first day on insulin - proximity of shot to meal

L

louisstools

Member
Hi :)

My 11 year old girl Missy is on her first day of insulin. Sadly our normal vet is on vacation and the vet that helped us today was working solo at the clinic and an urgent came in so our consultation got cut short. She's also not a good vet as she doesn't seem to care about my cat's particulars and my cat is VERY particular.

My girl has for the past 2+ years a very low appetite and is on an appetite stimulant (mirataz) to help boost it. She currently grazes as she only wants to eat 0.1-0.2oz (by kitchen scale weight NOT liquid) of kibble at a meal (this is like ~20 kibble). She eats about 14 times a day. But it's all on when the mood strikes her and not five minutes before or after. I can't make my cat eat. She won't do treats and there is no food that will excite her enough to eat if she's not in the mood. I'd rather not withhold a meal b/c she is already not a good eater and I need to get calories into her. I only knew she was sick when her "raging diabetes" caused her to eat less and have a poorer appetite.

My question the vet explained that she needs to eat "around" when she gets the shot but could not give me specifics on just how long that needs to be or what to do if the cat decides to not eat many hours before or after the shot time. Do I give her the shot late? Do we skip the shot? Is it ok if she eats a half hour before the shot time? An hour before the shot time?

I appreciate any insight yall have.
 
We need to get you set up with a spreadsheet so I can help. I am so sorry I didn’t see this before. I have been nursing a sick cat (with no appetite) myself. You should attempt to het some food into your sweetheart around shot time. It doesn’t have to be a huge amount. Then feed multiple small amounts throughout the early portion of the cycle prior to about nadir. Of course, since she’s not taking in enough calories (right?) I would make an exception and say you could still feed her up until two hours before your PMPS test. So the rule is to not feed for two hours prior to the morning and evening preshot tests. That is so we can know the actual blood glucose (BG) number without the influence of food.
 
It also sounds like she’s on a high carb diet. That’s not good for diabetic cats blood sugar. Tell me about the food she eats. How have her numbers been running? Do you have any BG data to share?
 
Suzanne & Darcy said:
It also sounds like she’s on a high carb diet. That’s not good for diabetic cats blood sugar. Tell me about the food she eats. How have her numbers been running? Do you have any BG data to share?
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hey, thanks for the response. I totally understand dealing with the sick cat. I hope you’re kitty gets better.

We just started the shots Friday and we’re not doing any monitoring yet. Only really because the vet hasn’t advised anything but we saw a substitute that Friday because our main Vet is on vacation. when she gets back on Wednesday of this week, will probably sync up with her and that’s when we may start monitoring. in the meantime, I have bought a device, but unfortunately I got the wrong strip so I have to run up to the store to get the right strips.

The food she eats is kibble. It’s a prescription for urinary tract issues. She has a history of getting crystals and UTIs. canned food is absolutely out of the question because she will not eat it. She’s been eating kibble for 12 years and eating this kibble for 11. she’s been getting enough calories but her appetite is so unpredictable she gets the appetite stimulant to try and even it out and to decrease the stress on me with her feedings because she will only eat a small amount at any given time maybe 0.2 ounces by scale and so she needs like 14 meals a day.

I have worked with our Vet for two years and also with a behaviorist for over a year and the cat will not take to scheduled feedings. When she’s hungry, she wants to eat and that’s that. her eating patterns are very high in the morning where the first two hours of the day she’ll eat about 45% of her food that she’s going to eat for the day and then by the time I eat dinner in the evening she’s pretty much done for the day. that’s about when the second shot is due, so it’s being given at a time when she historically doesn’t eat much and then you compound that with I can’t make her eat. There is no food that I can offer her that will tempt her enough to eat if she doesn’t want to eat. I will also add that she doesn’t do treats or snacks or anything. The only thing that that cat has ever eaten is pretty much That kibble.

i’m not sure what the vet wants to do with her diet. I know that in general, the vet is very very hesitant about changing her food up or anything around eating because it’s so stressful and the cat generally doesn’t comply.
 
I would never give insulin to a cat without testing because there’s always a potential risk of a deadly hypoglycemic event. That’s too scary for me. Even if, one day, the vet does a curve or does a spot check of BG and sees high numbers, that doesn’t mean the numbers won’t be lower at home (particularly because stress of being at the vet tends to elevate blood glucose.) Cats insulin needs can also change. You should always get a preshot test and at least one mid cycle test to try to determine your cat’s nadir (lowest point in the cycle.). Doses should be based on the nadir. Hopefully, your vet started with a very small dose. Vets are generally very heavy handed and clumsy with their insulin dosing because they receive minimal training in feline diabetes and they are not managing diabetic cats on a daily/hourly basis.

It is all still very new for you though. It’s good that you’ve bought a meter. It can take some time to get used to testing. We have a lot of help here for that. I don’t know if you’ve found it yet. I cried when I first tried to do BG testing on my boy. My vet never bothered to tell me to home test, but I already had done my research and just went to Walmart and bought my ReliOn meter (probably the most-used meter here) and read up on how to do it and started on my own. The vet wasn’t going to be around to protect my boy, so I was determined to do it. Later when I showed her a paper copy of my spreadsheet, she was impressed. She could see there was no point in me bringing him in for her to check him or to run curves (which would have been elevated because he always ran higher at the vet and then his BG would plummet on the way home.)

If you can’t change her diet then that’s just an obstacle you will have to deal with, you can try to work around it a bit. Her BG will be higher and she will need a higher dose of insulin than she would on a low carb diet. Dry food is also inherently dehydrating and isn’t great for a cat with crystals or UTIs, although I understand she’s not very food motivated and she’s used to this food. She’s a challenge for sure. I can tell you love her a lot! She must really stress you out with the eating! Here’s some information from a veterinarian on dry food.

https://www.felinediabetes.com/FDMB...r-more-than-just-carbohydrate-content.175004/
 
Thanks @Suzanne & Darcy . Just curious, which Relion model did you get? And yes, she is on a very small dose. She is on Prozinc and it comes in the "40 unit" syringe and she gets "1 unit" twice a day (so 2 units total). The substitute vet mentioned that with her BG and her diet the chances of her going into hypo on this dose are extremely low. But you're right it is a thing to worry about once we really "get going" and the dose increases.

It seems to me that the T-Shirt slogan for this forum is "Test, Eat, Shoot." And testing before giving insulin seems reasonable -- though how I incorporate this into our day will be a challenge b/c she is not fond of routine change. What decisions to you make when the clock says it's time for a shot based on what the BG test says? Do you increase/decrease the dose a tad? Do you wait a bit longer? Or is it simply to ensure they're not already in a low BG state before the "eat shoot" part? Sounds like there is a lot of nuance here.

I'll give that link a read. Yes, her diet has been very stressful. At one point 2 years ago we spent six months trying to get her on canned food but she developed frequent UTIs and wouldn't consistently eat it (tried every brand at petco and petsmart). She also didn't take too well to leftovers and any given meal she would only eat a tablespoon or so.

I'll take a look at the spread sheet and hope to get it up and running over this coming week!
 
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So the purpose of the pre-shot test is to make sure your cat is not too low to shoot insulin (it happens - our cats can surprise us.) With ProZinc you may occasionally need to shoot a reduced dose based upon the preshot test value, but often as you gain more spreadsheet data you are able to shoot lower and lower numbers— it’s a gradual process. With the data, we are able to know what to do. In the beginning there is a lot of trial and error, especially when we are deciding how much to shoot with a lower than expected preshot test number.
 
Suzanne & Darcy said:
So the purpose of the pre-shot test is to make sure your cat is not too low to shoot insulin (it happens - our cats can surprise us.) With ProZinc you may occasionally need to shoot a reduced dose based upon the preshot test value, but often as you gain more spreadsheet data you are able to shoot lower and lower numbers— it’s a gradual process. With the data, we are able to know what to do. In the beginning there is a lot of trial and error, especially when we are deciding how much to shoot with a lower than expected preshot test number.
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OK, that makes sense. So the point of the test is to very the amount that you shoot. If you shoot at all.

yeah, I can understand all the trial and error. My main focus right now is to just get used to the cat and the shots A morning and evening shot time that will work for us consistently. Finding an evening shot time where she’s going to eat consistently is gonna be very difficult.
 
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