18 year old cat just diagnosed after long time steroids - help!

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Simon's human

Simon's human

Member Since 2021
Simon, 18, is a Balinese neutered male who we rescued at the age of about 3. He had a routine blood test May 1 that showed a glucose level of 279. Vet ordered Fructosamine test which was 436. A BG test Jan. 8 was normal, 128. Vet thinks this is caused by years-long low dose use of Prednisolone for IBD which had been increased slightly in January. Cut back to every 4 days and I researched carb levels in food and switched him from his dry and wet food to very low carb wet (Kiwi Kitchens beef and chicken are -1 and -1.1. Others range from 1.4 - 6.8). Vet had given dry Blue Buffalo W+U, but it is over 25 carbs so have given Simon only an occasional very small handful. Disappointed that on 6/3 BG was 449, fructosamine 609. Simon was thin before this and has lost some weight and is wobbly. Will start insulin. Learned vet ordered Vetsulin and we will talk with him Wednesday 6/9. I mentioned TR to him Friday and he didn't seem to advocate that tho he knows tests at the vet's can drive up numbers. Said we would test again in 2 weeks. After reading posts here, I was hoping for Lantus insulin and TR. I'm very scared and confused about all of this. We're also dealing with a nearly 17-year-old dog who has side effects from her stroke last year, has had 3 seizures, weakening back legs because of age and now is developing dementia. Simon appeared to be doing fine before the May blood test - he had had 1 day of being lethargic a week before, with a lower than normal temp and had vomited once, but we had not noticed more frequent drinking or urinating. That really increased after the May blood test. I'll try to make a list of everything we should talk to the vet about Wednesday but wanted to check in here first for advice - and reassurance. Thanks!
Nancy
 
Hugs Nancy! It's all a lot to take in and then a second complex animal on top of the diabetes. Hang in there - the diabetes part does get easier after the (very) steep learning curve. I know nothing about Vetsulin but I encourage you to read about it and the "yellow stickies" at the top of the Vetsulin board (link here).

Here's a food chart (a little dated but a lot of us use it since the % of carbs from total calories is not generally published by food manufactures) - link. Generally, those here try to feed a low carb wet food that's <10% carbs and often it's 5% or less (Fancy Feast Classic Pates are one afforadable option though I'm not sure what foods work best with your IBD kitty). I do not personally have experience with IBD but I believe budesonide can be used in place of Prednisolone with less of impact on BGs (again, I have no personal experience here... @tiffmaxee do you have experience with IBD? I can't remember...maybe @Margaret (and Pearl) can stop by the next time they are online...she uses pred with Pearl and doses around the BG impact).

As for insulin, you are spot on asking for Lantus - The (2018) AAHA Diabetes Management Guidelines for Dogs and Cats recommends using Lantus or Prozinc to manage feline diabetes - could be worth the discussion with your vet (click that link for the paper).

BTW, are you home testing? Setting up a spreadsheet to track your data (and so others here can see it) would help. Here's some info on it - How to Create a Spreadsheet & How to Use the Spreadsheet. If you need help, just ask and we will get someone to help you set it up :bighug: The New? How You Can Help Us Help You page also has lots of good info.

Hope that helps a little bit :bighug:
 
Hi Nancy. Yes, see if you can switch from prednisolone to budesonide. It works for IBD and just might help reverse the diabetes.
Vetsulin is an insulin that works for dogs but not as well for cats. It causes harsh drops and doesn’t have as long duration. Push for lantus.
 
If your vet will let you switch to Lantus it's very expensive in the US
Most of us buy Lantus from Marks Marine in Canada
So much more affordable , you would need U-100 syringes with half unit markings when using Lantus

If you aren't home testing yet we can suggest what meter to buy that's very affordable . Most of us use human meters that's what our numbers are based on
Pet meters are expensive to test with because the text strips for them are very expensive
Like 54.00 for 50 strips and you do go thru a lot, plus you have to order them online


You can buy the human meter from Walmart
Relion Prime 9 dollars
Test strips for it 17.88 for 100
Lancets 26 or 28 gauge any brand is fine
Cotton rounds to put behind his ears when you poke , then hold it on his ears for about 10-20 seconds to stop the bleeding.

All of this will save you money for vet visits, testing at home

We also have a spreadsheet that we use to enter our cats BG to see how it's
working for him, we can then give you advice on dosing.

Susanne @JaxBenji has given you the links on how to set up your spreadsheet and also setting up your signature it's at the end of everyone's post
The New? How You Can Help Us Help You
Just go to the top of your page and tap on your name and you will see signature appear
 
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  1. Most of us use Lantus, . Lantus is expensive in the US so we buy it from Marks Marine in Canada
    We buy the 5 pack of solostar pens they will probably last you for over a year
    With Lantus you use U-100 syringes with HALF UNIT MARKINGS
    so you can increase or decrease by 0.25 units

    With the pen you can only adjust by whole units, that's why we use syringes to insert in the little gray rubber stopper and draw out the insulin from there
    The expiration dates will probably be 2022 or 2023 just keep them in the middle shelf in the fridge.
    After that you will not need another script to reorder
    Call them, you can probably just send them the script

    Last edited: Thursday at 9:19 PM
    Tyler’s Spreadsheet
    Thursday at 9:12 PMEditDeleteReport
    #3Reply


  2. Diane Tyler's Mom
    Joined:
    Sep 21, 2018
    Lantus Solostar PEN CAN (temp. gauge. ice pack, express-air mail) *single pen open box* Brand 100iu/ml one pen 3 ml $49.99 USD

    rx.gif
    Lantus Cartridges 5x3ml per box (temp. gauge. ice pack, express-air mail) Brand 100u/ml 15 ml $159.99 USD

    rx.gif
    Lantus Solostar PENS 5x3ml per box (temp. gauge. ice pack, express-air mail) Brand 100u/ml 15 ml $164.99 USD

    rx.gif
    Lantus VIAL Insulin (10ml per vial) (temp. gauge. ice pack, express-air mail) Brand 100u/ml 10 ml $110.99 USD

    https://rxcanada4less.com

    Tyler’s Spreadsheet
    Thursday at 9:14 PMEditDeleteReport
    #4Reply


  3. Diane Tyler's Mom
    Joined:
    Sep 21, 2018
    Just take the cap off the pen and use a U100, 3/10ml, 31 gauge insulin syringe to pull the insulin out of the pen!
    syringe-in-pen-pic-jpg.45006
    syringe-in-pen-close-up-jpg.45007
 
Hi Nancy! @JaxBenji tagged me, I can give you information about Prednisolone. Pearl is a Pred kitty. She gets it because of asthma - other steroids don't target the lungs the way the Pred does, and it definitely effects her BG but I've been having success controlling it (she also gets the Pred currently every 4th day, and had long-term use before being diagnosed with FD).

A question for you...is the Pred only for IBD? I mean, not for asthma or liver issues? Because if it's only for IBD have you considered a switch to Budesonide? That is the safest steroid you can choose in terms of it NOT effecting your cat's BG. I've used Budesonide very successfully for IBD (it is the steroid of choice for that ailment). The Pred comes in handy when you have inflammation in other areas as well (which is why it is chosen for Pearl).
 
Thank you all so much! You have shared so much helpful info that it's going to take me a little while to digest it all. Yes, Simon was only taking Pred for IBD. He had 1 very serious incident several years ago requiring a biopsy and I think 1 minor one since, but he was on Pred on an every other day basis until the May diagnosis, when it went to every 4 days. I'd really hate for him to have another bout, and I'll ask about Budesonide. I hadn't heard of that, but then I haven't researched IBD for a while. My husband asked at Costco today about diabetic supplies, and they have them too. Now that I have the names I can be more specific and check around. It does seem that it'd be a good idea to get Lantus from Canada. It is amazingly expensive here. I don't know how long I can/should wait to get Simon going on insulin. I wish he had some fat to spare, but he doesn't. If Vetsulin is what the vet has ordered, should we start with that and switch later, or wait? I was cautious when I was researching cat food carbs a week ago so I am not introducing different proteins. I found an online cat carb calculator on the diabetic cat international website that I used which was super easy. I was astounded at the results. From what I am learning now, that was the last super easy thing about FD we'll have! I think I need to wait to set up a signature like you all have until we know more about the insulin. I really appreciate your help!
Nancy
 
Heeeey, my 18 year old lady was just diagnosed with diabetes this year, too! Elderly kitties for the win!

I'm new at this all as well, so I cant offer a super lot of helpful advice like all the seasoned veterans here, but here's my two cents:

THIS CHART was SUPER helpful to me at the start of all this! (I initially fed her a lot of Fancy Feast patés, which are pretty low-carb.)

Before you go off buying crates of food, and considering Simon's age, I would actually ask the vet how Simon's kidneys are. Not to freak you out or overwhelm you with information! The vet that initally diagnosed my cat with diabetes kind of failed to mention to me that my cat was having kidney issues, and I went about a month not knowing and feeding food that proooobably didnt help the situation. Knowing that kind of changes how I now feed her. Diabetes and kidney issues seems to be issues that go hand in hand, because when the body gets overwhelmed with sugars in the blood, it's the kidneys that have to pick up the slack, and it can harm them.

Starting insulin will help Simon put on weight, since he'll now be able to process his food more, but it will be a slow process.
 
Hi :) if ketones are not an issue I personally would choose to just get a script for Lantus and start with that instead of starting with Vetsulin while you wait.

You can try to get a single Lantus pen in your local area while waiting for shipment of the others from Marks is that is where you are ordering from. The single pen comparatively may be more pricey but you can get going quicker on an insulin that has been proven to really help cats stabilize and reach remission. My thoughts also have to deal with the IBD complication and wanting an easy insulin that will work well with those medications and any BG swings due to the inflammation from time to time.

It’s very easy for your vet to give you a Lantus script and you’ll find it in stock at any local pharmacy. Calling around a bit will help you know who will sell you a single pen and some places are cheaper than others.

vet can even email you script. You can use it for your pen and for Marks order.
 
Simon's human said:
online cat carb calculator on the diabetic cat international website
Click to expand...
I'm not sure if this is the one you found - http://www.diabeticcatinternational.com/knowledge/calculating-carbs/ - but I believe the inputs are the Guaranteed Analysis values which, just as that site even says, are minimums and maximums (so the food could contain more than the minimum or less than the maximum). It's an okay place to start but it's really best to use Metabolized Energy (ME) values but if those aren't available then use the As Fed or Dry Matter values and calculate the % of calories that are carbohydrates using this post Calculating % Calories from Carbohydrates (that post also has a link on why Guaranteed Analysis values are not awesome - https://truthaboutpetfood.com/guaranteed-analysis/ ). I love math :bookworm: so am happy to help with any calculations. Weruva, Wellness, and perhaps a few others post As Fed / Dry Matter Basis information online; most pet food companies do not :rolleyes: There is even more info on Dr. Pierson's website on this topic...it may hurt your head lol but worth the read to understand - https://catinfo.org/commercial-cat-foods/ I'd just make your way through this when you have the time :bighug:
 
Another option regarding the cost of Lantus...

The patent on Lantus recently expired. It is now available in generic/biosimilar versions. You may want to check the price of Basaglar and Semglee. These are the two generics that are available.
 
I am so grateful for all your help - thank you! I just looked up budesonide for IBD and have no idea why Simon was put on Prednisolone instead. I like the fact that it seems more localized, although it had a warning about diabetes. I'll ask about switching. Our vet has already pared Pred down to every 4 days. As for the cat carb calculator, that's the one I had found and used. I guess it was too easy after all. That's the basis I used for buying Simon's new pet foods for him to test, so I will look at this other way of figuring. And I may need to ask for help in that - thanks for offering! I am pleading ignorance on ketones. I'll look that up next. I don't think Simon has been tested on that. And that is terrific news about Lantus' patent expiring so it can now be available in generic. I like your idea about trying to find perhaps just one single Lantus pen rather than start with an insulin we will likely change. I have read most of the AAHA guide on diabetes so far. So many things to learn about! I really like the idea of home testing but Simon probably won't. He hates having his claws clipped, so I can't imagine he would relax for this. He doesn't gobble his food all at once, and I've never tried treats with him as some recommend with the ear pokes. My husband will be the injector and poker (I hope.) He's given lots of sub-q fluids to our cats and dogs over the years. Diabetes is a first for us. I really do appreciate your guiding us through this. Thank you! The hardest part will come after we figure out next steps on insulin and testing. Simon says thanks too. He is quite vocal!
Nancy
 
Hi Nancy,

With the Budesonide you won't have to worry about only every 4 days likely. If Simon needs more than that to keep his IBD at bay, you can do that.
 
We have lots to talk about with Simon's vet later today: insulin, home testing, Budesonide. I looked up the post about calculating % calories from carbs, as well as the food chart from Dr. Lisa. I had not paid attention when I calculated carbs earlier from Guaranteed Analysis numbers. What a difference! Thanks! The Kiwi Kitchens chicken went from -1.1% to 14% carbs. The Kiwi Kitchens beef went from -1% to 4% carbs, but I discovered fat was 72%. Not good! Simon will be getting his favorite food back. That is Merrick Purrfect Bistro Beef, which I had calculated with GA at 25%. The level with TNA is 5%, and the other numbers are good too. He'll be a happy cat, at least until we start the insulin shots and ear pokes.
Nancy
 
I am even more uncertain after talking with Simon's vet Wednesday. He is going to keep Simon on Pred for IBD, but only 2.5 mg every 7 days. He does not advocate home testing but did mention the continuous blood glucose monitor that is attached to the cat for 2 weeks. He can start Simon on Vetsulin Friday but knows I am not very excited about Vetsulin. He said it would be a very low dose and he would be retested in 2 weeks. He also mentioned ProZinc and I mentioned Lantus. He knew about the generic. I don't know how hard it is to get ProZinc but I have also heard good things about that one. I don't know if I have to order that somewhere. I do think Simon needs to get going on insulin very quickly since his initial blood test was May 1. I wonder if I should start him on Vetsulin and then switch. Or maybe I can find ProZinc somewhere today so he can start it Friday. I read that the Free Libre (I think) continuous monitor wouldn't work very well on a skinny bony cat because of the way it attaches, and that is what Simon is right now. Part of this is his age, but I'm hoping he has a couple of good years in him still. The vet didn't think Simon would do well with a lot of ear pricking. But it seems to me that without some sort of home monitoring, dosages are a shot in the dark. And I'm frankly afraid of sending him over the edge.
Nancy
 
I don't have any experience with IBD & pred, but I will tag a few members who do:

@Sienne and Gabby (GA)
@PerfumedCatMom
@tiffmaxee
@Wendy&Neko

Prozinc or Lantus is a better insulin for cats. I hope your vet listens to you wrt to your choice of insulin.

The Libre stays on some cats the full 14 days and falls of others in a few. (When/Why Use BG with Libre). Is there a reason the vet though that Simon wouldn't do well with ear pricking?
 
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I have a sneaky suspicion that your vet would like you to be buying your insulin from him. Both Prozinc and Vetsulin are only for animals and are often dispensed by vets. (He probably doesn't know that both are available through Chewy's now that they started having an online pharmacy.) I would encourage you to give the vet a call and let him know you've read the AHAA guidelines and would prefer that he prescribe either of the insulins that are recommended by one of HIS professional organizations for the treatment of feline diabetes. Either Prozinc or Lantus are excellent types of insulin for kitties. Vetsulin is harsh and does not have adequate duration given a cat's fast metabolism. The insulin was developed for dogs -- it's other name is Caninsulin. There is a steep enough learning curve with getting started with managing your cat's diabetes and learning how to use Vetsulin only to have to change shortly after is, well, silly.

I currently have an IBD kitty. Gizmo is on 2.5mg of pred twice a week. The only side effect was earlier on when the dose was more frequent, he gained weight. Diabetes can be a side effect of steroids. However, not everyone who is on a steroid develops diabetes (either human or kitty). I suspect there's an interactive effect -- your cat may have a genetic tendency toward diabetes and the steroid puts things over the edge. Also, given Simon's age, he may be prone to develop other problems (e.g., diabetes) since drugs are slower to be processed. The good news is that if you can get him switched over to budesonide, the diabetes may go into remission.

I'd also make another suggestion regarding IBD. If you've not tried feeding Simon novel proteins, you may see a difference. The inflammation from IBD is almost like an allergy to certain foods. Many of the common sources of protein can be related to inflammation. I had Gizmo on a diet of chicken and turkey most of his life -- I thought these were "safe" proteins. Not so much! He now gets a combination of proteins -- pork, a lamb + rabbit, and rabbit. I'd also check labels and see if you can find foods that don't contain gums or carrageenan. They are also sources of inflammation.
 
I didn’t think Max would do well with testing at home and my friends that had cats that were diabetic never did. My vet got me testing after a few weeks. My friends cat’s never got regulated and peed all over the house. I became a testaholic after Max got a bg of 60 around 7 hours after a shot. So many that start with Vetsulin switch and waste time. JMHO.
 
My cat didnt like the ear prick/testing AT ALL at first, but shes come around. Half the time, she now wanders over on her own freewill when she hears me getting her supplies out.

I lay her on her side, give some chin scritches and long, stroking pets first to calm her, then prick her ear and take the sample. I then hold her ear where it was bleeding to stop the blood flow with one hand, while with the other I pet her and rub her chest.

Afterwards she gets (low carb) treats and kisses. She REALLY likes freeze dried chicken :cat:

Try to make it a positive experience for the kitty, and try to swallow any nerves you might have - they can pick up on it when you're nervous.

I read someone somewhere suggesting singing an upbeat song right before, to get in the right mood/headspace. Like, 'Happy Birthday' or something lol. I sing 'You are my sunshine' because I'm a sap.

Theres definitely a learning curve, and you're going to suck at it, and her ear sometimes doesnt produce enough blood, and you might waste a testing strip or two before you get the hang of it, but it DOES get easier and better!
 
Simon's human said:
He does not advocate home testing but did mention the continuous blood glucose monitor that is attached to the cat for 2 weeks.
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Your vet is plain wrong on not agreeing to home testing. Besides you can do it, and he's none the wiser. Some people start out with the continuous BG monitor (Libre), but you should still check high and low point with a hand held meter. Plus I've heard lots of stories of cats taking off the meter inside a day. As Sienne said, using the Libre is yet another way for the vet to keep you coming in, unless you learn how to attach it yourself - which some people have done. Neko soon started purring through testing - she was very interested in the treat that came afterwards. So was her buddy who also came running when I got out the test kit. Imagine his surprise when I tested him too. :p As others have said, there is a learning curve, and you have to learn to be calm throughout it.

I have an IBD kitty on pred. She also has small cell lymphoma, and pred is a part of that treatment, 3 years now. I've got her down to 1 mg per day, she can't go any lower without vomiting. She's not diabetic but too high a dose and she gets eye ulcers. My Neko was on budesonide, and well regulated at the time she started it. It did not impact her blood sugars, though I have seen it do so on some cats.
 
Thanks, everyone. I have a significant hearing loss, which makes it hard to hear/understand what the vet is saying, and that is aggravating. My husband called him again today to confirm what he said yesterday. He said he can start Simon tomorrow on Vetsulin, or at least give the package to my husband so he can start it here. He again said it would be a very low dose twice a day and Simon would be retested again in 2 weeks. He said that BG numbers change constantly during the day (which I understand.) I have no idea how long a vial lasts. I did learn that Costco carries ProZinc, which I had also been reading about. The cost is just a little more than Chewy's. I had thought maybe about asking the vet to write a prescription for it which I would then have Costco fill, but that probably means Simon couldn't get started until Monday. I have been online most of the day reading about Lantus and ProZinc and Vetsulin and also watched a couple of videos about cats with hypoglycemia. I'll have a kit ready before Simon's first shot. My husband wonders about the home testing. How many times a day do you do it? It seems from reading your posts that it is several times a day, at least in the beginning. And from hearing from all of you, I know that Simon might get accustomed to it. I'm certainly not ruling it out. I would like to have the BG info, for Simon's safety. He has never been one to love treats (unlike his deceased brother Schuster) so I'm not sure what he would think of as a reward. Before Simon had his severe bout with IBD a few years ago, I used to feed a variety of canned food with 2 varieties of dry food. After his IBD, I did try novel proteins but he didn't like them. Finally he settled on beef as his predominant canned food, and that has worked well, with a lesser amount of chicken or turkey. He is very sad to have lost his dry food but is happy I was able to restore his favorite beef canned food after reading Dr. Pierson's chart. I just hope this will go ok for him. He'll be closely monitored, at least physically. We're home anyway with our also elderly dog who has multiple health issues.
Nancy
 
Simon's human said:
Thanks, everyone. I have a significant hearing loss, which makes it hard to hear/understand what the vet is saying, and that is aggravating. My husband called him again today to confirm what he said yesterday. He said he can start Simon tomorrow on Vetsulin, or at least give the package to my husband so he can start it here. He again said it would be a very low dose twice a day and Simon would be retested again in 2 weeks.
Nancy
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Nancy, first hugs for going through all of this. I also have another cat with a grave illness so his Sister getting diabetes has been hard on me.
I need to urge you to get Simon on Lantus. All vets know it is the one with the best chance of remission. My cat, Missy, was on it for 6 weeks in 2018 and went into remission.
Now my cat, Sister, is on it and I would NOT use anything else. I buy it at CVS in my local Target. They found a discount for me after initially quoting $314 on the phone, and it was $99 for one 10ml vial which should last 5-6 months refrigerated and properly cared for. So if cost is the issue, please investigate the discounts pharmacies offer. There are many. I have purchased Flovent from Canada for my asthma kitty so I know it can be uncomfortable ordering from another country, at first. The other issue is getting your vet to WRITE a script for Lantus when he is clearly pushing Vetsulin. You can take Simon to another vet just for this illness. Just a suggestion. And regarding your vet saying that "BG numbers change" throughout the day, I think that is the point of home tests. Those who test on this board do so to find out what those numbers are to keep their kitties safe. If Simon's numbers are too low because you have switched to low carb food too quickly, you need to know that.
More hugs...
 
mosi_yazhi said:
My cat didnt like the ear prick/testing AT ALL at first, but shes come around. Half the time, she now wanders over on her own freewill when she hears me getting her supplies out.

I lay her on her side, give some chin scritches and long, stroking pets first to calm her, then prick her ear and take the sample. I then hold her ear where it was bleeding to stop the blood flow with one hand, while with the other I pet her and rub her chest.

Theres definitely a learning curve, and you're going to suck at it, and her ear sometimes doesnt produce enough blood, and you might waste a testing strip or two before you get the hang of it, but it DOES get easier and better!
Click to expand...
I am going to Google freeze dried chicken! Sister might enjoy that. Then I will Google scritches. Love the bit about You Are My Sunshine. Peeked at your SS. Olivia was diagnosed next year? LOL
Just teasing you. Also love the bit about the dinosaurs being killed as another worst day. :joyful:
 
I am so grateful for your responses, and I am so scared. My husband does want to start at least with the Vetsulin for Simon and that will happen tomorrow morning. He has picked it up. Advice from vet is to feed Simon 1/2 hour before shot and then another shot every 12 hours, with retesting after 2 weeks. Vet says to start with 2 units which seems high to me. What do you think? He has gotten only low carb wet food with an occasional few bits of dry food, but none the last couple of days. Simon is not always good about eating, so I won't leave food out tonight so he will be hungry. I will also pick up some Fancy Feast Classics that are recommended here. I'm hoping they are pate. I will also pick up some FF with gravy for high carbs in case of hypo. What is HC canned that is also mentioned? I'll also pick up some of those freeze dried chicken treats that people have mentioned. I read some of the threads here for cats on Vetsulin. I know most everyone here recommends Lantus. I have a friend (unfortunately she lives out of state) who swears by ProZinc for all her diabetic cats. I hope we will do home-testing rather than just physically observing, and I know everyone here recommends that too. But that is not in place now for when the insulin starts. I'm just scared. I'm sure that Simon is feeling my tension too.
Nancy
 
Simon's human said:
I am so grateful for your responses, and I am so scared. My husband does want to start at least with the Vetsulin for Simon and that will happen tomorrow morning. He has picked it up. Advice from vet is to feed Simon 1/2 hour before shot and then another shot every 12 hours, with retesting after 2 weeks. Vet says to start with 2 units which seems high to me. What do you think? He has gotten only low carb wet food with an occasional few bits of dry food, but none the last couple of days. Simon is not always good about eating, so I won't leave food out tonight so he will be hungry. I will also pick up some Fancy Feast Classics that are recommended here. I'm hoping they are pate. I will also pick up some FF with gravy for high carbs in case of hypo. What is HC canned that is also mentioned? I'll also pick up some of those freeze dried chicken treats that people have mentioned. I read some of the threads here for cats on Vetsulin. I know most everyone here recommends Lantus. I have a friend (unfortunately she lives out of state) who swears by ProZinc for all her diabetic cats. I hope we will do home-testing rather than just physically observing, and I know everyone here recommends that too. But that is not in place now for when the insulin starts. I'm just scared. I'm sure that Simon is feeling my tension too.
Nancy
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If you will be starting with Vetsulin, it’s very important that Simon eats before you give insulin. Vetsulin can hit very hard in cats and drop their BG very fast. The reason you’re supposed to wait 20-30 minutes after he eats before giving the shot is to make sure the food stays down. I would also recommend feeding a small snack 1-2 hours after you give the insulin. This is typically when Vetsulin kicks in and feeding a small snack at this time can sometimes help the blood sugar not drop so fast. On my spreadsheet, the 2019 tab is from when my cat was on Vetsulin. You can see how much it dropped her BG in 4-5 hours. 2 units seems high to me, especially if you will not be home testing.

Most everyone here (myself included) will highly recommend testing his blood sugar at home. I know it is very stressful to think about doing, especially when you are already so overwhelmed, and it may be something you need to work up to. But honestly, I was so much LESS stressed when I started home testing. It was so much better for me to know what my cat’s blood sugar was doing instead of having to worry and guess.
 
Our recommendation to new people starting dose of Vetsulin is 1 unit. My girl started on Caninsulin (same stuff, just rebranded in the US) and her vet started her at 1 unit. I also wouldn't wait two weeks to take him back in to get tested, but rather learn to test at home. It'll be much cheaper (and safer) in the long run.

You might want to read the following documents:
INTRODUCTION TO CANNISULIN/VETSULIN & N/NPH. and

BEGINNER'S GUIDE TO CANINSULIN/VETSULIN
 
I want to correct Wendy's post. Below is the starting dose recommendation for Vetsulin:

Starting Dose
  • 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.
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It sounded like you have transitioned your kitty to a low carb diet. It that is the case, the starting dose is 0.5u. Your vet is recommending a rather high dose for an insulin that can hit hard and fast. It is worrisome given that you haven't mastered home testing and you would not know how low the insulin is taking Simon's blood glucose.
 
Is there any more recent blood sugar updates than the June 3rd one that had his BG at 449? Sounds like there's been some food changes since then?
Simon's human said:
What is HC canned that is also mentioned?
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HC = high carb food. Apologies on our acronyms! The high carb food with gravy is perfect.
 
i am so grateful for your responses. After Simon's initial diagnosis in May, I started calculating carbs and about a week later switched his food. He was still getting a very small amount of the dry food from the vet, Blue W+ U, but not much. His last blood test was June 3, which seems like a long time ago. I was disappointed that his BG was up. Then I found your website and different advice about how to calculate and use Dr. Lisa's chart. Only 1 of his wet foods was in the too-high range of carbs, and I was able to return his favorite food to the safe list. Until a couple of days ago he was getting a teeny tiny far less than a handful of dry food perhaps a couple of times a day. We are planning to start with 1 unit rather than the vet's suggested 2. I hope that is still not too much. I have the emergency supplies onboard if needed, which I hope they aren't. I got both Fancy Feast classics for regular and Fancy Feast gravy lovers for hypo. He's a fussy eater so I hope these aren't an issue with him. We are hoping that he will eat sufficiently before his injection and will also do the food afterwards. I'm removing his food now so he won't have any more during the rest of the night. I am hoping we can begin home testing next week. Has anyone purchased glucometers from Costco? I know several have mentioned Walmart and Relion. Yes, I'm worried about this. I just hope all goes well since we will be relying on just physical monitoring for at least a couple days. Thank you again for your understanding and advice. We're hoping to get this going around 9 a.m.
Nancy
 
Now I'm wondering...should we start at 1/2 rather than 1? I think for the most part I had already switched to low carb before Simon's last test except for a tiny bit of dry. He wasn't getting that new wet food that proved to be too high before he had that test. But his BG was 449, which is over the 380. Simon will be fed soon.
Nancy
 
OK, thanks to the new Fancy Feast, Simon now has eaten enough food so we're waiting. We've looked at the syringe. It is in 1 dose increments which seem to be close together as it is. Are there different syringes that show 1/4 and 1/2?
Nancy
 
There are syringes with 1/2 unit markings which are highly recommended here. Unfortunately there are not any with 1/4 unit markings
 
Simon's human said:
OK, thanks to the new Fancy Feast, Simon now has eaten enough food so we're waiting. We've looked at the syringe. It is in 1 dose increments which seem to be close together as it is. Are there different syringes that show 1/4 and 1/2?
Nancy
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I have the 1 unit markings on a 30 unit syringe (BD ultra fine, 31 gauge) and I just eyeball it to get that 1/2 unit for my kitty.
 
Thanks again! Simon has now had 3 Vetsulin injections of 1 dose in alternating shoulders and will have another tonight. I've made sure he eats lots of food a half hour before the injections. Then I've fed him smaller amounts at 1 hour and 2 hours after, hoping to avoid the rapid drop from Vetsulin. He has always been more of a grazer with his food, but that doesn't work when I need him to eat sufficiently for this. I sit next to him and hold his bowls (2 food choices) and alternate them until he is pretty much finished. He is still drinking lots of water but doesn't seem to be peeing as much. And there's been no poop today. Can insulin make them constipated? That has ever been an issue with him - the opposite was true until we got him regulated. We will see the vet tomorrow when our elderly dog has her aquapressure treatment (B12 injections in acupuncture sites since she will no longer tolerate longer acupuncture sessions.) I am sure he will not be happy that we went to 1 instead of his recommended 2, but I am so glad we did. Simon has had monthly chiropractic and aquapressure treatments since he has aged. He doesn't run or jump anymore and uses ramps to get on furniture. I think we'll skip the chiropractic next go-around. Still hoping to perhaps switch to ProZinc and do home testing. I guess these syringes are just for Vetsulin and ProZinc so may not have the 1/2 dose marking. These markings look pretty close together to me.
Nancy
 
Simon's human said:
I guess these syringes are just for Vetsulin and ProZinc so may not have the 1/2 dose marking. These markings look pretty close together to me.
Click to expand...

Vetsulin and Prozinc both use U-40 syringes and you can buy them with half unit markings. Your vet may not have them
you have syringes with half unit markings

30-unit-insulin-syringe-markings.jpg



If you should switch to Lantus you would use U-100 syringes with half unit markings


We use all syringes with half unit markings because it's easier when shooting lower doses of insulin. We increase and decrease by 0.25 units
 
Hi Nancy it might be a good idea
to set up your signature, it's at the end of everyone's post in gray. I see your kitty has IBD you would add that also
You can look at mine or anyone other members

Click on your name upper right hand corner , a drop down will appear , tap in signature , fill out info
  • On the left, under Settings, Click on Signature. This is where you will put information that helps us give you feedback. There is a limit of two lines whichmay include two links; you may separate pieces with commas, dashes, | etc. This is where you paste the link for your spreadsheet, once it is set up.
  • Add info we need to help you:
    • Caregiver & kitty's name
    • DX: Date
    • Name of Insulin (do not include dose or frequency)
    • Name of your meter
    • Diet: "LC wet" or "dry food" or "combo"
    • Dosing: TR or SLGS or Custom (if applicable)
    • DKA or other recent health issue (if applicable)
    • Acro, IAA, or Cushings (if applicable)
    • Spreadsheet link. Please put the signature link on the bottom line of your signature information, on its own, so it is easy to find.
    • Please do not put any information about your location in the signature for security reasons. If you wish to add your country location, please add it to your profile.
Be sure to click the 'Save Changes' button at the bottom. If you need help urgently it is important we know these things at a glance. We don’t want to waste valuable time finding out information.
 
When you plan on home testing we have a spreadsheet we use to enter of cats BG numbers to see how the insulin is working for him and how low he's dropping.
We need this in order to give you advise if you have a question about dosing or if your cat drops too low and you need help bringing his BG up to safe numbers

It's at the end of everyone's post , mine says Tyler's spreadsheet if you care to look, you can also look at other members spreadsheets

I will give you the link to see how to set it up and it also explains how the SS works
If you need help setting it up we have 2 members that would set it up for you in a few minutes. Just ask
https://felinediabetes.com/FDMB/threads/how-to-create-a-spreadsheet.241706/
 
I just did the signature so I hope it shows up when I post this. It's been over a week since I posted. Simon had a blood test again at the vet's today about 2+ hours after injection and food. I don't know how that will affect the BG since he's under stress there. It has been very difficult to get him to eat sufficiently before the injections. He is a grazer and a nibbler, so I start pushing the food about 45 minutes before the injection, and then we wind up closer to a hour before I think he probably has enough. And that is probably only a little over a quarter of a 5.5 oz can. That is his first food in the morning since I don't leave it out at night. I then make sure he eats a little more around 1 hour and 2 hours past the shot. I take away his food about 3 hours before the evening shot. He had lost a little weight on the vet's scale. We started at 1 dose and imagine we will go to 2 after the results since that is what the vet had wanted to do. If anyone has any suggestions on how to get a cat to eat faster, I'd appreciate it! This is all food he likes - or at least indicated that he did.

This is a very stressful time, not just because of Simon. Our little dog Bella, almost 17, had a seizure Friday night and another 11 hours later. The seizures themselves weren't too awful, but she cried and was very distressed for over an hour afterwards each time. We've upped her seizure med but we're having her euthanized Wednesday. It frankly rips the heart out of us, but we can't let that happen to her again. Simon often licks her and they sometimes share the water bowl, so I know this will affect him too. As you all know, this is so hard. We've had them 15 1/2 years.
Nancy
 
Does anyone have suggestions on how to persuade a cat to eat in the half-hour time frame before injection? I have withheld food so that he should be hungry, but he only nibbles. It is taking an hour from the start of feeding until I feel it is safe to give the injection. And he probably has eaten only 1/4 of a 5.5 oz. can at that point. What is enough to be safe?
Nancy
 
Is he more of a grazer? Will he eat more later on? 1/4 of a can sounds like it should be enough. That’s about how much I give my cat for her larger meals because otherwise she will throw up. I just feed her small snacks throughout the rest of the cycle. If Simon will eat some more around +1 or +2 I think it should be okay
 
Thanks for getting back to me about Simon's food. Today has been a tough day since we had our little dog Bella euthanized. She was Simon's buddy for the last 15 1/2 years, so this will affect him too. I hope it won't add stress. The vet came to our house, so Simon got to say good-bye. As for his eating, yes he is definitely a grazer. I am encouraged that 1/4 can should be enough pre-injection. This morning I started offering 2 of his favorites 40 minutes before our goal for injection time, and after about a half hour of periodic nibbling I added another 2 that he likes. Between all his nibbling and my offering, he finally had probably 1/4 of a can. But the injection was 20 minutes past the goal. He has been on 1 unit Vetsulin twice a day since June 12. On June 21, after 9 1/2 days, he had another fructosamine test and there is, I think, hopeful news. The result was 418 as compared to 609 June 3. I don't know what the BG level was. We plan to increase to 1.5 units starting tomorrow. I push more food at 1+ and 2+ and also a little more before I call it a night. Then I take up the food so he has to wait until morning pre-dosage time.
 
Thank you. I had hoped to up Simon to 1.5 units today but I am having a horrible time this morning getting him to eat. I suspect he is grieving. It's been over an hour and I've tried 6 different cans, 2 of them new. He does some licking but not much actual eating. I think he has had enough to be safe but will stick to 1 unit, at least this morning. Were there any opinions about his drop in fructosamine numbers?
 
So very sorry to hear about your Bella. No matter how long they are with us, it never feels like long enough :bighug:

In regards to the fructosamine, those can be tricky to interpret. The lower number is definitely a good thing, but it doesn’t give a whole lot of insight into how Simon is responding to insulin on a day to day basis, it just lets you know that overall, his numbers have probably come down since the last one.

The thing about fructosamine tests is that they only give you an average of what his BG has been doing. My cat had several of them done and they showed that her regulation was good. I had a continuous glucose monitor put on and found out that her regulation was not good - her blood sugar was going really low and then really high to compensate. But really high numbers and really low numbers average out to good numbers, so the fructosamine looked good.
 
Thank you. Your explanation of how the fructosamine test can give false hope makes sense, sadly. Meanwhile, I'm stuck on just trying to get Simon to eat enough to be safe before injection. We left him at 1 unit this morning rather than up to 1.5. I read the suggestions on the thread about "alternate food suggestions for fussy diabetic cat". I just bought Pure Bites and some of the Nulo puree tubes to try. I noticed they have chickpeas on the ingredient list, but maybe a small amount doesn't matter. I didn't find Fortiflora at the 2 stores I went to but I'm sure it's around and online. I realize I'm not the only one dealing with a fussy eater who grazes. I know it would be better for him if we were doing home tests, but that hasn't happened yet. Do most of you have baby scales to weigh your cats? Maybe I should get one since I know Simon has lost weight. Which kind/brand do you recommend?
 
I know quite a few people do use baby scales, so not a bad idea if you’d like to try one! I don’t use one so I don’t have a recommendation.

I don’t know if fortiflora is sold in stores or not. I know you can get it on chewy.com and your vet would probably have it stocked as well. Hopefully you can find something to get your picky boy to start eating :bighug:
 
Thanks again. I should try to post a picture of Simon so everyone can see this picky eater. It looks like a regular restaurant buffet around here - start with 2 choices, add another couple since he won't finish the first two. This morning I had 6 bowls out before I thought he'd eaten enough. And then I push the snacks at 1 and 2 hours after. He thought the Pure Bites were tasty on top, the Nulo Puree tube not so much. I really want to up to 1.5 units from 1, but I don't want to start with the evening dose. I should add more of his food choices to my signature. I don't think he's tried the Instinct Rabbit. Instinct chicken and L.I. turkey are on his menu.
 
I am increasingly discouraged about getting enough food into Simon so he can safely have his injections. This morning we worked at this for over an hour. Last night he was sort of interested in Pure Bites freeze-dried treats and he even stuck his head in a bag of Orijen Tundra freeze-dried. I had sprinkled a little over his food which sort of attracted him - until it didn't. This morning we started with 2 choices, and he nibbled at one. Got out 2 more that he had liked last night. Just a few licks. Got out another 2 that he had liked the day before, and barely a lick. Sprinkled some freeze-dried crumbles and he refused to even sniff. Meanwhile, the clock is ticking. Tried some baby food beef and that brought a few licks. He's not used to that. Finally got out a can of Hills' a/d, and he nibbled perhaps 1/16 of it. From the food chart I read it is 12% carbs which is higher than I'd like, but I'm getting desperate. I'm afraid to up the dose with his food intake. We give the insulin 20 minutes after I finally declare he's eaten enough to possibly equal 1/4 of a can. Simon really liked his dry food which was too high in carbs, and we've taken all that away. He's always had some wet food too, so this is not a novelty for him. I think I'll look into Dr. Elsey's which some people have mentioned. I don't know if there is more than 1 dry cat food on that label. We could feed him with a syringe, but don't want to resort to that. He's getting tired of my stalking him. Any suggestions?
 
Help! I really do need help with this. We can't go any farther with trying to get Simon regulated if he won't eat. Tonight has been a disaster, and we've decided to skip the injection. I really need ideas. Should we give him an appetite stimulant? Mirtazapine? I can ask his vet Monday. I did get a bag of Dr. Elsey's Clean Protein chicken dry this afternoon and offered him a very small handful, which he ate. A few hours later it was time to start the process of pre-injection feeding, which I understand is to be completed 1/2 hour before. I started again with 2 choices that he has liked. He rejected one and only licked the other a little, so I offered a couple more. No dice. Then I tried the a/d and baby food which he had finally eaten this morning. No dice. Then I put 1/4 cup of Dr. Elsey's dry in his bowl, and he started gobbling, but soon stopped. He'd eaten possibly a quarter of that. I repeated it all and offered him several other choices. He really gets sick of my offering choices, I think. I think it tires him out. Yesterday I tried the Pure Bites and Orijen freeze dried treat crumbled on top, which impressed him for a nano-second then, but not today. He's an old kitty which may be a factor in trying to change his prior eating habits - a bowl of dry and a bowl of wet, both of which he ate. He had 2 kinds of dry food and at most, 2 kinds of wet food. He has liked all these new wet foods as we have explored them, but he doesn't like them twice in a row, apparently. I think also that he misses Bella, and that also could be a factor. I really want to get him regulated or even better, into remission, but I can't if he hasn't eaten enough. My last 3 posts have gotten increasingly frantic, I realize. Tonight we struggled for about an hour and a half with trying to feed before making the decision not to give the injection. A friend has recommended trying the Purina DM dry. We may use a syringe to force feed but would rather not.
 
Much has happened since my last posting and I have lots of questions. First, Simon's vet did another basic lab panel and fructosamine test July 8. His BG was 37 and the fructosamine was 286. We know that a trip to the vet can bring anxiety and higher BG readings so the vet had recommended Simon have a Gabapentin a couple hours ahead of testing. The test was done 4.5 hours after 1.5 U Vetsulin. He had had a "snack" 1 hour after injection. He showed no signs of having this extremely low BG. We are now giving him 1 U and on Tuesday July 13 are switching to ProZinc. I understand that it is a straight substitution so we will give him 1 U.

We will start testing this week, as soon as I get the equipment. I have been doing some research and am befuddled. I know lots of you use Relion. But there are 4 kinds. There are also lots of other brands. We got Simon's prescription at Costco, and they also have one. Some of the meters mention their lancets are more pain-free. I don't know what they're comparing them with, though. Some people have mentioned having to wait to get the control solution which I had never heard of before. I'm just not familiar with the ins and outs of all this.

I think we've solved the eating issue. We start offering food about 40 minutes before the injection. He eats as much of that one choice as he wants. Then he gets the rest via syringe to make it 1/4 can (5.5 or 6 oz.) Then he has the injection 30 minutes later. Per some earlier advice, we give a "snack"- maybe 1-2 teaspoons - at 1 hour and 2 hours past and then another at 4 hours past. This seems to work. He doesn't like the same thing twice in a row.

Since Simon was already down to just 1 Pred every 7 days, we have discontinued even that. He is still drinking and peeing a lot, so I know he is far from regulated. That low BG was a wake-up call that we really have to know what's going on with him.

Your advice? Thanks!
 
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