New, Questions on managing my cat's blood glucose

[dianna_liu]

Hi, my name is Dianna. I am new to this forum and I am really lost with what to do to manage my cat, Grape's diabetes and diet. I went on a trip for a couple days and came back to my cat in skin and bones and not being able to walk. I had a pet sitter feed my animals at home during that time and she said my cat hasn't been eating. I rushed her to the vet and they said she went into DKA and was severely dehydrated. She stayed there for 5 days and was placed on prozinc insulin 6 units once a day. Her diet changed from dry to canned food.

In the beginning she started doing very well and then slowly she went back to before. She became very picky of her food, still eating and demanding food but sometimes would be too lazy to chew anything even if it is soft canned food. She is definitely drinking enough water but is becoming hypoglycemic. I changed different wet food, broths, different flavors to try to find something that would be tempting enough for her to eat properly but it's been a battle. I ended up changing the insulin dosage from 6 units to 5 and then to 4 units. I am very worried because she still hasn't gained any of her lost weight back. Sometimes her blood glucose would be low and she would be wobbly on her legs. The vet just instructed me to give 6 units a day and change her diet to wet food, that's it. I was checking this forum out and realized that insulin should be given twice a day...I am at lost of what to do. I just ordered a pet glucose monitor on amazon today because I realized the necessity to monitor her glucose regularly. I was never told the need to check it by the vet and didn't realize it until I came across this forum.

I am so worried.

Any advice or help is appreciated!!

 

[Idjit's mom]

Hi and welcome Dianna and Grape, I love Grape's name! You have come to the right place to learn about treatment for Grape.
Since Grape is on Prozinc, be sure to read the yellow tagged information at the top of the Prozinc forum. You are quite right to recognize that monitoring her blood glucose regularly is not only important but critical. You will be able to track how the insulin is affecting her body and help prevent hypoglycemia. What kind of food are you giving her now? You say canned food, but not all canned food is good for our sugar cats.
Right now, however, she needs to eat whatever she will. I don't have experience with DKA but I do know that it's serious and Grape needs to be eating. Have you tried baby food meat with no other ingredients, maybe even mixed down with warm water to a soup? I think Beechnut is the brand with no cornstarch, but perhaps right now that doesn't matter, she needs food. I found a link to information on ketoacidosis: DKA
If you need help with finding out about home testing, take a look at this information: HERE and start getting Grape ready. Find a "station" a place where you will test, where you and Grape are comfortable and there is good light. Take her there, rub her ears, give her a low carb treat. Always treat when testing.
Dianna, I am going to tag some of the members here who are much more knowledgeable than I, so that you can get better information and advice on Grape and her recent DKA. @Marje and Gracie @Chris & China @Jill & Alex (GA)

 

[dianna_liu]

Hi and welcome Dianna and Grape, I love Grape's name! You have come to the right place to learn about treatment for Grape.
Since Grape is on Prozinc, be sure to read the yellow tagged information at the top of the Prozinc forum. You are quite right to recognize that monitoring her blood glucose regularly is not only important but critical. You will be able to track how the insulin is affecting her body and help prevent hypoglycemia. What kind of food are you giving her now? You say canned food, but not all canned food is good for our sugar cats.
Right now, however, she needs to eat whatever she will. I don't have experience with DKA but I do know that it's serious and Grape needs to be eating. Have you tried baby food meat with no other ingredients, maybe even mixed down with warm water to a soup? I think Beechnut is the brand with no cornstarch, but perhaps right now that doesn't matter, she needs food. I found a link to information on ketoacidosis: DKA
If you need help with finding out about home testing, take a look at this information: HERE and start getting Grape ready. Find a "station" a place where you will test, where you and Grape are comfortable and there is good light. Take her there, rub her ears, give her a low carb treat. Always treat when testing.
Dianna, I am going to tag some of the members here who are much more knowledgeable than I, so that you can get better information and advice on Grape and her recent DKA. @Marje and Gracie @Chris & China @Jill & Alex (GA)

Thank you so much for the reply! I didn't know what type of canned food to get for her since the vet didn't specify at all. I just experiment and buy whatever she's willing to eat at the moment. But I am looking around on this forum and I saw the food chart posted by Dr. Lisa. I am looking at the options right now.

 

[Idjit's mom]

Dianna, as I said I have no experience with DKA, only what I've read in threads here, but it's important to test for ketones since Grape has had DKA and is not feeling well. You can get the ketone testing strips at the pharmacy, no Rx needed and they are not expensive. Some use a long handled spoon to collect urine while kitty is in the litter box to get a sample. Very important right now to be monitoring for ketones if she is not eating.

 

[dianna_liu]

Okay. I will definitely do that. She is still eating and very demanding of food. It is just difficult to find the right one to feed her at the moment because she will like one thing for a day and then only take a few licks of that the next day.

 

[Idjit's mom]

Okay. I will definitely do that. She is still eating and very demanding of food. It is just difficult to find the right one to feed her at the moment because she will like one thing for a day and then only take a few licks of that the next day.

Haha, she's a cat!!! Dr Pierson recommends " start with protein minimum of 40, fat maximum of 50, carb max of 10, and for cats with kidney issues....phos less than 300." You can use the filter option on the food chart. Many of us feed Fancy Feast classics and/or Friskies pates. At least to start with, because they are so available at the grocery stores and affordable. Many other fine choices out there also, at pet stores and online, like Chewy.com. I am glad she is eating, I thought she was not. Still test those ketones, better safe than sorry. Some members have purchased ketone monitors or ketone/glucose monitors and use those instead of keto sticks.

 

[dianna_liu]

Haha, she's a cat!!! Dr Pierson recommends " start with protein minimum of 40, fat maximum of 50, carb max of 10, and for cats with kidney issues....phos less than 300." You can use the filter option on the food chart. Many of us feed Fancy Feast classics and/or Friskies pates. At least to start with, because they are so available at the grocery stores and affordable. Many other fine choices out there also, at pet stores and online, like Chewy.com. I am glad she is eating, I thought she was not. Still test those ketones, better safe than sorry. Some members have purchased ketone monitors or ketone/glucose monitors and use those instead of keto sticks.

She is on friskies prime filets right now alternating with some fancy feast broth packs when she is picky. I will pay attention to the protein, fat, and carb contents. Thank you!

 

[Jeff D / Sketch]

Okay. I will definitely do that. She is still eating and very demanding of food. It is just difficult to find the right one to feed her at the moment because she will like one thing for a day and then only take a few licks of that the next day.

Just FYI there are also blood ketone meters available now for home testing that work the same as a BG meter..(drop of blood on a special testing strip). This was easier for me than trying to get a urine sample....(Sketch was not a fan of his litter box habits being interrupted or hovered over) There are even combo BG / Ketone meters available.

 

[Idjit's mom]

A thought, in case you didn't know already, changing to a lower carb wet food will lower the BG (blood glucose). I am concerned about the dose of Prozinc Grape is getting. 6 U is huge, 4 is very large. I suggest you inquire in the Prozinc forum about this dosage and get some experienced input there. It might be causing the hypoglycemia you mentioned.
I know this is all a lot, and most of us were completely overwhelmed at first with the disease dx, plus you have had scary DKA. It is a steep learning curve, and a few things to learn/juggle at first: understanding the diabetes, the insulin, the testing, the diet change and how it all fits into your life. But, it's doable.
The information on the Home page, Getting Started and Education is excellent and worth reading. Lots more reading here in the forums. This is a very supportive community and you will get answers from caring, experienced members.

 

[Elizabeth and Bertie]

Hi Dianna, (((Hugs, hugs, hugs)))

She stayed there for 5 days and was placed on prozinc insulin 6 units once a day.

I ended up changing the insulin dosage from 6 units to 5 and then to 4 units. I am very worried because she still hasn't gained any of her lost weight back. Sometimes her blood glucose would be low and she would be wobbly on her legs.
The vet just instructed me to give 6 units a day and change her diet to wet food, that's it.

Firstly 6 units starting dose of insulin is incredibly high. Secondly, reducing the carb content of the diet can reduce the blood glucose, and therefore the need for insulin, considerably. Too much insulin causes hypoglycemia, and it looks like you may have seen symptoms of that. ...Hypo can sometimes increase sensitivity to insulin, which is another reason why the dose may need to be reduced. However, when ketones have been present great care must also be taken to ensure that a cat gets sufficient insulin. So it's important not to reduce the dose too far....

It sounds like you are home testing. Is that the case? How often are you doing that? And what kinds of numbers are you seeing? How 'low' did her blood glucose go when you saw those symptoms?

It is incredibly important that you test for ketones. You can use urine test strips to test the pee (you only need a drop). You should be able to get ketone test strips from most pharmacies. Also have an awareness of how your kitty's breath smells. Not all ketones are picked up by the urine test strips, so if you notice a fruity smell, or a smell like acetone, that can also indicate ketones.

FYI , Prozinc has to be given twice a day as it doesn't last more than 12 hours. That means a cat with a proneness to ketones has had no insulin in it's system for half the time. So it is a matter of finding a dose that can be given twice a day.

Eliz

 

[dianna_liu]

Hi Dianna, (((Hugs, hugs, hugs)))



Firstly 6 units starting dose of insulin is incredibly high. Secondly, reducing the carb content of the diet can reduce the blood glucose, and therefore the need for insulin, considerably. Too much insulin causes hypoglycemia, and it looks like you may have seen symptoms of that. ...Hypo can sometimes increase sensitivity to insulin, which is another reason why the dose may need to be reduced. However, when ketones have been present great care must also be taken to ensure that a cat gets sufficient insulin. So it's important not to reduce the dose too far....

It sounds like you are home testing. Is that the case? How often are you doing that? And what kinds of numbers are you seeing? How 'low' did her blood glucose go when you saw those symptoms?

It is incredibly important that you test for ketones. You can use urine test strips to test the pee (you only need a drop). You should be able to get ketone test strips from most pharmacies. Also have an awareness of how your kitty's breath smells. Not all ketones are picked up by the urine test strips, so if you notice a fruity smell, or a smell like acetone, that can also indicate ketones.

FYI , Prozinc has to be given twice a day as it doesn't last more than 12 hours. That means a cat with a proneness to ketones has had no insulin in it's system for half the time. So it is a matter of finding a dose that can be given twice a day.

Eliz

Hi! No, I haven't started home testing. I just ordered the glucose monitor today because I realized how important it is to home test. My vet didn't mention anything about home testing. He only instructed to give 6 units once a day with canned food as diet. I didn't know how wrong it was to just follow what he said until I started noticing her reaction to it and researching for more info. I haven't noticed any unusual smells in Grape's breath, but I will definitely check for ketones after I get home from work.

 

[Tanya and Ducia]

No, I haven't started home testing. I just ordered the glucose monitor today because I realized how important it is to home test. My vet didn't mention anything about home testing. He only instructed to give 6 units once a day with canned food as diet.

Hi there,
I am sorry but giving large dose without testing is very risky.
Hypoglycemia could turn fatal any time. Sorry for being so dramatic .. but I am serious.

Is there any chance you could get to WalMart today and get one of their cheap human meters that you can start using right away? I mean without loosing time waiting for the pet meter to be delivered? Please say yes - I''ll post which one exactly.

I do think that you need to start testing before the injection. The dose is large. With history of DKA you cannot skip shots.
Without knowing the glucose level just before the injection is very risky.
@dianna_liu

Walmart is one stop shop for all things needed for a diabetic cat's care and it won't be expensive.

 

[dianna_liu]

Yes, I can definitely stop by Walmart on my way home today. I did order the glucose monitor to be delivered tomorrow though.

 

[Tanya and Ducia]

Yes, I can definitely stop by Walmart on my way home today. I did order the glucose monitor to be delivered tomorrow though.

Great!

Relion Prime human glucometer~$10
a box of testing strips for it ~$9/50 ct - if your pet meter in tomorrow you can choose 25 ct box, even cheaper
a box of Relion Lancets gauge 26 - 30 $1.50/ 100 ct

a bag of cotton balls $4
Neosporin Ointment (not cream) with pain relief $4

ETA: almost forgot the most important thing -
Relion Keto Stix $6.50

I would also buy a couple of Fancy Feast Gravy Lovers that are high in carbs and fed to a cat in Hypo to bring the BG up quickly.
FF Gravy Lovers Chicken Feast - 2 or 3 small cans and FF Grilled Tuna or Chicken, each can is less than $0.70. You resrve such food for a Hypo event, not for daily feeding.

None of the diabetes supplies are returnable but I really think you should do it - to be sure you kitty is safe.
You can keep it as a back up meter once you start the pet specific.

There are many great and very knowledgeable people on the Prozinc Forum - do post there too. They can help with dose and many dealt with DKA before.

 

[dianna_liu]

Great!

Relion Prime human glucometer~$10
a box of testing strips for it ~$9/50 ct - if your pet meter in tomorrow you can choose 25 ct box, even cheaper
a box of Relion Lancets gauge 26 - 30 $1.50/ 100 ct

a bag of cotton balls $4
Neosporin Ointment (not cream) with pain relief $4

ETA: almost forgot the most important thing -
Relion Keto Stix $6.50

I would also buy a couple of Fancy Feast Gravy Lovers that are high in carbs and fed to a cat in Hypo to bring the BG up quickly.
FF Gravy Lovers Chicken Feast - 2 or 3 small cans and FF Grilled Tuna or Chicken, each can is less than $0.70. You resrve such food for a Hypo event, not for daily feeding.

None of the diabetes supplies are returnable but I really think you should do it - to be sure you kitty is safe.
You can keep it as a back up meter once you start in the pet specific.

There are many great and very knowledgeable people on the Prozinc Forum - do post there too. They can help with dose and many dealt with DKA before.

Thank you! I will definitely pick those up on my way home. She is very picky though, what kind of food does your cat like? Grape used to love everything but after she has diabetes, she started being picky with food. She tends to like seafood more than chicken or turkey though. So if she is hypo, then I should give something high in carb to bring the blood glucose up quickly? But for her regular diet, go with something that is low carb?

 

[Tom & Thomas (GA)]

Dr Lisa Pierson's information about diabetes has advice on the risks of changing diet and starting insulin at the same time.

 

[Tanya and Ducia]

So if she is hypo, then I should give something high in carb to bring the blood glucose up quickly? But for her regular diet, go with something that is low carb?

You got it!

I 'll post in a minute some info that perhaps you can print out that enplanes what to do in case of Hypo.

The FF Gravy Lovers is High carbs and FF Grilled is Medium Carbs food and given in small portion (like 2 teaspoons ) to a cat whose current glucose level is below 50 on the human meter or 68 on the pet specific. Then you allow 15 - 30 min for the food to absorb and take another test making sure that the BG is above either 50 on human or 68 on pet. Try FF Grilled Tuna feast - it is 12 or 13% carbs and her seafood flavor.

There are a lot of info to process at once. Do not attempt to understand it all right away. Do post on Prozink Forum tonight, thou, maybe just before your shot time? You can post the BG number and ask folks if it ok to give Large dose at the curent BG read. It's the safest way to do it, IMHO.

Be back with info on food and hypo.

 

[Tanya and Ducia]

Dr Lisa Pierson's information about diabetes has advice on the risks of changing diet and starting insulin at the same time.

my understanding is that the insulin is already in use. ProZ 6U.

 

[Tanya and Ducia]

How to Deal with Hypo

Hypo Kit

Food Chart - aim at finding something below 10% carbs total for daily, regular feed and something in the 10-15% and 16-22% carbs total for the Hypo events. ALso add some Karo or honey - in the extreme hypo cases spreading just a little of it on cat's gums help to bring the BG up.

 

[dianna_liu]

How to Deal with Hypo

Hypo Kit

Food Chart - aim at finding something below 10% carbs total for daily, regular feed and something in the 10-15% and 16-22% carbs total for the Hypo events. ALso add some Karo or honey - in the extreme hypo cases spreading just a little of it on cat's gums help to bring the BG up.

Okay! Thank you so much!! Does the human and pet specific glucometer measure that differently? I ordered the pet specific one online.

 

[Tanya and Ducia]

Does the human and pet specific glucometer measure that differently?

yes. The human ones read lower than pets. I always used human - btw Relion Prime. But your vet will be happy to see the pets reads - that's what they learn in school.

If WM does not have their brand of urine keto -sticks buy any brand, most of them inexpensive and it is very important that Grape does not develop ketones - after the DKA it is always the risk.

 

[dianna_liu]

yes. The human ones read lower than pets. I always used human - btw Relion Prime. But your vet will be happy to see the pets reads - that's what they learn in school.

If WM does not have their brand of urine keto -sticks buy any brand, most of them inexpensive and it is very important that Grape does not develop ketones - after the DKA it is always the risk.

Okay! Thank you so much for the information!!

 

[dianna_liu]

I just got home and my babysitter had given her a pack of FF broth earlier. I just tested her BG and it is extremely high. It is 470. I don’t know if it is just high because she was low earlier on. I haven’t been able to get a ketone test done on her because she hasn’t peed since I got home yet. She is still wobbly and hungry. What should I do at this point?

 

[Idjit's mom]

Dianna, how many times have you tested at home now? What were the readings at what time? Have you determined what the carb % of the "FF broth" is? and at what time did Grape eat. What is the size of the can and how much did she eat? Where are you located? US, Canada, UK?

 

[dianna_liu]

Dianna, how many times have you tested at home now? What were the readings at what time? Have you determined what the carb % of the "FF broth" is? and at what time did Grape eat. What is the size of the can and how much did she eat? Where are you located? US, Canada, UK?

This is my first time testing. I just tested 10 min ago. I don’t know how to calculate the carb % of the broth. She was fed around 1.5-2 hrs ago. I’m located in the US. The content of the broth is protein 7%, fat .05%, fiber 1%, moisture 92%, ash 3%. How do I calculate the carb %? I’m so worried. Do I feed her or give insulin first?

 

[Tanya and Ducia]

I just got home and my babysitter had given her a pack of FF broth earlier. I just tested her BG and it is extremely high. It is 470. I don’t know if it is just high because she was low earlier on. I haven’t been able to get a ketone test done on her because she hasn’t peed since I got home yet. She is still wobbly and hungry. What should I do at this point?

Dianna,

congrats on starting the testing!

If the FF broth is high in carbs than it is normal to spike in BG. Check the Food chart I linked earlier for % carbs in broth.

The number is high but we have some cats even higher.

Several things can cause hind leg wobbliness and one of then is the nephropathy - condition which is a result of being in high BG numbers. Many of this Board had overcome it. They will help. Other reasons is low Potassium level and/ or anemia. I thing Low K and anemia go hand and hand with DKA because my girl too had it.

All those things are manageable. I strongly suggest you post in the ProZ Forum - the people over there will help you with dosing.

Good things is that Proz is good at pulling HI numbers down and that exactly what you can concentrate on because you already have all you need to start proper dosing and monitoring.

I use different insulin and won't be able to help much.

 

[Idjit's mom]

I looked up the FF broth you were talking about, If they are the FF Naturals they are on on the food chart at zero carbs so that won't up the BG. You said she was low "earlier" and I wondered if you had tested before. Good for you getting to it so fast!
Post in the Prozinc forum with the ? about dosing. I cannot tell you that. PROZINC

 

[Chris & China (GA)]

The broths are pretty low carb....they're mostly water.

They're not on the cat food list because they're too new.

As others have said, 6U is an insane amount of insulin to start on. We usually start our cats here at .5 to 1U and very slowly work our way up.

470 isn't horribly high, but without knowing what her BG was earlier, it's hard to say what's going on, but I'd bet that she went a lot lower and is "bouncing" now.

Bounces happen because the liver releases stored sugars and hormones in response to a real (or perceived) threat. They happen because 1. the drop too low (a real threat!), 2. they drop too much, too quickly (mix of real and perceived) 3. they drop into numbers the cat's body just isn't used to anymore (perceived threat) ….or any combination of all 3.

Our cats are so good at hiding their illnesses that by the time we get them diagnosed, they've usually been diabetic for quite some time. Their body has become used to living in those higher numbers, so even just a drop from (for example) 400 to 250 could set off a bounce because the liver thinks it's too low.

Now that you have a meter, you want to always test before shooting to make sure she's high enough to get insulin at all.....then you want to try to test at least once mid-cycle on the AM cycle (between 4-7 hours after the shot) and always get a "before bed" test on the PM cycle ….most cats go lower at night, so it's really important to get that "before bed" test to make sure she's going to be OK while you're sleeping.

We usually Test/Feed/Shoot....all within about 5-10 minutes. You test to make sure it's safe to give insulin, Feed to make sure they're willing to eat (not sick or refusing to eat) and shoot.

 

[Idjit's mom]

I have been following along on the Prozinc forum. Just wanted to wish you a good night, and hugs to you and Grape. You are probably tired tonight, and have had a really busy day. As soon as you can though, do the signature/profile and the spreadsheet. Having that information readily available is really going to help your advisers. The spreadsheet does require that you have a Google account. I am hoping that you are using a computer or tablet that supports Google, Google Drive and Google Sheets. If you have problems setting that up, there are members here who can help.