Test Results Finally!

[libbysmom]

So I posted about two weeks ago that my 12 yr old Libby was just diagnosed as diabetic. That was my best guess and that of the vet after discussion. I've been in the medical field for 35 yrs so I know what diabetes looks like in humans so it wasn't hard to figure out. So thanks to this board I promptly made the switch from her all dry diet to an all canned diet. I noticed a great improvement in her within a few days. Less drinking, less urination and less hunger. Fast forward to today to her blood work. My cat hasn't needed a vet in years, so this was new experience for her. She weighed in at 21 lbs. Her BG was 316, much better than I expected. The rest of her CBC was good except her RBC's were a little low, but the vet wasn't worried. So, the vet starts the push for insulin. I querried her, because I didn't think her BG was that awfully high, considering it had only been less than 2 weeks on the new diet. She said if she gets down to 190-200 range she will be happy. Does that sound about right? Since I won't be around to monitor her I opted for pill instead of injectible insulin. The vet also seems to lean towards the pill since we don't have any place locally to get the injectible insulin. It has to be ordered from her supplier. So I will pick up the lantus (?) pills in a few days. I do have some questions though and my vet's assistant didn't seem to sure about the answer. The vet also started to push the "prescription" DM cat food, even dry! I declined and opted to stay with what seems to be working.

What do I watch for as far as possible hypoglycemic reaction? I know what it is in humans, but what are the signs in a cat?
Is the pill the right or best thing to do? I'm not sure if I should give the food and hopefully some weight loss a little time.
Any suggestions for timing of giving the medication and how to give it?
How do I know how much food to give my cat?

The vet would only give me a feeding chart if I went with her DM food. So right now I feed her half of a can of fancy feast, twice a day. I'm worried that isn't enough for her size. I was thinking of upping it to a full can, twice a day. Any feeding guidelines you can recommend is greatly appreciated. Since I have never fed her canned before I have no idea. Thanks in advance for your assistance. I really appreciate this group more than you know! confused_cat

 

[MollynSkooter]

I am fairly new myself, so I don't give out advice..

HOWEVER, I would suggest going to your original post and hitting the "edit" button and clicking on the Question Mark icon...that way when the more experienced peeps are looking, they will see you have a question and pop over to respond

 

[dirtybirdsoaps]

Welcome to FDMB,

Tons of info on this site. Its good that you have medical experience though because diabetes in cats is similar as the risks such as hypo, or dont give insulin without testing, or even watching carbs. 316 is too high, as to the pill form insulin I am not familiar with it although I thought I seen a post shortly ago about it being bad for the pancreas as to no where locally to get it? If your in the US I know people here seem to get lantus from target or walmart (I think). If you are not home testing, you should. It helps get an idea of what works but also what doesn't and helps you stay out of the hypo numbers. You can use a human meter, no need for a pet specific one. Most use relion's from walmart since theyre cheap, also pick up ketone strips....the same ones you'd use for humans. Here is the link for HYPO and what to watch for and how to treat:
viewtopic.php?f=28&t=15887

As to the calories:
The general formula is [13.6 X optimal lean body weight in pounds] + 70, so if your cat's best weight is 12lbs, it'd be [13.6 X 12 pounds] + 70 = 233 calories.

The number of calories per can of cat food is in the last column of this Food Chart. Most are either 3oz cans or 5.5oz cans

Cat Info is a wonderful site with all kinds of information on feeding, transitioning from dry to wet and just about anything else you'd ever want to know about feline nutrition

An unregulated diabetic cat will need to eat more than a regulated cat because without insulin, they can't get the nutrition out of the food they're eating. They're literally starving despite eating large amounts of food. As they become more regulated, they will eat less and less food (well..they SHOULD..we all know some of our kitties are just plain gluttons :lol:

21 lbs Has your vet expressed concern for your cat being overweight? I can't imagine my cats at 21, Hidey was 17 and is now 14 and I'm still working on bringing him down. I know diabetes is linked to obesity and I know part of Hidey's was his weight. Here is a link to Dr. Lisa's findings. She has a LOT of valuable info on her site: http://catinfo.org/

_________________

This post is originally from BJM. I copied and pasted it here and will give you an idea what to aim for:

Comparing a human glucometer to a pet-specific glucometer is like reading temperature in Celsius vs Fahrenheit. Both are correct. You just need to know the reference ranges to interpret what the numbers mean.

[Glucose reference ranges are unsubstantiated and have been removed by Moderator]

 

[Deb & Wink]

Since I won't be around to monitor her I opted for pill instead of injectible insulin. The vet also seems to lean towards the pill since we don't have any place locally to get the injectible insulin. It has to be ordered from her supplier. So I will pick up the lantus (?) pills in a few days.

There is no pill form of insulin. Lantus and all other insulins are injectable liquids only.

You can still monitor your kitty Libby. Many of us work and have other life responsibilities. We manage to test when we have time on days off and always test before we give a shot of insulin. There are also secondary monitoring tools. See BJM's signature for those.

There are pills such as glipizide that can make the pancreas work harder. Regulation on pills such as the glipizide is unusual in cats. We do not recommend the pills, because they can make the pancreas work so hard that any chance of the damaged pancreas beta cells recovering is <10%. You end up having a diabetic cat needing insulin shots for the rest of their life.

What you want is
1. a good insulin for a cat such as Prozinc, Lantus or Levimir. Lantus and Levimir are available at most any pharmacy in the US and Canada. Prozinc does need to be ordered, by your vet or you can get a prescription and order it online or at another pharmacy.
2. low carb canned food. Like the Fancy Feast or Friskies pate styles. Lots of other choices in this Food Chart. Just look for those <10% carb.
3. Home testing to check the BG (blood glucose) levels
4. Gradual weight loss if your cat is overweight since too much weight is a leading factor in insulin resistance in cats.

You've already made some good progress in switching your cat Libby to a better diet. What food are you feeding her?

Her BG was 316, much better than I expected. The rest of her CBC was good except her RBC's were a little low, but the vet wasn't worried. So, the vet starts the push for insulin. I querried her, because I didn't think her BG was that awfully high, considering it had only been less than 2 weeks on the new diet.

Two weeks is enough time to see how the food change will affect her BG (blood glucose) levels. Yes, it's time to start some insulin. Your best chance of remission is in the first few months. The longer you wait to start insulin, the more damage to those insulin producing beta cells in the pancreas will occur. Cats are unique in that they can often heal the pancreas and go off insulin, unlike us humans.

She said if she gets down to 190-200 range she will be happy. Does that sound about right?

Your vet may be happy to see those BG readings in the 190 -200 range, but normal range for a cat using a human meter is 40-120. Yes, readings under renal threshold (180-250 per various sources) is better for your cat, but you can certainly strive for even better BG control and make your cat healthier and feel better.

What do I watch for as far as possible hypoglycemic reaction? I know what it is in humans, but what are the signs in a cat?

Hypo symptoms are detailed in this post on how to treat hypos. You might want to print this out and read it over, and over and have a copy for reference if you do see hypo symptoms in your Libby. Many cats have no symptoms at all.

 

[libbysmom]

Ok, so great info! I have been feeding her Fancy Feast classic. I tried a couple Friskies but she didn't care for it. We have doing the canned food only 4 days, so I feel the 316 isn't too bad. The week prior I had been feeding her the canned with about a tablespoon of dry mixed in it. She has always refused to eat canned food, so I thought this was the easiest transition. My hubby also made the mistake of giving her a bowl full of dry food only on Saturday morning before I woke up. He didn't realize I wasn't giving her the dry anymore. I wasn't happy about that to say the least! Our cat is large (height and length) so that helps her carry that 21 lbs. The vet didn't even mention her weight, except to say that hopefully she will lose a little weight.

So, injectible insulin is preferred? What is the most reliable and most likely to help her normalize and stop the insulin? How hard is it to give? I worry that with cats regular vaccinations have been known to cause cancerous tumors, so don't these injections have the same side effects? I hate to fix one problem and cause another one.

I'm rather angry because I specifically asked my vet if the pill was actually insulin or something similar to Metformin (which acts on the pancreas) and she said it absolutely was insulin and the same as the injectible medication. Now it seems that isn't true. We are in a small town and only have a couple vet choices and this one was the best, most recommended in the area.

I don't have a Target near me, but I will have to see if our local pharmacy can compound the injectible insulin. I really don't want to use Walmart because you will literally wait 40 minutes or more in line and they make a ton of mistakes!! I do have a Walgreens and independent pharmacy that might be able to help. What about mail order? Is that an option? My vet did mention PZ insulin, so I wasn't sure if that the best one to use.

I'm off to read some of the recommended items. Thanks for all the info. I'm just feeling so overwhelmed! I know this will all fall to me to take care of and I just worry that I will mess something up or hurt her. I also don't want her to start hating me or staying away from me because I'm giving her shots.

Thanks!
Libby's Mom

 

[Deb & Wink]

Ok, so it hasn't been all wet low carb for a couple of weeks. From what you said, it thought it was. Maybe another week on the low carb wet food and you might see some better BG readings.

The Fancy Feast classic pates are a great choice. It sometimes takes time to find different flavors that our kitties like. I would not give up totally on the Friskies. It took me weeks to get my Wink to eat flavors other than the Fancy Feast Turkey & Giblets.

The vet didn't even mention her weight, except to say that hopefully she will lose a little weight.

Well, in my experience, vets are pretty reluctant to tell pet owners that their pet needs to go on a diet. Usually our diabetic kitties naturally lose some weight while they are in those higher, unregulated BG levels. They can't process all the food correctly, so will lose a bit. If your vet said that Libby will hopefully lose a little weight, that is vet speak for "Your cat is overweight".

So, injectible insulin is preferred? What is the most reliable and most likely to help her normalize and stop the insulin? How hard is it to give?

Yes, injectable insulin is the best way to allow your cats pancreas to heal. Three good insulins for cats are Lantus, Levimir and Prozinc. Lantus and Levimir are both depot type insulins, while the Prozinc is more of an in and out insulin. Best given twice a day for any of these insulins. Prozinc may fit your life schedule better but the Lantus and Levimir usually give a better chance of remission (80-90%) and a slightly gentler curve and longer duration. There are pros and cons to all the insulins.

Insulin is usually simple to give, shooting in the scruff or along the flanks. Depends on how cooperative your cat is. Many people shoot while the cat is eating and distracted.

Don't know about tumors related to shooting insulin. Never read any studies that this tumor formation occurs with insulin shots. If you have the choice between shooting insulin and making your cat feel better and not giving insulin and watching your cat waste away, starve because they can not process the food they eat correctly without enough insulin and continue to get more organ and nerve damage because of the high BG levels, develop diabetic neuropathy and other health issue, then you go with the insulin. Just my opinion.

I don't have a Target near me, but I will have to see if our local pharmacy can compound the injectible insulin.

I don't know of any pharmacy that can compound Lantus or Levimir. They are human insulins and Lantus should never be compounded or diluted, as you destroy the acidic? base and ruin it's effectiveness and depot effect. I've never heard of Prozinc being compounded either although some pharmacies can compound PZI. That presents issues of the compounded batches of insulin being different strengths and you never know why your cats BG levels vary so much. Was it the insulin strength or something else that happened that day?

Your vet should be able to fax or phone in an order to any pharmacy for the Lantus or Levimir. I would suggest you get the pens, like a mini-vial, as they can be used to the last drop before they lose effectiveness. You may need to hunt around for a pharmacy that will sell you a pen at a time. Less expensive that way. Normally, the pens are sold in 5 packs which can be a budget buster. Maybe do your research first before the vet calls/faxes a prescription in for you. Can't help you on how to get the Prozinc. Never used it.

Mail order is a possibility, but with the warm weather, you need to make sure the insulin is properly insulated for shipment. In cold weather, you need to make sure the temps are not low enough along the shipping route to allow the insulin to freeze. Freezing destroys insulin.

DCIN has a good writeup on how to get Lantus less expensively. Levimir has coupons/savings plan to help with the costs. I don't know the link to give you for that.

Yes, there is a lot of information available. Try to take time for yourself and relax. Libby did not become diabetic in a day or a week or a month and it will take time to get her feeling better.

Sorry to overwhelm you with yet more info, but you did ask a lot of questions. I probably missed answering some of them, so ask again if you need to. We say here that "The only dumb question is the one you don't ask."

You'll quickly feel like an old hand in no time.

p.s. What is your first name?

 

[KPassa]

Here's a write-up I did for the various insulins with links on how to get them that you might find useful.

 

[libbysmom]

Thanks! So the vet did call in the pill glipizide. I told the pharmacy that I changed my mind. I will call the vet tomorrow and ask for Lantus or the other injectible. I may also ask my pharmacist at work if he knows the best place to order it from at the lowest cost. I'm not giving up on the Friskies, as I have several cans / flavors. I originally could only find about 3-4 flavors of the Fancy Feast classics and they were all fish, so I knew that wasn't good. So far she has started eating the chicken flavors, but doesn't seem to like the turkey. I'm trying to keep a list so when I make my monthly trek down to the "big city" I can get just what we need from Petco or Petsmart. It is times like this that living in a small town, in the country isn't as good. I'm looking forward to doing some more reading and research. Thanks for the info and support, it means a lot!

BTW, my name is Marianne.