HELP New member - trying to figure out the correct dose

[Yvettt]

Hi All, I am sorry for any mistakes, English is not my first language.

I have 3 cats and Loka, the oldest one (she is 7 years old) was diagnosed with diabetes mid October. I have noticed that she was drinking a lot, did some googling and took her to the vet to confirm that she is diabetics. She was eating mostly dry food before (taste of the wild), but she do have access to wet food (other two eat raw meat from Purrform), she just doesn't like it.

We have now switch her to wet food (catz Finefood) but she still gets some dry food (thrive premium plus) when she is refusing to eat a wet one before the shot. She was a bit overweight (6kg in July) but now she dropped to 5kg.

She do have access to food all day since we have 2 other cats but we switch all of them to low carb food and they all eat the same. She doesn't eat that much anyway - we actually struggle to find wet food that she will be eating, even now she sometimes refuse to eat before the shot.

We are on canisulin, we started with 2 units but after a month we increased to 3. We are also home testing now but her results are all over the place. Few days ago her glucose level dropped to 3.2, and since then I was a bit afraid to give her 3 units, but now the numbers are very high. She had 28 yesterday before the shot, so I gave her 3 units, I have checked her at 1am and she was 6.8 but again this morning at 7.30 am she was 32. I gave her 3 units and I am doing a blood curve today, and I have a vet appointment tomorrow but I am just at lost. I don't feel very comfortable to increase dose or even keep 3 units since it can drop so quickly. I have a newborn at home so I can't check on her every hour, I was so lucky that I decided to do a blood curve that day and I did notice that her glucose dropped to 3.2, it happed so quickly, she was 20.7 around 8am, at 11 am she was 19 and at 12 it dropped to 5 and half an hour later it was 3.2

I just don't know what to do, it has been 1.5 months and we are nowhere near getting her regulated. I feel like she now hate me since I keep following her around and keep poking her ears but I just feel so afraid that she will go hypo. I cant sleep very well now, keep thinking - what if I will give her 3 units and fell asleep and I wont notice that she will get hypo overnight.

Should I speak with a vet and maybe try to change insulin?

How do you guys handle it? How long does it take to get it under control?

 

[Bron and Sheba (GA)]

Hi Yvett and Loki and welcome to the forum. Your English is very good.
Well done setting up the spreadsheet and home testing the blood glucose.
As you are are using an alpha track meter to measure the blood glucose (BG) you don’t want the BG to drop under 3.7 (68). If it does, you need to take action to bring the BG up higher. To do this you need to give some higher carb food or some honey. And then you need to test again 1/2 hour later to see the BG is rising

Do you have a hypo kit that has some high carb canned food in it and some honey?

It looks like Loki is bouncing from dropping low quickly. Bouncing is very common in newly diagnosed cats and it happens when the cats BG drops too fast, too low, or lower than the cat is used to. When this happens the cats body panics and dumps stored glucose and regulatory hormones into the system which sends the BG up high. Bounces can last from 1 to 6 cycles and there is nothing you can do but wait it out. When you test her are you giving her a small treat each time?

3 units is too much insulin as it dropped the BG too low. We go up and down in 1/4 unit increments. So you would go from 2 units to 2.25 units and then 2.5 units etc.
You will need 1/2 unit marked syringes for this.
However I would ask the vet if you can swap to another insulin which is better for cats such as lantus. Caninsulin is really an insulin for dogs not cats. Another good insulin is prozinc.

It is important that she eats well so offer her a meal 1/2 hour before you give the cat insulin. The routine is you test the BG, feed the food, wait 1/2 hour, then give the dose.
Also offer snacks of food 2 hours later at +2 and again at +4 and +6. This will help stop a big drop in the BG. Do this every cycle.

I think if you can swap to a more suitable insulin for cats you will find Loki does better.
What country do you live in?
Let us know how you get on at the vet tomorrow.
We can help you get Loki under control. You just need a decent insulin and some help from us. Diabetes is a very treatable disease.
Keep asking lots of questions, we are very happy to help you. And I’m so glad you have found us.
Bron

 

[Yvettt]

Thank you for a quick reply Bron. I am in UK.

I am using U-40 syringes with 1/2 markings so it might be hard to measure 1/4 unit. Vet told me to increase from 2 to 3 after 1 month. Unfortunately since it dropped to 3.2 (last Thursday) I was not able to speak with them, I have called but they were busy so the quickest I can see them is tomorrow.

I do feed her before the shot, but it is not always 30 minutes, they told me just to make sure she will eat, so as soon as she will eat at least half of the wet pouch (they are 85g) I give her a shot but if she will not finish the whole pouch I usually try to give her a bit of tuna loin or if she wont eat anything - 30g of dry food.

I only give her a snack (dry-freeze meat) during the shot, she is ok with testing so there is no need to distract her. But since we have 2 other cats, a bowl of raw meat and dry food is always available and she will occasionally have a snack during a day.
Vet told me it is ok to leave the food during the day, but should I maybe take it away after she ate in the morning and only give snacks at +2, +4 etc.? And leave it overnight when I can't feed her snacks every 2h?

I also not sure what to do if in the evening her glucose was below 18 - there was few times when it was in range of 16-18, she will have her meal but I was not very confident to give her a full 3 units so I would just lower it to 2 or 1 units. Is that ok?

I will speak with a vet tomorrow, not sure what is available in the UK, I think that the canisulin is the main one here.

 

[Bron and Sheba (GA)]

will speak with a vet tomorrow, not sure what is available in the UK, I think that the canisulin is the main one here.

Both Lantus and prozinc are available in the UK, so be firm you want to swap over as the caninsulin is not working well for your kitty.

I am using U-40 syringes with 1/2 markings so it might be hard to measure 1/4 unit. Vet told me to increase from 2 to 3 after 1 month. Unfortunately since it dropped to 3.2 (last Thursday) I was not able to speak with them, I have called but they were busy so the quickest I can see them is tomorrow.

A lot of vets say to increase in 1 unit increments but it is not a good idea and can cause what you have found….a drop too low. It is much better to increase in smaller amounts…..cats are only tiny.
To measure a 1/4 or 3/4 amount …you fill to 1/2 way between the whole unit and the 1/2 unit mark (for the 1/2 unit measurement) , and half way between the half unit mark and the next full unit mark for the 3/4 unit measurements. You have to eye ball it. I used a magnifying glass.

do feed her before the shot, but it is not always 30 minutes, they told me just to make sure she will eat

Always wait for 20 or 30 minutes when using caninsulin as it hits hard and fast and you need to make sure there is food aboard. With lantus and prozinc, which are much more gentle insulins you can feed then shoot straight away as the onset of insulin is not for 2 hours.

only give her a snack (dry-freeze meat) during the shot, she is ok with testing so there is no need to distract her. But

I would always reward her after testing with a small snack

Vet told me it is ok to leave the food during the day, but should I maybe take it away after she ate in the morning and only give snacks at +2, +4 etc.? And leave it overnight when I can't feed her snacks every 2h?

You can leave food out if you like but take it up for the 2 hours before the pre shot BG as we don’t want that food influenced. Yes leave food out overnight.

also not sure what to do if in the evening her glucose was below 18 - there was few times when it was in range of 16-18, she will have her meal but I was not very confident to give her a full 3 units so I would just lower it to 2 or 1 units. Is that ok?

**** 3 units is too much for her so reduce the dose now.
If she is over 15, it should be ok to give her a dose (but not the 3 units as it’s too much) as long as she is eating and has access to food. I would also always test again at say +3 to see she hasn’t dropped too much.
If you are unsure you can post and ask for help and stall, don’t feed and test again in 20 minutes.
Yes with caninsulin it is ok to give a lower dose to be safe.

 

[Yvettt]

Thank you so much, I spoke with a vet and she agreed to swich Loka to Prozinc. I have picked it up today but I did not want to start in the evening, since I cant really monitor her overnight. We will start tomorrow morning, fingers crossed it will work better than canisulin.

 

[Bron and Sheba (GA)]

Good luck with Prozinc. Let us know if you need any help.

 

[Yvettt]

She is hypo again. We switch to Prozinc this morning, 2 units. I updated the spreadsheet. She was steadily going down, she had some snacks during the day. Around 5.30 pm she was 6.8 - so quite low for +9 and now at 6.15pm she is at 3.8. I gave her some food and I will recheck in 15 min. Should I decrease dose by 1? or should I skip completely. She should have second shot at 8.15pm so in 2 hours time.

 

[Chris & China (GA)]

Sorry you didn't get a reply earlier but I'm glad to see you skipped!

Is she still getting any dry food? If she is, you need to get that out of her diet since it's very high in carbs but do it slowly and when you can test frequently because reducing the carbs in the diet can drastically reduce the need for insulin.

I think I'd drop down to 1U tomorrow and hold that for at least 6 cycles (unless she drops below 3.8 again) and see how she does. It's a lot safer to start low and go up slowly.

On your spreadsheet, could you put a line between the tests where you were using Caninsulin and the ProZinc? You'll see what I mean if you look at China's spreadsheet between 1/9/18 and 1/10/18

 

[Yvettt]

I hope that everybody had a nice Christmas

We had a few weeks of adjustments but still no improvement. We are off dry food now and only eating wet pouches. After increasing a dose to 2 units, at the beginning of January, she had a 9.1 AMPS so I stalled but after 3 h she was still only at 11.8 so we skipped a dose. So we ended up having 28 at PMPS.
I was to afraid to give her a full 2 units so I was giving her a bit less, just below 2. I spoke with vet and she told us to get back at full 2, I did and she ended up having 10.7 AMPS. I stalled until it was back at 14 and gave her 1.5 but for the next week she was keep having very high readings, even with 2 units.

Vet recommended yesterday to get up to 3, since I was not comfortable with that she agreed to increased to 2.5. Today is a first day at 2.5 and straight away, after 6h she is at 3.7. She almost screamed at me waiting for food, she had a whole small can of Purina Gold and 20 min later she is now at 5.6

It looks like there is just no good dose, 2 units is not enough, 2.5 seems to high. Any ideas?

 

[FrostD]

What is your feeding schedule? I am thinking we can probably change your schedule to help these numbers.

What country are you in?

2.25U is an option, just have to estimate it as best you can.

I would give 2.25U, and hold that for 4 days to see how she does (unless of course she goes low again). She is going to bounce from the 3.7, so you have to wait for that bounce to clear to see where she's at.

 

[Yvettt]

I am in UK. I gave her 2.25 since I did not want to risk to give her 2.5 overnight.

She gets wet food in the morning, between 7-8, I have 2 other cats so I just give them few pouches. I always make sure that she will eat at least one packet on her own (85g, they are eating HiLife its only natural Tuna One and Sheba Fine Flakes Poultry in Jelly). She will graze during the day from whatever is left from the morning. I usually give them one or two packets during the day so they can snack on them. Evening is the same, I will make sure that she will definitely eat at least one pack before the shot. She gets her shot around 7-8pm.
She was 28 before evening shot so I am guessing she is bouncing now.

 

[FrostD]

Ok. That feeding schedule should be okay.

I would not hold doses longer than 6-8 cycles, or 3-4 days, if you don't see blue numbers. Hopefully the 2.25U works, just give it a few days.

The other option is that ProZinc just isn't the best insulin for her, but being in the UK I don't know how easy/reliable it is to get an insulin like Lantus.