New and feeling a bit overwhelmed

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Ronala

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Hi,
My Siamese-mix cat Delynn is very newly diagnosed with diabetes and after doing some reading, I decided to come here for some advice and support. I'm feeling pretty overwhelmed with everything right now but want to do the right thing for my girl. I'm scared and have never given an insulin shot before. I hope some of you that have been through this can calm my nerves and help me to do the right things. Here's out story:

My baby girl just turned 15 years old this month and was diagnosed with diabetes about a month ago. To back-track--she was diagnosed with a thyroid disorder last October and has been on meds for that ever since. She did well for a time and then I started to notice that she was losing weight again and drinking a LOT of water. Peeing too much and was once again way too hungry all the time. I thought maybe her thyroid meds just needed adjusting but she developed a urinary tract infection about a month ago and a vet visit for that brought the diagnosis of diabetes. Thankfully the infection cleared up quickly and she has had no more trouble with that. I believe her blood sugar at that time was in the 240 or 340 range. (I can't remember exactly) My vet wanted to try feeding her a prescription diet to see if we could regulate her blood sugar by food alone. Then he wanted to test her again 3-4 weeks later to see how she was doing. Unfortunately, the food (Hills DM) did not bring her blood sugar down. In fact, last week when he tested it, it was 415. After doing some reading on my own, I realized that it was not a good thing for my kitty to be eating dry cat food. So I stopped that totally about 2 weeks ago and fed her just the canned Hills. Then after MORE reading, I realized that the Hills was actually higher in carbs than some other non-prescription foods and decided that I would feed her Wellness and some Fancy Feast since all I had read indicated that it was not necessary for her to be on the prescription food.

Let me say that when I took Delynn in for the urinary tract infection and the vet told me that her blood sugar was way too high, he asked me to leave her there because he thought she was probably in ketosis. However, after doing her bloodwork, he told me to come back and get her. The good news was that her kidneys are actually fine and everything looked good. He's a good guy and I know he really hoped the food would bring her blood sugar down. However it did not...

After re-testing both her thyroid and blood sugar last week, he wanted to do a complete glucose curve (2-3 days of testing) and told me that we could start it this week. To save me some $$ for her staying overnight for several days, he told me that I could bring her in early in the morning and pick her up late in the afternoon. So yesterday, that's what we did. According to the vet and to the tech who was keeping me filled in on how things were going for most of the day yesterday, Delynn did very well and responded well to the insulin. I do not know how much they gave her but will ask that question today. They tested all day and at the last test yesterday evening (at 5 pm) they said her sugar was normal and about 100. I picked her up just after 5 pm and brought her home. They sent home a can of the Hill's which is what they gave her to eat yesterday. She ate when she got home and even wanted to get up and eat during the night. I fed her the Hills and some Wellness that I already had open. Besides being hungry during the night (she got me up 3 times), she seemed fine.
I have not heard from the vet today but should soon.

One thing that concerns me is that last week when I questioned my vet about her diabetes, I asked him, "How much insulin do you start a cat out on?" He told me, "3 units twice a day usually." Now from just a the little bit I have read on this forum, that sounds way too high! I do not yet know what kind of insulin they are giving her or how much but will find out today.
Also the vet told me that they do not stock insulin there but that I have to get it somewhere else--at a drug store.
I guess my question is--Does the vet just write a prescription for the insulin and what type? Or will I have a choice in what to get? I have a lot of questions about it all and plan to really start reading the posts on this board tonight.

I have to admit that I'm very scared right now. I have never given an insulin shot before although they told me at the vet that they would show me how. It scares me to think that the vet might be starting my cat out on too high a dose of insulin. I do not have a meter yet and wonder how long it will take for me to find one. I was reading a post a few minutes ago on here and it sounds like all cats should start out low at about 1 unit of insulin.I am wondering now what I should do if my vets puts my cat on a high starting dose. Should I get the insulin, but only give 1 unit in the beginning? I am very afraid of her becoming hypo and will actually also be away from home this Friday probably right as she begins her shots. Thankfully my 22 year old son will be home from college as of tomorrow and I am going to print out the signs of low blood sugar for him. I also have syrup here in case. But I do not want him to have to deal with by himself as he has no knowledge of any of this. Unfortunately the reason I will be gone is that my partner is having her 3rd round of chemotherapy (for breast cancer) on Friday. Between that and a sick cat, I am very very stressed right now.

If any of you have any comments on what I have written, I would love to hear from you. This really is all new to me. Delynn has been a very healthy kitty cat all her life and only developed her thyroid and diabetes recently. It's so hard to see her go through all this, but I am determined to help her and do everything I can to help her to become well again.

Thanks for reading my post and I'll be back later on with some updates.
Ronala
 
i'm still pretty new to this, about a month and a half into it, so i will leave the advice up to the experts... BUT i will say.... it does get sooo much easier, i was so scared at first, and once i came here and got help from these wonderful people it eased my nerves. It DOES get much easier, and you have come to the right place
 
Welcome Ronala & Delynn to the best place you never wanted to be but will be so blessed to have found.

Caring for a diabetic cat is actually pretty easy once you get past the steep learning curve...so take a deep breathe we will hold your hand and paw through it all. :-D

First off.....3units is way too high of a starting dose! Most cats never need more than 1unit twice a day and many need even less than that. It doesn't surprise me that the diet trial didn't work considering the diet that they tried it on, it very well could have worked in the beginning if the diet had been a proper one, but that is water under the bridge now...so onward we go.

First off diet, you are on the right track with the Wellness and the Fancy Feast as long as the Fancy Feast is the Classics, anything with gravy is still way to high in carbs for a diabetic cat. This is the charts that most of us use to pick our sugarcat's food Binky's Lists You will want to pick the flavors of Wellness and Fancy Feast that are under 10% carbs and most of try to stay under 7% carbs (the third column). The Science Diet foods are horrible for diabetics and the only really good prescription diet that is suitable for a diabetic is Purina's DM but most cats won't eat it for long because of the high liver content, so you will be much better off keeping them on the Wellness and Fancy Feast.

Second insulin...The three best are Lantus, Levemir, & PZI/ProZinc the first two are human insulins and can be gotten at a regular human pharmacy, the PZI/ProZinc is a pet only insulin and would come from your vet or ordered online..I'm guessing if your Vet is saying you will be gettting it at a drug store then it isn't the later. The one that many vet's still prescribe that you will want to avoid as it is great for dogs and human's but not felines is Humulin N. The reason is because it is very harsh and doesn't last long enough in a cat's body, who metabolize insulin twice as fast as either humans or canines. If you are able to I would talk to your vet if he wants to put Delynn on N and tell him you would perfer either Lantus or Levemir, especially Lantus has a great track record for remission in newly diagnoised cats. If he balks start looking for a new vet.

Third...Home Testing, this is probably the single most important piece of the puzzle besides insulin, as not only will it keep $$ in your wallet, it will keep Delynn safe while on insulin and give you far truer numbers than at the vet's because all cats are stressed to some extent at the vet's and stress raises BGs. You also don't need a special pet only meter...most human meters work just fine, the only exception to that rule is anything with Tru in the name and the Freestyle meters that we have found give false low readings...Walmart has a great little meter called the Relion Micro, or the Relion Confirm both take a very small blood sample and the test strips (which is where the real expense is) are the cheapest around. The whole setup...Meter, Strips, Lancets, and Lancing device will run you under $50 to get started, maybe a little more depending on how many strips you stock up on.

The last thing you will need is Ketostixs to test Delynn's urine for Ketones, they are about $7 a bottle and way cheaper than a trip to the emergency room if they should happen...not a normal thing but something to be aware of.

If you vet wants to start Delynn on a dose higher than 1u twice a day, just tell him you are uncomfortable starting that high, especially with the other stresses in your life right now and you would like to start at a much lower dose and see how it goes, you can always go up if it isn't enough but you can't get it back out of the cat once it has been injected.

That just about covers the basics until we know what insulin and what dose you are starting out at so please keep us posted and we will help you every step of the way.

Again Breathe it gets so much easier, so easy in fact that I have 11 non-diabetic cats and have adopted 3 more as diabetics, 1 of which is in remission and off insulin for over a year, 1 that just started her OTJ (off the juice) trial today, to see if she is in remission and can be diet controlled, and 1 I just adopted 2 weeks ago this coming Saturday. Now if this was tough to do, do you really think with all the cats I already had I would adopt 3 diabetics? :lol: Everyone here eats exactly what my diabetics do, just good old fashioned Friskies Pate style canned cat food, (Because I'm too lazy to open that many 3oz cans of Fancy Feast per day ohmygod_smile )

Welcome Again to FDMB, and the proud ownership of a Sugarcat. What right now seems so overwhelming and scary will in the end feel like a blessing, because it will deepen your bond with your wonderful extra sweet girl....I promise!

Mel, Maxwell, Musette, Autumn & The Fur Gang
 
Well, Mel gave you some very good advice, so I will just emphasize the important parts:


1. 3u is WAY too high a starting dose. Most cats on a low carb, canned diet do not ever need much more than 1u. I would not give this dose of insulin. Here is a link to the AAHA diabetes guidelines, so that you can justify your decision to your vet: http://www.aahanet.org/PublicDocuments/AAHADiabetesGuidelines.pdf

2. Don't accept a prescription for Humulin N. This is not a good insulin for cats and it will be a waste of your money. Ask for one of the recommended insulins instead. Insulin suggestions for your vet are also in the AAHA guidelines, p. 217-218 (Levemir (detemir) is not mentioned but it works the same way as Lantus (glargine). Humulin N works in a similar manner as the Lente insulin described, with even a shorter duration of action in cats).

3. Home test! Curves at the vet are unreliable because the numbers are falsely inflated due to stress. This often leads to chronic overdosing at the vet. To give you an example, Bandit's (who is in remission) blood sugar is usually in the normal range (60-120 on a human meter), but he shoots up into the 200-300 range at the vet. Once he gets back home and calms down, his blood sugar returns to normal. So if we were judging insulin need based on vet numbers, it would appear that he needs insulin, when he actually doesn't. That is why home testing is 100% necessary to keep your cat safe. Hypoglycemia can kill in a second--you need to know how much the insulin is lowering his blood sugar. Plus, it will save you a TON of money. Fortunately, my vet told me I HAD to home test from the get go, and the only test at the vet I've ever paid for Bandit's diabetes is when he was diagnosed.

The large majority of newly diagnosed cats go into remission when a long acting insulin is used in combination with a low carb, canned diet (under 10% carbs), and small, careful dose adjustments via home testing.
 
Thank you all so much for your replies! I can't tell you how much better I feel knowing that you guys are out there and are willing to share all that you know. I am happy to report that my baby girl is home already today and will not have to go back for a 3rd day of testing. The vet said she responded beautifully and just like he would like to see a cat respond to insulin.
s
When I talked to the tech today, I questioned her as to the amount of insulin that they had given Delynn. She told me that yesterday (first day of testing), they started her out on 2 units right off the bat. Well, that worked alright but dropped her sugar pretty low-- down to 97 --so they backed off on it I don't believe they gave her a shot late yesterday afternoon at all. Then, this morning when she went in, I believe they said her BG was somewhere in the 300 something range. But with a shot of only 1 unit of insulin, it came down to about 123. They watched her this afternoon and said her sugar had started to come back up again. (was about 170 by 4 pm) So the vet wants me to give her an injection tonight about 7 or 8 pm. He said he was comfortable starting her out on 1 unit twice a day. He also wants to re-test her in 1 week. I asked him if he was concerned about her becoming hypo and he said no, not on just the 1 unit of insulin. Now, as to the type of insulin, he put her on one of the ones you guys mentioned. It is ProZinc. They told me that I would have to get it through their office. I think the other day he must have been thinking about dogs when he said I could get it from the pharmacy because the tech told me today (before I saw the vet) that cat's insulin always comes from them--the vet's office.

So tonight, I am suppose to give Delynn a shot of 1 unit at about 7 or 8 pm and then at 7 or 8 am in the morning. Two shots per day 12 hours apart. I'm a little nervous about it but I can do it. I'm sure it's just going to be difficult the first few times.

I do not have a meter yet to test her at home but plan to get one ASAP. I appreciate the suggestion of the meter and test strips at Walmart. I can get that tomorrow. I also will keep in mind the strips to test her urine. I appreciate all these comments and suggestions because as I said, I have never dealt with any of this before.

One thing I wanted to ask is about the cost of the insulin. At my vet, the ProZinc costs $106 a bottle. Now at the small dose she is taking, they said it should last her a couple of months. I have no idea if I can get this insulin somewhere else or not but it's obviously by vet prescription. By the way, just for reference, I am in the Nashville TN area. Today my vet costs for 2 days of testing (glucose curve), 1bottle of insulin, a box of 100 U-40 needles and a box to keep the used needles in (that I can take back to them for disposal) was $367. I have no idea whether that is good or bad but thought I would ask you guys what you thought. Here's the breakdown:

Insulin injection (day 1)-$32.00
Glucose tests-day 1 (3)-$87.00
ProZinc (1 bottle)-106.50
ProZinc syringes (U-40) 100-$21+tax
Insulin injection (day 2)-$32.00
Glucose tests-Day 2(3)-$87.00
Total $367.44

I had spent about $300 not long ago treating her for the bladder infection and getting her blood sugar and thyroid checked so almost $400 more today did not make me a happy camper. But I'm going to do whatever I can to make my baby girl well so whatever it cost was well worth it. I'm just curious as to how these costs might stack up in your area. To me it all seems very high but I guess it just depends on where you are and what vet that you use.

In spite of the wallop to my pocketbook, I am so happy to have my baby home and know that she will not have to go back in tomorrow. I will keep you all posted and please wish me good luck on giving her the first injection tonight.
I will be checking out the meters at Walmart tomorrow and start checking her blood sugar at home.

Thank you again for all your help. Anything else you might want to add would be very much appreciated!
:)
Ronala
 
ProZinc is a good mild insulin. I like the one unit, but am a little concerned about the low numbers at the vet. Numbers at the office can be 100 points higher because stress raises bg levels and cats are usually stressed at the vet. If she was 123 midcycle, she might have been very low at home...

Your decision, but if she were mine, I think I might skip the shot, get the meter and get a number before I give any insulin. It is easy to see if the dose will be safe when you have blood glucose numbers. Giving insulin with no numbers is a little scary.

At far as the expenses, you don't need to have the vet check her numbers. You can do daily testing and a curve at home and send your vet her numbers. They are likely to be much more accurate.
 
The initial costs are a lot since you have to buy the insulin, syringes, other supplies, etc. But it does get better. Here are tips on how to save money: http://binkyspage.tripod.com/frugal.html

You can use U100 insulin syringes with ProZinc. Some brands cost as little as $13 for a box of 100. You can buy U100 insulin syringes at any Human pharmacy. A prescription may be required. Most peple here buy online from AmericanDiabetesWholesale.com and other places. The most ideal ones to use are u100 3/10cc with half unit markings. But... there is a conversion chart you absolutely must use so that your cat is getting the right amount of insulin. 1 unit of U40 insulin in a U100 insulin syringe is not the same as 1 unit of U40 insulin in a U40 insulin syringe. This explains the difference between U40 and U100 and why the conversion must be made: http://www.felinediabetes.com/insulin-conversions.htm
 
Insulin injection (day 1)-$32.00
Glucose tests-day 1 (3)-$87.00
ProZinc (1 bottle)-106.50
ProZinc syringes (U-40) 100-$21+tax
Insulin injection (day 2)-$32.00
Glucose tests-Day 2(3)-$87.00
Total $367.44
Click to expand...

Those aren't outrageous prices for a vet to charge, but....
Glucose tests.....you'll never have to pay them to do another one if you are home testing.
Prozinc - that's right about the "going price". That bottle should last you for months though.
Insulin shots....well, seeing as how they charge you 21 cents each for the syringes (and you'll be able to get your next box if you need one for about half that much), and seeing as how they used less than a dollars worth of insulin on both shots combined....you can see where they make their money. You paid $64 dollars for 2 shots, and $174 for tests, so $238 total. The "parts" cost about 2 or 3 bucks. So that's a pretty good "labor" income, huh? For at most, a half hour's worth of actual labor.
That's the beauty of doing all this stuff yourself at home. Huge cost savings, and much less stress on you or your kitty. But don't feel "ripped off", seriously. That's just what vets charge. Makes me kind of wish I'd gone that way 35 years ago when I was picking a career. :-D

Carl
 
Hi Ronola,

I'm really new to this too and going back to the vet tomorrow. We started insulin last week and it looks like I'm going to end up with a bill like yours so they can do a curve. I haven't been able to master the glucose testing deal yet. Yesterday I could do it, today my kitty is anticipating it and is totally outraged with me even though he gets a treat at the end of each attempt. (get freeze dried 100% chicken if you need a highly desirable bribe).

The only thing I can tell you is don't touch the ends of the glucose meter test strips when you're putting them in the meter! When they're so expensive and when it's such a fiddly thing to get the drop of blood, it's better to get it right first time by only holding the middle of the strip.

I learned that today. It has cost me a box of test strips, but now I know.

I have found this forum to be far more helpful than I ever could have hoped. You are in the right place :)

Lulu & Winny
 
You have gotten alot of great advise already.

I just wanted to add the I used my first vial of Prozinc for 1 full year and it was good to the last drop.
 
Welcome! and you have gotten some great advice! I will only add the way I use my meter (Relion Micro):

rub ears gently for about a minute to warm them

pull the cap off the lancet (I free-hand) and for a newbie you want a lower number (26, 28 gauge) in your lancets as they have a bigger poking end and until you get the capillaries into that part of the ear you will need it for any success- they are usually cheap for a box of 100

take out one strip, close the canister, and place strip onto the lid (NOT in the meter- once set in the meter you have about 7-10 seconds to get the blood tested- and it usually takes more than 7 seconds to get the blood from the cat, newbie or not :lol:)

rub ears some more and poke the sweet spot area and then rub some more until you get a bead of blood
http://i106.photobucket.com/albums/m267 ... etspot.jpg

rather than trying to get the strip into the meter and test the drop on her ear (she hated the beeping and fidgeted so much and flicked her ears to get rid of the blood) I scrape my fingernail along the fur and pick up the drop of blood onto my fingernail and then lightly pinch the spot to stop it from bleeding

Once you have the blood stopped, set the strip in the meter, watch for the test icon (usually a drop of blood icon will appear) and, holding the meter like a pen (up and down) lightly touch the strip end to the blood drop and it will draw it up naturally. If you dump the blood on the strip end the reading will be incorrect/false or there will be no reading at all.

I found this last part by accident- I went to a health fair and had my bg checked and I saw the pharmacist student do that and realized I was doing it ALL WRONG!!!- that was why I had a whole box of 25 strips had come up bad :oops: .

other helpful hints are found here:
viewtopic.php?f=14&t=287

Good luck!

I get my syringes from W-M too- 100u and used a conversion chart when we were on PZI. The price I paid for it is comparable but they added in more for their convenience. But my bg checks were only $11 so I got you beat on that one, although mine is a small vet office and I managed to get about 40 syringes for free before i needed to purchase my own :-D . If you decide to stick with 40u syringes let me know as I have some left over from my last batch before I switched to 100u ones.

1u starting is good but I myself would take the time to change the diet FIRST and get the testing down before you start the insulin (about a week for the capillaries to come in good so testing is easier to do). It won't hurt Delynn too much to start a week later and it could actually do a lot more good to get the basics down and get the higher carbs out of the body so what you are dealing with is just the diabetes rather than the diabetes and carb combo.

And once you have the testing down you don't have to go to the vet to get a curve- you can get it yourself and take them the sheet to look at- unless they want to do it for free :lol: (mine didn't either)
 
Hi Ronala,

I'm in Nashville, too! Out of curiosity's sake, what vet did you take your girl to? My Mr. Kink was just diagnosed about a week ago, and since then, we've changed his diet and started home testing (I just did my first home glucose curve today!) so I know the next step will be finding a vet I want to take him to to get him on insulin.

How did you feel about your experience? Was the vet supportive of the idea of home testing (if you brought it up)? Thanks for any info!!
 
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