Change insulin dose against veterinary advice?

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Amanda Guimarães

Amanda Guimarães

Member Since 2020
(Posting here as advised by another user, since I have not received answers in the Prozink forum)

I went to the vet this Thursday and the nurse+vet said me that I should give the full 1.0 unit insulin even if my cat test is 92. They said me that he should not be lower than 72 (US numbers), in which case I should proceed with the hypoglicemic measures, wait one hour, and shot the insuline. They justified saying that the insulin dose was very low so there was no danger. They said me it would be bad to skip the insulin because it could give a too high blood result later on.

I am taking his first glucosecurve right now and I am worried. The first glucose test was alright, so I gave the insulin shot. I am taking measures for the glucose curve every two hours according to the veterinarian scheme. It´s been 4 hours and he´s got hyploglicemic numbers, so he has gotten more food now - he is eating. I will test again soon.

Last evening I took his glucose number and it was 146, so I followed the veterinarian advice and shot the insulin. But it didn´t feel alright, so I stayed awake longer (I normally sleep by that time) and just watched the cat, even if he had eaten a lot. 4 hours after the shot I tested again, finding it was even lower. I served him more low carb wet food, he refused to eat but meowed at me! So I served him a bit of dry food he had before, mixed with the low carb food, and than he ate everything. This took all of the night....

--> According to the veterinary I should never skip the insulin if it´s higher than 92; to not cause a higher blood result later on. But I´ve got two hypoglicermic numbers already? Do you think it´s safe to not give the insulin if it´s lower than 180, as you reccomend in here?
 
Amanda Guimarães said:
They justified saying that the insulin dose was very low so there was no danger.
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This blanket assumption is false.

The only dose that's safe is one that isn't too high for the particular cat. Cats can have symptomatic hypos on lower doses than 1 unit of insulin.

Amanda Guimarães said:
According to the veterinary I should never skip the insulin if it´s higher than 92; to not cause a higher blood result later on.
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The greater danger comes from low numbers. High BG levels are harmful but the damage they do takes time (DKA excepted). Hypoglycaemia can kill - quickly. As the saying goes at FDMB: better too high for a day than too low for a minute.

It is normal in the early days of the regulation process for kitties to spend some time at the beginning and the end of each cycle in slightly higher numbers. Also some kitties 'bounce' to higher numbers when they start hitting lower BG numbers - even when those numbers are perfectly safe - because their bodies have become accustomed to running in a higher range. (This morning's pink preshot may be bounce-influenced from a lower number yesterday.) The regulation process is gradual and can't be forced. The body needs time to relearn how to run in better numbers. As treatment continues the goal is to see a kitty's body become more familiar with healthier BG levels, leading to the kitty spending less time in higher numbers, and possibly even achieving remission.


Mogs
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Hey everyone <3

@Noah & me (GA) thank you for your kind remark.
@Critter Mom thank you for your careful answer and suggestions.

It feels to refreshing and nice to be able to have your support in this forum!! Thank you so much for doing this!
I have quite a long time experience with rescue cats and I am honestly to tired of suspectful veterinary advice. From my teen years until last year, my mom had Cat Gil, who was also diabetic; he died last year - 20-years-old - he was rescued when he was 10. It was alright in the end and he had a nice life, but I wish we knew about this forum than!
 
You will get a response in the prozinc forum, but those who are advising is in the US. So @Deb & Wink is on at 1 at night our time, so just hang on!
If you ever have an emergency you need to use this forum, and do a 911 tag.

Most of us, one way or another is doing something against the vet's opinion or advice. I was told not to test for example...
The most important thing is to find a vet who's wants to learn with you, who knows the basics, a vet on your side.

I'm doing my own thing, my vet know what I'm doing and has access to my spreadsheet, but I'm only following her advice if it makes sense to me. Trust in yourself and your gut feeling, you're most likely right :bighug:
 
@Critter Mom thank you <3 Here is RIP diabetic Cat Gil, in 2015 :-)

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I might try 0.75 on the next shot. 1 unit brought your kitty down too low earlier.


Another option since he's at such low numbers (trying for remission I hope) is to do a bit of a sliding scale. Like 0.25 if over 130 0.5 units if over 150 and 0.75 of over 180. Not everyone is a fan of sliding scales but I think they can sometimes work.
 
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The reason I asked you to withhold the food is that for safety the preshot BG should be taken after a 2 hour fast. Given Severino had food 1 hour before the 6.1/110 reading you'd have been able to get a fully fasted BG reading after one hour. Now that he's eaten again it will be 2 hours before a reading can be taken that isn't food-influenced. I'm tagging @JanetNJ to draw her attention to the 6.1/110 reading at the end of the curve. I think she would be best placed to discuss dosing for this evening.


Mogs
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Amanda Guimarães said:
Hej @Critter Mom,

sorry about the confusion. Because he needs to put some weight, the vet said that he should have food available when we asks for it.
I read your message just after giving him some more food as he asked. Yes, he ate 1 hour before getting the 6.1 reading.
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the reason
we say no food two hours before the preshot test is because it will raise the number. Then you will think it's safe to shoot, but when the food number wears off he could go too low. Other than the two hours prior to the preshot test he can eat as much as he needs. 110 is too low to shoot. Stall and let's see if the numbers go up
 
Amanda Guimarães said:
I went to the vet this Thursday and the nurse+vet said me that I should give the full 1.0 unit insulin even if my cat test is 92. They said me that he should not be lower than 72 (US numbers), in which case I should proceed with the hypoglicemic measures, wait one hour, and shot the insuline. They justified saying that the insulin dose was very low so there was no danger. They said me it would be bad to skip the insulin because it could give a too high blood result later on.
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Even cats on a small 1U dose of Prozinc can become hypoglycemic.
The meter you are using is a pet meter, so you should be a bit more cautious when your cat Severino has low BG numbers at the pre-shot test.

We have a saying here "Better too high for a cycle, than too low for a moment." This saying is comparable to your "Better safe than sorry."
 
Thank you everyone for your support yesterday :-) His blood was actually still quite low this morning and wasn´t much different than when we went to sleep. Because it was still lower than 180, I give him 0,75 this time. Contacted the veterinarian this morning, they said I will get an answer later today.
 
Another thing Amanda, if at all possible it would be very helpful if you could test more.
Specially when you're shooting so low.

Any reading lower than 68 on a pet meter is a reduction. And we have no way of knowing if Severino is going lower without testing.
 
Amanda Guimarães said:
@SashaV thank you! How often should I test?

I am currently doing pre-shots testing; before having food.

What do you mean by reduction?
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Really as often as you can.
Nadir is when the cat reaches the lowest point, and that varies with every cat. Mauers is lowest at +5 or +6.
We usually say that a +2 shows where the cat is heading, Mauer is always higher at +2, so I do a +3.
The point is, you can't test too much. Take a look on others spreadsheets and see how often they test.

What worries me is that your cat is a new diabetic, and is already blue and green, and that freaking awesome!!! but it also means you need to be more careful.
You might be closer to remission than you realize, and that would be awesome but dangerous if you don't test.

A reduction is a reduced dose of insulin.

And by the way, I'm also relatively new, so its just my opinion and thoughts so I don't have the experience to back it up.
 
So I need to start working but I will see what I can do! @SashaV your message came in the right time. We are 3 hours after his insulin and yesterday, doing the glucose curve, I saw a dramatically lower point at +4.

I tested right now and...tcharam! Lower than 4 :-( He is eating right now.

So odd, he was playing around...no symptons at all. But he is eating ravenously right now after I served more food!

(He normally asks me for more food from time to time. Not today!)
 
Amanda Guimarães said:
So I need to start working but I will see what I can do! @SashaV your message came in the right time. We are 3 hours after his insulin and yesterday, doing the glucose curve, I saw a dramatically lower point at +4.

I tested right now and...tcharam! Lower than 4 :-( He is eating right now.

So odd, he was playing around...no symptons at all. But he is eating ravenously right now after I served more food!

(He normally asks me for more food from time to time. Not today!)
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They rarely get symptomatic when they're low.
I'd say, whenever you get a neon green it's time for help. And you're already close at +3.

So if I were you, I'd start preparing for a long day, get your hypo-kit out and test again in 20 minutes. Make a new thread with his +3 BG reading and put a 911 tag on it.
Not to worry you, but to be on the safe side. I'm not competent to guide you through a hypo, you'll need the old-timers for that. Put a link to this thread.
He hasn't reached his nadir yet, so you're going to need some help..
@Bron and Sheba (GA) is in Australia and might be able to help you?
 
By way of reference, my Lola was diagnosed and received her first shot of Prozinc on September 14. She had her last shot the morning of October 18. It appears that changing her diet to low-carb, wet food might be what it takes (at least for the present) to eliminate her need for injections. (Unfortunately, she's still battling an infection, and now the side-effects and after-effects of the antibiotic, which pose a threat to remission.)

It was recommended to me that one day I test at +2, +4, +6 and another to test at +3, +5 +7, to help us see at what point during the day the Prozinc was at its most effective (making her BG reading its lowest). (For Lola, it was pretty consistently at +5.) That way we could determine how low she was dropping during the day and 1) keep her safe if the number dropped too low (hypo), and 2) determine when it was appropriate to reduce her dose (and 3) when it was appropriate to do an Off-The-Juice trial).

I was also told that sometimes numbers get lower during the night than during the day, so tests during the evening hours are a good idea, too.
 
Amanda Guimarães said:
Thank you @SashaV . It´s not the first time he gets this lower numbers :-( I am doing as advised by the veterinarian, he got more food with "druvsocker" on it. Going to test again soon!
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This low is low. It's too low for a new diabetic owner to deal with alone. That's why you need help, to keep him safe.
Honey might be easier to deal with. Keep him a bit hungry so you can push him back up with food.
 
@Pookie thank you, that´s so helpful!

Severino needs to put some weight and he is a quite hungry cat; I was advised by my vet to give him food when he asked for it. He asks for food 3x every morning, 1 time in the afternoon. He gets his final food dose at 19:00 and than he doesn´t eat until the morning. I am a light-sleeper and have woken up before to feed him; in September. But right now he doesn´t want to eat in the evening, even if I let food available. He sleeps all of the 8 hours with me and my partner, between us, like a baby!

I have been worried about giving insulin in the evening because of that but the vet said I should not worry. More as I read, more worried I get.

Can I give two different doses to the cat? I call the clinic this morning and shared all of the data; they said me that my veterinary is off today but that someone else and the nurse that knows Severino and has experience with diabetes would look and advice; but they said I should not change the dose meanwhile.
 
We usually shoot the same units in the AM and PM cycle. Usually! Every cat is different.

And at some point you should worry. You're cat is doing great, and insulin is a very very powerful drug.

I'd listen to the people here, instead of your vet. These people do nothing else than diabetes, your vet might only see to diabetic patients a year..
 
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