? New cat with diabetes... and not only that!

Hi! My cat has diabetes... and not only that, unfortunately. It's a long story - my boy Torky was rescued from the streets 7 years ago.
From the beginning, he had problems with a nasty stomatitis, which I haven't put an end to even now. After many treatments, he remained on Dexafort, which eventually triggered diabetes and nephropathy (eliminates proteins in the urine). I changed the vet again this week (more than 10 doctors have seen him in these years).
I discovered in the middle of January that his blood sugar was 360, and since January 31 I have been giving him Lantus insulin.
I am attaching the blood sugar values (I hope it will be seen, I will try to put the link in the signature). I found this forum (thank God!!) a few weeks ago and read a lot here.

Is it just me or is it a bit strange how the values have decreased?

Tonight I'm going to give him only 1 unit - that's what the vet wrote to me - over 250 3 units, 250-180 2 units, 140-180 1 unit.
What do you think?
I use a Lantus pen (not the syringe - I can't split the units). Here (I live in Romania) I only see 1 ml/100 IU syringes - with which it seems even more difficult to dose accurately.

https://docs.google.com/spreadsheets/d/1IWePAfipHq6sfYNS2u0KxSzPdZo5hdjzaF_XvpR0e1k/edit#gid=0

Thanks a lot for any ideas!



PS - excuse my English, I'm not a native speaker.

 

Hi Irina and Torky and welcome to the forum. Well done getting the spreadsheet and signature set up. That is very helpful. And yes I can see the spreadsheet.
Is the stomatitis any better or is it still ongoing ? Have any of the vets suggested removing some teeth to see if that helps?
I see the vet has given you a sliding scale for the Lantus. We don’t do that here. Lantus is a depot insulin and likes consistency as chopping and changing the dose messes with the depot.
Here is an explanation about WHAT IS AN INSULIN DEPOT …click on the blue writing.
I would chose a dose and stay with it unless the blood glucose (BG) drops below 5 (90 in US numbers)
I would go back to 1 unit and stay with that unless the BG drops under 5.
I am going to send you a link to our dosing methods. I think START LOW GO SLOW would be the better method for you at the moment.
Look for it in this link. It is after the Tight Regulation method
DOSING METHODS

I am wondering if you can buy some more suitable syringes online.
The syringes you need are U 100 3/10 ml, 30 or 31 gauge, 6 or 8 mm insulin syringes with 1/2 unit markings.
We have a few people here from Romania …I can’t remember who offhand but I will find out and tell you. They may be able to help you with some supplies and where to get them.
Keep asking questions, we are happy to help.
Bron

 

@Marina & Chico may be able to help you with things in Romania

 

Hi, thank you very much for your message. Now (in the morning at my place) he had 362.
I read the explanations about insulin depot. Probably the dose of 1 unit last night was too little. Should I give him 2 units and stay like that for a longer time (5-7 days) regardless of the results?


The stomatitis never got better. Now he has 3 canines - he lost almost all his teeth, 2 were extracted by the vet. Now the new vet suspects that there are roots left. We will do an X-ray on Monday.

 

How long have you been giving insulin? Did you start on 14 January? Did you start on 1 unit?
I’m going to ask @Bandit's Mom to have a look at your Spreadsheet and see if she can put the numbers in the correct dates. She will contact you

 

No, we started 3 days ago (3 units). I found high blood sugar on January 14, but we were out of the country for 10 days and there was no one to give him insulin. In addition, the vet wanted to give him Caninsulin. I found someone else who prescribes Lantus.

As I wrote above, the vet says: over 250 3 units, 250-180 2 units, 140-180 1 unit.
Or this means I always have to change the doses, which I don't see happening here (I've seen many spreadsheets on the forum)

 

I think you should go back to 1 unit and stay at that dose for a week unless the BG drops under 90 (5). If that happens you need to reduce the dose but that’s going to be hard when you are using the pen. We can come to that after. For now I would go back to 1 unit for a week

 

Hi @Irina and Torky! Welcome to FDMB. Are you using a pet meter? The SS format you are using is for pet meters that reads in mmol/L. I can set up a new spreadsheet for a human meter that reads in mg/dl if you'd like.

Bron, is there anything else that needs to be fixed on the SS that I'm missing?

 

I think just the wrong SS and the dates are not correct. thanks Bhooma

 

I use VivaChek Eco - it's a human glucometer. Now I have 3 different human glucometers at home - all in mg/dl - and yesterday, when I did several tests, I tried (at the same drop) on 2 glucometers at once and the values were similar.

 

I have already given 2 units now, I will see tonight what the values are. So would it be good to stay on 1 unit, even if I have values of 167 or 360 before the administration of insulin?

Regarding the syringes - the vet doesn't want me to use the syringe, I'll contact my forum colleague from Romania to see if she found suitable syringes somewhere. I want to be very sure that I'm not making a mistake with the dosage from the syringe - I've never had anything to do with diabetes until the other day, I didn't see what an insulin pen looks like until the other day.

 

Yes please go back to 1 unit of
insulin at the next dose.
2 or 3 units of insulin is too high a dose for a cat who has been on insulin less than a week. The normal starting dose is 1/2 to 1 unit of insulin.
I can’t imagine why your vet doesn’t want you to use syringes. Cats are tiny creatures and the normal increases in dose are 1/4 unit not 1 unit. Going from1 unit to 2 units is doubling the dose.
I hope your friend can find the correct syringes for you. Did you give your friend the correct syringes I gave you earlier.
We can help
You get the right dose with the syringe.

 

I will return to 1 unit and in the meantime I will try to see how I can find syringes. It was quite difficult to find a vet who would agree with Lantus - most prescribe Caninsulin.
Thank you very much for the encouragement, it's not really easy for me, I don't usually do injections, but now this is his only chance and I have to overcome my difficulties.


I forgot to mention that I did a fructosamine test before starting the insulin and I'm waiting for the result.
For nephropathy, I started giving him Semintra - anyway, in 3 days with insulin (administered in these strange doses) and with Semintra, his general condition seems to be better.

 

You are doing a great job in difficult circumstances. Torky is lucky to have you.
Just a reminder the syringes you need are U100 3/10 ml, 30 or 31 gauge, 6 or 8 mm insulin syringes with 1/2 unit markings.

 

@Irina and Torky I have sent you a request for edit access to the spreadsheet.

These are the syringes used in the UK and Europe:

 

I hope these are fine, my forum colleague also recommended them to me!



@@Irina and Torky I have sent you a request for edit access to the spreadsheet.


I try to find it!

 

Sorry, I don't see where the request is. Where should I look?

 

It will come to the gmail account associated with the SS (the one that is the Owner of the SS). Check the spam folder as well since it sometimes goes straight there!

 

Got edit access and I have changed the SS format to human meter and mg/dl.

 

Thank you!

Another question - Torky predominantly eats raw meat (or very quickly cooked - 3 seconds - for taste) - chicken breast.
But chicken meat doesn't really have many nutrients, so I give him a can every day or every 2 days (or less often, if he has problems with stomatitis, he doesn't want it at all). He also takes the paste with vitamins (the same way, when he feels like it, or some sachets with paste with omega 3, taurine, vitamins, etc. - only if he wants).

He likes these - and I have already taken them. I don't see that it contains carbohydrates - although the composition says various sugars. What do you think?

https://www.purina.co.uk/cat/cat-food/product-gourmet-revelations-chicken-wet-cat-food

 

I’d like to answer the questions in post 20 more fully than I can at the moment because it is late at night. I will get back to you tomorrow..

 

Hi Irina and welcome!!!

you’re in amazing hands with Bron here. I just wanted to say that here, we don’t dose by the preshot numbers like your vet is advising you to do. We dose by the nadir, or lowest he’ll go in a 12-hour cycle, which is why Bron said to only change the dose if he goes under 90 (5). We stay with the same dose for a few days to give Lantus a chance to work since it’s a depot insulin and needs consistency. It’s too bad most vets don’t understand how Lantus works, I wish more did.

 

Thank you for your message! I would like more doctors to prescribe Lantus for cats, not Caninsulin. I found a smart lady doctor, the first one who comprehensively addresses my cat's problems. Until now, everyone told me either to give up corticosteroids (no alternative - although if the cat does not eat or drink water, he will surely die in 2-3 days) or to euthanize the cat!

Now the cat had 280 + 6 hours after the morning dose. Should I go back to 1 unit (even if it will be over 300 at 10 pm, before the injection) or stay at 2 units??


I think the nadir is at +6, yesterday after 3 units it was 105, but today after 2 units (and only 1 unit last night) it was 280. I'm a bit confused! He receive prednisolone 5 days +antibiotic (Synulox) for stomatitis.



Finally I give him 1 unit... will see tomorrow morning the numbers.

 

Irina because Torky has only been on insulin for less than a week, it is important that he start on a low dose. Starting on 2 or 3 units is too much insulin for a very newly diagnosed cat. Cats starting dose is 1/2 to 1 unit. Now becasue you are using a pen at the moment. We have to start with 1 unit. Please stay with one unit for a week, unless Torky drops under 90. Even if the preshot BG is high.
Hopefully you will be able to get some correct syringes to use soon. The syringes @Bandit's Mom showed you are perfect.

I am concerned you are not feeding a nutritionally complete diet to Torky.
Chicken breast is fine to feed but he needs to have supplements added every day for the meal to be complete. can you show iPad the paste and the sachets you also give please. It sounds as if he only gets those sometimes when he will eat them.
I’m not sure the food in the link you sent above in post 23 is low carb @Bandit's Mom what do your think?
Do you have access to canned low carb foods than the would eat.?

 

Exactly what Bron said. Start low go slow which is one of our protocols here. Be patient and start at 1 unit and stay there for at least one week maybe more. Feline diabetes is a marathon not a sprint. Trust us

 

Thank you for the messages!!
Today the blood sugar was 360, I also gave him 1 unit (it seems he doesn't look as good as 2 days ago).

About food... if he could also read this it would be very good! He always ate only what he wanted - and considering the problem with stomatitis and the fact that he never drank water before the onset of diabetes, he got what he wanted. For me, eating was always equal to drinking water! If he doesn't eat for a day, he doesn't drink water for a day -- and that's dangerous for cats!

I always have a big box with a wide variety of canned foods and envelopes with pasta, vitamins, etc. Torky eats the same type of canned food 2-3 times and after that he might not want it anymore - or vice versa (he refuses 2-3 times and then eats). I threw away a lot of food during the time...

Eat the paste like this: https://www.zooplus.ie/shop/cats/cat_treats_catnip/vitakraft/300107
and 6-7 other similar kinds with omega 3, taurine, multivitamins, etc. For a few days they don't like it anymore (I threw away 4 out of 5!!!).

I'm also trying to give him Smilla vitamin paste https://www.zooplus.ie/shop/cats/ca.../434074?origin=hopps&q=smila vitamin&i=1&ro=1
but he also eats this when he feels like it! I also have Smilla vitamin paste for kitten!

In addition to these, I have various canned goods (no added sugar and no grains) from which I hope he will eat something - if he doesn't eat it within 5 minutes of putting it on his plate, he won't eat it at all!

 

I don't think there is any danger of reaching 90 with this dose and prednisolone every day. I see that it is over 350 (like before starting the insulin) and that worries me... I ordered the syringes yesterday and they will arrive next week.

 

If you’re worried about the water intake, you can try adding a little water to his wet food. Make it as slurry as he’ll eat it. I also find that moving water from a water fountain some times helps cats drink more water as opposed to the still water in a water bowl. Have you tried that?

can you remind me what the prednisone is for again? Just wondering if it’s something budesonide would be an option for since it tends to not affect the bg like regular steroids.

It would be good if you could shorten some of the info in your signature and add any other conditions he has in addition to diabetes. Take a look at how I squeezed all in in mine

 

Torky is now on prednisolone for stomatitis (very bad, which he has had since the beginning). Until now, he has had various treatments, but he remained on Dexafort - which I think caused his diabetes and kidney problems. The bad part is that, without strict control of the stomatitis, it stops eating and dies in a few days.

I put a lot of water in his food (at least 3 large spoons/portion or more). That was the only water he was drinking - other sources - the fountain, the water from the sink... did not work at all. Until he has diabetes, he doesn't drink water at all. Now he goes to the bowl every day and drinks - but not very much - about 50-60 ml/day.

 

Have you tried slippery elm bark for the stomatitis? I had a kitty with it years ago. She had all teeth except her canines removed and still had sores in her mouth. I started with the seb and it went away. Just a thought.

 

I have not used it, how is it administered - pills or syrup? Torky has had a nasty form of stomatitis for 5 years, he needs stronger drugs to keep it under control.
He has no teeth extracted - but he lost all his teeth during this time (at least 3 canines). Unfortunately, dental X-rays are not done for animals anywhere in Romania - we will try to do some regular X-rays tomorrow to see if there are any roots left - but even in this case I don't know what we could do, a good veterinary dentist I don't know if I can find. Even if he were to extract some more roots (if there are any) and if he doesn't extract them all, it's still for nothing. In his state of health, I don't know how he would endure anesthesia.
His inflammation is predominantly caudal - with the loss of the teeth, the actual inflammation of the gums has reduced, but the caudal one did not.
Now he is on prednisolone (injections for 5 days - let's see how long the effect lasts). Until now he was on Dexafort - that caused his diabetes and kidney problems.
Today I take a drug equivalent to Atopica (cyclosporine) - but I have to wait for the toxoplasmosis result before I can give it to him.

 

SEB comes in a capsule. You're supposed to empty the powder into a cup or something (I use a shot glass or a medicine cup), add water and then syringe some in. It becomes thick. I sometimes just dump some powder in the food, too. Some cats will eat it that way, some won't.

 

@Kahluasmom That's ok? How much is given from one capsule - whole or half? How many times a day? Thank you!

 

I just dump about half a capsule in a shot glass and then add some water and stir. It gets thick so I add more water until I can suck it up into a syringe. I give her about 1 ml whenever I notice she seems nauseous. Shes generally ready to eat about 30 minutes later. These days it takes longer because she has her 5,003rd UTI! That's the brand I have, too.

 

Thank you! Nauseous? My cat never seems to be nauseous. But when his mouth is more inflamed, he salivates and cannot open his mouth well.

 

It works for all kinds of stuff, it seems. The first cat I used it for had stomatitis. It worked wonders for her sore mouth. Currently, I'm using it for my IBD/UTI girl. It helps with her nausea and upset tummy. I hear it helps with constipation, too, but I've never used it for that.
On Friday, March 10, 2023 at 10:12:54 AM CST, Feline Diabetes Message Board <info@limestonemedia.com> wrote:
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Kahluasmom, Irina and Torky replied to a thread you are watching at Feline Diabetes Message Board - FDMB.

? - New cat with diabetes... and not only that!

Kahluasmom
I just dump about half a capsule in a shot glass and then add some water and stir. It gets thick so I add more water until I can suck it up into a syringe. I give her about 1 ml whenever I notice she seems nauseous. Shes generally ready to eat about 30 minutes later. These days it takes longer because she has her 5,003rd UTI! That's the brand I have, too.
Thank you! Nauseous? My cat never seems to be nauseous. But when his mouth is more inflamed, he salivates and cannot open his mouth well.
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