Beginner here- Need help with spreadsheet and doses

[Carlyfofarly]

Hello! My boy Chester was just diagnosed last week (Aug 3). I immediately switched him over to an all wet food diet starting the next day and started insulin Sunday night (Aug 8). I tried testing his BG before all shots but I just couldn't get it until this morning when he tested 19.9 mmol. Last week at the vet he was at 28.8 mmol so i'm thinking diet change helped a bunch? He is currently on Caninsulin U40 with U40 syringes but I am wanting to switch to Lantus after this vial runs out. Can someone help me with the dosing and do I need to do anything differently if I am planning on switching insulins in the next 2 months (or however long the vial lasts)?? Do I keep the dose as is for a while and try to test him more? Today was the first time I was successful after maaanny pokes and wasted strips over the last couple days and he hated me by the end of the test today so it breaks my heart each time...

Here is his spreadsheet- https://docs.google.com/spreadsheets/d/e/2PACX-1vSpXJmpmTiT7FliXefWcAYySE79_givNPdlgHpmRorBBWpmFoAJesh2lH39WykTrC7O3cT3ElvmlNsO/pubhtml

 

[Bree & Misty]

Hi Carly! Welcome, and great job testing and setting up a spreadsheet! The testing can definitely be a battle at first, but for myself and many others it's gotten way easier over time.
I'm fairly new here as well, so I can't give any dosing advice, but I wanted to welcome you and bump you up to the top of the forum so someone experienced can hopefully see your post.

 

[Shelley & Jess]

Hi there - waving from Ontario!

I'll tag a couple members that are familiar with Caninsulin
@JanetNJ
@FrostD

I haven't used Caninsulin so in the meantime the best I can do is give you the link to the Caninsulin dosing sticky:
BEGINNER'S GUIDE TO CANINSULIN/VETSULIN
that says:
Usually it’s best to start with a low dose of not more than one unit (1.0u), twice a day. The manufacturer recommends a starting dose of 0.25u to 0.5u per kg body weight.
If your cat is on a low carbohydrate (less than 10% carb), canned or raw food diet (there are a few select dry foods that are low carb) and blood glucose is less than 380 mg/dL (or < 20 mmol/L) the starting dose should be 0.5u.
If your cat is on a diet that is over 10% carb and blood glucose is over 380 mg/dL (or > 20 mmol/L), you can start at 1.0u.
If you are transitioning your cat to a low carb diet, your starting dose should be 0.5u.

I think for a few days while you're getting the hang of testing and waiting for a more experienced Caninsulin user to chime in it might be wise to follow the guideline and start with 0.5U.

 

[Carlyfofarly]

Hi there - waving from Ontario!

I'll tag a couple members that are familiar with Caninsulin
@JanetNJ
@FrostD

I haven't used Caninsulin so in the meantime the best I can do is give you the link to the Caninsulin dosing sticky:
BEGINNER'S GUIDE TO CANINSULIN/VETSULIN
that says:
Usually it’s best to start with a low dose of not more than one unit (1.0u), twice a day. The manufacturer recommends a starting dose of 0.25u to 0.5u per kg body weight.
If your cat is on a low carbohydrate (less than 10% carb), canned or raw food diet (there are a few select dry foods that are low carb) and blood glucose is less than 380 mg/dL (or < 20 mmol/L) the starting dose should be 0.5u.
If your cat is on a diet that is over 10% carb and blood glucose is over 380 mg/dL (or > 20 mmol/L), you can start at 1.0u.
If you are transitioning your cat to a low carb diet, your starting dose should be 0.5u.

I think for a few days while you're getting the hang of testing and waiting for a more experienced Caninsulin user to chime in it might be wise to follow the guideline and start with 0.5U.

Hi Shelly, thanks for replying! I've read the guide and he was initially 28.8mmol/L last week when he was diagnosed so the starting dose is good at 1.0u I believe as he has only been on it for 4 days? I thought I read somewhere you were supposed to wait a week between changes or something? He's still fairly high at 19.9?

 

[AmandaL&Belles]

@tiffmaxee @PerfumedCatMom @Bandit's Mom @Chris & China (GA)

 

[Shelley & Jess]

I thought I read somewhere you were supposed to wait a week between changes or something? He's still fairly high at 19.9?

- The number from the vet may have been a bit elevated from vet stress.
- I'm concerned about the food transition - you're right it can drop the BG significantly.
- We don't have any mid cycle tests to see how low the current dose is taking him.

 

[Carlyfofarly]

- The number from the vet may have been a bit elevated from vet stress.
- I'm concerned about the food transition - you're right it can drop the BG significantly.
- We don't have any mid cycle tests to see how low the current dose is taking him.

It's possible but he was purring the entire time even when the vet stuck a thermometer up his butt haha So I wouldn't think they would be that far off. What is concerning about the food transition? He has been fully switched over to wet food for 6 days now? I don't have the ability to test mid cycle until the weekends and I just started Sunday night with the insulin. I am going to try to get a couple more tests in but this morning was my first successful attempt so it's been a challenge...

 

[Chris & China (GA)]

Can someone help me with the dosing and do I need to do anything differently if I am planning on switching insulins in the next 2 months (or however long the vial lasts)?? Do I keep the dose as is for a while and try to test him more?

When you're ready to switch, you can just switch. You can give Caninsulin in the morning and Lantus in the evening. The dose you'd start at will depend on the dose you're on with the Caninsulin when you switch.

You will need to get U100 syringes if you switch to Lantus.

Is there a reason you want to continue with the Caninsulin? Since it looks like you're in Canada, you could get Lantus at any human pharmacy and start tonight. It's a much better insulin for cats.

 

[Carlyfofarly]

When you're ready to switch, you can just switch. You can give Caninsulin in the morning and Lantus in the evening. The dose you'd start at will depend on the dose you're on with the Caninsulin when you switch.

You will need to get U100 syringes if you switch to Lantus.

Is there a reason you want to continue with the Caninsulin? Since it looks like you're in Canada, you could get Lantus at any human pharmacy and start tonight. It's a much better insulin for cats.

No I said I want to switch to Lantus! But I’m already using the vial of Caninsulin the vet gave me and I can’t afford to waste money. The combo of the food switch and caninsulin is lowering the levels so far so I can wait until this vial is done. Is there a way of converting doses for U100 to U40 syringes? I have 100 of them and I’m just not able to afford buying supplies to not use them.

 

[Chris & China (GA)]

Is there a way of converting doses for U100 to U40 syringes?

Unfortunately no....you can do it the other way (use a U40 insulin in a U100 syringe) but not the other way around.

You might want to contact Diabetic Cats in Need. If you qualify, we can help you with the costs of supplies. You can fill out one of our applications on our website. If you need help, feel free to send me a private message by clicking on my name and choosing "start a conversation".

 

[Shelley & Jess]

It's possible but he was purring the entire time even when the vet stuck a thermometer up his butt haha So I wouldn't think they would be that far off. What is concerning about the food transition? He has been fully switched over to wet food for 6 days now? I don't have the ability to test mid cycle until the weekends and I just started Sunday night with the insulin. I am going to try to get a couple more tests in but this morning was my first successful attempt so it's been a challenge...

It'll take a bit of time for the ear to learn to bleed. Don't get discouraged - you're doing great!

Without mid cycle tests (no criticism here) we can't see how low the dose is taking him yet and what the full effects of a food transition have been doing for Chester. We've had kittys go off insulin from a food transition alone - ECID (every cat is different) it can take a few days to a week (or more) to see the full effects of a food transition.

Again, haven't used Caninsulin, can only go by the guidelines - just trying to help you keep Chester safe

 

[Katherine&Ruby]

Sorry, I can't help because I've never used Caninsulin, but I really hope you can get Lantus and soon. I don't know how much Caninsulin costs or even how much Lantus is for Canadians, but I know that Lantus works a lot better for cats.

 

[FrostD]

Welcome! You're off to a good start.

Does Chester have a history of ketones or DKA? If not, I would actually start at 0.5U, you can do that starting your next shot. We "don't care" about vet's number because that was pre-diet change, we'll go off numbers after the change. We obviously do care it just doesn't factor in to dose.

You'll more than likely hold that dose until testing is more consistent/reliable. Caninsulin can be a dangerous insulin, so we really need midcycle tests focusing on the +2 to +6 range, both day and night before we can consider changing the dose. 1U is probably ok but I've seen cats drop very low even from the pink range.

If there is a history of ketones or DKA then we'll have to reconsider.

Are you testing ketones at home?

 

[Carlyfofarly]

Welcome! You're off to a good start.

Does Chester have a history of ketones or DKA? If not, I would actually start at 0.5U, you can do that starting your next shot. We "don't care" about vet's number because that was pre-diet change, we'll go off numbers after the change. We obviously do care it just doesn't factor in to dose.

You'll more than likely hold that dose until testing is more consistent/reliable. Caninsulin can be a dangerous insulin, so we really need midcycle tests focusing on the +2 to +6 range, both day and night before we can consider changing the dose. 1U is probably ok but I've seen cats drop very low even from the pink range.

If there is a history of ketones or DKA then we'll have to reconsider.

Are you testing ketones at home?

I’m not sure if he does? Yes but the first reading I got after he’s been home and with diet change was 19.9 mmol? I work all day so I’m not able to get mid cycle tests. It’s just me and my cats so I have no other options. No I’m not testing ketones at home. With another cat it is impossible to tell which one peed in the litter box and I use pellets so not sure I would be able to get a reading anyways?

 

[Chris & China (GA)]

I work all day so I’m not able to get mid cycle tests

OK, we understand that not everybody can get mid-cycles so try to get at least a couple of tests on the PM cycle before you go to bed. I don't know when you shoot, but if you could get the PMPS, a +2 and a +4 or +5, that would be really helpful. Then on your days off, do a complete curve (testing every 2 hours from AMPS to PMPS.

This thread on "Is TR possible with a full time job?" was meant for using Lantus/Levemir but there are still some good ideas in there that might work for you too.

 

[Carlyfofarly]

I ha

OK, we understand that not everybody can get mid-cycles so try to get at least a couple of tests on the PM cycle before you go to bed. I don't know when you shoot, but if you could get the PMPS, a +2 and a +4 or +5, that would be really helpful. Then on your days off, do a complete curve (testing every 2 hours from AMPS to PMPS.

This thread on "Is TR possible with a full time job?" was meant for using Lantus/Levemir but there are still some good ideas in there that might work for you too.

I haven’t been able to get a reading except for once in 7 testing tries. He just doesn’t bleed at all these last couple tries and I’m doing it on the outside edge of the ear and trying all the tricks. He’s at the point where he won’t even let me touch his ears now..

 

[Chris & China (GA)]

He just doesn’t bleed at all these last couple tries and I’m doing it on the outside edge of the ear and trying all the tricks.

Are you warming his ear really well first? What gauge lancet are you using?

We know it can be very frustrating but if you keep trying, it will get easier. Each time you poke, the body starts to grow new capillaries into the area to "heal the injury". We call it "learning to bleed".

He’s at the point where he won’t even let me touch his ears now..

When you're able to, decide on where you want to test him. I liked my kitchen counter because it had good light, was at a good height and it blocked the escape routes. The wall and backsplash blocked 2, my body blocked one and if she backed up, she'd be in the sink...LOL It can be anywhere though...a rug on the floor, a table, a particular spot on the couch...wherever is good for you.

Just take him there as many times as you can, give his ears a quick rub and give him a special treat. Something he only gets when he's in his "testing spot". It really doesn't take them long to associate the place with the treat and it'll get to where any time you're getting the supplies out, he'll come running.

Remember that if you're feeling nervous and uptight, he's going to know it and think there's a reason he should be nervous and uptight too. Try singing a silly song. It forces you to use a different part of your brain so it's harder to send off those nervous signals. You are my Sunshine is a favorite song!

Hang in there. We really do understand it can be a struggle at first but it will get better.

 

[Mocha's_mom]

Hi Carly, I'm new here too and Mocha is on Vetsulin (same as Caninsulin). He was started at 1 unit twice a day and they basically said don't change his diet and come back in one week. I wasn't satisfied with that at all so I ran out and got my testing supplies and wet food immediately. So I'm going to try to do a glucose curve at home to avoid having to bring him back in for them to do it in the office. I've heard cats are much more stressed there and readings can be high.

I switched him from all dry to all wet food without much issue. He's always hungry so I think he'll eat anything right now. I don't have enough data yet to see how the insulin is working but I'm hoping the diet change will help. I'm going to give it one week and see where it gets us.

I'm having some difficulty testing too. I think the biggest thing is not to stress them out too much. If I don't get blood on the first or 2nd try I give up, give him a treat and try again later. They definitely pick up on our vibes and he knows I'm super stressed!! (I'm sure my tears don't help!). I have faith it will get easier!

 

[Carlyfofarly]

Are you warming his ear really well first? What gauge lancet are you using?

We know it can be very frustrating but if you keep trying, it will get easier. Each time you poke, the body starts to grow new capillaries into the area to "heal the injury". We call it "learning to bleed".



When you're able to, decide on where you want to test him. I liked my kitchen counter because it had good light, was at a good height and it blocked the escape routes. The wall and backsplash blocked 2, my body blocked one and if she backed up, she'd be in the sink...LOL It can be anywhere though...a rug on the floor, a table, a particular spot on the couch...wherever is good for you.

Just take him there as many times as you can, give his ears a quick rub and give him a special treat. Something he only gets when he's in his "testing spot". It really doesn't take them long to associate the place with the treat and it'll get to where any time you're getting the supplies out, he'll come running.

Remember that if you're feeling nervous and uptight, he's going to know it and think there's a reason he should be nervous and uptight too. Try singing a silly song. It forces you to use a different part of your brain so it's harder to send off those nervous signals. You are my Sunshine is a favorite song!

Hang in there. We really do understand it can be a struggle at first but it will get better.

Yes I’m warming it with the rice sock while massaging it, putting Vaseline on, using a 28g lancet. All along the outside edge of his ear. Tried both using the device and just free holding with cotton pad behind. Tried doing two small pricks close together. I just don’t get any blood droplets at all or they are too small. I even tried his paw pad yesterday and too small of a drop. If I do see any blood I try to squeeze/massage it out and nothing. I do it on the kitchen floor but he’s gotten to the point that he wants to run away and he does not want me touching his ears anymore. I’m getting so discouraged as in 8 test tries I’ve only managed getting it once. I just don’t know what to do

 

[Carlyfofarly]

Hi Carly, I'm new here too and Mocha is on Vetsulin (same as Caninsulin). He was started at 1 unit twice a day and they basically said don't change his diet and come back in one week. I wasn't satisfied with that at all so I ran out and got my testing supplies and wet food immediately. So I'm going to try to do a glucose curve at home to avoid having to bring him back in for them to do it in the office. I've heard cats are much more stressed there and readings can be high.

I switched him from all dry to all wet food without much issue. He's always hungry so I think he'll eat anything right now. I don't have enough data yet to see how the insulin is working but I'm hoping the diet change will help. I'm going to give it one week and see where it gets us.

I'm having some difficulty testing too. I think the biggest thing is not to stress them out too much. If I don't get blood on the first or 2nd try I give up, give him a treat and try again later. They definitely pick up on our vibes and he knows I'm super stressed!! (I'm sure my tears don't help!). I have faith it will get easier!

Sounds the same as Chester as he’s on 1U 2X a day as well and is always hungry! Like a 12 pack of food lasts me maybe a day between him and my other cat. I’m trying to free feed because he’s always hungry and I heard they’re like that until they get regulated.
Have you been getting readings? I want to do my own glucose curve but if I can’t get one reading even I won’t be able to and I’m really stressed about it all

 

[Mocha's_mom]

Sounds the same as Chester as he’s on 1U 2X a day as well and is always hungry! Like a 12 pack of food lasts me maybe a day between him and my other cat. I’m trying to free feed because he’s always hungry and I heard they’re like that until they get regulated.
Have you been getting readings? I want to do my own glucose curve but if I can’t get one reading even I won’t be able to and I’m really stressed about it all

I wish Mocha was that hungry! So far he hasn't even eaten a full can of FF in one day. Granted, I'm giving him treats every few hours so I'm sure the ham & turkey slices are giving him plenty of calories. He's still adjusting to the texture of wet food so I understand his hesitation. Before this he wouldn't get anywhere near wet food!! So at least I have his hunger on my side.

I am able to get readings. He's got black fur and I've got bad eyesight so I found that a set of magnifying glasses with a light (that you wear on your face) has helped me a lot! Before I felt like I was poking around and couldn't see any blood until a lot had come out. Make sure the ear is warm first. I found that just rubbing it with my fingers for a few minutes warms it up and increases the circulation. A cold ear won't give any blood. And like everyone says, the more you do it the more capillaries form in that ear and makes it easier to bleed. He does flinch when I do it so I know he feels it (whether its just sore because I'm doing the same spot or because the lancet is too big) but I know it's necessary so I'm white knuckling through it.

It's very stressful starting out. Both my husband and I have had difficulty getting blood each time. But the alternative is too risky. Not checking his glucose and blindly giving insulin could absolutely kill him. So I have to keep reminding myself of that every time no matter how difficult it is on both of us.

I'm trying to get a glucose curve today (so far so good!) to see where we're at. Worse case scenario he doesn't cooperate and I don't get all the readings but at least I know I'm not blindly shooting insulin without knowing ballpark where he's at.

What glucometer are you using? Different ones require different amounts of blood. The Alphatrak only needs 0.3 microliter which is the smallest that I know of. Some human ones need 0.5-1 which is a lot more.

 

[Carlyfofarly]

I wish Mocha was that hungry! So far he hasn't even eaten a full can of FF in one day. Granted, I'm giving him treats every few hours so I'm sure the ham & turkey slices are giving him plenty of calories. He's still adjusting to the texture of wet food so I understand his hesitation. Before this he wouldn't get anywhere near wet food!! So at least I have his hunger on my side.

I am able to get readings. He's got black fur and I've got bad eyesight so I found that a set of magnifying glasses with a light (that you wear on your face) has helped me a lot! Before I felt like I was poking around and couldn't see any blood until a lot had come out. Make sure the ear is warm first. I found that just rubbing it with my fingers for a few minutes warms it up and increases the circulation. A cold ear won't give any blood. And like everyone says, the more you do it the more capillaries form in that ear and makes it easier to bleed. He does flinch when I do it so I know he feels it (whether its just sore because I'm doing the same spot or because the lancet is too big) but I know it's necessary so I'm white knuckling through it.

It's very stressful starting out. Both my husband and I have had difficulty getting blood each time. But the alternative is too risky. Not checking his glucose and blindly giving insulin could absolutely kill him. So I have to keep reminding myself of that every time no matter how difficult it is on both of us.

I'm trying to get a glucose curve today (so far so good!) to see where we're at. Worse case scenario he doesn't cooperate and I don't get all the readings but at least I know I'm not blindly shooting insulin without knowing ballpark where he's at.

What glucometer are you using? Different ones require different amounts of blood. The Alphatrak only needs 0.3 microliter which is the smallest that I know of. Some human ones need 0.5-1 which is a lot more.

That’s good you’ve been able to get readings! Yes I’ve been doing the warming of the ear and it doesn’t help at all. I use the Bravo meter. It needs 0.5 unfortunately but the strips are insane for the Alphatrak in Canada so I’m not switching to anything else. I don’t even get 0.3 anyways so wouldn’t help. Literally nothing has been coming out