New to being a diabetic cat mom... Need questions answered please

[Gatoluna]

Hello everyone,
So as the title says I am a new diabetic cat mom. My guy is going be 8 years old and was diagnosed with diabetes about a month and half ago. I noticed he dropped weight rapidly and was lethargic so I took him to the vet and his glucose level was at 411. The vet prescribed Lantus (vial refrigerated) 1 unit twice a day and a diabetic food. He is now eating royal canin glycobalance hard and wet food for the weight of 14lbs. He started at 21lbs but in the last year he lost the weight and is now sitting at 14.2lbs. From the end of February to 3/31 he was doing his schedule below.
His schedule is as follows:
6:30 am 50g of hard food
7:00am 1 unit of insulin
12:45 10g of hard (snack)
6:30pm Wet food can
7:00pm 1 unit of insulin
On 4/1 I took him to the vet for his first glucose curve and the first reading was 428 @8:21 and 556 @10:21. He was on gabapentin because he doesn't like the vet. After those 2 readings the vet called and said I can pick him up and that he now needs to be put on 2units twice a day. After reading online I seen that stress can increase the reading, so I am not sure if that's what made it jump even higher. When I spoke to the vet I asked if I need to start testing his glucose at him they stated no and to bring him back in 2 weeks. Well I bought a monitor anyways and check his blood glucose before dinner last night and before giving him his 2 units and he was at 392. I have a few questions
- How often should I check his Blood Glucose?
- Should he be feed 2x a day before his insulin (like the vet says) and split the cals evenly? or can I keep his current schedule with the increase in insulin? he is vocal about being hungry.
- is jumping to 2units right away okay?
* I will be doing a curve at home a few days before I take him to the vet to compare their numbers to ours at home to rule out stress if needed.
Sorry for the long message but the vet doesn't always communicate and I get mixed answers, any help would be appreciated!!

 

[Mary & Jude]

- How often should I check his Blood Glucose?
- Should he be feed 2x a day before his insulin (like the vet says) and split the cals evenly? or can I keep his current schedule with the increase in insulin? he is vocal about being hungry.
- is jumping to 2units right away okay?
* I will be doing a curve at home a few days before I take him to the vet to compare their numbers to ours at home to rule out stress if needed.
Sorry for the long message but the vet doesn't always communicate and I get mixed answers, any help would be appreciated!!

Hello, And welcome to the FDMB! We're sorry you have to be here, but I think you'll find a lot of useful/helpful information here as well as a good support group of other caregivers.

In response to your questions:

1.You should check his blood glucose at least twice a day, right before you give his insulin. This preshot test will help you know if your kitty's numbers are safe to receive his insulin shot (I posted a link below that talks about dosing methods and it shows numbers you are looking for--see the section on the SLGS dosing method). If you give him insulin when his blood glucose is too low, this can lead to a dangerous condition called hypoglycemia, so this test is key. After that, we suggest that you test periodically through the day and night, especially to begin with, so that you can get a feel for how your kitty is managing the insulin.

2. We suggest that caregivers increase/decrease in .25 unit increments (again, see the dosing methods sticky below). Stress can absolutely boost a cat's blood glucose, so you might have seen inflated numbers when his bg was checked at the vets. That said, it's not unusual for a cat's blood glucose to be erratic when they are first diagnosed.

Most of us on the board who use Lantus follow one of two dosing methods. Here is the information on them: Sticky - Dosing Methods: Start Low, Go Slow (SLGS) & Tight Regulation (TR). Since you are feeding dry kibble, you would need to follow SLGS. And a word about food: Most of us try to get our kitties off dry food and onto a low carb food (no more than 10% and most of us shoot for lower--Fancy Feast Classic Pates is a brand favorite around here because they are low carb, usually around 5% carbs). Unfortunately, the Royal Canin diabetic food is one of the "prescription" foods that is highest in carbs. There are food charts on the forum to guide you with choosing a lower carb food--let us know if you need help locating them. If your kitty is resistant to switching off kibble, let us know, and there are some lower carb kibble brands we can recommend. The sticky will offer some information about numbers and dosing and increasing/decreasing. We are here to help you understand any of that.

A couple of other things: please take a few minutes to set up a spreadsheet to track your kitty's blood glucose numbers. After setting up the spreadsheet, please set up a signature on your profile and link that spreadsheet in it so that when you post we can see your kitty's numbers. The information for getting all of that started is here: Sticky - New? How You Can Help Us Help You!. Again, we are here to help with any of this.

Finally, don't be surprised if your post is moved to the main forum; the moderators like for people to post there first so that we can help you get your spreadsheet set up, etc., and so that you don't get overlooked (you can't move it yourself, but if it's moved, don't be surprised).

It's a lot. I know. Especially at the beginning. We've all been there. We're here when you need us.

 

[Sienne and Gabby (GA)]

Welcome to FDMB. It's likely the best place you never wanted to be.

I want to tweet some of the information that Mary provided.

First, you want to always test at pre-shot times, like Mary suggested. However, you also need to get at least one additional test during the AM and PM insulin cycles. The minimum number of tests is 4. Lantus dosing is based on the nadir (lowest point in the cycle) which if your cat reads the "rule" book, it's about mid-cycle. Most cats do not read the rule book and hate to be predictable!! This also means you will want to learn how to home test. We have lots of information on home testing. It will also save you from having to pay your vet to do a curve in the office. Office testing is rather unreliable since as you've noted, cats get stressed by going to the vet. Stress causes their blood glucose numbers to be inflated. While your vet may have been responding to what your kitty's numbers looked like when there, you have no idea what your cat's numbers are when at home and relaxed. There are also 2 options for testing. You can use a hand held glucometer. This is the traditional way to test for glucose level. A human meter is fine. Many people here use the Walmart Relion meter since the strips are inexpensive. And good for you for getting a meter and getting started with testing. (Let us know if you need any tips.) With continuous glucose monitors (CGMs) like the Freestyle Libre becoming more popular, many people are using them for their cat. If this is a good option for you, we have information on both using a meter or a CGM.

We encourage you to feed your cat more than twice a day. Several small meals is fine. However, as Mary mentioned, the Royal Canin dry food is extremely high in carbohydrates. Most dry food is not appropriate for a diabetic cat (and Royal Canin despite being labeled as "diabetic" is among the highest in carbs). There are only a a very few dry foods that are low in carbs. If you are switching off of the dry food, please start home testing. It's likely that the food is pushing up your cat's blood glucose numbers. If you've raised the dose and then you change to a low carb food, you need to know if the dose needs to be lowered as you transition the food. This is one of the food charts we link. It lists canned foods that are largely available in the US. You have lots of choices!! Many of the members here feed either Fancy Feast or Friskies pate style foods.

Please let us know if you have questions. The members here are generous with their time and knowledge. We're here to help.

We make dose adjustments in 0.25u or in some cases 0.5u increments. It's easy to speed past what may be a good dose for your cat if the dose changes are large.

 

[Gatoluna]

Hello, And welcome to the FDMB! We're sorry you have to be here, but I think you'll find a lot of useful/helpful information here as well as a good support group of other caregivers.

In response to your questions:

1.You should check his blood glucose at least twice a day, right before you give his insulin. This preshot test will help you know if your kitty's numbers are safe to receive his insulin shot (I posted a link below that talks about dosing methods and it shows numbers you are looking for--see the section on the SLGS dosing method). If you give him insulin when his blood glucose is too low, this can lead to a dangerous condition called hypoglycemia, so this test is key. After that, we suggest that you test periodically through the day and night, especially to begin with, so that you can get a feel for how your kitty is managing the insulin.

2. We suggest that caregivers increase/decrease in .25 unit increments (again, see the dosing methods sticky below). Stress can absolutely boost a cat's blood glucose, so you might have seen inflated numbers when his bg was checked at the vets. That said, it's not unusual for a cat's blood glucose to be erratic when they are first diagnosed.

Most of us on the board who use Lantus follow one of two dosing methods. Here is the information on them: Sticky - Dosing Methods: Start Low, Go Slow (SLGS) & Tight Regulation (TR). Since you are feeding dry kibble, you would need to follow SLGS. And a word about food: Most of us try to get our kitties off dry food and onto a low carb food (no more than 10% and most of us shoot for lower--Fancy Feast Classic Pates is a brand favorite around here because they are low carb, usually around 5% carbs). Unfortunately, the Royal Canin diabetic food is one of the "prescription" foods that is highest in carbs. There are food charts on the forum to guide you with choosing a lower carb food--let us know if you need help locating them. If your kitty is resistant to switching off kibble, let us know, and there are some lower carb kibble brands we can recommend. The sticky will offer some information about numbers and dosing and increasing/decreasing. We are here to help you understand any of that.

A couple of other things: please take a few minutes to set up a spreadsheet to track your kitty's blood glucose numbers. After setting up the spreadsheet, please set up a signature on your profile and link that spreadsheet in it so that when you post we can see your kitty's numbers. The information for getting all of that started is here: Sticky - New? How You Can Help Us Help You!. Again, we are here to help with any of this.

Finally, don't be surprised if your post is moved to the main forum; the moderators like for people to post there first so that we can help you get your spreadsheet set up, etc., and so that you don't get overlooked (you can't move it yourself, but if it's moved, don't be surprised).

It's a lot. I know. Especially at the beginning. We've all been there. We're here when you need us.

Thank you so much much for the information, I have actually ben thinking of changing his food so I will look into the fancy feast.

 

[Gatoluna]

How would you guys suggest weening my cat to a different feeding schedule and food? he still currently has hard and wet food left over as of now
He currently has a hard food auto feeder. His schedule is as follows currently:
6:30 am 50g of hard food
7:00am 1 unit of insulin
12:45 10g of hard (snack)
6:30pm Wet food can
7:00pm 1 unit of insulin

I will have to invest in a wet auto feeder as I am at work. most of the day.

 

[CORKY]

Any food transition needs to be a slow one, you do not want to upset the stomach , as well as changing from any medium or high carb foods to low carbs between 0-10% can cause a dive in the glucose levels, so is important you test often throughout the days during transition, you begin with a1-2- tsp of the new food removing the old, and for every feeding you take out another tsp, removing 1tsp of the old food, till the meal eaten is all the new food
Could you create your signature and spreadsheet? We are very numbers oriented, this way we can all be on the same page, links below, if you need assistance to create the SS we can create it for you

Sticky - New? How You Can Help Us Help You!
https://felinediabetes.com/FDMB/threads/how-to-create-a-spreadsheet.241706/

 

[Gatoluna]

Hello Everyone,
So I created my spreadsheet and started checking my cats BG. I began doing a curve today after his first meal and shot. He has been in the 400s consistently for the past 6 hours. I ordered his new food which is the fancy feast wet food. I will receive it today and slowly make the transition from the royal canin. I have a vet appointment on Wednesday for a Glucose curve but now I'm not sure if it is necessary since I am doing it at home today. I'm worried they will raise the insulin units (he's on 2 units 2x daily) even though the change in food for may bring his levels down. I am going to reach out to the vet and make sure I tell them all of this information. I have been very strict on giving him his insulin every 12 hours.

 

[CORKY]

Good job! Transitioning from high carbs to low carbs (Fancy Feast Pates) needs to be a slow transition not to upset the stomach, and testing during this process often during the day is important since the change from high to low can dive the glucose level down drastically. No need for a Curve at the vet., besides if you just started insulin, Lantus is a Depot insulin it will take 5-7 days for the insulin to take effect in the system, you can wait for that curve, is too soon.
Curves at home give realistic glucose levels, he's already on 2 units, a bit high, normally a new diabetic cat is good start with 1 unit and work from there every cat is different and react differently to insulin

 

[Gatoluna]

Good job! Transitioning from high carbs to low carbs (Fancy Feast Pates) needs to be a slow transition not to upset the stomach, and testing during this process often during the day is important since the change from high to low can dive the glucose level down drastically. No need for a Curve at the vet., besides if you just started insulin, Lantus is a Depot insulin it will take 5-7 days for the insulin to take effect in the system, you can wait for that curve, is too soon.
Curves at home give realistic glucose levels, he's already on 2 units, a bit high, normally a new diabetic cat is good start with 1 unit and work from there every cat is different and react differently to insulin

So the vet started him on 1 unit twice daily, he was on that for a month then 2 weeks ago he went for a curve at the vet and it was high and they increased it to 2 units. It has been almost 2 weeks that he has been on the 2 units twice daily. I am considering getting a freestyle libre to continuously monitor him. I just started the BG testing and I'm still learning so it makes me nervous because I don't get good pricks sometimes.

 

[CORKY]

Good Job on the SS We all have been in your shoes, nervous, inadequate can we do this?? But it gets better, I’ve been testing for 4 years obsessive tester I am and just 1/2 hour ago I used 3 strips, it happened and is ok, it gets better as the capillaries begin to swell, easier to prick, find a small sock and fill the end with rice and tie it to cup the ear see picture, introduces the lancet sides way not downward not to go thru the ear and the sock give you support to prick, was he tested for Ketones?

 

[Gatoluna]

Good Job on the SS We all have been in your shoes, nervous, inadequate can we do this?? But it gets better, I’ve been testing for 4 years obsessive tester I am and just 1/2 hour ago I used 3 strips, it happened and is ok, it gets better as the capillaries begin to swell, easier to prick, find a small sock and fill the end with rice and tie it to cup the ear see picture, introduces the lancet sides way not downward not to go thru the ear and the sock give you support to prick, was he tested for Ketones?

Thank you for the tips! So I don't think he has I have his recent labs and don't see anything regarding ketones. I read I can get urine test strips to test them?

 

[CORKY]

Yes Walmart has the ketones kit, inexpensive ;you place the strip in fresh pee, not from the litter you can catch or use a sterilized container under while he pees, as long as it’s not contaminated pee

 

[Kobe (Dean and Lesley)]

I'm worried they will raise the insulin units (he's on 2 units 2x daily) even though the change in food for may bring his levels down.

I would have the same concern. I would not raise the dose while changing the diet. If you are transitioning to low carb, you may see your cat needing less insulin. The members on this site will help you find an effective safe dose for your cat. You hold the syringe! The vet cannot make you give your cat a bigger dose. You will not get in trouble with your vet for keeping your cat safe!