New diagnosis and some questions

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kbean

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Hi all,

My one year-old cat, Spike, was (provisionally) diagnosed with diabetes today, based on his symptoms (fairly par-for-the-course stuff) and the UA at the vet's. The blood test should come back tomorrow and confirm it. In any case, this is a pretty terrible time to find this out, as I am going out of town for almost two weeks in a couple of days. Luckily, I have some friends who are willing to come over and take care of the cat while I'm gone, but I'm trying to get some more information so I know what to tell them. So...questions:

I know that things are probably different in every cat, but when should I start seeing a change in Spike's symptoms (i.e., assuming the dose is good for him, when might he start to perk up and/or stop drinking and peeing so much)? Frankly, the litterbox is foul even though I clean it every day because he pees so much and it smells so rancidly sweet. If the people coming over while I'm gone don't have to deal with that the whole time, that would be wonderful, but I want to warn them if this might continue on for a bit.

Is there anything in particular that people need to keep an eye out for that would indicate something is wrong with him, or that his insulin dose needs to be adjusted? I asked my vet if I needed to take blood sugar readings at home and he said not unless we were having difficulty with his dosing. I just want to make sure that my friends and I are aware of what to look out for that would merit a trip to the vet.

Finally, is there anything particular to young cats with diabetes that I should know about? Different symptoms, prognosis, etc? Am I correct in understanding that young cats who are diagnosed with diabetes are rarely the ones who are able to eventually go off the insulin?

Thanks for your help!
 
kbean said:
I know that things are probably different in every cat, but when should I start seeing a change in Spike's symptoms (i.e., assuming the dose is good for him, when might he start to perk up and/or stop drinking and peeing so much)? Frankly, the litterbox is foul even though I clean it every day because he pees so much and it smells so rancidly sweet. If the people coming over while I'm gone don't have to deal with that the whole time, that would be wonderful, but I want to warn them if this might continue on for a bit.
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Yes, the saying here is ECID (every cat is different). I saw a change in Bob within 3 or 4 days, but his original diagnosis was a lot worse than it sounds like your kitty is. Just a couple days is a really short time for you to get up to speed. The excessive drinking and peeing went away rapidly for Bob. And then there was a general improvement in his mood and activity level. But I also combined several things at once - diet change (absolutely no dry food, only low-carb wet food, insulin injections 2x per day, home testing for BG, and he was also receiving 100cc of lactate ringers every other day). He was in pretty bad shape.
kbean said:
Is there anything in particular that people need to keep an eye out for that would indicate something is wrong with him, or that his insulin dose needs to be adjusted? I asked my vet if I needed to take blood sugar readings at home and he said not unless we were having difficulty with his dosing. I just want to make sure that my friends and I are aware of what to look out for that would merit a trip to the vet.
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You should definitely tell them to set up an account here, or let them use yours temporarily. If they are new to feline diabetes, they are sure to have questions. They can get a rapid response here 24 hours a day, which will help if they are not able to contact your vet. I don't understand the vet's logic when you asked about home testing. How would he expect you to know if you were having difficulty with the dosing if you weren't aware before each shot what the kitty's BG reading was? If you immediately change his diet, that will have a positive effect on his BG numbers. It will drop his blood sugar, which might influence how much insulin to give him. People will be able to tell you more if you can first let us know what his BG numbers are from the vet visit, and what type (and dose) insulin the vet prescribes.

My suggestion is to hang out here tonight, or at least check back a few times in the next few hours. You're about to get a whole lot of great advice from a really great group of people.

Carl in SC
 
I guess the first thing that comes to mind is how would you know if you were having trouble with the dosing if you are not home testing! You were right to ask about testing - this is one of the 3 keys to successfully managing diabetes.

Key 1: diet - cats, and especially diabetics cats, should not have dry food. They do best on lo carb, wet canned food. If you read the FAQ, you will find a section on feeding and there is a list of commercially available canned food and the carb content is listed for an amazing variety. Choose some that are available in your area, that your cat likes, and are below 8% carbs. If your vet has sold you a prescription diet, or worse some dry food, take it back. They will give you a refund for it.

Key 2: home testing. You already know this is important, because you asked. You need a glucometre, available from any pharmacy - the same ones that humans use. You'll also need test strips and lancets to draw the blood. There are lots of videos on youtube, and each one of us has helpful tricks to offer when you get started.

Key 3: insulin. For some reason (maybe medication like steriods, infection, stress - or may remain a mystery) your cats pancreas is not producing enough insulin to balance the sugar/carbs that he is eating. By giving insulin it gives the pancreas a rest and helps it heal. A gentle, long lasting insulin like Lantus or Levemir seems to work best.

So now the questions: What is Spike eating now? Does he seem hungry all the time? Are your friends that will be watching him willing and able to home test and to give insulin shots? How often will they visit and how long will they stay? It is unlikely that he will be much improved in a few days, and (not to be discouraging) may actually seem a little worse before he starts to improve.

I'm sure that others will have thoughts for you.
 
Thanks for the advice so far!

Another question: I believe they're prescribing him Lantus. Does anyone know where this (and the syringes) might be cheapest to purchase? I'm a grad student and I'm definitely on a budget...

Just-As-Appy said:
What is Spike eating now? Does he seem hungry all the time?
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Right now he's eating Science Diet dry food, and some occasional wet food. I realize I'll probably have to change this. I'm planning to talk to the vet tomorrow about what he recommends. Luckily, Spike will eat pretty much anything, and he's only once had a problem when I changed his food. He is indeed hungry ALL THE TIME. He eats plenty of his own food and begs for mine constantly, even though he never gets it from me.

Just-As-Appy said:
Are your friends that will be watching him willing and able to home test and to give insulin shots? How often will they visit and how long will they stay?
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I've found some friends who are willing to give the shots while I'm gone. One of them will be the main person who will come over and feed/inject Spike, and two others will be backups, including my next-door neighbor who has some experience with injecting her dog. I'm going to talk to all of them and make sure they are clear on my contact information, my vet's contact information and all of the instructions on taking care of him. Someone should be by at least twice a day, and I might have my neighbor check in on him a third time just to make sure he's ok. Home testing...I don't know. I imagine if my friends will give him the shot that they will also test him, but I'm going to check in with my vet about this. A glucometer is not entirely within my budget at the moment, although if I have to get one I will.
 
You can purchase a glucometer for ten dollars at walmart. The one I use is called a Relion Micro. They also see the test strips for $20 for a box of 50 if I remember correctly.
Most will advise (me included) that you ditch the dry food asap. Too high in carb content. Carbs are a sugarcat's worst enemy.
What you want to feed is an all-wet low carb canned food. Most of us use Fancy Feast Classic, Friskees pate, or other low carb varieties. Here is a link to "Binky's Lists"
http://binkyspage.tripod.com/canfood.html
http://binkyspage.tripod.com/CanFoodOld.html
Another great thing to read is the FAQ:
http://binkyspage.tripod.com/faq.html

I am not sure about the Lantus questions, but I'm sure a lantus user will be here soon. I use PZI with Bob.
Definitely give serious thought to home testing. It is the best thing for your kitty. Diabetes is a manageable thing. Some cats eventually get off of the insulin completely. Even if they don't, they can still lead long and otherwise healthy lives.


Carl in SC
 
I'll just chime in here for a minute just to stress that changing from a dry diet to a lo carb wet diet WILL bring the bg numbers down.
If you are going to be gone for a few weeks and are not going to be able to test, I would not recommend switching to wet food until you return and start testing. When the lo carb food brings the bg numbers down and kitty is still getting insulin based on the higher numbers, well.....that could be bad. Deadly, actually.
Just be careful.
 
As I've been thinking about this, I've been considering boarding him at the vet's for part of my trip and then having my friends take care of him for the last 5-6 days or so. It's really too expensive to board him the whole time I'm gone, but I'm imagining that it might help to have him at the vet (presumably being taken care of by people who know something about this) while he's starting on this. Does that sound like a reasonable plan? I still doubt that they'll do regular BG testing (unless I ask), and I'm not sure I actually want them to, because I think it will cost me more money than I can afford right now. I'd be willing to start testing him when I get back, though.
 
I want to add that I didn't make my previous post to scare you. I just didn't want you to think of switching Spike's diet while you were away. Unless of course, your friend(s) can/will test him. He really is going to need to be checked before each shot so you will know how he is reacting to the insulin. Is he getting to much, not enough, things of that nature.
After switching Callie Mae to wet food, I did a little fine tweaking with her doses and within weeks she went completely OTJ (off the juice) and is now 100% diet controlled. If I give her dry/ high carb food, she has to go right back on insulin. Keep it away from her and she does A-OK!

Your vet is not going to check Spike before each shot and besides, that would cost WAY to much.
This is just me, but, I wouldn't board Callie Mae if I had someone who would come giver her injections twice a day. Callie Mae doesn't like the vet's to much.
She would disown me if I left her there for any length of time. :lol:
I know you want to do the best you can for Spike, and the timing sucks, but I'm sure you'll decide what's best.

eta: Is it really almost midnight? This board is addicting. I REALLY need to get to sleep. There is just SO MUCH to read. :lol:
 
Do you know how high Spike's blood glucose (bg) numbers are now? I suggest perhaps a different approach.

Purchase a glucometre now and test for the next few days that you are home. Change his diet to all canned and freeze enough in ice cube trays for 2 a day while you are away. Small, frequent meals are best for diabetics. Then just have your friends come in twice or 3 times a day and feed, clean litter box and play a bit. If they will test his bg before each meal, that would be great as well.

As for giving insulin, unless his bg is really high, I would be tempted to give a very small dose - like .5 unit while you are away. If he goes and stays at the vet, his bg will be higher b/c of stress. I would be surprised if the vet would give insulin without testing, but perhaps he/she would.
 
I have to give you my two pennies. Cedric is fairly young, will be 6 in September. He was diagnosed 2 weeks before I was set to go to CO for 3 days and then to work (I work part time at Walt Disney World) for a 5 day vacation with some friends. He was to be boarded at Best Friends at WDW for the week, but that changed with his diagnosis. he had to be boarded at the vet while I was in Boulder and since I couldn't pick him up on Sunday (vet not open), he stayed there Wed evening thru Monday am. He had his teeth cleaned while he was there and total bill was $500. It was $90 for the boarding, plus $4 and change for every injection (whihc because of the teeth cleaning was not twice a day every day - 5 injections I think). They charged a one time disposal fee for the syringes & lancets - $4.50 I think. it was the BG testing that whacked me - about $16 each and they did at least 3. Maybe they didn't inject him 5 times - this was in early May. Anyway, it was expensive. I have money saved, but to be honest, if your friends feel comfortable testing his/her blood sugar and giving injections, you might be better off leaving your cat at home (also less stress than at the vet). That's what I would have done if given the chance, but I didn't have the chance.

Good luck in whatever you decide and keep us posted!
 
The most cost effective way to get Lantus is in a 5-pack of 3ml pens or pen cartridges. (we use regular insulin syringes rather than injecting with the pen itself -- the insulin is in a cartridge inside the pen)

The vet needs to specify on the prescription "5-pack of 3ml" Lantus pens / cartridges. Also, ask for enough refills to last one year. Assume for now that means 2 refills of the 5-pack since each one will last at worst case 28 days -- so prescription should cover at least 13 pens.

Once you pierce the rubber with a needle, the insulin starts "aging". Lantus is guaranteed for 28 days -- with careful handling (refrigerate, do NOT roll or drop), most here get more than 28 days -- but keep records of blood sugar tests and you will see when the insulin is losing effectiveness when the blood sugar numbers start going up "for no reason".

If you buy a 10ml vial of insulin, you will end up throwing away A LOT!!! because it will definitely go bad before you can use it up.

A good starting dose is 1 unit every 12 hours. This is a pretty tiny amount, so make sure your pet-sitters understand the correct dose.

Syringes should not be re-used -- it will contaminate your expensive insulin to save $0.17.

I like these syringes, which have half-unit markings:
http://hocks.com/hocks-healthcare/hocks ... 40030.html

Call around local pharmacies for the best prices --- also check Sam's Club and Costco -- don't need to be a member to use the pharmacy.

Many of us buy our insulin from Canada as it is much cheaper there. --- allow 7-10 days for shipping though. Lantus is also called Glargine
www.canadadrugsonline.com
 
So the vet called back and his BG was 564. He also has some liver problems that the vet thinks are secondary to the diabetes. He's being started on Lantus, 2 units 2x/day. I asked the vet about boarding him there for the first little while that I'm gone and he confirmed that it might be a good idea because he'd be more supervised (as opposed to at my house, where he'd only be checked in on twice a day). They do not charge anything extra for the injections and I'll make sure there are no other fees I don't know about. While Spike is not thrilled with other animals (mostly because he just doesn't know they exist most of the time), he's also a fairly laid-back cat and I don't think he'd be overly traumatized by being at the vet's for a few days, especially since all he does right now is lay around anyway. If I go this route, I'll send his bed or something else that smells like home along with him.

The vet also recommended that I go ahead and change his food. He wasn't too concerned about his blood glucose dropping too much with both the insulin and a diet change.

Some more questions: I'm going to the store today to pick up new food and get some other supplies. Does anyone have any recommendation for a litter that will help deal with the god-awful diabetes urine smell I'm dealing with right now? I usually use Fresh Step unscented or Petco's store-brand refillable litter (I really dislike that perfumey litter smell) but he was going to the litterbox so often (and subsequently walking through his pee, which he's stopped covering up) that he was getting concrete paws that he couldn't clean (and neither could I). I switched to Nature's Miracle (which I think I actually like more than the clay litter anyway), but no matter how many times a day I clean the box it's not handling the smell very well. Any suggestions?

Also, I'm getting his prescription filled at Target and I may as well pick up a glucometer while I'm there. Does anyone know anything about the Target brand (Up & Up) meter? It's only $10 so it seems like a reasonable choice. I saw some online reviews complaining about needing the control solution and it being hard to get, but from what I've read on here it sounds like the control solution for the glucometers isn't totally necessary?
 
I'm not familiar with that particular meter, but I will tell you they give you the meter cheap so you get roped into buying the test strips (which can get pricey). So I would recommend checking the cost of the test strips before I made a decision on the meter.
 
Regarding litter -
When Bob first started showing signs of diabetes (excess drinking and peeing), we had no clue at all what was going on. We were using various scoopable brands, and were convinced that they had changed the formulas and make it no longer work right. Clueless we were.
We swiched to the "natural" brands, which were a lot more expensive, but they didn't work any better. Once we found out what Bob real problem was, and the treatments started, the problem went away.
By that time, we had settled on either the "pine" or "corn" based products (scoopable only). We did experience an issue when we changed litters. Bob didn't like the way they smelled as they were completely different from the usual brands like Arm and Hammer, Fresh Step, etc. So we had a couple of "rug" incidents until he realized that we were going to win this fight.
Today we use either "World's Best Cat Litter" or "Feline Pine". Neither has an offensive odor by itself, and they both seem to mask Bob's deposits' odors very well.

Carl
 
I've used Fresh Step for years. I was in the same boat as Carl, I thought they had changed their formula and that's why it wasn't clumping as well, here to find out it was the cat not the litter...

I'm not sure of everyones experiences (every cat is different), but Kit has already (in a weeks time on insulin) stopped drinking and peeing as much. You may find that in a very short time, the odor and amount will go back to normal, even if he isn't covering. I also tend to keep one (or two) of those $1 air fresheners stuck to the outside of the litter box and just replace it every month. It's perfumy, but you can pick a scent you can tolerate.
 
kbean said:
He's being started on Lantus, 2 units 2x/day.

The vet also recommended that I go ahead and change his food. He wasn't too concerned about his blood glucose dropping too much with both the insulin and a diet change.
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If you are changing completely to a diet of wet food, 2u is too high a starting dose. Most cats on a low carb wet diet only need around 1u of insulin. The highest dose Bandit has ever needed is 1.25u. He was 13.5 lbs at diagnosis (supposed to weigh around 12 lbs)and started at 1u 2x day. Remember that the starting dose is calculated based on IDEAL weight, not ACTUAL weight, so if your cat is overweight you need begin the dose based on what he should weigh. Many vets make this mistake. The other mistake often made is to start .25u per pound instead of .25u per kg.

Changing to wet food will likely immediately lower your cat's blood glucose by 100-200 points. Almost ALWAYS the cat needs the insulin dose lowered with the diet change. With you not being there to test, this is a dangerous combination.

Your vet should be incredibly concerned about his blood glucose dropping too much. Please print out the article I've attached, and the Lantus dosing protocol (http://felinediabetes.com/Roomp_Rand_2008 dosing_testing protocol.pdf)to give to your vet. If your vet will not follow it, I would adjust the doses on your own (there's a simplified version here: http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581. It is the only safe way to dose Lantus.

Hypoglycemia should always be a big concern with cats because they need so little insulin, and it really bothers me that so many vets treat it lightly and start the dose way too high! It also interferes with the treatment, because a cat receiving too much insulin (if it doesn't become severely hypoglycemic right away) will still suffer from high Blood Glucose from the mild hypoglycemia, because its liver will dump stored glucose into its system as a survival mechanism from dropping too low. The philosophy we use here is "start low and go slow", meaning, start with a low dose and raise the dose slowly, in .25 to .5u increments based on your home testing data.
 
I did the first shot! I distracted him with food and then did it...he didn't even notice. It made me worried I did something wrong, but I didn't feel any wetness around the injection site, so I'm guessing I did it okay. The vet tech who demonstrated it made it look so easy, but my cat has so much hair! It's hard to find skin.

Based on some of the responses here, I am going to wait to change his diet, although I'm going to stick with the Lantus dosing that the vet recommended. I'll be very sure when I drop him off there for a few days to tell them to keep an eye out for signs of hypoglycemia. When I get back, I'll check his BG and adjust his food from there.
 
Your on the right track! Julius is about 3-4 (SPCA.. who knows) anyway we caught his Diabetes early and he is in remission now.... he displayed symptoms for about 6 weeks before I put it together and got him checked out, with any luck you will get there two! Good Luck! This message board is a wealth of information it was my lifeline when Julius was sick!
 
That sounds like a good plan. I think it would be much better the other way around (eliminating the dry food and starting at a lower dose), but it sounds to me like you don't want to disagree with your vet's dosing advice. I understand that feeling, but sometimes you have to take charge with your cat's health if you know something isn't right. My vet is very open to me bringing her new information, and she has even changed her treatment guidelines for other patients because of it. To me, that's the sign of a good vet. They have to know a lot about many different diseases for many different animals, so you can't expect every vet to be an expert at every disease for every animal. A good vet is aware of their limitations and will happily read over and discuss new information brought to them.

I've also attached the article I seem to have neglected to attach in my last post. I really recommend giving it and the protocol to your vet.
 

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Oh, I also forgot--I use the Breeze litter system and I love it. With a diabetic cat, you have to change the pad twice a week instead of the one they recommend, but it is soooo much cleaner than litter. The only drawback to it is that soft or runny poo is a pain in the butt (no pun intended) to clean, so if your cat is prone to loose stools a lot you might not want to try it, but if those are a rarity then it's definitely worth it. They have a $10 off coupon on their website right now, and you can get it pretty much anywhere that sells litter.

http://www.breezeforcats.com/?D=4837057&T=6084908
 
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