New to all this! Question on insulin

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Molly the cat

Molly the cat

Member Since 2020
Hi all! Our Molly was just diagnosed with diabetes on Friday. She had to be hospitalized for diabetic ketoacidosis, which was absolutely heartbreaking. She made it through, thankfully, and we were able to bring her home on Tuesday evening. So, we just started with the BG monitoring, insulin shots, and the whole shebang yesterday morning.

She's on Vetsulin, and the doc had her at 5 units. Yesterday morning, we gave her the 5 units and she was really tired and seemed a little shaky, so we took her into our regular vet (not where she was hospitalized). The vet there said that she had low BG and that 5 units was too many, to skip her dose that evening and to give her 2 units starting the next morning (today). This morning we gave her 2 units of Vetsulin after breakfast.

Well, we got our BG monitor in today, so we tested Molly's sugar just before dinner. It was 426 - obviously too high. We've fed her but really aren't sure what dose she should get in about half an hour. 2 units too low? 5 too high? Which doctor's orders do we go with??

Sorry if this is a little scattered, but we are just so unsure, especially without a consensus about what to do. Any advice would be so appreciated. Thanks!

- Jen (making this post), Micki, and Joe
 
Hi Jen, Molly and family. Welcome to FDMB

I have never used Vetsulin but I can tell you that 5 units is way too high for a starting dose. Generally we recommend no more than 1 unit twice a day for any insulin. As you have already discovered, 5 units caused Molly to become hypoglycemic. This is a very dangerous condition. If this happens again rub Kari syrup on her gums and feed her some hi carb food to raise her glucose levels.

I am glad to see you are home testing. You want to test before she eats and then give the insulin after she eats. I suggest you only give her 1 unit tonight, but I am also going to reach out to the Vetsulin board so some members that use Vetsulin can advise you.
 
Welcome to the best place you never thought you would be. And kudos for starting to home test. It is the only way to keep Molly safe.

Molly the cat said:
The vet there said that she had low BG and that 5 units was too many
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Do you remember what the number was?

What meds did the vet send home with her?

What is she currently eating? With recent DKA in the frame, it is very important that Molly eat.

A bit of information on DKA:

FYI:
Read and print out these two links.
 
I'm not sure how to use the forum yet, so my post is awaiting moderation... is it better to just reply directly to the thread?

Anyway, this was my reply!:
Hi! Thank you so much for your reply and for the additional questions.

1. My mom was the one who took her and says that her reading was 147 at the vet's yesterday. If it's relevant, this was around 3pm and she had received her insulin at 8:30am.
2. She is currently receiving Vetsulin. That's the only medication we were sent home with.
3. She is eating Purina ProPlan Veterinary Diets DM Savory Selects (that's a mouthful!). We received this food from her usual vet's office. Thankfully, Molly's appetite has been good since she's been home.

Thank you so much for the links. I'll make sure and print them out/save them now!

- Jen
 
Ah okay! Got it. Thank you so much.

It was time to give her insulin so we gave her the 2 units. I'm hoping that's okay for tonight, since she had gotten 2 units this morning and she was okay throughout the day. Although, now I'm worrying a bit. I'll make sure to keep an eye on her.

You all are amazing. How does anyone sleep at night here??? Haha. Thank you so much for the help.

- Jen & Molly
 
5 is definitely too much for a recently diagnosed cat. Most cats never need more than 2-3 units. The usual starting dose is 1 unit twice a day.

Great job learning to home test. Numbers in the 400's before insulin is common in y the beginning. It's a marathon.
If you haven't already, feed a low carb wet food.

You can monitor ketones at home. I find the easiest way is with a ketone blood meter.
 
There a couple of things to consider. Vetsulin works fast and doesn't last the full 12 hours of the cycle. You tend to see swings in the numbers. The numbers will drop probably for the 4 hours or so after you shoot and then start to rise. It’s not surprising that numbers are high at pre-shot.

I would stick with the 2u The 5u dose was too much. I’d encourage you to test at 2 and 4 Hours after you shoot.
 
Thank you Janet. It's reassuring to know that numbers in the 400s are not atypical at the beginning. I do keep seeing on this forum that it's a marathon, and trying to keep that in mind!!

Sienne, thank you for the detail on how Vetsulin works. When you say testing at 2 and 4 hours, do you mean every time we give her her insulin, or just this time? Thank you!
 
Now that you’re home testing, it be a good idea go transition to low carb wet food only. Most of us feed fancy feast wet which is less than 10% carbs and that’s what you want. Take a look at this food chart to see where what you’re feeding now is. I have a feeling it’s high. Most vet prescribed cat food is high on carbs and there’s nothing special about it other than the price tag!
 
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Thank you for sharing this extensive spreadsheet of cat foods! The one they've prescribed Molly is listed as 10% carbs. So I suppose that's okay? But we will investigate the Fancy Feast wet food that you mentioned. Thanks again!
 
Molly the cat said:
Thank you Janet. It's reassuring to know that numbers in the 400s are not atypical at the beginning. I do keep seeing on this forum that it's a marathon, and trying to keep that in mind!!

Sienne, thank you for the detail on how Vetsulin works. When you say testing at 2 and 4 hours, do you mean every time we give her her insulin, or just this time? Thank you!
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You have to test her after giving insulin all the time, morning and night to see how the Vetsulin is working and how and when how low she drops
Most of us test 2 to 4 times after shooting, it all depends on what her numbers are and to keep her safe.
Scatters the hours you test her
On day @+2 ( 2 hours after you shoot) then @+3 @+6 day and night
Then the next day maybe test @+3, them @+5 then @+7
Take a look at anyone's spreadsheet, it will give you an idea what I mean
 
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    • Caregiver & kitty's name (optional)
    • DX: Date
    • Name of Insulin
    • Name of your meter
    • Diet: "LC wet" or "dry food" or "combo"
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tap on your avatar where it says your name ,then hit profile page ,tap on that ,then go up to the very top, upper right hand side and tap on your name ,it will bring down a drop box, tap on signature, the signature will be under settings, tap on the signature then and you can start to add what I posted above, make sure you hit save ,
Welcome to the best place you could ever be and an awesome group of people
 
Hi Jen,

Aleluia Grugru & Minnie said:
Now that you’re home testing, it be a good idea go transition to low carb wet food only.
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While in general it is good practice to change cats on higher carb diets to a low carb one (provided the caregiver is home testing and can monitor their kitty to keep them safe!), in your particular instance, Jen, I strongly recommend that you stick with the food that Molly is currently eating for the time being. My reasoning:

1. Molly is has just been through DKA. It is vital she continues to eat well so that she makes a really solid recovery. You need to ensure that Molly gets BOTH enough food and enough insulin every day to keep her ketone-free. Changing foods can cause tummy troubles and you don't want to get into a situation where Molly might experience eating difficulties and start throwing ketones again.

2. There are question marks over Molly's Vetsulin dose at the moment so it's not a good time to experiment with food choices. You're dealing with too many unknowns right now and, at 10% carbs, the current food is fine anyway.

-----------------

The first thing you need to do is determine how Molly is responding to her insulin, and this is where your home testing comes in. (Well done on getting to grips with it so quickly! :cool: )

Diabetic cats on insulin receive 2 doses a day, 12 hours apart. Each 12-hour period is called a cycle.

For each cycle:

1. You need to check Molly's blood glucose (BG) before each injection to make sure it is safe to give. These are called preshot (PS) tests, and you'll have one in the morning (AMPS) and one in the evening (PMPS).

2. You need to make sure that Molly does not eat any food or treats for two hours before each PS test (to make sure that the reading is not influenced by food).

3. The insulin you are using (Vetsulin) typically drops BG levels quite hard and fast at the beginning of the cycle, so you need to 'front-load' Molly with food for it to work on. Therefore, assuming it is safe to give the next dose, you need to feed Molly, wait 20-30 minutes and then, assuming she has eaten her grub OK, give her her injection.

4. As recommended above by Sienne, check Molly's BG levels 2 hours and 4 hours after the injection was given (+2 and +4 readings in FDMB parlance). This will give you insight into how low the dose is taking Molly's BG levels, so that you can determine its safety and efficacy.

Brief Summary of Daily Routine

For every cycle:

Lift food 2 hours before each PS BG check is due. Make sure Molly eats a substantial feed 20-30 minutes before each insulin dose. Feed Molly as normal during the rest of the cycle. If Molly is running in low numbers at any time, seek help and advice from your vet and also here. If at any time BG is <50 on a human meter you need to intervene immediately to raise BG back to a safe level. (See the hypo guides that Red posted links to earlier in this thread. You can post here for help as well.)

Morning:

* AMPS - preshot BG check (if less than 200 on a human meter, stall giving the injection, contact vet for advice and post here for help)
* Feed, and wait 20-30 minutes ('front-loading' with food - stall injection and seek help from vet and FDMB if Molly doesn't eat her meal)
* Give insulin dose (assuming it is safe to do so)
* AM+2 - test BG level (to check how quickly BG is lowering)
* AM+4 - test BG level (at the likely lowest point in the cycle - the nadir - to check dose safety)

Evening:

* PMPS - preshot check
* Feed and wait 20-30 minutes
* Give insulin dose (if safe)
* PM+2 - test BG level
* PM+4 - test BG level (the 'before bed' check - important for safety!)

We have a handy spreadsheet for you to record Molly's BG results as you go along. It will help people here to help you better when we can see how Molly's responding to her Vetsulin. Here are the instructions on how to set one up (and shout out if you'd like any help with this):

FDMB Spreadsheet Instructions

Understanding the Spreadsheet Grid

OK, that's your starter for ten. With feline diabetes, there's a bit of a steep learning curve at the best of times but you guys have had a real baptism of fire. :eek: I'm glad you've found us. We'll do all we can to help you and your little one. (She has a gorgeous face, BTW! :cat: )


Mogs
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Thank you all so much for the additional information. We are still getting Molly used to being pricked (she shied away from me this morning :() so hopefully we can started with the 2 hours after and the 4 hours after for testing soon. We'll give it a try today.

We have a pet glucose monitor, and her reading this morning was 297. I'm assuming that's still high, but I can't figure out if there's a conversion to the human reading? I'm looking through the forum now, but if anyone knows what that conversion might look like, it would be very helpful. Thanks!

*ETA oh and thank you! We love our little Molly girl and her little face :)
 
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297 on a pet meter ain't too bad at all for a newly diagnosed cat, Jen. It's in the diabetic range but BG can go much higher than that and Molly's only just starting treatment. The significance of the test depends on the time when the reading was taken relative to the time of the most recent insulin dose.

Most people here use human glucometers because the test strips are significantly cheaper than the ones for the pet meters. There's no direct conversion of readings needed (or really possible, though many here have tried in the past!). The key is to use the correct blood glucose reference range for the meter you are using.

FDMB uses the range 50-120mg/dL for human meters.

FDMB has evidence to support using 68mg/dL as the lower limit for pet meters. I've not been here for a while but IIRC the upper limit for a pet meter is about 150mg/dL but I hope other members will correct that figure if it's wrong.

When setting up Molly's spreadsheet, select the template for pet meters (it may be under the name 'Alphatrak').


Mogs
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Molly the cat said:
Thank you all so much for the additional information. We are still getting Molly used to being pricked (she shied away from me this morning :() so hopefully we can started with the 2 hours after and the 4 hours after for testing soon. We'll give it a try today.

We have a pet glucose monitor, and her reading this morning was 297. I'm assuming that's still high, but I can't figure out if there's a conversion to the human reading? I'm looking through the forum now, but if anyone knows what that conversion might look like, it would be very helpful. Thanks!

*ETA oh and thank you! We love our little Molly girl and her little face :)
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One way to help Molly respond better to testing is to reward her every time you test with a low carb treat. Freeze dried chicken is a great treat for them and most cats love it. Even though you can find them in the cat section of the pet food stores, it is a better deal to get the ones in the dog treat section. You get more treats for your money. ;) Also, even if you are not successful with the test, give her the treat anyway. Then she will begin to associate testing with something good.

Also, if you are nervous while testing, she will pick up on it and become nervous also. One suggestion we have is to sing while testing. Sounds silly right? But it will calm you especially if it is a silly song.
 
Lisa and Witn (GA) said:
One suggestion we have is to sing while testing.
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^ ^ ^ This! ^ ^ ^

It's not a silly suggestion, it works! Fake it till ya make it! :cat:

It may also help in the early days to take Molly to her testing station, give her lots of fusses and praise and her yummy treat, get her used to having her ears handled but don't do a test. Then move her away from the station. It should hopefully get her to associate her testing spot with nice things happening.

After a while some cats actually start sitting at their stations waiting to be tested! :)


Mogs
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Critter Mom said:
^ ^ ^ This! ^ ^ ^

It's not a silly suggestion, it works! Fake it till ya make it! :cat:

It may also helps in the early days to take Molly to her testing station, give her lots of fusses and praise and her yummy treat, get her used to having her ears handled but don't do a test. Then move her away from the station. It should hopefully get her to associate her testing spot with nice things happening.

After a while some cats actually start sitting at their stations waiting to be tested! :)


Mogs
.
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Absolutely!! I sing the same lullaby every time and Minnie knows when she hears it that is testing time and lays down and waits patiently :cat:
 
Hi everyone! Thank you so much for the advice, and for checking in again! Molly actually has her own song, called "Moll the Ball." I sang that to her last time we pricked her. Not sure if it's helping haha but I'll try and get in the habit of singing her song!

We tested her at +4 and BG was 91. She had a little snack of her regular wet food after that, as she was looking to eat something. Still not sure about how snacks work, but I am reading that that's a thing so I will look into it more! She seems to be doing fine, though, currently having an after snack nap.

I'm just about to finish my lunch break but when I'm off work for the day I'll take a look at setting up a spreadsheet for Molly. Thanks again!!

- Jen & Molly
 
Q: How low should my cat’s BG drop on Caninsulin/Vetsulin?
Usually it's best that newcomers aim for a nadir no lower than 90 mg/dL (5 mmol/L) as measured on a human glucose meter. This insulin can drop the BG quite sharply. Trying not to let the BG drop below this level as it gives an initial safety buffer while you are learning the ropes.

May even put a couple of drops of honey or karo on the food.
 
Red & Rover (GA) said:
See if you can get her to eat more food before you leave for work and leave out some extra food before you go back to work.
We really do not want her to go any lower than 91.
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Thanks for letting us know Red. I work from home thankfully, and my mom is here too. We're going to give her a little more food. She hopped up as soon as she heard my mom clinking the bowls around.
 
Let's see how the food affects her numbers.
Can you or your mom test at +4.5 and +5?
She is in safe numbers but for a newly diagnosed cat, it's a stand up and take notice number.

At 68 on a pet meter, action needs to be taken.

btw: it is impossible to compare pet and human meters. They use different references and scales. In the olden days, vets used to use human meters then a company got the idea to make pet-specific meters and charge a lot more.
The two meters give similar readings at lower levels but are farther apart with high numbers.
What we do know is that the "take action" number on a human meter is 50. The "take action" number on a pet meter is 68.
High is high on any meter.
 
Panic said:
Hi Jen. I skimmed your thread - am I right in understanding you're using a pet meter (Alphatrak)?
I am pretty sure @Deb & Wink said somewhere that she doesn't like seeing drops below 100-120 on Alphatrak for Vetsulin. I could be wrong, but I still think 91 on a pet meter would earn a reduction for Vetsulin.
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I used a pet meter, and while 91 is in the safe normal range, I agree that there's no real wiggle room.

Jen, you are doing an absolutely terrific job of looking after Molly and checking her BG levels. Molly is in safe numbers and she's doing fine but it's best to have a bit more of a safety margin at nadir.

Under normal circumstances, a dose reduction would be given as a matter of course. However, Molly is just recently recovered from DKA so a little extra caution is required regarding her insulin needs.

As discussed earlier in the thread, cats need both enough food and enough insulin to keep them ketone-free. Possible next steps are:

1. Feed a somewhat higher carb food and stay on the 2 unit dose.

2. Continue feeding Molly's current food and reduce the Vetsulin dose.

A decision needs to be made before Molly's next dose is due.

I recommend you phone your vet ASAP to let them know that the current dose took Molly down to 91mg/dL 4 hours after her insulin injection and ask about adjusting the dose or increasing the carbs in Molly's diet. (BTW, belt and braces, confirm to your vet that you're using a pet meter.)

Do you have a good supply of test strips? Do you have any higher carb food in the house?


Mogs
.
 
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Critter Mom said:
I used a pet meter, and while 91 is in the safe normal range, I agree that there's no real wiggle room.

Jen, you are doing an absolutely terrific job of looking after Molly and checking her BG levels. Molly is in safe numbers and she's doing fine but it's best to have a bit more of a safety margin at nadir.

Under normal circumstances, a dose reduction would be given as a matter of course. However, Molly is just recently recovered from DKA so a little extra caution is required regarding her insulin needs.

As discussed earlier in the thread, cats need both enough food and enough insulin to keep them ketone-free. Possible next steps are:

1. Feed a somewhat higher carb food and stay on the 2 unit dose.

2. Continue feeding Molly's current food and reduce the Vetsulin dose.

A decision needs to be made before Molly's next dose is due.

I recommend you phone your vet ASAP to let them know that the current dose took Molly down to 91mg/dL 4 hours after her insulin injection and ask about adjusting the dose or increasing the carbs in Molly's diet. (BTW, belt and braces, confirm to your vet that you're using a pet meter.)

Do you have a good supply of test strips? Do you have any higher carb food in the house?


Mogs
.
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Hi Mogs, thank you so much for your reply, and I'm sorry for the delay.

My dad is usually the one who tests her blood, but he was unable to do so **this evening. I tried a number of times but just couldn't get enough blood for a test. I'm not sure what else to do at this point.

I did phone the vet and she will be seen tomorrow at 8:30am. Thank you for advising to do that. The person who we spoke with on the phone agreed that her numbers were odd.

- Jen
 
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Critter Mom said:
@Panic, @Aleluia Grugru & Minnie -

Will you be around for a while? I can't stay any longer (chronic fatigue issues - about to pass out). I'm just worried that Jen and Molly might need some help on tonight's PM cycle so i'm hoping that someone could keep an eye out for updates from them.


Mogs
.
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I am so sorry to keep you waiting! Thank you so much for caring about Molly. Please get some rest!
 
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