Diabetes - Initial Treatment - Need Advice

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Davey's Mom

Davey's Mom

Member Since 2016
Hope I am posting this in the right spot! Our cat was diagnosed with diabetes a month ago and currently we are taking him to the vet once a week, they are testing his blood and then sending him home telling us to up his cansulim dosage by 0.1 every time. Last Thursday he went in and his blood was still well over 20.

We ended up buying a pet sugar tester to use at home and we would like to test ourselves and up his medication more frequently than once a week but when I mentioned it to the vet she said not to. The reasons she gave was that the medicine takes a week to react and I shouldn't trust the tester we bought for home. I'm concerned though because it's been a month and he is still a mess. He's drinking like crazy and his litter box is full all the time. It seems like if we continue to go once a week this process is going to take a long time and he is suffering. We just tested him this evening and his bloods at 23.

Does anyone have an opinion as to whether we really need to wait a week in between increasing insulin dosages?
 
Welcome. This is a good place to post your initial questions.

I was a Lantus user and know nothing about Caninsulin. Due to the holiday, the forum is not as populated as per usual, but someone knowledgeable with be along as soon as they can. In the meantime, you can start by reading this: http://www.felinediabetes.com/FDMB/threads/vetsulin-caninsulin-user-guide.302/

It's great that you've decided to home test. A guide to home testing is here: http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/
Data is what is needed to see how cycles play out. The more data you can get, the better.

If you could start a spreadsheet, that would help tremendously. http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
 
emjb14 said:
sending him home telling us to up his cansulim dosage by 0.1 every time.
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Could you please clarify this? I don't understand what you mean by 0.1. Is it 0.1 units? 0.1 mL? What is the total dose you're giving and how often are you giving it?

emjb14 said:
We ended up buying a pet sugar tester to use at home and we would like to test ourselves and up his medication more frequently than once a week but when I mentioned it to the vet she said not to.
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Did the vet say not to test his blood glucose at home or do you mean she said not to increase the dose more frequently? We recommend testing at home before every shot to make sure that the dose isn't too high. The cat should not have any food for at least 2 hours prior to testing so that the BG number isn't influenced by food. So the sequence is: test, feed, wait 20 to 30 minutes (Because Caninsulin is fast acting and there needs to be food on board), inject insulin. The dosing is done twice a day 12 hours apart.

emjb14 said:
The reasons she gave was that the medicine takes a week to react
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At the beginning doses might be held longer as a cat adjusts to getting insulin. As you get more BG data and know more how your kitty is responding this can change to more frequent dose adjustments.

emjb14 said:
shouldn't trust the tester we bought for home
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Most people on here use a human meter because the test strips are much cheaper. These tend to read lower than the special pet meters but members here are able to advise based on human meter numbers.

emjb14 said:
currently we are taking him to the vet once a week, they are testing his blood
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This is not necessary. You can test BG at home and get a better measure of how your cat is doing. They are often stressed at the vet's and this can raise BG a lot. If the vet prescribes a dose based on the clinic BG numbers it can end up being too high. It's also expensive to keep repeating these clinic visits.

emjb14 said:
his blood was still well over 20.
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If the BG numbers stay high it can mean the dose is too low but it can also mean the dose is too high. You need to learn to test at home and log all your data at one dose to see what's going on.

We can certainly help you to help your kitty.
 
Welcome to FDMB. There are a number of Caninsulin users here and we can help you as you work toward getting kitty's BG more regulated.

Kris & Teasel said:
These tend to read lower than the special pet meters but members here are able to advise based on human meter numbers.
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Emphasis mine.
Just to clarify, I think Kris meant to say we are able to advise based on Pet meter readings. We are familiar with both human and pet meter scales. :)
 
MrWorfMen's Mom said:
Welcome to FDMB. There are a number of Caninsulin users here and we can help you as you work toward getting kitty's BG more regulated.


Emphasis mine.
Just to clarify, I think Kris meant to say we are able to advise based on Pet meter readings. We are familiar with both human and pet meter scales. :)
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I didn't communicate this very clearly. My intention was to say that if a person was using a human meter, the numbers would be understood by people here on FDMB when advice is being sought. Similarly, numbers obtained using a pet meter are also understood here. :confused:
 
Hi All! Thank you very much for the quick responses and advice. Especially since it's the holidays! Sorry for the confusion on the dosage I'm using U-40 caninsulin syringes and have been increasing by one unit per week. He is currently having 8 units twice a day. The vet asked me to bring him in once a week in the morning and so far we've done this four times. Each time they have tested his blood twice, told me his sugars way too high still and to up the dose one unit and come back next week.

We are using a pet meter that I found and ordered from Amazon. It's called Fastacare pet I believe and I thought the price was decent but I don't know much about it. I got the meter and 70 strips for around $40 CAD

Sounds like I definitely have some research to do and should be charting numbers at home thank you. I will review the spreadsheet after Christmas and get it started. Thanks for the help so far!

Just to clarify the vet is saying she wouldn't trust a cheaper meter purchased at home. She is also saying not to up insulin dosages more than once a week because the dosage increase needs a week to see if it's working. This seems too long to wait although I'm no expert by any means but he still seems so sick. She said it could take four months to get him regulated and I was hoping there was an quicker way to get him feeling better. Also, it is expensive so we are hoping to do more at home.

We were told that he needs to eat immediately before a dose so we do take his food away for a while before so he's hungry
 
Hello and welcome. 8 units in a months time WOW. You are definitely correct to home test. There are a few conditions that require that much but it is uncommon.

We normally raise dose by 0.25 units. Normally dose is raised once a week. People familiar with caninsulin will help you with that.

Please start home testing. There are some informational in the Vetsulin (US name for insulin) forum. Please read them. Your kitty could need more or less, won't know until you get some tests done.

Kitties can be stressed at vets causing a significant increase in glucose. You cat could be in a bounce so your vet would get a high reading so of course they say to raise dose.

Testing is done before each insulin dose so you know it's safe to give. With caninsulin you feed 30 minutes prior to giving insulin. It is a fast acting insulin so you want food on board so there is something for the insulin to work with.

What kind of food are you using? Low carb wet food is best. That is usually the pate, or classic food. If you are using dry or food with sauce/gravy do NOT change unless you are home testing regularly. It could drop glucose dangerously low especially on that dose.

Most cats do better feeding mini meals like every 4 hours. Pick up any food and don't feed 2 hours prior to giving insulin so you don't have a food influenced test reading.
 
I did comparison testing of the Fastacare meter against an Alphatrak2 meter, the most commonly used pet meter. The Fastacare consistently read slightly lower in moderate to high ranges and slightly high in lower ranges. The differences were however all within the allowed meter variance.

8u twice daily is a very large dose. The average cat needs no more than 2u twice daily. As mentioned above, there are conditions that can cause a cat to need large doses of insulin but they are the exception not the rule. Normally cats are started on a small dose and very gradually increased until an optimal dose is found. Unless increases are done very methodically and slowly, it is quite possible to totally miss the optimal dose.

I would strongly suggest you decrease the dose of insulin immediately. As Kris mentioned earlier, too low a dose and too high a dose can both result in high BG readings. In your case, because the dose has been raised to 8u so quickly, the most likely explanation for the lack of any improvement is that the dose is too high. While I don't completely agree with your vet about holding a dose for a week as that might not be necessary if dose increases are being done carefully and in very small increments, in the early days it is sometimes necessary to hold the dose for a week to collect data and see how the cat is adjusting/reacting to insulin.

Your cat may currently be in a bounce which is a term for a phenomenon caused by the body's defense system. If the insulin is taking the BG low the body's defenses go into action to bring the BG back to a level the cat is familiar with and a diabetic has become use to higher BG levels so the body pumps them up with lots of glucagon making it look like the insulin dose is not enough when in reality it is too much.

If the dose is too high, and the defense system repeatedly gets turned on, the cat will eventually run out of reserves of glucagon and a hypoglycemic event will occur. For that reason if I were you, I'd back up the dose to no more than 1.0u and start over because it's highly likely you have missed the proper dose for your cat. We can help you sort this out if you would start one of our spreadsheets so we can see what is going on. The link to the spreadsheet is in Post #2 from Red & Rover.

I really am concerned for you and your kitty and strongly suggest you let us help you sort this out.:)
 
I strongly encourage you to follow the advice Linda has just given you. The dose of insulin you're giving seems extremely high. Restarting today at 1 unit is the best way to proceed. There are people here to help and if you can't get the spreadsheet up and running right away, just post your data in this thread. There are a few of us around to help.
 
I agree-- it's very likely that the 8U your kitty is on is far to much for him. Starting over at 1U twice a day and monitoring progress at home is the safest and (believe it or not) fastest way to get him feeling better. We can help with testing and making dosing decisions as you go forward, but the most important thing right now is to just back down on that dose so you can keep him safe!!!!
 
IMPORTANT NOTE to members helping here:

Kris & Teasel said:
Restarting today at 1 unit is the best way to proceed.
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May be too big a dose decrease - see below.

Ketone status needs to be established for this kitty. Please help caregiver with this as it's critical to cat's safety if dose is to be lowered. (Find an open pharmacy if no strips at home. Give tips on collecting urine straight away so sample can be gathered ready for when the test strips become available.)

Please get STARTING DOSE info and ask caregiver to post a link to the amazon listing for the meter she has purchased (need to have a better idea of the reference range it uses - ask the CG to check the meter documentation to see whether this info is provided, ESPECIALLY a reference point for hypoglycaemia). Thank you, Linda, for your info.

8IU Caninsulin BID is a crazy dose to be giving a cat 4 weeks into treatment and I think it is very likely far too high. Please help CG to do some tests ASAP to see what's happening to cat's BG levels. This data is needed before any dosing suggestions can be offered - I'm worried about dropping the dose back too far. (Ketone status needs to be established to avoid risk of ketosis/DKA.)


(Sorry this is so clipped.)


Mogs
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Critter Mom said:
IMPORTANT NOTE to members helping here:


May be too big a dose decrease - see below.

Ketone status needs to be established for this kitty. Please help caregiver with this as it's critical to cat's safety if dose is to be lowered. (Find an open pharmacy if no strips at home. Give tips on collecting urine straight away so sample can be gathered ready for when the test strips become available.)

Please get STARTING DOSE info and ask caregiver to post a link to the amazon listing for the meter she has purchased (need to have a better idea of the reference range it uses - ask the CG to check the meter documentation to see whether this info is provided, ESPECIALLY a reference point for hypoglycaemia). Thank you, Linda, for your info.

8IU Caninsulin BID is a crazy dose to be giving a cat 4 weeks into treatment. Please help CG to do some tests ASAP to see what's happening to cat's BG levels. This data is needed before any dosing suggestions can be offered - I'm worried about dropping the dose back too far. (Ketone status needs to be established to avoid risk of ketosis/DKA.)


(Sorry this is so clipped. Will post again as soon as I've sorted out things with Mittens.)


Mogs
.
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Very good advice, Mogs. Waiting to see if CG posts.
 
Ask the CG to get BG readings for period +2 to at least +7. Need to establish how low BG is going as a matter of urgency. (High and flat is another red flag.)

If it were my cat I would not give 8IU again.

.
 
Critter Mom said:
Give tips on collecting urine straight away so sample can be gathered ready for when the test strips become available.)
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Ketone test strips - eg. Bayer Ketodiastix - can be purchased at any human pharmacy and aren't expensive.

Ways to get a urine sample onto a ketone test strip:
1. If kitty holds his bum high while peeing, put the strip under him in the urine stream.
2. If he squats lower to the litter, slip a shallow, long-handled kitchen spoon under his bum to catch a few drops - dosen't take much.
3. Put a double layer of plastic food wrap in the area of the litter box that he prefers to pee in and push it down to make depressions that will catch some urine.
4. Put a layer of dried peas or similar in a clean plastic litter (or other) pan and try having him pee in that. If this works you can rinse off and reuse the peas for the same purpose.

Re ketone test strips: dip, shake off excess urine, wait 15 seconds (or whatever it says on the package) and view the colour change under a bright light.
 
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Here's what you need to do @emjb14
  1. Ketone status of urine needs to be established for this kitty. I've posted instructions for how to do this above.
  2. Give us your STARTING DOSE info (at diagnosis).
  3. Post a link to the amazon listing for the meter you have purchased so we can figure out how it reads relative to meters we know. Check the meter documentation in its instruction booklet to see whether this info is provided.
  4. Do some tests ASAP to see what's happening to your cat's BG levels. Testing every hour or two between now and later this afternoon would be good data. Said another way, test as soon as you read this and then every hour or two until you're about 7 hours post AM insulin dose. Are you in EST zone?
Once you have done all this we'll advise you on how far to drop the dose. Dropping to 1 unit might be too much. This is how FDMB works: one of us responds to a post, offers suggestions on what to do and others will weigh in to agree or disagree. All the input is combined so we can give you the best assistance.
 
Critter Mom said:
IMPORTANT NOTE to members helping here:


May be too big a dose decrease - see below.

Ketone status needs to be established for this kitty. Please help caregiver with this as it's critical to cat's safety if dose is to be lowered. (Find an open pharmacy if no strips at home. Give tips on collecting urine straight away so sample can be gathered ready for when the test strips become available.)

Please get STARTING DOSE info and ask caregiver to post a link to the amazon listing for the meter she has purchased (need to have a better idea of the reference range it uses - ask the CG to check the meter documentation to see whether this info is provided, ESPECIALLY a reference point for hypoglycaemia). Thank you, Linda, for your info.

8IU Caninsulin BID is a crazy dose to be giving a cat 4 weeks into treatment and I think it is very likely far too high. Please help CG to do some tests ASAP to see what's happening to cat's BG levels. This data is needed before any dosing suggestions can be offered - I'm worried about dropping the dose back too far. (Ketone status needs to be established to avoid risk of ketosis/DKA.)


(Sorry this is so clipped. Will post again as soon as I've sorted out things with Mittens.)


Mogs
.
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I've rewritten this into a list of step by step instructions for the CG.
 
Yes it is. I really don't like when someone posts then never comes back, why bother posting to begin with.

Maybe it's the holiday. They said earlier they would look at the ss after Christmas.
 
Thanks everyone for checking on this poster and chiming in. You're the bestest peeps! :bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug:

I too hate when a thread like this goes silent. I have the Jaws theme song in my head right now and really hope they see this very soon! :eek:
 
I'm praying that the OP has just been too busy with Christmas celibrations that the haven't checked their computer. I haven't checked my puter until 11 PM. Of course I'm not in OP position. Hopefully they will chech in soon.
 
I sent a PM at about 04:00 am today and there has been no response. Like everyone else I fear for the poor cat but unfortunately there is nothing we can do but wait and hope. :(:(:(:(:(:(:(
 
Hi All! It seems I have upset many of you by not answering right away I apologize. I didn't see the need to panic after my last post and planned to look at the links provided and do what I needed to do once things calmed down after the holidays. I have been seeing the vet weekly and didn't see this as a huge problem and was just looking for a little more guidance. I don't want to spill all my personal issues on here but my Grandfather is in the hospital in critical condition and I have small children among other things so this last few weeks has been hard and busy on the family.

I have my usual appointment at the vet tomorrow and I will bring up all your concerns for sure. The starting dose my vet told us to give the first week was 3 units so needless to say I'm very confused on why my vet would have me starting on these high doses that you all find to be outrageous. I feel like I should be able to trust my vet and expect that they know my pet but you all seem very educated in the matter and are obviously extremely concerned so I'm lost for words. I definitely have a decision to make and will do so after I talk to the vet tomorrow. I hope you can understand that I'm very lost on who's advice I should take....

I'm going to look through all your posts now more thoroughly. I just wanted to send a quick answer back before bed to give you some sort of update.

I believe someone asked for the link to the monitor I bought here it is: https://www.amazon.ca/FastaCare-Blo...UTF8&qid=1482979169&sr=8-2&keywords=fastacare

And he is easting fancy feast classic mixed in with a bit of dry food. He was eating dry food before we found out about his illness so I've been slowly getting him off of it because I read and was told that dry food is terrible for him.

Please note that he is not acting wobbly, spacey or anything of the sort. He's himself with the exception that he drinks much more than usual and fills the litter box with pee all the time. It's gotten better than it was but is still not back to normal. This is what flagged us to bring him to the vet in the first place.

He's an amazing cat that's absolutely wonderful to my kids and I really am trying to do what's right for him. Not sure if I mentioned this yet but he is almost 13 years old
 
Hello ! Even tho I have only been at this since July I still feel like a newbie in many ways. Just wanted to encourage and reassure you that you have come to the exact right place for u and your kitty. These loving, experienced kitty lovers have saved Elmo's life, held my hand and guided me in the wee hours of the morning and given me the guidance that has caused great improvement in our diabetes journey. I don't know much but I do know that tests taken at vet will produce a stress influenced higher number. That is why u are so wise to start home testing and get a number not influenced by vet office stress. The members of this board will love on and look after your kitty as if it were theirs and give you sound, tested advice which you can weigh in with your vets. My vet is thrilled I am on this board because sometimes it takes minute by minute instruction at odd hours when there is no vet. I am glad you are here and wanted you to know without a doubt that this is a safe, reliable place for you and your sweet kitty!
 
Also check out website catinfo.org, written by a vet with tons of great info that helped me formulate questions early on. It's a must read .
 
I'd like to mention as well that my cat is pretty big, he's 13 pounds and used to be 15 before he got sick. I was thinking maybe the vet started off at 3 units and is increasing by one unit each visit due to his size, is this possible in your opinion? I read on the caninsulin website something about starting off with 0.5 of a unit per kg (2.2 pounds) of bodyweight which pretty well works out to 3
 
emjb14 said:
Hi Beth 73! Thank you very much for your response I appreciate it and will review
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Oh you are very welcome :). I just remember being in your shoes at the beginning..so many questions, wanting to fully trust your vet but seeing possible differing info here. And add in your full plate with a grandfather in the hospital AND small children...you r one very busy lady. I know you are so busy with all going on in your life but I really think reading the catinfo.org website will clear up a lot and reassure you since it is written by a vet. Will be watching your threads with interest and care. You are in excellent hands here...a truly knowledgeable,caring group of extraordinary people :bighug:
 
Som
emjb14 said:
I'd like to mention as well that my cat is pretty big, he's 13 pounds and used to be 15 before he got sick. I was thinking maybe the vet started off at 3 units and is increasing by one unit each visit due to his size, is this possible in your opinion? I read on the caninsulin website something about starting off with 0.5 of a unit per kg (2.2 pounds) of bodyweight which pretty well works out to 3
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Someone far more knowledgeable than I can answer that question. I myself started out on vetsulin at a dose of 1 unit 2x a day for Elmo's 9 lbs....
 
I think most were under the impression that your kitty was getting 8 units twice a day.
3 units is way more normal than 8!
My vet started my boy with 7 units twice a day and it would have killed him if I didn't find this forum. I have since switched to a new vet.
Home testing is the best way to get an idea of how well the insulin is working. Vet and car ride stress is enough to raise it by significant amount.
Once you get completely off the dry food he might not need as much as he is getting now and your home testing will show that if that is the case.
 
It is best to test before every meal. Pick up all food 2 hours prior to test. There are caninsulin experts on that forum. I use prozinc and I'm not sure what best starting dose for your kitty would be. They can also walk you through when the best time to test him between meals would be and how long the insulin should work each cycle.
 
Beth 73 said:
Oh you are very welcome :). I just remember being in your shoes at the beginning..so many questions, wanting to fully trust your vet but seeing possible differing info here. And add in your full plate with a grandfather in the hospital AND small children...you r one very busy lady. I know you are so busy with all going on in your life but I really think reading the catinfo.org website will clear up a lot and reassure you since it is written by a vet. Will be watching your threads with interest and care. You are in excellent hands here...a truly knowledgeable,caring group of extraordinary people :bighug:
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Thanks so much this really is a lot to take in and this definitely does seem like an amazing group of people. The time everyone dedicates to this is incredible. I will read up tomorrow for sure. It's almost 12:30 here so I better get to bed.
 
StephG said:
I think most were under the impression that your kitty was getting 8 units twice a day.
3 units is way more normal than 8!
My vet started my boy with 7 units twice a day and it would have killed him if I didn't find this forum. I have since switched to a new vet.
Home testing is the best way to get an idea of how well the insulin is working. Vet and car ride stress is enough to raise it by significant amount.
Once you get completely off the dry food he might not need as much as he is getting now and your home testing will show that if that is the case.
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He is getting 8 units twice a day now that is correct but he started at 3. They up it one unit after each appointment because they tell me his sugar is still too high (over 20)
 
Hi emjb14. 8 units twice a day is a lot. Have you checked for Ketones? You really need to check for those. Also, what type of food is Elmo eating? I also struggled with whose advice to follow 1. my vet that took such good care of my dog, or 2. people I didn't know. It took me about 3 weeks to finally get a meter (I'm a little slower than you) and then another week to finally post what was happening with both my cats. I almost lost Woody because my vet was increasing his dose. We were at 12 units on the first day I checked his BG and posted them. My alphatrax showed he was bottomed out and was in serious trouble (the only symptom he was showing was an increase in wanting food). After some very strong guidance from some very caring people here I reduced Woody's dose. After I switched to all Friskie pates both my cats went into remission. Look at my SS for Woody and Buzz. If I wouldn't have taken advice from this board my Woody would not be alive today. I am glad I followed critter Mom, MrWorfMen's Mom, Squalliesmom, and many others' advice. The first thing is to understand that some vets really do not know how to treat feline diabetes and that it does take a great leap of faith to follow the advice from this board. But I've seen some great things happen over the past year on this board and I trust these members with both my kitties.
 
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I'm going to take my cat to the vet tomorrow and tell her about this site and that 8 units seems to high after a month according to everyone here to see what she says.

Afterwards, when he gets home I feel like it's best to follow the advice you have all given. From what I'm gathering I need to:

1) Start a spreadsheet immediately using the world template for pet meters. Share it on my signature.
2) Test 30 minutes before each shot, then after 2 hours, then after 5? This will be tricky to do on weekdays since I'll be at work but I can blood test all I need to Saturday and Sunday
3) Get ketone test strips at pharmacy immediately (can do tomorrow) and post results

Hope I got this right....
 
Oh!! Have you gotten any home testing done? My cat is on 6 units twice a day of prozinc but we moved up there from 1. They are different types of insulin so I'm not sure they can be compared.
I strongly urge you to get some pre-meal/preshot home tests done as soon as you can. I see you're very busy but it will give more insight on how the insulin is working for him.
He can be getting 8 units and dropping to very low numbers causing his liver to panic and cause a very high blood glucose by next dose. It's called a bounce on the forum.
If you can test before his shot and then maybe 4 hours after his shot that would give a better picture. It's best to get the pre shot test after 2 hours of no food so it's not influenced by food.
Ketones are very important to test for. With high blood glucose levels he can go into DKA and a ketone test will tell you if he's getting into trouble there.
 
Mum of two felines said:
Hi emjb14. 8 units twice a day is a lot. Have you checked for Ketones? You really need to check for those. Also, what type of food is Elmo eating?
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He's eating fancy feast wet food normally a can a day and then a bit of dry food still but not much. I'd say 1/4 cup at the very most. I used to have him strictly on dry food I didn't realize how bad it can be until now unfortunately :(
 
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