Nervous newbie with a grazer

[Jen]

Hello:
My cat Floyd was just diagnosed yesterday. The vet has instructed us to give him Glargine (Lantus) insulin at meal times (twice daily - 12 hours apart). Unfortunately, Floyd is a grazer who eats only dry food throughout the day. The vet said that we should switch him to Purina DM, preferably the canned. I had tried feeding Floyd canned before, with no success. The vet also said that he should consume a meal (as opposed to a few bites which is more doable) before the injection. So, last night I removed his dry food a number of hours before the new prescribed feeding time, and opened up the can. Much to my surprise, he ate some (probably half) of it. I didn't give him the insulin yet, as I was instructed to start today.

Last night before going to bed, I took away what was left in the bowl and fed him the canned food again this morning, during which I gave him the injection (very scary for me - I'm a tad tentative and feel quite incompetent… But I did it - I think!). Several hours before the designated evening feeding time I took the bowl away (almost all had been consumed, yippee), but he's now complaining that he's hungry.

I feel terrible for him, what with the sudden change in diet and routine, not to mention the needle.
Am I worrying needlessly?

Thanks,
Jen

 

[Vyktors Mum]

Grazing/free feeding is fine for cats on lantus, in fact better than just 2 meals per day. You just want to take the food away 2 hours before the shot to make sure you get a clean blood glucose (BG) test - are you home testing yet, if not you should make this your number 1 priority.

No need to feed the prescription food (most cats go off it pretty quickly) but you do want to change him to low carb canned food. Dry food is not good for any cat but particularly bad for diabetics because of the carb content. You can find low carb canned food that is cheaper and better for Floyd here: http://binkyspage.tripod.com/canfood.html

You have to be careful changing food because that can cause a substantial drop in BG by itself - some cats don't need insulin at all after changing diet. We usually recommend you make the diet change before starting insulin or not until after you are home testing.

Do you know what Floyd's BG level's were when tested at the vet? This is important info so it would help if you could add that info to your post.

Nothing anyone says is going to stop you worrying until you get into the swing of things but home testing will alleviate a lot of that worry because you will have confidence that you are keeping him safe. Cats generally adjust amazingly well to the whole diabetic thing - usually much better than their beans :lol:

Assuming that you are drawing the insulin with a syringe from cold lantus kept in the fridge - hold the syringe (where the lantus is) between your finger tips for a minute before shooting to warm it up, this takes the sting out of it when you inject.

Welcome aboard and congratulations for finding your way here so quickly, you will find the board to be an invaluable source of info and most likely better informed than your vet. Keep posting with any questions that you have.

 

[millerb]

We are going through the same issue. Skipper does not like wet food. I have tried every brand out there over the past 6 months, and have only found one he will eat (Wellness CORE). The vet said it was ok to give him the dry food, but he has kidney disease, so we can't go low carb/high protein. Just keep trying until you find one your cat likes!

 

[Blue]

Hello:
My cat Floyd was just diagnosed yesterday. The vet has instructed us to give him Glargine (Lantus) insulin at meal times (twice daily - 12 hours apart). Unfortunately, Floyd is a grazer who eats only dry food throughout the day. The vet said that we should switch him to Purina DM, preferably the canned. I had tried feeding Floyd canned before, with no success. The vet also said that he should consume a meal (as opposed to a few bites which is more doable) before the injection. So, last night I removed his dry food a number of hours before the new prescribed feeding time, and opened up the can. Much to my surprise, he ate some (probably half) of it. I didn't give him the insulin yet, as I was instructed to start today.

Last night before going to bed, I took away what was left in the bowl and fed him the canned food again this morning, during which I gave him the injection (very scary for me - I'm a tad tentative and feel quite incompetent… But I did it - I think!). Several hours before the designated evening feeding time I took the bowl away (almost all had been consumed, yippee), but he's now complaining that he's hungry.

I feel terrible for him, what with the sudden change in diet and routine, not to mention the needle.
Am I worrying needlessly?

Thanks,
Jen

Grazing is fine, but NOT the dry food. For sure remove ALL dry food and even the dry treats.
That vet canned food is not the greatest, but it's better than the dry.
For info on low carb wet food, here are a couple links. Look for any on Binky's list that are under 10% carbs.
Binky’s Food Lists
Feeding Your Cat: Know The Basics of Feline Nutrition
List of Low Carb Healthy Treats
Many people feed fancy feast or friskies canned pate foods, which are better and cheaper for your Floyd.

For you insulin, Lantus is a great one, but you do NOT have to worry about Floyd eating before getting a shot; thats' for older insulins that were much harsher on the cat. Let the boy eat!

In the start, until he is regulated, he's likely going to want more food because his body is not able to extract the nutrients it needs. if you ask any human diabetic, they will tell you that they eat more frequently, small amounts, in order to keep their BG more level. If they were to eat only twice a day, I think their BG would be like a rollercoaster.

Which brings me to home testing. If you are not hometesting, pick up a blood glucose meter at any pharmacy. If in the US, the Relion is a good meter and the strips are inexpensive. Other good monitors include OneTouch, Bayer, Accu-Check, but don't get any FreeStyle meters as their readings have been proven 'off' by many others.
Testing is easy, and it does NOT hurt the cat. My cats are used to it, and often they sleep through pokes. You can test on yourself to see how it feels.
Testing on cat’s ear
Instead of stressing Floyd by taking him into the vet for 'curves', you can test him yourself, at home, before shots, and you will know that it's safe to give him the shot. The numbers obtained at the vet are often not true because high stress will cause the numbers to be higher or lower than normal.
The vet may want to do a fructosamine test, which is just an average of what Floyd's BG numbers have been over the last 2-3weeks. If you are testing at home, the numbers will be true, and your meter will give you an average so you can save money on that test.

Home testing is the best way to know if Floyd is getting better and may be going off insulin.
Now here are some links about the insulin you are using:

Tight Regulation Protocol
Lantus & Levemir – Insulin Depot –AKA- Storage Shed
Lantus & Levemir – Data Ready to Shoot Low Numbers
Lantus & Levemir: Info, Proper Handling & Storage has picture of syringe and insulin pens.

For the insulin, you do not say what dose you are giving, but anything over 1unit twice a day would be too high for a start, especially since you are changing his food to all wet..... many cats are DIET CONTROLLED - once they are eating all wet low carb foods, their BG comes down to a level that does not require insulin shots.

Be sure to ask every question you have; someone here will have answers for you.

ETA:
Please do not feel terrible for changing his diet and routine plus giving the needles.... you are saving his life.
think of the dry food as McDonald's happy meals.... your little one may LOVE those meals, but they are far from healthy!
You just wait till you see how Floyd starts changing for the better; one of my cats comes to remind ME that it's time to test and get her shot. Floyd will know you are helping him as he starts feeling better.

 

[Jen]

Thanks to Vyktor's Mum, Gayle and Miller B for your quick responses, advice and encouragement. Gayle: I can't believe you referred to Floyd as "the boy"… That is how my husband and I always refer to him - how did you know?

Floyd's BG was at 25 (I think that's 450 USBG - I'm in Canada) when diagnosed. Floyd weighs 5.5 kg (about 12 pounds). We are not monitoring anything, and I don't think the vet is all that keen to have us do it. I'm hating the whole needle thing, but I must be doing it correctly. After three injections (1 unit each), I'm already seeing a huge difference in the litter box - it's incredible!

The vet instructed me to give Floyd 1 unit of lantus yesterday and today, and go up to 2 on Monday. Then, I'm to take him in for curve testing on Tuesday (forgive me if I don't have the jargon right). Is it OK to be increasing the dosage as prescribed?

Regarding the injections, is it OK to let the insulin warm up in the syringe for 30 minutes or so on the counter before administering (to avoid the cold lantus discomfort)?

Another question… Is anyone familiar with zoe needle free insulin jets?

Thanks again,
Jen the Nervous Newbie

PS: Miller B - good luck with your food search. This is all so over whelming.

 

[Julia & Bandit (GA)]

Your vet may not want you to home test, but he should. The current treatment guidelines recommend home monitoring (see p. 4): http://www.aahanet.org/PublicDocuments/AAHADiabetesGuidelines.pdf. Also, the dose for Lantus should NOT be raised in whole unit increments, but rather .25-.5u increments. Here's a link to the the dosing guidelines for Lantus: http://www.uq.edu.au/ccah/docs/diabetesinfo/link4.pdf. I've also attached an article for you to print out and give you your vet on Lantus, home testing, and dosing. I would print out the other two documents for him as well. Many vets just aren't up to date with their feline diabetes treatment--it's not their fault, it's really hard to stay current with every aspect of every disease for every animal, and the guidelines were just updated a few years ago.

If you don't have them already, you want to make sure you have 30-31g syringes that are .3cc, with 8mm needles and half unit markings. With the short needles, I'd be surprised if your cat even realized you were giving him a shot. I always gave Bandit his Lantus shot while he was eating, and I don't think he ever noticed.

If you give all this information to your vet and he still insists that you don't home test, you might want to switch vets. Give him a chance first, though--most vets just need the right information to come around on treatment.

There's an 84% remission rate for newly diagnosed cats with the treatment recommended in the article, but there's a window for that remission rate, so you really want to get on the right path as soon as possible.

 

[Jen]

Thanks for the info Julia. I will read the articles.

Regarding the needles, my vet has recommended 29 gauge with a half inch needle; he specifically said he didn't like the shorter needles. Floyd is a DSH... I could see why he might prefer a longer needle if Floyd had long hair, but I'd much rather be using a 31gauge, which only seems to be available in the shorter length. Do you think it's OK to switch, or should I have the vet explain his preference?

Also, and more importantly, the vet instructed me to pull back on the plunger once the needle has been inserted to look for blood in case a vein has been hit. I have been unable to do this (I just don't have the dexterity or co-ordination). It also makes the whole procedure more of a clumsy ordeal. Do I really need to check for blood?

Thanks again,
Jen

 

[Julia & Bandit (GA)]

Thanks for the info Julia. I will read the articles.

Regarding the needles, my vet has recommended 29 gauge with a half inch needle; he specifically said he didn't like the shorter needles. Floyd is a DSH... I could see why he might prefer a longer needle if Floyd had long hair, but I'd much rather be using a 31gauge, which only seems to be available in the shorter length. Do you think it's OK to switch, or should I have the vet explain his preference?

There is absolutely no reason why you can't use the shorter needles. In fact, I had a MUCH easier time using the 5/16" needles--I kept getting "fur shots" with the 1/2" needles because I kept poking through the tent to the other side and shooting the insulin out on his fur. After I switched needles, I never got a fur shot again.

I am really curious what possible reason your vet could have for NOT wanting you to use the short needles--I cannot think of a single logical reason for it. I would ask him to explain, but I would also tell him I was having trouble with the long needles and insist on the shorter needles anyway. Like I said, a vet doesn't have to be perfect, but he does need to be flexible and willing to work with you. If he's giving you a lot of resistance, you really might want to switch vets to one that will be more supportive. Telling you that you HAVE to use the larger needle size seems a bit controlling to me, which isn't a good sign.

As for the checking for blood--my vet also told me I needed to do this, and I was in tears that first week because I couldn't even get the insulin in my cat because of the 1/2" needle problem, let alone pull back a little to check for blood while he was squirming. I tried to check that first week, but after that I just gave up and gave him the injections. There was no point if I couldn't do it anyway and I was just making the injection harder for Bandit. I don't know how many people here check for blood, but nothing bad ever happened in the year that I gave Bandit injections without checking. As long as you're very careful about ONLY pulling up and shooting into the skin, there's no danger of hitting a vein.

Here's some good advice from the beginner's page:

Injections

The injection site influences how insulin works. If it goes straight into the bloodstream, you have an almost instant overdose. If it goes into a slab of fat, it will take forever to get to the blood for distribution to the rest of the body. Muscle is good, but painful for the cat, and hits the bloodstream pretty fast. You want it to go under the skin ("subcutaneous" or "sub-Q" or "SQ") in an area where there is good circulation and the only discomfort is a tiny prick.

You can inject anyplace that works for you, but the scruff of the neck should be avoided due to its poor blood supply. Either side of the spine, between the scruff and the hips, and at least an inch away from the backbone, is also good and along the abdomen is excellent. If you use an alcohol swab to clean the top of the vial, make sure the alcohol has completely dried before sticking the needle through. It isn't necessary to swab alcohol on the the injection site. If your cat has long hair and you are inexperienced with giving injections, you might trim a little hair in several spots to help you visualize the skin. Try to rotate injection sites to help prevent the formation of "granulomas" that are small knots of tissue with very poor blood supply.

Put the insulin back in the fridge right away to stay cold although most insulins won't be harmed if they are left at room temperature for a few hours. If you like, you can hold the filled syringe in your hand for a minute or two to take the chill off, or let it come to room temperature while you get the meal ready.

You can very your timing and approach to injection to suit your cat. Injecting while the cat is eating and his attention diverted works for many cats. The syringe barrel is held between two fingers and the plunger depressed with a third finger. Some people hold the syringe between the index and middle fingers, with the thumb ready to depress the plunger once the needle has entered the skin. Others hold the syringe between their thumb and middle fingers so the index finger is available to push the plunger. Don't put your finger on the plunger until you are ready to inject to avoid injecting into the fur only. Turn your hand over so the syringe is between your hand and the cat, which ensures that the needle is almost parallel to his body. The needle gets jabbed sharply into the skin, about halfway up the tent of skin. Many people will then pull back on the plunger slightly to make sure the needle isn't in a blood vessel. This is awkward for a beginner and if you are careful about only pulling up the skin and subcutaneous tissue, it should be unnecessary. Make sure your veterinarian demonstrates how to give shots and then watches your technique. You can practice on a piece of heavy vinyl, a pickled pig's foot, or many other objects until your movements are smooth.

Always stroke the injection site afterward -- if you feel moisture, then you lost some of the insulin. If you can't be there to watch for hypoglycemia later, never give additional insulin. Just note on your injection chart that your cat's dose went short by an unknown amount. It can be helpful to post a schedule on the refrigerator so you can check off when shots are given. This is especially important when more than one person in the household may give the shot.

 

[LILandKIT]

Hi Jen,

Just wanted to chime in and say that my vet gave me 29g 1/2" needles as well, and told me that I was to only buy needles from them. At this point, I didn't know any better and didn't even realize that they were the same needles that humans use and that I could get them at any pharmacy. I was so clueless. The first week went well, but then Kit started jumping everytime we came close to him with the needle. We tried while he was eating, we tried giving him treats, he would flinch and try to run away as soon as the needle just touched him. I would cry because I felt like I was hurting him. After learning about the 31g and the fact that I could just go out and buy them myself, I saw that they only sold the short ones. I was a bit nervous about getting those at first because Kit is long haired as well. I couldn't have been more wrong. He stopped flinching as soon as we switched because of the thinner needle, he doesn't even seem like he realizes I'm shooting him. And the shorter needles are so much easier to handle (in my opinion). Although I didn't have any major problem with the 1/2", after trying the short ones, I just feel like they are easier to control (not sure if that makes sense). Overall, in my experience, never want to go back.

Also with regards to the checking for blood. My vet said to do that too, but I really didn't have the coordination for that also. I did for the first week or so, but it was making things so complication. I, personally, never had a problem since I stopped. I like Julia's advice on this.

 

[doombuggy]

I wanted to chime that my Cedric is also a grazer. Befor he was dx'd, he ate both dry and canned (vet really pushed for canned). when he was dx'd last easter, he had both grainfree, high protein low carb canned & dry. When I took the dry food away his # went down 100 points in 24 hrs. 2 days later no more insulin shots. I still test him, in fact he was 78 saturday night (I am here in the US). He gets 4 smaller meals a day, 2 of whihc he gets via an auto feeder (Cat mate C20) that has an ice pack in it. My problem with him being a grazer is that the new guy I rescued in September wants to eat his food too! (he says Cedric gets better food, which is not true...).

You can home test and do your own curves. Like the others have said, if your vet is resistant (not sure why he would be since he's prescribed lantus off the bat) then find a new one. Post where you live in your profie ----> as we have quite a few Canadians here, eh!