A shot two hours early?

[Sarah97]

Can I give an SID Shot two hours early?
Or should I just skip it? He’s not regulated yet.
Please know that I’m only asking because I won’t be with him at the time of his insulin shot and it’s a long car ride for him. His BG will rise.
It’s a mix of fast acting insulin and NPH

 

[Sienne and Gabby (GA)]

I would skip. There's not enough data on your spreadsheet to know how this insulin will work.

I would also discuss changing insulin with your vet. Mixtard is not recommended for cats. In fact, NPH, which has been around for a long time, is not recommended for cats. Frankly, Mixtard is way too dangerous (IMHO) to be used in cats. In discussing it's use with a vet, her read on the use of Mixtard was that it might be of benefit in a cat that is hospitalized for diabetic ketoacidosis where you need to lower blood glucose levels very quickly, the cat is being monitored 24/7, and is on a continuous glucose or dextrose drip. I doubt this is the case for Tiggo. The vet actually put a note out on a professional listserv and it is not being used in the US with animals.

The American Animal Hospital Assn recommends either Lantus or Prozinc and has been making this recommendation for years. This is a link to their 2018 recommendation paper.

 

[Sarah97]

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I would skip. There's not enough data on your spreadsheet to know how this insulin will work.

I would also discuss changing insulin with your vet. Mixtard is not recommended for cats. In fact, NPH, which has been around for a long time, is not recommended for cats. Frankly, Mixtard is way too dangerous (IMHO) to be used in cats. In discussing it's use with a vet, her read on the use of Mixtard was that it might be of benefit in a cat that is hospitalized for diabetic ketoacidosis where you need to lower blood glucose levels very quickly, the cat is being monitored 24/7, and is on a continuous glucose or dextrose drip. I doubt this is the case for Tiggo. The vet actually put a note out on a professional listserv and it is not being used in the US with animals.

The American Animal Hospital Assn recommends either Lantus or Prozinc and has been making this recommendation for years. This is a link to their 2018 recommendation paper.

He was hospitalized for a week for being ketoacidic and when asked if he still has ketones the vet said yes he still has some traces in his urine

 

[Larry and Kitties]

Why are you giving SID (once daily)? Both components of the Mixtard 30 should wear off in 8-10 hours and BID (twice daily) dosing would ne a lot better than SID.
I have no problem based on your SS data of giving a SID dose at +22 hours vice 24 hours after last dose.

 

[Sienne and Gabby (GA)]

Trace levels are manageable. You want to make sure Tiggo is eating -- calories are important. You also want to add water to his food.

The general recipe for ketones to develop is an infection/inflammation + not enough insulin + not enough calories.

Given that Tiggo has had an episode of DKA, I would not skip his insulin. The issue with Mixtard is it has very limited duration and slams numbers down. Is your vet having you dose insulin only once a day? This is also not acceptable in a kitty that's post DKA. Please talk to your vet about switching your cat over to an insulin that's appropriate for felines. I'm just not comfortable with your giving your cat 2.0u. The drop from the 300s to 80 warrants a dose reduction. We usually reduce doses by 0.25u.

None of us have experience with Mixtard. If DKA were not a factor, I'd suggest you reduce the dose to 1.0u at both AM and 12 hours later so you're dosing twice a day. Is there a vet who's a cat specialist in your area?

@Larry and Kitties - I actually think the onset and duration are shorter, although it may depend on the ratio of R to NPH. See this post - there's info in the 3rd paragraph. I wasn't able to find any compelling research on the use of Mixtard in cats.

 

[Larry and Kitties]

I would have no problems with going to the same 2U Mixtard BID since you are using a human meter and have history of ketones. I would have not objection to droping it to 1 1/2 units BID but would not drop further to 1 units BID

 

[Sarah97]

Why are you giving SID (once daily)? Both components of the Mixtard 30 should wear off in 8-10 hours and BID (twice daily) dosing would ne a lot better than SID.
I have no problem based on your SS data of giving a SID dose at +22 hours vice 24 hours after last dose.

I know it was not the right choice, but he just finished his first week of insulin at home and he was very recently diagnosed. I'm still new to all of this and still learning. I was scared to not follow the vets advice and he would not listen to me.

 

[Sarah97]

Trace levels are manageable. You want to make sure Tiggo is eating -- calories are important. You also want to add water to his food.

The general recipe for ketones to develop is an infection/inflammation + not enough insulin + not enough calories.

Given that Tiggo has had an episode of DKA, I would not skip his insulin. The issue with Mixtard is it has very limited duration and slams numbers down. Is your vet having you dose insulin only once a day? This is also not acceptable in a kitty that's post DKA. Please talk to your vet about switching your cat over to an insulin that's appropriate for felines. I'm just not comfortable with your giving your cat 2.0u. The drop from the 300s to 80 warrants a dose reduction. We usually reduce doses by 0.25u.

None of us have experience with Mixtard. If DKA were not a factor, I'd suggest you reduce the dose to 1.0u at both AM and 12 hours later so you're dosing twice a day. Is there a vet who's a cat specialist in your area?

@Larry and Kitties - I actually think the onset and duration are shorter, although it may depend on the ratio of R to NPH. See this post - there's info in the 3rd paragraph. I wasn't able to find any compelling research on the use of Mixtard in cats.

Trace levels are manageable. You want to make sure Tiggo is eating -- calories are important. You also want to add water to his food.

Tiggo is actually eating pretty well I'm adding water to his food and because i'm scarred of the mixtard dropping his BG very rapidly, i'm adding a few grams of regular dry kibble. I work 8-6 to it's pretty hard to test him multiple times, that's why i only do it when i have a vacation or off work. Today i decreased the amount ofdry kibble i usually give him and his BG dropped to 80, Imagine if i stopped the dry kibble.
I'm working on changing vets, but the other vet is 2 hours away which is inconvenient, but Tiggo's foster parents trust him enough.
I'm scared of the ketones because it looks like he is developing some kind of respiratory infection :/.