New here, new diagnosis with concerns about vet treatment plan

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Lanna_Cartier

Member Since 2023
Hi, I’m new here. My name's Alanna I'm from Toronto. My cat Penelope was diagnosed with diabetes on February 8. She is 14 years old. She had been drinking a lot, peeing a lot, and losing weight so we brought her in based off of those concerns.

The seemed confident that switching her food and waiting to see whether that had an effect on her blood sugar. So we switched from her dry food to tiki cat and then waited two weeks to see whether it had an impact. After two weeks the impact wasn’t great enough, so the vet advised that we could wait one more week before starting insulin to see if there was any change. On February 28, we returned to the vet and he advised insulin, Caninsulin, stating at 1 unit twice daily for Penelope. She weighs 5.3 kg or 11.68 lbs. After a week we brought her back to the vet for a glucose curve.


The glucose curve still came back very high, so he wanted to increase her dose to 2 units twice daily. and the vet wanted her to return the following week for another curve. However, the experience at the vet was incredibly stressful for Penelope, so we asked whether it would be possible to complete our own glucose curves at home, to get more accurate readings, and also so that she wouldn’t spend the next two days stressed out. The vet advised a human glucose monitor that we picked up the same day.


On 2 units daily she seemed more playful and like herself. On March 16, my husband and I completed a glucose curve ourselves. We started taking readings at 10:30 as the vet advised, right after she had her breakfast and insulin. Her readings started high (17.4) but decreased throughout the day to 5.9 before returning to 16.9.


We sent the results to the vet and trusted them to continue to give us accurate advice. When they responded they advised us to increase her insulin to 3 units twice daily and repeat the glucose curve again in a week.

So we did as we were told. Penelope was less active throughout the week but didn’t appear to be particularly off. My husband and I both work from home, so we keep a pretty close watch on her.


On March 24 we completed another glucose curve and the results were weird. Her blood glucose started quite high and continued to decrease over the ten-hour period:


10:27:28.9

12:26: 17.9

2:37: 10.7

4:36: 6.4

6:35: 5.4


We sent along the results and waited to hear back. Yesterday we received a call indicating that the results seemed strange and implying that the reason was that we had performed the curve wrong (even though we’d done exactly the same thing as the week before). They wanted us to bring her in for another glucose curve. My husband and I decided to discuss it and call back in the morning. This seemed like a strange response. If the readings were not taken properly I’d expect to see a speed of numbers, at random, rather than a consistent gradual curve throughout the day. So I got very serious about finding clear information to better understand Penelope’s needs.

Based on my research, according to the manufacturer directions for Caninsulin and the advice of the AAHA, the ideal curve for a cat is between 120 and 300 (or between 6.6 and 16.7), which Penelope had been within during her March 16 glucose curve. Given that, it seemed really concerning to me that the vet had advised us to increase her dose from 2 units to 3. So we called the vet this morning, and when we tried to discuss it, he seemed adamant that the increase in dosage was appropriate.


After the call, I continued to research in order to find more clear information. Which is how I found this forum. I’ve been reading through all the getting started and new diagnosis information. From what I understand: “When you get the lowest BG of the cycle down to 120-150, you have effectiveness. At this dosage, the cat is exposed to the risk of hypoglycemia if something goes wrong, so now your approach is permanently changed to one of caution -- small changes, far apart, while you seek to improve the duration of the insulin action so the BG spikes stop.”


I tend to be a bit mistrusting of healthcare professionals. I have an autoimmune disease myself, and the process of diagnosis (and ongoing monitoring) has not been confidence inspiring, to say the least. So when Penelope was diagnosed, I made an active effort to trust in what our vet was telling us, so as not to undermine her care, but I’m quite concerned.

We just took Penelope’s blood glucose at 4:20 and it was 4.3, which seems very low. I suspect that it’s also rocketing up very high because her body is correcting for the too-high dose of insulin. Our vet seemed quite dismissive when we spoke. This is all to say, I’m sorry for this huge wall of text, but I’m new to this and I am worried. Any advice you may have would be very helpful. We were thinking of dropping her insulin back down to 2 units starting tonight and taking her blood glucose more frequently for the time being.
 
Welcome Alanna, Can you olease add to your signature that you are from Toronto Canada .
I'm going to tag a Caninsulin user for you
We do feed our cats more than just twice a day bigger meal at AMPS and PMPS and smaller meals 2 tsps of the wet food
Caninsulin is not the best insulin for cats, it's for dogs
It hits hard and fast, I see you live in Canada you can get Lantus or generic lantus without a doctors script ,just say it's for your pet, with lantus you would need U-100 syringes with half unit markings

Are you feeding her small snacks during each 12 hour cycles? Most of us feed at least 2-3 small meals such as 2 taps of her wet food
We never increase or decrease by full units we adjust the doses by 0.25 units at a time
Do you have the U-40 syringes with half unit markings?
Have you read this please read this especially about the starting dose
The 4.3 (77) you got today was low
I'm no expert but 2 units might even be too much for tonight
Are you testing first thing in the AM , then feed , then wait 30 minutes to give insulin? You need food on board because Caninsulin hits hard and fast

https://felinediabetes.com/FDMB/threads/beginners-guide-to-caninsulin-vetsulin.231587/
Tagging
@Suzanne & Darcy
I haven't seen her on since yesterday but I will also tag some members that aren't Caninsulin users for you that might suggest what dose to give until Suzanne comes on.
@Bron and Sheba (GA)
@Wendy&Neko
@tiffmaxee
@Sienne and Gabby (GA)
 
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Do you have a hypo kit set up just in case you need to bring Penelope's BG up
Such as
med and high carb wet food and some honey?


Fancy Feast Gravy Lovers Gourmet Beef Feast in Grav
20% High Carbs

Fancy Feast Gravy Lovers Gourmet Chicken Feast in Gravy 15% Med Carbs

Fancy Feast Gravy Lovers Turkey Feast in Gravy 15% Med Carbs

Fancy Feast Gravy Lovers Chicken and Beef in Gravy 15% Med Carbs

Good idea to mark the cans with magic marker how many carbs

Or any on the food chart. Doesn't have to be Fancy Feast just an example about the med and high carb foods
And some honey in the house

https://felinediabetes.com/FDMB/threads/dr-pierson-new-food-

Between 11% and 17% is medium carbs.

18% and over is high carb.

I see you will be setting up our spreadsheet soon here is the link and it will also explain how to enter the information to it
We don't use times because we are all! In different time zones
You would say +1 ( 1 hour after shooting insulin ) +2 ( 2 hours after shooting insulin ) and so on until you get to PMPS ( PM Pre shot) first test at night

Spreadsheet link
https://felinediabetes.com/FDMB/threads/how-to-create-a-spreadsheet.241706/
If you have trouble setting it up just ask we have a member that will be happy to do it for you

Here is a link for the glossery and what they mean
https://felinediabetes.com/FDMB/threads/fdmb-glossary.194472/
 
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This is all so helpful. Thank you! I'm so relieved to know that my instincts were right. Sorry for the delayed reply. We tested her again one hour later and it had gone up to 10.3.

I've added my location to my signature.

We had been feeding 3x per day because that seemed like a better rhythm for her, but our vet encouraged us to switch to 2x daily, in line with her insulin. Perhaps I'll switch back because she seems to graze more now that we are doing the 2x feeds anyway (so it doesn't seem like it is very effective). We have been giving the insulin with her meals because that is what our vet advised. Until now, we hadn't been testing aside from the weekly glucose curve (because our vet didn't advise it). He only recommended getting the glucose monitor because we let him know that we wouldn't bring her in weekly for additional glucose curves (it stressed Penelope out so much, she wasn't herself for days) and we specifically asked. I'll start testing Penelope's BG before meals tomorrow.

We have honey on hand, but no med or high-carb food. I can grab a stash tomorrow (and print off the hypo plan so we know what to do just in case).

We have the U40 syringes but they only have full unit markings.

I'll get the spreadsheet set up tomorrow.

After our conversation with the vet today he was supposed to send along documentation to support his course of treatment, but now I'm not sure whether it's worth it to try to educate him and advocate for a better more conservative treatment plan or find a vet that understands Penelope's needs better. The large increase when Penelope's BG was already dipping low really seems like a reckless course of action.
 
The large increase when Penelope's BG was already dipping low really seems like a reckless course of action.

This right here. Not to mention that Cainsulin hits hard and fast, and is a harsh acting insulin not as gentle and forgiving as Lantus/Glargine. The approach championed by members here calls for lots of home testing of the BG, tracking everything in a spreadsheet, and constantly analyzing how the insulin is working on the cat in order to determine if a dose should be slightly increased or slightly decreased. Usually in small increments. Very numbers driven, which I LOVE!

Hello from the Southern shores of Lake Ontario, I hail from WNY. :) Welcome to the FDMB, your kitty has no idea how lucky they are you found us! I myself owe a debt I can never repay to the kind people here. Oh shoot here come the waterworks, lol. Dammit where's that tissue box

I bought inexpensive generic glargine from a place in Canada called Mark's Marine. The insulin was Basaglar and it worked wonders on my boy, combined with following the guidance here and the TR dosing method. My boy Hendrick is now a diet-controlled diabetic feline in diabetic remission, so of course I am a big fan of Lantus/glargine.

I would highly recommend you request your vet change Penelope to glargine it is a much better insulin for cats. In fact the recently published AAHA guidelines do not recommend Canisulin (aka Vetsulin) for cats. As mentioned above you would need to get new syringes, U-100 type.
 
Welcome. Waving from the Kawarthas. You just saved your cat's life. Well done.

The dose is way too high. And it is not the best insulin. It hits cats hard and fast. Snacks throughout the first half of the cycle help.

Here is some reading so you can counter your vet:
I'm out of the house for the day but I'll try to post more tonight unless someone else beats me to it.

Tagging @Butters & Lyla – she's not on much these days but she lives in the GTA and knows of better vets (if need be).
 
Hi and welcome to the forum!

I agree with what everyone has already said. Caninsulin, as the name says, was made for canines who have a much slower metabolism than cats. It seems like your vet is treating cats as if they were dogs since he’s also advising on 2 meals a day only. The smaller meals throughout the day are easier on their already compromised pancreas.

Your instincts are correct. Unfortunately most vets do not know a lot about feline diabetes….they have many animals to look after and they all have different diseases and treatments.

With a diabetic cat you need

  • A low carb wet diet that is 10% carbs or under. Most of us use around 4-7% carbs
  • A suitable insulin such as Lantus or Prozinc which are long acting, more gentle insulins than the old insulins.
  • We recommend hometesting the blood glucose with a human meter…it is not necessary to use a pet meter which is expensive to run and is no better. It will keep your kitty safe and you will know how the dose is working for your kitty. Only testing every so often will not tell you what is happening in between those times and an awful lot can happen in even a day.
  • HELP US HELP YOU has information about the spreadsheet, signature and hypo box which you will need to be able to look after your beloved kitty properly

The other issue with caninsulin is that is doesn’t last a full 12 hours so your cat is not protected the entire cycle. Switching to a gentler longer lasting insulin will be much better for your cat :cat:
 
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Hello and welcome from BC. My vet also started us on Caninsulin "cause that's what the clinic did". I did some reading here, like you :), asked for a change to Lantus. Luckily one time I had to see a locum vet when mine was away, and he got us squared away on Lantus. Turns out you don't actually need a prescription for it. You can buy it in any regular drug store. The U-100 syringes you get to use with it are also available at the pharmacies for us too. My vet learned with me and we stayed with Lantus. If you think you need a new vet, one option is to start a new post here saying something like "looking for vet in Toronto" on the subject line.

You've done a great job starting on home testing as well. The Beginner's Guide to Caninsulin that Dianne linked for you contains a safe dosing method for Caninsulin. You'll see that if nadirs are between 5.0 (90) and 8.2 (149), you stay with that dose. So the curve you did on March 16th at 2 units did indeed show you should have stayed at that dose. This may be a little lower ideal range than what you see in AAHA for ideal curve, but remember that a lot of pet parents don't home test, so a higher curve would make sense in that case.
 
Sorry, I haven't taken the time to respond before now, but I am SO GRATEFUL for all of your advice and feedback. I had a brutal cold last week on top of dealing with this so I've been doing what I can. We switched her back to 2 units that night because that was within our immediate control. We've also been testing her more although I haven't had the energy to set up a spreadsheet. Today we were doing another glucose curve and her BG dipped very low (2.9, so we gave her a churu and some fancy feast with gravy like you recommended). It's starting to come up again, so we're coming up with a plan going forward.

We've switched her back to 3 meals and day and that has been working much better for her

Our vet was supposed to get back to us and has been completely AWOL so I'll take your advice @Wendy&Neko and post to find a vet that is more responsive and knowledgeable, because having some in-person support through this would be really helpful.
 
Hope you are feeling better now.

That glucose curve today with that 2.9 means that the 2.0 units is still too high a dose. You don't want them on a dose where they go below 5.0 (90) if using Caninsulin. If you can get syringe with 1/2 unit markings, I'd suggest going down to 1.75 units (eyeball between the lines). If not, just do the best you can to come up with a consistent dose below the 2.0 unit line.
 
@Wendy&Neko Thank you so much for this info! We took your advice, switched Penelope for her next dose, and did spot-checks throughout the week until we could get an appointment with our new vet. We didn't get any more low numbers since. And now that we've met our new vet, we've started on Lantus, so I'm going to spend the night reading all the info there to be sure we understand everything well. I really appreciate your quick responses, and will forever be apologizing for taking my time replying. I have ADHD so I often read a thing and take action and then completely forget I haven't responded, but I m so grateful for your support!
 
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