Insulin timing issue/question

[Daphne and Jayne]

Hi, everyone. I have a question about timing of insulin injections for Jayne. This morning, we gave Jayne her breakfast but she vomited and then did not want to eat. I called the vet and asked the receptionist to ask the vet whether to give Jayne her morning insulin injection. By the time he called me back, it was already three hours past her scheduled injection time, and he left a message (I was doing dishes and didn't hear the phone ring) saying to go ahead and give her 1 unit now and her regular amount of insulin after she eats tonight (she is supposed to get 3 units, twice a day) -- but he didn't say exactly when to give her the 3 units. By the time I got the message, the office had closed, so I couldn't call him back to clarify. I am unsure whether the vet meant to feed her and then give her the 3 units at the regular scheduled time or feed her and give her the insulin 12 hours after the 1 unit had been administered -- or even somewhere in-between. My inclination is to wait until 12 hours after I gave Jayne the 1 unit, but I thought it might be helpful to post here and see if anyone has any thoughts about this. It seems to me from what I've read that it's better to give too little insulin than too much. I also understand there is a window in which the insulin can be given, but I always try to be right on time. I plan to begin home-testing Jayne but have not done so yet. Thanks for any suggestions.

 

[lynn and bear (ga)]

Since you are not hometesting yet and also since Jayne is vomiting, I would say the safest route would be to wait the full 12 hours before giving her any more insulin.

I feel compelled to say that shooting 3 units of any insulin sounds kind of high to me if you are newly diagnosed and not home testing, and even more so if she is not eating. Do you need help getting started with hometesting?

Hope she feels better.

 

[Daphne and Jayne]

Thank you, Lynn. I just brought Jayne home Thursday evening after she had been back to the vet for another glucose curve (and at the vet since Monday morning), and they said she "wasn't responding to the insulin," so gradually raised her to 3. I agree, it sounds like a lot -- and yes, I am going to order the newbie kit and start home-testing this week. She has not been vomiting since this morning and ate some food a few hours later. That said, I also have gathered from reading on this site that the Hill's w/d is not the best option, but I worry about switching her over before my appt. with the new (more diabetic-cat-friendly) vet that I'm seeing Mon. or Tues. I definitely need help with getting started home-testing, and I thought going to this other vet (who was, coincidentally, recommended by someone on this board) would be a good starting place. I worry so much that I am trying to be a doctor/scientist on my own.
(Very cute kitty you have there, by the way!)

 

[lynn and bear (ga)]

Bear says thank you Daphne.

Sounds like you have had alot on your plate this week, it sure is overwhelming at first, I remember being terrified. Once you get the hang of all of this, I promise you it becomes automatic and comfortable.

Why was Jayne at the vet that long? Curious - Did they ever mention anything about ketones or ask you to test her urine at home? Did they give you the actual BG data that they collected while she was there?

If I were to give you one piece of advice (sorry if it is unsolicited), it would be to bite the bullet and start hometesting this weekend. If you are nervous about it (I know I was!), we can help you. It really will give you a clearer picture of what is going on with Jayne. Once you have the data, it actually empowers you and gives you the info you need to treat her effectively.

I really hope she feels better, poor girl has had a tough week.

 

[pamela and tigger]

Daphne, vomiting can also be a sign that she is going too low and becoming hypoglycemic. Until you start hometesting please lower the dose. You could very well be overdosing her.

You say the vet felt she wasn't responding to the insulin so they raised her dose to 3 units based on an in house glucose curve. Keep in mind that the W/D is very high in carbs and they are probably feeding her that during the day when she is there with them. So then they are suggesting to raise the dose based on these carb induced higher numbers.

Plus vet stress can raise blood glucose numbers so you can see why your vet 'thinks' the insulin is not working.

You said she doesn't particularly like the W/D and you are feeding Fancy Feast to her when she is home. So she could very well have lower numbers when she is at home and the 3 units is then way too much for her.

I am glad you are going to learn to hometest and I am also glad you are going to go to another vet. It sounds like your present vet is not really up to date on treating feline diabetes. The W/D itself is a very old school type of food to feed. Vets that know what they are doing in treating feline diabetes don't recommend it anymore.

Did you order a newbie kit?

Here is a list of symptoms to look for in a cat that is hypoglycemic:

http://www.felinediabetes.com/phorum5/r ... msg-925783

Here is a list of items to have in your hypo tool box:

http://www.felinediabetes.com/phorum5/r ... sg-1661798

And here are instructions on treating a hypo - please print these out and put them on your refrigerator or somewhere else handy:

viewtopic.php?f=14&t=1122

 

[Daphne and Jayne]

Thanks for taking the time to respond, Lynn and Pamela.

Just to clarify, I had initially been feeding Jayne Fancy Feast in with the dry Hill's w/d, but for the past week and a half I followed the vet's instructions to feed only w/d, which I gave to Jayne in a mix of dry and canned (I had been told previously by the emergency vet that I should give Jayne other food if she wasn't keen on the w/d, just so she ate something, but she seemed to be OK ultimately with eating the mix of canned and dry w/d). Jayne was tested for ketones two weeks ago and did not have any.

The vet asked me to come in for another glucose curve after we (my boyfriend and I) brought her in a week ago, on Saturday, for a test and her levels were high. Initially it sounded like she was only going to be there for a day or so, but they said she wasn't responding and kept her there for several days. No -- they didn't mention anything about testing her urine at home, just to watch how much water she was drinking and how much she urinated. In fact, they didn't really give us any literature, any information about hypoglycemia, any information about what to do if we weren't successful in administering the insulin dose, etc. when we left with Jayne when we picked her up the first time (after her diagnosis and the first glucose curve). This is (just) one reason I'm switching vets. They also have neglected to tell us the details of Jayne's levels, which is not acceptable. It's almost like they think we can't possibly understand the science behind diabetes.

When Jayne came home -- and this is still the case -- she had big red marks all over her ears from the testing done at the vet, which concerned me. I'm going to view the links and see what I need to know to perform the BG test successfully and how to evaluate the results. We actually have a Walgreen's Truetrack that my boyfriend bought to test his own glucose levels, but it seems from what I've read here that it isn't a very good glucometer for cats as it requires quite a large sample. I also need to fully understand what the results of the test mean insofar as how much insulin she needs. I'll read the linked pages and see what's what there first and then post again with any questions.

I really appreciate your help! I mean it.

 

[lynn and bear (ga)]

When Jayne came home -- and this is still the case -- she had big red marks all over her ears from the testing done at the vet, which concerned me.

That is horrible - the same thing happened to Bear in the beginning, big black scabs all over his ears. Maddening when some vets/techs don't do it correctly. When it is done correctly there isn't any of that. Even in cats that have had it done for years. Some people here use Neosporin to help the healing (I think), hopefully someone will chime in on that.

I also need to fully understand what the results of the test mean insofar as how much insulin she needs.

It might be difficult for you to do that alone right off the bat. The people here on FDMB who use PZI can help you navigate that if you want.

Please do familiarize yourself with the links that Pamela posted, your vet should have told you about that. Good luck with your new vet on Monday!