Newly Diagnosed Cat - need advice

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lolacat00

lolacat00

Member Since 2013
Hi Everyone -

My story: my cat Lola was acting very sick so I took her into the vet on 10/3 - she was admitted to ICU and discharged on 10/6 with diabetes diagnosis. Her glucose level was 509 when she was admitted and down to 233 at discharge. The vet prescribed 1 unit Lantus twice daily. The ER vet advised to bring her into our regular vet in 2 days for blood work, and for a blood curve in 7-14 days. Lola was eating primarily a dry food diet before hospitalization, since then we have been feeding her Wellness canned - 1/2 a can (5.5oz size) twice daily.

Lola had blood work done on 10/9 - her blood was drawn six hours after her morning dose of insulin and her glucose level was at 73. Initially the vet recommend to keep her on the same dose of insulin (1 unit), however after expressing concern at how low her level was he said "if it were his cat" he would decrease insulin to 1/2 unit twice daily, and schedule a blood curve ASAP.

After the blood curve on 10/14 the vet told my fiance Lola's blood glucose was stable and she may not need insulin long term, and recommended we seek long term care with an internal medicine specialist at the clinic Lola was initially hospitalized. They did not give him the actual results of the curve - after asking for two days I got the results today:

6:45 am - 1/2 unit Lantus given
7:15am - 87
9:15am - 67
11:15am: 71
1:15pm - 84

Lola has also been acting very hungry, we came home from work today to find she had dug through our garbage and tried to eat crumbs out of an empty bag of chips. Tonight I called the hospital she initially admitted to / diagnosed at for advice because I am worried her glucose levels are too low. Their only advice to me was to bring her in if she starts acting strangely and to make an appointment with internal medicine (I left a message for their scheduler).

I'm super frustrated because I feel like I'm being ping ponged back and forth between vets and they are not giving me any real advice except to keep bringing her in. I don't have a home monitor yet - we plan on buying a Kroger brand meter but they have been out of stock and the pharmacy said a shipment should be coming in this week.

MY QUESTIONS:
-Is Lola's blood sugar to low? Is it safe to continue administering 1/2 unit Lantus until we can start monitoring ourselves or visit an internal medicine specialist? We are not home during the work days, so I'm concerned she could crash when no one is around to help her
-Is it safe to increase her food and by how much? How much of an impact will this have on her blood sugar? It's hard to tell if she is just getting used to not being "free fed" dry food or is actually going hungry - if she's digging though our garbage I'm inclined to start feeding her more
-Any advice on Kroger meters? What are good "low" or "high" readings on this brand to aim for?

I've been researching like crazy and this website as well catinfo.org have been such a tremendous help, especially when I feel like I'm getting nothing but the runaround from vets. Thank you in advance!
 
Welcome to the FDMB! You couldn't be in a better place to care for Lola! (We'd love to know your name too)

To answer your question first, those are wonderful numbers. Between 50-130 are "normal" for a diabetic cat, and keeping Lola in those numbers will help heal her pancreas, and hopefully allow it to produce it's own insulin eventually.

You've done the best thing you could have done, and taken her off the dry food. It's all too high in carbs. Any of the foods that are less than 10% carbs on Dr Pierson's Food Chart are excellent choices.

Lantus is a "depot" insulin, so it's not possible to say from one set of numbers if the dose is too much, too little or just right. It takes 5-7 days (when you first start) to "build the depot" and then re-evaluate the dose (Unless it goes below 50...that's an immediate reduction)

That's why it's so important to home test, so the sooner you can get that started, the better we'll be able to advise you, as well as keeping Lola safe. If you have a WalMart handy, they have Relion brand meters that a lot of us use, and the strips are affordable too. (Or you can wait for the Kroger to get them, but the sooner you're testing, the safer you'll be). The meters are cheap (about $15)..it's the strips that run into money, and the Relion has the cheapest strips around.

You wouldn't give a child insulin without testing first to know it was safe, and our furkids are the same.

Now for testing at the vets....Tests done at the vets office are unreliable, because they're influenced by stress, which can increase the numbers by as much as 180 points. You're lucky in that your vet started you on a very sane dose. We hear all too often where vets start cats at 3 or 4 units!

Here are some glucose reference ranges used for decision making using glucometers. Human glucometer numbers are given first. Numbers in parentheses are for non-US meters. Numbers in curly braces are estimates for an AlphaTrak.

< 40 mg/dL (2.2 mmol/L) {< 70 mg/dL for an AlphaTrak}
- Treat as if HYPO if on insulin
- At nadir (lowest point between shots) in a long term diabetic (more than a year), may earn a reduction.

< 50 mg/dL (2.8 mmol/L) {< 80 mg/dL for an AlphaTrak}
- If before nadir, steer with food, ie, give modest amounts of medium carb food to keep from going below 50 (2.8).
- At nadir, often indicates dose reduction is earned.

50 - 130 mg/dL (2.8 - 7.2 mmol/L) {80 - 160 mg/dL for an AlphaTrak}
- On insulin - great control when following a tight regulation protocol.
- Off insulin - normal numbers. (May even go as low as the upper 30s (1.7 mmol/L){60s for an AlphaTrak}; if not on insulin, this can be safe.

> 150 mg/dL (8.3 mmol/L) {> 180 mg/dL for an AlphaTrak}
- At nadir, indicates a dose increase may be needed when following a tight regulation protocol.

200 mg/dL (11.1 mmol/L) {230 mg/dL for an AlphaTrak}
- no shot level for beginners; may slowly reduce to 150 mg/dL (8.3 mmol/L) {180 mg/dL} for long-acting insulins (Lantus, Levemir, and ProZinc) as data collection shows it is safe

180 - 280 mg/dL (10 - 15.6 mmol/L) {may be 210 - 310 mg/dL for an AlphaTrak}
- Any time - The renal threshold (depending on data source and cat's renal function) where glucose spills into the urine.
- Test for ketones, glucose is too high.

>= 280 mg/dL (15.6 mmol/L) {may be >=310 mf/dL for an AlphaTrak}, if for most of the cycle between shots
- Uncontrolled diabetes and thus at risk for diabetic ketoacidosis and hepatic lipidosis
- Follow your insulin protocol for dose adjustments
- Test for ketones; if more than a trace level of ketones, go to vet ASAP.

As long as you're feeding low carb, feed her as much as she wants. Several small meals a day is better for her pancreas anyway. Diabetics can't use the food they're eating because of the lack of insulin, so they are literally starving despite eating lots of food. As she gets under better control, her appetite will come down

Keep asking questions, and we'll do all we can to help you. With such encouraging numbers so early, Lola may be a great candidate to go OTJ quickly (Off the juice)
 
lolacat00 said:
Hi Everyone -

My story: my cat Lola was acting very sick so I took her into the vet on 10/3 - she was admitted to ICU and discharged on 10/6 with diabetes diagnosis. Her glucose level was 509 when she was admitted and down to 233 at discharge. The vet prescribed 1 unit Lantus twice daily. The ER vet advised to bring her into our regular vet in 2 days for blood work, and for a blood curve in 7-14 days. Lola was eating primarily a dry food diet before hospitalization, since then we have been feeding her Wellness canned - 1/2 a can (5.5oz size) twice daily.

Lola had blood work done on 10/9 - her blood was drawn six hours after her morning dose of insulin and her glucose level was at 73. Initially the vet recommend to keep her on the same dose of insulin (1 unit), however after expressing concern at how low her level was he said "if it were his cat" he would decrease insulin to 1/2 unit twice daily, and schedule a blood curve ASAP.

After the blood curve on 10/14 the vet told my fiance Lola's blood glucose was stable and she may not need insulin long term, and recommended we seek long term care with an internal medicine specialist at the clinic Lola was initially hospitalized. They did not give him the actual results of the curve - after asking for two days I got the results today:

6:45 am - 1/2 unit Lantus given
7:15am - 87
9:15am - 67
11:15am: 71
1:15pm - 84

Lola has also been acting very hungry, we came home from work today to find she had dug through our garbage and tried to eat crumbs out of an empty bag of chips. Tonight I called the hospital she initially admitted to / diagnosed at for advice because I am worried her glucose levels are too low. Their only advice to me was to bring her in if she starts acting strangely and to make an appointment with internal medicine (I left a message for their scheduler).

I'm super frustrated because I feel like I'm being ping ponged back and forth between vets and they are not giving me any real advice except to keep bringing her in. I don't have a home monitor yet - we plan on buying a Kroger brand meter but they have been out of stock and the pharmacy said a shipment should be coming in this week.

MY QUESTIONS:
-Is Lola's blood sugar to low? Is it safe to continue administering 1/2 unit Lantus until we can start monitoring ourselves or visit an internal medicine specialist? We are not home during the work days, so I'm concerned she could crash when no one is around to help her
-Is it safe to increase her food and by how much? How much of an impact will this have on her blood sugar? It's hard to tell if she is just getting used to not being "free fed" dry food or is actually going hungry - if she's digging though our garbage I'm inclined to start feeding her more
-Any advice on Kroger meters? What are good "low" or "high" readings on this brand to aim for?

I've been researching like crazy and this website as well catinfo.org have been such a tremendous help, especially when I feel like I'm getting nothing but the runaround from vets. Thank you in advance!
Click to expand...

First thing is food.... feed more; let her eat. that 5.5oz a day is not enough for even a healthy cat.
diabetic cats should be fed more as they are not able to extract the nutrients as needed to run their bodies. Almost all diabetic cats are ravenous for that reason.

I don't know the meter you mention.... where are you located? If you are in the US, any of the Relion meters will be just fine to use, so you can pick up a meter and test strips to test your cat at home yourself.... you may find out that your cat does not need insulin for long because of the food change.
Even if your cat no longer needs insulin, keep testing at home to ensure she stays in numbers under 130 or so, and do not switch back to any dry food or you may need to start up insulin again.
Non-diabetic numbers are around 40-130.

There is no reason why you can't free feed wet food; many people do.
As for the vets, most of them know very little about feline diabetes, and in time, you may end up knowing more than your vet. If you have your prescription for insulin, you really don't need the vet for anything else to handle your cat's diabetes.

Gayle
 
Thank you so much for your quick replies! I'm Rachael and live in Seattle, WA.
I will definitely start feeding Lola more - the vet recommended the 1/2 can twice daily, and I believed that increasing the amount would have more of an impact on her blood sugar. We have been feeding her the low-carb Wellness varieties, based on the same chart referenced above. I also bought some freeze-dried pure chicken to replace her old biscuit-style treats.

Kroger is a generic brand that I read is equal to a Wavesense meter. There isn't a Walmart near downtown Seattle where I live (I typically walk for transportation), regardless I will be finding a meter tomorrow be it Kroger, Relion, or other brand.

I believe my vet uses AlphaTrak (not 100% sure, but this is what they told me buy, which after researching I see isn't necessary). If that is the case wouldn't her glucose curve be too low (not even considering variations from stress of a vet visit)? Would my best course of action be to skip her insulin dose tomorrow AM, until I can start home monitoring? My main fear right now is if I were to give her insulin and be at work all day her blood sugar could drop too low while no one is home.
 
Hi Rachel..and hi again to extra sweet Lola!!

I have to agree..if those numbers were using an AlphaTrak, the general rule is that they read about 30 points higher than human meters, so those numbers under 80 would be under the 50 that we do reductions on. (that 67 would be a 37...and that can be dangerously low)

I think you'd be better to skip the insulin for now until you're home testing. With numbers that low, if you continue to give it without knowing where she is to start with, it wouldn't be safe to give it.

Once you're testing, we can see how she's doing and recommend where to start again. It might be best to do some testing and maybe start insulin on the weekend when you can be home to test.

Here's a "Shopping List" for when you go out:
Getting started shopping list
1. Meter ie Walmart Relion Confirm or Micro.
2. Matching strips
3. Lancets - little sticks to poke the ear to get blood . new members usually start with a larger gauge lancet such as 28g or 29g until the ear learns to bleed. Optional - lancing tool.
4. Cotton balls to stem the blood
5. Neosporin or Polysporin ointment with pain relief to heal the wound
6. Mini flashlight (optional) - useful to help see the ear veins in dark cats, and to press against
7. Ketone urine test strips ie ketodiastix - Important to check ketones when blood is high
8. Sharps container - to dispose of waste syringes and lancets.
9. Treats for the cat - like freeze dried chicken
10. Karo syrup/corn syrup or honey if you dont have it at home - for hypo emergencies to bring blood sugar up fast
11. A couple of cans of fancy feast gravy lovers or other high carb gravy food- for hypo emergencies to bring blood sugar up fast

We have a spreadsheet that will make it easier for you and us to keep track of Lola's numbers, and see the "patterns" so we can help advise you on doses. When you have time, it'd help for you to get a spreadsheet started. How to set up a spreadsheet

If you'd go ahead and add some information to your signature, it'll help too. Your name, your cats name, date of diagnosis, type of insulin, meter that you're using, any other health problems, as well as any other information you feel would be helpful. (you can see mine below here)

To fill in your signature, go to the top left of the page and click on "User Control Panel".
Go to "Profile"
"Edit Signature"
Add the information and "Submit"
When you get your spreadsheet up, you can add the link to that to your signature too

We look forward to helping you and Lola, and welcome to the sugardance!

Edited to Add..I see you found the Signature!! :-D
 
Thank you! I can't tell you how much better I already feel about Lola.
I'll be sure to post updates and get the spreadsheet set up.
 
You can order the relion meter online from walmart or ADW using the links above - i dont know anything about the kroeger meter. Many people here use the Relion confirm or micro, Arkray brands because they are reliable and good price. Avoid any "true" or "lite" meters. I am in Canada and cant get those so use the Bayer Contour.

If those numbers on 1/2 unit were taken at the vet, and using an Alphatrak, then they are too low! Anything under 80 on an AT merits a dose decrease. I suspect your cat may already be in remission, or need a lower dose. I would not shoot her for now until you get the meter

Feed her as much as you like, but weigh her every couple of weeks and adjust if she is changing weight in either direction. I free feed my cats wet food.

wendy
 
Lola Update:

Purchased a meter today - it is Kroger branded, manufactured by Agamatrix and appears to be identical to the Wavesense Presto/Up & Up meters. We were able to get a successful reading our first try :smile: a huge relief. Lola didn't love it but hopefully she'll get used to it!

I think I have the spreadsheet functioning correctly in my signature. Her last insulin dose was last night. Her first test on a human meter was this evening and read 97, this was an hour after she ate dinner.

I should lay off the insulin for now, but test often to see if her levels stay down... is this correct?
How often / when should I routinely test her for now? She's currently fed twice a day 6:30am / 6:30pm, if that makes a difference.

Thank you!
 
I wouldn't give insulin for a few days Rachael, and continue testing. It's possible that just by switching to low carb food, Lola might be able to be a diet controlled diabetic!

Even if she is, you'd still want to make sure she stays on low carb food, and test occasionally to make sure she doesn't go back up, but let's see how she does over the next day or two. I'd still try to get 4 tests per day if possible. One in the morning before feeding, one mid-day (or even 1 or 2 hours after if that's easier on your schedule), then again 12 hours later before feedings, and a last test "before bed"...If you do end up having to give her insulin, those 4 are really the bare minimum anyway, so it'll help you set a routine.

With her dropping so low during the vet curves, I think it's the safest thing to do, especially if you can't test during the day.

You can feed her as often as you like...small meals several times a day is actually good for the healing pancreas, but you want to make sure to take up food 2 hours before pre-shot tests (If you do end up needing to shoot)

You want to make sure that pre-shot tests aren't influenced by food. Most of us test/shoot/feed within about 15 minutes. You can leave food down for her during the day (adding water to it will keep it from drying out) or make foodcicles (add water to food, mix, put into an ice tray and freeze...pop out into a bag and leave in freezer). As they defrost, they regain their smell and provide a mid-day snack. The other option would be to buy an auto-feeder that's timed to open

You need to change the permissions on your spreadsheet...go to the top right where it says "Share" and click, and then choose "anyone with the link"...that way we can see it. Right now we can't.

Good luck to you and Lola!
 
Okay - the spreadsheet should be viewable now. My hope is this weekend while off work we can test every few hours to get a good picture of where we are at. I'll also try to work something out for more frequent feedings.

Thank you Chris for all your help. China looks a lot like my beloved childhood cat, Cujo.

I'll continue to test and post results.
 
Nice numbers! Normal cats sit between 50-130 (on a human meter) so lets hope she can stay there. You can help her pancreas a bit by feeding mini meals through the day instead of bigger ones which can overload it. And no high carb foods - not even treats.

If she can stay 50-130 for 2 weeks then we consider her OTJ

Keep us updated.
Wendy
 
I hope her numbers stay in the lower 100's and don't keep rising!

I have some questions about the supplements she taking...

Lola as prescribed Tumil K and Denamarin at the time of her diagnosis - She has been out of the Denamarin since Friday - could this be effecting her numbers negatively? The prescription refill is being mailed to us.

How important are Denamarin supplements in a diabetic cat? What is the best way to determine how long she should stay on it? Her potassium levels were low at diagnois, but normal at her last blood draw on 10/9. Would it be beneficial to continue the Tumil K as well?
 
Sorry Rachael, but I have no advice on the supplements since (so far) I haven't had to use any of them, but the best thing I can tell you is to consult your vet on if she needs to continue on them

I'd say with the numbers you've been getting so wonderful (even while taking them), I'd say they sure don't look to be influencing her blood glucose numbers!
 
For home testing, once you know the meter type and measurement type, you can look at the following table to see what various ranges mean. Human vs. pet-specific meters are like reading temperature in Celsius vs. Fahrenheit. Both are correct, but freezing point in Celsius is 0 degrees, while it is 32 degrees in Fahrenheit.

Here are some glucose reference ranges used for decision making using glucometers. Human glucometer numbers are given first. Numbers in parentheses are for non-US meters. Numbers in curly braces are estimates for an AlphaTrak.

< 40 mg/dL (2.2 mmol/L) {< 70 mg/dL for an AlphaTrak}
- Treat as if HYPO if on insulin
- At nadir (lowest point between shots) in a long term diabetic (more than a year), may earn a reduction.

< 50 mg/dL (2.8 mmol/L) {< 80 mg/dL for an AlphaTrak}
- If before nadir, steer with food, ie, give modest amounts of medium carb food to keep from going below 50 (2.8).
- At nadir, often indicates dose reduction is earned.

50 - 130 mg/dL (2.8 - 7.2 mmol/L) {80 - 160 mg/dL for an AlphaTrak}
- On insulin - great control when following a tight regulation protocol.
- Off insulin - normal numbers. (May even go as low as the upper 30s (1.7 mmol/L){60s for an AlphaTrak}; if not on insulin, this can be safe.

= 150 mg/dL (8.3 mmol/L) {> 180 mg/dL for an AlphaTrak}
- the lowest level pre-shot for ProZinc, PZI, or other non-depot insulins.

> 150 mg/dL (8.3 mmol/L) {> 180 mg/dL for an AlphaTrak}
- At nadir, indicates a dose increase may be needed when following a tight regulation protocol.

200 mg/dL (11.1 mmol/L) {230 mg/dL for an AlphaTrak}
- no shot level for beginners; may slowly reduce to 150 mg/dL (8.3 mmol/L) {180 mg/dL} for long-acting insulins (Lantus, Levemir, and ProZinc) as mid-cycle data collection shows it is safe

180 - 280 mg/dL (10 - 15.6 mmol/L) {may be 210 - 310 mg/dL for an AlphaTrak}
- Any time - The renal threshold (depending on data source and cat's renal function) where glucose spills into the urine.
- Test for ketones, glucose is too high.

>= 280 mg/dL (15.6 mmol/L) {may be >=310 mf/dL for an AlphaTrak}, if for most of the cycle between shots
- Uncontrolled diabetes and thus at risk for diabetic ketoacidosis and hepatic lipidosis
- Follow your insulin protocol for dose adjustments
- Test for ketones; if more than a trace level of ketones, go to vet ASAP.
 
Yes - Lola's been off insulin for 15 days now...
Thanks to everyone for your help, we definitely couldn't have done it without your advice and support. And we will be sure to keep an eye on her blood glucose levels from here on out.

Can't say THANK YOU enough! You are truly an amazing group of people who have no doubt saved hundreds (thousands?) of kitties. Lola is doing great and I am feeling very grateful.

Happy Halloween!
 
:mrgreen: :mrgreen: :mrgreen: CONGRATULATIONS!! :mrgreen: :mrgreen: :mrgreen:


Tips to stay OTJ

We say a cat is in remission if the cat can maintain BG levels for 14 days between 40-120 with most of that spent under 100. However, please keep in mind that once a diabetic always a diabetic.

1. Never feed dry - not even treats. If you change wet food types, be 100% sure the new food is also low carb and same low carb % as your current food. Some cats are very carb sensitive and an increase from 3-6% to 8-10% can spike the BG’s. Don’t feed if you aren’t sure!
2. Weigh every 2 weeks to 1 month to watch for weight changes. Too much of a weight gain can cause loss of remission.
3. Measure blood once a week, indefinitely. You want to catch a relapse quickly.
4. No steroids or oral meds with sugar - remind your vet whenever giving you any medication. Always double check.
5. Monitor food intake, peeing and drinking. If increasing, a sign of losing remission.
6. Regular vet checks for infection such as dental , ear or UTI. And get them treated quick!

If he does fall out of remission you need to be more aggressive and resolve issues/ back on insulin as soon as possible as the window for a second remission is tight if any.
 
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