New Member 23/10 Recent diagnosis difficult Main Coon

Hi everyone,

Some time ago my 11 years old Tortie Main Coon Calyco started being sick in the mornings bringing up biscuits from the night before, she was also drinking a lot. We new this was wrong and decided to get the carrier box out the garage for the first time in 5 years to get her tested for Hyperthyroidism.
Normal diet through the years of wet food and biscuits with treats at times, cooked fish occasionally.

History - She has never really liked the Vet after one of them lanced a boil too deeply, I did take her once for a Vaccine but she attacked the staff and she has not been back to any Vet since.
She is a nice cat at home and never gets angry with anyone.
She has never suffered any illness over the years and she has always been a strong cat often fighting of foxes in the garden.

We managed to take her to the Vet who along with the nurses managed to take a blood sample.
BG was 20 mmol and Thyroxine was normal. The blood was not sent away for a full analysis which I regret now.

I immediately started reading up (a lot from this forum) and switched her to a low carb diet (under 10 Kcal from Carb. The sickness stopped and she showed more activity during the day, it seemed like we had our cat back.
The next visit 4 weeks later was troublesome as they kept her in all day for Blood and Urine collection, this was a bad idea as she got wound up all day and then the sample was collected. This reading showed BG 22mmol/l and Fructosamine 394 umol/l no Ketones detected which was good.

They have now referred us to a hospital for DM treatment. The trouble is this is not fair on her due to the way she is and we have decided that we cannot put her through the torture that most cats might find bearable. I suspect that the Vet will not be able to treat her anyway.

Her original weight was 6.5kg, she is now maintaining 5kg but I feel I now need to reduce her weight more to try to kick start the normal insulin production.
She has now just started a zero Carb diet which I am going to monitor.
I am going to start to take urine readings and have been massaging her ears in readiness for home testing, at the worst I am hoping to get some blood apart from mine at some point.

She is currently fine in herself, she still goes out night and day and is not drinking loads, although she does seem to be eating more than in the past which is to be expected.

Any assistance or cases of remission or information would be gratefully received.
Is it possible to reverse the DM through diet and monitoring in cats?

Many thanks.

 

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jeanne

 

Waving from Canada.
A diet change can drop numbers overall by up to 5mmol but that might not be enough.
Some caregivers give gabapentin to their cats before a vet visit to calm them.
Is your vet unwilling to treat your cat because of its behaviour? or because they do not know enough about feline diabetes? Most vets get little training.
A hospital trip, in my humble opinion, is unnecessary. It does not sound like a complicated case. A new vet might be in order.
I'm tagging a few very knowledgeable and experienced UK members for you.

@Critter Mom
@Elizabeth and Bertie

 

Many thanks for your comments.
The Vet we have been sent to is the largest in the area and the original source of the problem. The new vet we went to was great but still with the same problem of not being able to treat her due to the nature. There is another Vet in the area but I do not want to put her through the torment.
Tried some calming substances in the past but nothing works, not even when I was in the room and I am her best friend.
I will keep posting updates on the progress.

 

I’m sorry that you had to find us but if anyone can figure out how to help you and Wurly you will find that here. Are you able to pull her? Is she difficult for you to handle?

 

I'm sure others who have had similar vet clinic experiences will chime in. My Rover was a total marshmallow.

 

Hi there,

If your kitty will accept it, I think the home BG testing is your best hope for monitoring. Desensitisation training might help (unless you've already tried it). Most members pick out a particular spot as a testing station and use diabetic-friendly treats, grooming sessions, etc., as rewards at each stage of the training process.

If the home BG testing proves to be viable, then you'll be able to do all the necessary daily safety checks and periodic curves if insulin treatment is started. Provided you can monitor her, there should be no need for her to require a hospital visit to start her on insulin.

While you're waiting to start insulin treatment, it is an important general safety precaution to test urine daily for ketones (using human urine test strips). I understand that your kitty is an indoor-outdoor girl, but keeping her in for a short time to catch a pee sample would help keep her safe (DKA is a life-threatening emergency). If, however, you manage to crack the home testing, there are also blood ketone meters and you could monitor that way. Strips for the ketone meters are pricey but you'd likely only need one per day - much cheaper than a hospital stay. Further information:

Ketones, DKA and Ketone Meters

Tips for Collection of Urine Samples


Mogs
.

 

Hiya,

I can get away with a lot with her but as soon as she knows that I am up to something that she objects to it is difficult to keep hold of her. She once pinned an adult Fox down at the end of the garden, no other cats dare to enter the garden including the big Tom's. Whilst I love it she is so strong and powerful, now I need her to relax I don't stand a chance :-(
I wear welding gloves when I trim her and she sees them as playtime so that could be a possibility.

 

Hi Mogs,

I have seen the video on desensitisation and will give it a go.
Can I obtain insulin without a prescription? If I could then I would only try it if I could monitor successfully and at a low dose, wouldn't want to Hypo her.
I have the urine test strips and have just bought some gravel stones to go in a different tray, I will be doing the first test tomorrow hopefully

 

Re insulin availability, which country are you located in?


Mogs
.

 

I mixed up your kitties name My apologies Wurly sure is a pretty kitty cat

 

Hiya,

UK. Everywhere I look it has to be prescription, should I go down that route then she will need to be tested in hospital :-(

 

Thank you

 

In the UK you definitely need a prescription for insulin.

By way of general info, there are two insulins currently licensed in the UK for cats: Prozinc and Caninsulin. You can get an Rx for Lantus or Levemir but you have to treat with the licensed ones first before a vet can legally prescribe an L insulin under drug cascade rules. Of the two licensed insulins, Prozinc is far superior for cats (longer duration) and I would suggest that as a first choice.

Bearing in mind that your cat has been very recently examined by the vet then the vet is in a position to be able to prescribe treatments. Considering that your vet knows how fractious your cat becomes in a strange setting, if you could demonstrate that you're able to test your cat reliably maybe it might be possible to negotiate with the vet to issue the prescription on the condition that they supervise the start of treatment. If you were to set up a shareable spreadsheet using the FDMB templates, you could share the link with your vet and they could monitor your cat's progress in real time and you could consult with them over the telephone. I think it would be worth having a chat with them to find out what might be possible. (Is your cat's name Wurly, BTW?) Best I can think of to suggest to you at the moment. I don't think it would be ethical for them to ignore a potential treatment avenue when the more conventional one they are advocating doesn't look like a realistic option for your little one. (Note: I don't know whether there are any legal considerations that might affect what the vet can do.)


Mogs
.

 

for your convenience
FDMB SPREADSHEET INSTRUCTIONS

 

Mogs,

Thank you very much for the observation there, never occurred to me that they might actually prescribe now they have a full blood and urine analysis.
They know I am caring and capable, I have explained my tracking of the food and calories on spreadsheets etc.
Wurly is one of her nicknames and it hadn't been used on the site before
The centre that the results were passed to is were it all went wrong years ago, they are shocking and they have not called to discuss the plan since being made aware 3 days ago.
I will definitely put a call in to the new local Vet who has been great and see if they can prescribe, worst case I might be able to inject once daily not ideal I know but could be a start.

 

Thanks JT I will look in to this soon.

 

Just a thought......Is there a direct correlation to the level of Glucose in the urine compared with the blood? I know the Renal filter works at a specific level to dump the Glucose out the body.
Just waiting for the first sample, gravel set in the tray!

 

Have you considered the burrito technique to wrangle Wurly? It works for many uncooperative kitties.

 

Isn't Gill and Mac in the UK? @Gill & Mac (UK)

 

JL, that's spooky as me and the wife were just discussing that as a possibility, thank you.
Lots of great comments and ideas coming through here, certainly lifting the spirit.

 

yes

 

5 kg doesn’t sound heavy for a Maine Coon (neither does 6.5 kg actually). Is/was she overweight?

I’m not familiar with the idea that weight loss will “kick start” a cat’s pancreas — especially if the cat is already at or below a healthy weight. I definitely wouldn’t restrict her food right now in an effort to induce weight loss because you could trigger additional, potentially more serious, problems.

Yes sometimes, but most often cats need at least a short course of exogenous insulin in addition to a switch to low-carb canned food in order to reach “remission.” In layman’s terms, the insulin injections help glucose to get into cells and also allows the pancreas a chance to heal.

In general, the longer a diabetic cat goes untreated, the harder it is to achieve remission. That’s one of the reasons it’s important to be proactive and not delay treatment too long. The other reason is that uncontrolled diabetes basically causes a cat to starve to death because their body can’t utilize the food they eat — a somewhat grim proposition. :-(

I was fortunate to have my first diabetic become diet controlled very quickly, which I knew because I was home testing his blood glucose and tracking the numbers. His diabetes was caught very early. My other two diabetics were different stories.

Here’s hoping your vet will prescribe Prozinc without another visit and that Wurly will decide to cooperate with testing and, if needed, insulin shots.

 

Just to let you know that most UK vets will issue a prescription (and will charge for it....) and then you can buy online. A little trick is that many pharmacies ask you to send a picture of the prescription, and perhaps you can get away with sending a picture to more than one place? i.e. you might get 2 or 3 vials out of one prescription?

 

She used to be 6.3kg which I think is about right for a female, the weight certainly matched the body shape.
I have been basing my theory on type 2 in humans and as cats can tolerate higher BG than us I guess I am just trying to reduce through other means.
It is difficult to explain to people how she is, if you could see her character in real life you would understand the dilemma I am faced with.
I appreciate your input and I know you are correct, I am going to try to get a reading this weekend

 

This is something I am definitely going to try

 

Good news, found a Vet that has prescribed and to my surprise I have managed to inject twice today at a low level, this is a massive step. First attempt took three goes even though the needle went in the fold on the first two.

 

I'm glad to hear that you were able to secure the Rx for the insulin. Which one is Wurly being treated with?

Just for the sake of my nerves, please can you confirm that you only drew up the one dose of insulin and depressed the syringe plunger on the third attempt, not that there were two 'fur shots' and then a third successful shot.


Mogs
.

 

though of the same thing.

 

So sorry I missed your tag @Roberta and Chloe for some reason I just didn't see an alert for it. I just saw it when I was reading this thread by coincidence.
@Wurly I was just about to reply and say the same as Mogs ie prescription only for definite in the UK and suggest getting a hold of the blood & urine test results and ringing round vets until you could find someone who would prescribe based on those. But I am very glad to see you have already done that and are all sorted. PS well done on getting your first injections done !!

 

Hi Mogs, only one shot. I was not confident at the time so no fingers near the plunger, If I miss or am not sure then it will be left alone until the next jab.

 

Hiya, AlphaTrak turning up today and I have already been completing Urine samples. I will be updating the Vet on the results and they will plot the graph. We are using Caninsulin

 

That's a dog insulin, isn't it? @Wendy&Neko

 

yes developed for canines hence the name .

 

My cat was diagnosed about a month ago and has been on Vetsulin (Caininsulin).

I bought a Breeze Litter Box and removed the pee pad. Every day I've measured his urine in hopes that the volume (not glucose in urine as you suggested) correlates with the disease level. It sure would be cheaper and easier to measure urine than blood glucose.

So far, the Vetsulin has not gotten the diabetes under control even with a low carb diet. I'll probably be changing insulin after visiting vet again. I hope that after my cat's diabetes is controlled, that the data show a correlation between urine volume and blood glucose. We'll see. By the way, the litter box costs nothing once set up. I just flush the urine or pour it in the flower bed. Maybe it will keep the snakes away (not fond of the venomous ones!).

 

Yuk between the pics I've seen on here of spiders the size of my fist & scary praying mantises I'm glad I am in the UK !

 

Caninsulin (aka Vetsulin) is licensed for use in both dogs and cats in the UK and also in the EU.

Cats typically do not get adequate duration of effect on this insulin. My understanding is that dogs get better duration on it.


Mogs
.

 

The UK probably has very little wild land left. I love the TV shows from England like Midsommer Murders. The villages are so quaint. They sure have a large murder rate, though, 20 seasons so far.

 

I love thst show too - Midsommer must be almost as dangerous as living in Oxford (Morse). We have plenty of room left for wildlife still thankfully with lots of green land and fields and moors left thank goodness but they don't come with such scary wildlife double thank goodness !!

 

Caninsulin is what is prescribed first as I understand it. To be honest I was lucky to get the prescription and any insulin is better than none in my eyes. Blood tester turned up today, not sure how this is going to go as Wurly has already had enough of the injections missing two over the last two days. This morning I just grabbed her with a glove on that allowed me to pinch the skin up enough to get the needle in the right place, minimal damage to my left wrist Prozaic has been mentioned but not until the testing has shown the curve. The Vet did also talk about Glipizide as a last resort. Is 1.5 UI a low dose for a 5kg cat with initial 20mmol/L BG?

 

It's more or less in the right ballpark per the manufacturer's guidelines:



It's slightly on the high side per the FDMB Beginners Guide to Caninsulin/Vetsulin:

Starting Dose

• Usually it’s best to start with a low dose of not more than one unit (1.0u), twice a day. The manufacturer recommends a starting dose of 0.25u to 0.5u per kg body weight.
  • If your cat is on a low carbohydrate (less than 10% carb), canned or raw food diet (there are a few select dry foods that are low carb) and blood glucose is less than 380 mg/dL (or < 20 mmol/L) the starting dose should be 0.5u.
  • If your cat is on a diet that is over 10% carb and blood glucose is over 380 mg/dL (or > 20 mmol/L), you can start at 1.0u.
  • If you are transitioning your cat to a low carb diet, your starting dose should be 0.5u.
• For those new to dealing with feline diabetes we recommend that you post and ask for help if the [preshot] BG is below 200 mg/dL (11 mmol/L) on a human glucose meter. Please post both here and on the Health forum especially if you see this forum isn’t busy. (For more information on what these numbers mean see ‘Home Blood Glucose Testing’ information below.)

​

(NB: The above excerpt from the Beginner's Guide is slightly out of date where it states that the manufacturers recommend starting doses based on weight. This is no longer the case. The most recent manufacturer guidelines are shown in the screen grab above.)

Glipizide is very much a last chance saloon treatment. The AAHA 2018 guidelines advise that drugs of this class (oral hypoglycaemics) should only be considered when caregivers refuse to give injections and are considering euthanasia. Oral hypoglycaemics push the pancreatic beta cells to produce more insulin. When the beta cells that are still functioning are already under tremendous strain, treating with such drugs can end up making things worse for the long term. Insulin treatment, on the other hand, supports the beleaguered pancreas and creates an environment where beta cells can rest and possibly recover some function, thus opening the door to possible diabetic remission.


Mogs
.

 

Ok, so 12 days on since starting the Caninsulin, 2 injections have been missed and 2 not 100% confident in delivery. 6 hour reading showed 15 mmol and 4 hour showed 6.9, surprisingly enough the ear pricking does not bother her (only just started to do this) I also managed to obtain a second reading with my own BG meter that showed 6.1 when the Alphatrack showed 6.9. Going to continue to get readings and see how long the insulin is lasting, fingers crossed.

 

FDMB SPREADSHEET INSTRUCTIONS

 

well that didnt work out right lol but the LINK is.

 

Thank you for the link, I will complete this as soon as I have more data. I am currently recording everything on my own spreadsheet, diet, times of injections, urine analysis and carb count etc. The problem at the minute is the injection, she flinches when the needle touches her fur, probably from one of the first injections that didn't go so well where she yapped, I have to be so quick with this. Looked at getting the vetpen but noway can I leave it in for 5 seconds, I am lucky if I get half a second. Still, her fur is now silky again, her body mass is better and she has put a bit of weight back on, no more draining the bowl of water and eating everything in sight

 

You need a finer needle. Also are you letting the insulin getting to room temp? Sometimes cold insulin stings. The only way to get Wurly to accept her shots is conditioning (like you did when first testing)

This is ALSO important. Your signature. Please set this up also

• under Settings, Click on Signature. This is where you will put information that helps us give you feedback.
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  • Add any other text, such as
  • Caregiver & kitty's name (optional)
  • DX: Date
  • Name of Insulin
  • Name of your meter
  • Diet: "LC wet" or "dry food" or "combo"
  • Dosing: TR or SLGS or Custom (if applicable)
  • DKA or other recent health issue (if applicable)
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  • Spreadsheet link. Please put the signature link on the bottom line of your signature information, on its own, so it is easy to find.
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Be sure to click the 'Save Changes' button at the bottom. If you need help urgently it is important we know these things at a glance. We don’t want to waste valuable time finding out information.

This will help everyone help you faster and with more efficiency. Trust me in an emergency this will only serve you.
All that info you enter will appear at the bottom of ALL your posts giving every one the info they need to give quick accurate help.

 

Hi, added spreadsheet, going to complete signature. Thank you.

 

Hi

Hi again, silly question.....TR or SLGS? Acro IAA Cushings?

 

It is the different dosing methods Tight Regime or Start Low Go Slow.
I asked exactly the same. I later found the glossary on here that has lots of useful definitions. I've put the link below - that page also has a link to another glossary which contains FDMB abbreviations both technical and more lighthearted (e.g. a DH is a dear hubby - whether meant sarcastically or not is up to the user & the situation !!)

Hope these help!

Gill

https://felinediabetes.com/dictionary/cat-health-dictionary.htm

 

Thanks Gill...having computer glitches all morning ...

 

Perfect injection tonight

 

Mogs, you were correct about the duration. I will be looking to switch to Prozinc soon, as she is getting fed up with twice daily injections, and letting me know about it!

 

Hi everyone, when switching from Caninsulin to Prozinc, would you expect to give the same initial dose or lower?

 

Hi
When the vet swapped us over we were on 1.5 iu of cansulin but he moved us to 1.0iu of Prozinc. So it was lower - the vet said he was doing that for safety as cats can react differently to different insulin so he dropped it back down.
Not sure if that is a standard approach but that's what happened with us. I'm sure others will offer you the benefit of their much more vast than me experiences.
PS after the post 2 weeks BG curve he put us back up to 1.5 iu as he was happy that Mac didn't have any over-sensitivity to Prozinc.
You could always try posting this on the prozinc forum too.
Gill

 

Thanks Gill. The Vet will call me in the week to discuss.

 

Try inserting the needle bevel up as show below.

 

That never occurred to me, just checked the needle and you can actually see the ramp (with glasses on) will give it a go tonight!

 

Wurly is rejecting the injections now, 3 x fur shot and one abandoned due to violent behaviour. Just managed the first shot in 2 days, she had been sick twice and was awake all day today (not her normal routine)
Does anyone have any ideas on how to resolve the situation? She is big and fiery and I have tried different rooms. I have ordered a Pheromone spray to go on my glove to see if this works. Asking Vet to switch to Prozinc for longer lasting cover.
Left arm rapidly getting covered in marks

 

Without the preshot BGs it's impossible to know but typically Caninsulin can produce big, steep drops in BG and that can make some cats feel really cruddy so that could potentially be a reason why Wurly is fighting you. Saoirse got to the stage where she ***hated*** getting Caninsulin injections. She started hiding in the most inaccessible places she could find when she knew her injections were due and even when I managed to get hold of her she would try hard to resist my attempts to administer the dose. I've seen reports of similar behaviour from other members whose cats were on Caninsulin too.

Saoirse was switched to Lantus and never once hid or resisted the injections thereafter. I hope that a switch to a different insulin will similarly help Wurly.


Mogs
.

 

We went a good three weeks without too much trouble and now it seems like we are back at the start. Going to ring Vet in the morning to get the prescription changed, else I will take Wurly up there and let her sort them out! Thanks for the advice again Mogs, I was thinking solely that she was bothered by the injection that I didn't relate to the way it made her feel. When I prick her ear she just twitches and lets me get blood no problem, so it makes sense.

 

Be sure to let us know how you get on.


Mogs
.

 

Collected Prozinc today, first shot will be in the morning, I am at home for 4 days so can test and monitor. Vet has suggested 1IU once a day until Wurly has calmed down a bit and I can supply a curve and Nadir as obviously they are trusting me without even seeing Wurly whilst switching insulin. Fingers crossed. The Prozinc datasheet makes multiple references to cat's going in to remission, here's hoping

 

Fingers and paws crossed in the Shire! I hope the switch will make Wurly will feel better. Be sure to keep us updated with how she gets on. (((Wurly)))


Mogs
.

 

Fingers crossed that she feels better soon.
Gill

 

1st shot today with Prozinc took ages, she was really not in the mood and I had to make sure 100% that it went in. But 6 hours later she tested at 11.6 with a reduced dose from previous which showed 15 so looking better and as I am only giving one dose for a while I might try my luck with another test on the ear later

 

9 consecutive shots and then bang, today she lets me know twice who is the boss

 

You're not alone - no fur shots for several weeks then 2 the week before last.
Think the fates of FD just like to keep us on our toes !!!

 

I have been looking at the auto injection pens, takes away the risk of the cat turning around suddenly and also gets the needle in the correct location on the skin. Think I might order one and try it.