New to this!

[Sherriek0304]

Hi, I am new to this! my name is Sherrie, and I am 27, and my cat, Pudgy, was just diagnosed with diabetes, literally 2 hours ago. I had to rush him to the vet, and was found to be in DKA. Our regular vet gave him a prednisone injection to help his allergies, which triggered the DKA. He is in the icu, and has started an insulin drip, as well as rehydration, electrolyte balancing. I am familiar with medical(human) terminology, as well as giving shots, and medical care. I work at a physician office, and I am in nursing school. I feel overwhelmed and scared about calculating insulin, and making sure I am doing everything correctly! He has been my buddy, and I want to be there for him when he needs me, and make him as happy and healthy as possible. He is a grey dsh, about 8 years old, and has such a loving personality. The vet did warn that cats associate people with the pain of shots, and said that treatment is usually unsuccessful because the cat is too difficult to administer the insulin. Have any of you dealt with this? Also, do you use insulin vials, or pens? Does it matter? The vet didn't know anything about Lantus pens, just the vials( I am able to get the pens cheaper). I have another cat, who is 14, and on medication for hyperthyroidism. I was planning on free-feeding a diabetic diet. Is this a good idea? I'm worried about not being able to test urine, due to having 2 cats. Any suggestions? I'm sorry for rambling, I have spent the last few hours shocked, crying, figuring out vet bills, and going through every emotion possible! This is my first time posting on a message board, and will be reading tons of previous posts, and would greatly appreciate any information! Please, pray for my little buddy Pudgy

Thank you so much,
Sherrie

 

[Carl & Polly & Bob (GA)]

Hi Sherrie,
The same thing happened to my cat last May. He spent 3 days in the ER but survived the DKA. Once he came home, I had to give him sub-q fluids for while, and two shots a day, and test his BG a few times a day. The fluids were to keep him hydrated and to supplement his potassium which was found to be low. Tonight, he's laying out on the floor, without a care in the world, and he had his last insulin shot in July of last year. I was just as scared and overwhelmed as you are right now. All I'm trying to say is that we know what you're going through and we want to try to help.

I don't understand how the Pred injection triggered the DKA. How did they explain that?

Right now, Pudgy is in the best place he can be, because treating DKA can't be done at home. Did they tell you how long they expect to keep him?

I feel overwhelmed and scared about calculating insulin, and making sure I am doing everything correctly!

OK, this is where we tell you to BREATHE! Don't be scared about calculating the insulin, and don't expect to do everything correctly. The insulin is pretty easy really, but it depends on what they prescribe and what dose they suggest. Once you know that, tell us what they recommend. Lantus, Levemir, and Prozinc....if you hear anything other than those 3 insulins, let us know. Lantus and Lev are human insulins that work really well on cats. Prozinc is formulated just for cats.

The vet did warn that cats associate people with the pain of shots, and said that treatment is usually unsuccessful because the cat is too difficult to administer the insulin.

Wow, first of all, I can't think of any possible logic that would make a vet tell that to anyone, and 2nd, the vet is 100% wrong. You've given shots, right? I promise you, Pudgy won't even know you gave him a shot. It's a sub-q shot with a short 31 gauge needle, and the dose is so small it's hard to even see in the syringe. It will not hurt him. And telling you the treatment is usually unsuccessful??? In a study that resulted in the protocol used here for Lantus, the remission rate for the kitties in the study was 84%. I'd say that's pretty successful. Cats go into remission here often. At least one did today. Look on the various forums on the board. Anytime you see a post with the "OTJ" icon, that's a cat that has gone "off the juice" which is our term for remission.

Insulin comes in both vials and pens, as you already know. You can use either, but the pens are more cost-effective if you're using Lantus or Levemir. You don't use the pens the same way a human would. You actually insert the needle into the pen and draw up insulin into the syringe. But we can teach you all that stuff later. If you search for "feline diabetes" on Youtube, there are videos that show how to give a shot, how to fill a syringe, how to home test blood glucose using a human meter. Dozens of them.

The most important thing right now is that Pudgy receive great care at the ER so he can get past the DKA. Please look around the board. It's huge, and the information here is almost limitless. Don't try to soak it all in too soon. Ask questions as they come to mind.

Feline diabetes is a very manageable condition. Pudgy can live a long and healthy life in spite of it, even if he never goes into remission.

The important things you'll need to learn -
How to administer the shots to a cat.
How to home-test blood glucose by getting blood from his ears.
How to get him on a low-carb all canned food diet.
How to record all the BG data by using a spreadsheet from google-docs and attaching it to your signature so you and everyone else can see it

We can help you with all of that. You've found the best place in the world to help you deal with this, Sherrie.

Prayers going out to Pudgy, and to you,
Carl

 

[Sherriek0304]

Carl,

Thank you so much for such a nice reply, I really appreciate it! I had no idea his diabetes could go in to remission, especially with the use of Lantus, which is what the vet will be prescribing. I'm also so relieved that cats don't go into hiding every time they see you, thinking you are going to hurt them. I know humans kind of get used to insulin shots, and after time it is no big deal. That is such a relief! As far as the DKA and prednisone correlation, we had no idea he had diabetes until last night, and took him to his regular vet on Monday for allergies, and he was given a prednisone injection. The vet last night said prednisone causes blood sugar problems, which I did know, and caused his unknown diabetes to go way out of control and cause DAK. His blood sugar last night was over 500, and as of right now, is 247, so his levels are responding, but he is still very lethargic and not really responsive when she tries to get him to stand. Will he be back to his normal self once he is feeling better and under control, or could he have perm damage? Also, does anyone use insulin pens instead of vials? I think it is the same, but no syringe, just pen needles. It may even be easier than using syringes/vials

I feel more confident today, and I'm ready to tackle this diabetes with my Pudgy!

Sincerely,
Sherrie

 

[Julia & Bandit (GA)]

Lantus is a wonderful insulin for cats with very high remission rates! I've personally helped treat three cats with Lantus (the first of which was my Bandit :smile: ), and all three are in remission and doing great! I would say that Bandit is healthier today than he was before his diabetes because the the diet change to canned food only, so I am completely in shock that the vet would tell you most treatment is unsuccessful in cats. I'm sorry, but that's a red flag to me with that vet and I probably wouldn't get advice about diabetes treatment from him. When the correct treatment is followed (a slow acting insulin like Lantus or Levemir, proper dose adjustments according to the Lantus/Lev dosing protocol and home testing, and a low carb, canned diet), the large majority of newly diagnosed cats go into remission.

If you need suggestions for low carb, canned foods there a TON in many different price ranges. Fancy Feast classics are really popular here because they are easy to find and most cats love them. Here's a link to the diabetic safe flavors: http://www.felinediabetes.com/glutenfree.htm. Or you can look at the canned food charts and pick something under 10% carbs: http://www.felinediabetes.com/diabetic-cat-diets.htm.

Ok, so now for some info. As Carl said, shots are incredibly easy. I gave Bandit his insulin injection while he was eating, and I don't think he ever once even realized he was getting a shot! You'll want to get .3cc, 5/16" (8mm), 30-31g needles with half unit markings. The half unit markings are important because dose adjustments for cats are made in .25u-.5u increments. You'll need a glucose meter--any human meter that takes a small sample of blood (.3-.6 microliters) is good--the Relion meters from Walmart are very popular here because they are good quality and they have inexpensive test strips, which is a very important factor in selecting a meter because you'll need to be testing Pudgy's blood multiple times a day.

Testing is a little difficult at first, but after a week or two you'll be a pro, even if your cats starts with a fight. Some cats are fine with it right away, but a few do need some patience. Nearly all cats come around and tolerate testing after a few weeks. The key is using a larger lancet so you can easily get a drop of blood (26g works well), and giving a low carb treat (100% Freeze dried chicken or salmon treats from the dog or cat treat section at the pet food store are very popular) after every test. Bandit was horrid and fought me tooth and nail the first week, and I had to wrap him in a blanket with just his head showing and put him in a basket to test him. Today, he comes running to me when he hears the meter beep on, lies down, and starts purring while I'm testing. It's amazing what treats can do!

Cats have very few nerve endings in the tips of their ears (less than people do in their fingertips), so it does not hurt them to poke and get the drop of blood. What they hate (and is why they struggle) is being restrained, and having something new and strange done to them by their scared and nervous human. Once you are no longer nervous about testing and the cat accepts the routine, everything works out just fine.

I'm attaching a couple articles or both you and your vet. I would print this material out and give it to him, and read it over yourself. Because your vet does not seem to be up to date with feline diabetes treatment, I would strongly recommend seeking dosing advice here in the Lantus forum, since cats in DKA need more aggressive dosing. To do that, you'll need to set up a spreadsheet for Pudgy's home test numbers that you'll start collecting when he gets home. Instructions for that are here: http://felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207
Also check out the stickys in the Lantus forum, because there is a wealth of information there.

Here are the AAHA diabetes guidelines: http://www.aahanet.org/PublicDocuments/AAHADiabetesGuidelines.pdf

Note p. 218, where it states "Home monitoring of BG is ideal and strongly encouraged to obtain the most accurate interpretation of glucose relative to clinical signs. Most owners are able to learn to do this with a little encouragement, and interpretation of glucose results is much easier for the clinician."

This is the article about the lantus dosing protocol which has an 84% remission rate in newly diagnosed cats:



And the dosing protocol itself: http://www.uq.edu.au/ccah/docs/diabetesinfo/link4.pdf

 

[Julia & Bandit (GA)]

Oh, and I forgot to mention, yes, I used the pens instead of the vial because they were more economical. I think most people here do the same. The vial goes bad before you can use all the insulin, so you end up wasting a ton. There's nearly no waste with the pens because they are much smaller. You just insert the syringe into the pen like you would a vial--but don't use the pen needles. Cats need much finer dosing than the pen needles allow. Check out this thread: http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=151

Also, are Pudgy's allergies respiratory or GI related? I would check this out: http://catinfo.org/#Feline_Asthma. I also know that steroids are not recommended for the treatment of asthma in diabetic cats--inhaled meds are the preferred form of treatment. If they're GI related or manifesting as dermatitis, changing the diet alone should help clear them up.

 

[Carl & Polly & Bob (GA)]

Will he be back to his normal self once he is feeling better and under control, or could he have perm damage? Also, does anyone use insulin pens instead of vials? I think it is the same, but no syringe, just pen needles. It may even be easier than using syringes/vials

I wouldn't worry about permanent damage. As his condition improves, you'll see with your own eyes how much better he looks and feels. Once his BG becomes more regulated, someone who doesn't know he's diabetic wouldn't be able to tell that he's diabetic. If he's lost weight, he'll put some back on. If his fur looks sort of ragged right now, it'll become soft and shiny again. He can get right back to his "old self".
People don't use just the pens because with the pens, you can only dose in 1u increments. When we adjust a dose up or down, we normally do so in .25u increments, so you would need syringes to do that. Using the syringes is just a lot more accurate, and once you learn how, it's just as easy.

Carl

 

[Ry & Scooter]

The vet did warn that cats associate people with the pain of shots, and said that treatment is usually unsuccessful because the cat is too difficult to administer the insulin.

Sorry, but that's some of the biggest BS I've heard on here yet. :lol: Unless you are using the wrong syringes or injecting wrong, your cat won't even flinch at the shot.

The reason so few people choose to treat diabetes is mostly because their vets don't recommend it. Lots of vets will just say "it's too much work, too difficult, too expensive, just euthanize the cats" and owners become overwhelmed and scared, not realizing how many millions of humans live a perfectly normal life with diabetes every day, and that a cat can live a perfectly healthy, normal life, right into old age, too, with proper treatment. And they could even go into remission and not need insulin any more!

The 3 keys to treating diabetes, in short :

1. Insulin. Lantus is great. Get the pens, but use a syringe to draw your dose. Follow a proper dosing protocol (someone will explain). Keep it in the fridge and don't shake or roll it.
2. Low carb canned or raw diet. There are lists out there that tell you what foods are low carb. They range from economical to premium. I like the happy middle. Fancy Feast classics (pate style) are a good easy to find food to start with.
3. Home testing. Like a diabetic human pokes their finger, we poke our cats' ears, before each insulin injection and a few times in between. We use human glucometers. Buy whatever one takes small samples and has cheap strips. Walmart's ReliOns fit the bill. Accuchek, Bayer Contour, and OneTouch are good but more pricy. No Freestyle meters or ones with "Tru" or "True" in the name.

Since your cat has already gone thru DKA once you will want to urine test for Ketones at least once a day. You can get Ketostix or Ketodiastix OTC at any pharmacy. You hold the testing pad in the pee stream or you can catch the pee with a spoon or plastic wrap and dip it in.

Remember to breathe, don't overwhelm yourself. This is a completely manageable disease, not a death sentence. If you have any more questions, feel free to ask.