HELP - NEWLY DIAGNOSED WITH MORE VET INFO

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hugglynn

Member Since 2013
I am hoping I can get more info from the experienced folks here as I just finally spoke to the Vet regarding 15YO Marvin.

First, I am a little disappointed that he has been at the vet for almost 24 hours and they told me yesterday he has a UTI, yet he was not treated yet! I did tell them what and how to administer treatment (one time shot vs. oral) at the end of the conversation.

But I did start out with the vet asking if I could start a more "conservative" approach with him, i.e., through diet, as opposed to beginning insulin immediately, i.e., on a low carb diet. I felt like I got a "deer in the headlights" reaction because they didn't respond at all to anything concerning a low carb diet other than to say she wants to do both--low carb diet & inuslin. I asked her how she knows what to give him if she is changing his diet and she said it is based on what has worked for other cats. It is going to be very difficult for me to monitor as I go back to work tomorrow after summer hiatus. I don't feel comfortable feeding my newly diagnosed cat in the morning, giving him an insulin shot and then going off to work. Basically, their recommendation is not in alignment with my conservative approach through diet first. His urine was 1000 for glucose and blood was 493. He is not in ketoacidosis. I told the vet what I was thinking was trying a low carbohydrate diet first and to see in a couple of days if this brought his levels down and I acknowledged that I realize this is not what she is recommending. I also asked her about home testing and she said "you can do that if you want and could get your own meter or chips that go into the litter box to test the urine." But basically they are recommending .5 units (didn't get the brand) 2 x per day with testing after a week and she also mentioned holding him for a day to do a glucose curve by letting him eat what he normally would during a day and testing him every two hours.

I do need to make a decision today as to whether I am going to start insulin or try diet alone first (and against vet recommendation)). They are also pushing their "presciprtion diet" that is either dry or wet (and didn't get that brand either, but probably Royal Canin). Any help would be so so much appreciated as I still feel kind of dazed and confused.
Thank you in advance
Lynn & Marvin
 
The insulin dose is conservative, so should be safe if switching to a low carb diet. That glucose level is very high and could be damaging internal organs; you need to start insulin now. Good options are Lantus, Levemir, or ProZinc. Do not accept humulin or Vetsulin/Caninsulin; they do not last long enough.

Low carbohydrate canned or raw food may be purchased over the counter and it will work just fine. Friskies pates, for example, are a low cost, low calories from carbohydrates option many of us use. For more info, go to Cat Info and share that with the vet.

Home glucose testing will help keep your cat safe. All you need is a decent human glucometer, test strips for the glucometer, and 27-28 gauge lancets to do the pricking for a sample of blood. The Arkray USA Glucocare 01 or 01 mini, available from our shopping partner ADW (link at top of page) works pretty well, only uses a tiny drop of blood, and best of all, is inexpensive for both the meter and the test strips. A branded version of this may be purchased from WalMart as the ReliOn Confirm or Confirm Micro. They're a shopping partner too, with a link at the top of the page, if you prefer to order online.

We don't recommend the AlphaTrak meters, for although they are pet specific, they and their test strips are very pricey, and you can't get test strips in the middle of the night, the way you can with retail meters.
 
I was thinking that's a good starting dose even with the diet change. Just because there are no ketones now doesn't mean that can't change.

Royal Canin isn't low carb. I personally would stay away from the prescription foods, they aren't very good quality food. And I especially don't favor anything a vet is selling.
here is the food list we all use.... dr lisa's food list
I also have my own shortcut shopping list taken from Dr. Lisa's list. I have all the 8% or lower carbs on it.
 
Thank you both. On the insulin brands, should I be calling pharmacies to check for those brands or are there national chains known to have them?
Lynn
 
Lantus and Levemir are human insulins you get at any pharmacy. They are U-100 insulins with 100 units of insulin in 1 mL. We recommend getting the insulin pens as they can be used completely before the insulin wimps out in most cases (the package says 1 month; we've had folks use them up to 6 months when kept in a refrigerator). The vial is 10 mL; each pen is 3 mL. You use a syringe to withdraw the insulin from both.
There is a savings card for Lantus pens at http://www.lantus.com,. Ask the vet to write for the pen, as dispense 1, refills 4. They come in 5 packs; talk about sticker shock!

ProZinc is available through vet offices of veterinary pharmacies with prescriptions. It is a U-40 insulin with 40 units per mL
 
hugglynn said:
And also, how do you tactfully tell the vet "no" to their prescription diet recommendation?
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You say only if the vet is going to pay for it, ie, its not in your budget. And you refer the vet to Cat Info for the food list to show that you can get low carb, over the counter foods yourself.
 
Lantus and Levimer are human insulins, so any pharmacy should carry them.

If you go with Lantus, ask the vet to write a scrip for Lantus Solostar pens. Then you can use the coupons to purchase the pens for $25 each. It comes in a box of 5 pens. Some pharmacies may sell one pen at a time. You will need to ask.


Here is the link to sign up and get the card:

http://www.lantus.com/sign-up/offers.as ... 4-58228089



In addition, ask the vet to write a scrip for the syringes you will need to go with the pens.

You need U-100 insulin syringes (comes with an orange cap), and get 0.3 cc (with 1/2 unit markings) it will make it easier to dose 0.5 units.

Also, you have a choice of long or short needles. My preference is short needle since it's tiny and less to insert into cat. There is no right or wrong to needle length, rather it's just personal preference, don't let anyone tell you that you must get one vs. the other.

If you go with short length, then the scrip should read

Box of U- 100 syringes (you get 100 in a box - at Walmart it's $13)
0.3 cc
31 gauge x 5/16" length

The gauge is important as this will be a very thin needle, so the cat won't feel it. The higher the gauge number the thinner the needle. 30 or 31 gauge are perfect for insulin syringes.
 
My goodness you folks are amazing and a wealth of information. I am pretty much near the point of tears, for my kitty and wondering how I am going to handle it all, and what I am going to do when we need to be away for an evening or early morning.
I did get the part and printing out all of the information about syringes, needles, etc. I haven't discussed brand with them, I suppose I need to call and ask about that next.
Thank you so much, again!
Lynn & Marv
 
I'd ask for Lantus. There is a tight regulation protocol which gets cats diet controlled about 80% of the time.

edited to add: There also is a Start Low Go Slow protocol for those who may not be able to test as much as tight regulation requires.

2010 AAHA Guidelines This is a useful, contemporary guide for vets treating feline diabetes.
 
Lynn honey, dry those tears. With all our great help there is no need for tears. We'll help you every step of the way.

We'll help you know when it is safe to shoot and leave to go for work.
We'll help you learn what you need to do to keep Marvin safe.
We'll help you with testing tips.
We'll help you with eating tips when your cat Marvin's appetite is low.
We'll reassure you that you can do this.
We'll remind you to take care of yourself.
We'll make suggestions of a routine to help Marvin.
We'll help to support you emotioanlly through this new sugardance you are doing with Marvin.

It will be ok. We have all been where you are now. You can do it.

I second the request for Lantus. Better remission rate, diet controlled diabetic, with the Lantus.

My foster cat Wink is a diet controlled diabetic. He has been off the insulin, OTJ, since March so almost 5 months now.

Here is a link to your first post here. http://www.felinediabetes.com/FDMB/viewtopic.php?f=28&t=102229
 
hugglynn said:
And also, how do you tactfully tell the vet "no" to their prescription diet recommendation?
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You can claim it's too expensive or, if you want to be a bit more subtle, you can buy it, use a can or two, and return it later, saying the cat doesn't like it. There is a 100% guarantee on all the prescription foods (Hills, Purina, and Royal Canin, which doesn't have a link on their website that I can find, but I do know they have a 100% satisfaction guarantee).

BJM said:
I'd ask for Lantus. There is a tight regulation protocol which gets cats diet controlled about 80% of the time.

AAHA Guodelines
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I third this. ProZinc is good, but Lantus is better (and yes, I'm totally biased :lol: ). It'll also be cheaper for you in the long run.
 
I do have another question, I mentioned Lantus to the vet tech and while she's heard of it, I don't think they have it, they said ProZinc is made for cats? So suspecting they start with ProZinc, can I switch to Lantus after ProZinc is given?? I would love to get him diet controlled, so far Marvin didn't exhibit any ill health other than urinating more and drinking more. He was still acting normally otherwise, doing the active (and non-active) things he did during the day. The tech mentioned he could lose a couple pounds, I personally didn't think he was that heavy--the vet told me not too long ago that he was just a big cat and she didn't consider him overweight. In a twist of good news, I have been in touch with a pharmacist friend and she is going to get me prices on all of the meds and she told me she can get me all the supplies--noting she has good connections, so hopefully that will mean meds/supplies at a reduced cost. I did inform the vet that with the cost of the insulin I would not be able to do the prescription diet and have already picked up some Fancy Feast classics and Friskies pates...just a few of each to see what he likes. I feel really badly for feeding him dry food all these years, I never really knew about the differences with canned, live and learn :-( My rescue did at least live a pretty good 15 years, rescued as almost an adult he might have had another fate.....
Lynn
 
Lantus is a human insulin so you would get it from a pharmacy with a prescription from the vet. The link to the AAHA diabetes guidelines mentions Lantus (glargine) as the optimal choice so I would print that out and take it to the vet and ask if you could be the vet's "guinea pig" on trying out the Lantus first. I suspect that it might even convince the vet to start prescribing Lantus for more cats. :-D
 
hugglynn said:
...I feel really badly for feeding him dry food all these years, I never really knew about the differences with canned, live and learn :-( ...
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My Emmy made it to at least 19 years old on a diet of mostly dry and wet; renal disease took her after I-131 treatment for hyperthyroidism slowed the renal function. The hyper-T had compensated some for the renal impairment.
(Spitzer came after her)
 
Hello, one more question about the insulins. I see in the AAHA paper two types of insulin mentioned (bottom of 1st column 4th page) that it recommend glargine (which is Lantus..correct). It also mentions & recommends PZI (human protamine zinc) and porcine zinc. Is PZI the compounded insulin and porcine zinc ProZinc? Which is which, I am confused.
Lynn
 
In the US, you can get ProZinc fairly easily with an Rx, from your vet or an online vet pharmacy. It is a U-40 insulin - 40 units of insulin in 1 mL, the syringes don't have half unit markings, and you have to purchase syringes online or from your vet. They won't likely have them locally.

PZI was available from BCCP; it may be a bit harder to get - more hoop jumping - and is not available from online pet pharmacies. Despite their claim, it does not last 24 hours in a cat; more like 10-12. ALso it is compounded and I have heard from a vet that compounding may result in variable concentrations from batch to batch.
 
hugglynn said:
Hello, one more question about the insulins. I see in the AAHA paper two types of insulin mentioned (bottom of 1st column 4th page) that it recommend glargine (which is Lantus..correct). It also mentions & recommends PZI (human protamine zinc) and porcine zinc. Is PZI the compounded insulin and porcine zinc ProZinc? Which is which, I am confused.
Lynn
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Yep, Lantus is the brand name for glargine.

Porcine (pig) Zinc is different from PZI/ProZinc (confusing, I know). The "street labels" for Porcine Zinc are Vetsulin, Humulin, Novolin, and Caninsulin. These are NOT recommended for cats, except in extenuating circumstances and extreme cases. PZI is the original version of Protamine Zinc and is usually bovine (cow) based. I believe this is still sold only in compound pharmacies in certain countries (UK, mainly). ProZinc, on the other hand, is a genetically-modified human insulin version of Protamine Zinc created specifically for cats and is (usually) available throughout the US.
 
Hey HUGGLYNN, I had THREE vets my 3rd is fantastic, the other two nearly killed my cat, i am not kidding or exaggerating for storytelling purposes. trust your instincts and the great people on this site :)
my first Dr ACTUALLY told me she refused to treat my cats because I didn't agree with anything she said. She didn't even believe he was diabetic until I did research found out about the Fructosamine test and INSISTED it get done. I had even gone as far as to buy a glucometer and show her the 380 readings, which she just attributed to stress and "it's a people glucometer"
after the fructosamine showed he was indeed diabetic, I had already made an appt somewhere else, she called to tell me the "surprising and unfortunate" news (like I'd been telling her for months and thousands of dollars of other unnecessary tests later, she even wanted me to get an MRI on my cat, HAHAHA). she tried to get me come back in and i politely told her my husband in a panic had taken him to another Vet (true actually), she politley said ok, then mailed me a letter saying she wouldn't treat my cats again. i laughed so hard i almost peed my pants.
the icing: she is a cat doctor, cat only place. i could literally write a 10 page story about the first two Dr's.
my new young Dr. is open to looking things up, sending me info, looking at forums even, I love her so much. it took time but don't keep a vet IF you end up uncomfortable or you feel pushed into a prescription diet (which did nothing but RAISE my cats blood sugar )
 
Did you pick up a home test kit? Heres a shopping list:
1. Meter ie Walmart Relion Confirm or Micro.
2. Matching strips
3. Lancets - little sticks to poke the ear to get blood . new members usually start with a larger gauge lancet such as 28g or 29g until the ear learns to bleed. Optional - lancing tool.
4. Cotton balls to stem the blood
5. Neosporin or Polysporin ointment with pain relief to heal the wound
6. Mini flashlight (optional) - useful to help see the ear veins in dark cats, and to press against
7. Ketone urine test strips ie ketodiastix - Important to check ketones when blood is high
8. Sharps container - to dispose of waste syringes and lancets.
9. Treats for the cat - like freeze dried chicken
10. Karo syrup/corn syrup or honey if you dont have it at home - for hypo emergencies to bring blood sugar up fast
11. A couple of cans of fancy feast gravy lovers or other high carb gravy food- for hypo emergencies to bring blood sugar up fast
 
Hi Lynn,

Would you be willing to put some info in your signature? It would help us to help you better. See my signature at the bottom of my post for helpful info to have in your signature.
 
I would check with your local jurisdiction as to whether you need a sharps container. Not everywhere requires them. Where I live my county says put sharps in a clear platic containter like a liter bottle, tape it close and write sharps or needles all over the outside I can place in regular garbage pick up :) I do own sharps container...but I Never use it :) I bought mine online.
 
Here is a fantastically cheesy guide I use for my own at home needle disposal. :-D

I even take it a step further and re-cap and remove the needles from the syringes (they easily twist off), tossing the syringe in the trash and the needle in my home-made Sharps container. I've been giving Michelangelo shots since last October and I have barely filled the bottom of a detergent container with just the needle caps. I'm not sure how common this method is around here but I first learned of it a while ago from a diabetic friend and then again when my own doctor showed me when I started having to give myself weekly injections a few years back.
 
Thanks for inquiring about Marvin. This has been a horribly busy two weeks, first with Marvin and the same day we got Marvin diagnosed our oldest Golden (we have two) went in for grooming and suffered what we found was a bad clipper burn to him bum/scrotum area and it literally took two of us to doctor and tend to him for over 7 days. We were on stress overdrive just as I returned to work after summer break! Now we are really concerned because the Golden, Bailey, now is drinking and urinating a lot (just like Marvin did) the past 2-3 days. I am hoping it is from his pain med & antibiotics and not something more serious. When you have animals it doesn't seem to end!! So we will probably have Bailey checked tomorrow.
Because of what happened with Bailey, I need to get Marvin in for a recheck of his glucose, however, he is on .5 of ProZinc 2x daily, adapted really well to Fancy Feast classics except he is screaming like mad a lot when he gets hungry and I feel badly :-( I have a friend who got me a glucometer and test strips for free, so I hope to get the testing initiated soon. I sometimes have trouble because of the low dose seeing if it is in the syringe or feeling like it went in him. His drinking and urinating reduced tremendously though.
I will keep updated on the progress. Thank you again everyone for the help. Someone requested I add info to my signature and I just haven't had a chance yet.
 
Until he is regulated he will be much hungrier. You may feed up to 50% more to help with that, as well as spreading the food out into several meals or freezing some to thaw and be nibbled more gradually.
 
I am actually spreading it out mostly because I know he was a grazer before. He eats a little, walks away, comes back in 10-15 minutes, or longer, and doesn't consume large quantities at one time. I even have to plan for that in the morning when we get up. I am sure every animal is different so we have to adjust to their habits a little,too. But when he is hungry, I go by how much he ate when I initially fed him and do give him more. I am sure he is probably doing a little carb craving, too, due to the food change.
Thanks for the info on the testing.
Lynn
 
How are things going? You can add water to the food to keep it from drying out and it lets you leave it out longer (I leave mine out for up to 12 hours before replenishing/refreshing).
 
When you say "leave it out" are you leaving it out for your kitty to consume or leaving it out at room temperature?
Lynn
 
I feed them fresh food about 3 times a day: once in the AM, once in the PM, and once before bed. I sometimes might feed them halfway between their AM and PM feedings if they're particularly hungry and finish their AM food early. Basically, whatever they don't eat at "mealtime," I leave in their bowls till their next feeding for them to graze on. They'll usually lick the bowls clean by the next feeding, but if they don't eat it all, I'll either mix in some fresh food or dump the leftovers if it's dried out too much.
 
I don't mix old food with new food to avoid the possibility of bacterial buildup and food-born illness.

(I couldn't afford the vet bills for that with 14 cats in the house!!!)
 
BJM said:
I don't mix old food with new food to avoid the possibility of bacterial buildup and food-born illness.

(I couldn't afford the vet bills for that with 14 cats in the house!!!)
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Yes! And this does depend on where you live. If the weather allows for it, you can leave it out much longer. These last few days, it's been a lot hotter so I haven't been re-mixing food.
 
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