20 year old cat BG advice please

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Dan K

Dan K

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Hello all,

I have a senior female cat (20 years old). She was recently diagnosed with diabetes and renal failure. The vet put her on 2 units of Novolin N every 12 hours. Initially I took her to the vet for BG tests 8 hours after injection. Which they said were good (BG 200). I bought my own pet smart meter and have been testing every few days. In the first few weeks her BG would be 400-450 8 hours after injection. Today about 2-3 hours after injection she could barely walk and was urinating while trying to walk to a pee pad and making a lot of different meowing noises. I immediately did a BG test and it read low. Which means under 40 on my meter (tested twice). I fed her wet food (fancy feast, that’s all she’ll eat) and some crunchy treats. Almost put some syrup on her gums to be safe, but she perked up slightly. Fast forward and I tested her right after she ate at her 12 hour shot time and her BG is 248. I haven’t given her a shot because I know too much insulin is worse than too little. Was thinking no shot tonight and test in the morning to see where she’s at. She’s been on insulin for about 6 weeks. Any advice is greatly appreciated. Note: her main meals are every 12 hours but I do give her a small amount of food or treats a few times a day because she’s a fatty and constantly hungry. She’s about 10 lbs, but still overweight for her frame.
 
@Dan K
Dan while you are waiting for one of the members I tagged I did a search on our site and copied it for you that one of the members I tagged had to say

First of all, Novolin N is one of the worst insulins for cats. It is a fast acting, harsh insulin.
If you can I would change the insulin to either Lantus or prozinc. Both of these are recommended by the American Animal Association. Novolin N and vetsulin are not recommended.
Also the starting dose is either 1 unit if you are feeding a dry high carb diet, or 1/2 unit if you are feeding a low carb canned/wet diet.

We recommend you feed a hour before giving the dose because cats need food in their system before the insulin hits.
so the outline is test, feed, wait one hour, then give the shot.
I would also give several snacks of food during the cycle…mostly first half of this cycle when the insulin is strongest.
A snack is a teaspoon or 2 of low carb food.

Do you have a hypo kit set up in case you need it.
HYPO SYMPTOMS AND WHAT TO DO
HYPO KIT

INTRODUCTION TO VETSULIN AND Novolin N

BEGINNERS GUIDE TO NOVOLIN N
 
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.
If you need help setting up the spreadsheet just ask we have a member who will do it for you
Also you should be feeding her small snacks during each 12 hour cycle ,so I'm glad you're doing that.
Most of us use human meters , that's what our numbers are based on anyway


For your Hypo kit
Med and High Carb food and some honey/karo
If you can get these where you live


Fancy Feast Gravy Lovers Gourmet Beef Feast in Gravy 20% High Carbs

Fancy Feast Gravy Lovers Gourmet Chicken Feast in Gravy 15% Med Carbs

Fancy Feast Gravy Lovers Turkey Feast in Gravy 15% Med Carbs

Fancy Feast Gravy Lovers Chicken and Beef in Gravy 15% Med Carbs

Good idea to mark the cans with magic marker how many carbs

Or any on the food chart. Doesn't have to be Fancy Feast just an example about the med and high carb foods


https://felinediabetes.com/FDMB/threads/dr-pierson-new-food-

10% and under is low carb
11% -15 is medium carbs.

16- 24 is high carb.
 
Diane Tyler's Mom said:
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.
If you need help setting up the spreadsheet just ask we have a member who will do it for you
Also you should be feeding her small snacks during each 12 hour cycle ,so I'm glad you're doing that.
Most of us use human meters , that's what our numbers are based on anyway


For your Hypo kit
Med and High Carb food and some honey/karo
If you can get these where you live


Fancy Feast Gravy Lovers Gourmet Beef Feast in Gravy 20% High Carbs

Fancy Feast Gravy Lovers Gourmet Chicken Feast in Gravy 15% Med Carbs

Fancy Feast Gravy Lovers Turkey Feast in Gravy 15% Med Carbs

Fancy Feast Gravy Lovers Chicken and Beef in Gravy 15% Med Carbs

Good idea to mark the cans with magic marker how many carbs

Or any on the food chart. Doesn't have to be Fancy Feast just an example about the med and high carb foods


https://felinediabetes.com/FDMB/threads/dr-pierson-new-food-

10% and under is low carb
11% -15 is medium carbs.

16- 24 is high carb.
Click to expand...



Thank you for this information!
 
Also, I held off on giving her the insulin tonight. I’ll test in the morning to see where she’s at. I’m thinking the 2 unit dose is high. But she does have renal failure and is 20 years old. So maybe that has to do with why the vet is trying to keep the glucose levels low. I plan on a vet visit again in the next few days to discuss.

Also I’m giving her fluids every other day (ringers solution) under her skin via needle.
 
Dan K said:
I’m thinking the 2 unit dose is high
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Definitely too high. If the vet wants to keep her numbers lower, he needs to prescribe an insulin that lasts longer than 8 hours in the cat. Lantus and/or Prozinc are good options. In the mean time, you need to lower her Novolin dose. Too low can cause hypo's, which can be deadly. It's a good thing you were home testing. By the way, what is the brand of meter you are using?

Testing a cat on Novolin at 8 hours after the shot is not a good time to test. Typically that's when Novolin is wearing off and the numbers have been rising for a while. You want to test much earlier when the insulin is at it's strongest and you'll see the lower numbers then. We've had members say the lowest point is between 2-6 hours after insulin is given.

Have you changed her food recently? Or has she always been on the Fancy Feast?

By the way, we've had quite a few members with kitties over 20. Age doesn't have any relation to type of insulin used. Kidney disease might impact diet (Fancy Feast is rather high in phosphorus) but also isn't a factor in type of insulin.

Diane has given you some great links. I encourage you to read them.
 
@Dan K
Have you tried any of the Weruva wet foods
They are low carb and low phosphorus both good for diabetic kitties who have Kidney Disease
Tap in this link and look at post #32 Post numbers are to the right of each post
There is a list of wet pate foods that I gave to another member
https://felinediabetes.com/FDMB/threads/new-member-11-8-and-i-am-tired.283363/#post-3124085
Thanks for doing your signature
Can you please add the name of the meter you are using to your signature also, we need to know if it's a human or pet meter
Just tap on your name up top then tap signature add the name of the meter and then tap save

If you want to give Ginger a treat also
Most of the members will give the Freeze Dried cat treats

Click on this link and look at post #6. Numbers are to the right
You can get any freeze dried treats ,information is there
https://www.felinediabetes.com/FDMB/threads/brand-new-many-questions-3.255627/#post-2878703

If you do switch to Lantus , most members use the generic lantus which is so much note affordable than the brand name
Just tap in this blue link

https://felinediabetes.com/FDMB/threads/new-member-11-8-and-i-am-tired.283363/#post-3121360
Look for post #4.The post numbers are to the right of each post, you will see all the information there
Almost all members use the generic lantus
With the U-100 syringes be sure to get the ones with the half unit markings since we adjust the doses by 0.25 units at a time
 
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Hi Dan. Here’s a link to a list of foods that are low in phosphorus and are also low carb- so foods more appropriate for cats with kidney disease and diabetes. This list is kept up to date. There’s some helpful information in the beginning, but scroll down and click on the fifth list that is the Diabetes CKD food list. Diet changes need to be made slowly in cats in general to prevent GI upset - and more so for diabetic cats (especially if changing from higher carbs to lower carbs but if you have had her on low carb food already like Fancy Feast classic pates then it’s not as much of an issue from a blood glucose standpoint but still would need to be done slowly to prevent GI upset.

https://www.bizave.com/foodlists/?f...76wfH5kehteCajlm-qPPTi3u1c307wE0dcV4pqGfRaj2Q
 
And, as Wendy already said, you need to reduce that dose immediately. In fact, please do not give insulin without posting for assistance here and telling is her BG number. What happened to her is scary. Thankfully, you are testing now and can keep her safe. Any chance of getting your vet to prescribe a better insulin for cats?

Hopefully, you can get a spreadsheet set up soon and populate it with the tests that you have done to date. The numbers should be stored in your meter.

Also, do you have any bloodwork that you can share?
 
Wendy&Neko said:
Definitely too high. If the vet wants to keep her numbers lower, he needs to prescribe an insulin that lasts longer than 8 hours in the cat. Lantus and/or Prozinc are good options. In the mean time, you need to lower her Novolin dose. Too low can cause hypo's, which can be deadly. It's a good thing you were home testing. By the way, what is the brand of meter you are using?

Testing a cat on Novolin at 8 hours after the shot is not a good time to test. Typically that's when Novolin is wearing off and the numbers have been rising for a while. You want to test much earlier when the insulin is at it's strongest and you'll see the lower numbers then. We've had members say the lowest point is between 2-6 hours after insulin is given.

Have you changed her food recently? Or has she always been on the Fancy Feast?

By the way, we've had quite a few members with kitties over 20. Age doesn't have any relation to type of insulin used. Kidney disease might impact diet (Fancy Feast is rather high in phosphorus) but also isn't a factor in type of insulin.

Diane has given you some great links. I encourage you to read them.
Click to expand...


Thanks you for the information! I have the pet test monitor. She’s been on fancy feast for a long time. I’ve tried healthier options and renal care food. But she won’t eat it and it gives her diarrhea. Also at 20 years old my wife and I decided quality of life over quantity. This cat lives to eat. It’s her only hobby. Haha.
 
If your cat if a fan of Fancy Feast, the other possibility to manage the kidney issue may be a phosphorus binder. You can feed your cat any canned food as long as you add the binder and it will reduce the impact of the phosphorus on the kidneys.

Like the others, I would encourage you to discuss the choice of insulin with your vet. The American Animal Hospital Assn no longer recommends Novolin for the treatment of feline diabetes. They recommend either Lantus (glargine) or Prozinc. Novolin does not last the entire 12-hour cycle and it can drop numbers very fast. Because of it's short duration, there can be abrupt swings from very high to very low during the cycle. Longer acting insulins are preferable given a cat's fast metabolism.
 
Suzanne & Darcy said:
And, as Wendy already said, you need to reduce that dose immediately. In fact, please do not give insulin without posting for assistance here and telling is her BG number. What happened to her is scary. Thankfully, you are testing now and can keep her safe. Any chance of getting your vet to prescribe a better insulin for cats?

Hopefully, you can get a spreadsheet set up soon and populate it with the tests that you have done to date. The numbers should be stored in your meter.

Also, do you have any bloodwork that you can share?[/
Click to expand...
 
Do you have a phosphorus binder you can recommend?
Update on Ginger. I took a BG test about 30 minutes ago, so almost 24 hours since her last insulin shot and it was only 268. To add to that I thought I was doing it he test pre-food but found out my wife had already fed her fancy feast 2 hours earlier! So 2 hours past food she’s only 268. I did not give her any insulin.
 
There is a wonderful site on kidney issues in cats -- generally referred to as Tanya's site. I honestly don't recall all of the information on binders. The menu bar on the left of the site will link you to the information on phosphorus control.
 
Dan K said:
Do you have a phosphorus binder you can recommend?
Update on Ginger. I took a BG test about 30 minutes ago, so almost 24 hours since her last insulin shot and it was only 268. To add to that I thought I was doing it he test pre-food but found out my wife had already fed her fancy feast 2 hours earlier! So 2 hours past food she’s only 268. I did not give her any insulin.
Click to expand...
Can you test her again 2 hours after that 268?
 
Suzanne & Darcy said:
Can you test her again 2 hours after that 268?
Click to expand...

Yes I can. I have about 75 test trips. It’s been about an hour already. She’s eaten a lot of food, with last food at 9:30am. I can test her in another hour to see where it’s at.

So to summarize so far. Last shot of insulin was 10am Thursday. My wife fed her at 7:30am today. I tested at 9:30am and fed her more (didn’t know my wife fed her). That test was 268 (9:30am). I’ll test again at 11:30am. That will be 2 hours post any food and 25.5 hours since last insulin shot.
 
Dan K said:
Do you have a phosphorus binder you can recommend?
Click to expand...
I used aluminum hydroxide from Thriving Pets. This is something you should discuss with your vet, if her phosphorus numbers are high enough you should start a binder, and the dose.

Most of us get a copy of our cats blood work when it's done. You do own that information. A number of the people here can read it and make suggestions.
 
Update. As of 11:30am eastern shes at 252 BG. So now 25.5 hours since last insulin shot. 2 hours post any food.
 
252 is higher than normal blood sugar values, though not far off given you are using a pet meter. Let's see where she is this evening. Have you been testing her for ketones?

Side note, most of us use human meters because the tests strips are so much cheaper, easier to obtain in a hurry, and our dosing methods were developed using human meters which was well before pet meters were a thing.
 
So I test for ketones with a urine strip? I haven’t been doing that. And I might go get a human BG meter. The strips are $1 each for this pet test. Is there a human BG meter you recommend?
 
Yes, you test with urine strips, like Ketostix is one brand. Test strips can be bought at most pharmacies. Tips to catch and test a urine sample

If you are in the US, I think a lot of people buy the Relion meters (from Walmart) cause they have the cheapest test strips but still only need a small blood drop.
 
Thank you. Yes I’m in the US. I’ll get the urine strips and probably switch to the relion meter when I get low on the current pet strips.
 
Dan K said:
Thank you. Yes I’m in the US. I’ll get the urine strips and probably switch to the relion meter when I get low on the current pet strips.
Click to expand...
I used to use the Alpha Trak 2 (and 3) pet meter also, but we switched to the Relion Premier from Walmart. It really is way cheaper. You can get 100 test strips for like $17. Way better than the $60 or so for the Alpha. It's just a matter of getting used to reading the numbers, as they read lower on the human meter. 50-120 is normal on a human meter but it's more like 68-150 on the pet meter. Anyway, good luck to you guys :)
 
Snickers and Chrissy said:
I used to use the Alpha Trak 2 (and 3) pet meter also, but we switched to the Relion Premier from Walmart. It really is way cheaper. You can get 100 test strips for like $17. Way better than the $60 or so for the Alpha. It's just a matter of getting used to reading the numbers, as they read lower on the human meter. 50-120 is normal on a human meter but it's more like 68-150 on the pet meter. Anyway, good luck to you guys :)
Click to expand...


I think I’m going to go that route. The Pet Smart meter is terrible. My poor cat. Her ear could be dripping blood on the strip and it doesn’t get a reading or says error about half the time. Then I have to use another 85 cent strip.

The last few days I’ve been taking a lot of readings. I’ve only given my cat 1 unit instead of the 2 units the vet started me at. I’m still getting readings around 225-250 12 hours post insulin. But 4 hours after insulin I’m getting readings below 60. Then at 8 hours after insulin 200. It’s like the curve on this insulin is too strong but then drops off too soon.
 
Also, I have started using a urine strip test. No ketone issues but her leukocytes are through the roof (500 on the strip). Not sure what that means. Online say could be urinary tract infection or maybe even cancer. I am touching the strips to a pee pad, so maybe that’s throwing some kind of false positive. Sounds like another vet visit might be in order. They said nothing about high leukocytes just 5 weeks ago during blood work.
 
If you are seeing numbers under 60, then 1 unit is too much insulin. Do you have syringes with half unit markings on them? If so, you might could try eyeballing a 0.75 unit dose.

Best to put the urine strips right in the urine stream if you can.
 
Wendy&Neko said:
If you are seeing numbers under 60, then 1 unit is too much insulin. Do you have syringes with half unit markings on them? If so, you might could try eyeballing a 0.75 unit dose.

Best to put the urine strips right in the urine stream if you can.
Click to expand...


Thanks Wendy. I’m going to buy the Relion monitor tomorrow. I’m sick from watching Gingers ear drip blood and not even get a reading. Last thing I want is her last time on this planet being remembered by me constantly poking her.
 
Dan K said:
Thanks Wendy. I’m going to buy the Relion monitor tomorrow. I’m sick from watching Gingers ear drip blood and not even get a reading. Last thing I want is her last time on this planet being remembered by me constantly poking her.
Click to expand...

Here is the link for the meter and test strips so you don't have to search for them
Relion Premier Classic Meter at Walmart for 9 dollars
https://www.walmart.com/ip/ReliOn-Premier-CLASSIC-Blood-Glucose-Monitoring-System/552134103

The tests strips are 17.88 for 100
https://www.walmart.com/ip/ReliOn-Premier-Blood-Glucose-Test-Strips-100-Count/575088197

@Dan K
 
Diane,

I can get a really good sized blood drop almost every time now. Does the Relion give errors or no reading a lot or has it been consistent with giving a reading? That’s my main concern. I just hate continually poking my buddy. She’s really sweet, but she hates the ear pokes more than the 18 gauge needle for the fluid every other day.
 
Dan K said:
Diane,

I can get a really good sized blood drop almost every time now. Does the Relion give errors or no reading a lot or has it been consistent with giving a reading? That’s my main concern. I just hate continually poking my buddy. She’s really sweet, but she hates the ear pokes more than the 18 gauge needle for the fluid every other day.
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Hi Dan I have used the Relion Meter since 2018 and never had a problem with it.
Tyler has been in remission since 1-24-21 so I have to say it's been consistent with the readings. Just follow the directions to set it up, it's easy By the way Ginger is such a cutie :cat:
@Dan K
 
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Dan K said:
Diane,

I can get a really good sized blood drop almost every time now. Does the Relion give errors or no reading a lot or has it been consistent with giving a reading? That’s my main concern. I just hate continually poking my buddy. She’s really sweet, but she hates the ear pokes more than the 18 gauge needle for the fluid every other day.
Click to expand...
When you use the Relion meter, just make sure that you are applying the tip of the test strip to the blood and letting it "soak up" into the window. You don't want to put the blood directly on the window or it will give you an error code. But if you can get the edge of the strip right up to the blood, then you'll see the little window fill up and then you'll know you're good. I hope that makes sense :)

And by the way, even with the Alpha Trak 3 I got a lot of error codes, so you're not alone in having problems with a pet meter. It was honestly so frustrating.
 
Snickers and Chrissy said:
When you use the Relion meter, just make sure that you are applying the tip of the test strip to the blood and letting it "soak up" into the window. You don't want to put the blood directly on the window or it will give you an error code. But if you can get the edge of the strip right up to the blood, then you'll see the little window fill up and then you'll know you're good. I hope that makes sense :)

And by the way, even with the Alpha Trak 3 I got a lot of error codes, so you're not alone in having problems with a pet meter. It was honestly so frustrating.
Click to expand...
Thank you for the tip. That makes perfect sense.
 
So I got the Relion premier and the corresponding test strips and man was it easier to use. Got a reading immediately. 8 hours post insulin Ginger was 90. Which from what you’re saying is actually closer to 125-130 or so. What are your thoughts on when to not give her insulting? At 12 hours post shot let’s say she’s only 90 on the human monitor.
 
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Dan K said:
So I got the Relion premier and the corresponding test strips and man was it easier to use. Got a reading immediately. 8 hours post insulin Ginger was 90. Which from what you’re saying is actually closer to 125-130 or so. What are your thoughts on when to not give her insulting? At 12 hours post short let’s say she’s only 90 on the human monitor.
Click to expand...
That's great you had better luck with the Relion! Yay! Excellent job.

I can't help with dosing, especially not with Novolin. Tagging @Sienne and Gabby (GA) and @Wendy&Neko who were helping you before.
 
Since you are fairly new to feline diabetes, and using NPH, the guidance is to not shoot if under 250 at shot time. And try to test for ketones to make sure that's not an issue with no insulin being given. Guidelines for NPH are here:
BEGINNER'S GUIDE TO HUMULIN N/NOVOLIN N/NPH You will note that any blood glucose value 90 or below on a human meter means the dose needs to be reduced by 0.25 units. That 90 you just saw means Ginger's insulin dose needs to be reduced by 0.25 units.

We'll be able to help you better if you can start a spreadsheet to track the BG results you've been getting.
 
Dan K said:
So I got the Relion premier and the corresponding test strips and man was it easier to use. Got a reading immediately. 8 hours post insulin Ginger was 90. Which from what you’re saying is actually closer to 125-130 or so. What are your thoughts on when to not give her insulting? At 12 hours post shot let’s say she’s only 90 on the human monitor.
Click to expand...

https://felinediabetes.com/FDMB/threads/how-to-create-a-spreadsheet.241706/
This link will also explain how to use the spreadsheet ,it's very easy. . As you will see we don't give times because we are all in different time zones
Take a look at anyone's Spreadsheet
Just an example
AMPS means AM Pre Shot ( first test in the AM)
+1 means ( 1 hour after giving insulin)
+2 means ( 2 hours after giving insulin and so on
PMPS means PM Pre Shot ( the first test you do at night, 12 hours from the AMPS test)
+1 same as above

If you were to test @+1 and it was ( 1 hour and 15 minutes after giving insulin )you would put the BG number whatever it was then put for example
200 @+1.25 in the 1 cell or block
If you test @+2 and it was ( 2 hours and 30 minutes after giving insulin )
and the BG number was let's say 210 you would put 210 @+2.5 in the 2 cell or block

If you tested @+2 (2 hours and 45 minutes after giving insulin )
You would put in the 2 cell or block 210 @+2.75 in the 2 cell or block
That goes for every time you test if its not exactly on the hour

.25 means 15 minutes
.5 means 30 minutes
.75 means 45 minutes

You would have to color code the colors in manually if you don't test exactly on the hour so they match the color codes above on the spreadsheet
 
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