Need some help - 16 year old diabetic

[jenwales]

We've just (2 days ago) taken in a relative's 16 year old cat.  According to them, he was diagnosed with diabetes in July but they have not treated him.  We have a vet appointment on Thursday.

George is a really sweet, friendly cat.  His coat looks horrible (dull and very flaky), he's skinny, and he definitely has significant muscle wasting in his hind quarters.  He hasn't jumped up on anything (though he jumps down) and he's very slow to sit and lie down.  He's avoided the stairs.  All he wants is attention and affection.  He's drinking a lot (but not as much as you'd think) and he's eating.  Litterbox habits are good.

George was eating a relatively low carb variety of Friskies canned (I'm at work, but it was one of the special diets) but his kibble was Deli Cat.  I have been giving him Wellness canned for the past 2 days, and Blue Buffalo Wilderness dry that I had on hand.  I had a diabetic cat years ago and changing his diet put him right into diabetic remission, but now I'm concerned that such an old cat might not be able to handle such a high protein diet.  I've asked my relative for a copy of his papework from the July visit but I don't know that she'll ever send it.

Thoughts?  I know my vet will try to put him on one of the Diabetes RX diets and I know most of them are not worth the bags they are put in.  I'd like to hear from anyone with experience.  I also want to stress out George as little as possible.  Poor thing only knew one home and family his entire life and has to be confused.

 

[the_food_lady]

Hi there,

Poor dear.   I had a diabetic cat for 6 years, he was an older fella (lost him sadly to cancer) too.   Chances are good that kitty will need twice daily insulin shots to regulate sugar levels, particularly given his state.   EVO dry is one that the folks on the Feline Diabetes Forum would often use as it's one of the only dry foods, other than Rx food, that's low in carbs.    Frankly, a diet of all canned food would likely be best.   With my boy Taco, much to his dismay, I took him completely off of dry food...and he got canned food twice a day.   As you don't want to make too many changes too quickly, you could try some EVO dry as well, particularly if kitty is used to a dry diet.  

You should check out the Feline Diabetes website;  it's an absolute Godsend to owner of diabetic cat, has tons of wonderful resources from giving insulin to testing blood sugar yourself at home (called "home-testing") which is so much more reliable than testing at a Vet clinic where stress will make their sugars even higher, etc.   Here also is the link to the Health Forum, I encourage you to join it.   A wonderful place to ask questions:

http://www.felinediabetes.com/FDMB/viewforum.php?f=28

Sounds like kitty's been diabetic for a while now so the chances are very low that a simple diet change to low carb food will be sufficient.   He should probably be given some subQ fluids at the vet as dehydration is common in unregulated diabetic cats.   So are UTIs so a urinalysis would be a good idea, too.   The dry skin and awful coat is often due to dehydration.

Giving twice daily insulin is not as overwhelming as it sounds.   I, as many do, bought one of the little human diabetic testing meters and would test him twice a day (or more if he seemed "off") prior to feeding and insulin time, just to see where things were at.   Initially it's best to do what they call a "24 hour curve"....where you test every couple of hours while starting on the insulin to see how that dose is impacting cat.   Dose changes should be done slowly......give any particular dose a good week to "settle"...and the mantra is "low and slow"....meaning, you don't start out with a high dose.  Some Vets are stupid and base starting dose on cat's weight.   My boy was 23 lbs and I got him regulated on 1.5 units twice a day.   Too high of a dose can cause sugar levels to drop drastically and be life threatening, causing hypoglycemia.

 

[sugarcatmom]

I agree with the_food_lady, a low-carb wet food diet and insulin injections are your best bet to helping this kitty get his health back. Don't worry about the high protein content of the low-carb foods, that's what he needs. If he does happen to have kidney insufficiency as well, just keep phosphorus levels in mind and stick with wet food, no dry. My cat is 19, has been diabetic for almost 10 years, and also has CKD for over 2 years. He eats a raw diet for meals and good quality canned for free-feeding and he's doing fabulous. Oh, and he's only on 0.5 units of insulin twice a day and weighs 16 lbs, so definitely don't let your vet select an insulin dosage based on weight.

Good luck! Caring for a special needs kitty can be a very rewarding experience.

Some excellent info at this site: http://petdiabetes.wikia.com/wiki/Main_Page
 

 

[catapault]

Start by taking George to your veterinarian for a glucose test to see what his levels are. Ask your vet if they want him to come in first thing in the morning after no food all night or if they want to test after a meal.

My cat, also 16 years old BTW, has her diabetes now controlled by diet - canned food only, low / no carbs.

When she did need medication at first it was a pill, Glipizide, that I was able to mix with a small amount of canned food. She'd eat it up and look for the rest of her food. Very easy.

Also, if your schedule permits - give her several meals / day. On my own I decided that if human diabetics are told to eat frequent small meals it should be helpful to a cat. So I feed her 1/2 of a 3 ounce can at each of four feedings: breakfast, lunch, supper, bedtime.

Good luck. This is a manageable disease, not a death sentence.

 

[jenwales]

Thank you all, and I apologize for being so late with that.  Life has a way of interfering!   I've spent what little free time I've had over the past few days reading everything I can and lurking at the FDMB board (thanks food lady).  We can do this.  The appointment is tomorrow and I faxed the vet a copy of the only blood work I was able to obtain (from July, his glucose was 397 but everything else was in the normal range.  I guess George started out healthy).  I've watched the "how to give injections" videos on You Tube and am confident I can handle that but the thing I'm worried most about is home testing and not mutilating poor George's ears. 

George has definitely perked up since Saturday so I think the diet has helped some.  I was thrilled when I got home last night and he jumped (gingerly) onto a chair.  It's the first time I've seen him off of the floor.  He loves the Wellness canned turkey but I think he misses his Deli Cat.  Too bad George!  He's nibbling a little at the Wilderness and I'm not ready to take it up yet as there is a 10 hour stretch of the day when I'm not home and I want him to have something.  One thing at a time.  He's still drinking more than normal for a cat, and I think he's urinating less than he was but that may be wishful thinking on my part.

My other cats are dying to meet him.  If all goes well at the vet tomorrow, we are going to start integration.  Wish us luck!

 

[sugarcatmom]

Hi Jenwales,

How did the vet appointment with George go? What type/dose of insulin is he starting out with?

 

[maewkaew]

Hey  I just wanted to add to the great answers you already got.  

I had a cat with diabetes for 6 years. (Sadly, he just died this year from cancer.)  and tested him every day except during one year when he temporarily went into remission   ( Then he had a bad pancreatitis episode and had to go back on insulin shots again and stayed on it the rest of his life.)  

I got some great advice on FDMB about the blood glucose testing. This is a cat who hated being restrained -  but another member with a very similar cat told me how she did it. basically with minimal restraint, and bribery, lol.   I  bribed him with dried salmon treats broken in very small bites.  but any kind of low carb  treat he liked would have worked.

 I was worried about hurting his ears too but his ears looked fine. One could feel that they were very slightly thickened around the edges after years of this,  but it did not look mutilated at all. and he really did not seem to mind.  Once he got used to it, he would come running and jump up to have his test!  because he knew he would get a treat afterward.   ( When people first told me about their cats doing that, I thought mine would never do that -- but he did!)

After the initial time that he thought i was trying to kill him ,  I backed up and then just went through the motions as if I were going to do the test,  warming his ear, holding the lancet device up to it,  but g without actually poking him,  which helped get both of us used to the process..  and each time I gave him a treat.   so that way we both got to practice . I did that several days before I worked up to actually using a lancet.      fortunately he was HIGHLY food motivated so his mind was on the treats.

One trick I used is I would smear on a   very thin amount of  triple antibiotic ointment with pain reliever on his ear before the test.  This ( or Vaseline) also helps the blood to 'bead up' which makes it much,much easier to get the sample. 

 At first if you have trouble getting blood you may need to  use bigger ( lower gauge) needles but later when the ears "learn to bleed" you might be able to use higher gauge ones.

Re food - The only one of the prescription foods that is really low carb at all is the canned version of Purina DM and you can get better food for less money in shops or ordering online.  You can get lots of tips on FDMB about food too.  I did start out getting the DM  but he didn't really like it after a while and I switched to Innova Evo. . then later on used a variety of wet foods like Wellness and Merrick Cowboy Cookout,    and the Merrick Before Grain kinds of cans.   Then later on,  after he got IBD,  I switched to Natures Variety Instinct venison, some raw and some canned. 

 ( Don't worry, diabetic kitties don't usually have as many other problems as my Louis. He was an unusually complicated patient.  )

George should soon be feeling so much better,  thanks to you.

 

[jenwales]

You are all wonderful.  Thank you for all of the information and personal anecdotes.  It helps so much to know that this is doable.

We had to move George's appointment to today and it didn't go at all like I was expecting.  Yesterday when we got home from work George had an open sore on his head near his ear.  I didn't think that much of it, other than maybe he has ear mites and was scratching too much (I never saw him scratching at all).  It was pretty red and nasty looking.  When we got to the vet, she said, "that looks like an abscess," and it was.  She drained it, gave him a shot of Covenia, and put him in a cone of shame.  Poor baby.

They did a full blood panel and an instant glucose test.  It was 360.  She was more concerned about the abscess than the diabetes and wants us to continue with the low carb canned (she recommended Purina DM and I bought a week's worth of cans.  I also have Wellness and Evo on hand) and come back next Saturday for a repeat glucose test and to start him on insulin.  We didn't discuss what kind, but everything I'm reading suggests Lantus is the best choice.  I was impressed because she seemed very informed and stated that just because he'll need insulin immediately doesn't mean he'll need it always and diet is incredibly important. 

George is in good health otherwise and although he's upstairs sulking in his Elizabethan collar, I think he'll forgive me today.

 

[kittylover23]

You are all wonderful.  Thank you for all of the information and personal anecdotes.  It helps so much to know that this is doable.

We had to move George's appointment to today and it didn't go at all like I was expecting.  Yesterday when we got home from work George had an open sore on his head near his ear.  I didn't think that much of it, other than maybe he has ear mites and was scratching too much (I never saw him scratching at all).  It was pretty red and nasty looking.  When we got to the vet, she said, "that looks like an abscess," and it was.  She drained it, gave him a shot of Covenia, and put him in a cone of shame.  Poor baby.

They did a full blood panel and an instant glucose test.  It was 360.  She was more concerned about the abscess than the diabetes and wants us to continue with the low carb canned (she recommended Purina DM and I bought a week's worth of cans.  I also have Wellness and Evo on hand) and come back next Saturday for a repeat glucose test and to start him on insulin.  We didn't discuss what kind, but everything I'm reading suggests Lantus is the best choice.  I was impressed because she seemed very informed and stated that just because he'll need insulin immediately doesn't mean he'll need it always and diet is incredibly important. 

George is in good health otherwise and although he's upstairs sulking in his Elizabethan collar, I think he'll forgive me today.

Awww poor baby George! My Lucky has had a few abscesses in his day, and they sure are not fun! Wellness and EVO are both very low carb foods, and I would go with these instead of Purina because they contain real meat. Good luck and purrs to you and your baby boy.

 

[maewkaew]

It sounds like you have a vet who is up to date in the research about low carb diet,  long-acting insulin,  and about how many cats on that combination can have their pancreas heal and don't need insulin shots forever  . but they do need to stay on a low carb diet..  

& it's too bad he has a nasty abscess but lucky he is getting it treated now.     Infection contributes to insulin resistance and makes the diabetes worse,  so take that into consideration that as the infection clears up,  that,  along with the diet change to lower carb wet food, will probably make him need less insulin than he would have right now.   So your vet made a good call in holding off on starting the insulin  and seeing how he is after the antibiotic has a chance, plus the low carb diet.  

Actually, although I'm not saying an abscess is a good thing,  there is a positive ramification to knowing he has this going on.. Without the infection ,  the blood glucose may have just been in the 200s (which is certainly too high and would require insulin injections,  but many cats are much higher when diagnosed).   I think with it being 330 WITH a raging infection , that is a sign that George really has a good chance of not needing insulin forever. 

You are right, Lantus is the insulin that has had most evidence of success in cats.  A similar long acting insulin is Levemir, and for some cats that the Lantus doesn't work well, the Levemir sometimes turns out to work better.  but I think Lantus is the best start.   Another kind of insulin that has worked well in quite a few cats are PZI type insulins,

There is a lot of info on Lantus over on the FDMB Lantus support group .  Check out the sticky posts there for tips about handling,  and about how Lantus works.  It is kind of complicated because it has an overlap effect going on. both because the main effect tends to be long acting. but also because it creates an "insulin depot" under the skin  ( which on  FDMB got nicknamed the "shed"  , like a storage shed) . and even after the main effect has worn off, it continues to slowly release a  small amount of insulin from this insulin depot / "shed" .  The idea of that is to better even out the blood glucose. 

 Even without the home BG testing ,  a majority of cats on Lantus and low carb wet diet are not needing to stay on insulin forever, at least according to some cat vets I've talked to. 

  The home blood glucose testing just seems to even increase the chances of remission since it allows one to more safely and reliably keep the cat at a normal BG level, which promotes healing of the pancreatic beta cells.   There was a study in which  over 80% of newly diagnosed diabetic cats went into remission on a certain protocol including  low carb diet,  Lantus or Levemir insulin, and home BG testing to help regulate the cat in or near normal levels.    In case you are interested in reading about it, the protocol is here:  http://www.tillydiabetes.net/en_6_protocol2.htm  .  I printed it out for my vet and gave her a copy of the article from a vet journal about it  ( by Rand and Roomp)  Here is the abstract.  http://www.ncbi.nlm.nih.gov/pubmed/19592286  .  You might still be able to find the actual article  somewhere online. 

 But don't feel too pressured that you must immediately learn everything there is to know about feline diabetes and do all this stuff that probably seems very complicated now..   It sounds like you are doing great and this cat is so lucky to have you.