How do I start TR while transitioning to wet food?

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tye

tye

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Hello, I am new here with some questions on doing TR as I transition my cat to wet food (and hopefully later on a different type of insulin).

First some background on him: Tye is 18 yrs old, male, and diagnosed w/diabetes in spring 2008. Since then, on the advice of the vet, he has been on 2 units 2x/day of Caninsulin. He is a fussy cat and has only ever been on dry food (Science Diet sensitive stomach) which we were told to leave out in his dish 24 hours a day (he grazes on it instead of eating at regular times).

He has been doing ok since diagnosed although some issues with constipation (we've been giving a dropper-full of mineral oil every night or so to keep things moving although I know this is probably not ideal). I also feel he doesn't have as much energy as he used to although this could be normal aging. He had a check-up this month (blood, urine tests) and everything came out fine except the vet wants me to take him back in for the all-day glucose monitoring test as he thinks maybe we need to adjust his insulin dosage.

HOWEVER - I am convinced at this point that instead of doing that I want to start TR. Since diagnosis we have had 2 hypo scares due to blind dosing. (Most recently because he was on antibiotics for a tooth infection and he refused to eat very much.)

I am comfortable doing home testing on him with my glucometer but still have a few questions I am hoping someone can help me with:

QUESTIONS

1. I understand that Caninsulin is not ideal. Can I still start the TR process with it for now until I can switch to something better, since it is all I have to work with for the moment?

2. While I try to get Tye to start eating wet food (which I anticipate will take weeks), how often should I be measuring & dosing?
I understand a change in diet can drastically change the BG levels so I am scared of another hypo episode. I am also anticipating that he will eat a bit less as I figure out how to get him to eat wet food..... and my vet also has me scared stiff that I should not be injecting if he doesn't eat.

Any advice? I have this Caninsulin chart - is it safe for me to dose based on these levels and if so, how often? Do I need to take into account when/how much he has eaten or do I just dose according to the BG numbers alone?

Recommended Starting Scale for Vetsulin (aka Caninsulin) (after 24 Hour Detox)
BG
US Metric Dose
(mg/dl) (mmol/L)
151-170 ( 8.3- 9.4) 0.25u
171-185 ( 9.5-10.2) 0.50u
186-200 (10.3-11.1) 0.75u
201-220 (11.2-12.2) 1.00u
221-250 (12.3-13.8) 1.25u
251-290 (13.9-16.1) 1.50u
291-350 (16.2-19.4) 1.75u
351-410 (19.5-22.7) 2.00u
411-450 (22.8-25.0) 2.25u
451-500 (25.1-27.8) 2.50u


3.My vet only prescribes Caninsulin so I need to find somewhere else to get it, which will probably take some time. I am in Toronto, Canada. Does anyone know what other type(s) of insulin is recommended and also available to buy here? (Any vet recommendations would be much appreciated)

4. Does anyone have any advice for what to do for his constipation?

Thank you in advance!!!
 
First, scrap the Caninsulin.
Lawsuit against Vetsulin Manufacturer
Vetsulin FDAs Warning December 15, 2009

You don't need to get insulin from the vet. I go to Shoppers and get what I want from the pharmacy.
There are others in Toronto or close by, so they can say where they get their supplies, but I have a Shopper's Optimum card and the points add up from my getting my insulin and syringes and test strips - a couple times a year, I get my 5-pack of Levemir with just the points.

So, a couple insulins that are much better, longer lasting, are Lantus and Levemir. Both are good, but I use Lev as my cats are high dose and some cats feel a sting with Lantus when the dose is high. It's up to you which insulin you decide to use, but you want to scrap the Caninsulin.

Next, you will avoid future hypo situations by home testing. Plenty of people are around to give you a hand with home testing times
Again, you can get your meter (often free with the purchase of a box of test strips) at Shoppers or any pharmacy, and more points too on the Optimum card!
It's important to test before giving insulin and know if it's safe to shoot.
I can't comment on your scale because I used caninsulin for only a very short time with Shadoe then switched to Lantus.
There are others here who can comment on the scale for you though.

Next, switching the food will be important, so if you need any tips on switching just ask. The sooner you scrap the dry foods, the sooner you will see better results and a happier cat.
Binky’s Food Lists
Feeding Your Cat: Know The Basics of Feline Nutrition

For the constipation, you can add in some RestoraLax, get that from any pharmacy. My Ollie is a big boy and does not move around alot so his stool takes its sweet time moving through him! RestoraLax helps alot; just add lots of water to the wet food (once wet's being eaten) as the powder draws moisture from the body to soften the stool and get it moving.

OK there you go.
Scrap the Caninsulin. See the links with the warnings.
Home test before every single shot and get a before-bed test.
Switch to wet food, low carb and scrap the dry food as it`s driving up the numbers.
RestoraLax at the pharmacy for constipation. Ask the pharmacist if there is anything maybe in liquid form and you can maybe mix it in drinking water or something.
Lantus or Levemir, 5-cartridge package with U100 syringes THAT HAVE 1/2 UNIT MARKINGS at any pharmacy.
 
Thanks so much for the fast response! Wow I can't believe my vet has said nothing about Caninsulin.

So are you saying that you can buy Levemir and/or Lantus from Shoppers without a prescription? Or do I need my vet to write one?

(That would be AMAZING if I could just buy it from Shoppers! I have been reading the other forum yourdiabeticcat.com and thinking I had to find PZI which seems next to impossible in Canada)

I already have and know how to easily use the glucometer so I can jump into home testing right away. It sounds like I should be doing this *during* the transition to wet food which makes sense... I didn't want to wait and risk hypo.

I am still confused however about *how often* to test/dose. Do I need to do this 24 hour insulin detox thing? Or chart some kind of hourly curve?

Right now Tye is getting insulin around 10-11am and again at 10-11pm. I am measuring and recording his BGs at both times and then if I can manage I do once in the middle of the day around 4pm or so (but no shot at that time).

Is this enough or do I need to test/dose more often? And do I need to worry about food intake at all or simply go by the BG levels?
 
My cat was very hard to transition to wet food.
I mixed water with it. She would eat a little bit (about 2 teaspoons) Then I would give her some dry food.
She ate a little more of the wet each time and less dry.
Buying FortiFlora and sprinking on top helps too.
Its a probotic and good for digestion as well.

It is important that the cat eats.
 
You might go to the Insulin Support forums for Lantus http://www.felinediabetes.com/FDMB/viewforum.php?f=9 and Levemir http://www.felinediabetes.com/FDMB/viewforum.php?f=10 and read the Stickies for each insulin. You can see how they work and which is best for your life style and your kitty.

Yes, you want to have hometesting down before you make the switch to all wet. Our Oliver went down 100 points overnight when we changed him from dry to wet. We would have had a hypo if we hadn't been testing and reduced the dose. Here are some hints to get him to eat when you do make the switch: http://www.felinecrf.org/persuading_cat_to_eat.htm New diabetics are often very hungry as their bodies are not processing their food well, so you don't want to be restricting food. Give him food as he is hungry but don't establish a pattern of overfeeding. You can free feed the wet; we freeze ours and let it thaw. Giving several small meals during the day is a good idea.

No detox necessary. Just start over with your new insulin at a low safe dose. Then you must test before each shot to know it is safe to give the shot. And you want to test at nadir (lowest point in the cycle) as often as you can. With Canninsulin, it is often 3-5 hours after the shot. With the milder insulins, it tends to be somewhere around the 6 hour point. After a week or so on the insulin, you can do a curve - every 2-3 hours over a period of a few days or in one day, if you and the cat can manage it. That will give you a good picture of how the insulin is working.

Keep reading and asking questions. It is a steep learning curve at first, but we will be happy to help.
 
Hillary & Maui said:
What does tr mean?
Click to expand...


TR - Tight Regulation, basically keeping your cat's BG levels in the normal range 24 hours per day. In my experience it means testing frequently and shooting more than twice per day. I'm sure others can explain it much better than I can.

For Tye, I would consider Levemir since he's been on insulin for a bit, you would need a script from your vet but once you get it, you'd pick the Lev up at a pharmacy or where others mentioned. While transitioning to canned only I'd be testing between 4 and 5 times per day because the transition alone could bring the BGs down by quite a bit naturally.
 
TR means Tight Regulation in this context, I think.

If you're in Canada - no prescription is needed, as Gayle said. If you're in the U.S., you do need a prescription.

One big caution -- please go to the LANTUS Insulin Support Group page and read the sticky posts.

The scale that you posted for BG versus Dose of Caninsulin -- that does not apply to Lantus and Levemir.

These newer human insulins work differently -- they build up in the body, so steady dosing is important -- no jumping around the dose for every shot (as you could do with Caninsulin)

It would probably be a good idea to start at a low dose, like 1 unit BID, when you change to Levemir or Lantus. (I prefer Levemir because it is less fragile than Lantus -- Lantus breaks down after 6 to 8 weeks, and Levemir I've been able to use the entire cartridge ~3-4 months)
 
Just to make it clear...you don't need TR, you need a better insulin, a food change and home testing. Once you've got that down, you'll soon see whbether you can be aggressive or not. But your first goal should be a happy and healthy cat :)
 
Thank you all for all the great advice and help.

Tye's numbers on the Caninsulin have been fluctuating all over (now that I have learned to measure him I realize this) so I am anxious to get him switched to the Levemir. Here's the current situation (not sure if I have the proper format for the chart, hope it makes sense):

11/23
8:15pm (+9) bg16.7
11:15am (+12) bg22.4 shot 2u

11/22
11:30pm (+11.5) bg16.6 shot 2u
6:20pm (+6) bg7.8
12:00pm (+13) bg20.1 shot 2u

11/21
11:15pm (+12) bg20.6 shot 2u
4:15pm (+5) bg8.8
10:55am (+11.5) bg19.7 shot 2u

11/20
11:30pm (+13.5) bg17.4 shot 1u
3:45pm (+6) bg11.1
10:00am (+15) bg19.5 shot 2u

It seems like the lowest he gets is around the 6 hour mark but even then it is not low enough (?)

As soon as we can start the new insulin I will post again about how it is going. After that - the food will be the next thing to tackle!

The problem right now is that he actually doesn't live with me but with my parents who are in their late 60s... they don't want to take on this home testing before every shot as they see it as a hassle (and also my dad's eyes cannot see the blood on the cat's black fur).

My understanding is that diabetic cats should never be blind dosed so I might have to take him in myself if my parents are not able to do this. (And that would be stressful for him - he lives in a big house with outdoor access right now whereas I am in a tiny apartment.)

Is anyone using Levemir 2x a day and NOT blind dosing? This is the only way I can imagine my parents being able to handle his care. Otherwise I will have to take him.... he is such a sweet cat and I want him to be the healthiest he can be.


Michelle (Tye's mom)
 
How wonderful you are hometesting! We use the American numbers on this site as the majority of people are American. Multiply your metric numbers by 18. If you can set up a spreadsheet: viewtopic.php?f=6&t=18207 it will make it a lot easier for both you and us to see what is happening. Your numbers look about right for Canninsulin. As you can see, he starts high and it takes him down low - has to feel like a rollercoaster. It will be great when you change to Levemir; it is much easier to work with and much easier on the cat.

Very few people here do not hometest. It is unsafe - you have to know if his numbers are low enough to give insulin and you need to know how the insulin is working so you can adjust the doses as needed. If you can, I would take him and hometest. Your parents would be devastated if they overdosed him because they didn't know his level and he hypoed.
 
To be very honest, blind dosing on any insulin is playing russian roulette with your kitty's life. IMHO


Mel
 
Blind dosing is not safe

But

Those of us who post here and those who test everyday ar the minority. There are many more who feed dry, use less than great insulins and shoot blind each and every time. Some of these cats do remarkably well! We can't judge what the best situation is for this cat, all we can do is give you the best info so you can decide with your parents what is right. Rehoming may or may not be best for this cat...either way, we will help

Jen
 
Hi everyone, merry Christmas!!

Just an update and some questions on Tye.

I have finally switched him to Levemir and in just 3 days he seems to be doing well so far - up and about much more and not sleeping as much.

You can see bg results so far in my signature link. He is on day #3 of Levemir, 1 unit 2x a day and tonight his bg came way down.

I wasn't sure how to enter this properly in the spreadsheet (if someone can let me know where this goes I would really appreciate it) - anyway at +12 hours since his morning shot he was at 175... so I did not give insulin as I was scared he would go too low. I waited until +14 hours and his bg was up a bit - to 193. So I gave him the Lev but only 0.5 unit.

Can anyone advise - did I do the right thing and then what do I do tomorrow? I have spent a few hours trying to search through the archives here but could not find a Lev dosing chart.

Also should I now be doing a curve - testing every hour to see where he's at?

PS he is still on dry food, I am tackling the insulin change first and then we will do the wet food so he doesn't have too many changes all at once

Thanks!
Michelle (Tye's Mom)
 
It sounds like things are improving, Michelle. Great job!

You can go over to the Levemir forum and ask the specific questions. viewforum.php?f=10 It is not as busy as this forum, but there is always someone on in the morning and evening, and they will get back to you. There is no dosing chart. We have found that no two cats react the same way to the same amount of insulin, so a chart can prove to be a dangerous tool. Your testing and record keeping is a much better way to handle dosing. Levemir users will be able to look at your spreadsheet and give you specific ideas for Tye.

Now that you are testing, and keeping good records, it is time to consider that food change. Dry food keeps his bg levels high and your insulin dosage will reflect that. Once you switch, be prepared for additional testing and a lowering of the dose. (Oliver went down 100 points overnight when we changed from wet to dry.)
 
Jen and squeak- I just wanted to add that sometimes people do have circumstances that limit what they can do.For example, even if Michelle could get the cat to eat mostly wet food that is still progress. Unfotunately with some people who give advise it seems to be a "my way or the highway" approach. I am glad you are not one of those people.

I have noticed there seems to be an increasing number of new people that have vets that will only presribe Humulin or a similiar insulin.It leaves them in a difficult position until they can switch insulin. Is their anyone who can help these people with dosage until they can switch insulin? Just telling them to switch to Lantus or Levemir is good longer term advice but in the meantime they might have a cat going hypo or having really high BG levels that put them at risk of ketoacidosis.
 
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