"New Member" 20.12.21 Hello - We love Pilchard. Recently diagnosed. Struggling a bit.

[FitzC]

Hello

I am Claire, UK based and have a lovely natured 10 year old cat, Pilchard, recently diagnosed with diabetes and having bouts of pancreatitis. Diagnosed September 2021 after falling ill quickly.

Currently inpatient at the vets, third time as out of hours emergency. Had seemed to be doing quite well on 2 units twice a day. Fructosamine was 333. We were feeling optimistic. Then we had one hypo, not sure why, no changes. So in the hospital, stabilised and off we went again. Saw the vet for check up 8 days ago, clinical signs ok but I was concerned about 300g weight loss. This weekend he was flat, vomitting and lethargy on Saturday, so after telephone consult off we went again. Doing quite well in hospital, eating again, much happier, monitoring his BG and for ketones in wee, which we need to get clear. He is probably in again tonight as BG is going a bit low in the middle of the day.

I bought a monitor and we take readings, special food, pretty vigilant.

Currently on Caninsulin AM and PM, 2 units, likely to be 3 units on release from the vet hospital. I take his BG before giving insulin. Readings before his AM and PM insulin shots were about 22 and mid points around 8 prior to this latest pancreatitis situation.

Feel we could do better for him. I wondered about tackling the pancreatitis, maybe probiotics. If anyone has experience of this please chip in.

I will discuss all with our vet but value the input of people looking after pets with this condition.

I have been reading posts and you have already supported us in lower moments.

 

[Red & Rover (GA)]

Welcome. Waving from Canada.

I wondered about tackling the pancreatitis

Here is some information:

• Pancreatitis: A Primer On Pancreatitis
• Pancreatitis: Article on Pancreatitis for UK residents

During a bout of pancreatitis, a cat needs pain meds, nausea meds, vomiting meds (they can be taken together), an appetite stimulant if they are unwilling to eat, and possibly fluids.

I'm tagging @tiffmaxee and @Olive & Paula who are experienced.

Currently on Caninsulin AM and PM, 2 units, likely to be 3 units on release from the vet hospital.

I'm assuming you are in the UK and your vet has to follow certain guidelines about the type of insulin.
Caninsulin is not the best insulin for cats. It was designed for dogs. Cats have a different metabolism. Caninsulin hits cats hard and fast, and it rarely lasts the 12 hours but what concerns me the most is increasing the dose by whole units. The best strategy is to increase by 0.25 units so that you don't go right past the optimum dose.

You can suggest/ask your vet for a switch to Prozinc. It is a much better insulin for cats.

I'm tagging a few members experienced with this insulin and a few members in the UK.

@JanetNJ
@FrostD
@Elizabeth and Bertie
@Diana&Tom

 

[tiffmaxee]

Welcome but sorry you need to be here. Pancreatitis does not respond to probiotics and not suggested by the experts on it. Red has given you information on it to read. Food doesn’t usually make a difference either. My cat had it fur a few years prior to becoming diabetic and is probably why he became diabetic.

Cats aren’t like people or dogs when it comes to diabetes. You can feed them the exact same food at the exact same time and then one day they will go too low or get too used to a dose and develop insulin resistance needing more and more insulin to break through. The insulin you were given is very harsh and can cause quick drops leading to a hypo. Testing at home and as you noted feeding can prevent a symptomatic hypo.

The insulins used by most vets that understand cats are lantus, Levemir, and prozinc. I’d ask your vet to switch to one of these asap.

 

[FrostD]

Currently on Caninsulin AM and PM, 2 units, likely to be 3 units on release from the vet hospital. I take his BG before giving insulin. Top readings were about 22 and mid points around 8 prior to this

Hello!

Red gave you good info on pancreatitis, I've also dealt with it a few times.

As Red mentioned, I would not increase in whole units. With Vetsulin, 0.25U is recommended because of how harsh it can be. I do also recommend a switch to one of the other insulins mentioned.

When you say top and midpoint, do you mean preshot and nadir? Or you've seen preshots between 8 and 22? It's a little unusual for a hypo to come out of nowhere if testing often/doing curves. Without looking at a spreadsheet, I'd wager a guess dose may actually be too high - it drops him too low, his liver dumps stored form of glucose to help save him, then he bounces high. Repeat.

What "special food" is he on?

Are you monitoring ketones at home? The recipe for DKA is not enough insulin + inappetence + underlying stress/inflammation. Pancreatitis often checks those last two boxes. Also need to keep water intake up as much as possible to keep flushing ketones.

 

[FitzC]

Hello, thank you for reply. He is on Purina Diabetic Management wet food.

His readings were low twenties when I tested him prior to his morning and evening shot, about 8 half way between those times.

I am not sure how to monitor his ketones at home, have been taking his sample to vet. Is there a test I can do myself? Although insured we are cracking through the amount he can use in his policy year so anything I can safely do at home would be of benefit.

He usually eats well, so only after he had snubbed two meals and been sick did I ring the vet. I wanted insulin advice. He was a bit lethargic and when I picked him up gently he made a noise suggesting pain in his abdomen. He was drinking a lot and got cross with his water bowl and splashed around in it. Vet said we had brought him in in the early stages of this bout. He has responded quite well.

I will surely ask about the other types of insulin. Thank you so much for your advice.

 

[FitzC]

Thank you for your response. I will be trying to get Pilcahard on another type of insulin as suggested.

Also will read the articles provided by Red & Rover. Very helpful already.

 

[Lando demando]

Hello, thank you for reply. He is on Purina Diabetic Management wet food.

His readings were low twenties when I tested him prior to his morning and evening shot, about 8 half way between those times.

I am not sure how to monitor his ketones at home, have been taking his sample to vet. Is there a test I can do myself? Although insured we are cracking through the amount he can use in his policy year so anything I can safely do at home would be of benefit.

He usually eats well, so only after he had snubbed two meals and been sick did I ring the vet. I wanted insulin advice. He was a bit lethargic and when I picked him up gently he made a noise suggesting pain in his abdomen. He was drinking a lot and got cross with his water bowl and splashed around in it. Vet said we had brought him in in the early stages of this bout. He has responded quite well.

I will surely ask about the other types of insulin. Thank you so much for your advice.

Hello!
I wanted to send you words of encouragement and empathy. I wanted to echo some great advice i got early on that may benefit Pilchard. I was told to have patience and stay the course. Lando has REALLY benefitted from that advice. I hope for the same for you and Pilchard!

 

[tiffmaxee]

You can cut costs by switching to a low carb canned food. There’s nothing magical about the RX food and it is pricey. Many here use fancy feast. There are lists for UK foods here. There are urine strips that test for ketones you can buy at a pharmacy.

 

[FrostD]

Ok. One thing you will want to be careful of is sometimes when the pancreatitis clears, numbers come down. So I'd be very hesitant to change insulin dose while he's dealing with it or just gotten over it (this is very specifically for Caninsulin).

You do not have to feed a prescription diet, you can feed any low carb wet food, but I will table that for now as the pancreatitis and ketones take priority.

At least in the US, you can buy urine ketone strips from any pharmacy, no prescription needed. Ketostix is a big brand here. A lot of people use a dedicated ladle, or put saran wrap on top of the litter, etc when trying to get a sample. If he's a shy litterbox user or you can't stalk him all day, they do make blood ketone meters, you use it just like a glucometer. That's a little more pricey though

 

[FitzC]

Yes, I wondered about timing of a change in insulin. Have read up a bit now and see that Lantus (Glargine) seems to be rated for cats. I will pursue this and see when we can change over. Will investigate the sourcing of ketone strips over here. I have some of the cat granules to get a sample. He is usually really good at producing samples.
He loves his litter box!

 

[tiffmaxee]

The change in insulin is needed. I would not wait. We can be conservative with dosing.

 

[FrostD]

Yes, I wondered about timing of a change in insulin. Have read up a bit now and see that Lantus (Glargine) seems to be rated for cats. I will pursue this and see when we can change over. Will investigate the sourcing of ketone strips over here. I have some of the cat granules to get a sample. He is usually really good at producing samples.
He loves his litter box!

Yes I just meant changing the dose itself - i.e. I would not increase to 2.25U or anything in the next few days just yet. If you get the Lantus we can help advise on the dose when you switch

 

[Sienne and Gabby (GA)]

In the UK, Prozinc is approved for cats and along with Lantus (glargine) is a good insulin for cats. I would see if your vet would be willing to use Prozinc. Caninsulin, as the name would suggest, was developed for dogs and does not have sufficient duration given a cat's fast metabolism.

Was pancreatitis the only reason for the hospitalization? Please make sure your cat was not diagnosed with diabetic ketoacidosis (DKA). We are more aggressive about dosing if DKA was in the picture.

 

[Red & Rover (GA)]

From UK Information (Food, Insulin, Vit B12 and other 'need to know' stuff):

URINE TESTING
KETONES: It is advisable to monitor all newly diagnosed diabetic kitties for ketones; and also to check again whenever the kitty seems unwell or is off her food.
Ketones, (created when the body breaks down fat for energy) are dangerous for diabetics, and can lead to a life-threatening condition called DKA (diabetic ketoacidosis). Fortunately, testing for ketones is simple, and just involves dipping the end of a ketone test strip into a drop of pee, timing it, and reading off the result. Anything above a 'trace' result is considered to be a reason to talk to your vet, ASAP.
Crumpling clingfilm loosely in the litter tray (over the litter) is often a good way to catch a pee sample.
'Ketostix' or 'Keto-Diastix' should be available from most pharmacies. 'Ketostix' test only for ketones, 'Keto-Diastix' test for ketones and for urine glucose. (The latter may be useful if you are not testing your cat's blood glucose at home. But it doesn't give 'real time' information about your cat's blood glucose. It only shows you how much glucose your kitty is excreting in her urine since the last time she peed.)

Note: Be aware that not all ketones are registered by the ketone test strips. If you notice that your kitty's breath smells fruity or like acetone this can also indicate ketones.

If your kitty has had DKA (diabetic ketoacidosis), or has previously tested positive for ketones, then you may wish to invest in a ketone blood test meter. This is more accurate then the urine test strips. Some UK folks recommend the the 'On Call GK Dual' ketone meter, available from Amazon.

Some helpful info on urine testing from the Sugarpet website:
http://www.sugarpet.net/urine.html ​

 

[Teetee (UK)]

Hi Claire, UK member here.
Bit long and winded sorry.
As others have stated Caninsulin was developed for dogs but used on cats until Prozinc was developed which is specifically for cats and i would certainly ask your vet about changing over.
If possible could you set up a spreadsheet and add a signature for Pilchard, everything you need to do it is in the link below.
The reason for a spreadsheet is because any member that helps you will need to see his BG numbers to determine any dose changes plus it's a great way to keep tabs on his progress. If you get stuck there are members on here that will help you, just shout out.
https://www.felinediabetes.com/FDMB/threads/new-how-you-can-help-us-help-you.216696/

There is also this other thread created by @Elizabeth and Bertie specifically created for UK members with loads and loads of valuable information and there is also a link in there with a long list of low carb UK foods.
https://www.felinediabetes.com/FDMB...-vit-b12-and-other-need-to-know-stuff.137376/

UK food list.
https://docs.google.com/spreadsheets/d/1J5JpMe6TDXrHq_aTl9hUtHy6Gs9oRBqlz4nPGKxtySA/pubhtml#

Going back to the change of insulin i don't know if your vet will prescribe Lantus as it's a human insulin and they only prescribe human insulin if the animal insulin is not working, it's called the cascade system.
https://www.gov.uk/guidance/the-cascade-prescribing-unauthorised-medicines#about-the-cascade.

Regarding Pilchards dose, if you do change over to Prozinc then i would personally if it were me start at 1.0 unit and build up as required, it's easier to build up the dose rather than give too much and risk a hypo, a more experienced member can help you with this but that's my personal view.

I have posted the below on another thread but maybe it might help Pilchard.
We had loads of problems with our cat Duke not eating and having severe bouts of pancreatitis (confirmed on 24th June)
One night (30th August) he had a low number and we gave him high carb Purina Gourmet Gold to bring his numbers up a bit, for days after that his bloods were all over and he was in pain, off to the vets and pancreatitis was confirmed again with blood tests.
Obviously at the time we didn't know what caused it but something caused his bloods to be all over and the only thing different he had that night was the Purina Gourmet Gold that contains the vegetable protein extract.
We stopped giving him Purina Gourmet Gold because it contains vegetable protein extract because for some reason reacts badly to it, also he started reacting badly to Whiskas and we couldn't understand why until i read the ingredients and low and behold they had started adding vegetable protein extract to it.
Now all we give him is Sheba fine flakes in jelly or food which does not contain the veg protein extract and he's not had one bad episode since and ate every meal since. No pain killers, no antacid and no appetite stimulants at all since swapping foods, (fingers crossed he stays that way) coincidence or not i don't know but i believe it's not.
I also noticed that the Purina Diabetic Management contains vegetable protein extract. Some cats react badly to vegetable protein extract some are ok with it, maybe that's Pilchards problem and worth a try.

 

[Elizabeth and Bertie]

I am Claire, UK based and have a lovely natured 10 year old cat, Pilchard,

Hi Claire, waving to you from Surrey!

Can you confirm that Pilchard just has/had pancreatitis, and hasn't also been diagnosed with diabetic ketoacidosis (DKA)?
...While the ketone test strips (details in Red & Rover's post above) are OK for general routine use in kitties, if a cat has had high ketone levels or DKA then it is really useful to get a blood ketone meter as this is more accurate. In the UK some of us use the On Call GK dual meter (also mentioned by Red & Rover above). ...The test is done in just the same way as a blood glucose test.

I take his BG before giving insulin. Readings before his AM and PM insulin shots were about 22 and mid points around 8 prior to this latest pancreatitis situation.

Well done for hometesting! Yay!
Are you testing before every insulin shot? And how often are you managing to get some other tests during the insulin cycle?

Insulin dosage should be based around the lowest numbers that a cat can drop to on a given dose of insulin. The pre-shot numbers mainly tell us whether our cat's blood glucose is high enough for insulin. And if hypo occurs the dose should be reduced immediately....
For newcomers to Caninsulin it's advisable to 'aim' to not let the blood glucose drop below about 5mmol as measured on a human glucose meter. If you're using a pet meter such as the Alphatrak then this number would be smidge higher, because pet meters 'typically' (not always) read a bit higher than human meters.
With Caninsulin the lowest number of the cycle (nadir) is quite often around 4 - 4.5 hours after the insulin shot. But in some cats it will be earlier or later than this ('Every Cat Is Different'...)

Really hoping that Pilchard feels much better very soon.
Keeping fingers and paws crossed.
Reassuring ((((Hugs)))))

Eliz

 

[Red & Rover (GA)]

it's called the cascade system.
https://www.gov.uk/guidance/the-cascade-prescribing-unauthorised-medicines#about-the-cascade.

Thanks, Tee. I went looking for information on this but couldn't find it. Now have it bookmarked.

 

[Olive & Paula]

Claire, sorry for diagnosis. I see you were given lots of info. Only things I can add is for ketone testing there are urine sticks you can get from chemist/pharmacy. There are a few ketone monitors you can get. You use it just like glucose meter. Strips are quite expensive though.

Pancreatitis can take time to resolve. If vet will supply you (like 30 days worth) with all necessary meds, you can get and stay on top of it. Pain med is definitely needed. Symptoms will come and go for awhile so you don't want to stop meds to soon. It could be a one time episode or it can become chronic (this is when you wants meds at home). Hang in, it can be a little rough at times.

 

[FitzC]

Hi Claire, waving to you from Surrey!

Hi and thank you for your response. We have been told Pilch had the markers for pancreatitis (blood tests & abdo pain, symptoms) and DKA caught early. He saw the emergency vet, the vet who originally caught his 1st emergency admit and the vet I consider to be my vet. Each seems to have a slightly different view. My vet said query pancreatitis, uncontrolled diabetes (fructosamine) was 539. He had seen the other vet 8 days previously and I took a urine sample in for Pilch, all clear, clinical exam fine, told to keep him on two units. I asked for advice as readings high.

He is now on 3 units AM and PM. I do readings before shots and at midpoint. I am doing more today.

 

[FitzC]

Hi Claire, UK member here.
Bit long and winded sorry.
As others have stated Caninsulin was developed for dogs but used on cats until Prozinc was developed which is specifically for cats and i would certainly ask your vet about changing over.
If possible could you set up a spreadsheet and add a signature for Pilchard, everything you need to do it is in the link below.

Thank you for replying. I am going to get going on all the information you have provided. I do have charts everywhere with the info on, so will try to get it transferred to the resources you have given me.

 

[FitzC]

In the UK, Prozinc is approved for cats and along with Lantus (glargine) is a good insulin for cats. I would see if your vet would be willing to use Prozinc. Caninsulin, as the name would suggest, was developed for dogs and does not have sufficient duration given a cat's fast metabolism.

Was pancreatitis the only reason for the hospitalization? Please make sure your cat was not diagnosed with diabetic ketoacidosis (DKA). We are more aggressive about dosing if DKA was in the picture.

I was told he had DKA, probable pancreatitis and that the diabetes was not controlled adequately. Seeing vet again tomorrow.

 

[FrostD]

Given that 72 you caught I would reduce to 2.75U. I understand you're trying to follow what vet is saying, but this really is not going to be the insulin for him. That was an absolutely massive drop that just triggered another sky high bounce, and that is going to continue to happen. With the DKA in the picture, I fear staying in Vetsulin is just going to trigger a relapse into DKA. Another point to consider is kidneys - he is well above renal threshold the majority of the time, over time that will damage his kidneys, as well as possibly cause some neuropathy. And his general well being - consider how you'd feel if your blood sugar swung that much that fast...I suspect any diabetic would tell you that feels like crap.

Again, not criticisms of you, just stating what I see on spreadsheet and current health

 

[FrostD]

To add - you cannot increase the dose to help the numbers because then you very seriously risk hypoglycemia. We recommend BG stay above 90 on Caninsulin.

 

[FitzC]

Given that 72 you caught I would reduce to 2.75U. I understand you're trying to follow what vet is saying, but this really is not going to be the insulin for him. That was an absolutely massive drop that just triggered another sky high bounce, and that is going to continue to happen. With the DKA in the picture, I fear staying in Vetsulin is just going to trigger a relapse into DKA. Another point to consider is kidneys - he is well above renal threshold the majority of the time, over time that will damage his kidneys, as well as possibly cause some neuropathy. And his general well being - consider how you'd feel if your blood sugar swung that much that fast...I suspect any diabetic would tell you that feels like crap.

Again, not criticisms of you, just stating what I see on spreadsheet and current health

Hi. We feel pretty confused really and I am concerned about how he feels. I don't feel it is working well as he has been an inpatient 3 times now including his initial diagnosis in early October. Due to him having a high reading this morning I called the vet. They said to do so if reading goes above 25 and it was 29.6 (around 530 US I think). On this basis I was told to give 3.5 units tonight. I am going to test him and see. I am concerned about just wacking the dose up and the effect on him and his longer term health. We are seeing the vet first thing tomorrow. I am going to push for an insulin switch.

I appreciate your help.

 

[FrostD]

Please do not give 3.5U. you can see he dropped from 29.7 down to 4. That leaves you almost no room for error against a hypo event, and that's as at 3U, let alone 3.5U. If the vet was aware of that 4 mmol and still recommended an increase I'll go take his license away myself, oy

 

[Marje and Gracie]

Regarding Pilchards dose, if you do change over to Prozinc then i would personally if it were me start at 1.0 unit and build up as required, it's easier to build up the dose rather than give too much and risk a hypo, a more experienced member can help you with this but that's my personal view.

I just saw this and want to warn you against restarting at 1u if you switch insulins. That’s not how we do it here and especially if the cat has had DKA. No matter which insulin you switch to, we see where he is making progress on the current insulin and then start at that dose. For example, he’s seeing a green nadir at 3u of Caninsulin although with that 72 today, I am going to urge you to reduce his dose to 2.75u tonight. If that dose is one that works better for him, then a new insulin would be started around that dose but not at 1u unless he earns reductions to 1u between now and when you switch.

I honestly wouldn’t be surprised if he’s overdosed based on his patterns and how quickly the dose was increased by 1u each time. We increase by very small increments (generally 0.25u) so we don’t miss the correct dose. He was looking better at 2u although if you don’t have any nighttime tests at all, you are missing half your data and cats frequently drop low at night.

 

[FitzC]

Please do not give 3.5U. you can see he dropped from 29.7 down to 4. That leaves you almost no room for error against a hypo event, and that's as at 3U, let alone 3.5U. If the vet was aware of that 4 mmol and still recommended an increase I'll go take his license away myself, oy

Think the 3.5 was if the pre shot evening reading was around 29 again.

It was back mid twenties so I gave 2.75. Just checked him at 12.15am and he was 12.8.

 

[FitzC]

I just saw this and want to warn you against restarting at 1u if you switch insulins. That’s not how we do it here and especially if the cat has had DKA. No matter which insulin you switch to, we see where he is making progress on the current insulin and then start at that dose. For example, he’s seeing a green nadir at 3u of Caninsulin although with that 72 today, I am going to urge you to reduce his dose to 2.75u tonight. If that dose is one that works better for him, then a new insulin would be started around that dose but not at 1u unless he earns reductions to 1u between now and when you switch.

I honestly wouldn’t be surprised if he’s overdosed based on his patterns and how quickly the dose was increased by 1u each time. We increase by very small increments (generally 0.25u) so we don’t miss the correct dose. He was looking better at 2u although if you don’t have any nighttime tests at all, you are missing half your data and cats frequently drop low at night.

Hi. His evening reading was mud twenties. I gave the 2.75 dose. I checked him at 12.10am and he was 12.8. Thanks for advice.

 

[Marje and Gracie]

Hi. His evening reading was mud twenties. I gave the 2.75 dose. I checked him at 12.10am and he was 12.8. Thanks for advice.

You’re welcome Please be sure you post all your BGs in the US mg/dL format as we don’t use mmol/L here. You can just check his SS and see what it converted the World number to. Any time he drops below 90 mg/dL, you should reduce the dose by 0.25u.

 

[Bron and Sheba (GA)]

Hi Claire, just wanted to check that you are feeding Pilchards plenty of food as I see he recently had DKA. Cats who have had DKA need to eat more than than their normal amounts as they recover as food helps keep ketones away. Insulin is also important so don’t skip any doses. If you are unsure, post and ask for help.
Are you testing a couple of times a week for ketones in the urine? If not I would recommend you go out and buy a bottle of dia-Ketostix and test Pichards urine. We don’t want to see any ketones in the urine at all. Please report any ketones.
I know you are going to try and swap to another more suitable insulin but in the meantime are you feeding Pilchard 30 minutes before you give the insulin? And are you giving him snacks during the first half of the cycles?

 

[FitzC]

Hi Claire, just wanted to check that you are feeding Pilchards plenty of food as I see he recently had DKA. Cats who have had DKA need to eat more than than their normal amounts as they recover as food helps keep ketones away. Insulin is also important so don’t skip any doses. If you are unsure, post and ask for help.
Are you testing a couple of times a week for ketones in the urine? If not I would recommend you go out and buy a bottle of dia-Ketostix and test Pichards urine. We don’t want to see any ketones in the urine at all. Please report any ketones.
I know you are going to try and swap to another more suitable insulin but in the meantime are you feeding Pilchard 30 minutes before you give the insulin? And are you giving him snacks during the first half of the cycles?

Hiya. Keto sticks arrived today so testing later. Saw vet yesterday, clinically happy and with readings too. He is looking better and playing a bit. Would still like a lower dose or swap of insulin. Vet a bit resistant. I usually have great faith in my vet he has looked after my other animals well. Under review.

Pilchard is fed 4 times throughout his cycle (evenly), use timed feeder if I need to. He tends to get a small piece of chicken as a treat between his main feeds. I mean the size of a 50 pence piece.

I test his BG, then draw up the insulin. Portion his food out and he gets his jab when he is fed, this is what I was advised.

 

[Elizabeth and Bertie]

He is looking better and playing a bit.

Am so glad to hear that Pilchard seems to be feeling a bit better.

Would still like a lower dose or swap of insulin.

From the data on Pilchard's SS (well done with that, BTW!) it looks like the dose is still too high...

That was a massively steep drop on the 28th from 29.7 to 4mmol... And then 3 hours later it had shot up to 26.4.
That looks very much like 'bouncing' (rebound), and is actually a really good example of this. Can you see - if you look at the pattern of numbers there on your SS - that it looks rather like a rubber ball dropping fast from high to low-ish numbers, hitting the ground hard, and then bouncing upwards ?

Bouncing is pretty common. And it can happen if the blood glucose drops too fast or too low, or both.
When the blood glucose drops too fast/low the body can respond to that perceived threat by releasing its own stored glycogen to raise the blood glucose level. It can also release hormones that can cause temporary insulin resistance, keeping the blood glucose from dropping. The effect can last anything from hours up to a few days. A common pattern is to see fast drops and/or low numbers followed by periods where the numbers are high and unresponsive to insulin. When the bounce wears off the body becomes responsive to insulin again... This can become a repeating pattern.
Sometimes vets increase the insulin dose because of the high numbers. But, in a pattern like this increasing the dose is not the answer, and it can just exacerbate the problem. Unfortunately it can also put the cat's health and life at risk...

That drop to 4mmol was, in itself, also too low for Caninsulin... Because Caninsulin can drop the blood glucose fast anyway it is safer to try to not let it drop below about 5mmol at the lowest point of the cycle. (This gives some buffer of safety in case it dose actually drop a bit lower.)

You are doing great! And you should be proud of yourself. You've learned to test blood glucose. And you've got a spreadsheet set up and are collecting data. That's fab!
Now that you are collecting data on your SS you have the chance to actually see what is happening with Pilchard's blood glucose. And I think you may be able to see now that the dose is too high and needs to be reduced in order to allow the numbers to settle out, and to help keep Pilchard safe from hypo...?
Because he's dropped below 5mmol, that means a dose reduction of at least 0.25 of a unit. If this were my cat I'd drop back to 2 units at this point, and then increase the testing to get a better picture of what is happening to the blood glucose on that dose. Getting more data will show you if that dose is too low or still too high.

I test his BG, then draw up the insulin. Portion his food out and he gets his jab when he is fed, this is what I was advised.

Yes, the sequence is usually Test, Feed, Shoot. And many people find it easiest to give the shot when the cat is eating.
With Caninsulin however, because it can start acting very quickly, some people find it helpful to wait for 20 - 30 minutes between feeding and giving the insulin shot. That's just so that the food has a chance to get into the system for when the insulin starts working. An option to withholding food completely is to give most of the meal after the test, and then keep a little back for when you give the insulin shot.
Snacks during the first half of the insulin cycle can help to slow the drop in blood glucose too. And this can, in turn, help to reduce low numbers and 'bouncing'.

Claire, forgive me if I've already asked you this (my old brain gets confused, haha!). Are you anywhere near the RVC in Herts? If so it's 'possible' you could get Pilchard onto their current remission trial...

Eliz

 

[Diana&Tom]

Hi Claire! There are a few of us here in the UK and we will always try to help as much as possible. Elizabeth has given you her usual excellent advice - I’d agree that the current dose looks too high - and don’t hesitate to ask if you’re not sure about anything

 

[FitzC]

I really do appreciate your help. I can see what you refer to in the figures.

I am very concerned about Pilch, the dose and impact long term. I am checking him more often on this dose. I attended the vet armed with my records and said I was concerned about insulin resistance, upswing etc, pointed out the plunge. We had a Graduate Vet, not the vet we expected. Not knocking her all vets start as Grad vets. She checked concerns with more senior vet. Vet response: he is not insulin resistant, leave dose as it is. The drop to 4 was not a concern, nor was the jump back up. The main concern for now is BG levels, as this is the current threat to him. The referral centre (Somerset) has not been back to them yet. Change to other insulin discouraged.

I felt a bit deflated and possibly thought of as a fusser. I am not sleeping too well as I get up to check how he is. I feel a bit doubtful of my own thinking. Pilchard looks "clinically well" at the moment but we have been here before. I will watch figures for the next few days and if I feel uneasy still, then it will be the referral centre as my vets seem pretty fixed.

I am willing to try test, feed and shot 20 mins later.

* I am in Devon, so Herts is a good drag but if they would accept me I would go like a rat up a drainpipe! We used to take our dog from Manchester to London for cancer treatment and wait hours*.

Thank you.