Newly Diagnosed Kitty, SO Many Questions!

[Loki'sMom82]

Hello, FD community. You are incredible! I (Amy) have already spent hours reading the articles and message board, and I filled out my FP profile and spreadsheet (see Signature).

SITUATION

My lovable 6-year-old male cat Loki was just diagnosed with diabetes on Oct. 18. This was based on the results of his blood, urine, and fecal panels which I put in the Labs tab of his spreadsheet.

Since that time, I followed my vet's instructions to change his diet (from Weruva Truluxe + an overabundance of Temptations treats each day) to Purina Pro Plan DM, Hills Prescription i/d, and freeze dried chicken for treats. The vet also prescribed Lantus and wants me to start him at 1u twice a day for the first 7-10 days before doing a curve in-office (which I instead plan to do at home).

Loki's lost 1.5 lbs (from 14 lb to 12.5) between his last vet visit in August and most recent in October.

QUESTIONS

I have some lingering questions, and since I'm a newbie, am freaking out..

1. I just read on this site that if Loki tested negative for ketones on his initial panel, that I should first to try get him in a healthy BG range using diet only (notes on food and link to Lab results above). He tested negative, but I'm wondering if there was something else in his lab results that would warrant getting him on insulin right away. So should we start insulin or aim for just the diet first?

2. Assuming you say to get him started on the insulin: his vet said to give him 1u BID per meal of Lantus for the first week and then do a BG curve, but I'm reading that if the kitty has been switched to a wet/canned low carb diet (notes on food above), we should start him at 0.5u BID. Should we start him at 1u or 0.5u for the first week?

3. Loki tends to eat a large portion of his wet food meals when they're given, but he'll leave some to graze on through the day. I'm planning on the SLGS approach. Is it ok to let Loki graze or no? If yes to grazing, do I need to remove the food for a period of time before his next BG monitor?

4. How should I adjust his meal portions in light of his diabetes, weight, type of insulin, and specific wet food?

5. Is it important to rotate injection sites? If so, how often?

6. If he tested negative for ketos to begin with, should I still use ketoanalysis strips to test his urine? If I get a trace or elevated result, what should I do?

7. Do any of you happen to know a cat sitter in Portland, OR who can do BG testing and insulin shots, the whole shebang?

Sorry so many questions, but THANK YOU for any advice you can provide!

 

[Sienne and Gabby (GA)]

Welcome to FDMB!! I love how organized you are. Thank you!!!!

Questions are good. We like questions.

1. I just read on this site that if Loki tested negative for ketones on his initial panel, that I should first to try get him in a healthy BG range using diet only (notes on food and link to Lab results above). He tested negative, but I'm wondering if there was something else in his lab results that would warrant getting him on insulin right away. So should we start insulin or aim for just the diet first?

Since you have lab work and Loki's blood glucose was high, I'd rely on the labs and not worry about doing a food trial. Most of us never did that. Unless Loki totally freaks out at the vet's office which would artificially raise his blood glucose reading, the labs are likely correct or at least indicative of diabetes. The only lab value I didn't see was for a fructosamine test. That would be diagnostic. It's like a human hemoglobin A1c that is definitive for whether or not someone is diabetic. The danger of waiting to give insulin is that if blood glucose is high, there's always the possibility of ketones developing.

2. Assuming you say to get him started on the insulin: his vet said to give him 1u BID per meal of Lantus for the first week and then do a BG curve, but I'm reading that if the kitty has been switched to a wet/canned low carb diet (notes on food above), we should start him at 0.5u BID. Should we start him at 1u or 0.5u for the first week?

The question is, what are you feeding Loki? If the foods you noted are canned, the DM is 6% carbohydrate which is fine. (Although, the ingredients are not stellar.) The ID on the other hand, is 23% carb. That's a high carb food even if it is canned. If it's dry food, it's even higher in carbs. If you can get rid of the ID, it would be fine to start at 0.5u. If you don't have a chance to switch out the ID immediately, you could start at 1.0u but I would also be monitoring Loki's blood glucose especially when you change over to an entirely low carb diet. The switch to all low carb could drop his numbers.

3. Loki tends to eat a large portion of his wet food meals when they're given, but he'll leave some to graze on through the day. I'm planning on the SLGS approach. Is it ok to let Loki graze or no? If yes to grazing, do I need to remove the food for a period of time before his next BG monitor?

Grazing is fine. In fact, we encourage members to provide several smaller meals during the early part of the insulin cycle. It is important to pick up any remaining food in the 2-hour period before shot time. You don't want his pre-shot number to be influenced by food since it could give you a misimpression of where your cat's blood glucose level actually is.

4. How should I adjust his meal portions in light of his diabetes, weight, type of insulin, and specific wet food?

Much of how you feed your cat is specific to your cat. A popular phrase here is ECID -- every cat is different. If Loki is at a good weight with the amount you're feeding him, stick with that amount of food. Adjust the amount if he needs to gain or lose. If you want to spread out his food, divide up the portion for the first part of the day (AM cycle) and you can feed up until the lowest point you see when testing. The low point in the cycle is the "nadir." Typically, with Lantus, it's around 6 hours (+6) after you give insulin. However, the nadir can and does change so you need to think in terms of what's typical for your cat. My cat had an early nadir.

Lantus is a long acting insulin. Unless you have blood glucose data to tell you otherwise, assume that Loki will have a nadir at +6. There are shorter acting insulins where you need to feed your cat then wait before giving a shot. With Lantus, you test, feed, and shoot all within a few minutes. Most of us would give a shot when our cat's face was in their food.

If Loki is acting like he's starving and threatening to chew on your ankle, feed him more. Diabetes interferes with getting nutrients into the cells and cats can be hungry until their numbers stabilize. Likewise, low blood glucose numbers can trigger a protective response -- your cat will want food since it can raise his blood glucose numbers.

5. Is it important to rotate injection sites? If so, how often?

Some people will rotate their shot site. I treated Gabby for 6.5 years. She pretty much got her shot in the same general area of her scruff the entire time. There's a lot of variability. The other part is Loki. My cat would not tolerate a shot anywhere other than in the scruff.

6. If he tested negative for ketos to begin with, should I still use ketoanalysis strips to test his urine? If I get a trace or elevated result, what should I do?

If Loki is sitting in high numbers or has some sort of infection/inflammation, getting a ketone test is a good preventative method to ensuring he's not developing ketones. Ketones at a trace level are manageable at home. Elevated levels are a trip to the vet. We tend to be pretty reactive if someone says their cat is throwing ketones and err on the side of caution.

7. Do any of you happen to know a cat sitter in Portland, OR who can do BG testing and insulin shots, the whole shebang?

I would start another thread asking this question. Also, check with your vet's office. There may be a vet tech who does pet sitting as a side gig.

A word or two of advice: I'd encourage you to not overthink diet or some of these other issues. The main take away with diet is low carb. If you've not wandered over to the Lantus forum, take a look at the sticky notes at the top of the board. They are a resource. There is a lot to juggle at the beginning of this process. Your questions are really good but don't let yourself get too overwhelmed. We're always around to help.

 

[Loki'sMom82]

Welcome to FDMB!! I love how organized you are. Thank you!!!!

Questions are good. We like questions.


Since you have lab work and Loki's blood glucose was high, I'd rely on the labs and not worry about doing a food trial. Most of us never did that. Unless Loki totally freaks out at the vet's office which would artificially raise his blood glucose reading, the labs are likely correct or at least indicative of diabetes. The only lab value I didn't see was for a fructosamine test. That would be diagnostic. It's like a human hemoglobin A1c that is definitive for whether or not someone is diabetic. The danger of waiting to give insulin is that if blood glucose is high, there's always the possibility of ketones developing.


The question is, what are you feeding Loki? If the foods you noted are canned, the DM is 6% carbohydrate which is fine. (Although, the ingredients are not stellar.) The ID on the other hand, is 23% carb. That's a high carb food even if it is canned. If it's dry food, it's even higher in carbs. If you can get rid of the ID, it would be fine to start at 0.5u. If you don't have a chance to switch out the ID immediately, you could start at 1.0u but I would also be monitoring Loki's blood glucose especially when you change over to an entirely low carb diet. The switch to all low carb could drop his numbers.


Grazing is fine. In fact, we encourage members to provide several smaller meals during the early part of the insulin cycle. It is important to pick up any remaining food in the 2-hour period before shot time. You don't want his pre-shot number to be influenced by food since it could give you a misimpression of where your cat's blood glucose level actually is.


Much of how you feed your cat is specific to your cat. A popular phrase here is ECID -- every cat is different. If Loki is at a good weight with the amount you're feeding him, stick with that amount of food. Adjust the amount if he needs to gain or lose. If you want to spread out his food, divide up the portion for the first part of the day (AM cycle) and you can feed up until the lowest point you see when testing. The low point in the cycle is the "nadir." Typically, with Lantus, it's around 6 hours (+6) after you give insulin. However, the nadir can and does change so you need to think in terms of what's typical for your cat. My cat had an early nadir.

Lantus is a long acting insulin. Unless you have blood glucose data to tell you otherwise, assume that Loki will have a nadir at +6. There are shorter acting insulins where you need to feed your cat then wait before giving a shot. With Lantus, you test, feed, and shoot all within a few minutes. Most of us would give a shot when our cat's face was in their food.

If Loki is acting like he's starving and threatening to chew on your ankle, feed him more. Diabetes interferes with getting nutrients into the cells and cats can be hungry until their numbers stabilize. Likewise, low blood glucose numbers can trigger a protective response -- your cat will want food since it can raise his blood glucose numbers.


Some people will rotate their shot site. I treated Gabby for 6.5 years. She pretty much got her shot in the same general area of her scruff the entire time. There's a lot of variability. The other part is Loki. My cat would not tolerate a shot anywhere other than in the scruff.


If Loki is sitting in high numbers or has some sort of infection/inflammation, getting a ketone test is a good preventative method to ensuring he's not developing ketones. Ketones at a trace level are manageable at home. Elevated levels are a trip to the vet. We tend to be pretty reactive if someone says their cat is throwing ketones and err on the side of caution.


I would start another thread asking this question. Also, check with your vet's office. There may be a vet tech who does pet sitting as a side gig.

A word or two of advice: I'd encourage you to not overthink diet or some of these other issues. The main take away with diet is low carb. If you've not wandered over to the Lantus forum, take a look at the sticky notes at the top of the board. They are a resource. There is a lot to juggle at the beginning of this process. Your questions are really good but don't let yourself get too overwhelmed. We're always around to help.

OH MY GOSH, THANK YOU SO MUCH!!! I feel like .. the more info I get, the more intimidated I am, and the more questions I have. But it seems like once you get going, it feels more and more manageable. I really appreciate you sharing your wisdom with me, thank you again!!