Pablo: Dx 4 months ago, now otj

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Pablo's mom

Member Since 2013
Hi.
My name is Kim and my Pablo is a newly diagnosed diabetic kitty. He had a considerable weight loss and began to show signs of discomfort in his hips, which prompted my vet to test.

Thanks to your message boards, I wasn't able able to get my vet to re-write Pablo's script to the lantus pen, which I can buy individually. She says there are different preservatives in the pen and she's not comfortable prescribing it. Sticker shock on the insulin! :o ($200.00/vial) I'm an RN and have tested and treated people with diabetes for decades! but this is my baby boy. I want to get it right. Oh, yeah, and I'm not working right now. nailbite_smile

If I may, I'd like to ask a couple of questions. First, shouldn't the diagnosis be made over the course of several testing sessions? Second, he is on a moderate calorie mixed dry/wet diet for urinary tract crystals. Does anyone have experience with this?

Thanks! I think I'm going to need all the help I can get!

What should I do next? How can I help him best?
 
Re: Newly diagnosed 12 year old Pablo.

I know we recommend the insulin pens over vial because the amount of insulin you will use usually 1 unit or less - there will be less waste with the pen than vial. If you break the vial, you lose your insulin, if you break a pen, you open a new pen.

Additionally, there is a Lantus savings coupon you can sign up for on www.lantus.com that you will be able to get pens for $25 per pen. A huge cost savings over the vial.

Be sure to write the cat's name and list the DOB as a minimum of 18 years old in order to meet the requirements of the discount card.

Regarding food, we highly recommend feeding a low carb wet (raw or canned) food diet only. Dry food is not good for many reasons - see this link for the reasons why we don't like dry food. http://www.catinfo.org

It is easy to test for diabetes, typically the vet will do a fructosamine test, which will give the average BG over a 2-3 week period and is a good diagnostic tool. A glucose test as part of a blood panel workup may or may not be accurate due to vet stress.

We strongly suggest learning how to home test in order to avoid taking the cat in for curves, bg testing, etc. and to save you lots of money for those costs.

You can purchase a human meter, it is not necessary to buy a pet specific meter. If you have walmart nearby you can purchase the relion micro or confirm, which are inexpensive compared to other meters and require a small blood sample.

We can help teach you how to home test and get you set up.

If you tell us where you are located - city/state there may be a member local who can also help you.


There are three key factors to diabetes management - insulin, home testing and food.

Please keep asking questions and let us know how else we can help you.
 
Re: Newly diagnosed 12 year old Pablo.

Welcome to FDMB!

Vet stress may raise the glucose 100-180 mg/dL; normal glucose is about 40-130 mg/dL in cats. If the blood glucose is high (over 310, the combined high ends of the normal plus stress increase) and urine glucose is high, its pretty certainly diabetes unless some other medical condition is at play (steroids for allergies or other? dental or other infection? Acromegaly, Cushings, insulin autoantibodies?).

If he's on a canned low carb diet, he may not need the Rx food for crystals. Pop over to Cat Info - Urinary Tract Health to see why.

I hear you on the sticker shock; there are some Canadian mail order pharmacies that will honor the prescription and ship to the US.
 
Re: Newly diagnosed 12 year old Pablo.

By the way, none of our Lantus users have reported any problems using the pen. The insulin is withdrawn using a syringe, not the pen needles.

Starting dose should be based on the lower of the cat's ideal or current weight, in kg, multiplied by 0.25 and rounded down. a lot of vets get this wrong and start too high!
 
Re: Newly diagnosed 12 year old Pablo.

Thanks for the encouragement.

I'm in Seneca Falls, NY, and would love to hear from anyone around here that has learned from experience.

I want my little man to feel as great as he can!
 
Re: Newly diagnosed 12 year old Pablo.

Me again. Sorry, I'm trying to organize my thoughts, we just received the Dx today.

Would it be better if I make his food?

And the bright spot here is that all my cats have insurance, it's just the upfront costs that are a bit overwhelming.
 
Re: Newly diagnosed 12 year old Pablo.

If you want to make raw food you can, but I would start by buying it first or making a small batch to test out on the cats to see if they even like it, before investing time and money into it - I have one cat who won't eat it.

If I sneak a little into canned food she will eat it, but not on it's own.

There are several commercially available raw food brands available online and in pet stores most are frozen, or freeze dried- like Nature's Variety, STella & Chewy's, Darwin's Natural Pet Products where you can purchase a sampling for $15.00 (which is a good deal) http://www.darwinspet.com/order-now/CatsOrder1.aspx

If you have a specialty pet store nearby you may want to visit it and see what they have in the raw food section - bring Dr. Lisa's food chart with you so you can see if it's on the list and low carb (which is under 10%) http://www.catinfo.org/?link=cannedfoods

She also has a recipe for making raw food if you want to try that too.
 
Re: Newly diagnosed 12 year old Pablo.

Oh forgot to ask, where is Seneca Falls near? We have some upstate NY people, just not sure where they may be in relation to you...I'll send a note and ask them to pop over.
 
Re: Newly diagnosed 12 year old Pablo.

Seneca Falls is roughly half way between Auburn and Geneva on the Thruway.

I read Dr. Lisa's recipe...sounds like a good diet for all of my kitties. I will check out the pet supply stores around here and see if they have any foods that fit the bill and try those out on the group.

And you're right. The starting dose of insulin prescribed was too high, per calculation. What gave me an uneasy feeling about it was that I have given the same dose to many of the adult humans I've cared for. Seemed excessive.

Thank you for all the advice and support.
 
Re: Newly diagnosed 12 year old Pablo.

I mapped you on Google - It'd be about a 2 hour drive to get to Canada, plus time to go through the border crossing.

Sooooo... maybe get your passport and when you need to get a Lantus refill, go to Canada for it. And have a day trip while you're at it.
 
Re: Newly diagnosed 12 year old Pablo.

Again, thank you for your help.

Driving to Canada may be just the answer!

May I ask you what you think about a statement my vet made to me when I asked her what else I could do to treat Pablo?
She told me I could have him euthanized. Is it just me or was that an incredibly uncaring reply? It makes me uneasy.
Maybe I'm being over sensitive, but is it time for a new vet? Maybe one that takes a more holistic approach?
 
Re: Newly diagnosed 12 year old Pablo.

Sadly, it is a typical reply from some vets.

I think the reason they say that is that not all pet owners are willing or able to treat diabetes and rather than allow the untreated animal to die a slow, horrible death - because not treating diabetes that will happen, they will slowly starve and waste away, this is the only solution they have - treat or euthanize.

It's not pretty or nice, but it is a reality.

Right now you are hyper sensitive to things and anyone suggesting harm to your baby is going to set you off (it would set me off too), but if your vet is good and you have confidence in the vet, then maybe the vet was just telling you what the alternative to treating is and not being callous.

Just another way to think about it.
 
Re: Newly diagnosed 12 year old Pablo.

Thanks for calming me down...lol. Yeah, I'm pretty raw right now over the diagnosis. But I've read that often remission so possible, so we'll proceed ahead with happy thoughts.

Does anyone here know anything or have experience with protamine Zinc insulin (PZI)? It's supposed to be better tolerated by cats.
I did the research and bought canned Soulistic food (very low carbs, no grains, high protein and moderate fats) today for the whole crew. Since we haven't started the insulin yet...but will tomorrow...I will get with the vet and see what she thinks. I'd like to make the change to Dr. Lisa's homemade raw diet. I already have the glucometer. I think part of the problem is the dry food he's been on for so long (very high carbs for some reason), but the super low carbs and high protein should help.
Again, thank goodness for pet insurance, right?
 
Re: Newly diagnosed 12 year old Pablo.

Prozinc is the newer variation of pzi and it is a good insulin. It works differently than Lantus and Levimer in that it is more of an in and out insulin and does not build up in the system like Lantus and Levimer.

If you have a schedule that needs a bit more flexibility, prozinc may be a better choice, because it allows a bit more fliexibility in dosing amount and timing.

All insulins need to be dosed in 12 hour increments and best to be conservative in the dose amount, meaning using a start low, go slow approach - a low dose is starting at 1 unit or even 1/2 unit.

It is a little trickier to dose at 1/2 units with prozinc because it uses U-40 syringes and I don't believe they come with 1/2 unit markings. If you ask the vet to write you a scrip for U-100 syringes with 1/2 unit markings, you can use the conversion chart to be able to micro dose. The vet may not want to do this as U40 is the syringe used for this insulin, but if you tell and show the vet that you have the conversion chart and want to be able to do in 1/2 units, hopefully the vet will agree and write the scrip.

Here is the conversion chart link:

http://gorbzilla.com/conversion_calculator.htm


If you go to the insulin support group for PZI you can read more about this insulin and lantus, levimer.
 
Re: Newly diagnosed 12 year old Pablo.

This is an option if your vet won't write for the U-100 syringes.

Making a Cardboard Reference Gauge for Half Units or Smaller.

If your syringes do not have half unit marks, you may approximate a measurement reference using a compass, a ruler, a fineline pencil, and some white cardboard (for sturdiness). This is most useful for U-40 syringes.

Draw a line equal to the length of 1 unit based on the syringe you are using. (If you change syringes, you may need to repeat this process.)

Using the compass, position the pin at one end of the line.

Set the compass angle to draw a small circle which is slightly more than halfway across the line.

Keeping the compass at the exact same angle, position it at the other end of the line and draw another circle.

The circles should overlap; if not, make the circles slightly bigger.

Using the ruler, draw a straight line between the 2 points of intersection between the circles; this marks 1/2 unit on the original line. (This line will be perpendicular to your original line.)

Repeat the process using 1 end of the full line, and the halfway point; that will get you about 1/4 unit.

If you can repeat it again, that would get you 1/8 unit.
 
Re: Newly diagnosed 12 year old Pablo.

Thank you both so much. I was freaking a little, but with the tips from you, and the research I've done and Pablo's sweet, loving heart, we're going to do this.

I owe him a LOT!
 
Re: Newly diagnosed 12 year old Pablo.

hello and welcome to the board

Did you get the insulin yet? You might want to wait a few days to see how the food change is working before starting insulin - assuming the vet didnt mention ketones. Plus I would second what the others said and start home testing his blood. Its more accurate due to no vet stress, plus cheaper. It will show you if the food change is working. We can recommend meters etc.

A pack of 5 Lantus vials is $100 at Costco in Canada. Last you 6 months if not longer if you keep them in the fridge.

Wendy
 
Re: Newly diagnosed 12 year old Pablo.

Thank you!

I am waiting a few days to see what the new food does. The vet said no ketones were present in Pablo's urine. He loves the new food (whew!) and all the others do too, so that simplifies things a bit.

I have a glucometer and we are going to start testing tonight. He's been a bit more alert and I have all reason to believe that he's going to react well to treatment.
 
Re: Newly diagnosed 12 year old Pablo.

Yep. I have ketosticks already, and I just bought a regular people glucometer, same as we use in the hospital.

The irony is not lost on me that I am hypoglycemic, that's why I had the test strips.
 
Re: Newly diagnosed 12 year old Pablo.

Ah but the difference is that many cats go into diet controlled remission whereas humans don't. The key factors are a low carb canned food, lantus or other good insulin and home testing to keep tight control of dose.

We won't wait too long on starting insulin if he doesn't respond to the food quick enough because the window for remission is only about 6 months and cats can bounce for quite a while. Read the stickies here to find out more.. http://www.felinediabetes.com/FDMB/viewforum.php?f=9

You have a distinct advantage from many newbies in that you understand the disease.. Now we just need to get your understanding for how it varies for cats,

Wendy
 
Re: Newly diagnosed 12 year old Pablo.

First round of BG testing: before meal - 127. 1 hour after - 217. No ketones in urine.

This is without the insulin. We'll move to the insulin tomorrow.
 
Re: Newly diagnosed 12 year old Pablo.

The initial starting dose should be low, for safety; 0.5 to 1.0 units is about the most a cat on low carb food should start at.

We advise new insulin users not to give insulin if the cat tests below 200 mg/dL.
And normal glucose levels are 40-130 mg/dL when not on insulin, so those, too, should not get a shot.

If you chose to give insulin between about 150-200 mg/dL, you must be home to monitor and test, and be prepared with ample testing supplies, high carb gravied canned food, and Karo or other syrup, because the response to the insulin is unknown. It could be OK, it could be not enough, it could be too much - when in doubt, go for safety and being prepared.
 
Re: Newly diagnosed 12 year old Pablo.

The vet originally prescribed 2 units, but that was based on his BG at the office when he was uber stressed. She also told me there was no way I could check it at home, but I found out the where and how in here, and he did well with it.

I followed the dosing guidelines y'all gave me, and that was high based on his weight.

We're taking it slow. And yes indeed I have Karo and some gravy food just in case.
 
Re: Newly diagnosed 12 year old Pablo.

Ok - just want you to be prepared! There's nothing worse that seeing the cat go into seizures from a hypo and not being able to intervene. We lost a couple this past year, because the vets did not start low, nor prepare the client to intervene.
 
Re: Newly diagnosed 12 year old Pablo.

I won't keep posting all his test results, but this morning, his BG was 117 before eating and 189 an hour and a quarter after eating.
The change in diet seems to have done him some good. I can tell I'll have to be extremely cautious with insulin. No way am I going to send him into hypoglycemia.
 
Re: Newly diagnosed 12 year old Pablo.

Was it Lantus that you decided on in the end?

We don't advise newbies shoot under 200 as they don't have the data to know how low the cat will go. I suspect your food is already kicking in and would be inclined to wait a few more days before starting insulin. Remember normal cats are 50-130 and he isn't much higher than that.

Also 2 units is WAY too high a starting dose - if he goes over 200 I wouldn't give him more than 1 unit. What do the dosing guidelines say about dose based on weight? But again I would not shoot if he is under 200.

Wendy
 
Re: Newly diagnosed 12 year old Pablo.

Thanks, Wendy.

I did not give him the lantus yet. I have it, but he was so close to the normal range that I felt it best to be conservative.
I expect there will be up and down values as we get Pablo regulated.

I agree that the new food is helping quite a bit.

I knew that the 2 unit dose was way high to start. I have given that much to human patients, and it doesn't sound right to me.

Kim
 
Re: Newly diagnosed 12 year old Pablo.

Pablo's started the Lantus and he's tolerating it well. His BG is starting to move down. So far, the most I've given him is 1u.
 
Re: Newly diagnosed 12 year old Pablo.

Sunday: before meals, 217, 189. After, 256, 238
Monday: before, 209, 215. After, 248, 307
Today: 220 this AM before, 257 after.
 
Re: Newly diagnosed 12 year old Pablo.

Can you tell me how these relate to shot time?

ie

Sunday shot 1IU at 8am and measured at 300 . + 2 measured at 256 (+ 2 means 2 hours after shot)

thanks
Wendy
 
Re: Newly diagnosed 12 year old Pablo.

Four months later and we are here: BG levels are measuring consistently between 55 and 100 without insulin. He remains on a mixture of home-made food and a raw food diet.

What does this mean?
 
Re: Newly diagnosed 12 year old Pablo.

This means that he is Off The Juice! Meaning, he no longer needs insulin and is now diet controlled. How long has he been giving you such great numbers without needing insulin?
 
Re: Newly diagnosed 12 year old Pablo.

I was hoping! I'm going to keep close watch on him, just because. He's been giving those readings for three weeks now. He's playing with his brother and sisters more than he ever did, and RUNS around the house.

It just feels so good to see him happy and well again.

Y'all were so helpful and supportive! I'll keep you posted.

Thank you!
 
Re: Newly diagnosed 12 year old Pablo.

You might go back to your first post, edit the subject line, click on the OTJ icon, and submit.
 
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