Just diagnosed with Feline Diabetes

Hi -

This is my first post here - so go easy

Yesterday, my 9 year old cat Mackey was diagnosed with feline diabetes.
His glucose level was 458. My vet said that he was "a healty
diabetic", as his blood and urine tests showed no other problems - no
ketones, etc.

She prescribed 5 units of Humilin U once daily. She didn't seem
concerned about changing his diet just yet (he eats Iams Weight Control
dry food - he's lost 4 pounds in two years and now weighs 19 pounds).
I was told to monitor his water intake and his urine output for two
weeks once I start him on the insulin.

I've been doing a lot of research online and am now even more
overwhelmed than I was to begin with. First, I have found out that
Humulin U is being taken off the market at the end of the year. I'm
concerned to start Mackey on this, if we are going to have to change
his course of treatment in a few months.

My other concern is the dosage level. Does it seem too high? Again,
my internet research tells me that 5 units is very high to start. She
based his dosage on his weight, but I've read that dosage by weight is
not always the way to go.

I am supposed to start his injections tomorrow, but am going to put it
off until I can speak to the vet on Tuesday morning. I don't feel
comfortable giving him his first shot with so many questions hanging
over my head.

I'm just curious as to what you think? I'm trying to gather as much
information before I speak to the vet on Tuesday.

Thanks in advance,
Laura

Hi Laura,

That's great that you're doing so much research in advance!

Yes, that dosage is VERY high. Our cat's sugar was over 400 when
diagnosed, and we started with 1 unit per day. Normal procedure is to
start off low, give their bodies time to adjust, then see if it is
enough. I think the warning bells going off for you are very justified.
I wouldn't start him on 5.

There are some people who are incredibly experienced with diabetic cats
on the message board at www.felinediabetes.com. They never tired of
helping Bob and I. Please sign on and introduce yourself and your
situation and you'll probably have 20 responses tonight yet!

Good luck. And by the way -- they will tell you about home-testing his
blood sugar, which really is a good idea.

Take care,

Rhonda

Laura wrote:


My other concern is the dosage level. Does it seem too high? Again,
my internet research tells me that 5 units is very high to start. She
based his dosage on his weight, but I've read that dosage by weight is
not always the way to go.

"Laura" wrote in message
oups.com...
Hi -

This is my first post here - so go easy

Yesterday, my 9 year old cat Mackey was diagnosed with feline
diabetes.
His glucose level was 458. My vet said that he was "a healty
diabetic", as his blood and urine tests showed no other problems - no
ketones, etc.

She prescribed 5 units of Humilin U once daily. She didn't seem
concerned about changing his diet just yet (he eats Iams Weight
Control
dry food - he's lost 4 pounds in two years and now weighs 19 pounds).
I was told to monitor his water intake and his urine output for two
weeks once I start him on the insulin.

I've been doing a lot of research online and am now even more
overwhelmed than I was to begin with. First, I have found out that
Humulin U is being taken off the market at the end of the year. I'm
concerned to start Mackey on this, if we are going to have to change
his course of treatment in a few months.

My other concern is the dosage level. Does it seem too high? Again,
my internet research tells me that 5 units is very high to start.
She
based his dosage on his weight, but I've read that dosage by weight is
not always the way to go.

I am supposed to start his injections tomorrow, but am going to put it
off until I can speak to the vet on Tuesday morning. I don't feel
comfortable giving him his first shot with so many questions hanging
over my head.

I'm just curious as to what you think? I'm trying to gather as much
information before I speak to the vet on Tuesday.

Thanks in advance,
Laura


Hi Laura,

My friend has a diabetic cat who receives 2 units once a day, 5 seems
high to me, but I don't know a great deal about feline diabetes. Jojo
(the cat) just takes it all in stride and never complains about getting
the injections, (his diet has not changed from pre-diabetes to now) I
wish you the best of luck.

Do you think you'll do your own sugar tests at home in the beginning to
closely monitor the sugar levels? I have diabetes and when first
diagnosed doing the sugar testing helped me help the doctors regulate my
insulin levels.

Trish

"Laura" wrote in message
oups.com...
Hi -

This is my first post here - so go easy


Laura,

My first suggestion is find another vet in your area who is a little more
current and experienced in treating diabetic cats. Your present vet is
behind the times and apparently unaware of recent advancements in the
management of diabetes in cats.



Yesterday, my 9 year old cat Mackey was diagnosed with feline diabetes.
His glucose level was 458.


Did your vet send out a blood sample to measure serum fructosamine
concentrations to distinguish physiologic (stress) hyperglycemia from true
diabetes? The trip to the vet, handling, and drawing blood often sends
cats' blood glucose soaring. Serum fructosamine isn't affected by stress
and gives a good picture of the cat's glycemic status over the past few
weeks.

I think you should test Mackey's blood glucose at home- where he isn't
stressed by traveling , drawing blood, and the overwhelming scents of past
and present animals at the vet's office. Home blood glucose monitoring is
very easy. Here's a short real-time video that you how fast and easy it is:

http://www.maxshouse.com/bgtest%5B1%5D.mpg

http://www.maxshouse.com/bgtest.rm

Home glucose monitoring is essential for successful diabetes management.
All you need is a human home blood glucose meter (AccuChek Advantage is the
most accurate), glucose test strips (AccuChek Comfort Curve) and lancets.
The AccuChek meter kit come with a lancet device- but I recommend buying an
AccuChek Soft Touch and matching lancets. The kit also includes about 10
glucose test strips to get you started. The cost of the meter kit and
optional Soft Touch lancet device and lancets shouldn't be more than $100--
which is less than an office visit.



My vet said that he was "a healty
diabetic", as his blood and urine tests showed no other problems - no
ketones, etc.


Has Mackey been drinking and urinating more than he has in the past?



She prescribed 5 units of Humilin U once daily.


Humulin U (Ultralente) insulin is a very poor choice for cats. The particle
size is very large and results in poor and unpredictable absorption.
Humulin U requires higher doses because its less potent than Humulin R,
Humulin L or PZI. Even though Humulin U is a long-acting insulin, most cats
still require twice-a-day dosing due to the insulin's poor absorption and
performance. Humulin U will make regulating Mackey's diabetes very, very
difficult and will increase the need for repeated glucose curves.



She didn't seem
concerned about changing his diet just yet (he eats Iams Weight Control
dry food

She most certainly should be concerned! Iams Weight Control- dry food
contains 43% carbohydrate and is probably contributing if not actually
*causing* Mackey's diabetes! Cats don't have the liver enzyme (glucokinase)
that's necessary for processing large loads of glucose from the portal vein.
Since the cat's liver can't metabolize large glucose loads rapidly, excess
glucose remains in the blood for longer periods of time and results in
persistent hyperglycemia.

Iams Weight Control is much, much to high in carbohydrates (43%) and *much*
too low in protein (28%) for a diabetic cat- actually for *any* cat!
High-protein diets *improve* insulin sensitivity- therefore, Mackey should
be eating a high-protein, low carbohydrate diet.

I've weaned several cats off insulin therapy *completely* and significantly
reduced insulin requirements in others by feeding the cats *canned* kitten
food such as Science Diet Kitten. I've been seeing even *better* results
from feeding diabetic cats these high protein ,very low carbohydrate Fancy
Feast diets:

Seafood Filets Ocean Whitefish & Tuna Feast in Aspic: 59% Protein, 1%
carbohydrate (DMB).
Seafood Filets Tuna & Oceanfish in Aspic: 59% Protein, 1% carbohydrate
(DMB)
Tender Beef & Liver Feast: 47% Protein, 5% carbohydrate (DMB)
(Friskies) Turkey & Giblets Dinner: 45% Protein, 6% carbohydrate (DMB)

Diet changes *must* be done under the supervision of a vet because these
diets will *substantially* reduce if not *eliminate* Mackey's insulin
requirements. Giving a cat his regular insulin dose after his insulin
requirement has been reduced or eliminated by dietary therapy can result in
*fatal* hypOglycemia. So, please consult a vet before implementing any
dietary changes.


-he's lost 4 pounds in two years and now weighs 19 pounds).


I think his weight probably is *the* cause of his diabetes and the diet he's
eating is certainly adding to the problem. Obesity causes *reversible*
insulin resistance- which *resolves* when obesity is resolved. The Fancy
Feast diets I mentioned above will also result in more rapid and substantial
weight loss.

I strongly suggest you buy a good pediatric scale- such as the Tanita 1583-
for monitoring Mackey's weight.
http://www.tanita.com/PediatricScales.shtml You might find a Tanita on ebay
for much cheaper. Its imperative that you monitor his weight and make sure
he doesn't loss weight to rapidly. Rapid weight loss in cats can result in
a very serious liver disease (hepatic lipidosis). I'd be happy to help you
tailor a weight loss diet for Mackey that you can submit to your vet for his
approval.



I was told to monitor his water intake and his urine output for two
weeks once I start him on the insulin.

Urine glucose monitoring with human test strips has some very serious
limitations when used on cats. Insulin doses should *never* be changed
based on urine dipstick readings.

First, the renal threshold for glucose in cats is *much* more variable than
in humans and dogs- it can vary from 200 mg/dl to 290-300 mg/dl. IOW, a
cat's blood glucose could be as high as 300 mg/dl before glucose 'spills'
into the urine where it can be detected by the test strip. So, a test strip
that reads 'negative' doesn't necessarily mean the cat isn't hyperglycemic.

Second: Cats don't urinate on command like dogs and humans. So, the urine
in a cat's bladder at the time of testing could be an accumulation of
several hours of urine production. Earlier postprandial spikes in urine
glucose can affect later urine glucose readings. IOW, the reading on the
test strip may not reflect the cat's true glycemic state at the time of
testing.

Third: Urine test strips cannot detect hypOglycemia- the lowest reading is
only 'negative". IOW, the insulin dose could be too high and the cat could
be hypOglycemic- but you wouldn't be able to detect it with a urine test
strip.

Urine test strips are *only* reliable for checking for ketones. That's it.



I've been doing a lot of research online and am now even more
overwhelmed than I was to begin with. First, I have found out that
Humulin U is being taken off the market at the end of the year. I'm
concerned to start Mackey on this, if we are going to have to change
his course of treatment in a few months.

That's a blessing in disguise. Humulin U works very poorly in cats.



My other concern is the dosage level. Does it seem too high? Again,
my internet research tells me that 5 units is very high to start. She
based his dosage on his weight, but I've read that dosage by weight is
not always the way to go.


As I said, Humulin U requires higher doses because the absorption and
performance is so poor.



I am supposed to start his injections tomorrow, but am going to put it
off until I can speak to the vet on Tuesday morning. I don't feel
comfortable giving him his first shot with so many questions hanging
over my head.

So you haven't begun his insulin injections yet? Great!!! Try the high
protein, low carbohydrate diets I listed above. I'm sure they will bring
his BG down- and hell probably require a lower insulin dose. However, his
weight will complicate his glycemic control until its brought under control.




I'm just curious as to what you think? I'm trying to gather as much
information before I speak to the vet on Tuesday.


The bottom line is that diabetes can be controlled and many cats have a very
good quality of life; in some, the process of regulation may involve just a
bit more work.

Best of luck,

Phil.

Phil P. wrote:

My first suggestion is find another vet in your area who is a little more
current and experienced in treating diabetic cats. Your present vet is
behind the times and apparently unaware of recent advancements in the
management of diabetes in cats.

I have an appointment for Friday for a second opinion with a vet
recommended by a friend - I don't just want to pick blindly from the
yellow pages.

Did your vet send out a blood sample to measure serum fructosamine
concentrations to distinguish physiologic (stress) hyperglycemia from true
diabetes? The trip to the vet, handling, and drawing blood often sends
cats' blood glucose soaring. Serum fructosamine isn't affected by stress
and gives a good picture of the cat's glycemic status over the past few
weeks.

I'm not sure - they did a Senior Comprehensive Lab on him. I didn't
know to ask about about serum fructosamine.

I think you should test Mackey's blood glucose at home- where he isn't
stressed by traveling , drawing blood, and the overwhelming scents of past
and present animals at the vet's office.

My mother is a diabetic and has a blood glucose meter and test strips.
Perhaps I will use it tonight, just to get a "calm" reading.

Has Mackey been drinking and urinating more than he has in the past?

Yes, he has been. That is what made me bring him to the vet. By
"healty diabetic" I think she meant that he didn't have any other
issues - ketones, thyroid issues, high blood pressure, etc.

So you haven't begun his insulin injections yet? Great!!! Try the high
protein, low carbohydrate diets I listed above. I'm sure they will bring
his BG down- and hell probably require a lower insulin dose. However, his
weight will complicate his glycemic control until its brought under control.

No, I didn't begin his injections yet. I didn't want to take the risk
when I still had so many questions/doubts.

Since I can't see the other vet for a second opinion until Friday, I am
going to speak to my current vet tomorrow (she is off today). I am
going to voice my concerns regarding the type of insulin, the dosage
and his diet. Based on her responses/reaction, I will decide how to
proceed.

The bottom line is that diabetes can be controlled and many cats have a very
good quality of life; in some, the process of regulation may involve just a
bit more work.

Thank you so much for all of the information. I'm glad that I will now
be able to have a productive/informed conversation with my vet
regarding Mackey's treatment.

- Laura

"Laura" wrote in message
oups.com...
Yesterday, my 9 year old cat Mackey was diagnosed with feline diabetes.
.... Thanks in advance,
Laura

Hi Laura,
This was about 10 years ago, but we had a cat, Josh, diagnosed as diabetic.
Based on my experience, which I admit is not current, I have some concerns
with your description of what your vet has said.

First, you do not feel confidant with the choice and dosage of the insulin.
You should discuss this with the vet and find out why that type of insulin
and why that dose. When Josh was diagnosed, the vet kept him for a couple
of days to do a glucose curve (I think it was glucose he was measuring) to
get Josh stabilized in order to determine the dose. I can't imagine a vet
expecting someone to give a diabetic cat his first insulin dose at home with
the dose based on the cat's weight. You are right to be uneasy.

We had periodic blood tests to make sure he was doing O.K. I think at first
it was once a week, then once a couple of weeks, and then monthly. I could
be wrong, but we did it fairly often to monitor his progress.

The vet said to watch Mackey's water intake and urine output. One of Josh's
symptoms was excessive thirst and urination. And it did slow down when he
was stabilized on the insulin. But I wouldn't use it as an indication of
what dose to give him.

Good luck with your cat. Diabetes can be managed, at least for a while.

Annie

"Laura" wrote in message
oups.com...

Thank you so much for all of the information. I'm glad that I will now
be able to have a productive/informed conversation with my vet
regarding Mackey's treatment.

Your welcome. Please let me know the results of your conversation with the
vet.

Phil