And now...EPI!

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Aleluia Grugru & Minnie said:
What food did you give her? Was it high carb? What meter are you using, human or pet? If it’s human she’s still in safe range but you do need her number to go up not down. In the future do not feed so much. You want her to be hungry to keep eating so you can bring her numbers up with food. One tablespoon at a time. Do you have high carb food at hand? Do you have your hypo kit?

Can you test again in 30 minutes after the last test and post please?
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I gave her Wellness Core cans, what she usually eats. Not high carb.
Thank you about the feeding tip.

I'm using a human meter (Contour next). I tested again after 20 minutes and got 70. Waiting to test again afterwards.

Edit: 81 after another 20 minutes. Looks better but I will keep on testing.
 
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Marisofi said:
I gave her Wellness Core cans, what she usually eats. Not high carb.
Thank you about the feeding tip.

I'm using a human meter (Contour next). I tested again after 20 minutes and got 70. Waiting to test again afterwards.
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Okay good. Take action number in a human meter is anything below 50. I’d test again in another 30 minutes to make sure she’s staying up.

you need to have high and medium carb food at hand. Did you read the sticky note about your hypo tool kit? Please read it and make sure you have it all at home
 
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Red & Rover (GA) said:
Do you have anything sweet in the house?
White sugar (can be dissolved in boiling water – helps it dissolve)
Syrup
Ice cream (not chocolate and not if your cat is lactose intolerant)
Icing sugar (it dissolves easily in water)
Click to expand...

Thank you all. I had bookmarked the pages on hypo but I hadn't prepared a kit because she was almost always way up in the 200s-300s-400s, so I really thought that my number one concern for the time being would be getting her numbers down. I'll go to the supermarket first thing in the morning and get everything needed.

She is now at 91.
 
Aleluia Grugru & Minnie said:
Great news! I think since she’s on caninsulin the worse is over. I’d test again in an hour if you can. Cats like throwing curve balls at you. Btw, she earned a .25 reduction going under 90 so her nerves dose should be 3.25. She earned it!!
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Will do. And just imagine that my vet has kept insisting that I boost her up to 5, which I have been trying to reach gradually. I think (based on what I've read) that the hypo is also related to the fact that I've changed her wet food from Hill's m/d to Wellness Core that is significantly lower in carbs. Still, she's been getting all these high pre-shot numbers though. Anyway, I will call the vet tomorrow (or rather today, it's 6:30 am here now) to let her know.

Maya is at 122 now.
Very thankful for all of your support.

P.S. It's a bit difficult to calculate 0.25 on the syringe, as there are only markings for 3, 4, 5, etc. So, I have been noting changes of roughly 0.5.
 
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You need to get 1/2 unit marked syringes. It’s hard to eye ball in on the unite marks for sure but .5 is too much to increase or decrease by. Btw, we don’t dose by the preshot numbers but by the nadir which is the lowest point in a cycle and the 52 you got today. The food does make a big difference. Happy to help and happy you’re home testing!!
 
Marisofi said:
Will do. And just imagine that my vet has kept insisting that I boost her up to 5, which I have been trying to reach gradually. I think (based on what I've read) that the hypo is also related to the fact that I've changed her wet food from Hill's m/d to Wellness Core that is significantly lower in carbs. Still, she's been getting all these high pre-shot numbers though. Anyway, I will call the vet tomorrow (or rather today, it's 6:30 am here now) to let her know.

Maya is at 122 now.
Very thankful for all of your support.

P.S. It's a bit difficult to calculate 0.25 on the syringe, as there are only markings for 3, 4, 5, etc. So, I have been noting changes of roughly 0.5.
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Also technically speaking, this was not a hypo. On a human meter, a hypo is under 50 and even then every cat reacts differently. Minnie has gone as low as 47 and acted perfectly fine
 
Marisofi said:
P.S. It's a bit difficult to calculate 0.25 on the syringe, as there are only markings for 3, 4, 5, etc. So, I have been noting changes of roughly 0.5.
Click to expand...
Try using a magnifier or even a pair of cheap reading glasses. A bright light helps as well. Practice with a used syringe and some coloured water. When you have what you believe is the correct amount in the syringe, put it aside and use it as a comparison.
Some people use calipers. A bit more about them here:
https://www.felinediabetes.com/FDMB/threads/dosing-with-calipers-updated-w-videos.79851/

A search found these in the UK. Can they be ordered? Are they available in Greece?
SOL-VET™ U-40 Insulin Syringe With 1/2 Unit Markings

Unique, high quality latex-free, non-toxic and non-pyrogenic insulin syringe specifically designed for pets.

  1. Half unit markings for more accurate dosing
  2. Optimal needle sharpness and smooth plunger control for more comfortable and accurate injections
  3. Transparent barrel with bold scale markings for easier reading and measuring
  4. Needle bevel is tri-cut for optimal needle sharpness
  5. Flat top rubber stopper minimises residual medication waste
Tagging some UK and EU members
@Gill & George
@Elizabeth and Bertie
@Critter Mom
@SashaV

Caninsulin is not the best insulin for cats. Is your vet willing to switch insulin?
 
Hi @Marisofi

Are you able to get the Sol-Vet half unit U40 syringes linked to in the previous thread? Some of our UK members buy these online. Maybe they're also available online in Greece?

Alternatively, is it possible to get U100 syringes with half-unit markings? U100 syringes are made for use with U100 insulins (those that have 100 units per ml rather than the 40 units per ml that Caninsulin has). But it is possible to use U100 syringes with U40 insulin in conjunction with a conversion chart to ensure the correct dose is measured.
http://www.felinediabetes.com/insulin-conversions.htm

Well done for dealing with that low number situation. It can be very scary the first time we see low numbers... (((Hugs))) :bighug:

When using Caninsulin the general starting advice is to 'aim' to not have the blood glucose drop below about 90 (5) as measured on a human meter. This is because Caninsulin can often drop the blood glucose quite quickly, and 'aiming' to not let the blood glucose go below about 90 (5) just gives some buffer of safety in case it does actually drop a bit lower than that.

The often quoted advice on the forum that the 'take action number' is 50 (2.7) refers more to cats on gentler long-lasting insulins such as Lantus and Levemir, as these don't usually drop the blood glucose so fast. The situation is a bit different when using faster acting insulins such as Caninsulin.
Because Caninsulin can drop the blood glucose fast it is safer not to wait until the blood glucose is below 50 (2.7) before taking any action. Sometimes the blood glucose can drop faster than the caregiver's ability to keep pace with it... So, it is helpful to try to not let the blood glucose drop much below 90.

With low numbers it's important to bear in mind too that it's not just what the number is, but also, where you see that number in the cycle. This will affect the action that is needed.
A '90' (or a smidge lower) at the peak of the cycle may be fine, and a nice thing to see. And no action may be needed other than testing again a little later to check that it's not dropping further (the peak of the cycle is not a rigid fixed point...)
A '90' earlier in the cycle may require some action to stop the blood glucose dropping too fast or too low. If it's close to the expected peak of the cycle it may be that a little low carb snack is sufficient to 'steer' the curve safely past the peak of the cycle. But if there is a long way to go to the peak of the cycle it may be necessary to use medium or even higher carb food to steer the cycle, depending on the situation. If the numbers are dropping really fast then the quickest way to slow or stop that drop is to give a little simple sugar such as glucose, honey, or syrup. What works best varies from cat to cat, but you will learn the kinds of things that work best for your own cat.

It's a sound idea to put together a little 'hypo kit' that you can grab quickly if you need to.
A hypo kit absolutely must contain a simple sugar source (glucose, dextrose, honey, or syrup). It's also good to have some higher carb food in gravy (the gravy is the most useful bit) and/or some higher carb liquid treats; some medium carb food; extra test strips; and a spare battery for your meter. ...Sometimes we joke that they should also contain an emergency bar of chocolate - that's for you, haha! :smuggrin:

Eliz
 
Red & Rover (GA) said:
Try using a magnifier or even a pair of cheap reading glasses. A bright light helps as well. Practice with a used syringe and some coloured water. When you have what you believe is the correct amount in the syringe, put it aside and use it as a comparison.
Some people use calipers. A bit more about them here:
https://www.felinediabetes.com/FDMB/threads/dosing-with-calipers-updated-w-videos.79851/

A search found these in the UK. Can they be ordered? Are they available in Greece?
SOL-VET™ U-40 Insulin Syringe With 1/2 Unit Markings

Unique, high quality latex-free, non-toxic and non-pyrogenic insulin syringe specifically designed for pets.

  1. Half unit markings for more accurate dosing
  2. Optimal needle sharpness and smooth plunger control for more comfortable and accurate injections
  3. Transparent barrel with bold scale markings for easier reading and measuring
  4. Needle bevel is tri-cut for optimal needle sharpness
  5. Flat top rubber stopper minimises residual medication waste
Tagging some UK and EU members
@Gill & George
@Elizabeth and Bertie
@Critter Mom
@SashaV

Caninsulin is not the best insulin for cats. Is your vet willing to switch insulin?
Click to expand...

Thank you! Haven't found these syringes yet but I will keep looking.

I spoke with the vet today. She is open to changing measuring method to TR but she suggests that we wait another week because Maya has just started taking her pancreatic enzymes and maybe they had an effect on the rapid change in BG.
 
Elizabeth and Bertie said:
Hi @Marisofi

Are you able to get the Sol-Vet half unit U40 syringes linked to in the previous thread? Some of our UK members buy these online. Maybe they're also available online in Greece?

Alternatively, is it possible to get U100 syringes with half-unit markings? U100 syringes are made for use with U100 insulins (those that have 100 units per ml rather than the 40 units per ml that Caninsulin has). But it is possible to use U100 syringes with U40 insulin in conjunction with a conversion chart to ensure the correct dose is measured.
http://www.felinediabetes.com/insulin-conversions.htm

Well done for dealing with that low number situation. It can be very scary the first time we see low numbers... (((Hugs))) :bighug:

When using Caninsulin the general starting advice is to 'aim' to not have the blood glucose drop below about 90 (5) as measured on a human meter. This is because Caninsulin can often drop the blood glucose quite quickly, and 'aiming' to not let the blood glucose go below about 90 (5) just gives some buffer of safety in case it does actually drop a bit lower than that.

The often quoted advice on the forum that the 'take action number' is 50 (2.7) refers more to cats on gentler long-lasting insulins such as Lantus and Levemir, as these don't usually drop the blood glucose so fast. The situation is a bit different when using faster acting insulins such as Caninsulin.
Because Caninsulin can drop the blood glucose fast it is safer not to wait until the blood glucose is below 50 (2.7) before taking any action. Sometimes the blood glucose can drop faster than the caregiver's ability to keep pace with it... So, it is helpful to try to not let the blood glucose drop much below 90.

With low numbers it's important to bear in mind too that it's not just what the number is, but also, where you see that number in the cycle. This will affect the action that is needed.
A '90' (or a smidge lower) at the peak of the cycle may be fine, and a nice thing to see. And no action may be needed other than testing again a little later to check that it's not dropping further (the peak of the cycle is not a rigid fixed point...)
A '90' earlier in the cycle may require some action to stop the blood glucose dropping too fast or too low. If it's close to the expected peak of the cycle it may be that a little low carb snack is sufficient to 'steer' the curve safely past the peak of the cycle. But if there is a long way to go to the peak of the cycle it may be necessary to use medium or even higher carb food to steer the cycle, depending on the situation. If the numbers are dropping really fast then the quickest way to slow or stop that drop is to give a little simple sugar such as glucose, honey, or syrup. What works best varies from cat to cat, but you will learn the kinds of things that work best for your own cat.

It's a sound idea to put together a little 'hypo kit' that you can grab quickly if you need to.
A hypo kit absolutely must contain a simple sugar source (glucose, dextrose, honey, or syrup). It's also good to have some higher carb food in gravy (the gravy is the most useful bit) and/or some higher carb liquid treats; some medium carb food; extra test strips; and a spare battery for your meter. ...Sometimes we joke that they should also contain an emergency bar of chocolate - that's for you, haha! :smuggrin:

Eliz
Click to expand...
Many thanks Eliz! I guess it was bad.. And to think that she was sound asleep, if I hadn't measured her BG, I would have had no idea...

I'm getting my hypo kit ready today (chocolate bar for me included ).
 
A thought:

My civvie, Lúnasa (aka The Noodle), has a very sensitive digestive system. She actually had an episode of acute pancreatitis a couple of years ago following a protracted period of GI disturbance when she was hyperthyroid. I tried her on umpteen wet foods but to no avail: they all triggered digestive upsets.

Our vet recommended Virbac Digestive Support veterinary diet for her, partly because other of his patients with similar issues had done well on it but also because, as dry foods go, it's not insanely high in carbs (16% kcals from carbs). Given that Lúnasa had already been diagnosed with early stage renal insufficiency I'd have far preferred her to be on a wet food - but she has to eat so reluctantly I gave it a go.

Lúnasa did really well on the GI support diet. She was on it for years. The Noodle's now at IRIS CKD stage III and I recently had to switch her to the renal support diet from the same range (closest ingredient match I could find) but she stopped eating enough and eventually refused it completely. I switched back to a mix of the CKD and GI support kibbles and thankfully she's eating again. She's also starting to poop more regularly again and seems more comfortable overall. Again, not ideal, but she'd get nowhere if she didn't eat anything.

I am wondering whether, given you need to feed a mix of wet and dry food at the moment, the Virbac GI kibble might be a food to consider for your little ones (assuming it's available where you are).

Virbac Digestive Support Veterinary Dry Diet
--------------------------------------------------------------

Ingredients:

Pork and poultry dehydrated protein*, potato starch, animal fat*, whole pea, mineral salts, pork and poultry hydrolysed protein, beet pulp, lignocellulose, linseed, fish oil*, psyllium fibre, fructo-oligosaccharides, chitosan, yeast nucleotides, yeast beta glucan, butyrate salts, pasteurised Lactobacillus acidophilus.

*highly digestible ingredients

As fed analysis:

* Protein - 44%
* Fat - 21%
* Crude Fibre - 3.5%
* Crude Ash - 8.5%
* Moisture - 4.9%

Carb Content (calculated):

* As fed: 18.1%

* Dry matter basis: 19.0%

* kcal from carbs: 16.0% <<< This is the value we're interested in when choosing a food for a feline diabetic.

I'm glad to read that Maya's eating better and her BMs are starting to improve in consistency.


Mogs
.
 
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Well done catching the low last night, Marisofi.

Given you've dropped the carb load in Maya's diet, I'm glad to see that this morning you reduced the dose back down to 3.5IU. (Note: Depending on Maya's response it may be necessary to reduce further, and soon.)

I fully understand how very much you want to see Maya in a better overall BG range - we all feel that way - but regulation is a gradual process that requires much patience on our part.

I very much recommend that you hold the 3.5IU dose for the time recommended in the Vetsulin guide.

It would benefit you from a safety perspective and also in determining dose efficacy to get a few more mid-cycle tests each day (as best your situation will allow).

A +2 test would help you to catch fast drops and, if necessary, intervene early with a low carb mini feed to help slow the drop. It also would give you an idea of where the cycle might be headed.

The guts of the drop should be measurable by +3 BUT BG levels could still go lower in the following hours (typically between +4 and +7 but it's possible for nadir to occur later, particularly if the dose is too high).

Tests between +6 and +12 typically throw light on the duration of the dose. Numbers climb significantly when the Vetsulin dose peters out - usually several hours before the next dose is due.

Of all the tests, the ones likely to catch fast drops early and the cycle nadirs are the most valuable.


Mogs
.
 
Marisofi said:
Thank you! Haven't found these syringes yet but I will keep looking.

I spoke with the vet today. She is open to changing measuring method to TR but she suggests that we wait another week because Maya has just started taking her pancreatic enzymes and maybe they had an effect on the rapid change in BG.
Click to expand...
I don’t think you can follow TR on caninsulin and I’d be very nervous about it with such a fast acting harsh insulin @Red & Rover (GA) and @Elizabeth and Bertie and @Critter Mom thoughts?
 
Aleluia Grugru & Minnie said:
I don’t think you can follow TR on caninsulin and I’d be very nervous about it with such a fast acting harsh insulin @Red & Rover (GA) and @Elizabeth and Bertie and @Critter Mom thoughts?
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Not that I'm aware of. There is a modified TR protocol for Prozinc now.

TR protocol using caninsulin makes me nervous as well.

Changing the Dose
Hold the starting dose for at least a week UNLESS​
    • your cat won’t eat or you suspect hypoglycemia
    • your kitty falls below 90 mg/dL (5 mmol/L). If kitty falls below 90 mg/dL (5 mmol/L) decrease the dose by 0.25 unit immediately.
After 1 week at a given dose perform a 12-hour curve (i.e., testing every 2 hours) OR perform an 18 hour curve (i.e., testing every 3 hours). Note: Random spot checks are essential in order to "fill in the blanks" on your kitty's spreadsheet. The goal is to learn how low the current dose is dropping kitty prior to making dose adjustments.
The general guidelines for making dose changes are:​
    • If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
    • If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
    • If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit
    • HOWEVER, there are some situations which signal that a larger than usual dose reduction is needed. If you are unsure, please post on this forum or in the Health forum and ask for input about your dose.
As your cat's blood glucose begins to fall mostly in the desired range [lowest point of the curve approaching 100 mg/dl (5.5 mmol/L) and pre-shot value around or below 300 mg/dl (16.6 mmol/L)], lengthen the waiting time between dose increases. If you decide to change another factor (e.g. diet or other medications), don't increase the insulin dose until the other change is complete but decrease the dose if your cat's glucose numbers consistently fall below 90 mg/dl (5.0 mmol/L) as a result of the change.
Don't be tempted to rush the process along by increasing the dose more quickly or in larger increments no matter how high your cat's blood glucose is! Rushing towards regulation will cost you time in the long run, because you may race past the right dose for your cat.​
 
@Aleluia Grugru & Minnie -

As Red observes above, TR is a protocol for cats on Lantus/Basaglar and Levemir, not Vetsulin/Caninsulin.

When cats start getting lower nadirs on Vetsulin/Caninsulin it becomes increasingly difficult to administer safely because it typically produces such big drops. Also curves are typically bucket-shaped. A cat can go from a fairly high preshot level down to potentially dangerous nadirs, even on a tiny dose.

As cats become better regulated on the depot insulins, curves become more like shallow smiles. This usually means that tightly regulated cats treated with those insulins can be dosed at lower preshot levels, leading to the cat staying fairly flat right through each cycle (with the required amount of testing to keep the cat safe), often referred to in the support group as "shoot low to stay low".

If Marisofi were to wish to aim for Maya to be tightly regulated, a different insulin would be needed.


Mogs
.
 
Hi Mari sofi - my cat Sootie has been on bovine pancreas the past 8 days or so. Yesterday he had first semi-solid poop in months and today it was SOLID. Ihad to up what I was giving him and that may still need playing. At first I was giving only 1/4 tsp per day like sprinkling salt on my supper. Now I am using a little more than 3/4ths of that 1 quarter teaspon with 3/ can of Fancy Feast Trout flakes.
I also give him a 1/tsp slippery elm with each meal, and a sprinkle of forta flora probiotics. He is also receiving 5 mg prednisone. None of our vets has been willing to get him in to see him nor do I honestly believe they even could have diagnosed him. They do not even carry prednisolone, only prednisone - fortunately I take prednisone for my kidnry transplant. So I have been sharing mine. Today he also had a sliver of acetaminophen (10mg i believe) which may be repeated in another 72 hours if he starts grinding his teeth again.
And now for why I visited the forum tonight - my other diabetic cat cotton had a 2.9/52 tonight at his 8:00 pmps so I am going to post about that. I fed him a gravy fancy feast, some dry quail kibble and a tsp of sugar syrup and got a 5.9 20 minutes after. I am stalling on his Lantus to see if numbers continue to rise - I know 2.9 isn't considered hypo but it surely puzzles me as I've never seen it so low - but a great number really!
Good luck with your baby, and from me to you, consider switching to lantus just to not get the horrible low nadirs and sudden jumps.
 
CB Terri said:
Hi Mari sofi - my cat Sootie has been on bovine pancreas the past 8 days or so. Yesterday he had first semi-solid poop in months and today it was SOLID. Ihad to up what I was giving him and that may still need playing. At first I was giving only 1/4 tsp per day like sprinkling salt on my supper. Now I am using a little more than 3/4ths of that 1 quarter teaspon with 3/ can of Fancy Feast Trout flakes.
I also give him a 1/tsp slippery elm with each meal, and a sprinkle of forta flora probiotics. He is also receiving 5 mg prednisone. None of our vets has been willing to get him in to see him nor do I honestly believe they even could have diagnosed him. They do not even carry prednisolone, only prednisone - fortunately I take prednisone for my kidnry transplant. So I have been sharing mine. Today he also had a sliver of acetaminophen (10mg i believe) which may be repeated in another 72 hours if he starts grinding his teeth again.
And now for why I visited the forum tonight - my other diabetic cat cotton had a 2.9/52 tonight at his 8:00 pmps so I am going to post about that. I fed him a gravy fancy feast, some dry quail kibble and a tsp of sugar syrup and got a 5.9 20 minutes after. I am stalling on his Lantus to see if numbers continue to rise - I know 2.9 isn't considered hypo but it surely puzzles me as I've never seen it so low - but a great number really!
Good luck with your baby, and from me to you, consider switching to lantus just to not get the horrible low nadirs and sudden jumps.
Click to expand...

Τhank you so much for sharing Terri! Looks like Sootie is a fighter, and so are you! Maya has never had raw meat in her life. She's been having a tough time letting dry food go, so I'll try to introduce changes slowly...

I actually took Maya to the vet today, so that she could have her B12 shot. We discussed changing to Lantus but the vet said that I should give her some time on Caninsuline first because she hasn't been on it for that long, and we have already messed with the dosage one too many times this month. Not sure if I could move to Lantus without her recommendation because I guess I would have to come up with the right dosaging all by myself...

I'm reading what I write and it reads as if I'm operating from the standpoint of fear because, well, I am! I guess we'll go for Caninsulin until the end of the month and monitor how it goes. As for the raw pancreas, I'll try to get her to try some for Christmas, let's see the reaction!
 
I understand it’s scary to go off of what your vet is recommending. Like taking the training wheels off but we’ll be here to help you. You start on 1 unit of Lantus and go from there. Sometimes vets need to be told what we want to do and not the other way around. I found every time I’ve been firm with a vet about what I want to do for my cat’s treatment they’ve seen I was resolved and agreed. It’s all in how you say it and present it to them. Not, do you think we should? But I’ve decided I want to do this. My two cents. Caninsulin is not a great insulin for cats. It was made for dogs hence the name canine. Dogs have a slower metabolism than cats. Those are the facts. Staying with it longer is only detrimental to your cat’s health. Be firm my friend. There are studies that prove this and I know someone here has a link @Panic @tiffmaxee
I’m saying this from experience. I spent months listening to my vet and Minnie kept getting worse. She developed severe neuropathy and couldn’t jump or go in or out of the litter box. It took that to make me wake up and stop listening and start taking control of her treatment. I hate to see anyone else have to go through the same :(
 
Aleluia Grugru & Minnie said:
I understand it’s scary to go off of what your vet is recommending. Like taking the training wheels off but we’ll be here to help you. You start on 1 unit of Lantus and go from there. Sometimes vets need to be told what we want to do and not the other way around. I found every time I’ve been firm with a vet about what I want to do for my cat’s treatment they’ve seen I was resolved and agreed. It’s all in how you say it and present it to them. Not, do you think we should? But I’ve decided I want to do this. My two cents. Caninsulin is not a great insulin for cats. It was made for dogs hence the name canine. Dogs have a slower metabolism than cats. Those are the facts. Staying with it longer is only detrimental to your cat’s health. Be firm my friend. There are studies that prove this and I know someone here has a link @Panic @tiffmaxee
Click to expand...
I hear you. I've read up on Caninsulin and everyone is
Aleluia Grugru & Minnie said:
I understand it’s scary to go off of what your vet is recommending. Like taking the training wheels off but we’ll be here to help you. You start on 1 unit of Lantus and go from there. Sometimes vets need to be told what we want to do and not the other way around. I found every time I’ve been firm with a vet about what I want to do for my cat’s treatment they’ve seen I was resolved and agreed. It’s all in how you say it and present it to them. Not, do you think we should? But I’ve decided I want to do this. My two cents. Caninsulin is not a great insulin for cats. It was made for dogs hence the name canine. Dogs have a slower metabolism than cats. Those are the facts. Staying with it longer is only detrimental to your cat’s health. Be firm my friend. There are studies that prove this and I know someone here has a link @Panic @tiffmaxee
I’m saying this from experience. I spent months listening to my vet and Minnie kept getting worse. She developed severe neuropathy and couldn’t jump or go in or out of the litter box. It took that to make me wake up and stop listening and start taking control of her treatment. I hate to see anyone else have to go through the same :(
Click to expand...
Wow... Ok I hear you. I see the vet every week for the B12 shot. Next week I'll go to her and firmly ask to make the transition. If she still refuses, I'll come back to you guys for help on figuring this out by myself.
 
Marisofi said:
Τhank you so much for sharing Terri! Looks like Sootie is a fighter, and so are you! Maya has never had raw meat in her life. She's been having a tough time letting dry food go, so I'll try to introduce changes slowly...

I actually took Maya to the vet today, so that she could have her B12 shot. We discussed changing to Lantus but the vet said that I should give her some time on Caninsuline first because she hasn't been on it for that long, and we have already messed with the dosage one too many times this month. Not sure if I could move to Lantus without her recommendation because I guess I would have to come up with the right dosaging all by myself...

I'm reading what I write and it reads as if I'm operating from the standpoint of fear because, well, I am! I guess we'll go for Caninsulin until the end of the month and monitor how it goes. As for the raw pancreas, I'll try to get her to try some for Christmas, let's see the reaction!
Click to expand...
I am using the powdered pancreas, it is freeze-dried, easy to use, keeps very well, and available online. I also got it at a local petvalu store while waiting for the stuff I mail-ordered.
I do not blame you for being cautious and fearful one bit - you can only work at the pace you are comfortable with, and you are dealing with issues with one cat that I am dealing with in two - so not so much for me to try and figure and balance as you ❤
With the Lantus I started at the same dose as I was at for Caninsulin, which for my cat was 2 units 2x a day. If or when you make a switch to Lantus you will find dosing help here at the forum.
But I remember "SLGS" - Start Low Go Slow. Starting with a small dose gives you time to see how your cat adjusts to it, and to increase in small amounts to see how it affects your cat without going too far.
 
To strengthen an argument to move to another insulin, the best thing to do is show the vet data. I'd suggest over a period of a couple of weeks get tests - as religiously as you can manage - around the nadir mark and also later in the cycle when the dose peters out (round about the +7-8ish mark for Maya as best I can see based on current data) then you can prove to your vet that the Caninsulin has insufficient duration.

It's my understanding that cats who start treatment with longer-acting insulins within 6 months of diagnosis have a better statistical chance of achieving remission.

With regard to 'going off piste' with insulin treatment, it's not a course I'd recommend. There's more to managing a diabetic than taking control of the insulin side of things. Diabetes is a chronic, multifaceted condition and cats need to be under the care of a vet in case any complications arise, especially in an emergency (e.g. severe hypo, ketosis/DKA). I think it's better to negotiate hard with the vet to prescribe a better insulin - armed with data and documentation from sources a vet would consider reputable to back up arguments - or perhaps go shopping for another vet who is more willing to work as a partner with you in Maya's care.


Mogs
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Hello friends!

Yesterday I saw the vet and explained why I would prefer to transition Maya to Lantus. Her reply was that Lantus is indeed a great option but that it would be best to try it after Maya has completed a couple of months on Caninsulin, for two reasons:
1. Maya seems to react well to Caninsulun
2. If Maya does not react well to Lantus, we won't be able to switch back to Caninsulin
Opinions?

We also weighed Maya and she has gained 300 gr :):):)
 
Marisofi said:
1. Maya seems to react well to Caninsulun
Click to expand...
Maya may react even better to Lantus. All going well, on an appropriate dose she should end up with much flatter curves in a narrower, better overall range. This in turn should enhance chance of remission.

With Maya's current Caninsulin dose, she's spending part of the day well above the renal threshold (a classic Caninsulin 'bucket shape' curve). I don't think that you'll have much play in the way of increasing the dose: she's already had nadirs below close to or below 100 on the 3.5IU dose and the 4.0IU dose took her too low for safety.

My understanding is that cats who start treatment within the first six months post-diagnosis with a long-acting insulin (Lantus/Basaglar, Levemir, Prozinc) have a greater statistical chance of achieving remission.

Marisofi said:
2. If Maya does not react well to Lantus, we won't be able to switch back to Caninsulin
Click to expand...
What reason did she give for this claim?

Also, Prozinc or Levemir would be better insulins to try if Lantus were not to suit Maya.

Marisofi said:
We also weighed Maya and she has gained 300 gr
Click to expand...
Attagirl, Maya! :cat:

How is her digestive system now, Marisofi? Is the vet going to run a follow-up TLI test?


Mogs
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I think everyone already expressed my concerns. For some reason your vet is stuck on caninsulin and it may be that it’s because it’s all she knows. If it were me, I’d either insist on what’s best for my cat or id look for another vet. We’ve already supplied you with all the ammunition you should need to prove your point. Did you read the link Panic posted? As Panic said on 12/12 “The 2018 AAHA Diabetes Management Guidelines for Dogs and Cats is what you should print out and give your vet. Highlight the parts where it recommends only Prozinc and Lantus/Levemir for felines. Caninsulin is only listed in the canine section.”

https://www.aaha.org/globalassets/02-guidelines/diabetes/diabetes-guidelines_final.pdf

the best shot at remission is getting your cat regulated within 6 months. You don’t want to waste precious time with an insulin made for dogs who have a much slower metabolism than cats
 
Critter Mom said:
Maya may react even better to Lantus. All going well, on an appropriate dose she should end up with much flatter curves in a narrower, better overall range. This in turn should enhance chance of remission.

With Maya's current Caninsulin dose, she's spending part of the day well above the renal threshold (a classic Caninsulin 'bucket shape' curve). I don't think that you'll have much play in the way of increasing the dose: she's already had nadirs below close to or below 100 on the 3.5IU dose and the 4.0IU dose took her too low for safety.

My understanding is that cats who start treatment within the first six months post-diagnosis with a long-acting insulin (Lantus/Basaglar, Levemir, Prozinc) have a greater statistical chance of achieving remission.


What reason did she give for this claim?

Also, Prozinc or Levemir would be better insulins to try if Lantus were not to suit Maya.


Attagirl, Maya! :cat:

How is her digestive system now, Marisofi? Is the vet going to run a follow-up TLI test?


Mogs
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Click to expand...
She didn't give any further reason.
She also did not suggest another TLI.
Maya is easing more and having diarrhea less often. Her stool is never completely solid though.
 
kalypso said:
I thought she had told you to only stay on caninsulin until the end of the month.
Even if it were true that you can't switch back to caninsulin, what difference would it make 6 months later? It doesn't make sense.
Is this the same vet that wanted you to start on 5u caninsulin right away?
Click to expand...
No that's not the same vet. She had suggested I started with 2,5.
 
Aleluia Grugru & Minnie said:
I think everyone already expressed my concerns. For some reason your vet is stuck on caninsulin and it may be that it’s because it’s all she knows. If it were me, I’d either insist on what’s best for my cat or id look for another vet. We’ve already supplied you with all the ammunition you should need to prove your point. Did you read the link Panic posted? As Panic said on 12/12 “The 2018 AAHA Diabetes Management Guidelines for Dogs and Cats is what you should print out and give your vet. Highlight the parts where it recommends only Prozinc and Lantus/Levemir for felines. Caninsulin is only listed in the canine section.”

https://www.aaha.org/globalassets/02-guidelines/diabetes/diabetes-guidelines_final.pdf

the best shot at remission is getting your cat regulated within 6 months. You don’t want to waste precious time with an insulin made for dogs who have a much slower metabolism than cats
Click to expand...
I see, yes.
So do you know of any guiding note that I can use to see how I can transition her to Lantus by myself. Meaning, how many units of Caninsulin translate to how many units of Lantus.
 
Aleluia Grugru & Minnie said:
I think the overall consensus here is to start with the same dose. So if she’s on 2 units of caninsulin, you’d start her on 2 units of Lantus. But you need a vet to give you a prescription for any insulin
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Thank you. Which means that 3.5 in Caninsulin equal 3.5 in Lantus.
I may be able to get it without a prescription, I'll give it a try.
 
Marisofi said:
Thank you. Which means that 3.5 in Caninsulin equal 3.5 in Lantus.
I may be able to get it without a prescription, I'll give it a try.
Click to expand...

Hi Marisofi!

In Greece you don't need a prescription for Lantus.
I have 3 unopened vials which I no longer need. I live in Evia - Halkida. I would be happy for you to have them. If distance is an issue for you and you know anyone around my area using Lantus please let me know
 
Yanna said:
Hi Marisofi!

In Greece you don't need a prescription for Lantus.
I have 3 unopened vials which I no longer need. I live in Evia - Halkida. I would be happy for you to have them. If distance is an issue for you and you know anyone around my area using Lantus please let me know
Click to expand...
That's so nice, thank you Tanna! I'll send you a PM. We're about to finish the last Caninsulin vial, so I figured we'd change after that.
 
Hi Marisofi,

I just had a look at Maya's spreadsheet. I see you got a 46 on the evening cycle of 26 December. That means the 3.5IU dose is too high (50 is the lower bound of the normal feline BG reference range as measured on a human meter). According to the FDMB Caninsulin guidelines, the dose should be reduced by 0.25IU immediately.

For future reference, the FDMB Caninsulin guide recommends reducing the dose by 0.25IU if BG goes below 90 (human meter). If you look back a couple of days on the spreadsheet, Maya dipped to 86 on the morning cycle of 15 December and down to 70 on the morning cycle of 22 December, both readings signalling that the 3.5IU dose needed to be reduced - ideally on the PM cycle of 15 December. The 26 December 46 reading confirms the 3.5IU is too high.

If ever you're not sure whether a dose needs adjustment you can always post for feedback on Maya's BG data.


Mogs
.
 
Critter Mom said:
Hi Marisofi,

I just had a look at Maya's spreadsheet. I see you got a 46 on the evening cycle of 26 December. That means the 3.5IU dose is too high (50 is the lower bound of the normal feline BG reference range as measured on a human meter). According to the FDMB Caninsulin guidelines, the dose should be reduced by 0.25IU immediately.

For future reference, the FDMB Caninsulin guide recommends reducing the dose by 0.25IU if BG goes below 90 (human meter). If you look back a couple of days on the spreadsheet, Maya dipped to 86 on the morning cycle of 15 December and down to 70 on the morning cycle of 22 December, both readings signalling that the 3.5IU dose needed to be reduced - ideally on the PM cycle of 15 December. The 26 December 46 reading confirms the 3.5IU is too high.

If ever you're not sure whether a dose needs adjustment you can always post for feedback on Maya's BG data.


Mogs
.
Click to expand...
Many thanks Mogs!
I saw your message and I've been administering 3.25 over the past 3 days. Today I took Maya to the vet for her Articlox shot (this is supposed to go on for a total of 6 weeks by the way) and we both came to an agreement that Maya will transition to Lantus after the holidays i.e. next week

Also, check out her weight! When I first joined the forum a month ago, she weighed 3 kilos.
 
She's put on nearly a kilo!!! :woot: That's brilliant. :cat:

Really pleased you've finally got buy-in from your vet for the Lantus. Wishing you both the very best for the coming year. :)

(((Marisofi and Maya)))


Mogs
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Critter Mom said:
She's put on nearly a kilo!!! :woot: That's brilliant. :cat:

Really pleased you've finally got buy-in from your vet for the Lantus. Wishing you both the very best for the coming year. :)

(((Marisofi and Maya)))


Mogs
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Click to expand...
I mean it when I say that I don't think I could have gotten her on track if it hadn't been for this forum! Thanks to @kalypso for recommending that I join, to you Mogs for always being present with a helpful piece of advice, and to all the other members who have pitched in to support Maya and I! Of course our work is far from over, it will never be over, but at least now it really feels like we have a fighting chance!

Happy New Year all!
 
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