What if Squeaky doesn't eat? What to do about insulin?

[Jan D & Squeaky]

Squeaky was doing okay this morning, vomited around 5:30, and since then has had a couple of drinks of water and one treat. It's 8:35 now and I'm aiming for testing at 9, then following our usual routine to play, give him his massage and inhaler, feed/eat, followed up by insulin at around 10 pm.

I hate to stress him out further with the ear prick and the shot. Sigh.

However since it seems like his stomach is upset, what if he doesn't eat? Does that change anything with regards to giving the insulin? Or understanding the BG test?

Thank you,
Jan

 

[Panic]

Are you planning on testing again at 10 before insulin? A lot can change in an hour so if you don't want to test at both 9 and 10 I would wait.

It can be difficult if they're not up to eating. A lot of people say "no food, no insulin" but if Squeaky were to actually be ill for some reason which was causing him to not want to eat, taking away insulin would lead to ketones and DKA. I believe giving half is still recommended, though don't quote me on that.

You'll have to forgive me if you've already been told this (been a long weekend for me) but with testing you want to withhold food 2 hours prior to getting a pre-shot test. The reason for this is because food naturally elevates BG, but we need to base our pre-shot test as high enough to require insulin without food affecting the numbers.

 

[Ale & Bobo & Minnie (GA)]

Do you have any anti nausea? It think it’s a must have if your cat is diabetic and has IBD/pancreatitis. With Minnie there are hundreds of times that I wouldn’t have been able to give her insulin if I didn’t give her an anti nausea so she could eat. Have you tried baby food? That’s easier on their stomach and even when they won’t eat anything else, baby food will usually work. The good news about Lantus is that you have about 2 hours to get them to eat since that’s about how long it takes to start to work. So this morning Minnie ate then vomited. I gave her an anti nausea and since I knew it would work in about 30 minutes, I gave her shot. I waited about 35-40 minutes and tried to feed her again and she did eat.

 

[Ale & Bobo & Minnie (GA)]

Is he on budesonide?

 

[Jan D & Squeaky]

Okay I'm totally confused as my brain can't think much at the moment. So I didn't know that there was an issue of testing BG an hour before giving insulin. So we learn. No he's not on budesonide. Yes I have cerenia at home here but since the vet isn't giving me much direction, I'm not sure if he's supposed to be getting any or not. He's been off it since Monday the 31st. I have only seen one other nausea episode since then with no vomiting. I just tested his urine in his box with the ketone strip, about 1/2 hour ago. It showed normal.

I was trying to put a little time distance between the ear prick and the shot, so he didn't have everything at once. Because after the ear prick he will jump down and I'll have to get the insulin ready. Guess I'll have to change that.

Our usual routine is: BG ear prick. Play. Massage. Inhaler. Eat. Insulin.

He has had one treat about 15 minutes ago. Prior to that, he hasn't eaten for about 6 hours, and then, it was some treats.

This morning he got his insulin shot at 10:30. I tested him about an hour before that (I didn't know there was a time issue) and his reading was 282.

It's about 9:10 pm. ******** So how would you stage tonight's events? Time and order? ********

Thank you,
Jan

 

[Jan D & Squeaky]

Are you planning on testing again at 10 before insulin? A lot can change in an hour so if you don't want to test at both 9 and 10 I would wait.

It can be difficult if they're not up to eating. A lot of people say "no food, no insulin" but if Squeaky were to actually be ill for some reason which was causing him to not want to eat, taking away insulin would lead to ketones and DKA. I believe giving half is still recommended, though don't quote me on that.

You'll have to forgive me if you've already been told this (been a long weekend for me) but with testing you want to withhold food 2 hours prior to getting a pre-shot test. The reason for this is because food naturally elevates BG, but we need to base our pre-shot test as high enough to require insulin without food affecting the numbers.

Please see reply on forum thread. Thank you.

 

[Jan D & Squeaky]

Do you have any anti nausea? It think it’s a must have if your cat is diabetic and has IBD/pancreatitis. With Minnie there are hundreds of times that I wouldn’t have been able to give her insulin if I didn’t give her an anti nausea so she could eat. Have you tried baby food? That’s easier on their stomach and even when they won’t eat anything else, baby food will usually work. The good news about Lantus is that you have about 2 hours to get them to eat since that’s about how long it takes to start to work. So this morning Minnie ate then vomited. I gave her an anti nausea and since I knew it would work in about 30 minutes, I gave her shot. I waited about 35-40 minutes and tried to feed her again and she did eat.

Please see reply in forum thread. Thank you.

 

[Jan D & Squeaky]

Is he on budesonide?

Thank you, please see reply in forum thread. Thank you.

 

[Panic]

That's okay, I'm sorry no one told you that already. It's a lot in the beginning, I know. With Lantus you want to test/feed/shot all within about 15 minutes. There's no rush to getting it all done WITHIN 15 minutes, I just mean you typically just do it one after the other and that's about how long it takes. The fact that you gave him a treat earlier is fine. Sometimes cats get into food within the 2 hr mark as well, you just make a note of it.

Lantus craves consistency. You want to stray no more than 15 minutes each cycle from the last cycle, OR no more than 30 minutes every 24 hours. Meaning if you like to shoot at 10, you want to limit your next shot no more than 15 minutes earlier or 15 minutes later than 10. Or 30 minutes in a 24 hr period (meaning you don't want to give insulin 30 min earlier in the morning and another 30 min early in the evening, you want to stick to a 30 minute change total if needed within 24 hrs). The reason for this is because one cycle of Lantus can affect the other. If you give more than 30 minutes early, it acts like you're giving MORE than full dose, and if you give more than 30 minutes late, it acts like you didn't give a full dose, and the BG might be a little higher next cycle.

If you shot at 10:30 this morning and would like to stick at 10:30, I would wait to test/feed/shot around then. If you want to start doing it at 10 PM I would do it at 10:15 tonight and then 10 tomorrow. I hope that make sense.

 

[Jan D & Squeaky]

That's okay, I'm sorry no one told you that already. It's a lot in the beginning, I know. With Lantus you want to test/feed/shot all within about 15 minutes. There's no rush to getting it all done WITHIN 15 minutes, I just mean you typically just do it one after the other and that's about how long it takes. The fact that you gave him a treat earlier is fine. Sometimes cats get into food within the 2 hr mark as well, you just make a note of it.

Lantus craves consistency. You want to stray no more than 15 minutes each cycle from the last cycle, OR no more than 30 minutes every 24 hours. Meaning if you like to shoot at 10, you want to limit your next shot no more than 15 minutes earlier or 15 minutes later than 10. Or 30 minutes in a 24 hr period (meaning you don't want to give insulin 30 min earlier in the morning and another 30 min early in the evening, you want to stick to a 30 minute change total if needed within 24 hrs). The reason for this is because one cycle of Lantus can affect the other. If you give more than 30 minutes early, it acts like you're giving MORE than full dose, and if you give more than 30 minutes late, it acts like you didn't give a full dose, and the BG might be a little higher next cycle.

If you shot at 10:30 this morning and would like to stick at 10:30, I would wait to test/feed/shot around then. If you want to start doing it at 10 PM I would do it at 10:15 tonight and then 10 tomorrow. I hope that make sense.

Thanks, then we better switch to a different insulin asap. There is NO WAY IN HECK I can be that precise with time. I have something called "time blindness." Basically I bumble through the whole day. Can't even hit my goal of getting dressed by 8 am every morning.

 

[Jan D & Squeaky]

That's okay, I'm sorry no one told you that already. It's a lot in the beginning, I know. With Lantus you want to test/feed/shot all within about 15 minutes. There's no rush to getting it all done WITHIN 15 minutes, I just mean you typically just do it one after the other and that's about how long it takes. The fact that you gave him a treat earlier is fine. Sometimes cats get into food within the 2 hr mark as well, you just make a note of it.

Lantus craves consistency. You want to stray no more than 15 minutes each cycle from the last cycle, OR no more than 30 minutes every 24 hours. Meaning if you like to shoot at 10, you want to limit your next shot no more than 15 minutes earlier or 15 minutes later than 10. Or 30 minutes in a 24 hr period (meaning you don't want to give insulin 30 min earlier in the morning and another 30 min early in the evening, you want to stick to a 30 minute change total if needed within 24 hrs). The reason for this is because one cycle of Lantus can affect the other. If you give more than 30 minutes early, it acts like you're giving MORE than full dose, and if you give more than 30 minutes late, it acts like you didn't give a full dose, and the BG might be a little higher next cycle.

If you shot at 10:30 this morning and would like to stick at 10:30, I would wait to test/feed/shot around then. If you want to start doing it at 10 PM I would do it at 10:15 tonight and then 10 tomorrow. I hope that make sense.

Any suggestions for an insulin that will work with haphazard times? Seriously. I can't rush, I can't do time very well. My stress is already off the charts. We have to find something I can do comfortably.

 

[Panic]

I didn't think I could either, which is why I didn't make the switch to Lantus for a long time ... turns out it was easier than I thought!

But anyway, Prozinc is a good long-acting alternative. Not as good as Lantus but still good. It's got about an hour of wiggle room. I don't recommend using that full hour if you can help it, but it's an option.

 

[Jan D & Squeaky]

I didn't think I could either, which is why I didn't make the switch to Lantus for a long time ... turns out it was easier than I thought!

But anyway, Prozinc is a good long-acting alternative. Not as good as Lantus but still good. It's got about an hour of wiggle room. I don't recommend using that full hour if you can help it, but it's an option.

Thanks I will ask the vet. I'm preparing my list of questions for her now, for Tuesday's appointment.

 

[Jan D & Squeaky]

I didn't think I could either, which is why I didn't make the switch to Lantus for a long time ... turns out it was easier than I thought!

But anyway, Prozinc is a good long-acting alternative. Not as good as Lantus but still good. It's got about an hour of wiggle room. I don't recommend using that full hour if you can help it, but it's an option.

Okay well I will just hobble through the next several days as best I can. Please let me know if there is anything else. People may have told me a lot of things, that I cannot grasp with one telling. Thank you for ALL your help.

 

[Panic]

I'll try to type out the basics for you in one message so you can just reference it instead of multiple pieces:

Concerning Lantus:

• Stay within 15 minutes of each shot time as much as you can. Don't give more than 30 minutes early.
• Withhold food 2 hours before pre-shots. It's okay if you forget, just be aware that his pre-shot test may be higher than it would normally be.
• For now do not shoot if pre-shot is under 200. (if it is, stall feeding, re-test in 20 minutes to see if he's over 200 and post if you can for advice)
• Give small meals throughout the day. Bigger meals at shot-time, smaller snacks of his food periodically. A good rule right now would be to give food 2, 4, and 6 hours after insulin.
• Leave food out during the night (use an autofeeder and/or freeze chunks of food to achieve this). Kitties drop lower at night.

Even on Prozinc, insulin in general is designed to work best when given 12 hours apart. If you feel you need to start things a half hour early to help you out, do that, and wait until you're within "shooting time" to shoot. The reason you don't want to do "pre-shot" test an hour early is because some cats are a lot lower even an hour before actual shot-time. For example, some cats experience a "double-dip" on Lantus, where an hour or two before shot-time they drop considerably before rising again. If you checked at +11 and saw Squeaky was only 140 for example, you might assume you need to skip. But if you had checked at actual shot-time, he would have read at 210, which is high enough for full dose. This is just an example of course, but that's why you want to determine dosing at actual shot-time.

 

[Jan D & Squeaky]

I didn't think I could either, which is why I didn't make the switch to Lantus for a long time ... turns out it was easier than I thought!

But anyway, Prozinc is a good long-acting alternative. Not as good as Lantus but still good. It's got about an hour of wiggle room. I don't recommend using that full hour if you can help it, but it's an option.

So we eat, then immediately do BG, then immediately do the shot? Do I have it right? Sorry that I am so slow to catch on.

 

[Jan D & Squeaky]

I'll try to type out the basics for you in one message so you can just reference it instead of multiple pieces:

Concerning Lantus:

• Stay within 15 minutes of each shot time as much as you can. Don't give more than 30 minutes early.
• Withhold food 2 hours before pre-shots. It's okay if you forget, just be aware that his pre-shot test may be higher than it would normally be.
• For now do not shoot if pre-shot is under 200. (if it is, stall feeding, re-test in 20 minutes to see if he's over 200 and post if you can for advice)
• Give small meals throughout the day. Bigger meals at shot-time, smaller snacks of his food periodically. A good rule right now would be to give food 2, 4, and 6 hours after insulin.
• Leave food out during the night (use an autofeeder and/or freeze chunks of food to achieve this). Kitties drop lower at night.

Even on Prozinc, insulin in general is designed to work best when given 12 hours apart. If you feel you need to start things a half hour early to help you out, do that, and wait until you're within "shooting time" to shoot. The reason you don't want to do "pre-shot" test an hour early is because some cats are a lot lower even an hour before actual shot-time. For example, some cats experience a "double-dip" on Lantus, where an hour or two before shot-time they drop considerably before rising again. If you checked at +11 and saw Squeaky was only 140 for example, you might assume you need to skip. But if you had checked at actual shot-time, he would have read at 210, which is high enough for full dose. This is just an example of course, but that's why you want to determine dosing at actual shot-time.

Thank you! I will print this out and review it frequently. Hugs! And Appreciation!

 

[Panic]

So we eat, then immediately do BG, then immediately do the shot? Do I have it right? Sorry that I am so slow to catch on.

Test, feed, shoot. If you fed first then tested and Squeaky wasn't high enough for insulin yet, you wouldn't be able to stall feeding to see if his BG would rise on his own.

HOWEVER. I think since you two are still getting the hang of it, if it makes Squeaky happy to eat first, go ahead and let him eat, then test. You can worry about stalling later when he's more comfortable about testing.

 

[Jan D & Squeaky]

Test, feed, shoot. If you fed first then tested and Squeaky wasn't high enough for insulin yet, you wouldn't be able to stall feeding to see if his BG would rise on his own.

HOWEVER. I think since you two are still getting the hang of it, if it makes Squeaky happy to eat first, go ahead and let him eat, then test. You can worry about stalling later when he's more comfortable about testing.

Wow, thanks. I think test feed shoot sounds good. Okay now it's 10:15 so you see how long things take me. He had his morning shot at 10:30 so hopefully we can do this pretty well today.

 

[Jan D & Squeaky]

Seriously, I tried 3 pokes to the ear and didn't get blood. This is so hard.
I will try again, I hate to stress him out so much.
I am not good at this kind of thing. Please pray for us.

 

[Panic]

It's okay. The capillaries take a little while to form before the blood comes easily. If you can't get it this time you could give a half dose instead to be safe. It's important that you don't get stressed trying over and over again. I always had a "give up" number so I would step back after a few tries, give a treat, and try next time.

 

[Jan D & Squeaky]

It's okay. The capillaries take a little while to form before the blood comes easily. If you can't get it this time you could give a half dose instead to be safe. It's important that you don't get stressed trying over and over again. I always had a "give up" number so I would step back after a few tries, give a treat, and try next time.

Thank you for hanging around and being here right now. (almost crying again)

He is such a patient friend. He let me poke him until I got blood. Then I got E13 so I got another strip and there was still blood on the first strip so I put it on the second strip. 391. Seems we are not doing so well.

He just had a little to eat. Mostly beef heart and liver and a treat. And some water. Now time for the insulin shot. We did 20 minutes. Well I haven't given the shot yet. It'll be 25.

 

[Panic]

Those E13 errors always made me groan.

That's just fine, you're still getting the hang of it so you're doing a-okay in my book! Glad to hear he's eating some too.

 

[Jan D & Squeaky]

Those E13 errors always made me groan.

That's just fine, you're still getting the hang of it so you're doing a-okay in my book! Glad to hear he's eating some too.

Yes and he ran to the water bowl to try to get out of getting the insulin shot.....

 

[Panic]

Tsk tsk!

Giving the shot while they eat is easiest, if they're distracted enough. Course depends on the kitty!

 

[Jan D & Squeaky]

Well we managed to live through this, at least for today. So what is going to bring the numbers down? So far the insulin doesn't seem to be making much of a difference in the numbers, except one good thing is he is drinking less.

 

[Jan D & Squeaky]

Tsk tsk!

Giving the shot while they eat is easiest, if they're distracted enough. Course depends on the kitty!

Thank you again for being here tonight.

 

[Panic]

Pre-shot numbers are the last numbers to go down. Since you've only just started testing, you don't have any info on how the dose is actually working - those are going to be in the mid-cycle tests.

Onset (the time that insulin kicks in and BG starts to dip) is usually two hours later, and nadir (the time when insulin brings BG down to its lowest) is usually 5-7 hours after insulin. Those are the times you want to test to see what the dose is really doing.

You're just starting so don't stress about it right now - but if you want to try your hand tomorrow at getting a test or two in between 2 and 7 hours after insulin, that can get you started. We also recommend a "before bed" test ... but again, when you're ready to try it. THEN we'll start seeing what Squeaky's BG is up to!

Thank you again for being here tonight.

Happy to help. And good job JAN tonight!

 

[Jan D & Squeaky]

Pre-shot numbers are the last numbers to go down. Since you've only just started testing, you don't have any info on how the dose is actually working - those are going to be in the mid-cycle tests.

Onset (the time that insulin kicks in and BG starts to dip) is usually two hours later, and nadir (the time when insulin brings BG down to its lowest) is usually 5-7 hours after insulin. Those are the times you want to test to see what the dose is really doing.

You're just starting so don't stress about it right now - but if you want to try your hand tomorrow at getting a test or two in between 2 and 7 hours after insulin, that can get you started. We also recommend a "before bed" test ... but again, when you're ready to try it. THEN we'll start seeing what Squeaky's BG is up to!


Happy to help. And good job JAN tonight!

Thank you, yet I am so discouraged. He's still sitting at the water bowl, staring off into space, with one of those looks like.... "If this is how it's going to be....." looks. And for me, the house is a mess and I am exhausted and 30 minutes past bedtime already. One of those time goals I can never meet. And cleaning goals I can never meet.

Well, we'll give it a fresh start tomorrow morning. I'm now giving Squeaky a lot of praise and a pep talk!

 

[Panic]

Cats feel pretty yucky in the beginning understandably. They can also feel a little salty about the new routine until they figure out it makes them feel better. Remember it's a marathon, not a sprint! He'll get better.

Give Squeaky a scritch from me too! G'night Jan.

 

[Jan D & Squeaky]

Cats feel pretty yucky in the beginning understandably. Remember it's a marathon, not a sprint! He'll get better.

Give Squeaky a scritch from me too! G'night Jan.

Thank you again for being here tonight! G'night, Elizabeth. That was my grandmother's name.

 

[Polgeria]

Okay I'm totally confused as my brain can't think much at the moment. So I didn't know that there was an issue of testing BG an hour before giving insulin.

My vet DID NOT inform me this either, so don't feel bad about it at all. All I was told to do was test at home. Nothing about when or how often, or even what numbers were good. I had to look that up on my own. All I was told was just the type of monitor to use, which I've since changed. I'd be soooooo lost without this forum.

Lantus craves consistency. You want to stray no more than 15 minutes each cycle from the last cycle, OR no more than 30 minutes every 24 hours. Meaning if you like to shoot at 10, you want to limit your next shot no more than 15 minutes earlier or 15 minutes later than 10. Or 30 minutes in a 24 hr period (meaning you don't want to give insulin 30 min earlier in the morning and another 30 min early in the evening, you want to stick to a 30 minute change total if needed within 24 hrs). The reason for this is because one cycle of Lantus can affect the other. If you give more than 30 minutes early, it acts like you're giving MORE than full dose, and if you give more than 30 minutes late, it acts like you didn't give a full dose, and the BG might be a little higher next cycle.

Any suggestions for an insulin that will work with haphazard times? Seriously. I can't rush, I can't do time very well. My stress is already off the charts. We have to find something I can do comfortably.

This happened with me and Mouse, especially in the beginning when I didn't know anything about Lantus. You really have to plan for it. Set yourself multiple warning alarms so that you don't have to rush. My process is to test, feed, shoot at 7 am, which means I'm up at 6:30. I test, let her eat, and draw up the shot while she's eating.

We all know it doesn't work like that. My other cats actually wake me up at 5:30 demanding food. Mouse still gets her shot at 7 though. She gets a test at 5:30. I see where she's at. She gets a token spoon full of food. She glares at me, she sees the other cats full food bowl. I get more glares. I chase her off the other cat's food for the next 30 minutes. I wish I was still asleep. I curse the other cats, cause they're the ones that woke me up. I have coffee. I pick up the food the other cats didn't eat. Mouse is still on the counter, glaring at her empty food bowl and me. I glare back. She knocks something off while making eye contact. It wasn't coffee, so I don't care. It's finally 7 am, so I test her again. She can finally eat a good meal. she loves me again. I give her the shot. She doesn't notice.

Do your best to maintain the 12 hour window between shots. It's incredibly important. Take a look at Mouse's SS, she didn't start getting good numbers until I started maintaining that. You really see her turn around as soon as I joined this forum, and took the team's advice to heart.

Yes and he ran to the water bowl to try to get out of getting the insulin shot.....

Mouse has started to feel so much better after her shots that she now runs to my lap after eating to get her shot, or waits on the counter for it. She gets confused when I tell her I already gave it to her when she was eating. You'll get there. Cat's know when we're trying to help them and tend to come around.

Thank you, yet I am so discouraged. He's still sitting at the water bowl, staring off into space, with one of those looks like.... "If this is how it's going to be....." looks. And for me, the house is a mess and I am exhausted and 30 minutes past bedtime already. One of those time goals I can never meet. And cleaning goals I can never meet.

You can do this! It's a lot of work when you first start out, but you've got this. It really does become part of your routine. The more you do it, the easier it gets. It took me about 2 weeks to get the ear prick down. I was already familiar with subq shots, since I did home fluids previously, but that took me a bit when I first started those too. Just remember, it's ok to feel overwhelmed. Keep breathing through it. You and Squeaky are going to get through this together

 

[Jan D & Squeaky]

My vet DID NOT inform me this either, so don't feel bad about it at all. All I was told to do was test at home. Nothing about when or how often, or even what numbers were good. I had to look that up on my own. All I was told was just the type of monitor to use, which I've since changed. I'd be soooooo lost without this forum.





This happened with me and Mouse, especially in the beginning when I didn't know anything about Lantus. You really have to plan for it. Set yourself multiple warning alarms so that you don't have to rush. My process is to test, feed, shoot at 7 am, which means I'm up at 6:30. I test, let her eat, and draw up the shot while she's eating.

We all know it doesn't work like that. My other cats actually wake me up at 5:30 demanding food. Mouse still gets her shot at 7 though. She gets a test at 5:30. I see where she's at. She gets a token spoon full of food. She glares at me, she sees the other cats full food bowl. I get more glares. I chase her off the other cat's food for the next 30 minutes. I wish I was still asleep. I curse the other cats, cause they're the ones that woke me up. I have coffee. I pick up the food the other cats didn't eat. Mouse is still on the counter, glaring at her empty food bowl and me. I glare back. She knocks something off while making eye contact. It wasn't coffee, so I don't care. It's finally 7 am, so I test her again. She can finally eat a good meal. she loves me again. I give her the shot. She doesn't notice.

Do your best to maintain the 12 hour window between shots. It's incredibly important. Take a look at Mouse's SS, she didn't start getting good numbers until I started maintaining that. You really see her turn around as soon as I joined this forum, and took the team's advice to heart.


Mouse has started to feel so much better after her shots that she now runs to my lap after eating to get her shot, or waits on the counter for it. She gets confused when I tell her I already gave it to her when she was eating. You'll get there. Cat's know when we're trying to help them and tend to come around.



You can do this! It's a lot of work when you first start out, but you've got this. It really does become part of your routine. The more you do it, the easier it gets. It took me about 2 weeks to get the ear prick down. I was already familiar with subq shots, since I did home fluids previously, but that took me a bit when I first started those too. Just remember, it's ok to feel overwhelmed. Keep breathing through it. You and Squeaky are going to get through this together

Thanks for sharing your story. My life is rather a mess at the moment and I'm so worn down from 4 years of vomiting and diarrhea. We'll do our best!