Injecting insulin

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helga

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Al E. Cat was diagnosed diabetic last month. First week - no problem with the injections. Then he spent a day at vet's getting a blood glucose curve done. Since then he gets very agitated and fights as soon as I get a hold of him. I can never be quite sure if the needle went in properly. Sometimes its bent. I am on my own with this and can't figure out a way to hold him and get the needle in. Help.
 
How is your kitty acting otherwise? The reason I ask is sometimes, if their bg glucose is low, they will fight the injections because the insulin makes me feel bad. We advocate testing at home. That way you know before each injection whether it is safe to give insulin and how much is safe to give. If you want to know more about hometesting, we have lots of resources for you. We have taught many people over the internet.

What kind of insulin and how much? There is a chance that your kitty is receiving too much insulin if his dosage is based on levels from a vet visit. Often cats are stressed at the vet (strange noises, smells, other animals and people who are NOT the mommy) and stress raises bg levels. Then when the kitty gets home and is no longer stressed, the dose may be too high. This is one of the reasons we test at home.

We always gave Oliver his injection while his head was deep into the food dish and he never noticed. There are techniques that will help. Here is an info sheet on giving an injection: http://felinediabetes.com/injections.htm

There are wonderful resources and people here who would like to help you and your kitty.
 
At the moment Al is supposed to get 7 units of Caninsulin twice a day. I can't see a lot of difference in him yet from when he was first tested and diagnosed. He eats a lot, drink like a horse and leaves mega pee puddles around the house. A lot of the time he is quite lethargic and his fur looks dull and unkempt which is why I took him in for a check-up in the first place. And with the peeing and drinking a lot I sort of wondered if he was diabetic. I volunteer at a local animal rescue and work around a couple of diabetic dogs. That first week when the injections went well I did it when Al was dived into the food dish. Now even when the food is first put down he moves in circles away from me as soon as I lay a hand on him.
 
Well, for starters, there has been a recall on Caninsulin or Vetsulin as it is called in the states. There is a quality control problem: http://www.fda.gov/AnimalVeterinary/new ... 188752.htm Caninsulin is also a difficult insulin to regulate diabetic cats with. It is harsh and hits the kitty fast, taking the bg levels down within 3-5 hours after the shot and then it wears off fast, leading to a roller coaster effect. Very few people use it here. Here is a site that will give you more info on how it works: viewtopic.php?f=19&t=302 Most people use a milder, longer lasting insulin like ProZinc or Lantus or Levemir.

And that is a LOT of insulin. How much did he start on? We recommend starting at one unit twice a day. You can always increase it as needed, but if you start over the best dose, it can cause a condition called rebound: http://petdiabetes.wikia.com/wiki/Somogyi_rebound

If I were you, I would start hometesting now. (The vet who posts here has described giving insulin without testing like driving down the freeway with a bag over your head. You are literally blind to what is happening. ) We figure we wouldn't give our two legged children insulin without testing their blood sugar first. We do the same for our kitties.

It could be that he needs that much insulin. It is more likely that he was started over his ideal dose and he may be getting too much insulin every day and feeling awful.
 
Al started off on 5 units and after a week on successful injections showed no difference in his glucose levels. Thanks for all the info. I will ask my vet about the Caninsulin. She never mentionned that there different kinds. Also she said that we should discuss home testing after we get him stabilized. I was supposed to keep bringing him in weekly to get the blood glucose curve done but I am on a pension and simply couldn't swing it. Also he was so totally freaked out after being at the vet's all day last time. When I got him home his pupils were dilated and he kept looking around as if something was going to pounce on him. But now I will get him in again and ask about home testing. I am so worried about doing something that will harm him.
 
I don't understand why your vet would start out on such a high dose. If it was too much insulin from the beginning, it is possible that he has constantly been in rebound.

The only way to stabilize him is to hometest. Being stressed at the vet produces blood glucose levels that are abnormally high and doses based on those levels are too high. It is good that your vet is willing to teach you to hometest. Why take him in again if it stresses him out so much? Most vets have a resident cat; maybe you can practice on him/her. Or, as I said, we can teach you.

I know it is hard to hear conflicting advice. We like our vet but she started us on 4 units twice a day, too high of a dose. Then she went on Christmas vacation and we had nowhere to turn. So we came here the first day, learned to hometest and rapidly reduced his dose. Vets are like GPs; they know a little about a lot of things, but they are not feline diabetes specialists. Everyone who posts here has/had a cat who is regulated or in remission. Our protocol works and we have helped hundreds of cats.

If I were you, I would print out some of the information on this site and take it in. Include this page by a vet who is a feline diabetes expert: http://www.catinfo.org Ask questions. Learn to hometest. You have to be the advocate for your cat. You are the one that loves him best and is responsible for his care.

Which reminds me - what is your name and the name of your cat?
 
My name is Helga and my cat ( one of my 5 plus one foster) is Al aka Al E. Cat. He is an orange tabby roughly 10 years old who has been with me 2 years now. His previous owners, my neighbours, moved away and couldn't take him. I like the way some people have a picture of their cat but haven't figured out how to do that. Have already printed off the warning about the Caninsulin(Vetsulin) to ask my vet about.
 
Helga, besides getting him off the Caninsulin and on to a better insulin for cats, the absolute best thing you can do right now is go buy a meter, test strips and lancets and start hometesting. I will never understand so many vets saying they would show owners how to test ONCE THE CAT IS STABILIZED. There are many cats that wouldn't be alive today if owners had waited for that to happen with the dose their vet had their cat on. They would have killed them with a major hypo. Also, you do not need your vets permission to hometest and it is the one major thing you can do to help Al E.
 
Hi Helga,

Can you please confirm what the syringes say on the label?

If you are using human U100 syringes with U40 Caninsulin -- then the 5u (which is an alarming big dose) is really only 2u (less scary) because Caninsulin is dilute compared to human insulins.

If you are using U40 syringes that you bought from the vet --- then 5u = 5u and is too much for a starting dose.

If given too much insulin, the liver will dump extra sugar to "soak it up" -- giving the appearance of still having high blood sugar. (called "rebound")

I have two adopted diabetic cats -- and both only need 0.25u BID. It is very possible that Al E Cat's ideal dose is less than 5u.

Vetsulin/Caninsulin has been recalled -- so changing insulins and starting over at 1u BID would be good. Also -- learning to check blood sugar at home will save you a lot of vet visits, and give you peace of mind that Al E Cat is doing ok.

Regarding the shots and cringing / running away.... You should lift the skin and inject into the gap or "tent" -- try NOT to poke muscle as that hurts. We usually inject while kitty is busy eating. They hardly notice.

If the needle is bending, something is wrong with your technique.
 
I am using a 1 CC Caninsulin syringe that says for use with U-40 insulin only. The needle gets bent when he jerks away while it is still in his skin not when I have a successful shot at it. You need 3 hands to do this job effectively - one to hold the cat still, one to do the skin tent and one to jab. This morning I did manage a good shot.
 
Also, I am making a vet appointment to get a demo on home testing. The dosage I give is what the vet prescribed. As a newbie I'm scared to do anything else. But am trying to learn what I can.
 
I'm glad the shot worked out okay, but I am still concerned with your dose. I am glad you are getting a demo on hometesting. Be sure he tests the ear, not a vein. We have lots of tips to help you.

Maybe take along Dr. Lisa Pierson's (DVM) site. (www.http:catinfo.org) It might help your vet to see a website by another vet who advocates our protocol: starting on a low dose of a good insulin, wet lo carb food and hometesting. I am wondering how many diabetic cats he/she has treated. The insulin and the dose do not sound like someone who is very experienced.

I know you want to trust your vet. But just read a few of the posts on this page. There are lots of people who were started on too high a dose and not taught to hometest, and then came on this website and using our methods, their kitties are on their way to regulation or remission.
 
it is safer to give less insulin than more insulin.

Too much insulin can cause seizures, coma, blindness and death. (read about HYPOGLYCEMIA so you know what signs to look for and how to treat it)

Ask your vet what kind of results he has had in the past with diabetic patients.

One person that came here giving a similar high dose -- the vet said most of his diabetic patients survive treatment for an average of 6 months and go blind / pass away. Please -- if you want a better result, please learn to monitor blood sugar at home. Most vets do not know about home testing in the way that we do it -- pricking the edge of the ear for a tiny blood sample. My vet draws blood from a vein in the leg -- not something I can or want to do at home.

Having a degree does not automatically make a doctor an expert at everything. Most vets are "general practice" and spend about 3 hours of their 8 years of education learning about treatment of diabetes in ALL species. And that education may be years out of date.

We just want to help you and your cat live long and healthy lives.
 
I know. I really appreciate all your advice and help. And when I first started giving Al insulin I printed off the 'Hypoglycemia Quick Reference from this website and it lives on the kitchen counter. My vet is good. I've now made the appointment for Al to go in for another blood glucose curve and for me to discuss hometesting and all your excellent information with the vet.
 
As the others have said, that's an awful lot of insulin to be giving your cat, and if he does not need that much, it's extremely dangerous!

OK the insulin you are using is a poor choice. I first used that insulin for my Shadoe and it was horrible. I switched to Lantus and saw immediate improvements. You have the warnings to show your vet. I don't know where you are located, but in Canada, we don't need any rx for the insulins; we just go to the pharmacy and buy what we want. Tell your vet you want an rx for another insulin.

The curves at the vet must be horrible; no wonder your poor cat is so upset. The curves at the vet are not going to do much good at all. The numbers will likely be very high so the vet will say to give a high amount of insulin. Then you go home and your cat's BG goes down, and that dose ends up being too high. My Shadoe has higher BG at the vet, but is lower at home. My Oliver has very much lower BG at the vet but 20min after getting back home, his BG comes back up again.

You can pick up any ordinary glucose monitor at the pharmacy and test strips, then just test your cat at home. You will then be able to see how well or poorly this insulin is actually working. Home testing is very simple and my cats literally sleep through my poking the tip of their ears to get a drop of blood for the meter. There are many cats who display NO signs of hypo - my Oliver was very low but I caught it be testing. He was not acting any different but I had to feed him some HC to try and bring up his number. Home testing has saved alot of cats' lives.

If it were my cat, I'd switch to a better insulin and give a much lesser dose until you could see from home testing just how the insulin is working. Sure you can discuss it with your vet, but please know that others are home testing even though the vets may not think it's needed. Both my cats are eating less, peeing less and their coats are completely different, so shiny now that we are off caninsulin.

Who knows? That dose may be needed and your cat just has a resistance issue, but it's best to test and prove what's really needed. And testing at home will give you true numbers. A vet curve will not tell you much at all, but it will be making your vet richer.
 
I am in Canada - Fraser Valley, British Columbia to be precise. Do you mean you can get insulin without a prescription? Does 'Rx' stand for prescription? It would probably be cheaper that way too. Lactulose, which I use for one of my cats who gets major constipated, costs as much for a tiny vet provided bottle as it costs for a litre bottle bought at the pharmacy. I will get all the stuff for hometesting but I need my vet to show me how things are done. I learn best by watching someone.
 
Just so you are ready, here is what you will need for hometesting:

A human glucometer. Any one that sips and takes a tiny sample is fine. The meters are often free at drug stores; it’s the strips that are expensive. You can, however, buy them on ebay at less than half the price of stores. Lots of people here like the Walmart brand, but my understanding is that you can't get them in Canada. But I have heard your meters are very inexpensive.

Lancets and a lancet device. Usually, until the ears “learn” to bleed, a 25-26 gauge is good. Any type will work.

Ketone strips. Just like human diabetics use. You will sometimes need to test urine if the numbers are high.

Rice sack. Make this out of thinnish sock, filled with raw rice or oatmeal and then knotted. You heat this in the microwave until very warm but not hot. Then heat the ears before poking.

Also nice to have. Flashlight: so you can look at the ears and find the little capillaries that come off the vein running down the ear. Vaseline: Put a tiny smear where you want to poke. It will help the blood bead up.

Have we given you the video: http://www.youtube.com/watch?v=_zE12-4fVn8
 
Helga, welcome to you and Al. You have gotten good advice. I just wanted to chime in that both my diabetics were started in that insulin (vetsulin here in the states). Beau was raised to 7u once a day, while he was still eating dry food and it was way too much. I was also not testing at home then, but taking him to the vet weekly for tests, and then for a curve, where he hypoed for them (probably was dropping very, very low at home too and I didn't know it).

What I wish I had done was learn to home test right away instead of waiting six months. That and get rid of the dry food. When I did that, with help from folks here, his dose ended up being just under 1u twice a day. And I found that most cats on that insulin were around .75u to 1.5u twice a day. Not 7u. That dose really scares me.

I love my vet, she is very good too, but she didn't know that much about feline diabetes. I really believe that this disease must be managed at home, not at the vet. She also wanted to wait until he stabilized to address things like diet. I don't think he would have ever gotten "stabilized" if I didn't test and change his diet.

I switched Beau to another insulin, after 2 years, that I bought from Canada over the internet without a script. It is called levemir. It is a much better insulin for cats than caninsulin. Beau is in remission now, diet controlled, and I adopted a second diabetic cat, Jeddie, so he wouldn't be put to sleep. He is on levemir now. He also was a handful when I got him, and bit me hard when I tried to test him, but it wasn't long before I could do that fairly easily (I wrapped him in a fleece blanket so only his head was showing). How, a year later, he purrs while I test him. I test, give the shot and then give a treat - usually boiled chicken breast. Treats really help get them to accept the process as something good.

Hang in there and ask questions. Maybe someone from here lives nearby you and can come over and show you how to test?
 
Hi Helga,
I've sent you a PM. I'm south of the river, and am willing to help you out with home testing and maybe a few other ideas.
 
A PM is a private message. Near the top left of most pages in the forum is a line that says if you have any new private messages. If you click on it the message inbox will come up. Also, when you send a PM the recipient gets a email announcing it with a link to the ePM.
 
Helga,

The message will still be there. Go back up to new messages and click. It will take you back to the message. Scroll down to the bottom of the message. There is a little bar to the right that says "reply". Click that and answer. Then go to the bottom of your new message and click "submit". That should work.
 
To Just-As-Appy: E-mail would be easier. Even with the instructions I can't make a reply work to the PM. Anyhow a vet session is scheduled for this coming Tuesday to discuss Al's treatment now that you guys have given me all this excellent information to process.
 
This morning I put out Al's food and stroked him a bit preparatory to injecting. As soon as I went for a fold of skin he backed right off and started snarling. Kept on growling like a wild animal and wouldn't even approach the food dish until I walked to the other side of the room. So for the moment the injection is not going to happen. Have to try again later. Yesterday went pretty good. Al was a mostly outdoor cat when he belonged to the neighbours and even now if the weather is halfways decent prefers to be outside. Forced to stay in doors he is a sprayer. He was neutered late in life after one too many abcessed wounds gotten from fighting. His people weren't always clued in to the state he was in because he hung out in my yard a lot. On several occassions I carried him home and pointed out the damage. On the whole he is (or was) a relaxed laid- back sort of character but this situation is stressing him out major. And me too. Right now although it is cold, wet and dark he is outside. But there is a roofed over picnic table in back with two large dog (cat) houses filled with warm bedding for any feline needing shelter. Al's probably in one of them now.

This site is not for venting but for a while this morning things seemed hopeless.
 
This IS a place for venting. We are all here to support each other.

As we said, if he is getting too much insulin and it is making him feel bad, that could be why he is fighting the shots.


I tried to send you a private message and it looks like you haven't picked that option. Go to the User Control Panel at the top of the page (right hand side) Click on it. On the next page that comes up, choose Board Preferences on the left hand side. The next page that comes up is Edit Global Settings. Look down the list and pick "Allow Users to send Private Messages" Change the No Button to Yes. After you have done, I will try to send you a message to see if it works.

Don't despair. We'll make this work.
 
My cat is an outdoor cat as well - one of my 2 barn cats. I always fed them and closed them in at night to avoid being eaten by coyotes. I now close the diabetic in the garage to keep the food separate. I test, feed, and shoot in the morning b4 letting out, and then at night when shut back in. He is out all day. I have made the time in pleasant with a warm bed, treats, lots of rubs and some grooming when he'll put up with it. He too is a sprayer, and is famous for following people into the bathroom at his old barn and spraying their legs when the trousers were down. He too is pretty laid back, but when the answer is 'no' there isn't much to be done but agree. He is strong and has claws!
 
Hi From Calgary! Wish I lived closer and I'd come over and help

Honestly , from scanning your thread, I'd bet money that your cat has been overdosed from the very beginning and feels like cr*p everytime the insulin kicks in which is why he's resisting. I really hope your vet gets more uptodate quickly on the other options that are available for treating CATS, not DOGS which is what caninsulin is best suited for.

Jen
 
Okay. I think the PM is properly enabled now. Al isn't a totally outdoors cat. He comes in when the weather is cold and unpleasant. But not today because he is pissed off at me. One bit of news. The animal rescue I volunteer at is basically a hospice for elderly and special needs animals and the lady who runs (and founded it) is a nurse. Spoke to her this morning and she said after I get things sorted out with my vet tomorrow about changing insulin and about home testing I could bring Al up to the rescue for a couple of weeks to get his levels stabilized and get him used to the routines. Great news to know that option is there. But I would still like to do things at home if possible. Al's would be awfully miserable shut up in a kennel in a building with barking dogs and lots of other activity. Anyhoo, got to dash. One of my other cats has a vet appointment.
 
That is a very lovely offer but totally unnecessary and possibly dangerous. Why? Because if he is stressed there (or at a clinic for that matter) it is possible that his blood glucose levels would increase from the stress and then end up overdosed. We all 'regulated' our cats at home and it is completely doable. It just takes time, patience and some education.

Jen
 
Back from the vet with Al. We have changed over to Lantus ( glargine ). Al also had some X-rays and it turned out his spine is very arthritic and probably pained him when he was handled. He had a dose of metacam and we'll see it that helps. My vet feels until Al and I get comfortable with the insulin injections I should not try home testing. For now I will go with that. My thanks to everyone who came with reassurance and help. I am going to log off here for a week or two to process all the new information. Otherwise it is too overwhelming.

Thank you.
 
Hope you will read one last post.

All we can offer you is our collective experience. We have lots of people who come on for the first time because their kitty has hypoed. They have been giving insulin without testing, and suddenly it is too much and the cat has a seizure.

You have to do what you can handle. There was a group at the previous forum who tried alternate testing, like urine litter. It is a poor substitute but better than nothing: http://www.felinediabetes.com/phorum5/r ... 27,1292821

When you want help, we will be here.
 
Just be careful with the use of Metacam for cats. In the USA it is only approved as a one-time injection in cats. The oral is not approved in cats. See:
viewtopic.php?f=22&t=22322

helga said:
Back from the vet with Al. We have changed over to Lantus ( glargine ). Al also had some X-rays and it turned out his spine is very arthritic and probably pained him when he was handled. He had a dose of metacam and we'll see it that helps. My vet feels until Al and I get comfortable with the insulin injections I should not try home testing. For now I will go with that. My thanks to everyone who came with reassurance and help. I am going to log off here for a week or two to process all the new information. Otherwise it is too overwhelming.

Thank you.
Click to expand...
 
But many vets like mine still use metacam orally for cats in certain situations and for short term only. It is hard to accurately dose by using the oral drops, which is part of the issue. I'd suggest that you talk with your vet about long term pain relief that is not metacam.
 
Al only had the one dose of metacam at the animal hospital. Didn't get any to take home. My vet said you had to be careful with it. Also Al seems to be feeling a bit better. After sitting in the basement closet since I brought him home yesterday he is now curled up in his usual spot on the living room sofa and the afternoon injection went very well.
 
Al is doing not too bad. On the Lantus he is eating, drinking and peeing less. But to complicate things, Moochie is in hospital being treated for a bad urinary blockage and Sunny has to go in for some major dental work on Friday. Never rains but it pours.
 
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