Insulin increase and Diet

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Ninja & Baby

Ninja & Baby

Member Since 2017
My cat has been in the hospital for four nights. He is home now. The vet increased his insulin level from 1 unit to 2. However, I'm pretty sure he was eating Hill Science Diet for Diabetes during his stay. Now, he's home with me, and I feed him no more than 6 or 7 % carbs....usually less. I'm thinking Hill Science Diet is around 20%. The vet said his BG never hit below the mid 200s. Since he's back on his low carb food, is 2 units of insulin going to be too much?
 
Ninja & Baby said:
My cat has been in the hospital for four nights. He is home now. The vet increased his insulin level from 1 unit to 2. However, I'm pretty sure he was eating Hill Science Diet for Diabetes during his stay. Now, he's home with me, and I feed him no more than 6 or 7 % carbs....usually less. I'm thinking Hill Science Diet is around 20%. The vet said his BG never hit below the mid 200s. Since he's back on his low carb food, is 2 units of insulin going to be too much?
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Maybe you could play it safe and try increasing by only 0.25 u at a time. You'd get to 2 u eventually (if necessary) but Ninja would be safer.
 
Since you are using Vetsulin, there isn't as much trouble with switching doses around as there would be with a "depot" insulin. I suspect you are correct that he'll need less than he did at the vet (between stress and the higher carb food elevating his BG). I worry about reducing the insulin right after a DKA episode, however-- you definitely don't want a repeat of that, and insulin is a major weapon to keep ketones down.

Another option would be to shoot the 2.0U, but monitor very closely (BG tests at least every two hours to at least +6 after the shot tonight) and be prepared to intervene with high carb food.

How long until you would normally shoot? I would like if some of the more experienced members could weigh in here on the pros and cons.
 
Nan & Amber said:
Since you are using Vetsulin, there isn't as much trouble with switching doses around as there would be with a "depot" insulin. I suspect you are correct that he'll need less than he did at the vet (between stress and the higher carb food elevating his BG). I worry about reducing the insulin right after a DKA episode, however-- you definitely don't want a repeat of that, and insulin is a major weapon to keep ketones down.

Another option would be to shoot the 2.0U, but monitor very closely (BG tests at least every two hours to at least +6 after the shot tonight) and be prepared to intervene with high carb food.

How long until you would normally shoot? I would like if some of the more experienced members could weigh in here on the pros and cons.
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I won't shoot until about 7 p.m. eastern time. It is currently 5:21 p.m. Like you said, Nan, Ninja is currently recovering from an episode of DKA.
 
Was the Hills at the vet dry food or wet? There is a difference in the carbs but not quite so stark between the wet foods as there is with the dry vs. wet. Did the vet say Ninja had DKA? If so, it's important to give enough insulin. I'd be hesitant to back off on the insulin anymore than absolutely necessary but also keeping in mind that he could have been running a bit higher just from stress at the vets. Check his pr-shot BG tonight and depending on that we can help you decide. First you need to be sure about the difference in carbs. Hill M/D dry is 18% carbs. If he was eating the wet Hills we'll check the carbs in it for comparison.
 
MrWorfMen's Mom said:
Was the Hills at the vet dry food or wet? There is a difference in the carbs but not quite so stark between the wet foods as there is with the dry vs. wet. Did the vet say Ninja had DKA? If so, it's important to give enough insulin. I'd be hesitant to back off on the insulin anymore than absolutely necessary but also keeping in mind that he could have been running a bit higher just from stress at the vets. Check his pr-shot BG tonight and depending on that we can help you decide. First you need to be sure about the difference in carbs. Hill M/D dry is 18% carbs. If he was eating the wet Hills we'll check the carbs in it for comparison.
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They were giving him both wet and dry food. The vet said he had DKA, but it wasn't really a full-blown case. He said he checked him this morning and his urine was clear of ketones.
 
I checked the Hills M/D wet food carbs and it's 16.3% YIKES! Never would have imagined it would be that high. So yes you are definitely going to have to monitor closely and perhaps drop the dose slightly. If pre-shot reading warrants, he's eating well and you can monitor tonight up to about +6 if need be, then I'm thinking 1.5 units but let's see what his pre-shot is before making any final decisions.

I bet Ninja is happy to be home and Baby is happy to see him!:cat::cat:
 
MrWorfMen's Mom said:
I checked the Hills M/D wet food carbs and it's 16.3% YIKES! Never would have imagined it would be that high. So yes you are definitely going to have to monitor closely and perhaps drop the dose slightly. If pre-shot reading warrants, he's eating well and you can monitor tonight up to about +6 if need be, then I'm thinking 1.5 units but let's see what his pre-shot is before making any final decisions.

I bet Ninja is happy to be home and Baby is happy to see him!:cat::cat:
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There's a black cat that looks just like Ninja hanging around the house. He thinks he's tough. He has Baby convinced, but Ninja isn't scared of him. When I got him out of the car, he was fighting me to get to the offending cat. I got him in the house and locked him in. He's been mad ever since. He enjoys a good fight.

Should I check his BG before or after his evening meal?
 
Ninja & Baby said:
There's a black cat that looks just like Ninja hanging around the house. He thinks he's tough. He has Baby convinced, but Ninja isn't scared of him. When I got him out of the car, he was fighting me to get to the offending cat. I got him in the house and locked him in. He's been mad ever since. He enjoys a good fight.

Should I check his BG before or after his evening meal?
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That's hilarious! Though, of course, not if he actually gets the chance to fight, then it is scary. But it's definitely a sign that Ninja is feeling better!
 
Oh, sorry-- missed the question at the end!

Test before the meal, definitely-- you want to get a number that is not influenced by food. Post for feedback. If the number seems too low to shoot, we may want to wait 20-30mins and test again-- again, best if there's no food on-board yet, we'd be interested to see if he's moving up or down on his own.
 
Nan & Amber said:
Oh, sorry-- missed the question at the end!

Test before the meal, definitely-- you want to get a number that is not influenced by food. Post for feedback. If the number seems too low to shoot, we may want to wait 20-30mins and test again-- again, best if there's no food on-board yet, we'd be interested to see if he's moving up or down on his own.
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Thanks, Nan!
 
Ok the big questions now are how well he eats and how long you can monitor tonight. At that pre-shot you could give him the 2u as long as you can monitor to at least +5 (about MN your time) and possibly longer if need be. This is a tough call because you need to keep his BG down as much as possible and if he was staying around the 200s at the vets at nadir on 2u it should be fine. I'm always a bit dubious about what the vet considers nadir....some think it happens at a specific time in the cycle:rolleyes: while others know it moves and test more frequently to find the real nadir.
 
MrWorfMen's Mom said:
Ok the big questions now are how well he eats and how long you can monitor tonight. At that pre-shot you could give him the 2u as long as you can monitor to at least +5 (about MN your time) and possibly longer if need be. This is a tough call because you need to keep his BG down as much as possible and if he was staying around the 200s at the vets at nadir on 2u it should be fine. I'm always a bit dubious about what the vet considers nadir....some think it happens at a specific time in the cycle:rolleyes: while others know it moves and test more frequently to find the real nadir.
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I asked the vet about that, and he said it can vary. It can be at one time on one day and somewhere else the next. I guess I will have to have him sleep with me so I can monitor him.....the cat....not the vet.:stop:
 
Ok stop it Paula, I darn near choked on my wine with that crack! :p You have lucked out and have a SMART vet! YEAH! :joyful:That gives me far more confidence about shooting the 2 units.
 
Paula, I am assuming you gave Ninja his 2u of insulin. If you can get a test at +1.5 to +2 hours post shot it should give you an idea of just how fast Ninja is dropping. Post your reading and I will check back in about 9pm. to see where he's at. :)
 
Sorry, Linda. I just now saw your post. That was a very nice offer. Yes, I gave Ninja his 2u of insulin. I never did test him again. I have cameras in my house that send me emails when it captures motion along with pictures. Ninja tends to ramble at night so I set my phone to alert me when new emails came in reporting movement. Anytime I heard an email come in I knew it was him because Baby was in bed with me. I listened to notifications until about 2 a.m. o_O When I saw the picture of his face buried in the food bowl, I figured he was OK and it was time for me to get some sleep.
 
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That's quite the set up you have there and certainly a help for monitoring Ninja but I wouldn't trust that as an indicator of whether Ninja's BG is running too low or not.

I know testing is a bit difficult right now but without testing you really don't know what is happening with Ninja and you need to know how low he is going and how fast to determine the best dose of insulin going forward. It's important to note that cats often go lower overnight than they do during the day too and for that reason, even though I know my cat pretty well at this point, I make dose changes only when I can reliably monitor usually on a day cycle. You didn't have that choice last night with the recent DKA as it's vitally important to give enough but not too much insulin right now to keep ketones out of the picture. It's a balancing act that can only be managed with testing.

There are cats who show no outward signs of hypoglycemia and don't even head to the food bowl to correct the situation. They can suddenly be in a full hypoglycemic episode which can be tough and sometimes impossible to deal with at home. That is why we suggest testing early in the cycle to see how much the BG is dropping. That testing gives you the ability to steer kitty through the cycle, determine if more monitoring is needed or to abort the cycle altogether if monitoring is not possible. Vetsulin can and does pull the BG numbers down very quickly and last night you gave a higher dose based readings the vet was getting which can be elevated by stress along with a food change so even more important to monitor with all those changes to the program.

Ninja's BG may start coming down now that he is home, recovering and on the lower carb food so going forward, it's important to test between +1.5 and +3 whenever possible especially before bed to keep Ninja safe. If you are out all day at work, testing at these times is not possible but that just makes getting those tests in the evening even more vital. Any data you can get is good data. It all helps to give you a picture of how the insulin is working for Ninja and that will give you the tools to make dosing decisions going forward and keep Ninja safe and healthy.
 
Looks like you didn't get a pre-shot reading this morning, gave insulin and then got the HI reading at +3. This could very well be indicative of Ninja going low last night and/or possibly having been lower this morning when you gave the insulin.

This is what we call a bounce and it's a normal response to BG levels that kitty is not accustomed to, BG dropping very quickly, or even possibly going to unsafe low levels. With a diabetic who has become accustomed to higher BG levels the defence system can be activated earlier than it would in a non diabetic cat. When the body decides the BG is too low or dropping too fast it sets off the release of other hormones that cause glucagon to be released into the bloodstream resulting in higher than usual readings. Bounces can take up to 3 days to clear the system and make regulating the cat more difficult.

I cannot emphasize enough the importance of testing before shots and getting some mid cycle tests to keep Ninja safe and to bring numbers down slowly and steadily so that triggering of the body's defence system is kept to a minimum. It not only will keep Ninja safe but it will make getting him regulated much easier.
 
Here is what I am wondering. I left out a small bowl of Evo Kitten and Cat Food. His BG was Hi. The last time he ate Evo the same thing happened. Coincidence?

Also, I didn't test him this morning because he was guzzling water. I felt sure he was high. Inevitably when he is drinking like that, his BG is through the roof.
 
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Evo dry food is supposed to be about 8% carbs and is considered to be one of the acceptable dry foods carb wise however there have been other members report that it has caused elevated BG levels. I wouldn't totally discount it playing a small role but I wouldn't assume it's the only explanation either especially since Ninja was eating Hills which is even higher in carbs at the vets. A slight increase from the food I could understand but not such a substantial one.
 
You're probably right about the bouncing, but I'm also curious about the Evo. Tapioca Starch is the 3rd ingredient. Isn't that high in carbs.

Just checked BG again at +5 and it was still Hi. Just to make sure I was not getting inaccurate reading, I took my own BG and it was 96. Probably not a monitor problem.
 
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You're right. Tapioca is high in carbs and it concerned me too because in my cat's food it's the second ingredient and her food is 15% carbs. I started her current food after EVO became unavailable in Canada so have compared the two and I've personally seen no difference whatsoever from food influences in my cat. Now that said every cat is different and I don't think my girl is particularly carb sensitive. Some cats will react to even small increases in carbs while others don't seem to be effected much at all. Ninja may be more sensitive but I still don't think it should be assumed to be the culprit in this situation. An hypothesis yes and something to keep an eye on but without testing both before and after feeding it vs. other food it's only an assumption.
 
Sigh . . . . .I'm so afraid he's going top develop ketoacidosis again. Is there any significant difference in testing with Alpha Trak vs a human glucose meter?
 
Ninja & Baby said:
Sigh . . . . .I'm so afraid he's going top develop ketoacidosis again. Is there any significant difference in testing with Alpha Trak vs a human glucose meter?
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The two meters will give different readings, with the human meter reading lower. The difference becomes larger at high BG numbers and less when BG is lower. On either meter, high is too high. It's the low numbers you have to watch for hypo - below 50 on a human meter and below 68 on a pet meter like AlphaTrak.
 
Paula, the AT2 meter will read higher than a human meter and the difference get larger the higher the BG but using a human meter is perfectly safe. Note that the human meter will read HI at a lower BG (it doesn't have the same range as the pet meter) so if you were using an AT2 meter you might have got an actual number but it would still have been very high. The only advantage to using the AT2 meter is that your results will more closely equate lab values but it is very expensive to use (strips are about $1 each) and really not necessary when we have reference numbers to use with human meters.

Testing both BG and ketones is key to keeping Ninja from developing DKA again. Check his urine at least daily right now and get BG tests when you can. You need to get that BG down and right now it's really looking like he's bouncing big time. Keep him off the dry food if possible but make sure he eats.
 
Thank you guys for your help!! I don't know what I would do without you. I took up all dry food earlier today. I have some Fancy Feast Classic Chicken out for snacking. I keep thinking Ninja probably needs all food removed until his meal time this evening, but he is already so thin.
 
Ninja & Baby said:
Thank you guys for your help!! I don't know what I would do without you. I took up all dry food earlier today. I have some Fancy Feast Classic Chicken out for snacking. I keep thinking Ninja probably needs all food removed until his meal time this evening, but he is already so thin.
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If he likes the Fancy Feast let him eat several small meals between shots, just take up the food 2 hours before. If he's thin he needs the calories and post DKA, eating enough is essential.
 
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Ditto to what Kris said. Right now you can let Ninja have the food he wants (within reason) and just adjust the insulin accordingly. It's more important to get enough food into him and to put a bit of weight back on him right now than to worry about what that might do to his insulin needs.
 
That HI continuing all day is a bit concerning. Is there any chance you might have given a furshot this morning? It's happened to most of us at some point or another and all you can do is wait for the next shot time. If you haven't tested for ketones today, I would definitely do so. I take it Ninja is eating well and on his own. Any other signs he might not be feeling well.
 
I guess I could have given a fur shot. I ran my hand through his fur and I didn't feel anything. I push the needle until it stops and then depress the plunger. Is that correct? I asked my first vet about a shorter needle and she wasn't open to the idea. I'm trying to get urine for a ketone test, but he's not in the mood. He is eating fairly well, but he doesn't appear to feel very well.
 
Ninja & Baby said:
I guess I could have given a fur shot. I ran my hand through his fur and I didn't feel anything. I push the needle until it stops and then depress the plunger. Is that correct? I asked my first vet about a shorter needle and she wasn't open to the idea. I'm trying to get urine for a ketone test, but he's not in the mood. He is eating fairly well, but he doesn't appear to feel very well.
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You're injecting correctly. Also, kitties can take a while to recover from DKA. It's very hard on them.
 
I am attaching a picture of an old syringe. Please let me know if it is at the correct marker for 2 units. I think it is ......but better safe than sorry. Also, he tested negative for ketones.
 

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Ninja & Baby said:
I guess I could have given a fur shot.
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Paula it was just a thought and I was just speculating. It's just that kitty can shift a bit and the needle shifts too. It's likely you would have noticed a wet spot if he didn't get any insulin but if he got some, it might have dissipated enough or even leaked out after you checked.
Can you get another test at about +1.5 hours post shot tonight? I would also double check the meter on yourself again first though. I have no idea what your meter does but I have a meter that for some reason reads high when the battery is running low. I always keep an extra meter battery or two in my box of supplies.

There are no shorter needles in U40 syringes. While some of us using human insulin do use a slightly shorter needle, you run a slightly higher risk of fur shots. Our needles come in 2 lengths and I am a whiz at fur shots with the shortest ones! :rolleyes:
 
MrWorfMen's Mom said:
Paula it was just a thought and I was just speculating. It's just that kitty can shift a bit and the needle shifts too. It's likely you would have noticed a wet spot if he didn't get any insulin but if he got some, it might have dissipated enough or even leaked out after you checked.
Can you get another test at about +1.5 hours post shot tonight? I would also double check the meter on yourself again first though. I have no idea what your meter does but I have a meter that for some reason reads high when the battery is running low. I always keep an extra meter battery or two in my box of supplies.

There are no shorter needles in U40 syringes. While some of us using human insulin do use a slightly shorter needle, you run a slightly higher risk of fur shots. Our needles come in 2 lengths and I am a whiz at fur shots with the shortest ones! :rolleyes:
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I just did a PMPS at 1.5 and it was still hi. I checked mine as a comparison and it was 94. Is it possible that something is wrong with the insulin? Also, he tested negative for ketones.
 
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Nan & Amber said:
I was just writing a post about that. How does your insulin look? Any clumps? Are you mixing it well before drawing it out?
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The insulin looks fine. No clumps. It is a tad cloudy looking. I roll it around between my hands before I inject. I did forget and leave it out for about 30 minutes one time.
 
I haven't used Vetsulin, so I'm not deeply familiar with it, but my understanding is that it needs to be mixed gently before use, and should be somewhat cloudy, with little particles suspended in the liquid, but shouldn't have big clumps or sediments. If the vial is relatively new and has been treated well, it shouldn't be bad, but it does happen, rarely. Doesn't sound like there are any screaming red flags here-- other than the high numbers, of course. It is worrying that he's been "HI" all day.
 
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