New diagnosis... trying what to do about Peaches!

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ker95

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Peaches is my mama's boy. He was a big boy - over 20 pounds - but we noticed a rapid and extreme weight loss in the past week. Yesterday he was diagnosed with diabetes. He's 10, and is already down to 14 pounds.

I've been living on your board last night and this morning, and my husband and I are trying to figure out what to do.

Our schedule is horrible/unpredictable. Every other weekend we go out of town, and our work hours are long with varied schedules. We also have two other (younger) cats.

Our vet (and we have no problem going to another one for a 2nd opinion or to work with us on options), said we had two choices.
#1) She would keep Peaches for a minumum of 5 days, possibly 10 if need be, testing every hour while they determined proper insulin dosage. Keep in mind that Peaches HATES going to the vet, and will be absolutely miserable the entire time. When that was decided he would be released to us for twice daily shots, with the first follow up with the vet in a week.

#2) Do nothing, and when Peaches gets 'unhappy', put him down. I asked what *she* would do (she has multiple cats herself) and she told me this is the option she would probaby do because of her schedule.

We currently leave (dry) food out all day for all the cats to eat when they're hungry. The first thing we did this morning was get one of the Fancy Feast canned foods that was recommended & give it to Peaches, who loved it. May not have been the right thing to do, but we had to do *something*.

We're having a hard time with this. We *could* take Peaches with us when we go away every other weekend (although he doesn't like riding in the car) but are terrified that we won't be able to stick with the tight schedule required for testing/injections.

Peaches is very, very dear to me, and the thought of losing him is horrible. The thought of just watching him wither away to nothing is almost incomprehensible. The concept of making him sicker by messing up the schedule is terrifying.

You all seem to be such wonderful parents to your diabetic furkids.. could you please give me some insight?

Thank you,
Marilyn (Peaches mom)
 
I think that your vet's options s*ck :)

Honestly, it isn't as tough as it sounds. With the PZI insulin you aren't stuck on a strict 12-12 schedule the same as you would be with lantus (or so it seems). When you go away every second weekend you can hire a pet sitter/neighbour/friend to do shots.

Your cat should NOT be sent to the clinic for regulation as it doesn't work. Regulation happens over time at home.

Best thing you can do is
1. change food to reduce the carb content
2. test urine for ketones (a side effect of unmanaged diabetes)
3. give insulin in a low dose twice a day
4. learn how to test blood glucose levels at home

Diabetes can be extremely easy to treat and manage, it just takes a bit of a steep learning curve and some common sense. We can help you!

Jen

ps NOT treating is cruel as he will starve to death. Either treat or PTS before he gets any worse. Sounds very harsh but I'm just being honest. But PTS is really not required!!!!
 
Ditto all that Jen said. Go to Walmart and buy their Reli-On meter, test strips, lancets for poking the ear, and buy a bottle of Keto-Diastix (tests urine for ketones and glucose). You're already switched to the canned food and sometimes that alone is a major help. Remove all dry food and if needed, buy a timed feeder to put more canned in while you are away at work. BCP in TX is a compounding pharmacy and your vet can order you the BCP PZI insulin and get the first 5ml vial free. After that they would only need a script from your vet and the insulin is shipped overnight directly to you. I agree with Jen on using BCP over Lantus......schedule can be more flexible. Sometimes just removing all the dry and giving a week or two of shots may put him into remission.

Even though Peaches may not like to travel, you can take him with you....many have and they do adapt and get used to it. He is not an old kitty and learning all you can and treating his diabetes you can many years ahead with Peaches. Right now Mishka is the only one of mine receiving insulin and it will be 7 yrs. in Oct. for her. Vinnie is in remission and Hope......well with her we really do not know why after 4 1/2 years of getting shots she went into remission but it will be 8 years for her this Sept.

It will become routine for you and you will get all the help you need here on FDMB. I also agree with Jen about your vet and her responses to you. She needs to educate herself more and bring her knowledge of FD up-to-date.

As for weight loss, Mishka had lost 10 1/2lbs. before her owners noticed anything and then decided to put her down rather than treat and she was only 5 at the time. She gained back the weight she needed and now weighs exactly 10 1/2lbs so you can imagine how overweight she must have been.

Welcome to the board........it will become a piece of cake to deal with.......just read and ask questions. You will also create an amazing bond with Peaches....beyond what you already have.
 
Marilyn, many of us came here in shambles not knowing or believing we could handle our cat's diabetes. I was one of them. It's honestly not all that hard, and even if it's not perfect you will see tremendous improvement almost immediatly.
Are you giving insulin yet? please ask for pro-zinc pzi as it is much more forgiving of timing of shot.
You can give the curves (that's why your vet wants the cat all day to figure out dose) but in the mean time you can start on 1unit. We can walk you thru each and every step.
if you want a quick heads up on what you need right away you can even call me and i'll give you a list to pick up today. I make and send newbie kits but this sounds like you want to start immediatly.
You can do this...we will work on the schedule details later...in the meantime give your kitty some relief. order the pzi today.
my # will be sent in a pm. that is on the upper left corner of your screen. a message only you can see ok.
lori and tom
 
I second everything said so far. I REALLY think you need to call around to other vets to get another one on board with you. Ask about their standard treatment protocol and tell them how you would like YOUR kitty treated and see if they will help you.

ProZinc and/or PZI are two very similar insulins that are much more flexible in shot times than Lantus/Levemir is. There are people that give a shot every 8 hours, and those that give shots on varying schedules all the time.

1. Switch food to canned wet. Try to find food that is less than 10% carbs. You can find this out on Janet & Binky's food charts
2. Purchase a glucose meter. Many use the Relion Confirm/Micro from walmart (cheap test strips)
3. Purchase ketostixs (like $15 for 50) to test for ketones in the urine.
4. Find a vet that offers a treatment plan you like!!!!!


We have all been in your shoes at some point, and many of us have gone with a different treatment protocol than the first vet recommended. There are a lot of knowledgeable people on this board and we see posts for kitties that have gone into remission and off insulin all the time! Everyone is here for the kitties - we'll help you as much as we can!
 
Just wanted to chime in the the weekends away issue.

Some of us here just take our cat(s) with us.

Smokey & Mr. Kitty went everywhere with us. Camping, boating, in motel rooms, etc.
 
I hear your struggle and your dilemma. The feedback from the folks here really reflects how much they want to help you through this decision and let you know that there might be some options. Its alot to digest initially and can definitely be overwhelming. Ultimately, you and your husband know your situation better than any of us. You can always start the process and see how it goes for you and your kitty. And then re-evaluate after a period of time. Decide to continue or discontinue. See what is doable. The folks have a motto here...Every cat is different. I just want to add...Every family situation is different as well. Whatever decision you make will be the right decision for right now based on your current knowledge. You've made the right decision to get all the information and feedback you can to make the right decision for your family.

Just one more thought...if you do decide to treat with insulin and have concerns about going out of town, you may want to ask your Vet clinic if they know of any cat sitter or even if any of the vet techs provides this service.....coming twice a day or even do a sleep over.

Just my 2 cents.
 
You folks are *awesome*!!!!

I have my WalMart shopping list (going tonight), Peaches is already on the canned food only (snoring while he sleeps in the chair across from me), but the Vet is out today so it will be tomorrow before I tackle that battle. She's not the only vet around ;-)

The youtube link (and then I wandered of course) were extremely ... not only helpful but confidence building.

We're going to do this - I can't wait until Peaches is healthy again!

<considering looking into airline cat carriers for when both my husband and I have to be somewhere at the same time LOL>

Thank you thank you thank you...

will be back as we start this journey......

Marilyn & Rick, owned by Peaches
 
Glad to hear you are comfortable w/going forward with the treatment. The folks here are very supportive and knowledgeable.

I'm a newbie as well. And will defer on medically related questions for now, but will jump on board w/providing emotional support.

....so welcome aboard.
 
Marilyn there was something I wanted to tell you but forgot. When you start testing you must make sure that peaches feels this is a happy joyous event. give him lots of praise before during and after EVEN if it's a failed attempt. you might offer treats for afterwards and you also do not feed for an hour or so before testing. will mess with your results.
give him head scritches, good boy, or whatever your highness likes to hear.
if you feel any stress or frustration do not let him be aware of it.
that's one way to get him to act like 'Buddy"
and please inform us of your numbers tonight and keep a running record. this will prove valuable. the more we here follow your #'s the better off you'll be at shot time.
 
Have to find the spreadsheet form you all use (and then figure out what all the abbreviations are, but i'm putting this here so i don't lose it...

8/12/10 9:10 pm 320

from what i've read from some of your posts, that isn't as bad as we were expecting. But I can't be SURE when he ate last because we were off buying the supplies.

it'll be interesting when we get the vet's original Wed AM reading from her when we go there tomorrow!

And, yes, we made sure Peaches knew he was a very very good boy (and put food out afterwards) :-)

Walmart is a little richer tonight, but that's ok. It bothers me that we probably won't have insulin until Tuesday, but not much we can do about it.

btw, DH did the lancet bit this time. Hopefully we'll improve with experience- luckily Peaches is a very cooperative cat (for us)

The first couple of steps of this journey has begun.. thank you for offering a map!

-Marilyn
 
this might be the abbreviations your talking about.

amps (am pre shot #) this is the test you'll take before food and the morning shot.
pmps (same as above but in the evening, generally 12 hours later.)
anything with a + after the amps or pmps is the number of hours since the shot. therefore there is no need to state time of day since we are world wide and that would get confusing.
since you are not shooting yet..this will not apply. but you can tell us at this point the #'s and the time since last test. in other words. 8pm 320, +6 290

once you start shooting you'll open your day like this for example.

amps 345
+2 290
+4 210
+6 175
pmps 315

does this make sense...it will help us and you see how it's working. and don't worry you won't always be testing so much...just beginning.
 
oh and btw, welcome to the VAMPIRE'S CLUB...you initiated with flying colors. great job with the testing and yes that is a good # for no insulin yet.
 
Welcome Marilyn , Rick & Peaches to the best place for DC Want to share a bit with you May 5 /10 my cat was DX took 1 week to get him off dry food loves can so np.today we have been off insulin for 17 days ...The important thing is read all the stickes.Listen ...people here understand and know what they are doing. Not saying anything about vets but mine wanted to start high. I went with advice from here and so glad I did. My vet was a little upset with me but Trey is my baby....And here we are happy healthy and beautiful..Best of luck on your new journey to a healthy life style for your Peaches...All my cats are now on can food only...Kath

Angels on board helping you all the way
 
I cannot believe that vet. There are so many vet articles printed just for vets promoting hometesting now. God help others that go to this vet with a new diabetic kitty. Good for you for going to another vet. I have never asked a vet....I just tell them I hometest.....and the one ER vet that went against it got over 20 printed pages, all from veterinary journals, on hometesting.
 
Vet articles on home testing

Marilyn, Cheri/Louis did a lot of work to put this all together. Maybe print it off and give to your "former" vet and enlighten her on the subject and maybe some cats will be saved.

CONVERT-A-VET : Professional studies/articles on home testing
Posted by: Cheri and Louis (IP Logged)
Date: August 28, 2007 10:59AM

For folks who want to convince their vets of the value of home testing (as I did myself), here is a list I have put together and called "Convert-a-Vet". It is natural that your vet would want to see information from PROFESSIONAL VETERINARY sources, and these studies and comments on home testing blood glucose and on the use of portable blood glucose meters fit that qualification. The majority are from peer reviewed literature.
At the end of this I made a place for web sites of vets who support home testing and I've just put Drs Hodgkins and Pierson. Let me know if there are more you can think of, or if there are any other professional sources that would be useful for this list.
I can make a nicer looking version and save as a PDF if people think it worthwhile.


HOME BLOOD GLUCOSE TESTING FOR DIABETIC PETS: INFORMATION FROM VETERINARIANS

Home BG testing may not yet be common at many veterinary practices, but, far from being a radical, untested idea, it is recommended by…
National veterinary organizations….Veterinary textbooks…University veterinary hospitals… AAFP… VIN…Veterinarians who have specialized in DM

The Canadian Veterinary Association
Official advice for the treatment of pet diabetes is to home test
Information on their website: [www.animalhealthcare.ca]
Quote: "Recently, a home blood glucose monitoring initiative was reported in the literature that provided a practical method for owners to check blood sugar at home by doing a small prick in the ear and using a low volume automated glucose meter. This is a big step forward in feline diabetes management because it is well known that while in hospital for monitoring, cats tend to not eat well and are stressed, both of which can interfere with blood sugar assessment. It is important to have a blood glucose curve done after insulin therapy is begun so that the veterinarian can check how quickly a particular cat processes the insulin type prescribed. Cats have a very wide spectrum of time that it takes to metabolize the insulin, and this test is very important for the safety of long-term insulin therapy."

DVM Newsmagazine, Sept. 01, 2001 “Blood Glucose Monitoring”, Diane Monsein Levitan, VMD, Dipl. ACVIM, [www.dvmnewsmagazine.com] “There is a trend developing in veterinary medicine: using a blood glucose meter designed for human diabetics as a simple, rapid, pain-free method of getting immediate and accurate blood sugars on diabetic pets. The advantages of such a technique are clear: the pet is in its natural home environment, thus diminishing the role of stress on blood glucose values. Samples can be obtained easily in dogs and cats using a device purchased in any pharmacy by performing a simple ear stick technique to obtain a blood sample. Repeated sampling is easily performed. The results are a true measure of blood glucose at the time of the test (Proceedings of the 19th ACVIM Forum, Abstract #100). The test is simple to do and owner compliance is likely. The day-to-day variations of blood sugar in pets can be taken into account and insulin dosages can be adjusted on a daily basis, if need be. These methods have been described and have improved quality of glucose regulation and accurate assessments of insulin requirements. (Reusch CE, Wess G, Casella M: Home monitoring of blood glucose concentration in the management of diabetes mellitus. Comp Cont Ed Pract Vet 2001;23:544-556.)
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Canine and Feline Endocrinology and Reproduction, Third Edition (2003)
Feldman, Edward, DVM, DACVIM, and Nelson, Richard, DVM, Dipl ACVIM, School of Veterinary Medicine, Univ. of California, Davis ISBN-13: 978-0-7216-9315-6
In its chapter on feline diabetes, this veterinary textbook includes information and illustrated instructions for home testing (pp. 565-566) and recommends the “Sugarcats” website as a resource for clients.
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University of Zürich vet hospital's use of home blood glucose monitoring since 1999

Dr. Claudia Reusch, DECVIM-CA ,Clinic for Small Animal Internal Medicine, University of Zürich, discusses how home monitoring of blood glucose has been integrated into their protocol for treatment of DM since 1999 in presentations to the World Small Animal Veterinary Association World Congresses in 2002: Experiences with Blood Glucose Home Monitoring by Owners of Diabetic Dogs and Cats [www.vin.com] and in 2006: Update on Feline Diabetes Mellitus World Small Animal Veterinary Association World Congress Proceedings, 2006 [www.vin.com] Quote: “...A variety of problems are associated with the determination of BGCs in hospitalised patients. The process is time consuming and relatively expensive and therefore, is not performed as frequently as required. Stress or lack of food intake can markedly influence BG concentration….Therefore, in-hospital BGCs can be difficult to interpret or may even be useless. During the last years, methods have been developed for obtaining capillary blood (mostly from the inner ear) by means of lancing devices manufactured for humans. Measurement of blood glucose concentration is performed using one of the many portable glucose meters (PGM). …. “Measurement of capillary blood glucose (home monitoring, HM) has been part of the routine protocol for long-term management for diabetic cats in our clinic since 1999… About 70% of our cat owners are willing and able to perform HM. Also long term compliance appears to be good. In a recent study 76% of the owners performing HM used the technique for more than one year for up to 4 years. HM did not appear to influence the frequency of re-evaluations in the hospital. Most owners did not change insulin dosages on their own, but called for advice. All cat owners believed that HM had raised their self-confidence with regard to their ability to manage the disease in their pets. ...In our study the percentage of well regulated cats was higher than in comparable studies not using HM. Therefore we assume that curves generated at home reflect the true metabolic situation better than those performed in the hospital.”
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PUB-MED ABSTRACTS
USE OF PORTABLE BLOOD GLUCOSE METERS
& HOME BLOOD GLUCOSE MONITORING OF CATS AND DOGS WITH DM


ABSTRACTS - PBGMs

J Am Vet Med Assoc. 2002 Aug 1;221(3):389-92.
Comparison of glucose concentrations in blood samples obtained with a marginal ear vein nick technique versus from a peripheral vein in healthy cats and cats with diabetes mellitus.
Thompson MD, Taylor SM, Adams VJ, Waldner CL, Feldman EC.
Department of Small Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Canada.
OBJECTIVE: To compare blood glucose (BG) concentrations measured with a portable blood glucose meter in blood samples obtained with a marginal ear vein (MEV) nick technique, from a peripheral venous catheter, and by direct venipuncture in healthy cats and cats with diabetes mellitus. ANIMALS: 1 0 healthy cats and 11 cats with diabetes mellitus. Procedure-On day 1, blood samples were collected every hour for 10 hours by the MEV nick technique and from a peripheral venous catheter. On day 2, blood samples were collected every hour for 10 hours by the MEV nick technique and by direct venipuncture of the medial saphenous vein. RESULTS: For all cats, mean BG concentration for samples collected by the MEV nick technique was not significantly different from mean concentration for samples obtained from the peripheral venous catheter. For healthy cats, mean BG concentration for samples collected by the MEV nick technique was not significantly different from mean concentration for samples obtained by direct venipuncture. For cats with diabetes mellitus, mean BG concentration for samples collected by the MEV nick technique was significantly different from mean concentration for samples obtained by direct venipuncture; however, for the range of concentrations examined, this difference was not clinically important. Conclusions and Clinical Relevance: Results suggest that for the range of concentrations examined, the MEV nick technique is a reasonable alternative to venous blood collection for serial measurement of BG concentrations in cats.
PMID: 12164536 [PubMed - indexed for MEDLINE]

J Small Anim Pract. 2000 Feb;41(2):60-6.
Capillary blood sampling from the ear of dogs and cats and use of portable meters to measure glucose concentration.
Wess G, Reusch C., Clinic for Small Animal Internal Medicine, University of Zurich, Switzerland.
Two new methods for collection of capillary blood from the ear of dogs and cats for the measurement of blood glucose concentration using portable blood glucose meters (PBGMs) are described. The first method uses a lancing device after pre-warming the ear, while the second employs a vacuum lancing device. Both methods generated blood drops of adequate size, although the latter method was faster and easier to perform. Accuracy of the two PBGMs was evaluated clinically and statistically. Although assessment of statistical accuracy revealed differences between the PBGMs and the reference method, all of the PBGM readings were within clinically acceptable ranges. Measurement of capillary blood glucose concentration is easy to perform, inexpensive and fast. It may be used by owners to determine blood glucose concentrations at home, and could serve as a new tool
for monitoring diabetic dogs and cats. PMID: 10701188 [PubMed - indexed for MEDLINE]

Am J Vet Res. 2000 Dec;61(12):1587-92.
Assessment of five portable blood glucose meters for use in cats.
Wess G, Reusch C., Clinic for Small Animal Internal Medicine, University CH-8057 Zurich, Switzerland.
OBJECTIVE: To evaluate the clinical and analytic accuracy of 5 portable blood glucose meters (PBGM) in cats, with emphasis on the detection of potential sources of error. ANIMALS: 200 cats. PROCEDURE: Venous blood glucose readings from 5 PBGM were compared with the results of a hexokinase reference method. Agreement among methods was determined by error grid analysis and statistical methods. RESULTS: A total of 2,975 PBGM readings and 513 reference values were analyzed. The accuracy of the PBGM varied in different glycemic ranges. The largest differences between PBGM readings and reference values were in the high glycemic range; 4 PBGM underestimated and 1 PBGM overestimated the reference values in most instances. In the low and reference glycemic ranges, the absolute differences between PBGM readings and reference values were small. Despite the analytic differences in accuracy, 4 PBGM had 100% and 1 PBGM had 98.7% of readings in the clinically acceptable values of the error grid analysis. Within- and between-day precisions were good for all PBGM. Significant differences were not detected between readings of EDTA and lithium-heparinized blood and fresh blood without anticoagulant. Compared with these blood types, 1 PBGM had significantly different readings with fluoride anticoagulated blood. In blood samples with a low Hct, all PBGM overestimated glucose concentrations. Sample volumes < 3 microl resulted in inaccurate measurements in 3 PBGM. CONCLUSIONS AND CLINICAL RELEVANCE: Performance varied among the 5 PBGM analyzed; however, all PBGM were deemed acceptable for clinical use in cats.
PMID: 11131603 [PubMed - indexed for MEDLINE]

Clin Tech Small Anim Pract. 2002 May;17(2):70-2.
Portable blood glucose meters as a means of monitoring blood glucose concentrations in dogs and cats with diabetes mellitus.
Stein JE, Greco DS.Veterinary Teaching Hospital, Colorado State University, 300 West Drake Road,Fort Collins, CO 80523, USA.
The use of portable blood glucose meters (PBGM) has become common in veterinary medicine as a rapid means of monitoring animals' blood glucose in a variety of medical conditions. These hand-held monitors allow for diagnostic and therapeutic decisions to be made quickly and relatively inexpensively using only a small amount of blood. Both in conditions resulting in hyperglycemia, such as diabetes mellitus, and in those resulting in hypoglycemia, such as sepsis or the presence of an insulinoma, veterinarians have come to rely on PBGM to provide critical information on the status of their animal patients. In particular, PBGM are frequently used to measure individual blood glucose values in an animal over a period to create a blood glucose curve when evaluating the effectiveness of insulin therapy in diabetic dogs and cats. PMID: 12219719 [PubMed - indexed for MEDLINE]
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ABSTRACTS - HOME MONITORING OF BLOOD GLUCOSE

J Feline Med Surg. 2006 Apr;8(2):119-27. Epub 2005 Dec 1.
Home monitoring of the diabetic cat.
Reusch CE, Kley S, Casella M., Clinic for Small Animal Internal Medicine, Vetsuisse-Faculty University of Zurich, Switzerland. creusch@vetclinics.unizh.ch
Many owners are able and willing to perform home monitoring of blood glucose concentrations in diabetic cats. Once owners are familiar with the technique, they appreciate its advantages and show long-term compliance. The success of home monitoring hinges greatly on careful preparation and instruction of the owner. Owners must have ready access to veterinary support if needed. Initially, most owners call for advice, and several of them need repeated explanation or demonstration of the procedure. The frequency of re-evaluations of the diabetic cats by veterinarians is not affected by home monitoring. One of its major advantages is that it enables frequent generation of blood glucose curves. In complicated cases, more than one curve can, therefore, be performed at home before a treatment decision is made. According to preliminary data cats managed with home monitoring may have better glycaemic control than those managed without. However, those results need to be confirmed in a large group of cats.
PMID: 16325445 [PubMed - indexed for MEDLINE]

Can Vet J. 2005 Aug;46(8):718-23.
Retrospective study of owners' perception on home monitoring of blood glucose in diabetic dogs and cats.
Van de Maele I, Rogier N, Daminet S.
Department of Medicine and Clinical Biology of Small Animals, Faculty of Veterinary Medicine, University of Ghent, Salisburylaan 133, B-9820 Merelbeke, Belgium. Isabelvandemaele@hotmail.com
Home monitoring of blood glucose (HMBG) concentrations has been recommended in the monitoring of human diabetics for 3 decades. During the last number of years, it also gained popularity in long-term follow-up of diabetic cats and dogs. The aim of this retrospective study was to evaluate the practical feasibility of and identify the major problems encountered with HMBG in diabetic pets. A standard questionnaire was filled in by owners of 9 diabetic pets monitored with HMBG. The need for more than 1 puncture to obtain a blood drop, the creation of a sufficient blood drop, the need for assistance in restraining the pet, and the resistance of the pet were the most frequently encountered problems during HMBG. The major obstacles for the owners to start with HMBG were also identified. In conclusion, HMBG is a practical and simple technique for most owners and, overall, owners were satisfied.
PMID: 16187716 [PubMed - indexed for MEDLINE]
Article online: [www.pubmedcentral.nih.gov]

J Feline Med Surg. 2005 Jun;7(3):163-71. Epub 2005 Jan 7.
Home-monitoring of blood glucose in cats with diabetes mellitus: evaluation over a 4-month period.
Casella M, Hassig M, Reusch CE., Clinic for Small Animal Internal Medicine, Vetsuisse-Faculty, University of Zurich
Home-monitoring of blood glucose concentrations has recently been introduced to owners. The objectives of this study were to investigate the feasibility of home-monitoring of blood glucose in diabetic cats by owners, the problems encountered and to compare glucose concentrations at home with those measured in the hospital. Twelve of 15 cat owners were able to generate glucose curves over the study period of 4 months. Most problems were related to restraining the cat, generating negative pressure with the lancing device and producing a blood drop. In the majority of cases, these problems could be resolved during the study. Blood glucose concentrations in the clinic tended to be lower than at home; some of the differences were significant. No association between tolerance of the procedure and blood glucose concentrations measured at home was found. We, therefore, assume that the lower glucose levels in the hospital were caused by lack of food intake. In 38% of cases, treatment based on hospital curves would have been different from that based on home curves. Home-monitoring appears to be a valuable tool in the management of cats with diabetes mellitus. One of its major advantages is that it enables frequent generation of blood glucose curves, which is of particular importance in cats that are difficult to regulate. PMID: 15922223 [PubMed - indexed for MEDLINE]

J Am Vet Med Assoc. 2004 Jul 15;225(2):261-6.
Evaluation of long-term home monitoring of blood glucose concentrations in cats with diabetes mellitus: 26 cases (1999-2002).
Kley S, Casella M, Reusch CE., Clinic for Small Animal Internal Medicine, Vetsuisse Faculty University of Zurich
OBJECTIVE: To evaluate owner compliance with longterm home monitoring of blood glucose concentrations in diabetic cats and assess the influence of home monitoring on the frequency of reevaluation of those cats at a veterinary hospital. DESIGN: Retrospective study. ANIMALS: 26 cats with diabetes mellitus. PROCEDURE: Medical records of diabetic cats for which home monitoring was undertaken were reviewed, and owners were contacted by telephone. Signalment, laboratory test results, insulin treatment regimen, details of home monitoring, clinical signs during treatment, frequency of follow-up examinations, and survival times were evaluated. RESULTS: Monitoring of cats commenced within 12 weeks (median, 3 weeks) after initial evaluation; 8 owners were unable to perform home monitoring, and 1 cat was euthanatized after 1 week. In 17 cats, duration of home monitoring was 4.8 to 46.0 months (median, 22.0 months); 6 cats died after 7.0 to 18.0 months (median, 13.0 months). In 11 cats, home monitoring was ongoing at completion of the study (12.0 to 46.0 months' duration). Fourteen owners completed blood glucose curves every 2 to 4 weeks. Cats managed with home monitoring received higher dosages of insulin, compared with cats that were not monitored. Four of 17 cats managed by home monitoring had transient resolution of diabetes mellitus for as long as 1 year. Home monitoring did not affect the frequency of reevaluation at the veterinary hospital. CONCLUSIONS AND CLINICAL RELEVANCE: Owner compliance with long-term home monitoring appeared to be satisfactory, and home monitoring did not affect the frequency of reevaluation of patients by veterinarians.PMID: 15323384 [PubMed - indexed for MEDLINE]

Clin Tech Small Anim Pract. 2002 May;17(2):86-95.
Home monitoring of the diabetic pet.
Mathes MA., Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO 80523, USA. dogged@colostate.edu
Home monitoring of the diabetic pet is a challenging proposition for many pet owners. Diabetes, unlike many other diseases, requires that the client, not the veterinarian, treat the disease. It is crucial that veterinarians reinforce and educate clients that successful treatment of diabetes mellitus will depend solely on the client's actions throughout the course of the treatment. This article provides guidelines on educating clients in the home monitoring process.This commonsense approach covers elements of in-home monitoring, including general appearance, clinical signs, behavior changes, feeding schedules, and medication administration. Additionally, thorough explanation is provided for clients who wish to take a more active role in obtaining and monitoring blood and urine chemistry values. This information is provided to assist the veterinary technician and veterinarian in educating clients of their responsibility in treating this disease.
PMID: 12219722 [PubMed - indexed for MEDLINE]

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Other Articles

“Understanding feline diabetes mellitus: Pathogenesis and Management”, Rand, Jacquie and Marshall, Rhett, University of Queensland Center for Companion Animal Health, Australia, in Waltham Focus, Vol. 15 No.3. (2005). [www.uq.edu.au] “Blood glucose measurement at home in the cat’s normal environment has distinct advantages for the cat and provides similar data… Home blood glucose measurement removes much of the stress-induced hyperglycemia, as well as the problem of hospital inappetence…”

Susan Little, DVM, Dipl. ABVP, “Managing Chronic Diseases in Cats” DVM Newsmagazine online, 1 June 2005
[www.dvmnews.com]: Blood glucose curves are essential in managing feline diabetes, yet cats may be stressed during hospitalization, making it difficult to interpret results. One solution is to teach clients how to perform blood glucose curves at home using capillary blood sampling from the ear and a portable blood glucose meter. VeterinaryPartner.com offers an excellent client resource for home blood glucose monitoring, including a video demonstration.
Home blood glucose curves offer substantial benefits for veterinarians, patients, and owners. Evaluation of cats monitored with home blood glucose curves has shown that owners appreciate home blood glucose curves because they avoid the stress of hospitalization for their cats.10 In addition, cats are re-examined just as often, and owners aren't prone to changing insulin doses without consultation. In almost 40% of cases, home-based blood glucose curves suggested a different treatment plan than blood glucose curves performed at the hospital.11
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Client Information


American Association of Feline Practitioners and the Cornell Feline Health Center, Cornell University, College of Veterinary Medicine, Ithaca, New York, in a brochure for cat owners suggests the possibility of home blood glucose monitoring. “Some cat owners are willing and able to take on the task of measuring their cat's blood glucose levels at home rather than in a veterinary hospital-a potentially less expensive and more accurate monitoring method. Ask your veterinarian whether home glucose testing might be suitable for you and your cat. More information can be found online at http://www.sugarcats.net/sites/harry/bgtest.htm.” Online version: [www.vet.cornell.edu]

Veterinary Information Network (VIN)’s VeterinaryPartner website has a page on Home Testing of Blood Glucose for Diabetic Cats including a video demonstration. [www.veterinarypartner.com] VeterinaryPartner’s page on DM includes a link to [www.felinediabetes.com], which recommends home BG testing as the best method of monitoring a diabetic cat.

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Websites of veterinarians that recommend home testing.

Dr. Elizabeth Hodgkins, DVM, is a feline nutrition expert and the creator of the canned formula of Purina DM. She has treated hundreds of cats with diabetes mellitus and has developed a protocol that has helped a majority of these cats to no longer need insulin injections. Home blood glucose testing is a crucial component of the protocol. Her website describes her successful protocol and the theories on which it is based.
[www.yourdiabeticcat.com]

Dr. Lisa Pierson, DVM, has an excellent website with very informative articles on feline nutrition and health. This article on feline diabetes recommends a low-carb wet diet and careful home monitoring of blood glucose, and includes instructions and photographs.
[www.catinfo.org]


Cheri and Louis




Louis dx'd Sept.2006 ~ Lantus (Glargine) Oct 2006-June 2007; Diet-controlled July 2007-June 2008 ; Hospitalized June 2008 - DKA, Pancreatitis, UTI, hepatopathy, etc. ~ Now on 2.25u Lantus BID. ~ We are using the German Tight Regulation Lantus Protocol ~~~ One tough Meezer! ~~~ Louis's Spreadsheet

Various info on Diabetes, Lantus, Home testing:

■Feline Diabetes Mellitus: Pathogenesis and Management (Rand,Marshall, U of Queensland)

■Dr. Rand's Lantus Protocol (University of Queensland)
■German TR protocol for Lantus or Levemir from http://www.tillydiabetes.net

■Home Blood Glucose Testing for Diabetic Pets: Information from Veterinarians (longer version of our "CONVERT-A-VET post)
Feline Nutrition Info: ■Website of Dr. Lisa Pierson, DVM - http://www.catinfo.org

■Dr. Elizabeth Hodgkins, DVM, Feline Diabetes and Obesity: The Preventable Epidemics

■www.catnutrition.org - Informative site from educated lay person

■Dr. Debra Zoran, PhD, DVM The Carnivore Connection to Nutrition in Cats JAVMA, 2002....READ & SHARE WITH YOUR VET!
 
Even vets who are resistant can come around. I would have sworn I was going to end up changing vets. I did take Sya in for one curve initially and had a great chuckle when the vet miraculolsly found that my numbers were the same as his. She hasn't been in for curves since. I just bring in my spreadsheet when she goes in for a check-up or e-mail them in if it's been a while.
Also, something to think about in terms of time away if you end up giving insulin and have a willing friend. My vet gave me a vial of sterile water (which is how he showed me how to do injections) and I taught my friend how to inject Sya. She even learned how to do the BG tests (which are harder than insulin as far as I'm concerned) Anyway, I went away for a week and all went well. There are pet sitters who will do it as well. Anyway, if you have a fellow cat loving friend perhaps they can get on board with you and you can trade cat care when all the beans in your house are away.
 
Marilyn, I was in disbelief to learn that my cat, Blackie, was diagnosed with diabetes, however, I also knew that she would be because I caught her drinking a lot of water 2 days in a row before we took her to the vet.

I agree with Jen, too. Diabetes IS very manageable, and treatable. You can do this. It may sound daunting in the beginning, especially with your schedules, however, once you get the hang of it, including the ear poking, it'll be second nature to you. It'll take you but a minute to get a BG reading on the monitor, and then you're both done, until the next test. I usually have some boiled chicken on hand for Blackie every time I test her. Sometimes, I'll give her brushings, instead. At this point, though, she wants the chicken, and that's fine with me. LOL

We all were in your shoes at some point, feeling the same things that you're feeling. You'll do fine. :) PTS is not an option in my books.
 
Hi there

just popped in and saw your first post here.
I'm not surprised by vet's option number two.
That's a terrible thing to say to a client!
I too had a vet who tried to discourage me telling me "one day you will come and your cat will be dead" "and most people give up after 3 months"

Well, that was last year. My cat Luna is now diet controlled and off insulin, approximately 4 months after that horrible quote from that vet.

Slowly some vets are coming around, yet some are still stuck on the PTS speech. This disease is treatable and manageable.
With the right insulin for your kitty and your schedule, it can work out.

Best of luck to you and your decisions. Be strong and take control. It'll be ok!
 
Update :)

After our original vet was incredibly close minded, we tried another vet who was recommended by a number of folks around here. Peaches and I visited him last Friday. Knew we were on the right path when he said 'home testing and regulation is the only thing that really works'.

I trust him even after one visit. The first thing he did was put Peaches on a Purina diabetic management food (keep in mind the first vet didn't even mention diet), and told me that he had a large number of cats that went off insulin just diet controlled (first vet said she had ONE cat in all her years that went off insulin). Twice a day feeding.

After a full lab test (no keotones, no organ issues), vet was adamant that we go with humulin to start. He gave me a handful of reasons, and well... back to the trust issue.

So Peaches is getting 2 units twice a day starting Monday evening. This morning we are actually seeing some results - he was down to 185 from 348 last night. The doctor wants us to wait a bit before we do the curve.

I tried to do the lancet bit, but failed miserably. So back to poor DH doing it while I hold the cat. I'll get there :)

Going to be a change in lifestyle for all of us - no more free feeding for any of the three cats and we've ordered a new carrier for Peaches to travel with us - but it feels like we're doing the right thing.

We *all* thank you for this forum - without it I don't know what path we may have taken.

-Marilyn & Rick (owned by Peaches, Tribbles & Heidi)
 
Hi Marilyn,

Wonderful that you found a vet that supports hometesting; too bad he started with Humulin. It isn't an awful insulin; it is just harder to regulate with because it usually hits cats hard and fast. That is, their lowest numbers during the cycle can be 3-4 hours after the shot and can be quite low, and then they start right back up. The other insulins usually offer a smoother cycle - with the lowest point 6 hours or so after the shot and then a gradual move up.

But if you are hometesting, it isn't impossible. You don't have to do a full curve now, but you need to find the nadir (lowest point) now. It is what you base the dose on. The preshot numbers are vital, to make sure it is safe to give your dose, but the nadir really tells you how the insulin is working. If I were you, I would take a reading about 3-5 hours after the shot over the course of the next few days and see when he is lowest. The thing you don't want is for him to be going really low at the nadir and then bouncing back up for the preshots. This can happen because his body reacts to the low number by producing more glucose. Rebound: http://petdiabetes.wikia.com/wiki/Somogyi_rebound
 
The new vet sounds good, but yet his insistance on DM and Humulin is rather weird in someone who is a fan of hometesting. If your cat stops liking DM it would be a good opportunity to get something healthier (at some point you need to go over the ingredients list with your vet and ask why he recommends it). And hometesting will give definitive proof of how the Humulin N is working.

Once the dust settles, I'd also accumulate some info on PZI and lantus as they are MUCH better than N...

Jen
 
Marilyn H insulin is not an insulin much used aroung here. perhaps you could get a prescription for pzi pro zinc, or levimer, lantus? and 2u's is not a typical starting dose.
will you keep posting your #'s and progress. there is hope of remission. we can really carry you thru dosing problems etc.... keep us informed k?
best of luck for you and peaches,
lori
 
As others have stated, you can feed just regular canned food. N is a fast acting, short duration insulin, and so many newbies have had their cats go into remission either with just diet change(no dry at all) or diet and some use of Lantus. Lantus (Glargine) is a great insulin for a cat never been on insulin. Glad you are hometesting and would suggest possibly trying to use a lancing device. I always use one, cannot do just a lancet poke, and it is simple and very quick to use. With N insulin please be aware that kitty HAS to eat a good 1/2 hr at least before shooting N. Food needs to be on board.
 
I don't feel like I am knowledgeable enough to tell you what insulin to use or not to use, but it seems to me if your kitty is already dropping points by diet alone, I would go with lantus which has one of the highest remission rates in cats ... your kitty might just need a few weeks or a month on that along with a diet change and perhaps be a diet controlled kitty!
 
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