Newly Diagnosed

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paul

Member Since 2014
Hi all,

So a bit of background info about my cat who has been newly diagnosed with diabetes.

A month ago my 14 year old cat, Julius, started getting conjunctivitis in one of his eyes which he has suffered from his whole life and normally passes in two days but this one lingered for a week so I called the vet in to check his eye. At the same time I had started suspecting he may have diabetes because he was eating up to 5 cans of food (Fancy Feast) a day and drinking bowls of water (he weights just over 5kg). The vet did a blood and urine test and confirmed he had diabetes and also prescribed ointment for the bad eye.

The vet immediately told me to start giving him 2 and a half mls of Lantus and to change his food to a vet prescribed low carb diet immediately. This was a huge shock to me that I would have to start insulin right away and stop all his favourite foods to a brand only sold at a vets which I was told was quite 'bland' tasting.

The vet taught me how to do the insulin shots but after reading a lot online I refused to give him 2 and half mls as I thought that was a lot from what other people had started their cats on. However I have since learnt that the syringe sizes in Australia are different than the UK and US so it may not be as much as it sounds. Even though I started him on only 1 and half mls of lantus.

10 mins after the shot Julius immediately curled himself in a ball and started thumping his tail like he was really angry and annoyed. Then he ran towards one of the bedrooms and was preparing to squeeze himself under the bed to hide. I could tell something was wrong so I picked him up and reassured him for a while and when I put him down he ran to the pantry cupboard in kitchen and starting scratching at the doors wildly. I opened the pantry cupboard and he jumped in and curled himself in a corner and just hung his head down. This is totally unheard of behaviour from him.

Naturally having just learnt about diabetes a few hours earlier and having basic knowledge about feline diabetes I assumed he was having a hypo because I could tell something was wrong. I called the vet and he said don't worry about it and that I was watching him too closely. I was NOT reassured. Still I gave my cat some sweet cane sugar and watched him. After several hours and much worrying from me he came out of the cupboard and ate some food and seemed ok.

I had calmed myself and thought it was just a one off reaction so 12 hours later I gave him another shot and the same behaviour again. He just became very restless and almost acted like he didn't know where to run and hide. I called the vet and he said it can't be a hypo because that would happen an hour after the injection and that my cat must just not be liking the injection.

OK so I thought I will try once more 12 hours later and just sit with Julius for as long as I needed.

I did another shot 12 hours later and sat with him and boy did he became an angry cat about 15 minutes after his lantus injection. This is a cat I've had for 14 years and is the gentlest cat anyone has ever met. For me to see him angry and agitated is behaviour that I had never seen until these injections.

Anyway I called the vet and I told him that I was stopping his lantus injections until my cats conjunctivitis had cleared up because I felt like too much was happening to my Julius. He was getting new food which he didn't like much, lantus injections and ointment squeezed into one of his eyes. I thought it was all too much and I decided I would deal with one thing at a time and my priority was to get his eye better.

Once I stopped the lantus he was a happy cat again without the injections. Then one morning I went to put ointment in his eye and I saw the eye had a thick white substance growing over it so I immediately got a specialist involved who looked at the eye and found an ulcer which Julius had apparently scratched and the white growth was only a scab healing over it so I was prescribed some eye drops 6 times a day.

I thought it was a good time to get a second opinion on my cats diabetes. So with a second vet we did a glucose curve over 12 hours which was three tests 4 hours apart. His results were, 17.3, 17.6 and 15.4 - if that means anything to anyone, the numbers may be different here in Aus. I told the vet that this was my second opinion and she confirmed those results meant diabetes and to start the lantus I already had in the fridge but on a smaller dose since I had explained my cats previous reaction and I wasn't comfortable with a larger dose.

So two days ago I prepared myself to start the insulin again but on an even lower dose, only one ml. Within 15 minutes he started getting really angry and wanted to hide so I reassured him and again he went straight for the pantry cupboard and hid right in the darkest back corner and hung his head down and shut his eyes. I tried to give him his absolute favourite treat to eat and he wasn't interested so I gave him some sugary stuff which he ate then his tongue was just hanging out and his head was side ways which literally started giving me a heart attack and I just sat with him and watched him closely but he still hid in there for hours. The injection was at 7pm and he finally came out of hiding after midnight.

I must also mention that all these lantus shots were given straight after eating a full bowl of food and 12 hours apart. And I will also mention that both vets had checked my technique about how I was administering the injections and it was correct.

Its obvious these insulin shots are affecting his behaviour.

My question is has anyone else heard about or seen this sort of behaviour in their own cats or other cats after a lantus injection??

I called the second vet and told her about his reaction after the first shot and she said it can't be a hypo because that would happen several hours after an injection. I told her the first vet said a hypo would happen after an hour. Its all very confusing. I have stopped his insulin and needless to say he is once again happy (his eye ulcer scab is almost better btw).

He is having the second vet visit again in a few days and she wants me to give him an injection of lantus while she is there and then she will immediately check his glucose level to reassure me he isn't have a hypo and she suspects its a 'behavioural problem'. To me its strange that a cat I've loved for 14 years suddenly has behavioural problems only when he is given an injection on insulin.

I can not find any other people online that have mentioned this sort of behaviour from their cat after insulin. And the only thing I can think of is it is mild hypo because he gets angry and restless and just wants to hide for hours after an injection. I should also mention that naturally when he has been hiding after the injection I constantly check on him and his legs just twitch and twitch. And its not the twitching from dreaming either as his eyes are open and glassy and his limbs just twitch like crazy. I've told all of this to both vets but I keep being told its not a hypo and I am either watching him too closely or its a behavioural problem. I respect both these vets opinions but at the same time I have known for 14 years every sound, movement, motion and habit that my cat does and I know when something is not right with him.

I have also told the second vet I want another complete blood and urine test done again to double check for diabetes. Although he has all the symptoms I just want it all done again.

Any advice from anyone about reactions to lantus and if this behaviour is normal when a cat starts insulin would be greatly appreciated. Its all very bewildering and I'm ready to take on the commitment to take care of him but something just doesn't feel right about these injections I'm giving him.

I also emailed my vet today and asked about giving Julius just a blank injection (no insulin or air) to test whether it is simply the injection that is annoying him but I haven't heard back from the vet yet.

I would also like to know if other diabetic cat owners out there feed their cat Fancy Feast? Both vets have told me to stop feeding him that and give him a brand called M/D which is sold only in Australia at vet clinics and is low carb and high protein but I have compared the protein/carb values in the M/D brand to the Fancy Feast and FF actually has quite a few options that have less carbs than the M/D brand and higher protein, so once again I'm confused and would like to know if FF is ok to keep giving to him.

I thank everyone on here for all your advice, in two weeks I have learnt so much about feline diabetes.
 
Paul,

Welcome to the FDMB. I'm still fairly new here and some of the more knowledgeable and experienced members will stop in to help you. I can tell you that the M/D is not necessary. The general rule of thumb for sugarcats is to feed them canned food with no more than 10% carbs. You can check out this Food Chart from catinfo.org to find a variety of foods that are 10% or lower. I suggest surfing through the website. There is a lot of educational info there. Including a bit about "prescription or alphabet diets" and how they're over priced and not necessarily high quality.

I can understand wanting to listen to the vet but I agree that no one knows your cat better than you. If you think something is "off", then absolutely question the vets advice. I know cats generally don't like getting sticked/poked (neither do we :smile: ) but it certainly seems odd that your cat would start to shake and hide. Again, I'm new but that sounds like a hypo to me.

I know you have a lot going on but some things that will likely be suggested to you are:

1. Start Home testing. Most people here use human glucose monitors with cat specific reference ranges. A couple of the more popular models are the ReliOn Confirm and ReliOn Micro, both can be purchased at Walmart. Here's a link on Home Testing Tips

2. Also, it would good for you to set up a spread sheet to record your cat's blood glucose readings and link it to your signature. You can step by step instructions Here. This helps advice givers to better understand how your cat is reacting to the insulin.

3. When you have some time to read you should start with the New to Group Sticky

Again, some of the more experienced members can better answer your question about why your cat could be reacting angrily from the injections. If it's okay to give him a "fake" injection or not. I just wanted to give you some basic info. GL!
 
You can give him an injection of the same amount of water, it won't hurt him. I did that to practice giving insulin under vet's supervision.

Sorry to hear Julius is having a tough time. But he's lucky to have you to look after him.

Lori
 
Idea #2: Take him to the vet and ask the vet to inject him there and hang out 15 minutes so they can see his worrying behavior. They should have an empty room you can hang out in to keep an eye on him, if not he can sit in his carrier until he gets weird.

Lor
 
Yes, some cats can have behavioral changes with Lantus. It has a slightly acidic pH and can sting, too. You may need to switch to Levemir or ProZinc which also are long acting insulins.

Starting dose for Lantus is based on lean body weight - the lower of current weight or ideal weight.
How much does your cat weigh?
How much should your cat weight?
Take the lower number
Convert to kilograms (pounds / 2.2)
Multiply by 0.25
Round down to nearest 0.25

You are dosing in insulin units, not milliliters.
- 1 mL has 100 units in it (U-100) for Lantus or Levemir; 40 units for ProZinc. BCP PZI can be either concentration

Lori&Scout said:
You can give him an injection of the same amount of water, it won't hurt him. I did that to practice giving insulin under vet's supervision.

Sorry to hear Julius is having a tough time. But he's lucky to have you to look after him.

Lori

STERILE water. Tap water may have contaminants.
 
Yes, good point on the sterile water!!! I'm planning to use bottled water to teach my boyfriend and catsitter how to shoot. Hopefully that's sterile enough.

Lor
 
Nope. Bottled water may not be sterile; don't risk that.

Have him practice injecting on an a piece of chicken with skin using a syringe and anyliquid you want. A colored liquid will let you peel back the skin and check.

Pinch up some skin.
Push in the needle in the tent
Press in the plunger
Pull out the needle

Dispose of sharps as required by local law.
 
Lori&Scout said:
Yes, good point on the sterile water!!! I'm planning to use bottled water to teach my boyfriend and catsitter how to shoot. Hopefully that's sterile enough.

Lor

Maybe ask the vet where to get some sterile saline to use for injection? It should be cheap if it is a safe thing to use.
 
Check our SHOP link and search your local version of Amazon for sterile water.

But if you practice on a piece of chicken with skin first, you don't need sterile wate. Any liquid will do.
 
Thank you for all the info. It has been invaluable.

The vet eventually called me and told me I can stick him with just air or saline to test his reaction to the needle. I didn't have any saline so last night after Julius ate his meal I went about the same motions I did in the past and prepared him for his shot and gave him a lovely dose of natural air under his skin. I checked the syringe and saw it was a bit moist so I knew the needle must have gone on. I went to the lounge as I had in the past and just watched him from there. 5 mins, 10 mins, 20 mins and even an hour later no reaction to using just the needle with no insulin. He acted completely normal and went about his normal business. Even when he was out of sight and I checked on him he was just very relaxed and cleaning himself after his low-carb Fancy Feast - everything perfectly normal.

Just to be 100% sure I decided to give him another dose of air tonight after his meal and just as above no reaction at all. Right now he is quite happy and is currently asleep with me on the lounge one hour after the shot.

Ordinarily, one hour after his shot he has gone literally glassy eyed, frantic and very very anxious before settling on a dark place to huddle into a ball and stay away for hours.

I'm a bit disappointed as I was hoping he was just feeling put out by having a needle after eating but now its obvious that it is the insulin. And as mentioned Lantus can cause a reaction in a cat. Its just the reaction he has is so severe. He just goes ballistic and crazy after his shot and its frightening to see his eyes glass over as he runs for a dark place to hide. How can I deal with that twice a day in the past I feel like I've been injecting him with poison and something that is hurting him.

I have the vet coming again on Wednesday (I get home visits which are surprisingly cheaper than taking him to the clinic for some strange reason) and I will get her to draw blood and urine and just get a second lot of results. It will make me feel better. And as she mentioned over eating and drinking could be symptoms of something other than diabetes so I just want to be 100% sure diabetes is what he has. I would hate to be injecting him with insulin if he didn't need it and if he does than I don't know how I will deal with his reaction but I will definitely talk to the vet about other types of insulin.

I will also talk to her about a glucose meter as it sounds like they are just as important as the insulin and I would feel more comfortable if I could home test him daily as well.

When I start his insulin (if indeed he has diabetes) then I will also begin a spreadsheet to keep a record of all his details.

I am also going to keep giving him the low-carb Fancy Feast varieties. The formula the first vet told me about called M/D has just the one single low carb flavour which I was told is 'bland' tasting. Julius would starve and refuse to eat that for the rest of his life I know what he is like - a fussy eater. He is even turning his nose up at the Fancy Feast low carb options as he is use to the gravy filled ones and fish and crab varieties but fortunately he does eat the low-carb tins just a bit slower. He has been happy eating Fancy Feast for 14 years so it will be a relief if I don't have to change his diet too much.

And if he is 100% confirmed to have diabetes do you think its wise to start insulin with a low carb diet? I remember the vet telling me that his numbers aren't high and he certainly isn't near to being in a life threatening situation so perhaps I should just keep him on the low-carb diet and test his levels myself before starting insulin. I don't know I'm not sure. Obviously it would be ideal if he didn't need insulin and could just be on a low-carb diet only. And I have to admit in the past he certainly has been spoilt for food. I was also giving him those Fancy Feast Broths, they are those little soups in the packets. I was giving him up to 4 a day as well as his regular tins. It wasn't until I read the label on the back of the broths that it states to give them one every 24 hours. I felt terrible as that could have caused the diabetes. Now I have stopped giving them to him as much as he loved them I just got the feeling they may be packed with delicious naughties as he would go wild whenever he saw a packet.
 
I'd start with the food change asap.

I would insist on a different insulin than Lantus. Levemir is another depot insulin, ProZinc is a non-depot insulin that may work well, too.

And I'm very surprised the vet had you inject air. Why? Because if air in inadvertently injected into a blood vessel, it can cause an air embolism, which can be fatal. There may have been a very slim chance of that, but it doesn't seem like a good idea to me.

We've all had the realization of "d*mn I may have caused my cat's diabetes". If you look at what is being marketed and at how the ingredients are labelled, though, you may see that we've not been told the truth about cat food and feline nutrition. We were duped. And vets' nutrition training is often a seminar by the food manufacturer, which is undoubtedly biased towards their products.
 
BJM is right - injecting air can be very dangerous if you hit something you shouldn't. I would get the vet to give you some saline solution. That's what they had me practice with.
 
Injecting a couple of "units" of air directly into a vein should not cause any problem.

Generally, small amounts of air are broken up in the capillary bed and absorbed from the circulation without producing symptoms. Traditionally, it has been estimated that more than 5 mL/kg of air displaced into the intravenous space is required for significant injury (shock or cardiac arrest) to occur.[1] However, complications have been reported with as little as 20 mL of air[7] (the length of an unprimed IV infusion tubing) that was injected intravenously.

http://emedicine.medscape.com/article/7 ... view#a0104
 
This may not be the problem, but have to ask...
Lantus requires the use of a U-100 syringe. Are you sure you're using U-100 syringes?

Your reference to shooting "mLs" of insulin combined with kitty's behavior following a shot is concerning. 1 mL of insulin would certainly overdose any cat other than some with high dose conditions. For that reason I think it's important to verify the use of the proper syringes for the insulin you're using.

Here's a picture of the markings on a U-100 syringe that is 30 units or less, measured in whole or half-units:

resource.gif


Do either of the markings shown above match your syringes?

Somewhere on the box the syringes came in or on the syringes themselves it should say something like "3/10 cc/mL (30 units) with half-unit markings for U-100 insulin" or "3/10 cc/mL (30 units) with whole unit markings for U-100 insulin" or "U-100 INSULIN".



BD Syringes are very popular in most countries (not-so-much in the USA for some reason):


(Click on the picture to enlarge)


It would be helpful if we could rule out the possibility of a problem with over-dosing because of the use of the wrong kind of syringe. We've seen it happen here more than once...
 

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And U-100 means 100 units of insulin per milliliter (mL).
Are you filling the entire syringe?
 
When I injected Julius with the air I did pull back on the plunger to see if any blood would appear in the syringe and whether I had hit a vein with the needle and it was ok on both occasions. We've all heard the horror stories about air in syringes so I was careful to make sure I wasn't doing that to him. Thats the way the vet taught me to do it so I hope that was right.

And I am using the U-100 syringes with the lantus as that is what is stated on the box of the syringes. In the pic below the syringes are identical to the one on the right and I was filling it up just over that very short first line (not the larger line up to the 5). So it equalled one and a half mls/units.

resource.gif


I do have another question though. How fast does hypo come on for a cat? Both vets said it can't possibly come on in 10 minutes but for some reason he is showing symptoms of hypo shortly after the injection. He is restless, glassy eyed, there is head tilting, wanting to hid, not interested in his fav foods and limb twitching. Plus on one accession his tongue was just hanging out. I have never seen that behaviour in 14 years.

I'm pretty sure after his second round of blood/urine tests he will still test positive for diabetes so if that happens I don't think I am going to feel comfortable giving him anything more than half a ml of lantus (if I don't swap insulin types that is).

So, is it possible for hypo to come on within 10 minutes? In particular a cat that doesn't even have a build up of insulin in his body? What if a cat didn't need insulin and was given insulin - would they go hypo?
 
paul said:
...And I am using the U-100 syringes with the Lantus as that is what is stated on the box of the syringes. In the pic below, the syringes are identical to the one on the right and I was filling it up just over that very short first line (not the larger line up to the 5). So it equalled one and a half mls/units.
...
I'm pretty sure after his second round of blood/urine tests he will still test positive for diabetes so if that happens I don't think I am going to feel comfortable giving him anything more than half a ml 0.5 units of Lantus (if I don't swap insulin types that is).

So, is it possible for hypo to come on within 10 minutes? In particular a cat that doesn't even have a build up of insulin in his body? What if a cat didn't need insulin and was given insulin - would they go hypo?

You may be seeing a reaction to the Lantus and may need to use a different insulin.

Also, this needs to be very clear. You are dosing units, not mL. 1 mL = 100 units. 1.5 mL=150 units!

If a cat did not insulin and was given some, it could be fatal. That is one of the reasons we home test.
Short-acting insulins such as Regular or NPH can drop the glucose abruptly., That is why they are difficult to use in managing feline diabetes.
 
happy to hear you're using the correct syringes. every once in awhile someone comes through here who has been given the wrong kind of syringes.
paul said:
So, is it possible for hypo to come on within 10 minutes? In particular a cat that doesn't even have a build up of insulin in his body? What if a cat didn't need insulin and was given insulin - would they go hypo?
--- i have not heard of any cats who have had a hypo within 10 minutes of having received an injection of Lantus insulin ever.
--- i've seen several instances of a caregiver giving insulin to the wrong cat... a non-diabetic cat. they've turned into non-events, but it's probably because the caregiver took immediate action to counter the effects by feeding high carb foods.
 
Yes I'm not sure why I keep saying mls instead of units but its units I should be saying.

I also couldn't find any evidence anywhere of another cat experiencing a hypo 10 minutes after a shot especially a cat that has no build up of insulin in their body over days and weeks but I am going to discuss other insulin options with the vet on Wednesday because there is no way I can stay calm with a reaction from Julius like that twice a day - they sure do like to make us worry sometimes don't they?

As mentioned before I'm getting another lot of blood/urine tests done on Wednesday. With the first lot I just kept repeating over and over to the vet that I was sure Julius had diabetes but the vet was sceptical until he called the next day and casually said it was diabetes but I remember him also saying he found an irregularity with Julius' kidneys but said not to worry he has diabetes and needs 2 and a half units of Lantus per day. Looking back I just feel like my constant arguing with the vet that he had diabetes may have swayed him to believe that and so didn't investigate the kidney issue much further - which could explain the excess thirst if he has kidney problems.

I don't know my mind is a bit confused, part of me thinks he is having such a bad reaction to lantus because he doesn't need it and because the dose has always been very low it hasn't been fatal, plus every time I managed to give him sweet syrup during these episodes. But another part says he has diabetes but probably needs a different insulin. Then another part says he has kidney problems - my mind is on overdrive with possibilities.

I have a question actually. I was reading on here yesterday how someones cat was perfectly normal and then within a few weeks the excess eating and drinking came on and that members cat starting dragging is back feet and was diagnosed with diabetes all within a few weeks. How fast does the diabetes happen? Because I can confirm that Julius has been eating and drinking excessively for at least a year if not more. And yes it was bad of me not to have him checked but I just assumed he was getting older and bored and therefore eating more and because some of those Fancy Feast varieties are quite salty (especially the fishy ones) he was drinking more as a result of more food. I didn't even know cats could get diabetes until recently when I literally stumbled upon it by accident.

In any case we should get the blood/urine results back in 24 hours after Wednesday so I will know more by Thursday I guess.
 
Switching to low carb canned food is good for both diabetes and renal disease, except you want to keep the phosphorus lower. The Friskies Special Diet Pates meet those requirements.

A urinary tract or other infection can temporarily elevate glucose levels, so if one was present, then treated, the need for insulin would vanish.
 
Has your kitty been tested for other diseases like hyperthyroidism and kidney issues? Perhaps your kitty is having some sort of allergic reaction to something in the insulin such as a preservative and though it is said that lantus can sting you wouldn't think it would cause a reaction like you are seeing because it stings. Trust your instincts.
 
You asked about diabetes coming on suddenly. Well the diabetes won't have come on suddenly but visible symptoms can and do. Just 2 months ago my perfectly healthy (on the outside) kitty started walking funny on his back legs. I immediately took him to the vet as I susoected kidney disease which also presents itself with back leg weakness abd I had lost z previous cat to it. after blood tests were done he came back with high BG and pronounced diabetic. To me it was very sudden but cats like to hide their illnesses from us.

Juliet and Silver
 
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