New to the forum - conflicted on advice from vet.

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Gummers

Member Since 2013
Hello All,

I'm new and feeling overwhelmed. :( I just got back from the vet with the news that more likely than not my 10 year old cat "Bob" has diabetes. Diabetes is something I've suspected since accidentally reading about it on catinfo.org a few weeks ago, where I was looking up how to help my cats lose weight.

We went in for a fructosamine test are going in for another glucose curve in a week and a half. He hasn't been prescribed insulin at this time but vet said it will likely be needed. He is obese at 9kg and the vet was optimistic that with weight control and getting him down to 5.5kgs, the diabetes might be managed without medication.

Anyway, the vet told me the cat needs to diet and tried to sell me Royal Canin Obesity Management dry food. I just switched them over to canned Friskies supreme supper from Royal Canin Indoor dry and I'm hesitant to switch them back to dry food after what I've read online. The vet further told me that he doesn't believe that wet is any better than dry and that it will be impossible for my cat to lose weight on Friskies. He also said that on friskies my cat will be nutrient deficient, and even with lower carbs in the canned food (8%) it will be worse for the cat than the dry as the Royal Canin food releases fiber/sugars into the blood at a controlled pace. ? I am not sure who to believe but I'm skeptic about the vet since his office was filled head to toe with bags of Royal Canin food.

He has no health problems other than the obesity and diabetes. The only complicating factor is that I live in Dubai and there is a tiny selection of cat food brands available. Most of the "quality" brands recommended aren't sold here.

Any advice/information welcome. :)
 
If the Royal Canin is the Royal Canin Indoor 27, it's somewhere around 47% carbs. Also, according to the ingredients label, of the first 5 ingredients 4 of them are some type of grain. Of the first 12 ingredients, 8 of them are some type of carbohydrate.

In comparison, the Friskies canned, first 6 ingredients, has only one carb, rice and that is the 6th ingredient in the list. Ingredients are listed in order of quantity in the food.

That means there are far fewer carbohydrate ingredients in the Friskies versus the Royal Canin and a much lower percentage of carbs. My personal opinion would be to stay with the Friskies. I feed my own cats the Friskies pates and the Fancy Feast classic pates only.

I have a cat that was overweight 7.5 kilos (16.5 pounds). He lost 2.04 kilos (4.5 pounds) on a gradual weight loss plan, 1-2% per week over a one year period and is now down to 5.45 kilos (12 pounds). It can be done on the Friskies with portion control. I agree it is important to get your cat to a normal weight but it will take time to do it safely. Cats do not need fiber in their diets to lose weight. Portion control is the key.

it will be worse for the cat than the dry as the Royal Canin food releases fiber/sugars into the blood at a controlled pace. ?
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Cats do not require any fiber in their food. In fact, because of their short digestive tract, it can be harder on their systems to process fiber. Cats bodies and natural diets contain no more grain or fiber than may be in a mouse carcass.

Here is one vet's nutritional advice on weight loss in cats. http://www.catinfo.org/?link=felineobesity Click on the link to read about obesity in cats and how to manage.

p.s. Would you add your location to your user control panel information please? Upper left of screen, user control panel, profile tab, edit profile, change location to Dubai, submit to save. Thanks.
 
Its not Indoor 27, it "Obesity Management" which claims to be high protein. However, like many of the other royal canin dry foods, 5/6 of the first ingredients are some sort of grain so it is still likely high carb.

I switched to Friskies based on reading catinfo and I already went out and bought a scale. Its just difficult to be confident about my decision to help my cats lose weight and get healthy when the vet is so persistent and vocal about selling his own brand. :(
 
Hello and welcome to FDMB!

A diagnosis of feline diabetes can be overwhelming at first. But take heart, you've come to a great place for advice and support; and everyone here has been where you are now. (Big (((hug))) to you!)

Many vets seem to recommend dry food - mine certainly did.... :roll: But it IS generally really high in carbohydrates, and the experience of people on this forum is that low carbohydrate wet diets work best for diabetic cats.

If you switch your cat to the dry food it is likely that his blood glucose could increase dramatically...

Do you have any idea what sort of blood glucose levels your cat has?
Would you be willing to learn to test your cat's blood glucose levels at home? This probably sounds a bit scary but only involves taking the teensiest weensiest droplet of blood from the outer edge of your cat's ear and then transferring that droplet to a test strip in a glucose meter. Most of us here use ordinary glucose meters that are made for human diabetics.

Testing a cat's blood glucose levels at home ('hometesting') shouldn't hurt your cat at all as there are very few nerve endings in the edge of the cat's ear. But it might take a few goes to get the hang of things. I test my cat's blood glucose while he's munching on a few low carb treats.

Hometesting would enable you to see whether your cat's blood glucose is high enough to warrant an insulin shot; it will give you a sense of understanding and control over the disease like nothing else can; and it will save you money in vet's bills because you will be able to do any 'curves' at home!

Elizabeth
 
Gummers said:
... Its just difficult to be confident about my decision to help my cats lose weight and get healthy when the vet is so persistent and vocal about selling his own brand. :(
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If I had followed the advice of the vet who diagnosed my cat's diabetes my cat would have died 6 years ago, because that vet recommended that I have him 'put to sleep' (Grrrrrr!)

The next vet was more sympathetic but still recommended a special diet for diabetic cats (which he sold at his clinic). I read up online, got more confident, realised that feline diabetes is a home-managed illness, and decided to do things my way. I cannot say that it was a comfortable decision at the time, but it absolutely was the right decision... ;-)


Eliz
 
Vets are authority figures. We want to believe what they tell us. On the other hand, you live with your cat, see changes in him quicker, live with him on a day to day basis and love him dearly. You understand your cat better. How would you like to manage your cat?

These AAHA Diabetes Management Guidelines for Dogs and Cats, is a vet journal published article from 2010. You may want to print out a copy and read it over. Maybe even politely pass a copy along to your vet. http://www.aahanet.org/PublicDocuments/AAHADiabetesGuidelines.pdf Vets treat many different conditions in many different types of animals. We here on this message board live Feline Diabetes 23/7.

The Royal Canin Obesity Management canned cat food is still to high in carbohydrates for a cat, around 27-28%. It is difficult to be precise, because cat food can be made in different places in the world and contain different percentages of ingredients.

Since you are in Dubai, your Royal Canin cat food may be coming from Australia and not the US. There may be some other recommendations of foods that we can provide you if you know where the cat food is being made. This will involve some reading of labels to see where the food is manufactured. Let us know what the food labels say as far as country of origin and we can have some more people give suggestions on food in that part of the world.
 
I'm willing to test at home, and I don't think its scary. No scarier than having to give injections, anyway.

My vet just emailed and wants to keep him for several nights to stabilize him and glucose curves. I'm not really thrilled with the thought of my cat cooped up in a cage for days/nights. Is that normal?
 
Gummers said:
I'm willing to test at home, and I don't think its scary. No scarier than having to give injections, anyway.

My vet just emailed and wants to keep him for several nights to stabilize him and glucose curves. I'm not really thrilled with the thought of my cat cooped up in a cage for days/nights. Is that normal?
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Normal for vets wanting to do it? Absolutely.

Necessary for a vet to do it? Nope.... You can curve at home with much less stress to yourself, your wallet, and your kitty, and get more accurate results to boot.

I also wanted to mention, two of my cats seem to be losing a bit of weight on their own since I started the wet food... sometimes the obesity is directly due to the excessive carbs in some dry foods. Given a better diet, they don't seem to feel the need to just nibble all the time, they only go for the food when they're actually hungry.

I personally think I would worry less about the weight at first, until you can get a handle on the diabetes and see how the wet food is treating kitties bg levels.
 
Some wonderful articles on feline diabetes by international expert Dr Rand here

Another link to share with your vet, if you so wish.
 
Gummers said:
My vet just emailed and wants to keep him for several nights to stabilize him and glucose curves. I'm not really thrilled with the thought of my cat cooped up in a cage for days/nights. Is that normal?
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Good instincts. You can't regulate a cat in a cage - unless that's his normal living conditions, which it isn't.

Stress can raise BGs in many cats, and Bob will be stressed if he spends a few days caged there. It's for that reason that curves really cannot be done at the vet's. A curve should be done in the cat's normal environment- where he sleeps, plays, eats, etc. We suggest doing our own curves, using the same glucometer as a human diabetic uses. It will save you time and money, and ease the stress on your cat, as well as giving you a far more realistic portrait of how he is really doing.

Your vet may be interested in reading this from the Canadian Veterinary Association (bold and italics mine):

Recently, a home blood glucose monitoring initiative was reported in the literature that provided a practical method for owners to check blood sugar at home by doing a small prick in the ear and using a low volume automated glucose meter. This is a big step forward in feline diabetes management because it is well known that while in hospital for monitoring, cats tend to not eat well and are stressed, both of which can interfere with blood sugar assessment. It is important to have a blood glucose curve done after insulin therapy is begun so that the veterinarian can check how quickly a particular cat processes the insulin type prescribed. Cats have a very wide spectrum of time that it takes to metabolize the insulin, and this test is very important for the safety of long-term insulin therapy.
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And ignore his food advice. It's a slow process, but many vets are coming to realize how terrible dry food is for our cats. My own vet (after my urging) has been doing her own research and has stopped prescribing dry food. So much is just common sense... once you realize what's going on!

Most vets are not taught nutrition in their training, so they repeat what they learn from the pet food salesmen. Obviously pet food companies have a vested interest in selling their product.

A couple of common myths:

1. dry food is better for the teeth.
Nope, no truth to that at all. That would be like telling people to have a couple of crackers to clean their teeth after a meal. Instead, we tell them to have an apple - the moist, fibrous structure helps clean the teeth. For a cat, gnawing on a piece of raw meat (like a chunk of stewing beef) would be far better for their teeth.

2. dry food is complete nutrition
Check the ingredient list on the bag. Remember that cats are obligate carnivores and need only fat and protein. Their bodies can barely digest carbohydrates. Your average dry food is filled with corn, other grains, starches and "meals". It does not meet their needs at all. Most of the protein in dry food is plant protein, not animal protein. Real meat is generally missing.

This may be the most important reason of all to switch to canned or raw food: a cat's most vulnerable organ is their kidneys - kidney failure is the leading cause of death (by disease) in cats. Moisture intake is VITAL for good kidney health. Dry food is... well... dry. And cats have very low thirst drives, so never get enough water by drinking. The moisture has to be in their food. A cat at a water bowl is already dehydrated.

Here's my favourite website by a vet who has specialized in feline nutrition (our own Dr. Lisa) : http://catinfo.org/

Good luck. It sounds like Bob is in VERY good hands.
 
Let us know what kind of insulin your vet wants to prescribe and at what dosage. We like the longer lasting insulins like Lantus, Levimir and PZI. Not sure what is available in Dubai.

One issue we see with new members is a prescribed insulin dose that is too high. We tend to be conservative and urge members to start at a lower dose. If your cat receives too much insulin, there is no way to take it back out. You will need to deal with the excess insulin and hypos are not fun to deal with.

One reason for your cat to stay at the vet is if he had an episode of diabetic ketoacidosis also known as DKA. This is caused by high ketone levels in the body and is not treatable at home. Monitoring at a 24 hour facility is needed and is very expensive ($3000-5000 here in the US).

If the ketone levels in your cat, Bob, are normal, you can bring him home and start treating him. What are his blood glucose numbers now?

Your vet may not like you doing this, but remember, you know your cat best and it is your decision on what the next step should be for him.
 
There is so much information that its difficult to digest. My cat doesn't have a prescription yet. Vet said his numbers were 26. Vet said nothing about DKA, but did say that everything else in his blood was surprisingly healthy given the glucose levels.

Anyway, I spoke again with the vet that I've been having trouble with and he was evasive when I asked what type of insulin he prescribes. He said it was "human insulin" but not to worry because they used it on cats all the time. So... I decided to call another vet. I know I'm going to have to fight my cat to accept treatment, I don't want to have to do the same with a vet. The new vet was pro-wet food and accepting of home testing. She said she would show me ways to get blood from the ear and other spots and how to do injections. The new vet even said they would start low and move cautiously - she sounds like someone who might want to work with me instead of dictate.

The new vet said they usually prescribe caninsulin. I will ask about other options and if they are available here.
 
Caninsulin does not tend to work very well in cats; it just doesn't last long enough. and, it was developed for dogs.

If you can get it, both Lantus and Levemir are long-acting human insulins with a good effect on cats - see the U of Queensland articles on using these.

Another option is some form of PZI type insulin. In the US, its ProZinc; there is a PZI mentioned by some of our European members that may be availble to you.
 
Caninsulin does not tend to work very well in cats; it just doesn't last long enough. and, it was developed for dogs.
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The Caninsulin is processed very quickly in cats because of their rapid metabolism. About twice as fast as in a dog. Some countries, like the UK, require vets to prescribe caninsulin first and then prove that it is not working well.

That is wonderful to find a vet who is supportive of 1. working with you 2. answering questions 3. wet/canned food 4. home testing 5. an appropriate low dose to start. All things we like to see in vets and recommend people look for those qualities.

and he was evasive when I asked what type of insulin he prescribes. He said it was "human insulin" but not to worry because they used it on cats all the time.
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I would not feel comfortable working with a vet that wanted to keep the type of insulin they recommend a secret.
 
Since you are not giving any insulin yet, now is the ideal time to change the food to the low carb canned that you got.

You should also be able to go to the local human pharmacy and purchase the following. You don't need a doctor's permission or prescription in most countries to get these supplies, it is probably the same in Dubai too.

- a glucose meter - Not sure what is available in Dubai - but do not purchase any Freestyle ones that use "butterfly" strips - some people have had problems with this - you want to purchase a meter that will "sip" the blood onto the strip and only requires a small amount of blood
- strips to go with the meter
- lancets (the things used to poke the ear to get blood)
- ketone strips - used to test urine for ketones and DKA

We can help you learn to test - there are videos and demos you can watch and we can provide guidance on tips and technique here.

You already found Dr. Lisa's site (and she has great information there). If your vets are open to receiving new information, you may want to direct them to her site as well. Especially the one that thinks dry food is best. They can read about the dangers of dry from another vet and realize that it really isn't the best food available.
 
Asides the caninsulin choice, the new vet sounds good.

What type of Friskies are you feeding? Some varieties can be too high in carb and this is a good time to work on bringing his blood sugar down with food before you start the insulin.

Wendy
 
I am feeding the cats Supreme Supper, which from the lists posted seems to be at 8% for carbs. The vet said there are also varieties of fancy feast that are super low but they are 4x the price of the friskies and I've got 3 cats to feed, so spending 14$ a day on food seems excessive for what would only be a moderate reduction in carbs and increase in protein.

I went to the new vet today. I had high hopes but he basically said that he prefers to use caninsulin and hasn't used any other type of insulin. He also didn't seem as that knowledgeable about diabetes in cats as the previous vet, but I could be confusing knowledge with bravado as this vet seemed to have a much milder personality. He and the nurse did show me how to lance the ear and the correct way to give injections.

Good news, I guess, is that insulin is available over the counter - though only some brands are available here. I plan on walking over to the pharmacy tomorrow and pricing out a glucose meter, strips, needles and insulin. I think I could technically get all the items I need to treat my cat without the vet, I just don't have the knowledge or the confidence to think this is a good idea.
 
How about getting the testing supplies and waiting on the insulin? Maybe we can get you one of the good ones. Also cheapest meter choice is ReliOn from Walmart. Other meters may not cost much but strips are expensive
 
While the members of this board can help guide you with managing diabetes at home, it is always good to have a vet supporting you, especially in emergency situations. Of the vets you have met, is there one that you overall liked best? Do you think that vet would be open to learning more about diabetes and treating cats and willing to work with you? If you can get a vet who is open and willing to learn, we can provide information that will help the vet help you and you can learn together.

Might be worth asking.


The insulins we recommend for cats are:

Lantus (glargine)
Levimer (detemir)
Prozinc

My guess is that the pharmacy will have Lantus or Levimer easily available.

There are a few other flavors of Friskies you could feed that are low in carb, such as:

turkey & giblets dinner
salmon dinner
mariner's catch

the special diet variations:

Beef & Chicken Entree
Beef & Liver Entree
Turkey & Giblets Dinner
Whitefish Dinner
with Salmon

with fish flavors, you do want to limit how many times per week you feed this to only 1 or 2 times, as the fish tends to be high in mercury

but at least you have more choices in the Friskies brand - now the question is are they available in Dubai?
 
I know that the white fish, and turkey and giblets are widely available.

I prefer the new vet. He (initially thought it was a woman) accepts no for answer and is supportive of home testing. I asked the new vet about lantus and it was dismissed - but I guess they want my business though so I can always try and force the issue and I doubt they will offer too much opposition.

What glucose meters require the least amount of blood to be accurate? I am willing to spend more if it means its going to be easier on myself and the cat. I'm going to purchase emla cream as well to numb the area as my poor Bob really hated having his ear lanced to get a reading.
 
Shoot. Forgot you were in Dubai. No Walmart, no insulin options from here. Can you order on eBay? It's one way to get cheaper strips. Lantus and Levemir are human insulin so your vet can get them. Wonder if giving him the animal studies/research would help
 
Most meters are fine to use with cats. The ones we found that may not be best are Freestyle with the butterfly test strips and any meter with TRU in the name, like TruTrack, TruResults.

Look to see if you can easily get and remember you need the matching test strips:

Bayer Contour meters
One Touch Ultra meters
Accu-Check meters


Both are good, reliable and don't need a lot of blood.

When you look at the meters, it should tell you on the box how much blood is required, this will help guide you too.

If you cannot locate these brands, write down what is available and we may have heard of them and be able to offer recommendations
 
Alright. So new vet wants to wait another three weeks for the fructosamine to come back to "confirm" diabetes to make sure he isn't in a 'pre-diabetes state". My cat shows every sign of having diabetes, including walking low on his hocks and shaky legs (but not all the way down yet). All his glucose tests have been in the 450+. I suspect he's had diabetes for a while now.

I don't want to wait another three weeks, I want to get started treating him now. Vet says he isn't comfortable starting him on anything until the test he did comes back to confirm what he admits he is 99% sure of :roll: .

I bought a one touch ultra meter and strips and the pharmacy across the road sells lantus (100U/mL) and other poking supplies. I've got some emla. I've set up a hypo kit as described on this site. I've been looking through every one's SS sheets and I've set one up for Bob, though obvs. no data in it yet.

He's been only low carb friskies exclusively for nearly two weeks.

Is there a good reason to wait or should I start treatment low and slow on my own? I hate waiting.
 
since you have the testing supplies and just changed his food, I would start by testing him at various times during the day/night to see what his bg levels are and if the food change is enough and won't need insulin. if he is not in normal bg level (which is 40-120), then you can start insulin immediately.
 
There is no reason to wait since you have the testing supplies. I agree with Wendy on getting some tests now. You said you have been on the low carb Friskies food for two weeks. That is plenty of time to see if the food has brought the BG (blood glucose) numbers down. I think testing at home will get you some useful data.

The good ones to get would be
1. a morning test, before food. Label this on the spreadsheet as AMBG (morning test, no insulin so not a pre-shot test)
2. a mid-day test, around +6
3. a evening test, before food about 12 hours after your morning test. Label this on the spreadsheet as PMBG (evening test, not on insulin so not a pre-shot test)

I'm suggesting these test times because if you do need to start insulin, these will have you started on a routine, at the correct times. Look reasonable to you?

Would you please add a link to your signature so we can see your spreadsheet? Yes, no data yet but there will be. :-D

Directions for our standard spreadsheet also explain how to link it into your signature in the user control panel. http://www.felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207 That way, anyone on the board that is interested can view it.
 
Take a few tests as Deb said over the next couple of days and let us know what they are (Spreadsheet would be ideal) and then from that we can have people advise on dose..

What flavours of the Friskies are you feeding? Just the pates?
 
Not sure if I missed it and someone else already mentioned it, but for him walking on his hocks, methyl-b12 (zobaline is the cat version) is highly effective for diabetic neuropathy. It can take up to 3 months before you start seeing a change, but some have reported much faster changes (a matter of days).
 
KPassa said:
Not sure if I missed it and someone else already mentioned it, but for him walking on his hocks, methyl-b12 (zobaline is the cat version) is highly effective for diabetic neuropathy. It can take up to 3 months before you start seeing a change, but some have reported much faster changes (a matter of days).
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No one has mentioned methyl-b12. I will bring it up on the phone with the vet in the next day or two. I will do the testing Friday and Sat and on monday report back.

He doesn't hock walk as badly as some cats I've seen on youtube, but his almost hock walking and thirst are the two things that tipped me off that there might be something wrong with my cat. OK, off to start supper and link a chart to my siggy!
 
You can also purchase the B12 at a local human pharmacy. You just want to be sure that it only contains Methylcobalamin B12, as there are several types of B12 and this is the one that helps with diabetic neuropathy.

Also, be wary of ones that contain sugar or sugar substitutes. It comes in capsule and pill forms. If you get the pill form, melt it in some water then add to wet food. If you get in capsule form, empty capsule into wet food.

You want to give between 3-5 mg (3000-5000 mcg) daily. The easiest thing to do is add it to the food and serve. Don't worry if he gets too much, the body will pee out what isn't needed. It is also safe if other cats eat the same food, so no need to worry there either.
 
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