Diabetes - Initial Treatment - Need Advice

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I believe with caninsulin you want to test, feed, wait 20 minutes then give shot. Please correct if I'm wrong! It's best to do it this way with any insulin just in case your cat decides to puke after a meal. Fancy feast classics are low carb. You want to stay away from any types with "gravy" because they have much higher carb levels. But it's good to keep one on hand for your hypo kit.
 
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.

Got it thank you! He will be at the vet tomorrow but I will start this tomorrow evening. He usually has shots at 7am and 7pm and I get him at the vet at 5ish so I'll be able to take the food away to do this.
 
Mum of two-- I'm going to let you take over on this. I'm not familiar with caninsulin and looks like you have much more experience than I do.
 
I believe with caninsulin you want to test, feed, wait 20 minutes then give shot. Please correct if I'm wrong! It's best to do it this way with any insulin just in case your cat decides to puke after a meal. Fancy feast classics are low carb. You want to stay away from any types with "gravy" because they have much higher carb levels. But it's good to keep one on hand for your hypo kit.

Thanks! I did figure out how to use the meter but wasn't sure what the right times were to test. Now I have an idea.
 
I have to log off for now (almost 1am here) but as mentioned after the vet tomorrow I do plan to get ketone strips, start the spreadsheet and the blood testing. If anyone has further advice on when/how I should test please feel free to let me know and I will check this feed tomorrow evening after work and before I start anything. Thanks!
 
You could test every hour if you wanted to. Personally I test before meal then feed and give shot. Then I try to test every 2 hours or at least two hours after his shot and 6 hours because that is typically when Prozinc peaks. Someone familiar with caninsulin can tell you when the best times to test during the cycle are and when it typically peaks.
 
I have to log off for now (almost 1am here) but as mentioned after the vet tomorrow I do plan to get ketone strips, start the spreadsheet and the blood testing. If anyone has further advice on when/how I should test please feel free to let me know and I will check this feed tomorrow evening after work and before I start anything. Thanks!

Hi,

I will just tell you my personal story with Caninsulin:

My cat has been diagnosed in November last year. Of course, at the beginning, I wasn't aware that this board exists, and that it was possible to perform home testing.
So, like you, I started Caninsulin with a reasonable dose (2 IU BID), and had regular appointments to the vet to adjust the dose.
And like you, at one time, the dose was 8 IU at a time, and this time was when I discovered this board, and decided to buy a meter to home test.
And such a surprise : my cat didn't really have the same answer to insulin at home compared to what was happening at the vet. His pre shot numbers were terribly high because between two shots, he was terribly low (less than 40 on a pet meter!). The dose of 8 IU was really too high, and my cat was bouncing all the time!
I even encountered some hypo episode with symptoms!

After that was discovered, we decreased drastically the doses, and found that the problem was that my cat was metabolizing Caninsulin too quickly, and we changed the type of insulin. But that's another story....

All that being said, with Caninsulin, tests shall be performed before each shot, and in between: let's say 3 and 5 or 6 hours after a shot, as it's the peak action of this insulin, and that's when you can see terribly low numbers.
 
Dear EMJB,
I'm so sorry that you feel so torn between the advice you receive here and from your vet's. It is very difficult as we, naturally want to trust and rely on the professionals which we are not but the vets are supposed to be.
Unfortunately we have seen so many stories here when the vets killed or nearly killed cats (unintentionally of course due to lack of knowledge how to treat a diabetic cat, knowing more how to treat diabetic dogs and applying the same protocols to cats).
The amount of information we have gathered here to help people to understand how to treat FD is a best tool to help with this very difficult and sometimes puzzling disease. I have a very good vet but when I first started treating my cat it was the same story as with the others - vet tells you to inject your cat with this very powerful substance INSULIN and tells you to to it in a blind fashion, doesn't tell you to slowly change your cat's food to a low carb one and they want to perform 2 weekly curves. This is all wrong. Do you know why they do it like that? Because they have no knowledge how to treat FD for starters (but specialists know) and they think you are a human being not capable of testing your cat and drawing any conclusions from that, it brings them more money if you keep bringing your cat for curves and also in order to explain and teach you how to treat FD they would have to spend a lot of time with you which is not a good business move for them. They make mega money on the prescription food they sell so they always push for that food.
As I said earlier I attend a very good vet surgery but at the beginning they were like other vets. I put my foot down, learnt quickly about FD from this site and informed my vet that I'm going to do it my way and I need her support. Blank refused prescription diet despite her insistence that I need to feed Rocky special diabetic food. I have told my vet about this site and showed her printed spread sheet with Rocky's blood glucose (BG) numbers. It was 2 years ago and I can't believe how much my vets have changed!
So, I will still insist that the dose of insulin you give is far TOO HIGH! Increasing the dose by 1 unit every week is INSANE (sorry)! Unless the cat has some other serious condition which requires high dose of insulin. So far you have not been informed by your vet about such a possibility.
My opinion is very strong because I feel very passionate about FD and I don't believe that we should be blaze about it as wrong treatment can kill.
I hope that you will manage to wrap your head around the problem and find a reasonable ground. If you prove to your vet that you are capable, have knowledge and explain that you are determined to work hard at it and work WITH the vet to get the best care for your kitty, I'm sure they will take it on board.
Best of luck.
Marlena:bighug::bighug::bighug:
 
Good Morning !! I know you r probably at work and kitty is at vet but had a thot....when u go pick him up today, ask ur vet if there r any special reasons/conditions that r necessitating the high dose or is this because of hisBG alone. This info would greatly help the experienced people here understand and move forward with help. You r doing great and ur kitty is blessed to have you:bighug:
 
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....
Yes, this is the way to start but you need to test, feed, wait for 30 minutes, then inject. :)
 
Thanks for the update and so glad your kitty is alright. As mentioned earlier, we have seen far too many very close calls as a result of high dosing instructions from vets and on occasion some tragedies. Hypoglycemia can kill and an unmonitored cat getting too high a dose of insulin is not safe. Most vets do not treat that many diabetic cats. They treat far more dogs and vets treat our cats like dogs who do need higher doses. We have 24/7 hands on experience and lots of evidence that starting low and gradually and methodically raising the dose is far safer and effective. Insulin is a hormone that triggers other hormones in the body.....it's not a pain pill where if 1 aspirin doesn't help you can take 2.

As for your vets comments about the meter you purchased. I gave you some info on that meter based on my own testing of it and my feeling (and I'm pretty sure everyone here would agree) that any meter is better than no meter. What you do at home is entirely up to you but please do not have blind faith in your vet. They are after all just human and mistakes do get made. The vet wants to help your cat but they just don't have the experience and many are still relying on what they learned in a few short hours in vet school. What we offer, is years of experience with thousands of cats who have happily lived long quality lives. Experience is often the best teacher. :)
 
I know it's very early in your diagnosis, but that dose your giving is awful high for a newly diagnosed cat.

There are a few medical conditions that do require high doses and even higher than what you giving. There are uncommon but they are out there. Most vets do not order the tests (they are sent out to the only place that runs them (MSU). And they don't believe kitties can have them but they do. The tests are for insulin resistance and one for Acromegaly. It does take awhile to get results since the tests are only done a certain day of the week.

FWIW, You might consider getting them done. If they are positive then the dose your giving is required and probably needs more. And probably a different kind of insulin as large doses start to sting or burn. If tests are normal then this dose can be super dangerous and changes in food and routine need to change.

Before anymore increases I would get these tests done so you know what your dealing with and what direction to go in.
 
Hi All! Thank you all for your advice, the vet just called so I am sneaking in an update at work... I told her about everyone's suggestions and concerns mentioned on this site and she said she would be completely supportive of me handling this at home if his levels still weren't still off the walls. She tested him today after his insulin injection and got a reading of 33 and then another at 27 a couple hours later. She said it's still really high and since he's still excessively thirsty and showing the same symptoms at home she does not find it possible that we've missed the appropriate dose. She mentioned that she would like to get him at a reading of 10 before I start testing and treating at home. Her advice is to up to 9 units for a week and if there's still no improvement to discuss other medications/alternatives next week.

I got the ketone strips and am going to use those plus start the spreadsheet tonight and not up the dose. Afterwards, I'll give you an update and if you can please let me know what you think it would be much appreciated. From what I'm understanding doing regular testing at home and using the ketone strips should provide confirmation as to if I'm overdosing him correct?

Thank you for everyone's advice and support thus far!
 
if you can please let me know what you think it would be much appreciated.

If the BG is very high they will drink and urinate a lot. The BG can be high if they're untreated, if the dose is too low OR if the BG is elevated by that bouncing process we described to you. At the very least you could begin testing at home and regard it as practice for when the vet wants you to get home monitoring under way. There's no reason for not doing that and if you record all the test results you'll have something to compare your later records to. If you want to try this the best times to do it are:
  • AM and PM before feeding (no food for 2 hours beforehand)
  • somewhere about the middle of the time between AM and PM shots or late evening.
she does not find it possible that we've missed the appropriate dose.
It's very easy to miss the good dose if you start high and increase by 1 unit at a time. That's why generally we recommend starting at 1 u twice a day and only increase in 0.25 u fractions. My cat was around 13 pounds at diagnosis and he was started at 1 u twice a day.

she would like to get him at a reading of 10
Did she say a reading of 10 before insulin or when the insulin is at its peak effect? When Caninsulin (Vetsulin) is working as it should, the BG will start at its highest point just before injection time, decline gradually to its lowest value about 4 to 6 hours later and then gradually rise to another high point just before the second injection of the day. It's the low value that can be a worry - too low can cause an episode of hypoglycemia that can be fatal.

up to 9 units for a week
One of the other posters above mentioned a few conditions that can cause a kitty to need this much insulin. These are relatively rare conditions and special tests are needed to find out if they are present. If those are not factors in your kitty's health status then 9 units twice a day is a VERY high dose. That's what worries us. A kitty might tolerate it for a while because of internal processes that keep BG propped up - often artificially high - and then those processes can't do it anymore and the kitty crashes.

I sincerely apologize if what I've said confuses you more because it runs against what your vet has said. We all understand that feeling of loyalty to a vet with whom you might have a long and productive relationship. Our focus here is always on what a poster has told us about their kitty, any proposed treatment and how it measures up against the combined experience of many people over a long time treating their own FD kitty 24/7.

Let us know your thoughts. :cat:
 
From what I'm understanding doing regular testing at home and using the ketone strips should provide confirmation as to if I'm overdosing him correct?
Confirmation of overdosing requires a log of BG data at a range of doses over a lengthy period of time. Ketone testing will tell you whether your kitty is at risk of developing a complication of unregulated diabetes called diabetic ketoacidosis.
 
Caninsulin/Vetsulin at that dose will burn and or sting. It's also possible that insulin just doesn't work for you kitty and another might be considered.

Also don't agree that you can't begin monitoring until after you find correct dose. HOGWASH

I think a second opinion by another vet should be considered. And getting those 2 tests mentioned for high dose conditions.

I know when I used vetsulin and reached 5 units. My vet said they couldn't give anymore. So what do you do, he needs it? They said food change that's all. Found new vet.

Your situation is extremely concerning.
 
Definitely start testing as soon as you get home. Don't wait for a certain dose level.
My boy bounced today. He was 327 before his shot. I gave him 5.8 units and in 4 hours he was 130. 6 hours after his shot he was 128. Beautiful numbers! Then in a two hour time period (so 8 hours after his shot) he was up to 456! By the time he was due for his next shot he was OVER 600.
His dose of 5.8 was too much for him this morning. So his liver panicked and started working to raise his blood glucose.
So if I wasn't testing I would think wow that dose doesn't work for him at all! When it was just too much for that level.

*NOTE* this is NOT typical behavior for every cat. But it shows how a "bounce" from a dose that is too much works.
 
I used the ketone strip and got a dark green color for glucose (I'd say close to 1/4 category) and the ketone section remained a beige color for negative. I only had a very small amount of urine to work with so maybe I will try again later just to be sure. It's a good thing from what I'm understanding if it's coming up negative right?

Didn't test his blood yet but I will be soon!
 
I used the ketone strip and got a dark green color for glucose (I'd say close to 1/4 category) and the ketone section remained a beige color for negative. I only had a very small amount of urine to work with so maybe I will try again later just to be sure. It's a good thing from what I'm understanding if it's coming up negative right?

Didn't test his blood yet but I will be soon!
Negative on the ketones is great. Don't worry about the glucose part of the strip. Testing BG with the ear prick is the way to assess that.
 
Thanks! I'll keep up with the blood tests and next week I will mention the testing Woodsywife suggested with the vet while discussing "further options".
 
Hi All! I've done quite a bit of BG checks over the last few days and so far everything is still fairly high regardless of time. I haven't noticed him getting so low that he's in the danger zone at all but I do notice how his sugar drops after injections.

Although the numbers are high I have noticed that they are quite a bit lower than the readings done at the vet so I'm assuming he must be stressed when he has to go there.

I'm no expert but the numbers seem to suggest to me that caninsulin may not be the fix for him :( From what I understand 100-199 is the place to be and he isn't even close to there.
 
Hi @emjb14

I, too, was very relieved to hear back from you the other day. Good news that you are now home monitoring BG and ketones; you're doing great! :)

Others above have already advised you that if the starting dose isn't right it can set up the situation where subsequent dose adjustments may make matters worse, not better, for a diabetic cat on insulin.

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

At 3 units, categorically Davey's starting dose of Caninsulin was too high.

The following information on dosing is not from FDMB; it is straight from the manufacturer's own guidelines for the insulin you are using (i.e. the dosing information your vets should be following).

There are two brand names for this insulin: Vetsulin (US) and Caninsulin (Europe and Canada - not sure about other countries). Below I have provided links to the dosing guidelines on both vetsulin.com and caninsulin.com because there is a slight variation between dosing recommendations on each of the sites but BOTH sites state clearly that the MAXIMUM recommended starting dose of this insulin for a cat - independent of body weight - is 2 units.

From caninsulin.com: -------------------------------------------------

Starting Dose Guidelines:
  • Pre-treatment blood glucose concentration is used as guidance for the calculation of initial insulin dose in cats.
  • To avoid overdosing particularly during initial stabilization, round the cat’s bodyweight down to the nearest whole kilogram and the calculated dose down to the nearest whole or half unit.
Baseline Blood Glucose Concentration: <20 mmol/L <360 mg/dL [lab/pet meter values]
  • Units of Caninsulin per kg Body Weight (rounded DOWN to nearest whole kg): 0.25 U/kg body weight
  • Starting Dose (rounded DOWN to nearest whole unit): 1 unit twice daily.
Baseline Blood Glucose Concentration: >20 mmol/L >360 mg/dL [lab/pet meter values]
  • Units of Caninsulin per kg Body Weight (rounded DOWN to nearest whole kg): 0.50 U/kg.
  • Starting Dose (rounded DOWN to nearest whole unit): 2 units twice daily.
*The maximal dose should ideally not exceed 2 IU per injection in the first 2-3 weeks of treatment.

Dose Adjustment Guidelines:
  • Dose adjustment should be based on the clinical response and the results of serial blood glucose samples and not just a single sample. Ideally a blood glucose curve should be made before the insulin dose is changed.
  • Changes in dose should be made after a period of adjustment to a particular dose or regime. In cats the dose can be adjusted as infrequently as after 1-3 weeks on a particular regime. Increases of 1IU per injection are recommended.
From vetsulin.com: -------------------------------------------------

Starting Dose Guidelines:

For cats, the initial recommended dose of Vetsulin® (porcine insulin zinc suspension) is 1 to 2 IU per injection. Cats should be started on twice-daily injections of Vetsulin at 12-hour intervals. Note that in cats, Vetsulin dosing is calculated on a per animal basis; in contrast, initial dosing for dogs is based on body weight.
Dose Adjustment Guidelines:
  • Reweigh the cat. Modify overall dosage of Vetsulin if significant weight gains or losses occur.
  • Ask for owner’s overall impression of the cat’s progress, especially in regard to polyuria and polydipsia.
  • Sample blood glucose level to determine if regulation has been achieved, keeping in mind that cats often present with stress-induced hyperglycemia.
  • Adjust dose in increments of 1 IU per injection twice daily, if needed, based on the glucose curve evaluation and clinical signs.
  • Allow at least 14 days between dose adjustments unless hypoglycemia occurs.


Mogs
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Hi All! I've done quite a bit of BG checks over the last few days and so far everything is still fairly high regardless of time. I haven't noticed him getting so low that he's in the danger zone at all but I do notice how his sugar drops after injections.

Although the numbers are high I have noticed that they are quite a bit lower than the readings done at the vet so I'm assuming he must be stressed when he has to go there.

I'm no expert but the numbers seem to suggest to me that caninsulin may not be the fix for him :( From what I understand 100-199 is the place to be and he isn't even close to there.
I'm sorry to say this - again - but the numbers on your spreadsheet tell me that your kitty's dose is too high. I hope you have read the information posted above by Critter Mom about dosing Caninsulin/Vetsulin. Those are the manufacturer's guidelines. It would be a good idea to go directly to those websites, print out the dosing guidelines and take them to your vet. We really don't want your kitty to have a hypo episode.
 
Please check Woody's spreadsheet. My vet started him on 3 then upped everyday until he got to 10. During this time he was at the vets and they checked him once a day which I am not even for sure if they checked a fasting BG or after he ate. When I finally got him home I took him in every week. Each week the vet raised his dose 1 unit. Mat 13 units I decided I needed this board's help. The first reading I took he was LOW. The reductions was on the advice of the people here.

I really think your dose is too high. Please look at Critter Mom info. She has a lot of experience and she and others saved Woody.
 
Ok understood sorry this is a lot to take in and I keep thinking that if his levels are still very high that the medicine is a) not working or b) not enough. I guess it's just what seems logical at first until you make sense of all this plus it doesn't help matters when the vet is saying the same.

I do agree with you all and now I am wondering what to do next with his dosages. Do I start right back to one or do I slowly decrease from 8. It would be risky to make a big adjustment all at once right???
 
It is a lot to take in and it takes a leap of faith!!!! Let me tell you it was extremely hard for me. I remember crying in the car because I was so worried about my kitties. I was talking to myself why the heck I would take advice from strangers. I finally decided that I couldn't be hurting Woody anymore than what he was. I hated taking him in to get checked, they would snip a Claw until it bled, I was sick to my stomach every time. I am SO glad I decided that I would give this board a chance.
I can't give dosing advice but I'll tag a few members that helped me @Critter Mom @Tuxedo Mom @manxcat419 @MrWorfMen's Mom @Larry and Kitties @BJM @Marje and Gracie Maybe they can help. On post #8 MrworfMens mom says what she would do.
 
Please DO NOT give 8u again. If this were my kitty I would reduce the dose down to no more than 2u and probably even to 1u and start over. As Critter Mom said earlier., even the 3u that was initially was a high dose. Insulin is a hormone that triggers other hormones in the body. It a NOT a medicine. It's not like an aspirin where if one doesn't take the headache away you can take 2 at the next dose. To treat it in this fashion is nothing short of terrifying. Dose increases should be done in small increments of 0.25u to0.5u. These are small creatures so small amounts do make a difference.

I know you want to trust your vet but this is a very common vet problem. They see your cat in their clinic when they are under stress which elevates their BG. This leads them to think that the cat needs far more insulin than it really does. Right now, you are likely seeing the result of a lot of bouncing as your cat's body fights the huge dose of insulin you have been giving and the readings on your spreadsheet seem to confirm that opinion.

I hope I have caught you in time. Please test your cat at +1.5 hours post shot and see how much the BG has dropped. If more than 5mm (100 points US) you need to test again no later than +2.5 hours post shot and feed Davey a small snack to try to slow the BG drop. Repeat as needed. If Davey continues to drop and you need assistance, (any reading at or below 5.5mmol is a warning quick action is needed) post here with a 911 prefix to get assistance ASAP.

Oh and please try to get pre-shot tests before ALL shots to ensure it is safe to give insulin at all!

Happy New Year!
 
OK, no direct experience with Caninsulin here though 8u is a big dose with ANY insulin, especially if you've got to 8u fairly quickly. Regardless of the fact that you're using Caninsulin (I'm much, much more familiar with Lantus as that's what I've used), I would drop back to the starting dose based on Davey's weight immediately - it's entirely possible, as others have already said, that he was overdosed from day 1 and the high numbers you're seeing are his body trying to protect itself from too much insulin. It may take a few days for Davey's numbers to settle - please don't be tempted to increase quickly again if you don't see better numbers immediately. In my experience, many vets do start out with too high a dose. When Rosa first started on Lantus, I was told to give her 2u twice a day and not to home-test. The dose was based on old starting dose calculations, which had been revised but the vet wasn't aware of that at the time. Thankfully, the wonderful people here showed me why this was too much for current guidelines based on Rosa's weight and talked me through learning to home-test as well. And, as luck would have it, when Rosa's dose did finally reach 2u through gradual increases, that was the exact dose that dropped her low for the first time and started her back down the dosing scale. I shudder to think of what could have happened if I'd just gone along with what I was advised by the vet!

I hated taking him in to get checked, they would snip a Claw until it bled, I was sick to my stomach every time.
This...is disgraceful. Bearing in mind that we, as lay-people with no formal training, can get a blood sample without causing this sort of damage, I'm horrified that any vet or tech would test this way. I do sincerely hope this isn't common practice and isn't happening to anyone else here!
 
This...is disgraceful. Bearing in mind that we, as lay-people with no formal training, can get a blood sample without causing this sort of damage, I'm horrified that any vet or tech would test this way. I do sincerely hope this isn't common practice and isn't happening to anyone else here!

I cringe at the thought of my little kitties getting that done. I am so mad over that whole episode. And do you know my old, **** vet drives by my house 6 times a day and not once have they called about my "diabetic" cats. It's been 11 months since they last saw them!!!
 
DO NOT GIVE 8 units. Insulin is very unpredictable and does not work in a straight line. I am currently dealing with a hypo kitty so I can't stay on long. His PMPS test was 391 and 3.75 hours later he was at 23. This is on Levemir which is a gentler long acting insulin. I have got him to a workable level right now but it just shows how insulin can hit hard.

Please listen to the others who have advised a low starting dose and slowly work up. Also home testing is IMPERATIVE!!
 
I cringe at the thought of my little kitties getting that done. I am so mad over that whole episode. And do you know my old, **** vet drives by my house 6 times a day and not once have they called about my "diabetic" cats. It's been 11 months since they last saw them!!!
That's awful. And really just goes to show that, although the majority of vets really do want to help our babies, there are some who just don't have the sort of caring and careful attitude we need. But you and your boys are doing awesomely well without them - and the credit for that goes to you for taking control of the situation and getting them well again.
 
And do you know my old, **** vet drives by my house 6 times a day and not once have they called about my "diabetic" cats. It's been 11 months since they last saw them!!!

I hear you there....the vet that originally diagnosed China (and we never went back to because I'd spent the night reading here) has never once called to see why she didn't come back for more testing or to ask how she was doing on the new food (the dry W/D they'd convinced me she'd need to eat before I got online) or anything else. I had suspected for years that the only thing he cared about was his bank balance, but I know now that I was right in my original opinion
 
I hear you there....the vet that originally diagnosed China (and we never went back to because I'd spent the night reading here) has never once called to see why she didn't come back for more testing or to ask how she was doing on the new food (the dry W/D they'd convinced me she'd need to eat before I got online) or anything else. I had suspected for years that the only thing he cared about was his bank balance, but I know now that I was right in my original opinion
nits not like he doesn't know who lives here. We've lived on the same street for 18 years! And the population of our town is 3000.

He drives by in his 2016 crew cab pickup! And of course his son drove a brand spanking new mustang throughout high school. I knew I was contributing, but geez. He did wonderful things for my dog, Kosmo, but was horrendous for my cats.
 
Please DO NOT give 8u again. If this were my kitty I would reduce the dose down to no more than 2u and probably even to 1u and start over. As Critter Mom said earlier., even the 3u that was initially was a high dose. Insulin is a hormone that triggers other hormones in the body. It a NOT a medicine. It's not like an aspirin where if one doesn't take the headache away you can take 2 at the next dose. To treat it in this fashion is nothing short of terrifying. Dose increases should be done in small increments of 0.25u to0.5u. These are small creatures so small amounts do make a difference.

I know you want to trust your vet but this is a very common vet problem. They see your cat in their clinic when they are under stress which elevates their BG. This leads them to think that the cat needs far more insulin than it really does. Right now, you are likely seeing the result of a lot of bouncing as your cat's body fights the huge dose of insulin you have been giving and the readings on your spreadsheet seem to confirm that opinion.

I hope I have caught you in time. Please test your cat at +1.5 hours post shot and see how much the BG has dropped. If more than 5mm (100 points US) you need to test again no later than +2.5 hours post shot and feed Davey a small snack to try to slow the BG drop. Repeat as needed. If Davey continues to drop and you need assistance, (any reading at or below 5.5mmol is a warning quick action is needed) post here with a 911 prefix to get assistance ASAP.

Oh and please try to get pre-shot tests before ALL shots to ensure it is safe to give insulin at all!

Happy New Year!

Thank you and sorry I wasn't home to catch this yesterday but will start back at 1 unit today. Happy New Year to you as well!
 
Thank you and sorry I wasn't home to catch this yesterday but will start back at 1 unit today. Happy New Year to you as well!
That's a wise move. Have you tried urine ketone testing yet? :)

Please post your BG numbers on your spreadsheet and if you can get some tests between AM and PM doses or through the evening that would be very useful. It shouldn't take many cycles (the 12 hours between doses) before we know whether the 1 u dose needs to be raised.
 
Thank you and sorry I wasn't home to catch this yesterday but will start back at 1 unit today.
[Emphasis mine]

I have a different view. I would be very wary of dropping the dose back this far and this fast. (Been working on this behind the scenes.)

I do agree that the dose of 8.0 IU is very high for a newly-diagnosed cat - but because dose started on the high side and got ramped up extremely quickly (and based on inadequate testing!) we don't have any reliable way at this time to determine how much insulin Davey actually needs. Dropping back to 1.0 IU with BG numbers as high as they currently are could increase risk of Davey producing ketones. (Very early days: minimal data; we don't know whether Davey might be ketone-prone; and we don't know whether or not he may have other undiagnosed issues which may either be elevating BG levels or causing poor response to insulin - although there has been some response to Caninsulin already.)

Had the manufacturer dosing guidelines been followed for Davey then, even if the most aggressive dosing allowed for within those guidelines were used, the maximum dose he should be receiving right now is 6 IU BID Caninsulin. Had the guidelines been followed in a more judicious fashion (a better approach) the dose by now should be around 3-4 IU BID Caninsulin.

It is vital that you do a urine ketone test today - before doing any reduction in insulin dose. If ketones are at all positive then vet must be contacted and appropriate treatment sought immediately. Insulin dose should NOT be reduced and vet should be briefed. High carb food could be left out at all times to improve safety and BG should be monitored closely.

To determine whether insulin overdose is the actual issue here I would propose reducing the dose in stages and rigorously monitoring BOTH BG AND KETONES throughout the process. Dropping back to 6 IU BID might be a good place to start: within manufacturer guidelines; less risk of ketones developing; and somewhat safer than the 8 IU BID (if the 8 units is indeed too high). I would advocate against dropping the dose below 4 IU BID at this point: too many unknowns.

NB - watch out for BG going unexpectedly very low during any dose reduction programme (especially in the early part of the cycle). PS tests need to be done prior to ALL doses of insulin. Mid-cycle testing from +1 - +4 hours post-dose (and later if possible) need to be done every day on at least 1 cycle for safety. (PM cycle if out of house during day.)

For safety, dosing would need to be reviewed continually throughout any dose reduction programme. Adequate testing is critical for safety.

Other members may have different views/suggestions.


Mogs
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That's a wise move. Have you tried urine ketone testing yet? :)

Please post your BG numbers on your spreadsheet and if you can get some tests between AM and PM doses or through the evening that would be very useful. It shouldn't take many cycles (the 12 hours between doses) before we know whether the 1 u dose needs to be raised.

Yes I have done ketone testing and it came up negative each time so far.
 
I did give 8 this morning yes by the time I reviewed everything here his morning dose had already passed.
Can you do some mid-cycle testing on Davey today? While he might simply run high all day, it's also possible that he might drop fast to too low a number before bouncing back up.
 
Can you do some mid-cycle testing on Davey today? While he might simply run high all day, it's also possible that he might drop fast to too low a number before bouncing back up.

I agree with April. I'd suggest: PS test; feed; wait 20-30 minutes then give insulin; test at +1, +2 and +3 hours after the dose was given (and further tests if necessary/possible).

Caninsulin hits quite hard and fast after the injection is given and may start BG dropping quite quickly - especially if the dose is too high. If the drop is too fast/steep then the cat's defences may then quickly kick in to push BG levels back up into high numbers again. This would be missed if testing were only done around the +4 - +6 period of the cycle. Getting the earlier tests in will help you build a better picture of what's going on.

You can actually see an example of such an early dip in Davey's PM cycle on the first line of his spreadsheet (lower at +1).


Mogs
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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.
I recommend in the strongest terms that you do not make any changes whatsoever to Davey's diet for the time being: if the dose is too high then his current diet will be doing something to protect him from a potential adverse event. If you were to reduce the carb load in his food it could greatly increase his risk of having a hypo episode.

Once the dosing side of things is sorted out then you'll be able to review Davey's food choices and manage any diet changes safely with your home testing.


Mogs
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I recommend in the strongest terms that you do not make any changes whatsoever to Davey's diet for the time being: if the dose is too high then his current diet will be doing something to protect him from a potential adverse event. If you were to reduce the carb load in his food it could greatly increase his risk of having a hypo episode.
I completely agree, Mogs. The first day Rosa was on insulin, I'd been told by the vet to give her 2u and remove all the dry food from her diet immediately! As luck would have it, I'd given her first dose and fought my way through trying to get wet food into her before I found the FDMB. :eek: Fortunately, the great people here were very quick off the mark to tell me that because the dose I'd been told to give was double what it should have been, and I had no way of testing until the following day, I had to give her the dry food back until I could make sure she was safe through a diet change.
 
Thank you and sorry I wasn't home to catch this yesterday but will start back at 1 unit today. Happy New Year to you as well!

I agree with Mogs here......dropping all the way back to 1U isn't a good idea because we don't have any data on Davey yet

Usually when we get a high dose cat here, we suggest dropping back some, but not all the way back to the starting dose because it tends to just end up taking longer to get back to an effective dose and allows glucose toxicity to build up in the meantime

If Davey were my cat, I'd drop back to 5-6 units and test as much as possible until we can actually see what's going on....if he's getting too much insulin, we'll know soon enough without risking his health by dropping back too much, too quickly

You DO need to make sure you get tests in on the PM cycle too....Most cats go lower at night, so it's really important to get at least a "before bed" test at night to make sure he's safe while you're sleeping
 
@emjb14 I bet your head is in a muddle with all the advice you are getting! I'm not going to add anything to the mix just wanted to say well done to you for trying everything you can.

Sky's story is similar in many ways - started on a high dose and advised not to test. Her reaction to this was to go hypo very quickly. She did respond well to caninsulin but seemed to be too harsh for her - and it seemed to stay in her system longer than the 12 hours. I too wanted to trust my vet but with the best will in the world, they cannot be experts on everything they see. The combined knowledge of the people on here is amazing - I would never drop the vet advice but consider everything.
 
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