Another peeing problem! Diabetic kitty

Hi Sandy and welcome to TCS!

I've asked that a moderator move your post to its own thread so that people can see it better and respond to your question.

Sandy, welcome to TCS. I moved your post to the health forum because this appears to be health related rather than behavioral. You also have your own thread now instead of tacking onto an existing thread.

Sorry, I really don't know much about feline diabetes. There will be others who have more experience with it.
for Max. Hope you can get the diabetes under control soon.

Welcome to TCS - I hope very soon some other member's will find this thread and offer some suggestions for you on how to manage feline diabetes. I am sorry you are going through this and poor Max too. Sending many vibes for you to get some answer's.

Welcome to TCS!  I don't know anything about diabetes, but as I mentioned to another recent poster, in order to stop a cat from peeing in the same spot (the rug in front of the litter box) you need to remove that rug and clean it thoroughly with an enzyme cleaner like Nok Out.  Just putting a cookie sheet under the mat won't remove the smell from the mat, although it should help protect your floor .  BTW, depending on what your actual floor is made of, it's possible the smell has even soaked into the floor, so you might need to treat it as well.  I'm surprised Max's brother doesn't pee there also.

 

Hoping someone who is familiar with feline diabetes will come along soon and answer your other questions.

Hi Sandy,

Sorry to hear about the diabetes diagnosis. Been there, done that! My kitty, Aztec, has been diabetic for 9 years, and at almost 19 yrs old now, he's still going strong.

 

Couple things: that 3u 2x/day is a rather large starting dose. Most cats start out at 1u bid, at most 2u. What if Max's ideal dose is less than 3u? Then you've already overshot the mark and it will take so much longer to figure that out. Much better to start low and slowly work your way up. If the dose is too high, Somogyi rebound is likely to occur, which means big swings in blood glucose (and symptoms like increased drinking/urination, making it look like it isn't enough insulin). Hypoglycemia also becomes a very deadly risk.

 

What was Max eating, and what does he eat now? (brand, flavour, wet or dry?)

 

The peeing outside the box is likely due to the high volume that Max is peeing right now. In the litter box, it pools around his feet and he doesn't like it. I found switching to Yesterday's News paper pellet litter prevented the pee pools and Aztec much preferred that. Not all cats like the texture though. Make sure the box is super clean, and consider adding a couple more boxes until Max's diabetes is under better control.

 

Some links you should really check out, if you haven't already:

http://www.felinediabetes.com/

http://petdiabetes.wikia.com/wiki/Somogyi_rebound

http://petdiabetes.wikia.com/wiki/Low-carb_diet

http://www.felinediabetes.com/bg-home-test.htm

 

I also had a diabetic cat ...when his BG became stable  the large amounts of urine also stablized...When he feels better...this should stop...

On a side note there are message boards dedicated just for feline diabetes...they saved my cats life btw...When I found them my cat was on22 units of caninsulin..they told me he was getting way to much and encourgaged me to bascily start over and start home testing DAILY...doing my own curves every week...In the end my cat had a MAX dose of 4 to5 units of caninsulin..They saved his life and saved me tons of money ...Just wanted to let you know that ....

http://www.felinediabetes.com/

 

 

Many people have long or erratic work schedules and don't do exact 12hr dosing. The only potential problem is that the next shot might be at +10 hrs, and there could be some overlap issues. That's another reason to home-test. If kitty's bg hasn't come up enough at the 10 hr mark, adding more insulin could be risky. Giving less insulin at that time could be one alternative if your son doesn't want to home-test. 

 

One thing you haven't mentioned yet is Max's diet. This is a very important piece of the puzzle. A great many cats actually go into remission once they've been switched from a high-carb dry diet (the cause of most cases of diabetes) to a low-carb wet one. I wouldn't do the switch while he's getting the whopping dose of 3u bid, or without home-testing, but that's something to eventually consider.

 

The fact that he's drinking and peeing more now that he's on insulin is very concerning. Did your vet tell you what signs to look for in case Max becomes hypoglycemic? Did he tell you how to treat it?

W/D is one of the worst diets for a diabetic (extremely high in carbs - the dry is 37% carb calories, the canned is 26%. Cats should be eating less than 10%). Has he been on this for a while, or did the vet just switch him because of the diabetes? Back in the "old days", vets would prescribe W/D thinking that the high fibre would help slow glucose absorption. Doesn't work that way for cats, who actually need high protein and low carb. W/D makes diabetes worse. My advice would be to switch both your cats over to a grain-free wet food like Wellness, Nature's Variety, By Nature, Weruva, Merrick, etc, and ditch the dry completely. BUT, you absolutely have to drop that insulin dose and start home-testing if you do. I would go down to no more than 1u bid. There's a very good chance that if you do that, Max will be able to come off exogenous insulin. Here's an excellent link explaining the relationship of diet and diabetes: http://www.catinfo.org/?link=felinediabetes

 

As for a glucometer to try, lots of people use the Freestyle monitors with great results. I've used a few different brands over the years and as long as it's used consistently, it doesn't really matter what kind it is. I think in some cases if you buy 100 test strips, you get the glucometer for free. You'll also need a lancet device (I like the pen style ones) and some lancets. 

 

Your vet is not at all up-to-date on treating feline diabetes. Max's increased drinking/peeing can quite likely be explained by the switch to W/D, combined with too much insulin. Despite what your vet thinks, it's imperative that you stop feeding W/D and drop that insulin dose. All the current literature, as well as the experience of thousands and thousands of diabetic cat owners, indicates that cats need a high protein, low carb diet. That is not what W/D is. Switching to a low carb WET diet (no more kibble) will not only help Max go into possible remission, but will help his brother lose weight and prevent him from getting diabetes as well. You don't need your vet's permission to do this. Please learn as much as you can about feline diabetes from those links I gave you, and if your vet won't work with you on this (and hopefully learn something along the way), find a better one.

 

 

One of the cheaper (but still reliable) blood glucose testing meters (aka glucometer) is the Relion, which you can get at Walmart. Just ask the pharmacist. They can also provide you with lancets, etc. Do you get your insulin and syringes from the vet or the pharmacy? It's much cheaper from a pharmacy, although I think in the U.S. you need a prescription. Your vet should write you prescription if you ask for it (sometimes they charge a small fee). If not, find another vet.

 

Some other decent glucometer brands:

FreeStyle

One Touch

Accu-Chek

Bayer

 

 

Caring for ones companion animals is a very serious responsibility, and often, in light of that concern, members will create threads seeking information from other members. While we allow and encourage expression of opinions and the recounting of personal experiences, it is the forum's official position that no online advice can ever supercede or replace the care and advice of trained medical professionals who have first hand knowledge of the individual animal's condition. We strongly urge members to refrain from advocating the practice of ignoring medical advice

We all see your reply. The only way to keep it private is if you send a person a PM (personal message).

 

 

Depends on Max. Does he get stressed at the vets? Most cats do, and it can indeed affect blood glucose levels (called stress hyperglycemia). The other problem is that when a cat is in a cage at the vets all day, it's not going about its normal routine, which can also impact the results. The cat doesn't eat when it normally does, or maybe not as much (if at all), or maybe more than it would at home. A curve done at home where the cat is comfortable and doing what it normally does is going to much more accurate. And cheaper!

 

I hear ya. It can be a daunting prospect. Took me many tries to get the hang of it, but now I can do it in my sleep. Not all vets know how to do it either though, and some even discourage it. Don't let that stop you. Here are some great tips and videos that should help: http://felinediabetes.com/FDMB/viewtopic.php?f=14&t=287

 

One other thing: there are a couple of animal-specific glucometers that some vets sell, but you don't have to use those. The human ones work just fine, are way cheaper, and it's easier to get the test strips. Some of the manufacturers of the human glucometers saw a way to cash in on diabetic pet owners who were using them and have been marketing the animal ones to vets as being more accurate. They aren't. 

 

 

Really, they're all pretty easy. As long as it uses sipping test strips (and I think pretty much all the meters do these days) and a small amount of blood, you should be fine. Some require coding and some don't, so maybe get one that doesn't require it if you want (coding is just entering a number into the meter to match the batch of test strips that you bought). 

 

Quote:

 

I know how you feel. It does get easier, I promise. And with any luck, Max can go into remission and you won't have to keep giving him shots forever. Some info for you on how the combination of Lantus and a low-carb diet can resolve diabetes in cats: http://www.ncbi.nlm.nih.gov/pubmed/19592286

 

Do you have any Ketostix or Keto-Diastix for testing ketones in Max's urine? Did the vet give you info on hypoglycemia? 

 

 

 

 

 

 

From any pharmacy. They stock them behind the counter, so you'll have to ask the pharmacist. Ketostix test just the ketone levels in the urine, where as Keto-Diastix test for both ketones and glucose. You mostly want to focus on the ketones, which can lead to a life-threatening condition called keto-acidosis. One thing that's helpful about testing urine for glucose if you aren't home-testing bgs, is if you start getting negative tests (so no glucose present in the urine). That means blood glucose has been below the renal threshold since the last time the cat peed (somewhere around 240-290 mg/dL). This is when you might want to be careful that you aren't giving too much insulin. So urine testing does have it's place. Another tool in the toolbox.  

 

Woohoo!!! Congratulations! Not sure if you rubbed or warmed up the ear first for a few minutes but that will really help make it easier to get a drop of blood. I use a thin old sock filled partially with uncooked rice (a knot tied in the end). I heat it in the microwave for about 30 secs (time will vary depending on the microwave and the amount of rice in the sock) to make it warm but not too hot. You'll find it awkward at first, but try to enclose Max's ear in the sock for a few secs at a time, like this: wrap the ear, then remove sock and give him pets, then wrap the ear again, then remove and pet (and rub the ear too, to get him used to it being handled), and repeat until you feel the ear is nice and warm and you can even see the little vein that runs along the edge of it. 

 

Also try using the lancet device on a deeper setting at first. You can eventually dial it down to something shallower later once the blood starts coming easier. And make sure to press it firmly against the ear, with a folded tissue as backing on the other side of the ear to prevent the lancet from going through and getting your finger. After you get the blood sucked up in the test strip, press the tissue over the poked spot and hold it there for a few seconds to minimize bruising. 
 

 

The ideal times to test are generally just before you give insulin, and then some spot checks around the +3 (3 hours after insulin), +6 (6 hours after insulin) and +9 (9 hours after insulin). But you don't have to do all those spot checks on the same day, especially when you're just getting the hang of testing. One day get a +3 reading, the next day +6, and so on. Log all the numbers that you get in a notebook, with the date, the amount and time of insulin, and what/when Max ate. I also like to keep track of the number of times kitty pees a day and how much he drinks (measure out a specific amount of water twice a day, say 2 cups, and then poor what's left back into the measuring cup after 12 hrs and subtract it from the original amount). 

 

When you get more comfortable testing, you can try doing your own curve at home. That would typically mean testing Max's bg about every 2 hrs, like this:

PS (for preshot)

+2

+4

+6

+8

+10

+12 or PS. 

 

One more important thing about testing: make sure you give Max a small extra special treat after each test, something that he loves and only gets at test-time (and preferably low-carb, like freeze-dried chicken such as Halo Liv-A-Littles or Real Food Toppers). That will help him to learn to love getting tested! My cat purrs the whole time and used to come running when he heard me warming up his rice sock (he's too old to do much running these days). 

 

Cats are really amazingly tolerant of high bg numbers for much longer than dogs or humans would be. That's not to say that you don't want them coming down soon, but it isn't a race. After gathering more data and trying to figure out a trend, you and your vet will be in a better position to figure out what to do next. 

 

 

Quote:

 

Okay, just keep a close eye on Max and try to get some tests around +6, give or take, to see how low he might be going. Without the high carbs of the W/D, that insulin dose might have a more profound effect. I'd still be inclined to drop down to no more than 2u. 

 

 

Quote:

 

You're doing great!!! Diabetes is a serious, complicated condition, made even more complicated by the fact that our cats can't talk to us and tell us how they feel. But you and your husband are taking the steps required to get Max on the road to recovery. Hang in there!!! Make sure you take time to look after yourself too. Wine and/or chocolate and/or a nice hot bubble bath can really help. 

 

How much is he eating a day? Personally, I would feed him if he's hungry, or at least space out the meals evenly throughout the day if you can. Until Max is better regulated, he can't fully utilize the food he eats and therefore feels hungry all the time. 

 

The fact that he went down to 250 at +6 shows that he's at least having a response to the insulin. I'd be curious to see how fast he's dropping so if you can get a +2 and +4 at some point, that should provide valuable info. 

 

 

Good luck! Let us know how it goes....

 

 

Double post....

Make that a triple! 

 

Sandy, how did Max do at the vet's yesterday?