Getting a cat off insulin - when to give a dose

[oldmeller]

Hi everyone,

My cat was diagnosed about a month and a half ago. He was put on two units of caninsulin twice a day. We did a fructosamine check after a month and the vet upped his dosage to 3 units of caninsulin in the morning, and 2 units at night. We started researching and found the wealth of knowledge on switching his diet to an all canned one. We started doing this and he seemed a bit sick. We got a blood glucose monitor a week ago and have been checking his blood several times daily. Now that he's off the dry food it seems like he barely needs any insulin at all. HIs ratings are normally between 5 and 10 so we have not been administering insulin. When it rises above 14 we have been giving him a half unit which seems to drop him very low. He has now not had insulin in 2 days. When he spikes to 14 should we be giving any insulin? At what bg rating should we be administering some?

Any help on this would be much appreciated!!

Thank you,
Melanie

 

[KPassa]

Congratulations on getting the testing started. :thumbup

As you learned the hard way, we highly recommend that if they're already on insulin that you start testing before you change the food and/or drop the dose significantly. It's great that you got him on the lower carb food and were able to catch this steep decrease in BGs and stop the insulin.

Caninsulin is a notoriously harsh insulin for a cat's faster metabolism: it drops them fast and far and then wears off quickly, which might be why you're seeing such a drastic drop in numbers when you only give the .5u.

What I would suggest the next time you get a reading over 10, do a "food test" and feed him and then test again in 2 to 3 hours. His numbers should be lower if his pancreas is working and he might not even need any insulin. Because of this, it's usually recommended to feed several small meals a day as it helps support the pancreas better. If you're not already doing so, try feeding him a little more often if possible.

 

[Deb & Wink]

Here are some reference ranges that member BJM wrote up. It includes both the US and international ranges, so I thought that might be helpful to you.

Reference ranges for decision making

Conceptually, it is somewhat like reading a thermometer in Celsius vs Fahrenheit. Freezing, for example, is 0 degrees Celsius and 32 degrees Fahrenheit.

Here are some glucose reference ranges used for decision making using glucometers. Human glucometer numbers are given first. Numbers in parentheses are for non-US meters. Numbers in curly braces are estimates for an AlphaTrak.

< 40 mg/dL (2.2 mmol/L) {< 70 mg/dL for an AlphaTrak}
- Treat as if HYPO if on insulin
- At nadir (lowest point between shots) in a long term diabetic (more than a year), may earn a reduction.

< 50 mg/dL (2.8 mmol/L) {< 80 mg/dL for an AlphaTrak}
- If before nadir, steer with food, ie, give modest amounts of medium carb food to keep from going below 50 (2.8).
- At nadir, often indicates dose reduction is earned.

50 - 130 mg/dL (2.8 - 7.2 mmol/L) {80 - 160 mg/dL for an AlphaTrak}
- On insulin - great control when following a tight regulation protocol.
- Off insulin - normal numbers. (May even go as low as the upper 30s (1.7 mmol/L){60s for an AlphaTrak}; if not on insulin, this can be safe.

> 150 mg/dL (8.3 mmol/L) {> 180 mg/dL for an AlphaTrak}
- At nadir, indicates a dose increase may be needed when following a tight regulation protocol.

200 mg/dL (11.1 mmol/L) {230 mg/dL for an AlphaTrak}
- no shot level for beginners; may slowly reduce to 150 mg/dL (8.3 mmol/L) {180 mg/dL} for long-acting insulins (Lantus, Levemir, and ProZinc) as data collection shows it is safe

180 - 280 mg/dL (10 - 15.6 mmol/L) {may be 210 - 310 mg/dL for an AlphaTrak}- Any time - The renal threshold (depending on data source and cat's renal function) where glucose spills into the urine.
- Test for ketones, glucose is too high.

>= 280 mg/dL (15.6 mmol/L) {may be >=310 mg/dL for an AlphaTrak}, if for most of the cycle between shots
- Uncontrolled diabetes and thus at risk for diabetic ketoacidosis and hepatic lipidosis
- Follow your insulin protocol for dose adjustments
- Test for ketones; if more than a trace level of ketones, go to vet ASAP.

 

[Deb & Wink]

Hi Melanie and welcome!

Where do you live? With the Caninsulin, I'm guessing it might be Europe, as Caninsulin must be prescribed first over there.