Doing everything as good as possibile and still it is not enough :(

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Justas

Justas

Member Since 2022
Good day,

it has been almost 6 months after our cat was diagnosed with diabetes and I find myself in a spot where I have started my information gathering journey on this topic - this forum.

To put it simply - I am not sure what more we could to help our cat.

This is what we have already done:
1. changed food from dry (damn this one in the first place!) to wet. We have picked one with very low amount (~1 %) of carbs, high quality food (https://www.lilyskitchen.co.uk/for-cats). This is despite our vet recommended to use some specialized dry food for diabetic cats (~8 % carbs);
2. we bought a glucose monitor and we use it minimum twice each day, usually right before feeding;
3. we have changed feeding graphic to two times per day to have more control over the process;
4. we were advised by wet to administer 2TV of insulin two times per day (as the cat was in a bad state once it was diagnosed, ~24 mmol), but after only a few times we had found that the actual doze could be much lower. For a few months it seemed that in order to keep our cat in a level of 4-6 mmol it was enough to administer just about 0,4TV and only once per 24 hours, not twice.

We were kind of happy with the results, but nowadays we got to see some bigger spikes in our measurements (12-19 mmol!), even once we started giving insulin twice per day. The smaller doze still works good, sometimes we even reach results lower than 3 mmol, which is worrying, but one the other hand we do not have a way to administer a doze which would be smaller than 0,4TV...

Is there something we are doing wrong? Maybe we are missing something? What should we do to avoid these spikes?

Or maybe that's the way it will be now?

Big thanks in advance for all your insights.

Justas
 
First of all welcome

And sorry to hear you are having some trouble regulating your cat, it seems that you are on a good path just need some adjustments in what you have been doing, to help you better please give us some more information about your cat, what is his name? Does he have other illness besides diabetes? Are you using a human or a pet glucose monitor? What type of insulin are you using? What type of syringes are you usintg? Where are you located? Could you please share with us the test results you are getting?

Maybe is a language thing but just to be sure when you say you are giving 0,4 TV you mean you are giving 0.4 units of insulin? How are you measuring the 0.4 units?

One thing I do think that is not helping is giving him insulin just once a day unfortunately because of how cat's metabolism work they need insulin twice a day or their numbers start to act really weird ( the spikes you are getting could be in part because of this), if the dose you were giving was too much you may need to give smaller doses but you really need to give it twice a day
 
Some cats are just hard to regulate. My wiggles started insulin 2 ½ years ago I got acceptable BG values on about 0.4 units Levemir.. Then about 1 ½ years ago his BG values were inconsistent. He was always on low-carb canned since diagnosed as diabetic. He received a dental several bad teeth were extracted w/no change in BG inconsistency. He was on Levemir before, I tried glargine and Prozinc with no change but Prozinc seemed to be worse. I tried different injection locations and needle lengths with no change. I am still working on it. Yesterday evening his PS was 47 down from 338 in the morning with 0.9 units glargine. I gave no insulin yesterday evening and this morning his PS was HI (>600). We can only do our bast.

Wiggles is the hardest cat to regulate. I got my DeeDee last Nov he was on 2 units Vetsulin and obese (17 lbs). He is on low-carb canned and his dose is about 0.9 uniys Glargine with PSs less than 150.
 
Here is a link helping us to help you link. If you noticed, our members have some basic information about their cat's in their signature. This helps us to not pester you by asking the same questions (your cat's name, insulin type, date of diagnosis, etc.) repeatedly. We also have a link to our spreadsheet in our signature. We are very numbers driven. The spreadsheet is a record of your cat's progress. By linking it in your signature, we can follow along and provide feedback should you need the help

I can ask someone to set up the spreadsheet for you if you want :cat:
https://felinediabetes.com/FDMB/threads/how-to-create-a-spreadsheet.241706/
 
It's wife of Justas writing. Sorry for the lack of information - we live in Lithuania (english is not my native so there may be some unclierity at that point - sorry for that). Our cat's name - Morkus, he is 10 years old abyssinian, he hasn't any other illness besides diabetes. He has a lot of energy and is playful mostly all of the time (except when he has these spykes). We are using human glucose monitor because our Vet told us that these are more accurate (we are using "Contour plus ONE") and insulin is "Caninsulin". Syringes we are buying at veterinary clinic - https://gintarinestorageprod.blob.core.windows.net/gintarine/0034652_600.jpeg.
Justas made a mistake about the dosage: VET prescribed 2TV of insulin (0,05 ml), twice per day but when we started doing this Morkus had critically 2 mmol/l mostly all the time so i changed the dossage to 0,01 ml. And everything was fine: we changed food (i made a lot of calculation to know how many carbs are in different food so we stayed to Lily's because of very low carb intake (0-2%), no grain and no sugar while in diabetic "Royal canin" there are 8% of carbs + 1.8% of sugar. And we came to this point when Morkus had only 1 injection per day of 0,01 ml insulin (i measure it by graduation on syringe - 1 section - 0,01 ml). We thought that we are lucky and MOrkus will have remission soon but something happened and now he has these spykes. Food is the same, dosage is the same, timing is the same, he doesn't get any other food between the meals so we can't understand what has changed. The problem is that even when he has 18-20 mmol, the 0,01 of insulin is enough for him to lower it to 4-5 mmol. Sometimes even to 2 mmol so why we are not making an injection a second time a day when he has 4-5 mmol already (it may lower to critical condition).
p.s. Thank you for spreadsheet - i'll try to fill it. Aušra
Here are some readings:
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Hi and welcome to the forum.
Do you think you could take a photo of the syringe you are using with the dose you are giving so we can see please? You will need to copy and paste the photo onto the page.
Thee are a couple of things that are concerning me….with the testing….you need to test the blood glucose (BG)before you feed. Then you feed and wait 30 minutes before giving the insulin.
If you can also get a test at about 4 hours after the insulin dose to see how low the dose is taking Morkus.
I am going to ask @Bandit's Mom if she will help you set up your spreadsheet. She will send you a private message.

With the food ………feed the main meal 1/2 hour before you give the dose of insulin because the cat needs to have some food in the system before the caninsulin dose hits. I would also give a snack at +2 and +4 (2 and 4 hours after the dose of insulin) to help stop the BG dropping too low.

By the look of the information you have posted above, the BG is dropping very low….2.7 is far too low for caninsulin and you need to reduce the dose now.
Probably the spikes you are seeing are from bounces when the BG drops too low and the cats body panics and dumps stored glucose and regulatory hormones into the system which shoots up the BG.

Insulin for cats needs to be given twice a day otherwise you will have 1/2 the time when there is no insulin in the cats system…that is another reason you could be seeing spikes.
If you can put in any BG data you have into the spreadsheet that will help us a lot.

Here is a link to BEGINNERS GUIDE TO CANINSULIN

please keep asking questions.
 
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It's a syringe we are using. I'm injecting less than 1 graduation when it's 11-12 mmol, 1 graduation - 13-17 mmol and 1,5 when its 20 mmol and more. (It's really small dosage because our vet prescribed 5 graduation.) We just see that even 1 graduation is way too much sometimes. We check level of glucose at 7 o'clock in the morning, then giving food and i'm injecting (if neccesary) on 8' oclock. In the evening - the same routine: glucose check at 19:00 and injection at 20:00. If i don't feel confident - there are more random checks. (this morning at 6:46 it was 4,8 mmol and now - 21:00 only 5,7 mmol. I didn't injected insulin this morning because he was just fine with 4,8 mmol - these readings today are WITHOUT any insulin - so why we are confused. The food, the routine is the same. Aušra
 
Have you been able to set up the spreadsheet yet? We really need to see some data, not just a few random BGs, if that is possible please. I’ll tag @Bandit's Mom again.
Those syringes are not the correct syringes
You need the U 40 syringes for caninsulin.
I will tag @FrostD to help you with this.

Also if the pre shot BG is 4.8 skip the dose but keep checking the BGs.
@Justas please read this post again in case you have already read it. I have changed the information.
 
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firstly, congratulations on all you are doing. I had the same very poor control with caninsulin. it is terrible for cats. it was designed for dogs and is metabolized too fast making big ups and downs.
I changed to Lantus after going to 3 different vets (here in Ireland) until one would change the prescription.
the improvement with Lantus is amazing - even after a week !
I recommend you ask for this ASAP and if needs be, show you vet the RVC study on longer acting insulins that have better control for cats.

I also found it very important to get needles that hold a very small volume so that the unit lines are further apart and you can better prepare small doses. I also get them with half-unit markings so that I can see.

When Arthur was uncontrolled at 2units of Caninsulin twice a day, the vet put him on 3 units. this nearly killed him and I realized that not all vets have much experience of controlling diabetes. I reduced his dose that same day to 2.5 and started looking for a vet who would prescribe him glargine / Lantus which is a different concentration, so even more important to use the correct lowest volume needles and with half-markings.
 
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One suggestion would be to switch to a longer acting insulin Caninsulin is not a great insulin for cats. Most cats respond better to long acting insulins. Good choices are ProZinc, insulin glargine (Lantus, Basaglar & Semglee) and insulin detemir (Levemir).
 
When you do your signature I would also add you are from
Lithuania
Here is a link helping us to help you link. If you noticed, our members have some basic information about their cat's in their signature. This helps us to not pester you by asking the same questions (your cat's name, insulin type, date of diagnosis, etc.) repeatedly. We also have a link to our spreadsheet in our signature. We are very numbers driven. The spreadsheet is a record of your cat's progress. By linking it in your signature, we can follow along and provide feedback should you need the help

I can ask someone to set up the spreadsheet for you if you want :cat:
https://felinediabetes.com/FDMB/threads/how-to-create-a-spreadsheet.241706/
 
Justas said:
6217d3907f63e.jpg

6217d3b0b2215.jpg

It's a syringe we are using. I'm injecting less than 1 graduation when it's 11-12 mmol, 1 graduation - 13-17 mmol and 1,5 when its 20 mmol and more. (It's really small dosage because our vet prescribed 5 graduation.) We just see that even 1 graduation is way too much sometimes. We check level of glucose at 7 o'clock in the morning, then giving food and i'm injecting (if neccesary) on 8' oclock. In the evening - the same routine: glucose check at 19:00 and injection at 20:00. If i don't feel confident - there are more random checks. (this morning at 6:46 it was 4,8 mmol and now - 21:00 only 5,7 mmol. I didn't injected insulin this morning because he was just fine with 4,8 mmol - these readings today are WITHOUT any insulin - so why we are confused. The food, the routine is the same. Aušra
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To make sure I understand - the picture with your thumbnail at the first line on the syringe is the dose you are using?

Where do you order your syringes from? Is it online (internet)? Can you send me a hyperlink to the company? And can you send me a hyperlink to the ones you have?

I believe Bron is right - if those syringes are orange, those are for U100 insulin. Does it say U100 anywhere on the syringe or the box/bag they come in?. It is hard to tell from the picture, but I believe each small line in your syringe is 2U?
 
FrostD said:
To make sure I understand - the picture with your thumbnail at the first line on the syringe is the dose you are using?

Where do you order your syringes from? Is it online (internet)? Can you send me a hyperlink to the company? And can you send me a hyperlink to the ones you have?

I believe Bron is right - if those syringes are orange, those are for U100 insulin. Does it say U100 anywhere on the syringe or the box/bag they come in?. It is hard to tell from the picture, but I believe each small line in your syringe is 2U?
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Yes, it's correct - it's the biggest dose i inject. Smaller one when he needs it is below 1 gradation. When Morkus was diagnosed with 2'nd type of diabetes half a year ago he was prescribed with 0,05 ml insulin. In Vet clinic we got syringe with smaller gradation - like that one in this link. When i was out of it i went to clinic again but they had only these with biger gradation - like that. It's for insulin as well but not as comfortable because Morkus needs the smaller dose - 0,01 sometimes - 0,02 ml. So when he has 3-5 mmol i don't inject him - he reacts very intense even to small dose of injection. I went to few Vet clinics to find this syringe with smaller gradation but all of them had only this orange one. I googled - nobody in Lithuania from e-shops or wet clinics has it so i'm using this one. We are thinking to buy somewhere online it because as i can see from your comments - the main problem could be the gradation/dose.
p.s. yes the syringes are U-100 and its written 1 ml. When in vet clinic they gave us the syringe doctor showed me that i need to inject 5 lines 2 times per day. So if he was prescribed with 0,05 ml and its 5 lines i asumed that 1 line is 0,01 ml and sticked to that. 0,05 ml was way too much for Morkus - after injection he had almost every second time below 3 mmol so i stoped it. We visited 2 clinics for that and they werent sure what to do - "just stick to the 2 times per day and watch him". So we left on our own and did a lot of research, readings and experiments with food and dose. The hardest thing - what to do when he has normal rate of glucose before injection time? We are measuring him when we can but most of time we are at work.
p.p.s. I made spreadsheet and signature. Thank you ladies for great support and sorry for my english ;) I hope it won't be a problem to understand our PROBLEM :)
 
You are doing great so far, and with a little more time and patience, Morkus is going to be fine, people here have a lot of experience and will help you, besides your english is good enough, so that even I ( english is not my first language either) understand you
 
Ok I will be back later after I do some googling. For now - each small line on your syringe is 2 units of U100 insulin. The conversion to U40 is divide by 2.5. So when you fill it to the 2 units line on a U100 syringe, it is 0.8 units of U40 (2U line / 2.5 = 0.8)

U100 insulin has 100 units per mL, U40 is 40 units per mL. So the 2U line on your U100 syringes is 0.02mL, yes. We do everything here in terms of units though

He is on a very small dose of insulin which is great. You are doing the right thing by skipping shoes, especially when you can't measure such small doses

Language is no problem! I try to use simplified English in case you have to use a translator, but t is hard sometimes with the technical terms
 
Google is not cooperating.

What you want is either:
- U40 insulin syringes, 0.3mL, ideally with half unit markings. Like these: https://www.chewy.com/ulticare-insu...IKFHx1zrERRrlS9cHIcyOH8jJl9mOb-4aAis7EALw_wcB

If U40 syringes just are not available in Lithuania, you can continue to use the U100 but you need ones with much smaller volume. 0.3mL volume is best, half unit markings are ideal. Like these: https://www.adwdiabetes.com/product...kSzGqKEmPTir86uBPWE4BzuwZMmB6KPcaAiubEALw_wcB

Humans do not usually use the 0.3mL syringes, too small. Is there a pet-specfic company you know of that would ship to Lithuania? Maybe you could ask a pharmacist too?

If.you have to use the U100 syringes, please put that on your spreadsheet and in your signature, that is important for us to know. Again, the conversion factor is 2.5 (if you want to give 1 unit U40, you must fill to the 2.5 line on a U100 syringe). Here is a link to the conversion chart: http://www.felinediabetes.com/insulin-conversions.htm
 
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Justas said:
Big thanks for all of you - we will make changes based on your advices. I hope this will help, in any way, you are all true cat friends! :)
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You're welcome!

Now, this 0.02mL dose is still too high. Can you try to draw the insulin so there is just barely any in the syringe? Just a hair's width of insulin in there? Like this:
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I found yeasterday in one wet clinic these syringes and bought plenty of them. They are way smaller - 50 U with small needle. (Scale Graduation 1 I.U.) As at first we were prescribed 5 scales, it's way easier to lower it to 1 or 2 graduation. As well i talked with doctor in this clinic about other form of insulin you have mentioned and they agreed that it would be better just they weren't able to sell it to me because i'm not their client (it needs prescribtion). So we will go to our clinic and i'll ask to change Caninsulin. I think, that with your help we are on a good way. (p.s. I filled spreadsheet and will correct ml to IU later - with big syringe it was easier for me to measure in ml). Aušra
 
Red & Rover (GA) said:
There is a recent member next door in Poland who uses caninsulin.

@Crisp
Where do you get your U40 insulin syringes?

Waving from Canada.
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Good morning!
I got the U40 syringes at the very first pharmacy that I went into. I almost fell over, it was so easy. I couldn't figure out quickly how to upload a photo. Here is shared link to google drive - the syringe packaging.

https://docs.google.com/document/d/1rfCdJ-pY5ekr9h7ihc2BD62Qu0z5-lwpL5jCB0MkcVo/edit?usp=sharing
 
Justas said:
I found yeasterday in one wet clinic these syringes and bought plenty of them. They are way smaller - 50 U with small needle. (Scale Graduation 1 I.U.) As at first we were prescribed 5 scales, it's way easier to lower it to 1 or 2 graduation. As well i talked with doctor in this clinic about other form of insulin you have mentioned and they agreed that it would be better just they weren't able to sell it to me because i'm not their client (it needs prescribtion). So we will go to our clinic and i'll ask to change Caninsulin. I think, that with your help we are on a good way. (p.s. I filled spreadsheet and will correct ml to IU later - with big syringe it was easier for me to measure in ml). Aušra
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Ah much easier!

Yes at the dose he's on and his low numbers, I would recommend what is called a depot insulin like Lantus (glargine) or Levemir (detemir). Those are more gentle insulins and usually better at these lower doses.

ProZinc would be my last choice, but it's ok if that's all you can get. It's not always as good at the lower doses. Sometimes on ProZinc you have to let the BG stay higher overall because you can't increase safely.
 
Justas said:
I found yeasterday in one wet clinic these syringes and bought plenty of them. They are way smaller - 50 U with small needle. (Scale Graduation 1 I.U.) As at first we were prescribed 5 scales, it's way easier to lower it to 1 or 2 graduation. As well i talked with doctor in this clinic about other form of insulin you have mentioned and they agreed that it would be better just they weren't able to sell it to me because i'm not their client (it needs prescribtion). So we will go to our clinic and i'll ask to change Caninsulin. I think, that with your help we are on a good way. (p.s. I filled spreadsheet and will correct ml to IU later - with big syringe it was easier for me to measure in ml). Aušra
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I hope you can change insulin it will help him a lot, the other insulins are gentler for cats and they do much better
 
Can you create a US tab on your spreadsheet, most of us look st US numbers
Thanks so much
If you are anywhere other than the US, please click on this link for the World Spreadsheet Template for HUMAN METERS:
World Spreadsheet Template

If you need help just ask and one of our members will do it for you :cat:
@Justas
 
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