New member - need advice on managing recent diabetes diagnosis

H

HelenaM

Member Since 2026
Hello everyone,

Thank you for accepting me to this forum and for any advice you can share.

My 16-year-old cat, Nalu (5.7 kg), was recently diagnosed with diabetes. He is dealing with a very complex mix of conditions: Chronic Kidney Disease (CKD) with a recent creatinine level of 3.32, mast cell tumor in his spleen and liver, pancreatitis, and asthma/bronchitis. He also just finished a 30-day course of antibiotics for pneumonia.

Nalu has been on prednisolone for his tumor since January, which likely triggered both his diabetes and a (now) severe carpal hyperextension that is heavily impacting his quality of life. We gradually tapered his prednisolone from 5mg to 3.75mg, and down to 2.5mg about two months ago, but his glucose and fructosamine levels remain high. He is also on fluticasone inhalers for his lungs (among many other medications for his multiple diseases).

Our vet currently recommends:
  • Decreasing the prednisolone further (which worries me greatly because of his cancer and respiratory issues).
  • Placing a FreeStyle Libre sensor to monitor his glycemic trends and safely adjust insulin.
  • Starting Lantus insulin at 1 IU every 24 hours subcutaneously.
I am managing so many concurrent illnesses that I feel completely overwhelmed and lost regarding this new diabetes diagnosis. I hoped the recent prednisolone reduction would help, but his numbers are still poor.

Diet & Lab Values:

Diet: He eats a mix of wet and dry CKD food (Royal Canin Renal Special and Hill's k/d Chicken Stew), which I know is unfortunately high in carbohydrates.

Urine: Glucose is present at 100 mg/dL.

Fructosamine History:
May 22: 592 mmol/L
June 24: 424 mmol/L
July 8: 391 mmol/L (drops followed the reduction to 2.5mg prednisolone)
July 31: 512 mmol/L (after prednisolone was temporarily increased back to 3.75mg)
Sept 16: 486 mmol/L (decrease followed reduction to 2.5mg prednisolone)

I would be incredibly grateful for any advice on managing the FreeStyle Libre, Lantus insulin, balancing his renal diet with his diabetic needs, and any other recommendations you may give me.

Please let me know if you need any more details. Thank you so much in advance.

Helena
 
Welcome to FDMB Helena
We are glad you found us, we are here to help you with all your concerns and dosing advice, Lantus is a an excellent insulin, you are starting with a low dose of 1.0 unit, however, Lantus is a 12-hour insulin which means Nalu needs 2 doses a day, (every 12 hours) this is also one of the reasons he still has such high glucose levels. A diabetic cat needs to have a diet of wet can or raw food between 0-10% carbs, he should be on a schedule, feeding 3-4 small meals or snack during the day plus the two main meals before shot, the protocol is test-feed-shoot, and Nalu should not have any food 2 hours prior shooting, if you are feeding kibbles and grazing, this is also a reason for high BG's, the transition from high carbs to low carbs need to be a slow process not to upset Nalu's stomach this transition also requires to test often during the process. Most members use Fancy Feast Pates between 0-10% carbs most feed up to 5%.
Using the CGM is a good option, however, is good to also have a handy a human monitor since the Libre tends to read low numbers lower, the sensor can malfunction of fall of, most members use the ReliOn Premier human monitor and strips (Walmart) or any other human monitor, you do not need a pet meter, too expensive, below is a link on CGM. also you can change the sensors yourself, you do not need the vet for this, and you save your money and Nalu's stress, cats are very sensitive to stress, and vet visits will only increase the BGs which could result an unnecessary increase in dose.
We are very numbers oriented, so to all members be on the same page, we would like you to create your signature and Nalu's spreadsheet, links below, if you need assistance creating the spreadsheet, we can create it for you. keep posting no concern is a small concern, I will tag a member that can give you answer to the medication and illnesses Nalu is experiencing, also a link of Drs approved food list below, the third column contains the carb %s ;)

Sticky - New? How You Can Help Us Help You!
https://felinediabetes.com/FDMB/forums/spreadsheets-tech-support-testing-area.6/
Links to FOOD CHARTS


Getting Started With Continuous Glucose Monitors (CGMs) for Diabetic Cats
@Wendy&Neko
dosing advice, giving Lantus once a day
 
Last edited:
Thank you so much for the detailed information. I am going to review everything you sent, create the spreadsheet, and set up the signature. Could you please just confirm if the link for the food charts is correct?

In the meantime, I have a couple of urgent questions:

CGM vs. Manual Testing: Nalu has been very stressed at the vet lately. I am hesitant about attaching a device to his back, especially since he receives daily subcutaneous fluids. In your experience, which method do cats tolerate better? He is already on around 14 medications and supplements, and I want to minimize his stress - though he is very easy to medicate. In case we decide to do it manually, how often should it be done?

Diet and CKD Management: How can I balance his diet with his ckd? Most non-renal foods are high in phosphorus, and I am already struggling to control Nalu's phosphorus levels even with the lanthanum carbonate.

Thank you in advance for your help,
Helena
 
HelenaM said:
Thank you so much for the detailed information. I am going to review everything you sent, create the spreadsheet, and set up the signature. Could you please just confirm if the link for the food charts is correct?

In the meantime, I have a couple of urgent questions:

CGM vs. Manual Testing: Nalu has been very stressed at the vet lately. I am hesitant about attaching a device to his back, especially since he receives daily subcutaneous fluids. In your experience, which method do cats tolerate better? He is already on around 14 medications and supplements, and I want to minimize his stress - though he is very easy to medicate. In case we decide to do it manually, how often should it be done?

Diet and CKD Management: How can I balance his diet with his ckd? Most non-renal foods are high in phosphorus, and I am already struggling to control Nalu's phosphorus levels even with the lanthanum carbonate.

Thank you in advance for your help,
Helena
Click to expand...
Hi Helena! Welcome!

I think the vast majority of kitties here tolerate manual testing very well and given how expensive the Libre is, manual testing is typically where most people start. And then they explore Libres if their cat is very difficult to test, or manual testing just doesn’t work for whatever reason.

If it makes you feel better, Moonie comes to the testing room on her own because she knows that’s where the treats are and I’ve never ever seen her flinch or change her face when I do her ear pokes.

Blood glucose should be tested before giving the insulin shot to make sure it’s safe to shoot. In the beginning I think people are encouraged to post for advice if you see 150 or lower. I always test around 2 hours after the shot to make sure the insulin isn’t taking Moonie too low. You may want to test more often in the beginning to collect data while you’re trying to understand how your cat processes insulin as every cat is so different! You will probably want to do a spot check every now and again whenever your cat’s nadir is because the dosing is based on how low the insulin takes your cat. Most kitties nadir around +6 on Lantus but it can be different for different cats.

In general though, if Moonie gives me a blood glucose number that is flat (within 20 percent of the preshot number) or higher at +2, I know it’s not an active cycle and I can stop testing. If it’s an active cycle, you may want to do additional tests depending on how fast the drop was and what the number is. You can always post here if you have questions and people will try to help!

On balancing CKD and LC - this is a food list that shows both phosphorus and carb values. I personally feed the Lamb Burgini which Wendy recommended that we try - it’s good on phosphorus and low carb at 7.5% (higher carb than other options but still below 10%)

https://www.bizave.com/foodlists/CKD Diabetes Food List.pdf
 
Last edited:
HelenaM said:
Thank you so much for the detailed information. I am going to review everything you sent, create the spreadsheet, and set up the signature. Could you please just confirm if the link for the food charts is correct?

In the meantime, I have a couple of urgent questions:

CGM vs. Manual Testing: Nalu has been very stressed at the vet lately. I am hesitant about attaching a device to his back, especially since he receives daily subcutaneous fluids. In your experience, which method do cats tolerate better? He is already on around 14 medications and supplements, and I want to minimize his stress - though he is very easy to medicate. In case we decide to do it manually, how often should it be done?

Diet and CKD Management: How can I balance his diet with his ckd? Most non-renal foods are high in phosphorus, and I am already struggling to control Nalu's phosphorus levels even with the lanthanum carbonate.

Thank you in advance for your help,
Helena
Click to expand...
you should test before each shot and at lest 2-3 times during the day, I re-send the food chart link, cats are very sensitive to stress, and vet visits are the main source, so if your vet suggest a curve, this you should do it at home, a curve is simply testing every 2 hours for 1 cycle (12 hours), and CGM comes in handy for this, however remember that the sensors read lower than reality, if that were to happen you need to manually check for safety, giving a treat is a good idea to associate testing with a treat, make sure is a low carb treat and after testing
 
Thank you so much for all the information. I have scheduled a vet appointment for next week to place the CGM (though I am still deciding if this is the best option for Nalu) and get full instructions on how to administer the insulin. I haven't started it yet since I just received the prescription and this was the earliest appointment the vet had available.

I also reviewed the food list, but I don't think most of those options are available here in Portugal. Do you happen to know of any EU-available pet foods that meet the low phosphorus and low carbohydrate requirements?

Regarding the Lantus, my vet mentioned: "Put Nalu's daily food out for him, as you do not need to make sure he eats right before his injection because this is a basal insulin." Is this correct?

Many thanks again,
Helena
 
HelenaM said:
Thank you so much for all the information. I have scheduled a vet appointment for next week to place the CGM (though I am still deciding if this is the best option for Nalu) and get full instructions on how to administer the insulin. I haven't started it yet since I just received the prescription and this was the earliest appointment the vet had available.

I also reviewed the food list, but I don't think most of those options are available here in Portugal. Do you happen to know of any EU-available pet foods that meet the low phosphorus and low carbohydrate requirements?

Regarding the Lantus, my vet mentioned: "Put Nalu's daily food out for him, as you do not need to make sure he eats right before his injection because this is a basal insulin." Is this correct?

Many thanks again,
Helena
Click to expand...
This is a UK specific list that I’ve seen shared here. I don’t know if this would be more helpful
Food Info for UK

You definitely will want to make sure that he eats before you give him insulin. While Lantus is a depot insulin, your cat’s BG may go too low if they don’t eat (or eat very little) and you shoot the normal dose that’s calibrated for when he eats.

If your cat is a reliably good eater you can definitely shoot while he’s eating but I’d make sure that he eats if he’s not.
 
Hi everyone, thank you so much for all your help.

Nalu took a turn for the worse yesterday, so I rushed him to the vet. They’ve already placed the CGM, but the vet advised waiting 2 days to assess his glucose levels before starting insulin. His average reading is 215 mg/dl - would that equate to around 245 mg/dl in a cat? He is still on renal food and experiences spikes after eating Royal Canin dry kibble, but sometimes also while sleeping.

Finding a food that is low in phosphorus, carbs, and fat (for his triglycerides) with moderate protein is proving incredibly difficult here in Portugal. Even the low carb formulas have phosphorus levels that are too high for Nalu's Stage 3 CKD. It's definitely a tough balancing act.

Would it be okay if I shared a table I put together to get your input? Since I likely won't find a single food that ticks every box, I'm thinking of rotating between two or three options throughout the day - perhaps keeping the renal food as the base, and giving him diabetes food twice a day alongside a phosphorus binder and Porus One.
Which takes precedence in terms of diet: diabetes or CKD? My reasoning is that insulin can help control the diabetes, whereas low phosphorus is central for his kidneys. Nalu's renal markers worsened significantly in just 6 weeks (creatinine jumped from 2.5 to 3.3 and phosphorus from 4.20 to 5.21) after I introduced a little bit of Gourmet wet food because he was getting tired of his prescription renal food (though I also suspect he might have an infection and am currently waiting for his urinalysis results)...
 
The prescribed food you are feeding is very high in carbs, this is one of the reasons for Nalu's high glucose levels after feeding, the higher Nalu keeps his BG levels high the chances of more pancreas damage as well, a non-diabetic cats' glucose number is 50-120, this is where we want Nalu to be with time. I am tagging the member Tim suggested to see if he can find you a member in Portugal that can give you some input on low carb foods in your area
please read the link on CKD as well in the meantime, also remember that CGM will read low number lower than reality, so if you get a two-digit number please re test manually and take the manual reading as value

@Gill & George
Tim suggested that perhaps you might know of a member in Portugal that can help Nalu's mom find low carb foods

2026 iCatCare consensus guidelines on the diagnosis and management of chronic kidney disease in cats
 
Last edited:
Thank you so much, everyone.

I’ve put together a food table based on what is available here in Portugal, while also taking into account some of the foods in the UK list that was shared (thank you so very much for that). Hopefully, my calculations are correct. I've attached the table and would love to get your feedback or comments on these options.

I'm still feeling unsure about the right approach. While I understand the need for a low-carb diet, I am also concerned about his ckd. It feels like a catch-22: carbohydrates stress the pancreas, but phosphorus damages the kidneys. As a tentative plan, I was thinking about keeping him on a renal wet food but introducing diabetic food for two of his meals. Nalu only has one functioning kidney, and at 3.7 cm, it’s already on the smaller side. If I prioritize the diabetes, I will need to give him a phosphorus binder with his diabetic food. However, he is already taking so many medications throughout the day. Because the phosphorus binder needs to be spaced at least 2 hours apart from his other medications, managing this schedule would be virtually impossible.

The CKD Guidelines shared do say: "To manage a cat with diabetes mellitus, a low carbohydrate diet may be introduced. Making specific nutritional recommendations for a cat with CKD and diabetes is a balancing act between feeding a reduced phosphate diet and trying to avoid an excessively high carbohydrate load. Some canned veterinary therapeutic renal diets are sufficiently low in carbohydrates (<5 g/100 kcal) to be fed to a cat with these comorbid conditions. If it is not feasible to feed a canned diet exclusively, the priority should be feeding a higher carbohydrate, lower phosphate diet (vs feeding a lower carbohydrate, higher phosphate diet), and diabetic remission may still be achieved." So, it sounds like I should focus on a low-carb renal diet instead of a standard diabetes diet. The goal would be to keep carbs as low as possible, even if it isn't quite as low-carb as a strict diabetic plan. Is my understanding correct?

I’ve been managing Nalu's CKD for more than three years now and have been in Tanya's support group for about two years (they actually recommended this forum to me). This new diabetes diagnosis is what I'm really struggling with when it comes to his diet - and honestly, everything else too. It feels like a much more complex daily management routine, but maybe that's just because it's so new to me...
 

Attachments

Hi, I’m very sorry for the delay in replying; my life is currently very busy. I can help you with any questions regarding diabetic-friendly products available in your city. From what I’ve seen, your cat is dealing with other health issues as well; you can check the ingredients on the cans to see the potassium content and choose the ones lowest in both carbohydrates and potassium. Generally speaking, veterinary diets are a bit like junk food for our pets, but everyone is free to decide what to feed their cat. Let me know if you need any further help with nutrition—best regards.
 
Thank you all. Nalu's condition has unfortunately worsened, probably due to an AKI on CKD crash, and we are now contemplating our next steps. Since he won't eat by himself, I'm syringe-feeding him. Thank you so much for all your support, even though our time here was short.
 
You must log in or register to reply here.
Back
Top