? It's been 2 decades, I'm rusty... helping a newly dxed cat

[Sara and Snoopy's mom]

Hi all,
It's been about 20 yrs since I last had a diabetic cat but I need to get back up to speed fast. I imagine things have changed a bit on the past 2 decades as well
I am helping a friend** whose cat was just diagnosed. ** actually it's a couple but the cat is primarily the wife's so if you see me switch between her and them, that's why. They both own the cats (they had 6 when I met them but they are down to just this one) The wife makes all the decisions about their care.

The vet sent them home with Vetsulin 1U BID and instructions to come back in a week for a spot check, do that for 6 weeks and then the vet will do a curve.
They gave her a transdermal Mirtazapine for her an appetite stimulant. The cat has IBD too.

No mention of home testing. Told to feed cat and then give insulin, if the cat doesn't eat her full meal, give half dose.
Very little instruction about hypos.

I offered to take the cat for a few days to a week to test her BGs. Or rather, to try to!

The cat has been on liquid prednisolone off and on for many years for IBD.


Two years ago Perla was slightly overweight at 11lbs
She is now 8.9lbs


ANYWAY! I've got the cat with me and I need a reminder of when to test and what the BGs should be

The cat has had insulin since Wed with no home testing done.

Because this is a high stress cat, I will not be testing her right away but will be home all the time to watch her for hypos and will test if I need to, I am hoping to ease her into it so if she is indeed, diabetic, she will be easier to test on a daily basis (assuming I can convince the owners to do so)
If she's just borderline diabetic, hopefully she can be diet controlled, now that they see what happens when they continue to feed dry food and tons of treats.

ok so IIRC, it's test (if you do) feed, shoot, wait 2 hrs and test again?
is that the normal protocol for new diabetics?

I've never used Vetsuliin, the bottle actually says to shake it!! and the syringes are TINY.
The owners were offered a different insulin but chose the cheaper one.... not knowing anything feline diabetes and what might be different about them besides the price.


a few questions off the top of my head:

what is a normal fructosamine value
and what is clearly diabetic
and what is borderline or new diabetic?

how long before a curve is usually done?

I've got a Care Touch meter (my own) is that reliable enough?


thanks

 

[Bron and Sheba (GA)]

Hi and welcome back. That is kind of you to help your friends
With Vetsulin...its not the best insulin for cats...you test, feed, wait 30 minutes then shoot.
A far better insulin would be lantus or one of the biosimilar ones. A bit more expensive but worth it.
Fat cats are certainly not healthy cats. I'm glad Perla is now thinner. I remember when Sheba was diagnosed I was told to keep her lean.

what is a normal fructosamine value
and what is clearly diabetic
and what is borderline or new diabetic?

Cats are 191-349 (IDEXX)

how long before a curve is usually done

I would do a preshot test before every dose and then ideally test at +2, +4 +6 until you can see when onset and nadir occur. I think that is more important than a curve at this point. If you want to do a curve you could go it after a week in addition to the other.

I've got a Care Touch meter (my own) is that reliable enough?

I would think that is fine as long as the strips are in date.

BEGINNERS GUIDE TO VETSULIN I would print this off for your friends

I would make sure Perla eats a good meal before the dose and then offer at least 2 or 3 snacks during the first half of the cycles. A snack is one or two teaspoons of low carb food. Do this for the am and the pm cycles.

Are you going to set up a spreadsheet and signature for you friends to use?
HELP US HELP YOU is the link for the SS and signature. Also I would make sure they have a good hypo kit set up in case it is needed.
Ask as many questions as you like
Bron

 

[Sara and Snoopy's mom]

UPDATE she ate. whew. Shot given. Not testing her til she comes out of the carrier, that's her safe space. She's a high strung cat, don't want to stress her out any more than is necessary.

thanks again for all the good info.

 

[Bron and Sheba (GA)]

Well done getting her to eat.
I can see you are in a difficult position and I guess you have to work out what to do with what you have got.
It is a shame they didn't go with a better and less harsh insulin. Vetsulin doesn't last the 12 hours and it onset quickly.
Will she eat during the cycles when she is at home do you think?

 

[Sara and Snoopy's mom]

Reports are that she's been eating well for some time, rarely goes off her food.



They were actually told in Oct 2021 that the cat had high blood sugar and either was diabetic or could be on the verge of becoming so, it's really unclear.

 

[Bron and Sheba (GA)]

Oh dear it is all very sad for the cat.
Certainly getting her onto a low carb wet diet would be a good start and if they give friskies or fancy feast it should not be too expensive.
Giving the dry food is not a good idea at all.
There is a dry food now that is low carb but it is not cheap i dont think.
Young again zero carb which is actually 5% carbs and Dr Elseys Clean Protein.
Then there is the ZIwiPeak air dried raw food that is a bit like dry but is low carb. and Stella and Chewys freeze dried raw.
I dont live in the US so am not aware of prices of dentals but will tag @Suzanne & Darcy and @tiffmaxee as they may know the price of a dental. $2000 does sound excessive to me.

 

[Sara and Snoopy's mom]

Thanks Bron.

They sound very receptive at this point to changing the diet

but they wanted to do the diet change right away while she's on insulin and is not being tested.
They don't understand how insulin works and think that since the vet doesn't want to test her for a week, it will take that long to have any effect at all (which when you think about it, for the uneducated, is not a totally unreasonable assumption)

this is why I offered to try to test her





oh I am sure that a dental has gone up considerably since I last had one done (I lost my Nell in 2016, she had her last dental in 2015 and it was around $450 or so) This was at one of the more reasonable vets with whom I had a long term relationship, I know that other vets in the area were charging $1000 or more. I'm not close to any big urban areas so vet fees tend to be a bit less in this area in general, but since the pandemic and with the severe vet shortage we have here (and I guess in a lot of other places?) vet fees have skyrocketed.

~~~~~~~~~~~~~~
I mentioned the Dr Elseys Clean Protein, turns out that is very easy to get at amazon, Chewys and even Walmart and now that they know what insulin can cost, a dry food that costs $7 a pound doesn't sound quite as bad as they used to think.
Also made up a long long list of perfectly acceptable lower cost wet food that they can give her.

 

[Bron and Sheba (GA)]

If they are going to do the swap to a low carb diet...that is great...but as you know, she will need to be tested during that time as the low carb food will give lower BGs. I'm glad you are there for them.

 

[Sara and Snoopy's mom]

thanks
I hope I didn't bite off more than I can chew, so to speak
I feel so rusty.

 

[tiffmaxee]

If X-rays are needed a dental will be 1500- 2000. I joined VCA Care Club even though I have insurance because it wasn’t covered and I could pay it off monthly. My cat had one extraction too.

 

[Chrispooky12]

I don't know how many teeth cats have, but when Panzer got all but his 2 top canine teeth pulled it cost me right under $900. This procedure was done in October of 2021 right around the time I joined the FDMB. It may vary from state to state though. $2000 is absolutely ridiculous but if they can afford it then I'm very happy for the kitty. I know it helped Panzer tremendously. You are an absolutely amazing person for helping this kitty. Good luck & I hope this kitty gets the care she deserves!

 

[Sara and Snoopy's mom]

If X-rays are needed a dental will be 1500- 2000. I joined VCA Care Club even though I have insurance because it wasn’t covered and I could pay it off monthly. My cat had one extraction too.

yeh those are prices I'd expect for California, but for NH, it's a bit high.
Oh, this cat's people use Care Credit for their own dental needs (whatever isn't covered by their insurance) I wonder if they know you can use it for the cats? I used to use it for my Nell. Most vets will give them a promo period of a year with no interest.

 

[Sara and Snoopy's mom]

I don't know how many teeth cats have, but when Panzer got all but his 2 top canine teeth pulled it cost me right under $900. This procedure was done in October of 2021 right around the time I joined the FDMB. It may vary from state to state though. $2000 is absolutely ridiculous but if they can afford it then I'm very happy for the kitty. I know it helped Panzer tremendously. You are an absolutely amazing person for helping this kitty. Good luck & I hope this kitty gets the care she deserves!

Not sure where you live, but that's more in line with what I would expect for this area. The $2 grand quote is most likely the high end, if everything that can go wrong does, estimate, the lower end of the estimate is probably closer to half that. I have gotten super high estimates for dentals but they had included the possibility of the cat's jaw breaking! eep! which thankfully isn't common and didn't happen. I guess it was possible as one of her bottom teeth had broken off and they had to go digging for the root. I think this is what alerted us to her having the FORLs.

thanks for your input. Yes a dental would be a big help to this cat. I hope they go forward with it.

 

[Sienne and Gabby (GA)]

Sara --

As usual, Bron and others are providing great information.

A couple of things to consider...
Vetsulin is a harsh insulin. It can drop numbers hard and fast. This is the reason you need to be sure food is on board before giving insulin. I'm wary of starting this cat on 1.0u of Vetsulin if no one is home testing. I do think that getting the kitty on a low carb diet is a good idea BUT, between changing the diet and not testing, I'd consider a lower dose (like 0.5u). Also, you can always add corn syrup (Karo or other brand), maple syrup, honey, etc. to Perla's food if you're concerned that numbers are dropping.

It's quite possible that Perla's numbers were elevated at the vet's office. For a skittish cat, a car ride and visit to the vet can cause blood glucose (BG) numbers to skyrocket. Having fructosamine results would help. This is a link to information on how to interpret fructosamine results.

In addition to vet stress, if Perla has been prescribed prednisolone, this may be contributing to elevated numbers or this may be a steroid induced diabetes. If so, the steroid may be necessary to control the IBD. I'm also guessing your friends are not terribly knowledgeable about how to manage IBD. Getting Perla on a diet of novel proteins may help. We have members with IBD kitties so we can offer some assistance with that, as well.

If it weren't enough, if Perla needs a dental, it may be the dental issues that pushed the BG numbers over the edge. Any source of infection or inflammation will inflate BG numbers. We often see diabetic cats that have gone into remission who then have dental issues and are back in diabetic numbers.

 

[JL and Chip]

Hi Althea - welcome back. It’s so nice of you to step up to help your friends and their cat. By the way, I still have a few of your catnip toys. They were always favorites with my crew.

I encourage you to try testing soon. As has been pointed out, Vetsulin is not a good choice for cats (harsh, short duration) and you really need to get some data to make sure it’s safe to shoot insulin, especially if you’re already questioning the diagnosis. The food change to low carb canned makes it doubly important to test, as switching to low carb can significantly reduce BG.

If you need a crash course on more suitable insulins, we can help you get up to speed. Lantus, which is a human insulin (or the much cheaper biosimilars), seems to be the go-to choice these days. Prozinc is a pet insulin and is also a good choice.

Important Note: if you switch insulins, you might need different insulin syringes (due to differing strengths/concentrations of the insulins). Just ask and we’ll help you.

Are you continuing the prednisone while the cat is with you? Steroids can definitely affect BG. Do you have any info on what the symptoms were or how it was diagnosed? It’ll be interesting to see whether you see any signs while the cat is at your home. My Charlie had IBD and he ended up being a steroid-induced diabetic. When we stopped prednisolone, his blood glucose went back to normal range and he went off insulin quickly. If steroids are needed, budesonide often has less impact on BG than prednisolone.

Remember that stress can elevate BG, so whether it’s stress from the vat clinic or stress from transitioning to your home, it might affect BG for awhile until the kitty settles in. Just give things time to shake out and try to collect as much BG data as you can in the meantime.

Spreadsheets for tracking BG data are a big thing here now (they didn’t exist when I joined, so you might not be familiar either). They’re actually very helpful, so if you are willing, it would be great to get one going. Bhooma (Bandit’s Mom) can set one up for you in a few minutes if you’re interested. @Bandit's Mom

 

[Sara and Snoopy's mom]

removed all speculation for now and accidentally removed the whole post, sorry! I can't recall what I wrote and don't have time to re write it now
will be back later

 

[Sara and Snoopy's mom]

Hi Althea - welcome back. It’s so nice of you to step up to help your friends and their cat. By the way, I still have a few of your catnip toys. They were always favorites with my crew.

I encourage you to try testing soon. As has been pointed out, Vetsulin is not a good choice for cats (harsh, short duration) and you really need to get some data to make sure it’s safe to shoot insulin, especially if you’re already questioning the diagnosis. The food change to low carb canned makes it doubly important to test, as switching to low carb can significantly reduce BG.

If you need a crash course on more suitable insulins, we can help you get up to speed. Lantus, which is a human insulin (or the much cheaper biosimilars), seems to be the go-to choice these days. Prozinc is a pet insulin and is also a good choice.

Important Note: if you switch insulins, you might need different insulin syringes (due to differing strengths/concentrations of the insulins). Just ask and we’ll help you.

Are you continuing the prednisone while the cat is with you? Steroids can definitely affect BG. Do you have any info on what the symptoms were or how it was diagnosed? It’ll be interesting to see whether you see any signs while the cat is at your home. My Charlie had IBD and he ended up being a steroid-induced diabetic. When we stopped prednisolone, his blood glucose went back to normal range and he went off insulin quickly. If steroids are needed, budesonide often has less impact on BG than prednisolone.

Remember that stress can elevate BG, so whether it’s stress from the vat clinic or stress from transitioning to your home, it might affect BG for awhile until the kitty settles in. Just give things time to shake out and try to collect as much BG data as you can in the meantime.

Spreadsheets for tracking BG data are a big thing here now (they didn’t exist when I joined, so you might not be familiar either). They’re actually very helpful, so if you are willing, it would be great to get one going. Bhooma (Bandit’s Mom) can set one up for you in a few minutes if you’re interested. @Bandit's Mom

Hi JL and Chip,
nice to see you again. Wow you've still got some of the catnip toys? that's great, I'm glad your crew liked them. Although I was aware of one body pillow that was machine washed and dried and survived two cats and last I heard, it was in still in use after 20 yrs of being loved on! (I still make them if you need more LOL)

OK I had posted a bunch of stuff that was mostly speculation, information is trickling in from the owners and I will have the lab results in an hour or so, the husband will be dropping them off
so more later!






thanks so much JL (and everyone else) for all your great advice and support.
I never thought I'd be back here, but it's so nice to know that folks are still as wonderful as they were when I had my last diabetic Snoopy.