? I seem to have no idea what I am doing or where to start

[UKGinger]

Hi, I am working through the useful information here but since Big Fella was diagnosed my brain has given up. I am being told so many different and conflicting things and need to get organised, but not getting it right.

He came to live with us in June after I had managed to get his owner to finally take him to their vet. It dragged on and his fast breathing was diagnosed as asthma, I am sure it was not, but as a result he was put on steroids etc. He was also found to have thickened intestines. His insurance ran out and his owner didn't want to pay because 'he is an old cat anyway' so he is now ours, he is about 13. I changed vet once I was under no obligation to his original one and he was diagnosed correctly, steroids stopped.

I have no figures however I know his BG is high, and is currently on 2 units of caninsulin x2 daily. It has been difficult getting it into him as he is now suspicious and tries to get away, resulting in bent needles (vetpen).He started on 1 unit x2, so I am assuming it will be increased again as I have noticed he is peeing quite often, there are regular sized clumps in the litter but sometimes hourly. He has a drinking fountain.

I have been told not to change his food, unfortunately he is not on the best diet, and doesn't like good stuff. I feed wet, apart from a little treat if necessary but he loves gravy. He had almost stopped eating before he was diagnosed but was being fed little and often which of course he is now used to but as he licks the gravy off I leave the food down and mostly he will eat it. He eats more at night.

He is on Vit B injections weekly and is due for the third one this week, was on lactulose but it seems to cause as much discomfort as not getting it, so need to find an alternative.

He is an indoor cat now, he is also sleeping most of the time, especially after the insulin and is lethargic and sometimes just sits and looks spaced out. Does this mean he needs to see the vet before his weekly check?

At the moment I just need to know where to start, an idiots guide would be great and as simple as possible because I am finding this really hard. Advice on feeding times especially.

 

[CandyH & Catcat]

a couple of comments, others who are more experienced will chime in

rather than using a vetpen, I'l encourage you to use a regular syringe, since you can set up fractional doses that way, over the years people here have found it is much better to increase or decrease by quarter of units rather than whole units .. it may also be easier to inject Big Fella

some cats who prefer gravy over pate, will do okay if you add water to the canned food, or broth made without spices or vegetables at all -- especially if you stew the chicken yourself at home and use that

I'd encourage you to go buy some ketone testing strips (Ketostix or the equivalent) since there is always a possibility of ketones forming when there's not enough insulin in his system, not enough food, and a possibility of inflammation or infection

you'd be wise to go purchase a glucometer -- those targeted for humans are fine, most of the protocols we have developed here, have been done using them; if economy is a consideration, the ReliOn meters sold at Walmart are fine, and the test strips for them are among the least expensive

testing is CRUCIAL to working towards relieving his symptoms and moving him towards regulation at least --

I'll leave dosing advice to the "experts" here, though I have a feeling that you might be using a higher dose than he actually needs

welcome !

 

[Idjit's mom]

Oh, Ginger, how I wish there was an "Idiot's Guide to Feline Diabetes", but as there isn't, you have found the best place to be to learn about the condition, how to provide effective diabetic treatment for Big Fella and hopefully kick start your brain again and keep your sanity.

I can attest to the board helping keep my sanity and bringing me off the ledge of utter panic and despair when Idjit was diagnosed. This board is not only a library of applicable information, it's also a world wide support group. We all share a strong love for our kitties, we are all dealing with feline diabetes and we share everything we can to help each other out.

You have already begun down the path of what steps to take next. I read your Introduction post:
http://www.felinediabetes.com/FDMB/...nd-intestinal-thickening.219629/#post-2448409
and the responses from fellow UKers Elizabeth and Bertie, and Diana&Tom. Those two members are knowledgeable and experienced, dependable and inordinately kind and helpful.
So, they can provide info on food, supplies etc that we here in the US do not know about as well.

I'm sorry Big Fella is objecting to the insulin injections, but hopefully with some practice on your part and patience on his, this can be resolved in time. You may just need to alter the injection site and/or the needle gauge to make it more comfortable for him. It also may be the insulin itself, there are alternatives to the insulin you are using and that can be explored.
We encourage members to use syringes instead of the pen needles as you can angle the needle tip for a more comfortable injection and be able to reduce or increase a dose by finer increments than one unit at a time. You use the pen as a mini vial and there are videos here that show you how to do that.

I am an older, stiffer, and rounder version of a very fine woman (ahem) and found that I needed to give Idjit his injection in a creative way. My husband holds him when we test (he's a big strong boy and I only have two arms and hands). When that was over, I fixed the syringe, fixed the food and we adjourned to the bedroom, where I had laid a towel on the bed. I put the food on the towel, Idjit plowed in and I was able to inject him in comfort. He never seemed to notice the injection.

I am searching for other information on injection techniques here on the board, and of course, when I am looking for it I can't locate. But I will, because not everyone uses the "tenting" technique, but rather a "wrist roll" technique that works better for them.

Ginger, you are going to get response, you are going to get links, suggestions, descriptions of what worked, what didn't etc. The important things you are going to hear is: low carb wet diet (that is a process in itself) home testing ( which is going to let you know how the insulin is working and help prevent a hypoglycemic event), and the insulin therapy. Just three basic components of effective diabetic treatment for any human, cat, dog etc.

It's a lot of info to tackle at first, but take it step by step, and always ask questions, we even allow a certain amount of whining and breast beating because sometimes it really is just too much! Along with the info you will get, you will also get a lot of love, understanding and empathy. We all stood in your shoes at one time or another.

 

[Chris & China (GA)]

If you're having trouble with using the "tent" method, have you tried the "wrist roll" method?

You grab some fur between your thumb and forefinger and then "roll" your wrist to gently pull the skin....where the fur "breaks", you shoot.

It's kind of hard to describe, but here's a picture that should help give you the general idea.

 

[MrWorfMen's Mom]

Deep breathes. This is overwhelming at first but shortly it will all become routine.

A couple of things stick out for me.

The first is that it appears your vet may have increased Big Fella's dose by a full unit (from 1 to 2u) in one go. We recommend making dose changes in 0.25u increments which if you are using the Vetpen is not possible. I believe however that it is possible to do 0.5u increments with the Vetpen. We recommend getting syringes with half unit markings and using those instead of the Vetpen but in the meantime, you should have the ability to back the dose up to 1.5u.

The second thing I notice is you have not mentioned home testing and I won't be the least bit surprised if this is something your vet didn't even mention. Home testing is the only way to really know what is going on with Big Fella and ensure that you are dosing according to BG levels in his normal environment. BG tests taken at the vet are notoriously elevated in most cats and sometimes by substantial amounts (5 to as much as 11 mmol) which leads the vet to think kitty needs much more insulin than they do. Not only does this make the cat feel poorly but it can be dangerous and cause BG to drop too low.

I would strongly suggest you get a human glucometer that takes a small sample of blood and start testing Big Fella at home. We can help you learn how and it will keep Big Fella safe, get him feeling better and give you peace of mind.

On the food front, there is a UK food list HERE. This document has lots of useful info for our UK members but you'll have to scroll down to get to the food list. You'll find info re: syringes in the document too.

 

[Red & Rover (GA)]

Welcome from a Canadian ginger human. And thank you for rescuing such a lovely cat. Rover came to me in a similar way. His owners thought 10 years was a good enough life for a cat.

The Beginner's Guide to Caninsulin. http://www.felinediabetes.com/FDMB/threads/beginners-guide-to-caninsulin-vetsulin.186099/

UK information: Food, insulin, and other need to know stuff: http://www.felinediabetes.com/FDMB/threads/beginners-guide-to-caninsulin-vetsulin.186099/

Tagging @Elizabeth and Bertie and @Diana&Tom for you. Both in the UK.

Feline diabetes is a steep learning curve. We've all been at the beginning and have been overwhelmed. Ask any question. Mostly likely, there is an answer.

 

[Idjit's mom]

If you're having trouble with using the "tent" method, have you tried the "wrist roll" method?

You grab some fur between your thumb and forefinger and then "roll" your wrist to gently pull the skin....where the fur "breaks", you shoot.

It's kind of hard to describe, but here's a picture that should help give you the general idea.
View attachment 47990

Bless your heart Chris, I know the description is here but I just can't find it. Thank you so much.

 

[CandyH & Catcat]

I've tented and wristrolled, both work, what I've found is that Catcat doesn't mind the injection, it's the messing with his fur that gets a growl out of him

if I pet him and ruffle his fur back and forth, then grab fur and inject, then ruffled the fur once more, I get less reaction -- I often shoot while he's in the process of eating and more often than not, he doesn't even notice

 

[UKGinger]

Thank you all so much, I will refer back to the posts and read them properly when (if) I ever get enough sleep and can feel less stressed. When I see him so sleepy and weak looking I wonder if I did the right thing, we had taken him to the vet thinking it was the end because the hospital notes (they wanted to do tests for asthma, polyps and lung wash etc. which I declined) indicated that if there was no improvement he should be PTS. Vet said he still had some life in him and was tough so he ended up being tested and was then diagnosed, we then had to decide whether to continue, and here I am. Yes the steroids were for asthma but also to help with his intestines.

I had already tried home made chicken broth, organic chicken, he refused the broth and tried a tiny sliver of chicken. He doesn't recognise good food as being edible so is still eating Felix and Gourmet type stuff. I do add water, his predecessors both had water added to their food so it is habit.

I haven't spoken with the vet about testing yet, mainly because so far I have seen 4 different vets and am planning on trying to arrange to see the same one each time but fixing times is difficult, made worse by needing to take him 4 hours after the insulin.

I feed him before/while I inject him, and I was doing OK, had a routine until I varied the site a bit too much and hurt him. He is so thin I find it difficult to get a good pinch of cat, also thin skinned. Watched the vet with the Vit B and she also hurt him, so not surprised he runs away. I have small hands, stiff joints and find the vetpen is OK for me.

So, what do I do if there are ketones? He had them when he was assessed and kept in, and again when tested.

Feeding - I read about free feeding, is it OK to do, or little and often?

We don't have Walmart so I would need to buy online or from the vet for testing, however my main concern just now is trying to keep him eating and reduce BG which I know is really high.

Hard poo - he sits hunched up after lactulose, there was a time when he was normal but that was on the lower dose of insulin.

 

[Margie and Jackson]

You could try pumpkin for his constipation. That’s worked wonders for my cats and adds moisture, too. Just plain cooked pumpkin or any winter squash. If you’re from the UK, canned pumpkin might not be as available to you.

 

[UKGinger]

Wrist roll, whereabouts do you put the needle in please? I suspect if I do it where the skin breaks I will get it wrong as I seem to be doing with everything just now. So tired I can't concentrate.

I use (try to use) the tent method, but if I check for the little place to inject he notices.

So far I have stuck it in me, stuck it straight through and injected nothing, and had it bent most times when he tries to get away. If I hesitate he gets suspicious and if I try to get on with it he notices and swears at me, and tries to get away. I like that I can click the vetpen and it is done.

 

[MrWorfMen's Mom]

You could perhaps try Miralax (not sure what the UK brand name is) which uses water vs. an undigestible sugar to combat the constipation (Lactulose).and as mentioned, pumpkin sometimes helps too.

As for the injections, feed Big Fella most of his meal and wait your 20 to 30 minutes then give him the rest and try injecting while he is distracted while eating. Alternate sites for injections are shown in the diagram below.

 

[MrWorfMen's Mom]

If you can roll some skin so that you can see skin and not fur, then pull up gently and aim for that spot and hold needle at 45 to 60 degree angle. There should be little to no resistance when you insert the needle.

 

[Idjit's mom]

Tagging @Elizabeth and Bertie, and @Diana&Tom for some input on getting and using syringes for injections, as well as testing supplies for home testing the blood sugar.

I'm sorry you are so tired out and dealing with these issues with Big Fella. I feel badly that he is feeling badly and sure hope you can help relieve some of the issues. You do not need vet's permission or blessing to test at home. Many vets don't suggest or support testing, and that's a dangerous path to walk with any diabetic. Better to take the time to learn and actually do the testing rather than end up in the pet ER with a critical hypoglycemic event.

Big Fella is getting 2 units twice a day, and the recommended starting dose is usually one unit twice a day. It could very well be that this dose is causing him to feel worse than he did before, because his body is given a big dose that startles his system (oh no, too low!!), so he dumps stored sugar into the bloodstream to compensate and then the blood sugar spikes again. Vicious cycle and the "fuel" can eventually run out=hypoglycemia.

That can't feel good at all. If you test, you are going to be able to see if this is happening, and reduce the dose to get his blood sugar regulated and Big Fella feeling a whole lot better.

 

[Chris & China (GA)]

I suspect if I do it where the skin breaks I will get it wrong as I seem to be doing with everything just now

Yes, you insert the needle where the "break" is and you can see skin.

And you're NOT doing everything wrong! You're trying to treat a cat with multiple problems when most people would just euthanize....that's a LOT that you're doing right!

 

[UKGinger]

Tagging @Elizabeth and Bertie, and @Diana&Tom for some input on getting and using syringes for injections, as well as testing supplies for home testing the blood sugar.

I'm sorry you are so tired out and dealing with these issues with Big Fella. I feel badly that he is feeling badly and sure hope you can help relieve some of the issues. You do not need vet's permission or blessing to test at home. Many vets don't suggest or support testing, and that's a dangerous path to walk with any diabetic. Better to take the time to learn and actually do the testing rather than end up in the pet ER with a critical hypoglycemic event.

Big Fella is getting 2 units twice a day, and the recommended starting dose is usually one unit twice a day. It could very well be that this dose is causing him to feel worse than he did before, because his body is given a big dose that startles his system (oh no, too low!!), so he dumps stored sugar into the bloodstream to compensate and then the blood sugar spikes again. Vicious cycle and the "fuel" can eventually run out=hypoglycemia.

That can't feel good at all. If you test, you are going to be able to see if this is happening, and reduce the dose to get his blood sugar regulated and Big Fella feeling a whole lot better.

He started on 1 unit x2 which actually turned out to be none at all to begin with as I hadn't got all the air bubbles out, then a couple of days of the correct dose, followed by a few days of half a unit because when I asked if it was correct I was told the wrong amount, he was then put on 2 units. They did say he needed the 2 units when he was tested. I did mention changing the insulin but it was early on so not sure if it is a good one for him, I am about to start a new vial tomorrow. I feel that I need to be able to actually inject him correctly and work out how much to feed and how often first and then move on from there because there is so much I need to learn, the best approach for me is to get one thing right before I move on to the next, otherwise I will mess it all up.

He has a selection of food, as always for overnight, I am in two minds about leaving him so much but if he is feeling he wants to eat it will be gone in the morning. Is this bad?

 

[Red & Rover (GA)]

If DKA has been in the picture recently, then yes, do leave food out.
The recipe for DKA = not enough insulin + not enough food + an infection or something else going on.

Information on DKA can be found here

he is not on the best diet, and doesn't like good stuff.

If the "good stuff" is prescription food, you should be able to return it to the vet for a full refund. Just say he won't eat it.

 

[Red & Rover (GA)]

Also tagging @Kate & Toby in the UK who very recently went through this and switched from caninsulin to prozinc (a much gentler insulin that does not have a hard, fast drop like caninsulin).

 

[MrWorfMen's Mom]

Have you been storing the insulin in the fridge? If you just started insulin about 4 weeks ago you don't need to start a new vial now. The one you are using will remain good for 3 months from the date it was first used and possibly longer. The 28 (or 42) day expiry indicated on the package insert is only indicative of how long the insulin was actually tested for regulation purposes. It's till good long after that expiry date.

 

[UKGinger]

If DKA has been in the picture recently, then yes, do leave food out.
The recipe for DKA = not enough insulin + not enough food + an infection or something else going on.

Information on DKA can be found here


If the "good stuff" is prescription food, you should be able to return it to the vet for a full refund. Just say he won't eat it.

Good stuff is the low carb, high meat food, I have stacks of different food but he only likes Felix and Gourmet. Lots of things he didn't want have gone back for refunds but I have an order from Zooplus which he doesn't like.

 

[UKGinger]

Have you been storing the insulin in the fridge? If you just started insulin about 4 weeks ago you don't need to start a new vial now. The one you are using will remain good for 3 months from the date it was first used and possibly longer. The 28 (or 42) day expiry indicated on the package insert is only indicative of how long the insulin was actually tested for regulation purposes. It's till good long after that expiry date.

 

[UKGinger]

Yes, it has been in the fridge but has almost run out. I seem to recall being told it would last about 4 weeks when we got it.

 

[MrWorfMen's Mom]

Oh silly me. I was thinking about a vial with 10ml in it instead of the 2.5ml Vetpen. If Big Fella's dose goes down tho' still good to know!

 

[Diana&Tom]

Hi again (sorry, don't know your name?), I'm glad you found your way here. We all know how much there is to take in but it does fall into place surprisingly quickly, if you're keen to learn - and you clearly are, so you'll be just fine

There isn't an idiot's guide to FD as such but have you read the beginner's guide to Caninsulin, which sums most things up in an accessible way? If not, here it is:

http://www.felinediabetes.com/FDMB/threads/beginners-guide-to-caninsulin-vetsulin.186099/

I've been tagged for info on where to get diabetic supplies in the UK but I'm not exactly clued-up on that, having not had a diabetic cat for some time. But Elizabeth can certainly help, as can Kate & Toby, both tagged, also @Georgiana & Perlutz - all are currently treating diabetic kitties.

It's always good for overall health, of course, to feed as good a diet as possible. You could do worse than Felix and Gourmet if he won't eat anything else, but persevere if you possibly can - mix a little of the better stuff in with existing food to start with and see if he manages that, and gradually increase the proportion of good stuff over a few days. Or sprinkle some Parmesan cheese over a new food, or a crumbled freeze-dried treat - both are usually very tempting to cats and may "fool" them into carrying on eating the food!

As you've seen, there's an amazing community of people here and you' e already had some great advice. Keep reading and asking questions, we're here to help

 

[Bron and Sheba (GA)]

Hi and welcome to you and Big Fella...what a beautiful boy!
Thank you for rescuing him and giving him a second chance. You are wonderful to do that.
You will find this a very supportive and helpful forum with lots of people willing to help and support you.

 

[Kate & Toby]

Hi and welcome, you have 100% found the right place, also I think you are wonderful for rescuing Big Fella (LOVING the name also!), Toby is 12 and its really no age at all, with the help of this wonderful community we are slowly and surely seeing improvements, so hang on in there and stick with us.

With regards to supplies, I went to Lloyds Pharmacy and bought Ketostix, I think they were about £5, I try and catch Toby having a wee every couple of days and just pop the little stick in his flow, if Big Fella doesn't like you going near him when he pees then many people place a layer of cling film over the litter which allows the wee to pool and you can dip your ketostix in after he has left the tray. It is really important to test for ketones as if not caught early this can cause a fatal condition called Ketoacidosis, also once your cat has had it, it means unfortunately that they are prone to getting it again. The main way to avoid it is, feeding little and often, keeping fluids up, and regular insulin. I have a water fountain too, although Toby likes it when I put cold fridge water in a glass for him, that almost guarantees he drinks a big amount! If you see anything higher than a "Trace" reading you need to take Big Fella to the vet.

With regards to the Glucose meter, I use an Aplpha Trak 2 which is the vet one specifically for animals, which I bought from "Animed" it cost about £80 including a vial of testing strips, however the testing strips are very pricey (£46 per pot) and I use about a pot a week! That being said, I know Georgina uses human strips in her Alpha Trak and has good success and they are a third of the price, I don't know anything about human meters I am afraid.

With regards to food, I feed Hi Life which is available in Tesco and Waitrsoe and comes in "Chicken Dinner" and also fish flavours, they might be more gravy like. I also feed sheeba fine flakes in jelly. I have a shop near me called Pets Corner (they are a big chain) and they have nearly all the foods on the UK list and sell them in individual pouches and cans so you can try which ones big fella likes without investing in a whole box, alternatively Pets at Home also have a great variety. In terms of dry food, whilst I try and avoid it, I do have some to leave out when I cant be home, the lowest carb one available in the UK is "Thrive" its available on amazon (2 10kg bags for £20 I think).

With regards to injecting, I agree with the others the needles are far easier than the pen, but appreciate that you are having trouble, that being said, at this point its just important to get the insulin in him. I buy my needles and insulin from my vet at the moment but when I need new supplies I will be buying from Animed.co.uk.

We started on Caninsulin, but changed over to Prozinc as it lasts much longer and with the caninsulin the vet just keptwanting to up and up the dose, the Prozinc is a specific Cat insulin, have a chat to your vet.

I don't know if any of the above will help, but even if just one thing jumps out that's good. All the very best and do keep coming back and asking questions, nobody minds at all, we all "get it". x

 

[UKGinger]

Hi and welcome, you have 100% found the right place, also I think you are wonderful for rescuing Big Fella (LOVING the name also!), Toby is 12 and its really no age at all, with the help of this wonderful community we are slowly and surely seeing improvements, so hang on in there and stick with us.

With regards to supplies, I went to Lloyds Pharmacy and bought Ketostix, I think they were about £5, I try and catch Toby having a wee every couple of days and just pop the little stick in his flow, if Big Fella doesn't like you going near him when he pees then many people place a layer of cling film over the litter which allows the wee to pool and you can dip your ketostix in after he has left the tray. It is really important to test for ketones as if not caught early this can cause a fatal condition called Ketoacidosis, also once your cat has had it, it means unfortunately that they are prone to getting it again. The main way to avoid it is, feeding little and often, keeping fluids up, and regular insulin. I have a water fountain too, although Toby likes it when I put cold fridge water in a glass for him, that almost guarantees he drinks a big amount! If you see anything higher than a "Trace" reading you need to take Big Fella to the vet.

With regards to the Glucose meter, I use an Aplpha Trak 2 which is the vet one specifically for animals, which I bought from "Animed" it cost about £80 including a vial of testing strips, however the testing strips are very pricey (£46 per pot) and I use about a pot a week! That being said, I know Georgina uses human strips in her Alpha Trak and has good success and they are a third of the price, I don't know anything about human meters I am afraid.

With regards to food, I feed Hi Life which is available in Tesco and Waitrsoe and comes in "Chicken Dinner" and also fish flavours, they might be more gravy like. I also feed sheeba fine flakes in jelly. I have a shop near me called Pets Corner (they are a big chain) and they have nearly all the foods on the UK list and sell them in individual pouches and cans so you can try which ones big fella likes without investing in a whole box, alternatively Pets at Home also have a great variety. In terms of dry food, whilst I try and avoid it, I do have some to leave out when I cant be home, the lowest carb one available in the UK is "Thrive" its available on amazon (2 10kg bags for £20 I think).

With regards to injecting, I agree with the others the needles are far easier than the pen, but appreciate that you are having trouble, that being said, at this point its just important to get the insulin in him. I buy my needles and insulin from my vet at the moment but when I need new supplies I will be buying from Animed.co.uk.

We started on Caninsulin, but changed over to Prozinc as it lasts much longer and with the caninsulin the vet just keptwanting to up and up the dose, the Prozinc is a specific Cat insulin, have a chat to your vet.

I don't know if any of the above will help, but even if just one thing jumps out that's good. All the very best and do keep coming back and asking questions, nobody minds at all, we all "get it". x

Thank you for all the above. I will look at getting the Ketostix first. He had ketones when he was diagnosed, and a trace last week in his test, vet just to take him back if he didn't eat.
He won't eat any of the foods that are actually chicken or fish flakes, pieces or mush, I have been trying for a long time as I had them all for my little girl and he would eat all her left overs except anything with decent protein in it. So have failed with Natures Menu, HiLife, Little Big Paw,Meowing Heads and the new one that I can't remember the name of which is really soft and almost pate like. I have Animonda, Bozita and Miamor, chosen for low carb/no sugar, he hates Bozita and will lick the sauce off Animonda. Miamor is in jelly but is like gravyand for that reason I hoped it might work but he will lick at it and lose interest. He won't touch the Sheba in jelly. Still currently on Felix Gravy Lovers minus the rubber bits, Gourmet Solitaire in gravy/sauce and a bit of Felix Meaty Loaf. He would eat dry but although I have tons of it I don't let him have it. I bought Applaws for the high meat content and it was the best I could get at the time, but have Lilys Kitchen and Meowing Heads as well as RC Exigent and IAMS from before he was diagnosed when I was just trying to get something into him.

He actually came to meet me this morning, kind of. He has his own room so that he doesn't get let out by mistake in the morning before I get up, of late he has stayed in his comfy bed and I have waited on him and tried to inject him while he isn't looking.

I will ask about Prozinc. Vet started him on a low dose of Caninsulin and I think is going to increase it until they get it right. I counted 4 little wee clumps this morning which was between about 2.00 a.m. and 9.30 a.m. He had his insulin about 10.00 before bed. I have no idea if that is good or not.

 

[UKGinger]

Hi again (sorry, don't know your name?), I'm glad you found your way here. We all know how much there is to take in but it does fall into place surprisongly quickly, if you're keen to learn - and you clearly are, so you'll be just fine

There isn't an idiot's guide to FD as such but have you read the beginner's guide to Caninsulin, which sums most things up in an accrssible way? If not, here ir is:

http://www.felinediabetes.com/FDMB/threads/beginners-guide-to-caninsulin-vetsulin.186099/

I've been tagged for info on where to get diabetic supplies in the UK but I'm not exactly clued-up on that, having not had a diabetic cat for some time. But Elizabeth can certainly help, as can Kate & Toby, both tagged, also @Georgiana & Perlutz - all are currently treating diabetic kitties.

It's always good for overall health, of course, to feed as good a diet as possible. You could do worse than Felix and Gourmet if he won't eat anything else, but persevere if you possibly can - mix a little of the better stuff in with existing food to start with and see if he manages that, and gradually increase the proportion of good stuff over a few days. Or sprinkle some Parmesan cheese over a new food, or a crumbled freeze-dried treat - both are usually very tempting to cats and may "fool" them into carrying on eating the food!

As you've seen, there's an amazing community of people here and you' e already had some great advice. Keep reading and asking questions, we're here to help

Thank you. As per my reply to Kate and Toby re: food, it looks as if I am stuck with Felix and Gourmet for now, I have done the mixing stuff but if there is anything different in the bowl he isn't keen, especially stuff he is meant to like, including Fortiflora and brewers yeast for his other problems. For some reason he isn't interested in cheese either, he did like Lick e Lix until the recipe was changed recently and will sometimes take a Sheba creamy treat thing but not if it is on something he doesn't like. And I thought I was winning with freeze dried treats the first time he had them, but he won't touch them now.

He has always been fed on the cheapest food as far as I could tell, whatever was on offer, and I think GoCat too. It is sad when you want to give them something good and they don't realise it is food.

 

[UKGinger]

One more question - ketones and needing to take him to the vet, what do they do?

 

[Diana&Tom]

Thank you. As per my reply to Kate and Toby re: food, it looks as if I am stuck with Felix and Gourmet for now, I have done the mixing stuff but if there is anything different in the bowl he isn't keen, especially stuff he is meant to like, including Fortiflora and brewers yeast for his other problems. For some reason he isn't interested in cheese either, he did like Lick e Lix until the recipe was changed recently and will sometimes take a Sheba creamy treat thing but not if it is on something he doesn't like. And I thought I was winning with freeze dried treats the first time he had them, but he won't touch them now.

He has always been fed on the cheapest food as far as I could tell, whatever was on offer, and I think GoCat too. It is sad when you want to give them something good and they don't realise it is food.

Yes it is sad when we try so hard to feed our kitties good food and they turn their noses up because it doesn't look or smell like food to them... it's hard to break those habits but don't give up, it may be possible if you persist! Try something strong-smelling if you haven't already - tuna is usually irresistible to cats. It sounds as if you've already done your utmost though so just do what you can - if's important that he eats well. Just avoid Go Cat!

 

[Kate & Toby]

They will keep him very hydrated via IV fluids, monitor BG and keep it regulated, adjust Electrolyte levels, I cant remember exactly but they give other minerals to help rid the body of the poisonous acid levels, if they aren't eating they will syringe feed or put in a feeding tube. It is a very serious condition that deteriorates quickly, I cannot emphasise enough that if you detect ketones you should seek veterinary advice.

 

[UKGinger]

He is booked for a check up tomorrow, but apparently the vet is having trouble getting Vit.B which he also meant to get by injection.

Does anyone know if I can get the injectable form online please? I already have the capsules/powder and it was no good, he really needs the injections for another 2 weeks and then probably monthly.

I am going to ask about changing the insulin (assuming they can get that).

 

[UKGinger]

Yes it is sad when we try so hard to feed our kitties good food and they turn their noses up because it doesn't look or smell like food to them... it's hard to break those habits but don't give up, it may be possible if you persist! Try something strong-smelling if you haven't already - tuna is usually irresistible to cats. It sounds as if you've already done your utmost though so just do what you can - if's important that he eats well. Just avoid Go Cat!

It was once renamed Gone Cat, maybe unfairly attributed to deaths, I am pleased to say I have never used it. I always wean kitties off dry if possible.
I still have some pouches on standby, and will go back to tuna when he has had a break from being presented with it, vets always give him tuna so I have been taking his food in when he has had a stay so that he has something he likes.

 

[Georgiana & Perlutz]

Hi Ginger, I’m glad you’ve found your way here. Most of us will relate to your frustrations, tiredness etc, we’ve all been there! But hang on, it does get better and easier! You’re amazing for giving Big Fella another chance when for others he was “just an old cat”!

I see others have already given you sound advice and I just wanted to add something about testing for ketones. I haven’t managed with Kate’s methods, Perlutz will simply walk away if I try to go around him when he’s doing his business and the cling film didn’t work either, he would either avoid it like a pro or simply remove it so I’m using a special non absorbent litter called Katkor. I bought a cheap small litter box that I only bring out when I test for ketones, I put the Katkor in in (I use 2 bags, they’re small), replace the usual litter box with this one and wait. Katkor even comes with a pipette and recipient you could use to collect urine at home for a urine test at the vets. I buy Katkor from VetUK, costs just over £2 and it can be washed and reused (unless you need a sterile urine sample for urine test at the vets when you’d need a new bag). VetUk also has the cheapest syringes with 0.25 markings that I could find, should you decide to go for syringes instead of a pen.

I’m sure it’s been said before, but you should start testing his blood glucose before every insulin shot. When I started Perlutz on insulin, he was on 2u of Caninsulin and the vet said home testing is not necessary I ordered a meter the next day after diagnosis regardless of what the vet said, it just took few days for it to arrive and these few days, I gave insulin without checking his blood glucose and I wish I haven’t! Perlutz was miserable, he was lethargic, not his usual cuddly self, avoided us and would just lay on his own somewhere, lost his appetite and just looked like he lost his will to live As soon as we began testing, we realised we must have been giving him insulin when his bg was too low to give insulin, especially to a newly diagnosed. From then on, we didn’t give insulin on days his bg was too low and he soon went back to his normal self. I hope I don’t scare you with this, but I wish I knew all this back then!

 

[Diana&Tom]

He is booked for a check up tomorrow, but apparently the vet is having trouble getting Vit.B which he also meant to get by injection.

Does anyone know if I can get the injectable form online please? I already have the capsules/powder and it was no good, he really needs the injections for another 2 weeks and then probably monthly.

I am going to ask about changing the insulin (assuming they can get that).

@Elizabeth and Bertie any idea???

 

[Elizabeth and Bertie]

It has been difficult getting it into him as he is now suspicious and tries to get away, resulting in bent needles (vetpen).

Hi, there are different ways to give insulin shots, apart from (most often used) 'tenting' technique. I 'think' someone has explained the 'rolling the skin back' technique further up the thread.
The tenting technique never seemed to work with my first diabetic because he was a bit of a fidget and was inclined to move suddenly. But I found I could just pull up a handful of loose skin between the fingers and thumb of my non-dominant hand and then give the shot almost directly downwards into the skin that I was holding in my hand. This had a couple of advantages; firstly, it meant that if he moved I could still give the shot as long as I was still holding onto that handful of loose skin. Secondly it meant that it wasn't possible for me to hurt him by pushing the needle too deep because the needle was shorter than the depth of skin that I was holding in my hand... ....If that makes sense..?
With my new diabetic (came here in Feb) the tenting technique seems to work just fine though. Strange...

Giving shots can just take a bit of practice, but you absolutely will get the hang of it. ...I hated needles and practiced on an orange at first, and that was actually really helpful...

Similarly, testing blood glucose at home really isn't that hard to learn. Most people who try to 'hometest' can do it with just a little bit of practice. And most cats can be tested just fine, especially if they are rewarded with treats or cuddles.
I don't know where you are in the UK, but if you're anywhere near Cobham in Surrey you're most welcome to come and see how I test my kitty, Bonbon. She had someone else come and watch just recently and was just fine with that.

apparently the vet is having trouble getting Vit.B which he also meant to get by injection.
Does anyone know if I can get the injectable form online please? I already have the capsules/powder and it was no good, he really needs the injections for another 2 weeks and then probably monthly.

Just did a quick search and can't seem to find this online in the UK. But I am surprised that your vet can't get it, because I think this is pretty standard stuff...
Is this for use as an appetite stimulant?

Eliz

 

[Kate & Toby]

Hi Ginger, I’m glad you’ve found your way here. Most of us will relate to your frustrations, tiredness etc, we’ve all been there! But hang on, it does get better and easier! You’re amazing for giving Big Fella another chance when for others he was “just an old cat”!

I see others have already given you sound advice and I just wanted to add something about testing for ketones. I haven’t managed with Kate’s methods, Perlutz will simply walk away if I try to go around him when he’s doing his business and the cling film didn’t work either, he would either avoid it like a pro or simply remove it so I’m using a special non absorbent litter called Katkor. I bought a cheap small litter box that I only bring out when I test for ketones, I put the Katkor in in (I use 2 bags, they’re small), replace the usual litter box with this one and wait. Katkor even comes with a pipette and recipient you could use to collect urine at home for a urine test at the vets. I buy Katkor from VetUK, costs just over £2 and it can be washed and reused (unless you need a sterile urine sample for urine test at the vets when you’d need a new bag). VetUk also has the cheapest syringes with 0.25 markings that I could find, should you decide to go for syringes instead of a pen.

I’m sure it’s been said before, but you should start testing his blood glucose before every insulin shot. When I started Perlutz on insulin, he was on 2u of Caninsulin and the vet said home testing is not necessary I ordered a meter the next day after diagnosis regardless of what the vet said, it just took few days for it to arrive and these few days, I gave insulin without checking his blood glucose and I wish I haven’t! Perlutz was miserable, he was lethargic, not his usual cuddly self, avoided us and would just lay on his own somewhere, lost his appetite and just looked like he lost his will to live As soon as we began testing, we realised we must have been giving him insulin when his bg was too low to give insulin, especially to a newly diagnosed. From then on, we didn’t give insulin on days his bg was too low and he soon went back to his normal self. I hope I don’t scare you with this, but I wish I knew all this back then!

My vet gave me a few bags of that litter, I agree it's good, I never even thought about washing it! That's brilliant! Especially as I was so bothered about putting all those bits of plastic in the bin when we are trying to be plastic free. I'll definitely get some! As a side, Toby couldn't care less if I went near him, I think its because he must have no chance of stopping mid flow Haha!

 

[CandyH & Catcat]

a slightly more ecological substance, if you're trying to get away from plastic, I have been told that lentils are an option, they don't absorb the liquid, at least at first they don't

I went that direction since Catcat's regular litter is actually equine stall bedding, pellets from fir and pine trees .. for us it works better than clay litter, plus it can be composted since it turns into sawdust when dampened

 

[UKGinger]

Just did a quick search and can't seem to find this online in the UK. But I am surprised that your vet can't get it, because I think this is pretty standard stuff...
Is this for use as an appetite stimulant?

Eliz[/QUOTE]
He has a deficiency due to his thickened intestine, previous vet gave us the capsules but the powder didn't work. A few weeks ago someone was wanting Pro Kolin while I was waiting and they had a substitute instead as they couldn't get it. This is worrying me a fair bit.

(I wish I did live near Cobham, moved out of Surrey a while ago.)

With regard to the litter, little balls, have had them before but will try the basic way first and hope for a well directed flow. Cling film is likely to be dug up. He is a softy when it comes to litter, I use Greenwoods or Cats Best original and the Greenwoods is a bit more crunchy, he doesn't like the feel of it on his paws. I don't use clay due to licking it off and being swallowed, it can't be good for the intestinal tract, and I never gave it any thought until I read of a kitten that had swallowed a fair amount and it had caused a serious blockage.

 

[UKGinger]

Still trying - yesterday morning was the first 'fur shot', I have partially missed before but not this much. This morning all went well, I thought, minimal swearing, except the Vetpen didn't click until after I had removed it, I had been wondering what happened when the insulin ran out, so I suspect he didn't get a full dose again.

Lots of clumps of pee throughout the day, normal size ones but I think too many although am not clear on how much pee there should be?

Tonight a new vial of insulin and he really swore at me and bent the needle so only got about one unit instead of two. Is it OK to straighten the needle and use it? (Vet said to only change it once a day).

 

[MrWorfMen's Mom]

I would not reuse needles. They are meant for one time use only. To try to straighten a bent needle could result in a needle broken off under the skin and even a straight needle gets dulled with one use. See picture below. Not only will it make injections more uncomfortable but it could also introduce bacteria and cause an infection.

 

[UKGinger]

We went to the vet this morning, he has lost more weight since last Friday. I have to increase his insulin to 2 1/2 units. He is eating and was peeing a lot. Vet talked about euthanasia today.

Originally had taken him there because I thought it was the end of the road, before he was diagnosed, but 4 weeks on he is no better and I am wondering if I should let him go.

 

[Diana&Tom]

We went to the vet this morning, he has lost more weight since last Friday. I have to increase his insulin to 2 1/2 units. He is eating and was peeing a lot. Vet talked about euthanasia today.

Originally had taken him there because I thought it was the end of the road, before he was diagnosed, but 4 weeks on he is no better and I am wondering if I should let him go.

Oh I am so sorry to hear the vet's suggestion... it's always very upsetting to hear that when we've been trying so hard with such hope to make our kitties better. The weight loss is worrying, that's for sure - did the vet have any ideas about what has caused this? And what did he/she say about the diabetes? Was a blood glucose test taken at the surgery, or was blood taken to be sent away to run a fructosamine test (which gives an idea of bg over a period of two or three weeks, and is often carried out to actually diagnose FD).
Has a curve showing his response to the insulin dose been carried out at all? - sorry if I've missed that, but without that information it's hard to tell whether some of the symptoms he's showing are due to either too little or too much insulin,.. or something else altogether.

I know how difficult it is to make the "right" decision but I think a lot of it depends on what you've educated yourself about to try to understand whether the symptoms you're seeing are treatable, or whether they're beginning to mount up and look insurmountable. A poorly kitty may show symptoms that look as if he's had enough, but he may simply need a different course of vet care and treatment that could turn things around. Do you have confidence in your vet, or do you feel they could be more thorough? Have other tests been done? Apart from the weight loss and sleeping a lot, is your cat showing signs of giving up? If he's still interested in food, that's usually a good sign.

I may not have read your thread thoroughly enough to be sure, but I'd say, if you haven't already, get some bg data to see what's going on.. that would at least give you a starting point.

The bottom line is that any decision to PTS or not should be based on a kitty's quality of life. If you feel there is hope, don't make a hasty decision without looking at a few more options for treatment. But if he is utterly miserable, stops eating, etc, then you might have more of a clue about what to do.

It's very tough and my heart goes out to you.

 

[Kate & Toby]

hey, so sorry to hear this. I just wanted to say that when I took Toby to the ER less than a month ago with Ketoacidosis, I too was told "to give euthanasia proper consideration". It's not been easy, and I have had a sleepless night every single night since, and I don't want to give you false hope, but I now have a very happy boy, who has tremendous quality of life, I take each day as it comes with him and appreciate every snuggle. If you have hope and you're prepared to dedicate time and effort to Big Fella, and feel he has some quality of life left then by all means seek a second opinion.

Sending you my best wishes.

 

[MrWorfMen's Mom]

I'm so sorry to hear Big Fella is feeling so poorly but I don't think you should give up hope just yet.

A question....... do you think Big Fella is more lethargic and generally feeling worse now than before he was started on insulin?

The reason I ask is because some cats just don't feel well on Caninsulin. I think a lot of it has to do with the swift and often short action of that insulin which sends kitty's BG on a roller coaster of highs and lows. I'm also a bit concerned that the dose is being increased too quickly and based on readings taken in the vet's office which are usually elevated due to vet stress. This can lead to overdosing which only serves to magnify the swift BG changes that Caninsulin can cause.

I would strongly suggest you discuss a change of insulin with your vet to ProZinc which is a gentler insulin much better suited to cats. I would also suggest you start home testing Big Fella to see where his BG levels really are in his home environment. Home testing would give you a much better picture of what is going on with Big Fella on a day to day basis and provide information to better guide you and your vet on how to proceed to treat Big Fella's diabetes.

We can help you learn to home test and assist you to understand how the insulin is working and provide guidance to get Beg Fella regulated. I really think a change of insulin and home testing would make a world of difference for Big Fella and you.

 

[Diana&Tom]

Totally agree with what Linda says above. If your vet isn't being too constructive, consider looking for a new vet - many of us here have had to do just that.
I know home testing sounds tricky but really it's just a knack and most people surprise themselves how quickly they manage to master it and get into a routine. Can you give us a rough idea where you are in the UK? - it's possible that someone lives near you and could help.

 

[UKGinger]

Thank you all, I am really not doing very well with this. I feel I keep messing up his insulin by not getting the dose right. I asked the vet about changing insulin but she said he needed more time to stabilize first. Had been told previously to take him in 4 hours after his injection but was then told to take him next time after 6 hours, so it looks as if I was wasting my time this morning really, although he did get the Vit B shot.

Vet was fine about home testing apart from the struggle I am having to get a needle into him as he runs away now and pulls away with the needle in, so trying to get blood would be very difficult. I can probably manage the pee test. She is concerned because I am struggling with it.

Vet asked how aggressively I wanted to treat him given his age and weight loss, but thinks it is the insulin dose rather than his IBD that is the problem. I reminded her that he had originally gone there to be PTS and the vet said he was a tough cookie (different vet), he was then diagnosed but since then I don't feel I have got to grips with the insulin, first of all injecting him but discovering I hadn't got the air out of the pen, then giving the right dose, 1 unit, and checking with the vet was told it was wrong so halved it. Returned to the vet to discover that it should have been what I was giving him, and then it was doubled to 2, so went from half a unit to 2 straight away. I hope that makes sense. Today I was told to give another half as his BG is still high.

He has taken to staying in his bed rather than keeping me company since we began the insulin, and is happy for me to keep putting food in front of him.He had Felix Gravy Lovers gravy this morning with his insulin, then off to the vet and on his return half a tin of Gourmet mousse with water. I don't know if the Vit B is doing any good but he was deficient before.

I really thought he would have put some weight on this time and found it hard to think he could get any thinner. My last cat had IBD and was as thin and she ended up with renal lymphoma, he looks the same but he eats.

I wish I could clear my head and make some sense of it all, I look at him and think it is wrong to try to keep him going, and then I think maybe there is a chance but the vet seems to be giving up on him. Different vets saying different things, and can't get to see the one I want to see.

 

[Diana&Tom]

I really feel for you... it is so upsetting to see our kitties unwell and not knowing who to trust and what to do for the best for them.
So the vet is basically saying that after a mere three or four weeks and not getting the insulin dose right, it may be time to give up...? Sorry but that's nonsense and very defeatist. FD is very treatable if you have the time, attitude and desire to make your cat better. He may well have several more good years in him.

Perhaps you could try to convey to the vet that you'd like to make a serious effort to treat the FD correctly - and that does mean starting at a lower dose and testing blood at home. Please let us know what we can do to help.

 

[MrWorfMen's Mom]

I agree with Diana.....the vet is being defeatist and quite frankly it doesn't make sense to suggest Big Fella needs more time to stabilize before changing insulin. If the insulin isn't working and making Big Fella feel worse, then it needs to be changed. The right insulin for your cat is the one that works for him.

He's still losing weight because he's not regulated and he's not regulated because the proper dose has not yet been determined. The proper dose can't be determined solely on a BG reading in the vet's office 4 to 6 hours after the insulin shot. All cats are individuals and while the vet's intention may be to see how low the current dose is taking BG, all cats do not reach peak insulin action in the 4 to 6 hour timeframe. Some on Caninsulin have their peak very early at 3 hours while others may be as late at 7/8 hours. Unless you randomly test to see when that low occurs, you don't have any idea of what is happening. The vet is doing nothing better than taking a shot in the dark.

Home testing is easy once you learn the basics. Most of us thought we'd never be able to test our cats only to end up with a cat that comes when called to be tested. We can help you learn how to test. Start rubbing and massaging Big Fella's ears every time you pet him to get him used to having his ears touched and give him a low carb treat every time. He will associate the ear touching with a treat and come to enjoy the process. Testing doesn't hurt the cat. They object to having their ears manipulated rather than the actual testing so making it an enjoyable experience works wonders.

I frankly think the Vetpen might be what is causing you grief as far as the injections are concerned. They are finicky things to work with and unless you keep the needle in place for a second or so after injecting, you may not get all the insulin into the cat. I'd consider using syringes instead if I were you. I think you'd find it would give you better control, Big Fella less discomfort/fuss, and it would allow you to increase doses in smaller increments to ensure you don't bypass the ideal dose.

Your story is not uncommon and the number of cats we see overdosed by vets is alarming to say the least. Big Fella is not an old cat in my view even if the vet community considers him a senior. He has lots of good years ahead and with a little TLC and patience you can enjoy several more years together.

 

[UKGinger]

Totally agree with what Linda says above. If your vet isn't being too constructive, consider looking for a new vet - many of us here have had to do just that.
I know home testing sounds tricky but really it's just a knack and most people surprise themselves how quickly they manage to master it and get into a routine. Can you give us a rough idea where you are in the UK? - it's possible that someone lives near you and could help.

I am in NW London.
Re: the vet, mostly they are kind and friendly, however so far have seen 4 different vets, 2 were positive and of the others, one who is very sweet (and new) has twice mentioned euthanasia, and the other was very abrupt and just left the room after the consult without speaking. I get the impression they think I am keeping him alive needlessly, and I am wondering if they are right.

It seems so difficult to find the right vet. Over the years we have almost exhausted the local options, for various reasons, and I liked this one for their kindness when my other boy was at the end of his life, although he never had treatment there they were so kind to him.

I just wish someone could take care of him until there was an improvement because I am just not getting it right, the stress I feel must be affecting him too.