? New with Questions

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Dan and Marc

Member Since 2019
Hello,

About 95% sure our 12 year old male(Chronos) has diabetes, have vet appointment tomorrow, but he is drinking pretty frequently (prior he never drank because we add water to his wet food), weight is a somewhat lower and we have a Contour Next meter that is showing him at 330+. Acting fine otherwise.

I am mainly worried about his BG being this high and what consequences that pose until we see the vet.

History that is relevant:

For him, his brother passed away at 6 years due to kidney failure (think genetic issues) and Chronos had higher kidney numbers at the time as well. We had switched him to Hills KD (not ideal in retrospect due to how high the carbs are) and he was technically diagnosed with kidney disease. We saw an internal medicine vet for this. However after 4-5 years now I think, his CREA and all other kidney values are great and the internal med vet said he considers Chronos in non-progressive kidney disease which is rare but great when it occurs. Basically will take some event, if it ever happens to push him into progressive kidney disease. So overall that has been well maintained and the main reason we have kept him on the diet and doing everything we have been.

Three years ago our oldest cat(Vesta) at the time was diagnosed with Small cell lymphoma and we started steroid, chemo. She was also at the time eating the same hill KD since her kidney values were also moving towards that trend. During he treatment she developed diabetes, basically same symptoms as Chronos now, we consulted a vet nutritionist who recommended Royal Canin Renal D, it has the lowest carbs of all the renal diets. We switched her to that and her diabetes resolved on its own.

We have ordered the same diet for him and will transition him to it (originally we didn't because his BG has always been fine and both vets didn't want to change things if not needed, plus he has had a history of having digestive issues when transitioning diets).

Obviously my hope is the diet and lower carbs will help as it did our other cat (she still stayed on the steroids and never had a issue with diabetes again, unfortunately she passed 2 years ago due to secondary cancer).

Any insights or things I should be paying attention do would be helpful, quite stressed.

Thanks,
Dan
 
Hi Dan, my name's Kyle. Welcome to the best place you could possibly hope for to find help for Chronos. I know you're stressed and overwhelmed right now, boy do I ever. I was so lost and heartbroken when my boy Hendrick was diagnosed. But finding this place was like a firm, strong hand reaching down into the surf and pulling my head above the crashing waves and out of the undertow. Saved me, saved Hendrick.

We see steroid-induced diabetes here on the forum from time-to-time, and it does seem like in many cases the kitty can go into diabetic remission. Non-steroid induced diabetes doesn't seem to resolve quite the same but it does happen. Good job with the low-carb food and checking his BG. I'd say your diagnosis is solid.

To help Chronos the most, you'll want to set up a BG-tracking spreadsheet for the experts here with decades of experience to analyze and assist you with helping Chronos and dosing. Have you looked into your options for kitty-cat insulin? I am biased towards Lantus/insulin glargine because it has helped my buddy so much. If your vet says Vetsulin that's a hard no. Not a good insulin for cats, very harsh.

As far as high BG, many cats with diabetes live with high BG for months on end before diagnosis. Yes it's not good over an extended period of time but it sounds like you have noticed things quickly and he is going to be on insulin soon so there shouldn't be much concern there. Checking for Ketones may be a good idea though.

That's enough for now I don't want to overwhelm you further. I'll pop back in later (or someone else will) with some links to setting up your Signature, Spreadsheet, etc.

us cat-dads are a bit of a rare breed, this site is predominantly cat-moms. Nothing wrong with that! I just like to see it when another human loves their cat as much as I love Hendrick, whatever gender!

-Kyle
 
Hi Kyle,

Thanks for letting me know cats do go for quite some time with high BG without much ill effects. Thats my main concern while we get him figured out. I know for sure we will be switching the diet and monitoring that and am aware that steroid induced diabetes does typically resolve more frequently then others. Though Vesta was still on the steroids and just the diet change was enough for her. My main plan and once we talk to vet is to switch the diet and monitor his BG plus whatever recommendations from the vet. I know last time she wanted us to try the diet initially for a few weeks while checking her BG. We noticed it going down pretty quickly actually until she reached normal levels and that was the end of her diabetes incident.

So we will probably do the same with Chronos initially unless she advises us otherwise to start Insulin sooner. Either way the diet change will help due to just how drastically different the carb count is. Once we have all that figured out and if we are moving to the insulin route I will be sure to set up my signature/excel accordingly.

If you can think of anything else or have any thoughts let me know.

Thanks again,
Dan
 
I would just caution against too much delay in starting insulin.

The main concern with the high BG, to me, is developing ketones. Hendrick was diagnosed with diabetes on a Wednesday. Vet said we would come in the following week to learn how to give insulin and get our prescription.

By Saturday, his ketones were so high he had no appetite, was lethargic and very unwell. We rushed him to emergency -- DKA (diabetic keto acidosis). Which is deadly. Two nights in the hospital and he was discharged woohoo! Sad wallet though ($3400).

so might be a good idea to do daily ketone checks while doing the diet transition. And be super-vigilant of the signs of DKA. It is true, you must do the diet transition FIRST then start insulin, doing both at once is super dangerous.

I used a blood ketone meter to check Hendrick:

https://smile.amazon.com/gp/product/B01G5OE0QY/?tag=felinediabetesfdmb-20
 
Hi Kyle,

I didn't realize you could check for Ketones without dipping it in urine? Or am I confusing something? If not this would be great, much easier to get blood from his ear then trying to stick a strip under him when peeing. If so I will order this right now.

Thanks,
Dan
 
Sorry last question as well, what levels would I be looking for with that meter, I know human ones can show slightly different for cats. What are "normal" ketone levels that meter would read?
 
Dan and Marc said:
Hi Kyle,

I didn't realize you could check for Ketones without dipping it in urine? Or am I confusing something? If not this would be great, much easier to get blood from his ear then trying to stick a strip under him when peeing. If so I will order this right now.

Thanks,
Dan
Click to expand...

no you are not confused. Using ketostix and testing urine is indeed what many do. Probably most. The Blood ketone meter is a better option imo for sure. It is more accurate, gives you a number value, and you don't have to stalk Chronos to the litter box! Biggest downside is the cost of the ketone strips, they are stupid expensive at $20 for a bottle of just TEN strips. But a lot cheaper than a DKA hospitalization!

For cats, if I recall correctly Ketone levels to watch for are:

Under .6 = no concern. Trace amount
From .6 - 1.5 = watch out. Warning, possible DKA incoming
Above 1.5 call the vet immediately IF other symptoms present such as lack of appetite, odd head movement, lethargy, vomiting, staggering


Let me dig up an old post and make sure I have those values correct.
 
Thanks, also sorry I know I said last, but is there any other meters you would recommend. We are trying to find one in a store right now, since Amazon wont send us the one you recommend for 2+ days and I would want to be checking him now if possible. Would any human meter that tests both be viable?
 
hahaha Dan, you should never stop asking questions my dude. Bring it on!

Ok I found this info from one of my personal heros, Melissa (FrostD)

FrostD said:
Re: ketones - 0.9 is a little higher than I like to see bit not immediately dangerous. For a regulated cat it's usually LO - 0.4, occasionally 0.6. So 0.9 not outside the realm of "normal" for unregulated cat. Just keep doing what you're doing with food and fluids, etc. Once they get to 2.4-2.5 it's guaranteed DKA (that's what @JaxBenji posted above - the forum post she linked is a little misleading, if you read the study in that link they looked at a bunch of cats and ketone levels and that was the conclusion).

I know the strips are expensive but I'd test daily or every other day if you can, just to make sure they're not trending up. Or alternate using urine strips and the meter. Once he's regulated it's usually just a weekly thing.
Click to expand...

Regarding getting one at a brick-n-mortar...I just saw a recent post where a few types of ketone meters were mentioned let me see if I can find it. I personally only know of the Nova Max. They do sell it at places like Walmart though, if that helps.
 
I will add that you can generally keep the ketones at bay even with high BG numbers as long as the cat is getting about 150% of their normal caloric intake and drinking plenty of water to flush them out.

I didnt know this when Hendrick got diagnosed with diabetes, and we immediately were instructed to only feed every 12 hours by our vet. Well that meant he was NO WAY going to be getting more than his normal intake, not at all. Less, actually. So we put him right in DKA with that approach. Still kicking myself. (and fired that vet)
 
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Thanks Kyle,

Yea we are trying to find it now. Walgreens doesn't have it and wasn't even aware of ones that do both. Trying Walmart now. What symptoms would he show if the ketones got dangerous high? So far he is acting his normal self, wants food right on his schedule, cuddles etc, only thing is the drinking.
 
When you get a chance can you post most recent lab work?

There is actually no need for the specialty diets. Latest research for "kidney cats" is that a low phosphorus diet is best (once phosphorus in bloodwork gets above 6 you usually also need to add a phos binder to the food...and depending on what stage they're in may need to add subQ fluids). You can usually return the prescription foods for full refund.

@Diane Tyler's Mom has a list of low carb low phos foods that are good for diabetic kidney cats (there's a LOT of them here...I suspect my cat is as well and treating his hyperthyroid is going to unmask that).

How long has he had the drinking/peeing symptoms for?

There are some other getting started links and such but I don't have time at the moment to drop those in here, I'll get back around to it later tonight
 
No luck so far finding it in a store sadly. Did order on Amazon and picked up some urine strips for the time being. The urine strips we have however look to be color coded with ranges in mg/dl: negative, 5, 15, 40, 80, 160. Is anyone able to help me understand at which point it would indicate DKA? I know Kyle's values were for the meter but not sure how to interpret the strips.
 
And he decided to pee just now, luckily had a plastic ladle to use and got some of it. No change on the strips so guessing means negative for now.
 
Dan and Marc said:
No luck so far finding it in a store sadly. Did order on Amazon and picked up some urine strips for the time being. The urine strips we have however look to be color coded with ranges in mg/dl: negative, 5, 15, 40, 80, 160. Is anyone able to help me understand at which point it would indicate DKA? I know Kyle's values were for the meter but not sure how to interpret the strips.
Click to expand...
The blood meters usually aren't in stores...ADW usually runs a sale where if you buy strips meter is free, or vice versa. I believe WalMart is cheapest right now for extra strips.

So with the urine strips, you're looking for anything between negative and 5. If it's clearly negative, you're good. But if the color is starting to sway towards 5, be on the lookout
 
Hi FrostD, we aren't as concerned with the food. We met with a veterinarian nutritionist who is the one who suggested the Royal Canin D because it has the following: Protein g/100 kcal: 6.3, Phos mg/100 kcal: 80, Carb g/100 kcal: 4.1, she also gave us amounts for if we substituted 1 or 2 tablespoons of chicken breast and how that would affect the numbers since cats who have lower CREA can have the extra protein and it will also reduce the carb count. This is what we did with our other cat who was able to go into remission from diabetes due to the diet change and never had it return.

We have had a lot of experience unfortunately with kidney cats but thankfully our internal medicine vet specializes in kidneys and is very well known (he has done or participated in several studies on Tanyas CKD site that she quotes). Before we saw him is when we started the Hills KD which in hindsight we wouldn't have done but he said since Chronos has had only positive changes in his kidney values over the past 4 years and that he is considered to now have non-progressive kidney disease which he said is rare (but good) and at this point will take an episode of some kind to trigger him into progressive kidney disease, he didn't want to change anything with him unless it was needed. His BG has always been good until now.

I know diet and food are a very charged topic in the CKD community so just explaining our position and why we have chosen what we have. But thank you for your input and the resources you provided.

Dan
 
Well I certainly won't belabor the point!

I'm curious what kind of "event" he thinks would knock him out of it. Diabetic cats are also prone to pancreatitis (truly my most hated illness), I suspect something like that might be enough systemic stress. DKA probably as well. Unless he's thinking more like acute kidney injury.

You may consider thyroid check too, PU/PD was my cats only sign of thyroid problems.

So the diet change may help, only way to know is to transition it and spot check BG here and there. We do recommend waiting til diet change is complete before starting insulin, unless there are ketones in the picture OR you think it will take longer than a week to transition his food.

Now some housekeeping:
Help Us Help You - this will help you get the spreadsheet set up as well as signature, hypo kit, relevant links, etc. The spreadsheet is set up as if you're already using insulin, so just log whatever tests you have in the +1 column for now (and be sure to put "NS" in the dose column to avoid confusion)
Some ketones/DKA reading


Next part assumes insulin will be needed -

Aside from the obvious carb content requiring higher doses of insulin to offset it, you will also find that the dry food tends to affect numbers a little more unpredictably, and over a longer span of time (example: wet food takes about 20-30 mins to start impacting BG, and the effect is usually gone within 2 hours; the dry is hard to say, but takes a bit longer and can affect for several hours). Due to this, you would need to follow our more conservative dosing methods - which essentially means holding the doses a little longer and reducing any time a number is below 90.

You did not mention which insulin you are considering...I know you are hopeful diet will do it, but I'd suggest doing some reading. Vetsulin is no longer recommended for cats, too harsh and often doesn't last long enough. ProZinc is a recommend insulin and the only one FDA approved for cats (which matters zero to me but may to you). Lantus and Levemir are the other recommended insulins. Lantus has biosimilars now that are comparable in price to ProZinc. Factoring everything in - the CKD, the food, etc my recommendation would be Lantus. It tends to be a more gentle insulin with flatter cycles, and cats with multiple conditions do well on it. ProZinc is a little harsher in most cats, and just in my experience doesn't do as well with the more complicated cases.

The Renal D is 16% carbs. So, just barely a high carb food. For your hypo kit you'll want something around 20% and another around 25% - now ideally this will be wet food, because when they're in low numbers wet food acts more quickly than the dry, and usually more predictably. But I understand all the things you have to balance. The K/D varieties are all around 27% so that will suffice in a pinch.
https://catinfo.org/chart/index.php
 
Mainly all the things that can cause an acute kidney injury but the main thing he would be concerned with is anything that affected his blood pressure pretty heavily, for example he would be quite hesitant to put Chronos under anesthesia unless the risk was worth it.

We will be doing full blood work tomorrow and a urinalysis and if it doesn't already include the thyroid check (I know it includes one value for the thyroid) but not sure if there was also a more specific one, depending on how much blood they get we could do that too. He has had issues in the past behaving for blood/urine but our regular vet has worked out a system that so far (fingers crossed) has worked the past couple years.

Thanks for saying but yes I for sure won't be doing the food change and insulin at same time.

Currently I haven't looked to much into insulin but will use the resources here as best I can. Cost isn't a concern for us thankfully but the points you brought up about Lantus look promising. I do recall reading about the hypo kit so that will get put together if he does end up on insulin for sure.

He only eats wet food, all our cats do because of all the CKD stuff we have been through.
 
Gotcha. Sorry, habit for me to assume...so many people are pitched the dry KD. Got my RC letters crossed, the F is the dry
 
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