Struggling to Start Insulin Because My Cat Won’t Eat — Need Advice

[hellen_maggie]

Good morning everyone. This is my first post here, so let me introduce myself — my name is Eleni and I’m from Greece.

My 12.5-year-old cat was diagnosed with diabetes on November 5th with a glucose reading of 340. After switching her to diabetic dry food, we rechecked a week later and it was still high (309), so my vet advised starting insulin. The feeding plan he gave me is: measure glucose in the morning while fasting, give the insulin injection, and then feed her immediately. He stressed that she MUST eat after the injection.

The problem is that she has been free-fed her whole life, and now she struggles with eating in two meals. She’s supposed to eat 34 g in the morning and 34 g in the evening, but she only eats about 11–12 g right away and needs up to 4 hours to finish the rest. I’ve tried everything — warming the kibble, removing and re-offering the food, playing with her, even adding a tiny bit of wet food — nothing works.

Her glucose readings over the past 6 days have been: 309, 287, 258, 269, 199, and this morning 311. I feel lost and stressed. How can I safely start insulin when she doesn’t eat enough right after the shot? Why are her readings fluctuating so much?

I also work full-time and I’m away from home about 9 hours a day. How can I reduce the risk of hypoglycemia while I’m gone?

Thank you so much for reading — any advice or personal experience would mean a lot to me.

 

[Robo & B]

Good morning Eleni you've found the right place.

First we are going to disagree with a lot of the advice from your vet. There are members here who have turned themselves into feline diabetes experts from spending years caring for their pets and reading and learning everything that they can. Sadly vets just don't have the time to dedicate to learning this thoroughly about every illness they treat and rarely have much knowledge or training in feline diabetes specifically.

We are going to need some information from you to help you and your cat.
What insulin are you using?
What food are you feeding?
I see you are already home testing - which is great. Are you using a human or pet meter?

Without knowing what insulin you're using this is just general advise. I don't think there are any insulins that it's advised you shoot first and then feed after. Generally we feed and then either shoot immediately or with a faster acting insulin (caninsulin) you wait half an hour and then shoot.

As to fluctuating readings. The meters all have a tolerance of around 20%, that means you could retest the exact same sample at the exact same time and get a reading of 180, 200 or 220 and that would be absolutely fine. That also means the higher your cat is reading the larger the variance might be because it's a percentage of the whole. I'm not sure I've explained that very well sorry! Also cats do just vary their blood sugar- we all have spreadsheets here which we track readings on. There are guides to help you set that up later, it's easy don't worry, but I'm trying not to overwhelm you.

We have plenty of members who work out of the house full time and still manage to safely treat their cats diabetes, you are going to be able to do this.

 

[Tim & Pookey]

Hi Eleni and welcome. What’s your cat’s name?

I think the answer to your questions lies in feeding multiple smaller meals throughout the day. That’ll help with the eating and keep her blood glucose steady.

What food are you feeding? We recommend a low carb (<10%) wet food. I’m not sure what foods are available in Greece. Let me think about what members we have from there…

What insulin did the vet prescribe? And how much? Lantus (glargine) and ProZinc are the two go-to insulins nowadays.

It’s usually test, feed, shoot in that order. I think your vet was just emphasizing that she needs to have food in her when the insulin starts working. Which is true. But what if she’s nauseous one day and won’t eat for you, and you’ve already given insulin. I think that’s the concern I’d have. For Lantus at least, there’s a 1-2 hour window after the shot before the insulin starts working.

We’ve all been where you’re at, hang in there though. Getting the food right will be a big help. While we wait for more folks to offer their input, see if you can work through the stuff in here.
Sticky - New? How You Can Help Us Help You!

 

[hellen_maggie]

Good morning Eleni you've found the right place.

First we are going to disagree with a lot of the advice from your vet. There are members here who have turned themselves into feline diabetes experts from spending years caring for their pets and reading and learning everything that they can. Sadly vets just don't have the time to dedicate to learning this thoroughly about every illness they treat and rarely have much knowledge or training in feline diabetes specifically.

We are going to need some information from you to help you and your cat.
What insulin are you using?
What food are you feeding?
I see you are already home testing - which is great. Are you using a human or pet meter?

Without knowing what insulin you're using this is just general advise. I don't think there are any insulins that it's advised you shoot first and then feed after. Generally we feed and then either shoot immediately or with a faster acting insulin (caninsulin) you wait half an hour and then shoot.

As to fluctuating readings. The meters all have a tolerance of around 20%, that means you could retest the exact same sample at the exact same time and get a reading of 180, 200 or 220 and that would be absolutely fine. That also means the higher your cat is reading the larger the variance might be because it's a percentage of the whole. I'm not sure I've explained that very well sorry! Also cats do just vary their blood sugar- we all have spreadsheets here which we track readings on. There are guides to help you set that up later, it's easy don't worry, but I'm trying not to overwhelm you.

We have plenty of members who work out of the house full time and still manage to safely treat their cats diabetes, you are going to be able to do this.

Thank you so much for your reply and support! Right now, my biggest challenge is that my cat can’t eat her full portion at once for the two meals per day. Because of this, I haven’t started insulin yet and I don’t even know which insulin we would use.

I went to the vet again, and he said I could give insulin either a few seconds before she starts eating or while she is eating — definitely not after. I’m really confused about the timing and what’s safest for her.

I’m feeding her Royal Canin Diabetic dry, and I sprinkle a little of the wet food of the same brand on top to make it more palatable. I’d like to transition her to wet food gradually, but that’s not possible yet because she has a very sensitive stomach and has been used to dry kibble her whole life.

I’m using a human glucose meter for testing.

I would also like to mention that I’m not fully convinced it’s time to start insulin yet. I still hope that her readings (which have been better until this morning) might return to that level, and maybe we could avoid insulin — which I am really scared to give her. This is just my personal worry, not something my vet suggested.

I would really appreciate any practical tips or guidance on how to get her to eat enough at once and start insulin safely. I’m feeling a bit lost and worried, and any advice would mean a lot!

 

[Robo & B]

Thank you so much for your reply and support! Right now, my biggest challenge is that my cat can’t eat her full portion at once for the two meals per day. Because of this, I haven’t started insulin yet and I don’t even know which insulin we would use.

I went to the vet again, and he said I could give insulin either a few seconds before she starts eating or while she is eating — definitely not after. I’m really confused about the timing and what’s safest for her.

I’m feeding her Royal Canin Diabetic dry, and I sprinkle a little of the wet food of the same brand on top to make it more palatable. I’d like to transition her to wet food gradually, but that’s not possible yet because she has a very sensitive stomach and has been used to dry kibble her whole life.

I’m using a human glucose meter for testing.

I would also like to mention that I’m not fully convinced it’s time to start insulin yet. I still hope that her readings (which have been better until this morning) might return to that level, and maybe we could avoid insulin — which I am really scared to give her. This is just my personal worry, not something my vet suggested.

I would really appreciate any practical tips or guidance on how to get her to eat enough at once and start insulin safely. I’m feeling a bit lost and worried, and any advice would mean a lot!

So the reason I was asking about insulin type is that most actually work best with spreading the food out- which would obviously work better for your cat. And get around your current problem of trying to get her to eat half her food for the day in one sitting. The only exception being caninsulin which isn't actually a vey good insulin for cats but does seem to be what some old school vets still prescribe.

As @Tim & Pookey has mentioned Lantus (glargine) and ProZinc are good insulins and you do not need to feed your cats dinner all in one go. They work much better with the food spread out. Those are the insulins that you shoot while the cat eats.

Royal Canin Diabetic dry food isn't actually a great food despite the name! Trying to transition her to wet food is a good idea. The best wet food are going to have under 10% carb. I can help you work that out from the analytical constituents on the can. They don't need to be specialist diabetic foods, just need that carb % low enough.

Has your vet done any blood tests or checked your cats ketone levels? Ketone are important and you can get test strips which you dip in the urine at home to check them. If your cat has anything above trace ketones you really don't want to delay starting insulin.

 

[Lauren & Esse]

Personally I would prioritize switching your kitty to a low carb wet food and seeing how much that changes things. Many cats are able to stave off (or completely rule out) using insulin purely by getting onto a low carb diet. Ideally you'd have kitty on an all-wet diet that's under 10% in carbs. The diabetic dry food is not low carb.

If you need recommendations for low-carb wet foods available in Greece, possibly some of our other members can help you @Yanna @Carol & Rico @Anna1. There's also this link that is UK-oriented, but maybe some of those are available elsewhere in Europe?

You might find this helpful: Transitioning Feline Dry Food Addicts to Canned Food

 

[hellen_maggie]

Hi Eleni and welcome. What’s your cat’s name?

I think the answer to your questions lies in feeding multiple smaller meals throughout the day. That’ll help with the eating and keep her blood glucose steady.

What food are you feeding? We recommend a low carb (<10%) wet food. I’m not sure what foods are available in Greece. Let me think about what members we have from there…

What insulin did the vet prescribe? And how much? Lantus (glargine) and ProZinc are the two go-to insulins nowadays.

It’s usually test, feed, shoot in that order. I think your vet was just emphasizing that she needs to have food in her when the insulin starts working. Which is true. But what if she’s nauseous one day and won’t eat for you, and you’ve already given insulin. I think that’s the concern I’d have. For Lantus at least, there’s a 1-2 hour window after the shot before the insulin starts working.

We’ve all been where you’re at, hang in there though. Getting the food right will be a big help. While we wait for more folks to offer their input, see if you can work through the stuff in here.

Thank you for your suggestions! I’ve also read in my research that many recommend a low-carb (<10%) wet food for diabetic cats. I discussed this with my vet, but he is firm that most diabetic foods have roughly the same effect and that Royal Canin is an excellent choice. He also told me that, when you account for the moisture content, wet food is basically the same as the dry kibble.

I do want to try transitioning her to wet food, but very gradually, because Maggie has a very sensitive stomach and I want to avoid upsetting it.

Honestly, I’m feeling a bit overwhelmed. I’ve been with this vet for 25 years and he has helped me through very difficult cases, both with my cat Maggie and my dog, so I really used to trust him, at least until now.. That’s why I feel even more lost and confused with all the different information I’ve found in my own research.

We haven’t started insulin yet — my vet said to stabilize her food intake over the next few days first, and then we’ll see.

 

[Robo & B]

Thank you for your suggestions! I’ve also read in my research that many recommend a low-carb (<10%) wet food for diabetic cats. I discussed this with my vet, but he is firm that most diabetic foods have roughly the same effect and that Royal Canin is an excellent choice. He also told me that, when you account for the moisture content, wet food is basically the same as the dry kibble.

I do want to try transitioning her to wet food, but very gradually, because Maggie has a very sensitive stomach and I want to avoid upsetting it.

Honestly, I’m feeling a bit overwhelmed. I’ve been with this vet for 25 years and he has helped me through very difficult cases, both with my cat Maggie and my dog, so I really used to trust him, at least until now.. That’s why I feel even more lost and confused with all the different information I’ve found in my own research.

We haven’t started insulin yet — my vet said to stabilize her food intake over the next few days first, and then we’ll

I'm sorry I know it's tough to find your expert (the vet) has more gaps in their knowledge than they are willing to admit. But he is absolutely wrong about the food. You know this from the research you've done yourself.

Dry food just isn't very good for cats full stop. And as to them having the same ingredients once you take out the moisture? Also completely untrue for the foods we feed. You can calculate it yourself, and we do. You exclude the moisture and do the calcs from the dry content.

But I'm also inclined to try to get your cat over to low carb wet food and see if that brings the diabetes into control without insulin (or at a lower dose). But you do need to check for ketones- I'm hoping your vet has done this?

 

[Lauren & Esse]

Just to be clear, there is no rule that says diabetic cats can only eat two big meals a day. I have heard this guidance is more appropriate for dogs and the insulins they use.

In fact, it's usually better to eat two bigger meals (that would go with their shots, if on insulin) and several smaller snacks throughout the day--that's what most members here do.

Unfortunately vets do not always have the best or most up-to-date info on nutrition, much of what they know might be general guidelines--or education provided by the prescription food companies.

 

[Carol & Rico]

Thank you for your suggestions! I’ve also read in my research that many recommend a low-carb (<10%) wet food for diabetic cats. I discussed this with my vet, but he is firm that most diabetic foods have roughly the same effect and that Royal Canin is an excellent choice. He also told me that, when you account for the moisture content, wet food is basically the same as the dry kibble.

I do want to try transitioning her to wet food, but very gradually, because Maggie has a very sensitive stomach and I want to avoid upsetting it.

Honestly, I’m feeling a bit overwhelmed. I’ve been with this vet for 25 years and he has helped me through very difficult cases, both with my cat Maggie and my dog, so I really used to trust him, at least until now.. That’s why I feel even more lost and confused with all the different information I’ve found in my own research.

We haven’t started insulin yet — my vet said to stabilize her food intake over the next few days first, and then we’ll see.

Hi there, as a mother of a 15 year old cat in remission, living in Greece, I have to tell you that there are NO vets who can treat diabetes according to the protocols! I've got the same vet for almost 20 years but when it came to Rico's treatment, I followed this group's guidelines and proved to be right in doing so! My vet told me exactly the same things yours did. Feel free to message me for details. I hope your baby will feel better soon!

 

[hellen_maggie]

Hi there, as a mother of a 15 year old cat in remission, living in Greece, I have to tell you that there are NO vets who can treat diabetes according to the protocols! I've got the same vet for almost 20 years but when it came to Rico's treatment, I followed this group's guidelines and proved to be right in doing so! My vet told me exactly the same things yours did. Feel free to message me for details. I hope your baby will feel better soon!

Hi there, as a mother of a 15 year old cat in remission, living in Greece, I have to tell you that there are NO vets who can treat diabetes according to the protocols! I've got the same vet for almost 20 years but when it came to Rico's treatment, I followed this group's guidelines and proved to be right in doing so! My vet told me exactly the same things yours did. Feel free to message me for details. I hope your baby will feel better soon!

Thank you so much for your message and for sharing your experience, it truly gives me hope during this difficult time. If you don’t mind, I would love to hear a bit more about how you managed your own cat’s treatment.

What approach did you follow for regulating her blood sugar? Which canned food or brand do you use here in Greece? It would also help me a lot to know what type of insulin you’re using, whether you give it before or after meals, and anything else from your experience that you think might be useful.

I feel like I’m struggling on my own and trying to do the best I can, so any guidance from someone who has actually been through this would mean a lot to me.

 

[hellen_maggie]

So the reason I was asking about insulin type is that most actually work best with spreading the food out- which would obviously work better for your cat. And get around your current problem of trying to get her to eat half her food for the day in one sitting. The only exception being caninsulin which isn't actually a vey good insulin for cats but does seem to be what some old school vets still prescribe.

As @Tim & Pookey has mentioned Lantus (glargine) and ProZinc are good insulins and you do not need to feed your cats dinner all in one go. They work much better with the food spread out. Those are the insulins that you shoot while the cat eats.

Royal Canin Diabetic dry food isn't actually a great food despite the name! Trying to transition her to wet food is a good idea. The best wet food are going to have under 10% carb. I can help you work that out from the analytical constituents on the can. They don't need to be specialist diabetic foods, just need that carb % low enough.

Has your vet done any blood tests or checked your cats ketone levels? Ketone are important and you can get test strips which you dip in the urine at home to check them. If your cat has anything above trace ketones you really don't want to delay starting insulin.

I’m not really familiar with what ketones are, to be honest. We did full blood biochemistry tests at the vet and he told me that everything looked good and nothing was concerning. But I will definitely ask him specifically about it, thank you for mentioning. Do you think that royal canin diabetic wet food is ok? (starch 1,2%, total sugars 1,3% are listed on the package)

 

[squeem3]

Here is info on ketones: Ketones - Felinediabetes.com Ketones can be tested via a fresh urine sample (use the same urine test sticks Human diabetics use) or by a ketone blood glucose meter.

The Royal Canin wet food is only slightly better than the dry. The carb content is too high for a diabetic. @Carol & Rico can suggest suitable foods if she checks back in this thread.

Carol used glargine insulin for her cat. It's noted in her signature. That's a good choice. With glargine, there is some flexibility with the timing of food and insulin. Most people test the cat first, feed the cat, and while the cat is busy eating give the insulin. It's ok if you give insulin first and then feed. No need to wait X amount of time between food and insulin. Whatever works for you and your cat If the cat doesn't eat right away, no worries. Just leave the food out. A few small snacks spread throughout the day is best for diabetic cats. The only food thing to note is to not give food within 2 hours of a glargine insulin injection. Food will cause blood glucose levels to spike.

As already mentioned, vets don't know much about nutrition and some just go by whatever the pet food companies market and push to sell. It's ok to ignore the vet on what to feed

 

[Robo & B]

I’m not really familiar with what ketones are, to be honest. We did full blood biochemistry tests at the vet and he told me that everything looked good and nothing was concerning. But I will definitely ask him specifically about it, thank you for mentioning. Do you think that royal canin diabetic wet food is ok? (starch 1,2%, total sugars 1,3% are listed on the package)

ok, you can get ketosticks that you can use to test with yourself- I'm not sure which ones are available in Greece sorry.

No that food doesn't look any good if it's the same formulation as available in the UK.

protein	8.9 %
fat	3.2 %
fibre	1.1 %
ash	1.7 %
moisture	82.5 %
starch	1.2 %
total sugar	1.3 %

Gives around 15% carb by dry weight which we class as a medium carb food. You really do want under 10% with a lot of us aiming for 5%

 

[CORKY]

Welcome Hellen to FDMB, it is overwhelming to be told your cat has diabetes, especially when, most of us have been caught off guard, and on top of that we need to work full time. You have received very good tips and suggestions from all the members that posted, your vet sound like an old schooled vet, unfortunately likes it was said above, not too many vets are knowledgeable in the present when it comes to FD, and treat this illness in cats as it were a dog, to start with, there is no such thing as a "prescribed" diabetic food, humans with diabetes eat regular food just like us, the only difference that they do not eat carbs to keep their sugar level down, if pre diabetic, once full blown diabetic they will need insulin as well. The same for a cat, A diabetic cat's glucose should be between 50-120, your cat needs insulin, and a low carb wet food diet between 0-10% crabs, and the 10% is the DRY MATTER CARB that coubts the Royal Cannin foods contain anywhere between 20-25
% carbs if not more, cats cannot digest carbs, so the pancreas damage not releasing insulin, once you regulate the BG with low carb diet and insulin, and several meals during the day, you will start to see the Glucose numbers lower The best insulins for cats are ProZinc and Lantus, they are a 12 hour insulin and soft on a cat and the protocol is Test, Feed, Shoot, unlike Caninsulin it is a harsh insulin that hits hard with a quick down spiral, and the name specifies that is a dog insulin. You mentioned you work, you may want to purchase a Wet food Feeder, that you can program up to 3 meals, and YES!, the transition needs to be a slow one, your baby's stomach is already sensitive we don't want it to get worse, You are in the right place, keep posting any concern you may have, no concern is a small one. We are here for you

 

[squeem3]

You mentioned you work, you may want to purchase a Wet food Feeder, that you can program up to 3 meals,

Some feeders do up to 5 meals It depends on what OP can get in Greece or can order online from Amazon or other similar web site.

Many people here work full time, live alone, and are able to manage their diabetic cat all on their own It's doable. The beginning is hard since there are so many things to learn. You and the cat do get into a routine.

 

[Carol & Rico]

Thank you so much for your message and for sharing your experience, it truly gives me hope during this difficult time. If you don’t mind, I would love to hear a bit more about how you managed your own cat’s treatment.

What approach did you follow for regulating her blood sugar? Which canned food or brand do you use here in Greece? It would also help me a lot to know what type of insulin you’re using, whether you give it before or after meals, and anything else from your experience that you think might be useful.

I feel like I’m struggling on my own and trying to do the best I can, so any guidance from someone who has actually been through this would mean a lot to me.

It would be a VERY long list to write everything in detail but, since we both live in the same country, I could give you my phone number and guide you all the way. In general, I've followed the TR protocol and all the instructions given to me here. I believe if you search the chat, you will find all the discussions I've had here. As about food, I experimented with several brands from the list and finally found the ones that are helping Rico - each kitty responds differently to each good. All in all, I'm here for you and I'm willing to help you out in anything you want!

 

[Yanna]

Hi Helen!
I trusted my previous vet as well so I followed their advice and fed my diabetic cat Royal Canin diabetic and used caninsulin. It proved to be the wrong way to go as my cat was not even close to being regulated, she had high glucose for about two years.

Please do your own search, there are guidelines for the management of diabetes in cats.

You need to feed your cat low carb food (wet) : Purina pro plan diabetes, Animonda Carny, Bozita, Animonda integra diabetes, Wellfed from Petcity. There's a list with more options.

Insulin: Lantus

You don't need to feed every 12 hours.

Feed before or around the insulin time and then give small snacks every 2-3 hours.

Test your cat for ketones. You can do this at home. Buy Siemens ketostix from the pharmacy.

I live in Greece. Please do not hesitate to ask me any questions

 

[CORKY]

It would be a VERY long list to write everything in detail but, since we both live in the same country, I could give you my phone number and guide you all the way. In general, I've followed the TR protocol and all the instructions given to me here. I believe if you search the chat, you will find all the discussions I've had here. As about food, I experimented with several brands from the list and finally found the ones that are helping Rico - each kitty responds differently to each good. All in all, I'm here for you and I'm willing to help you out in anything you want!

Remember not to post any personal details in this forum thread, use the private message post

 

[squeem3]

Try this old thread for European brands of foods: Canned cat food for EUROPEANS and INTERNATIONAL buyers

 

[Carol & Rico]

Remember not to post any personal details in this forum thread, use the private message post

I know, that's why I asked Hellen is she'd like me to contact her with my phone number.

 

[hellen_maggie]

Hi Helen!
I trusted my previous vet as well so I followed their advice and fed my diabetic cat Royal Canin diabetic and used caninsulin. It proved to be the wrong way to go as my cat was not even close to being regulated, she had high glucose for about two years.

Please do your own search, there are guidelines for the management of diabetes in cats.

You need to feed your cat low carb food (wet) : Purina pro plan diabetes, Animonda Carny, Bozita, Animonda integra diabetes, Wellfed from Petcity. There's a list with more options.

Insulin: Lantus

You don't need to feed every 12 hours.

Feed before or around the insulin time and then give small snacks every 2-3 hours.

Test your cat for ketones. You can do this at home. Buy Siemens ketostix from the pharmacy.

I live in Greece. Please do not hesitate to ask me any questions

Hi Yanna, I’m really glad to e-meet you and thank you so much for your advice. I’m feeling very confused right now and I really need some help with the following:

If I understand correctly from this forum, the steps are: measure her glucose, give her food, and as soon as Maggie starts eating, give the insulin. After that, how many grams does she absolutely need to eat to be safe and avoid a high risk of hypoglycemia, and within what timeframe after the injection? For example, if her daily portion at the moment is 68 grams, what percentage of that does she need to eat after each injection to be safe?

Also, my vet said she will need 2 injections every 12 hours (I don’t know which insulin yet, but I plan to ask about Lantus). Is the risk of hypoglycemia for the full 12 hours or just for a few hours after each injection? I’m trying to see if I can adjust my work schedule around this. The bad thing is that I cannot give her treats every 2–3 hours because I’m away from home for 9 hours daily because of my job.

Is it ever possible to get out of this nightmare, or will our life from now on just be injections, measurements, insulin, and endless stress?

I’ve also been looking for wet food, which one would you recommend best, Hills m/d Diabetes or Purina Pro Plan? I’m torn between the two, unless there’s a better option.Are the ones you suggest better? Right now she’s eating high-carb kibble (royal canin diabetes), and I need to start insulin under these conditions since I don’t have time to transition her gradually to wet food. Is it risky to switch her to a low-carb food while she’s on insulin? I’m so confused…thank you so much for your help..

 

[Yanna]

Hi Yanna, I’m really glad to e-meet you and thank you so much for your advice. I’m feeling very confused right now and I really need some help with the following:

If I understand correctly from this forum, the steps are: measure her glucose, give her food, and as soon as Maggie starts eating, give the insulin. After that, how many grams does she absolutely need to eat to be safe and avoid a high risk of hypoglycemia, and within what timeframe after the injection? For example, if her daily portion at the moment is 68 grams, what percentage of that does she need to eat after each injection to be safe?

Also, my vet said she will need 2 injections every 12 hours (I don’t know which insulin yet, but I plan to ask about Lantus). Is the risk of hypoglycemia for the full 12 hours or just for a few hours after each injection? I’m trying to see if I can adjust my work schedule around this. The bad thing is that I cannot give her treats every 2–3 hours because I’m away from home for 9 hours daily because of my job.

Is it ever possible to get out of this nightmare, or will our life from now on just be injections, measurements, insulin, and endless stress?

I’ve also been looking for wet food, which one would you recommend best, Hills m/d Diabetes or Purina Pro Plan? I’m torn between the two, unless there’s a better option.Are the ones you suggest better? Right now she’s eating high-carb kibble (royal canin diabetes), and I need to start insulin under these conditions since I don’t have time to transition her gradually to wet food. Is it risky to switch her to a low-carb food while she’s on insulin? I’m so confused…thank you so much for your help..

For some cats, just the change to low carb food is enough for them to go into remission. If there are no ketones, you could try feeding low carb food before you start insulin.

Hills m/d is not low carb. Try to find a low carb food that your cat likes to eat. I wouldn't mind the quality of food right now. If you check the UK list, there are a lot of options available in Greece.

Don't worry too much about the grams you need to feed per day. Once you find a food she likes, feed according to her kilos, but if she wants to eat more than that, just feed her.

Feed 2 bigger meals before or around insulin time and then give 1-2 tsps every 2-3 hours. You could use a time feeder when you are not at home.

If you switch to low carb food while your cat is on insulin, you need to be very careful, test more, perhaps you would need to reduce the dose.

There many experienced members in this forum who could explain better than me how insulin works.

You are in the right place.

 

[hellen_maggie]

Remember not to post any personal details in this forum thread, use the private message post

Thank you all so much for your help!

 

[CORKY]

You shouldn’t worry about hypoglycemia if you cat has a BG higher than 150, I say that number because your a newby, I shoot Corky right after I see he has eaten a few bites, I just go behind him pull up the scruff and shoot, he does not even stop eating the grams he eats is irrelevant, what counts is that you test 2 hours after shooting if you can after the first shot, I suggest you purchase a wet food feeder. You’ll time it to open every 4 hours, if you have the correct dose of insulin he should not get hypo, relax, take it one step at a time, right now the most important thing is the low carb food, home testing and tge right insulin like Lantus or ProZinc, and the foods you just mentioned On your last post are a no no, they are also very high carbs. I will tell you what was told to me here at first “ take a step back, breath in and breath out, cats are very sensitive to stress, you stress, they stress” you will be ok! Your cat will be ok, Trust this forum and their members they save cats lives every day, they saved my Corky, I trust every sugestion, increase/decrease blindly, My Corky will be a lifetime diabetic, but today his BG numbers are remission numbers 2 Digits, compared to how he spend 8 days in the hospital with 650 BG when first diagnosed, the important first step is to get the wet feeder before you start insulin, transition during the weekend to wet 10% foods, learn to test, also FYI you can also get the Libre3. Monitor and sensor, no need to draw blood you use your phone and u can see his hourly BG reading as you work, I do have to warn you though, tge sensors are expensive and only last maybe 14 days soñé times less, and it has its faults it reads low numbers much lower than reality, but it might be something you may want to consider at least till you get more comfortable with the process

 

[Robo & B]

Hi Yanna, I’m really glad to e-meet you and thank you so much for your advice. I’m feeling very confused right now and I really need some help with the following:

If I understand correctly from this forum, the steps are: measure her glucose, give her food, and as soon as Maggie starts eating, give the insulin. After that, how many grams does she absolutely need to eat to be safe and avoid a high risk of hypoglycemia, and within what timeframe after the injection? For example, if her daily portion at the moment is 68 grams, what percentage of that does she need to eat after each injection to be safe?

Also, my vet said she will need 2 injections every 12 hours (I don’t know which insulin yet, but I plan to ask about Lantus). Is the risk of hypoglycemia for the full 12 hours or just for a few hours after each injection? I’m trying to see if I can adjust my work schedule around this. The bad thing is that I cannot give her treats every 2–3 hours because I’m away from home for 9 hours daily because of my job.

Is it ever possible to get out of this nightmare, or will our life from now on just be injections, measurements, insulin, and endless stress?

I’ve also been looking for wet food, which one would you recommend best, Hills m/d Diabetes or Purina Pro Plan? I’m torn between the two, unless there’s a better option.Are the ones you suggest better? Right now she’s eating high-carb kibble (royal canin diabetes), and I need to start insulin under these conditions since I don’t have time to transition her gradually to wet food. Is it risky to switch her to a low-carb food while she’s on insulin? I’m so confused…thank you so much for your help..

The Purina pro plan diabetes wet food looks ok carb wise (around 4.5%), but please check it's the same ingredients - sometimes they differ the recipe in different regions
Nutrition & Analytical Constituents

Moisture: 77.5%
Protein: 13.8%
Fat content: 4.9%
Crude ash: 2.2%
Crude fibres: 0.6%
Starch: 0.42%
Total sugar: <T0.5%

It's not got the best ingredients and I think you can get better quality for the money but if you really want a diabetes specific food. That one may be worth a try.

 

[CORKY]

here is a cat carb calculator, that I use often, it can help you determine the carbs of each food you have or choose to feed, remember, the Dry Matter carb is the one you are going to look for, use the ingredients or nutrients that Robo & B mentions above in his post

Cat Food Nutrition Calculator | Elizabeth C Scheyder

 

[hellen_maggie]

The Purina pro plan diabetes wet food looks ok carb wise (around 4.5%), but please check it's the same ingredients - sometimes they differ the recipe in different regions
Nutrition & Analytical Constituents

Moisture: 77.5%
Protein: 13.8%
Fat content: 4.9%
Crude ash: 2.2%
Crude fibres: 0.6%
Starch: 0.42%
Total sugar: <T0.5%

It's not got the best ingredients and I think you can get better quality for the money but if you really want a diabetes specific food. That one may be worth a try.

Thank you so much for your concern. I already bought that specific food this morning and spread a small amount of it on her kibble, which she ate. But I’m very worried about switching from kibble to wet food because she has a sensitive stomach. And time is pressing because we have to start insulin. Her reading today (after four attempts) was 302. I feel so disappointed… Today I have an appointment with another vet who was recommended to me as being more experienced with feline diabetes. This afternoon I will also have the ketone test strips. There’s so much to deal with, and I’m afraid that I might not be good enough for my little girl.

 

[hellen_maggie]

Thank you so much for your concern. I already bought that specific food this morning and spread a small amount of it on her kibble, which she ate. But I’m very worried about switching from kibble to wet food because she has a sensitive stomach. And time is pressing because we have to start insulin. Her reading today (after four attempts) was 302. I feel so disappointed… Today I have an appointment with another vet who was recommended to me as being more experienced with feline diabetes. This afternoon I will also have the ketone test strips. There’s so much to deal with, and I’m afraid that I might not be good enough for my little girl.

Same ingredients, I just checked!

 

[Robo & B]

Thank you so much for your concern. I already bought that specific food this morning and spread a small amount of it on her kibble, which she ate. But I’m very worried about switching from kibble to wet food because she has a sensitive stomach. And time is pressing because we have to start insulin. Her reading today (after four attempts) was 302. I feel so disappointed… Today I have an appointment with another vet who was recommended to me as being more experienced with feline diabetes. This afternoon I will also have the ketone test strips. There’s so much to deal with, and I’m afraid that I might not be good enough for my little girl.

We have all been were you are now. Feeling overwhelmed! But honestly you will settle into a routine and once you've had time to get your head around it you and your cat will be fine.

Getting blood from the ear gets easier don't worry

 

[hellen_maggie]

We have all been were you are now. Feeling overwhelmed! But honestly you will settle into a routine and once you've had time to get your head around it you and your cat will be fine.

Getting blood from the ear gets easier don't worry

i hope so, because her ears are already in a bad condition, full of wound. i am having a lot of difficulty with the measurments

 

[CORKY]

i hope so, because her ears are already in a bad condition, full of wound. i am having a lot of difficulty with the measurments

At the beginning I felt so inadequate I had no knowledge on FD , I really thought I let down my Corky for not noticing he was sick, he spend 8 days hospitalized. I came home with him with a bag of supplies, 10 minutes instructions, his vet for 9 years fired me, and no money, I cried till there were no more tears, he had a Libre sensor that would fall off or stop working before the 14 days , the monitor would violently wake me up in the middle of the night reading hypo numbers( monitor error,) so I had many sleepless nights, my neighbors thought I was about to have a nervous breakdown, it wasn’t until I found this forum by coincidence 3 months later researching every day where could I get help, I was even told I should put him down! This Forum saved both our lives, physically and emotionally I was not well. I am telling you my story so you can understand that it does gets better, I have not stepped foot in a vets office again since I found this forum, I trust them blindly They saved my Corky’s life, you can click below on his spreadsheet to see for yourself, that this shall pass, FD is manageable, we all have our stress story and tears, but the outcome seeing our precious fur baby flourish again gives us pride! That there are for instance tge members in this board that truly dedicate their time free of charge to help us cat mommies, Vets are great for many reasons of different illnesses, but for FD ? This is where I need to be, so, take a step back, breath in, breath out, the main thing you need to do is transition the dry food to wet, is not sprinkling over the dry or free feeding, you serve in every meal less dry more wet, mix it well, you’ll be surprised how quickly they adjust, if you start insulin and give dry food there will be no improvement in his glucose numbers, please be precise in requesting Lantus or ProZinc, it’s your cat, you know him better than your vet, you see Or hear something you do not agree with tell him, he may have the diploma, but you have your cars best interest,,you’re going to do a great job I’m sure, let us guide you and help your concerns and dosing suggestions, just trust!

 

[Robo & B]

i hope so, because her ears are already in a bad condition, full of wound. i am having a lot of difficulty with the measurments

I'm just quickly copying this from another post. There is a guide somewhere but I can't find it right now. Trust me you will get better at getting blood

Always aim for the sweet spot warm the ears up first, you can put rice in a sock and put it in the microwave, test it on the inside of your wrist to be sure it's not to hot, like you would test a babies bottle. You can fill a pill bottle with warm water and roll it on the ears also.Just keep rubbing the ears with your fingers to warm them up

6. As the ears get used to bleeding and grow more capilares, it gets easier to get the amount of blood you need on the first try. If he won’t stand still, you can get the blood onto a clean finger nail and test from there.
When you do get some blood you can try milking the ear.
Get you finger and gently push up toward the blood , more will appear

 

[hellen_maggie]

At the beginning I felt so inadequate I had no knowledge on FD , I really thought I let down my Corky for not noticing he was sick, he spend 8 days hospitalized. I came home with him with a bag of supplies, 10 minutes instructions, his vet for 9 years fired me, and no money, I cried till there were no more tears, he had a Libre sensor that would fall off or stop working before the 14 days , the monitor would violently wake me up in the middle of the night reading hypo numbers( monitor error,) so I had many sleepless nights, my neighbors thought I was about to have a nervous breakdown, it wasn’t until I found this forum by coincidence 3 months later researching every day where could I get help, I was even told I should put him down! This Forum saved both our lives, physically and emotionally I was not well. I am telling you my story so you can understand that it does gets better, I have not stepped foot in a vets office again since I found this forum, I trust them blindly They saved my Corky’s life, you can click below on his spreadsheet to see for yourself, that this shall pass, FD is manageable, we all have our stress story and tears, but the outcome seeing our precious fur baby flourish again gives us pride! That there are for instance tge members in this board that truly dedicate their time free of charge to help us cat mommies, Vets are great for many reasons of different illnesses, but for FD ? This is where I need to be, so, take a step back, breath in, breath out, the main thing you need to do is transition the dry food to wet, is not sprinkling over the dry or free feeding, you serve in every meal less dry more wet, mix it well, you’ll be surprised how quickly they adjust, if you start insulin and give dry food there will be no improvement in his glucose numbers, please be precise in requesting Lantus or ProZinc, it’s your cat, you know him better than your vet, you see Or hear something you do not agree with tell him, he may have the diploma, but you have your cars best interest,,you’re going to do a great job I’m sure, let us guide you and help your concerns and dosing suggestions, just trust!

Believe me, I’m in the same situation you were back then… I’m trying to gather as much information as I can so I can do the best possible for my girl . I won’t be able to handle anything less. I’m just really exhausted because I’ve been to so many doctors and none of them have given me the answers I need. I STILL HAVEN’T UNDERSTOOD EXACTLY WHAT I’M SUPPOSED TO DO. I’m waiting to find out which insulin he wants to give to Maggy so I can figure out the steps and the protocol I need to put some order in my mind and stick to it strictly, which is not possible yet.


What i have definitely decided is that I want to transition her to wet food, but that takes time. I’m still at a very early stage, and that stresses me out. I have to do it slowly, for her own good. Beyond that, everything else is up in the air.


How is your Corky today? Since he’s going into remission, have you stopped the insulins? I really hope your answer is positive… I can’t bear the thought of having to put my Maggy through pricks for measurements, injections, etc. for a long period of time. We will both collapse

 

[hellen_maggie]

I'm just quickly copying this from another post. There is a guide somewhere but I can't find it right now. Trust me you will get better at getting blood

Always aim for the sweet spot warm the ears up first, you can put rice in a sock and put it in the microwave, test it on the inside of your wrist to be sure it's not to hot, like you would test a babies bottle. You can fill a pill bottle with warm water and roll it on the ears also.Just keep rubbing the ears with your fingers to warm them up

6. As the ears get used to bleeding and grow more capilares, it gets easier to get the amount of blood you need on the first try. If he won’t stand still, you can get the blood onto a clean finger nail and test from there.
When you do get some blood you can try milking the ear.
Get you finger and gently push up toward the blood , more will appearth

I'm just quickly copying this from another post. There is a guide somewhere but I can't find it right now. Trust me you will get better at getting blood

Always aim for the sweet spot warm the ears up first, you can put rice in a sock and put it in the microwave, test it on the inside of your wrist to be sure it's not to hot, like you would test a babies bottle. You can fill a pill bottle with warm water and roll it on the ears also.Just keep rubbing the ears with your fingers to warm them up

6. As the ears get used to bleeding and grow more capilares, it gets easier to get the amount of blood you need on the first try. If he won’t stand still, you can get the blood onto a clean finger nail and test from there.
When you do get some blood you can try milking the ear.
Get you finger and gently push up toward the blood , more will appear

thank you so much, it could be priceless!! I hope this will help me

 

[squeem3]

There are diet transition tips here: Transitioning your cat from dry to wet food

If you go to the main FelineDiabetes.com page there are links at the top with more info on diabetes, treatment options, etc Felinediabetes.com

The thing is, most vets have no clue about diabetes. It's not a a subject taught in depth in veterinary school. Many people here don't rely on their vet for much other than a prescription for insulin and check ups and vaccinations as needed.

Since your cat has not started insulin yet, do the diet change now (slowly!) and learn how to test your cat's blood glucose levels. Normal blood glucose levels are roughly 60 to 150 mg/dl in cats. Ideally you want your diabetic cat to be within this range and that may need both diet and insulin.

Depending on which insulin the vet prescribes, there are specific protocols to follow. Information on ProZinc is here: Prozinc / PZI Information on Lantus / glargine is here: Lantus / Levemir / Biosimilars Give them all a read and decide if you want to do the Start Low Go Slow Method or Tight Regulation. SLGS is ideal for people who work full time jobs and can't test during the day but it is possible to do Tight Regulation.

If the vet prescribes something else, there is most likely a forum for that here on FDMB.

The sooner a cat starts on the right diet and a good insulin, the greater the chances of remission are. But some cats just don't ever reach remission and that's ok You can follow a dosing method exactly and feed a good food but the cat's body just doesn't want to function properly. Don't focus just on the diabetes and numbers. You have to look at the whole cat. As long as the cat is healthy and doing well and you're doing everything right for the diabetes, that's all that really matters

 

[CORKY]

Believe me, I’m in the same situation you were back then… I’m trying to gather as much information as I can so I can do the best possible for my girl . I won’t be able to handle anything less. I’m just really exhausted because I’ve been to so many doctors and none of them have given me the answers I need. I STILL HAVEN’T UNDERSTOOD EXACTLY WHAT I’M SUPPOSED TO DO. I’m waiting to find out which insulin he wants to give to Maggy so I can figure out the steps and the protocol I need to put some order in my mind and stick to it strictly, which is not possible yet.


What i have definitely decided is that I want to transition her to wet food, but that takes time. I’m still at a very early stage, and that stresses me out. I have to do it slowly, for her own good. Beyond that, everything else is up in the air.


How is your Corky today? Since he’s going into remission, have you stopped the insulins? I really hope your answer is positive… I can’t bear the thought of having to put my Maggy through pricks for measurements, injections, etc. for a long period of time. We will both collapse

Corky's numbers are remission numbers, but he will need insulin for life, he will be a lifetime diabetic, his pancreas damaged, mostly from growing up from when I adopted him from the shelter at 8 weeks old till he as 10 on MeauMix dry kibbles free fed, i had no idea about the fact that cats cannot digest carbs and 99% of kibbles contain anywhere between 20-35% carbs, so being an indoor cat all his life his exercise has been limited, being a boy, and probably genetically are the reasons of his diabetes, but as soon as I changed his food and I also put my Coco a 1/2 Main Coon on the same schedule, food, everything started to change. Transitioning is not hard, all you have to do is, example, lets say you feed 1/2 cup in each meal, you replace it with 3 tbsps. of wet food mix it together and in every other meal, you remover a little bit more of the dry replacing it with the wet, until he is eating all wet, you will have to test though as soon as you start the transition, the change in dry to wet makes a difference in the BG numbers, it lowers the BG, this is why is so very important you start this transition right away, this does not means you should not start using insulin by any means, simply that once you start the first shot, we can see lower numbers, we would love to help you with the dosing and any concern you may have once you begin dosing, but we ar numbers oriented, we would like you to create your signature and spreadsheet, the links below, if you have difficulty with the spreadsheet, we can get a member to create it for you, we do need to know the daily BG development after each shot, do not overwhelm yourself so much, that is what we are here for to make this journey with you much easier

Sticky - New? How You Can Help Us Help You!
https://felinediabetes.com/FDMB/threads/how-to-create-a-spreadsheet.241706/

 

[hellen_maggie]

low carb wet food diet between 0-10% crabs, and the

Corky's numbers are remission numbers, but he will need insulin for life, he will be a lifetime diabetic, his pancreas damaged, mostly from growing up from when I adopted him from the shelter at 8 weeks old till he as 10 on MeauMix dry kibbles free fed, i had no idea about the fact that cats cannot digest carbs and 99% of kibbles contain anywhere between 20-35% carbs, so being an indoor cat all his life his exercise has been limited, being a boy, and probably genetically are the reasons of his diabetes, but as soon as I changed his food and I also put my Coco a 1/2 Main Coon on the same schedule, food, everything started to change. Transitioning is not hard, all you have to do is, example, lets say you feed 1/2 cup in each meal, you replace it with 3 tbsps. of wet food mix it together and in every other meal, you remover a little bit more of the dry replacing it with the wet, until he is eating all wet, you will have to test though as soon as you start the transition, the change in dry to wet makes a difference in the BG numbers, it lowers the BG, this is why is so very important you start this transition right away, this does not means you should not start using insulin by any means, simply that once you start the first shot, we can see lower numbers, we would love to help you with the dosing and any concern you may have once you begin dosing, but we ar numbers oriented, we would like you to create your signature and spreadsheet, the links below, if you have difficulty with the spreadsheet, we can get a member to create it for you, we do need to know the daily BG development after each shot, do not overwhelm yourself so much, that is what we are here for to make this journey with you much easier

Thank you so much , to you and to the whole team , for trying to help me. It honestly makes a huge difference to feel that I am not alone in this. And yes, I would really appreciate help with the spreadsheet.

I also want to share our situation at the moment. This morning her BG reading was 310. After the test, I gave her 17 grams of dry food with half a teaspoon of wet food mixed in (slightly more wet food than yesterday to keep moving with the transition). She ate in two small sessions, and as soon as she finished and walked away from her bowl, she vomited a little. I panicked, called my vet, who told me it could be from the high blood sugar or from the food change. Either way, he told me to start insulin as soon as possible, as long as I monitor her today and make sure she doesn’t vomit again.

My problem now is that I honestly don’t know what to do. Should I continue the transition to wet food or stop? I feel scared and unsure, and I worry about taking risks.

As for the medical advice I received:

1. My long-term vet of 25 years recommends starting with a low dose of Caninsulin. He says it is the only insulin he trusts. His routine is: test BG, start feeding, then give the injection. He says she must eat at least 15 grams (out of the 68 grams she should get daily) so that her stomach is not empty when she receives the shot. He recommends two injections per day, 12 hours apart, and one fasting BG test every morning. He advised starting with a small dose.
2. Last night I also saw another vet (with specialization in endocrinology), the third one so far. He told me something different: he wants me to start Lantus tomorrow, with a very low dose at first for a few days. He wrote down 1 unit (0.01 ml), one injection to begin with, and then we see how things go. He said not to stress about the food right now but continue free-feeding if that’s what she’s used to. He told me: “We will work around the cat’s habits, not force her into ours.” He said wet food is better, but insulin is urgent, and the diet adjustment can happen gradually afterward. He said I could test for ketones if I want (I asked him first about it), but based on what I described (she is active and not showing signs of illness) he doesn’t think ketones are likely. I havent reached to test her so far, i hope i will during the day. He also said that when we start insuline, for at least the first three days I should measure BG every 2 hours. If I don’t want to poke her so often, he suggested using Libre3. But I don’t want Libre. My cat is extremely difficult and intolerant of handling. Even for basic procedures she needs sedation , even for blood draws. So for a Libre, she would need sedation again, and I really don’t want to put her through that.

We talked for about an hour and a half, but because I was overwhelmed and crying the whole time, i didn t ask what happens after those first three days of testing every two hours, how often do I need to test after that?

I am also unsure about free-feeding. What if she decides not to eat before the injection? What am I supposed to do in that case?

I feel very confused. I would really appreciate your guidance on how to proceed and which vet’s protocol might be best to follow. It would also help me a lot if you could tell me the correct sequence of steps, I’m so afraid of making a mistake.

Thank you again for being here for me and Μaggie.

 

[CORKY]

The First Vet:
1. If he had FD schooling he needed to know that Caninsulin is a dog insulin, and it hits hard and quickly in a cat, therefore often testing is necessary. Small dose? How much? You do not need sedación to place a Libre sensor whatsoever, you just shave a golf like size of hair about 3” he’s off the spine and stick it to the skin is a small needle as big as tge tip of a pin
Second Vet:
1. Lantus is a 12 hour insulin, therefore you need two shots, one in the morning, one at night, not one to see how it goes
3. Free feeding is no good especially kibbles, you would be beating the purpose of insulin and damaging the pancreas more, risking further complications
4. The bit of vomit is usual, is the first time eating more wet than dry, don’t stop the transition, unless the vomiting is constant
5. Cat adjust quickly as long as you put her on a steady food schedule and the grams she eats are not as urgent or as important as the carbs consumed, cats cannot digest carbs, you are spending way too much money going from vet to vets and that stresses out a cat and you are stressing way too much yourself, and I know that you are trying so hard to help your Maggie, but are you perhaps wanting to hear your right answer? We are giving you the tools on how to regulate him, and what he needs for that to happen, did you speak to any of the vets about your concerns or doubts, Vets sometimes empose on us what we have to do not what we should do to get our cats better and regulated when it come to FD,
I will tag a member to do the spreadsheet for you, make sure that you completed your signature, the spreadsheet you’ll get, needs to be downloaded on GOOGLE DRIVE so all the member can have access to read it and you posting ok. We’ll talk about that when is ready, right know you just make sure that if you are starting the insulin what’s the dose and make sure you test before each shot I will also tag another member to help you with Lantus dosing and to rectify anything I have said that needs correcting, she is the Wizard of Lantus and many many matters on FD, and relax, you are being wise on getting opinions but at times too many opinions with different outcomes for the same question (FD) is overwhelming and no wonder you are confused, and cats by being active does not have anything to do weather there’s presence of ketone or not, is by testing the urine and usually high BGs, cats are sneaky they hide illnesses very well
@Sienne and Gabby (GA)
@Bandit's Mom
I know the holidays is near, but is there any way you can help Maggie’s mom with the spreadsheet?

 

[CORKY]

I want you to know you are doing amazing! We all have made mistakes at first, myself, not too long ago for some idiotic moment I forgot to give Corky’s shot, when I saw the full syringe in the fridge door 4 hours later I was in tears all night long and feeling miserable and did’nt sleep a wink testing him every two hours, I wanted the ground to swallow me, we’ve all been there, but it gets so much better, and soon you’ll see and laugh about it latter, but we love our cats as we love our children for me my pets are my family and Corky has been with me for 12 years, I tear up at the thought of loosing him, stay here concentrate here, and all your stress will be gone in no time, I trust this forum blindly the members here are better schooled on FD than some vets are I see it post after post the miracles of a cat on remission, regulated, healed, with their dedication and love they help us

 

[Robo & B]

Thank you so much , to you and to the whole team , for trying to help me. It honestly makes a huge difference to feel that I am not alone in this. And yes, I would really appreciate help with the spreadsheet.

I also want to share our situation at the moment. This morning her BG reading was 310. After the test, I gave her 17 grams of dry food with half a teaspoon of wet food mixed in (slightly more wet food than yesterday to keep moving with the transition). She ate in two small sessions, and as soon as she finished and walked away from her bowl, she vomited a little. I panicked, called my vet, who told me it could be from the high blood sugar or from the food change. Either way, he told me to start insulin as soon as possible, as long as I monitor her today and make sure she doesn’t vomit again.

My problem now is that I honestly don’t know what to do. Should I continue the transition to wet food or stop? I feel scared and unsure, and I worry about taking risks.

As for the medical advice I received:

1. My long-term vet of 25 years recommends starting with a low dose of Caninsulin. He says it is the only insulin he trusts. His routine is: test BG, start feeding, then give the injection. He says she must eat at least 15 grams (out of the 68 grams she should get daily) so that her stomach is not empty when she receives the shot. He recommends two injections per day, 12 hours apart, and one fasting BG test every morning. He advised starting with a small dose.
2. Last night I also saw another vet (with specialization in endocrinology), the third one so far. He told me something different: he wants me to start Lantus tomorrow, with a very low dose at first for a few days. He wrote down 1 unit (0.01 ml), one injection to begin with, and then we see how things go. He said not to stress about the food right now but continue free-feeding if that’s what she’s used to. He told me: “We will work around the cat’s habits, not force her into ours.” He said wet food is better, but insulin is urgent, and the diet adjustment can happen gradually afterward. He said I could test for ketones if I want (I asked him first about it), but based on what I described (she is active and not showing signs of illness) he doesn’t think ketones are likely. I havent reached to test her so far, i hope i will during the day. He also said that when we start insuline, for at least the first three days I should measure BG every 2 hours. If I don’t want to poke her so often, he suggested using Libre3. But I don’t want Libre. My cat is extremely difficult and intolerant of handling. Even for basic procedures she needs sedation , even for blood draws. So for a Libre, she would need sedation again, and I really don’t want to put her through that.

We talked for about an hour and a half, but because I was overwhelmed and crying the whole time, i didn t ask what happens after those first three days of testing every two hours, how often do I need to test after that?

I am also unsure about free-feeding. What if she decides not to eat before the injection? What am I supposed to do in that case?

I feel very confused. I would really appreciate your guidance on how to proceed and which vet’s protocol might be best to follow. It would also help me a lot if you could tell me the correct sequence of steps, I’m so afraid of making a mistake.

Thank you again for being here for me and Μaggie.

Ok your long term vet is trying to treat your cat like it's a dog. Caninsulin is a dog insulin- it's literally there in the name. It does make the advice he is giving make more sense but it is the wrong advice and wrong insulin for a cat.

The third vet seems much more in line with advice here. I would trust that vet more. We'll need a member with experience of lantus to say whether that much initial testing is necessary. Free feeding can work, what you don't want is your cat eating all their food in one go.

Your cat being sick could be something and it could be nothing. I really would like you to check for ketones. Since Maggie is diabetic and not on insulin she is at risk. If you can get the ketostix all you need is to dip them in the urine, have a countdown on your phone and match the colour when the timer runs out.

Do you have your insulin yet? The order for lantus insulin is test, feed,shoot. Maggie only needs to have eaten a little to be able to inject the insulin, if she isn't willing to eat you have to wait to inject till she is - that may mean missing a shot or using treat foods to wake her stomach up and get her eating.

 

[Robo & B]

Sorry meant to say if your cat is a natural grazer and you are trying to get her to eat more in one sitting. The throwing up could be because of that. We call it scarf and barf. It just means they eat too quickly and their stomachs are too full so some or all of the food comes straight back up

 

[hellen_maggie]

I want you to know you are doing amazing! We all have made mistakes at first, myself, not too long ago for some idiotic moment I forgot to give Corky’s shot, when I saw the full syringe in the fridge door 4 hours later I was in tears all night long and feeling miserable and did’nt sleep a wink testing him every two hours, I wanted the ground to swallow me, we’ve all been there, but it gets so much better, and soon you’ll see and laugh about it latter, but we love our cats as we love our children for me my pets are my family and Corky has been with me for 12 years, I tear up at the thought of loosing him, stay here concentrate here, and all your stress will be gone in no time, I trust this forum blindly the members here are better schooled on FD than some vets are I see it post after post the miracles of a cat on remission, regulated, healed, with their dedication and love they help us

So, which vet do you advise me to start with? I assume the one who recommends Lantus? But he said to begin with just one injection per day, 1 unit. Should I really start that way, or should it be two injections per day?

Also, does it actually make sense to test every 2 hours for three full days? And if I follow this approach, what is considered ideal feeding with Lantus? How many meals should she have, and how close to the injection, before or after?

One more thing: I understand that Lantus is a long-acting insulin. Does this mean that Maggie is at risk of hypoglycemia throughout the entire day? And how can I manage that safely when I have to be at work? how do you manage that?

I also don’t know how many daily tests are needed (after the first 3 days that i should test every 2 hours) on Lantus. I’m really sorry if I’m repeating myself, but I still don’t fully understand what the right steps are, and that’s why I haven’t started yet. Please tell me what you think about all the above so you can help me make a decision. I know time is not on our side, and that delaying might harm Maggie.

Thank you again for your help and every advise.

 

[Sienne and Gabby (GA)]

I want to provide a bit more information. Vets, at least in the US, do get training in treating diabetes. The major research on the use of glargine for treating feline diabetes came out of Australia. The issue is more that in veterinary training they are discussing every animal possible during lectures on diabetes. Vet schools don't specialize in cats only. In the US, the American Animal Hospital Association has published guidelines for the treatment of diabetes. They recommend either glargine (Lantus) or Prozinc. Feel free to share the linked paper with your vet. In many European countries and Canada, for quite some time, Caninsulin had to be prescribed first because it was developed for animals. That has since changed. As others have noted, Caninsulin was primarily developed for dogs. The issue is that cats have a much faster metabolism than dogs and they burn through the insulin in less than the 12-hour cycle which makes a shorter acting insulin less than wonderful for cats. As a result, there can be wide swings in cats' blood glucose numbers. That said, we've also seen cats do relatively well on Caninsuln. (They do lots better on Prozinc and glargine, though.)

As a comparison, think about human diabetics. I don't know a single human that typically eats only when they have an insulin shot. People tend to eat at least 3 meals per day and sometimes eat between meals. There's no reason it has to be different for a cat. With an insulin like Caninsulin, that tends to drop blood glucose hard and fast, having the majority of food available at shot time makes sense. (You test, feed, wait 20 - 30 min, then give the insulin injection because you need to have food in your cat's system so the numbers don't bottom out. ) However, it also makes sense with a shorter acting insulin like Caninsulin that you have food available. Most cats will look for food if their blood insulin numbers are dropping (or if they are used to grazing). It's like humans, if your blood glucose drops, you get hungry.

It's fine to gradually transition your cat off of dry food to a low carbohydrate, canned food diet. We encourage a canned food diet for a few reasons. First, cats have a limited thirst drive. Canned food contains far more moisture than dry food. For a diabetic, this is particularly important. Kidney disease is a disease of aging that affects many cats. Diabetes is hard on the kidneys. Keeping a cat hydrated, especially a diabetic cat, is critical to kidney health and prolonging the cat's life. Most dry foods are not of wonderful quality. They contain ingredients such as "powdered cellulose". That's a polite way of describing sawdust. Overall, Royal Canin is not a great food due to the amount of carbohydrates. There are very few dry foods that are low in carbs and I have no idea if any of those foods are available in Greece. Not to disagree (again) with your vet, the rationale for feeding a dry food makes absolutely no sense. According to your vet, a pet food that contains carbohydrates is no different than a food that doesn't contain carbs. Most dry food contains carbs. These are the first several ingredients in the RC Glycobalance dry food: Chicken by-product meal, barley, wheat gluten, corn gluten meal, soy protein isolate, tapioca, powdered cellulose, chicken fat, natural flavors, dried chicory root, fish oil, psyllium seed husk, potassium chloride, sodium pyrophosphate, calcium sulfate, vegetable oil, fructooligosaccharides. The last ingredient is a sugar. The items I put in bold all are carbohydrates. In addition, cats are obligate carnivores. They do best on a high quality protein diet. By-products and wheat gluten are not great sources of protein. You want muscle meat and there's no quality protein in the dry Glycobalance.

 

[hellen_maggie]

So, which vet do you advise me to start with? I assume the one who recommends Lantus? But he said to begin with just one injection per day, 1 unit. Should I really start that way, or should it be two injections per day?

Also, does it actually make sense to test every 2 hours for three full days? And if I follow this approach, what is considered ideal feeding with Lantus? How many meals should she have, and how close to the injection, before or after?

One more thing: I understand that Lantus is a long-acting insulin. Does this mean that Maggie is at risk of hypoglycemia throughout the entire day? And how can I manage that safely when I have to be at work? how do you manage that?

I also don’t know how many daily tests are needed (after the first 3 days that i should test every 2 hours) on Lantus. I’m really sorry if I’m repeating myself, but I still don’t fully understand what the right steps are, and that’s why I haven’t started yet. Please tell me what you think about all the above so you can help me make a decision. I know time is not on our side, and that delaying might harm Maggie.

Thank you again for your help and every advise.

i did the ketones test. Thank god, negative

 

[hellen_maggie]

I want to provide a bit more information. Vets, at least in the US, do get training in treating diabetes. The major research on the use of glargine for treating feline diabetes came out of Australia. The issue is more that in veterinary training they are discussing every animal possible during lectures on diabetes. Vet schools don't specialize in cats only. In the US, the American Animal Hospital Association has published guidelines for the treatment of diabetes. They recommend either glargine (Lantus) or Prozinc. Feel free to share the linked paper with your vet. In many European countries and Canada, for quite some time, Caninsulin had to be prescribed first because it was developed for animals. That has since changed. As others have noted, Caninsulin was primarily developed for dogs. The issue is that cats have a much faster metabolism than dogs and they burn through the insulin in less than the 12-hour cycle which makes a shorter acting insulin less than wonderful for cats. As a result, there can be wide swings in cats' blood glucose numbers. That said, we've also seen cats do relatively well on Caninsuln. (They do lots better on Prozinc and glargine, though.)

As a comparison, think about human diabetics. I don't know a single human that typically eats only when they have an insulin shot. People tend to eat at least 3 meals per day and sometimes eat between meals. There's no reason it has to be different for a cat. With an insulin like Caninsulin, that tends to drop blood glucose hard and fast, having the majority of food available at shot time makes sense. (You test, feed, wait 20 - 30 min, then give the insulin injection because you need to have food in your cat's system so the numbers don't bottom out. ) However, it also makes sense with a shorter acting insulin like Caninsulin that you have food available. Most cats will look for food if their blood insulin numbers are dropping (or if they are used to grazing). It's like humans, if your blood glucose drops, you get hungry.

It's fine to gradually transition your cat off of dry food to a low carbohydrate, canned food diet. We encourage a canned food diet for a few reasons. First, cats have a limited thirst drive. Canned food contains far more moisture than dry food. For a diabetic, this is particularly important. Kidney disease is a disease of aging that affects many cats. Diabetes is hard on the kidneys. Keeping a cat hydrated, especially a diabetic cat, is critical to kidney health and prolonging the cat's life. Most dry foods are not of wonderful quality. They contain ingredients such as "powdered cellulose". That's a polite way of describing sawdust. Overall, Royal Canin is not a great food due to the amount of carbohydrates. There are very few dry foods that are low in carbs and I have no idea if any of those foods are available in Greece. Not to disagree (again) with your vet, the rationale for feeding a dry food makes absolutely no sense. According to your vet, a pet food that contains carbohydrates is no different than a food that doesn't contain carbs. Most dry food contains carbs. These are the first several ingredients in the RC Glycobalance dry food: Chicken by-product meal, barley, wheat gluten, corn gluten meal, soy protein isolate, tapioca, powdered cellulose, chicken fat, natural flavors, dried chicory root, fish oil, psyllium seed husk, potassium chloride, sodium pyrophosphate, calcium sulfate, vegetable oil, fructooligosaccharides. The last ingredient is a sugar. The items I put in bold all are carbohydrates. In addition, cats are obligate carnivores. They do best on a high quality protein diet. By-products and wheat gluten are not great sources of protein. You want muscle meat and there's no quality protein in the dry Glycobalance.

Thank you very much for all the information, it is truly clear and easy to understand, and it helps me a lot. I would be very grateful if you could also help me with the questions I asked today in my message to Corky, which I am copying below.
hellen_maggie said:
So, which vet do you advise me to start with? I assume the one who recommends Lantus? But he said to begin with just one injection per day, 1 unit. Should I really start that way, or should it be two injections per day?

Also, does it actually make sense to test every 2 hours for three full days? And if I follow this approach, what is considered ideal feeding with Lantus? How many meals should she have, and how close to the injection, before or after?

One more thing: I understand that Lantus is a long-acting insulin. Does this mean that Maggie is at risk of hypoglycemia throughout the entire day? And how can I manage that safely when I have to be at work? how do you manage that?

I also don’t know how many daily tests are needed (after the first 3 days that i should test every 2 hours) on Lantus. I’m really sorry if I’m repeating myself, but I still don’t fully understand what the right steps are, and that’s why I haven’t started yet. Please tell me what you think about all the above so you can help me make a decision. I know time is not on our side, and that delaying might harm Maggie.

Thank you again for your help and every advise.

 

[CORKY]

i did the ketones test. Thank god, negative

See Hellen I told you Sienne is a Wizard at explaining with much more clarity! If "I were you I would follow her suggestions to the letter, I do she is extremely knowledgeable with Lantus and dosing, and a curve is only testing every 2 hours for 1 cycle (2hours), and that's it then you just continue to test the following day as you normally do, This is a process, on step at a time, you should not worry about hypoglycemia, if you test feed shoot, and several small meals during the day, there is a protocol for each either Lantus or ProZnic, there are several protocols for feeding, but you need to make the decision on which vet you want, my common sense tells me The Vet that will prescribe Lantus, but you must speak to him let him know that perhaps he should start on a low dose since Lantus is a 12 hour insulin, Maggie will need two shots, let this vet see that you are getting prepared , let him now about this Forum, most vets are happy to see your care, and most of all take control of the knowledge yu have by letting him know what you have learned, for right now, , everything will be ok, We are her for you, keep asking

 

[squeem3]

You can do 1 unit of Lantus daily. It would be 0.5 units in the morning and 0.5 units in the evening. Cats need insulin twice a day.

Always test before giving insulin. That way you know if your cat is at a safe enough level for insulin, generally advised any number over 150 mg/dl. The spot checks can be done at any time between the insulin shots. It doesn't need to be at the same time every day or even done every day. Always test if your cat is showing hypo symptoms or if you think your cat might be showing symptoms.

 

[Sienne and Gabby (GA)]

Happy to reply.

If you look at the AAHA guidelines I linked, cats need twice a day dosing. While Lantus is long acting, it doesn't last 24 hours in cats. They require twice a day dosing. See page 4 of the guidelines in the paragraph above "Treatment for Dogs." It specifies insulin should be given to cats every 12-hours. How large of a dose you begin with depends on what you're feeding your cat. If you want to do what your vet is suggesting, give 0.5u of insulin twice a day -- a total of 1.0u daily.

You do not need to test every 2 hours. We recommend a minimum of 4 tests per day. You ALWAYS want to test before giving an insulin injection -- the AMPS and PMPS tests on your spreadsheet. This test will let you know if it's safe to give insulin. You then want to get a minimum of one additional test during both the AM and PM cycles. You can look at my spreadsheet. I tested a lot and I have 6+ years worth of data. I'm also someone who really, really likes having data. The exception to the 4 tests per day is if your cat's numbers are running low. You want to test more frequently to make sure your cat stays in safe numbers. We have information on managing low numbers.

Most of us feed our cats several small meals during the first half of the insulin cycle unless our cat is a grazer. I typically fed Gabby at shot time, and more food an hour, and two and/or 3 hours after, her shot. She also had an early nadir (lowest point in the cycle) versus a nadir that was about mid-cycle. When you feed your cat is more of an "art" than anything else and depends on your cat. Because Lantus generally doesn't start working immediately, you can test, feed, and shoot all within a few minutes. I gave Gabby her shot when her head was in her food bowl.

Most cats have a "curve" -- numbers are highest every 12-hours when the insulin has mostly worn off and are at the low point (nadir) around 6 hours into the cycle. However, some cats typically have an early or late nadir. Gabby's nadir was at around 3 hours post-shot except when it wasn't. Nadirs can and do move around. Cats do not like to be predictable! Keep some high carb food at home (e.g., Fancy Feast Gravy Lovers) or your can use a few drops of corn syrup or honey if you need to bring low numbers up. Many members find that having a timed feeder helps with managing numbers when at work. If I saw that Gabby's numbers were running a bit low before I left for the day I would make sure she had food and might load the feeder with something that was a bit higher in carbs. A lot of this depends on your cat and how carb sensitive your cat is.

Keep asking questions!!

 

[hellen_maggie]

See Hellen I told you Sienne is a Wizard at explaining with much more clarity! If "I were you I would follow her suggestions to the letter, I do she is extremely knowledgeable with Lantus and dosing, and a curve is only testing every 2 hours for 1 cycle (2hours), and that's it then you just continue to test the following day as you normally do, This is a process, on step at a time, you should not worry about hypoglycemia, if you test feed shoot, and several small meals during the day, there is a protocol for each either Lantus or ProZnic, there are several protocols for feeding, but you need to make the decision on which vet you want, my common sense tells me The Vet that will prescribe Lantus, but you must speak to him let him know that perhaps he should start on a low dose since Lantus is a 12 hour insulin, Maggie will need two shots, let this vet see that you are getting prepared , let him now about this Forum, most vets are happy to see your care, and most of all take control of the knowledge yu have by letting him know what you have learned, for right now, , everything will be ok, We are her for you, keep asking

The vet who prescribed Lantus suggested that I start with 1 unit (0.01 ml) of Lantus, one shot per day. It’s a low dose, right? But I need to ask him about the two shots…