Hello and looking for advice

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vtshep1

Member Since 2012
Hello, my name is Scott and I just registered here as I just learned our cat is diabetic. I have more to learn but would like to see if anyone has perspective on a couple items. I apologize for the long first post and thank in advance for any advice.

First off I appreciate this site/resource is here as it seems to be tremendously helpful; I read a number of the pages last night and will need to read more.

Background:
Cat (Buddy) is 14, born in a dumpster from a stray behind a vet office, gifted to me as a kitten. I noticed symptoms over the past month or so, I wish I put it all together sooner.

Symptoms leading to diagnosis:

--1 Cat is laying on the floor a lot, never really did this before (although still climbing around condo to get to food, jumping on bed to see us…just not as much). Noticed some clumsiness but not sure if related (nerve) or he is just very old
--2 Cat is disengaged to some degree, harder to get to purr, wont purr as loud
--3 Cat is drinking a ton and peeing a lot (looking back I think this was happening for approx 4 weeks until we realized :(
--4 Cat lost some weight, maybe a couple pounds, he was overweight and I wouldn’t call him underweight now at all…maybe a pound or two overweight.

Google searches led me to diabetes on Monday, got into vet same day, Tuesday suspicions confirmed from tests, cat immediately brought to animal hospital for 4 days to stabilize (today is Wednesday). I am not sure I am educated enough at this point to properly assess the severity, but the cat didn’t have ketones or go into shock. I think his glucose level was in the 300’s when he first hit the vet’s office, but maybe was 400s, will confirm. They also said he has chronic kidney disease, one is “used up” the other is damaged but they hope he can be treated for all. He is reacting to insulin and the plan is to take him home on Friday which leads to some anxiety and my questions.

Questions: I have two areas I am initially very concerned about, any insight would be appreciated

Behavior Challenge
Behavior challenge overview- An extremely mellow cat and super affectionate, but freaks out if you try to poke/manipulate against his will. He wont even allow nails to be cut without going nuts (so we stopped that). The vet has indicated he is one of the worst they have had to deal with when testing, poking, and prodding. This is my primary concern as I don’t know how in earth we are going to administer shots or test.

Behavior question 1 - What are the best needles and blood glucose test equip I can buy to minimize the freak out (e.g. are 30g needles the best)? I am not concerned about cost when surmounting this initial hump.

Behavior question 2 – I have never attempted anything of this nature on him, and it is not going to be pretty, any tips for both long and short term strategies?

Schedule/Caretaker

Schedule challenge and caretaker overview - My wife and I are in our 30s, we are both working professionals without kids, we both work extremely demanding jobs. I have actually been averaging 90-100 hour work weeks for the past year (this unfortunately is not an exaggeration, 14 hour days 7 days a week). With work, business trips, etc. I am very, very concerned as I know it will be extremely difficult for us to feed and insulin twice a day on schedule. My knee jerk reaction is I need to find a caregiver who can do this for all evenings. Our dog walker said she has done this before. I am not sure how we can afford this but will try to figure it out. Hypoglycemic seems to be a terrifying thing if this is done wrong.

Schedule/caretaker question 1 – Are there people who specialize in this I can hire to initially help us learn how to handle this, especially with the behavioral challenge? If so how do I find them?

Schedule/caretaker question 2 – Any advice on how to approach this with our dog walker if we go this way? Concerned as she has a number of walkers that help her with all the dogs in our high-rise condo building...and of course they need to do this correctly.

Schedule/caretaker question 3 – Being home to monitor during the day is not an option with our jobs. I am concerned about puking up and going hypo with nobody around. I am looking into IP web cams I can access via work or something…but not sure that will do much except provide torture watching if I am in an office in another city.

Lastly are we nuts trying to do this with our work situation? I don’t think an answer of yes will stop us from trying but may urge us to see if there is a home for him where someone is capable of handling.

Thanks for any advice.
Scott
 
You do have some challenges, Scott, but I think the members here have all dealt with some of your scenerios so hope we can help.

Yes, get a thin gauge needle to shoot with. Lots of us shoot while the cat has his head deep into his breakfast or dinner and they don't seem to notice. Here is some info on giving the shot:
How to give a shot

You might practice on an orange until you feel confident.

Some people here have dealt with feral cats, so the process is possible. What seems to happen in lots of cases, is that the cat realizes the shot makes him feel better and he becomes patient with the process. And it's a lot easier than trimming nails! A quick shot - 2 or 3 seconds - and you're done.

Since you have a challenging cat, I would conquer the shot first. But we will strongly urge you to start testing at home as soon as you can. We do have ways to do that with difficult cats, but the general approach is to give him a treat he loves only at testing time; soon they associate the treat with the process and let you do it. For now, I would start with desensitizing:

First pick a place where you want to test. Some people use the kitchen counter, a blanket on the floor, between your legs while sitting – whatever works for you. Take the kitty there and give him lots of praise while you play with his ears. Give a treat and release. Next time, add the rice sack (thin sock filled with raw rice, heated in the microwave until very warm but not hot) or a prescription pill bottle filled with very warm water. Lots of praise, treat and release. Finally add the lancet so he will get used to the noise. The hope is that when you finally poke, they will be used to the process and know a treat is coming!

Also, since you anticipate some issues with this whole process, be sure the vet prescribes a gentle, long lasting insulin like Levemir, Lantus or ProZinc. They will be easiest to work with.
 
Hi Scott and welcome to the feline diabetes board!

It sounds like you are taking the right steps into getting your little kitty back to 100%! I know others will be here soon, with links and videos and helpful hints to answer your questions ..

With mocha, we home tested her with the wal mart brand, relion micro human meter. Your vet may suggest their brand, which is supposedly calibrated differently for pet blood. You do not need to buy this meter. I would say over 90% of the members here use human meters, and majority of them use the wal mart relion brand because they are cheap enough for the meter/strips and wal mart is open 24/7 and there is usually one within a few minutes from your home .. for those late night runs :-D

We had mocha on Lantus insulin for 22 months before she became "OTJ" (off the juice) She is fed a low carb diet of wal mart brand special kitty cat food. It's cheap enough for our budget and she loves it .. her favorite flavor is turkey and giblets, which I do believe is around 3 or 4% carbs. Dry food is a NO NO. The dry food carb content is out of this world, even the specialty dry food your vet may strongly recommend. It is not needed/necessary. There is a list on this forum somewhere, called the janet and binksy food list, and it shows multiple brands of food and what carb % they are. Most of them can be found at your local grocery stores.

Your vet may also recommend taking kitty back for fructosamine testing, or curves. There is no need for that. If you home test, you are doing your own curves. There is a link on here as well, for starting up a spreadsheet for keeping track of your kitties numbers. Mine is linked at the bottom of this post if you are interested in looking at mocha's numbers.

Testing and poking your kitty might be your biggest struggle. Remember, there are treats out there for encouragement. A lot of people here use freeze dried chicken as treats. Get the cat used to being held, rub the ears, click the pen .. as you continue to do this, and to reward the kitty with treats, whether you have success or not with getting the blood, it will become easier. If not, there are ways you can hold your kitty (the kitty burrito method comes to mind) to get the job done. It is not impossible, it just takes patience (and lots of tears and frustrations .. hey, I won't lie! :-D )

As far as your work schedule goes, I can't help you much there .. I was lucky enough to be an at home wife all day so I was here to monitor mocha as much as needed .. but there ARE a lot of people on here with demanding jobs, school, kids, etc. .. It can be done ..

If it was me, I personally would go pick kitty up from the vets office .. I don't see any reason why vet's hold the cats at their offices unless they do have other problems, such as ketones, dehydration, etc. No wonder they are having a hard time with kitty .. it's scary being there, away from the home they know .. numbers won't be true anyways, stress can raise a cat's blood sugar numbers by over 100 points ..

But you are in the best spot for finding answers and support at any time day or night .. so read up, ask questions, and make yourself feel at home!
 
You are doing a fantastic job taking the initiative and educating yourself this early in the game! Diabetes in cats tends to be something that requires a lot of added educational effort in addition to simply following your vets advice, as many are a bit behind in their research or aren't familiar with all the details required for proper care. And if you add CKD to the mix, that's a double whammy.

The very first thing I'm going to emphasize with both conditions is diet, which is key to managing both diabetes and CKD. There are several commercial foods that are good for both conditions. Here's a great website that explains the basics of feline nutrition: http://catinfo.org/. To manage diabetes, you want to feed a low carb (less than 10%) canned food, and to manage the kidney disease, you want to feed a high quality, low phosphorus canned food. Many vets simply recommend low protein diets for cats with CKD, because they are by default low in phosphorus. However, it's the quality of protein and phosphorus levels that matter, not the protein values. The low-protein prescription kidney diets have only been shown to be beneficial in end stage renal failure and should not be fed long term. In fact, they can cause muscle wasting when fed in early stage CKD and are completely inappropriate for an early stage cat.

Here's an updated food list with the values for several premium foods: https://docs.google.com/leaf?id=0B8...MzhkYTkxOGM4NThk&sort=name&layout=list&num=50. You're looking for something with less than 10% carbs (for the diabetes) and less than 250 mg/kcal of phosphorus (for the kidneys). The foods I would suggest are Merrick's Before Grain Beef, Merrick's Before Grain Turkey, Merricks' Cowboy Cookout, Merrick's Surf & Turf, Wellness Turkey, EVO 95% Chicken & Turkey, and Blue Wilderness Duck.

If those are out of your price range the next best thing to feed are the low carb Friskie's Special Diet Turkey & Giblets and Salmon flavors. However, I would strongly urge a food without byproducts, and keep in mind that they're still cheaper than the prescription foods and usually about the same as many grocery store brands if bought in bulk. Studies have shown that the quality of the protein source does make a difference in controlling the disease, and that needs to be considered along side phosphorus content.

Here is a fantastic website with a lot of information about CKD: http://www.felinecrf.org/

For the diabetes, the three things that are key in managing the disease are 1. A low carb, canned diet, 2. A slow acting insulin (Lantus [glargine] or Levemir [detemir]), and 3. slow and small dose adjustments made via daily home testing (with a human meter--vet meters are expensive and unnecessary). Newly diagnosed cats have an 84% chance of remission if you use the right insulin (Lantus or Levmir), home test daily, and feed a low carb, canned diet.

Ok, so now to some of your questions:

vtshep1 said:
The vet has indicated he is one of the worst they have had to deal with when testing, poking, and prodding. This is my primary concern as I don’t know how in earth we are going to administer shots or test.
Click to expand...

Testing and giving insulin shots seems very hard at first, especially when the cat is generally difficult. However, even fractious cats come around if you approach shooting and testing the right way. The insulin syringes you get depend on the insulin you're prescribed--Lantus and Levemir (recommended) will need to be administered with U-100 syringes, while Prozinc (2nd choice, but still an ok insulin) is administered with larger, U-40 syringes. The NOT recommended insulin for cats, Humulin N (NPH) will come with U-100 syringes. If your vet tries to write you a script for this insulin, do not accept it and insist on one of the others. Humulin N is a good insulin for dogs, but it is ineffective and dangerous for cat. You want to get .3cc, 31-33g, 5/16" syringes with half unit markings. These are the smallest syringes you can get, and many cats don't even feel you giving the shot, which is injected subcutaneously. I always gave Bandit his shot while he was eating, and if he ever noticed it, he certainly didn't show it because he was mowing down his food.

Many cats hate testing the first few weeks, but nearly all of them come around and accept it eventually. Bandit fought me tooth and nail the first few weeks, and I was convinced he'd never accept it. a few weeks later, he was running to me when he heard the glucose meter click on. What I did with him at first was put him in a fleece blanket lined basket slightly larger than him, and wrapped him up with another blanket so that only his head was sticking out, and then I'd do the ear pokes. Cats have very few nerve endings in their ears (less than people have in their fingertips), so it's not the ear pokes that bothers them--it's restraining them and doing something new and strange, and sensing your fear and nervousness. So you want to get that drop of blood as quickly and easily as possible. Start out with 26g lancets--the 30-33g lancets that will come with your meter are very difficult to get a drop of blood with. Warm the ear before you poke, and make sure you back the ear with a tissue or cottonball as you're poking. Apply pressure to the spot for 20 seconds after the poke to prevent bruising, and apply a tiny bit of neosporin + pain relief (ointment, not cream) afterwards. Most importantly, give a low carb, diabetic safe treat after every test. I use Beefeater's freeze dried treats in the cat treat section at Petsmart: http://www.petsmart.com/product/index.jsp?productId=2751598&fb_source=message

vtshep1 said:
Being home to monitor during the day is not an option with our jobs. I am concerned about puking up and going hypo with nobody around. I am looking into IP web cams I can access via work or something…but not sure that will do much except provide torture watching if I am in an office in another city.

Lastly are we nuts trying to do this with our work situation? I don’t think an answer of yes will stop us from trying but may urge us to see if there is a home for him where someone is capable of handling.
Click to expand...

I managed Bandit's diabetes on my own while working a full time job with a 2 hr commute, a part time job on the weekends, and going to grad school. If I could do that, anyone can. If you follow Tight Regulation (the recommended dosing protocol for Lantus and Levemir with the 84% remission rate), you need to get three tests a day--once before each shot, and mid-cycle test about 6 hours after the shot. I was at work for 12 hrs during the day and could not make it home for lunch breaks because of the commute, so I got Bandit's mid-cycle tests at night. His shots were at 7am/7pm, so I would test at 10-11pm before going to bed, and then set an alarm and get up for 5 minutes to feed and test him at 1am every night. Yes, it is a pain in the but, but your body gets used to it (just like parents getting up for their newborn) and the benefits of correctly dosing your cat and likely getting him into remission is 100% worth it. When I was home on the weekends, I did a curve during the AM cycle on either Sat. or Sun., and got some extra tests in during the AM cycle.

Once you have testing down, you also have the option of teaching a pet sitter (high school or college kids work well) how to test and have them come in a few days a week to get the mid-cycle test during the day. I did this briefly when grad school and the late night testing was kicking my butt. The college student I taught to test came in 3 times a week at 1pm, and those days I slept through the night because I had a mid-cycle test. She worked for next to nothing--she lived nearby and it was only 10 minutes each day worth of work.

Keep asking questions! There is a lot to learn about both CKD and Diabetes, and this web site is a wealth of information!
 
Welcome Scott and Buddy,

You have found a great place to get help. So many of us have walked in your shoes, new to all of this,
apprehensive about whether we can do it, while at the same time wanting to help our sugarbabies.

I do not have experience with the kidney disease but I would guess it's all the more important for Buddy to
get his diabetes regulated.

You didn't mention what kind of food you are feeding? That's usually one of the first questions here.
Dry food is often why so many of us are here. None of us knew it was so bad for our cats.
Since you haven't picked Buddy up yet, be wary of the vet trying to send you home with prescription foods.
Now someone else will correct me if the kidney disease makes your case different for the prescription food.

The prescription foods are very high in carbs ( with one exception which is average in carbs) and
finding a low carb wet food can really have a drastic effect on the glucose level.
It is important to not start on a high dose of insulin if you need to transition the food.
It only takes a couple of days to see the difference changing the food makes.
Here is the food list.
http://www.felinediabetes.com/diabetic-cat-diets.htm
I printed the old list and the new list and carry it with me when shopping, low carbs highlighted in yellow.
You want at least under 10% carb, some of us try for less than 5%. The merrick's and Wellness are really great if your cat likes it. But also fancy feast classics ( no gravies, no grilled, no new blends)
http://www.catinfo.org/ is a must read for the food issue.

So if the vet wants you on a higher dose to begin with, you might want to slow that down for the food issue
and to get a handle on the glucose monitoring.
Hopefully you will have a supportive vet who works with you.

You will need to get a monitor and decide if you prefer a lancing device or freehand a lancet.
You will want a 28 gauge lancet or device.
I can recommend the accu-chek softclix plus , it is a 28 gauge. I really like it. i use setting 4.
When looking at meters, I hear to stay away from anything with tru in the name

So many of us have had cats that don't want to cooperate, especially at first but they tend to come around
( even willingly for some) because you give them a special treat ( their favorite) only at testing time.
The first week you may have to wrap him in a blanket ( burrito style). My girl doesn't want to be held down
and quickly cooperated just to avoid it.

As for your schedule, you will need to figure out 12 hr intervals. You don't mention whether or not your wife
could do the evening schedule and you could do the morning?
That would also be a way to manage this. It is beneficial for you both to be involved if possible because whoever
is at home would need to pay attention at least some of the time.
But lots of people have to disappear for many hours a day.
But you could have a hired helper. Many of us would probably love to find one.


Those symptoms all are the diabetes. He is not feeling good. And his body is starting to starve because of the diabetes. That will improve when the insulin begins.
The weakness is from neuropathy which is common with diabetes. Many here are giving B12 supplements.
this is the product. If you hunt for it elsewhere, make sure it is methylcobalmin. Not all b12
are the same.

Vitacost Vitamin B-12 Methylcobalamin -- 5000 mcg - 60 Capsules
http://www.vitacost.com/vitacost-vitami ... 0-capsules

A commonly given dose here is 3 mg -5 mg.
B vitamins are water soluble and any excess is excreted in the urine.


the bottle above is 5000mcg which is the same as 5 mg. You can empty the whole capsule and mix in with the canned food or use part of it if you prefer the 3 mg dose.
Click to expand...

And the best needles are the 31 gauge 3 ml with short needles ( 5/16) with half unit markings.
http://www.felinediabetes.com/injections.htm

the vet should show you how to give an injection but this is helpful too. pay attention to the part about the bevel.

I'm sure I didn't cover everything.
This is a process and it is a steep learning curve.

You can do it. So many of us felt overwhelmed and like we were riding an emotional rollercoaster and after a week of
doing it, you find that you are figuring it out and getting a rhythm and see how much it's going to improve your cat's life.
Ask questions, often. We want to help you just like we were helped.
 
Hi Scott! Poor Buddy! My cat Ninja had may similarities to Buddy related to the symptoms leading to diagnosis: 1) lying on the floor; 2) disengaged; 3) drinking and urinating; and 4) lost weight.

Behavior Challenge Overview: My cat Ninja, too, will not let you clip her nails and I stopped trying many years ago. The shots do not hurt Ninja whatsoever. She doesn’t even register that I am giving them (I give them to her while she is eating). My vet said, “Most cats don’t feel the injection.” I think we tend to humanize the experience (how we would feel if you stuck us) and assume it hurts for the cat too. But in my experience, it does not.

It is no surprise that Buddy is stressed at the vet. My vet kept Ninja for the first day of testing and said she was so uncontrollable, that they only got one blood test from her all day – which was a waste of time and money and put unneeded stress on Ninja. I have since learned that blood tests taken at the vet are unreliable and often lead to a higher starting level of insulin than the cat truly needs.

Cats, even non-diabetic cats, experience a rise in blood glucose in stressful situations. There are several studies documenting this phenomenon. It is called feline stress hyperglycemia. So a 300 reading taken at the vet might actually be a 150 reading if taken at home. Stress can raise a cat’s BG significantly.

The more experienced members of this board will probably tell you that it is not the best idea to leave your cat at the vet for “stabilization” – though perhaps Buddy’s chronic kidney disease is playing a role in this decision (?). What typically happens is that, due to the stress of being at the vet, the cat’s blood glucose (BG) levels are higher than what they would normally be, and based on these inflated numbers, the vet often recommends a higher starting level of insulin to combat this – sometimes resulting in low BG levels and possible hypo situation once the cat gets home. Some recent posters here have experienced this very thing.

I would also tell you that many vets are not up on the current protocol for treating feline diabetes and that I had to change vets to find one who was knowledgeable and supportive. Here is a checklist to help you determine if you are working with the right vet: http://gorbzilla.com/decisions_decisions.htm

Here on this board, they advise to “start low and go slow.” A typical starting dose of Lantus for example, would be .5 or 1 unit, given twice a day. You go up from there, based on blood glucose readings you collect over time. Others will comment here on the advisability of leaving Buddy at the vet; but I can tell you that you will get your truest BG numbers in a stress-free home environment -- on which to base the starting insulin dose. My second vet told me this very thing; she said, “I would not advise doing regulation or testing here in the office as you are not going to get accurate readings.” I knew then that she was the vet for Ninja and me.


You didn’t mention what food you are feeding Buddy, but wet food is a critical component to diabetes management. Many cats (I believe around 25%) do not need insulin at all if they are switched to a low carbohydrate wet food. Those that do still require insulin will almost always require a lower dose. So if you haven’t already done so, you might want to switch Buddy’s food BEFORE you start insulin treatment and see what affect you get from that.

If your vet recommended any dry food, that is incorrect; and if they recommended any “prescription” food (like Hills R/D, M/D etc) that is not the best choice either as all have too many carbohydrates for a diabetic cat. Many vets sell these products in their office, but are also profiting off the sale. Read this excellent article from veterinarian, and feline diabetes expert Dr. Lisa Pierson, to learn about the best food options for diabetic cats: http://www.catinfo.org/?link=felinediabetes

As to Buddy allowing the BG testing, I too was of the opinion that Ninja would never allow it. After all, she is named Ninja for a reason…LOL!!! And for the first couple weeks, it was extremely difficult until I learned the secret of desensitization (staging mock BG testing rituals that ALWAYS involved giving her favorite treats – so this would be a relatively pleasant experience for her); and restricting treats to only those times. After a couple of weeks, things started falling into place nicely and after a month, I could test her whenever I felt like it. This whole testing and shooting schedule now takes less than 5 minutes, twice a day. The first month is the hardest; but if you make a good, committed effort at first, it will pay off in the long run as this becomes an easy part of your normal routine.

Behavior Question 1 (testing equipment). Syringes: Different types of insulin use different syringes (either U-40 or U-100). If you are using Lantus (glargine),you will use a U-100 syringe. There are three different types of U-100 syringes, and they differ by capacity – how much insulin they hold. Humans typically use the one that holds 100 units or less; but YOU want the one that holds 30 UNITS OR LESS, as it is easier to supply smaller doses that way.

I use Walgreens Super Thin II Syringes, short needle. The box says 0.3mL, 31 gauge (needle), 5/16” needle length. They are about $16 per hundred syringes at Walgreens. Some buy theirs at Walmart for $13.

Testing supplies: I use Walmart's Relion Micro blood glucose monitor. It is about $12 for the meter and $36 for 100 testing strips. I also purchased the Alpha Trak monitor at the insistence of my vet (it is made specifically for animals), but have not found it as useful as the human meter. The strips are hard to find and the Alpha Trak also reads higher than the human meters – making it difficult to compare. Most people on this site use human meters; and they are also recommended by Dr. Lisa Pierson – referenced in the article above.

Behavior Question 2 (not going to be pretty…LOL!): I explained part of this earlier – what worked for me. Others will chime in with what worked for them. If you want more detail than provided above, feel free to send me a private message (PM button to the right).

Schedule/Caretaker Question 1: Depending on where you live, I would guess that there are a number of Vet Techs who would have experience giving injections and would come to your home for relatively little money. Personally I would look on the SERVICES sections of CraigsList (there is a category under Services specifically for pets) and see who is there (make sure you get references); or alternately, you can ask your vet as they may have some resources too.

Schedule/Caretaker Question 2: If you are simply looking for help with injections, pretty much anyone can do this and I don’t see why your dog walker could not be trained to do this too. If you hire a vet tech initially (as in Question #1) perhaps your dog walker can meet with the Vet Tech a few times to learn/perfect the technique before leaving the dog walker on his or her own with this.

Schedule/Caretaker Question 3: Not sure how to answer this, but if you START LOW in your insulin dose and maybe hire the vet tech to come in and check on Buddy mid-day for the first few weeks – that might get you going toward regulation.

But again, I think it might be worthwhile to do the food change first for a few days (assuming Buddy has been eating dry food (???) as maybe that’s all he needs.

Others will comment as well. Sorry so long, but trying to answer your questions to the best of my ability.

PS: If you post where you live, there may be members who live in your area who are willing to come work with you to get you started.
 
Thank you for all the responses and welcome, this information is insanely helpful. I think this may be the most helpful forum on the internet! I have a lot of links and info to read. Our cat is pretty miserable in the vet, I am going to try to get him out sooner than Friday if possible, he is coming in with numbers in the high 200s right now at the vet I think. He is very unhappy and has peed all over himself during the last test they did I am going to drop in on my way to work in the AM to check on him and talk to the doc.

Many questions about what he was eating, it was dry food, IAMs weight control.

He is eating canned food at the vet now. The vet told me right off the bat he needed low carb food but something special because of the kidneys.

We live in Jersey City, NJ across the river from downtown Manhattan so if anyone would like to make some extra cash to help us get started and make sure we are doing this right please let me know. We are somewhat nervious we may do something wrong.

Any comments on this shopping list? I don’t mind spending more money if there is a better option.

Hypo stuff:
--high carb (HC) canned food that contains gravy and is over 15% carb such as Fancy Feast grilled, marinated, or Gravy Lovers varieties
--Bottle of corn syrup – terrified if I ever need to use this - also find out the closest 24 hour emergency vet
--a needle-less feeding type of syringe (free from any vet's)

All else:
--Ketosis testing with Ketostix or Ketodiastix
--Blood meter - accu-chek softclix plus
--Treats – Beefeater's freeze dried treats
--Food – canned, something with less than 10% carbs (for the diabetes) and less than 250 mg/kcal of phosphorus (for the kidneys). Suggestions are Merrick's Before Grain Beef, Merrick's Before Grain Turkey, Merricks' Cowboy Cookout, Merrick's Surf & Turf, Wellness Turkey, EVO 95% Chicken & Turkey, and Blue Wilderness Duck
--Insulin - slow acting insulin (Lantus [glargine] or Levemir [detemir]) (demand a script for this not the Humilin)
--Syringes - U-100 syringes for the Lantus or Levemir (.3cc, 31-33g, 5/16" syringes with half unit markings)
--Lancets - accu-chek softclix plus
--neosporin + pain relief (ointment, not cream)

Insulin dosage - work with the vet to start with a lower dose as her readings are likely elevated due to anxiety. A starting dose of Lantus, would be .5 or 1 unit, given twice a day. Pay attention to the part about the bevel . the number side of your syringe should be face up. If you have it upside down, it's more painful.



Again, thank you for the help!
 
Hi again,
just looked up that food he was on. Iams weight control was 43% carbs. Ouch.

good news is you said his bg numbers were in the 200's.
I'm betting you can reverse this one, maybe even just with the food change. That number isn't high. It's just
above the threshold which is between 50 and 120.

I would print and take the binky's lists and hobo list with me to the vet. Since you have kidney issues, find out
what will help that most. All the values are on the list. If the only other factor is the phosphorus, it's on that chart.

All of the prescription foods the vets peddle have high carbs. all but one but it is still higher than I would want.
Need a little research for this one because of the added problem. Many of us won't touch any of the prescription stuff
except there is one condition that needs it. I don't remember what that was.


I'm the one with the accu-chek. I like it's accuracy. con is that the testing strips are basically 50 cents each.
I think the other one , the relion, is cheaper and lots of people here have it.
I also here the bayer contour is a good one. Those are the only 3 I would have chosen myself.

I don't know all the statistics but I have heard that Lantus is the one right now with the most promise. They have
a good percentage of cats that go in remission early as long as the diabetes is caught early, within the first 6 months.
And you are in that pool.

lancets/lancing device.... I recommend the accu-chek softclix plus.... regardless of what meter .... It is a 28 gauge.

syringes will have the needles already on.

can't help you in NJ. I'm far far away in NM. :-D
 
Thanks, i updated my list above, he is in the 200s now after treatment with insulin for 1.5 days although i have seen thier test results and there are some high 300s on there. I am going to ask tomorrow what his level was at diagnosis...still reading and in awe of how information packed this site is. What on earth did people do before the internet!?
 
A little pint of vanilla ice cream also helps with a potential hypo and most cats love it. Hometesting is the main thing to learn.........never shoot without testing first and never become complacent and let your guard down thinking my cat is doing so great I can skip a test. My Mishka is coming up on 9 years of b.i.d. shots, no remission for her, and never once in all these years have I ever given her a shot without testing first.
 
First Week Strategy: The issue you will face in the next few days is this: If Buddy has been at the vet getting “stabilized” he is receiving insulin during this time, and as mentioned in the posts above, at a level chosen to combat the blood glucose readings obtained by the vet – which are likely elevated, perhaps significantly elevated, due to stress.

As Rhiannon mentioned in her post, Buddy’s readings at the vet -- in the 200’s -- are not extraordinary high by comparison. My cat posted readings in the 500’s and 600’s even after starting insulin. In any case blood glucose readings taken at the vet are typically unreliable.

If you plan to try the diet change first, to see if that alone is enough to bring Buddy into remission, you would likely give no insulin for a few days (once you bring Buddy home) to see what affect the diet change alone is having on his blood glucose levels. I will ask the more experienced members of this board to weigh in if they believe this is a viable first-week option.

In her excellent article on feline diabetes (http://www.catinfo.org/?link=felinediabetes) veterinarian and diabetes expert Dr. Lisa Pierson notes: “Unless the patient's clinical signs warrant immediate insulin administration, I try a diet change - with no insulin - for 5-7 days to see what impact the new diet will have on the blood glucose.” If the BG numbers do not normalize within 5-7 days, Dr. Pierson recommends that insulin be started at a low dose. The experienced members of this board can help you determine a safe and effective dose based on the BG numbers you get from Buddy’s home blood glucose monitoring.

If you choose to do the diet change AND continue giving insulin in the first week, Buddy MAY require a substantially reduced dose than the one recommended by your vet. We have had several incidents of vets prescribing 2 units or more of insulin, twice a day, and once the cat gets home and BG levels lessen (because they are no longer in a stressful environment, and/or the change of diet), the vet prescribed dosage now proves too much for the cat and they experience a hypo incident. The more experienced members of this board can help you determine an optimum starting dose. They typically recommend .5 or 1 unit twice a day.

From my perspective, I would say that bringing Buddy home sooner rather than later would be preferable, as I do not see the value of keeping him at the vet. The stress is only increasing his blood glucose levels (solely my opinion).

Best of luck to you. Please post if you have additional questions. There are many people standing by, waiting to help you and Buddy achieve success.
 
You're looking for something with less than 10% carbs (for the diabetes) and less than 250 mg/kcal of phosphorus (for the kidneys). The foods I would suggest are Merrick's Before Grain Beef, Merrick's Before Grain Turkey, Merricks' Cowboy Cookout, Merrick's Surf & Turf, Wellness Turkey, EVO 95% Chicken & Turkey, and Blue Wilderness Duck.
Click to expand...

I just found this where someone else was talking about kidney disease.
The key is the 250 mg/kcal of phosphorus. This is listed on Binky's.
 
I was looking at phosphorus contents of all my own low carb choices and I'd have to say
you probably want to stay away from fancy feast because of the phosphorus.
Binky's list showed that most of the fancyfeasts were above 250.
 
This is very important...do NOT use the Binky's list for phosphorus values. The carb values are still pretty accurate because they don't change much unless there is an obvious change in ingredients,but the phos values can and do change. There are several foods listed on that list as low phos which are now insanely high in phosphorus. Use the updated premium food list I provided in my earlier post. There are store finders for all the premium food brands on the brand websites, and if you shop around they are about the same price or cheaper than fancy feast, and higher quality.
 
Oh thank you Julia for that updated list.
I had not read anything about the binky's list having incorrect values for the phosphorus.

I will correct my list and put " updated" in the subject heading so everyone will know the newer values are there now.
 
Hello,
Just got off an extra long work day. I picked up the supplies…sans the food recommended above, I couldn’t find it. I also couldnt find the accucheck softclick plus, i bought the accucheck compact plus which uses the softclick lancets. I didnt see a separate dedicated lancet, which i thought i was supposed to also get so i got a box of 100 softclick lancets (they work on this device). The vet seemed to be weary the accucheck was not designed for pets.

I am supposed to take Buddy home tomorrow afternoon. My wife was out of pocked all day but I was able to visit Buddy at the vet on the way to work and in between evening meetings. Unfortunately neither the doc nor I had enough time to review the entire list of questions I have, but we got to some. We have a half hour scheduled tomorrow for this. We will also use the time for her to review what we need to do. I told the doc we were going to home test and she said OK, but seemed concerned we may drive ourselves crazy. Another doc at the animal hospital mentioned we would be doing curves in the near future. I also asked how many people who have brought in diabetic cats just put them down rather than treat, the answer was a lot...mostly due to the financial burden, not sure if that is more than normal as we are deep in an inner city. And no, if the prognosis is pain and suffering free for Buddy we wouldnt consider that, i was just curious.

The questions I got answered were:

What were his glucose levels in the past day?
They have been in the upper 300s and 400s.

Any insight into why they went up from 200s and 300s?
They were overly cautous and skipped a shot either last night or yesterday AM because his number was somewhat low.

Is the special food he is on now low carb, high protein?
No, the doc is working with a pet nutritionalist and the initial plan is to treat the CKD via diet and treat the diabetes with insulin. If this doesn’t work and the diabetes cant be brought under control we will adjust the plan.

I have heard it isnt the protein itself that is the CKD issue…it is the type of protein, what are your thoughts?
Yes, the phosphorus (as mentioned here) is the issue (or maybe she said part of the issue) however the doc seemed confident in the nutritionalist’s recommendations and stressed we will be monitoring and indicated we will react if the diet and insulin are not regulating this.

Are freeze dried meats a recommended treat for when administering tests and shots?
No, not with the CKD, maybe something high fiber, and there was another component I didn’t retain. She said she was also going to reach out to the nutritionalist and ask for advice on treats.

Is there a plan to compensate for the likely inflated glucose readings due to the stress of being in the vets office?
Yes, the doc suggested we would start on a reduced insulin amount, 2 units of Lantus twice a day. For some reason I neglected to ask how many units he is on now (I plan to ask for the record of thier curves/insulin amounts/etc). To be honest I think she might have eluded to not being positive if it would be 2 units...I assume this is why she wanted to keep him today and until 5PM tomorrow, run more tests, get more data.

I have a long list of further questions to ask tomorrow… The doctor seems to be in allignment with all said here and I havent been leading her. I feel confident in the docs knowledge but we are nervious as we are new to this. The only diversions I think stems from the CKD complication. One divergence from the advice here is the potential reccomendatoin of 2 units of Lantus twice day, which seems high based on feedback here...but is 2 units still too high if Buddy is NOT on a low carb high protien diet (for the CKD)? Another divergence is the reccomended food...again for the CKD, I need to ask and understand more about what this food is. I wanted to get to the food links above today but work today wouldnt allow for that...I have been staying up late researching this and am spent, need to sleep...

Any thoughts are appreciated.

I will be working from home tomorrow, visiting Buddy in the AM, and picking up Buddy at 5, plan to spend the weekend working from home and tending to this, i will also work from home Monday and as many other days as possible/needed next week.

Thanks again for the advice.
 
Hi again,

I know you've been overwhelmed with all the learning but these two links will address nearly all of the issues you
brought up in this post. Dr. Lisa Pierson is a favorite around here and she has it all written up. You can print it
and highlight the parts that you are asking about and even be able to find it quickly to back up your own arguments/questions for discussion with your vet and nutritionist.

http://www.catinfo.org/?link=felinediabetes
http://www.catinfo.org/

She addresses the use of human glucometers. The alpha trak ( the vet one) is expensive and no better, all you need
is a comparison test when you are in the office. The accu-chek meter ( as I recall ) was maybe 20 different in the numbers but if you always take your meter with you and do comparison tests, you will know how much your meter
differs from the vets.

She addresses all things about the diet and explains why the "prescription" diets are bad and why.
More info to back you up as you question the nutritionist. Vets don't tend to bother learning about diet for diabetes, that is why they have a nutritionist lined up for you.


You will want to be successful at home testing with a preshot test before each shot and at least one mid point before
you shoot a dose of 2 units.
The stress of being at the vets, as they admitted, raises the numbers.
But you are also looking at changing the food and that will also lower your numbers right away.
Looking back, you were on a very high carb dry food. When you take that away for a lower carb wet food, your cats
blood glucose will also go down because of that change. ( It can be as much as 100 less in your bg test)
Suddenly you are on too high of a dose which is dangerous for your cat.
Dr Lisa also addresses this . It's right there for you to show your vet.

So IF you change the food right away , you will want to start at a lower dose than 2 units.
You need time to make sure you have the testing under control. .5 units is safer for a newbie just starting out.
You said you were nervous and that's how we are were. It comes with practice and learning/research and just asking questions about any part of it. We have all been there. It can be a very emotional roller coaster.

To start on 1 unit but you have to be monitoring before shots and in the middle so you have some feedback to know if the dose is too much.You need several consecutive days to establish a baseline and let the insulin build it's shed ( if lantus is your insulin)
If you aren't monitoring inmediately, than .5 . But without monitoring, you are blind.

I don't know about the treats for ckd. I know moisture is a big issue for that.
There are some who add water to the canned food to get a little more moisture in their cat.
I hadn't heard about the fiber issue for a treat.
You need a treat to reward Buddy for cooperating when you test.
There aren't that many good choices that are low carb.
I'll be interested to see what the nutritionist recommends.
The freeze dried can be rehydrated. If your cat likes boiled chicken, there are some who use that as a treat.
I use the PureBites freeze dried shrimp but I put a couple of drops of water and rehydrate them. My cat loves them.

I would ask the nutritionist about a product called Fortiflora Feline.
http://www.healthypets.com/fortiflora30.html

It is a probiotic and Dr. Lisa talks about it in her article on diet. I would think this would be helpful for the fiber issue.

If you can manage to read thru the two links , Dr Lisa addressed all your concerns and gives you the ammo
to be able to talk about it all with your vet and nutritionist.
I can't say any of it as well as Dr. Lisa.

That list I gave you yesterday also has the phosphorus content on the lower carb food. I decided I wanted that info
on the list too. It's a good starting place and it is now updated with the lastest numbers.
http://www.felinediabetes.com/FDMB/viewtopic.php?f=28&t=76226

Dr. Lisa tells why she doesn't like the prescriptions foods.

So i would get to know those 2 articles.

And of course, www.felinediabetes.com
http://www.felinediabetes.com/bg-meter.htm walks you thru home testing and the sweet spot on your
cats ear.

It's great that Buddy finally gets to come home.
 
Thanks for the additional info, based on my visit i think we are going to start at 1 unit twice a day to begin with and see how it goes. That does make me feel a bit better. We will monitor as well. I will get to those links you sent. thanks again!
 
Hi Scott! It is amazing to me that (according to your vet) so many of her clients are choosing euthanasia for their diabetic cats over treatment. After you learn how to test (that was the learning curve for me) it is FAR, FAR EASIER to test and inject insulin than it is to give a cat a pill! I am not exaggerating. I complete the testing and injecting now in about 2 minutes flat.

In addition, considering that 25% of newly diagnosed cats can go into remission with a simple diet change; and up to 84% of the other newly diagnosed cats can go into remission by implementing the tight regulation protocol (according to the Rand study) it is remarkably sad that people are discarding these animals over a condition that is so treatable. Even the cats that never go into remission can live a normal life span with insulin that, again, takes about 2 minutes, twice a day.

This is in no way directed at you Scott, as you are taking the initiative to learn as much as you can and to treat Buddy; and in addition have been kind enough to have given this “dumpster-kitty” the opportunity for a long, happy life. Kudos to you.!

On to your questions:

Regarding the fluctuations in Buddy’s numbers while still at the vet, from 200-300 one day and up to 400’s the next – it can be several reasons. I am not the expert on this but will share my speculation. A) it could be the building stress of being at the vet for so long; each day Buddy is there, the stress level increases; or B) it could be that he is receiving TOO MUCH insulin. When the vet says, “we skipped a shot last night or yesterday because his number was somewhat low” and now Buddy is in the 400’s today – that could mean that the dose they are giving him is too high.

Here’s what happens: you inject a cat with, say 2 units of insulin. If too much, it sends the blood glucose very low (at or near hypo). Your vet said they skipped a shot because Buddy’s number was “somewhat low.” When the blood glucose gets too low, the cats body sometimes produces counter-regulatory hormones to bring the BG back up, and this can result in high numbers the next morning (like 400’s). If you inject the same 2 units the next morning, you continue this same roller coaster effect. I will ask the more experienced members of the board to verify that I am explaining this correctly, or provide greater detail.

On the Special Food: I would recommend you read Dr. Lisa Pierson’s excellent article about Feline Nutrition, the section on kidney disease. She does not recommend any cat with CKD be on dry food or the Hill’s prescription K/D. Read why here: http://www.catinfo.org/#Kidney_Failure

Scott, with all due respect, I do not feel the same level of confidence in your vet ‘s knowledge of these issues that you do, and with Buddy’s CKD complication it might benefit you both to seek a second opinion on the treatment plan. I mean no disrespect; but that is what I would do if Buddy were my cat.

The fact that your vet doesn’t actively advocate home testing is indicative of her level of knowledge about management of feline diabetes (“she said OK, but seemed concerned we may drive ourselves crazy.” Vets who are up on the current knowledge strongly advocate (almost demand) home testing - understanding that it is the cornerstone for effective diabetes management.

A new board member , Jane (PumaMum) is a good example. She joined 7/3, reporting that her vet said something similar: “This vet doesn't believe in home monitoring, when I asked about it he commented that it makes people manage their cats too closely.” Jane ignored this advice and began home testing anyway. In less than a month, her cat Puma is now “off the juice” (in remission, no longer receiving insulin). See Puma’s OTJ party on 8/1. I can’t tell you why so few vets are not more knowledgeable about the benefits of home testing – but having to educate your vet, or alternately, find a new vet is not uncommon among our members.

I too, wanted to trust my original vet. He seemed kind and was located close to my home; but as time progressed, it became clear to me that he was not up to date in his knowledge of feline nutrition or diabetes (and yes, he had a “nutritionist” on staff who routinely prescribed the Hills products). With the help of this board, I found a 2nd vet in my area, and although she is not at the level of Dr. Lisa Pierson, is more progressive and learned in these areas than my original vet.

If you have the financial resources to do so, I believe you can set up a paid phone appointment with Dr. Lisa Pierson herself (e-mail: drpierson@catinfo.org -- make sure you put in the subject line: "Requesting a phone*consultation appointment"). I do not know Dr. Pierson but have read all her publications, compared her recommendations to the two vets I have used in managing my cat’s feline diabetes, and believe her to be at the forefront of knowledge related to feline health overall – not just diabetes. With Buddy’s complication of CKD, I would want a specialist’s viewpoint of this – but again, that is just my opinion. There may be other specialists in your area with whom you can consult as well.

Best of luck to you! Please post again to let us know how you and Buddy are doing.

☺
 
I am also going to disagree with your vet on several points.

Diet--if you're not going to be able to get your cat's diabetes under control (and you won't with the high carb prescription kidney diets), then there is no point trying to treat the kidney disease because the cat will likely pass away from complications from uncontrolled diabetes long before early stage kidney disease. So at this stage in the game, the diabetes MUST be priority over the CKD in diet.

However, that's presuming that there aren't foods good for both conditions. In my previous post, I pointed out several that are good for both CKD and diabetes. So this isn't an either/or situation with the diet--it's a both/and.

Many vets still prescribe low protein diets for early stage CKD cats, and this is NOT a good thing for an early stage cat, even if diabetes wasn't in the picture. Low protein causes muscle wasting, and should NOT be fed long term to an early stage cat. It's only been shown to be beneficial (as opposed to a high quality protein, low phosphorus diet) at end stage kidney disease. Here is some information on the subject: http://www.felinecrf.org/nutritional_requirements.htm#what_is_protein.

When my Gabby was prescribed a low protein diet for her early stage kidney disease, I fed it to her for about a month. She was getting really weak and losing weight on it, plus it was a struggle to get her to eat it because she hated it. So I started doing my own research, which is when I read about the change in food recommendations for early stage cats because low protein will cause muscle wasting, which can be more detrimental to the cat's health than the CKD for an early stage cat. That's when we switched to a low phosphorus, high quality protein diet (canned, of course, because CKD cats need lots of moisture). In the 2 and a half years I had left with her, her CKD did not progress AT ALL (she passed away from cancer, unrelated to the CKD). This was confirmed by the vet with her bloodwork and a Urine Specific Gravity test that she had done right before she passed. Neither my old vet (that prescribed the low protein back in 2009) or my new vet recommends low protein diets for their early stage cats anymore, as they've both caught up on the research.

Home testing--Here are the American Animal Hospital Association diabetes guidelines: http://www.aahanet.org/PublicDocuments/AAHADiabetesGuidelines.pdf. I would print them out and give them to your vet. Note on p. 218 (4), where it states:
Home monitoring of BG is ideal and strongly encouraged to obtain the most accurate interpretation of glucose
relative to clinical signs.
Click to expand...
. I would also print out and give your vet this article: . It explains that the 84% remission rate with Lantus is ONLY associated with the dosing protocol outlined in the article (linked here: http://www.uq.edu.au/ccah/docs/diabetesinfo/link4.pdf), and dosing protocol can only be done if you're home testing at least three times a day.

Both the diabetes and the CKD can get under control, but only if you pursue the right treatment for both. Vets must be general practitioners for many different diseases for many different animals, so it's not likely they will be current or know every detail for treating every aspect of every disease, especially in cats (which usually take a back seat to dogs). I have a fantastic vet, but I've had to educate her about certain aspects of both diabetes and kidney disease because she just hadn't seen the current research. If I had trusted my vet implicitly without doing my own research, both my cats would have suffered under my vet's advice, with both the CKD and the Diabetes.

If you don't feel like arguing with your vet, bring the prescription low protein diet home and just don't feed it, then return the food to your vet for a refund and say your cat won't eat it. The kidney diet food tastes pretty awful to most cats, and on top of that CKD cats are notorious for being picky (which is why rule # 1 with a kidney disease is to feed the cat what it will eat), so it wouldn't even be unusual. Then just say if you're not feeding the prescription diet anyway, might as well try this OTHER approach with low carb, low phosphorus. Instant vet approval with no arguing.
 

Attachments

well said , Julia!

I couldn't address the ckd . We don't have that issue. But I think you said that so well this instance that I'm going
to print it and put it away in case I ever do have that issue. ( and our other cat in the house might have that)
 
Yikes, a couple more things I forgot to address--

2u is a high starting dose, not a reduced starting dose. The starting dose formula for cats on Lantus is .25u per kg of ideal weight. So unless you have a very large framed cat like a Maine Coon (and I'm not talking about an obese cat, because we are going by ideal weight), then 2u is way too much. The usual starting dose is .5u-1u, depending on the size and weight of the cat. Most cats on a low carb canned diet do not ever need much more than 1u of insulin, and many need even less than that. To give you an idea, my Bandit weighs 13 lbs, and the most Lantus he ever needed was 1.25u. You need to start under your cat's ideal dose and slowly work your way up in .25-.5u increments. It's better to have high numbers for a while than to drop too low for a second. The starting formula for Lantus is both in the article and the protocol I provided.

Are freeze dried meats a recommended treat for when administering tests and shots?
No, not with the CKD, maybe something high fiber, and there was another component I didn’t retain. She said she was also going to reach out to the nutritionalist and ask for advice on treats.
Click to expand...

Freeze dried chicken treats (100% chicken, no added ingredients) are not high in phosphorus and perfectly fine to feed. Just avoid the fish ones, which are high in phosphorus.

the doc is working with a pet nutritionalist and the initial plan is to treat the CKD via diet and treat the diabetes with insulin. If this doesn’t work and the diabetes cant be brought under control we will adjust the plan.
Click to expand...

I am sincerely doubting the cat credentials of this pet nutritionist, because the advice being given does not coincide with current feline diet recommendations for either disease. You don't feed a diabetic child potato chips for every meal and then try to compensate for the horrible diet with extra insulin. The diabetes is simply not going to get under good control that way, and there is no point subjecting the cat to weeks or months of uncontrolled BG for something that any decent pet nutritionist would know is pointless.

I am being very adamant about you getting on the right diet for both diseases from the start for two reasons--first, there is a window on remission, and the longer you wait to begin the correct treatment (low carb diet/lantus/regulation via home testing), the less your chances are of getting to remission, and that's not good for the cat. Second, at the same time your cat will be suffering from uncontrolled diabetes, he will also be slowly wasting away from the low protein diet. That's going to put you in a far worse position after you've waited a few months and watched things deteriorate.

You can also get a second opinion from a different nutritionist. I believe Dr. Pierson (a leading feline nutritionist) from www.catinfo.org does phone consults, I would send her an email and see if she would consult with your vet on the diet.
 
Hello,

I sent a note to Dr. Pierson asking for a phone consult, she already responded. Vet indicated one unit twice a day of Lantus, only if Buddy finishes a meal. He was is the 200s to 300s today and they were giving him 2 units. Since he got home he hasnt eaten a full meal, just nibbled a little, instead he groomed himself for a bit and wont seem to finish the food. So...trying to get him to eat so i can give him a shot.
 
So glad Buddy is home and glad to hear you are getting a 2nd opinion on the treatment plan. Don't know if your vet mentioned this, but the timing of the shots is important - they should be given 12 hours apart. So when you delay in the evening, that means you will have to delay tomorrow morning's shot as well (as the insulin lasts about 12 hours). Alternately, the more experienced members of this board may be able to advise you about giving a reduced dose if your time frame is compressed. Please keep posting to let us know how Buddy is getting along.

Melanie
 
He only ate a little bit of food. i took his first BG test (twice) and the results were 373 and 390. He is sleeping, i think he is really tired from the vet stay. So I shouldnt administer the shot, right?
 
Define a little bit.
1/4 - 1/3 of a can of fancy feast ( 3 oz can) is a meal portion for my cat. I do feed at least 4 times a day. (usually 6)

I bet he is glad to be home.
 
He is on Hills KD, I would estimate he ate maybe 1/8 (if even that) of a can a couple hours ago. The first test wasnt too bad, I think because he is to tired. I have to go to the vet tomorrow and get copies of the test results for the phone consultation.

Thanks again for all the help and advice, I am reading the last of these links in this thread.
 
So why did you go with the Hill's?
I don't want to make you feel harassed. It is your decision.
We all want Buddy to get better.
That's what this forum is for.

I find it hard to believe that Dr. Pierson would have thought that was the way to go. ( she's so good about getting right back to you)
She doesn't like Hill's at all. ( www.catinfo.org )
The k/d is 29% carbs, 200 phosphorus.
The k/d with chicken is 27% carbs and 183 phosphorus.

I bet the reason Buddy isn't eating much is he's not impressed.
I haven't heard of a cat yet who loves it.
 
Rhiannon: I think Scott is consulting with Dr. Pierson tomorrow, so the Hill's may be a recommendation from his current vet -- and may be something he is planning to discuss with Dr. Pierson tomorrow (?).

Scott: On the shot for tonight, I am sorry none of our more experienced members have gotten back to you yet on that, but it is getting pretty late (9:40 pm here on the East Coast) so if your current vet said not to shoot, then that is probably the best advice for tonight. You can start fresh in the am. I am anxious to hear his BG levels in the morning, after a night at home. Hoping they are considerably lower. PS: You have done a remarkable job educating yourself on this and getting up to speed. The fact that you got, not one but two, blood glucose tests within hours of getting Buddy home is VERY IMPRESSIVE. I know you are going to do really well with this, and I am sure Buddy is very appreciative.

Melanie
 
Hello, I dont have any other low phosphorus food, I looked for the Mericks Turkey yesterday but couldnt find it. I just checked thier website and the script that runs on the "where to buy" - "find a retailer" freezes my laptop (IT loads us down with security). I wasnt sure what to do when i confronted the vet about the hills and she seemed to defend the nutritionalists credentials and said this is what i needed...she also reccomended i could to a phone consult if i wanted to with another nutritionalist...so I am. I have not yet consulted with Dr Pierson so frankly i dont know what to do. I am reading her site and some of the other posts now. As soon as I get the test results from the vet tomorrow i will send them over to Dr Pierson. Dr Pierson said she would want to review all before she could accuratly perscribe the right food, which makes sense. She did say the Hills wasnt something she would feed.

I think Buddy is also happy to be home. It is a bit early to declare victory on testing, i suspect i only got the tests because he is exhausted. I dont have treats for him because i am terrified to give him anything since i dont know what he should be eating. He smells terribly as he peed himself at the vet and freaked out when they tried to bath him so i told them to leave him as is to avoid the stress. He growled at me quite a bit when i tried to wipe him down so I am going to let him marinate and groom himself.
 
Oh, and i think i missed the sweet spot on my first test and got the vien as what i would classify as more than enough blood came out (a couple large drops), seems the sweet spot is very thin. i hit him with the neosporin reccomended...somewhere i read in the last couple days. Goodnight, i will check him in the AM, hopefully he eats the Hills then.
 
And if anyone knows if we should leave him a little food out for overnight please let us know. Since he hasnt had insulin we were planning to leave nothing out so he can eat in the AM and get his shot.
 
iI would leave "some" out overnight because he will likely eat it in the middle of the night, with hours to spare.
He probably didn't eat much at the vet's since he was stressed.


You Are doing Great to have already gotten a few tests in.
:thumbup
I look forward to seeing the am number too. Sounds like he had frightful time with the vet.
Poor guy.

You know he's greatly relieved to be back in his own home with his family. cat_pet_icon







I looked up some comparables for you so you have more choices than just the cowboy cookout when you get to shop again.
You'll need a different pet store besides PetsMart. I'm sure they will sell these soon but they weren't there the last time
I went.
5% carb - Merrick Cowboy cookout - 203 phosphorus
1%carb - Merrick Before Grain 96% beef - 163 phosphorus
2%carb - Merrick Before Grain 96% turkey - 177 phosphorus
4% carb - Wellness turkey 201 phosphorus

The k/d is 29% carbs, 200 phosphorus.
The k/d with chicken is 27% carbs and 183 phosphorus
 
Ok. Don't forget to wait 12 hours before the next shot (every 12 hours), unless one of the more experienced members here advise otherwise. Have a nice evening.

:)
 
Will do, am calling the vet first thing in the AM also to get the test results. Thanks, goodnight.
 
Wellness Turkey is a good food for both CKD and diabetes, and you can get it at pretty much any pet store if you need a food right away. I'm partial to the Merrick's myself, so once you get to a computer that lets you do the store finder, definitely check it out. Many feed and farm stores carry it at a very reasonable price, and I believe PetCo also carries it but a bit expensive there (but still less than what you would pay for a prescription food from the vet).

Most important is that your cat eats right now, even if it's not the exact food you want. If he's not eating, give him whatever he will eat until you can find a food he likes and fits the diet recommendations. That may take some trial and error, so don't get discouraged and give him what he wants (canned preferably). There's a lot of options. As I mentioned, the kidney prescription diets don't taste good to cats, so if he's not eating it, just give him something low carb you can find in the meantime until you find a good food.

I am VERY glad you're consulting with Dr. Pierson, as she's helped a number of cats in this exact situation. You seem to have a good vet, so I think you're very close to getting things worked out between the two of them.

It may have gotten lost in the post earlier, but freeze dried chicken treats (100% chicken, no other ingredients) are lower in phosphorus and low carb. You can find them in the cat treat section at Petsmart (Beefeaters) or in the Dog section of other pet stores, just make sure it's 100% chicken.
 
409 - wont eat, didnt like this last test, and it continues to draw a lot of blood. Calling the vet to see when I should administer.
 
At this point, I would give him anything he will eat - even dry food, whatever he ate before. You can offer him food on your finger to see of that gets him started. Add water to the wet food and make it soupy. Add tuna juice or Parmesan cheese or freeze dried treats on top. You can syringe food by watering it down and using a needle less syringe, put small amounts in the corner of his mouth.

The combination of high numbers and not eating can be dangerous.
 
Don't (overly) panic about the 409. My cat was in the 400's for the first weeks treatment. As Julia mentioned, the important thing is to get Buddy to eat something, even if it's not the exact food he was prescribed; and he did eat last night (like 8 or 9 hours ago) so it's not like he has gone a long time without eating. I believe Dr. Pierson says this in her articles as well. If you can get him to eat some of the low carb canned, like the Wellness Turkey Julia mentions, his blood glucose will come down significantly on its own (just getting the dry food out of his system).

Also, with my cat, if I just leave the food out she will eat it eventually; though not necessarily on MY timetable. You didn't shoot last night until 11pm, so your next shot is not due until 11 am anyway. In addition, things are not going to go "perfectly" for you this week -- and that's ok. You may have some "fur shots" where the insulin doesn't go in (PS, if that happens, do NOT inject again - just wait till next shot time); you may not get a blood glucose reading you want, and Buddy's numbers may run high. Try not to panic about it; knowing it will all come together in time. I would also say that the times I have hit the vein and produced a lot of blood from NInja's ear, the test results from that blood seem to be higher than normal. We had a little bit of a discussion on that recently here on the Board; and some others commented on this too. Don't know if that holds true for your test on Buddy or not. But the important takeaway is, do not worry over one test or one shot. Dose adjustments (up or down) are made based on trends over a number of days -- so right now, your job is to collect data. Note in the spreadsheet any pertinent details (such as...what Buddy ate or didn't eat, his demeanor, big blood drop, etc.).

Speaking of spreadsheet, have you had a chance to do one yet? I know you've had PLENTY of time to get this done (LOL!!!!!!). Here is a link explaining how to start and post on the spreadsheet, and how to link it to your signature -- so that whenever you post about Buddy, the more experienced members of the board will be able to bring up Buddy's spreadsheet and give you recommendations based on the info you include there. The spreadsheet is pretty self explanatory. You start by recording your AMPS - which is your morning pre-shot blood glucose number. Then the next column says +1, followed by +2, and +3... all the way to +11. This simply means one hour after the injection (+1), two hours after the injection (+2) and so on. So if you gave Buddy his injection at 11pm last night and checked his BG level this morning at 8am, you would record the reading of 409 in the +9 column (because 8am is nine hours after you gave the injection).

Let us know if you have any questions or need help getting the spreadsheet set up. That spreadsheet is going to be critical to the management of Buddy's dose so would be good to get that up in the next day or so. Here's the link: http://www.felinediabetes.com/FDMB/view ... =6&t=18207

PS: I agree with Sue (above) saying that high numbers and not eating can be dangerous for your cat; but my point was that Charlie did eat last night around 11 pm, and just because he didn't eat at 8am this morning does not mean he will not eat at 11am when he gets a little hungrier --or when you give him something he likes better. If it goes on the rest of the day though (no eating all day) then like Sue says you might be more concerned. [More experienced members of the group: did I explain this correctly?]

Melanie
 
Thanks Rhiannon! Can you PM me and tell me what I am doing wrong (I just copied and pasted the address - so not sure why that is not working). :)
 
Melanie,

Whenever you include a link, you need to highlight it and go up and choose the URL button on the top of this box(in the line with Bold and underline...). That makes it a usable link.
 
He had close to half a can last night when i gave him the shot, he ate another 1/4 overnight. This AM when i called the vet she said to give him the shot due to the BG of 405. He nibbled on a little bit of food since then, maybe 1/8 can of Merricks BG Turkey. Buddy doesnt seem to like the freeze dried chicken treats. He also isnt allowing me to test him, will try again in a bit, he is sleeping non-stop. Working on the spreadsheet.
 
what was his favorite treat?

You may have gotten a flavor that he's not so interested in.
When I first found the purebites, i bought chicken and shrimp.
My cat is highly motivated for shrimp ( or crab legs).
She ate the chicken for a day and now she won't touch it.
But then I found turkey and that one she really likes.
I don't want to use shrimp all the time ( especially since Purebites shrimp comes from the Indian Ocean)

Some cats here like boiled chicken.
Buddy might like the parmesan cheese. That one seems to get lots of interest from cats.

You'll have to experiment to find the one that peaks his interest .
Because that treat will help motivate him to put up with the testing.

My cat still doesn't like the testing after 3 weeks but she wants her treat.
You may have to roll him in a blanket ( burrito style).
I had to do that at first but my cat quickly decided she'd rather cooperate and not be restrained.
So now the only restraining I have to do is hold her ear so she doesn't flick it before I get a reading.
 
I have hit him 5 times now with the lancet using the blood meter, didnt draw enough blood to test with, needless to say, he isnt happy. I was using the lancet by hand and completely peircing it last night, which is how i got too much blood. Any advice appreciated, i am trying to warm his ear with a washcloth...

**********Edit - 7th try did the trick, got the test. Will stop posting updates now that i have the spreadsheet going. I also bought the Pounce Tuna Flavored Moist treats...he seems to marginally still like those.
 
Yay! A spreadsheet.
Those are so helpful.
Already 100 less right in the nadir area, that's progress.
The number will go back up as you get closer to the next shot time.


Do be advised that the pounce treats are not low carb. So they are good for now but you do want to experiment with
finding something low carb as you get your bearings with all the new adjustments.
Tuna? so Buddy may be a seafood lover.
a bite of real human tuna might be his motivator. ( be sure and find a nice glass container with a tight lid so your fridge
doesn't start smelling like tuna)
I will have to go look up the phosphorus level for that but at least it is pure protein, no carbs.

Here are two other possibe treats he might like.
I found a freeze dried salmon- called Beefeaters by Nature's One Salmon treats.
http://beefeaters.com/products/item/freeze-dried-salmon-for-cats-7281
If you want me to find a store where you can order it online, tell me. I am The shopper.
The other one is Bonito flakes.
http://www.amazon.com/Japanese-Bonito-Flakes-3-52-Ounces/dp/B000UWE0AO/?tag=felinediabetesfdmb-20
this is the human version, cheaper than the one's packaged for cats.
This is great to crumble up on top of a food you want him to eat. like his canned food that he's not so keen on. ;-)
I put this on the raw food that I'm trying to get my cat to switch to.
 
vtshep1 said:
I have hit him 5 times now with the lancet using the blood meter, didnt draw enough blood to test with, needless to say, he isnt happy. I was using the lancet by hand and completely peircing it last night, which is how i got too much blood. Any advice appreciated, i am trying to warm his ear with a washcloth...
Click to expand...

Most people have trouble with testing at first. The good news is that Buddy's ears will "learn to bleed" in time - for me, that happened after about 3 weeks of poking. Not sure why, but once the ears are poked enough, they just start to bleed more readily. Some here have indicated that they grow additional capillaries (?). Not sure, but it does happen and you will be able to get blood easier at that time. Until then, the thing that helped me most was to remove the cap from the lancet pen so the lancet was exposed. That allowed me to aim the tip of the lancet more precisely, but still allowed me to use the pen for the spring action. If you do this, hold the tip of the lancet a short distance from the ear and fire. Early on, I sometimes pierced Ninja's ear - which is not the goal - but that is ok and there was no long term damage to Ninja's ears.

Also helpful to me was the massage technique. Once you KNOW you have pricked the ear in a good place, even if you don't see blood, put the lancet pen down and use both hands to massage the ear, bringing blood from the rest of the ear to the hole you just poked. The technique I use is this: Grasp the ear, placing your thumbs on each side of the hole (thumbnails facing up and thumbs pointing toward each other, maybe an inch apart). Index fingers are together behind the ear for support (fingernails facing out) - then using your thumbs, massage with both thumbs (outward in) toward the hole.

More often than not, a little bead of blood appears. You don't need much. If you can see it, it is probably enough (though this assumes you are using a meter like the Relion Micro that requires only a .3 blood drop). Make sure you angle your test strip toward the blood drop so that the strip just "kissing" the drop. It must be allowed to "sip" the blood in order to work. You cannot glob the blood on the end of the test strip, it must be allowed to sip (yes, I know that sounds gross...LOL!).

Also of help to me was using the cosmetic cotton rounds as backing while testing. They serve multiple purposes: 1) they keep you from sticking your own finger; 2) they absorb any excess blood and 3) if you fold them over Buddy's ear when you are finished...and press firmly for about 10 seconds or so, it stops any additional bleeding and also helps to prevent scabs (at least that has been my experience).

And as mentioned earlier, it is ESSENTIAL that you associate the testing with a treat of some kind -- the best treat in the world to Buddy -- something he only gets at testing time (typically food, but could be petting, brushing, catnip or whatever else that has historically floated Buddy's boat. This is the way you will get your cat to accept the testing. Mine was a NIGHTMARE but now purrs.

Does Buddy like any human food?

And finally, related to missing the sweet spot on Buddy's ear: What color is Buddy? If he is light in color, you might try marking the sweet spot on his ear with a Sharpie marker before poking. I know that sounds nuts, but this was suggested by another board member a couple of weeks ago. I found this article in the New York Times Health and Science section supporting the use of sharpie's over surgical pens. The article references a study done by infection control experts at the University of Alberta comparing the use of sharpies over surgical pens (Sharpies won). Here is the link if you want to read it yourself and I will copy some of the pertinent text below: http://well.blogs.nytimes.com/2008/10/2 ... a-sharpie/
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"In a controlled experiment, the tips of both kinds of pens were heavily contaminated with four types of bacteria that can cause surgical site infections, including two germ types that are resistant to antibiotics. The researchers recapped the markers and allowed them to sit for 24 hours. Surprisingly, the sterile, one-use marker was still contaminated. But the Sharpies were not. As it turns out, the ink used in a Sharpie pen has an alcohol base, making it an unexpected germ fighter. The researchers, who will present their findings at an infectious disease conference later this month, noted that they used an unusually large number of germs on the markers to conduct the experiment. That suggests that in the real world, a Sharpie would be highly effective in preventing the spread of germs even after multiple uses.

“We went much further than what would happen in real life,” said Dr. Sarah Forgie, associate professor in the department of pediatrics, in a press release. Dr. Forgie noted that the pen itself should be cleaned with an alcohol swab between patients, just as is done with stethoscopes. However, she said the marking tip does not pose a risk of bacterial transmission and doesn’t need to be discarded after each use, potentially saving thousands of dollars in annual hospital costs."
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Final tip about the sweet spot, aim high up on the ear, maybe 1/2 inch below the tip. I was aiming too low at first so once I adjusted I got more blood.
:)
 
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