Morning Insulin shot challenge

[Siggi H]

Hello, we are at the end of week 2 with Insulin shots, twice a day and doing 3 blood tests, first one first thing in the morning, than he eats and than he gets his shot, 8am....than a test at 4/5 pm, when he comes inside from day out, than 8pm , than evening testing at around 10pm.

Now for the last couple days the morning shots are a challenge as he fights it, hissing, he's stressed and nervous. He usually a very happy, relaxed cat, who most of the time purr's still for the first blood test....

Question is, can the test be after the breakfast, just before the shot? Or too close together?
The afternoon test at 4/5pm and shot at 8pm are a bit easier, but often I have to wake him up.....wonder if there is a better way?
Maybe a less stressful one? or less time I have to 'pick' him up, as now he starts running when he sees me....

Many thanks!!

 

[MrWorfMen's Mom]

With Humulin, you need to make sure Obi has food on board before giving insulin. If he is being fussy in the morning, it's probably because he isn't eating overnight and is ravenous which is normal for an unregulated diabetic cat. You could try leaving some food out for Obi overnight to ease off his hunger before test time but any food left out should be picked up at least 2 hours prior to the morning BG test which may be problematic. A timed feeder could solve the problem if Obi will just gobble up the food when it's put down and/or picking up the food for the 2 hour fasting time needed in the morning doesn't work with your normal schedule.

You could try giving Obi a couple of tsps. of food, then test, then continue feeding but if you absolutely have to feed him before testing, just make sure you test him immediately after he finishes eating. The food will take a few minutes to hit his blood stream so shouldn't have a significant effect on BG if testing is done right after he eats.

It doesn't appear you are getting pre-shot tests at night. It's very important to get a pre-shot test before every shot to ensure it is safe to give Obi insulin. I'd also suggest you try to get some tests earlier on the day cycle. You are testing later in the cycle and are likely not seeing the lowest point in the cycle which is the information you need to determine whether Obi needs more or less insulin.

 

[Siggi H]

Hello Linda, thanks for this.
The times feeder sounds like an interesting idea, but although he is hungry he so annoyed in the morning that he doesn't want to eat at all!
Will try the idea of giving him a bit of food, do the test, have him eat and than give him the shot. Need to find out a way to calm him, and us, so that it's not a stressful thing for him

Afternoon tests are very hard, as during the day he is outside in our compound and comes and goes. 4pm is usually the time he comes in, but not always.
Also, the 4/5 pm results have been high compared to morning and night tests....which confuses us.

Another challenge is his food that I just have learned that we need to change to cater at this point more to his diabetes, than to his kidney problem. Working on that.

Thinking I might ask the vet if there is another option than Humulin. It's really hard to get something here in Kenya on a regular basis and in general. Humulin is easy to get and in constant supply.

 

[Idjit's mom]

Siggi, could you explore the idea of using an insulin that humans use like Lantus or Levemir? Perhaps do some of the research yourself on what human diabetics use there more often in Nairobi, and go from there. Many members here use those two insulins for their cats and they work very well.

 

[MrWorfMen's Mom]

While Humulin isn't the best option for cats, it is used periodically and can work for some cats. If you can get ProZinc, Lantus or Levemir they do tend to last longer in cats which is why you are seeing those higher numbers later in the cycle. The insulin is simply wearing off. The most dramatic effect on BG will be seen earlier in the cycle so if it's possible to keep Obi indoors periodically to grab an earlier test even at +2/3 post shot, it certainly would make getting him regulated easier.

Is there a special treat he likes? Perhaps employing a little bribery with something he loves could help quell some of his fussiness. If he knows his treat is coming, perhaps he'll settle a little more.

 

[Siggi H]

Siggi, could you explore the idea of using an insulin that humans use like Lantus or Levemir? Perhaps do some of the research yourself on what human diabetics use there more often in Nairobi, and go from there. Many members here use those two insulins for their cats and they work very well.

Thanks for that tip! Will for sure check this out. Have a pharmacy here that has been very helpful...will talk to them and see what the vet says.

 

[Siggi H]

While Humulin isn't the best option for cats, it is used periodically and can work for some cats. If you can get ProZinc, Lantus or Levemir they do tend to last longer in cats which is why you are seeing those higher numbers later in the cycle. The insulin is simply wearing off. The most dramatic effect on BG will be seen earlier in the cycle so if it's possible to keep Obi indoors periodically to grab an earlier test even at +2/3 post shot, it certainly would make getting him regulated easier.

Is there a special treat he likes? Perhaps employing a little bribery with something he loves could help quell some of his fussiness. If he knows his treat is coming, perhaps he'll settle a little more.

Thank you Linda! Will check on those 3 insulin options...learning so much. No idea it can wear off so quickly, but that explains a lot. The +2/3 can work...will just keep him in a bit longer.....what's periodically that makes sense? Once a week? more?

 

[MrWorfMen's Mom]

By periodically I mean as often as you can. Ideally you would do so each day but with a kitty probably itching to get out, it might not be feasible. Maybe try doing a +1 one day, a +2 the next and a +3 the day after and rotate so Obi doesn't get too bent out of shape trying to go out. Upset kitties aren't co-operative about testing and their BG can rise just from the their angst. And if he is being particularly unco-operative some days, don't sweat it. Any data is good data.

 

[Siggi H]

Got it! Need to throw him off a little, don't I?! Need to relax too as well, as I'm also getting too stressed....
Will check on those other insulin's tomorrow and check in again.
Have a lovely Sunday.

 

[Myrtlesmum]

Could you also try testing wherever he is sleeping? My cat is a bit on the grumpy side of things when it comes to tests, so wherever she happens to be - especially in the morning - is where I test her. It can be a little hard on my back depending if she’s on the floor or the very middle of the bed but anything to keep her calm. It’s actually really good doing this as she can be half asleep, I give her a little scritch on the head so she knows I love her and then quickly test before she quite knows what has happened. Then I feed her and give her insulin. It’s now all a little less stressful than it was at the beginning.

 

[Siggi H]

Could you also try testing wherever he is sleeping? My cat is a bit on the grumpy side of things when it comes to tests, so wherever she happens to be - especially in the morning - is where I test her. It can be a little hard on my back depending if she’s on the floor or the very middle of the bed but anything to keep her calm. It’s actually really good doing this as she can be half asleep, I give her a little scritch on the head so she knows I love her and then quickly test before she quite knows what has happened. Then I feed her and give her insulin. It’s now all a little less stressful than it was at the beginning.

Hello Myrtles Mum, funny enough the tests are the lesser challenge of the two.....the shots are the problems......this morning after the test, did a lot of distractions, treats, foods and it did go a bit better.

 

[Siggi H]

While Humulin isn't the best option for cats, it is used periodically and can work for some cats. If you can get ProZinc, Lantus or Levemir they do tend to last longer in cats which is why you are seeing those higher numbers later in the cycle. The insulin is simply wearing off. The most dramatic effect on BG will be seen earlier in the cycle so if it's possible to keep Obi indoors periodically to grab an earlier test even at +2/3 post shot, it certainly would make getting him regulated easier.

Is there a special treat he likes? Perhaps employing a little bribery with something he loves could help quell some of his fussiness. If he knows his treat is coming, perhaps he'll settle a little more.

I found Lantus here and we are going to get it today to hopefully start him on it tomorrow.
Any suggestion on what dose to start him with? He's been getting 2 units of the Humulin twice right now....really appreciate the input on this!!

 

[MrWorfMen's Mom]

When a cat has been on insulin the switch to Lantus is done directly so you would start with 2u. The longer lasting insulin works a bit differently and has to build up a depot in the body which takes a few cycles so you won't see the full effect from the Lantus for several days.

Have you read the stickies at the top of the Lantus/Levemir forum? Start there and when you move over to the L/L/ forum, the folks there will want to know if you are going to use the Start Low Go Slow (SLGS) method or the Tight Regulation (TR) protocol. TR is a bit more aggressive while SLGS is a little more relaxed. Some folks start off with SLGS and once they become more familiar with how the insulin works for their cat, they switch to TR. It's entirely your decision.

 

[Siggi H]

Thanks for this!!
Started reading the stickies - will familiar myself a bit more with it now and see what makes sense and what we can do!
Obi still not eating well today, hope his afternoon reading will be ok and he'll eat more for his dinner!
High hopes for the new insulin....

 

[MrWorfMen's Mom]

Have you checked Obi for ketones? A good idea to do so particularly if he is not eating as well as usual.

One other thing to consider. Do your syringes have half unit markings? If not can you get 0.3ml syringes with half unit markings? They are ideal for dosing changes which are usually done in 0.25u increments.

 

[Siggi H]

Please can you tell me what ketones is?

We have been searching high and low and called pretty much all suppliers here, nobody has 0.3ml syringes......
0.5ml is the smallest.

now just discovered that the Lantus only comes in a Pen form here, needles need to be attached......NO idea if that can work and if possible to get small amount out of this thing. Have to go tomorrow and talk to them.

 

[CandyH & Catcat]

fortunately for our cats, you do NOT need to use the pen needles -- the pen can be used like a vial, insert your regular syringe and draw the insulin

one difference, do not inject air into the pen, it's internally pressurized already -- I've read that air introduced into pen, can mess with the insulin

 

[CandyH & Catcat]

copied from one of the yellow sticky postings on the Lantus forum

 

[MrWorfMen's Mom]

The photo above is the Lantus cartridge that is inside the pen. Just remove the cap on the pen as if you were going to attach a needle and insert needle in the rubber stopper.

 

[Siggi H]

fortunately for our cats, you do NOT need to use the pen needles -- the pen can be used like a vial, insert your regular syringe and draw the insulin

one difference, do not inject air into the pen, it's internally pressurized already -- I've read that air introduced into pen, can mess with the insulin

Brilliant, thank you!
Just heard back from the Pharmacist, who 'cracked it' as she put it, how to get the small dose out. So relieved!! I think I'm giving these people new things to explore and discover..hehehe

Will pick it up in the morning!

 

[Siggi H]

He is still very sleepy today, no energy, now approaching 7pm, has hardly had any food, just a tiny bit just now and back to sleeping. Insulin shot coming up at 8pm....what to do??

And from drinking quite a bit last few days and peeing as well, today almost no water, no pee......his nose is cold and wet and he's purring, but bit worried.

 

[Myrtlesmum]

I notice he last tested at 8.3 - He may not be hungry as his blood glucose is in a more “normal “ range. I notice with my cat that when her blood glucose starts to normalise that she eats far less than when her bg is higher. See what the PMPS is then decide what if anything to shoot. If it was me and he tests under 200, I would skip the dose. It would be great if you could get in some around +4 tests as that is often the lowest point with Humulin - it would give you more confidence in knowing how much insulin to give when his numbers vary.

 

[MrWorfMen's Mom]

His BG appears to be down lower than it's been lately possibly due to lack of food? Have you tried watering down his food and warming it a bit to see if that will entice him? sprinkling some parmesan cheese or oregano will entice some cats. Can you get some meat only baby food or poach up some chicken for him? I'd definitely try to syringe some water into him and if need be some food run through the blender.

Ketones are basically the body trying to get the nutrition/energy it needs by breaking down muscle and organ tissue. They occur when diabetics don't get enough insulin, enough food and usually have an infection/inflammation of some sort. Dehydration is also a factor. You should be able to get ketostix at the pharmacy to check his urine for ketones. Any ketones over a trace in the urine are cause for a vet visit. Ketones if they get too high, lead to a condition called Diabetic ketone acidosis which is very serious very expensive to treat and can be fatal if not dealt with early and aggressively. This why we urge you to check for ketones especially when kitty goes off their food.

Some folks can just hold a spoon under kitty's bum to catch a bit of urine to test., Others put scrunched up plastic wrap into the litter box hoping to catch a few drops to test in the plastic. There are also meters you can get to test for ketones through the blood. Ketones will be detected in blood samples before they show up in the urine.

 

[Siggi H]

Thank you! That is good to know.....funny that now we decided to try Lantus he might get better with Humulin?!
But he is also not entirely himself, very tiered, no energy, didn't spend much time outside and the no drinking thing......will test him again in half an hour and see what it says!
In your opinion, would you stay a bit longer with Humulin or should we change?
Will get the +4 tests!

 

[Siggi H]

His BG appears to be down lower than it's been lately possibly due to lack of food? Have you tried watering down his food and warming it a bit to see if that will entice him? sprinkling some parmesan cheese or oregano will entice some cats. Can you get some meat only baby food or poach up some chicken for him? I'd definitely try to syringe some water into him and if need be some food run through the blender.

Ketones are basically the body trying to get the nutrition/energy it needs by breaking down muscle and organ tissue. They occur when diabetics don't get enough insulin, enough food and usually have an infection/inflammation of some sort. Dehydration is also a factor. You should be able to get ketostix at the pharmacy to check his urine for ketones. Any ketones over a trace in the urine are cause for a vet visit. Ketones if they get too high, lead to a condition called Diabetic ketone acidosis which is very serious very expensive to treat and can be fatal if not dealt with early and aggressively. This why we urge you to check for ketones especially when kitty goes off their food.

Some folks can just hold a spoon under kitty's bum to catch a bit of urine to test., Others put scrunched up plastic wrap into the litter box hoping to catch a few drops to test in the plastic. There are also meters you can get to test for ketones through the blood. Ketones will be detected in blood samples before they show up in the urine.

When at the pharmacy tomorrow will see if I can get that there and test his urine...getting a bit worried about that now! Will test him in half an hour, see what it says.

Yes, dried everything, warm water, his favorite food, wet food, chicken with broth, which made him gag (he usually at least has the broth) and finally offered him some dry kibbles last resort (for the kidney, although too much carbs I was desperate) he only had some. Will look for baby food tomorrow also and have some chicken in the house we can poach for him.

 

[Myrtlesmum]

Thank you! That is good to know.....funny that now we decided to try Lantus he might get better with Humulin?!
But he is also not entirely himself, very tiered, no energy, didn't spend much time outside and the no drinking thing......will test him again in half an hour and see what it says!
In your opinion, would you stay a bit longer with Humulin or should we change?
Will get the +4 tests!

My cat was on Isophane (Humulin) when she was first diagnosed in 2017 and went into remission after about a month. This time I started her back on the Isophane but was convinced to change to Lantus. Personally, I like Isophane as it is very predictable - I found that with a given dose I knew almost exactly how much she would drop and what her PMPS would be. With Lantus I find she is a bit more all over the place although maybe I just need to give it more time. I know this post will probably bring on a heap of posts about how Lantus is so much better and people on here seem to be very passionate about it and a bit anti-Isophane but every cat is different and what might work for one cat may not work for another. Yes, Isophane is a bit harsher and causes a bit of a faster drop but when you find the right dose you can end up with a nice, consistent curve. Ultimately the decision is up to you, there really is no right or wrong answer - just trial and error.

 

[CandyH & Catcat]

ECID -- every cat is different -- we transitioned to Lantus because the Caninsulin/Vetsulin was not lasting the full 12 hours between shots, and his BG went up for several hours before shot time -- if Humulin/Isophane lasts long enough, and is predictable, that's all to the good

the fatigue/tiredness concerns me, makes me think something else is going on besides the diabetes, hoping you find out what it is and that it's treatable

 

[Siggi H]

I notice he last tested at 8.3 - He may not be hungry as his blood glucose is in a more “normal “ range. I notice with my cat that when her blood glucose starts to normalise that she eats far less than when her bg is higher. See what the PMPS is then decide what if anything to shoot. If it was me and he tests under 200, I would skip the dose. It would be great if you could get in some around +4 tests as that is often the lowest point with Humulin - it would give you more confidence in knowing how much insulin to give when his numbers vary.

We just tested him and it went up a bit again, could have been the little bit of kipples and it is now at 16.2....which is 292. Still hesitant to give him the shot as really not much food to talk of and it was an hour ago..... what should I do? and he's not getting up to eat now......do I make it get up and see if he eats?

 

[Siggi H]

ECID -- every cat is different -- we transitioned to Lantus because the Caninsulin/Vetsulin was not lasting the full 12 hours between shots, and his BG went up for several hours before shot time -- if Humulin/Isophane lasts long enough, and is predictable, that's all to the good

the fatigue/tiredness concerns me, makes me think something else is going on besides the diabetes, hoping you find out what it is and that it's treatable

Hello Candy, that's what happened with Obi, usually afternoon readings have been high....

His kidneys are also compromised, although levels are not too bad yet.....and he sometimes has UTI's which doesn't look that's what he has now.
It's the not drinking an tiredness , it started yesterday, but thought he just didn't have a good day and was annoyed with shots etc. This morning was a bit better, but than slowed down....

 

[MrWorfMen's Mom]

I would definitely see if you can get him to eat again before shooting insulin and even then I think a reduced dose might be safer till his appetite improves. If you give insulin and he isn't eating and starts going low, you won't have much to work with in order to keep BG in safe range.

 

[Siggi H]

Bit of a rough night....Obi didn't eat last night and we had him sleep with us. At 2am he vomited everything out of the very little he eat. Slept a bit more and a bit more vomit at 6:30am. He did drink, but no interest in food. Took him to the Vet and he will stay in for the day for fluids, urine tests and something to get his appetite up. Was able to stay and be with him when they put the needle in for the fluids etc. He is such a brave little guy, but scared to bits.....first time drip and staying at vets clinic. Hope to be able to pick him up at 6 pm tonight.

 

[Siggi H]

My cat was on Isophane (Humulin) when she was first diagnosed in 2017 and went into remission after about a month. This time I started her back on the Isophane but was convinced to change to Lantus. Personally, I like Isophane as it is very predictable - I found that with a given dose I knew almost exactly how much she would drop and what her PMPS would be. With Lantus I find she is a bit more all over the place although maybe I just need to give it more time. I know this post will probably bring on a heap of posts about how Lantus is so much better and people on here seem to be very passionate about it and a bit anti-Isophane but every cat is different and what might work for one cat may not work for another. Yes, Isophane is a bit harsher and causes a bit of a faster drop but when you find the right dose you can end up with a nice, consistent curve. Ultimately the decision is up to you, there really is no right or wrong answer - just trial and error.

Thanks for this!!
Really do appreciate the input....as it turns out after last night we will stay with Humulin for a bit longer, change his schedule a bit (give one shot at 8am and the second at 4pm to balance out his afternoon highs) Lantus is an option and I now know we can get it here, but will try this first. Vet thinks most of this comes from him being totally stressed, so, the less invasive we can make it for him the better for now!

 

[Myrtlesmum]

Bit of a rough night....Obi didn't eat last night and we had him sleep with us. At 2am he vomited everything out of the very little he eat. Slept a bit more and a bit more vomit at 6:30am. He did drink, but no interest in food. Took him to the Vet and he will stay in for the day for fluids, urine tests and something to get his appetite up. Was able to stay and be with him when they put the needle in for the fluids etc. He is such a brave little guy, but scared to bits.....first time drip and staying at vets clinic. Hope to be able to pick him up at 6 pm tonight.

I hope the vet can sort ou what is going on and Obi starts to feel better soon - both for his sake and yours!

 

[MrWorfMen's Mom]

change his schedule a bit (give one shot at 8am and the second at 4pm to balance out his afternoon highs) Lantus is an option and I now know we can get it here, but will try this first. Vet thinks most of this comes from him being totally stressed, so, the less invasive we can make it for him the better for now!

Why does the vet think Obi is stressed? How is the vet suggesting you make this less "invasive"? Is the vet suggesting you test less? Or was the vet just referring to the vet visit?

Due to the shorter action of the Humulin, there are times when 3 shots a day at 8 hour intervals can work HOWEVER that schedule is very difficult for you, the caregiver and switching to a longer acting insulin like Lantus would be preferable both for you and Obi. If the suggestion is to give insulin only twice daily at 8am/4pm it's not going to fix the problem because there will still be 8 hours a day when the insulin will be far less active if active at all. If you try an 8 hour shot schedule, it will be necessary to test more rather than less to ensure Obi stays safe because you will have to make sure BG is high enough to give shots that close together.

I trust the vet checked Obi for ketones. Were they negative? See if the vet will give you some anti-nausea medication and an appetite stimulant to use at home. Cerenia and/or Odansetron are options for nausea and that should be given with an appetite stimulant because you don't want to be stimulating a nauseated cat's appetite.

 

[Siggi H]

Took day off yesterday to give Obi a break after a tough day for him at the Vets office.....he got 4 x 100ml fluids, urine test, and vitamins with anti-nausea meds. Brought him home, only had a bit of food. Very guarded and sleepy. Restless during the night. Next day, Wednesday still no interest in food, so we got an appetite stimulant and it kicked in around 7pm and he had a nice dinner, eat about 100gram of wet food and some boiled chicken. This morning we took his reading at 14.6/263 and monitoring his eating. Still not perfect, but he comes in for small nipples. One more day off for him.

Ketones were negative!! Attaching the test. I understand it confirms the compromised kidneys, but rest not too bad. The glucose result to be expected, as he must have been in a state!

We are not sure why he vomited.....assumption is he eat something bad outside.

Starting insulin again tomorrow.

 

[MrWorfMen's Mom]

Glad to see the ketones were negative and that Obi has eaten on his own. While I wouldn't have stopped the insulin completely with those BG readings it looks like his BG has stayed pretty much the same. That said, the BG could still be influenced by less food. I'd keep checking for ketones at home even if Obi is eating better and get back on the insulin.
If Obi's appetite is still not optimal, you might want to consider a slightly reduced dose of insulin until he recovers completely and appetite returns to normal.

 

[Siggi H]

We just took another reading....our 4pm and it's at 13.9/250...... can it be the less food?! After a nice breakfast he had only little nipples so far, just now he had a bit more of a meal. But still less than 'normal'. His bigger meal is a bit later in the day. So, we see.
Sadly I can't check the ketones at home as the test strips are not available in Kenya....will bring some back from Germany when I go in Aug!!
Thanks for the tip on slightly reducing the dose......those tests are not making sense to us.....

 

[MrWorfMen's Mom]

Those readings are a bit puzzling given Obi has had no insulin for a few days. If he had an infection/inflammation one would usually expect BG to be up rather than down. While I'm sure the diminished food intake is playing a role, I also have to wonder if the dose of insulin may have been a little too high causing some elevation. Too much insulin can look just like too little. Right now I'd concentrate on getting as much nutrition into Obi as you can and I wouldn't worry about the carb content of his food so much as getting calories into him. Insulin can be dosed to deal with extra calories/carbs when kitty needs food and is reluctant to eat what they need if BG should start going up.

I'm quite surprised Ketostix or such are not available. Do they have strips that measure sugar in the urine? If so, there are strips that measure both sugar and ketones (Diastix is one brand) and maybe the pharmacy just didn't think of those or even know about the dual purpose.

 

[Siggi H]

I'm quite surprised Ketostix or such are not available. Do they have strips that measure sugar in the urine? If so, there are strips that measure both sugar and ketones (Diastix is one brand) and maybe the pharmacy just didn't think of those or even know about the dual purpose.

I'm trying to find out if available someplace.

We are having a hard time.....on day 3 now again with insulin, again Obi is not eating and found him outside vomiting and trying to pee every 2 min, UTI with blood and a bit of diarrhea . Got him inside, settled, some water and ACV with water in him (always helps). He's sleeping now and resting.

I'm have a feeling he developed the UTI due to stress ( as urine test on Tuesday was fine).....he hates the insulin shot, had to do it with towel yesterday as not a chance otherwise. He also has been cleaning himself at times excessively, which is new for him.

.....

 

[MrWorfMen's Mom]

If there is blood in Obi's urine, he's trying to pee repeatedly, has diarrhea and his appetite is off, sounds to me like a visit to the vet is in order. You need to make sure Obi eats something and stays well hydrated. While his BG isn't horribly high it is still elevated and I don't think withholding insulin for those few days was a good idea. I would be very concerned about ketones and get Obi to the vet as soon as you can.

 

[Myrtlesmum]

And I hate to be a butinsky, but by dosing him in the morning, then 8 hours later and then next morning is 16 hours later puts him on a very irregular cycle for insulin and gives his bg time to climb higher during that 16 hour period. I would say, if you really want to do the 8 hour thing it would make more sense to give insulin every 8 hours. Or every 12 hours. Personally, I would be going for trying to find the right dose for every 12 hours - 8 hourly is very unusual and may be hard for you to maintain.