I'm new - Zeus recently diagnosed with diabetes

[knolet]

My 5 year old cat Zeus was overweight (15 pounds), so I switched his food to purina overweight management - dry food. He lost 5 pounds pretty quickly and I knew something was wrong. He was diagnosed with diabetes on May 2, and I feel terrible - it's all my fault.

I've now switched him to purina diatetic management canned food (Per the Dr.s direction), and he's receiving Lantus injections 1 unit twice per day. The Dr. started him at 2.5 units, after a week, he did a glucose curve test. No sugar in his urine. Results within normal levels, maybe even a bit on the low side. Decided 2.5 units was too high. The Dr. said Zeus might have turned the corner to not needing insulin. I was so happy! So we decreased the insulin to 1 unit twice per day. Another urine test a week later, Zeus did have sugar in his urine, so I increase Lantus to 1.5 units twice per day. We go back next week for another glucose test.

I've read many of the posts here (and tons of internet searches), and lots of you do the blood tests at home. The Dr. hasn't talked with me about it at all. I'm so confused. If I do the tests at home, Where do I find out what the levels should be? and how do I use that to decide whether to give insulin or how much?

Also, Zeus used to gobble his food quickly, even the purina diatetic management. But the past couple of days, he hasn't wanted to eat it. It took almost an hour for him to eat 1/2 can of food. I tried warming it in the microwave and adding a little water. Any suggestions to get him to eat? Or another food that is good that I could try?

Thanks so much for any advice that you could give me!

 

[Sue and Oliver (GA)]

Others who use your insulin will be along with dose suggestions.

Yes, we test at home. It is the only way to be sure that each dose you give is not too much insulin for the blood glucose level. We feel tests at home eliminate the stress the cat can experience at the vet - stress raises bg levels. And it is much cheaper! We have taught hundreds of people how over the internet and would be glad to teach you.

Many cats tire of the taste of DM. It is mainly liver. We feed Fancy Feast, Friskies, Wellness, Merrick - whatever we can afford that the cat will eat that is under 8-10% carbs. There is no "prescription" in DM. It has the same ingredients as most cat food and is inferior to many. We use this food chart to help us find foods: Janet and Binky’s chart

Let us know how we can help.

 

[squeem3]

My 5 year old cat Zeus was overweight (15 pounds), so I switched his food to purina overweight management - dry food. He lost 5 pounds pretty quickly and I knew something was wrong. He was diagnosed with diabetes on May 2, and I feel terrible - it's all my fault.

Welcome :smile: Don't blame yourself for your cat's diabetes. Almost everyone here has a diabetic cat because they fed dry food for years not knowing how bad it is for cats and have since learned what a proper diet is.

I've now switched him to purina diatetic management canned food (Per the Dr.s direction), and he's receiving Lantus injections 1 unit twice per day.

Great that you are using Lantus :thumbup Be sure to read the info stickies at the top of the Lantus board to understand how the insulin works for cats: http://felinediabetes.com/FDMB/viewforum.php?f=9

You don't need the prescription food, canned or dry. The ignredients are nothing but junk (worse than even the cheapest brands of commerical foods) and cost and the food is expensive. Many cats get bored of eating the food after awhile.

So what to feed instead? A low carb commerical canned food that fits in your budget and your cat likes to eat. Some popular brands are Fancy Feast, Friskies, Wellness, Nature's Variety Instinct, and Merrick. Use these food charts:

Binky's canned food charts
Pet Food Nutritional Values list
Dr. Lynne's Wet Food list
List of low carb gluten free Fancy Feast

On Binky's charts, stick with foods that have a number 10 or less in the carbs colum. On the Pet Food Nutritional Values Chart, look at the %kcal from carbs column and choose foods that have a number 10 or less.

I've read many of the posts here (and tons of internet searches), and lots of you do the blood tests at home. The Dr. hasn't talked with me about it at all. I'm so confused. If I do the tests at home, Where do I find out what the levels should be? and how do I use that to decide whether to give insulin or how much?

Testing at home is much more accurate than having the vet do it. And cheaper, too.

Normal non-diabetic levels are roughly 60 to 150 mg/dl. You want your diabetic cat to stay in this range for as much as the time as possible with insulin, and hopefully one day without insulin.

Lantus dose changes are based on the nadir (lowest blood glucose level in a 12 hour period). Nadir is roughly 6 to 8 hours after an insulin shot, though some cats may have an earlier or later nadir.

A typical Lantus curve:

+0 - PreShot number.
+1 - Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number.
+3 - Lower than the PreShot number, onset has started.
+4 - Lower.
+5 - Lower.
+6 - Nadir/Peak (the lowest number of cycle).
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (may dip around +10 or +11).
+12 - PreShot number.

It helps to track your cat's blood glucose levels on a spreadsheet. Most people here use a spreadsheet that is on Google. The instructions are here: http://felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207

Also, Zeus used to gobble his food quickly, even the purina diatetic management. But the past couple of days, he hasn't wanted to eat it. It took almost an hour for him to eat 1/2 can of food. I tried warming it in the microwave and adding a little water. Any suggestions to get him to eat? Or another food that is good that I could try?

He might be already bored with the prescription food. It's moslty liver based which cats get tired of eating. You can return the food to the vet for a refund and then us the money to buy a commerical brand of food that is low in carbs and has a wider variety of flavors.

 

[Pumbaa]

When my Pumbaa shows a disinterest in eating, all I have to do is sprinkle a little parmesan cheese on top of his food and he gobbles it up like crazy. Other people use Fortiflora, but since I always have parmesan in the fridge, that works for me.

The first couple of times I home-tested my Pumbaa, my knees were shaking. Now, Pumbaa sits there purring when I do it. So don't worry...if I can do it, you can learn how to do it. I started getting Pumbaa used to home testing by putting high value treats (canned sardines packed in water, no salt) in front of him while I was testing to distract him and so that he thought of this as a positive thing. Now I don't even have to bribe him to home test.

The Relion meters at WalMart are used by many here because the test strips are cheaper than other meters, and people have posted that they get the Arkray test strips even cheaper online through a different source and those test strips work fine. (I didn't post a link because it will depend on what meter you get. I got the Relion Confirm Micro.)

The people here are wonderful and will gladly help you with any questions. They certainly helped me become less stressed about all of this.

Suze

 

[Caitlin & Mr. Kink]

Hey there! I was just in your position at the beginning of this month. Newly diagnosed, and feeling like it was all my fault because of a recent switch to dry food :cry: Our guy was losing weight, too, and we were all YAY and then he got diagnosed...you can't beat yourself up over it, though.

You don't really need to be taking your cat in to the vet every couple of weeks - it gets expensive, and the curves won't be very accurate. I just learned how to home test not too long ago, and now Mr Kink is a pro! I really don't think he even feels the prick at all. He just doesn't like me grabbing at his ears - haha.

This board has been an absolute godsend for me. Everyone here is so knowledgeable, friendly, and helpful. They've all either been through it, or are currently going through the same thing you are, so it's definitely reassuring for me to be a part of this community and feel supported and plus, I learn SO much!

It's easy to get overwhelmed in the beginning, so just ask any question that pops into your head! I feel like I ask stupid questions all the time, but someone's always there with an answer. laptop_smiley

 

[Julia & Bandit (GA)]

I also want to point out that it is very difficult to dose Lantus properly based on vet testing. Numbers are inaccurate and inflated due to stress in the animal, and the vet really just guessing at the dose. Vet testing also leads to chronic overdosing since the numbers are inflated. Cats can read 100-200 points higher at the vet, so the vet adjusts the dose based on those numbers, and then you get home and the cat gets into a chronic hypoglycemic situation, and the owner has no idea that this is the reason they are having trouble regulating.

Most cat on a low carb, canned diet do not need much more than 1u of insulin--but most people do not realize this until they start daily home testing and realize their cat is dropping way lower on their current dose than they or their vet thought.

Here is the dosing protocol for Lantus: http://www.uq.edu.au/ccah/docs/diabetesinfo/link4.pdf. This protocol has an 84% remission rate in newly diagnosed cats. Please print this out and give it to your vet, along with this article:


Also, here are the American Animal Hospital Association Guidelines, which I would also give to your vet. Note p. 218 (4), where it states that home testing is ideal and preferred over office testing.

Bandit eats low carb Merricks now, but the entire time he was on insulin (he's been in remission for almost 2 years) he ate the diabetic safe flavors of Fancy Feast. I switched to the Merricks because Bandit was formerly obese (like Zeus he went on a weight control prescription diet and got diabetes from the high carb load), and the Merricks is very high in protein, low carb and low fat, so it's optimal in maintaining him at a healthy weight. However, you can feed ANY low carb food, and even the premium foods with higher quality ingredients like Wellness and Merricks are far cheaper than the DM. The DM is pretty much the same thing as the liver-based Fancy Feast (also made by Purina), so you're really only paying an inflated price for the label. Check out the ingredients for DM:

Liver, poultry by-products, meat by-products, water sufficient for processing, chicken, salmon, oat fiber, salmon meal, guar gum, potassium chloride, carrageenan, salt, Vitamin E supplement, calcium phosphate, taurine, thiamine mononitrate, zinc sulfate, ferrous sulfate, niacin, calcium pantothenate, copper sulfate, Vitamin A supplement, manganese sulfate, menadione sodium bisulfite complex (source of Vitamin K activity), pyridoxine hydrochloride, riboflavin supplement, Vitamin B-12 supplement, biotin, folic acid, Vitamin D-3 supplement, potassium iodide.

vs the ingredients for Fancy Feast Liver and Chicken:

Liver, meat broth, meat by-products, chicken, poultry by-products, artificial and natural flavors, calcium phosphate, guar gum, potassium chloride, taurine, salt, magnesium sulfate, zinc sulfate, thiamine mononitrate, Vitamin E supplement, ferrous sulfate, niacin, manganese sulfate, calcium pantothenate, Vitamin A supplement, copper sulfate, menadione sodium bisulfite complex (source of Vitamin K activity), pyridoxine hydrochloride, riboflavin supplement, Vitamin B-12 supplement, biotin, folic acid, Vitamin D-3 supplement, potassium iodide.

As you can see, its pretty much the same thing--in fact, the Fancy Feast is slightly better because it has a bit more muscle meat (chicken) than the DM does. Ingredients are always listed on labels from the most to the least ingredient.

 

[Vidya & Boo]

Friskies is a good, low-carb, inexpensive, and widely available food (only the "pate" flavours are low-carb, though, not the "in gravy" ones). There are enough flavours that you should be able to find something Zeus will like. Don't worry about his weight (unless he becomes very skinny) -- just like with humans, if you're feeding him a good diet and allow him to eat as per his appetite, his weight will settle into whatever his natural set-point is -- it may be anywhere from fairly thin to really fat, but his body will know best what's comfortable for him. As others have said, don't blame yourself for the earlier food change -- myths about body-weight and health, as well as a lack of nutritional knowledge, are just as rampant among vets as amount human doctors, unfortunately.

If you're changing his diet, you definitely want to start home testing right away, as food has the biggest influence on glucose levels. There are lots of threads on here discussing glucose metres, and what's available will differ depending on the country you're in. We use the Accu-Chek Aviva, with Softclix lancets (wielded by hand, not in a lancet pen), and they work wonderfully for us. It takes practice, but you'll get the hang of it!

 

[knolet]

Thank you all so much for the advice - and for the kind words to not blame myself - I so greatly appreciate it!!! This board is awesome, I've learned so much already! I am going to start home testing Zeus, It make so much sense now that you've all explained it - I can't believe Zeus's doctor didn't talk with me about it.

I did buy some of the Fancy Feast canned food, and started mixing in a little to get Zeus to eat. He loved it! So, therefore I loved it :smile:

I know I'm going to have so many more questions when I get the meter. I'm nervous about testing, but I was about giving the injections too until I'd done it a few times.... not that I'm a pro by any means, but I do feel much more comfortable giving them now. It helps that Zeus is normally a pretty mellow cat.

Another question - From what I've read, I'm now scared about Zeus having a hypo attack. How soon after giving an injection would this happen, or can it be predicted? I normally give Zeus his first shot around 6:30 am, and then I have to leave for work about an hour later. I always check on him before I leave, and then I usually come home for lunch about 6 & 1/2 hours after that morning injection. He usually meets me at the door, but today he didn't. He was asleep on the enclosed porch soaking up the sun

Thank you again everyone, thanks for the info, the links, and the support. I'm looking forward to making new friends here, and hopefully I can help someone else too along the way!

Kathie

 

[Sue and Oliver (GA)]

Hypos are very scary and can happen in the early stages of dosing. The best protection is to learn how to hometest. If you test before each shot, you will know that the dose you have given should be safe. That greatly lessens the likelihood of hypo. And a early test before you leave will give you an idea of the way the cycle might go.

We'd encourage you to get the supplies and start tonight. Here is a shopping list:

A human glucometer. Any one that sips and takes a tiny sample is fine. The meters are often free at drug stores; it’s the strips that are expensive. You can, however, buy them on ebay at less than half the price of stores. Lots of people here also like the ReliOn from Walmart. It is an inexpensive meter and its strips are the cheapest around. Try the meter out on yourself or someone else before you try it on your cat. You want to be familiar with it before you poke the cat.

Lancets and a lancet device. Usually, until the ears “learn” to bleed, a 26-28 gauge is good. Any brand will work as long as the lancets match your device.

Ketone strips. (Ketostix) Just like human diabetics use. You will sometimes need to test urine if the numbers are high.

Rice sack. Make this out of thinnish sock, filled with raw rice or oatmeal and then knotted. You heat this in the microwave until very warm but not hot. Then heat the ears before poking.

Also nice to have. Flashlight: so you can look at the ears and find the little capillaries that come off the vein running down the ear. Vaseline: Put a tiny smear where you want to poke. It will help the blood bead up.

And some lo carb treats to give your kitty, successful test or not Lo carb treats

 

[Vidya & Boo]

Another question - From what I've read, I'm now scared about Zeus having a hypo attack. How soon after giving an injection would this happen, or can it be predicted?

Depends on the cat and on the insulin, but generally somewhere around the +3, +4, or +5 hour after the insulin shot. By getting tests at those times when you are home (after the PM shot; on weekends/holidays), you'll find out when Zeus' nadir (lowest glucose point) tends to occur, and also be able to see a pattern between the level of glucose drop and the pre-shot testing levels. Make sure you leave out some wet food for him while you're at work, too -- many cats will 'self-correct' by eating when they feel their blood sugar dropping (as do most humans!).

Another thing you probably want to pick up at the drug store is a small roll of that fabric bandage tape; you can slip it over the finger that you put behind his ear while you are pricking it, to hold the ear steady without pricking yourself! (Unwrap some layers of tape to adjust the size, if necessary.)

 

[cotton]

You don't need the prescription food, canned or dry. The ignredients are nothing but junk (worse than even the cheapest brands of commerical foods) and cost and the food is expensive. Many cats get bored of eating the food after awhile.

So what to feed instead? A low carb commerical canned food that fits in your budget and your cat likes to eat. Some popular brands are Fancy Feast, Friskies, Wellness, Nature's Variety Instinct, and Merrick. Use these food charts: confused_cat

 

[Julia & Bandit (GA)]

Another question - From what I've read, I'm now scared about Zeus having a hypo attack. How soon after giving an injection would this happen, or can it be predicted? I normally give Zeus his first shot around 6:30 am, and then I have to leave for work about an hour later.

Ditto what the others have said--but if you are testing several times a day (before each shot and one or more mid-cycle tests), if a hypo does occur, you will be able to catch it and treat it before it becomes dangerous. Making sure food is available is also a good idea--I work 12 hr days and could not be home to test Bandit mid-cycle during the week when he was on insulin, so I would freeze a portion of canned food and put it in an auto feeder like this one and set it to release the food at his nadir (the point in his cycle where his blood glucose typically drops the lowest). If your cat is not a food-crazy gobbler like mine that needs controlled portions (he will eat everything in his path until he pukes and then eat some more), you can add some water to the food and leave it out, or just leave out a frozen portion.

When you're home and you test and catch a lower number, you simply feed to boost his BG back up into a normal range. This can be low carb food, or higher carb food (you'll want to have a couple cans of this on hand for this purpose--any of the Fancy Feast flavors with gravy are higher in carbs, I used FF gravy lovers), depending on how low he is and if the number keeps dropping.

Following the dosing protocol will also help prevent hypos. When you slowly and carefully raise the dose based on your home testing data, it's far less likely you'll overdose your cat. Remember that the protocol is a guideline, not a hard and fast rule. How aggressive an approach you take getting his blood sugar under control depends completely on how much you are able to test. I worked two jobs and was in grad school when Bandit was on insulin, so I could only test minimally, 4 times a day with a curve on the weekends. This meant I had to be more cautious raising the dose and more liberal in lowering it. Someone who can test 8 times a day would be able to more quickly make dose adjustments because they would have enough data to be safe. It all depends on your lifestyle and how it can best work for you. :smile:

Btw, here is the link to the AAHA guidelines I forgot in my earlier response: http://www.aahanet.org/PublicDocuments/AAHADiabetesGuidelines.pdf

 

[knolet]

A few more questions -- how long does the Lantus last? I thought I read that it should be replaced after 30 days, but the doctor said it was good for 6 months? Also, he said that I could re-use the needle (only once) - so use the same needle for the morning and evening shot. Is that OK to do? It seems that might contaminate the insulin, wouldn't it? And last one for now The doctor told me to inject air into the vial, then pull out a little more insulin that I needed and then push the difference back in. But I was watching a youtube demonstration and the person was saying that it's really bad to do that. What do you think?

Thanks again for all the advice - you're all wonderful, and I'm learning so much from reading the posts.

 

[Larry and Kitties]

I would not reuse the syringes. Not worth the risk.
You might be able to get six months out of a vial before it goes bad. Most users here purchase the five pack of 3 ml disposable pens and draw the insulin out the top through the rubber stopper when pen needles are inserted. Although the cost per ml of the pens is more than the 10 ml vial, many users use up a pen before it goes bad. Thus it is really less expensive.

 

[squeem3]

How to handle and store Lantus: http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=151

The 10 ml bottle may last as little as month, sometimes for a few months. Very few people can use the entire 10 ml to the very last drop. The only way you know if the insulin has popped out is by wonky bgs numbers or if you see white things floating inside the insulin. The SoloStar pens are more economical for most diabetic cats. Each pen is 3 ml and you can use a pen to pretty much the last drop. The pens come in a box of five so that's at least a 5 month supply you have on hand. A box of pens is about $225 or so. Some people have been able to purchase individual pens at the discretion of the pharmacy. Your vet has to specify the prescription for the Lantus SoloStar pens.

Here is a $25 coupon for the Lantus SoloStar pens that you can use later: http://felinediabetes.com/FDMB/viewtopic.php?f=15&t=36964

Do not reuse insulin syringes. The needle gets dull after one use and will cause pain if used again, not to mention you may risk contaminating the insulin.

You don't need to inject air into the 10 ml bottle and you should never inject air into a Lantus SoloStar pen. The pens are designed to work with negative pressure. And never inject extra insulin back into the bottle or pen.