Insulin question.

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Juleslynne43

Hi. I'm starting my cat on twice daily insulin today. My question is, it has to be given every 12 hours right? Well two nights a week I don't get home from work til 9:30pm. If I give him the dose then (his morning dose is at 6:45am), I then can't give the morning dose as it will only be 9 hrs not 12. Should I miss the evening dose?

He drops very quickly after the dose. Yesterday's curve showed:

8:45pm night before - 28 mmol/L

6:45am (before insulin) - 21 mmol/L

9:30 am - 6.8 mmol/L
11:30am - 7.3 mmol/L
1:30pm - 7.5 mmol/L
3:30pm - 8.5 mmol/L
5pm - 14.1 mmol/L
7pm - 28.1 mmol/L
9pm - 23.2 mmol/L

Vet is emailing today to tell me if we are going to start evening doses but I think she will say yes. He was only diagnosed three weeks ago as this is his first curve. His gets 2 units Lantus once per day.
 
A couple of years ago I was on an 8/16 hour cycle on the weekends because of work. I gave two shows a day.

In your case you can give a reduced dose on the short mornings. That is what I did depending upon the BG before sh the shot.
If you do a full PM dose and then give a full AM does on the shot time I am afraid the cat may drop too low.
 
Juleslynne43 said:
... His gets 2 units Lantus once per day.
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What are the chances you could enlist a friend, or a student interested in veterinary science, to do the evening shot on nights you can't get home in time? Check your local high school guidance counselor for recommendations and post for college students. Or even a Vet tech or pet sitter needed to earn some pocket change might be able to come.

He might do better splitting the 2 units, even if you do 1.25 am and .75 pm at more than 12 hours later. You'll need to test to see how it works, but it may be OK if you are very careful.
 
Sorry I mustnt have been clear. He's going from 2 units once per day to 2 units twice a day.

I wouldn't trust anyone else to come to my home to do the shots. No way.
 
That is a hell of a jump in dose. Typically, we increase dose by 0.25 to 0.5 units at a time. With the need to have a long:short time span, you might start by splitting up the current dose - go ahead and discuss it with your vet - you need to be able to test out a solution that will work, without taking your cat too low.

Low numbers can kill quickly; high numbers cause problems over the long haul.

What about a "day care" kind of placement on your long days, where he'd be supervised, shot on time, and monitored?

What food are you giving?
 
Jules, I understand from your other threads that veterinary advice is very important to you. Thing is, I agree with BJ that going from 2IU SID to 2 IU BID is a very significant dose increase. The first 12-hour cycle may be OK but the second cycle may see a lot more insulin active in your cat's system and that may take the BG numbers lower.

If you haven't done so already, I'd recommend you click on the following link and download a copy of the "Managing Diabetic Cats" PDF. The file contains the published Roomp-Rand protocol for treatment of diabetic cats with long-acting insulins and gives comprehensive schedules for starting doses and subsequent dose adjustment criteria. Perhaps you might consider discussing the document with your vet? My vet and I found it very helpful to do so.
 
You can't comment without having seen or examined my cat. There is a reason he is doubling his dose. Seriously, those of you who comment need to be careful with advice as you don't have all the facts. I appreciate a response merely to the question I posed and I got what I needed from the first responder. Thanks Larry and Kitties.
 
It appears that my post has upset you. I apologise for that. I was only trying to be helpful. Having one's cat go into very low numbers unexpectedly as a result of giving too high a dose of insulin is both dangerous and frightening.
 
The vet wouldn't tell me to give too much insulin. They are trained.

I'm done with this unhelpful forum.
 
For the record, a vet instructed me to give too much insulin. That's why I was so concerned to help you because I had direct experience of receiving incorrect dosing instructions from a trained professional. As a cat caregiver I was instinctively concerned about the dose being too high and said so, but the vet insisted I give the dose they specified. That night my cat had a symptomatic but thankfully mild hypo episode - the only one she has experienced since start of treatment with insulin (and which I thankfully caught because I was regularly home testing.). With my current vet's complete support, I now follow the dosing guidelines in the TR protocol and I have successfully kept my cat in safe numbers ever since.

Just like the rest of us, vets may be trained in their speciality but they, too, are human and they are not infallible.

Perhaps if you had chosen to volunteer more of the background facts relevant to your cat's current status you might have received responses more specific to your needs?

I think it's sad that you consider this forum to be unhelpful. Speaking for myself only, I don't know what I would have done without the education and support that I have received from the kind and helpful members here. Regardless of whether or not you choose to continue membership, I wish you all success in helping your cat to get better.
 
Human doctors specialize because in just the human species alone, there is so much information, it is difficult to keep up.

Veterinarians are responsible for treating numerous species and it is impossible to keep up on every disease and condition for every species. It is much more useful to brush up on specific conditions as they are encountered. We live with diabetic cats day in and out, which most vets do not. As a result, we focus on that condition and look up new research articles frequently.

Still not convinced? Go to the online Merck Veterinary Manual, the standard reference in the veterinary field - a required textbook for many of their vet school courses. Read details about diabetes per the Merck Veterinary Manual. This is but 1 of the references vet use to manage care of diverse species that they see. It is a great reference, and although technical, will help you work with your vet to optimize your cat's care.

Here are some excerpts from it:
In cats, recent evidence has supported the use of high-protein, low-carbohydrate diets.
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It is usually preferable to have blood glucose testing performed at home to avoid changes in the pet's routine and the stress of in-hospital testing. Studies in both dogs and cats have shown that at-home monitoring improves glycemic control and increases the likelihood of obtaining remission in diabetic cats. In cats, high-protein diets along with insulin therapy are initiated, with reevaluation in 5–7 days. In newly diagnosed cats, insulin glargine is the insulin of choice. Glargine is a long-acting basal insulin. Used in conjunction with high-protein, low-carbohydrate diets, it is associated with remission of diabetes and discontinuation of insulin therapy in 80%–90% of cases within the first 3–4 mo of treatment. NPH, lente, or PZI insulins may also be used in cats, with starting dosages ranging from 1 to 3 units, bid. However, these insulins are not associated with high rates of diabetic remission.
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I feel genuine pity for you. Assuming that your last post is actually the truth, I feel desperately sorry for your cat.
 
Critter Mom said:
I feel genuine pity for you. Assuming that your last post is actually the truth, I feel desperately sorry for your cat.
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Don't believe everything you read then. Neither do I on this forum. Please keep away from responding to any of my posts. I do not want your input.
 
I lost a cat to a hypo overnight because the vet had me giving too much insulin, she was my very first diabetic cat, and I still to this day carry the guilt of killing my best friend. I realize I was doing the best I could to care for her with the information I had at the time. But she is still dead. Since losing her, I have gone on to adopt 4 more diabetic cats. Of those 4 I lost a second one also to a vet not handling an emergency correctly but of the other 3 two are in remission and no longer receiving insulin and the last one is on a very low dose (0.3) twice a day. It is because of this board, the scientific researched protocol here that all 3 are doing great.

But as they say, pictures are worth a thousand words.


My Cassavona when I adopted him at 11u bid of Levemir, shot blind at home and only curves run at the vet's and free fed prescription dry diabetic food. Poor clinical signs, obese at 37lbs, unable to walk because of diabetic neuropathy. 8 years old, had been diabetic since age 6 years old.


My Cassanova 8 months later after I took what I learned here and changed his diet to Friskies Pate Style canned food, started home testing and adjusting his dose according to the established protocol here. Weight down to a healthy 17lbs. Running and jumping great, loves playing with the year old kitten in the house, and off insulin as of the time of this picture. (September 8, 2014)

Vet's can and do make mistakes. So far they have managed to kill two of my cats. They are after all human. And they have a very tough job keeping on top of all the lastest advancements for treating every disease for every species that they see at their practice.

I love my vet, she is a awesome woman and for most things she is great, but she also readily admits that when it comes to Feline Diabetes that I know more than she does, and in fact calls me to help her out with other diabetic cats, including having me foster cats for her other clients when they need to board them.

Mel and The Fur Gang
 

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Back in 2010, my vet told me to go from 3 units twice a day to 4 units twice a day. Very shortly after that, my cat had a seizure and would have died if he had not been sleeping with me so I knew he was in trouble. By the time we got him stabalized and transported to the emergency vet, his BG was in the low 70s. The same vet almost killed my other cat by prescribing too high of a dose for MRSA in his bladder. I switched vets and am very happy with my current vet who has saved both of these cats by giving appropriate doses of medicine and increasing insulin slowly. If it had not been for this message board and my new vet, I would not have my two boys.
 
Critter Mom said:
I feel genuine pity for you. Assuming that your last post is actually the truth, I feel desperately sorry for your cat.
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For the benefit of other members, I posted the response above in response to a post from Juleslynne43 which described the forum as "unhelpful", described members of this board as "sad cat people" and stated that her cat had been euthanised last night. Juleslynne43 subsequently edited said post and replaced the original post text with a smiley face.

I am not in any way seeking an argument here, and I shall no longer reply to any posts by Juleslynne43. I just felt very strongly that other members who may not have seen the relevant post before it had been edited should be made aware of the full context of why my comment was made.
 
Juleslynne43 is precisely the type of commenter who should be banned. Posting a question and then attacking those who posted careful and detailed responses as "unhelpful" is just trolling a its worst. Forums like this exist precisely because vets are less than perfect, and few have the ability or time to specialise in one aspect of feline health. And honestly, even if she was kidding about euthanising her cat, that might well become a self-fulfilling prophecy if she insists on blindly following her vet's advice and doubling the insulin dose all at once like that.
 
to all members who have posted in this thread:
the thread has been reported and will be dealt with by the team of moderators. no further comments are necessary at this time. for that reason i am temporarily closing the thread pending review by your moderators.

Juleslynne43, feel free to start another thread with questions you may have if you decide the forum is helpful and in fact you're not "...done with this unhelpful forum."


best to all...
jill


After reviewing this thread a decision has been made for it to remain closed.
Just a reminder for all... Let's all play nice!
Thank you,
Your team of Moderators
 
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