Just Diagnosed

[Theo33]

Théo was just diagnosed with diabetes. He is 15 years old, 11.5 lbs, and has been on a low carb diet for the last 7 years. Théo’s blood glucose was 330mg/dl all other tests results were normal except cholesterol which was high. He has been prescribed Novalin N insulin without daily glucose testing. The vet said we should judge by Théo’s physical presentation. Théo is to return to the vet in 3 weeks for additional bloodwork. Given all that I have read on this board and discussion with other diabetic feline guardians this seems highly unusual. If the AAHA has not recommended Novolin N for cats since 2018 there would have to be a very good reason for choosing that form of insulin. That reason was not shared with me. The lack of daily glucose testing is baffling.
Has anyone else had Novolin N prescribed for their diabetic cat and/ or no daily home testing of blood glucose?

 

[Tim & Pookey]

Welcome! Unfortunately, it is pretty common for folks to land here with the same instincts that you have about the insulin and home testing. I think there are a couple reasons or factors as to why some veterinarians don’t push home testing. Regardless, we’re big believers in it being the only way to keep your cat safe.

Can you see about getting Lantus or Prozinc?

Just basic human diabetic supplies will work for home testing. ReliOn or equivalent meter and 28 or 30G lancets.

Some good information in here getting started:
Sticky - New? How You Can Help Us Help You!

 

[CORKY]

Welcome to FDMB
Tim & Pookey is right, instincts are our best friend, the best insulins for cats are Lantus and ProZinc, they are a 12-hour insulin gentle on the cats' system, also home testing is a priority, judging by Théo’s physical presentation, is insane, cats hide illnesses very very well, and hypoglycemia is not a pretty site aside from the fact that it puts at risk your cat's health and heart, even death, You can purchase as Tim said the ReliOn Premier monitor and strips (Walmart) the meter is $9.00 and the strips are $9.00 for 50 or $17.88 for 100, is always good to have extra strips handy. you do not need a Pet meter, any human meter is just as accurate; so, Testing before each shot is very important to avoid hypoglycemia, you should request your vet to prescribed Lantus or ProZinc, it is your cat, you are in control, you want what is best for your cat, also if your vet speaks about doing a curve on Theo, this can be done at home, is simply testing every 3-4 hours for a cycle (12 hours) cats are very sensitive to stress, what better way to stress Theo than a vet visit for a whole day inside a cage, so the curve glucose levels done at the vet will be unrealistic, high, this can cause an unnecessary dose increase.
There's is also the option of the CGM , continuous monitoring by ABBOTT, link below
Diabetic cats need to have a diet of wet can or raw foods between 0-10% carbs, should be on a feeding schedule with 3-4 small meals or snacks during the day to keep the insulin in check, besides the two main meals before each shot. Link for a Drs approved food list below the third column contains the carb %, we look for Dry matter Carbs, do not feed any diabetic food or "prescribed" food they contain between 18-30% carbs, cats cannot digest carbs. so no kibbles, no grazing
We are very numbers oriented, we would love to help you stabilize Theo, we would like you to create your signature and Theo's spreadsheet this way we can all be on the same page6, keep posting we are here for you. if you have difficulty creating the SS let us know we would be more than happy to create it for you, there are sticky notes in our Main Menu that have much valuable information, and it does gets easier!

Sticky - New? How You Can Help Us Help You!
https://felinediabetes.com/FDMB/threads/how-to-create-a-spreadsheet.241706/
Info - Dr. Pierson - new Food Chart
Getting Started With Continuous Glucose Monitors (CGMs) for Diabetic Cats

 

[Theo33]

Welcome! Unfortunately, it is pretty common for folks to land here with the same instincts that you have about the insulin and home testing. I think there are a couple reasons or factors as to why some veterinarians don’t push home testing. Regardless, we’re big believers in it being the only way to keep your cat safe.

Can you see about getting Lantus or Prozinc?

Just basic human diabetic supplies will work for home testing. ReliOn or equivalent meter and 28 or 30G lancets.

Some good information in here getting started:
Sticky - New? How You Can Help Us Help You!

Thank you. I have requested Lantus be prescribed. The vet did not think Prozinc was appropriate based on Théo’s numbers. He agreed to write a prescription for Lantus.

 

[Theo33]

Welcome to FDMB
Tim & Pookey is right, instincts are our best friend, the best insulins for cats are Lantus and ProZinc, they are a 12-hour insulin gentle on the cats' system, also home testing is a priority, judging by Théo’s physical presentation, is insane, cats hide illnesses very very well, and hypoglycemia is not a pretty site aside from the fact that it puts at risk your cat's health and heart, even death, You can purchase as Tim said the ReliOn Premier monitor and strips (Walmart) the meter is $9.00 and the strips are $9.00 for 50 or $17.88 for 100, is always good to have extra strips handy. you do not need a Pet meter, any human meter is just as accurate; so, Testing before each shot is very important to avoid hypoglycemia, you should request your vet to prescribed Lantus or ProZinc, it is your cat, you are in control, you want what is best for your cat, also if your vet speaks about doing a curve on Theo, this can be done at home, is simply testing every 3-4 hours for a cycle (12 hours) cats are very sensitive to stress, what better way to stress Theo than a vet visit for a whole day inside a cage, so the curve glucose levels done at the vet will be unrealistic, high, this can cause an unnecessary dose increase.
There's is also the option of the CGM , continuous monitoring by ABBOTT, link below
Diabetic cats need to have a diet of wet can or raw foods between 0-10% carbs, should be on a feeding schedule with 3-4 small meals or snacks during the day to keep the insulin in check, besides the two main meals before each shot. Link for a Drs approved food list below the third column contains the carb %, we look for Dry matter Carbs, do not feed any diabetic food or "prescribed" food they contain between 18-30% carbs, cats cannot digest carbs. so no kibbles, no grazing
We are very numbers oriented, we would love to help you stabilize Theo, we would like you to create your signature and Theo's spreadsheet this way we can all be on the same page6, keep posting we are here for you. if you have difficulty creating the SS let us know we would be more than happy to create it for you, there are sticky notes in our Main Menu that have much valuable information, and it does gets easier!

Sticky - New? How You Can Help Us Help You!
https://felinediabetes.com/FDMB/threads/how-to-create-a-spreadsheet.241706/
Info - Dr. Pierson - new Food Chart
Getting Started With Continuous Glucose Monitors (CGMs) for Diabetic Cats

Thank you. Théo has been on Young Again Zero Mature (dry zero carbs) for 7 years with Wellness Complete Health (wet 4 carbs). The vet has agreed to prescribe Lantus. Théo’s glucose numbers were down to 168 ml/ dl during the day and half of testing. The vet said he is on a low dose while I am away and will start adjusting (if needed) and monitoring glucose when I return. I have a vet tech pet sitter who is familiar with diabetic treatment. Not sure what else I can do at this point.

 

[Tim & Pookey]

I’d encourage you to read some of the information at the top of the Lantus forum about making dosing decisions. Not bashing your vet, but just based off what you’ve said so far, I’d be surprised if they were following a proven approach for how to make dosing decisions. I could be wrong though.

Are you going on a trip?

Even if the dose is small (what is the dose they want you to start at?), there can be risk of low blood glucose. Hopefully the sitter can get some tests in.

 

[Theo33]

Thank you. I will read the Lantus forum sticky notes.

Yes, unfortunately, Theo was just diagnosed as I am about to leave on a trip I can’t change.

I don’t have the new prescription yet, but the Novolin N was 2 units per shot (u-100 insulin .5ml syringe). Not sure if that information is helpful.

 

[CORKY]

Thank you. I have requested Lantus be prescribed. The vet did not think Prozinc was appropriate based on Théo’s numbers. He agreed to write a prescription for Lantus.

I find that your vet is inconsistent in the information he gives you neither insulin is any different according to the cats glucose levels, perhaps you should inquire weather your vet has updated knowledge on Feline Diabetes, but I’m happy to know he gave you the script for Lantus, I also hope Theo was placed on a low dose, all cats are different and react different to insulin we increases and decreases should be done in 0.25 unit increments especially that you will not be home for Theo even though you have a sitter that’s a vet tech. Have a safe trip

 

[squeem3]

Did the vet do a fructosamine test to dignose the diabetes? Or was routine blood work done and the blood glucose level was 330? The blood glucose test in regular blood work only shows what the level is at the time of blood draw and many cats will have a super high level. It's unusual that the low carb diet your cat was already would cause diabetes. Is it canned food under 10% carbs? Does your cat take steroids for another health condition?

You want to use U100 3/10 cc (0.3 ml) syringes that have half unit markings. It's generally advised that newbies start insulin at no more than 1 unit twice a day
Insulin can pack a punch.

 

[Theo33]

Did the vet do a fructosamine test to dignose the diabetes? Or was routine blood work done and the blood glucose level was 330? The blood glucose test in regular blood work only shows what the level is at the time of blood draw and many cats will have a super high level. It's unusual that the low carb diet your cat was already would cause diabetes. Is it canned food under 10% carbs? Does your cat take steroids for another health condition?

You want to use U100 3/10 cc (0.3 ml) syringes that have half unit markings. It's generally advised that newbies start insulin at no more than 1 unit twice a day
Insulin can pack a punch.

Thank you. I asked several times about doing the fructosamine test. I finally got an answer that it would be done after the trial period.

A senior panel and T4 level tests were done.

The Lantus dosage was prescribed as 1-2 units every 12 hours. I will do 1 unit not 2. Again, odd that the dose was not definitive.

I also thought it odd that a cat on a low carb diet, not overweight, not on any medications and no other health issues would have diabetes.

The canned food is under 10 carbs; it has 4 carbs.

 

[Theo33]

I find that your vet is inconsistent in the information he gives you neither insulin is any different according to the cats glucose levels, perhaps you should inquire weather your vet has updated knowledge on Feline Diabetes, but I’m happy to know he gave you the script for Lantus, I also hope Theo was placed on a low dose, all cats are different and react different to insulin we increases and decreases should be done in 0.25 unit increments especially that you will not be home for Theo even though you have a sitter that’s a vet tech. Have a safe trip

Thank you. We are doing 1 unit every 12 hours.

I am concerned by the vet’s inconsistencies. It is a well regarded veterinary practice that has been around for 40 plus years. I want to make sure my cat’s treatment reflects current best practice for his situation.

 

[CORKY]

good, because is either 1or2 units, not 1-2 units, when you return from your tip, perhaps you should incest a little bit of time searching for a vet that has knowledge on Feline Diabetes, he can have 60 years experience, he most likely is a great Vet, that does not mean he is schooled on the new Feline diabetes protocols, sometimes the older the vet has been around they are usually set in their ways there has been so many new studies and discoveries on Feline Diabetes! so you do not need a specialist, just a vet that when you ask the questions of everything you have learned here so far are answered properly. also, I if you do decide to seek another FD experienced vet, I would hold off the fructosamine test for the new vet. and if you do, make sure to take all the lab test that Theo has done, they are yours you paid for them

 

[squeem3]

Adding that stress elevates blood glucose levels so the 330 was most likely a vet stress influenced number.

Does your cat have any of the typical symptoms of excessive urination of sugary-smelling pee, weight loss but always hungry?

How long is your trip? I suggest holding off on insulin until you return. Many cats don't do well if their owner is away and they start a new routine of medications with a stranger who may or may not have much experience especially when it comes to needles and measuring doses correctly.

When do you go on the trip? If you have a few days, I suggest buying a Human blood glucose meter from any pharmacy and learn how to test your cat's levels. If you have a local Walmart store, the Relion brand of meters sold there is popular with US FDMB members. The basic no frills meter is all you need (Premier Classic, I think). If you don't have a Walmart, any pharmacy like CVS or Walgreens or Costco sells a few different brands like AccuChek and Bayer and Freestyle. If you have Amazon Prime and can get next day delivery, that's another option but stick with brand names just in case you ever need to run out to a store pharmacy to buy more test strips because you forgot to order more online. And use the FDMB affiliate link so the board gets a donation at no cost to you (plugging for @Tim & Pookey ) Amazon

Normal cat blood glucose level is roughly 60 to 150 mg/dl. Test randomly a few times a day if you can. Hometesting Links and Tips

 

[Wendy&Neko]

Unless you have confirmation that he has no ketones, I would not stop insulin while you are away. You can use Ketostix or similar to test for urinary ketones. Tips to catch and test a urine sample

Novolin N is an insulin sometimes suggested for dogs, who have completely different metabolisms than cats. Some vets have more experience with dog diabetics.

 

[Theo33]

Adding that stress elevates blood glucose levels so the 330 was most likely a vet stress influenced number.

Does your cat have any of the typical symptoms of excessive urination of sugary-smelling pee, weight loss but always hungry?

How long is your trip? I suggest holding off on insulin until you return. Many cats don't do well if their owner is away and they start a new routine of medications with a stranger who may or may not have much experience especially when it comes to needles and measuring doses correctly.

When do you go on the trip? If you have a few days, I suggest buying a Human blood glucose meter from any pharmacy and learn how to test your cat's levels. If you have a local Walmart store, the Relion brand of meters sold there is popular with US FDMB members. The basic no frills meter is all you need (Premier Classic, I think). If you don't have a Walmart, any pharmacy like CVS or Walgreens or Costco sells a few different brands like AccuChek and Bayer and Freestyle. If you have Amazon Prime and can get next day delivery, that's another option but stick with brand names just in case you ever need to run out to a store pharmacy to buy more test strips because you forgot to order more online. And use the FDMB affiliate link so the board gets a donation at no cost to you (plugging for @Tim & Pookey ) Amazon

Normal cat blood glucose level is roughly 60 to 150 mg/dl. Test randomly a few times a day if you can. Hometesting Links and Tips

Théo has lost weight and he is always hungry. The appetite is not new, but the weight loss is. I thought it was thyroid but his T4 is normal. I can’t detect a sugary smell from his pee.

I am gone for 18 days. The vet tech is experienced with giving pets insulin.

I have been looking at insulin testers. Thank you for the suggestion. I will pick one up tomorrow.

 

[Theo33]

Unless you have confirmation that he has no ketones, I would not stop insulin while you are away. You can use Ketostix or similar to test for urinary ketones. Tips to catch and test a urine sample

Novolin N is an insulin sometimes suggested for dogs, who have completely different metabolisms than cats. Some vets have more experience with dog diabetics.

Thank you. I now have Lantus insulin.

 

[Theo33]

good, because is either 1or2 units, not 1-2 units, when you return from your tip, perhaps you should incest a little bit of time searching for a vet that has knowledge on Feline Diabetes, he can have 60 years experience, he most likely is a great Vet, that does not mean he is schooled on the new Feline diabetes protocols, sometimes the older the vet has been around they are usually set in their ways there has been so many new studies and discoveries on Feline Diabetes! so you do not need a specialist, just a vet that when you ask the questions of everything you have learned here so far are answered properly. also, I if you do decide to seek another FD experienced vet, I would hold off the fructosamine test for the new vet. and if you do, make sure to take all the lab test that Theo has done, they are yours you paid for them

Thank you. I will be looking for a vet with current feline dIabetes treatment knowledge. I have started checking other options.

 

[CORKY]

Great news on both counts! great decision