New member, need help w/ Shen's treatment plan for steroid-induced diabetes

[Nimi S]

Hi all,
Long post alert!
I’m Nimisha, from Mumbai, India.
My cat Shen (nearly 12 years old, male, neutered, 6.5kg (14.33 lbs) has recently been diagnosed with diabetes. I haven’t been feeling very confident about the vets I’m consulting and would appreciate any guidance on our current situation. Over the last one month, I've been reading up and researching a lot but honestly there's so much information to absorb and unfortunately a lot of key information pertains to resources that I feel I might find difficult to find here in India. Any advice on the kind of handholding I should be seeking from our vet would be appreciated. Would also love if I could be introduced to any FDMB members residing in Mumbai/India who could possibly direct me to local resources/relevant material.

TLDR: Shen got steroid-induced diabetes from prednisolone (38 days usage over 24Jan to 12Mar2023, dosage between 1.25-5mg) for an allergic response that he’s been suffering from for over 1 year. I’d tried antibiotics, antifungal, antibacterial treatment over the last 1 year from 3 different vets. The 4th vet suggested prednisolone which was actually working great but also led to his diabetes. I guess Shen was already predisposed/pre-diabetic.
While his diabetes diagnosis was confirmed on 9th Mar, his insulin treatment started only from 6th Apr thanks to differing advice (to wait for his blood sugar to drop on its own post stopping steroid) from another vet. Currently he is getting 1.5 units of Biocon Insugen 30/70 40IU , dual-acting insulin only once daily. I now have doubts about the dosage, frequency and type of insulin, as well as his food options and feeding schedule.

BACKGROUND: (You may skip this part. I'm simply expanding on the above for anyone who may think this could be relevant)
Shen has been rubbing his eyes, leading to redness and inflammation for over a year now. Over the last 12 or so months, I tried 3 different vets and a combination of anti fungal/ anti bacterial/ antibiotic medicines which did not work. On 24 Jan 2023 I tried a new vet (an online consultation for which I had a free coupon, so thought might as well use it) who put him on Prednisolone tablets (Wysolone 5mg) and Gatifloxacin eye drops (Gatilox 3mg). The medicines worked amazingly well but i noticed that Shen lost some weight (around 1.6lbs) by the 3rd week of treatment. When I brought this up and asked if it was linked to the medication, the vet told me to monitor his weight but that it was unrelated, as steroids usually cause weight gain, not loss. Over the course of these 1.5 months, Shen was on Prednisolone at varying lower doses and frequencies, as the vet said that we needed to figure out and administer the smallest amount of the steroid needed to keep Shen comfortable. Around the 4th week of his treatment, I noticed that he was drinking a lot more water and peeing more too. At his next follow-up a week later, the vet said that these were typical signs of diabetes and to get a blood test to confirm it (while still insisting it wasn’t due to the steroid :’( )
His blood sugar (after nearly 14 hrs of fasting, from a lipemic sample) was 334mg/dl (09Mar).
The vet admitted it was steroid-induced and changed his eye medication (to non-steroid eye drops) and advised to give 0.04ml (~1.5 units) of insulin once a day for 2 days and to do a blood sugar test on the third day to make appropriate adjustments. ( The insulin advised to be used was Biocon Insugen 30/70 40IU , dual-acting insulin. Onset of action is within ½ hour, reaches a maximum peak effect within 2 to 8 hours and the entire duration of action is up to 24 hours.)

However the local vet I was taking him to for the blood tests, suggested to wait for a week to check how low the blood sugar would drop after stopping steroids. Post 7 days it went to 297mg/dl (20th Mar) and then the vet suggested to wait for another 10 days. Between this wait period, I got Covid and could take Shen for a test only after 15 days, when the blood sugar had increased a bit to 301mg/dl (5th Apr), at which point the vet suggested to start administering the insulin. During this time, Shen had been on his eyedrops and while his eyes aren't as good as they had been with the steroids, they were still doing ok.
END OF BACKGROUND

We started insulin from the next day - Thu 6Apr.
The vet I take him to locally does not seem to have too much experience with feline diabetes as she gave me no advice about the changes I need to make to his diet, his feeding times, emergency signs, frequency of glucose readings, related complications/conditions etc. Whatever little I’ve learnt is by browsing the Internet.

Current Feeding, Injection and Glucose readings schedule:
- Pre insulin, he was on 90% dry food. He mostly sleeps during the day and eats during the evening and night. He used to get small meals anywhere between 7-10 times during the day. Ever since starting the insulin, I'm trying to change it to 50% wet, 50% dry around 3-4 times a day.
- Currently he is getting 1.5 units of insulin only once daily. I was supposed to take a BS lab test on the 3rd day and the vet would have suggested revisions based off of that. But I waited a few more days since I didn't have any readings for Day 1.
- His first injection was administered by the vet as I first needed to see how to do it. As the vet is open only between 11am-1pm and 6-8pm, Shen's first injection was at 12pm and that is the timing I’m stuck with as of now.
- the 40IU syringe I'm using doesn't have 1/2 unit markings, so I've been eyeballing the 0.5 unit and managing.
- I’ve purchased a human glucometer (AccuChek Instant) and have been taking 4-5 readings per day.
- The glucometer sends the readings to an app on my phone. I’ve plugged these values into the FDMB spreadsheet too.
- I’m doing more frequent readings since we’ve only just begun and I keep worrying about hypoglycaemia. The lowest reading I’ve seen so far was 160mg/dl on the 2nd day at +5 . I panicked and ended up giving him some food. He was also drooling for the first time ever (except for one time when I'd tried mixing a tablet in his food and then too it had been foamy not sticky)
- I’ve also purchased keto-diastix and used it on the 4th day (09 Apr). The ketone strip was negative and the glucose strip was at the 500mg/dl color.

Now coming to my main worries:
1. Ever since I’ve started injecting insulin, Shen has been drooling. It isn’t a lot but it’s constant, especially while sleeping (which to be honest is nearly all day now).
2. For the first 3 days, he was very lethargic and dull. He perked up on the 4th day but I think I might have not given the shot properly and also he majorly ate only dry kibble.
3. He usually sleeps during the day and eats mainly at night. When awake he begs for food every few hours, and especially at night he goes on the kitchen platform and starts pushing things off of it for attention and food. He’s stopped doing that now.
4. He is eating all the food that he’s given but again he doesn’t go to the kitchen to beg for it.
5. I feel that the area around his rib cage (approximate liver area) is kind of raised and hard. I don’t know if I’m imagining it since I hadn’t really tried feeling it before. But it feels different compared to my other cats' bodies. I’m considering getting a liver/kidney blood test in a day or two and also ask the vet if she thinks something's wrong.
6. On the 3rd day, while pulling in the insulin into the syringe, there were some air bubbles, which I noticed after pulling out the needle from the vial. I pushed the insulin back into the vial and then pulled out another dose and administered it. I later read that in such instances the dose must be discarded. Since I didn't know if I had contaminated the remaining insulin in the vial by doing so, I bought a new vial of insulin. I'd still like to check if the older vial is usable (would keep it around in case of an emergency).

Would appreciate your advice on this so that I may be able to correlate it to whatever I hear from the vet. I’m honestly not very hopeful of getting well-informed advice from the vets I’m consulting but I do want as much information as I can get.

1. Should his insulin dose be changed to twice daily, 12 hours apart, instead of only once daily?
2. Should the insulin dose be increased/changed from 1.5 units?
3. Should the type of insulin be changed or is it too soon to tell (currently on Biocon Insugen - 30/70 40IU injection contains Biphasic Isophane Insulin)
4. Is the stomach area/liver enlarged/ abnormal? Is this linked to diabetes?
5. Could he have any dental issues- what is the reason for drooling. I've tried looking into his mouth but couldn't really see any obvious signs of damage, although his upper canines have been a bit chipped for a while now
6. Does he need a urinalysis?
7. Should/can I gradually shift the shot time by 15-30 mins every day to eventually start between 7-8am daily?
8. Suggestions for wet/dry food ratio, low carb brands and feeding schedule (I’m leaning towards something like this - assume x = 12pm
x-30 mins -- meal 1
x -- injection 1
x+5.5hrs -- snack 1
x+11.5hrs -- meal 2
x+12hrs -- injection 2
x+18.5hrs -- snack 2
I know the shot and feeding schedule varies from cat to cat and parent to parent but just wanted to know if it'll work towards somewhat preventing hypoglycemia.
10. Shen has been on Farmina Vet Life Obesity dry food for the last 6 years (he was nearly 21lbs at his peak in 2017 and was 18.07lbs in Jan 2023, right now he’s 14.33lbs)
I’m trying to figure out a good low carb wet/canned food brand and leaning towards Purina fancy feast based on whatever I’ve read online. But while it gets delivered, I’ve been giving him Whiskas chicken gravy along with the dry food. I know Whiskas is one of the worst brands but I didn’t want to give only dry food and this was being delivered the quickest. I think his BS started increasing more on day 3 and 4 due to this.

I know these are a lot of worries/questions for the first post, so I'm not expecting answers to everything. I'm also sort of using this to document my observations and experience.
I'll be going through the other threads on the forum to pick up advice / relevant information on the food and symptoms. Any links would be appreciated too!

Anything else I should be looking out for? Anything I should NOT be doing at all?

Sorry for the long post. I know I might have repeated some stuff.

Thank You!

 

[Wendy&Neko]

Hello and welcome here. Good for you on home testing already and your questions sound like you've been doing a lot of research. Tagging @Bandit's Mom who lives in your part of the world.

Regarding insulin, Lantus would be a much better insulin for him. It's given twice a day to cats, once a day to humans. Cats have faster metabolisms. Isugen is not a recommended insulin for cats.

Food, the obesity dry food won't help his weight. Do you think he'd eat a low carb wet food? Do you think his allergies might be related to the type of protein he is eating? We've had people switch to different proteins (such as lamb, rabbit, etc) to help skin allergies.

 

[Diane Tyler's Mom GA]

Hi all,
Long post alert!
I’m Nimisha, from Mumbai, India.

@Bandit's Mom

 

[Bandit's Mom]

Hi Nimisha, this is Bhooma and I'm from Mumbai too. Reading your post takes me back to Oct 2019 when my cat Bandit was diagnosed with diabetes! My vet too suggested I use Mixtard 30-70. I did a lot of research online (just like you did) and figured out that it wasn't a great insulin for cats. My research too brought me to FDMB!

I will try and provide as much info as I can. If I miss out anything, please let me know.

FOOD:
Food Options:
Cat food is a big challenge in India. I too switched Bandit to Farmina Vetlife Obesity when she was diagnosed with diabetes, but it's 27% carbs. And it has a ton of fibre to make cats feel full after eating less. When Bandit was diagnosed she was hungry and thirsty all the time. She would eat a ton of the Vetlife Obesity and **** twice a day! There are no low carb options in dry food in India. The lowest carb dry food I could find is Farmina N&D Prime Chicken & Pomegranate which is 16% carbs. Still too high. Unfortunately Bandit will not eat wet food, so she is on this food.

There are very few low carb options in wet food and the good ones are super-expensive. The most affordable ones are Whiskas in Jelly (which is not the best quality food, I think) and Meo (which seems to be even worse in quality). Felix which seems to be a mid-range brand is probably better quality than Whiskas or Meo. There are other brands which have low carb options in wet food like Sheba, Little Big Paw, Farmina N&D which are quite expensive. I've also seen adverts online for raw food like BARF, Kennel Kitchen, Bruno's Wild Essentials, Clumsy Bumsy, etc. Some of these are good, but super expensive.

The Fancy Feast variants available in India are not the low carb ones, so don't bother with them.

If Shen will eat wet or raw food you want to switch him completely to a low carb diet and see. Considering his diabetes is steroid induced, a low carb diet and insulin support for some time might actually be enough for him to go into remission. We have seen this in some cats who have had steroid induced diabetes, but I don't want to get your hopes up. Paws crossed and hope for the best!

When and how much to feed:
Unregulated diabetic cats cannot process their food which is why they are always starving and lose weight despite eating so much. Once their blood sugar is brought under control that ravenous hunger reduces and they slowly start to regain weight. For now feed him as much as you want as long as his weight is not an issue. You want to feed a decent sized meal with the insulin shot and small meals through the day and night. That will keep them happy and is also easy on the pancreas. Ideally you want to feed more food in the first part of the cycle (a cycle is the 12 hours following the insulin shot) when the insulin action is strongest and can counteract the food. Later in the cycle, you feed less or avoid feeding, if possible. Feeding late in the cycle can reduce insulin duration and cause numbers to go up.


INSULIN:
Insulin Type:
Like Wendy said, Lantus is a much better insulin for cats. You get a few brand options in Insulin Glargine. Lantus is the most expensive but you have cheaper options manufactured by Biocon, Cipla and Wockhardt. Glargine is a u100 insulin and you would use u100 syringes with them. The good thing about India is that pharmacies don't insist on prescriptions for most medicines including insulin so I just went and bought a Lantus pen and started Bandit on 1U twice a day. The challenge was that with pens you can dose only in full units and the only U100 insulin syringes you get in India are 100 unit syringes with 2 unit markings. So it was not possible for me to dose in fractional units. I was/am crazy enough to ask friends and family living in the US to bring me insulin syringes with half unit marks and that's what I still use! Sometimes I've even paid for shipping from the US!

Dosing:
A cat's metabolism is much faster than humans, so giving insulin once a day is not enough. You want to give insulin twice a day 12 hours apart. I don't think you will get 24 hour duration even with the 30-70 dual acting insulin. You could try giving a lower dose twice a day and see how that works out. If you can completely stop dry and feed only wet, that would make a big difference to his insulin requirements. If this is possible, we can discuss how to proceed on the dosing front.

On the 3rd day, while pulling in the insulin into the syringe, there were some air bubbles, which I noticed after pulling out the needle from the vial. I pushed the insulin back into the vial and then pulled out another dose and administered it. I later read that in such instances the dose must be discarded. Since I didn't know if I had contaminated the remaining insulin in the vial by doing so, I bought a new vial of insulin. I'd still like to check if the older vial is usable (would keep it around in case of an emergency).

We suggest not pushing excess insulin back into the pen/vial because the lubricant in the syringes could cause the insulin to degrade/lose potency. However, some people have been doing this before they realized not to and the insulin has not gone bad. What you do is draw out a little more insulin that you need - say half a unit - point the syringe with the needle facing up, flick the barrel of the syringe so that the air bubbles collect to the base of the needle and try and squeeze them out. You would expel the excess insulin in the air. Sometimes getting the air bubbles out can be quite a pain - even after a lot of practice!


Testing:
Btw, I too started with using the Accuchek Instant S glucometer but I switched to Alere (made by Abbott) because the strips were much cheaper. The only issue is that at lower numbers (below 70) it reads much lower, so I need to verify the number with an Accuchek. This is a good site to buy strips for cheap. I've begun to use it quite regularly:
https://www.healthklin.com/Diabetes-Care/GULCOMETER-SUGAR-TEST-STRIPS-KIT
and this one:
https://microsidd.com/product-category/diabetes-care/

The normal range for blood sugar with a cat is 50-100 mg/dl on a human meter. It is below 50 that you need to worry about low numbers/hypoglycemia. The longer Shen spends in normal numbers, the more his pancreas get a chance to heal. He dropped to 160 on the 7th which was a number that his body was not used to so it responded by what we call "bouncing". Bouncing is defined as:

"Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast. The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". Usually, a bounce will clear kitty's system within 3 days (6 cycles)."

So the higher numbers you saw on 8th and 9th could have been him bouncing from that lower number of 160 on the 7th. It will be interesting to see if he clears the bounce today.


I'm not sure what could be causing the drooling. I don't have experience with it so I will tag @Bron and Sheba (GA) and @Wendy&Neko. You might want to get his teeth checked. Did the vet get full bloodwork done at the time of his diabetes diagnosis?

I'm sure I've missed out some info/questions, so please feel free to ask any more questions you have! I have been where you are now, so I know how lost and overwhelmed you are feeling - especially with conflicting info from the vets.

 

[Bron and Sheba (GA)]

Unless it is the teeth I can't think of anything else that would be causing the drooling either.
No new medications?
Only other thing I can think of is, maybe the insulin is causing the blood glucose to drop too low. Maybe reducing the dose may help.

 

[Nimi S]

Hello and welcome here. Good for you on home testing already and your questions sound like you've been doing a lot of research. Tagging @Bandit's Mom who lives in your part of the world.

Regarding insulin, Lantus would be a much better insulin for him. It's given twice a day to cats, once a day to humans. Cats have faster metabolisms. Isugen is not a recommended insulin for cats.

Food, the obesity dry food won't help his weight. Do you think he'd eat a low carb wet food? Do you think his allergies might be related to the type of protein he is eating? We've had people switch to different proteins (such as lamb, rabbit, etc) to help skin allergies.

Hello!

Thanks for the insulin recommendation. I'll look into the options available here ASAP.

With respect to his weight, does he need to lose any more to help with the diabetes? I know he'd be ok to lose a few more pounds but it's just been sad to see him lose 3.3lbs over the last 2.5 months Should I try to bring him closer to 11-12lbs over the next few months? Am I crazy for wanting to fatten him up again?

He's generally ok with the wet food he's been introduced to (tried Whiskas, Royal Canin, Sheba so far). I'm optimistic that he'll accept the low carb variety too. My idea was to give the dry and wet food in a 25:75 ratio once I finalized on a good, locally available low-carb wet food brand - I'm going through @Bandit's Mom 's recommendations and will start the switch in a couple of days.

With respect to his allergies, I don't know what could have triggered them. It's been a year since it started and I can't remember what all changed at home (when it started, it felt like he was rubbing at a scratch caused by one of our other cats, so we let it heal normally for a few days - it just spread to the other eye too). He's been on the same dry food for 6 years now, so it doesn't feel like it's the food. The vet who put him on prednisolone had mentioned hypoallergenic diet food but at the same time said that it wasn't worth switching to unless we knew for sure that his current food was causing the allergy.

I don't know if it's worth mentioning that while he was off the steroid for the last 1 month, another vet suggested Advocate spot on for his ear mites. I don't know if I imagined it but his eyes seemed to be doing better, even without the other eyedrops. So I'm now wondering if it could be flea allergy dermatitis. But I didn't see the same response when he was given Selamectin spot on. So I'm confused

 

[Nimi S]

Unless it is the teeth I can't think of anything else that would be causing the drooling either.
No new medications?
Only other thing I can think of is, maybe the insulin is causing the blood glucose to drop too low. Maybe reducing the dose may help.

Hello!

As of now, the only medication he's getting is the insulin. I'll be updating his medication for his eye/allergy after updating the vet.

While his teeth aren't in the best shape exactly, the drooling started specifically after the first shot of insulin. There's a chance that his BS was lower on day 1 since I fed him the food after the shot and pre-shot he'd eaten 6 hours before. That may have caused the low sugar but unfortunately I couldn't get any readings that day. He did not drool at all on day 4 and ate enthusiastically. But today Day 5, he's back to drooling a a bit and ate very moodily pre-shot.

That said, I will get his teeth checked out because I too think it's a dental issue.

With respect to reducing the dose, he's currently receiving 1.5 units of Insugen 30/70 40IU once a day. Other members have suggested switching to a different insulin altogether, so I'm looking into that as well.

 

[Bron and Sheba (GA)]

I completely agree with swapping to a different insulin such as Lantus. I was only suggesting you reduce the dose in the meantime while you get organised to swap to a better insulin.
If you could get a spreadsheet up and running, we will be able to see what is happening with the blood glucose.
@Bandit's Mom has given you lots of great information.

 

[Larry and Kitties]

(currently on Biocon Insugen - 30/70 40IU injection contains Biphasic Isophane Insulin)

This insulin is 30% R and 70% N/NPH and is not suitable for a cat, especially only once daily. This insulin would result is a fast drop in BG but of short duration of maybe 8-10 hours. Even twice daily injection results in All N/NPH would be a little better but Lantus (or another brand glargine insulin) would be the best.

 

[Bandit's Mom]

I don't know if it's worth mentioning that while he was off the steroid for the last 1 month, another vet suggested Advocate spot on for his ear mites. I don't know if I imagined it but his eyes seemed to be doing better, even without the other eyedrops. So I'm now wondering if it could be flea allergy dermatitis. But I didn't see the same response when he was given Selamectin spot on. So I'm confused

A vet told me that cats can react differently to Advocate and Selamectin. When my other cat had mange, Advocate did not help at all. Selamectin cleared it up.

 

[Nimi S]

Hi Bhooma @Bandit's Mom

Thanks for sharing so many inputs in such detail. I've been starved for information from the vets, so this is very reassuring, especially knowing that you're from Mumbai too.

I'm not sure if I've used the quoting feature correctly. Apologies in advance.

FOOD

The Fancy Feast variants available in India are not the low carb ones, so don't bother with them.

Thanks for pointing this out, I was going to order as much of this as I could get my hands on. I wrongly assumed that brand variants in all countries would have similar %s of carbs, proteins etc.

There are other brands which have low carb options in wet food like Sheba, Little Big Paw, Farmina N&D which are quite expensive. I've also seen adverts online for raw food like BARF, Kennel Kitchen, Bruno's Wild Essentials, Clumsy Bumsy, etc.

I've been seeing all these brands as well but I haven't been able to figure out how to calculate the % of carbs. Most of the wet foods mention 80-90% moisture, and 5-10% of proteins and fat but nothing about carbs, so I'm very lost here. And if the variants available in India don't have the same %s as those in US/other countries, then the food charts available won't be of much use either.

For now feed him as much as you want as long as his weight is not an issue. You want to feed a decent sized meal with the insulin shot and small meals through the day and night.

This is good to know. I'd stopped feeding him at night completely after starting the insulin. I won't go overboard with the meals since I'm still giving him dry food mainly.

INSULIN

I just went and bought a Lantus pen

Something like this? https://pharmeasy.in/online-medicin...r-100iu-pre-filled-pen-of-3ml-cartridge-23976

I was/am crazy enough to ask friends and family living in the US to bring me insulin syringes with half unit marks and that's what I still use!

Would you please direct me to a reliable website for shopping for these syringes from the US. I can consider asking friends who're coming to India this month to get some for me. I looked up on Amazon.com - they do seem to have those options but some have mixed reviews.

Just to check, you use the pen and the syringes both for administering Lantus?

DOSING

If you can completely stop dry and feed only wet, that would make a big difference to his insulin requirements. If this is possible, we can discuss how to proceed on the dosing front.

I'm not completely confident of switching to wet instantly. I'm guessing I can figure this out over the next 15-20 days.

Would you recommend holding on to switching the insulin and the dosage till I'm able to fix his diet first? Or can i start a low (1U), twice a day Lantus dosing with the dry food while making the switch to the wet food? I will be introducing whatever decent low carb option (whether brand or homemade) that I'm able to get in the next few days.

TESTING

Btw, I too started with using the Accuchek Instant S glucometer but I switched to Alere (made by Abbott) because the strips were much cheaper.

Thanks for the recommendation and the websites. The AccuChek was sort of a panic buy and I only realised after buying it, how expensive the strips were - I already wasted 4 before I figured out what I was doing wrong.

I've been seeing the word Bouncing on the forum but I didn't really understand how that worked. His BS preshot today was 356 mg/dl and at +3 was 210 mg/dl.

DROOLING and RAISED STOMACH/LIVER AREA
I will get his teeth checked to see if its unrelated to the insulin.
I noticed that the area towards the end of rib cage was a bit raised and hard to touch (at least as compared to my other cats but I could be overthinking too). This was before i came across the term Hepatic Lipidosis, so now it makes me worry if its that. I will have this checked at the vet's too.

With respect to his lab tests, we'd gotten CBC, Liver, Kidney and Fasting Blood Sugar done at that time of his initial diagnosis. I've updated his labs in the sheet.
The next time, 10 days post stopping the steroid, we did his FBS and Liver, and the previously elevated liver values had already cleared up.

NEW QUERY - DEPENDENCY ON and RELIABILITY OF VETS
Since I'm new to this, I'm not completely confident yet of not involving vets in the modification to Shen's treatment. I haven't had the best experience with vet in recent times, but I'm still unsure of managing confidently on my own.
Also, the vets I have met seem to have a bit of an ego and aren't as helpful or forthcoming with information, when they realize that I'm seeking multiple opinions.
How would you suggest going about involving vets into this?


I'll be going through your response again as you've shared a lot of useful information. I have my work cut out for me.

 

[Nimi S]

I completely agree with swapping to a different insulin such as Lantus. I was only suggesting you reduce the dose in the meantime while you get organised to swap to a better insulin.
If you could get a spreadsheet up and running, we will be able to see what is happening with the blood glucose.
@Bandit's Mom has given you lots of great information.

His drooling has reduced considerably over day 4 and 5. I'll observe him today and if the drooling increases, I'll try reducing the dose.
Would reducing the dose by 0.5 unit work (from 1.5 to 1) ?

I've updated his BS and lab results in the sheet. Hope everyone is able to view it.

 

[Nimi S]

A vet told me that cats can react differently to Advocate and Selamectin. When my other cat had mange, Advocate did not help at all. Selamectin cleared it up.

I think that makes sense as they are made of different drugs, I guess.

Selamectin itself had different reactions on my cats - 2 of them lost a bit of their fur (grown back since) on the area of application, while Shen was fine.

 

[Bandit's Mom]

Thanks for sharing so many inputs in such detail. I've been starved for information from the vets, so this is very reassuring, especially knowing that you're from Mumbai too.

Happy to help! It's amazing how little vets know. Everything I know about FD, I've learned thanks to FDMB.

I'm not sure if I've used the quoting feature correctly. Apologies in advance.

You're doing great for a "newbie" to the forum!

Thanks for pointing this out, I was going to order as much of this as I could get my hands on. I wrongly assumed that brand variants in all countries would have similar %s of carbs, proteins etc.

The carb% should be more or less the same across countries. I though I saw only flavours with gravy in FF. You could email Purina India and ask them for the carb% of the FF variants on a "dry matter basis". Some of these cat food companies actually respond to emails on nutritional info. I have emailed Farmina in the past and gotten a response.

I've been seeing all these brands as well but I haven't been able to figure out how to calculate the % of carbs. Most of the wet foods mention 80-90% moisture, and 5-10% of proteins and fat but nothing about carbs, so I'm very lost here. And if the variants available in India don't have the same %s as those in US/other countries, then the food charts available won't be of much use either.

There are carb calculators available online, but they will give you only an approximate value. Cat food companies in the US (and India) only put out Guaranteed Analysis values which are only max/min ranges, so any calculation done using them is only an approximation. Here's a carb calculator:
http://scheyderweb.com/cats/catfood.html
Look at "Dry Matter Carbohydrates" at the very end.

Here's a very detailed page on how to calculate carbs in cat food!
https://catinfo.org/commercial-cat-foods/#Calculating__Percentage_of_Carbohydrates:

Here's an excel sheet I had prepared with carb% of cat foods available in India. Some of the data could be as old as 2019-2020:
https://docs.google.com/spreadsheet...ouid=114607564641258845756&rtpof=true&sd=true

Something like this? https://pharmeasy.in/online-medicin...r-100iu-pre-filled-pen-of-3ml-cartridge-23976

Yes, that is a Lantus Solostar pen. Online pharmacies like Pharmeasy, Netmeds, 1mg etc will ask you for a prescription. They might offer you a free doctor consult and a prescription - you'd have to say it is for you and not your cat! Otherwise, just walk into a brick and mortar chemist and buy one. They are not particular about prescriptions.

In India you get 3ml insulin pens as well as 3 ml insulin cartridges. You can use both in the same way as vials and draw insulin from them using syringes. If you get an insulin pen, you can get pen needles and inject using the pen. However, you can only give 1U at the least and multiples of 1U using pens. More info here on how to use syringes to draw insulin from pens and cartridges:
Insulin Care & Syringe Info: Proper Handling, Drawing, Fine Dosing

Here's a YouTube video on how to give a cat insulin using a pen. There are many other videos available as well.

Would you please direct me to a reliable website for shopping for these syringes from the US. I can consider asking friends who're coming to India this month to get some for me. I looked up on Amazon.com - they do seem to have those options but some have mixed reviews.

Your friends can just go to a Walmart and buy Walmart's ReliOn brand of insulin syringes. You want the 30 unit ones (0.3 ml). They come with half unit marks. They cost ~$13 for a box of 100. A box of 100 syringes weighs around 300 gms, so not a lot to carry. However, in the US, in the states of NY, NJ, NH, ME, CT and IL you need a prescription to buy syringes, so friends in those states cannot help. They aren't available on the Walmart website. You have to go to the store and buy them.

Another place to buy syringes online is www.adwdiabetes.com. They have multiple brands with half unit marks. Cheapest is Care Point Vet. They work out a little more expensive than Walmart since they charge shipping. They will again not ship to the states which require a prescription unless you provide one.
https://www.adwdiabetes.com/product/16367/carepoint-vet-u-100-pet-syringe-31g-half-unit
https://www.adwdiabetes.com/product/1316/surecomfort-u100-syringes-half-unit-31g-3-10cc-5-16in-100ct

Syringes with half unit markings are available in the UK as well, so if you have friends coming from there, they can get you syringes from there too. Will share brand details if you need them. I'm worried I might be throwing too much info at you!

Would you recommend holding on to switching the insulin and the dosage till I'm able to fix his diet first? Or can i start a low (1U), twice a day Lantus dosing with the dry food while making the switch to the wet food? I will be introducing whatever decent low carb option (whether brand or homemade) that I'm able to get in the next few days.

I'm going to loop @Bron and Sheba (GA) and @Wendy&Neko on this. You could try 1U of Lantus twice a day. The only issue is that if 1U is too much, you do not have the option of giving less. At least with the current insulin and u40 syringes, you can eyeball 0.5U. In my case, Bandit was stuck at 1U for around 20 days (even though she needed more insulin) because I was waiting for a friend to get me syringes from the US so I could increase to 1.25 and then 1.5 and so on.

NEW QUERY - DEPENDENCY ON and RELIABILITY OF VETS
Since I'm new to this, I'm not completely confident yet of not involving vets in the modification to Shen's treatment. I haven't had the best experience with vet in recent times, but I'm still unsure of managing confidently on my own.
Also, the vets I have met seem to have a bit of an ego and aren't as helpful or forthcoming with information, when they realize that I'm seeking multiple opinions.
How would you suggest going about involving vets into this?

I understand exactly what you are saying. I don't think I can help with that though - because I went rogue after I found FDMB and completely followed the dosing methods here to manage Bandit's diabetes. I haven't gone back to a vet again for that. Even when I take her to a vet for other reasons and they give me advice on how to manage her diabetes, I just take it in through one ear and throw it out from the other. It's appalling how little vets know about feline diabetes.

I'm going to take a look at Shen's labs. Please feel free to ask me any more questions you have.

 

[Bandit's Mom]

With respect to his lab tests, we'd gotten CBC, Liver, Kidney and Fasting Blood Sugar done at that time of his initial diagnosis. I've updated his labs in the sheet.
The next time, 10 days post stopping the steroid, we did his FBS and Liver, and the previously elevated liver values had already cleared up.

His labs look okay. I don't see anything major to worry about. His phosphorous is strangely high for a cat with otherwise very good kidney values. I would not worry about it now. You can get his bloodwork done again in 6 months. I see you have an issue with his sample being lipemic - is that even after fasting? Bandit's samples are also often lipemic - unless I fast her for a few hours before the blood draw.

Btw, could you please move the Template tab on your SS all the way to the right so that it's the last tab? Thanks!

On the dosing front, you could try giving 1U of the existing insulin twice a day for starters and see how he does on it. If you have been giving it at noon, from tomorrow you can give it at any time convenient to you since you are only giving it once a day till now. You want to give insulin a time such that you can get a +2 or +3 before you go to bed. Most people shoot between 5am/pm and 8 am/pm depending on their schedules. Once you pick a time, you want to give insulin as close to 12 hours apart as possible.

@Bron and Sheba (GA) what do you think about going down to 1U twice a day (from 1.5U once a day) with the existing insulin. I know that neither of us has any experience with dual-acting insulins....(?)

 

[Bron and Sheba (GA)]

what do you think about going down to 1U twice a day (from 1.5U once a day) with the existing insulin. I know that neither of us has any experience with dual-acting insulins....(?)

As it is an' in and out' insulin, the cycles should be independent of each other and not be influenced by a previous one.
I think it would be worth a try seeing how 1 unit twice daily goes, or even 0.75 Unit twice a day, as long as Nimisha can monitor the cycles and she doesn't give the dose, (or stalls), if the preshot is under 200 or maybe 220 for safely. If the BG drops below 90, the dose would need to be reduced.
I would not change the food over at the moment to low carb if you are going to change the insulin times to twice a day.
I would also make sure he gets a good snack at around +1.5 as well as his other snacks, and a good preshot meal an hour before the dose is given.

 

[Nimi S]

I see you have an issue with his sample being lipemic - is that even after fasting? Bandit's samples are also often lipemic - unless I fast her for a few hours before the blood draw.

Btw, could you please move the Template tab on your SS all the way to the right so that it's the last tab? Thanks!

His sample was lipemic even after 14 hours of fasting. The vet even told me to stop him from drinking water (!!), since 12 hours of fasting (tried on the previous day) had given a lipemic sample. That felt very cruel to do especially now that he gets thirsty so often.

I think it could have been steroid-induced lipemia in Shen's case. The first 2 samples for FBS were taken while he was on the steroid and a week post stopping the steroid.

His most recent FBS on 5th Apr (24 days post stopping steroid) did not mention that the sample was lipemic and he'd also fasted for around 12 hours.

I've moved the TEMPLATE tab to the right now!

 

[Bandit's Mom]

The vet even told me to stop him from drinking water (!!), since 12 hours of fasting (tried on the previous day) had given a lipemic sample. That felt very cruel to do especially now that he gets thirsty so often.

That is ridiculous and totally ignorant

 

[Nimi S]

I though I saw only flavours with gravy in FF. You could email Purina India and ask them for the carb% of the FF variants on a "dry matter basis". Some of these cat food companies actually respond to emails on nutritional info. I have emailed Farmina in the past and gotten a response.

Thanks for the tip! I've mailed Purina about this. They don't really have too many FF varieties in India (at least not in stock atm), so I've just asked them for information about the 2 variants I could find in online petstores right now:

• Purina Felix Chicken with Jelly Adult Cat Wet Food
• Purina Fancy Feast Tuna Affair with Whole Shrimp Cat Wet Food

I'll try doing this for the other brands as well and hope for some luck on their response.

Here's an excel sheet I had prepared with carb% of cat foods available in India. Some of the data could be as old as 2019-2020:
https://docs.google.com/spreadsheet...ouid=114607564641258845756&rtpof=true&sd=true

This is amazing.. I think I'm going to cry at the effort you've put into this.
Thanks for the links to the online carb calculators - I'll experiment with them in a bit.

I'm worried I might be throwing too much info at you!

I much prefer this actually. It really helps having the right kind of information in one place. And after reading stuff online for the last one week, I find this much more concise!
Otherwise I have some 100 tabs open on my web browser trying to read everything from everywhere.

Thanks for the recommendations on the Lantus pens and the 100IU syringes. I'll process this information once we figure out how soon to switch Shen from Insugen to Lantus.
If the overall feeling is that Lantus is more effective, then I'll start moving things around to get the stock in place sooner than later.

I went rogue after I found FDMB and completely followed the dosing methods here to manage Bandit's diabetes.

I think I'm inclined to follow the same route

 

[Bandit's Mom]

Purina Felix Chicken with Jelly Adult Cat Wet Food

This might be low carb. Usually wet food in jelly is low carb.

This is a site I use to order food, litter etc. They seem to have more varieties of FF, but not sure how many of them are low carb:
https://shakehands.co.in/cat/cat-food/cat-wet-food

 

[Nimi S]

As it is an' in and out' insulin, the cycles should be independent of each other and not be influenced by a previous one.
I think it would be worth a try seeing how 1 unit twice daily goes, or even 0.75 Unit twice a day, as long as Nimisha can monitor the cycles and she doesn't give the dose, (or stalls), if the preshot is under 200 or maybe 220 for safely. If the BG drops below 90, the dose would need to be reduced.
I would not change the food over at the moment to low carb if you are going to change the insulin times to twice a day.
I would also make sure he gets a good snack at around +1.5 as well as his other snacks, and a good preshot meal an hour before the dose is given.

OK. So I could do 2 things with the Insugen:
1. Since he's already got his 1.5U AM shot today, I could give him 0.75U (??) at +12 today, provided preshot is 220
or
2. Skip the PM shot today, give him 1U twice daily from tomorrow.
As @Bandit's Mom suggested, since I've been giving him the single shot at noon daily, would it be ok if I started the two-shot regime at 8am starting tomorrow, provided his preshot at 8am is 220?


Also, dumb question, but currently I measure his pre-shot, feed him and then give him the shot within the next 20-30 mins. If I give him the preshot meal an hour before the dose, should I still be checking the BS again just before the dose? Is it ok to assume that it's still going to be sufficiently high for the dose?

 

[Nimi S]

This might be low carb. Usually wet food in jelly is low carb.

This is a site I use to order food, litter etc. They seem to have more varieties of FF, but not sure how many of them are low carb:
https://shakehands.co.in/cat/cat-food/cat-wet-food

I've been using Shakehands for a while now too.
I'll check the Felix varieties and see if i can find more information on their %s.

I keep trying out other online pet stores, searching for discounts. Have managed to get scammed too!
So far Supertails, Heads Up For Tails, Petsy, Vetco, Caninecare, Marshall's Pet Store and Shakehands have been very reliable.

 

[Bron and Sheba (GA)]

No dumb questions here. So ask away.
No need to recheck the BG before giving the dose if you have already tested it and fed him. Most cats get a bit of a food bump after eating as well of about 20 points or so. I would feed and then wait an hour to give the shot each time, so you might want to have your schedule 7:7 so you can give the dose at 8 am.

I would skip the dose tonight and then restart tomorrow at the time you want to have the schedule.
As well as feeding the main meal 1 hour before the dose, I would give a snack at +1.5 each cycle to coincide without the drop in the blood glucose. I would also give a snack around. +3 and +5 each cycle,

 

[Nimi S]

No dumb questions here. So ask away.
No need to recheck the BG before giving the dose if you have already tested it and fed him. Most cats get a bit of a food bump after eating as well of about 20 points or so. I would feed and then wait an hour to give the shot each time, so you might want to have your schedule 7:7 so you can give the dose at 8 am.

I would skip the dose tonight and then restart tomorrow at the time you want to have the schedule.
As well as feeding the main meal 1 hour before the dose, I would give a snack at +1.5 each cycle to coincide without the drop in the blood glucose. I would also give a snack around. +3 and +5 each cycle,

Got it. Thanks!

Do I need to make any revisions to the SS, since I'll be moving ahead the dose schedule by 5 hours now and introducing a 2nd shot?

 

[Bron and Sheba (GA)]

I

Got it. Thanks!

Do I need to make any revisions to the SS, since I'll be moving ahead the dose schedule by 5 hours now and introducing a 2nd shot?

I would just note in the remarks column that you are going to swap to twice daily doses and you are skipping tonight and starting the schedule at the earlier time slot of…..

 

[Nimi S]

Hey Bhooma @Bandit's Mom

I’ve been asking a couple of friends staying in the US about bringing along the u-100 syringes when they come to India next (by mid-May latest).

They want to know whether they’ll be asked at Customs why they’re carrying empty syringes and whether they would require a doctor’s prescription to carry them.

Also what’s the most number of boxes (of 100) I should request for in one go, assuming weight isn’t an issue. I was thinking 500 syringes would last me comfortably for the next 6 months. (Am i undermining the failed attempts/defective pieces ?)
But I’m worried of any damage to the syringes during transit.
How has your experience been?

Also, while I'm able to, is there any other diabetic supply item I should try to get from the US?

I came across this on https://diabetes.org/tools-support/know-your-rights/what-can-i-bring-with-me-on-plane , while trying to get some information regarding this:

Do I need to have my prescription with me?
While TSA does not require you to have your prescription with you, having it may expedite the security screening process if you are subject to additional screening.

What are some examples of items that are permitted through security?

1. Insulin and insulin loaded dispensing products (vials or box of individual vials, jet injectors, biojectors, epipens, infusers and preloaded syringes)
2. Unlimited number of unused syringes when accompanied by insulin or other injectable medication
3. Lancets, blood glucose meters, blood glucose meter test strips, alcohol swabs, meter-testing solutions
4. Insulin pump and insulin pump supplies (cleaning agents, batteries, plastic tubing, infusion kit, catheter and needle)—insulin pumps and supplies must be accompanied by insulin
5. Glucagon emergency kit
6. Urine ketone test strips
7. Unlimited number of used syringes when transported in Sharps disposal container or other similar hard-surface container
8. Sharps disposal containers or similar hard-surface disposal container for storing used syringes and test strips
9. Liquids (to include water, juice or liquid nutrition) or gels
10. Continuous blood glucose monitors
11. All diabetes related medication, equipment, and supplies

Does point no.2 mean that I can't get my friend to bring the syringes without an accompanying vial of insulin?

The TSA also says the same thing (https://www.tsa.gov/travel/security...lowed when,to facilitate the security process.)

Unused Syringes
Carry On Bags: Yes (Special Instructions)
Checked Bags: Yes
Unused syringes are allowed when accompanied by injectable medication. You must declare these items to security officers at the checkpoint for inspection. We recommend, but do not require, that your medications be labeled to facilitate the security process.

 

[Bandit's Mom]

They want to know whether they’ll be asked at Customs why they’re carrying empty syringes and whether they would require a doctor’s prescription to carry them.

I've had several people carry back syringes for me and not one has been asked for a prescription. I even used one of those Buy and Ship companies in the US to ship the syringes to me (for a mini fortune!) and even they did not ask for a prescription.

Also what’s the most number of boxes (of 100) I should request for in one go, assuming weight isn’t an issue. I was thinking 500 syringes would last me comfortably for the next 6 months. (Am i undermining the failed attempts/defective pieces ?)
But I’m worried of any damage to the syringes during transit.
How has your experience been?

You need not worry about them getting damaged in transit at all. They come in individually wrapped packs of 10 syringes like they do in India. And 10 packets in a box of 100. 500 syringes will last you 250 days at 2X a day. If you keep having friends coming from the US, you could have them bring you 2 boxes at a time - in case they are worried about customs.

Also, while I'm able to, is there any other diabetic supply item I should try to get from the US?

No. There is nothing else. Insulin and meter/strips are available here.

Does point no.2 mean that I can't get my friend to bring the syringes without an accompanying vial of insulin?

Yes you can. The maximum I've had people carry is 3 boxes of 100 because weight was an issue and they've never declared them or had any issue with customs in India or TSA in the US.

 

[Nimi S]

I

I would just note in the remarks column that you are going to swap to twice daily doses and you are skipping tonight and starting the schedule at the earlier time slot of…..

I'm updating the SS but i think I'm confusing myself a bit by overthinking.

if AMPS is time of the main meal & pre-shot, then actual shot is at +1, starting today.
so when i give him snacks (or do meter readings) at +1.5, +3 and +5, does it mean AMPS +1.5 or actual shot +1.5 (which would actually be AMPS +2.5 in my case)

All of my earlier inputs to the SS have been done assuming AMPS was actual shot time (since i was feeding within 20-30 min of pre-shot and meal) and i was basing the other timings as actual shot time +x.

 

[Bron and Sheba (GA)]

The AMPS is the actual shot time. Just put the AMPS BG into the AMPS column as you normally do and then give the shot an hour later. Then the +1 is one hour after the shot (and the AMPS), the +3 is 3 hours after the shot (and the AMPS).
We know that with the insulin you are using, you need to wait an hour before the shot.....Does that all make sense?

 

[Nimi S]

Yes, i think i understand now. Was trying to over-complicate things.

Just wanted to share another update. I took him to the vet today to figure out why Shen has been drooling. The vet had a superficial look at his teeth and said that while he had slightly redder gums, his teeth and gums looked ok.
This is a vet, who is new to his current diagnosis, but had previously treated him for Gingivitis in 2019.
She asked to see his lab work (said it looks fine) and queried about his diabetes diagnosis.
While I didn't specifically ask for her inputs on the diabetes treatment, she admitted that his dosage might need to be increased but for some reason asked me to hold off on doing that for another week, then get a complete blood work again (except CBC) next week and then modify the dosage, while making no major changes to his diet (said i could try giving him raw minced chicken and hard boiled eggs for one meal, along with wet food and his current obesity dry). When I asked if I could start dosing twice a day from today, she said that'd be risky.
I feel scammed every time I leave a vet's clinic

I'm going ahead and will be giving the PM 1U shot, after checking his preshot.

I wanted to check if it's ok to start adding a little bit of wet food to his meals and snacks, while switching to the two-dose regime? If I could start introducing wet food at some point into this regime, then I'd like to keep some stock handy. As of now I haven't got any wet food as I don't want to keep switching between multiple brands and affect his BG in some way.
I know @Bron and Sheba (GA) said not to change the food over at the moment to low carb if I were to to change the insulin times to twice a day.

I'm was planning on getting the Royal Canin Instinctive Loaf for Adult Cats ( according to the http://scheyderweb.com/cats/catfood.html calculator, the dry matter carb % in this is 7) - I don't think I can afford this in the long run, but I can give this to him for a couple of weeks (whenever i do introduce wet food), while I figure out a mix of raw, homemade diet and canned food which I can keep him on, on a regular basis.

I don't know enough about how the diet and the dosing interact and work together, but I do feel that his BG was lower on days 1-3 since he had more wet food than dry as compared to days 4-6.

Still unsure if the drooling was due to the introduction of insulin but will wait for a few more cycles and observe how it goes.

His +7 today was 465 mg/dl

 

[Bron and Sheba (GA)]

I can’t see the point of repeating all his blood tests if they were Ok the other day…that is an unnecessary expense.
While you are changing over to twice a day dosing, I would not change the food. It’s better to do one thing at a time. Give it a week and then we can look at the food.
In the long run you will want to be feeding him a low carb wet diet with no dry food at all.
There is no doubt that on the days you feed some wet food, the BG will probably be lower and that is the ultimate goal, but until we can see what the twice a day insulin is going to do with his BGs, we don’t want to be adding in lower carb food. If we do, we won’t know if it is the insulin or the wet food that is lowering the BG.
I hope that all makes sense to you.

 

[Bandit's Mom]

Just wanted to share another update. I took him to the vet today to figure out why Shen has been drooling. The vet had a superficial look at his teeth and said that while he had slightly redder gums, his teeth and gums looked ok.
This is a vet, who is new to his current diagnosis, but had previously treated him for Gingivitis in 2019.
She asked to see his lab work (said it looks fine) and queried about his diabetes diagnosis.
While I didn't specifically ask for her inputs on the diabetes treatment, she admitted that his dosage might need to be increased but for some reason asked me to hold off on doing that for another week, then get a complete blood work again (except CBC) next week and then modify the dosage, while making no major changes to his diet (said i could try giving him raw minced chicken and hard boiled eggs for one meal, along with wet food and his current obesity dry). When I asked if I could start dosing twice a day from today, she said that'd be risky.
I feel scammed every time I leave a vet's clinic

I too feel scammed every time I go to a vet and it's so much torture for the cats as well! The last time I had taken Bandit to a vet (Crown Vet in Worli) they had prescribed Dologel to be applied on her gums twice a day for Gingivitis. Another vet had prescribed something else (maybe the same thing but a different brand. Let me look for it in old prescriptions). So this vet had nothing to offer for why he was drooling? I agree with Bron about not repeating the blood tests so soon. Why bother when the tests done just a month back were all good?

I'm was planning on getting the Royal Canin Instinctive Loaf for Adult Cats ( according to the http://scheyderweb.com/cats/catfood.html calculator, the dry matter carb % in this is 7) - I don't think I can afford this in the long run, but I can give this to him for a couple of weeks (whenever i do introduce wet food), while I figure out a mix of raw, homemade diet and canned food which I can keep him on, on a regular basis.

Not sure this is low carb. As per Dr. Lisa Pierson's food list, it is 13% carbs - if I am getting the variant correct.

Royal Canin Adult Instinctive - Loaf in Sauce 56 - 13% carbs
Royal Canin Instinctive 7+ - Loaf in Sauce - 22% carbs

Why not look at Whiskas and Felix for now? I think Felix must be cheaper than RC?

 

[Nimi S]

I can’t see the point of repeating all his blood tests if they were Ok the other day…that is an unnecessary expense.
While you are changing over to twice a day dosing, I would not change the food. It’s better to do one thing at a time. Give it a week and then we can look at the food.
In the long run you will want to be feeding him a low carb wet diet with no dry food at all.
There is no doubt that on the days you feed some wet food, the BG will probably be lower and that is the ultimate goal, but until we can see what the twice a day insulin is going to do with his BGs, we don’t want to be adding in lower carb food. If we do, we won’t know if it is the insulin or the wet food that is lowering the BG.
I hope that all makes sense to you.

It makes sense, I was getting impatient and greedy - especially because from the last 3 days his BG has started to look like he isn't on insulin at all.

@Bandit's Mom

So this vet had nothing to offer for why he was drooling? I agree with Bron about not repeating the blood tests so soon. Why bother when the tests done just a month back were all good?

Absolutely nothing to offer on the drooling. I think at this point I've opened and checked Shen's mouth wider and deeper than she did today.
She also suggested putting him on the feline diabetic prescription diet, which I already knew isn't available here and I think i read that it also has too many carbs in it to consider as an option.
I basically just went there to narrate Shen's diagnosis and the history behind it and came back with no new or useful input

Not sure this is low carb. As per Dr. Lisa Pierson's food list, it is 13% carbs - if I am getting the variant correct.

So, I was exploring the RC variants available in Mumbai/India and trying to find more details about their %s on the RC website.
This variant https://www.royalcanin.com/in/cats/products/retail-products/instinctive-loaf-wet is what i looked at and entered the guaranteed analysis %s in the carb calculator.
If i'm not wrong, it's the same as the one available on Shakehands https://shakehands.co.in/royal-canin-instinctive-loaf-mousse-pate-pouch-shc7903
I don't know why it doesn't appear as one of the options when we type Instinctive on the RC website, but it's listed under their retail products.

Why not look at Whiskas and Felix for now? I think Felix must be cheaper than RC?

You're right, both Whiskas and Felix cost less than half of what RC does. I think I just have a bias against Whiskas because of its generally bad reviews. I've heard it leads to kidney issues but I'm unsure if that is true for both its dry and wet varieties.
Let me not rush into this since I have some time before I need to introduce wet food into his diet. Although Felix sounds like a better option right now.

Thanks to you both for your reasonable inputs. I feel a bit grounded now

As an aside, I've managed to find a few friends coming from the US by April end who can get me the U-100 syringes with 1/2 unit markings (going with the Walmart ones).
Am I right in assuming that Shen would eventually have to move on to Lantus, as the general consensus is that it works better for cats compared to Insugen?
Just checking since I don't want to go overboard with the quantity of syringes I'm asking to bring, in the event that he ends up sticking to the u-40 insulin/syringes.
Types of insulin is one topic I haven't read about at all so far, so I don't know about the utility of these syringes in case he switches to any other type.

On a different note, I assume its ok to continue raising queries on this thread. I read that it's more appropriate to start another thread once the replies reach 50, to avoid over accumulation of information for new contributors to process through and respond to.
Do advise me whenever i would need to do so!

 

[Bandit's Mom]

So, I was exploring the RC variants available in Mumbai/India and trying to find more details about their %s on the RC website.
This variant https://www.royalcanin.com/in/cats/products/retail-products/instinctive-loaf-wet is what i looked at and entered the guaranteed analysis %s in the carb calculator.
If i'm not wrong, it's the same as the one available on Shakehands https://shakehands.co.in/royal-canin-instinctive-loaf-mousse-pate-pouch-shc7903

I would go to a pet store and look at the GA values on a pouch. The RC websites list 3 textures for Instinctive and of them is Loaf. The others are gravy and jelly. The GA values on their website work out to 7% carbs but the GA values on the Shakehands website (https://shakehands.co.in/royal-canin-instinctive-loaf-mousse-pate-pouch) works out to 22% carbs. Maybe the 3 variants have different carb%. Usually pates and foods in jelly are low carb. I would verify the crab% before dropping a pile of money on them

Let me not rush into this since I have some time before I need to introduce wet food into his diet. Although Felix sounds like a better option right now.

Why do you feel you don't need to rush into feeding wet food? Diet is an essential part of diabetes treatment - just like human diabetes. You don't need to change his diet tomorrow itself but it would be good to do it sooner rather than later. I would say, get Felix for now and start the diet change. You can always switch to a different brand of wet food as you figure out your options. BTW, Farmina Matisse mousses are also low carb. Cheaper than RC but more expensive than Felix. And Farmina is a good brand.

As an aside, I've managed to find a few friends coming from the US by April end who can get me the U-100 syringes with 1/2 unit markings (going with the Walmart ones).
Am I right in assuming that Shen would eventually have to move on to Lantus, as the general consensus is that it works better for cats compared to Insugen?
Just checking since I don't want to go overboard with the quantity of syringes I'm asking to bring, in the event that he ends up sticking to the u-40 insulin/syringes.
Types of insulin is one topic I haven't read about at all so far, so I don't know about the utility of these syringes in case he switches to any other type.

Yes, I would strongly recommend going with glargine. It a MUCH better insulin for cats - gentler and longer acting than Insugen. There is a ton of experience here with glargine that you can access 24 X 7. Not to mention established/published dosing protocols like TR.

On a different note, I assume its ok to continue raising queries on this thread. I read that it's more appropriate to start another thread once the replies reach 50, to avoid over accumulation of information for new contributors to process through and respond to.
Do advise me whenever i would need to do so!

Might be a good idea to start a new thread from tomorrow, actually

 

[Nimi S]

I would verify the crab% before dropping a pile of money on them

Why do you feel you don't need to rush into feeding wet food? Diet is an essential part of diabetes treatment - just like human diabetes. You don't need to change his diet tomorrow itself but it would be good to do it sooner rather than later. I would say, get Felix for now and start the diet change. You can always switch to a different brand of wet food as you figure out your options. BTW, Farmina Matisse mousses are also low carb. Cheaper than RC but more expensive than Felix. And Farmina is a good brand.

Actually I do want to rush into feeding him wet food.
What I meant when I said I have some time was that I don't need to start tomorrow, but maybe a week into the twice a day dosing routine.
I didn't want to rush into buying wet food in bulk because I've been all over the place (as you might be able to tell ) with my wet food selection, mainly coz I do want to start giving him the wet food.
As you suggested, I'll have some wet food option handy right now so that I can start switching him to it sooner and then figure out a long term wet food brand as I go
Will check out the Farmina Matisse reccomendation.

And will start a new thread tomorrow. Thanks!

 

[Bandit's Mom]

I didn't want to rush into buying wet food in bulk because I've been all over the place (as you might be able to tell ) with my wet food selection, mainly coz I do want to start giving him the wet food.

Don't buy anything in bulk yet. You don't know if he will eat it.

 

[Bandit's Mom]

Actually I do want to rush into feeding him wet food.
What I meant when I said I have some time was that I don't need to start tomorrow, but maybe a week into the twice a day dosing routine.

I forgot that @Bron and Sheba (GA) had suggested not changing food since you are going to be giving insulin twice a day. My bad.