New Diabetes - started insulin yesterday

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Ashley1

Member Since 2014
ashley, my14 year old cat was diagnosed with diabetes earlier this week, and was started on caninsulin yesterday. She has been drinking and peeing a lot more than usual, and lost quite a bit of weight. On blood work her glucose was 26 mmol/L. She received 2 units of caninsulin last night, and 2 units again this morning. I checked her sugar 4 hours after today's insulin dose and her sugar was 5.4 mmol/L. That's quite a drastic change from 26! We have also changed her food to fancy feast classic, and cut down the treats.

I'm worried about the 5.4 reading today even though it's a normal number, since she's showing decreased interest in her canned food. Prior to starting her on insulin yesterday, she was always waiting at the food bowl for her food. Today when I gave her food, she just walked away without eating it. Since I was worried about the reading, I gave her a few treats in hopes of boosting up the sugar. Is the decrease in appetite normal? Should I hold the insulin for this evening if she's still not eating better? My goal is to give her 2 cans of fancy feast a day. Do you think that's enough for a 4.6kg cat?

(I live in Canada so the units for the glucose measurements are different.)
Thank you!
 
It is important that she eat before insulin with Canninsulin. It tends to have a fast, harsh onset, taking them down early in the cycle and lasting less than 12 hours. There are some things you can do to make the wet food more appealing: add some warm water and make a gravy with the pate, sprinkle on parmesan cheese or tuna juice, add some sprinkles of a treat she really likes on top.

It is important she eat and important she get the insulin shot. Iw ould work on getting her to eat.

That was also a big drop. If she has recently started wet low carb ( which can greatly reduce the blood glucose levels) you might consider lowering the dose to one unit, testing carefully. It is always easier and safer to increase the dose slowly as the tests indicate, rather than getting a low number and trying to decide how much to reduce the dose.
 
Hi

My cat remi first started on caninsulin and I too found the drops quite harsh. I am not experienced enough to advise on dosage except I will say that I reduced remi's dose quickly as I didn't feel such a drop was safe. I went from 1 unit twice a day down to 0.60 to start with and worked from there.

When a cat is glucose is uncontrolled they are always hungry but as the sugar begins to get where it should there appetite can diminish as it is using the food more efficiently. But when they drop too low they should tell you they are hungry as they
Need more sugar.

From what you wrote it sounds like you are relying on the glucose reading taken at the vets? This will be higher than when she is at home. You must check Ashley's blood glucose before you give her the insulin. So you test her blood, feed her and the. Give the insulin. Then check when you can but ideally at few times through the cycle.

You are aware how to deal with low numbers weren't you. Have you read the sticky on hypos?

viewtopic.php?f=28&t=15887
 
Can we get you started using our grid to record your glucose tests? It will help us give you better feedback.

Instructions are here.

Understanding the spreadsheet/grid:

The colored headings at the top are the ranges of glucose values. They are color-coded to clue you in as to meaning.

Each day is 1 row. Each column stores different data for the day.

From left to right, you enter
the Date in the first column
the AMPS (morning pre-shot test) in the 2nd column
the Units given (turquoise column)

Then, there are 11 columns labeled +1 through +11
If you test at +5 (5 hours after the shot), you enter the test number in the +5 column
If you test at +7 (7 hours after the shot), you enter the test number in the +7 column
and so on.

Halfway across the page is the column for PMPS (evening pre-shot)
To the right is another turquoise column for Units given at the evening shot.

There is second set of columns labeled +1 through +11
If you snag a before bed test at +3, you enter the test number in the +3 column.

We separate day and night numbers like that because many cats go lower at night.

It is merely a grid for storing the info; no math required.
 
Thank you for all your responses.
I have her readings attached below:

https://drive.google.com/open?id=0B_dMmAtS9bqyT3hYN0VvbzJXMUE&authuser=0

I didn't get a chance to do a pre-insulin reading this morning, since I only purchased the glucometer today. Her first reading was the 5.4, which was after her insulin injection. She had a little bit of food in the afternoon, but was not too interested.

She was supposed to have received her insulin injection an hour ago, but her glucose reading was 10.4, which was still within the normal range. Because she's not eating much, I'm holding her insulin injection for the evening. I've tried opening up new cans of food with gravy, which are usually her favourite, but other than the sauce, she's not eating much of the food. I've also tried mixing water with the pate, but not much luck either. The only thing she's interested in are her treats, which she shouldn't be having. I let her have a few today because of her lower readings.

I know the symptoms of hypoglycemia that I need to be watching out for, and what to do. But when she's not eating much, and her sugars are in a reasonable range, I really don't feel comfortable giving the insulin. If this keeps up, I'm thinking of calling the vet and bringing her back tomorrow. She seems more lethargic than usual, and has very little appetite. I'm scared of further weight loss, and hypoglycemia.
 
With a diabetic cat, the decrease in appetite is not normal, and seeing the vet soon is a great idea. Her BG numbers might be lower because she isn't eating much. But the not eating is the big problem. Do you know if the vet checked her for ketones in her blood or urine? If not, see if they can.
He might suggest an appetite stimulant, but discovering the cause behind the lack of appetite is critical, so that other things like ketones or hepatic lipidosis (fatty liver) don't occur and add to the diabetes.
 
We had the blood work done on Monday. Everything looked pretty good except for the elevated glucose and fructosamine. Her liver tests were normal and she didn't appear to be in DKA. I think it's unlikely for her to be in DKA now while on insulin and with her lower glucose.

She is still eating but less than I would expect her to. Maybe the lower blood sugar is making her feel crummy. If her sugar is used to sitting at 26, and all of a sudden dropped to 5, she's probably not going to feel very good. I will hold her insulin for tonight, and check her sugar in the morning. I'll definitely reduce her insulin dose in the future, and see the vet tomorrow.

Thank you for your help!
 
I think that sounds like a good plan. I have to say that remi didn't do great on caninsulin. For cats a longer acting insulin is recommended and I would perhaps raise this with your vet- lantus (glargine ) levimer. Have a look at my spreadsheet and you can see how the two insulins work differently.

I will find the link to the article that explains recommended treatment

http://www.felinediabetes.com/AAHADiabe ... elines.pdf

Ketones can still appear at lower glucose levels and so would recommend after seeing the vet you get some ketostix and test his urine daily for ketones.
 
Hi there,

Sorry if my tone sounds rushed but I'm in the middle of packing to move house next week. My cat, Saoirse, was initially treated with Caninsulin and we had similar issues to you. It was a difficult time and I hope some of our experiences might help you avoid some of the pitfalls we encountered.

1. From what I've read here, ketones can be a risk even when a cat is on insulin and even at lower BG levels. Testing with urinalysis strips is straightforward and will help keep Ashley safe. (Saoirse's not ketone-prone but I still checked her anyway.)

2. Caninsulin is a very harsh insulin. As you've already seen it can drop the BG level hard and fast. As already mentioned above, food must be eaten at injection time. Saoirse was miserable and poleaxed on Caninsulin for 9-10 hours out of every cycle. She used to hide most of the time and tried to avoid being injected. Her mood and demeanour is much better on Lantus, and while injections don't fill her with joy, she doesn't run to hide any more. In general, Caninsulin is not a great insulin for cats. Insulins such as Lantus and Levemir are gentler and longer acting (might be worth considering going forward - you can learn a lot about different insulins here). Let your vet know about Ashley's mood, appetite, energy levels and behaviour as well as BG numbers.

3. If you are getting big drops like that, based on my experience I would recommend that you test early in the cycle so you can catch big drops in numbers. After insulin, if Ashley starts looking for food - even if she doesn't eat any - that can be a good indicator that the Caninsulin has started to kick in. Close monitoring of clinical signs and BG in the first 3-5 hours - is a great way to keep your kitty safe. I usually tested at +2 or +3 to see how hard and fast the drop was going to be. If I saw a strong appetite uptick I would test immediately. If a drop was sharp, I tested again shortly afterwards and checked again until Saoirse was past nadir (lowest BG in cycle). This is especially important in the early days when you don't have much test data and don't yet know your kitty's pattern of response to the insulin. I am fortunately in the position where I can monitor throughout the day but if that's not possible, the +2 test can be very valuable as an early warning indicator that closer monitoring may be needed.

4. I've only been on this board for a few months but I have seen a number of cats here that seem to have digestive upsets and appetite changes when they start insulin treatment. Of course, some are to be expected. If your cat has been polyphagic (constantly hungry despite eating more, and possibly losing weight at the same time) then insulin will help her to start using her food better, thus reducing her need for extra. However , I have seen several cats here exhibit nausea symptoms and these can lead to inappetence. (Saoirse has pancreatitis but I think some of her early nausea and inappetence problems were insulin-related based on my observations of her. I've also seen anecdotal reports of human diabetics experiencing tummy upsets from insulin. You can find a really good guide to nausea symptoms plus both natural and medical remedies for same at the link below:

Tanya's Site - Nausea and Appetite Problems

I tried all the tricks listed above for Saoirse with limited success. I eventually got the right meds for her (famotidine for acid stomach, ondansetron for nausea, cyproheptadine for appetite) and things got much better for us. In my endeavours to encourage Saoirse to eat I ended up triggering a pancreatitis flare. Granted, our situation was complicated by Saoirse's then low-grade pancreatitis but if I adopted another diabetic cat in the morning and she started showing signs of nausea I would try the temptation techniques for only a short time before going to the vet to get help, doubly so where Caninsulin is in the mix because of the precipitous drops that are its hallmark - for both our sakes. (Appetite problems are tough on both cat and caregiver: earlier intervention would have saved the two of us an awful lot of distress.) If it's just a tum upset, a short course of famotidine and/or an anti-nausea med might be all the meds needed until the body adjusts to the foreign insuiin. Definitely let your vet know about the problems and ask for lots of advice about dosage.

Hope some of the above helps. Sorry it's so rushed (and not proof-read :oops: ).
 
Ashley seems like she's eating better. I left half a can of fancy feast out over night, and it was all gone by the morning! She was even playing with her toy and chasing it around for the first time in weeks! I checked her glucose again this morning, and it was 10.0. So I'm holding her insulin again. Maybe the dietary change was enough for her to keep her diabetes under contol. She's peeing and drinking normally now too. I'll call the vet to update her to see what she wants me to do.
 
I'm glad to hear that Ashley's feeling so much better! Fingers and paws crossed for you both that she's an early OTJ girl. :smile:

I found it very valuable to learn about how withholding the dose of Caninsulin may have helped her to eat better. Thanks for sharing your experience.
 
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