Caninsulin dose question

Status
Not open for further replies.
Sue484

Sue484

Member Since 2015
Hi. Is there a TR protocol for Caninsulin? Three days ago my cat Romulus was in hypo number on AT 2.4 (43). I lowered his dose to 1IU but his nadirs now are only in the yellow. How long should I give it before I increase?
 
Hi Sue,

Attempting to tightly regulate a cat with Caninsulin is, based on my experience of it, not feasible; the drops are typically too harsh. Our vet said that it can take about a week for a dose change to settle. I just had a look at Romulus' spreadsheet. If he were mine I'd be inclined to stay at the 1.0 IU dose until such time as I had enough time to test him during a dose increase. If you are off work at weekends, if his numbers don't improve on the 1.0 unit dose, maybe up it to 1.25 units and take nadir tests over two days? This is just a suggestion. Other members may suggest a different - and possibly better - course of action.


Mogs
.
 
Yes going up to 1.25 is a good idea at weekends. Only trouble is I use a VetPen, so can't do quarter doses. I could use one of Frankie's syringes but not sure what the conversion would be.
 
I get confused. Which are the Lantus syringes? U100 ? Frankie's Lantus syringes are the orange topped ones. Does that mean Caninsulin syringes are U40?
 
Does this mean I need to draw 3U in the U100 syringe to give Rom 1.25 Caninsulin?
 
Last edited:
Sue484 said:
I get confused. Which are the Lantus syringes? U100 ? Frankie's Lantus syringes are the orange topped ones. Does that mean Caninsulin syringes are U40?
Click to expand...
My U100 demis have an orange cap - I think it's standard but please get confirmation. If you're giving Frankie Lantus then those should be U100 syringes. Caninsulin syringes should be U40, as it's a U40 insulin.

Sue484 said:
Does this mean I need to draw 3U in the U100 syringe to give Rom 1.25 Caninsulin?
Click to expand...
Measuring 3.0 units of U40 insulin in a U100 syringe will draw up a dose of 1.2IU of the U40 insulin.
.
 
Sue484 said:
Three days ago my cat Romulus was in hypo number on AT 2.4 (43). I lowered his dose to 1IU but his nadirs now are only in the yellow. How long should I give it before I increase?
Click to expand...
2.4 on an Alphatrak? Crikey, Sue.... I'm so glad Romulus is OK...:nailbiting:

It may be that Romulus' numbers are still running higher because his body has released counter-regulatory hormones to try to keep the blood glucose from dropping. This is a protection mechanism.
Because of this, I think it would inadvisable to increase the dose until you are positive that any bouncing has cleared. The most important thing is that he is kept safe.

This forum does not recommend 'tight regulation' with Caninsulin. That is because it is not considered safe to try to take a cat into the lower range of numbers with insulins that have early onsets and steep drops.
If I were using Caninsulin now I would not aim to take my cat lower than 5 at the peak of the cycle (so maybe 6 on an Alphatrak). That would hopefully allow some buffer of safety should the cat drop lower than the range I'm aiming for.

Whilst tight regulation is not advisable with Caninsulin, sliding scale dosage can work well with some cats. This is possible because Caninsulin is a non-depot insulin. The shot that you give should be out of the system by the time you give the next shot (that's assuming that you're giving 2 shots a day.) Sliding scale dosage does enable some caregivers to help level out their cat's BG levels.

Some members have also had success levelling out the numbers by giving 3 shots a day instead of 2. The starting point for this is to first find a BID dose that works fairly well (without taking the cat too low at peak) and then splitting the day's total insulin dosage into 3 instead of 2 shots. It is also important to ensure that the cat is past the peak of the cycle and it's BG is rising. The aim of the technique is to reduce both the preshot numbers and the extent of the drop, and thereby keep the cat in a better range (safely) for more of the time, without the highs and lows that can occur with 2 shots a day.
However, this is a very time-intensive technique. I did it for a while, giving shots at 5am, 1pm and 9pm. And of course, it's not just the matter of giving the shots; it's also necessary to test during each of the 3 insulin cycles....

I see from Romulus' SS that there have been a number of occasions where his preshot has been too low to shoot.
That may be caused by too much insulin (ie, that he's rising from a much lower number earlier in the cycle). Or it may be that his pancreas is producing some insulin of it's own and is extending the cycle. Without more data I don't think it's possible to tell...

As I said earlier, I strongly suggest that you don't increase at this point. I think letting things settle out seems the more prudent option.
(Remember, with Caninsulin you don't have to worry about losing your depot. Caninsulin and Lantus are very different insulins...)

Eliz
 
What Eliz said, but also be watchful for dose-to-dose carryover. Caninsulin is not a depot insulin but a dose can exert a residual effect for two cycles or more, depending on the cat. Certainly in Saoirse's case there were occasions where either her insulin was damaged (left it out one summer afternoon in a south-west-facing oven of a kitchen) or where she got uncomfortably low on a tiny dose and it took over 24 hours before her numbers started to climb significantly.

If you hit a 'dosing wall' with Caninsulin, I'd suggest seriously considering switching Romulus over to Lantus (unless you've already tried it with him and it didn't agree with him, in which case Prozinc or Levemir might be options to explore).


Mogs
.
 
Hi Sue @Sue484 ,
I see you've increased the dose back to 1.5 units (because of those high numbers). What is your plan at this point?
Are you planning to shoot a lower dose if you see a lower preshot, or stick with a fixed dose?

And re Mogs' comment above, have you tried Romulus on Lantus at all? Or has he only ever been on Caninsulin?

Eliz
 
Hi Eliz. @Elizabeth and Bertie . Yes I increased Rom's dose as 1 unit was doing nothing for him, and the more I think about it, the more convinced I am that I shot him twice when he gave me that hypo number. I will see how he goes on 1.5 again. He was doing really well, but I suppose he has to get back in the rhythm. If I see a low pre shot, I do reduce. He has never been on Lantus as Caninsulin does work for him and due to the silly licensing laws here if it works, they cannot give Lantus. Frankie only got Lantus because he was not reacting at all to Caninsulin in over a year and got neuropathy so the RVC prescribed it for him. The only good thing they did do for him!!!
 
No because that is for newly diagnosed uncomplicated cases. Frankie was referred for an acro test because they suspected insulin resistance.
 
OIC. I did ring them to find out about the trial and to enquire about how their work might help more cats to get access to Lantus or Prozinc in the UK. I also offered to send them Saoirse's data if it would be of any use to them as anecdotal evidence. It wasn't a goer for us because neither Saoirse nor myself could have coped with the travel and also Saoirse had a co-morbid Dx of pancreatitis. Ruth actually gave our main vet a ring afterwards and I think it may have helped a bit towards Saoirse getting her Lantus Rx.
 
I never even saw a diabetes specialist. I saw an oncologist with an interest in internal medicine. If I hadn't found this site I was going to ask to be referred to Stijn the top bod at the RVC. Did not like or trust the oncologist one bit.
 
That's very poor, Sue.

Saoirse was referred to another of the top veterinary hospitals earlier this year to assess a potential problem with her liver. They were fine for the scans and so forth, but I felt that they were backward when it came to feline diabetes. their approach to day-to-day management of feline diabetes. I also didn't appreciate not being listened to when I warned them about Saoirse's med sensitivities. They insisted on prescribing a much higher dose of bupe than I know she can tolerate. All it took was two doses to trigger a pancreatitis flare. I was far from happy. They also mucked up things to do with Saoirse's diabetes treatment that were working really well with our own veterinary practice, and I was furious about that. I still am. It has impaired Saoirse's treatment options.
 
Yes it was very poor. My vet was more than willing to refer me to Stijn as she said I need to have complete confidence in my vet. Luckily there was no need as I found this site and he finally started seeing improvements. I had such high hopes as they treat his Cardiomyopathy so well and have done for 6 years. But they put him on high carb prescription dry food only, started him on 3 units of Lantus and went up 1 unit at a time and said Methyl B12 was unnecessary.
 
It certainly does and I don't understand why as it must be fairly common. Maybe most people don't bother with treatment and just pts.
 
Sadly, that's the truth, Sue. :( I have seen a statistic quoted here in the past about the percentage of people who do not treat. I can't remember the exact figure but I think that percentage-wise it was in the eighties or nineties. :( I do wonder whether that figure might be influenced by some vets not really encouraging people to treat their cats or - as we see here sometimes - some vets actively trying to steer their clients towards euthanasia. :mad::(

I don't know whether you saw @Janina Rzeznitzeck's survey asking about how people manage their cats' diabetes recently. I think that it's great that she and her colleagues are doing work that may help to better educate people whose cats receive a diabetes Dx (and some of their vets) that it is an eminently treatable and manageable condition; and may hopefully save some lives.
 
This may be a silly question, but if you have one cat on Lantus, couldn't you use the same vial for both? You could just convince the chemist or the vet that you are a klutz, and keep dropping the vial when you need more?
 
Shiloh & Rhonda said:
This may be a silly question, but if you have one cat on Lantus, couldn't you use the same vial for both? You could just convince the chemist or the vet that you are a klutz, and keep dropping the vial when you need more?
Click to expand...
I must confess that I would almost certainly do something similar if another of my cats becomes diabetic. I'd get the diagnosis, get my initial vial of (the obligatory in the UK) Caninsulin, and then probably use my long-lasting Hypurin PZI...

However, as we say in these parts, 'the best insulin is the one that works best for the cat'. And there are cats for whom Caninsulin/Vetsulin works just fine. (We've had a few Caninsulin/Vetsulin remissions here recently and that is not at all unusual: I've been here long enough to see this happen consistently over the years). And there are cats who haven't done well on Lantus. It's a very good insulin for cats, but it's not a magic bullet.....

And then there is the knotty matter of keeping the vet informed...or not.... Should the vet know that we are trying an alternative insulin? Should we try to get their consent? Shouldn't the vet know which meds the cat is on? These are very personal choices, and not everyone will be comfortable with just trying an alternative insulin without first getting their vet's blessing....:rolleyes:
.
 
I think what I'd do would be to try to get veterinary support first. If I got nowhere and my cat really needed the alternative insulin, then I would go with my cat's health needs, not the preference of the vet. I would hope that when presented with appropriate evidence showing the efficacy of the alternative insulin the vet might reconsider and prescribe the alternative insulin in the future. I say this as someone with experience of treating a cat with two different insulins and as someone who is fairly confident that she knows her own strengths and limitations with respect to the management of a cat's insulin needs.
 
Last edited:
The tricky bit would be getting my vet to write the prescription for Lantus, I could probably get away with dropping it once, but twice and three times is pushing it. Rom has to go for a check up whenever insulin is prescribed, so next time I go I will mention switching to Lantus for him. My vet is usually very accommodating but the licensing laws here means effectively her hands are tied even if she did want to prescribe it for him. Saying that, Rom is not doing at all well since his hypo numbers a few days ago.
 
I think you could build a case that Caninsulin isn't working that great for Romulus, Sue. Most of the time he's getting very high preshot tests, which mean that he's not properly regulated for part of the day. Do you test his urine? If you can show that he's regularly getting glucose in his urine that would be concrete evidence of poor regulation. Also, how are his clinical signs in response to the Caninsulin? Any mid-cycle lethargy? Does he ever get withdrawn while the dose is active in his system?

.
 
He spends most of his days outside now Summer is here so I rarely see him in the litterbox. He acts fine while the dose is active, he has never been the most energetic of cats but he is no different. I will definitely speak to the vet next time I go.
 
Status
Not open for further replies.
Back
Top