Tommy has diabetes

[Ash]

I start a seperate thread for Tommy (keeping Noodle's urine crystal thread for Noodle's problems).

As I mentioned elsewhere, we had bloodwork done for Tommy, as he is almost 8 years old. My vet called me today with the bad news that he has a blood sugar level of 324, which is very high she said. She will come the day after tomorrow to discuss diet, insulin injections etc with me, and show me how to inject him.

He also has slightly elevated kidney levels, blood urea of 56, and serum kreatinine (sp?) of 2.0. She said not to worry about that too much though, and something about that treating the kidney situation could interfere with the diabetes treatment.

I have read about the symptoms of diabetes, and he has been more thirsty and hungry lately, started about 6-8 weeks ago. We attributed it to the heat and boredom (I talked about it in another thread, that he's more whiney and always wants to eat). And I have once seen him peeing in the shower. He has not lost weight. (He weighs about 12-13 pounds.)

I'm not so much worried about the injections as I think I can learn that, but the diet ... He's picky. He wants the cat dry food, or meat, fish, or bread. He doesn't eat anything else. We will of course stop the bread immediately, but getting him to eat new food won't be easy. And even if he does adjust to a special diet cat food (which would be an imported brand), there is no garantee that I will always be able to get it here! I can't switch back and forth between normal and diet food, can I? I don't know what to do.

I had told her that I frequently ask you (Traci) for advice, and she now asked me to describe the situation to you, and see what you say. She will bring the reports with her when she comes, I could then tell you the other results, if you need to know them.

Any advice?

[Traci]

Well, his current diet is not appropriate....and if your vet can get imported veterinary diets, by all means, get it. Ask her what brand, type, etc is available for her to get. Any of the veterinary diets listed Here would be ideal for your vet to look into. (note, only the veterinary diets, not regular type)

What metric system is your vet using for labwork....US Traditional Unit or SI Unit (System International)?

[Ash]

But the thing is, even if a diet food is available now, it might suddenly not be anymore. It's with everything here like that - you get things and then again not for months. And then what?

I will give her the list you suggested though, see what she can do.

I will ask her what metric system she uses. She said the normal blood sugar level is between 110 and 140, and his is 324.

May I ask, why do you find his current diet not appropiate? You mean for a diabetic not appropriate?

[Traci]

I think we talked about this before....meaning the bread, meat and anything else. You're only using alittle of the Whiska's right now (memory fails me)?

A commercial cat food, as long as it is formulated properly and of high quality is usually all that is needed for healthy adult maintenance food. But, when there is a primary condition to be concerned about, such as diabetes, when a veterinary diet is prescribed, this diet is formulated specifically for the purpose of treating the condition. For example, in diabetes, you would want an appropriate formulation for calories, carbohydrates and possible fiber sources....since commercial pet food isn't formulated for the purpose, it isn't appropriate (unless the diabetes does not require insulin, etc)

[Ash]

No, he gets Whiskas as his regular food (twice a day), and he gets sometimes meat (when we eat meat), sometimes fish (but rarely), sometimes egg (because he goes bananas about eggs, it's his favourite treat), and bread pieces when we eat, because he loves them too. We have stopped the bread already. His main diet is Whiskas.

(You were thinking about my dogs - my vet had advised homecooked food for them, which we feed them once a day.)

I understand that diabetes requires a different diet (high in protein, low in carbs?), and I saw on the link you provided that Waltham is doing one, the same company who does Whiskas and Pedigree, so I hope that their diabetes food is available here as well. But as I said, supply here is sporadic, sometimes not even Whiskas is available, for example. So, my concern is, what do I do if we start on a diabetes cat food, and then it's not available for three months? What do I feed him then? Regular Whiskas again?

To avoid this potential problem I thought maybe it would be better if I start him on a home-made diet (high protein). I know you will object to that, and you're probably right, the reason why I'm thinking along those lines is that I would have the constant supply of it under control. And is it not an important premise in handling diabetes, that the cat gets the same food regularly? Maybe I'm wrong about this. Maybe I can switch back to regular food when the diet isn't available and adjust the insulin level?

Lots to worry about ...

Another thought: when she took the blood from him, he had had bread to eat about two hours previously. Plus he was very upset and scared when we held him down to draw blood. Could both these factors have contributed to the high sugar levels? Wouldn't he show more severe symptoms if his sugar levels were constantly that high? He doesn't drink excessively, he doesn't flood the litter box, and he didn't lose any weight. Should we do a urine test to confirm before starting to administer insuline? I'm scared to overdose him!

I noticed though that his whining in front of the front door and his need for attention and inbetween food seems to be increasing. Does he feel uncomfortable because of the diabetes?

[Ash]

Well, I went into town and to the largest pet store we have here, where we buy our pet food as well. The guy knows me and I explained what I need. He said it is not available here in India. There is simply not enough demand for it. Also, import restrictions allow only chicken and fish based foods in (no beef/lamb based). The Indian manyfacturers don't do any diet foods for cats either.

However, they have one low-fat cat food in the shop (made in the US I think). He claimed that fat breaks down into sugar in the body, so a low fat food would be good for Tommy. Is that true???

He'll ask his supplier if he knows a way. But he said I'd probably have better chances if I'd find a supplier outside of India who would be willing to send me a packet a month. Maybe Dubai or Singapore, he said.

Maybe my vet will have other ideas as well.

Looks like I'm having a battle on my hands!

[Traci]

How does your vet treat her other diabetic patients, what diets does she suggest for them, and is she familiar with diabetic regulation/treatment? I would suggest she review common protocols for diagnosing/treating/managing diabetes in cats, and evaluate the common diets prescribed for them, then have her spend some time comparing food lables with those that are available to her/you.

It is possible the glucose levels were high due to stress, but was urine glucose tested as well? If not, I would advise that BOTH urine and blood glucose are tested together, for accuracy, and you should be prepared for additional blood tests to determine accuracy or to check the glucose curve in order to determine what treatment is necessary (insulin). When first diganosing diabetes, it is important to monitor glucose curves several times for accuracy and to determine the best course of treatment.

As for the diet, the most commonly prescribed is high fiber, high protein, low to moderate fat content, and low in carbohydrates. Your vet needs to compare labels with those of the veterinary diets in order to come close to a suitable diet for dietary managment...I doubt the Whiska's is appropriate. Waltham's vet diets may soon be changed/handed over to Royal Canin's veterinary diets, so ask your vet to look into that if Royal Canin is available to her. The link I gave includes links to the companies she can check out to compare labels.

I do not recommend home-preparing food for Tommy, as you can't supplement it properly, you could run the risk for severe nutritional deficiencies that could also cause other primary organ disfunction. It would be extremely difficult to replicate a prescription veterinary diet for a diabetic cat. I also suggest that you cease feeding the fish or any other meat, bread, etc.

I understand the unavailability of vet diets in your area, but your vet has to get involved and start researching/comparing labels in which to choose the most appropriate diet for Tommy, this will also correlate with his blood glucose levels, response to insulin, etc, that is, if she is in fact, experienced with treating diabetic cats. If she isn't, I would ask for a referral to a vet who is, or to consult with a specialist however she can.

[Ash]

Yes, I will discuss all this with her tomorrow, maybe show her your reply and the list of diet foods.

I don't know how experienced she is with diabetes.

When in the pet shop, I compared lables of several cat foods they had to see how much carbohydrates they have - and was surprised to find in each case only protein, fibre, fat and ash mentioned. No carbs mentioned at all. This was the case also for the imported US brands. So how does one know which one is low in carbs?

Today, instead of Whiskas I bought a product made in the US called Pro Pac Superpremium Cat Food by Performance Pet Foods. Based on chicken, rice, fish and egg and with many added vitamins and minerals, the analysis reads:
Protein 32%
Fat 21%
Ash 6%
Fiber 3.5%
Moisture 10%
Is that any good? From the same company they had the low-fat food. I think this is the most expensive brand you can get here.

When managing diabetes, what is more important, the diet or the insulin shots? It's rather unlikely that I will get the optimum food for him here.

Urine was not tested, we never expected him having diabetes. But she mentioned already on the phone that we will have to do more urine testing.

[Traci]

The dietary approach is just as important as the insulin regulation. Since absorption of insulin requires a suitable diet (management) that is properly formulated with caloric distribution, the diet is crucial in managing the disease.

It is not uncommon for pet foods not to list carbohydrates in the "gauranteed analysis" statement on the package, but the source of carbohydrates should be listed in the ingredient list. The caloric distribution is the protein, fat, fiber and carbohydrate listed in the guaranteed analysis.

In a veterinary prescribed diet, specifically geared for managing diabetes, the content should roughly be as follows...NOTE: this is an example, but may not be suitable for every cat, since insulin regulation is important when implementing any diet for managing the disease:

From the "guaranteed analysis" listed on the package, or "average nutrient content"...and "dry matter basis":

Protein: 40% - 52%
Carbohydrates: 15% - 23%
Fat: 12% - 22%
Fiber: 1.26% - 5.5%

These are NOT specific for every cat, and vary per manufacturer, and they also vary per ingredients used for carbohydrate and protein sources used in the food. My recommendations are Hill's Rx M/D, or Purina DM, as these two carry a good amount of research behind them, including controlled clinical trials. However, it is equally as important to choose a food that is palatable to the cat, because if the cat refuses to eat it, it isn't going to benefit him. Most vets carry samples of at least two different veterinary prescribed diets for diabetes, so using the samples can be helpful when initiating a diabetic diet.

I hesitate on advising much beyond this because I'm not sure your vet has even accurately /definitively diagnosed diabetes yet, and she needs to retest the blood/urine glucose, and even perhaps frequent glucose curves to get an idea if it needs to be regulated with insulin or not. I strongly suggest she reads up on current treatment and management protocols we use in the states to diagnose and treat diabetes, or to consult with a vet who is experienced in this area.

[Ash]

Okay, thank you for that, Traci! I will discuss this with her and then get back to you!