Hello. My elderly cat got diagnosed

I feel terrible because I feel like the signs were there for a long time and we just didn't put 2 and 2 together.

In the summer we noticed we were filling the cat's water fountain a lot and it seemed like our older cat was constantly drinking. We felt that was a good thing, since our previous cat suffered from chronic dehydration. But it started to seem a bit abnormal.

Finally, we took him to the vet and now we're kicking ourselves because apparently that's a classic sign of diabetes. Sigh.

Anyway, a few thousand $ later and weekly vet blood tests and shockingly expensive food, insulin, needles, etc... we felt like we were at least doing the right thing with taking him to the vet.

But...

Then I start looking for food alternatives because a small bag is > $90 at the vet. That's when I come across https://catinfo.org/feline-diabetes/ and now I'm starting to panic that my vet is steering me in the wrong direction!?! Our cats were always on a wet/dry alternating diet (we were sure we were told that dry food was important for teeth and that wet should be more of a treat), but since going to the vet they've (both - they eat together) been on a fully dry "prescription" diet. The info on that site says that's the exact wrong thing to do!

I'm trying to digest all this info (pun seriously not intended). I'm not sure if I'm committing the feline equivalent of self-diagnising through webMD. Maybe my vet really DOES know best, but the info on that site sure rings true to me. It makes sense that a cat should have a high protein, low carb, high moisture diet. It makes sense that stress levels would make a vet-visit glucose reading barely reliable. It makes sense that we should be monitoring glucose at home and frequently rather than changing his diet and introducing insulin at levels that are only adjusted every 7-14 days.

But then if all that's true... it means my vet is either willing to sacrifice his patients' health for profit or is ignorant of his own craft... and I'm not sure which is worse.

I guess I'm here asking: Do I listen to the Internet, or to my vet? Ironically, I'm asking the Internet but I already know what my vet would say.

 

Hi and welcome to the forum.
Your instincts are correct. Unfortunately most vets do not know a lot about feline diabetes….they have many animals to look after and they all have different diseases and treatments. Vets also get their information about nutrition from the big cat food manufacturers so they are biased in what they recommend. A dry high carb diet is not good for any cat, especially a diabetic cat. That’s like feeding your diabetic child a diet of biscuits, ice cream and sweets.
With a diabetic cat you need

• A low carb wet diet that is 10% carbs or under. Most of us use around 4-7% carbs
• A suitable insulin such as Lantus or Prozinc which are long acting, more gentle insulins than the old insulins.
• We recommend hometesting the blood glucose with a human meter…it is not necessary to use a pet meter which is expensive to run and is no better. It will keep your kitty safe and you will know how the dose is working for your kitty. Only testing every so often will not tell you what is happening in between those times and an awful lot can happen in even a day.
  
• HELP US HELP YOU has information about the spreadsheet, signature and hypo box which you will need to be able to look after your beloved kitty properly

Can you tell us what insulin your kitty has been prescribed and the dose please?.
A word of warning though…don’t change the food you are feeding at the moment over to the low carb food until you are testing the blood glucose because a change over can drop the BGs by up to 100 points and we don’t want you to have a hypo on your hands.

We are happy to help you with setting up the spreadsheet, sorting out what food to buy, how to transition safely to a low carb diet, how to learn to home test and much more.

FOOD CHART have a look on this chart and choose foods that are under 10%.
You will also need some higher carb foods for that hypo box..information in the help us help you link.
This is an excellent site for diabetic cats…it has been around for more than 25 years and has very experienced people to help you.
Keep asking lots of questions.
Bron

 

Exactly what he said and welcome!

don’t worry, we’ve all been there where you are but now we are here and so are you

 

Hi there, I was in your shoes 1 year ago. It was a huge leap to trust some strangers on the internet over my vet, but I'm glad I did. My boy has been in remission six months now thanks to the FDMB, I owe a debt I can never truly repay, and so i try to pay it forward by sharing my story.

 

Very few cats are diabetic so it's not taught well in veterinary colleges, don't feel bad for not putting 2 and 2 together. For once Doctor Google is right, still not sure about bacon being good for you though.
When you listen here it's the collected wisdom of 28,976 members to date. There's no replacing the practical knowledge of someone who has lived it and not just memorized a textbook.

 

Ditto what everyone here has said. If it wasn't for the experienced members here giving me advice Tyler wouldn't be going on 2 years in remission coming up on 1-24-23 ( knick on wood )

 

Hey, thanks everyone for the supportive responses.

Ok, thanks. Is the list at https://catinfo.org/chart/index.php considered a good repository of information?

The little vial says Lantus 100

Yeah, that makes sense to me. I've not yet figured out how I know what to do once I get a reading, but I'm sure that information is there. The information that I was reading before coming here (https://catinfo.org/feline-diabetes/) says you use those readings to alter the dose... but surely I'm not left to just guess.

 

Duh... Ok, I just now realized "Food Chart" and "Help Us Help You" are links... thanks.

 

Just some feedback on that NEW? HOW YOU CAN HELP US HELP YOU! page... WAY too many acronyms! Considering that's for new folks, every single acronym on that page should be expanded, at least once.

For example, here's an exerpt:

Alright, I figured out pretty quick that BG = Blood Glucose, but even that should be written as "if the Blood Glucose (BG) level over..." and then later it can be referenced as BG. I have zero idea what TR and SLGS is.

Look at the section "Make sure your signature is up to date":

I mean... huh? And I'm a native English speaker! I feel for those that are struggling through this that also don't understand the colloquialisms being used (for example, "Other insulins mostly use 200 mg/dL (11 mmol/L) as the no shoot number for newbies", which is likely to mean absolutely nothing to a non-native English speaker).

Just feedback, really. This is incredibly important information, and it almost reads like it was specifically written to confuse.

 

Yes. Dr Lisa Pierson wrote the food lists we have here on the forum.

It sounds as if you were prescribed Lantus which Is an excellent t insulin for cats. What dose are you giving..?

OK thank you for your feedback. I wrote that information and will look at it again.

 

And please know that the information you provided is greatly appreciated! It just is obviously coming from a perspective of someone that already is familiar with the terminology, yet is intended for an audience that isn't. A few tweaks would make a big difference, I think.

Insulin dose: 2.5 "units". I'm not really sure what that equates to. It is 2.5 on the scale a 0.3mm syringe. We started at 0.5 then it was upped to 2.0 and yesterday to 2.5

 

When was your kitty diagnosed. A jump from 0.5 unit to 2 units and then 2.5 units is quite a jump.
We recommend increasing the dose in 0.25 unit increments so we don’t go past the best dose and it is safer for the cat.
An increase from 0.5 to 2 units is an increase of 300%. That is a huge jump in one go.
How did the vet arrive at that amount of insulin?
Did he do a curve at the vets. It is a well known fact that cats BGs are elevated at the vets due to stress.
I am concerned at the increase so quickly in dose.

 

Diagnosis was about 2.5 weeks ago. Changed to 2.0 after one week and then 2.5 the next week.

I share your concern! They even told us that the stress could be elevating it and it did give be pause (how can we make decisions based on known-bad data?)... but what we weren't aware of that too high of a dosage could be dangerous.

That's the main reason I'm trying to wrap my head around all this.

I really have no idea how they come up with the numbers.

 

https://felinediabetes.com/FDMB/threads/what-is-the-insulin-depot.150/

You can see why hometesting is so important. Cats don’t get stressed when tested at home and you will get a true reading at home of what the BGs are.
I can’t imagined why the vet felt the dose had to be increased so quickly. Did he give you any BG numbers at the time?
Lantus is a depot insulin and as such it takes a week in the beginning for the depot to fill and the true effect of the dose to be felt. After that you need to wait at least 3 days for the depot to refill once the dose is increased.
WHAT IS AN INSULIN DEPOT
Are you testing for ketones in the urine? If not I would recommend you buy a bottle of Ketostix from Walmart or a pharmacy and test the urine to see there are no ketones in the urine.
I would also reduce the dose of insulin back to 2 units until you are hometesting and can see the effect the dose is having on the BGs.
Make sure you also have your hypo kit set up incase you need it. Once a cat is showing signs of a hypo they are dangerously low. Once you are hometesting you will be able to avoid that by feeding and bringing the BGs back up to a safe level.
Are you giving snacks during the cycles and well as the two main meals?

 

In case you still need help figuring it out. Intersting, english is my second language and I don’t remember having any issues... TR and SLGS (start low, go slow) are the 2 dosing protocols we use here. I’m sure there’s a sticky note somewhere that explain each at length. LC means low carb wet food.

 

@Diane Tyler's Mom

Respectfully, its too much right now. I'm trying to still wrap my head around the basics and don't feel I have the capacity to setup a spreadsheet or learn what things like "Chushings" and "TR" and "IAA" mean. I'll get there

After the first test only, yes. Not after the subsequent ones. The first test showed 32.72 mmol/L. I understand that's not the preferred unit on this site, and I found a calculator that says to times by 18, so I suppose that would be 588.96, which seems absurdly high compared to what I'm seeing in, for example, Diane's spreadsheet. How could that be the case if he was only showing one symptom? Why would they start at just 0.5 units if the reading was that high? Can stress levels make THAT big of a difference?

Nope... wasn't even on my radar. Is that something I urgently have to get figured out too? Honestly, I can't even imagine HOW one collects a urine sample from a cat!

I actually just posted a related question.

Why wouldn't the vet have warned me about this?? I'll get on that.

A little bit. He's been habituated to begging for Temptations every time I open the pantry. I've been giving him a couple, maybe 2 times a day between meals. Is that a no-no?

 

Temptations are too high in carbs
As for treats for testing
You can give any freeze dried treats they are all low carb
Tap on this blue link and read post #64 the post numbers are to the right of each post and you can read about the freeze dried treats I listed

https://felinediabetes.com/FDMB/threads/new-to-this-i-need-advice.269452/#post-3007388

You can even give plain boiled chicken pieces

 

Some.people slide a - dedicated - soup ladle underneath. Others put saran wrap on top of the litter.

There are some other tips here:

Tips for Catching Urine

 

Or if you happen to be there when they go in the litter to pee. I would just stick the strip under Minnie when she was peeing and voila!

 

The helping us to help you post has some basic information that is important such as setting up your spreadsheet and signature. Not all of that information is critical as your getting started. Some of the references to what to put in your signature refer to high dose conditions that would not be diagnosed early in a diabetic cat's journey. We don't expect you to know everything. There is a glossary that's on the Health Links/FAQs page. FDMB has a huge repository of information. If we provided new members with every link, they'd be even more overwhelmed.

Some of the first several steps:

• We tend to stress getting started with home testing as a first step. This give you control over what's going on with your cat and how Cairo is responding to insulin. You will know if numbers are high or getting closer to normal or dangerously low.
• Your spreadsheet is the place to keep track of your test data. It will allow you to see trends. It also allows us to follow along with your cat's progress and offer suggestions.
• Getting your cat on a species appropriate, low carb diet. You've done great by finding Dr. Lisa's website. We are strong advocates of a low carb canned food diet. Vets tend to get limited training in nutrition when in school and the training they subsequently get is from the sales reps from the pet food companies. If you read the ingredients in the prescription diets, they food is not typically very appealing. The dry food diabetic diets are outrageously high in carbs. (Ask your vet for the carb content of the dry food he's selling you. I bet he doesn't know or has incorrect information!) You do not need to be spending money on prescription diets. Most of the cats here eat Fancy Feast or Friskies low carb pate style foods. The list from the Feline Nutrition website is a great guide to finding low carb (less than 10%) foods.
• Insulin is important. The insulins that are endorsed by the American Animal Hospital Assn for the treatment of feline diabetes are Lantus (glargine) or Prozinc. If you want a copy of their guidelines, they can be found on the Health Links/FAQs page that I linked above.

If you need more information about the insulin your vet has prescribed and dosing methods, this information can be found on the individual Insulin Support Group pages. It is helpful to have the information about what insulin you're using in your signature. From your spreadsheet, it looks like you're using Lantus. You may want to review the sticky notes at the top of the Lantus board for more insulin specific information.

The beginning of this process is utterly overwhelming. It doesn't matter if you are a veterinary or medical professional -- there have been members here with those backgrounds and they find that it's completely different when it's their cat. In a few weeks, it all becomes part of your routine and it becomes a great deal easier. In the mean time, please ask questions. We're here to help.

 

Hi people.

So an update (followed by a question): I couldn't test my cat's blood. I tried, and I tried and I tried and I only once ever got enough blood from his ears, and that's when I hit the vein. I've got > 1000 test strips here, 2x meters and nearly 1000 lancets lol... and they're destined to go unused.

I kept taking the cat in for weekly glucose curves. One time, about a month ago now, I have to wonder if the vet tech screwed up and overdosed him with insulin, because that was the first and only time that his blood sugar dropped dangerously low. They kept him all day on a glucose drip and we installed one of those $100 Freestyle Libre patches on him. I only got 2 days out of that thing, and then we found it on the floor the next morning with bite marks on it. While it was in though, his numbers were steady and good.

He's been off insulin since that vet visit a month ago. His curves since have all been fine. So the vet says it appears to be managed on diet alone.

Speaking of diet: As I said in my original post, they sold us the really expensive kibble and then I learned here that wet food was better, so I've switched him to 100% wet food.

He does seem hungry pretty much all the time. I'm not sure if we're under-feeding him (I don't think so) or if he's just complaining because he used to have access whenever he wanted it.

Ok, so here's my question: I realize it is maybe too soon to tell, but assuming he's in remission on diet alone, what do we do about teeth? I've always heard (even today at the pet food store) that dry food should be their primary diet for teeth and wet food only used as a treat. OK, that's misinformation, clearly... but there's got to be some truth to it. Should he be 100% wet food, or should we maybe give him kibble once per week or something?

Thank.


oh, ps... he's going to the bathroom WAY less. I take that as a good sign.

 

You need to keep him on a low carb wet diet for life. If you go down the track of high carb dry food his Bgs will go up again. He is not cured of diabetes, he is just diet controlled
If you live in the US there are a couple of lows carb dry foods you can get. They are Young again zero carb (5%) and Dr Elseys clean protein.
You can also get Ziwi peak freeze dried food which is a raw food and most cats love it.
And Stella and Chewys freeze dried raw.
I would be checking that the Bgs are in fact low enough for him to be in remission. If they are above normal and he’s not getting the insulin he needs, you are going to run into problems.
I would recommend you test weekly for ketones in the urine. You do this will a bottle of ketosteix which you can buy from any pharmacy or Walmarts.
If he is in fact in remission , you will need to monitor the BGs every month moving forward to see that the Bg are not rising.

 

Yeah, I get that... I'm committed to the high quality wet food diet and we'll continue to get his blood tested.

Primarily I was asking about teeth. But Google gave me that answer (if this source is to be believed):

 

It is a myth that dry food is better for cats teeth…peddled by the big cat food manufacturers no doubt. If you ever see a cat vomit after he has eaten dry food you will see they don’t chew it but simply swallow it.

 

Hi again bcsteeve, I am very glad to see you back here, and so sorry the testing has been unsuccessful. I was truly concerned for you when you posted "I give up" and then you went quiet. If Cairo is off insulin and diet is working, then that is just truly wonderful.
As Bron says, without the odd test it is truly hard to say that he is diet controlled remission. Any chance to try again to get a test??? Or if you have recently? (outside the vets office) .

I will need to look for the vet association approved site I visited with this info, (when i find it I will link it here) but in a nutshell it made sense. As Bron mentioned, kitties tend to swallow most cat food whole (kibble included) and you can see this when you watch them eat. They grab it with front teeth and then swallow. The site explains it like this: watch a cat (for comparison) eat a mouse or bird. They will latch on, bite, turn their head and chew with their molars and this motion is very different from kibble. Offering a bit larger (not so bitesized pieces) of a muscle meat (such as chicken thighs, or gizzards) that they actually have to shred and tear up in order to eat, using their molars, will go a long way to helping dental health and keep teeth cleaner than kibble.
I do hope you stick around, there is so much combined knowledge here. And we are all looking out for eachother's best interests.