New Member - Isabelle diagnosed and I have questions

Status
Not open for further replies.
D

dj4Isabelle

Member Since 2014
I just found out two days ago that my 12 year old cat Isabelle was diagnosed with diabetes. I'm trying to stay calm and handle the situation, but I've got two questions/concerns that I want to run by this board, and see if anyone has any opinions.

Concern 1 - diagnosis - Isabelle had shown no signs of diabetes. Eat and drinking normally, urine and poop regularly. (For history, she did develop hyperthyroid two years ago, started losing weight (down to 10+ pounds), had the radiation procedure to get that correct. However she was one of the 5% of cats that developed hypothyroid after the procedure (essentially over corrected the problem) and now takes a small dose of soloxine daily to keep her thyroid regular.) Her weight stabilized and she actually has gained some weight in the last two years, so her weight is elevated 13+ pounds, but not to the level of obese. Anyway, about a year ago on a vet visit, Isabelle's ears had gunk in them. The vet cleaned them out, but didn't think there was an issue. 6 months later, some more gunk, cleaned and moved on. The most recent 'well' visit was about 3 weeks ago. Vet decided that she had a bad ear infection in both ears and that we needed ear drops to clear it out. So 3 weeks ago, no diabetes signs, no current health problems other than daily soloxine to balance thyroid. I gave the ear drops twice daily for 10 days. As soon as I started giving those ear drops (which was stressful for me, and probably her), she started frequent and a lot of urination. Lots of clumps in her litter box and they were bigger than usual. I assumed that this must be a side effect of the medicine. After 10 days her ears looked better, no itching at them, and her frequent urination started to subside (but still higher than it was before ear medicine). About 4 days after that she started itching at her ear again, so we took her back to the vet to see if we needed more ear medicine. The Vet said that the ear infection was better but her ears had a yeast infection. Also, she had lost 1.2 pounds in three weeks (she went from 13.8 to 12.6 I think) The vet gave us some more drops (different ones) that would help with the yeast infection and also help with any lingering ear infection. They also decided to take her blood on Friday 11/13 because of concern about the weight loss. I gave ear medicine over the weekend. Her urine output was still high, but not quite as high as with the original ear medicine, but still high. Then Tuesday we got a call from the vet that her blood levels were in the 400s. And a diabetes diagnosis was born. They decided that was so high that they wanted her to come in right away for a day long 'curve' test. And we were instructed to buy insulin (lantus at $298 for a 10ml bottle) They gave her lantus and did the day long curve. We got her back that night, and after a meal (I'll discuss that in concern 2), gave her 2 units of insulin. Wednesday morning, she only ate half a meal, and she per instructions, we gave her half of a dose (1 unit of insulin). Wednesday night, she only ate about half a meal, so we gave her half a dose again with the plan to call the vet in the morning. Today, this morning, she ate about half of a meal, and vomited. The vomit only contained some food, so I know that she got some food in her. And vomiting is not uncommon with her when she eats too fast (which she did). Anyway, we didn't give a dose of insulin because we didn't know how much she ate. We called the vet, and they had us bring her in. Her glucose was 'almost 400', so they gave her insulin and are doing another 'curve'/monitoring test today. That's where I stand right now...

(let me add in this as well, it is 'concern 2'. Isabelle has always been a nibbling eater, not a meal eater. We would give her a half cup of dry food a day, and she would eat bits of it throughout the day. Also, she has only eaten dry food since she was a kitten. Now Wednesday night, the vet gave us wet food, and said that she had to eat just two meals a days, and not leave any food out so that she would eat "meals" to coincide with insulin shots, so we've added that stress of completely adjusting when she eats AND what she eats, creating more stress in her life)

So my concern is, is it possible that she doesn't have diabetes. The fact that her frequent urination symptoms started at the exact time I started the ear medicine and/or the fact that she has had some high stress days because of the vet, and the new food, and the new eating schedule, could that be causing the elevated glucose readings? I'm ready to take care of her for the long haul of twice daily insulin injections, and blood monitoring and all that, but before I go full steam ahead, I want to know if this is for real. I've got a few more days of ear drops to complete, and then that should be done. Is it possible that once we are done with that medicine that she will go back to normal? How will I even know she is normal since I am now full steam ahead with insulin and shots and wet food, and two meals a day, etc. Should I consider getting a monitor and doing my own curve tests? After reading this history, how many experienced cat diabetes owners/experts have doubts that Isabelle is a diabetic cat? Should I have any doubts about this diagnosis?
 
Well she is diabetic because of the elevated glucose readings, but she maybe what is known as a transitent diabetic, in that the ear drops more than likely contained a steroid. Which combined with a high carb dry food diet pushed her over the edge into diabetes. The good news is that most of them that become diabetic because of steroid use, will go into remission with a diet change and the stopping of the steroids.

With some of the older insulins you had to make sure the cat ate and had food in their stomach before giving, that isn't the case with Lantus. Most of us either free feed canned wet food or give several small meals through out the day. Secondly, there is nothing special about the prescription foods, and in fact some with better quality ingredients are sitting on your grocery store's shelves right now for a much more reasonable price. I, personally, have 16 cats and 3 of those are diabetic ( I adopted them that way). Everyone here eats exactly what my 3 diabetics do, just plain no frills Friskies pate style canned cat food. Maxwell not only went into remission and off insulin altogether on this diet but has remained insulin free for 4+ years. Cassanova went into remission after 8 months on this diet and just recently went back on after an injury that required the use of a steroid and now that he is healed is reverting back to OTJ (Off the Juice, with insulin being the juice) now that the steroid has been removed.
And my Autumn will be insulin dependent for life more than likely, although she is on a tiny dose of .3u every 16 hours.

Your best bet for helping Isabelle is to get yourself a human glucometer and test her at home yourself. If she is a steroid induced diabetic, then that is the surest way to catch falling numbers and be ready to reduce her dose quickly if once the steroids are removed if she too becomes a diet controlled diabetic cat and no longer requires insulin.

Mel and The Fur Gang
 
Welcome to FDMB,

I will try to help with some of your questions, and hopefully someone with more experience (especially ones w/ diabetes AND other health issues) will pop in soon.

In my opinion, I would say yes it is most likely accurate that she has diabetes. I say this because she her blood glucose is so high, but also the fact that you feed her dry food, and Im sure her other health issues have not helped. Dry food is very high carb (except a few). I know you said she just recently started having a higher out put of urine which may be a benefit, meaning she most likely is in the "beginning stage" which has a better rate to go into remission.

As to the food, you don't want to switch foods without home testing. Diet alone can drop bg drastically, so yes I would run out and buy one. Most here use the relion brand from walmart. I use the micro its cheap, cheap test strips, and needs little blood. Also when it comes to food change, you want to do it slowly because it can be hard on their stomach (maybe why she vomited?) Im assuming your vet gave you a prescription food, which for your reference is not necessary, most here feed fancy feast pates, or friskies pates.

Doing your own curve is a great idea because stress can also raise bg, so a curve at the vet may not be as accurate as it would be in a comfortable area. I would also suggest diabetic friendly treats to help with this. Most here use freeze dried chicken. ALso some neosporin OINTMENT with pain relief can help.
 
Vet stress may raise the glucose from 100 to 180 mg/dL.
A high carb diet may contribute 100 mg/dL to the glucose levels.

Thus, from 200 to 280 mg/dL could be due to readily changeable factors.

If you are already using insulin, you need to be home testing before you change the food. See my signature link Glucometer Notes to begin learning what the levels can mean.

If you have NOT started insulin, switching the food to low carb, canned or raw, over the counter (not prescription) food will help greatly. Change about 20-25% of the food each day to reduce the chances of GI upsets (diarrhea, vomiting, or food refusal) due to sudden food changes.
 
Thank you for all the quick responses. I'll reply more later, but I wanted to follow up with a quick update and question.

First the question to BJM. I have already printed out your notes so I am glad to see your response. I love your comparison chart with the human meter and the pet meter. I just bought a relion micro meter and did the first test tonight before the insulin shot. Isabelle's reading was 387 on the human meter. My question is:are most of the glucose levels in the spreadsheets that you see on this site based on human meters or the alphatrak pet meter? As I start my chart and compare to goal levels I want to make sure I'm evaluating and comparing correctly. I think I read that the alphatrak pet meter is 30% higher which would put my test tonight at about 500 if it was an alphatrak. Should I be putting 500 on my chart or 387? What is the goal that I would hope to see on the human meter before I give the insulin shot once Isabelle gets regulated?

Second is a comment. Isabelle's kidney levels have been slightly elevated since the hyperthyroid radiation treatment in 2012 so we have been on purina NF dry food to manage her kidney levels. We and the vet are hesitant to change to a lower carb food because we don't want to cause kidney issues. I will say that we are planning to go to a specialist at the university vet school in the area to get a diabetes specialist's opinion on how we should handle her diet, but at the moment we are sticking with the dry food to keep the kidneys behaving.

But I'm happy to get these opinions. I don't feel like our vet is an expert on this so I'm trying to soak in as much information and advice as I can.

So current update. Isabelle 2 units of lantus twice a day, last pmps reading 387 on human meter. And she is happily laying next to me right now.
 
Most folks are using human meters because the pet meters are so expensive!

Those not in the USA are generally testing in mmol/L, and may be using either human or pet meters.

The reference range colors on the spreadsheet are based on human meters. The colors and rules can be edited if desired.

Depending on the insulin and protocol, there are specific number ranges to target; my reference is a summary of some of the key features.
What insulin are you using?
Lantus or Levemir are depot insulins which have overlap from shot to shot. You can use a Tight Regulation protocol or a Start Low Go Slow protocol.
All other insulins are in and out for a duration of effect up to 12 hours, such as ProZinc and BCP PZI.

For renal -sparing low carb food, check out Friskies Special Diet pates. Also pop over to Feline CRF to see their food list, plus tons of great info on managing the condition.
 
I'm on lantus using the start low go slow method. With a 2 year old at home we don't have the time resources to be able to do the tight method

One more question tonight. When we were getting our 'demo' on insulin shots at the vet , they said after you insert needle pull back on plunger a little to see if you draw blood, and if not then plunge it in. Does everyone do that pull back step? I find that quite a challenge to do and hard to see anyway because of fur. I'm worried that maybe I'm not getting insulin In because of this step. Maybe I'm just paranoid but I want to make sure I get that insulin in and the pull back seems counter intuitive. Just curious if everyone does that.
 
In 4 year of treating several different diabetic cats I've never done it and never had a problem. Also all but one of mine have been long-haired so I can't even see the needle or about 1/4 of the syringe. lol We are talking very fluffy cats. Again like BJM your mileage may vary.

If you are going to go with the SLGS protocol you are certainly welcome to join us over on Relaxed Lantus as that is exactly what that forum is for, or TR Lantus just make sure you put in your signature that you are using SLGS in bold large font so they all know over there which protocol you are using. TR is a bigger and busier forum, with a lot more people around all hours of the day and night, while Relaxed is smaller and usually the most active during the day and weekends. Just because we all have real life commitments that take us away from the board. But because we are smaller when we are around we tend to have more time to help with snags and explain the pros and cons and how this all works. Either spot you will find lots of friendly folks willing to help you every step of the way. It's our way of paying it forward for all the help we got when we were right where you are now. :-D

Mel and The Fur Gang
 
Thanks for the advice on moving over to the TR or Relaxed group. I'm going to get over there once I get everything settled. I'm just getting my spreadsheet set up.

So far in testing last night 387 PMPS, and this morning 429 PMPS. Still just day 3 on insulin so waiting the week before I even analyzed the dose of 2 units twice a day.

My question today revolves around lancelets. My starter pack from Relion came with 10 blue lancelets, that appear to be 30 gauge. I went to Walmart and saw that they sell a 33 gauge (mint green color I think) lancelet.

I'm thinking, the thinner the gauge (higher is thinner) then the less pain to my cat. But I want to make sure that it will still draw blood. What gauge lancelets to most people use? is 30G typical?

Also, I watched a couple of youtube videos that encouraged me to use the lancelet device, but instead of the using the popping action, just manually prick the ear. The reasoning was that the sound of the lancelet popping sound scares your cat, and they will start to run away. Is anyone manually pricking the ear, or are they using the lancelet device (if so, what depth?) The scary part of manual pricking is that I'm not sure how hard to push, but so far after two tests, Isabelle has been good about it. Just a little flinch and that's it.

So, what gauge are people using for lancelets, and are people manually pricking or using the device?
 
Glad to hear that your are home testing- it is the most important thing you can do to keep your kitty safe!

My Tiger also was hyperthyroid, we had the Radio-iodine treatment done, then she became hypothyroid. ohmygod_smile It is not that uncommon for hyperthyroid to mask the symptoms of Chronic Kidney Disease. Once I started treating hypothyroid with Levothyroxin, the early signs of CKD started to show up. Her case is not enough that treatment is needed and so-at this point our vet is watching closely.

Feeding a diabetic kitty with CKD is tricky, but the specialist who treated hyperthyroid advised to stick with the low carb diet for Tiger's diabetes, rather than a high carb prescription low phosphorus food. I know you say you are hesitant to switch to a more diabetic friendly diet, but you could also ask your vet about a phosphorus binder to be used with a low-carb diabetic friendly food. Tanya's Website is a fantastic resource for CKD, http://www.felinecrf.org/phosphorus.htm and also Dr. Lisa Pierson is another excellent resource: http://www.catinfo.org/?link=cannedfoods
 
When you first start out home testing, we recommend that you use the larger gauge (bigger pin prick) lancets such as those used for alternate site testing. A 25-28 gauge lancet is easier to use at first. So, will it cause less pain if you have to poke your cats ear 2 or 3 times with the smaller gauge lancet or only once with the larger gauge? It depends on how good you get at the poky poky dance.

In time, the ears really do "learn to bleed" better as they form more capillaries. Warming or getting that blood circulating with rubbing helps a lot too.

I've never switched to the thinner 30-33 gauge lancets and still like to use the larger gauge (26-28) alternate site testing lancets, often labeled "For Alternate Site Testing" on the box.

It's really personal choice for choosing between free handing the lancet or using the lancet pen. I always had a problem finding the darn blood drop in Wink's black fur, so found free handing the lancet gave me a better chance if hitting that "Sweet Spot" and drawing blood. In the beginning, I even shaved a tiny patch of fur on Wink's ear over the "Sweet Spot" to help me see the blood drop. I occasionally try the lancing pen, but still have issues hitting the right spot so have mostly reverted to free handing the lancet.



Hope that helps. Keep those questions coming and be sure to read other people's posts. We may have talked about something in another post that would be helpful to you too.
 

Attachments

  • sweet spot diagram.jpg
    sweet spot diagram.jpg
    42.8 KB · Views: 273
Status
Not open for further replies.
Back
Top