New Member - Jane and Ragnar, dx 9/10/20

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Jane and Ragnar

Member Since 2020
Hi all and thank you for sharing your support and expertise. My kitty is Ragnar, age estimated at 11 years old.

Ragnar was a semi-feral kitty who hung around my yard on and off for 3 years as a young cat. I fed him and put a bed out on the porch, and in return he stared at me while I did yard work (and he has a creepy stare!) and hissed every time I came out to put a bowl of food by his bed.

I finally had to catch him up because he was limping, and I took him into work to get him checked out (I was hospital manager for a vet surgical specialty practice). We also neutered him and tipped his ear. Once I let him back outside, I thought he'd never be back. Six months later, he was fat and happy sleeping in my house and had quickly decided that a litterbox beats pawing around in the dirt. He is such a lover, and definitely one of the most special cats I've ever had.

He's a snorky cat with chronic herpesvirus (at least that's what we think) plus hyperesthesia over-grooming. He's been on short courses of prednisolone maybe once every 9-12 months when the over-grooming starts to dominate his waking life. He had just finished one round at the end of August when I started to notice that he might be losing weight and becoming PU/PD. The pred dose should have been much too low to precipitate diabetes, but here we are.

Bloodwork won't be back till tomorrow, but vet did prelim diagnosis based on symptoms and urine glucose of 3++. I gave Ragnar his first dose of 1 unit of basaglar tonight. I guess we're on the SLGS program, since I wasn't given any instructions to do anything but watch for signs of hypoglycemia.

I feel a bit thrown into the deep end, like I wasn't given the full "this is what happens next" spiel, because of 1) COVID and the limitations of curbside drop-offs, and 2) because the vet knows I was a vet tech (but that was a long time ago!!!!). So I'm doing quite a bit of self-education here and elsewhere online.

It seems like the vet's approach is to just do the low dose insulin for a week and then do an in-hospital glucose curve, but I'm taking the bull by the horns and getting set up tomorrow for in-home testing. Ragnar didn't even notice the insulin injection tonight, so I'm hoping for some of that laissez-faire when I start BG testing!

The vet also said that he really wants Ragnar to gain back some weight, so doesn't want me to switch to all-canned LC diet yet. (Ragnar will eat some canned but prefers dry.) I will continue on the combo wet/dry that I'd been feeding until we run the curve at the vet office next week and then want to move to a LC wet diet in conjunction with insulin changes as necessary.

Whew, sorry for the novel. Thanks again for being a place of support!
 
Welcome, Jane and Ragnar! Is he named for the hero of Norse legend? He sounds like quite the character. :)

It looks like the two of you are off to an auspicious start down the FD highway.

If you're in the US, Walmart's Relion Prime meter has the best-priced test strips.

I wasn't given any instructions to do anything but watch for signs of hypoglycemia.
Here are some useful resources for you from the forum FAQ section:

How to Treat a Hypo (print this out, familiarise yourself with it, and keep it somewhere handy).

Hypo Toolkit (includes suggestions for higher carb foods which are used to help raise numbers if a kitty is running low).

I'm not sure whether you got the result for Ragnar's ketone test but you can continue to monitor them at home. It's a sensible safety precaution, especially as he's just been diagnosed and with a 3++ urine glucose result his numbers are likely to be fairly high at the moment (renal threshold is c.250-290mg/dL / 14-16mmol/L as measured on a veterinary glucometer). More info:

Testing Your Cat For Ketones

Tips for Collecting Urine Samples

So that we can help better, we ask members to record their BG test results in a colour-coded spreadsheet. As you accumulate data for Ragnar it will be an invaluable guide to assessing the safety and efficacy of his insulin treatment. Here are the links you need to get started:

FDMB Spreadsheet Instructions

Understanding the Spreadsheet Grid

Should you need any assistance setting up the spreadsheet, just let us know.

Hope that's enough to get you going. It's a bit of a vertical learning curve in the early days. Give a shout out for anything you need help with. :)


Mogs
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Semi ferals can become some of the best companions - I love Ragnar's story. One lucky boy! We've had a few current and former vet techs here before. Welcome aboard.

The best thing to help him gain weight will be to get him in good blood sugar numbers. Once you've started home testing, we can help you with that. In the mean time, to help us help you:
New? How You Can Help Us Help You!
 
A good rule of thumb for daily calorie intake to help maintain or gain weight, is 20 times ideal weight. So if he should be 10 pounds, he should be getting 200 calories a day at least. A bit more now that he needs to gain. Diabetic cats lose weight because they can’t process the nutrients in food well so they eat but are still constantly hungry and lose weight. They also burn calories just by peeing since there’s sugar in their urine. I’m sure your vet can tell you what he thinks his ideal weight should be!
 
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@Critter Mom , thanks for taking the time to send those links! I had already read through a bunch before posting (didn't want to be THAT person who just jumps in without putting in some work!) and will no doubt be referring to the info over and over.

@Wendy&Neko , yes, he's named after Ragnar the Viking. I chose that because he looked like such a tough guy, then had to laugh later when he turned out to be a softie (but hey, he still has quite a bit of presence and confidence and his stare still scares the non-cat people who visit!).

@Aleluia Grugru & Minnie , thanks for that shortcut on calories. He's definitely got at least 3 pounds to gain back!
 
If you've not visited the Lantus (Lantus, Basaglar, Levemir) forum, there's a great deal of information in the sticky notes at the top of the board. (I suspect you have since you mentioned SLGS.) Once you have your spreadsheet and signature set up, you may want to consider posting on the Lantus board.

There are only a few dry foods that are low in carbs. Dr. Elsey's Clean Protein and Young Again Zero Carb are both low in carbs. Otherwise, any dry food you're giving Ragnar is going to bump up his blood glucose (BG) levels. An alternative may be freeze or air dried raw food. They are more like dry food in texture. Stella & Chewy's makes a freeze dried food and ZiwiPeak has air dried. Suspect the manufacturers would send you a sample to see if Ragnar finds their food edible.
 
If you've not visited the Lantus (Lantus, Basaglar, Levemir) forum, there's a great deal of information in the sticky notes at the top of the board. (I suspect you have since you mentioned SLGS.) Once you have your spreadsheet and signature set up, you may want to consider posting on the Lantus board.

There are only a few dry foods that are low in carbs. Dr. Elsey's Clean Protein and Young Again Zero Carb are both low in carbs. Otherwise, any dry food you're giving Ragnar is going to bump up his blood glucose (BG) levels. An alternative may be freeze or air dried raw food. They are more like dry food in texture. Stella & Chewy's makes a freeze dried food and ZiwiPeak has air dried. Suspect the manufacturers would send you a sample to see if Ragnar finds their food edible.

Right now, the vet doesn't want me to change his food because he is so underweight. He wants to stick with current diet until his recheck next week and just try to get as many calories into him as he'll eat right now. I know that it is a tricky situation though, trying to lower his BG while still getting enough calories into him.
 
Also, the good news is that all the rest of his bloodwork came back clean, so no concurrent hyperthyroidism or other overt issues. His BG was 378 at that point, so thankfully not as high as it could have been.

The other good news is that I am not diabetic. LOL! I know this because of course I had to try out the lancet if I was going to use it on him, and hey, why not check my own BG too! Pretty funny that I decided to try my earlobe, got everything ready, screwed up my courage, pushed the button, and.... nothing. I thought I'd surely messed up putting in the lancet. I had to dial up to 5 before I could even feel it on my earlobe. At 3, I could barely feel it on my finger. Really not like the old days of a giant painful jab on the finger and a correspondingly large drop of blood.

It will definitely take more practice to use it on Ragnar though. First few attempts drew zero blood and I couldn't even see a poke mark. Fourth try got some blood but not quite enough. Fifth try, nothing, so I called it a day. I've read all the tips on this site though, and will try again tomorrow!
 
I decided to try my earlobe, got everything ready, screwed up my courage, pushed the button, and.... nothing. I thought I'd surely messed up putting in the lancet. I had to dial up to 5 before I could even feel it on my earlobe. At 3, I could barely feel it on my finger. Really not like the old days of a giant painful jab on the finger and a correspondingly large drop of blood.

You're a braver woman than me Jane - shame there's no high 5 image! I wimped out and tested out the lancet at 2 different settings on the husband not me evidence below - at least he held stiller than Mac !:)
 

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Jane -

Just an observation regarding food. Don't equate calories with carbohydrates. For example, you could feed any number of cans of something like one of the Tiki varieties -- most of which are 0% carbs. The calories range up to 240 calories per 6oz can. The Hills M/D is 13% carb and is 156 calories per can. The Tiki food would not have an effect on your cat's blood glucose and potentially provide more calories whereas the Hills would cause a noticeable spike in numbers. The Hills is also higher in fat than Tiki and some of the latter are much higher in protein. In other words, Tiki is a higher quality of food and can provide at least as many calories as the Hills and probably costs about the same.

Unfortunately, vets get most of their information about nutrition from the representatives from pet food companies. The training for most DVMs and MDs in nutrition is traditionally quite limited. Recently, the FDA had to step in with the pet food manufacturers who were calling food "prescription" and made them stop doing so since for most of the "prescription" food they marketed had nothing in the ingredients that was meant to address a medical condition. If you consider that some of the diabetic "prescription" dry foods are very high in carbs, these foods can hardly be considered to be prescriptive with respect to "treating" feline diabetes! Most vets push the prescription foods because they have gotten their information from the food marketing people and they sell it in the office. (FYI - the pet food companies guarantee their products so you can return it even if the case or bag has been opened.)
 
What size lancets are you using? In the beginning, it's better to use larger ones, such as 26 gauge, than smaller ones that will work better once is ears get better at bleeding. That plus warming the ear really do help. And for those of us with black eared kitties, I found a very tiny bit of vaseline smeared on the poke site before hand helped the blood to pool up, instead of diving into and hiding in the dark fur.
 
@Sienne and Gabby (GA) - Noted. My vet hasn't mentioned switching to a prescription food. He wants Ragnar to stay on the current diet (free-fed Fromm Game Bird Dry plus ProPlan Prime Plus canned) for the first week until we see how he reacts to the insulin, since he is underweight and generally just picks at the wet food compared to how much dry he eats. Then we'll address diet change at that point, adjusting insulin as needed. He is a cat specialist (and also has three diabetic cats of his own) so I feel pretty good about following his advice as we start up.

@Wendy&Neko , I'm using a 28g lancet now. I was able to get three readings today. Seemed to work best if I press down fairly firmly with the lancet device. I also did make a rice pack and had it ready to go, then totally forgot to use it. I will next time though! I also made the rookie mistake of letting go of his ear (even though I'd read NOT to do that!) and saw that precious drop of blood go flying. LOL, all the things we have to learn the hard way even though they are told to us ahead of time.

I did notice that the Cornell Feline Health Center recommends that owners should NOT milk the ear to get a larger drop because it can affect glucose levels. So I won't do that in the future.
 
Do you have a link to that info, Jane? I'd like to read more about it. :)


Mogs
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I'm looking for it now. I went to so many different websites yesterday but am going through my history. I might have gotten it wrong on where I saw it, since I can't find it there again today. It was definitely on a reputable veterinary website though, and I know I didn't read it wrong because I thought it was odd that I hadn't seen that advice anywhere else. I'll let you know if I find it again.
 
@Critter Mom and @jt and trouble (GA)

This is not the original website that I mentioned the other day (haven't come back across it), but they mention they same issue about not milking the blood. It's in the text below the pictures of pricking the ear. Unfortunately, it says that it's based on unpublished data, so that's not really much help. Would have been nice if they at least said "can change reading by 10 mg/dL" or "can change reading by 25 mg/dL" or whatever.

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