Should I use insulin or diet change?

[Gabrielle90]

Hello. My cat was diagnosed a week ago with diabetes. His levels were 359 with no urine ketones. At time of diagnoses he also was diagnosed with a uti and a tooth infection. Uti was treated yesterday with a antibiotic shot. Yesterday at the vet I was given prozinc and advised to give 2 units , 2 times a day. I was also told not to test for the first 10 days alone when I asked… obvious red flag.

He’s been on elseys dry food and Sheba wet pate for 4 days now.

Today is Saturday and I was going to start giving him insulin on Sunday morning and I wanted to use Saturday as a test day on testing his glucose myself. However this morning I gave him Sheba and decided to test him and his glucose was 271 after eating. I’m very scared to even give him insulin especially not 2 units with such low numbers. What does this group advise to do? Should we see how a diet change works , should I do a low dose of insulin? I’m so scared to hurt my cat

 

[Wendy&Neko]

Hello and welcome. You've got good instincts - 2 units is too high to start. Depending on insulin type used and dosing method followed, most people start around 0.5 or 1.0 units here.

You are also right that we don't wait to test blood sugars. Also, good job on the first glucose test. What type of meter are you using?

What food was he eating before the food transition? 4 days should be enough to get any higher numbers from his old food mostly out of his system. The antibiotic can take a couple days to really start working the infection, so that's an excuse to hold off one more day.

And one more questions - sorry about that. Are you testing ketones at home? You can get urine dipsticks like Ketostix to just keep an eye on things if you do hold off insulin any length of time. I've seen kitties that need dentals throw ketones. Any plan on fixing the tooth infection.

And finally, we ask people to put some information in their signature - so we don't have to keep asking as many questions. Details are in this post: New? How You Can Help Us Help You!

 

[Gabrielle90]

Hello and welcome. You've got good instincts - 2 units is too high to start. Depending on insulin type used and dosing method followed, most people start around 0.5 or 1.0 units here.

You are also right that we don't wait to test blood sugars. Also, good job on the first glucose test. What type of meter are you using?

What food was he eating before the food transition? 4 days should be enough to get any higher numbers from his old food mostly out of his system. The antibiotic can take a couple days to really start working the infection, so that's an excuse to hold off one more day.

And one more questions - sorry about that. Are you testing ketones at home? You can get urine dipsticks like Ketostix to just keep an eye on things if you do hold off insulin any length of time. I've seen kitties that need dentals throw ketones. Any plan on fixing the tooth infection.

And finally, we ask people to put some information in their signature - so we don't have to keep asking as many questions. Details are in this post: New? How You Can Help Us Help You!

Hello. I’m using the relion premier classic.
Before dr elseys and Sheba we used the Tiki cat high protein and mostly friskies pate or shreds.

I do plan to get his tooth fixed but his current vet did not want to do it until his numbers were stable. I don’t have much trust in this vet though and they pushed back on my feeding him dr elseys and home stuff and really wanted me to feed hills. I do not test ketones at home no, I haven’t bought those yet.

I just don’t know what I should be doing. Im so baffled that my vet would even suggest a high dose and tell me not to test. It seems like this is common though. It’s very scary to have to take this into my own hands.

How often should I be testing at home and how long to decide is diet change alone is working? How often before feeding, middle and during? Thank you so much

 

[Ale & Bobo & Minnie (GA)]

ReliOn is a great meter and yes, sadly most vets do not know a lot about feline diabetes….they have many animals to look after and they all have different diseases and treatments. Vets also get their information about nutrition from the big cat food manufacturers so they are biased in what they recommend. Were you feeding the higher carb tiki foods?

I’ll let Wendy chime in about the food transition. As far as testing right now before insulin, it would be a good idea to test at least once a day to get a sense of where his numbers are. Once you start on insulin, you’ll want to get an average of 4 tests a day. Always get a preshot test before each insulin shot and for these you want to withhold food for at least 2 hours to make sure you got a value that was not influenced by food so you know if it’s safe to shoot. Then you want to get a midday test, to try and pinpoint his nadir (lowest bg in an 12-hour cycle and that’s typically around +6 with Lantus and prozinc) and a before bed test to see where the numbers are headed overnight.

270 is still a diabetic bg but he may not need that much insulin and I’d definitely start with the lower dose Wendy suggested.

 

[Sienne and Gabby (GA)]

The Tiki cat was likely fine. Most of their line of food is low in carbohydrates. This is a chart that has the nutritional composition of most of the canned foods available in the US. Any food that is less than 10% carbs is what we consider low carb. However, most of the members here feed their cat in the 5% carb range. If you are using the Dr. Elsey's clean protein line of food, it is low in carbs.

Unfortunately, vets do not get much training in nutrition. They get a minimal amount when in vet school and the rest comes from the food manufacturers sales reps who sell them the "prescription" food. Just an FYI, none of the so called prescription diabetic foods are prescription. The manufacturers lost a class action suit for calling the food "prescription." In fact, many of the diabetic foods, especially the kibble, is quite high in carbs. Your instincts are very good!

We have a slightly different mindset than most vets. While it's important to get your cat's diabetes under control, it's easier on your nerves to start at a lower dose and gradually increase versus starting at a higher dose and risking hypoglycemia. The latter is panic worthy and is especially an issue if you aren't testing and don't know what's happening with your cat's blood glucose levels. Hence, we are strong advocates for home testing. It also means you don't have to take your cat to the vet for a curve. While it may be scary, it's only scary at the beginning. This will all become very routine.

As for testing...
Do not give your cat any food 2 hours prior to when you plan to give insulin. You always test before you give a shot -- you want to be sure that it's safe to give insulin. Ideally, you want to get a test around the middle of the cycle when the insulin is bringing numbers to their lowest (i.e., the nadir). I would also suggest getting a test 2 - 3 hours after you give insulin. This will give you an idea of where the numbers are going. You also want to get a test before you go to bed every night. The minimum number of tests daily is 4 -- your two pre-shot tests and a test during both the AM and PM cycles.

Members here test at variable times. I was a testaholic. My cat was prone to early, fast drops and frequent testing gave me control over her numbers. Not every cat is like mine was.

If you've not had a chance to read it, this is a link to our page on Prozinc. You may want to take a look at the sticky notes at the top of the page.

 

[Wendy&Neko]

On that Prozinc forum you'll see yellow starred Sticky Notes, which are a good place to start. The Dosing Methods one tells you starting dose. For the Start Low Go Slow method (recommended to start), you would give 0.5 units if on an all low carb wet or raw diet, or 1.0 units if feeding some dry food.

On when to decide when to start insulin, I'd do what Ale suggests and test each day at roughly the same time of day, and see where his numbers are trending. 271 on the Relion means he still needs insulin. You should know by a week after food transition if that's going to change significantly. You don't want to wait too long, because the sooner you can get a cat regulated on insulin, the greater the chances of diabetic remission.