My Newly Diabetic Kitty, Theo

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Arienna

Arienna

Member Since 2014
Howdy folks, my name is Arienna. It's been a rough few days so I'm gonna ramble a bit.

I think, maybe, my cat might have always had diabetic tendencies but we've always had him on a grain-free low carb kitty food. In February I moved to be close to my school (I'm an engineering student and researcher) and the Theo cat developed some sort of itchy reaction to something in his environment. Around the same time I think his cat food changed recipes - we got a fresh bag, poured him a serving and he promptly threw up in his bowl. So I swapped his food slowly for Eukanuba and took him to the vet for his itchies. The vet gave him a steroid shot and it was like magic. No more itching, his fur grew back, he seemed much happier. Over the last couple of months though his Litter Robot started having issues. It was running constantly and the uriney litter was sticking real bad to the works. I swapped him out to a regular litterbox and started to notice - my cat pees a LOT. Like, a small mountain of clumped up litter to be cleaned every day and I seem to be refilling his fountain a lot. But because he's always had the automatic cleaner I wasn't sure if it was an unusally huge amount or not - he's a big dude (16 lbs of lean kitty), maybe he just drinks a lot.

Last week he started itching again so I took him straight to the vet on Saturday. We're still trying to figure out what makes him itch so I described everything I'd noticed in them and my vet said she wanted to take a blood sample to check some things (he'd also gone from being a 16 lb lean cat to 13.5 lbs. Almost 15% body weight lost!), but there was no reason not to give him a shot. When we went home, Theo ran right under my bed and hid out which is unusual for him, but I figured he was feeling bruised and cranky and let him be. The next day I went to a friend's house, we did a big bulk food shopping trip and made about 20 quarts of chicken soup - it's a long process and kept me out of the house all day. I got home early Monday morning and found my cat dying. He was hunkered down over his water fountain, staring grimly off into space. Looking around my house I found evidence that he'd either peed or thrown up a thin watery liquid in three places. I called the vet and they said to bring him in immediately. His glucose was over 400, he was deathly dehydrated and weak and listless in my arms. I sat in the exam room, dribble feeding him water and waiting while they ran tests, consulted things, and came back to me with a $450 estimate for the day's care and telling me that he needed a 1 to 3 day hospital stay. There was a long pause while they avoided eye contact and waited for me to tell them whether to treat Theo.

It's been a really rough couple of days. The over night bill care bill is $850.. I can't afford it so we've been taking him home at night and I've been sitting vigil over Theo, watering him and trying to get him to eat, watching for desperate signs and then bringing him back to them before my morning classes. I've spent a ridiculous sum but he's pulling through. Today I brought him home with a list of instructions that included administering an injection. If his numbers are okay in the morning they're going to have us switch to the Lantus insulin and I'll be managing his diabetes.

Phew. So, now I'm here. I'm staring down the line at a future that just changed radically. I'm feeling kinda overwhelmed and thought I'd come introduce myself and get some reassurance that life does go on. :/
 
Welcome Arienna and Theo!

Sounds like you two have been through a lot these past few months. Was he diagnosed with DKA (diabetic ketoacidosis) at the vet? That usually does require hospitalization and fluids, so it's a good thing they kept him for a few days to treat that.

What insulin are you currently using? I'm guessing either humulin or Novolin since these both are fast-acting insulins that work well to bring kitties out of immediate DKA danger. Not great for long-term, but great for expediency. Lantus is a great insulin for cats for long-term use, so it's good that they'll be having you use that.

Steroids can also be a factor (and even a cause) of diabetes. This is a good thing because it increases the chances of remission (where a cat no longer needs insulin and is strictly diet-controlled). Just be aware in the future that if he needs steroids, you may have to compensate with insulin to keep the blood glucose (BGs) down.

Food: most all dry food is too high in carbs for our kitties, even the grain-free versions. This vet, Dr. Lisa Pierson, explains why in her comprehensive website on feline nutrition so you'll want to ditch the dry. In fact, you might notice his skin condition clears up! However! You don't want to change the diet without home-testing first! A diet change can significantly reduce BG levels and insulin requirements so you want to be monitoring him while you do this. Here's a link to some ear-testing tips that will give you an idea of what home-testing is all about.

I've given you a lot to digest, so please ask for clarification or additional information. The only bad question is the one that goes unasked. ;-)
 
Hi Arienna and sugardude Theo and welcome to the best place on the planet to help your extra sweet kitty.

Would you please tell us a couple of things.
1. Did the vet mention ketones?
2. Did the vet say DKA (or diabetic ketoacidosis)?
3. What food are you feeding?
4. What insulin are you giving right now? You mentioned you gave a shot, but not which insulin.
 
Thank you! Theo's currently dozing on my keyboard and I haven't the heart to shoo him away tonight, so forgive any difficult to understand extra commentary. ^_~

Theo did get diagnosed with DKA and he's been treated with Humulin. It's been a little tricky because he responds very quickly to the insulin but his potassium levels have been low and it's been a real struggle to get him to eat anything to help raise them naturally. Fortunately, I've always hand fed him treats so we've been fooling him into thinking his food is a treat. :) Time consuming, but worth it! I have a vial of humulin that I've been taking home with his treatment sheets in case we have to rush him to emergency care overnight. My vets have been amazing - one told me, "If anything happens, you ignore the cost. You go straight to emergency care and you tell them you're a student and don't have any money but they have to save your cat." But while the home care may have slowed things down a bit, they've also allowed Theo to get lots of sleep and destress (he's a codependent little lovie) and we haven't had any emergencies... Just a steady, slow improvement. Tomorrow morning I'll be taking Theo back to my vets before my morning classes start and they'll check his numbers. If his BG and electrolytes are good, we'll start him on Lantus and I'll be managing his diabetes at home.

We hope not to do anymore steroids ever again. :/ This has been a nightmare! I keep thinking of my poor baby dying on my floor while I was out goofing around and cooking soup. But we will be changing his diet, probably to fancy feast classic. I plan on home testing... my vet said I should get a pet specific glucosometer (SO EXPENSIVE!) through them, but I'm looking around the site and it seems you all use the human ones alright. Do they need calibrating against a vet's test results? My vet sent me home with a little baggie of Purina DM dry food, a can of Fancy Feast Classic wet, and told me to offer Theo separate bowls of weighed out regular dry and DM dry - they want to know how much he's eating of what to couple against the results they get in the morning. I gave him my first injection two hours ago. He seems okay. Still not his normal self and I keep poking him periodically to make sure he's still alive. He's taking it with more grace than I would... Though he's alternating between sprawling on his tree and flopping over my keyboard. :)

Edit:

1. Yes, ketones!
2. Yeah, diabetes ketoacidosis, my poor baby.
3. I have been feeding him Eukanuba since October when he started rejecting the Wellness Core grain-free stuff. Tonight we're eating Purina DM dry food and trying to convince him to eat some Purina DM wet. He had half a can this afternoon, but he's a dry food addict. We're gonna wean him off that, but it's gonna be a bugger. He's also on an anti-nausea medication because he was throwing up all his food and water which is supposed to have a side effect of making him hungry but I'm not seeing it. I'm getting him to eat about 15-20 kibble bits at a time by offering them by hand and poking him when he doesn't eat them.
4. Two hours ago I injecting him with a half unit of Humulin.
 
Yes, most of us here do use the human glucometers instead of the pet specific ones. It's not just that the pet specific ones like the Alphatrak are expensive, but the test strips are too. The human meter test strips are a fraction of the cost of the Alphatrak. I know, I started with an Alpahtrak and quickly switched to the Relion Confirm.

If you live in the USA, you can go to Wal-Mart and pick up the Relion Confirm or Micro for around $15-17. Also get 100 test strips for about $36. The Relion Prime is about the same cost for the meter, the strips are $9 for 50 ($18/100) but it needs a bigger blood drop for testing.

We have reference ranges for the different types of meter, human and pet. We'll get you those later.

For now, with Theo having DKA it's very important that you
1. get him to eat enough. Whatever he'll eat. Change the food later.
2. test for ketones with urine test strips
3. keep him hydrated

DKA can not usually be treated at home. We are pulling for you and Theo and hope he gets past the DKA quickly. It's the electrolyte balance you can't test for at home. That's the most dangerous part of DKA.

Did the vet give you sub-q fluids and teach you how to give those?
 
Deb & Wink,

I've only been treating him at home for the nights! Every morning I take him to my vet and they take care of him for the day with fluids and blood and urine monitoring. It's the best we've been able to afford. Initially his electrolytes were good but his blood glucose was over 400. He responded very quickly to the insulin and his blood glucose was down to 147 when I took him home the first night. I gave him 30 mL of water every half hour for the first night but couldn't get him to eat.

When we went back to the vet in the morning, his blood glucose was over 300 and his potassium was low - they began trying to balance the both of those out over the day. By the end of the second day at the vet he was doing much better in terms of attitude - he's a well behaved gentleman who never bites or claws but he started to complain loudly at the testing. The sweetest sounds I've ever heard. That night he was less obsessed with his water and I allowed him to free drink and tried to coax him into eating. The vet thinks he ate more than I thought because of the fatty traces in his tests the next day.

Today at the vet he's been doing well but a little low on potassium still. They were adding some with his fluids but nervous about over doing it - I have a potassium tablet to give him orally shortly and I'm going to get some wet food into him if I have to put it on his tongue one bit at a time. (He's such a willing fellow).

I take him to the vet in the morning and they'll do some more testing - if his glucose and potassium are within range then we're over the DKA and they'll have me start managing his diabetes at home with Lantus.

Really he's been recovering way better than I had any right to hope for.
 
Welcome to FDMB.

Folks have covered most of the important stuff so far.

Perhaps the following on what the test numbers from different meter types mean will be helpful.

Comparing a human glucometer to a pet-specific glucometer is like reading temperature in Celsius vs Fahrenheit. Both are correct. You just need to know the reference ranges to interpret what the numbers mean.

[Glucose reference ranges are unsubstantiated and have been removed by Moderator]


* * * * * * * * * * * * * * *​

How to use the glucose reference values chart:

When you get a test, look for the number on the chart that either equals, or contains, the test value you have. Read the information. As needed, make a decision and act.

Ex. You are a new insulin user and you test your cat before giving insulin. The test is 300. It probably is safe to give insulin.

Ex. You are an established user of Lantus, following the Tight Regulation protocol. You've tested around +5 to +7 to spot the nadir. It is 200 mg/dL. You probably need to increase the dose, following the instructions for the protocol.

Ex. Your cat is acting funny. The eyes are a bit dilated. You are concerned and test the glucose. The number is 35 mg/dL. ACK! The cat may be in a hypoglycemic state. You quickly follow the HYPO protocol linked in the glucose reference values chart. (which we really, really, suggest you print out and post on your refrigerator.) Funny you should ask that.. let me find it.
 
Thank you for the infomation, BJM... I'll be printing this and the Lantus tight regulation protocol and taking it to the vet today when I pick Mr. Theo up.

We're having a pretty good day today. When I woke up this morning he did NOT want to get back into the cat carrier and complained the whole way to the vet and the whole time I described how our evening had went. Loudly and at length - music to my ears after how limp and weak he was the first couple days. When I called for my lunch time update they told me that his potassium is back up to normal and his BG is still way, way high but that's not unexpected and they've put him on the Lantus, which should be his insulin type for now on. I plan to bounce the tight regulation Lantus plan off of my vets and make sure there's nothing I don't know about Theo's specific problems that would be a danger before I start it.

Phew, what a week. All the way from hopeless desperation to the first glimmers of hope to a firm resolution to handle it.

(You're all wonderful)
 
Phew, what a week. All the way from hopeless desperation to the first glimmers of hope to a firm resolution to handle it.
Click to expand...
Wow! You certainly have been on a rollercoaster this week!

It's so good to hear that Theo is doing better today. Sounds like he has survived this DKA episode which must be such a relief to you.

Let us know how things go and if we can answer any more questions for you.
 
Oookie. Well, the vets want him back tomorrow morning for testing. That's every day this week - expensive kitty day care. -_-

I showed them the tight regulation protocol. My vet had some concerns which were:

1. Ketones are rare in cats. Go ahead and check it but, she said, it almost never happens. (Theo's ketoacidosis was super unusual, she says)
2. She wants Theo to start with a full unit BID, not the 0.25U BID specified by the protocol
3. She doesn't want me to drop Theo's dose without talking to her first, but we can email the spreadsheets and get a second opinion.

They're fine with me home testing. In fact, my vet asked, "You know where to get the blood?" "From the ear!" "Yeah.. and he'll probably let you. Easiest cat to pill I've ever met." They were leery of me using a human glucose meter but I said the readings can be converted. Tomorrow I'm going to take it to them so that they can calibrate it against their own pet specific meter.

Otherwise things are alright. Theo seems in good form though there's still too much wounded kitten in his meow, not enough irritated princeling. I keep hoping that "Tomorrow" will be the last day we go into the vet for all day tests... Getting awful tired of it. They said his blood sugar is at 500. 500! My poor baby. 1 unit of Lantus at 9.
 
Oh, Theo! Another day at the vet's for you tomorrow. Sorry to hear that. Hope you get to come home days soon and be with your mommabean more. Your mommabean says she'll know when you feel better, because you'll sound like a princeling, demanding to be waited on ASAP! Hope that happens real, real soon.

Depending on what Theo weighs, the 1U dose of Lantus your vet started you at is probably correct.

The starting dose for Lantus is based on your cat's ideal weight or current weight if underweight.
Convert weight to kilos ( pounds divided by 2.2 kilos per pound)
weight in kilos times 0.25 Units per kilo.
Round down to the closest quarter unit for safety and ease of measuring.

For example 10 pounds/ 2.2 = 4.5 kilos
4.5 * 0.25U = 1.125U
1.125U rounded down to the nearest quarter unit, so 1U to start.

We find that most cats end up at 1U with this formula. Unless Theo is the tiniest of kitties, we would not suggest starting him at 0.25U either. I think your vet may have missed the per kg part of the protocol.
Using a weight based formula for determining a starting dose of Lantus or Levemir when following the Tight Regulation Protocol:
•the formula is 0.25 unit per kg of the cat's ideal weight
•if kitty is underweight, the formula frequently used is 0.25 unit per kg of kitty's actual weight
Click to expand...
 
1. Some cats are prone to ketones, some are not. Mikey has been diagnosed for a year and a half now and has never had ketones. Other cats on here have ketones much more frequently. Some cats have even gone into DKA multiple times. Since Theo already had it once, it's wise to keep checking his urine and treating him at the first sign of ketones to prevent another DKA event. The ketostix are inexpensive and last a while. Here are some tips on urine catching.
2. 1u BID is a good starting dose. The TR Protocol has a formula for .25u based on 1kg of ideal weight. For most cats, that equals out to .75 to 1.25 u.
3. Any time Theo drops below 50, that's an automatic dose reduction of .25u. Other than that, the Lantus TR forum has people who view spreadsheets every day and can advise you on increases/decreases in dose for you to discuss with your vet.

It can take up to 5-7 days after initially starting Lantus to see its full impact. This is where we introduce you to patience pants. ;-) I think Deb & Wink might stop by and offer you a selection to choose from. :lol:
 
My vet warned me... But for a guy whose numbers are sooo high, he's a pretty okay guy. He's walking around. Poking into boxes. Alternating between sprawling on his perch and on my keyboard (his other perch). I have successfully administered his potassium tablet and his shot for the night.. And I'm soo proud, he ate about half a can of the Purina DM cat food. I sprinkled a little of the purina DM dry on top to make it more appealing. I'll keep doing that for a couple weeks, wean him down a bit.

These patience pants. Are they comfy? Like pajama pants? Can I wear them to school or will the guys laugh at me? :P
 
Well, let me see now if I can send some comfy patience pants to you. Let me know if these work. I have a vast and every expanding lending closet and I'm happy to loan out patience pants whenever someone needs them.


These light blue ones have a nice drawstring waist, wide legs so I think these should be comfy for you. What do you think?
 

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Oh man! Blue is my favourite colour... I think those will do nicely. :D

I know that now that we're on the Lantus it'll take a couple days to get into gear but I'd be lying if I said it didn't upset me how high his BG is everyday. Plus, every day my vet says, "We want you to bring him in again tomorrow so we can monitor". The bills keep racking up but nothing seems to be changing. Nerf. I'm assembling a collection of information for my vet.. the Tight Regulation procedure for Lantus, explanations of human vs feline glucose meters, information about cheaper Lantus access, information about DCIN, IMOM, all the stuff I wish they'd know to make available to me Monday when I was facing thousands of dollars in vet bills with Theo's life hanging in the balance.

If anyone has suggestions on what's best for showing to vets or other things I should take in, please let me know.
 
You making slow but steady progress in this sugardance Arienna. Baby steps ok.

You have a great picture up of Theo. Looks like he loves, loves, loves head scritchies. It's only a tiny step from there to get him to love having his ears touched and rubbed. :lol: :lol: :lol:

You got your SS (spreadsheet) up and running and the first test number on there. The number of units of insulin goes in the U column. the + hours are how many hours after your shot. Remarks for things of note like what you are feeding and quantity, medications, any good or bad things going on with Theo.

You'll be a pro at the testing in no time, and welcome to the Vampire Club!
 

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Thanks Deb! This website is amazing - before I found it I felt so lost and out of control. Now I feel like I can get on top of things. ... Also I will now have to make vampire faces at Theo, brb. ^_~
 
Congratulations on the first poke! Yes, if you hit a vein, you'll get more more blood and it is more prone to developing scar tissue (which is why you don't want to poke the vein all the time). But the kitties don't really feel it any different than an ear poke on the edge, maybe a tiny little prick if anything, since cats have few nerve endings in the tips of their ears (this is why they cut off the tip for feral cats that have been fixed).
 
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