IBD. More on IBD and diet on these pages: https://www.ibdkitties.net/ and https://www.rawfeedingforibdcats.org/

 

[Jacques and Pumpkin]

The other issue is that I'm gluten intolerant and even having gluten in pet food is a problem for me...

One silver lining is that the you want a grain-free food, so so unless they’re using it as an additive your options will often already be gluten free.

 

[Sienne and Gabby (GA)]

Welcome to FDMB!

You've gotten some great information already. I'm in complete agreement with Wendy -- human meters are fine. Vets seem to have developed an affection for pet-specific meters in the last few years. Many vets are now suggesting continuous glucose monitors (e.g., the Libre) which are human meters. (They don't seem to be able to make up their minds between pet vs human meters!)

If your kitty is a grazer, there is no need to try to change your cat's habits. It will frustrate both you and your cat. I no longer have my diabetic cat but Gabby was fed over several hours. Most of the members here allow their cat to graze or feed multiple small meals.

There are good options for novel proteins. You'll want to look at varieties of food such as rabbit, venison, lamb, kangaroo, or anything you haven't fed your cat. Raw food diets are also fine as long as you select novel proteins.

If you plan on hanging around and want to get started here, this post on helping us to help you will give you information on the basics of getting started. There's information on how to set up your signature which will prevent us from asking you the same questions over and over again. There are also instructions on how to set up a spreadsheet. We all have spreadsheets attached to our signatures. It's where you can keep track of Ollie's blood glucose test data and we can follow along and offer feedback. The linked post also has information on setting up a hypo kit.

Please let us know how we can help. The members here are very generous with their time and knowledge.

 

[Diane Tyler's Mom GA]

Hi Setia if you live in the US you can purchase the Relion Premier Classic Meter at Walmart for 9 dollars
https://www.walmart.com/ip/ReliOn-Premier-CLASSIC-Blood-Glucose-Monitoring-System/552134103

The tests strips are 17.88 for 100
https://www.walmart.com/ip/ReliOn-Premier-Blood-Glucose-Test-Strips-100-Count/575088197



Here is a link about testing your kitty
https://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/

Always aim for the sweet spot warm the ears up first, you can put rice in a sock and put it in the microwave, test it on the inside of your wrist to be sure it's not to hot, like you would test a babies bottle. You can fill a pill bottle with warm water and roll it on the ears also.Just keep rubbing the ears with your fingers to warm them up

6. As the ears get used to bleeding and grow more capilares, it gets easier to get the amount of blood you need on the first try. If he won’t stand still, you can get the blood onto a clean finger nail and test from there.
When you do get some blood you can try milking the ear.
Get you finger and gently push up toward the blood , more will appear
You will put the cotton round behind his ear in case you poke your finger, after you are done testing you will fold the cotton round over his ear to stop the bleeding , press gently for about 20 seconds until it stops
Get 26 or 28 gauge lancets
A lot of us use the lancets to test freehand not the lancing device
I find it better to see where I'm aiming
Look at the lancet under a light and you will see one side is curved upward, that's the side you want to poke with

 

[Larry and Kitties]

I myself prefer multiple small meals vice free feeding because I would then know if the cat is eating or not eating consistently. If you leave all the food out and give shot only alfter maybe eating some and he never eats more then you can be proactive un expecting a low BG and can take action before BG goes too low. WIth free feeding it is hard to determine how much the cat eats when.

 

[Setia]

Thank you again, everyone. I have set up Ollie's SS and linked it (I think). I do not have data yet but am going out in the next bit to get a monitor and test strips. I am so grateful for the help and advice and I'm of the opinion having more data is always better, so tracking his BG is important. I also would like to change his food. We have another cat, she's about 1.5 years old. For now, she's been eating the same HP but I feel like she would also do so so much better with a wet food. I have been reading the links and pinned threads in some of the forums and you all are a true blessing. I feel so much better about all of this.

 

[Ale & Bobo & Minnie (GA)]

Welcome and you got awesome advice already. Just want to reiterate what others already said. Feeding twice a day only is old fashioned advice and it usually comes from vets more used to treating dogs since that works for them. Cats however, have much higher metabolism and they need to eat several small meals throughout the day. It’s also a lot easier on their pancreas, especially for a cat with history of IBD and pancreatitis. Most of us feed the bigger meals around shot times and smaller meals or treats throughout the day. Unregulated diabetic cats also need more calories since they can’t process the nutrients in food well and eat but are alwyas hungry and end up losing weight.

sorry if I missed this, but is he on anti nausea and anti vomiting meds like ondansetron and Cerenia? It would be great if you could add all his meds to your signature as well

 

[Setia]

Thank you so much! I have added this meds now. He got a cerenia injection and then has baytril and metronidazole for 10 days. He only gets these when he has a flare up or if vet thinks he might have a flare up. Since he got majorly sick, this is only the 2nd round of meds he has needed with the last in July.

I was able to get a BG monitor and strips from the grocery store, which was ironically cheaper than two pharmacies and walmart. We will test him before his 9 pm big meal. After reading all of the wonderful replies, we went ahead and gave him 2 little meals after his big one at 9 am. He's still not eating as much as normal but that also is what happens while he's recovering from IBD issues. His pancreas actually tested great on Thursday, so glad for that!

Thank you all so much for all of the help. I cannot begin to express how grateful I am. <3

 

[Ale & Bobo & Minnie (GA)]

I would suggest trying ondansetron in addition. Both my cats have/had IBD and are/were on it daily. The Cerenia never helped much but the ondansetron is what kept them eating. They work differently and can be taken simultaneously.

 

[Diane Tyler's Mom GA]

When you get a chance can you add the meter you will be using to your signature also

 

[Setia]

I added the meter. I feel bad since I would think it hurts to be poked twice, but Ollie didn't seem to care aside from "mom why do you have my ear and why is there a light, feed me" hah. His BG was only 90 though. He's eating his dinner now, so I imagine we still give him the 1 unit after he eats.

edit: the PZ forum says to test again in 20 minutes to verify if BG is going up, so we are doing that first.

edit 2: getting blood from a cat's ear is very tricky and manually poking seems MUCH better. The second read is 89. I have NOT given him insulin.

 

[Jacques and Pumpkin]

Not shooting sounds like the right call. With BG that low I would wait until you get advice from an experienced member before shooting. You almost certainly want more data before you’re ready to shoot that low.

It might help to post in the PZ forum if you haven’t already, especially when you want help deciding about whether to shoot or stall.

 

[Jacques and Pumpkin]

Also with numbers that low it’s really important to get a curve. You might already be due for a dose reduction, but you need to see the nadir of the curve to know for sure. Just being at 90 you’re right at the edge of being due to reduce.

 

[Setia]

Also with numbers that low it’s really important to get a curve. You might already be due for a dose reduction, but you need to see the nadir of the curve to know for sure. Just being at 90 you’re right at the edge of being due to reduce.

That's wild to me. He just started insulin yesterday effectively. Tonight would have only been his 4th dose. I'm so frustrated with the vet who said to not worry about testing and just give insulin every 12 hours. I really hope his regular vet returns soon.

 

[Jacques and Pumpkin]

That's wild to me. He just started insulin yesterday effectively. Tonight would have only been his 4th dose. I'm so frustrated with the vet who said to not worry about testing and just give insulin every 12 hours. I really hope his regular vet returns soon.

On the plus side, if these numbers hold up, you might just need a diet change to get Ollie into remission.

Be very careful with any diet change though. With BG this low you could easily crash him by yanking the carbs. You definitely want to work with someone experienced with PZI like @Suzanne & Darcy

 

[Ale & Bobo & Minnie (GA)]

You switched him to wet food didn’t you? That’s likely why you’re seeing the lower numbers. Anything under 90 earns a 1/4 unit reduction. He may need to go down to .75 units. We’ll see but good call on skipping especially since monitoring overnight can be tricky

 

[Setia]

You counted him to wet food didn’t you? That’s likely why you’re seeing the lower numbers. Anything under 90 earns a 1/4 unit reduction. He may need to go down to .75 units. We’ll see but good call on skipping especially since monitoring overnight can be tricky

We have not switched foods yet especially since the trip to the vet was because of an IBD flare. I was hoping he'd get better from that before we started trying new foods again. We'll check him again in the morning and see where we are. Thank you!

 

[Sienne and Gabby (GA)]

Great job on getting started testing. The only additional suggestion I would make is to give Ollie a treat every time you test regardless of whether the test is successful or not. Some cats are troopers when it comes to testing. I suspect that reinforcing their good attitude will make the process easier for you, as well. Some cat's come running to be tested because they know they'll get a treat. You'll want to look for low carb treats such as freeze dried chicken or other freeze dried protein. Some members use cooked chicken or whatever their cat considers a treat (e.g., brushing).

You might want to consider lowering the dose given the numbers you're seeing. Personally, I think it's easier on the caregiver's nerves if the dose is a bit lower and you're not fearful that you're going to overdose your cat.

 

[Ale & Bobo & Minnie (GA)]

We have not switched foods yet especially since the trip to the vet was because of an IBD flare. I was hoping he'd get better from that before we started trying new foods again. We'll check him again in the morning and see where we are. Thank you!

I just went through the same thing with Bobo. He’s now on budesonide in addition to ondansetron and Cerenia. We’re on the 4th day and he started eating a little better each day. Today he’s almost back to normal has your vet discussed budesonide with you?

PS- I’ve also found that keeping anything beef off his food diet has helped a lot

 

[Setia]

@Sienne and Gabby (GA) We're really lucky because Ollie is a baby who wants us to carry him around and cuddle him 24/7. He seems to not care about any of this since he's getting loved on every time. Because he's on the HP food, we stopped giving anything else but when/if we switch to a novel protein, I will definitely find treats to give.

@Ale & Minnie (GA) As far as meds go, Ollie has done much better than his sister. Before we lost her, she was on various steroids and cerenia on and off. She did not tolerate medicine well so we were always limited. For Ollie, catching it early with a round of baytril and metronidazole seems to help clear everything up. He did have a shot of Cerenia on Thursday when he was dx and he finally ate a lot better last night so I'm hoping he's on the mend in that regard.

Thank you so much for your replies