Lily needs some help

[Fluffykittycat]

Hello,

My lovely cat, Lily (Russian Blue), was diagnosed with diabetes in January of last year. We received some not great vet advice- no need for insulin just change her diet-which subsequently resulted in Lily getting really sick and starting to show problems on bloodwork with lipidosis flags.

We found a new vet who had a stronger approach to treatment-insulin plus diet change. To make a long story short, we also discovered that Lily is allergic to most cat food. She now has access throughout the day to Royal Canin dry Hypoallergenic food and eats Fancy Feast canned food. We seem to go along really well until something else happens and it is starting to take it's toll on both of us.

I do weekly spot testing of her blood glucose since I live rurally and getting the little test strips is not that easy. What I was noticing about the spot testing is that she was starting to climb up in numbers again. The vet, through email, advised that I increase her dosage but she suddenly experienced a low (hit a 2 on the Alpha Track machine). Weeks went by and the numbers climbed again. I took her in to the vet to get checked out after I also noticed that her back legs seemed shaky and she wasn't jumping as much.

The bloodwork came back with her improving on one of her liver values but still not out of the clear for lipidosis, she may have ketones, and her fructosamine test said she was 624, which the vet described as really bad. Her insulin dose has been increased to 3 units in the morning and 3 at night. I use a Lantus injector pen and she doesn't seem to mind too much having insulin since she also gets a freeze dried turkey treat.

Today is our first attempt at a blood curve and I am already concerned about her numbers. We don't seem to have much of a curve and instead have more of a gentle dip and we are back up to the high numbers again (20.9, 18.3, 20.9). All of those numbers are directly after some morsel of food. My questions for the wonderful people out there are:

How do I know if the high numbers are related to ketones?
Can minor ketones be treated at home?
How quickly do bg values come down after an increase in insulin?
Does the fact that I am bribing her to stay still, with a turkey morsel, artificially increase her values?

I appreciate the help and guidance of the forum as I have been learning a lot about how to help my cat through reading the posts. I'm not finding the treatments very successful and I am very concerned about losing my cat to a disease which should be treatable.

 

[Suzanne Burton]

@Chris & China (GA) @MrWorfMen's Mom @Nan & Amber (GA) @Bron and Sheba (GA) @Red & Rover (GA) ; Hi, I'm just tagging some people that I know will be able to answer all of your questions. The one question I have would be is if you could put Lily on all canned food? The kibbles are just too high in carbs and send the BGs soaring.

 

[Chris & China (GA)]

How do I know if the high numbers are related to ketones?

While we worry more about ketones when the numbers are high, they can actually be produced at any BG number. Ketones are a by-product that's produced when there's not enough insulin to get the glucose from food into the cells, so the body starts to burn it's own fat and muscle to try to "feed the cells". You can use urine ketone strips or buy a special meter that measures blood ketones to test and see if there are ketones present and how high they are.

Can minor ketones be treated at home?

Sometimes....if they are over "trace" though, that really needs vet intervention. If "trace", getting fluids, extra food and lots of testing is required if you're going to try to treat at home.

Does the fact that I am bribing her to stay still, with a turkey morsel, artificially increase her values?

As long as the turkey is plain turkey (no added sugars), it shouldn't effect the numbers.

How quickly do bg values come down after an increase in insulin?

This is a very complicated question and not easy to answer. First, how were your doses increased? By whole units at a time? (like from 1 to 2 to 3?) It sounds like that might be the case since you say you're using the pen. We don't recommend using the special pen needles because cats need to be increased in much smaller increments so you don't bypass what could be a "good" dose. Too much insulin can look like not enough. We only recommend increasing in .25 to .5 unit increments. You can buy regular insulin syringes with half unit markings and pull the insulin out of the pen.

Next, only testing weekly isn't enough. We test before every shot and (if possible) test at least once mid-cycle on the AM cycle (to see how low the dose is taking her) and then at least a "before bed" test on the PM cycle. Most cats go lower at night so it's important to do those "before bed" tests.

Where do you live? We know the strips for the AlphaTrak are crazy expensive, so we recommend using human meters that are cheaper to use and there are places you can order them online to be shipped to you too so being rural wouldn't matter as much.

We have a spreadsheet we all use that really helps us to help you. Getting a spreadsheet set up for Lily and recording your tests will really help. Here are the Instructions on getting the FDMB spreadsheet

It will also help if you'll fill out your signature (the gray words you see below all our comments). If you go to your sign on name (top right of the page) and click, there's a drop down menu. Choose "Signature" and a new box will pop up. In that enter some general information like:

Your name/cat's name, age, sex, date of diagnosis, type of insulin, type of meter, type of food, any other health problems or meds? and a general location. When you have your spreadsheet set up, the link will go here too.

Suzanne is also 100% correct...if Lily can tolerate the Fancy Feast Classics, they are much better for her, both by being low carb and by getting extra water into her. Kibble is too high carb for a diabetic cat.

Hang in there! There's a lot of help here and the people here are very generous with their time and experience. Hopefully we can help you have many more years of love from your "extra sweet" girl.

 

[Sienne and Gabby (GA)]

I have a few suggestions...

Testing - more is better. Occasional spot checks really don't tell. you very much. Lantus dosing is based on the lowest number in the cycle, the nadir. Depending on when. your testing and if you've not run a curve, you don't know when Lily's nadir is. I'd suggest you set up a spreadsheet. This is the link to the instructions. We are very numbers driven and need to see Lily's test results in order to be able to give you any suggestions about dosing. In addition, home testing is the only way to keep your cat safe. The bare minimum number of tests is 4 -- a test before you give a shot and another step during both the AM and PM cycles. Most of us test more than the minimum. Also, you can order strips online, Amazon, Ebay, and ADWDiabetes all sell strips and are usually considerably discounted compared to buying strips at a pharmacy. If you are using a Relion meter, you can also order strips from Walmart online.

Food - The Royal Canin dry food is over 40% carbohydrate. That's astronomically high in carbs. Fancy Feast, if you are using the pate style food is probably around 5%. A diabetic cat should be getting food that is less than 10% carb. You might want to consider a raw food diet using novel proteins. The protein source in the Royal Canin is either duck or rabbit. Both are available as raw or freeze dried that you can reconstitute. The other issue with dry food is the low moisture content. Cats do not have an inherent thirst drive. This is why canned food is so much better for our kitties. The high moisture content in canned food is good for their kidneys. Diabetes is tough on the kidneys and dry food makes it tougher. Chances are the high numbers after a "morsel" of food are due to the dry food.

Ketones - High numbers are not necessarily indicative of ketones. Ketones develop if there's an infection or inflammation + not enough insulin + not enough calories.. Cats can develop ketones when numbers are in lower ranges. Trace levels of ketones can be treated at home but be aware that trace can go to critical very quickly. More calories, adding water to food and insulin are key. But, you will have to be testing both for glucose and for ketones. You can test urinary ketone with Ketostix.

Dosing - Lantus is a depot type of insulin. It takes approximately 3 days/6 cycles for the depot to stabilize after any change in dose. However, we encourage people to use a syringe and not the pen for dosing. The pens will only permit dose adjustments in 1.0u increments. We change doses in 0.25u amounts.

Bribing - a small bit of pure protein will not have an immediate effect on numbers. If you're giving a treat, testing, then feeding and giving a shot all within a 10 - 15 min window, the treat will have virtually no effect. The turkey needs to be digested for it to have any influence on numbers.

Please read the sticky notes at the top of the board if you've mot already done so. There's an overwhelming amount of information in those posts.

 

[Bron and Sheba (GA)]

You have had great information from Sienne and Chris.
I would also consider a raw diet as Sienne suggested.

When you swap from the dry food to the low carb food, do it slowly and make sure you are monitoring the blood glucose levels closely. With the withdrawal of the high carb dry food, the BGLevels can fall by more than 100 points. By doing it slowly and testing frequently, you will be able to catch the drops in the BG level and adjust the dose of insulin to keep Lily safe.

I would suggest you post on here and say you are doing the swap to low carb food so that we can watch and help you with any changes that need to be done with the dose.