Advice Needed

[Mr Bo's Mam]

Mr Bo was diagnosed with diabetes 3-4 weeks ago. He is 12 (ish) and we are in the UK. He appeared not to be responding to his dose of insulin (Caninsulin) so it was increased from 1 unit to one and a half, then we were due to start him on two units a day Boxing day but he became very unwell Christmas night which resulted in an out of hours visit. He had blood tests done and had "minimal" ketones and a UTi so was put on fluids and a long acting antibiotic and came home two days later.

We started home testing yesterday - pre food yesterday morning he was 23.2 and last night 22.6 - he was given 0.50 Caninsulin following each test.

This morning my husband fed him before I had chance to test him. I have given him 0.50 Caninsulin but he seems to be drinking more today. We also noticed before he was diagnosed that his breathing seems not so much laboured but noticeable. He had chest x rays and blood tests have shown no other issues. Any suggestions please of how we can move forward today. I only have 7 test strips left, have ordered more but they don't come until Tuesday. (Sorry for the long post). Help much appreciated.

 

[Diana&Tom]

Helllo and welcome to FDMB! This is very early on in the treatment of Mr Bo and it sounds as if you're being very vigilant and doing a great job so far, so well done.

Is there any reason you've dropped the dose to half a unit? It may not be enough at this point to lower bg and minimise symptoms such as excessive drinking. Numbers in the 20s as you've been getting probably warrant a higher dose. It's correct to start low and increase slowly, but if he's already been on 1u and 1.5u and not responding, you could probably re-start now at 1u and see what that does for a few days with a view to increasing if numbers don't start to go down.

Seven strips might just see you through till Tuesday if you test just twice a day before each shot - but it's always best to have a few spare in case you see worrying symptoms mid-cycle and need to test then. It sounds as if you've ordered the strips online but you should be able to get further supplies from Boots or any chemist.

Have you read the beginners guide to Caninsulin? It might be helpful to print it out and read it thoroughly if you have doubts, but keep posting here anyway. Good luck!

http://www.felinediabetes.com/FDMB/threads/beginners-guide-to-caninsulin-vetsulin.186099/

 

[Mr Bo's Mam]

Helllo and welcome to FDMB! This is very early on in the treatment of Mr Bo and it sounds as if you're being very vigilant and doing a great job so far, so well done.

Is there any reason you've dropped the dose to half a unit? It may not be enough at this point to lower bg and minimise symptoms such as excessive drinking. Numbers in the 20s as you've been getting probably warrant a higher dose. It's correct to start low and increase slowly, but if he's already been on 1u and 1.5u and not responding, you could probably re-start now at 1u and see what that does for a few days with a view to increasing if numbers don't start to go down.

Seven strips might just see you through till Tuesday if you test just twice a day before each shot - but it's always best to have a few spare in case you see worrying symptoms mid-cycle and need to test then. It sounds as if you've ordered the strips online but you should be able to get further supplies from Boots or any chemist.

Have you read the beginners guide to Caninsulin? It might be helpful to print it out and read it thoroughly if you have doubts, but keep posting here anyway. Good luck!

http://www.felinediabetes.com/FDMB/threads/beginners-guide-to-caninsulin-vetsulin.186099/

Thank you for your reply. I have just tested Mr Bo and his BG is 23.7 - he was given 0.50 three hours ago. What should I do? Should I give him more insulin now?

 

[Diana&Tom]

Thank you for your reply. I have just tested Mr Bo and his BG is 23.7 - he was given 0.50 three hours ago. What should I do? Should I give him more insulin now?

Only just been able to come back here and see your reply - no, don't give more insulin now. Caninsulin is given only at 12-hourly intervals. This is because like other insulins, it has a certain ONSET time (when it starts to work), a NADIR (when the bg is lowest during the cycle) and DURATION (how long it lasts before it peters out completely). Without data to show any of this, we don't know how the insulin is working, so if you dose again too soon in the cycle it could result in an overdose which is the very last thing you want.

We don't know how the 0.5u worked as even though you have the 23.7 three hours after shooting, we don't know what the pre shot number was. From what you said in your first post, you would likely have seen a number in the 20s also, as the amount of insulin probably wasn't enough to drop him much if at all. BUT this is guessing, you need to look at pre shot numbers in conjunction with dose and any mid cycle numbers to see exactly what the insulin is doing.

My main suggestion at this point is to stock up with strips and get some more tests in, then keep a note of your data and enter it onto a spreadsheet - that way we can see exactly what's going on and can offer more precise help. Do you need help with the spreadsheet? - if so please say, there are people here who can help (not me unfortunately).

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

 

[Sienne and Gabby (GA)]

Welcome to FDMB.

I'm guessing you're using a glucometer for pets? If that's the case, you can use a human glucometer (which is what many, many people use). The problem with a pet meter is just what you've noted -- the strips are not available in a pharmacy and have to be ordered. The strips are also very expensive compared to the strips for a human meter. There is not a huge difference in how a pet vs human glucometer are calibrated. The human meters run a little lower. I used a human meter for 6.5 years with my diabetic kitty and never had a problem. (And, frankly, it's what even vets used before pet specific meters were widely available.)

There is one prevailing issue -- your kitty was having issues with ketones recently. Not knowing what your vet told you about ketones, they can quickly become a life-threatening issue. Ketones develop if your cat has some sort of infection or inflammation (such as the UTI), isn't getting enough insulin, and not eating enough calories. I would encourage you to be very careful about reducing the insulin dose if blood glucose (BG) numbers remain high.

You can also test for ketones. You should be able to pick up ketone test strips (one brand in the US are Ketostix) to test for urinary ketones. Any pharmacy should have them. You need to follow the instructions on the box and see what the color coding tells you about the presence of ketones. As long as the levels are trace or lower, everything is fine. If they are higher, it's a trip to the vet. There are also blood ketone meters. The strips for the meters are expensive but you do not have to try to sort out the color coding -- the meters give you a number.

I realize that in the UK cats are required to be started on Caninsulin (or at least this was the case). Frankly, Caninsulin was an insulin developed for use with dogs. It does not have the duration to be as effective in cats given a cat's metabolism. The American Animal Hospital Assn guidelines for treating diabetes in cats (and dogs) indicates that either Lantus (glargine) or Prozinc are recommended for treating feline diabetes. This is a link to information for members who live in the UK. There is information on Insulins in the UK with a link to the International Society for Feline Medicine that makes the same recommendations regarding insulin choice. You may wish to discuss the choice of insulin with your vet.

How well is your kitty eating? And what is your cat eating? You want to make sure your cat is eating a low carbohydrate, canned food diet. In the link I provided for members in the UK, there is a link to a food chart for the UK. You want to select foods that are low in carbs -- under 10% carbohydrate. Many people here use foods that are about 5% carb. If you are feeding your cat a diet that is substantially high in carbs, please transition slowly and test regularly. Lowering the carb content of food can cause BG numbers to drop in many cats.

 

[Mr Bo's Mam]

Welcome to FDMB.

I'm guessing you're using a glucometer for pets? If that's the case, you can use a human glucometer (which is what many, many people use). The problem with a pet meter is just what you've noted -- the strips are not available in a pharmacy and have to be ordered. The strips are also very expensive compared to the strips for a human meter. There is not a huge difference in how a pet vs human glucometer are calibrated. The human meters run a little lower. I used a human meter for 6.5 years with my diabetic kitty and never had a problem. (And, frankly, it's what even vets used before pet specific meters were widely available.)

There is one prevailing issue -- your kitty was having issues with ketones recently. Not knowing what your vet told you about ketones, they can quickly become a life-threatening issue. Ketones develop if your cat has some sort of infection or inflammation (such as the UTI), isn't getting enough insulin, and not eating enough calories. I would encourage you to be very careful about reducing the insulin dose if blood glucose (BG) numbers remain high.

You can also test for ketones. You should be able to pick up ketone test strips (one brand in the US are Ketostix) to test for urinary ketones. Any pharmacy should have them. You need to follow the instructions on the box and see what the color coding tells you about the presence of ketones. As long as the levels are trace or lower, everything is fine. If they are higher, it's a trip to the vet. There are also blood ketone meters. The strips for the meters are expensive but you do not have to try to sort out the color coding -- the meters give you a number.

I realize that in the UK cats are required to be started on Caninsulin (or at least this was the case). Frankly, Caninsulin was an insulin developed for use with dogs. It does not have the duration to be as effective in cats given a cat's metabolism. The American Animal Hospital Assn guidelines for treating diabetes in cats (and dogs) indicates that either Lantus (glargine) or Prozinc are recommended for treating feline diabetes. This is a link to information for members who live in the UK. There is information on Insulins in the UK with a link to the International Society for Feline Medicine that makes the same recommendations regarding insulin choice. You may wish to discuss the choice of insulin with your vet.

How well is your kitty eating? And what is your cat eating? You want to make sure your cat is eating a low carbohydrate, canned food diet. In the link I provided for members in the UK, there is a link to a food chart for the UK. You want to select foods that are low in carbs -- under 10% carbohydrate. Many people here use foods that are about 5% carb. If you are feeding your cat a diet that is substantially high in carbs, please transition slowly and test regularly. Lowering the carb content of food can cause BG numbers to drop in many cats.

Hi, thanks for your reply. I am using a human glucometer - the codefree one from Amazon but I can't get the strips to use with it unless I order them online.

I have read up on ketones and I have also ordered some ketostix, again, I have been to three local pharmacies and phoned two others and all say they can order them in but don't have them as stock. I ordered these from Amazon too either yesterday of Friday.

Mr Bo is currently on Caninsulin but as soon as our regular vet is back in work on Thursday, I am going to ask her about changing this. I asked the emergency vet we saw Christmas night if we could change and she said it wasn't recommended but to speak to our regular vet to discuss managing the insulin use further.

Mr Bo went off his food Christmas day and by Christmas night wasn't eating. Once he was treated for the UTi his food intake picked back up and has been good until today. He is eating Tesco's own brand food which I found on the list as being under 10% carbs. Another UK member said it was a good choice food too. Mr Bo has been on this food for the last couple of months but we were also giving him biscuits which we have now cut out completely since the 27th Dec. and have been giving an extra pouch of food instead. I think the issue has been that I gave him 0.50 unit of insulin when it should have remained at the higher dose of 1. He has been on 0.50 for a couple of days and I feel now in hindsight this was too low. We only started home testing yesterday. Tonight his BG was 24.8 so I gave him one unit half hour after his food.

I have ordered more glucose strips (one lot was ordered end of last week and is due to come Tues or Weds and another lot is suppose to be here tomorrow on 24 hour delivery according to the email I received tonight.
Mr Bo is alert, has been playing on and off with his piece of ribbon and has been interacting with the other cats. He is also preening himself, appears to be drinking less this evening than he was during the day and has used the litter tray. He is an indoor cat who gets very stressed at the vets and I am aware that he must have felt very frightened being at the vets for two nights on the 25th and 26th Dec, in fact the vets rang and asked us to pick him up earlier than planned because they thought he would do better at home. he is a lovely, lovely cat who deserves to be well looked after as he has been let down by humans before coming to us ten years ago. He is very much loved so thank you for taking the time to share your knowledge.

 

[Mr Bo's Mam]

Only just been able to come back here and see your reply - no, don't give more insulin now. Caninsulin is given only at 12-hourly intervals. This is because like other insulins, it has a certain ONSET time (when it starts to work), a NADIR (when the bg is lowest during the cycle) and DURATION (how long it lasts before it peters out completely). Without data to show any of this, we don't know how the insulin is working, so if you dose again too soon in the cycle it could result in an overdose which is the very last thing you want.

We don't know how the 0.5u worked as even though you have the 23.7 three hours after shooting, we don't know what the pre shot number was. From what you said in your first post, you would likely have seen a number in the 20s also, as the amount of insulin probably wasn't enough to drop him much if at all. BUT this is guessing, you need to look at pre shot numbers in conjunction with dose and any mid cycle numbers to see exactly what the insulin is doing.

My main suggestion at this point is to stock up with strips and get some more tests in, then keep a note of your data and enter it onto a spreadsheet - that way we can see exactly what's going on and can offer more precise help. Do you need help with the spreadsheet? - if so please say, there are people here who can help (not me unfortunately).

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

Thanks for your reply. Yes, I am stocking up on the BG monitor strips - I now have two lots coming one hopefully tomorrow on 24 hour deliver - I have had the email to say it has been dispatched. I held off giving a "top up dose" as advised, Mr Bo had a BG reading of 24.8 so I have given him one unit 12 hrs apart from his last shot. The test was done before food and the insulin given half an hour after food.

I have looked at the spreadsheets and will ask my son if he can help however I may well be back asking for help with one in the near future. Many thanks for your help

 

[Sienne and Gabby (GA)]

If you need help with your spreadsheet, please tag @Marje and Gracie. She's wonderful with the spreadsheets.

It sounds quite frustrating that you're having to order so many of your supplies. You might want to consider a back-up meter - one where you can purchase strips at a local pharmacy. Most of us do purchase strips online given that the costs at a pharmacy are exorbitant. (Or, if you can get the house brand strips at a Walmart here in the US, those are economical.)

Please let us know how we can help.

 

[Marje and Gracie]

Thanks for your reply. Yes, I am stocking up on the BG monitor strips - I now have two lots coming one hopefully tomorrow on 24 hour deliver - I have had the email to say it has been dispatched. I held off giving a "top up dose" as advised, Mr Bo had a BG reading of 24.8 so I have given him one unit 12 hrs apart from his last shot. The test was done before food and the insulin given half an hour after food.

I have looked at the spreadsheets and will ask my son if he can help however I may well be back asking for help with one in the near future. Many thanks for your help

Please send me a private message to help with or do your spreadsheet. Just click on “Marje and Gracie” to the left and then “start a conversation”. Welcome to the board!

 

[Deb & Wink]

I'd take Marje & Gracie up on her offer. Only takes her a minute or 2 to set up the SS for you.

Asda is the name for Walmart in the UK. Unfortunately, items that are stocked at Walmart in the US might not be available in the UK. I'm not even sure that Asda has a pharmacy section like we do at Walmart in the US.

 

[Diana&Tom]

It's definitely worth getting a back-up meter that uses strips you can get quicker than the Code Free ones from Amazon. You'll get through a lot of strips! A good choice would be the One Touch Ultra which has been around for years and is very reliable - and you can buy strips from both pharmacies and ebay (many people here get supplies from ebay as they are much cheaper - as long as you check out the seller's reputation and expiry date of the strips you should be fine). I think some Asda stores have a pharmacy but not all - if there's a big store near you it might be worth asking if they have their own brand blood glucose testing supplies, but I doubt it somehow. Boots may have, not sure.

Don't hesitate to get the spreadsheet set up - once it's there, it's not difficult to use and it will make a big difference to how much we can help you. I think you could go for a 1u dose, with numbers in the 20s, but as you're getting more strips soon it's not a bad idea to wait until they arrive and you can test more often. Even half a unit's adjustment in dose can make a surprising difference to bg. When we see the response to a dose over a 12-hour period it will be easier to comment with more certainty.

The Tesco food you mention sounds fine (as is most wet food in jelly not gravy). Avoid anything that lists added sugars or starch in the list of ingredients. Several of us here like the Nature's Menu varieties which are good quality and which you can buy online at www.fetch.co.uk

Keep asking questions and good luck!