May be fostering an insulin dependent kitty - need advice!!!

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RenaRF

Member Since 2011
Ok. So I DO have experience with FD. My sweet Clide (God rest his soul - lost him to cancer on 3/5/13) was a diet-controlled diabetic. I home tested, so I know how to do that.

I do a lot of senior and special needs cat rescue. I got a call from the manager of a pet boarding facility. A kitty boarded with them fell ill during boarding and, per the boarding agreement, was taken to the vet (this was last Sunday). Vet diagnoses FD, BGs around 600 (!!). The boarding facility manager called the owner, who clearly stated she would not be treating for diabetes and would take kitty to the shelter. Boarding manager called me for help. Boarding manager also bought insulin out of his own pocket for this kitty so that he could be treated at the vet's.

Kitty is about 7 years and 7 months old, black tabby, very handsome and very friendly. Fixed. UTD on shots. He's 13lbs. right now, and could frankly use some additional weight to be at an ideal weight (1/2 to 1lb would be great). Vet has been trying to get him regulated. He is on a wet only diet (big change from what he was getting) and he's getting Lantus insulin. I am not clear right now on the amount. He's staying at the boarding facility and seeing the vet for his insulin on my dime - I'm going to give him a few more days for them to try to get him regulated. He's been bouncing all over the place, apparently - 600 one moment then nice and comfy at 120 but shooting up in the hours post-shot to 250-ish. Bouncy.

I've never given insulin. I've given SubQ fluids, though, so I do understand tenting. I've read all through the website and I am supposed to give the insulin shot in the abdominal region? Is that a requirement? Can it be given elsewhere, like in the "saddle" region? What gauge needle is appropriate?

I don't understand the spreadsheets everyone uses or how and when to test and use them to ensure a safe insulin dose. Can anyone walk me through it very simply? For example - do I test before he eats? After he eats? Both? What do I do if he's very high before eating and before a shot?

Are there cheaper sources to obtain insulin than from the vet?

It is very highly likely I will bring him home this coming weekend. He'll be separated from my other cats initially for everyone's comfort, and I will be feeding any of the numerous commercially available low carb high whole protein wet foods, which raises a separate concern. He's currently being given prescription wet - I don't know which one just yet. But if it's Hill's it has 14% calories from carbs. if Purina, it has 3% calories from carbs. I tend towards the Merrick low glycemic products, which seem to be between 5-10% calories from carbs. Do I need to be worried about changing him when I get him home, or should I continue the prescription food and make a slow change? Any advice on how to safely make a slow change?

This cat is a SWEET cat. I'm so thankful he won't end up at a shelter. But I have no clue what to do on the insulin front and need help fast!! Thank in advance!!
 
Re: May be fostering an insulin dependent kitty - need advic

If you need any help with blood-glucose testing and other things just let me know. I live by Reagan-National airport.

Lantus is a human insulin and yo can get it at a pharmacy. Most find that it is less expensive in the long-term to get the five pack of disposable 3 ml pens and draw the insulin out in a syringe since the 10 ml vial will likely go bad before it is even half used.
The scription food are not necessary Merrick is great.
 
Re: May be fostering an insulin dependent kitty - need advic

I borrowed this from a post that Hillary and Maui did to Brian and Piggy a few days ago. She covers alot of info for new members. Please read it over, click on the links to get more great info and then ask questions. How does that sound?

you can manage diabetes economically and we can help with that. for example, if you home test, you won't have to bring your cat to the vet for tests - $$ saved

get a prescription from the vet for lantus or prozinc and price shop it at online pet pharmacies - 1800petmeds will match any price you find from an accredited vet pharmacy. and yes you will save $$ than buying from the vet. viewtopic.php?f=14&t=88089

regarding food - Fancy Feast or friskies canned is fine - but you want to give pate style, no slices, chunks, diced, or gravy - please check out dr. lisa's site for a list of low carb foods - you want to stay under10% and my preference is 5% or less http://www.catinfo.org - you can find the food chart on the right hand side of her site

removing all dry food, including treats - temptations, pounce, etc - all are too high in carbs - here is a list of low carb healthy treats - viewtopic.php?f=14&t=9172

you can buy a meter and strips inexpensively - go to walmart and pick up a relion meter and matching strips - be sure to get one that takes a small sample, Confirm or Micro need .3 - also get - lancets, and ketostrips - all available in diabetes section and/or behind pharmacy counter.

there are tricks to testing and here is a link - viewtopic.php?f=14&t=287

while you are at it - put together your hypo tool box -just in case you ever need it - viewtopic.php?f=14&t=2354

oh and starting at 2 units, we consider that a high starting dose and recommend starting at 1 unit or even 1/2 unit every 12 hours. and we also suggest when first starting, to not give insulin if the bg is 200 or under - this is just to keep the cat safe and as you start testing and collecting data, which you will put into your spreadsheet - you will be able and even encourage to shoot under 200.

yes here is the link to spreadsheets - viewtopic.php?f=6&t=18207

is Your cat walking on her hocks, you know flat footed and not on her toes? does she have trouble walking - if yes, then she may have diabetic neuropathy and along with giving insulin, we recommend using Methylcobalamin B12 - it must be this type of b12 -

http://www.laurieulrich.com/jasper/methylresource.html

this is the place to ask questions and get help - how else may we help?

I've been fostering a diabetic kitty for about 3 months now. He was in the shelter for about 3 months, getting insulin but unregulated. He was a dry food addict so I took the time to transition him over to the canned food. Took about 3 weeks. He went OTJ (no more insulin needed) about 3 weeks after that.

I've never given insulin. I've given SubQ fluids, though, so I do understand tenting. I've read all through the website and I am supposed to give the insulin shot in the abdominal region? Is that a requirement? Can it be given elsewhere, like in the "saddle" region? What gauge needle is appropriate?
Insulin can be given in the scruff but some consider the absorption rate to be less than optimal because there are fewer blood vessels in the scruff. You can shoot the insulin along the flanks or in the belly if the cat will let you. Recommendations are to move about 2 inches down from the spine and pick a spot. Vary the spot from day to day to avoid the formation of scar tissue. Needle should be parallel with the spine, on about a 45 degree angle.

Needle gauge, the higher the number, the smaller the needle so less painful for the cat. I like the Relion 3/10 cc , 5/16" short needle, 30-31 gauge with 1/2 unit markings.

If he is bouncing, he may have dropped too low and liver is trying to compensate by pumping glycogen? into the bloodstream. The dose is probably too high.

When to test. We like to see before every pre-shot to make sure his BG (blood glucose) number is not too low. I don't provide dosing advice, not experienced enough with lantus. Starting dose is usually based on cat's current or ideal weight, whichever is lowest in kilos. 2.2 pounds per kilo. Multiply weight in kilos by 0.25 to get the number of units. Normally, this would be around 1unit. It's easiest to round down to the nearest unit because the markings on the syringes are in 1 unit and sometimes 1/2 unit markings with the 3/10 cc syringes. Do not recommend the 1 cc syringes because the markings on the syringes are in 2 unit increments.

I'm sure I haven't covered everything but start with this for now. ;-)

Good luck, you have a good heart for taking on this kitty.

p.s. I think I broke the links to the viewtopics when I did the cut and paste into this post. You'll need to cut and paste them into your website address at the top of the page to get them to work.
 
Re: May be fostering an insulin dependent kitty - need advic

All of this is GREAT info. Thank you so much. I do have a question on this part, quoted below:

Deb & Wink said:
When to test. We like to see before every pre-shot to make sure his BG (blood glucose) number is not too low. I don't provide dosing advice, not experienced enough with lantus. Starting dose is usually based on cat's current or ideal weight, whichever is lowest in kilos. 2.2 pounds per kilo. Multiply weight in kilos by 0.25 to get the number of units. Normally, this would be around 1unit. It's easiest to round down to the nearest unit because the markings on the syringes are in 1 unit and sometimes 1/2 unit markings with the 3/10 cc syringes. Do not recommend the 1 cc syringes because the markings on the syringes are in 2 unit increments.

His current weight is 13lbs. His ideal weight is probably slightly higher than that - 13.5-14lbs (he's a big framed kitty). I think that would equate to 5.9 kilos - is that right? Then multiply that by 0.25 and I come up with 1.45 units. Does that sound correct? I have no idea what they're giving him currently. We had to get the owner to surrender him officially, which she did late last night, so my plan is to go and talk to the vet tomorrow and get the particulars. I would also like to ear test him at the same time (roughly) as they will blood test him with a draw to get an idea how my meter compares to their draw, just for reference.

When Clide was first diagnosed (my sweet diet-controlled FD guy I lost to cancer in early March), his curve was consistently about 330 on BG. Before starting insulin, however, I switched him to a wet only low carb diet - I chose the Merrick wet foods, 5-8% calories from carbs depending on the variety. He mostly ate the Cowboy Cookout, which was 5% calories from carbs. Prior to that (not knowing any better), he had been on Purina DM wet and dry - so pretty danged carb rich, so the diet change was totally serious. I did NOT do insulin while we made this change. BG at retest a week after the change was about 220, and two weeks after the change, it was 117. He never went on insulin.

SO. My question is this: Henry was switched to one of the prescription wet foods on Sunday - so he's four days in on that. Depending on the brand, he's either getting as high as 14% carbs (Hill's) or as little as 3% (Purina). When I bring him home, should I hold off on ANY insulin to see if we can get him diet controlled??
 
Re: May be fostering an insulin dependent kitty - need advic

Insulin will give his pancreas a chance to rest, maybe to heal.

Follow the protocol for dose calculation and round down for safety.

To start, do not inject under a 200 glucose level. As you accumulate data showing the insulin response, you may gradually lower the 'No shot' number.
 
Re: May be fostering an insulin dependent kitty - need advic

His current weight is 13lbs. His ideal weight is probably slightly higher than that - 13.5-14lbs (he's a big framed kitty). I think that would equate to 5.9 kilos - is that right? Then multiply that by 0.25 and I come up with 1.45 units. Does that sound correct?

Ok, so he is a little underweight right now. Then we want to dose on that lower weight. So 13/2.2 = 5.9 kilos. 5.9 kilos * 0.25 units = 1.47 units. Yup our math is very close. So you could start at either 1.5 or 1 units. We like the "start low and go slow" approach so starting at 1 unit would be safer. Once you put the insulin in, you can't take it out.

But on to your next question because you thought you might want to try diet controlling first.


When I bring him home, should I hold off on ANY insulin to see if we can get him diet controlled??
Yes, you could try to hold off on the insulin for a little bit and try the diet switch. I do not think you want to wait more than about a week to see how he is doing on the low-carb diet. It would also be dependent on if his BG numbers are lower as opposed to higher. If over 300 or so, I would not want to go long without some insulin, probably start the insulin right away. If his BG numbers are under 250, then try the diet change for a while. I'm not sure how long before we would advise starting on insulin. Need some more eyes on this. BJM is more knowledgable than I am on some of this stuff.

He is already getting some insulin so I don't know if it would be good to stop it.

The Merrick Cowboy Cookout and Grammys Pot Pie are two of the lower carb options in that line of cat food.

If a cat is already on insulin, the diet switch is harder to do because you need to be making concurrent changes in the insulin dosage. You would need to be home testing to make sure he did not drop too low and lower the dosage in accordance with the nadirs.

To give you an example from my own experience. I switched my foster Wink from dry Hill's w/d (37% carb) to low carb canned and saw a dramatic drop in a couple of weeks as I fed less and less dry food and more and more low carb canned. The multiple hypos were not fun. Got to the point where I said, no more dry, no more insulin, I'm simply going to monitor him for a few days and see how he does. A few days turned into an OTJ trial and that failed the first time as the BG's kept rising into the 140-180 range. I then started microdosing, 0.1 units to give the littleest bit of help to the pancreas to allow more healing. Second OTJ trial successful and now below 100 consistently and still diet controlled.

Good plan to bring your meter along to the vet and get a reading. A human glucometer usually reads 30 points lower than a pet specific meter.

Let us know how things go at the vet.
 
Re: May be fostering an insulin dependent kitty - need advic

Hello there

First I cant see his SS - access is denied? Can you share it?

Second - as you know, you will want to switch him to a low carb canned as soon as possible if he isnt already on it. If he currently is getting high carb I would switch him to low carb but I would be inclined to do a few tests before taking him off the insulin as I am concerned at how high his BG could be. You dont want to stop the insulin either if he is getting ketones so you should test his pee for ketones too.

Wendy
 
Re: May be fostering an insulin dependent kitty - need advic

Wendy&Tiggy said:
Hello there

First I cant see his SS - access is denied? Can you share it?

Second - as you know, you will want to switch him to a low carb canned as soon as possible if he isnt already on it. If he currently is getting high carb I would switch him to low carb but I would be inclined to do a few tests before taking him off the insulin as I am concerned at how high his BG could be. You dont want to stop the insulin either if he is getting ketones so you should test his pee for ketones too.

Wendy

Hi Wendy. I will figure out to share it - but I have to note: right now there's nothing in it as I don't physically have him yet.

I visited him at the vet's today - they are trying to regulate him. He is getting 1u of Lantus every 12 hours. They started treating him on Sunday when his BG came in over 600. For the first few days, his apexes were above 500 and nadirs around 120. Over the past two days, however, his apexes have been in the low 300s and nadir last night was 74 - they were concerned about hypo so he went from the regular vet's to an ER (24 hr staff) vet for monitoring. He did NOT become hypo.

They are feeding him the Royal Canin diabetic wet - no dry. I can't find that exact food on Catinfo.org to see how the carbs are. I don't like the food, frankly, because the first ingredient listed is "Chicken Meal", and I would prefer a whole protein, grain free low carb wet like Merrick's Cowboy Cookout or Grammy's Pot Pie. So I guess my first goal is to find out the % calories from carbs in the prescription wet.

I have left him in the vet's care for a few more days as they try to stabilize him on the Lantus. He could come to me as early as Sunday or as late as Wednesday of next week. They have tested his pee for ketones and, thankfully, none present at this point (and would like to keep it that way). I do know how to home test and have a meter, so I will DEFINITELY home test. The advice I have been given is NOT to take him off of insulin unless his BG is below 200. BUT. I am deeply concerned about making a diet change AND giving insulin and the risk of HYPO. I feel like I don't know enough to prevent hypo. If he went down to 74 just on 1u Lantus every 12 hours, what happens if I change his diet while he's on insulin? Do I give him 1/2u to be safe?? This is what I don't know and need to learn before he comes here.
 
Re: May be fostering an insulin dependent kitty - need advic

I just want to say bless you for taking this kitty. Good luck with him. You are a very special person for giving him a second chance.

Terri
 
Re: May be fostering an insulin dependent kitty - need advic

The lower BGs could be because his depot is building up, or it could be the food change.I dont know the carbs in that food.

However if he isnt showing ketones then maybe you can try diet first and see how it goes - you should see results within a week of a diet change. If he sky rockets high (say over 300) you might want to start insulin again without waiting on the diet.
 
Re: May be fostering an insulin dependent kitty - need advic

Rena,

I would watch the insulin dose closely. You have a highly stressed kitty. First he's been given up by his people, then he's at this boarding facility and next he's staying with you, a stranger. I know you'll do great with him, but the stress from these changes is going to make dosing a little wonky at first. Add to this that he's been switched from his regular diet and eating the W/D at the facility, that can cause belly aches and increase BGs. Then if you switch him to canned when he comes, we may have more belly issues.

In this case, start low, go slow is very important. I might add a feliway diffuser to his room to help keep him calm. You're going to do great and hopefully he'll find his furrever home quickly. Thank you for saving this sweet kitty.

-Jennifer (DCIN Director of Case Management)
 
Re: May be fostering an insulin dependent kitty - need advic

Thank you so much for fostering this kitty. Without you, this cat may not have a life. Bless you and the new kitty.

Lisa & Leo
 
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