After more than a year, still struggling to insulin my cat

[Jayneorrain]

Hello, I'm Jayne and I have a diabetic cat, Phileas. He is 15ish years old and was diagnosed with diabetes in January 2023. It has been a brutal year and a half, and I'm hoping you have some advice.

Phileas HATES his insulin shots. Our vet has been extremely judgemental that his diabetes is so poorly managed, but I don't know what to do. He currently "gets" 6 units of the lantus solostar pen two times daily and but his glucose levels are still way too high and his diabetic neuropathy is getting worse.

The problem is that it's nearly impossible to give him the shot. He's started scratching and biting when I even approach with the needle. I'd say he probably only gets the correct dose half of the time, and it's not uncommon for him to flail so much that he rips the needle out of his skin. It's extra hard because I'm a petite person so I cannot physically hold him with one arm, reach that arm around to pick up the skin (which is how my husband does it on nights he won't sit). He needs to either sit for the insulin, which is increasingly rare, or I have to full body pin him. My husband works out of town a full 50% of the time. I feel like a failure of a cat mom. I know he's sick because he's not getting his insulin. I just don't know how to get it to him. I've tried to ask my vet for advice, but they just tell me that he will get used to it. It's been a year and a half. He is getting the opposite of used to it. Do you have any tricks for getting cats to sit for insulin? Are there cats who simply never adjust?

Phileas has always been a high anxiety cat. He has always been a daddy's boy who gets upset when my husband is away. Now, I'm dealing with that while trying to give him a shot.

 

[Bron and Sheba (GA)]

Hi and welcome Jayne and Phileas to the forum.
Please don’t feel a failure …and it is very poor your vet is so judgemental about it all.
I’ll ask a few questions if you don’t mind to get an idea of things.

• How did you reach 6 units? Did you go back to the vet for curves? And how often was that.?
• I would assume if you are using a pen, that you went up in 1 unit increments? Is that correct?
• What type of food are you feeding Phileas?
• Is the food wet or dry?
• Have you tried giving the dose as he is eating?
• Have you ever had a freestyle libre meter fitted for a fortnight to see how the blood glucose is reacting to the doses?

Most cats do get used to the injections and don’t even feel it. Phileas probably is scared of the process not the actual injection. Maybe if you could completely change the routine and get him desensitised to it, maybe that would help. Try taking him to another area and petting him and doing nothing but give him a treat and do that several times over a few days before actually giving the dose. Don’t let him see the pen. And try feeding him something yummy as you give the dose so he can associate it with something nice,

We actually recommend using a syringe, not the pen, as we can then go up or down in 1/4 unit increments… and then don’t go past the best dose. The vet will probably poo-who that idea…they often do…but it works. So that is another idea to try. We can show you how to get the insulin from the pen to the syringe easily.
I think a freestyle libre meter which is attached to the cat for a fortnight would be very useful to see what the dose is actually doing to Philieas. He could be getting too much insulin.

If the neuropathy is getting worse you can try giving him Zobaline from lifelink.com
You can’t get it from the vet and you don’t need his permission to give it. It is a tablet which can be crumbled onto the food and seems to be tasteless.

Keep posting daily so we can help you get this sorted out. Don’t despair please
Bron

 

[Jayneorrain]

Thank you for your response!

How did you reach 6 units? Did you go back to the vet for curves? And how often was that?
- We increased by a unit every few weeks until he stabilized. My husband was doing the curves at home with an Alpha trak because Phileas would attack the vet when she tried to do it. We did the curve every few weeks. He stayed at 5 units from the end of last summer until about 2 months ago when we started noticing the neuropathy and excessive drinking/thick peeing again. My husband did another curve and the vet bumped it up again. We tried explaining to the vet that we thought the problem was likely that he simply wasn't getting enough insulin because we were struggling to administer it. She was both super judgemental that we weren't always successful with it and adamant that it wouldn't be the cause at the same time.

I would assume if you are using a pen, that you went up in 1 unit increments? Is that correct?
- Yes. It is a pen.

What type of food are you feeding Phileas?
Is the food wet or dry?
- Phileas eats Nulo wet food and Natural Balance dry food. We tried the special diet foods from the vet for a few weeks, but he simply chose to not eat which was alarming. He's a picky eater!

Have you tried giving the dose as he is eating?
- I have, but he flips out if I touch him while he eats at all so I've never even been able to tent the skin.

Have you ever had a freestyle libre meter fitted for a fortnight to see how the blood glucose is reacting to the doses?
- We have not.

Most cats do get used to the injections and don’t even feel it. Phileas probably is scared of the process not the actual injection. Maybe if you could completely change the routine and get him desensitised to it, maybe that would help. Try taking him to another area and petting him and doing nothing but give him a treat and do that several times over a few days before actually giving the dose. Don’t let him see the pen. And try feeding him something yummy as you give the dose so he can associate it with something nice,
- It seemed for a long while that he had gotten used to it. That took MONTHS. Then we had a few months of ease where he was getting his 5 units, sitting nicely for them, and seemed really healthy/happy. A few months ago, he went back to being super uncooperative. That's when his neuropathy came back and subsequently when the vet increased to 6 units. I'm not sure if it's worth mentioning, but it also became very hard to tent his skin around that time. It feels like his skin doesn't move freely anymore?? Or like he's tensing so much that it's hard?? The period when he allowed insulin with ease was my husband's off season. He would let either of us do it, but my husband was home. The problems also seemed to start when my husband started spending weeks away. The reason this may be relevant is that long before he was diagnosed with diabetes, he would always become very anxious the first few days my husband was away. (My husband didn't always work out of town, but we moved back to our home town in 2020 and his work is 5 hours away in the city.)

We actually recommend using a syringe, not the pen, as we can then go up or down in 1/4 unit increments… and then don’t go past the best dose. The vet will probably poo-who that idea…they often do…but it works. So that is another idea to try. We can show you how to get the insulin from the pen to the syringe easily.
- I think finding a way to administer the insulin is top priority before changing to a syringe. I'm not opposed to trying new things though!

I think a freestyle libre meter which is attached to the cat for a fortnight would be very useful to see what the dose is actually doing to Philieas. He could be getting too much insulin.
- How would we go about asking the vet for this?

If the neuropathy is getting worse you can try giving him Zobaline from lifelink.com
You can’t get it from the vet and you don’t need his permission to give it. It is a tablet which can be crumbled onto the food and seems to be tasteless.
- I will definitely look into this.


I don't know if this matters, but we also have 1 other cat in the home. We got Phileas in 2012. We adopted him from the SPCA after bringing him into the SPCA. He had been hanging around our house as what we thought was a kitten. The SPCA told us he was actually 2-4 years old, just small from not eating. They neutered him and waited until the stray hold was over. We visited him regularly and eventually convinced our landlords to let us adopt. He definitely has always had feral cat vibes (especially around food) even though he is the sweetest snuggler.

 

[Bron and Sheba (GA)]

Hi Jayne and Matt

the food wet or dry?
- Phileas eats Nulo wet food and Natural Balance dry food. We tried the special diet foods from the vet for a few weeks, but he simply chose to not eat which was alarming. He's a picky eater!

The dry food would be high carb. If you live in the US you can get a few types of low carb dry but not many. I will ask @Diane Tyler's Mom to tell you about the low carb dry and where to get it.
I’m not sure if the Nulo canned food is low carb or not (I don’t live in the US) but I’ll give you a link to a food chart we have and you can look for foods that are 10% or under carbs which are suitable for cats with diabetes. If you do decide to change to a low carb option…and I would recommend you do…then you would need to be monitoring the blood glucose closely when you do any changeover as the BGs could drop quite a bit.
FOOD CHART

think a freestyle libre meter which is attached to the cat for a fortnight would be very useful to see what the dose is actually doing to Philieas. He could be getting too much insulin.
- How would we go about asking the vet for this?

As you are using an alphatrak meter there is no need for you to use a freestyle libre. I was unaware you were hometesting when as asked about it. That is great you are hometesting. Do you think you could set up a spreadsheet and enter a couple of weeks data so we could see what is happening? Here is a link to how to set up a SS. HELP US HELP YOU
If you have any trouble setting it up I can ask @Bandit's Mom to help you with it.

think finding a way to administer the insulin is top priority before changing to a syringe. I'm not opposed to trying new things though!

You might find it easier using a pen. And you can then increase or decrease in much smaller amounts which is preferable.
The syringes you need are U100, 3/10 ml, 30 or 31 gauge, 6 or 8 mm insulin syringes with 1/2 unit markings. There are several abramds to choose from.

This is how you get the insulin from the pen to the syringe.

I'm not sure if it's worth mentioning, but it also became very hard to tent his skin around that time. It feels like his skin doesn't move freely anymore?? Or like he's tensing so much that it's hard?? The period when he allowed insulin with ease was my husband's off season.

Do you always give the insulin in the scruff of the neck? If so it could be getting tough. It is better to rotate the areas where you give the doses. It is possible it is hurting him because the skin has become thickened. Here is a diagram of the places you can give the insulin. You will need to tent in what ever place you choose.

Do you test before every dose insulin? It is recommended you do so that you know it is same to give the dose.
Also if you can test somewhere around 1/2 way through each cycle, that will tell us how well the dose is working.

also do you have some honey or Karo and some high carb food incase of a hypo?

 

[Diane Tyler's Mom GA]

Bron tagged me to give you some info on low carb dry food ,these are about 5 or 6% carbs

Dr Elseys you can buy on chewey site
https://www.chewy.com/dr-elseys-cleanprotein-chicken/dp/146269?utm_source=google-product&utm_medium=cpc&utm_campaign=12791446238&utm_content=Dr. Elsey's&utm_term=&show-search=1&gclid=EAIaIQobChMI0PvU2Zj79wIVRIdbCh3JawEkEAQYASABEgIInfD_Bw


Dr Elsey's also at Walmart
https://www.walmart.com/ip/Dr-Elsey...ViI3ICh0suwO_EAQYAiABEgJrOPD_BwE&gclsrc=aw.ds

Dr Elsey's Amazon
https://www.amazon.com/dp/B07FCJHDPR/ref=twister_B09GHFJY65?_encoding=UTF8&psc=1

From what I have read on our site they are 5 or 6% carbs so that's ok
I read the same thing about The Young Again Kibble stinky poops

Dr Elsey's will send you a sample . You can see if Callie likes them before buying them ,get the chicken flavor. Dr Elsey's Clean Protein

Dr Elsey's web site
https://www.drelseys.com

I think this is there phone number
Phone: 877-311-2287

You can also get these syringes without a vets script
https://www.amazon.com/UltiCare-31-Gauge-Veterinary-Insulin-Syringes/dp/B009LTE0DO

@Jayneorrain

 

[Sienne and Gabby (GA)]

Bron had offered some great suggestions. As far as diet, the Nulo is less than 10% carbohydrate. We consider low carb as under 10%. The Natural Balance is an entirely different story. Their chicken and salmon dry food is over 36% carb. You are feeding your diabetic cat a food that is pretty much ice cream, cake, and candy. FWIW, the "diabetic" prescription dry foods aren't that much better. If you're testing, you may want to consider gradually transitioning Phileas to a lower carbohydrate diet. The change in food may cause his numbers to drop quickly, so it's important to keep an eye on his blood glucose levels.

Given that he's so temperamental about shots, is he OK with home testing?

Do you happen to know what the gauge is on the pen needles that you're using? The pen needles come in 29 - 32 gauge. The higher the number the thinner the needle. Most cats don't seem to notice a 31 or 32 gauge needle. Also, with the pen, you need to hold the pen in place for a few seconds after an injection. You don't need to do that with a standard syringe.