Lily, newly diagnosed, lots of questions and in need of recommendations!

Hi everyone!

First off, so happy this place exists. I've already learned a lot from the threads I've browsed. Feel free to read this all or just skip to my questions at the bottom if you'd like! I'll bold them to make them easier to see.

A week ago today, my family's cat Lily was diagnosed with diabetes, which came with a lot of guilt, anxiety, and sadness over how this happened. She lives with my parents while I live about an hours flight away, but come home often and take care of all of her health issues and vet visits. We video chat often and noticed two weeks ago that she was drinking a lot of water and seemed generally uncomfortable. I flew back last Wednesday and immediately noticed that she looked ragged and lost weight. She was now about 9.5 lbs from her usual 11.2.

Luckily we had a cat vet visit already scheduled for the next day, which was supposed to be a follow up after a different health scare during the summer (repeated diarrhea that lasted for about a month but resolved on its own). After describing the symptoms, the vet did a physical check up and very strongly suspected diabetes. They ran bloodwork and urine - BG was 463 mg/dl and fructosamine was 433. The vet also mentioned ketosis (maybe not the right term) but after examining the urine, said ketones weren't found in her urine, just her blood, which I guess was a "positive?" This terminology is all so new to me! She did however have a lot of bacteria in her urine, e.coli specifically, so she was prescribed amoxicillin. She's been having that am/pm in liquid form. However, it's so sweet smelling, I'm curious if that impacts her numbers at all.

We got sent home with Prozinc, syringes, and a recommendation to purchase the AlphaTrak3, which I ordered that day. We were told 1 unit every 12 hours. Amazon had a delay in shipments so it didn't arrive til Monday (11/6) evening. Since arriving, I've tested before each shot, although, I didn't realize til yesterday that I should test before she eats. The vet also mentioned only shooting if her BG was above 250. You can see in the spreadsheet what the numbers were, but for two of those times, I didn't give her any insulin. I gave all of the updated readings so far to my vet, and he said we could do a more refined dosing, so .5u if BG is above 200 but below 250, and 1u if above 250.

Now for food. She previously would free feed from dry food all day, with on serving of wet food for dinner, mixed in with Proviable DC as her probiotic (started during her diarrhea woes). She'd also get a lot of Temptations treats, about 10 a day max. She hasn't had any dry food or treats since last Friday 11/3, and I'm actively trying to find a good low carb high protein pate for her to switch to. We tried the Tiki Luau pate and she doesn't even recognize it as food. So, for now, I've been mixing about 1-2 teaspoons of her favorite Sheba Perfect Portions to trick her into eating the pate. That's been working but definitely isn't a long term solve.

Questions!

1. Diet - Does anyone have recommendations for pate foods that are smelly and enticing? I know Fancy Feast Classics are the recommended starting foods here, but I'd like to try some others with slightly better nutrition before going to FF. I have a feeling she'd like the FF so would rather keep it as a backup. And with figuring out nutrition, should I be looking at the protein/carb percentages with moisture included? Or the dry matter numbers? I'm reading that food should have protein % above 40 and carbs % below 10 - are those numbers for dry or with moisture? I've looked at so many food spreadsheets at this point and it's really overwhelming!

Also, does anyone have recommendations on treats? She really loved Temptations and I want to find a replacement for her that she's excited by. The vet recommended freeze dried proteins, but she won't even look at them!

Are there recommended supplements? She seems to be prone to UTIs and I also want to make sure I'm helping her any way I can. I read about one on a thread here that was for UTI prevention but can't recall the name.

2. Testing - I've noticed in other spreadsheets that people test quite frequently, sometimes every hour, rather than just twice with each shot. Is there a reason for doing that regularly? Rather than doing it every once in a while? I know it makes sense for a curve, but doing it on a day to day seems like a lot. The process is pretty stressful and I really hate poking her so would love to test the right amount of times but not go overboard and stress her out. It's also expensive! We've already gone through so many lancet needles and I know the test strips are expensive too, although we should be covered on those for a bit.

3. Remission - I don't want to expect that this will happen but of course it would be the best case scenario. Our vet mentioned Lantus vs Prozinc at the time of our visit, but I was so overwhelmed with the info, I didn't fully hear or understand that Lantus has a better chance for remission. We have a follow up on 11/22, is it worth asking if we should switch? Her water consumption has definitely gone down and she's been looking a little better, so the doctor said that's a sign the Prozinc is working, I'm just getting paranoid and want to do the absolute best for her.

Like I said above, I don't actually live with her full time, just when I visit my parents, although I do tend so stay for really long periods of time because luckily I WFH. So I've cancelled my original flight to go back and am committed to getting her regulated and healthy, fingers crossed.

 

Prozinc is a great insulin so you’re off to a great start! And thank you for setting up the spreadsheet

Ill try to answer most of your questions, but also tagging @Bron and Sheba (GA) since you mentioned ketones.

getting her off dry is ideal so also great job there. Honestly, it’s whatever they’ll eat. Mine would only eat fancy feast so I stayed with that. Here’s the FOOD CHART we go by, have a look on this chart and choose foods that are under 10%. You will also need some higher carb foods for that hypo box..information in the help us help you link.

it’s always a good idea to give them a probiotic but not specific supplement that I know of for diabetes.

best treats are freeze dried. Anything by PureBites or VitalEssential works. You can also give baked chicken and some most lickables are low carb. Mine also love Bonita flakes.

for daily testing, we recommend at least 4 times. Preshots, and yes you need to withold food for at least 2 hours for those, then one more around midday to try to catch the nadir and also a +2 in the evening to see where the numbers are headed for the night since most cats tend to go lower at night. I don’t agree with your vet about only giving insulin if she’s above 250. A diabetic cat needs consistent insulin as in twice a day, especially if there were ketones there. No insulin equals ketones. I’d strongly recommend that you give 1 unit if she’s above 200. If she’s under, you have 2 options. You can stall without giving food and retest in 20 minutes to see if the bg is going up on its own. Or you can give a token dose, 15-20% of the regular dose. Tagging @Suzanne & Darcy who is experienced with prozync. We have 2 dosing methods here SLGS and the modified TR. you can read more about both in the prozinc forum here https://felinediabetes.com/FDMB/forums/prozinc-pzi.24/ and I suggest you also read all the yellow sticky notes

Pet meter test strips are expensive which is why most of us use h

This is an excellent site for diabetic cats…it has been around for more than 25 years and has very experienced people to help you.

Keep asking lots of questions.

 

As far as remission, your best chance is to be consistent with the dosing. With Lantus, TR has the best remission rate and I got Bobo into remission on that. You could try the modified TR with prozinc. Also worth mentioning that changing the diet to all low carb foods can help tremendously with remission. You’re already seeing some blues there so I’m guessing shes a good candidate and also the 1 unit may be too much. It may be best to give .5 unit so you can be more consistent but let’s see a few more days if data.

 

Welcome to FDMB!

This is a link to information on feline nutrition. The chart that Ale linked comes from the linked webpage. We consider low carb as lower than 10% although, most members feed their cat food that's in the neighborhood of 5%. Members lean toward Fancy Feast and Friskies pates because they are not horribly expensive. Others opt for more premium food -- Weruva, Tiki, or ZiwiPeak. There are lots of choices! Many others here use a raw diet. We do not recommend dry foods. There are very few that are acceptably low in carbs.

Probiotics are a great supplement. The other consideration is keeping your cat hydrated. Diabetes is hard on the kidneys and kidney failure is a problem for most cats as they age. Adding water to your cat's food is helpful especially since cats have a limited thirst drive.

Some of what you're seeing with regard to testing frequency is the influence of continuous glucose monitors (CGMs) like the Freestyle Libre. There is a sensor that's attached to your cat and you take readings off of your phone. The sensors last about 2 weeks (unless your cat is Houdini and can remove it). We always suggest learning how to home test since the sensors can fail or aren't always accurate in lower ranges. My cat was diabetic before CGMs were available. I tested a lot. I had a cat who liked to be unpredictable and who had an early onset and nadir. However, the minimum number of tests is 4 -- once before each shot and at least once during the AM and PM cycles. You may need to test frequently if your cat drops into low numbers and you are monitoring to determine if numbers are rising because you're feeding some higher carb food to steer the numbers back up. It's also important to know how low the insulin dose is taking numbers -- hence getting test around the lowest point in the cycle (i.e., the nadir). Dosing is based on the low numbers not on the pre-shot numbers. The pre-shot numbers tell you if it's safe to give an injection. Also, getting a curve (testing every 2 hours for a 12 hour period) allows you to see when insulin onset and nadir occur and what kind of duration you're getting from the insulin. While this sounds like a lot, it gives you data so you have a better idea of how your cat is responding.

Prozinc and Lantus are the two insulins that are endorsed by the American Animal Hospital Assn. There is likely more data available on remission with Lantus only because one of the people doing research on feline diabetes (i.e., Jacqui Rand, DVM) was working with a group in Germany that had a ton of data with Lantus that was used to develop the dosing protocol. There's only one study from 2009 that compares the two insulins and it is not a randomized controlled trial. It also used an older form of Prozinc (i.e., PZI).

Any thoughts about teaching your parents to home test?

This is a link to general information about Prozinc. And this is a link to dosing information using Prozinc.

 

I have only ideas on treats cos my cat turns up her nose on freeze dried protein - but she likes it cooked. I use chicken and salmon fillet pieces (from Applaws or Fancy Feast but a few brands make them) that are prepared cooked. There are also other fish available. Pretty sure people also make their own, I just like premade.

 

Thanks everyone for your responses so far! I actually picked up some freeze dried salmon from PureBites and she's obsessed with them, I think she just likes salmon and they're also super smelly. Only thing is I have to break the treats into smaller portions because she's not used to chewing big pieces.

And great info about the testing frequency, that makes sense. And yes, our doctor mentioned the Freestyle Libre, but Lily won't even wear collars so I wouldn't have high hopes for keeping one of those on.

I'd love to teach them to home test but they have limited mobility themselves and Lily's quite speedy and gets herself in spots that are hard to reach. Maybe I'll try next week though.

The nutritional information is quite overwhelming! I've been referencing the charts but sometimes I can't find the right food name, maybe because they're newer or updated. For now though, I plan on picking up a variety of single cans to see what she goes for. Before diagnosis, we had been feeding her dinner from the canned Purina Sensitive Stomach line, which she loves. Purina doesn't list and carb contents though so I emailed them. Hopefully they answer! Chewy says the carb content is around 5% but I'd love to hear it from Purina directly.

Another question about insulin regulation. As we continue to give the insulin, is there a general amount of time people tend to see improvements? Meaning, about how long does it take for a cat to regulate? I know it's totally individual and case by case, just wondering if there's a general time frame. She's not hanging out at her water bowl anymore, which is awesome, and she's gaining a little weight back, but her coat still isn't back to how fluffy and non greasy it usually is.

I'm assuming we should base improvements on the numbers being regulated so apologies if my question is too far fetched.

 

There is really no meaningful average time to regulation. I have treated cats for years and I would say a few were not "regulated" after years on insulin.

 

In theory, I agree with Larry. However, it may depend on what you mean by regulation. Some cats are not well regulated whereas others are in normal range numbers but still require insulin. Ideally, Lily will not be ravenous, will not be living next to the water bowl, and her coat will improve. While it's a bit trite, managing your cat's diabetes is a marathon, not a sprint. It actually sounds like she's doing incredibly well since she was diagnosed about a week ago.

 

Hi everyone!

This morning Lily's BG was 431, the highest read I've gotten on our home monitor so far. She had a good amount for breakfast and I gave her 1u before heading out for the day. I checked her again 7 hours later and her BG was 94. Then for her PM dose, she tested at 92, so I didn't give a shot.

Is that big of a jump from morning to her +7 BG worrisome? I didn't get any readings between since I wasn't home.

 

It is but not uncommon on unregulated cats. I’d strongly suggest you give the full 1 unit dose when she’s above 200. You’ve been halfing when she’s above 200 and it’s perfectly safe to give the 1 unit dose. This is why you’re seeing the higher numbers in the amps. You’re getting good numbers and she’d be doing even better if you kept the dose consistent. You did right skipping last night as she was pretty low. You may see some bouncing today. I think we talked about giving her .5 unit both am and pm so you can be consistent. You need to decide and pick one. I think .5 is not enough based on the data you’ve gotten. Maybe .75 but we won’t know until you stick to a dose.

 

I'd lean toward giving a 0.5u dose. I'm erring on the side of caution because you didn't have any PM test data in order to know how low Lily's numbers were dropping during the PM cycles. And even with the test last night, the numbers were rising due to your having skipped the shot. Getting a minimum of four tests per day will help enormously. You need your two pre-shot tests and at least one test during both the AM and PM cycles. Right now, with how Lily's numbers are bouncing, it's particularly important to know just how low the numbers are dropping.

 

Thank you both! I agree with you Ale, I expected those numbers to be higher since she was without insulin for the night. I talked to our vet and he said >200 we can give .5u consistently and see how it goes. I am curious about others who shoot under 200. I've browsed a lot of spreadsheets and have seen plenty of people who still do so. Think we'll try out our vets plan for a few days first though. I've definitely been testing more so hoping to get some idea of the trends.

 

As you learn and get used to testing and collecting data, you’ll feel more comfortable shooting the full dose at lower numbers. Under 200. I used to shoot Minnie her full dose in anything over 70, Bobo too, and the pros here helped me with that. You have to be able to monitor when you do and use food to keep the numbers from going too low. The goal is to keep your cat within the normal range 70-120 for as much of the day as possible because that’s when the pancreas can heal and so shooting at lower preshot numbers help achieve that and keep them surfing those blue and green numbers