Need dosing advice for Caninsulin

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Terry & Wilba

Terry & Wilba

Member Since 2017
Hello All, I'm from the UK and my 12 year old cat Wilba was recently diagnosed diabetic and I've been reading the many helpful posts on here for a couple of weeks now.

Wilba was diagnosed around a month ago (33mmol / 594mg) and was been prescribed Caninsulin, 4 units twice a day. 2 weeks after, the vet took a curve and the first reading was a very low 2.2 (40mg). They explained that it could be he hadn't eaten much that morning and they recommended I drop him down to 3 units twice daily. Wilba is a grazer and no matter how much I tried I couldn't get him to eat much in one go.

At the same time of being prescribed Caninsulin I changed his food to that recommended in http://www.felinediabetes.com/FDMB/...-including-link-to-low-carb-food-list.137376/.

The same week after his 2.2 reading Wilba vommited twice, it was quite runny and dark brown. I was worried he was hypo and stopped his insulin for a day and ordered an Alphatrak2. Since then I have taken these readings:

Thurday 16 Feb
1 unit Canisulin at 7:10PM

Friday 17 Feb
no insulin given
6:34PM - 9.4mmol / 169mg

Saturday 18 Feb
no insulin given
9:36AM - 9.1mmol / 164mg
11:50AM - 10.3mmol / 185mg
6:19PM - 8.1mmol / 146mg

Sunday 19 Feb
no insulin given
9:44AM - 11.8 mmol / 212mg

I will take him back to the vet in a week or 2 but I am worried if I should be keeping him off caninsulin based on the above readings, at what point should I give him a shot and how much? I read 5-15mmol (90-270mg) is normal for diabetic cat but should I be aiming for 5mmol/90mg? Caninsulin seems to give a very steep drop so I'm worried about Wilba going hypo if he maintains similar BG levels and carry on with his shots.

Apologies if this is posted in the wrong forum but any advice is much appreciated :)

Thanks, Terry
 
Welcome Terry. :bighug: :bighug:

It is so good that you started home testing. With the numbers that you have posted, especially with having no insulin on board, it would not be wise to be giving insulin at those numbers. There could be other factors at play that caused the high glucose readings. Kitties can often have much higher readings at the vets due to stress. Doing the readings at home gives a much better picture of the actual glucose readings. Also if you were feeding Wilba high carb foods that can also cause the levels to be higher. The numbers that you have listed are only slightly high when using a pet meter like you are. Depending on when the readings were done...whether Wilba had eaten or not within a few hours of the test...they are not bad numbers at all.

You have changed to a better diet which can make a MAJOR difference with glucose numbers. There have been some kitties that have been able to get off insulin just with a diet change. The doses that your vet ordered were far too high for a newly diagnosed kitty, so it is very fortunate that you chose to do your own tests.

To get more people responding you can change your title ...go to the top of the page to the right of the title..there will be an option for Thread Tools. If you highlight it it gives you the option to Edit Title. Change the title to something like "Need dosing advice for Caninsulin" and more people should respond.

Good luck :bighug::bighug:
 
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Hi Terry and welcome from another UKer - we are in the minority here but there are several of us around.

As Mary Ann has said, the numbers you've been getting aren't bad at all, and the high BG at diagnosis could have been caused by other factors - vet stress, an infection, etc. That is not unusual. The 4u dose you were giving is definitely on the high side though and may well have been too high, causing the hypo number.

As far as dosing now is concerned, I would go cautiously. I am tagging one of our very experienced UKers, @Elizabeth and Bertie , who will be able to give you more specific advice.

Best of luck and do keep coming here - you are in the very best place for help for both Wilba and yourself.

Diana
 
Thanks Mary Ann, I have changed the title as recommended :)

I feel better keeping him off the insulin now I can get do my own BG readings. I just checked the food spreadsheet again and his regular foods are on there, other than 'Purina ONE Adult Chicken and Whole Grains Dry Cat Food'. He was drinking alot of water which prompted me to get him to the vet.

Hopefully his new diet will keep him off needing insulin, I just need to get better at getting his blood samples :oops:

Terry
 
Thanks Diana,

Yes, I was hoping if the numbers keep stable I can keep him off insulin. I'm worried about the dosage if it raises slightly (above 15mmol) as he doesn't eat much in one go (and I'm away at work 7.30am to 6:30pm).
 
Hi Terry, and welcome!

And well done, you, for learning to hometest. It will get easier! :bighug:

I see you're using an Alphatrak meter.
The normal blood glucose range for a non-diabetic cat is roughly 2.7 to 7.2 on a human meter. The Alphatrak usually 'reads' slightly higher than a human meter, so that 8.1 that you got could be at the upper end of the normal range. That's very encouraging! (Some cats can go into 'remission' from their diabetes; ie. have their diabetes controlled by low carb diet alone.)

I agree that the numbers you're seeing are maybe a bit low to be giving Caninsulin. For newcomers to diabetes our general recommendation is that no insulin is given if the blood glucose, at the time of the shot, is below 11 on a human meter. For Alphatrak users that 'no shot' number could be set a little higher, maybe 12.5, or even higher.
The info here (from a Sticky in the PZI subforum) was actually written for PZI insulin, but also holds true for Caninsulin:
  • The proper sequence for dosing insulin is: Test/Feed/Shoot. In the beginning, if your cat’s BG is not up to at least 200 mg/dL {11 mmol/L}, if your schedule allows, you can stall (without feeding) for 20+minutes, then retest the BG. You are looking for a number that is rising, not falling and up to 200 mg/dL {11 mmol/L}. If you stall once, but can’t do another round of stalling and your cat hasn’t reached a BG of 200 mg/dL {11 mmol/L}, you’ll need to skip the dose and wait until the next cycle. NOTE: Because pet-specific meters (such as the AlphaTrak2) often read higher than human meters, you may want to adjust the NO-SHOOT number to 225 mg/dL {12.5 mmol/L} or even 250 mg/dL {14 mmol/L} This gives you an added margin of safety when using an AlphaTrak2 or other pet-specific meter.
Terry & Wilba said:
should I be aiming for 5mmol/90mg? Caninsulin seems to give a very steep drop so I'm worried about Wilba going hypo if he maintains similar BG levels and carry on with his shots.
Click to expand...
With Caninsulin it's advisable, at least initially, to try to not let the blood glucose drop below around 5 - 5.5. The reason for that is because, as you say, Caninsulin can give a very steep blood glucose drop in some kitties, and trying to not let it drop below 5 - 5.5 gives some buffer of safety. As the caregiver gathers data about how their kitty responds to insulin they may well allow the kitty to drop into slightly lower numbers if appropriate.

As to the speed at which the blood glucose can drop, this can be slowed down somewhat with the use of food.
With Caninsulin we suggest that the kitty is fed about 20 - 30 minutes prior to the insulin shot. That's so that the kitty has food on board for when the insulin starts to take effect. Some people also find it helpful to give a snack (or part of the main meal) about 1.5 to 2 hours after the insulin shot. Then there is more food in the system for when the insulin reaches it's peak effect (and lowest number of the cycle).
Many people see the lowest number of the cycle at around 4 - 4.5 hours after the shot. But it might be as early as 3 hours after the shot, or later, at around 6 hours after the shot. 'Your mileage may vary'. ;)

As to how to proceed, I wonder if it's worth continuing with the low carb diet to see if the numbers come down any further on their own.
What exactly are you feeding Wilba at the moment?
And how often are you feeding him?
(Small meals throughout the day can encourage the pancreas to work without overwhelming it with too much to do at any one time.)

If the numbers don't come down sufficiently with the diet change alone then you may wish to try giving very small doses of insulin - if you are comfortable with that. Are you using syringes or a Vetpen?

Eliz
 
I use a petsafe timed feeder for Smoky and it has been a lifesaver for me. I work during the day and he needs to eat small meals throughout the day. Are you able to get a timed feeder in the UK?
 
Hi Eliz, wow, thanks for all the info! I made a big order of various foods when Wilba was first diagnosed, Ropocat, Granata, Nature's Menu, MAC's, Om Nom Nom, for treats I've got Zoolove air dried, and Thrive. He's not keen on some of it so I sometimes mix in some Sheba/Whiskas/Felix. I feed him around 7am and 7pm everyday, he will eat a quarter of it initially but it will take him several hours before he finishes it all so I guess it is equivalent to several small meals.

I'm currently using VetUK 0.5ml U40 syringes, they have lines for half units so I can go down as low as 0.5 units. The NO-SHOOT number was what I was looking for :) I will continue testing and give a small dose (0.5 -1 units) if it's above 13-14mmol. I was paranoid about the levels given by the Alphatrak2 (even though the test solution level was OK). I think I will do a comparison with my vets reading next time I'm there.

Lisa, I was looking at getting a timed feeder as the vet said if he's not eating enough before shooting then I could feed him earlier and give him more time to eat more. However, this was before I started home testing and before knowing his BG levels weren't actually too bad. I don't think I will ever be able to get him to eat 2 meals a day and finishing all the food in 1 sitting, I'm just happy when I get up in the morning and when I get back from work to see his bowl is empty :)
 
Terry & Wilba said:
I'm currently using VetUK 0.5ml U40 syringes, they have lines for half units so I can go down as low as 0.5 units.
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Aha, well, since you have syringes (and not Vetpen) you can actually measure much smaller than .5 of a unit with those if necessary, but it just needs a bit of 'eyeballing' the dose.
And, IF it turns out that your kitty needs very small doses then it is also possible to use a different syringe altogether to make that easier (but that's probably more info than you need at the moment.)

If you find that your kitty's blood glucose is dropping too fast on Caninsulin, and you're not able to manipulate that with food, then there are other insulins that your vet can prescribe. There is an insulin called Prozinc that's been formulated specifically for cats (Caninsulin was formulated for dogs). Prozinc has only fairly recently become available in the UK, but has been used in the US for quite a while. And if that doesn't work, then there are 'human' insulins that your vet can prescribe under the 'cascade system' of prescribing (but UK vets vary enormously in their willingness to prescribe 'human' insulins.)

Terry & Wilba said:
I made a big order of various foods when Wilba was first diagnosed, Ropocat, Granata, Nature's Menu, MAC's, Om Nom Nom, for treats I've got Zoolove air dried, and Thrive. He's not keen on some of it so I sometimes mix in some Sheba/Whiskas/Felix. I feed him around 7am and 7pm everyday, he will eat a quarter of it initially but it will take him several hours before he finishes it all so I guess it is equivalent to several small meals.
Click to expand...
Wow! What a feast! :woot:
And yes, that does sound like the equivalent of several small meals.

Terry & Wilba said:
I will continue testing and give a small dose (0.5 -1 units) if it's above 13-14mmol.
Click to expand...
Let's hope that Wilba's blood glucose doesn't sneak up to 13-14mmol. But if it does, then I'd suggest trying just half a unit to begin with. And then testing a couple of hours later if possible to see how that's starting to affect his blood glucose.
Are you out of the house all day? Just wondering what opportunity you have for testing blood glucose after you've given the insulin shot. Some folks test during the evening if they can't manage to do it during the day.

We have a spreadsheet template here where you can record the data from Wilba's blood glucose tests. It can be really helpful to see all the data 'at a glance'; and it makes it much easier to spot trends and patterns. If you want help setting it up there are some smart techy people here who can assist (I'm not one of them... :smuggrin: )
FDMB SPREADSHEET INSTRUCTIONS

Eliz
 
Terry

One thing that would be very useful would be to set up a spreadsheet to record all the test numbers. Here are the instructions for setting one up.

http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

Since you are in the UK your readings are in mmol/l and you are using the AT2 pet meter so this would be the sheet you would want to use:

https://docs.google.com/spreadsheets/d/1hLCvQ-GPSqWBSD6X5afzxSzxFEGx7wTNZbIr12GPBVg/edit?usp=sharing

You enter your readings on the world reading tab and it will automatically convert to US numbers on the other tab so that members in the US can help you with information and advise.

Until you have collected more data It may be a good idea not to shoot for a few days. If you suddenly see the numbers going back up high then a shot may be needed, but at this point the numbers are not too far off the normal range when using a pet meter.

If you need help with setting up a spreadsheet then just give a holler. There is someone who can help you get set up very quickly.


ETA I see Elizabeth posted very similar information while I was typing so you have some good information from her.
 
Sounds like he is doing just great without insulin at the moment but it's good that you can test - it does get easier :)

It's very frightening how vets just seem to prescribe a high dosage initially but don't advise you to test - I was one of those and had a hypo cat in the first week. Her dose was 5 units - the emergency vet was horrified and said she should have been started at the lowest point and increased. My vet seemed to work on 1 unit per kg of weight!

My vet never seemed bothered about her eating - as long as I don't feed her biscuits she can eat several meals a day (which is a good job otherwise she wouldn't be happy!)

Hopefully you can get by without insulin.

Karen
 
Just an update, on Tuesday Wilba's level at 18:49 was 5.5, fed him, 2 hours later is was 11.1, no shots given that day.

Yesterday evening it was 20.8! Gave him 2 units of caninsulin and 2.5 hours later it dropped to 3.8, should have given him a smaller dose in hindsight. Tonight before feeding it was 7.4 (no shots). I've not changed what I'm feeding him so I wonder if it might be some specific ingredient in the different flavours which caused the spike?
 
Possibly keep a food diary to see if there are any correlations between spikes and the food and/or flavour eaten?

Hindsight is a wonderful thing!
 
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