New Member - Overwhelmed

[Brad and Lil Bit]

Lil Bit was just diagnosed with DM on Sunday. 12.5 yr old female DMSH. Feral who adopted me. Great health until the past year or so. Gastrointestinal issues. Very picky eater - tried every brand/flavor. Would not eat anything other than dry. Finally found a system that worked for feeding and schedule with a mix of Iams sensitive and Whiska wet - small portions about 4 times a day. She is all knowing and sees through walls at this point.

Vet has prescribed 1 unit Glargine one time in the morning. Never mentioned testing other than 10-14 days for curve. Vet tech was wonderful said you need to test before feeding and as needed but no recommendations. Lil Bit took everything like an angel as always. At home she is not. Sunday evening arrived home and was good. Monday my first time trying to administer insulin was horrible for both of us. Overwhelmed with guilt and unsure.

Purchased AlphaTrak 3 with everything as I didn't know any better. First Test this morning was not great but got it done. 25.9 mmol. Need insulin. She ate while facing me which she never does. Saw me move and bolted. 1hr 15mins later finally got her. She is still drinking a lot until she settles and is very quiet. Vet said it's all so easy, just give her the insulin and keep doing what your doing is the most important part. Adjust later. I've had to adjust her feeding as it was 60/40 dry as times don't work for testing/injection

What do I need to look for in monitoring her? How often do I need to test? she is a very unwilling party. Sorry that was so long

 

[Sienne and Gabby (GA)]

Welcome to FDMB!

It should get easier. Keep in mind that you may be activating Lil Bit's feral instincts. You need to make sure she feels safe and not threatened. It will be challenging in the beginning. However, if Lil Bit is smart, she'll begin to realize that the result of what you're doing is helping her to feel better. And try to not communicate your anxiety about testing and shooting to your kitty.

One other thing that may help -- TREATS! There are freeze dried protein (e.g., chicken) treats that most cats really like. Some members will use baby food (no onions or garlic). I've never researched the ingredients in any of the lockable treats but you could check into those. If your cat likes cooked chicken, that works, as well. (We did have a member who used cooked shrimp as a treat but I'm not sure what the member's budget was!!)

It sounds like you're very tuned in to Lil Bit's health. Has there been any diagnosis as to what the GI issue may be? Part of why I ask is that you may need to see if novel proteins (e.g., rabbit, venison, pork, duck) are better suited to her or if it's a matter of her being stubborn. There are a couple of dry foods that are sufficiently low in carbs to be suitable for a diabetic cat -- Dr. Elsey's Clean Protein and Young Again Zero Carb. In general, canned food is better for cats but she has to eat! If you've not seen this chart, it contains carbohydrate information on most of the canned foods that are available in the US. I'm not sure if you're in the US, though given that you're using mmol/L for your blood glucose readings vs mg/dL that are used in the US.

Glargine, as well as all other insulin, should be dosed twice a day. Despite glargine being a once a day dose in humans, a cat's metabolism is faster than a humans and twice a day dosing is standard. There are two dosing methods that can be used with glargine. The Tight Regulation Protocol typically has cats starting dose based on weight and generally calculates out to around 1.0u. The Start Low Go Slow (SLGS) method sets the starting dose at 0.5u. You are limited to using SLGS because Lil Bit is eating dry food.

One option with regard to home testing would be to consider a continuous glucose monitor like the FreeStyle Libre. A sensor is attached to your cat's skin (the vet will need to shave a patch) and you can read blood glucose levels from a phone app. The Libre has its pros and cons. We always suggest that caregivers get comfortable with using a hand held glucometer since the Libre will give inaccurately low readings at the lower end of the normal range. However, the Libre will give you and your cat time to get used to testing and giving insulin injections. FWIW, most of us will give our cat her shot while eating. Hopefully, food is a distraction and you will have minimal trouble if you give insulin while your cat is preoccupied with food.

With testing, you need to get a reading before giving insulin. You also don't want to feed your cat within the 2 hour window prior to shot time. It's also important to get at least one test during both the AM and PM cycles. For most cats, glargine reaches its most active point/lowest blood glucose numbers around the middle of the cycle. So, the minimum number of tests that are needed is 4.

You may want to do a bit of reading about glargine. This is a link to the Lantus forum. At the top of the page are "sticky" notes. They provide a great deal of education about the way glargine works, dosing, and other helpful information.

The other information we will find helpful is in this link to a post on helping us to help you. There are instructions on how to set up your signature and a spreadsheet. Your signature contains basic information about Lil Bit. Having the information there means we won't keep asking you the same questions repeatedly. The spreadsheet is a way you can track your cat's progress. It also allows us to follow along and provide input.

Please let us know if you have questions. We're here to help.

 

[Brad and Lil Bit]

Thank you so much for the reply. This is just a whirlwind for me. I am in Canada and only knew mmol by a quick chart the emergency vet drew quickly. First kitty and on my own now. I appreciate all the help and support. Lil Bit was not diagnosed with anything GI other than she had a very sensitive tummy and that her food was no longer agreeing with her system. I was told to find something that agreed with her and add in a little wet food. Vet still recommended dry at that time. I just adjusted to find something that she enjoyed and worked in combination with smaller meals more often.

I have read the Lantus information and now see that there are so many different options and things to look for. I am trying my best for my little girl. I will look at starting the spreadsheet as soon as I can. Currently she is snoozing very deeply and here I am plotting to do a glucose check. You mentioned 4 times a day? When I'm working I would only be able to do 3 possibly. Early morning, when I get home prior to her next meal and then at night. The Freestyle Libre looks interesting - I'll have to do more research. My little boss might disagree. I have looked at getting a wet timed feeder as well.

Do cats often have like a glucose type crash similar to how humans do? On a sugar high and then...now I'm tired. Yesterday she was very active after the insulin for an hour or 2 and then quiet most of the day. Then back up when she had her dinner.

The emergency vet was great, but I just wasn't prepared with all the questions, and he was looking at a packed waiting room. I initially thought her kidneys were shutting down and was preparing for the worst. Diabetes!? Ok I'll figure it out was the only thing that crossed my mind and to be able to spend time with my everything.

 

[Sienne and Gabby (GA)]

The beginning of this process is completely overwhelming. In other words, you're exactly where everyone here would expect you to be.

There are definitely similarities between humans and cats when it comes to diabetes. Too much insulin can cause a hypoglycemic response. There is information in the Helping Us to Help you link that gives outlines how to handle low numbers. This is also a post from the Lantus board on managing low numbers. I'd either bookmark the latter post or print it out so you have it handy. Cats can also drop into lower ranges and you then see an upward spike (aka "bounce") in numbers. It's a normal response -- annoying but normal.

The bottom line with testing is that you do as much as you can do. Like you, I was working. My cat tended to have her nadir (low point in the cycle) early -- around 2 - 4 hours after her shot. I moved her shot time to early -- 5:00. That gave me enough time in the AM to get several tests before I left for work so I knew that Gabby was in safe numbers. I could be home shortly after 5:00 for her PM shot. Giving some thought to what your optimal shot time is may help. Many people here work or are students and they may miss a mid-cycle shot due to those obligations. A timed feeder is a big help if you'll be out of the house during the day or have evening plans.

Yesterday she was very active after the insulin for an hour or 2 and then quiet most of the day. Then back up when she had her dinner.

I'd encourage you to pay attention to those kinds of observations. While it takes 5 - 7 days for glargine to build up in your cat's system and for the insulin depot to stabilize, it doesn't mean that numbers don't drop. You'll become familiar with how your cat reacts to insulin and be able to use that information.

Not all of the foods that are available in the US are available in Canada. I'm tagging a couple of people who are more familiar with what's available. @Wendy&Neko @Christie & Maverick

 

[Wendy&Neko]

A lot of the foods available in the US are available in Canada, plus we have some of our own. Check out this slightly older food list for wet foods under 10% carbs. You may have to go to smaller chains, such as Bosley's/PetValu to find the foods, or even smaller chains. I know a store in Vancouver that only deals with cat products. . They have a really good selection. Another list with product is here:

• CANADIAN Food Chart

There are newer ones not on that list like Canada Fresh or Open Farm. Not all the Canada Fresh are low carb, but they do have multiple protein choices. If your kitty has a senstive tummy, you may wish to try a protein she's not used to, in which case a freeze dried raw food might work as they come in a lot of different options. Brands are Stella & Chewy's, Nulo, Primal, plus probably others as this has been a growing area lately. Freeze dried raw provides some crunch which might be a way to transition the cat. You do want ones that are primarily meat products.

 

[Wendy&Neko]

I just remembered (with another member's help), the name of a lower carb dry food available in Canada, called Squarepet. It is turkey and chicken. I wouldn't suggest dry food as the ultimate food choice, but it could help with the transition.

I see you've started the spreadsheet, well done!