Advice Needed - Insulin Problem or Mild Hypo?

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Trish J

Trish J

Member Since 2015
Hiya everyone,

Wondering if anyone can give me some advice, particularly a call-out to @Squalliesmom as I know she's got a lot of experience with Caninsulin (Vetinsulin)?

Bit freaked out today. Kismet was only diagnosed Auguat 22nd and due to various complications with pancreatitis/cereal allergy she's not regulated fully as yet and I'm still on a big learning curve.

The vet started her off on 2 units of Caninsulin even though she hadn't eaten for two days and she had a really weird reaction to it. Reduced it to 1 unit which she's been okay on, less urine, less appetite and thirst. She refused to eat her normal food, so I've had her on a high protein, low carb diet, giving her food little and often as I was advised. As she's been eating more normally, five days ago I increased it to 1.5 on the vet's phone advice and another slight rise in dose today.

Up to now she's been fine on the 1.5 units, but this morning before her injection her litter tray was back to being full of urine and she was ravenous - just like before she was diagnosed. I injected her insulin with a slight increase (a conservative 1.8 unit), but she's stayed really hungry, inbetween being very sleepy, though she hasn't used the tray or drank much water since.

Is this likely to be a mild Hypo or a sign the insulin has lost strength? I've been careful to follow all the steps, but I left the Caninsulin (UK name for Vetinsulin) out of the fridge for a couple of hours the day before yesterday, although as the kitchen was pretty cold. As a precaution I've managed to get a new bottle of Insulin from the vets, though can't get her over there to have her BG tested until Monday.

Since Kismet's last vet visit (which traumatised her and us) I've been monitoring her by appetite/urine/thirst as I'm still trying to home-test her BG without success, though I intend to try again later. I'm hoping to get a Keto/Glucose urine test done oday too.

If anyone can offer any insight/advice it would be very much appreciated. I'm really stressed out at present due to other family health problems and now really worried at this sudden change in her when she seemed to be doing so well. :(

Trish
 
Trish J said:
Hiya everyone,

Wondering if anyone can give me some advice, particularly a call-out to @Squalliesmom as I know she's got a lot of experience with Caninsulin (Vetinsulin)?

Bit freaked out today. Kismet was only diagnosed Auguat 22nd and due to various complications with pancreatitis/cereal allergy she's not regulated fully as yet and I'm still on a big learning curve.

The vet started her off on 2 units of Caninsulin even though she hadn't eaten for two days and she had a really weird reaction to it. Reduced it to 1 unit which she's been okay on, less urine, less appetite and thirst. She refused to eat her normal food, so I've had her on a high protein, low carb diet, giving her food little and often as I was advised. As she's been eating more normally, five days ago I increased it to 1.5 on the vet's phone advice and another slight rise in dose today.

Up to now she's been fine on the 1.5 units, but this morning before her injection her litter tray was back to being full of urine and she was ravenous - just like before she was diagnosed. I injected her insulin with a slight increase (a conservative 1.8 unit), but she's stayed really hungry, inbetween being very sleepy, though she hasn't used the tray or drank much water since.

Is this likely to be a mild Hypo or a sign the insulin has lost strength? I've been careful to follow all the steps, but I left the Caninsulin (UK name for Vetinsulin) out of the fridge for a couple of hours the day before yesterday, although as the kitchen was pretty cold. As a precaution I've managed to get a new bottle of Insulin from the vets, though can't get her over there to have her BG tested until Monday.

Since Kismet's last vet visit (which traumatised her and us) I've been monitoring her by appetite/urine/thirst as I'm still trying to home-test her BG without success, though I intend to try again later. I'm hoping to get a Keto/Glucose urine test done oday too.

If anyone can offer any insight/advice it would be very much appreciated. I'm really stressed out at present due to other family health problems and now really worried at this sudden change in her when she seemed to be doing so well. :(

Trish
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Trish, this sounds to me like she's hypo. Do you have a glucometer for home testing? It would be great if you could get a BG number. How long has she been acting like this?
 
Hi @Squalliesmom, thanks for getting back to me so quick. Kismet's only been like this since this morning, pre-and-post injection, she was on good form yesterday. :( I bought a glucometer but haven't managed to get enough blood from her ear yet, despite several attempts previously. I'll have another try or when my partner gets back, maybe I can get him to hold her while I try a paw pad. If I manage to get some numbers I'll post them here.

She hasn't used the litter tray for a few hours, though I've got it ready to take a Ketone/glucose sample. She's sleeping again now. Is there anything I should/shouldn't do? Should I give her some high-carb food? Also, should I go back to a lower dose of insulin tonight? Any advice much appreciated xxx
 
If you can't test her at home I would seriously suggest a visit to the vet for testing and possible treatment for a hypo incident. There are some things you can do to help with a hypo, has your vet given you any info on this? If you have honey or Karo syrup you can rub a small amt on her gums to help bring her BG up, but this is a temporary measure, and she should still see the vet. You can also give a small amount of a gravy-style food, best really if you can manage to give a spoonful or so of the gravy by itself; you don't want to fill her up in case you need to get more food in her, later. I am very hesitant to recommend these things without knowing what Kismet's BG actually is. However if she is hypo, you need to get her BG up as soon as possible.

Can anyone else please weigh in here, maybe @Cat Ma, @Robin&BB, @BJM, someone with more experience?
 
Hi @Squalliesmom, oops we cross-posted. The vet isn't available today, we live right out in the sticks and I have no transport to take her into the bigger-practice. I'll give her a little high carb gravy food as you suggest and I'll try hard to get some BG measurements asap. Thanx for your help xxx
 
Hi Lucy @Squalliesmom, Yes, pre=injection: ravenous, loads of urine/drinking; post-injection: ravenous/sleepy, not drinking so much or urinating. I'm so confused!
 
It sounds like you are on the right track with the ear testing, it just takes patience and practice. Are you warming her ear before you prick it? SO much easier to get a little blood if the ear is warm! Some people put a little rice in a sock and warm it in the microwave (just make sure it doesn't get too hot, test it on the inside of your wrist, first, then hold it against the ear for a few seconds, or you can use a warm , wet wash cloth in the same fashion. It's really important that you try to get a BG reading as soon as possible.
I can sympathize with being out in the middle of nowhere, I am in the same situation.
 
I'm sorry, Trish, that you're having such a rough go of it right now! I have no personal experience with Vetsulin, and without a bunch of data in a spreadsheet, I'm rather hesitant to weigh in on exactly what to do right at this moment - except to agree with Lucy on her tips above re: getting enough blood out of your kitty for the BG checks. I know that can feel like such an insurmountable task when you first start attempting it! Just do your best. (As the sooner you can start a handle on regular testing for Kismet, with some numbers flowing into a SS, the easier it will be for you to "read" how your kitty's body is reacting to the insulin - this will help you tremendously in deciding what you need to do about dosage adjustments.)

Do let us know when you're able to get another BG# out of Kismet; I know you're trying!:bighug:
 
If you need to raise her BG the honey/syrup will raise it quickly but only last about 20 minutes, or less. The gravy food will take longer to raise BG but is longer-lasting. When Squallie went hypo I used both, honey first, actually gave it about three times while I waited for my son to go buy some gravy food, and then the gravy/gravy food.


I really wish you could get a BG reading on Kismet, I don't want to give you the wrong advice in case this is something other than a hypo episode!
 
Trish, it could be too much or too little insulin. The only way to know for sure is to get a blood glucose test. What size lancet are you using? The was the problem for us. Humans use 30-31 gauge lancets and they may be too small for cats at first. 25-27 gauge can work better. If you only have the smaller gauge, try double poking - a quick second poke in the same place. If he takes off, get the blood on your fingertip and test from there.

Your ketone test will help. I will tell you if she has ketones (usually due to too little insulin, not eating and an infection) I would get it asap. If it is even a trace, with her strange behavior, I would get her to the vet.
 
So, try warming the ear as Lucy said, double poking, blood on the fingernail - a blood glucose level would settle this in a second. If that is impossible, I think I'd go to the vet. If it is a hypo, they are deadly and fast. But treating for a hypo if he has DKA (the ketone test) wouldn't be a good idea either. Do you have the ketone strips. Can you catch him peeing?
 
Thanks @Squalliesmom and @Robin&BB - yep the Home BG test seems the only real solution so long as I can conquer it this time. She's just woken up and I gave her a little high carb food just to play it safe as she seems ok, just still ravenously hungry but avoiding the special kitty litter I prepared to test her urine! I've warmed her ear, and tried different lancet settings previously, but it's been really difficult to get her to give up enough blood. I'll try again shortly. Still wondering if leaving the Caninsulin out of the fridge made that bottle ineffective, but guess the BG test is the only pointer to whether it's down to that or her being Hypo from the raised dose. Many thanks for your support - its appreciated :) xxx
 
I don't think that a couple of hours outside the fridge would make the Caninsulin ineffective; I did the same thing with ProZinc one day, months ago, and it's still working just fine.:bighug:
 
While you work on the blood testing, can you get some KetoDiaStix to test your cat;s urine for ketones and glucose? Although less precise, it gives us some clues what is going on. See Secondary Monitoring Tools to see some other assessments which may be helpful such as dehydration checks, measuring water intake, and the number and size of urine deposits in the litter box. These plus vet labs have been used in the past to guide insulin adjustments.
 
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HI @Sue and Oliver (GA) @Squalliesmom & @Robin&BB Just got fresh urine test done with Bayer Keto-Diastix: Ketones tested completely negative, glucose is 10+++ 1% mmol/L 56 mg/dL 1000 - I presume that means pretty high in glucose as it's the 2nd hghest?? I don't fully understand the readings, my brain is refusing to work now! Hate to sound stupid, but does this mean she's defo not hypo?

I feel a bit overwhelmed trying to understand why she has suddenly taken such a turn.

Will try to get blood shortly. Yeah, I need to try and get some 25 gauge lancets, nowhere sells them locally, so will look online. Will try a double prick of the auto-lancet I've got on highest setting as I'm getting a bit urgent about it now. :( Thanks you lovely people xxx
 
Good. Glad no ketones. Congrats on getting it. The urine test is not as good as the glucose level For knowing how the insulin is working, as her urine has made its way through her body. Blood is immediate. But it is vital for knowing if there are ketones present.

So our guess is that she is higher rather than lower.. I wouldn't do anything with that until you see how high and when. The thing to remember, and it's what the blood glucose testing tells you, is that they can bounce and drop. So a high number in the morning before the shot can be because they need more insulin but it can also be because they dropped low overnight and then bounced up. (Bouncing is when their body perceives a lower level than it is used to and releases extra glucose, resulting Ina higher than normal level). Adding more insulin to a cat who is bouncing can result in higher highs and lower lows. So it is vital to know the difference. Testing before each shot and mid way through the cycle will give you that picture.

Keep refining your testing technique, ask for tips and get some numbers. Then we can help you figure out this puzzle.
 
Urine glucose means that since the previous void, the glucose in the blood has exceeded the renal threshold for your cat (there can be individual differences among cats).
That does NOT exclude having low glucose in the blood now - it doesn't give you current info. It suggests that is much less likely, though.
 
Trish, you are in much more capable hands than mine, now, thankfully! Really glad you got the ketone test, fingers crossed for the BG test! I will check back in in a bit to see how Kismet is doing. :)
 
Thanks @Sue and Oliver (GA), @Robin&BB @Squalliesmom and @BJM xxx My brain is aching, trying to understand all this, including bounces, but I'll persevere trying for Home BG and getting some numbers posted when I do, may be some hours though as I may need to go and have a little weep. I'll also find my reading glasses so I can stop making so many typos. I'm intelligent most of the time - honestly ;) Thanks for all the help xxx
 
Trish J said:
...I may need to go and have a little weep. I'll also find my reading glasses so I can stop making so many typos. I'm intelligent most of the time - honestly ;) Thanks for all the help xxx
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Oh, Trish, I know how confusing and scary it can be. Don't weep too much, you are doing the right things for Kismet; where would she be without you? Right now, just concentrate on getting a BG test so you have some numbers to work with, without that you really can't know what's going on. It will get easier, you can do this! Now, take a deep breath and hug your baby! :):):)

Please keep us posted!!!
 
Hi @Squalliesmom, Thanks so much for your thoughts. Just to keep you posted: both me and my partner just tried to take BG, ears and foot pad. Couldn't get quite enough blood out of either, and I promise you we tried every hint and tip everyone's given, ear-warming, vaseline, double-poke, rubbing, nearly the lot! We got close, but still not enough... and the glucometer only needs a tiny amount, so you can imagine how we are here... stress city!

I'm going to have to find some different lower gauge lancets as that's the only thing I haven't been able to try as yet. Thank you so much for your good wishes. I will keep trying daily, but we've definitely all had enough tonight. Hoping she'll be better on the new bottle of Caninsulin dose tonight. Keep your fingers-crossed for us on that and I'll post back on how she's doing tomorrow. Thanks again for all the support, and I promise to try and keep the weeping to a minimum ;) xxx
 
Trish J said:
Hi @Squalliesmom, Thanks so much for your thoughts. Just to keep you posted: both me and my partner just tried to take BG, ears and foot pad. Couldn't get quite enough blood out of either, and I promise you we tried every hint and tip everyone's given, ear-warming, vaseline, double-poke, rubbing, nearly the lot! We got close, but still not enough... and the glucometer only needs a tiny amount, so you can imagine how we are here... stress city!

I'm going to have to find some different lower gauge lancets as that's the only thing I haven't been able to try as yet. Thank you so much for your good wishes. I will keep trying daily, but we've definitely all had enough tonight. Hoping she'll be better on the new bottle of Caninsulin dose tonight. Keep your fingers-crossed for us on that and I'll post back on how she's doing tomorrow. Thanks again for all the support, and I promise to try and keep the weeping to a minimum ;) xxx
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Trish, how is Kismet doing now? Has she improved any?
 
If you're still having trouble drawing blood, you can poke 3 or 4 times in the same place with a higher # lancet. I never had luck getting blood out with a 30 lancet without poking several times. Don't worry; the poking doesn't hurt the cat. Also, be sure to aim for the "sweet spot", the area between the vein and outer ear. See sweet spot photo below. The poking will get easier.

If you got a glucose reading at the vet today, keep in mind that it is likely higher than what you'll get with home testing. Vet values can raise 100 points or more, especially with a stressed cat. Caninsulin is a shorter acting insulin so it is quite likely Kismet is not getting more than 8 or so hours of benefit on it. We will better know how it is working when you are home testing.
 

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I found that if I go at the blood drop from above or at a 45 deg angle I had much better luck. At first I was trying from the side and the blood would go under the strip and not enough into the strip.
 
Hey! So I was super busy at work all day and just now noticed this thread...sorry. :( Let me ask this do you "milk" the ear? I would poke 2 or 3 times next to each other and then milk just a bit and get some blood that way at first. That helps the blood well up some so you can get some out.
 
Hi @Squalliesmom Lucy, Kismet seems a lot better today thanks for your concern. xxx Her urine is much more compressed and she's acting more normally too, hungry, but not as ravenous. So relieved! I think something really must have gone wrong with the Caninsulin bottle, as there's visible improvement since her dose out of the new one last night and this morning. I'm still not sure I fully understand what a `Bounce' is, but it also sounded like that could have been a possibility.

Thanks @Cat Ma and @Rachel for the advice, re testing. I may try and have another go later and try extra pokes with the lancet pen I have until I can get hold of lower gauge. Pretty sure I'm doing it in the sweet spot, but can't get more than a tiny spot out even after milking it for a couple of minutes. We had more of a result from the back paw pad but not quite enough. She went mental though, struggling and whinging and it freaked my partner out so much, that he refused to try again - I have no chance of getting access to her paws by myself.

In my defence our vet had an awful time getting blood out of her too - she said she has really thick skin and the experience there is so traumatic that the BG levels are likely to be highly inaccurate anyway. We're going back for a frustosamines test on Monday. I will also try and get another urine sample today to see if there's less glucose than yesterday.

Thanks to all for all your continued support for us xxx
 
Have you tried looking at your cat's ear with a flashlight? I know that's what finally worked for me. I was able to really see the vein in her ear and from there, I could determine where the sweet spot was for her. I don't know why that made such a difference from looking at the diagram, but it really did!

Don't feel bad...it's tough at first! I know the first few times I gave up figuring I would NEVER be able to do this at home. It took time, but she did eventually come running for her tests. Do you give bribes...uh...I mean treats after? I'd suggest taking her to wherever you plan to test her several times a day...pet her, play with her ears a bit, and give a treat. Even when you don't test, if you do that a couple times a day, it might get her used to the idea that in this place, you touch her ears, and she gets treats. Just a thought. It'll get easier!
 
Trish J said:
Hi @Squalliesmom Lucy, Kismet seems a lot better today thanks for your concern. xxx Her urine is much more compressed and she's acting more normally too, hungry, but not as ravenous. So relieved! I think something really must have gone wrong with the Caninsulin bottle, as there's visible improvement since her dose out of the new one last night and this morning. I'm still not sure I fully understand what a `Bounce' is, but it also sounded like that could have been a possibility.

Thanks @Cat Ma and @Rachel for the advice, re testing. I may try and have another go later and try extra pokes with the lancet pen I have until I can get hold of lower gauge. Pretty sure I'm doing it in the sweet spot, but can't get more than a tiny spot out even after milking it for a couple of minutes. We had more of a result from the back paw pad but not quite enough. She went mental though, struggling and whinging and it freaked my partner out so much, that he refused to try again - I have no chance of getting access to her paws by myself.

In my defence our vet had an awful time getting blood out of her too - she said she has really thick skin and the experience there is so traumatic that the BG levels are likely to be highly inaccurate anyway. We're going back for a frustosamines test on Monday. I will also try and get another urine sample today to see if there's less glucose than yesterday.

Thanks to all for all your continued support for us xxx
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Hi Trish, glad to hear Kismet is doing better today! Don't give up on the home testing, it can be very frustrating, but you'll get there. What meter are you using to test with? If you can use a tiny amount of Neosporin, or even Vaseline, on her ear first, it helps the blood drop to bead rather than just trickle through the hair, plus it will help soothe her ear a little.
 
Squalliesmom said:
Hi Trish, glad to hear Kismet is doing better today! Don't give up on the home testing, it can be very frustrating, but you'll get there. What meter are you using to test with? If you can use a tiny amount of Neosporin, or even Vaseline, on her ear first, it helps the blood drop to bead rather than just trickle through the hair, plus it will help soothe her ear a little.
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Hi Lucy, Thanks for the advice. I am using the Fastclix lancet pen that came with the Accuchek Aviva glucometer. It has a sort of barrel of lancets. I used Vaseline - can't get Neosporin in the UK unfortunately. I'm currently calling round all the local pharmacies in a wider region to see if they stock 25G freehand lancets. Would 28G work as well? They seem to be more easily available. Online lancets here seem pretty expensive and only in large amounts! Money is tight, especially as we're having to feed her cereal-free wet foods as well as vet bills and supplies. Since her Pancreatitis attack she refuses to eat the only supermarket cereal free brand, lil stubborn gal. :(
 
Rachel said:
Have you tried looking at your cat's ear with a flashlight? I know that's what finally worked for me. I was able to really see the vein in her ear and from there, I could determine where the sweet spot was for her. I don't know why that made such a difference from looking at the diagram, but it really did!

Don't feel bad...it's tough at first! I know the first few times I gave up figuring I would NEVER be able to do this at home. It took time, but she did eventually come running for her tests. Do you give bribes...uh...I mean treats after? I'd suggest taking her to wherever you plan to test her several times a day...pet her, play with her ears a bit, and give a treat. Even when you don't test, if you do that a couple times a day, it might get her used to the idea that in this place, you touch her ears, and she gets treats. Just a thought. It'll get easier!
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Hi @Rachel, yep I tried a flashlight. I can see the main vein fine and am aiming just to the side of it between vein and outside rim in the top area. I think the vet is right, she just has stubborn thick skin! I just need to find the right key to getting it right, and perhaps the lancet is not thick enough to make a big enough hole, even with a double poke and milking.

It does help knowing that other people had probs with this at first too. I do feel a bit of a failure, especially having made a few attempts now. But I won't give up easily. I really want to get her regulated before any more damage is done, especially at her age. Thanks for the advice xxx
 
Did I remember that you have already tried resetting the lancet setting to make a bigger hole? If not, that might help too. You might try a 28 and double poke. It's the wire - the lower the number, the fatter the lancet. If your lancet device has a cover, you might try taking it off. That made it easier for me to see exactly where I was poking.
 
HI @Sue and Oliver (GA), Yes you remembered right. I've tried the deepest depth setting on two pokes yesterday. I tried it on myself and it hurt like hell, tried it on Kismet and only made a tiny puncture which wouldn't milk much at all.

I just found a pharmacy who have 23g and 28g lancets in stock, but no 25g. Which one might be the better bet? 28g? Thanks in advance!
 
Thanks for your quick reply Sue. I can only really afford one box as they don't sell them in small numbers. Perhaps I'll go for the 28g as it seems to be mentioned a lot. The fact there's no mention of folk using 23G around here is spooking me a bit! Fingers-crossed this will be the turning point! xxx
 
Hi Trish, I started out using 28g on Squallie. One of his ears is harder to get blood from than the other, I usually end up poking that ear a little below the "sweet spot" to get blood from it. I think that ear has a patch of thicker skin in the sweet spot, it feels different when I try to poke it there. I have never used a lancing device, I have always just done it free-hand because it feels like I have better control that way. I have also found with Squall that it is easier to use the inside of his ear rather than the outside, less hair and easier to see, and he doesn't seem to mind. :)
 
Hello, Trish - Just writing to add some words of encouragement ... I, too, use 28g lancets, free-hand. (They work really well!) I tried using the lancing device that came with my meter; found it too cumbersome for me. (And noisy! My kitty didn't like that at all.) Like Lucy said above, it feels like I have better control doing it free-hand. So you might want to give that a try, as well.
 
Hello. I also use Vetsulin. I also use a 22g needle not a lancet. Saw my vet using this and asked why/how. I was shown to poke and sort of wiggle or scrape around. It works very well for me.
 
Trish J said:
I may try and have another go later and try extra pokes with the lancet pen
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I don't use the lancet pen, just the lancet to poke. A lot of us do it this way, the free-hand way and find it easier. What helps me is to hold the ear with a cosmetic pad (kleenex or paper towel is fine, too), poke, and the gently blot up any blood afterwards with the pad. Warming up the ear beforehand and "milking it to bleed" is also important.
 
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Cat Ma said:
I don't use the lancet pen, just the lancet to poke. A lot of us do it this way, the free-hand way and find it easier. What helps me is to hold the ear with a cosmetic pad (kleenex or paper towel is fine, too), poke, and the gently blot up any blood afterwards with the pad. Warming up the ear beforehand and "milking it to bleed" is also important.
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I use a cotton ball behind the area I'm going to stick, protects fingers and is handy for easy clean-up afterwards. I usually use it to apply gentle pressure for a few seconds, too, to help stop bleeding, if necessary, and minimize bruising.
 
HI @Squalliesmom Lucy, @Cat Ma @Robin&BB and @woodsywife. Hey, thanks for all the encouragement and info . It really is appreciated, and I am taking it all on board even though I'm loathe to report I still haven't managed to bleed Kismet enough for the test strip! I managed to buy a box of 28g Unilet Lancets. Got everything prepared, ear warmed and vaselined, treats etc. She wriggled as I was about to poke and I panicked and poked twice. Only poked her right thru the ear and tissue and stabbed myself! Result: she yowled, but still no blood from her while I bled like crazy trying to milk her ear - STILL no joy! I've decided to laugh rather than cry over it now, I WILL get there!

Kiz also decided today she didn't want to use the replacement urine test litter tray she's been fine with up to now. She just held on, even though I could see she desperately wanted to go. Afer 4 hours of this I got frightened in case she got a UTI and caved in. Of course she went straight in and did her business before I could even grab a test strip to shove under her.

I'm not giving up, but I am going to give my Home BG attempts a break for a couple of days in an effort to calm both of us. I haven't been sleeping and I think she's picking up on my stress levels, even though I've tried to be very calm around her.

Despite all this Kismet seems to be okay. Her urine is more compact during the day/evening, it's just the mornings it seems to be puddling. She's definitely had more energy today and been hungry but not ravenous. We have an appointment at the vet for blood tests on Monday. Maybe she can give me some extra pointers.

Lucy, thank you so much for all your support in particular! People on this forum have been so lovely and generous with their time, it really is a lifesaver. It does give me the impetus to get beyond the despair and stay determined to keep trying :) Bless you All xxx
 
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