2nd night on caninsulin and reading 3.7 (66.6) at +4

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phlika29

phlika29

Member Since 2014
Hi everyone

Remi is on 1 unit of caninsulin and tonight is his second dose.

Yesterday remi reading were :

23.2 mmol/l pre shot
+ 2 15.06 (271.08)
+12= 7.7 so no insulin given (148.6)
+17= 20.8

Tonight :

23.0 pre shot (not feed for five hours)
Fed
+2= 12.4 mmol/l (223.2)
Fed
+4= 3.7 mmol/l (66.6)

Have just fed him and added in some of his old food as I am currently transitioning him of the dry food.

Will his level go any lower? It took me five attempts to get a BG reading and I don't much fancy doing it again tonight. He is alert at the moment
 
'fraid the testing's not over yet, Sarah. You'll need to test him - possibly several times - to make sure his numbers rise and continue to rise.
 
I have fed him a handful of his old biscuits and his new wet food. I had been transitioning him of the dry royal canin. Hypoallergenic onto applaws chicken in jelly and had been reducing the dose. This evening and tonight I hadn't given remi any of his old food.

So in reserve I have honey and I have royal canin convalescence support sachets which I will make up now in case I need to use.

It has been an hour since his last BG and at least twenty minutes since he last ate. I guess I will try to get another BG reading and wait for responses. It is +5 now and so will this be the peak low? My main worry is that last night remi was lower in the morning 7.7 mmol/l
 
Hi Sara,

I've just posted on the TR forum to ask if someone can come to help you.

Have you managed to feed Remi some higher carb food? If so, can you let us know. Then can you test him again shortly after to see if his BG comes back up?
 
It's likely to be a long night, Sara.

It might be a good idea to make up the high carb food and give some to Remi to give the insulin something to work on.
 
Yep have fed him some of his old higher carb food and his new wet food. Will retest in a minute
 
That's great.

Warm his ear a little longer and maybe you'll find it easier to get the blood drop for the test.

Post the result when you have it. Then keep refreshing your browser so that you can see replies when they come in.
 
Thank you for replying, Darin.

I'm a novice and I don't have the experience to help Sara.

Sara, Is the convalescent food a wet food?
 
I've only given him the dry food so far and it has raised the level. The liquid convelsance food is made up ready in case I need to use it. Will syringe it as I used to.
 
The steering numbers routine for low glucose is this:

Feed 1 to 2 teaspoons of high carb gravy or regular food with a few drops of syrup/honey/etc on it
Wait 20-30 minutes then re-test.
Repeat if needed.

High carb gravy and syrups will wear off quickly; the dry will take longer. Since you've given some dry already, I would go with just gravy or syrup at this point, until the dry starts kicking in.

Once you're past +7 (approximate end point of likely nadir period), with 3 rising glucose levels, and above 100 mg/dL, you're going to be able to relax a bit, and go longer between tests.
 
What number are we looking for it to rise to?

Remi is very food sensitive and I am concerned that giving a gravy food with all the other crap in it will set of a panc flair and so if okay with people here I would prefer to give the liquid royal canin convalescence

http://www.vetuk.co.uk/royal-canin-vete ... hets-p-254

But do I still need to now his numbers have raised?
 
Darin & Charlie said:
Once over 2.8(50) you will test every 30 min and need to see 2 rising numbers that are not influenced by food.
Click to expand...
It never got that low. It went down to 3.7 and the latest one after dry food was 5.9 mmol/l
 
If he'll eat it, go for it. The important thing is getting in some calories quickly without giving him so much he vomits.

How long has it been since the shot now?
 
Thank you so much. I was so worried for Sara and Remi.

I'll go remove the alert. I'll check back in a while before I go to bed.
 
You just want to keep him above 2.8(50) I use lantus but use to use vetsulin, same as what you use, it would peak around 4 to 5 hrs after shot.
 
BJM said:
If he'll eat it, go for it. The important thing is getting in some calories quickly without giving him so much he vomits.

How long has it been since the shot now?
Click to expand...

oh he loves it:). I only stopped it last week.

So it is now nearly +6 since his shot. The last reading after his dried food was 5.9 (106.2). Will give him a little of the liquid food.
 
That recent number is pretty good. You can go about 30 minutes until the next test.
 
Darin & Charlie said:
I was just letting you know that when he is less 2.8 you need to start higher carb food intervention.
Click to expand...
Thankyou. I was worried I had written the wrong number so where :)
 
BJM said:
That recent number is pretty good. You can go about 30 minutes until the next test.
Click to expand...

Have given him a 5 ml syringe of his liquid food. Will retest in about five minutes as that will also be +6
 
Just done at +6 and it reading 7.3 mmol/l ( 131.4)

What needs to be done now. Is it safe to go to bed yet? As I could sleep!
 
Ummm ... I'd retest in 30 minutes without feeding to see if he's stable.

A note on naps: if you nap in 45 minute increments, it is easier to wake up. So nap 45 minutes, 90 minutes, etc
 
So do you think the same thing happened to him last night? I only got one reading at + 2 yesterday and it was 15. Then when I woke up and tested at + 7 it was 7.7 mmol/l (138.6). So maybe in the night he went quite low?

Also if I ever make it till morning what do I do when his next dose is due? Playing about with the higher carbs will have upset his levels anyway and going on these two evening doses is 1unit too high?
 
Hi, Sara.

You're doing great. Since BJ has been offering wonderful help and support, I'm not going to interfere. I'm to overly familiar with Caninsulin. However, there is a post we use on the Lantus board that you may find useful. It's a step-by-step guide to handling low numbers.
 
I think 1 unit is probably too high. You might drop down to 0.5 units and get your spreadsheetset up so the patterns can be seen in his response.

Understanding the spreadsheet/grid:

The colored headings at the top are the ranges of glucose values. They are color-coded to clue you in as to meaning.

Each day is 1 row. Each column stores different data for the day.

From left to right, you enter
the Date in the first column
the AMPS (morning pre-shot test) in the 2nd column
the Units given (turquoise column)

Then, there are 11 columns labeled +1 through +11
If you test at +5 (5 hours after the shot), you enter the test number in the +5 column
If you test at +7 (7 hours after the shot), you enter the test number in the +7 column
and so on.

Halfway across the page is the column for PMPS (evening pre-shot)
To the right is another turquoise column for Units given at the evening shot.

There is second set of columns labeled +1 through +11
If you snag a before bed test at +3, you enter the test number in the +3 column.

We separate day and night numbers like that because many cats go lower at night.

It is merely a grid for storing the info; no math required.
 
Thanks for the info.

I think we had a quick nap. Remi is reading 11.0 now (198) at +8. No food has been given. Is it safe to go to bed? Poor remi's ear is terrible now. That took four attempts.

What about tomorrow morning. If it is above the safe range shall I give half the dose ? The needles aren't very accurate for such a small dose. What is the safe range. Above 11?

Do I give any more food now?
 
You may relax on the food. Leave some regular food out in case he wants to nibble.

I think it is safe to go ahead and crash.

If you have a wood or metal ruler with fine markings such as millimeters, you can set that next to the syringe to estimate 0.5 units consistantly.
 
Thankyou. Remi looks terrified every time I come near him now:(. His ear looks really bad. It can be so easy one time and impossible the next. He is just eating his new wet food. Then will go to bed.

So if the number above 11 tomorrow am I will go ahead and give a half dose. Will try my metal ruler. Then I don't think I can cope with monitoring him every hour but if I do it at plus 2 and plus 4 and plus 6 we should be okay? What sort of drop should I be looking for?

Finally I had nearly got him off the dry food. On the lower dose it should be okay to give him little to zero of that shouldn't it? I am as much worried about messing with his food and causing panc flair as anything else.

Am off to bed now but finally I can't thank everyone who has helped me tonight and over the last few days. Without you I think it would have been impossible.
 
As long as his pre-shot is OK to give insulin, you can wait to test him around +5ish if you want.


If you can get some Neosporin ointment (not creme) with pain relief or something similar, putting a dab of that on the ear can help immensely in healing. Also, apply direct pressure after the test to reduce bruising. Just a minute to help it clot in a small area instead of seeping.

A high protein, low carb treat with every test, even if not successful, can help a lot.
 
Well, how are things the morning after the night before? I hope you got some sleep at last? Remi js obviously very sensitive to insulin - that was a big steep drop at +2 - so although it was a stressful few hours you can at least see now how very important it is to test as often as you can. It may well have been that Remi dropped pretty low the night before, too. So despite the anxious few hours you have in fact made progress because you have collected more data and begun to see a pattern.
You have had good advice from BJ and others on what to do this morning at what number, but still test after dosing so we can see if the pattern - steep drops - repeats.
As for poor Remi's ears, again you have had good advice so if you follow that, it will help you also to feel less stressed. And please remember treats - they really are important, so that Remi isn't too freaked out by all of this and co-operates willingly because he knows he will get a little something nice for good behaviour.
I hope today is better for you.
 
Morning everyone. I got a few hours sleep but not very restful.

This morning I really heated the ear and got a good blood drop. The reading was 25.5 mmol/l (459). So I went ahead and gave .5 of a unit. Or at least I think I did. The needles are set to give up to 20 units and it was near impossible to try to find the 0.5 of a dose even with a metal ruler. I am also not sure that such a small dose got into him properly. Can I get smaller syringes from the vet or elsewhere for the caninsulin. I can't go on like this.

I have accu fast clicker and I am not sure what depth to set it on. Last night I went up to three and it pierced his ears. Plus it is okay to pierce the top of the ear?
 
Morning! I expect the reading is up at least partly because of the additional/different foods given last night to offset the drop.
OK, so did a successful blood test (congratulate yourself) and you've given 0.5 units, or tried to. I know what you mean about being unsure if the insulin was injected - a small dose like that can be hard to tell. Was Remi's fur at all damp at the injection site? If people don't inject correctly it is sometimes called a 'fur shot' where the insulin ends up on the surface of the skin/fur. It's easier to tell if you're injecting bigger quantities, but for such a small dose I think most people would be unsure. Not much you can do for the moment but bear it in mind in future, and take your time injecting so you can be confident you're getting it right.
I don't know about smaller syringes but I expect Elizabeth, our main UK expert, will know. I will ask her to come here and read your posts from overnight.
As for the ear pricking, yes, you prick the edge of the ear where the vein is. If you look back at your previous threads I think someone (KPassa?) posted some useful links there. This morning could be a good time to chill a bit and check up on some things like that - knowledge is power!
 
Hi Diana

It didn't feel damp but I haven't seen him perk up yet at all and it is now 1 hour post shot. The last two times he suddenly came to life and acted more like his old self. Now he is just laying on his side asleep and doesn't have much energy.

I phoned the vets and they said they would look into it and get back to me but those are the right syringes for caninsulin. A dog maybe but not a cat!

Yes I have read KPAssa guide. It is very helpful but when it comes to actually doing it I still panic. I think a big part of my problem is that when I am anxious I rush things to get them over with. I
 
Hi Sarah,

Gosh, you've had quite a night. Well done! And thank goodness you are hometesting!

I absolutely agree on that dose reduction to .5 unit.

Regarding measuring .5 unit, are you using the 1ml or the .5ml Caninsulin syringes? (It's easier to measure smaller amounts in the .5ml syringe).
Also, VetUK also do their own range of U40 syringes (suitable for Caninsulin). I've just emailed them to ask if their syringes have .5 unit markings and will let you know what they say. (And incidentally the VetUK syringes are way cheaper than the Caninsulin ones...)

Another option to consider, if it looks like Remi is going to be needing small doses, is to use U100 syringes with your U40 insulin.
Different insulins come in different concentrations/dilutions. Caninsulin has 40 units of insulin per ml and is generally used with U40 syringes. Many other insulins have 100 units of insulin per ml and are measured in U100 syringes. If you were to put a unit of U40 Caninsulin into a U100 syringe it would come to the 2.5 unit mark there (but would of course still be one unit of Caninsulin). Using U100 syringes can make it much easier to measure small doses of U40 insulin. But the idea can take a bit of 'getting your head around'. And you'd need to feel comfortable about the idea of it. There is a conversion chart here if you're interested in seeing how it works: http://www.felinediabetes.com/insulin-conversions.htm

Eliz
 
I don't know if I am tired but I think I understood what you just said.

The box says it is 0.5 ml caninsulin syringe. So I was using the first mark on the syringe. This morning I just had to guess the halfway point which was impossible. The vets haven't got back to me yet but said they would look into it. Should I phone them and suggest the U100 syringes? I don't want to have to do the same tonight if at all possible. Especially as my hands are quite shaken at the moment. For all I know I only gave him .25 of a dose!
 
Hmm so at +2 the BG is now still high at 23.3mmol/l (419.4) Does this mean I missed the shot /got the dose wrong or may it still drop?

Many thanks.
 
My vets don't have any U100 syringes and the nurses very suspicious about who told me to drop to .5 of a unit. I told them my vet (who is away on holiday did).

Can I source these syringes anywhere else in the uk today?
 
They have got some syringes and I am off to get them in a bit. I am so relieved.

Now I have another concern. When I was fiddling about with trying to get the right amount in the syringe a drop formed on the outside of the bottled. Before I realised what I was doing I flicked my hand down twice to get the insulin drop off. Have I ruined the insulin? I asked the nurse and she said no. What do you guys think?
 
Phlika29 said:
Hmm so at +2 the BG is now still high at 23.3mmol/l (419.4) Does this mean I missed the shot /got the dose wrong or may it still drop?
Click to expand...

I know it's easy to say but do try not to worry. You are doing brilliantly. And it will get easier very soon. Really!

There are a number of reasons why the blood glucose may still be high.
First off he had higher carb food which may still be keeping his numbers high.
And it may be that the insulin didn't go into Remi properly.
It is also very possible that he is experiencing a 'bounce'. Bouncing is a common phenomenon, especially in newly diagnosed cats.

'Bouncing'/'Rebound' can be triggered when a cat's blood glucose drops too low or too fast (or indeed both). "Too low" doesn't necessarily mean 'dangerously low'. Bouncing can be triggered when the blood glucose drops lower than the cat has become accustomed to.
The cat's body senses danger and releases glucose into the system. (The blood glucose level can swing up very high as a result of this.) The body can also release counter-regulatory hormones, the purpose of which is to keep the blood glucose high for while. This looks like temporary insulin resistance (ie, you give the shot but the blood glucose remains high and unchanging('flat').

In Remi's case it could be that the speed of the drop was sufficient to trigger a bounce all on it's own. (Typically, drops of 5.5 mmols or more per hour may trigger a drop (and that may well vary from cat to cat)). But he also dropped quite low too.
That 3.7 was actually a very nice number, and in different circumstances you might have been very pleased to see it (ie, if it was a bit further into Remi's diabetes story and you saw it at the peak of an insulin cycle where the preshot level had been maybe around 9 - 10). But to 'freefall' to that number from a great height will have given his body (and you!) a bit of a fright.

Bounces can take up to a few days to clear, but may well clear faster than that. You may see a response to the next insuin shot you give. I know it's hard, but it is a bit of a waiting game. Try to be patient. And rest assured that you've done everything you can do at this point.

Sending you a big reassuring (((hug))),

Eliz
 
Phlika29 said:
...When I was fiddling about with trying to get the right amount in the syringe a drop formed on the outside of the bottled. Before I realised what I was doing I flicked my hand down twice to get the insulin drop off. Have I ruined the insulin? I asked the nurse and she said no. What do you guys think?
Click to expand...

Although insulin needs to be handled gently I think it's unlikely that flicking the vial a couple of times would have damaged it. When I've collected insulin from my vet I've occasionally seen him or the vet nurse sometimes give a bottle a quick vigorous shake before handing it to me. I cringed when I saw that. But the insulin was still fine...
 
Morning Sara.

Pleased and relieved to see that you got through the night OK. Yourself and Remi have had a bit of a baptism of fire. I know his ears have been through it but they'll heal quickly. Better tatty ears than a hypo.

When testing, always give Remi treats (even hand feed him a little piece of home-cooked chicken by hand), and talk to him soothingly, positively and confidently. Even if you don't feel confident, fake it till ya make it! ;-) Remi loves and trusts you, and seeing you more positive will reassure him. Give him lots and lots of fusses and tell him what a good, handsome boy he is. (And he is handsome! Lovely avatar picture.) Maybe groom him a little as part of his testing routine? (Saoirse likes that.)

WRT Remi, the lethargy and the worry about whether or not you gave the insulin properly this morning, you'll need to monitor his clinical signs and test during the day. Every cat responds in their own way, but FWIW Saoirse had a big drop during her transition to wet food and the following day she was absolutely poleaxed after it. Her clinical signs were better the following day.

I'm only a novice sugar kitty parent and experienced members will be able to give much better information, but on review of events I think there is a strong possibility your pre-dose number last night may have been influenced by a Somogyi rebound. Remi's low number yesterday morning was most likely the lowest that it has been in a while, his system may have panicked and signalled his liver to dump extra glucose into his bloodstream in response. The rebound may continue to affect his numbers for several days but there's no guarantee of that. Also last night's low might make him even more sensitive to the Caninsulin so the smaller dose could have a strong effect.

Remi has also had some higher carb food overnight and that will affect his numbers for a while, too. When his body uses up that food, it is likely that his numbers will lower accordingly. That, too, will influence dosing decisions.

Be sure to have your hypo kit laid out on standby just in case you might need it. It's easier to get it organised while everything's calm and relaxed instead of trying to grab stuff in an emergency when you may be flustered. Be sure to always keep a good stock of lancets and test strips at home.

The early weeks after diagnosis can be absolutely exhausting for care-givers. It's important to factor your own tiredness into your dosing decisions. Once the insulin is in, you can't get it out and should Remi's BG get worryingly low (as it did last night) you need to know that you'll be able to stay awake to monitor him and see him through the low safely. I offer this not to alarm you, but so that you might be saved from situations such as the one I found myself in when Saoirse's BG levels took that huge drop during her unplanned but very abrupt transition to wet food (necessitated because of her unexpected refusal to eat dry high-carb after an adverse reaction to a spot-on treatment). I had already started running Saoirse's first 24-hour curve while she was still on high carb dry with only a tiny amount of low carb wet and i was absolutely shattered after it. The stress and worry over the unexpectedly abrupt cut-over to low carb wet (the only thing she'd eat) drained me even further. I was in the fortunate position that I had already gathered some data so I knew that Saoirse hit nadir at +2 to +3 and started rising after only a few hours. I did a pre-bed test for her nadir and thankfully caught the hypo (4.3 on Alphatrak- c. 2.8 on a human glucometer) but I was in great danger of passing out from exhaustion. It's a predicament I wouldn't wish on anybody. I will be forever grateful to the FDMB members who helped me stay awake that night so I could keep my girl safe. I had to remain standing the whole night to avoid losing consciousness. Not recommended.

I completely understand your desire for Remi to have BG levels in the normal range as soon as possible. We all want that for our little ones. But his body needs time (not necessarily a long time) to get used to the low carb food and the insulin and for his pancreas and liver to learn that these lower, safe BG levels are OK. As long as Remi is clear for ketones and you're monitoring for them at home, a high number is MUCH safer than a low one until you have more data and know Remi's pattern. Once the insulin goes into his system, you can't get it out again. "Start low and go slow" and "better high for a day than too low for a second" (ketones permitting) are two of the best general guidelines I have learned since joining FDMB. As you gather more test data, hopefully you'll see Remi's day averages gradually drift down into the euglycaemic range as his therapy continues.

Well done for getting through last night. You must be exhausted. Give Remi some scritches for me and treat yourself to something nice! cat_pet_icon
 
Thanks eliz and Crittermom

I've just got back from the vets and I cried so much at the receptionist that she went and got one of the vets. He had a nice chat with my and explained the syringes and printed me out the conversion table for the u100 syringes. So tonight as long as the BG reading is above 11.1mmol/l (which I am sure it will be) I will give a o.5 unit dose of caninsulin. This will be will be from a U100 syringe and this I will take the insulin up 1.5 notches (as there is no .25 marker).

Please someone confirm that this is correct. We went over it a few times so I should have that right.

I have just taken a +5 reading and it is 21.1 mmol/L (379.8).

The vet confirmed better to be too high than too low, and yes I tested for ketones this morning and it was negative. I think I am in sure a rush to get under control as his sister died from ketones without really getting the underlying condition in control.

So are you saying that even at .05 dose he could drop too low again :cry: From the somogyi rebound. This is a worry, what I want then is a slow lowering of levels. Will make sure I add a little dry to his food just after the injection but he is nearly off the stuff now. Will make sure I keep taking readings tonight but should I do anymore this afternoon or just leave him be?

He is booked in to the vets on Monday for a curve.
 
Actually, Somogyi rebound has never been convincingly demonstrated in cats. Sienne from the Tight Regulation board has explained this numerous times. That would happen with sustained overdosing of insulin.

Bouncing - compensatory hormones releasing stored glucose (glycogen) - can happen a lot early on. The resulting high numbers may take up to 3 days to clear. Stay calm and wait it out. We'll get you some "patience pants" if we need to!

The conversion factor to use a U-100 syringe with a U-40 insulin is easy if you remember that each 0.5 tick mark equals 0.2 units of Caninsulin. So you can just count the ticks - 0.2, 0.4, 0.6, 0.8 as you go up the syringe.
 
BJM said:
Actually, Somogyi rebound has never been convincingly demonstrated in cats. Sienne from the Tight Regulation board has explained this numerous times. That would happen with sustained overdosing of insulin.

The conversion factor to use a U-100 syringe with a U-40 insulin is easy if you remember that each 0.5 tick mark equals 0.2 units of Caninsulin. So you can just count the ticks - 0.2, 0.4, 0.6, 0.8 as you go up the syringe.
Click to expand...

So that's right then. I go up three marks on the during to get to 0.6 of a dose? I might try to just under three marks to get to my 0.5

Is the somogyi rebound the same as a bounce? I read a good thread about bouncing.

I am going to leave remi to rest until we take his next level at 7 pm tonight. I think he has had enough of my manhandling him today.
 
No, Somogyi is not the same as bouncing. Bouncing is a short term response of up to 3 days. Somogyi is chronically higher numbers due to too much insulin and has not been demonstrated in cats. Dusty went OTJ in a couple of weeks and I only tested him weekly when I went over to his owners. The day I came in and he was too low, we tried no insulin - he never went super high due to insulin he didn't need, he just ate what he needed to compensate for the insulin.

And a dose of 0.6 units would be fine too, if you can't quite measure the 0.5 units.
 
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