Starting insulin tomorrow, nervous

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orangetabby8

orangetabby8

Member Since 2021
My baby girl was diagnosed last Friday with diabetes and I immediately switched her to a low carb canned food diet (Fancy Feast pate) and low carb treats.

I have noticed a huge difference in the amount of urine output and she drinks a lot less water. She loves her Fancy feast pate and eats 2 cans a day. She’s excited for food time but doesn’t bug me for dinner an hour before so it seems to keep her satisfied. She is and has been negative for ketones.

My vet had told me they want to start Prozinc and the appointment for that is tomorrow. They said they want to start 1u twice daily. I didn’t expect her sugars to drop to the 150s with just a diet change so I’m becoming increasingly nervous about starting insulin. I put my questions below.

1. Would I even start off at 0.5 units twice daily? Her blood sugar is within normal range now according to the reference range given by the vet (their upper number is 175).

2. I leave town for a couple days next week and I’m worried about hypoglycemia if she is on insulin. While my pet sitter is experienced in insulin administration, it’s still pretty difficult to test my baby. She is getting better about it but it can be difficult to draw blood and I was unsuccessful this morning so it isn’t a guarantee.

3. I work a job that often has 11-12 hour shifts (I work in healthcare) and I can’t just come home to check her in the middle of the day. I’m required to stay at work until my shift is over. Is anyone else in that position and how have you dealt with this? From reading threads it seems that a number of people can come home for lunch sometimes or partially work at home.
 
Love seeing these results from diet changes.

Yes, you do still want to give some insulin. I think she has a very good chance at remission, but we've found the strongest/longest-lasting remissions happen when they are in almost completely green numbers (my situation is a little different given the acromegaly but take a look at my spreadsheet).

Do you have a hypo kit with a variety of medium and high carb foods, as well as honey/karo syrup?


Do not start at 0.5U. I believe that will be too high, especially if you can't be home. I would start with what we call a drop dose, on a day you can be home (or someone around to test). You push the plunger all the way down to expel any air, insert into the vial, then release so it pulls in just a drop of insulin, then pull syringe out of vial. When giving the shot, try to hold the plunger down for about 10 seconds to give the insulin time to absorb. At this time I would only give the drop dose if BG is above 150, below that skip until you get more data.

Chances are a drop dose may not be enough, but better safe than sorry given your schedule. Give the drop dose maybe a week to see what happens, then can consider an increase if needed.

Did you look over the ProZinc dosing methods? Given your schedule I'd suggest Start Low Go Slow, where you hold the dose for a week, do a curve, then evaluate next steps. And reduce the dose any time BG goes below 90.

A lot of people like the Libre, but it probably won't do much good if you can't get home anyway. I personally am not a fan, anecdotally it seems to read falsely low and scare people into thinking there's a hypo/cat is needing reductions...but compared with a handheld pet or human meter it's nowhere near that.
 
If you find yourself skipping a lot of shots let us know, and please do continue to check for ketones

Another thought - do you have a timed autofeeder for while you are away?
 
FrostD said:
Love seeing these results from diet changes.

Yes, you do still want to give some insulin. I think she has a very good chance at remission, but we've found the strongest/longest-lasting remissions happen when they are in almost completely green numbers (my situation is a little different given the acromegaly but take a look at my spreadsheet).

Do you have a hypo kit with a variety of medium and high carb foods, as well as honey/karo syrup?
Click to expand...


Me too! I definitely didn't expect this big of a change but I'm really happy to see her improving.

I do have a hypo kit from the list here.

FrostD said:
Do not start at 0.5U. I believe that will be too high, especially if you can't be home. I would start with what we call a drop dose, on a day you can be home (or someone around to test). You push the plunger all the way down to expel any air, insert into the vial, then release so it pulls in just a drop of insulin, then pull syringe out of vial. When giving the shot, try to hold the plunger down for about 10 seconds to give the insulin time to absorb. At this time I would only give the drop dose if BG is above 150, below that skip until you get more data.

Chances are a drop dose may not be enough, but better safe than sorry given your schedule. Give the drop dose maybe a week to see what happens, then can consider an increase if needed.
Click to expand...

I am off work this Saturday and can be home all day so that would be a good day to give her first dose. I'm not sure if they are planning to dose her at the vet today, but I am going to decline especially if they want to give her an entire unit or even a half unit.

This morning, her fasting blood sugar was 123 so it seems to be continuing to drop with the switch to low carb canned wet food.

FrostD said:
Did you look over the ProZinc dosing methods? Given your schedule I'd suggest Start Low Go Slow, where you hold the dose for a week, do a curve, then evaluate next steps. And reduce the dose any time BG goes below 90.
Click to expand...

I read through the ProZinc dosing methods and it says: "Below 150 mg/dl (8.3 mmol/L), don't give insulin." Should I still be trying to do the drop dose if she is in the 120s? 120s is still higher than she should be but this says not to give insulin below 150.

FrostD said:
A lot of people like the Libre, but it probably won't do much good if you can't get home anyway. I personally am not a fan, anecdotally it seems to read falsely low and scare people into thinking there's a hypo/cat is needing reductions...but compared with a handheld pet or human meter it's nowhere near that.
Click to expand...

I looked into the Libre but I highly doubt she would be pleased with that and I agree it won't do much good since I couldn't get home anyways. I do have a camera in my house that I can watch her with.

FrostD said:
If you find yourself skipping a lot of shots let us know, and please do continue to check for ketones

Another thought - do you have a timed autofeeder for while you are away?
Click to expand...

Thanks, will do! I'm checking for ketones daily and she has continued to be negative.

I don't have a timed autofeeder, probably a good idea for when she starts insulin. Currently, I feel her every 12 hours and that's been working really well.
 
Her numbers may drop even more if you feed small meals throughout the day. We usually do 2 larger meals at shot time, and then two small snacks each cycle. Try not to feed after +6 ish, because that is when insulin would be wearing off and not able to keep BG lower

I mentioned above - do not try a drop dose below 150 yet. You may eventually be get there, but I can't recommend it knowing you won't be home and without seeing how she responds to insulin over time
 
FrostD said:
Her numbers may drop even more if you feed small meals throughout the day. We usually do 2 larger meals at shot time, and then two small snacks each cycle. Try not to feed after +6 ish, because that is when insulin would be wearing off and not able to keep BG lower

I mentioned above - do not try a drop dose below 150 yet. You may eventually be get there, but I can't recommend it knowing you won't be home and without seeing how she responds to insulin over time
Click to expand...

Oh I read that wrong haha i thought it said to give a drop dose if below 150.

Would you recommend just holding insulin if she below 150 and continuing to test and see how she trends? If she remains below 150, would you recommend never giving insulin?
 
Let's see how she does on the day you're home to give first shot. Since you have hypo kit, I'd try the drop dose if 120 or higher when home. Depending on how she does with that would determine what you can do when not home.

Want to make sure you're aware of this chart:
https://catinfo.org/chart/index.php

Make sure you have some in the 13-15% range, as well as 16-20%.
 
FrostD said:
Let's see how she does on the day you're home to give first shot. Since you have hypo kit, I'd try the drop dose if 120 or higher when home. Depending on how she does with that would determine what you can do when not home.

Want to make sure you're aware of this chart:
https://catinfo.org/chart/index.php

Make sure you have some in the 13-15% range, as well as 16-20%.
Click to expand...

Okay sounds good. If she is >120 on Saturday AM check, then I'll do a drop dose and check every 2 hours to see how low she goes.

I'll check the higher carb wet foods I bought to make sure they are high enough.
 
New here - how do you check for ketones? Is that something that can be done at home? My cats was a bit higher, but my vet didn't worry too much about it. But of course I worry
I was worried as well, but you can do it!
 
Pet said:
New here - how do you check for ketones? Is that something that can be done at home? My cats was a bit higher, but my vet didn't worry too much about it. But of course I worry
I was worried as well, but you can do it!
Click to expand...
Hi. You can test for ketones by buying a bottle of Ketostix from Walmart or a pharmacy and testing the urine.
I would suggest you start your own thread so we can help you
 
Update:

Took her to the vet today, told the vet about the switch to food and showed the vet my spreadsheet.

He actually recommended holding off on insulin for now and testing a fructosamine in a couple weeks. He also recommended continuing to home test and to start insulin if her numbers go back up.

He said he was concerned about hypoglycemia since I work long hours and can’t come home if something goes wrong.
 
So the fructosamine won't tell you anything you don't already know, assuming you can keep testing her.

It's really your call. You can wait another week or two and see how her numbers (and ketones) or doing, but I personally think it's worth seeing what happens when you're home and try a drop dose if above 120. If that takes her lower than comfortable, leaves you no choice but to let her be without insulin in my opinion. Would just have to keep testing her every few days to watch for any upward trends

For reference, my cat has been in remission since August. I test sporadically at random times and have never gotten a number above 91, except for when he had a severe infection. That's the case for most cats in a true remission, pretty much always green numbers
 
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