Dosing advice needed, lower than usual BG today

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Natallie96

Natallie96

Member Since 2022
Hi everyone, I'm after some advice.
I haven't yet set up my signature, but I have got Mitzi's spreadsheet attached to my signature.
Here's some basic info:
Cat: Mitzi
Diagnosed: 19th Feb 2022
Located: Peterborough, England, UK
Insulin & units: Caninsulin 2 units twice daily using VetPen
Food: Sheba fine flakes & thrive chicken dry food left out during the day & night

I have also posted this on another feline diabetes page on Facebook, but wanted to get as much advice as possible.

Since diagnosis on 19th Feb 2022, Mitzi has been having relatively high BG levels, mostly mid to high 20's and recently a couple of 30's. She's currently on 2 units of Caninsulin twice daily, which we administer at 7am & 7pm.
Unfortunately, whilst trying to prevent our other cat from fighting with the neighbours cat last night, Mitzi got shut away in the kitchen without any food or water, but was still able to get outside via the catflap. She was shut in at around midnight, and we only realised when we came down at 6.30am to test her. Subsequently, her BG level this morning was 16.8. We still gave her the 2units of insulin and to be fair, she was brought down very nicely to 6.9 at +4, and 10.3 at +8.
Obviously I don't need telling off about being an irresponsible owner, and already feel awful enough and she sure got lots of cuddles this morning.

Given that she's been the lowest she has ever been since diagnosis, do I still go ahead with 2 Units or can I reduce to 1.5 as she had dropped to 6.9 at +4?

Mitzi will be due her insulin again in 1 hour 20 minutes, at 7pm UK time.

We have been testing Mitzi consistently since her diagnosis, but I've only recently realised that we use spreadsheets, so only managed to set one up going back to the 7th April.

Sorry for the long post!

Any advice is welcome, thanks in advance
 
Ok, the 2 month mark is usually where we start to take a closer look at the insulin itself. I'm sure you've already been told Caninsulin isn't suitable for cats so I'll spare you that.

It is dropping her too hard and too much, and she's not getting enough duration from it. You could try tweaking your feeding schedule to help slow those drops, but realistically it's still not going to get you a nice curve. You really don't have room for an increase in dose because it's dropping her so much.

You could consider a switch to ProZinc, but in my experience cats that swing like this on Caninsulin tend to do the same on ProZinc, just a little more muted. Realistically, a depot insulin like Lantus (glargine) would be better suited for her. Basaglar is a biosimilar.
 
FrostD said:
Ok, the 2 month mark is usually where we start to take a closer look at the insulin itself. I'm sure you've already been told Caninsulin isn't suitable for cats so I'll spare you that.

It is dropping her too hard and too much, and she's not getting enough duration from it. You could try tweaking your feeding schedule to help slow those drops, but realistically it's still not going to get you a nice curve. You really don't have room for an increase in dose because it's dropping her so much.

You could consider a switch to ProZinc, but in my experience cats that swing like this on Caninsulin tend to do the same on ProZinc, just a little more muted. Realistically, a depot insulin like Lantus (glargine) would be better suited for her. Basaglar is a biosimilar.
Click to expand...

Yeah I’ve seen that not a lot of people recommend Caninsulin, but have seen some kitties go into remission using Caninsulin so it does give me a little hope.

How long do you think we should stick with Caninsulin before making the move over to Lantus?
 
Natallie96 said:
Yeah I’ve seen that not a lot of people recommend Caninsulin, but have seen some kitties go into remission using Caninsulin so it does give me a little hope.

How long do you think we should stick with Caninsulin before making the move over to Lantus?
Click to expand...
Now lol or rather, soon. We usually say give an insulin 2-3 months before making a decision.

But the main reasons I am recommending the change are (1) she is above renal threshold most of the time and that wears on the kidneys, as well as higher risk for UTIs and such (bacteria thrive on the extra sugar in the urine) and (2) the risk of DKA. She isn't getting enough insulin, but you don't have a lot of room to increase safely. That is the biggest factor, inability to increase

There's probably not much harm in using up what you have, but it can take some time to get a new prescription, get it filled, etc.

Shadow is getting close, right now we're trying to fine-tune some doses

Sergio just got into remission but we are not sure how long it will last. She couldn't give insulin safely any more so decided to see how an OTJ trial would work. His numbers are a smidge higher than we like to see, so she is prepared to restart on Lantus if he creeps up

Unfortunately Mitzi is just one of those cats that reacts strongly to Caninsulin, it's very common. @Ashleigh & Ares is a fairly recent convert as well, hopefully she can pop in and you can see the night and day difference

@trudy66 I cannot remember - was Kloey on Vetsulin (Caninsulin) originally?
 
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FrostD said:
Now lol the main reasons being (1) she is above renal threshold most of the time and that wears on the kidneys, as well as higher risk for UTIs and such (bacteria thrive on the extra sugar in the urine) and (2) the risk of DKA. She isn't getting enough insulin, but you don't have a lot of room to increase safely.

There's probably not much harm in using up what you have, but it can take some time to get a new prescription, get it filled, etx

Shadow is getting close, right now we're trying to fine-tune some doses

Sergio just got into remission but we are not sure how long it will last. She couldn't give insulin safely any more so decided to see how an OTJ trial would work. His numbers are a smidge higher than we like to see, so she is prepared to restart on Lantus if he creeps up

Unfortunately Mitzi is just one of those cats that reacts strongly to Caninsulin, it's very common. @Ashleigh & Ares is a fairly recent convert as well, hopefully she can pop in and you can see the night and day difference

@trudy66 I cannot remember - was Kloey on Vetsulin (Caninsulin) originally?
Click to expand...

if I used up what I already have, it won’t be for another 7 months, the vet gave us 10 vials of insulin to use, and it’s looking like we get through about 1 per month. Don’t think I’ll be waiting 7 months to use up the rest of the Caninsulin if this is how she is reacting.
I’m in the UK, and I’ve tried to search places that sell Lantus online and can only see that pens are for sale, not vials. Is this right? I’m aware that I can just purchase the U100 syringes and draw it up out the pen, is that the way everyone else does it? Or is there a secret website that sells the vials?
Wow just had a look at Sergio’s SS and that’s amazing!
I’m part of the UK feline diabetes group on Facebook and many people on there state that vets are very unwilling to prescribe Lantus or similar as it apparently isn’t licensed for use in cats in the UK? So most just tend to stick with Caninsulin or prozinc.
It’s incredibly difficult to figure out what the best route is for Mitzi as she clearly isn’t doing very well on Caninsulin :(
 
Yes I think the majority of us actually use the pens. Since they're smaller volume, much better chance you'll use it up before it potentially goes bad.

We have a sort of similar problem here in the US. For the longest time Vetsulin (Caninsulin) and ProZinc were the go-tos, but in 2018 that changed with the updated AAHA guidelines...but I'm going to guess a UK vet may not care much about those? ProZinc is currently the only FDA approved one for cats (FDA is our government regulatory agency for drugs).

I know @Elizabeth and Bertie is in the UK, any thoughts?
 
FrostD said:
Now lol or rather, soon. We usually say give an insulin 2-3 months before making a decision.

But the main reasons I am recommending the change are (1) she is above renal threshold most of the time and that wears on the kidneys, as well as higher risk for UTIs and such (bacteria thrive on the extra sugar in the urine) and (2) the risk of DKA. She isn't getting enough insulin, but you don't have a lot of room to increase safely. That is the biggest factor, inability to increase

There's probably not much harm in using up what you have, but it can take some time to get a new prescription, get it filled, etc.

Shadow is getting close, right now we're trying to fine-tune some doses

Sergio just got into remission but we are not sure how long it will last. She couldn't give insulin safely any more so decided to see how an OTJ trial would work. His numbers are a smidge higher than we like to see, so she is prepared to restart on Lantus if he creeps up

Unfortunately Mitzi is just one of those cats that reacts strongly to Caninsulin, it's very common. @Ashleigh & Ares is a fairly recent convert as well, hopefully she can pop in and you can see the night and day difference

@trudy66 I cannot remember - was Kloey on Vetsulin (Caninsulin) originally?
Click to expand...
Yes, she was on vetsulin 1st. She wound up going into DKA and was hospitalized. Her The ER vet changed her to Lantus. and it has been night and day difference.
Down now to 0.5 units twice daily with BG under 100 for over a month now. Wish I had been more persistent with the vet to start her on lantus and I feel we would have avoided the DKA and hospitalization.
I would advise anyone to make the switch sooner rather than later.
 
I've just been on the phone with the vets this morning.
The nurse who I spoke with said that they have to follow a cascade when trying different insulins, so as Mitzi was first put on Caninsulin, the next option is to try ProZinc.
We have an appointment on Thursday 21st at 9.40am to speak with a vet and show the spreadsheet to show that Mitzi is not doing well on Caninsulin at all, so hopefully they will agree to at least try ProZinc.
 
Gotcha. Good luck! Hopefully she'll at least get a little more duration form ProZinc. She might surprise me and do well on it, never know. I would also ask how long they'd want her on ProZinc before making a call it's not working (we usually say 2-3 months if there's clearly no progress, if it seems there's some progress then it stretches a little to see how it goes)
 
FrostD said:
We have a sort of similar problem here in the US. For the longest time Vetsulin (Caninsulin) and ProZinc were the go-tos, but in 2018 that changed with the updated AAHA guidelines...but I'm going to guess a UK vet may not care much about those? ProZinc is currently the only FDA approved one for cats (FDA is our government regulatory agency for drugs).

I know @Elizabeth and Bertie is in the UK, any thoughts?
Click to expand...

In the UK the key reference guidelines available to vets are the ISFM consensus guidelines on managing diabetes in cats, and the RVC's own guidelines. ...However, it seems some vets do not know about these guidelines...
[ISFM guidelines: https://journals.sagepub.com/doi/pdf/10.1177/1098612x15571880 ]

In the ISFM guidelines 'longer lasting' insulins are preferred. And 'longer lasting' includes Prozinc, Lantus, and Levemir.
The RVC recommend that new cases of diabetes be prescribed Prozinc, since this is the only longer lasting insulin licensed for cats in the UK. ...But they are not averse to cats being on human insulins (one of their research trials compared Lantus with Prozinc). The RVC do raise the point however that there is no pharmacovigilance with the use of human insulins in cats, while safety data is gathered for veterinary insulins.

We are still seeing many new UK diabetic kitties being started on Caninsulin. One of the main reasons, it seems, is simply that this is what many vets are used to using. And they may well already have this in stock for diabetic dogs in their care.
However, a snapshot poll in a UK feline diabetes FB group (asking which insulin people were currently using) found that numbers using Caninsulin and Prozinc were actually very similar, with only marginally more using Caninsulin. What the poll didn't show though was whether any of those currently using Prozinc were using Caninsulin first; and this is certainly the case for some of those cats.
There are UK cats on human insulins too, but these are far fewer (and possibly more on Levemir than on Lantus). Vets can prescribe these under the 'cascade' system if a veterinary insulin isn't sufficiently effective. In practice this is an extremely simple thing for a vet to do. The challenge for some folks though is persuading their vet to prescribe any alternative insulin. Vets vary enormously in their willingness to do this. And in this regard the data stored on spreadsheets can be extremely useful in presenting the cat's case.

Natallie96 said:
Yeah I’ve seen that not a lot of people recommend Caninsulin, but have seen some kitties go into remission using Caninsulin so it does give me a little hope.
Click to expand...
I've actually seen quite a lot of kitties go into remission on Caninsulin over the 15 years that I've been here. But, from what I've observed, the ones that do so seem 'mostly' to be in that group of cats that only need a short time on insulin and maybe a switch to a low carb diet in order to go into remission. If Caninsulin can't get good glycaemic control in the relatively short term then it may well be that a longer lasting insulin would do the job better.


Eliz
 
Thank you so much! And I agree - those that I've seen end up in remission tend to hit the ground running with nice cycles, low doses, etc almost right out of the gate.
 
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