Diabetic cat with diarrhea

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marisofigia

marisofigia

Member Since 2020
Hello everyone!

I'm a new member from Europe and I signed up because I need any help that I can get...

Maya is a 12-year-old Persian cat (not pure-bred) who has been my companion through some of the toughest times in my life. In August she was diagnosed with diabetes. We tried to lower her blood sugar level by getting her on a diet of diabetic food, but to no avail. In October she started taking insulin (Caninsulin 5mg) and soon thereafter the real problems began. She started eating less food, drinking more water, and having diarrhea. She also got a UTI.

My family and I took her to a couple of vets and had her stay at a clinic for three nights. Now she's back at home, but not much has changed. All the blood work has come back fine. The UTI has been treated. I am told that she may be missing pancreatic enzymes, so we've ran some special tests on that and are waiting for the results.

In the meantime, she's getting frailer and frailer. Just a few months ago she was so happy and healthy... If only we could stop that diarrhea! She's getting Metrobactin and FortiFlora. Any advice that you can give would be much appreciated. The vets have done their job, friends and family have expressed their sympathies, she and I are on our own now.
 
The first thing I’d suggest is switching insulin. Caninsulin got its name because it was made for canines and it’s not the best insulin for cats who have higher metabolisms. What food is she currently eating? The diarrhea could be related to pancreas issues or something like IBD, which Minnie has. I give her 2 probiotics to help with it. Visbiome which is for the IBD and S. Boulardii which helps keep their stool healthy. The fortiflora is not meant for that. She could also be b12 deficient. Have they tested for that? Again, with anything like IBD or pancreatitis they need b12 shots.

5 units is a very high dose. Caninsulin hits hard and fast. You need to make sure she has food onboard at least 20-30 minutes before the shots. Would you consider home testing. I’m just concerned that she may have needed the higher dose because of the UTI, but her bg levels may have gone down since it was treated. How did you get to the 5 units? Was it a gradual increase?

lots of questions but it’s the best way to make sure we can help you. Welcome! :bighug:
 
WELCOME TO FDMB Marisofi and extra sweet Maya! We are glad you found us! Poor Maya and YOU! Lets see if we cant get this ship righted! I take it you are not home testing Mayas blood sugar. What you need to do is go to the nearest drug store and pick up a human glucose meter , some strips and some 26 gauge lancets. We can teach you how to use them.
I'm going to ask you to do some housekeeping. Please click this link and read up on how things work around here Please pay particular attention to the Profile signature section. Your signature will appear at the bottom of all your posts. It will contain all of Mayas particulars needed, by any member that comes to help. It also will save you from having to answer the same questions over and over.
New? How You Can Help Us Help You!

You have landed in a safe place for Maya.
WELCOME TO OUR FAMILY:bighug:

This is the best site on this planet, to learn everything you need to know, about feline diabetes and beyond.;)
We all look forward to meeting you both.

jeanne
 
Many many thanks to you all!
I will update my signature asap.

In the meantime, I got Caninsulin because both vets I saw told me to do so. I just took their word for it... We started her off at 3mg every 12 hrs. Now she's at 5.

She's eating Hills m/d wet food for diabetic cats and Royal Canin dry food for diabetic cats. She hates them both.

I have a glucose meter.

The tests she did 1 week ago showed no vitamin deficiency, but that may have changed by now.

I feel like I'm in one of these movies where the kid is diagnosed with an illness, the mom goes to all the doctors but gets nowhere, then finally finds some hope via a treatment known to few. It's not the same thing of course, but I am so surprised and frightened by the fact that doctors can get things so wrong...
 
Marisofi said:
She's eating Hills m/d wet food for diabetic cats and Royal Canin dry food for diabetic cats. She hates them both.
Click to expand...
This alone is probably keeping your cat in higher numbers and not hypoing.
Marisofi said:
I feel like I'm in one of these movies where the kid is diagnosed with an illness, the mom goes to all the doctors but gets nowhere, then finally finds some hope via a treatment known to few. It's not the same thing of course, but I am so surprised and frightened by the fact that doctors can get things so wrong...
Click to expand...
and this is sadly too common.
Look at it this way, when vets are in training they get at the most one days training in diabetes (and that is most likely for dogs) they have a lot to cram into their education So many animals to treat with so many things broken bones, diseases, you name it. Throw in diabetes and its a LOT.
I honestly trust the information about diabetes here more, than with ANY vet. Unless you find (the elusive) vet that specializes in diabetes. FDMB is the place to be.
j
 
Hello Marisofi and Maya-
So glad you have arrived!
My vet gave me Caninsulin too, with the attitude that it was the greatest thing - I don't think he knew the difference. And he made no mention of getting a meter to know my cat's blood glucose levels.
I would no more give my cat insulin without checking BG than I would give it to myself without knowing my BG. I like living, thanks.
Cats can do better on higher BG than humans can, and so during my cat's regulation period I have been telling myself not to stress and panic if it's high. But it still will eventually damage their internals so regulating it needs to be fone. Also nobody wants to see their furbaby lethargic and miserable.

I switched from Canninsulin to Lantus(glargine) on the 20th of this month (yeah 6 days ago!) after 2 weeks on Caninsulin.
If you check my spreadsheet, it was a *vast* difference for my kitty Cotton. On Caninsluin I was seeing drastic swings from highs over 500 to lows of 142 in a single 12 hours period at a Caninsulin dose of 3.5 units. I worried about him becoming hypoglycemic if I increased his dose to bring down the highs because of those lows.There was no way I could feel comfortable regulating dosage and feeding with that range.
My switch to Lantus has in a VERY short time brought numbers that are predictable and consistent, and I feel much more comfortable. He is down now in a 250-350 range because his body has a 'depot' of insulin to draw on (read about the depot in the Lantus thread). In another 2-3 weeks I expect to have him consistently below 150s.
Bear in mind 'ECID' - Every Cat Is Different. Maya may have different results from Cotton, but in general the benefits of Lantus I read about are significantly better than Caninsulin.

I understand you are in Europe - but here is a link to a page by DVM Lisa Pearson, **L9TS OF GOOD INFORMATION that is easier to understand:

https://catinfo.org/

It has a pdf with a spreadsheet of various canned foods and their protien/fat/carbs relative to one another. Diabetic kitties do much better on wet food that is high protien/low carb:

https://www.google.com/url?sa=t&sou...FjALegQICRAB&usg=AOvVaw2-56TGnJXS2_8vg73QgYF-

You and Maya are NOT on your own here.
This can be overwhelming at first but does get easier!
 
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Hi Mari, If you want a reply form anyone on this thread click reply on that persons post. That person will get an alert that you have a question for them. (hope that makes sense)
Its usually a one to one switch. That is. if Maya is currently getting say 1 unit of caninsulin, she would get 1 unit of Lantus.
Hold on for more advice on this. ok?
@Critter Mom can you please confirm???
j.
 
Critter Mom said:
Hi Jeanne,


Impossible to offer any suggestions about insulin without any BG data, Jeanne. There's no way of assessing the safety of the Caninsulin dose so no way to gauge whether a similar dose of Lantus would or would not be safe.


Mogs
.
Click to expand...
Sorry I'm just going by what I have read here. So you are saying that Mari should not switch until she has more data with the caninsulin. .
 
jt and trouble (GA) said:
Sorry I'm just going by what I have read here. So you are saying that Mari should not switch until she has more data with the caninsulin. .
Click to expand...
I'm saying that I can't suggest anything specific about any insulin without data, Jeanne. In the absence of cat-specific information it would not be safe to do so. The only thing I can do at the moment is provide general information, namely that cats metabolise insulin more quickly than dogs so typically Caninsulin peters out a few hours before the next dose is due. In comparison, Lantus typically has better duration in cats and is therefore likely to be a better treatment choice overall.


Mogs
.
 
The recommended starting dose for any insulin is 1 unit. If you switch to a gentler longer lasting insulin like Lantus, which I understand is harder to get for cats in Europe, or prozync I would start from scratch again at 1 unit. Starting at 3 is too high and I think the reason she hasn’t dropped too low is because you’re still feeding dry.

so, no need to feed special prescribed by the vet expensive food. It’s not even better for them as most are still too high in carbs. You want food that is less than 10% in carb content. Here in the US most of us feed fancy feast or friskies which you can buy anywhere and are perfectly fine. I’m sure other members in Europe can advise about what’s available over there for you.

Since you have a meter, are you testing and how often? If you have collected data, can you please input it into our spreadsheet format so we can all see it? There are instructions for setting up in the link JT posted but we can help if needed so let us know! Ideally, you want to test everyday before each insulin shot so you know what her bg is and if it’s safe to give insulin. Just like humans wouldn’t inject themselves before testing to make sure it’s safe. Same for cats and yes, it’s something else most vets never discuss. For those am and pm preshot tests, you want to do it on an empty stomach so the number you get is not food influenced. No food for at least 2 hours before those tests. You test, feed, then give the insulin in that order. It’s also very helpful to get another midday test to try to see what her nadir is, lowest point in a 12-hour cycle. We dose here based on the nadir and not the preshot numbers. With caninsulin, the nadir tends to be early on like 2-4 hours after the shot then it wears off. Since we’re all over the world in different time zones, we say +2 or +5 to indicate 2 hours after the shot or 5. I’d strongly suggest you also transition her out of the dry food which is high in carbs and not good at all for diabetic cats. The insulin is working to bring her bg down while the dry food is working to keep it up so it’s a never ending battle. But in order to do this safely with such a high dose, you really need to be testing and getting those preshot numbers daily. I’d also contact your vet and say you want to try a different insulin. Say you researched and found evidence cats have better remission rates on the 2 I mentioned above.

hope this is not too overwhelming. Wdyt and how do you feel about all of this? :cat:
 
Critter Mom said:
I'm saying that I can't suggest anything specific about any insulin without data, Jeanne. In the absence of cat-specific information it would not be safe to do so. The only thing I can do at the moment is provide general information, namely that cats metabolise insulin more quickly than dogs so typically Caninsulin peters out a few hours before the next dose is due. In comparison, Lantus typically has better duration in cats and is therefore likely to be a better treatment choice overall.


Mogs
.
Click to expand...
I agree but given that she hasn’t seen any improvement on her cat, I’d think trying a different insulin that typically is better for cats would be a smart idea.
 
One more thing, I’d ask the vet of they specifically tested for b12 deficiency since it’s not a standard test and not included in a regular blood panel. If they didn’t, I’d suggest running it. The b12 shots are important if there anything irregular going on with her pancreas. Did they test for pancreatitis? Ask about that as it’s also a specific different blood test. I always forget what’s called but @Panic can tell you what it is
 
Marisofi,

Important safety note:

Please do not try to change the food Maya's eating until you have started home testing her blood glucose levels and understand how her current insulin is working.

Reducing the carb load in the diet can cause a big drop in the overall blood glucose range and usually the insulin dose needs to be reduced in line with the diet change: More information about safely transitioning to a lower carb diet:

catinfo.org - Feline Diabetes


Mogs
.
 
jt and trouble (GA) said:
Hi Mari, If you want a reply form anyone on this thread click reply on that persons post. That person will get an alert that you have a question for them. (hope that makes sense)
Its usually a one to one switch. That is. if Maya is currently getting say 1 unit of caninsulin, she would get 1 unit of Lantus.
Hold on for more advice on this. ok?
@Critter Mom can you please confirm???
j.
Click to expand...
Thank you for clarifying Mogs!
 
Aleluia Grugru & Minnie said:
The recommended starting dose for any insulin is 1 unit. If you switch to a gentler longer lasting insulin like Lantus, which I understand is harder to get for cats in Europe, or prozync I would start from scratch again at 1 unit. Starting at 3 is too high and I think the reason she hasn’t dropped too low is because you’re still feeding dry.

so, no need to feed special prescribed by the vet expensive food. It’s not even better for them as most are still too high in carbs. You want food that is less than 10% in carb content. Here in the US most of us feed fancy feast or friskies which you can buy anywhere and are perfectly fine. I’m sure other members in Europe can advise about what’s available over there for you.

Since you have a meter, are you testing and how often? If you have collected data, can you please input it into our spreadsheet format so we can all see it? There are instructions for setting up in the link JT posted but we can help if needed so let us know! Ideally, you want to test everyday before each insulin shot so you know what her bg is and if it’s safe to give insulin. Just like humans wouldn’t inject themselves before testing to make sure it’s safe. Same for cats and yes, it’s something else most vets never discuss. For those am and pm preshot tests, you want to do it on an empty stomach so the number you get is not food influenced. No food for at least 2 hours before those tests. You test, feed, then give the insulin in that order. It’s also very helpful to get another midday test to try to see what her nadir is, lowest point in a 12-hour cycle. We dose here based on the nadir and not the preshot numbers. With caninsulin, the nadir tends to be early on like 2-4 hours after the shot then it wears off. Since we’re all over the world in different time zones, we say +2 or +5 to indicate 2 hours after the shot or 5. I’d strongly suggest you also transition her out of the dry food which is high in carbs and not good at all for diabetic cats. The insulin is working to bring her bg down while the dry food is working to keep it up so it’s a never ending battle. But in order to do this safely with such a high dose, you really need to be testing and getting those preshot numbers daily. I’d also contact your vet and say you want to try a different insulin. Say you researched and found evidence cats have better remission rates on the 2 I mentioned above.

hope this is not too overwhelming. Wdyt and how do you feel about all of this? :cat:
Click to expand...

I have one issue, and please excuse my ignorance in this. You are speaking in units but I measure the insulin in mg.
view
view

https://drive.google.com/file/d/1-BoPx2zXSzxkezi4Nt8FX0s4Ae0fKKeO/view?usp=sharing
https://drive.google.com/file/d/1l514aZ48bOFdtdDs-pGuJ0LGqn7i2Ec4/view?usp=sharing
How do I convert for the spreadsheet?

Also, I use a human glucometer (Contour next), measuring in mg/dL.
 
Aleluia Grugru & Minnie said:
One more thing, I’d ask the vet of they specifically tested for b12 deficiency since it’s not a standard test and not included in a regular blood panel. If they didn’t, I’d suggest running it. The b12 shots are important if there anything irregular going on with her pancreas. Did they test for pancreatitis? Ask about that as it’s also a specific different blood test. I always forget what’s called but @Panic can tell you what it is
Click to expand...

This is what we've done so far, but we're also waiting for another set of results:
Maya's blood work November 2020
Maya's blood work October 2020 1 2
 
Marisofi said:
I have one issue, and please excuse my ignorance in this. You are speaking in units but I measure the insulin in mg.
view
view

https://drive.google.com/file/d/1-BoPx2zXSzxkezi4Nt8FX0s4Ae0fKKeO/view?usp=sharing
https://drive.google.com/file/d/1l514aZ48bOFdtdDs-pGuJ0LGqn7i2Ec4/view?usp=sharing
How do I convert for the spreadsheet?

Also, I use a human glucometer (Contour next), measuring in mg/dL.
Click to expand...

Does your vial on Caninsulin give a measure on it?
Here is a picture of my Lantus and syringes and how they are marked:
https://m.facebook.com/photo.php?fb...008485758935&set=a.1543585962600914&source=48

It is 100 units per ml, and 10 ml, so 1000 units in this bottle. The syringes are *specific* to this concentration. Caninsulin uses a 40 unit /ml syringe here, and you'll note the sigificant difference in volume to get the same number of units in Caninsulin.

https://m.facebook.com/photo.php?fb...935&set=p.2532669150359252&source=47&__tn__=R

Not certain what you are working with in Europe.

photo.php
 
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Marisofi said:
You are speaking in units but I measure the insulin in mg
Click to expand...
Is there any chance you could post a photo of the box for the insulin syringes, please?

Also, please can you take another picture of the syringe with the plunger pulled back to the position you use when measuring the dose you're giving. Please can you:

1. Use a white background behind the syringe so that we'll be able to see the position of the plunger more clearly.
2. Include the measurement scale in the photo.
3. Leave the syringe cap on so that we can see the colour.


Mogs
.
 
Another important general safety precaution for unregulated kitties is to test their urine daily for ketones. You can get urine ketone test strips at any pharmacy (the human ones are used for cats). General rules for ketone test results are:

Negative - OK, continue to monitor daily.

Trace - Monitor more closely (especially if the kitty isn't eating so well, if any insulin dose has been skipped, or if any infection/inflammation/other illness is present or suspected).

Higher than Trace - get kitty to vet immediately for emergency treatment.

See Ketones, DKA, Ketone Meters for further info.

Tips for collecting urine samples


Mogs
.
 
Item last for this evening:

Nausea and appetite problems - symptom checklist

Keep an eye out for any of the above symptoms. If you see any, let your vet know because nausea symptoms can be managed using ondansetron (human drug, if your vet doesn't carry it you should be able to get a written prescription and fill it at a regular pharmacy) or Cerenia. (Not sure where you are in Europe but, to the best of my knowledge, in the EU Cerenia is only available as an injection from the vets.) The root cause of the nausea still needs to be determined but the meds can help a kitty eat better (sometimes with the aid of an appetite stimulant).

If pancreatitis is the issue causing the loose stool then pain relief would also be indicated (buprenorphine) - relieving the pain goes a long way towards helping the cat to eat better. Much helpful info in the following:

IDEXX Feline Pancreatitis Diagnosis and Treatment Guidelines


Mogs
.
 
Critter Mom said:
Is there any chance you could post a photo of the box for the insulin syringes, please?

Also, please can you take another picture of the syringe with the plunger pulled back to the position you use when measuring the dose you're giving. Please can you:

1. Use a white background behind the syringe so that we'll be able to see the position of the plunger more clearly.
2. Include the measurement scale in the photo.
3. Leave the syringe cap on so that we can see the colour.


Mogs
.
Click to expand...
It appears to say unit 100 insulin on one of the photos - i must wonder if the caninsulin comes in 40 i.u. or 100 i.u - if the first, it might explain the seemingly high dosage of 5 units, as it would be a lower concentration of insulin.

Marisofi - when you have a moment, can you show us a clear picture of your insulin bottle and the box label if you have it?
 
CB Terri said:
It appears to say unit 100 insulin on one of the photos - i must wonder if the caninsulin comes in 40 i.u. or 100 i.u - if the first, it might explain the seemingly high dosage of 5 units, as it would be a lower concentration of insulin.
Click to expand...
Yes, I think they are U-100 syringes and Caninsulin is a U-40 insulin, hence my asking for more pictures so we can get a better understanding of the dose being given. (Hopefully when Marisofi posts the additional pictures we'll get a clearer understanding of her set-up.)


Mogs
.
 
Critter Mom said:
Is there any chance you could post a photo of the box for the insulin syringes, please?

Also, please can you take another picture of the syringe with the plunger pulled back to the position you use when measuring the dose you're giving. Please can you:

1. Use a white background behind the syringe so that we'll be able to see the position of the plunger more clearly.
2. Include the measurement scale in the photo.
3. Leave the syringe cap on so that we can see the colour.


Mogs
.
Click to expand...

Thank you all again for doing this, esp on a day that's a holiday in the US!

Here's the Caninsulin bottle, the syringe, the syringe from another side, and the syringe next to a ruler (in cm).
 
Critter Mom said:
SNAP fPL - on the spot yes/no/unclear result.

Spec fPL - goes to external lab, returns numerical result indicative of level of inflammation if pancreatitis present.


Mogs
.
Click to expand...
I just checked with the clinic. I'm still waiting for results on B12, TLI, and folic acid.
I've also updated the spreadsheet with today's testing and the lab results I have.
 
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Καλό απόγευμα, Marisofi. :)

Marisofi said:
Thank you all again for doing this, esp on a day that's a holiday in the US!
Click to expand...
I'm in the UK. ;)

Thank you for the extra pictures. It appears that you're using U-100 syringes with Caninsulin, a U-40 insulin.

So that we all start using the same terminology, here are some basics:

1. Insulin is quantified in International Units (IU), not milligrams or millilitres.

2. Different insulins have different strengths:

(a) U-40 insulins contain 40IU of insulin per ml of liquid.

(b) U-100 insulins contain 100IU of insulin per ml of liquid (i.e. they're stronger by volume than U-40 insulins)
​
3. Insulin syringes come in U-40 and U-100 types, and are intended to match the strength of insulin being used. The markings on the syringes correspond with the volume of liquid that contains the appropriate number of international units of the matching insulin.

HOWEVER...

It is possible to use U-100 syringes plus a conversion chart to administer a weaker, U-40, insulin - with appropriate care and attention (plus some initial support from FDMB members familiar with this technique).

Because you've been using U-100 syringes with Caninsulin, a U-40 insulin, the actual amount of insulin you're giving Maya is less than 5 units per dose; it's actually 2 units of Caninsulin (see conversion chart linked above). A dose of 2 units is not excessive for a recently diagnosed cat - certainly safer than an 'actual' dose of 5 units so soon!

Important Safety Note: Please do not give a larger dose!

Stick to drawing Caninsulin up to the '5' mark on your U-100 syringes (unless you get a BG test result under 90, in which case you would need to reduce the dose immediately). For now, gather BG test data to check the safety and effect of the current dose. We can help you going forward with how to correctly measure Caninsulin doses on U-100 syringes.

If you were also using U-100 syringes when you first started Maya's Caninsulin treatment and drawing up to the '3' mark on the U-100 syringe, then the 'actual' amount of insulin in the dose would have been 1.2IU, and that is a reasonable starting dose for most newly diagnosed feline diabetics.

I recommend that you put a call in to the vets to confirm whether they already know that you are using U-100 syringes with the U-40 Caninsulin and that your actual dose at present is 2 units Caninsulin, NOT 5 units. You need to establish this with them so that you're both talking about the same actual number of units in any future discussions you have about dose size. I recommend that you also seek input from experienced Caninsulin users here with regard to dose size. (Note: This will all get a lot less messy as you gather more test data for Maya, because her BG levels are the best guide possible to determining the size of dose needed.)

NB: If your vet tells you to change to U-40 syringes and measure up 5 units on those in future, I recommend strongly that you don't follow that advice. I think that there is a risk that an actual 5-unit dose could be too high for Maya.

If I've not explained the above clearly enough, please let me know because it's vital for safety that I've got this info across to you in an understandable manner. :)


Mogs
.
 
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NB: As soon as I've got confirmation from you that I've explained the above adequately and that my understanding of the syringes you're using and exactly how you're measuring the current dose is correct I'll give you some pointers on how to record dosing info correctly in Maya's spreadsheet.


Mogs
.
 
Marisofi said:
I've also updated the spreadsheet with today's testing and the lab results I have.
Click to expand...
Your turn now, Marisofi. :)

1. Please can you test Maya's BG as soon as possible after getting this message and post the result plus the number of hours between the time the dose was administered and the time the BG reading was taken. Given the time difference between us it'll probably be too late to catch nadir on this 12-hour cycle, but it may give info on duration of the dose (all data are valuable).

2. I've seen the lab results in the spreadsheet (thank you!). Could you let us know what date those tests were run and also whether Maya received any treatment for the UTI.

3. Did your vet order a Spec fPL test in addition to the B12/folate and fTLI tests? If not, has Maya ever been tested for pancreatitis (SNAP fPL, Spec fPL)?


Mogs
.
 
Critter Mom said:
Καλό απόγευμα, Marisofi. :)


I'm in the UK. ;)

Thank you for the extra pictures. It appears that you're using U-100 syringes with Caninsulin, a U-40 insulin.

So that we all start using the same terminology, here are some basics:

1. Insulin is quantified in International Units (IU), not grams or millilitres.

2. Different insulins have different strengths:

(a) U-40 insulins contain 40IU of insulin per ml of liquid.

(b) U-100 insulins contain 100IU of insulin per ml of liquid (i.e. they're stronger by volume than U-40 insulins)
​
3. Insulin syringes come in U-40 and U-100 types, and are intended to match the strength of insulin being used. The markings on the syringes correspond with the volume of liquid that contains the appropriate number of international units of insulin.

HOWEVER...

It is possible to use U-100 syringes plus a conversion chart to administer a weaker, U-40, insulin - with appropriate care and attention (plus some initial support from FDMB members familiar with this technique).

Because you've been using U-100 syringes with Caninsulin, a U-40 insulin, the actual amount of insulin you're giving Maya is less than 5 units per dose; it's actually 2 units of Caninsulin (see conversion chart linked above). A dose of 2 units is not excessive for a recently diagnosed cat - certainly safer than an 'actual' dose of 5 units so soon!

Important Safety Note: Please do not give a larger dose!

Stick to drawing Caninsulin up to the '5' mark on your U-100 syringes (unless you get a BG test result under 90, in which case you would need to reduce the dose immediately). For now, gather BG test data to check the safety and effect of the current dose. We can help you going forward with how to correctly measure Caninsulin doses on U-100 syringes.

If you were also using U-100 syringes when you first started Maya's Caninsulin treatment and drawing up to the '3' mark on the U-100 syringe, then the 'actual' amount of insulin in the dose would have been 1.2IU, and that is a reasonable starting dose for most newly diagnosed feline diabetics.

I recommend that you put a call in to the vets to confirm whether they already know that you are using U-100 syringes with the U-40 Caninsulin and that your actual dose at present is 2 units Caninsulin, NOT 5 units. You need to establish this with them so that you're both talking about the same actual number of units in any future discussions you have about dose size. (I recommend that you also seek input from experienced Caninsulin users here with regard to dose size. (Note: This will all get a lot less messy as you gather more test data for Maya, because her BG levels are the best guide possible to determining the size of dose needed.)

NB: If your vet tells you to change to U-40 syringes and measure up 5 units on those in future, I recommend strongly that you don't follow that advice. I think that there is a risk that an actual 5-unit dose could be too high for Maya.

If I've not explained the above clearly enough, please let me know because it's vital for safety that I've got this info across to you in an understandable manner. :)


Mogs
.
Click to expand...

I'm at a loss... I went back to the clinic and they said that I should use 5 units every 12 hours from this. I really don't understand what was the miscommunication when I bought the U-100 two weeks ago and both the pharmacist and the vet told me that it was fine!!! So, now what?

I tested before giving her the insulin and it was 418. I also updated the spreadsheet.
 
Critter Mom said:
Your turn now, Marisofi. :)

1. Please can you test Maya's BG as soon as possible after getting this message and post the result plus the number of hours between the time the dose was administered and the time the BG reading was taken. Given the time difference between us it'll probably be too late to catch nadir on this 12-hour cycle, but it may give info on duration of the dose (all data are valuable).

2. I've seen the lab results in the spreadsheet (thank you!). Could you let us know what date those tests were run and also whether Maya received any treatment for the UTI.

3. Did your vet order a Spec fPL test in addition to the B12/folate and fTLI tests? If not, has Maya ever been tested for pancreatitis (SNAP fPL, Spec fPL)?


Mogs
.
Click to expand...

She's never been tested for SNAP fPL, Spec fPL. I can take her tomorrow...
 
Hi Marisofi,

Thanks for getting back to me.

Marisofi said:
I went back to the clinic and they said that I should use 5 units every 12 hours from this.
Click to expand...
They're asking you to give Maya two and a half times as much insuin as she has been receiving. That's a huge increase and could potentially be dangerous.

It may be that Maya will need more insulin but it is possible to get to a better dose gradually and safely. Here are the FDMB guidelines for Caninsulin (aka Vetsulin) where you'll see the approach we take here to dosing with Maya's insulin.

To get a better picture of what's happening with Maya's insulin could you run a curve tomorrow?

1. Lift all food 2 hours before preshot test is due.

2. Take preshot reading.

3. If preshot is high enough (>200), feed Maya and wait 30 minutes.

4. Administer insulin. NB - STICK TO CURRENT DOSE, i.e. 2 UNITS of Caninsulin. (Please don't increase per your vet's recommendations. Please wait to see what's going on with Maya's BG on the current dose.)

5. Take BG readings at +2, +4, +6, +8, +10 hours after insulin dose given, and then the PMPS.

The above readings would give both you and us some better picture of how low the current dose takes Maya and how long it is active in her system.

If you can't manage the full curve, please can you take readings somewhere in the period +3 to +5 hours after the dose was given on both AM and PM cycles so that at least we'll get some idea of how low the dose is currently taking Maya. Indeed, going forward it's recommended to get AM and PM tests mid-cycle every day.

With more readings to work with we'll be able to make better suggestions on how you might proceed - safely! :)


Mogs
.
 
Critter Mom said:
Hi Marisofi,

Thanks for getting back to me.


They're asking you to give Maya two and a half times as much insuin as she has been receiving. That's a huge increase and could potentially be dangerous.

It may be that Maya will need more insulin but it is possible to get to a better dose gradually and safely. Here are the FDMB guidelines for Caninsulin (aka Vetsulin) where you'll see the approach we take here to dosing with Maya's insulin.

To get a better picture of what's happening with Maya's insulin could you run a curve tomorrow?

1. Lift all food 2 hours before preshot test is due.

2. Take preshot reading.

3. If preshot is high enough (>200), feed Maya and wait 30 minutes.

4. Administer insulin. NB - STICK TO CURRENT DOSE, i.e. 2 UNITS of Caninsulin. (Please don't increase per your vet's recommendations. Please wait to see what's going on with Maya's BG on the current dose.)

5. Take BG readings at +2, +4, +6, +8, +10 hours after insulin dose given, and then the PMPS.

The above readings would give both you and us some better picture of how low the current dose takes Maya and how long it is active in her system.

If you can't manage the full curve, please can you take readings somewhere in the period +3 to +5 hours after the dose was given on both AM and PM cycles so that at least we'll get some idea of how low the dose is currently taking Maya. Indeed, going forward it's recommended to get AM and PM tests mid-cycle every day.

With more readings to work with we'll be able to make better suggestions on how you might proceed - safely! :)


Mogs
.
Click to expand...

Ok well noted. I will give her 2 units of the U-40. I will try to take all the BG readings but I'm afraid I may not be that good with this because it takes me some time to find that small vein on the ear...
 
Critter Mom said:
Καλό απόγευμα, Marisofi. :)


I'm in the UK. ;)

Thank you for the extra pictures. It appears that you're using U-100 syringes with Caninsulin, a U-40 insulin.

So that we all start using the same terminology, here are some basics:

1. Insulin is quantified in International Units (IU), not grams or millilitres.

2. Different insulins have different strengths:

(a) U-40 insulins contain 40IU of insulin per ml of liquid.

(b) U-100 insulins contain 100IU of insulin per ml of liquid (i.e. they're stronger by volume than U-40 insulins)
​
3. Insulin syringes come in U-40 and U-100 types, and are intended to match the strength of insulin being used. The markings on the syringes correspond with the volume of liquid that contains the appropriate number of international units of insulin.

HOWEVER...

It is possible to use U-100 syringes plus a conversion chart to administer a weaker, U-40, insulin - with appropriate care and attention (plus some initial support from FDMB members familiar with this technique).

Because you've been using U-100 syringes with Caninsulin, a U-40 insulin, the actual amount of insulin you're giving Maya is less than 5 units per dose; it's actually 2 units of Caninsulin (see conversion chart linked above). A dose of 2 units is not excessive for a recently diagnosed cat - certainly safer than an 'actual' dose of 5 units so soon!

Important Safety Note: Please do not give a larger dose!

Stick to drawing Caninsulin up to the '5' mark on your U-100 syringes (unless you get a BG test result under 90, in which case you would need to reduce the dose immediately). For now, gather BG test data to check the safety and effect of the current dose. We can help you going forward with how to correctly measure Caninsulin doses on U-100 syringes.

If you were also using U-100 syringes when you first started Maya's Caninsulin treatment and drawing up to the '3' mark on the U-100 syringe, then the 'actual' amount of insulin in the dose would have been 1.2IU, and that is a reasonable starting dose for most newly diagnosed feline diabetics.

I recommend that you put a call in to the vets to confirm whether they already know that you are using U-100 syringes with the U-40 Caninsulin and that your actual dose at present is 2 units Caninsulin, NOT 5 units. You need to establish this with them so that you're both talking about the same actual number of units in any future discussions you have about dose size. (I recommend that you also seek input from experienced Caninsulin users here with regard to dose size. (Note: This will all get a lot less messy as you gather more test data for Maya, because her BG levels are the best guide possible to determining the size of dose needed.)

NB: If your vet tells you to change to U-40 syringes and measure up 5 units on those in future, I recommend strongly that you don't follow that advice. I think that there is a risk that an actual 5-unit dose could be too high for Maya.

If I've not explained the above clearly enough, please let me know because it's vital for safety that I've got this info across to you in an understandable manner. :)


Mogs
.
Click to expand...
This is what I was suspecting, that the syringe was 100 i.u. and the caninsulin was 40 i.u, and so the 5 unit measure with that combination was appropriate and giving somewhere around 2 actual units of insulin. It is a relief to see 40 iu on the vial.

I wish that every vet would take the time to explain to pet parents just what they are instructing them to administer and how, when a new medication is prescribed. Thank goodness for FMDB.

I definitely agree with Mogs that it's imperative for your vet and you to be on the same page as to actual units of insulin, and not simply volume, due to concentration.

The chart she linked to will be very handy if you continue to use the 100 iu syringes and 40 iu Caninsulin.

I am very glad you came here.
 
Marisofi said:
Ok well noted. I will give her 2 units of the U-40. I will try to take all the BG readings but I'm afraid I may not be that good with this because it takes me some time to find that small vein on the ear...
Click to expand...
You don't need to find the vein, Marisofi. You need to hit the 'sweet spot' between the vein and the edge of the ear:

QhIbBpEQ4xLGQYkG6XRvsLf-cVQ230_bP_1EfAqwcYelvOP3hv0vo5b3Ayp8JTlrq_Q53QGrt3QwEmO_O7MNxrjyVWIZGz_PlAETI6HDIMhbglBvGKBHNpZiJ8UWdmdea2DhfNxf


Testing tips and suggestions to follow...


Mogs
.
 
Critter Mom said:
I know that what's coming out poor Maya's rear end at the moment ain't great, but is she eating a normal amount of food?


Mogs
.
Click to expand...
No, she's not. She seems to want to, but she's not eating enough. I've had to feed her that diabetic food almost by force... Today I just went rogue and bought her some rotisserie chicken, just because I wanted her to eat something. And she did! Not much, but she did, and I didn't have to force her...

Thank you again for all your help!
 
CB Terri said:
This is what I was suspecting, that the syringe was 100 i.u. and the caninsulin was 40 i.u, and so the 5 unit measure with that combination was appropriate and giving somewhere around 2 actual units of insulin. It is a relief to see 40 iu on the vial.

I wish that every vet would take the time to explain to pet parents just what they are instructing them to administer and how, when a new medication is prescribed. Thank goodness for FMDB.

I definitely agree with Mogs that it's imperative for your vet and you to be on the same page as to actual units of insulin, and not simply volume, due to concentration.

The chart she linked to will be very handy if you continue to use the 100 iu syringes and 40 iu Caninsulin.

I am very glad you came here.
Click to expand...
I'm glad too! At least now I have an idea of what I'm doing...
 
Here is the testing method I used. Perhaps it might give you some ideas to add to your own testing technique.
  1. For most meters you can insert a test strip part way without switching it on. Once you've done the poke you can then push the strip the rest of the way into the meter to activate it. (Reduces the likelihood that the meter will time out before you can get the blood sample onto the strip.)

  2. Fold a sheet of kitchen paper in four lengthwise and cut it up into 1" strips. You will use these to cushion and support the ear during the test.

  3. Apply a thin film of Vaseline or Neosporin ointment (not the cream!) onto the edge of the ear to help the blood sample bead up instead of wicking into the fur. (Wipe off any excess.)

  4. To get a blood sample you need to increase the blood flow to the ear, so make sure the ear is really, really, really warm (but not hot) - especially in the early days of testing. (Note: With repeated 'poking', more capillaries form in the test area, so it becomes easier to get samples reliably.)

  5. Once you have the testing area of the ear well warmed, wrap a strip of folded kitchen paper round your index finger then place finger under the sweet spot area of the ear you're testing to support it during the poke.

  6. Use your thumb and middle finger to lightly but firmly grip the ear and paper strip in place so that the edge of the ear is taut but not overstretched; the little bit of tension will make it easier for the lancet to break the skin surface (and it helps to keep kitty's head from moving around too much).

  7. When using a lancet 'freehand', make sure the bevelled side of the lancet is facing upwards. Hold the lancet at a slight angle to the ear similar to the way you hold a pen when writing, not perpendicular (easier to see where you're aiming and also makes skin prick easier).

  8. When it comes to the actual poke, prick the sweet spot on the edge of the ear in a similar way to how you might quickly prick a balloon with the tip of a needle to make it pop. If you aim as close to the edge of the ear as possible you are less likely to hit the marginal ear vein.

  9. Keep hold of the ear while you're pushing the test strip into the meter to activate it. (Kitties are prone to shake their heads after a poke, sending your precious blood sample flying across the room. Holding the ear reduces likelihood of this happening.)

    (Note: As you become more practised in testing, you'll be able to activate the meter just before doing the poke and still have plenty of time to collect the sample on the strip before it times out.)

  10. When using the glucometer, bring the test strip to where it j-u-s-t comes into contact with the blood droplet and hold it there. The strip should then 'sip up' the amount it needs to run a valid test. Most meters beep or give a visual cue to let you know that enough blood has been collected on the strip.

    If your cat is a wriggler, try collecting the blood sample on the back of your (clean) fingernail and test it from there.

    If a test fails and you still have a lot of blood on the strip from the failed test, don't throw it away. Instead, you could pop another strip into the meter and test using the blood on the strip from the first test. (Saves an additional poke so also helpful for wriggly kitties!)

  11. After the test, fold the paper strip over the edge of the ear and apply gentle pressure to the test area for about 20-30 seconds to minimise bruising.

  12. Keep giving lots of praise throughout the process and reward with a favourite diabetic-friendly treat or favourite activity (e.g. brushing).
With a bit of time and practice you'll be able to work out a technique and a routine that works best for you and Maya.


Mogs
.
 
Last edited:
Marisofi said:
Ok well noted. I will give her 2 units of the U-40. I will try to take all the BG readings but I'm afraid I may not be that good with this because it takes me some time to find that small vein on the ear...
Click to expand...
Here is a picture of the ear capilliaries that I screenshot from another post on FDMB - it's very handy. Also you will hear from others, if you warm your kitty's ear first you will get blood much more easily as it expands the capilliaries:. I used to use a warm wet cloth in a ziploc baggie, now i use a half cup of uncooked long grain rice in an old sock, and microwave for 33 seconds.

https://m.facebook.com/story.php?story_fbid=2533514476941386&id=100008485758935
 
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