? First time poster – in desperate need of advice!

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Matt & Redbeard

Matt & Redbeard

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TL-DR: just found out my cat is diabetic. Essentially leaving the country for a month. No idea what to do.


Hello everyone, Matt and Redbeard here. So absolutely grateful I have found this community. Like many of you, I was absolutely shattered when I learned of Red’s diagnosis, and quickly searched out whatever treatment I could. First, a little background, and then the dilemma I find myself in…

Redbeard is an 11 year old neutered short-harir domestic tabby. He went in for dental work in January, and needed anesthesia. They did his bloodwork to ensure sure he was healthy enough for it, and his blood markers were all totally fine (BG around 90 I believe… I don’t have the paperwork in front of me at the moment). His weight was around 19 lbs (he's a big boy, but definitely could have lost a few lbs) Fast forward to early May and I notice he is drinking a lot more water and urinating more. I didn’t think anything of it, as it is hot as heck here in FL. But I took him to the vet on Monday and received the terrible news, BG around 370, weight dropped down to 15 lbs. I was devastated. What’s worse, the vet essentially just handed me a vial of vetsulin, told me to buy him Hill’s M/D, and good luck. No advice beyond giving him 2 units BID. I couldn’t believe how nonchalant they were, or the bad advice I was given.

Immediately I read up on the high-protein, low-carb diet and moved to switch him over. He has been eating FF classic for two days now. I am headed to Walmart as soon as my flight lands this afternoon, and will start BG monitoring tonight. I’d like to establish a few days of baseline numbers, just to see where he is at with diet-only alterations. I have voraciously read this board for information on how long to keep him in a pre-insulin state, but I’m seeing no more than 3-5 days. This is a huge problem…

I know there is no ideal time to find out your beloved pet has diabetes, but this is literally the worst time imaginable. My fiancé and I leave next Friday (8/20) to travel to Europe for our wedding, and will return home on the evening of 8/29 (10 days). I then have to depart overseas again for work the following Sunday (9/5)… another 12 days. I want to initiate insulin treatment ASAP to start to normalize his BG and hopefully get him on the path to remission, but realistically, I cannot initiate round the clock monitoring and treatment until September 16th, more than a month from now. I would love to get some lantus and initiate a SLGS protocol, but with me being gone, I don’t know what to do!

Our original plan was to just have a Rover sitter check on him daily (which is what we’ve always done on our previous trips), but now I will have to leave him with my parents on this upcoming trip to Europe so they can feed him his wet food. I can maybe coax them into giving him the vetsulin, but no way are they going to monitor BG. So do I just ask them to administer 1 U BID and watch him closely until I return and can start making curves? Or do we just keep him on the high-protein diet and wait until next month when I can initiate lantus?

Another possibility is to just hold off the insulin until I return on the 28th, start treatment that week and try to make my first few curves, and train my fiancé to monitor BG and treat him while I'm gone on that second trip. But then I'd need to try and secure an Rx for lantus immediately and order it while I'm overseas. Or she can just use the vetsulin for now and then I can transition him on 9/16. I’m so lost and praying you guys can give me sound advice. Thank you so much in advance!!!


PS – I will set up my signature and spreadsheets as soon as I get home tonight and take some initial readings. Currently at the airport.
 
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My cat was just diagnosed as well and I'd see if your parents will check the BG. It's honestly SUPER easy. My cat doesn't even seem to be bothered by the process. I'll be petting him, flip his ear over, check the BG and continue to pet. Other than thinking the cotton ball is a toy he doesn't bat an eye. I was super worried when I learned about testing, etc. but it's been a 100% non-issue.

An alternative would be to see if the vet could board him while you're away. I travel a lot for work and when he was diagnosed they said that if I needed that I'd just need to bring his vial and equipment when he'd need to be checked in.
 
Yikes! I am so sorry this is your situation and the timing it so terrible.

The food change will probably help quite a bit if you can get some tests in before you go. And having 2 people able to test and give shots is going to be much easier than trying to manage it yourself, if your cat will allow your fiance to do so (my cat will let my husband check BG, but he doesn't give her shots.) Establishing a good testing routine can take some time, depending on the cat. I "prepped" my cat for a day or two before I even attempted getting a blood drop. Played with and manipulated her ears and gave her treats each time. Clicked the lancing device near her ears and gave her treats each time. Gave her a treat when she let me stick her ear, even if I didn't get blood. It can take a few days to "train the ears" to bleed (regrowing capillaries in the ear edges). Warming the ear definitely helps stimulate the blood! Many fill a sock with few tablespoons uncooked rice and heat that in the microwave to help warm the ears. I also gave her a treat any time she let me rub her ear with this weird-smelling thing before attempting to test with it.

You might want to look into a Freestyle Libre device. I've never personally used one, but I believe it is attached to your cat and takes BG readings by scanning an app on your phone. It's supposed to work for up to 2 weeks. Some cats remove them... some stop working. But this could be a good solution if Redbeard is with your parents and they can't test. They can share numbers with you and you can make the decision if he needs to get a shot.

I'm NO expert, but knowing what I know now, I would forgo the Vetsulin. 2U is too high of a dose with simultaneous diet change. 1U BID might even be too much. At our first diagnosis, my cat was on 1U of Vetsulin BID but also we were on high carb "prescription" food so that was keeping her safe (I was also not testing at the time) and the vet declared her in remission after a few months. I was flying blind and had no idea.

Since your vet already gave you the diagnosis, it might be worth calling and asking them for a script for Lantus. If not, hopefully other vets would be willing to prescribe it without seeing the animal (maybe just the test results?). This site may help you find a better vet: https://catfriendly.com/find-a-veterinary-professional/ They don't necessarily specialize in diabetes treatment, but hopefully they'd be more up on feline treatment.
 
Thank you for the replies and suggestions. The Libre is a great idea, but I just called the vet's office and of course she just left for vacation. I'd have to find a new vet willing to write the Rx, acquire the device, bring Red to a new vet for implantation (all before we leave town), and I'm not sure it would fit my immediate needs. It's good for establishing curves, but are they calibrated well enough in cats to know if you should shoot or not?

Is there a simple how-to guide on here on how to interpret the BG levels that I could provide my parents? I've seen a few replies with hard and fast rules (below 50 is hypo and act now, don't shoot below 200, etc.) but is there a more comprehensive guide?
 
Matt & Redbeard said:
Thank you for the replies and suggestions. The Libre is a great idea, but I just called the vet's office and of course she just left for vacation. I'd have to find a new vet willing to write the Rx, acquire the device, bring Red to a new vet for implantation (all before we leave town), and I'm not sure it would fit my immediate needs. It's good for establishing curves, but are they calibrated well enough in cats to know if you should shoot or not?

Is there a simple how-to guide on here on how to interpret the BG levels that I could provide my parents? I've seen a few replies with hard and fast rules (below 50 is hypo and act now, don't shoot below 200, etc.) but is there a more comprehensive guide?
Click to expand...

Not that I've seen... From what my vet told me this afternoon, 'normal' for a cat is typically around 100-300 mg/dl (feline calibrated lab values). However on a human meter I don't know exactly how that would read.
 
My understanding is that the Libre is a human monitor that is just attached. As long as it is scanned at the time you would take a BG test, you would have the same number as having done a BG test. And that would give you (and us) the information we need to help with dosing advice.

On a human BG monitor, normal cat BGs are between 50-120. The resources and references on this page were developed with meters calibrated for humans, so the Libre or the meter you get from WalMart would match the guidance you find here.

This intro post on the Lantus forum describes the different ranges (on a human reader) in terms of a cat's regulation. I'm not sure if that answers your question or not. For many of us, the goal is the last step - normalization and remission. Since you won't be able to start that journey for a few weeks, a form of regulation will likely have to suffice.

I think until you establish your own cat's patterns, especially with a food change, it's difficult to say do X at this number or Y at this number. If you can get some readings before you go, we'll be able to steer you and your parents a bit better. Praying that the food shows a big difference!

In general, it's safer for a cat to have too high blood sugar than too low, so long as it's not overly prolonged. Did the vet mention anything about ketones? Whether they were positive or negative? Ketones can be tested for at home with urine strips you can get over the counter from most pharmacies. Hypoglycemia is what you're on alert for if you give too much insulin. Ketones are what you're on alert for if you give too little. If he doesn't have a history of ketones, giving too little insulin for a few weeks until you can get better established might be safer than risking too much insulin.

Hopefully tonight the more experienced users, admins, and mods will be here to weigh in. I've only got a few month's experience with this. Some of them have years of collective knowledge and are familiar with a similar case to yours.
 
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Hi Matt and Redbeard and welcome to the forum.
I am sorry you have found yourself in this situation.
It would not be a good idea at all to just leave him on a low carb diet without any insulin….you would run the very real risk of him developing ketones which can progress to ketoacidosis which is very serious illness and can be deadly…..an expensive to treat.
A couple of ideas…..
If you got a freestyle libre attached which would read the blood glucose levels……do you think your parents would give the insulin?
They could post here every day and we could help them…
We have a lot of older caregivers so age is no barrier to looking after a diabetic cat. We also have two very young children who are looking after a diabetic cat so any age person can do it.
We can help every step of the way.
You would be far better off getting Lantus insulin than using Vetsulin which is a harsher insulin and meant for dogs.
You would need to get your parents setup with the correct food, a hypo kit and lots of information which we can give you.
What do you think?
 
Hi Matt, I'm new here too. Mocha was diagnosed over the weekend and I'm so grateful for this forum. My vet sounds a lot like yours (when I saw you were in Florida like me I thought maybe we had the same vet lol) and she was very nonchalant about everything. Basically your cat has diabetes, here's Vetsulin 1 unit twice a day. Come back in a week to drop him off for the day to do a glucose curve and we go from there. If and when he finally goes into remission you'll know it because he'll become hypoglycemic after a dose. Then just bring him in and we'll check on him. WTH?!

I asked if I could monitor his BG at home and she said she didn't recommend it. I'm a medical professional and have plenty of experience with human diabetics I think I can handle it. Anyway against her advice I immediately got a human glucometer at walgreens while I waited for my AlphaTrak to come in the mail. I didn't dare give him insulin without knowing what his glucose was beforehand. I think that's terribly irresponsible.

She told me NOT to change his diet at all. He was eating high carb Iams dry food all day. He had gained 3lbs over the course of the year from eating all that crap. Probably that's how he developed diabetes in the first place. After reading on this site I immediately switched him to all wet low carb food. Previously he wouldn't get near any wet food but I've had success with some of the FF pates and gravy kinds this week. I think just because he's starving he'll eat just about anything.

His BG has come down a bit probably from mostly diet and the small amount of Vetsulin he's getting. But I'm watching closely because he's eating a lot less and canned food has less calories than dry. So if he doesn't eat it can be dangerous to give him insulin. I always check his BG before a dose.

I think your fiance definitely needs to learn how to check his glucose & give shots no matter what. I mean, she's gonna need to do it after you're married anyway. It's been a "bonding" experience for my husband and I LOL (I say that jokingly because we've got differing opinions on how things should be done. He's a bit rougher with Mocha than I am). Maybe you can do your own glucose curve at home this week before you leave? One unit of Vetsulin may not do a lot but at least you'll know if you're in a safe range (between 100-300) and could rest easy for a week without changing the dose.

I don't know how old your parents are but I agree with what someone else said. We have people of all ages & abilities here who are able to check BG and give insulin shots. The insulin shot is the easy part. BG is a bit harder. You can also draw up the insulin in the syringe ahead of time for them to dose. I think that's safe to do with Vetsulin (not Lantus) but you may want to check with the moderators on here to be sure. There's also a product called VetPen which is Vetsulin in a pen form that you just dial the dose.

I wouldn't recommend changing to Lantus right away. I want to change to Lantus too but I also want Mocha on a steady diet first to see where that gets him. My vet didn't even recommend changing diet but I think that alone might help more than you know. I'm comfortable changing diet and giving insulin ONLY because I'm here to monitor his BG as often as I need to. And I know Vetsulin has a fast onset & short duration so it's a bit easier to dose as it wears off quickly. He may go back up in the hyper range after it wears off but that's a bit safer than being hypo. With Lantus any change in dose may take a few days to take effect because of it's long duration of action. You need to be very careful with small adjustments.

I've never used Rover but I read a horror story about them giving an overdose and almost killing the cat. I don't know that I'd trust a stranger to do it. You can also draw up a syringe with food coloring and water to the exact dose that they could use for comparison. That way there's no question as to where the "1 unit" mark is on the syringe. (You'd think it'd be obvious but you'd be surprised what people don't know). Maybe that would help your parents be confident that they are drawing up the right dose.

Again, I'm new to all this also but I'm learning a lot from this site. Certainly more than my vet has given me!!
 
Some really great suggestions! Pre-filling the syringes is a wonderful idea to help my parents. I got an Rx for the Libre today so I'm going to see if I can sort that out before I leave for work again on Monday. I was able to finally test his BG today with a Relion meter. Took several different lances before we got it to work with a 26 gauge. He was at 275 mg/dl a couple hours after his meal :( administered the vetsulin and will retest at +2 and +6 today to see how he responds to it.
 
GREAT JOB getting your first BG reading! While 275 is high, it's not nearly as bad as it could be. When I started testing, Chloe's numbers were so off the charts the meter didn't even read a number. It just said "HI." Took us several days to see a yellow on the spreadsheet.

Also, food makes the BG go up. Insulin makes it go down. If you tested after you fed him, it was probably lower.

The flow is test, feed, and then give insulin. Because of how Vetsulin works, generally you wait 20-30 minutes after they eat to give the shot. Meals/shots are roughly 12 hours apart, and if you miss or aren't sure if you got the full dose in there (called a fur shot), DO NOT give more insulin. Since we never know how much got in there, it's always safer to have too little insulin than too much.
 
As you learn your way around here, you'll want to get your spreadsheet and signature set up.

Here are the instructions for the spreadsheet and signature in case you haven't found them yet.

The link to the spreadsheet should go on the second line of the signature by itself so advisors can find it quickly. It's not mentioned in the signature instructions, but the second line of the signature doesn't start until you hit "Enter." So even if all the info in the first line spills over to multiple lines, it still counts as one line.
 
Hi Matt and Redbeard, I'm glad to see you're past the hysteria we see too often here and this really is the best place to be.
-The idea of having someone else log in here has worked well before, someone (I'm not qualified) will take up the cause and check for their posts. As always, too many cooks in the kitchen...
-There is no one standard dose for any insulin or cat. When I boarded my cat I had his dose slightly reduced, higher numbers have their own danger but are easier to deal with than a hypo episode.
-It's happened before here, one partner gave an AM shot, the other partner assumed none had been given and gave a second shot. Nothing is mistake proof.
-My wife doesn't enjoy driving at night and no GPS in the car. Our fridge was plastered with maps and directions to the nearest emergency clinic, cab company phone numbers etc.
-I have serious memory issues. It may be condescending but the simple "when to eat, not to eat, when to shoot" can also go on the fridge.
-You won't get any grief here for "abandoning" your cat because you haven't. We don't do shame here. I may be gone for a short bit, hope you have a great trip.
 
You guys are wonderful. Already I am feeling so much more confident with his treatment protocols. I finished my sig and set up the spreadsheet. Have already taken several readings today. I think I will go the Freestyle Libre/cat shirt route (so he can't tear it out) for my parents. This way they can quickly assess his BG and only shoot if needed. We can stick with the vetsulin for now, and then as soon as I get back from these trips, I'll switch to Lantus. In the meantime, I will continue to read everything possible on here.
 
Hi Matt,
Using prefixed syringes is not a good idea. Syringes have some sort of solution on the inside of the to make them slide amd. It is not recommended to refill syringes.
A better idea is to fill a syringe with a dark solution of black tea or something red up to the correct dose of insulin so your parents can use it as a reference when filling the syringe. You would need to clearly mark the syringe so they don’t accidentally use that one. I am sure, if shown, your parents would be capable of pulling up the correct amount.
2 units may be too much insulin….the normal starting dose is 0.5 to 1 unit.
With vetsulin you need to feed the main meal before the shot of insulin 30 minutes before the dose so Redbeard has food aboard for when the insulin hits.it is an insulin that hits quite hard and fast.
Lantus is a longer lasting and gentler insulin.
I would also recommend you feed a couple of snacks during the first half of all cycles at say +2 and +5
Once you swap to Lantus the main meal is given just before the dose
Please make sure you take advice from experienced people.
We can make sure your parents are supported while you are gone if they will post on here. We are a knowledgeable and supportive community.
 
Matt,

Insulin’s syringes absolutely can be filled in advance with the correct dosage. They should be carefully recapped and placed back in the refrigerator for storage needle point up.

Just prior to use they should be rolled in the palms to again remix the solution. The ONLY insulin this isn’t recommended for is Lantus due to a manufacturers recommendation.

This is a doctor and hospital accepted practice that has been done for literally decades with no ill effects - as long as the dosage is correct.

https://www.uofmhealth.org/health-library/aa122700
 
@Denver
Matt is swapping to Lantus insulin so prefilling is not recommended. It is a much better insulin for cats. Also because doses change, especially in the beginning, prefilling could lead to errors. It would be far better for his parents to learn to draw up the insulin each dose. We have many older people who look after diabetic cats every day with no issues drawing up the insulin.:)
 
It looks like Redbeard, Magic and Mocha are all on Vetsulin. I'm not changing Mocha over to Lantus anytime soon and I think we're all a little bit weary given our situations. I know a lot of people have their sugar babies on Lantus but we aren't there yet. I think we all need to figure out where we stand first before we know anything! Sometimes our vets start us out on Vetsulin.

I'm a pharmacist (for humans) and yes, Vetsulin can be kept in the fridge (in a syringe) face up. We are not talking about Lantus (glargine insulin).

We are here to share knowledge :)
 
I think it is a VERY good idea to switch to Lantus. Vetsulin is an insulin for dogs. I’ve seen many people switch from Vetsulin to lantus but never the other way around. You will waste valuable time if you don’t switch. Your parents won’t have any trouble dosing and we can help with dosing and support on the lantus forum. You won’t be sorry I promise you. I will be more than happy to help.
 
The current guidelines for the treatment of feline diabetes (FD) published by the American Animal Hospital Association (AAHA) in 2018 no longer recommend Caninsulin/Vetsulin for the treatment of FD. 2018 Guidelines for treatment of FD

As for the topic of pre-filling syringes, as Bron said, there is lubricant in the syringe. Can you do it with Vetsulin, I don't know...its chemical composition is different than Lantus, but why take a risk that the lubricant could potentially contaminate the insulin, regardless of which insulin you are using? I also wonder whether you can adequately shake up such a small amount that is in the syringe so that it gets to that milky suspension before injecting. To me, the better option is to fill up a sample syringe with a coloured liquid to use for comparison, if you are concerned that your parents can't draw up the correct amount on their own.
 
I would wholeheartedly support Bron’s point. It is unlikely that a dose will remain the same over a month. Pre-filling syringes will be asking for trouble either with under or over dosing or allowing glucose toxicity to develop.

I would also endorse a switch to Lantus. Vetsulin is not recommended by the American Animal Hospital Assn due to its inadequate duration in cats. In addition, it tends to drop numbers aggressively. Lantus is far more gentle.

And, while I agree that we are here to share knowledge, we are also here to not just share the research on feline diabetes, we are also able to share experience. Some of the people posting have been here for years (and years and years). Many vets start a caregiver’s cat on Vetsulin because it’s what they have in stock for dogs. The last time I checked, cats are not small dogs. They also tell caregivers not to home test despite published recommendations supporting home testing. There are a large number of cats on Lantus precisely because the research indicates that along with Prozinc, it is best suited for treating FD. It’s up to the individual caregiver to choose what he or she wants to do with respect to insulin choice research notwithstanding.

FYI , if you switch to Lantus you will need U100 syringes.
 
Sienne and Gabby (GA) said:
I would wholeheartedly support Bron’s point. It is unlikely that a dose will remain the same over a month. Pre-filling syringes will be asking for trouble either with under or over dosing or allowing glucose toxicity to develop.

I would also endorse a switch to Lantus. Vetsulin is not recommended by the American Animal Hospital Assn due to its inadequate duration in cats. In addition, it tends to drop numbers aggressively. Lantus is far more gentle.

And, while I agree that we are here to share knowledge, we are also here to not just share the research on feline diabetes, we are also able to share experience. Some of the people posting have been here for years (and years and years). Many vets start a caregiver’s cat on Vetsulin because it’s what they have in stock for dogs. The last time I checked, cats are not small dogs. They also tell caregivers not to home test despite published recommendations supporting home testing. There are a large number of cats on Lantus precisely because the research indicates that along with Prozinc, it is best suited for treating FD. It’s up to the individual caregiver to choose what he or she wants to do with respect to insulin choice research notwithstanding.

FYI , if you switch to Lantus you will need U100 syringes.
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Agreed, but given his situation for the next month he'd be safer just sticking to a small dose of Vetsulin to get him started. It's perfectly safe to draw it up ahead of time into his own syringes (there's no lubricant if you're drawing up from a multidose vial of Vetsulin into a clean syringe). And at this point drawing it up ahead of time rather than relying on someone else to do it and potentially getting it wrong is probably the safest bet. Is it ideal? No. But something is better than nothing. If he's able to get a few days of data and a glucose curve at home then he'll have a lot more data to go by.

I believe Lantus is probably the way to go for most of us, but we need to be hypervigilant to make sure we get the right dose. Because of its longer duration of action any small adjustment can take a while to see. With Vetsulin it drops quick and goes right back up. Most vets want us to stay in the safe zone in the beginning (100-300) so Vetsulin makes that easier.

My recommendations are simply given because of Matt's unique situation. All of us want to be "perfect" right from the start but sometimes our life situations make that hard. We have to make choices. Trust me, if I could give Mocha a 100% perfect diet, and test his BG every hour for 24 hours, and follow the AAHA guidelines and start him on Lantus right away then I would! But unfortunately he's a finicky eater, I can't always get blood on the first try, and my vet wants me to start with Vetsulin. I'm working with what I can.

I've dealt with human patients my whole life and I've always been shocked at how many times people won't take meds due to price, inconvenience, etc. People would rather skip taking a drug altogether because it's expensive even if it's life saving. I remember when Lantus was $400 and I had patients who said they just won't take it. That's understandable. So then you should use Humulin R (old school but only $10) and measure your BG frequently and give it multiple times a day. Nope! They won't even do that! They'd rather just not do anything. Doing SOMETHING (ideal or not) is better than nothing. My job as a pharmacist is always to find a cheaper easier alternative to expensive drugs. It may not be the latest greatest drug rep recommendation but there's always an alternative. So, adapting to an individual's life situation is the best medicine. My life's work is finding the best option for each individual circumstance. I mean, people euthanize their cats because they are scared of dealing with diabetes!! There's always a better solution. Maybe not perfect, but it's something.

*end rant* LOL :)
 
Bron and Sheba (GA) said:
Using prefixed syringes is not a good idea.....You would need to clearly mark the syringe so they don’t accidentally use that one.
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Syringes aren't made to be left sitting around with medication in them over extended periods of time. The seal in the plunger can degrade over time. It's a better idea to bend the needle back on some sample syringes (a 1 unit, a 2 unit etc.) so no one can ever poke themselves or accidentally inject it.
Once I was done with a syringe I would bend the needle back and put the safety cap back on. Be careful, the needle can go straight through the cap and poke you. Never use pliers or tools to cut the needle off, it's high grade stainless steel and needs a medical grade tool for that. Bending the needle back costs nothing, I kept ours in a small bucket with a lid under the sink.
Have you thought about having someone log in here while you're gone? They don't need to "talk the talk", none of us do. Just a simple "Hi it's Bob with Matt's cat Redbeard, I'm wondering about something". You can always change your password later.
 
@Mocha's_mom
My comments were geared toward Matt's situation.

Like you, I've dealt with patients all of my career as a member of a med school faculty as well as a member of this community for over a decade. The notion of first, do no harm are words to live by. You have not been here long enough to know that we have trained vets and vet techs, MDs, and nurses in how to manage feline diabetes. You have quite literally no experience with Vetsulin. If this were Humulin N, your experience with humans might be relevant. I realize that you don't like being called out. However, in my role as a moderator, it is incumbent to correct information since we have no idea who is lurking and what they would do the said information. I suggest we stop swapping credentials since for me, it's not about my needs but about the cat.

If Matt were going to be home to monitor his cat, this would be an entirely different set of circumstances. Any one of the moderators or members experienced with Vetsulin would urge someone new to FD to either change insulin or to proceed very, very cautiously. If it is someone else caring for your cat, the issues relevant to safety are paramount. A lower dose of Lantus is safer than the equivalent dose of Vetsulin. And, of course if Murphy's law is operating, this is even more the case if the Libre becomes temperamental or Redbear removes it or decides to not eat or not eat well because Matt isn't there.

Shooting a small dose of Vetsulin is no guarantee that numbers won't drop. (I suggest you spend some time looking at spreadsheets over on the Vetsulin board.) It's no guarantee with Lantus either but at least with Lantus, given it's later onset and nadir, you have more time to catch the drop in numbers. The drop from Vetsulin can be precipitous which is what makes it a potential danger for cats especially since many cats give no indication that their numbers are (dangerously) low. And if the only numbers you're looking at are pre-shot numbers, the results of Vetsulin dosing can be misleading.

@Matt & Redbeard - let us know if you've made any decisions and if so, how we can help. We have a good amount of experience with members who are traveling -- although probably for not quite as long but we'll help you figure out a good plan (and a plan B).
 
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Mocha's_mom said:
Agreed, but given his situation for the next month he'd be safer just sticking to a small dose of Vetsulin to get him started. It's perfectly safe to draw it up ahead of time into his own syringes (there's no lubricant if you're drawing up from a multidose vial of Vetsulin into a clean syringe). And at this point drawing it up ahead of time rather than relying on someone else to do it and potentially getting it wrong is probably the safest bet. Is it ideal? No. But something is better than nothing. If he's able to get a few days of data and a glucose curve at home then he'll have a lot more data to go by.

I believe Lantus is probably the way to go for most of us, but we need to be hypervigilant to make sure we get the right dose. Because of its longer duration of action any small adjustment can take a while to see. With Vetsulin it drops quick and goes right back up. Most vets want us to stay in the safe zone in the beginning (100-300) so Vetsulin makes that easier.

My recommendations are simply given because of Matt's unique situation. All of us want to be "perfect" right from the start but sometimes our life situations make that hard. We have to make choices. Trust me, if I could give Mocha a 100% perfect diet, and test his BG every hour for 24 hours, and follow the AAHA guidelines and start him on Lantus right away then I would! But unfortunately he's a finicky eater, I can't always get blood on the first try, and my vet wants me to start with Vetsulin. I'm working with what I can.

I've dealt with human patients my whole life and I've always been shocked at how many times people won't take meds due to price, inconvenience, etc. People would rather skip taking a drug altogether because it's expensive even if it's life saving. I remember when Lantus was $400 and I had patients who said they just won't take it. That's understandable. So then you should use Humulin R (old school but only $10) and measure your BG frequently and give it multiple times a day. Nope! They won't even do that! They'd rather just not do anything. Doing SOMETHING (ideal or not) is better than nothing. My job as a pharmacist is always to find a cheaper easier alternative to expensive drugs. It may not be the latest greatest drug rep recommendation but there's always an alternative. So, adapting to an individual's life situation is the best medicine. My life's work is finding the best option for each individual circumstance. I mean, people euthanize their cats because they are scared of dealing with diabetes!! There's always a better solution. Maybe not perfect, but it's something.

*end rant* LOL :)
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I have to agree fully with Sienne. We’ve both been here a very long time and can vouch that not every cat responds to the same dose of the same insulin in the same way. Our saying “every cat is different” is not just to be glib. Kitties are not furry people and their metabolism is different. Vetsulin is a harsh insulin in cats compared to Lantus and, if a caregiver can afford it, we will always encourage them to move from Vetsulin or Normalin/Humulin to one of the L insulins or PZ.

I also don’t agree that everyone here wants to get it perfect right from the start. New members are usually too terrified to worry about that and members who have been here even a few weeks and longer quickly realize they aren’t in control.

In addition, while we are a peer review board and every member can provide comments, it’s a basic premise here that one does not advise for or against using an insulin they have never used in a cat or give specific dosing advice on an insulin they have never used unless they are very experienced and have used a few different insulins and understand the mechanisms of how each works in a cat.

Mocha's_mom said:
we need to be hypervigilant to make sure we get the right dose. Because of its longer duration of action any small adjustment can take a while to see. With Vetsulin it drops quick and goes right back up. Most vets want us to stay in the safe zone in the beginning (100-300) so Vetsulin makes that easier.
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This statement alone makes my point. We can give you many examples which disprove both the first and second sentence. Vets want CGs to keep the cats in such a high range of BGs because they can’t always be available to help out if the cat’s BG falls lower. Their advice is not given for the cat’s best interest. It’s called “liability”. My own vet specifically told me this. That’s why she found this site to be invaluable as there is usually someone on 24/7 to help if the BG is dropping or is a lower BG the CG is worried about. I am glad you and Mocha found this site since your vet does not seem knowledgeable about FD.

I’d also like to dispel any statements about cats, insulins, and not dosing if the cat is not eating. I would definitely be cautious with the shorter duration insulins that have no depot if a cat is not eating because food absolutely needs to be on board before the insulin onsets. That is not true with the L insulins and there are many, many situations where not giving insulin to a cat that is not eating can be dangerous and contribute to the development of ketones and DKA. Rather than reinvent the wheel, I’ll just provide this post.
 
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I hear ya. I'm not trying to step on anyones toes or give unwelcome advice. Sounds like Matt has a couple weeks where his cat will be under someone elses care and he even said he was debating not even starting treatment until he got home from all the trips. Just thinking that something is better than nothing for a very short period of time. Is it ideal? No of course not.

And trying to switch to Lantus right now when he's gonna be leaving in a few days doesn't seem like the easiest thing to do. Maybe when he gets home and can keep a closer watch would be a better time to switch. Just trying to think of the easiest way for him to get through these next few weeks.

I know my vet is ultra conservative and said 100-300 is good (and yes, I totally think it's the liability thing) that's why I'm going to try to keep tighter control on my own because I want what's best for my cat, not some vague rules about keeping it in the high range. I know she wants Vetsulin for now so I'm going to try it for a while and see where we stand. So far it's looking like Lantus is the best option because it looks like Mocha's nadir is at +2 and goes up from there. I don't want him to be in the high range as it wears off before his next dose. But I have to give Vetsulin a fair chance before asking for a change. I certainly don't think my vet is an expert in diabetes nor does she think that most caregivers are willing to do home monitoring. She actively discouraged it which is so bizarre! I'd never dream of giving insulin without knowing what his BG is beforehand!

I'm still learning and don't claim to be an expert so please don't misunderstand my intentions. I know there are plenty of people here with years and years of experience and I find the information invaluable. I'm sure Matt appreciates everyone's knowledge.
 
Mocha's_mom said:
Sounds like Matt has a couple weeks where his cat will be under someone elses care and he even said he was debating not even starting treatment until he got home from all the trips
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@Matt & Redbeard
Hi Matt, not starting treatment until you get back is not a good idea at all. Diabetic cats that do not get insulin are running a big risk of developing ketones which can lead to DKA which is an extremely serious illness and can be deadly.
 
My girl was on Caninsulin first, then Lantus. Vetsulin is a US specific branding of Caninsulin. As you can guess by the name, an insulin first created for dogs. My vet was really reluctant for me to switch, probably because she wasn't familiar with Lantus. Fortunately I got a locum vet and he switched me. Both Neko and I were much happier after the switch. Lantus lasted much longer and she wasn't starving as much as she was when the Caninsulin wore off early. She had a couple special conditions that made her diabetes trickier to handle. However, I can related to having your cat on the less than ideal insulin for a while, as circumstances could demand. I agree with the others that you should start insulin treatment now rather than wait until your return. Congrats on the pending marriage by the way!

Any chance you can find a vet tech or petsitter willing to stop my your parents to do periodic BG checks? When people go away on holidays/work trips, we usually suggest a slightly lower dose for safety. In your case it could just mean some increases are delayed, unless the periodic blood sugar checks show it'd be safe to increase. And don't write off your parents until you ask - we've had caregivers in their 80's here doing tests.
 
re my post #15 about notes on the fridge.
Someone may have already mentioned this, how to spot a Hypo episode, what you need and what to do.
Sorry, could someone please post the link.
 
Welcome Matt and Redbeard
Good job with the SS Matt. Is he only getting 2u once a day? Just in the morning?

How have you getting on? s, he took quite a drop on those 2units.

You mention the diet change, to a wet Low carb diet, was he on dry before?

Dry can take (in some cats) some time to work out of the system, and when it does the insulin needs can reduce considerably, lthat could see the 2u drop his blood glucose levels even more than you saw yesterday, you need to be especially vigilant at this stage, with the food change and be in Ng new to insulin, that 2u dose may need to be adjusted down.

It is possible that with vetsulin, he may have even dropped lower than that 87 at +4, he could have been lower at +3 or +5,. I might have checked his BG again at +5 or +4.5 to make sure he was done dropping.
 
Hey all, thank you so much for continuing the advice! Redbeard is doing great so far. This morning his BG was only 124 at breakfast after no insulin for the previous 18 hours. I had to take him to the vet to get his Libre, and his BG spiked afterwards to around 220. He got 1 unit of vetsulin and held steady all day! He ranged from 78 to 128 mg/dL, so I held off any more insulin. I had to leave town again for work, but my fiancé will test again in the morning and shoot if necessary. These numbers seem too good to be true. Can he really be responding this well after only one week of insulin and a full switch to a low-carb diet? Is he knocking on the door of remission??
 
Some cats become diet controlled with the switch to a low carb diet so that is a possibility. That’s one reason for the concern with a harsh insulin like Vetsulin. I’m glad your fiancé will test.
 
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