Hello, I'm Dr. Deb and will do my best to help you today.
I'm sorry for this concern for your cat. There's no question that diabetic cats will be better controlled if we can get them to eat a diet which is low in carbohydrates and high in protein....a ratio more typically seen in canned foods than dry.
While there are several different prescription foods which meet this criteria (and perhaps some over the counter canned ones as well), I personally prefer Purina DM since I've the best success with it. It comes in either dry or canned.
The following link may be of help since it covers this topic in some detail. You'll also be able to access links which list access to lists of both canned and dry foods. I aim for <10-12% carbs.
I hope this helps. Deb
You're more than welcome.
What brand of Hill's is he eating?
M/D dry is a good choice for him.
I do find that cats who eat 100% canned food tend to drink far less than those eating dry so it would make sense that he might be thirstier on the dry M/D.
Most average, healthy cats are going to urinate about twice in a 24 hour period so this seems pretty reasonable to me. One way which owners will monitor their cat's diabetes will be by water consumption and urine production. It's not a precise measurement, of course, but a rough way of determining if their cat is reasonably controlled or not.
Glad I can help:)
Most cats tolerate insulin injections quite well so I'm glad to hear that Woody is one of those patients.
It sounds as if his blood sugar values are likely reducing but without a glucose curve, we can't really know how quickly the insulin is working in his body, for how long it's working and how low the insulin is taking his blood sugar.
I've found that managing diabetes in cats can sometimes be a challenge but I would expect him to start acting more like his old self after at least a week or so.
The following link discusses at-home testing for diabetic cats which actually isn't quite as daunting as it might first appear. Taking blood from an ear vein and using a glucometer at home is vastly superior to hospitalizing a cat since stress can so dramatically affect their blood glucose numbers.
At this point, we don't know if he's a hard to regulate diabetic or not but the following link also discusses this particular situation:
In fact, if you look to the right hand side of the page of any one of these links, there's a number of other articles which discusses diabetes in great detail. I suspect you've already done a large amount of homework on the subject but if you haven't, then they may be useful.
Here's another great link as well: http://www.vet.cornell.edu/fhc/health_information/brochure_diabetes.cfm
Sorry that I had to step away from my computer and have just now seen your additional reply and questions.
For what it's worth, regulating diabetes in older cats seems to be much more difficult than when they're diagnosed at a younger age...not that it isn't a challenge regardless of the patient's age (since it is!) but perhaps just less of one, if that makes sense.
For me, the classic signs of diabetes are increased thirst, increased urination and weight loss...all of which he had initially if I understand you correctly. Unless a patient is ketotic, then I don't typically smell anything unusual about their breath.
Most of the diabetic cats that I've diagnosed don't have other systemic issues going on with them. I always want to check a urine, though, to ensure that there isn't a urinary tract infection since diabetics are so prone to them.
I always worry about cancer when I diagnose this condition in older cats but it's less of a worry when they're his age.
I'm certain that blood work as ruled out many other conditions such as kidney issues or Hyperthyroidism so I'm not sure if your vet is having a sixth sense that something else is an issue with him (which is certainly possible, I suppose) but at least he's visibly responding to his insulin (and diet) which is a good thing thus far. There's no evidence that he has a secondary problem that I can see at this point.
No worries about the additional questions although I'm sorry that we keep missing each other:(
I don't see much harm in giving Woody a small amount of tuna in spring water several times a week. I probably would avoid a large, steady diet of it since there might be mercury concerns for him just like for us.
Please feel free to continue to contact me this next week if you have additional concerns; we may play the equivalent of "telephone tag" but I'm on my computer multiple times during the day; I'll get back to you as soon as I can if I'm offline when your post another question.
Additionally, even after you've rated (if you do, of course), we can continue to discuss Woody's diabetes at no additional charge to you.
In the meantime, best of luck with him:) Kindest regards, Deb
Hello again, Adele:)
Clearly what's morning for you is way early morning for me since we're in different countries:)
That's good news that Woody appears to be brighter today and has a good appetite.
If you can't manage to get the insulin into him every 12 hours, that's preferable but if there's an hour's or so difference either way, that should still be fine.
Specifically, yes, 1/2 hour either way should be ok. If you have to give it a little later one day, then just restart at the time you'd like to give it the next day. ...as long as we're not talking about 4-5 hours later than it should be given (which isn't likely to be the case). But if it is, then I might skip that dose and restart as normal the next day.
It's always better to run a little higher on glucose in the system as opposed to worrying about hypoglycemia (because he's given too much insulin).
You're not the first person, nor will you be the last, to leave the insulin bottle out of the refrigerator for a short period of time. It should be fine.
There are no "daft" or inappropriate questions from my perspective; only the ones not asked:)
You'll be old hat at this before too long although I know it can be a little intimidating at first. Deb
I'm glad to hear it:)) Deb
I'm not sure exactly what you're asking. A small twitch when giving an injection isn't an uncommon reaction and doesn't mean that he's being hurt...just that he may feel it a little bit. The insulin needle is exceedingly small, as you know. Perhaps, he felt pressure from the insulin being injected? I'm not sure but this isn't something to be overly concerned about.
I'd advise you to approach the procedure with confidence in your ability to do so and recognize that this is bothering you more than him.
I don't know if a video will be helpful in easing your mind but there are a number of them on YouTube; just google "How to give your cat an insulin injection".
I think this is a situation where the comfort level improves the more often you do it. There aren't any "secret" tips or I'd definitely share them with you:))) Gently lift the scruff, create a "v" and inject into it....that's usually what I tell my owners to do and to vary the site where you inject a little bit each time. Of course, I usually demonstrate the procedure in person and have them also inject with sterile saline a few times to get a "feel" for when the needle punctures the skin.
What wonderful news about Woody:) I'm so glad that he seems to be responding to the insulin as well as he appears to be. You must be absolutely thrilled!
Yes, it's perfectly fine to offer him both canned and dry prescription food since he prefers the variety. Since some cats like to graze, I'll often suggest that owners leave out a small portion of dry for their diabetic cats.
If he's well regulated, then he shouldn't need food available throughout the day especially if you're only gone for a few hours at a time.
If you leave food outside, you're likely to attract all sorts of unwanted critters who will eat the food and thus it won't be available for him....not to mention all of those critters expecting a future free meal:)
If only the reality were close to what you envision, then you could start a soup kitchen for the local critters in need :)))
Woody and I never lost confidence in you and knew that you'd figure it out given enough time:)
I'm glad that I've been able to help you help him; he sounds like an amazing cat and I hope he's one of the fortunate feline diabetics who are easily controlled.
I'm really glad to hear that Wood's appetite is so good; that's definitely a barometer of his overall well-being.
The behavior that's troubling you may be absolutely normal for him, under the circumstances, but it may also reflect his blood glucose levels. Every cat will respond differently as to how quickly the insulin which is given takes effect and how long it lasts before the glucose might creep up again.
And, remember, most cats spend the largest percentage of their time sleeping anyway especially if they over do it a bit too soon after being ill.
I probably wouldn't be too concerned unless what we might call his lethargy is a recurrent pattern of behavior over the next few days. Deb
As usual, glad to help:)
Well, he's back in now but I agree that you should let him do what he wants to do. If he misses his insulin injection by a short amount of time, no real harm will be done.
how soon after injection could the insulin start to work?
That's a difficult question to answer since it depends on the insulin and the patient. Most insulins will last about 12-14 hours in a cat's body which is why injections are given twice daily. It might start to work within 1-2 hours after being given or might take longer.
That's why a glucose curve is invaluable to analyzing how quickly a particular insulin takes effect, how long it lasts for peak effect and when it starts to wear off.
Most cats seem to be pretty forgiving about insulin injections especially if they don't appear to react in any way when the majority of them are given.
I probably don't have to tell you this but cats are pretty emphatic and can sense our anxiety or moods. My pep talk for today is to approach this procedure with confidence and authority; no trepidation allowed.
It will become second nature before too long.
Yes, you can.
Yes, you can:)
Thanks for today's update.
I'm wondering if the amount he drinks is being affected by the increased amount of food? The amount of water he'll drink in any one given day depends on a lot of factors including (but not limited to) how well his diabetes is controlled, dry versus wet food consumption, activity level, ambient heat/humidity.
However, I'm wondering if there is any chance that Woody could return to being the cat he was? That's certainly the goal and what has been achieved for some diabetic cats, especially if they're well controlled.
You don't want to know how many times I've done the same thing to myself! I've yet to stab an owner, though, and hope to never do so.
Well, I probably wouldn't have done that but I can understand why you did:)
Even after you've rated (and I'll thank you in advance for doing so), we can continue to discuss this issue about Woody at no additional charge to you. Pretty good deal, right?
The site does prefer that a new question be asked if a different topic is raised; however, we've been essentially discussing the same issue now since we first started communicating.
If you feel that you'd like to provide additional compensation, then you can leave a "bonus" when you rate although it's not mandatory nor expected. It's appreciated but not required in any way.
And, yes, you can always request me at any time; I'll be happy to help if I can. Just add "For Dr. Deb ONLY" at the beginning of your question so that other experts won't answer. Of course, if it's something critical, you may not want to wait until I'm back online (if I'm off when you post, that is).
It sounds to me as if he's improving slowly but surely each and every day....which is, indeed, a very good thing:) Deb
If it helps to reassure you about needle accidents, I can't tell you how many times I've inadvertently stabbed myself and have yet to have had any issues.
If the needle is sterile (before he's injected), even less of a concern but even if you prick yourself after it's used, if you wash the penetrated skin thoroughly with soap and water, you should be fine in terms of any infection which might develop.
I also agree with your vet that there are no diseases which you can pick up from contact with his tissue or blood in this way.
I hate to disagree with fellow professionals but I NEVER use a needle more than once. The risk of infection is just too great in my opinion especially in a diabetic.
I would love to see a picture of him if you can manage it; I love putting a face to the name, so to speak:)
A beautiful picture is in my mind's eye of him acting like a cat should act.
Well, he could have shared his waste products with the wild outdoors but I guess he thought you'd appreciate it more if he used the litter box:)
It might be too much to expect that he'll never flinch or react when an injection is given but he may have a "sweet spot" where he tends to feel it less.
I'm happy that he's interested in hunting but I hope the bird was not his victim:( D
What a difference a week makes, right?
You did say that I could 'rate' you but still continue this conversation didn't you? Yes, I did:) We can continue to communicate exactly as we have been.
I love that you've simplified where to give his injections; glad his color pattern makes it so easy:) D
The rating as well as the "additional sum" is appreciated; thanks... and, no worries about the amount:) Something is always better than nothing as they say:))) D
Always glad to hear good news so thanks for sharing:) Deb
Good afternoon, A.
In theory, you can give insulin injections subcutaneously (under the skin) anywhere on a cat's body; it's just easier around the scruff, neck area where there's looser skin to lift
I suspect your vet is going to be impressed with how well Woody looks when he sees him:) D
Yes, I would agree that your scale probably isn't as accurate as the one at the vet's office, but the fact that he seems to have put on a bit is definitely a good thing:)
It doesn't take much to trigger vomiting in a cat so I don't tend to worry too much about it unless it's a consistent problem.
Continued good news is always welcomed:) Deb
It sounds as if he might have overdone it a bit since he stayed away all day. I'm not surprised that he slept the remainder of the evening.
This pattern of behavior may be the new "normal" for him so as long as he's eating, engaging with the family, not hiding and still wants to explore the big outdoors, I'd assume that this is the case:)
Certainly his quality of life is tremendously improved from what it was pre-insulin. D
Glad I can be here for you both. I suppose if we're going to look at the "glass at half full" (as opposed to the opposite), then at least his diabetes has caused a more affectionate side of himself to emerge.....which is obviously a very good thing:) D
Will look forward to a report:)
As for treats, you'll just want to avoid those which might have sugar in them (more of a problem for dogs than cats). A few of any kind are likely to be fine, though, regardless of what they are.
That's great news that your vet is so pleased with Woody's progress. I just knew he would be:)
Don't feel stupid about making a mistake with his injection; it happens to the best of us all the time! But if you haven't already heard back from your vet about what to do, your instincts are correct: you don't want to give him another pm dose since there's a risk of overdosing him and causing hypoglycemia.
He'll be fine even though he may not have gotten his normal amount of insulin.
I'm not going anywhere so if something else happens, you know where to find me:)))
Not every situation is ideal when it comes to our pets so an occasional missed dose isn't a huge concern or problem in most cases.
I wouldn't be surprised if the stress of the car ride/visit as well as a higher than normal blood sugar caused him to behave as he did this morning, especially since he's acting more his new "normal" now.
If you do purchase a spare bottle of insulin, just be sure to double check the expiration date if it's not used relatively soon. I'm sure you'd know to do this, but just reminding you:) A
Unfortunately, I don't really quite know how to answer your concerns. In most cases, once a diabetic patient is reasonably stabilized (their blood sugar isn't fluctuating wildly in other words), they tend to behave about the same from day to day.
A blood glucose curve hasn't been done on him so as I mentioned before, we don't know how quickly the insulin takes effect, how long it lasts and how low his values go in response to the insulin.
Perhaps his behavior is reflective of the fact that his blood sugar is better than it was but perhaps it's still somewhat high? Or he's just having a less energetic or hungry day.
I think he's trying to mess with your head:) How's he doing????
Cats are famous for making us crazy but I suspect you already know this:)
I probably wouldn't try to over-think his behavior for one day unless he's obviously not himself (like he was three weeks ago).....although I know this isn't easy to do.
That sounds like a good plan to me:)
I assumed he'd been doing well since I hadn't heard from you in a few days; glad to have my assumption confirmed:)
As I think I've mentioned before, not all diabetic cats will respond as well as he has; thank goodness, he's one of the lucky one.
He's doing great from the sounds of it and it must be so heartwarming to see him back to a semblance of his normal self:)
Continued good news....I always love to hear it:)))
Continued excellent news:)
I can't seem to recall if he's eating a diet with higher protein and lower carbs; if so, then in addition to the increased exercise he's getting, he may not be getting as many calories as he used to. Carbs can contribute to weight gain in cats; when you reduce them, they tend to lose weight or not gain.
When I reviewed our rather long exchange, I saw where he's on the M/D. This may account for not gaining weight.
I personally think it is better for our pets (and for us) to be on the leaner side as opposed to carrying a few extra pounds.
Longevity studies have confirmed that leaner cats tend to live longer, healthier lives.
Yeah, me, too:))))
Believe it or not, I was wondering how the boy was doing just this morning:)))
That's excellent news that he's moving ever closer to being his old self with his established routine. If he keeps this up, he'll get a gold star at the next vet visit:) D
I'm just so glad that things seem to be turning out well for him:)
I'd love to see a picture of him. The following link walks you through the process although it's not always the easiest thing to do for some folks for some reason: http://ww2.justanswer.com/how-do-i-send-photo-or-file-expert
It's fun putting a face to the name so to speak:)
I certainly wouldn't have suspected that the two of you would have become closer but what a wonderful side effect to the insulin he's being given...if that's what's responsible for this new "Woody":)
I'll take it!
Everything is always a trade off, isn't it???
You don't have to give him his insulin injections exactly 12 hours apart although as close to this as possible is the ideal.
I wouldn't give him his insulin earlier tonight but I would probably give it to him around 8:30 pm.
Then just restart him tomorrow morning at 7 AM or at 6 Am if you're trying to give them to him earlier.
It's better to give insulin longer than 12 hours apart as opposed to fewer hours than this ....although one hour earlier isn't likely to make much of a difference if this makes sense. D
I think you were clear but my answer may not have been:(
Yes, I'd probably give him his insulin tonight around 9'ish and then 8 am tomorrow should be fine. Then, I assume you're trying to get him on an 8am and 8 pm schedule. D
Yes, don't go predicting what he's going to do since this will guarantee that he'll do just the opposite!!!
He's going to get another gold star, I think:)
Well, there's always that problem!!!!
Way to go Woody:)))
I'd love to keep receiving updates on Woody, especially if they continue to be good ones:)
If I've said it once, I've said it literally a million times: cats are simply amazing creatures and it's rarely a sure thing to bet against them. There's not always a positive outcome when things happen with them but there often is. D
Don't beat yourself too much up about this. I've been practicing for over 30 years and from time to time, I still somehow manage to do the same thing when vaccinating cats and dogs.
It happens to the best of us, unfortunately:( D
He'll be fine although I can understand why you'd be so annoyed with yourself. But, think of it this way: it could have been worse. You could have given him an overdose of insulin!!!
It might not have been as bad as it sounds but you'd have had to monitor him like a hawk for signs of hypoglycemia....not a pleasant prospect.
Your words mean a lot to me so thanks for saying them:)
Each and every day, I'm appreciative for how special and amazing cats are; I simply can't imagine my life without one....or more:) D
Always good to hear:)
You may inadvertently give his fur another insulin bath at some point in time but I hope you'll roll with it. D
I suppose it was unrealistic to think that there wouldn't be set backs from time to time, especially since he goes outside where it's much more difficult to completely control his environment.
I might not have given him the full dose of insulin after he returned home unless he ate breakfast for you but am glad that your vet suggested a lower dose for this pm.
I'm not sure I understand why you're not to give him his insulin in the morning, though. D
No apologies necessary.
Every vet manages their diabetes somewhat differently so I don't want to second guess what your's is doing or thinking.
When a diabetic is not eating (for whatever reason) or if I'm uncertain as to what they did eat, then I typically suggest 1/2 of the normal dose of insulin, regardless of what a "spot check" BG may show. I previously keep harping on glucose curves but we can't possibly know how quickly the insulin works and how far the BG drops based on one value alone.
Clearly he wasn't hypoglycemic when your vet evaluated his BG but stress (ie the car ride) can elevate it,too......sometimes to quite a high degree.
Whatever may have been going on would seem to have passed or is resolving which is obviously a good thing.
Always glad to help you and Woody, of course:)
I'll look forward to an update. Deb
Wonderful news:) And, glad that your vet and I are on the same page:))
I, too, might be tempted to keep him inside but I suspect his quality of life would significantly suffer and that wouldn't be at all fair to him as I'm sure you'd agree. So, you'll just have to live with the possibility of the unexpected happening from time to time. I'm sure that some might say that a standard routine is....just, well, DULL!! Although in this case, dull wouldn't necessarily be such a bad thing.
That's not a spoiled boy at all, is it???
Perhaps he will stay a little closer to home over the next few days so as to provide you with a certain peace of mind about him.
You and I both know that he knows when you worry about him.....but some days, he probably can't be bothered to put your needs above his own. Some cats are just selfish that way:)))
I wouldn't have a problem giving him fish, especially the small amounts which he's getting. If it keeps him happy and satisfied, then why not? would be my response. D
This is one very lucky cat who has found his way into the life of someone who spoils him so unmercifully!!!
Unfortuantely, I can't see what you see on your end of things although I have received bonus amounts from other folks on this site even after the question was rated....but perhaps the UK site is different for some reason. I appreciate your wanting to do so but it may require contacting Customer Service if there's no easy link or icon that you can see.
It sounds as if you're ok since he's been eating this much food throughout the day. Since so many diabetic cats do like to graze (they're not fed at specific times of the day in other words), insulin is often given when it's due but not necessarily associated with a big meal.
I completely understand why you'd be so worried given last week's adventure but I think he'll be fine.
And, any additional bonus is always appreciated so thanks for making the effort to figure out how to do it:)) D
Well, of course!!!! At least it's better than in the middle of the night.
Sorry it's taken such a while to get back to you; my computer went on the fritz and I've just got it back. Whatever additional amount you sent is always appreciated so no worries about the amount:)
If you need the rain as badly as we do, then it's one more reason to be glad that you're getting it...in addition to keeping Woody inside, of course:) D
Not sure what to say about him.
Some cats will develop behavioral issues where they beg for something different than what is already put out for them.
I believe I've mentioned that hypertension can cause some cats to act in odd ways.
Early senility or cognitive dysfunction issues can also cause them to behave differently.
Not sure that I think either one of these is the problem though. D
Sounds like he's trying to keep you on your toes...or drive you crazy, one or the other:)
But you do know that many cats are a riddle, wrapped in a mystery, inside an enigma, don't you???
Cats have many talents and you've listed just one of them:)
Thanks again for the update about your special boy.
This new pattern of behavior is likely to be the norm for him although I've long ago given up trying to completely understand why cats behave as they do! (please reference my earlier remark about a riddle, mystery, enigma)
I know when the weather changes and becomes cooler, my outside cats tend to spend more time indoors. Not sure if this might be a factor or not.
I don't doubt that diabetes has likely changed him but he's also a mature cat now; many cats often tend to be a little less active as they age so this may also possibly play a role.
There should be an expiration date on the insulin bottle that you have. As long as it's refrigerated after each use, then it should still be effective.
I think I know how he feels since I, too, have better days than others:)
but glad that he's stable and no crisis has arisen with him:) D
One of my dog's stomach tends to expand quite a bit to the point where it's really obvious after she drinks a fair amount of water; more than likely this is what you observed.
Cats don't typically leak when they sleep or have incontinence issues but that's not to say that they can't develop them; it's just more of a problem observed in dogs. I suspect if he did drink more than normal, then his bladder was so full that there was some spillage.
You might have hit his scapula although I can't be sure. He most likely wouldn't have reacted much unless you hit a nerve, though.
So, no harm, no foul, as they say. Deb
A, I don't like the sound of that:(
I may have to log off soon, although I'll check back in soon, if I do. D
I'm not sure I have a good explanation for why he collapsed either although I'm not sure I would have advised you to give him his full amount of insulin if he wasn't eating.
I usually suggest 1/2 th dose since I worry about hypoglycemia. If he won't eat on his own, then you may have to force feed him (not something you'll probably relish doing) or rub honey or pancake syrup on his gums every so often so that his blood sugar doesn't plummet.
I know this may seem counter intuitive but full dose on insulin in a patient who isn't eating is always a possible recipe for hypoglycemia.
You did what your vet told you to do so don't feel bad; it's just not what I would have done (although different vets do practice differently). Given this timeline, he's probably not at a high risk for developing low blood sugar...which is obviously a very good thing.
Most insulins will last 12 hours but can peak at different times. Unless he's had a glucose curve done, we don't know when that might be for him.
But, having said that, the full dose of insulin (given 10 hours ago) is likely not going to be a factor since it's already losing effect in his body.
The small dose you gave may not cause any issues for him either if is was less than 1/2 of what he'd normally receive.
This saddens me beyond words:( For some reason, I thought that more might be going on with him this episode although I can't explain why I thought that.
I know there's going to be a huge hole in your heart for a long time to come but I hope that in time you'll be able to remember him with tears of joy, rather that sadness.
My heart is breaking for you. Deb
It's been more than my pleasure and an honor to share even this small portion of Woody's journey with you. D