Take2: Six months in and frustrated

[Awilliams]

Hi everyone - I've been reading your board for several months since our cat, Nathan, was diagnosed in July but just joined today. Nathan is 12 years old and diagnosed after sudden weight loss and a dehydration episode that nearly killed him. He has been to a specialist and his ultrasound showed evidence of pancreatitis, inflammation of his gallbladder and cysts on his liver. Bloodwork is otherwise normal. The doctor's first directive to us was to get the diabetes under control. He has held his own the last few months, but is now up to 3 units, 2x per day. He eats Purina Pro Plan DM food, wet only. He has ebbed and flowed, but this morning he had what seemed like a hypoglycemic episode. I feel like the more his insulin has increased, the worse his symptoms have become. Our vet wants us to feed him twice a day only, but there is no way we can get him to 2x per day. I know these kitties have ups and downs, but I'm beginning to lose hope. Our vet tests Nathan's fructosamine regularly. Does anyone have advice on other foods to consider? I don't like the idea of our vet only recommending a food that they sell. Any other advice is appreciated.

 

[MrWorfMen's Mom]

First of all welcome to FDMB. I see you posted in Welcome already. Here is a link to your welcome post.
http://www.felinediabetes.com/FDMB/threads/six-month-post-diagnosis-and-frustrated.221661/

3units twice a day is not a huge dose and certainly not unheard of, but it is a bit more than a lot of cats need. You mentioned he had what you thought might be a hypoglycemic episode this AM. Can you tell us exactly what you saw that makes you think it was hypoglycemia, how long (# of hours) after his morning shot this happened, and when Nathan had last eaten and what he ate prior to the episode. I presume from your post, you've never seen this happen before and that you are not home testing Nathan's BG.

When Nathan was hospitalized at diagnosis, did the vet mention ketones or DKA?

Please do not give insulin again until we try to determine if what you saw was likely hypoglycemia.

 

[Awilliams]

When he was diagnosed in July after hospitalization, he did have keytones in his urine. His diabetes developed from pancreatitis, from what the specialist told us. Regarding what I thought was hypoglycemia, he had stumbled when I let him into the kitchen that morning to eat and it startled me. From watching him walk and talking with our vet, it seems to be a little bit of neuropathy in his back leg. We took him to the vet that day, and his fructosamine levels are finally showing progress and he in "fair control" range at this point. His kidneys are good and all other blood word looks great, according to the vet. Because he was still ravenous and extremely thirsty, she upped insulin to 4 units, 2x per day and will check his fructosamine levels again in a month. We've had lots of discussions with the vet about managing the symptoms instead of trying to manage to numbers. We are not home testing. I have read a lot about how people are taking care of diabetic kitties and trying to balance that info with how our vet recommends doing so. There is so much info out there, it's overwhelming. Anyway, Nathan is holding his own right now and seems to have a little bit of that sparkle back.

 

[MrWorfMen's Mom]

I am so glad to hear it wasn't a hypoglycemic episode and happy to hear the fructosamine showed fair control. I do however have major concerns about increasing the dose by a full unit on the basis of a fructosamine test. That's a huge increase and few cats ever need 4 units of insulin. I would strongly suggest however that you consider home testing to see what is going on day to day with Nathan. Not only might it help get him better regulated but it also would keep him safe.

We can help you learn to test and help you make decisions about dosing to keep Nathan safe and on the path to good regulation. Your vet is providing you with instructions and acting in accordance with what they are able to do and think you as the pet parent would be willing to do. They also don't usually have a lot of diabetic cats in their practice thus limiting their hands on experience with feline diabetes. Many treat cats like dogs when the two are totally different situations. The folks here, while lay people, live breathe and sleep feline diabetes 24/7 and the experience amassed here is worth its weight in gold.

It's entirely your decision how you want to deal with Nathan's diabetes but we are here to help you in any way we can.

 

[Awilliams]

I appreciate your help and insight. They have been increasing him very slowly since his July diagnosis, but I did worry about the jump from 3 to 4. Do you have any insight on how cats with pancreatitis as the culprit of diabetes fair vs. cats that develop diabetes based on weight issues over time? He was suddenly sick and diagnosed this summer and had never been a really overweight cat. I'm wondering if it makes it harder to regular the diabetes? Also, can you point me to an article or instructions for home testing. I'm definitely willing to give it a try. We love our vet very much but I will admit that I'm researching the holistic vets in our area to see if that is a better approach for Nathan. Also, I can't get our vet to tell me it's ok to change food. They are very set on DM as a solution, but after reading the threads on food choices and Dr. Pierson's food comparison chart, I want to find another solution. I know that has to be considered carefully given his current insulin dosage so we won't make any sudden moves. Also, feeding him twice a day is an impossibility. If we try to do that, he sits in the kitchen and howls at night, jumps on the counter and searches for food. We end up giving him a smidge of food before bedtime or else no one in the house would sleep. So I'm also trying to read up on feeding time recommendations. He is on Lantus which seems to allow for more of a grazing schedule if I'm not mistaken? Anyway, lots to consider and thank you already for the advice.

 

[April & Quincy]

Also, I can't get our vet to tell me it's ok to change food. They are very set on DM as a solution, but after reading the threads on food choices and Dr. Pierson's food comparison chart, I want to find another solution. I know that has to be considered carefully given his current insulin dosage so we won't make any sudden moves. Also, feeding him twice a day is an impossibility. If we try to do that, he sits in the kitchen and howls at night, jumps on the counter and searches for food. We end up giving him a smidge of food before bedtime or else no one in the house would sleep. So I'm also trying to read up on feeding time recommendations. He is on Lantus which seems to allow for more of a grazing schedule if I'm not mistaken? Anyway, lots to consider and thank you already for the advice.

I am one of the ones whose cat was also on DM, per my vet, as a very helpful solution. However, I started researching cat food, what's in it, what the protein/fat/carb content should be and was surprised and sad to learn that this expensive cat food I was raking out tons of money for was no better than some other food I could buy for much cheaper!! So I decided to slowly switch to Fancy Feast, one with lots of protein and fat. My vet just told me last week she wants me to switch back to DM. I see her tomorrow and I know she'll say the same thing but I know not only am I saving money, but more importantly, my cat is getting a much better food for his needs.

 

[MrWorfMen's Mom]

Other health conditions can and do often have an impact on controlling BG. Pancreatitis is one of those conditions. That said we have lots of folks here who are or have dealt with that situation so again, I think we can help you deal with the multiple issues that Nathan and you are dealing with.

On the diet front, I agree with @April & Quincy. The ingredients in DM are absolutely no better and often inferior to those in many retail brands of food. Vets get their nutritional education from the big brand pet food companies and get brain washed into thinking the so called prescription diets are best. In reality there is nothing prescription about most of the so called prescription diets and in fact while the vet will suggest DM is for diabetics it is really a dietetic NOT diabetic food. Many diabetics need to regain weight they lost before diagnosis so feeding dietetic food defies logic. The DM food is too high in carbs for diabetics and the while the DM pate is ok on the carb front, the Savory Selects wet food is 10% carbs which is a the upper limit of recommended carbs.

The simplest solution with the vet is to tell them that Nathan has stopped eating the DM food....Nathan has to eat so you found an alternative. I wouldn't however consider changing diet until you are home testing as some kitties can have a dramatic drop in their insulin needs as a result of diet changes if carbs are lowered.

Also feeding twice a day is old school and it's actually better to feed multiple mini meals throughout the day. It's easier on the pancreas and helps keep BG more controlled and of course helps let you sleep because you no longer have a kitty howling or breaking into the garbage can because he's ravenous.

For home testing, a human meter available locally works just fine. Many folks here use the Relion meters available at Walmart. The main expense involved is the strips for the meter and the Relion strips are very reasonably priced. Do get some larger lancets for testing (26 or 28 gauge is ideal).
HERE is some information about home testing. Have a peak and then let us know what questions you have. We are full of tips and tricks to make the process as easy as possible for both you and Nathan.

 

[Awilliams]

Prior to Nathan's diagnosis, he and our other cat both ate Fancy Feast only (chicken, turkey, beef pate, no gravy.) In June, both of our cats became very ill. Nathan had pancreatitis and was suddenly diabetic and our other cat was diagnosed with inflammatory bowel and Peyer's Patches. It was a rough few weeks of back and forth and near death experiences for both of them. I started reading up on Fancy Feast, searched message boards online and even the Better Business Bureau. Dozens of people had reported their cats suddenly becoming ill at the same time as our cats and there were messages that FF had changed the formula and/or started making the food overseas. I couldn't verify any of the info, I asked our vet repeatedly about it, but we just could not go back to feeding them FF. When we opened a can and put it in front of them, both cats walked away. Now we have a diabetic kitty and an IBD kitty, high food bills and pretty complicated feeding rituals. But we love them and will do whatever it takes to make them happy! We have two specialty pet food stores in town with lots of small-batch options. I plan to take Dr. Pierson's food chart and use it when selecting a new brand to consider for Nathan.

We just bought some DM pate formula as he was eating the savory select formula up until now. I asked the specialist we saw why Royal Canin and the Purina DM formula are most recommended by vets for cats with the conditions ours have. I told her I was skeptical. She said that both of those companies certify that the formulas are made in feline food-specific facilities where no contamination takes place with other product lines, and that's why she trusted it so much. She also said that Royal Canin even flew her medical class to France to tour their headquarters and plants located there. As she told me that, I thought, well this is no different than any supplier/vendor wanting to secure business; get them while they are young! She may trust the brand, but her story just made me more aware of the fact that these are conglomerates trying to make sure they are always the recommended brand, even though it isn't a one size fits all scenario. Anyway...the search continues. Food is the one part of this equation that I haven't been able to get our vet to budge on, and it just bothers me.

I will look into getting our testing supplies this weekend. I'm grateful for the advice and sounding board. I have felt very alone and helpless in this situation until now!

 

[Sarah&Soph]

I think the issue with fancy feast is that more cats have food intolerances than people realize, and what they think is FF “poisoning” their cats is really just their cats not being able to tolerate it. FF is a perfectly fine option, but because almost every variety of their food contains chicken, fish, and unspecified byproducts, I think it makes it a culprit in a lot of food intolerance cases. FF and friskies are also frequently the target of those fake posts that go around social media about “batch number xxx poisoning and killing cats!” which I think contributes to people’s distrust of it.

There are plenty of other good options on the food chart that are better ingredient wise than the DM. Weruva and tiki cat are two good brands to consider, and a single protein might be better for your IBD kitty. Instinct is a pricey brand, but they have two novel protein varieties that are low enough carb for diabetics, if both your cats will be eating the same food.

And if your vet won’t budge on the food issue, well, my philosophy is they only know as much as you tell them!

 

[MrWorfMen's Mom]

You're never alone around here. Usually someone has experienced the same issues and can offer some suggestions or ideas.

On the food front, I'd be very careful about the insulin dose and definitely wouldn't raise it to 4u while changing over to the DM pate from the Savory select and to be blunt, your vet should know that if he/she is going to be so adamant about feeding the food they are promoting! Even a 4% carb change could result in a lowered insulin dose being needed. Some cats are more carb sensitive than others. I remember running into a RC rep in my early FD days at PetSmart. Told her what I was looking for (under 10% carbs). She couldn't have possibly been more clueless.

I agree with Sophie. I have been feeding FF Turkey/Giblet pates for years an never had an issue. From the label, there was no indication of formula changes when those reports of problems were circulating. I too would think it might be a sensitivity of your cats rather than the food. Hounds and Gatos and Ziwipeak both have novel proteins if that is what you need but both are pricey. There are lots of alternatives out there and all you can do is experiment a little at a time to see what works for Nathan and your other kitties.

 

[Sienne and Gabby (GA)]

My kitty, Gabby, was one whose diabetes was likely related to pancreatitis. She was quite ill when diagnosed -- diabetes, pancreatitis, hepatic lipidosis, and diabetic ketoacidosis. I had 2 vets preparing me that she might not survive. After 3 days in the ICU, she was back home with me. It was another week or 10 days on meds and probably a month before I found FDMB. If you want more information on pancreatitis, this is a Primer on Pancreatitis that one of our member put together.

One of the things that will make your life much simpler is if you feed your IBD kitty and your diabetic kitty the same food. For what you're paying for the prescription food, you can buy a much higher quality human grade food that is a novel protein that is also low in carbohydrates. I have an IBD kitty. I largely feed a raw diet. I found a great deal of information from this group -- Raw Feeding for IBD Cats. Even if you don't want to go the raw food route, there is wonderful information on supplements, etc. that can help with managing IBD. They also have a Facebook group. If you want a canned food, ZiwiPeak is very high quality -- no gums or carrageenan which can contribute to IBD -- and they have venison, lamb, and sometimes a lamb and rabbit combination which are novel proteins that are necessary for an IBD cat.

 

[Si am cat mom]

I appreciate your help and insight. They have been increasing him very slowly since his July diagnosis, but I did worry about the jump from 3 to 4. Do you have any insight on how cats with pancreatitis as the culprit of diabetes fair vs. cats that develop diabetes based on weight issues over time? He was suddenly sick and diagnosed this summer and had never been a really overweight cat. I'm wondering if it makes it harder to regular the diabetes? Also, can you point me to an article or instructions for home testing. I'm definitely willing to give it a try. We love our vet very much but I will admit that I'm researching the holistic vets in our area to see if that is a better approach for Nathan. Also, I can't get our vet to tell me it's ok to change food. They are very set on DM as a solution, but after reading the threads on food choices and Dr. Pierson's food comparison chart, I want to find another solution. I know that has to be considered carefully given his current insulin dosage so we won't make any sudden moves. Also, feeding him twice a day is an impossibility. If we try to do that, he sits in the kitchen and howls at night, jumps on the counter and searches for food. We end up giving him a smidge of food before bedtime or else no one in the house would sleep. So I'm also trying to read up on feeding time recommendations. He is on Lantus which seems to allow for more of a grazing schedule if I'm not mistaken? Anyway, lots to consider and thank you already for the advice.

Hi ! I also recently just diagnosed with my guy- diabetes and elevated liver enzymes. I also worked in veterinary medicine for 11 years and made the mistake of feeding foods that were not feline appropriate. Also, I will just say at my day practice- full disclosure- we recommend Purina, Hills or Royal Canin prescription diets because that's what Drs. in general do...it's the " business" of medicine. You met with and talk to reps, they give you stuff, you recommend and prescribe products. Do I think that most vets are great and honestly love providing care for pets? ...YES. Do I also think that just like in Human medicine there is a lack of correlative research in nutritional needs and how they contribute to diseases?... Absolutely! Vets see a lot of patients and my impression was they like to have a standard procedure for treating certain diagnosis and will adjust or personalize or tweek that treatment as needed, but later on. Sometimes I feel like we have to have more of the answers to know how to ask the right questions * shrugs*
I am glad you are looking at other options and information. Don't be afraid to ask for what you want- your veterinary staff is support staff ( we/they work for you technically). You know your cat.
I hope your Nathan feels better soon !!!

PS: my guy is on Lantus and I feed meals at 6am/6pm and snack size meals at 12pm / 12 am. Not eating for 12 hours wasn't working for him and he seemed worse not better for it to me when I checked his numbers. He had always eaten 3 smaller meals / day.

 

[Awilliams]

Hi ! I also recently just diagnosed with my guy- diabetes and elevated liver enzymes. I also worked in veterinary medicine for 11 years and made the mistake of feeding foods that were not feline appropriate. Also, I will just say at my day practice- full disclosure- we recommend Purina, Hills or Royal Canin prescription diets because that's what Drs. in general do...it's the " business" of medicine. You met with and talk to reps, they give you stuff, you recommend and prescribe products. Do I think that most vets are great and honestly love providing care for pets? ...YES. Do I also think that just like in Human medicine there is a lack of correlative research in nutritional needs and how they contribute to diseases?... Absolutely! Vets see a lot of patients and my impression was they like to have a standard procedure for treating certain diagnosis and will adjust or personalize or tweek that treatment as needed, but later on. Sometimes I feel like we have to have more of the answers to know how to ask the right questions * shrugs*
I am glad you are looking at other options and information. Don't be afraid to ask for what you want- your veterinary staff is support staff ( we/they work for you technically). You know your cat.
I hope your Nathan feels better soon !!!

PS: my guy is on Lantus and I feed meals at 6am/6pm and snack size meals at 12pm / 12 am. Not eating for 12 hours wasn't working for him and he seemed worse not better for it to me when I checked his numbers. He had always eaten 3 smaller meals / day.

Thanks so much for this info and your support. We love our vet, but I think I'm about one visit away from changing and looking at holistic vets. There is also a site that a veterinarian friend recommended called petdiets.com that is made up of vets who develop diet recommendations in conjunction with your vet based on your pet's diagnosis. I've mentioned it to our vet a few times and I hope to be able to get them to at least look into it.

 

[MrWorfMen's Mom]

To be honest, I think the majority of folks here deal with the diabetes on their own and use their vet for yearly checkups, dentals, shots or other medical concerns so if you like your vet, I wouldn't stop using them for the pancreatitis and IBD etc. Just take control of the diabetes and don't get into that discussion with them if possible. Once you get Nathan onto a different diet and his BG is better regulated, you'll have proof that other diets can work too.
As Sienne mentioned, a raw diet works well for many diabetic and IBD kitties.