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!!

 

[Loki'sMom82]

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!!

I realized I have a couple follow up questions. Thanks in advance - I feel like my brain is going to explode with how much I'm learning, LOL!


Since I'm removing the Hills Prescription i/d (high carb) today, this means dinner tonight (Fri., Oct. 31) will be the first time his diet is entirely rid of any high carb foods. I was planning to start his insulin tomorrow night (Sat., Nov. 1). Is the 24-hour window enough time to justify starting at 0.5u? Or should I keep him on an entirely low carb diet for longer and then start the insulin (and at 0.5u)?

 

[Wendy&Neko]

Are you home testing Loki's blood sugar regularly? If so, you'll be able to see if he's responding to the change in food. If you are shooting just 0.5 units of insulin, you should be able to start his insulin tomorrow. One caution, pick a time when you can monitor (test his blood sugar) fairly closely. We recommend testing before his first shot, then at 3, 6, and 9 hours after the shot to start.

There is some more information you can put in your signature that can help us. See details in this post: New? How You Can Help Us Help You!

One note on food, almost all the Weruva Truluxe are low carb and suitable for diabetics. Minus the Temptations of course! Take a look at this food chart for carb% values. You want carbs under 10%.

 

[Loki'sMom82]

Thank you again!!!

Fixed my signature and now have a plan for implementing all low carb diet (tonight), BG testing (tomorrow night), and 0.5u insulin (tomorrow night with curve, then staying at same dose through the week before adjusting if needed).

 

[Wendy&Neko]

If you can get a few sample blood glucose tests either tonight and/or tomorrow, it should help give you and idea what he's doing normally (without insulin) now. Plus give you some practice testing before giving insulin.

 

[Loki'sMom82]

Thank you again ****so**** much! I was able to get one successful BG reading (tried twice more, couldn't get enough blood) before starting him on insulin tonight. Loki's doing beautifully, and I'm now getting the hang of it, phew!! Staying up tonight to check his BG every few hours.

I have a couple more follow up questions if that's ok? Please let me know if I should post them somewhere else.

1. Loki gets fed 2 x day, and he'll eat maybe half the portions at first, then graze the rest of the day. I read that I'm supposed to remove his food 2 hours before each pre-shot to get an accurate BG reading. However, Loki will beg for those 2 hours, and I don't want to exacerbate his condition. Is it ok to put out a zero carb treat (like totally plain boiled chicken) for those 2 hours before his pre-shot or would that affect his BG / the reading?

2. I'm confused about what to do if Loki's BG goes under 50. Do I treat this as a possible hypoglycemic episode - or - view it as progress and implement a reduction?

Much thanks,
Amy

 

[squeem3]

Most people give their cats multiple small meals spread throughout the day. A programmable timed feeder works well. Maybe schedule a snack 2.5 hours before the next insulin time so your cat's tummy is happy.

If there are no symptoms under 50, I would just monitor bgs closely for the next few hours and offer some medium carb food. At the next insulin time, decrease the dose by 0.25 units or otherwise suggested by a FDMB mod.

 

[Wendy&Neko]

If you have to feed 2 hours before giving insulin, a few zero carb treats is OK, though feeding 2.5-3 hour before is better.

If your kitty goes under 50, yes, you do have to give higher carb food. Cats differ in how carb sensitive they are. Medium carb does not work for all. Until you learn what works for you kitty at what point in the cycle (time between shots), I would stick with higher carb food. You do not want kitty lingering under 50, that can be dangerous. Some cats do not show symptoms below 50. I once caught my cat sleeping, but in the 30's.

 

[Loki'sMom82]

Wendy&Neko, I'm still in the first week of insulin and testing. On 0.5u and a low carb wet food diet, his PS numbers are low in the AM, much higher in the PM.

It's Friday night, and I was planning to continue 0.5u through Sat. and Sun., run a curve on Sun., then adapt dose on Mon. if needed.

Is it safe to wait till Mon. to adapt his dose or do the numbers imply I need to do this ASAP? Or is there something else the numbers are implying??

Thanks so much!!!

 

[Wendy&Neko]

From what I see, his AMPS is lower than his PMPS. I don't see any other tests after AMPS or PMPS, so we don't know how low he's going. Many cats go lower at night. Can you try to get any other tests between shots? Ideally in the 4-7 hours range afterwards, or at night before you go to bed, which might be earlier.

That 90 he saw this morning has me worried that he went lower before AMPS this morning. Can you do a curve tomorrow instead of Sunday? If he goes below 90, you reduce the dose immediately, you don't wait for the curve.

 

[Loki'sMom82]

Thank you!! Yes, since he had his PMPS at 8, I'll take his BG again at midnight.

I can't do a full curve tomorrow, but I'll work to get as many as I can a few hours apart and then check back in. Thank you so much!!