RawPetMedics Feline Friday: Diabetes

Good morning, America. Good morning for the rest of the other side of the Atlantic. For the rest of us, good afternoon. Hopefully you're joining in. Welcome to Feline Fridays on Raw Pet Medics. I'm joined by the wonderful Julianne and Amaya. Dr. Amaya, you're coming on now. There we go. Say hello, everybody.

Hello. Good morning.

Oh, great. So I am so looking forward to talking about our subject today, but before we do so, I would like to just have a word about the Holistic Cat Conference, free to everybody with a cat and without. So if you've got friends, family, anybody wants to join in, please just send them the link. We'll put it on our social media shortly. For those of you who've been on Dr. Judy's page, you'll see several links already posted there. It will be here. So you can just get online and that's going to feature both Dr. Judy, myself, but also Amaya as well. You've got a slot and hosted, of course, by our wonderful Julianne. Julianne, do you want to give us a little bit of a lead-in of things you're looking forward to?

Absolutely. Thank you very much, Brendan. And as you said, the links are everywhere. So all over our social medias. It's a free online event. It's 2 days and it's basically talking all about cats. So it's holistic because we are looking at emotional, mental, physical, and actually the energetics as well. So all the different elements that affect the cats. We've got topics that include clarity on chakras, which I'm doing. You're doing homeopathy. We've got gut health, mushrooms, kidney disease, learn to love the litter box, essential oils. We have got something for everyone. So it's a completely free event, but you do need to register your space so that you get all the webinar details. So as Brendan said, everyone, we've popped the link here. And it's on our social medias as well. We're also offering a VIP ticket, which means that you can get access to the replays, because obviously for some people across the pond, 10 AM on the Saturday is a little bit early. Yeah, when they look at the different time zones, which is why the second day is a bit later. So we're trying to incorporate that. So really looking forward to it. I have to say, I can't actually pick one topic because I'm just excited about it all. It is, it's going to be a really great event. So make sure you sign up, peeps.

Yeah, brilliant, absolutely brilliant. So I'm looking forward to it as well, and that's, uh, you know, so please do join us the 25th, 26th of February. So just a week, just over a week to go.

Yeah, really excited.

Get your interest registered right now, we want to see you there, and just invite all of those other people with cats along too. I think it'd be really great if we can share all of the information Oh wow.

So I was gonna say, so if people can share it in groups, share it in cat groups, breeder groups, you know, food, cat food groups, if you can share the link to the conference, you know, the mission underlying it all is about giving cats a voice, and that's about helping guardians to understand their cats. So please share as far and wide as you can so that we can reach as many guardians and support them as best we can.

Brilliant, brilliant. So We're just waiting for Amaia, who's just somewhere in the middle of the Mediterranean and has just lost stream for a moment. So I'm sure she'll come back to us.

Oh no, Amaia, come back.

Somewhere, please. No, we'll be fine. We can crack on. There's so many things for us to talk about in the meantime. So she's here. She's coming.

She did that before. We were going to go off for an extended.

She got bored. She wants to find something else.

I know I'm talking a lot about the conference. I'm sorry. So excited.

I half think actually it was one of her cats jumped off the windowsill, went straight across her computer and probably switched it off. But that's probably—

and I was like, what happened?

We can't hear you very well.

Oh, you need to plug your microphone back in now. That's the next thing. There we go. Right, it's always fun, bit of tech fun. No, you might need to lean in.

Maya's had a little bit of a stressful week, so we'll just give her a minute. No pressure, no rush.

Oh, look, we're going to dig you out of a hole very quickly. Look, we're going to talk about diabetes. We've all got things that we want to add in here. Some of you guys may have seen a little bit that we touched on last week when we did diabetes for dogs, and we touched a tiny bit on cats. And I said I was going to bring you so much more today because it is a difference for cats, very much closer to the human model of having type 2 diabetes. So, so much more that we need to talk about there than it is with canine buddies. So, um, here we go. Gonna give it another go for Amaya, who's desperately plugging things in and plugging things out.

And come on, come on. No.

Yes, we can hear you. That's you. You just need to lean in.

Is this better? Is this better?

That's better. That was better. There we go. So, um, first things, look, your personal experience. Anybody, uh, I mean, obviously I see them clinically. Um, Julianne, have you— you said you had personal experience with diabetes in cats?

Unfortunately so, yes. My previous cat Pickle, we, we battled with it for years, and it took us over 2 years to get a diagnosis of it to start with. So, you know, it was— we had a very bumpy journey. And I always say that cats are with us for a reason. She was very poorly and the diabetes underpinned that, her health. You know, we struggled in a lot of ways, of which I know we'll talk about, you know, as we go through the topics today. But yeah, it's been something that was a very steep learning curve in how to represent her, how to engage with my vets. It was, you know, it was a very personal journey. Yeah. Which I will rant about at some point. But, you know, it's a very personal topic.

Great.

So, and Amaya, you know, with Felvac for Cats and all of your stuff that you're doing now with nutrition, where are you at? Are you giving people just nutritional advice? Are you giving people sort of holistic medicine advice along with that? Where are you coming at it? From?

Well, actually, I take any chronic disease, and what I do is try every single aspect from it— behavioral, nutritional— because I can't see things in just one side of things, you know, just nutritional, because nutrition in cats is always related to behavior. And also, if the cat doesn't feel good, he won't eat as well. So you have— I think of myself, like, trying to work with the small pieces of the puzzle and just bring in one, uh, at a time, you know, and try to collect everything as a holistic medicine, of course. And I, I try to use mostly, uh, natural products in the way.

Yeah, so I, I would say, Julianne, to me, there's, there's areas that we need to talk about, you know. That's going to be, uh, what symptoms to spot, you know, what's leading into this, um, the difficulties you found, and, and maybe myself and Mamaia can answer these. So I think, and then we're going to talk a little bit about treatment following diagnosis and then the nutrition, why nutrition is so important for cats, particularly in this. But I think for everybody out there, it probably is going to be most useful coming at it from your point of view, Julianne. So I think if you want to ask the questions and then maybe we can come in with the answers for you and you can add some other hints and tips that you found along the way.

So nicely passing it on there. I'm running!

Somebody's calling.

Yeah, yeah, all of a sudden I've disappeared.

Oh no, no, no, I've been half the screen.

Oh, so close.

Yeah, I, I thank you for that. I mean, it's like I said, I'm really passionate about the topic. Um, I think one of the hardest things for me that I'd like to start with is you know, identifying it, because don't put me at the top.

Oh, I love the control.

Indeed. We, we— she— so Prickle was a rescue cat, and when, when she was found as a stray, so she had sores all over her ears, she was very skinny, very scrawny. So I did what I thought was right, which was free feed dry food. So I had dry food down all the time for her. She also had wet once, twice a day at the time, but it was like, you know, here, have you have your food, you know, um, I love you, eat, be healthy. That's where I was, that in that space. And what happened was she started to vomit. So this was one of the symptoms that we dealt with. And every time I went to the vet, they kept saying to me, change her food, change her food, change her food, she's sensitive to it, she's sensitive to it. I didn't know you could ask for allergy testing or, you know, protein testing things to understand her intolerance levels. And it wasn't until we had— we went on a Saturday morning. I was at the end of my tether and I said, like, pleaded with this vet and said, I need, you know, something's not right. It was a locum vet. She said to me, look, let me go and just do one thing. She took Pickle into the back of the surgery. She tested her blood glucose and she came back in. She said to me, I know what it is. She's diabetic. Her blood glucose is over 25. And I just burst into tears because I was like, we've got an answer finally. So I will pause there because then we'll go on to treatments. But I would like for you two to share with everybody, like, symptoms, you know, because for us it was just vomiting, which could be like a dodgy packet of food, or it could be that she had an upset tummy, you know, she'd eaten something outside. So what symptoms and we'll come to Brendan first. What symptoms should people look for if we're talking about diabetes?

Yeah, so I think it's a really good point that you've made there because there's so many things that can lead into this diagnosis. You've seen vomiting, but actually weight loss often comes in. Now, most people say, but this is all about obese cats, you know, type 2 diabetes. Yeah, but it's the weight loss in those circumstances that we need to be aware of. One of the next things, probably the highest symptom is the thirst. We see these cats driven to drinking more and more and therefore urinating. Sometimes inappropriate urination is the first thing the owner sees, but actually it's not inappropriate urination. They've just totally filled the litter tray. They're still finding other spots to go to. I don't mean filled like it's overflowing and that's why you've got problems. I'm just talking about they've used up the litter as far As far as they're concerned, they don't want to go back in the wet stuff. They're going to go somewhere fresh. And so seeing inappropriate urination could be a symptom. You know, we can't make dive-in assumptions here and be aware urine glucose becomes a really important sign for diabetes mellitus. Okay, for cats, because if your cat is stressed in the surgery, a one-off pinprick, if they— so a normal range is between 5 and 8, okay, roughly millimoles per litre of glucose. And when they get to a stress situation, such as in the surgery, having a blood test, they may go up to 10, 12, something like that. They won't generally get to 25. I would say that's going to be extremist, but they will get a high glucose in their bloodstream. So we actually can look at taking in the diagnostics a different type of blood to sort of look at the longer-term protein-bound glucose that can occur so that we can understand, is that a long-term or is that a stress thing? However, if your cat is urinating excessively and drinking more than normal, and then I would say collect some urine So clean the litter tray out, collect the urine, and pour that into a pot and be able to take that to your vet for them to test. If there's glucose in that urine, sometimes also ketones, that will be the point when we will say, do you know what, we need to redo some tests to look at that protein-bound glucose.

That was something that we ended up doing later down the line. I would get test strips to dip her urine myself to get those answers and that information. We've lost Amaya. Is not participating today?

She keeps coming back in and out. I think they, they are suffering the storm. So we're suffering Storm Otto up here. There is a storm going on, um, uh, I believe down the south coast of Spain. I don't— didn't think it had hit Mallorca yet, but you know, she's in the mid-Mediterranean. I think she's on an island now. It's just like island life.

Hello.

Actually, no, there's no rain at all. No, there's no problem. Actually, it's sunny. It's already spring. It's almost spring so far. So that's not— I don't know what's going on. Actually, I lose the camera and then I'm still here. I can still hear you. I don't go anywhere. So I don't know what's going on.

And we can see you. Don't make any horrible emotions.

Don't make any faces. No faces, he says. Although I do say from the last one, I remember you going like this and I just— that's funny. Amaya, talking about symptoms, is there anything that you would like to add to what Brendan has just— what Brendan has said?

Yeah, there's— there are two things that I notice a lot, and one is that the weight loss that you mentioned in the beginning, um, there is a— people most of the time they tell me that they don't see the weight loss in their cats. And usually it's when they are fed kibble. You can see that they— I always say that they are very rounded in the abdomen and very thin in the thighs, right? So they have this circle, and that's not the shape of a cat, right? So it's sometimes it's hard to see that they are losing muscle in their thighs because they see the abdomen that's still big, or sometimes they they think that this, how do you call it in English, the bag that they have below the primordial pouch, that sometimes they think that's belly as well. So they don't, it's not always that easy to acknowledge that your cat is losing weight. And then when you realize that, it's too late. So if you just always make sure that the thigh levels or even If you see that they are losing weight and you can, you know, you start seeing the bones here, that's too extreme, but still I've seen cases like that, that they said, no, my cat's not losing weight and they are not weighting their cat. And suddenly you say, no, yes, the problem is, you know, we already have a very severe problem here. And the other thing is that I see very often and it's not specifically related to it, but it is. It's recurrent infections. Most of the time you get some, I don't know, ear issues or even dental or any other recurrent, and it's always coming back. And the cat might or might not be fat. It's not necessarily that. There are many things, you know, you're still fighting with underlying causes or diseases. And once you treat them and you make some changes, but still you're still having an issue, just, you always have to look into a more chronic illness such as diabetes and others. That's the thing. But recurring infections is one of the things that you have to look, if you see that and thirst, for example, then you have to look into that. You have to look also for hyperthyroidism. Still, you know, there are many things that you can look into, but let's not normalize certain symptoms or certain things just because, oh, I just treated with this, it won't come back for another 6 months. And it's not normal to have that. And the last thing is vomiting. It became something that I always hear this is It's normal in cats. I hear that all the time. I said, so it is normal for you to vomit? So there is a mix, there's a confusion here about what regurgitation and vomiting is, because if your cat is anxious, suffers anxiety, and then he eats fast and then he regurgitates the food, then address the anxiety first and then we'll figure it out, other things. Vomiting for cats is not normal. No, not even having hairballs is normal at a certain point. So we need to stop thinking that this is normal because as it happened to you, you only see vomiting and probably vets wouldn't even care about that once you do have a problem. Or— and we don't think that that could be diabetes.

No, I agree. And that's— I think that's what my frustration— because I knew something was wrong and it was just like change of food, change of food all the time. And And this was part of my journey about realizing that I needed to speak up for her. You know, I needed to speak for Pickle and it was okay to ask my vet questions. That wasn't something that I did up until that point because I, and I'm going to be really frank with you two, I know you two are vets, but I trusted my vet because they had the white coat on. They were in the position of authority. They'd had the training, they had the knowledge, they were the medical professional in the room. So I didn't realize, I didn't think, I didn't know that I could ask questions. I could ask for a second opinion. I could ask for an explanation. I did exactly what they told me to. And now I would do things completely differently because anybody watching this live with us now on replay, you can ask your vet questions. You could ask for explanations and you should be, you should be doing that because you are your cat or your animal's guardian. You know, you speak for them, you know. And so when we, when we had the diagnosis, the first thing they talked about was, you know, how to treat it, which was insulin. Now, I had no— no one told me about the fact we could go into remission. No one told me about the fact that that was even an option. I was told we inject her twice a day. That was it. And we start with this amount of insulin. Come back in a week. We'll see how she's done. Now, I get that from a starting perspective, like, you know, let's, let's, let's get things moving. What I wasn't informed at any point by my vet was that I could check her blood glucose at home, that I could check her urine as Brendan said, with the ketones and for the glucose myself. So we, and so I ended up getting to that a bit later down the line. So let's talk a little bit now about treatment because it took us a good 18 months to get her, to get Pickle in any form of regulation or regulated with insulin. I didn't realize that blood glucose testing at home was the key to management. So Brendan, what advice or what treatments would you use? Like, what would be the next steps for you from like diagnosing to then dealing with and treating?

Okay, so you've got two stages here. You've got the super acute, really high issues of diabetic ketoacidosis. So they're really sick, collapsed, you know, glucose is through the roof. They've got ketoacidosis, which is not just using fats to metabolize, but it's such that it's actually changing the pH of the bloodstream and it's actually causing them to be really ill. And they may even be collapsing this stage. And at that point, there are going to be some fluids usually needed to be given. They're going to need to be on intravenous insulin to try and get that glucose down. There's going to be some things that need to happen, but this is saving your cat's life. You sort of got to look at that. Let's look at then The other end is the sort of more chronic, look, my cat's not been quite right. They've had a bit of illness, they've been overweight. Maybe within that you've started to see some of this thirst that's starting to occur and maybe some weight loss. And at that point, this is where, as with humans, the first things that you're going to do is look at, okay, if they're not super off the scale and going into ketoacidosis, we need to look at the diet. Okay, now when I was at university 13 years ago, that was a situation of no, diabetic patients need insulin. You know, we're taught that. And actually, cats are weird because they need a protamine zinc insulin because of the way they metabolize insulin, and they need it a lot, you know, to take a lot longer to be released and not have acute insulin lentil versions. That's what we were taught, you know, you go out there, get on with it, monitor their glucose. They didn't even used to tell us about the spikes you'd get in glucose if they were stressed, you know, it was just get on with it, you know, balance them out, and you'd be trying to work out why the day's glucose curve was all over the place depending on which clinician took the blood. And so it's It's really a case of diet first for type 2 diabetes. If your cat is a classic fat cat that's maybe got inflammatory disease, that's where I would be looking these days. Okay. It was really interesting how they were almost gobsmacked in the late '90s when Hills brought out something called Metabolic Diet, so MD, and they suddenly started talking about 'Oh my God, this diet's amazing.' So it was high fat and protein, almost zero carbs in there. And they started to talk about the amazing remission of diabetes with this diet. And you're just sort of like, yeah, yeah, you know, there was no transition from, from human medicine into feline medicine at all. It was just like, you know, they were, they were so proud of their little food that they'd come up with. And it was nothing to do with their food at all. It was just that they'd misunderstood the disease totally. So, you know, but it is a really useful sort of reflection on if you're going to feed, you know, what we talk about— raw is in the title, you know— if you're going to feed raw, why it can be so advantageous and the things that you might just need to adapt in that is making sure that you're not going super high protein. Within the foods. But we're going to talk about diet a little bit later on. Main things, yes, insulin, probably need, you know, if you're in the acute phase, if you go into insulin, then you're going to be looking at a longer, lower release, slower release, some great additions. Now you're going to be looking at how their glucose responds to that because every cat is an individual. So some will respond quicker than others and you need to adapt for that. And, you know, with humans, they often will have a longer-term version which will go through the day and give them a baseline of glucose uptake, because that's what insulin does. It allows your cells to take up glucose and use it. That's the importance of it. So you can have really high glucose because your cells cannot take that up into their systems because there's not enough insulin there. There. So they have this baseline, and then what they do is they have a little top-up if they're feeling slightly faint, you know, or edgy. They'll know that they need to take some glucose but also give themselves a little bit more insulin at that time. So they're learning about when their glucose is low, but how they get that glucose into their cells so they don't have— you can't do that for cats. So you've got to start looking at some of these wonderful new additions we've got now, which is the dermal sort of implants. They're these little implants that you can stick to your cat. So you have to shave a little tiny— now I'm going to say here 10 pence piece size in this, and everybody else is going to go, what size is that? Okay, so it's about a centimeter and a half across. Okay, that will need to be bare skin so that you can place this implant onto the skin and it just needs to be stuck on. Some people will use a suture glue, which is effectively super glue, to stick it on. It has a little reader which will read the glucose within the bloodstream and it Bluetooths to your phone. So you literally can have what's going on constantly.

I'm sorry, but like, can I just pause and say, what the hell? That is amazing. So I spent 6 weeks doing behavior modification to get Pickle to sit on the arm of the chair using a sock full of rice that was warm, stroking her ear a few times, using a little tiny pinprick, pricking her ear, and then getting the little droplet of blood to go into the glucose machine. Like, I kid you not, like blood glucose testing, like ear pricking was a major, major stressor.

Could I just ask, what was the sock full of rice for?

To warm the ear, to get the blood pumping.

Oh yeah, yeah, yeah. That's something they suggest a lot. Yes, too.

But now you're telling me you can just shave a spot, stick a pad on, and you can just read it on your phone? Is that what you're saying to me?

Yeah, I would, you know, I heard about this only from Pete Colshaw because that's not in— well, at least not where I work, nobody knows about it. I, I heard it. I heard it the first time, uh, with Pete Colshaw and, um, And he said, no, this is simple. I was like, yeah, that's amazing. I'm still teaching, you know, how to— what, what you did, Julian, you know, teach them to be compromised, to work in, uh, you know, making the glucose curve and, you know, all those things. And yeah, I heard about that. It was like, wow.

Yeah. And, and Bob's, Bob's absolutely right. Okay. Uh, this is your friend, isn't it, Julian?

So from a point of view, yes. She's also had a diabetic cat as well.

So that's right, you're absolutely right. If they're not stuck on right, they can fall off, of course, because cats will look at it and go, so you've got to choose your spot. Okay, the thing that you need to be aware of is that they are usually based around human glucose curves. Okay, now you're looking at trends with these implants. That's the point. Okay, so you're working it out on trend. So just to inform people out there, the amount of glucose which is bound to protein is different in dogs to it is in humans, is different in cats to it is in dogs and humans. So for— I'll get these right, I hope— for humans, it's roughly 50/50. For dogs, I believe that it's 60/40, and I think cats is up 70, 30, something like that as the level of glucose. So there's slight adaptations. So you do, if you're going to do the ear pinprick, there are some great new strips which only need a very, very small amount, whereas you used to have to have a proper bubble on the skin surface to suck up the blood in a number of years ago. I'm not going to repeat how many years ago it was when I started. But for, for now, you know, you're looking at microdots of blood that you can use. They've got a little thing and you just need to adapt the glucose meter to whether it's for a cat or for a dog. Okay. So that you get that accurate.

Okay.

And glucose testing is the key because we would go to the vets frequently for them to check our glucose. I didn't know that I could do it at home because they didn't tell me. And of course, like you said, Brendan, you know, you go into— they go into a veterinary surgery and they're stressed. So what happens to their body? You know, everything's heightened and it wasn't a true reading. And then we would adjust her insulin dose based on the glucose reading we had in the vet's office, you know. So, so we, we went through that part of the journey. I am distracted by the gorgeous white cat. He's got a mane like Leo, like Baby Mouse.

She's right here listening.

So the next step of our journey, you said about diet, and I'm going to come on to that in just a minute. But before that, Bob's mentioned it, and I know Amaya, I want to come to you on this point. Tight regulation protocols. So I didn't— I was lost, right? And I'm someone who likes information. I'm a detail person, which I know drives you two crazy, but it's true. I am a detail person. So I went online and started to do research and found out, you know, there were forums, there were cat diabetic cat forums. I'm like, oh wow, okay, go into it completely overwhelmed with information but managed to start to wade through it. People started talking about tight regulation protocol, and I didn't even know it was a thing. I didn't know you could use it, and when I mentioned it to my vet, he just rolled his eyes and just ignored it. So I actually at one point started this against my vet's wishes. Now, I don't say this lightly to anybody. Please do not do this like just ad hoc. I wanted to try to support my cat. And then actually what happened was when I went back to speak to him after we looked into just starting it, he— I asked about switching insulin to make it more effective. He laughed at me, but he did it because I said to him, this is what I want. So I found a bit of strength to say, like, you know, this isn't what you would do. That's fine. This is what I want to do. I'm her guardian. So, Amaya, tell us a little bit about what is tight regulation protocol and you know, how, how can it make a difference?

Okay, so this is the way I do it. Um, the thing is to, uh, what I do is try to— well, once you change your diet, right, you just go to a low-carb diet. And, uh, you know, if you are— if you're already doing a dosage of insulin, and because usually what— when they come to me, I do not diagnose, I I tend to already have the diagnosis and the treatment already set in place. So what I do is when I start changing the diet, I ask them to go to do this curve of glucose, right, to make sure what the levels are. And once we— at first we need to start doing this when you reduce the carbohydrates in diet. Then you might be using a lot of insulin, right? Because insulin, it's supposed to put the sugar into the cells, like, just like Brendan said. So what we try to do here is to, in a way, push a little bit the body to work. I don't know how to explain this. Let me see if I can get the the words right, but what we try to do here is to push a little bit the body with a, with a play a little bit with the glucose levels and the insulin levels and reduce the carbohydrates in diet. This is how, and we try to push it a little bit instead of panicking at the first, a little peak of glucose. Right? So it, for me, what I know about this type regulation is that what you do is simply balanced the amount of the way you address nutrition and the way you put the carb— well, not carbohydrates, the diet, how you prepare the diet and play with those glucose levels until you manage to get— reduce the amount of insulin and move forward from that. I don't know if that came across because it's For me, it's really hard to explain.

That's okay. Brendan, do you have anything to add?

Yes, I mean, so from— I do see that actually the diet type. So, I mean, moving away, I mean, one of the primary things that you're going to need to do if you're even balancing with insulin is to get that diet right. There's no point in having, you know, shots of glucose going in here, there, and everywhere through the day. For that cat because you're not going to be able to monitor and therefore change their insulin dose in time to cope with that. So you've to some degree got to start tightening up how you're feeding. And as I said to you, the first thing is going to be trying to get them to use fat metabolism normally, try and reduce their dependence on glucose so much and the need for that to be shooting up and down. Which is readily available for cats because they're carnivores, you know, they're built to do this. So that's fine. So regulate the type of food you're not going to— so it's going to be low glycemic index. Okay, so that means reducing the glucose that they really release. So you don't want anything that's a processed starch that's going to have any sort of glucose syrup in it to make thickened or, you know, nice and glossy. All of those sort of things need to go because they are going to disrupt that level of glucose shooting up. Okay. And if there's no insulin there to help deal with it, they're just going to be all over the place. So really try and, you know, do your testing. Absolutely testing at home. Use one of these, you know, glue-ons if you can get your vet to do them. Use the home testing kits that you can get. You can get them on Amazon now. You just make sure that it's— if it is the human one, there's a calculation you need to do to adapt it. And then it's looking at trend anyway. And yes, they are cheaper, but there are animal ones available, you know, as a kit. And it's all the instructions are in there. So you can get those available. There's one which is purple in color. I'm not going to go any more into branding than that. Okay. And so you can purchase those as a kit and start to monitor. So every hour or so through the day, as Amaya says, you don't worry about the little blips. It's about the trend. Okay. Very much. And you're trying to bring that trend into a level Now people say to me, we used to just balance them, that we were monitoring glucose at home generally for, for clients, and in order to monitor glucose, if they went negative, they fell below 8 millimoles per liter. So actually that means, because that's the cutoff for filtration through the kidneys of glucose, so if they're above that, you can test a small amount in the of glucose in the urine, you think, great, it's a really low amount. I've got close to that. And then if you've got much higher, you used to say, oh, we're not giving enough insulin. You know, we need to up that. But it's a very sort of messy situation because if they're below 8 millimoles, all of a sudden they're negative in the urine and you don't know at what point below 8 they are. They could be still within the normal range between 5 and 8. Or they could be 3 and waiting to have a seizure if they go any lower. And that was always the concern. With blood testing, you can be much tighter because you can be looking for that range of when they're getting, you know, down to below 5. Okay, are they getting down now to be super low that they're going to start to have other consequences? So we need to warn people if you accidentally feed wrong and overdose with insulin, yes, you can have a hypo, which can lead to seizures. Okay, which is a low level of glucose can lead to seizures. So be aware of that, but don't panic about it. If you can monitor and you know for cats you're resting between 5 and 8, then that's a really good way of tight regulation. And if they then get to lose weight, and switch to fat metabolism, that's when you suddenly realize that the amount of insulin you need to keep them between those ranges starts to drop off and they go into remission.

Yeah.

And that is the point that we, we struggled to get to. So no, no one told me that diet would impact. No one told me to stop free-feeding dry food. Right. I, we got to that point, but—

or even some certain wet foods, because you mentioned something very important, Brendan, that it's the that sugary thing that the gravy has, that even very natural brands, I've been looking at this very detailed, is that sometimes they have this, they say natural broth, tuna in natural broth or something like that. And then you realize that the natural thing has a little bit of sugar in it. So it is not, when you change from kibble to a canned food, then okay, it's better. But still, I would always recommend to go in this case to raw because of how the nutrients assimilate, how, you know, it's all high protein. You can control this fat metabolism that you were talking about. And then the carbohydrates, you can measure them and actually know what you're feeding. And the best results that I got were when, you know, when they got into the good raw diet. But with wet food, you have to be careful. Be careful of the brands that you buy.

Absolutely. I mean, and a lot of the supermarket wet foods, when you look at the list of ingredients, we've talked about ingredients before, you know, the first word is sugars, you know, various sugars. And it's like, so, so, you know, we are, we are Raw Pet Medics, Feline Fridays, you know, let's talk a little bit more about diet and the impact.

So let's pick Yeah, and I just want to, again, very rightly, if your cat is raw fed and is using fat metabolism, this ratio is far better. However, all of the others were previously looked at. I gave the 5 to 8 is what we look at for dogs and cats who are usually kibble fed. Okay, so, you know, these are revised levels. You can sort this if your cat cats' metabolism is normal and they can go down to this without having episodes. It just happens that if your cats can't take up glucose and that's all their energy source is based around because of the high processed diets, they can start to have episodes, seizures, etc., if they drop too low. Okay, so you're quite right, Bob. You know, they are all the time reevaluating the appropriate feline blood glucose depends on diets, etc., that they're being fed.

Yeah, absolutely. Thank you for that, Brendan. And diet was really, you know, the first kind of game changer for us when we were still on— when we were still trying to use tight regulation protocol, we still couldn't get her stable. So that glucose curve, there were peaks, but there were real big drops and then real big peaks and even out. And then— and it just— we couldn't get it. And I didn't realize what it was. I didn't realize it was food, you know, and we've talked about so many times, you know, every one of our episodes, like nutrition is key. And we— I finally got her off dry food. And I agree with you, Amaya, you know, raw, particularly with diabetes, best. But Pickle wouldn't tolerate it. What actually happened is that we managed to do half wet and half raw because when she would have full, fully raw, you know, days, whatever, she got really constipated. So then we would try lactulose, which then can dehydrate them, you know, and we're in a bit of a vicious circle, right? So we constantly had issues with our poops. And, you know, we would come home some days and we'd be looking to find where, like Brennan said, a bit inappropriate urination. We'd be looking around the house to try and find where the poops were, you know. And was it a little hard nugget? Was it worse? You know, was she actually going? And so for her, every cat is an individual. We managed to get her usually around the 8, 8.5 to 9. We got her lower at times, but it wasn't constant. We didn't get her off insulin and her best diet was a mixture of wet and raw. And it was really at the time high quality wet. Unfortunately, it's not anymore because it's been bought by Mars. It was a high quality wet brand and you know, very, uh, high, high protein, good quality ingredients, you know. Um, so, so for her, like, get into even introducing raw— why are you smiling? What have I said now?

No, I, I just loved your comment.

My sister works for Mark Wright as well, so I'm not saying anything.

I'm just laughing because I love the way you said it.

We just like making you feel self-conscious. It's fine.

You do every time when you two start to smirk. I'm like, oh God, what is it? Um, you made me think of the room. Never mind, we didn't bring that up.

That was you.

That was all you did it now.

Just see if I can find that Barry White.

Anyway, that'll do, mister. That'll do. Nutrition is key. We only managed to kind of stabilize her when we made her nutrition better. And for anybody that is dealing with a diabetic cat, whether you've just got a diagnosis or you're trying to keep them stable, from my perspective, my experience with Pickle, the two things that I would say is to record data, have a little book you know, we've talked about your glucose curves, we've talked about monitoring their glucose. And the second thing is nutrition. You know, it's trying to get them on, you know, a low-carb food. Like we said, raw is best. Depends what age your cat is diagnosed as to whether, you know, we've talked before about transitioning. You know, we've got to think about the stress with making those changes. Now, obviously, I'm not saying keep feeding your cat dry food if they're diabetic because you're basically fighting, you know, an actual downward, you know, battle. You're never going to be able to give a good quality of life. But even if you can introduce, you know, a bit of high-quality wet and like Amaya said, bringing in the raw as well.

Yeah, well, what you say about constipation, that's a very interesting topic because, you know, diabetes will make you be a bit dehydrated, you know, because the, the blood will be thicker, the, you know, you will be losing a lot of urine due to the, that glucose and everything. So it's very normal. I've seen it a lot when, when you have that and you're trying to change to raw and then they suddenly get constipated. So, uh, we, then we have to make some adjustments because you can make adjustments in the diet. I, I was trying to think about something general, but but then I realized that it's not. Every single cat has their own thing. And so what I try to combine is a little bit of, I look into fiber, I look into putting a little more liquid into the, like bone broth or something. It depends, 'cause sometimes bone broth, it won't work. It depends. But I use different sources to get everything more moist and make sure that they are hydrated. And you know, if you need sometimes to do something else, just do it, because the problem of constipation is it's water intake and water in the body. So that's something to look into. And then the wet foods, they're very good. At least here in Spain, we have a variety of really good brands of wet food. The only thing is that most of the times they don't have to put that they have sugar in it, because when they say natural thing or natural broth or whatever, they are not mentioning that it has a little bit of sugar. So make sure you look into the brand and what you're feeding and using as a wet food, because someone said here that they cannot feed the cat raw because they tried and transition is— they're struggling with that. So that's, uh, you can, you can look for products processed that, you know, have little or nothing of carbohydrates and and that will work. You know, we are saying what's best, but you know what we think is best.

And I would certainly say, look, at the very least, make it so that it's low GI, so the glycemic index is low. So if your cat's— and you know, Kelly, you've said for Banjo that you've literally got a situation of, you know, they don't want to take raw. They're not going to want this strange new diet. There are ways of creating a diet or choosing a diet off the shelf which may simulate what you've fed before. So there are some sort of low-processed foods out there, cooked diets that may add butternut squash in instead of it being another source of carbohydrate like rice or something like that that you want to avoid. And that you're just trying to get them moved across slowly so there's no great shape changes to their diet. You know, you do a slow transition and that you get them to that point. And if they'll then take that, that's great. You know, but ultimately, if you can get them to raw, brilliant, go down that diet change. But you've got to get them stabilized first and foremost. And, you know, that's, that's a really important component. One other thing I forgot to say with regards to the levels as well. If you monitor with a human blood glucose monitor, what you perceive as normal for your cat will also be on the low side, okay? Because the amount that the human glucometer would be thinking is available in the blood it will read it as lower than it actually is because of the amount that's protein-bound. So just be aware of that for those people that have read the normal figure that's been put in the comments. There's lots of debate depending on who's testing still out there, but it is going to be what they're being fed on, it's going to be which glucometer you're using, all sorts of other aspects to it. And I would then say all of the things that Amaya's done with diet there, to me, follow up the other bit that I wanted to make. This is partly an inflammatory condition. If you have anything which is going to drive your cat's sympathetic system, so high stress environments, you know, you've moved house, you've started to decorate, you've suddenly decided to use some obtuse color that they don't like. No, that was for Carol.

That's a dig at me. I know that, Brendan.

But from a point of view of, um, there's new cats in the neighborhood that are stressing them out, they can't go out because you've just moved and you don't want to let them out, um, and then they're already on an inflammatory food that's high carb added into that, they're already overweight and, um, they're starting to become insulin resistant. Okay, that's part of an inflammatory process. That cortisol that they will release because of that stress actually negates the effect of insulin. It competes with the insulin, so they become insulin resistant. So all of that, people are saying, well, how is that linked? That's linked because of that cortisol levels. If they stay artificially high, that can lead to problems. So it's not just about diet, but diet is really important. There are other inflammatory processes you need to try and nail down and And in that comes stresses. So try and nail down some of those stresses, and that can all help to suddenly unravel the disease and stop it being a problem.

Yeah. And when you talk about stress, those are very normal things, you know, but sometimes we don't look after how we feel. And that's for you, Julianne, to explain a little bit further. But you know how the guardian feels and the energy that they So I've noticed many times that when they suddenly get their cat diagnosed with diabetes, they are all frustrated and stressed and they don't know what to do and they are running in circles, you know? And that kind of energy is not good because then you're trying to push the cat to test the glucose and do all those things, right? And that by itself, it's inflammatory for the cat. Be aware of that as well and try to ask for help, someone that, you know, can assist you, can help you, can support you, whatever. That it's also a way to stress your cat. So I will let Julianne explain a little bit further because that's what you do. Then I do it.

It is. And actually, like, the first time we blood glucose Pickle, we blood checked Pickle, I was so stressed about it that we did it with the lancet pen that came with a machine. And it went— the little pinprick thing, the needle point, went straight through her ear. And for the next 3 hours, she had stress-induced cystitis, and she was leaving drops of bloody wee all over the house. So, like, it, it was, like, beyond stressful, right? It was one of the most difficult moments of our relationship. But on the flip side of that, there was one day, and then I'll never forget it, when we were sat on the sofa spooning like we used to. You know, I'm stretched out, she's in my little kind of crooky bit here, I had my hand on her tummy like we would, and I remember thinking like, help me heal her, you know, help me heal her. And I, because I was just lost, right? I was so overwhelmed. I just joined the forums. My vet was very contradictory to what, to the route that I wanted to take. And I felt so lost. I was just like, help me heal her. And when we blood, when we checked her blood glucose that evening, she was 5.6, a number I had never seen before for her and actually never saw again. So in that moment of my complete surrender, because I was just like, I don't know what else to do. And in that moment of just pure intention, and I know some of the science buffs in the community may kind of raise their eyes, but that's what happened. You know, I just wanted to help and I didn't have any of the stress to give it. You know, I was just like, I give in. We are where we are. And it was a real turning point because I think one of the moments that I realized is just how impactful my energy, my emotion, my emotional state is on our cats, you know. And