New member-Lily the challenging diabetic

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CheeseheadNicole

Member Since 2013
Hi all,

My 11 year old cat Lily was diagnosed with diabetes 6 weeks ago during a routine check-up. Her original glucose reading was in the mid-300's. Small amounts of ketones were in her urine, but she was not in diabetic ketoacidosis. We began slowly switching from "regular" dry food to canned Science Diet MD and began insulin injections (ProZinc), 1 unit, twice daily. A glucose recheck at week 2 was in the low-400s (higher than before insulin possibly because first test was mid-morning, subsequent tests have been at ~3:30PM). At week 2, we increased to 2 units, twice daily. She had some vomiting so the vet suggested a switch to dry Science Diet MD, which she seems to be tolerating better. Week 3 glucose test unchanged in the low-400s so increased to 3 units. Week 4 glucose reading still unchanged to increased to 4 units insulin, twice daily. Week 5 glucose reading (today) was 352. Movement in the right direction! We are increasing to 5 units this week. All the glucose tests have been done at the vet. Besides excess thirst, small weight loss, and coat change, she is doing well.

Besides being hard to regulate, the vet also detected a heart murmur and a follow up X-ray showed Lily has fluid around her heart. Heart meds will be needed after the diabetes is regulated. AND...Lily has had lifelong allergies to dust mites and grain storage mites and was on a low dose of liquid Prednisone for years, given every other day or as needed. We immediately stopped the Prednisone as it has links to diabetes, but excess grooming (itchiness) has returned. Vet is thinking Atopica might be a better alternative, again after the DM is regulated.

I have read a lot on this website (thank you!!!). I worry about keeping her on a dry food diet (even though it's Science Diet MD) but wondered if we should wait to try something else until her glucose levels are under control. Thoughts? I'd also like to start home glucose testing and purchased a Reli-On Confirm human glucometer...but the vet is really recommending the Alpha Trak since it is "calibrated" for animals. The vet tech took a blood sample today and measured with my glucometer at 279 and their Alpha Trak at 352. Is there a way to convert the human glucometer reading to a cat reading? The Alpha Trak meter and test trips are much more expensive, but maybe it's worth it if vet is comfortable with the home readings.

Thanks for any advice. The diagnosis of diabetes and heart problems was hard to take. Now the added challenge of trying to manage a hard to regulate kitty has been overwhelming. I just want my Lily to feel better.
 
Hi there....I'm by no means an expert but there were a couple of things I wanted to comment on, hoping to help.

First off you can easily use a human meter vs an Alphatrak -what I found by googling is that a quick and dirty conversion is that human meters come up with a number about 66% of the Alphatrak (from http://k9diabetes.com/forum/showthread.php?t=3440)

Then I wanted to mention that yes, canned food is best for sure...but generally folks try to feed 10% carbs or less - and Science Diet is twice that (from http://www.catinfo.org/?link=cannedfood ... cial_Foods) That said, you should be home testing before you change foods because feeding lowcarb can cause a dramatic reduction in blood sugar - and a corresponding reduced need for insulin.

And the itching is connected with being diabetic (at least for my cat it was)....so if you get the BG levels down - that issue might well go away without you needing to give any medication.

I'm sorry about the heart issues -that's not something I have any experience with.

But I do think your cat will be easier to regulate if you go to a <10% carb canned food...or if nothing else , a lower carb dry food like Evo, Wellness Core or Young Again.

Em
 
You may be able to find a better, low carb food by perusing the chart at Cat Info.
Since you are home testing, the following may be helpful:

Here are some glucose reference ranges used for decision making using glucometers. Human glucometer numbers are given first (mg/dL). Numbers in parentheses are for non-US meters (mmol/L). Numbers in curly braces are estimates for an AlphaTrak.

< 40 mg/dL (2.2 mmol/L) {< 70 mg/dL for an AlphaTrak}
- Treat as if HYPO if on insulin
- At nadir (lowest point between shots) in a long term diabetic (more than a year), may earn a reduction.

< 50 mg/dL (2.8 mmol/L) {< 80 mg/dL for an AlphaTrak}
- If before nadir, steer with food, ie, give modest amounts of medium carb food to keep from going below 50 (2.8).
- At nadir, often indicates dose reduction is earned.

50 - 130 mg/dL (2.8 - 7.2 mmol/L) {80 - 160 mg/dL for an AlphaTrak}
- On insulin - great control when following a tight regulation protocol.
- Off insulin - normal numbers. (May even go as low as the upper 30s (1.7 mmol/L){60s for an AlphaTrak}; if not on insulin, this can be safe.

> 150 mg/dL (8.3 mmol/L) {> 180 mg/dL for an AlphaTrak}
- At nadir, indicates a dose increase may be needed when following a tight regulation protocol.

200 mg/dL (11.1 mmol/L) {230 mg/dL for an AlphaTrak}
- no shot level for beginners; may slowly reduce to 150 mg/dL (8.3 mmol/L) {180 mg/dL} for long-acting insulins (Lantus, Levemir, and ProZinc) as data collection shows it is safe

180 - 280 mg/dL (10 - 15.6 mmol/L) {may be 210 - 310 mg/dL for an AlphaTrak}
- Any time - The renal threshold (depending on data source and cat's renal function) where glucose spills into the urine.
- Test for ketones, glucose is too high.

>= 280 mg/dL (15.6 mmol/L) {may be >=310 mf/dL for an AlphaTrak}, if for most of the cycle between shots
- Uncontrolled diabetes and thus at risk for diabetic ketoacidosis and hepatic lipidosis
- Follow your insulin protocol for dose adjustments
- Test for ketones; if more than a trace level of ketones, go to vet ASAP.
 
Hello and welcome to the board!

The dry food could well be keeping her high, it would be best to switch to a low carb canned as the others mentioned as that could help regulate Lily. Many of us here feed Friskies pates, Fancy feast classic pates or Wellness grain free . Ems link has a list of foods you can choose from. But i wouldnt do that until you are home testing because her insulin needs could drop fast.

The prednisone is likely also to have caused this issue. When did you stop it?

Wendy
 
Hi to sweet kitty Lily and her caregiver. Would you please tell us your first name?

I'm Deb and that tuxie pictured over to the right is my sugarkitty Wink. He is a diet controlled diabetic for the last 5 months and does not need insulin shots for now. I switched him from vet recommended high carb Hill's dry food to low carb canned Fancy Feast classic pates and Friskies pates and he quickly went off the insulin.

The diabetes can take a long time to regulate. I do not understand why your vet wants to wait on treating the heart issues. Fluid buildup around the heart is making her body work harder to keep everything going. Diseases can and should be treated concurrently. For example, we have members here that have diabetic cats that also have kidney disease. They are treating both those diseases at the same time, so their kitties will feel better and live longer lives.

I strongly suggest talking to your vet again and treating all her issues concurrently, especially the fluid around her heart. If that treatment means some steroids to help with the itching, you compensate by increasing the insulin dose.

I worry about keeping her on a dry food diet (even though it's Science Diet MD) but wondered if we should wait to try something else until her glucose levels are under control.
Click to expand...
Classic Catch-22 situation. The BG (blood glucose) levels will remain high until you change to a lower carb food. You don't want to change the food until the glucose levels are under control. Sort of an endless circle, chasing your tail and never being able to catch it. Changing to a lower carb food will help bring the BG's down. We strongly suggest home testing first, because the food change can drop the BG's 100 points or more.
 
Welcome extra sweet Lily and Lily's MamaBean! MY Lily sends extra hugs...she's just sweet, not 'extra sweet'.

You've got lots of answers already so I won't add more other than to say we also use the Confirm meter - have tried all sorts of brands but this is our favorite as it takes such a small blood drop. We have 2 diabetics - KT's ears bleed well but Dakota's ears don't give up blood easily so the smaller required drop makes a BIG difference! When I compared my Confirm against vet's Alphatrak, our numbers were almost the same as yours on both meters! I've noticed that the higher the number, the more difference in the readings. The lower the readings, the closer they agree but the Alphatrak will always be higher....

BIG HUGS! Glad you found us!!!
 
CheeseheadNicole said:
Hi all,

My 11 year old cat Lily was diagnosed with diabetes 6 weeks ago during a routine check-up. Her original glucose reading was in the mid-300's. Small amounts of ketones were in her urine, but she was not in diabetic ketoacidosis. We began slowly switching from "regular" dry food to canned Science Diet MD and began insulin injections (ProZinc), 1 unit, twice daily. A glucose recheck at week 2 was in the low-400s (higher than before insulin possibly because first test was mid-morning, subsequent tests have been at ~3:30PM). At week 2, we increased to 2 units, twice daily. She had some vomiting so the vet suggested a switch to dry Science Diet MD, which she seems to be tolerating better. Week 3 glucose test unchanged in the low-400s so increased to 3 units. Week 4 glucose reading still unchanged to increased to 4 units insulin, twice daily. Week 5 glucose reading (today) was 352. Movement in the right direction! We are increasing to 5 units this week. All the glucose tests have been done at the vet. Besides excess thirst, small weight loss, and coat change, she is doing well.

Besides being hard to regulate, the vet also detected a heart murmur and a follow up X-ray showed Lily has fluid around her heart. Heart meds will be needed after the diabetes is regulated. AND...Lily has had lifelong allergies to dust mites and grain storage mites and was on a low dose of liquid Prednisone for years, given every other day or as needed. We immediately stopped the Prednisone as it has links to diabetes, but excess grooming (itchiness) has returned. Vet is thinking Atopica might be a better alternative, again after the DM is regulated.

I have read a lot on this website (thank you!!!). I worry about keeping her on a dry food diet (even though it's Science Diet MD) but wondered if we should wait to try something else until her glucose levels are under control. Thoughts? I'd also like to start home glucose testing and purchased a Reli-On Confirm human glucometer...but the vet is really recommending the Alpha Trak since it is "calibrated" for animals. The vet tech took a blood sample today and measured with my glucometer at 279 and their Alpha Trak at 352. Is there a way to convert the human glucometer reading to a cat reading? The Alpha Trak meter and test trips are much more expensive, but maybe it's worth it if vet is comfortable with the home readings.

Thanks for any advice. The diagnosis of diabetes and heart problems was hard to take. Now the added challenge of trying to manage a hard to regulate kitty has been overwhelming. I just want my Lily to feel better.
Click to expand...

There is nothing wrong with human meters.... if they are good enough for humans, they are good enough for our cats. The fancy expensive pet meters are not special at all. What you want is a meter that can help you track how your cat is utilizing the insulin you give to get into a non-diabetic range. The human meters do that and the pet meters do that as well. If the pet meter whistled Dixie or something, maybe it would be something to consider buying but not, it's just a money grab. There are a few human meters to avoid like all of the FreeStyle meters, but the Relion ones are great.
Bottom line: why pay more if the more economical method is just as good?

OK regulate a cat on dry food diet? Not gonna happen. Unfortunately, you are at a pretty high dose, so you will have to be testing a bit more when you switch over to wet food, and be ready to drop your dose fast once the numbers come down. Also, with ketones in the picture, you will have to be very careful.

I would pull that dry food because it's horrible for diabetics; I have no idea why vets even suggest it.
And that expensive vet Science Diet wet food is 14% carb so it's no good either! Try to see if you your cat will eat fancy feast or friskies pates before changing the dry. Find your wet food from Dr. Lisa's list and stay under 10% carbs.
catinfo.org/docs/FoodChartPublic9-22-12.pdf

Now for the heart. Your vet's got it backwards..... put aside the heart issues till the diabetes issue is settled? Well, if the heart stops working, there will be no diabetes issue. I think we can work with the 2 issues at once but you need to get the heart issues sorted..... if there is fluid around the heart, that needs to be handled above all else.
Next, if she needs prednisone, then she should be taking it! So what if it causes a rise in her numbers, just give more insulin!
Too many vets seem to be focusing on the wrong things....

So, the numbers at the vet office are meaningless because stress with being at the vet will raise numbers, and not knowing the times of the injections or when the food was eaten, well, not much can be suggested on those numbers.

Get yourself a meter if you have not already. The Relions are great. Also get KETOSTIX to test urine at home for ketones. Some cats are prone to them, so you need to know if your girl is or not.
Get the people on this board to help you set up a google spreadsheet, and start testing Lily right away at home; there is zero need for expensive trips to the vet for curves/testing.
Get some cans of wet food from Dr. Lisa's list that are below 10% carbs; fancy feast and friskies pates are a good start.
Get Lily back on pred if she needs it; you don't stop a needed medication just because it causes higher numbers... you just alter the insulin dose.
Get as much info as you can on the heart issue. What grade is the murmur? Did the vet have an echo done to determine Lily's heart issues, and the state of them? Did this vet handle all the heart readings or did someone specializing read the heart issues?

Your vet is pushing expensive food and meters on you but can't be bothered to treat Lily's heart?
Something really wrong with that picture.

Start testing Lily's BG with the Relion and try to do a curve, testing every 2 hrs at home so you can see how the current dose of insulin is working while she has the current diet.
For sure, test her urine daily to check for ketones, and post right away if a test strip shows even a trace.
Try Lily on some pates; I bet she'll love them.

To me, the heart is the most important issue, then start the pred if it's needed, and then finally, the diabetes is something that can roll with the punches...... pred raises numbers, just raise the insulin dose... simple as that.

Gayle
 
How are you doing this evening Lily? Think you can talk your momma bean into sharing her first name with us?

Hi Lily girl. I bet you are from Wisconsin. It's that cheesehead part of your FDMB id that gave me a clue. Are you in WI? Pretty place and great cheese. I'm a cheese addict myself. My momma bean Deb gave me another taste of goat cheese today. I licked it off her finger and asked for more! :cool: - Wink
 
Once you get into home testing:

Here are some glucose reference ranges used for decision making using glucometers. Human glucometer numbers are given first. Numbers in parentheses are for non-US meters. Numbers in curly braces are estimates for an AlphaTrak.

< 40 mg/dL (2.2 mmol/L) {< 70 mg/dL for an AlphaTrak}
- Treat as if HYPO if on insulin
- At nadir (lowest point between shots) in a long term diabetic (more than a year), may earn a reduction.

< 50 mg/dL (2.8 mmol/L) {< 80 mg/dL for an AlphaTrak}
- If before nadir, steer with food, ie, give modest amounts of medium carb food to keep from going below 50 (2.8).
- At nadir, often indicates dose reduction is earned.

50 - 130 mg/dL (2.8 - 7.2 mmol/L) {80 - 160 mg/dL for an AlphaTrak}
- On insulin - great control when following a tight regulation protocol.
- Off insulin - normal numbers. (May even go as low as the upper 30s (1.7 mmol/L){60s for an AlphaTrak}; if not on insulin, this can be safe.

> 150 mg/dL (8.3 mmol/L) {> 180 mg/dL for an AlphaTrak}
- At nadir, indicates a dose increase may be needed when following a tight regulation protocol.

200 mg/dL (11.1 mmol/L) {230 mg/dL for an AlphaTrak}
- no shot level for beginners; may slowly reduce to 150 mg/dL (8.3 mmol/L) {180 mg/dL} for long-acting insulins (Lantus, Levemir, and ProZinc) as data collection shows it is safe

180 - 280 mg/dL (10 - 15.6 mmol/L) {may be 210 - 310 mg/dL for an AlphaTrak}- Any time - The renal threshold (depending on data source and cat's renal function) where glucose spills into the urine.
- Test for ketones, glucose is too high.

>= 280 mg/dL (15.6 mmol/L) {may be >=310 mg/dL for an AlphaTrak}, if for most of the cycle between shots
- Uncontrolled diabetes and thus at risk for diabetic ketoacidosis and hepatic lipidosis
- Follow your insulin protocol for dose adjustments
- Test for ketones; if more than a trace level of ketones, go to vet ASAP.
 
Thanks for the great replies. Lots of great info to take in.

My name is Nicole, mama to sweet Lily. And you guessed it, Cheeseheads from Wisconsin. :)

Guess I better go buy some canned food like many have recommended to have on hand and watch those videos again on how to do home testing. Has anyone had problems with vomiting when slowly switching from dry to canned? Any advice? I did not know if vomiting was due to food switch, food intolerance for that particular kind...or something unrelated to the food.

Lily's heart murmur was a grade 1. No echo or other heart testing done yet besides the X-ray. My vet consulted with a heart specialist in another city (which she did refer us to if we wanted additional testing) and that vet specialist concurred that if Lily was not exhibiting signs of cardiac distress and BG were high with ketones, getting the diabetes under control was the first priority. Since heart meds can interfere with BG and insulin, they didn't want to complicate the initial treatment of diabetes. But you make great points and we're going to have to manage BG with heart meds anyway. Might as well figure that out sooner than later. Vet was on the fence about starting heart meds this week and I opted to wait another week to see if we could get the BG down more. That was partly because I just wanted some bit of hope, some good news that we had her regulated before adding in something else to "mess up" her numbers. It is overwhelming and emotional.

Long term Pred use is known to cause diabetes (wish I would have known that years ago) so that was the reason to discontinue use. Lily was on a low dose, 0.5ml, every other day for at least 5 years...though after a year or so, we did it less frequently than every other day and more on an as-needed basis. Do others have sweet cats on Pred?

And for what it's worth, we're feeding Lily (and her talkative brother Hobbes) at 5:30am and 5:30pm, with vet glucose testing around 3:30/4pm every Friday.

I have to be out of the house tomorrow until mid afternoon. When is the best time to home test BG? Who can help me with a spreadsheet or other tips? Should I start slowly switching over to a recommended canned food before I do a curve? Earliest I could spend a day at home to do a curve is Friday.

Thanks everybody!!!
 
Please always test before the shot.
Whenever possible, get a test in the +5 to +7 hours after the shot - the expected low point (or nadir).
For your peace of mind, snag a before bed test to make sure he isn't diving overnight, so you can sleep ... or intervene if needed.

The nadir is how doses are adjusted. When I switched Spitzer, his dose dropped below 1 unit from the initial 3.

Change food gradually to avoid GI upset - about 20-25% switch over per day.If he develops diarrhea, hold steady for a day or two, then continue. A probiotic may help the transistion. FortiFlora is one many cats like and it may be ordered through our shopping partner Amazon (link above)
 
To answer your questions

- home testing tips - I agree with BJs suggested test times too. https://docs.google.com/document/d/13c_CPZVKz27fD_6aVbsguadJKvjSrSAkD7flgPPhEag/pub

- since you mentioned ketones I would also suggest you go and buy a pack of urine ketone test strips - they are like $10 - and test her pee a few times a week or whenever she is over 340. Its adviseable for all diabetic cat owners to test for these regularly anyway as ketones are very serious. Here are urine catching tips too: https://docs.google.com/document/d/1quta5WLEjdO0Y_t2dAYSwN84h-LNZWxOdtVsJDKZ16A/pub

- heres how to set up a spreadsheet but let us know if you need help: http://www.felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207



Wendy
 
I've had two cats with heart murmurs. The 2 are very different cases so I just wanted to give examples of each of them.

My civie Monet has had a grade 1 heart murmur for the 6 years I've owned him. No other complications like fluid around his heart. He is doing fine. The heart murmur has not progressed and gotten worse. No medications needed for Monet, not unlees you can consider freeze dried liver treats as medication. ;-)

My civie Libby, passed away early this year from complications of heart disease. She had a grade 2 murmur with a gallop rhythm. That progressed to a grade 3 with fluid around her heart and lungs. Her last echo and ultrasound indicated a small heart attack with damage to the left side of the heart. Medications helped for a while but she went downhill rapidly and had labored breathing from the fluid buildup. Saddle thrombosis was a possible complication so she was on baby aspirin to help with that.

These are some of the reasons why I urge you to get some medication from your vet to help with the fluid around her heart. The fluid buildup around her heart could be compressing other organs and making them work harder.

There is a member on the PZI forum, Theresatramondo, and her cat Tiffy is dealing with diabetes, heart disease and other health issues. Some of the heart meds do mean a increase in the insulin dose, as she has found out.
 
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