Newly diagnosed - lots of questions

[MrPawsKitten]

So much info to take in! So much conflicting information! So, could use some advice!

Background: Paws was diagnosed with diabetes on Monday, after having been lethargic all weekend. He had severe constipation, but his blood glucose was 482 so we discussed that it meant diabetes. He had also lost 2 lbs in 2 weeks (from 12.6 lbs to 10.5 lbs), which also indicates diabetes. They had to sedate him to flush the constipation (which was so stressful given his heart murmur), but he came out of the procedure just fine. Brought him home and rush-ordered insulin and new food.

That evening, he was doing very poorly so we took him to the emergency vet, where they said his blood glucose was 524 and he was severely dehydrated. No ketones in the blood or urine, though. They kept him inpatient for a day and a half to treat him with fluids and insulin. Brought him home Wednesday afternoon, and started home insulin shots.

So here are the questions:
Insulin Shots: I've been noticing a band-aid-like smell on his back after I give him his shots. From what I've read on here, it sounds like that's the smell of insulin - so I'm likely giving him at least a partial fur shot. But he's not at all wet after the shot, I'm sure I'm getting it inside his skin, and I'm not pulling the syringe out early. What am I doing wrong? Or is that just to be expected?

Food: Our vet recommended switching to DM. But the emergency vet said his kidney levels were elevated which would mean potential early kidney disease, and the DM would be bad for that. Before the diagnosis, we had been giving them Royal Canin selected protein PV or PR dry food (because Smokey, our other cat, has food allergies), supplemented by a 5.5oz can of Weruva BFF wet food shared between them every day. We've discontinued the dry food, and have since been giving them two cans each of BFF per day, since from what I've read it seems like it's a good balance of protein and fat, with low phosphates and carbs. But I'm at a loss as to what to do long-term, because it's expensive, and also particularly because Smokey has the food allergy issue. Obviously we need to find out about the kidney levels since apparently elevated kidney levels could just be dehydration - they're going in for complete tests on Monday. But otherwise, any suggestions?

Snacks: They're used to grazing all day. So this twice-a-day feeding schedule is not making them happy, and Paws gets sick (just clear stomach fluid) if he hasn't eaten in too long. How critical is it that they only eat when Paws is given the insulin? Or is it okay if they eat most of the food then, but then continue to graze on it for a couple hours?

Excessive Urination: We've noticed Paws is still urinating a LOT. I'm assuming that's just because the diabetes isn't yet under control?

Glucose Levels: While getting the meter all set up, in addition to testing Paws, just for kicks I tested myself and Smokey. We got the OneTouch Ultra2 meter. Paws's test at +4 was 284 - so still some work to do there; we're going to do a full curve at Thanksgiving. But Smokey's test was 49. He's never had any blood sugar issues, and he's behaving just fine... but even so, that's awful low, right? Should we be concerned?

Thanks in advance!

 

[Squalliesmom]

Hi, welcome to FDMB! We're glad to have you and Paws join us! Paws is a real cutie.

Let me try to answer your questions in order -

Insulin shots: Sometimes a bit of residue clings to the needle and sticks to the fur or skin, and will give you that band-aid smell. You will feel dampness if it's a fur shot.

Food: It is perfectly alright for him to snack all day, if that's what he's used to. As a matter of fact, we usually recommend feeding more than just twice a day, diabetic kitties seem to do better with several smaller meals per day. Some folks use timed feeders, but you can also just leave some food out; if you mix a bit of water in it, it helps it stay moist, and helps with hydration, too. The only time we don't want them to eat is two hours before shot time; we test before each shot to make sure it's safe, and we need a glucose reading that is not affected by food. As far as what to feed, we recommend wet or canned food that has less than 10% carbs. Here is a fairly comprehensive LIST of most of the readily available foods in the US.

Excessive urination: This is normal in an unregulated diabetic cat. However, it can also be a sign of kidney disease. My cat is very well-regulated, and does not have kidney disease, but has continued to pee absolute oceans every time he goes, so that's a hard question to answer definitively. You're vet can probably better answer that one, although my vet has no idea why my cat pees so much! I do add a good bit of water to his food, so that may be part of it.

Glucose levels: In a non-diabetic cat, 49 is within the normal range. It would be too low in a diabetic kitty. I'm so glad you are already testing, it's really vital to your kitty's health and well-being!

Have you has a chance to peruse this site? There are lots of "stickies" at the beginnings of the forums, they can give you lots of information and are worth reading. SInce you are using Lantus I recommend the ones at the top of the Lantus forum; also here in the General Health forum. Last, but not least, these on the tech support forum will help you to set up your profile and spreadsheet. Don't let the spreadsheet intimidate you, it's just data entry!

Feel free to post any more questions you have. The only stupid question is the one that goes unasked!

 

[tiffmaxee]

Hi and welcome. Yes there is a lot to learn but you are way ahead in that regard. The best thing you have done is to start home testing and joining the FDMB. . I wasn’t so smart, lol. If you don’t feel moisture I’d bet all the insulin is getting in except for what’s left on the needle which is likely not even a drop. It can take several cycles to see what this dose will do so while the BG is high he will urinated a lot.

Do you have the latest labs yet? If you can post them it might shed light on the status of his kidneys. I assume they checked for a UTI? What you feed him will depend on the results you are waiting to get. The DM is high carb so not ideal at all for diabetics. Most feed regular canned pates that are 10% carb or under. Check out Dr. Pierson’s food list for ideas. What were you feeding and did the issues from food allergies go away?

Many healthy cats have very low BG so Smokey is fine with a 49. Human meters read lower than pet ones but work really well for managing cats.

I fed Max who had chronic pancreatitis many small meals a day. I just tried to stop or give very little after +7 and nothing two hours before insulin. There’s no reason to feed only two meals.

I suggest that you to start posting on the Lantus board as more people will be reading to help you.

Keep asking questions. I can already tell you will be a pro very soon.

 

[MrPawsKitten]

Thanks so much for all the info! I've looked through the Lantus forum, and I think I have a better understanding of what we're doing. The vets did check for a UTI - there was no sign, so no worries there.

I'll try to get the labs when I have the cats at the vet on Monday, and will load them into the sheet.

For food, I originally had the cats on Blue Wilderness grain free chicken dry food, with a can of Fancy Feast gravy a day. Smokey crashed, and the emergency vet did an ultrasound that showed thickened intestinal walls - either cancer or IBS. We decided to presume it was IBS, so the vet had us switch to w/d - which he continued to vomit up, the only thing that stabilized him was Weruva chicken with added pumpkin. Once stabilized, the vet then put them on PV dry (and since that has been on backorder, switched them to PR dry)... they hate the PV/PR moist, so we've been giving them the BFF moist food, since we now know older cats should be primarily on moist food, and also know about Dr. Pierson's list.

I'll start posting on the Lantus forum tomorrow, still have lots of questions. Thanks again!

 

[tiffmaxee]

Does fancy feast pate agree with them? No grain or wheat but it is high phosphorus. We like answering questions here so keep them coming.

 

[MrPawsKitten]

They LOVE any kind of Fancy Feast, but with the possible kidney disease in both cats, I was warned away from it due to the phosphorus content. So that makes me nervous. I suppose I could try a phosphorus binder, but in the past any time I've tried adding anything to the food, they know and turn their noses up at it.

Another odd question - is there any reason to shy away from the $30 per 100 "damaged box" test strips on eBay? Cheapest I could find anywhere. A lot of those seem to expire soon but the ones I found don't expire until the end of 2018.

 

[tiffmaxee]

I bought most of my strips on eBay. As long as they have not been opened I wouldn’t shy away from a damaged box is sealed. Watch for auction. If willin to buy in volume that can be a really good deal.

If the ff agreed with them, look for lower grain free foods made of the same type of protein. Once Max’s kidneys were involved if was so hard to find food that worked for both.