To treat or not?

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DTMFA

DTMFA

Member Since 2015
We have an 18 year old cat named James. He was just diagnosed with diabetes. It is in an early stage, and veterinarian is urging us to start insulin as soon as possible because there is a chance that he could go into remission. We are torn on whether or not to treat James. It is expensive, and purchasing a glucose meter, syringes, testing strips, and expensive insulin is a big commitment, not to mention the actual time commitment. He only has a limited amount of time left with us anyway, and we don't want that time to be miserable for him, filled with injections, stress and pricks in his ear. Basically, he is nearing the end of his life, and we are wondering how long he would be comfortable if we did not treat him. And if we do treat him, what is the possibility that he will go into remission within 4 months as the doctor says? Thank you for any insight you can offer.
 
In my opinion, the minor discomforts of treating the diabetes well outweighs the misery of not treating it. My senior cat suffered for four months with untreated diabetes, because my vet wouldn't test him for it, and he was a sick, unhappy cat, who was slowly starving to death because without insulin his body could not absorb proper nutrients. He is doing very well on insulin, now. I manage the expense, and really never even thought to question the time commitment . He is 17 now and has been on insulin for 5 months.

Nobody can tell you with any degree of assurance whether or not your cat will go into remission; every cat is different. Usually the earlier it is diagnosed and treated the better the chances for remission are, but that's no guarantee. If you choose not to treat him he will not be comfortable for long, and eventually will suffer nerve damage, malnutrition, ketoacidosis and death. I don't mean to sound so brutal, but those are the facts of it.

I hope this helps you make your decision.
 
Thanks for your response. I do well understand that untreated diabetes will eventually end in death, but, not to sound harsh myself, that's how his life will end soon enough anyway. At what point do you say enough? Expense is indeed a concern for us, as is time, since it is important that insulin be administered at certain times and glucose checked similarly, etc. It wouldn't be easy. I'm worried we are about to spend a lot of money on all the equipment, just to find that it is a) traumatic for James b) not tenable for us and c) extending his life without regard for quality. We love James, we have tended him with care for 18 years. Please don't think that I am callous or uncaring.
 
Treatment begins with proper nutrition. You don't mention what James is eating, but a low carb, canned food is essential for his well being. It doesn't have to be the expensive vet stuff, most of us feed Fancy Feast Classics, Friskies Pate or 9 Lives Meaty Pate. If you're feeding dry, try switching James first, then test his BG to see if he still needs insulin.

You are not uncaring. That's why you're here, to learn if you can help James. My cat is 11, he doesn't mind the daily testing or the shots. Money is tight here, but I've found many ways to save money on his treatment. Time, well you do have to commit to twice a day shots, but often you can figure a schedule that will work. As far as James' age, I've had many cats that lived over 20, one now is 23. In the end you will know what is best for James and no one here will judge you for you decision.
 
Thank you. We had a diabetes scare about 5 years ago with James, and we switched him entirely to Friskies pate food, which is low in carbohydrates and high in protein. It made enough of a difference at the time that he did not need insulin. However recent tests have shown that his blood sugar is going up. He started drinking a lot of water and urinating a lot as well. It looks like it's time to start insulin for him.

We are considering going ahead and spending the money to start him on insulin for the next four to six months, hoping that he will go into remission. If he doesn't, I'm afraid we're going to make a pretty tough decision. We simply cannot afford to continue those kinds of treatments indefinitely, and it's going to put a huge burden on us not to travel. We were planning to go home for Christmas, but I don't see how we will be able to do that if James needs twice daily shots. I would normally do the shot one shot before breakfast, which is at 5 a.m. (I work early). There is no way I can get a cat sitter to come at 5 a.m. and from what I'm hearing, it's not flexible to change feeding times or shot times. I'm just not sure how to handle this.
 
I don't know where you are, but Many people here use Lantus(Glargine). They buy it from Canada for much less than in US. I use Levemir, which is similar. I get a single pen for $75 it holds 300 units. How many units will James be on?
 
I do understand your position. I am disabled and very limited in physical ability, and have a very limited budget, as well. Many cats live happy lives into their 20's, even with diabetes. Treating him is a commitment of time, yes, but maybe not as untenable as you may think, especially if more than one family member is willing to pitch in and help. Do you have a friend or neighbor who might be willing to help with giving care and shots while you travel?Maybe your vet can help you find a capable pet sitter, sometimes veterinary techs will take on that kind of job temporarily. Alternatively, could James travel with you?

Please don't feel that I am judging you, I just want to make sure you have the information you need to make the right decision for James. If you choose not to treat him the kindest thing you can do would be to euthanize him so he doesn't suffer with this ugly disease. If you choose to treat him you will find this site will offer you loads of support in all areas of life with a diabetic cat. Either way, we ALL want what is best for James. :)
 
We will more than likely move forward to treat him and just take it a month at a time. We can probaby take him home for Christmas, hope he's OK with a 6 hour drive! Thank you all for your help. We are not ready to let go of James. He's a great old man and I hope he will recover from this. Please cross your fingers for us.
 
Please keep us posted and if you have any questions, please ask! Lots of people here have great suggestions for scheduling and other time and money saving tips. Good luck, I hope everything works out for you and James.
 
Unless your vet is illegally repackaging glargine, you will either get a 300ml pen or a 1000ml vial. As long as you keep in refrigerated and handle with care, both should last you 4-6 months, much longer than 50 days.

No one can give the odds of remission. Glargine had really great remission odds in the studies done, over 80% in newly diagnosed, 30% in long term. Since you say James has some issues before and had been diet controlled, not sure which category he'd fall in. I've had 5 cats go into remission on Lantus and a diet change. I'd say its worth giving James a shot.
 
I want to encourage you to try treatment....You won't believe it's the same cat once you get the diabetes under better control and it doesn't have to cost a fortune either.

I live on SSI of about $700/month and have 2 other cats on top of China. A box of syringes from WalMart is $12.58 (for 100 syringes)....a box of lancets less than $10....and I feed her a mix of frozen raw and Fancy Feast....my other 2 eat Friskies

The biggest cost is the insulin, but that doesn't have to cost a fortune either. I was where you are last year...trying to find a way to afford the Lantus (glargine) and the vials were costing over $250...the Solostar pens were over $450 and nobody would split open a box of 5 to sell me just one. Literally weeks before having to make a final decision, I found Marks Marine Pharmacy in Canada. A vial is $99.99 and a box of pens is $144.99.....the pens are the best buy and will last most cats up to 2 years if cared for properly!!....that breaks down to less than $10/month!!

Since then, I've spread the word about Marks and a LOT of people here are buying their insulin from them. They're safe, reliable and have great customer service

You shouldn't be buying insulin from your vet either....Lantus does not recommend "re-packaging" and it sounds like that might be what your vet is doing. There's no way to guarantee it's pure and uncontaminated that way either. Ask for a prescription so you can shop around for the best price (and then send it to Marks!)

To help you see the difference between un-treated and treated, here are some pictures of China....and I think a picture is worth 1000 words:
China before diagnosis.jpg (click on picture to expand) This is China when she was first diagnosed

China after 4 months insulin therapy_zpsf9fd87af.jpg This is China 4 months later!!
 
For eight years I flew with my diabetic cat on six hour flights across the country to go visit my Dad on my yearly vacation to California. And we also took six hour drives to Pittsburgh PA to attend an FDMB reunion held there each year. They can get used to traveling. I would highly recommend getting him micro chipped if he is not already, and used to a harness and leash. My boy was 11 when he was diagnosed and lived to be 20 with a full life, because of the help from this board.
 
Just saw this in the Supply Closet forum, thought it might be helpful to you, if you haven't already seen it. I believe he still has some left; I don't know how this compares to other Lantus (Glargine) prices as I use a different insulin.
 
Hey everyone, I appreciate your enthusiasm, but everyone need to remember that James is 18. He's not going to adjust well to change. He likes his bed, his food dish, cuddles and us. He's really only got a couple years left in an ideal world, and the question is how do we want that time to be?

We are very grateful for everyone's advice. We are still really struggling with what to do; it may be kinder to give James all of our love and let him go. He's already weak and suffering from muscle wasting in the back legs; his front legs tremble; he vocalizes more at night than he used to. Who would we be prolonging his life for? There are a lot of consequences of treating AND not treating; too much insulin is much more dangerous than not enough. i'm afraid to overdose him and that he will suffer as a consequence. In-home glucose testing looks difficult. The more I read the more complicated it seems. I think he would deal with the injections well, but I fear for his anxiety and discomfort as we stabilize him. I'm not sure it will be worth it; it will also cause anxiety for our family as we spend the money and struggle with the strict timing issues. I continue to welcome everyone's input, and I know that since I am posting on a site specifically for people who are treating cats with diabetes, most people will continue to urge me to treat.

If we have to euthanize James, it will be incredibly hard for us, but less so for him. He's lived a long and well-loved life.
 
The weakness in his legs is likely to be diabetic neuropathy, which improve greatly, sometimes completely, once glucose levels are under control. Home testing seems difficult and complicated, I know, but it is actually very simple and relatively easy to do.

Yes, most of us here would probably advocate treatment, based on the the little we know about James and our experiences with diabetic cats. If your veterinarian is also urging you to treat James I must assume that he/she feels that this is the best course of action for James and that he has a good chance of improving and doing well with insulin. However, you know your cat, and your heart, best, and only you can make this decision. You have to do what you feel is best for James.
 
Of course this is a decision that only you can make, but we've seen such great results and cats that were near death that do so much better and go on to live several more years of good life

Testing, while it might seem daunting, is really quite readily accepted by even the most difficult cat. What most cats don't like (at first) is that you're fooling with their ears, but with a little conditioning, most of them not only accept testing, but even sometimes "demand" it! We always give a treat and cats soon learn that when they're in their "testing spot", they're going to get a yummy treat and don't care what we're doing with their ears.

China's treat was a little piece of baked chicken....now all I have to do is move in the direction of her "testing spot" and start unzipping the meter case and she's there!

What you can do to prepare James is to decide on one spot for testing, take him there several times a day and just give his ears a rub...then he gets a treat (some cats really like freeze dried chicken/turkey, but any low carb treat will work). Soon he'll be associating that spot with the treat instead of the fact you're playing with his ears. There are lots of video's on YouTube on testing a cat's blood glucose and when we first started watching them, I had to think that those cats MUST be drugged, but now that we're doing it, I know that they weren't

The weakness and shaking is more than likely diabetic neuropathy....and it's treatable too. The first thing is to get the blood glucose under better control and there's an OTC medication called Zobaline for cats that has worked wonders. Here's a great video on how far back they can come

We are here for you every step of the way. Let us know how we can help you! There's not much this board won't do to help another sugarcat!
 
DTMFA said:
It is expensive, and purchasing a glucose meter, syringes, testing strips, and expensive insulin is a big commitment, not to mention the actual time commitment. He only has a limited amount of time left with us anyway, and we don't want that time to be miserable for him, filled with injections, stress and pricks in his ear.
Click to expand...

For Comet I started a cost spreadsheet. You can see the cost, the shopping list, and vendor number on his SS. His glucose meter start kit from Walmart cost just under $50 (free shipping if you spend $50). With 100 strips it comes out to 44 cents a test. I purchased the ReliOn Prime Glucose Meter, strips, lancing device, and 26 gauge lances.

I tested myself first with the lancing device to understand what the pain index was and tried taking my blood with just the lance. I would recommend the lancing device if you have any hesitation in poking your cat. It will apply the right pressure for you. I hope in time I can just use the lance.

We have only tested Comet 14 times. He is not on insulin yet. Comet and the husband had some challenges at the start. It took multiple pricks the first 13 reading times from his ear. The drama was mostly Comet wanted to not be underneath the husband. Most events took 10 minutes. A few times husband went through the ear...Comet had no idea...we celebrated the second time because we knew we could get enough blood to test...

The last reading, the 14th reading, husband got it on the first poke. No drama. Comet was like "whatever" dad. This is the stage I think everyone is talk about that you get to.

The break out cost of insulin...I do not have yet....but will add it in the next few weeks when we advance to the next stage.

My vet's advice on treatment level: What makes him a happy kitty?
Father's vet advice: Do you want this cat or a cat? She use this question to find out what the owners want as a goal and then help make it happen.
 
Thanks for the continued advice everyone, I really do appreciate it! I'll be consulting the vet tomorrow with a lot of questions, I will tell you how it goes :)
 
Hello!

I just saw this post. If you are currently treating I just wanted to let you know you are not alone in treating an elderly cat. My Pudden is also 18 and was diagnosed Nov. 5th. She too has nueropathy.

So far she is doing wonderful and the nueropathy is almost gone. I have found testing to be super easy and the shots are even easier than that. Insulin lasts 6-8 months so if the cost is divided up it is not too bad. I use a relion prime meter which uses very inexpensive strips. Money is hard for me so I understand your hesitation on the expense. I am disabled and make less than $500 a month.

I am hoping to get many more years with Pudden. Many cats live into their twenties nowadays and diabetes doesn't have to mean the end.
 
I'm going to be blunt. My avatar Smokey will be 18 in April and I only have had him for the last 19 months (I inherited him). We don't know how long he will be with us, shoot we don't know how long any of us will be here. He is lucky enough that diabetes is his only disease.

I can say without a doubt he wouldn't be here today if left untreated any longer. And he would have been very miserable. His untreated diabetes was bad enough that he was actually starving (lost more than half his body weight) and you could see the pain on his face. The constant vomiting caused stomach pain and burned his throat. Because his owner didn't remember he was diabetic so we don't know how long he'd been without his insulin. And they fed him nothing but dry food and only 1/3 cup a day. This is not quality of life.

If you choose to treat, best to start asap, better chance to control it early and possible remission. In this forum is a room called Supply Closet. There are 2 people selling insulin now. You can purchase insulin from Canada. There are usually people that have meters they don't use and willing to give or sell. Some stores you can buy test strips and get meter free.

If you choose not to treat it would be kinder to James to end it now, so he doesn't suffer through the months of being sick and miserable and starving.

Good luck with your decision. You will do what is best for your situation.
 
Good for you (and for James!), welcome to the club! And I see that he tested at only 232 this morning. I would *kill* for a 232 PMPS :p

He's a beautiful boy, and lucky to have you.

Best,
Sandi.
 
@DTMFA I didn't mean to imply you wouldn't. I'm very blunt, always have foot in mouth. I didn't know if you knew how harsh this disease is. I didn't. I'm sure you will make the best choice for all of you. I just didn't want James to suffer if you decided not to treat. I know my Smokey did.

A little background on Smokey and our journey:

He was my parents cat. He has been in our family with various relatives his whole life. The longest has been with my parents. He was diagnosed in November 2012. It was also the last time he saw a vet. My mother developed severe Alzheimer's. My father was unaware of Smokey's diabetes (I knew but that's all I knew) and in denial of my mother's Alzheimer's. I live 4 hrs away. My mother became hospitalized in May 2014 she wasn't expected to live. When I got there the conditions were unbelievable. Smokey clearly suffering in many ways. I found out my father didn't know about Smokey. Course it was a weekend and vet was closed. Insulin in the house old but not expired. Only found one syringe with the insulin. So I only gave 1u until we could get in touch with vet. Monday I demand the vet see us. They were no help. Didn't even check his glucose and said he was suppose to get 2u. He was on Prozinc. Didn't even make sure I knew how to give it. I knew nothing about this in cats. I didn't know about FDMB. My father decided it was to much for him and I took him until he could go back to them which was a possibility so not treating wasn't an option. On my way home I called my vet, explained the situation and they stayed open until I got there. His glucose I think was 596 or close to it. Smokey was constantly vomiting, lost half his weight, having litter box issues which I think was the main reason that caused the conditions in the house and the cause of the virus my mother caught which caused her heart and kidney failure. In July 2014 my father decided he couldn't take Smokey back. And Smokey was still not well by any means and I had to decide whether to let him go or not. We already had 3 others, one who was special needs but not diabetic. My hubby wouldn't give an opinion. Since he has pay for all the care I was torn. My vet doesn't use Prozinc because of cost. It was over $200 a month and I couldn't afford that. So we started Vetsulin at 2u.I still didn't know about home testing or FDMB. Took Smokey to every 4 weeks for test. I asked about me testing at home because I could not afford the visits. He said to test when I thought Smokey was "off". Eventually he was up to 5u twice a day. They said he couldn't get anymore than that. We removed all dry food. I still wasn't testing. September 2015 Labor day weekend, intuition told me to start googling hypoglycemic symptoms. I found FDMB. Same night I introduced myself Smokey was in hypo episode. Members here got me through it (and many more since). This is when I really started to get involved with his diabetes. Yes the initial outlay has been overwhelmingly. I have learned so much. But now know what food, where to get insulin (started Lantus October 3 2015). All 3 cats on same food. I'm stocked with insulin until April/May. Working on stocking strips (I use Alpha Trac, expensive strips). Started Zobaline to keep neuropathy at bay. After 7 months of feeding him every 2 hours around the clock, Smokey doesn't vomit anymore, no more box issues unless I'm remiss in cleaning all of them. He gained most weight back. He is playing and grooming now and walking better. He still isn't regulated but progress is being made. He is on 1.75-2u twice a day. His readings are getting better and lasting longer. I'm not striving for remission but will take it if it happens. I striving for blues to keep him in the renal limits. Knowing what I know now I would treat. I might have chosen otherwise if Smokey was officially mine from the start.
 
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DTMFA said:
We gave James his first shot of insulin this morning. So far...so good!
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So glad you decided to treat James! He is indeed lucky to have you guys :-) Our Ivana is 17.5 yrs old, and was diagnosed about 3 mths ago. Like James, Ivana was set in her ways and routine. We wondered if she was going to hate us for changing her diet and feeding times etc, but she eats better now than at pre-diagnosis, and has adjusted well to a new feeding regime. Infact, she event waits by the testing basket when it gets close to test time or she just feels like a treat :-) For a kitty who used to hate having her ears touched, I reckon that's a pretty good achievement! It is most definitely doable for the Golden Oldies, and I can see from James' spreadsheet that he is doing wonderfully already with those blues!
 
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