New Member - Hannah’s insulin journey

[shanny_c]

Hi everyone,

My name is Shan, my husband Sean and I are new here and looking for guidance on my cat Hannah’s diabetes management. I’d really appreciate any advice.

Background:

• Hannah is a 13-year-old cat, about 7–7.3 lbs, she only has 3 legs and almost no teeth (due to severe teeth infection 4 years ago)
• She was diagnosed with diabetes in the beginning of March, she displayed symptoms of excessive urination, drinking a lot of water, weight loss, fatigue, and diabetic neuropathy.
• Vet did full check up on her, everything else seems fine according to the vet, including her kidney and pancreas.
• Currently on 1 unit of Lantus (insulin glargine U100) every 12 hours
• She is eating a low-carb wet food diet (all canned)- Purina Pro Plan Focus Adult 11+ Chicken and Beef. According to the chart our vet gives us, this can food only has 2% carbs in it.

Recent health issue:
Last Wednesday(3/25), we brought her to the vet to install the Freestyle Libre 3 Plus sensor, when she came back, she ate some food but less than 5 minutes started to vomit violently, for the next 6 hours, she threw up 3 more times after eating each time. We suspected she was really stressed after the vet visit, I stayed up all night monitoring her, but thank goodness vomiting stopped at around 10pm. On Monday, after a few failed attempts of insulin injections (I got it in eventually) she had 3 episodes of vomiting in the morning and seemed quite stressed again. But it stopped luckily on Monday afternoon. Since then, her appetite and condition have improved, and she is now eating again.

Monitoring:
We are using a FreeStyle Libre 3 Plus sensor for continuous glucose monitoring (we are not doing ear pricks due to stress).

Her insulin level on 3/30 evening til 3/31 early morning

Insulin level on 3/31 morning until afternoon (around 5pm)

Insulin level from 3/31 night until this morning at 4am


Blood glucose patterns:

• After her sensor was installed on 3/25, her nadirs were around ~190 mg/dL, but mostly really high even with 1 unit of insulin twice a day. So my husband emailed the vet with screenshots, vet responded with increasing her dose to 2 Units twice a day.
• But right after vet made this decision on 3/30, in the past couple of days (as shown on the screenshot above), her nadirs have dropped significantly to around ~100 mg/dL (sometimes close to that range consistently) This whole time, due to our concern of her vomit and fear of low blood sugar, we still only have been giving her 1 unit twice a day
• During the day, she can drop from 300+ down into the low 100s

However:

• At night, her glucose often rises again, sometimes reaching 300+ or even “HI”
• The pattern seems to be:
  
  • Good daytime drops
  • Followed by nighttime highs

International Trip soon:

• Sean and I are going to China on 04/19, coming back on 5/2. I really wish it can be cancelled but it’s a really important trip booked last year (my grandma is going to meet Sean for the first time in person)
• We booked a sitter on Rover, she is trained vet assistant and comfortable with doing insulin shots. She will come twice a day to do the shots, but she can only come 10-hours apart, but our vet said 10-12 hours should be fine?
• We also bought automatic feeder, to ensure Hannah can have food 4 times a day.

My questions:

1. Does this blood sugar pattern look like bouncing from lower numbers (since she recently started reaching near-normal ranges)?
2. Could this be related to her recent vomiting/stress earlier in the week?
3. Is 1 unit still an appropriate dose, given that she can drop to ~100, but still has high numbers later in the cycle?
4. Since we are using an insulin pen (only allowing whole units), would it be better to switch to syringes for finer adjustments?
5. Since we are going on 2-week trip pretty soon, should we remain 1 unit until we come back to adjust more dosage?

Miscellaneous notes:

• We ordered Zobaline for her neuropathy, but haven’t started yet due to still unstable blood sugar level and recent vomit.
• Good things we’ve noticed since insulin started on 3/9: she pees significantly less, before 6-7 times, now only 2-3 times a day. Her weight went from 6.7 lbs (3/2) to 7.3 lbs (weighed at vet last Wednesday). She still has good appetite and eats about 2-2.5 3oz can a day.

Please let me know if there’s any other information I can provide. I truly appreciate any help/advice given, it’s been a tearful and stressful month, with a lot of uncontrollable factors adding in, but we don’t want to give up on Hannah, just like how she’s never given up on herself.

Shan and Sean

---

 

[CORKY]

Welcome to FDMB
you are doing all the right things, however your vet is wrong about the Purina Pro Plan chicken and beef wet/dry food this food contains 25.5 % Dry Matter Carbs, which is what you want to look for, he gave you the carbs as fed; cats cannot digest carbs, most likely the high numbers, I see are because of this food here’s the calculation of the nutrients, and yes cats are very sensitive to stress, and there's nothing that can stress them more than a visit to the vet, now, have you always fed low carb food? diabetic cats need to have a diet of wet can or raw food between 0-10% carbs, most member feed Fancy Feast Pate, or Friskies Pates, most feed up to 5%, if you were not feeding the food you described before, the vomiting could be the cause, transitioning of food needs to be a slow process, especially from dry, high carbs, not to upset the stomach and it also causes a dive in the glucose level. is important for Hannah to have a feeding schedule and feed between 3-4 times during the day, plus the two main meals before shot, Lantus is a Depot insulin and food keeps the insulin in check (no food 3-4 hours before shot) so grazing is out of the question the protocol for Lantus TEST/FEED/SHOOT of course using the Libre, you just check the monitor, with the sensor/monitor also you should have a hand held monitor, most members use the ReliOn Premier human monitor and strips, (Walmart), in case the sensor falls off or stops working before the 14 days, that's how long a sensor lasts, also if you get a 2 digit reading you need to test manually, the Libre tends to read the low numbers lower than reality, so you will take the human monitor BG as value, if your vet discusses a "Curve" please do not take Hannah to the vet for that, a curve is simply testing every 2-3 hours for a cycle (12 hours ), the Libre does that by itself, at the vet you would be wasting your money and placing Hannah under stress, so the BG numbers will be unrealistic which can cause an unnecessary increase in dose. below are several links, We are very numbers oriented, and we all want to be on the same page, so we would like you to create your signature and Hannah's spreadsheet, you do not need to insert every hour for the day, the important BG numbers are the prior to shot and 3-4 other BG readings during the day, also a link for a Drs. approved food list, the third column will contain the carb %s, a carb calculator, you can calculate the food with the nutrient %s, in the food, remember we are looking for the DRY MATTER CARBS. We are here for you; Hannah is lucky to have you. I do not give dosing advice, but I will tag a member that can assist you with dosing, you m are in the right place
@Sienne and Gabby (GA)

Sticky - New? How You Can Help Us Help You!
https://felinediabetes.com/FDMB/threads/how-to-create-a-spreadsheet.241706/
https://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf
Cat Food Nutrition Calculator | Elizabeth C Scheyder

 

[Kobe (Dean and Lesley)]

Since we are using an insulin pen (only allowing whole units), would it be better to switch to syringes for finer adjustments?

It is possible to use a syringe with an insulin pen allowing for 0.25 unit adjustments. That is how many of us use the pens. An experienced member will help you with finding an insulin dose that will be effective AND SAFE for your cat. Changing the dose by a whole unit at a time is dangerous. One unit for a human isn't a big change, but it is for a cat! Your insticts were right on!!!

For Lantus you will need U-100 Syringes. The size is important. If you geat a huge syringe, you won't be able to do tiny doses. Look for Size: 3/10cc. You want a short, fine guage needle, like 31G x 5/16’’. You need Half Unit Markings to do the fine dosing. Walmart and Sams have these BEHIND the counter at pharmacy. I have also used this kind from Amazon:
UltiCare VetRx U-100 Pet Insulin Syringes, Comfortable & Accurate Dosing of Insulin for Pets, Compatible w/Any U-100 Strength Insulin, Size: 3/10cc, 31G x 5/16’’, w/Half Unit Markings, 60 ct Box

The ones from Walmart, Sams, and the Ulticare ones from Amazon are all good.

This group saved my cat. We will help you!!!

 

[CORKY]

Yes! The members that give dosing advice recommend to increase/decrease in 0.25 units at a time and it usually takes 3 cycles with the same dose to begin to see changes and a pattern, this is where the spreadsheet becomes very important for you and the members that assist you
Also, once Hannah is fully on 0-10% carbs you will see less pooping, maybe every other day, there’s to waste anymore, all cats are different thiscIS in case Hanna’s litter box behavior changes is not out of constipation, Corky and Coco grew up from babies with MeauMix dry grazing, when Corky was diagnosed both were transitioned to Fancy Feast, they used to poop sometimes even twice a day, now is every other day, fish tends to constipate a bit, liver and giblets Feeding 1/2 a can in each meal is good.

 

[squeem3]

The UltiCare VetRX have only 60 syringes in a box. A box of (Human) insulin syringes has 100. There's no difference at all between U100 veterinary syringes and U100 Human syringes other than the amount of syringes per box and the price (UltiCare VetRX is $$).

If you have a Walmart nearby, the Relion brand of syringes is good. You want U100 3/10cc. The box will not specifically say half unit markings but the syringes do have them. Don't ask the pharmacist about half unit markings because most of the time they have no idea what you are talking about and may try to get you to buy 1/2cc syringes instead (you don't want these).

Or just buy your syringes at any pharmacy with a prescription or various places online. Amazon doesn't require a prescription. Diabetic supply web sites may ask for a prescription. It depends on what your state law is. Lots of brands out there: Monoject, BD / Embecta, UltiCare, etc.

Zobaline is expensive. Here's a cheaper alternative:

posted by @Diane Tyler's Mom GA

the Vitacost brand another member told me about
Vitamin B-12 Methylcobalamin -- 5000 mcg - 100 Capsules

Same as Zobaline , but the Zobaline is so expensive as you know
This is the same thing
The only difference is the Zobaline has 200 mcgs of folic acid
So I bought the folic acid at the supermarket and crush it up and added it to the Vitacost brand
If you can't find the 200 mcg get the 400 mcg and cut it in half and crush it up and add it, some members didn't even add the folic acid and the neuropathy improved
The Vitacost brand is a capsule so just open it and pour the powder on the wet food
Has no taste, no need to crush it up, I still give it to Tyler every now and then and he has never tasted it in his food , I always add water to his food and just stir up the methyl B-12 good
I switched to the vitacost brand because the zobaline was too expensive,
Even though the vitacost brand is 5000 mcgs and the zobaline is 3000 mcgs
What they don't need they will pee out because it's water soluble.

The Zobaline is expensive for 60 pills, 30.00 some other places want 33.00
I used to use the Zobaline when I joined, then a member told me about the Vitacost brand .

It took about 2 months for Tyler to get back to walking normal, jumping on to the couch, running around
But every few weeks I did see a slight improvement

Info on using Lantus for cats: Lantus / Levemir / Biosimilars

Dose changes are only made 0.25 units at a time. You have to hold a dose for at least 7 days to build up the depot. The only exception is if the cat hypos which means a decrease of 0.25 units at the next insulin time.

The food charts:

Links to FOOD CHARTS

A newer US chart: Cat Food As-Fed Chart

CGM info: Getting Started With Continuous Glucose Monitors (CGMs) for Diabetic Cats

You'll need to know how to test from the ear or a paw pad as a back up in case the Libre fails or falls off (it happens) or reads LO. If the vet didn't tell you, the Libre only lasts for 2 weeks before it needs to be replaced. A replacement is expensive.

 

[shanny_c]

Welcome to FDMB
you are doing all the right things, however your vet is wrong about the Purina Pro Plan chicken and beef wet/dry food this food contains 25.5 % Dry Matter Carbs, which is what you want to look for, he gave you the carbs as fed; cats cannot digest carbs, most likely the high numbers, I see are because of this food here’s the calculation of the nutrients, and yes cats are very sensitive to stress, and there's nothing that can stress them more than a visit to the vet, now, have you always fed low carb food? diabetic cats need to have a diet of wet can or raw food between 0-10% carbs, most member feed Fancy Feast Pate, or Friskies Pates, most feed up to 5%, if you were not feeding the food you described before, the vomiting could be the cause, transitioning of food needs to be a slow process, especially from dry, high carbs, not to upset the stomach and it also causes a dive in the glucose level. is important for Hannah to have a feeding schedule and feed between 3-4 times during the day, plus the two main meals before shot, Lantus is a Depot insulin and food keeps the insulin in check (no food 3-4 hours before shot) so grazing is out of the question the protocol for Lantus TEST/FEED/SHOOT of course using the Libre, you just check the monitor, with the sensor/monitor also you should have a hand held monitor, most members use the ReliOn Premier human monitor and strips, (Walmart), in case the sensor falls off or stops working before the 14 days, that's how long a sensor lasts, also if you get a 2 digit reading you need to test manually, the Libre tends to read the low numbers lower than reality, so you will take the human monitor BG as value, if your vet discusses a "Curve" please do not take Hannah to the vet for that, a curve is simply testing every 2-3 hours for a cycle (12 hours ), the Libre does that by itself, at the vet you would be wasting your money and placing Hannah under stress, so the BG numbers will be unrealistic which can cause an unnecessary increase in dose. below are several links, We are very numbers oriented, and we all want to be on the same page, so we would like you to create your signature and Hannah's spreadsheet, you do not need to insert every hour for the day, the important BG numbers are the prior to shot and 3-4 other BG readings during the day, also a link for a Drs. approved food list, the third column will contain the carb %s, a carb calculator, you can calculate the food with the nutrient %s, in the food, remember we are looking for the DRY MATTER CARBS. We are here for you; Hannah is lucky to have you. I do not give dosing advice, but I will tag a member that can assist you with dosing, you m are in the right place
@Sienne and Gabby (GA)

Sticky - New? How You Can Help Us Help You!
https://felinediabetes.com/FDMB/threads/how-to-create-a-spreadsheet.241706/
https://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf
Cat Food Nutrition Calculator | Elizabeth C Scheyder

Hi Maria,

Thank you so much for this detailed reply, I learned a lot from it, and I have several follow up questions/responses:

1. You said the Purina pro canned food we are giving her has about 25% carbs in it, I read through the chart you attached carefully, and realized this is the same chart our vet gave us when Hannah was first diagnosed, on there, the specific can we picked showed carb content of 2%, as shown in the screenshot below:
So should we still proceed with this can food?

2. You asked have I always fed Hannah low carb food? I would say half and half. She LOVES dry food but I am under the impression that it’s best to feed cats wet food, my other cat Cheeky has been on all canned diet since I adopted him. But since Hannah loves dry food so much, so I introduced wet food to her when she first came to our house, and let her eat half wet and half dry food all this time. Only after she got diagnosed with diabetes in the beginning of March, did I transition her diet to all canned food. Does cat take this long to fully get used to diet change usually?

3. I had no idea about the no feeding 3-4 hours before insulin shot, I definitely have been feeding her an hour or 2 before her evening shots…I’ll add that to my notes, thank you so much for this info!!

4. Vet did suggest us taking her in for them to do the blood draw and test for BG for 12 hours, we never consider that option especially given how last time Hannah threw up so much after vet visit of installing the libre, let alone leaving her there for 12 hours…

5. I feel like such a wuss for saying this, but I’m terrified to do the ear pricks for blood, it took me multiple teary tries to finally kind of got a hold of insulin shot…Hannah is also really easily stressed with pain too, as Monday I failed a couple times on insulin and afterwards she threw up again and tried to hide away, so I’m really not confident on doing the test strip…So far she has been not caring about the sensor at all, didn’t try to bite it off or lick it, so hopefully it can stay on for the whole period…

6. Yes I will create the spreadsheet tonight! The app that is linked to her sensor is on my husband Sean’s phone, and he’s at work currently, so when he comes back I’ll collect as much data as I can from the app and attach it to my signature!

Thank you again for your advice on this, finding community like this means the world to Hannah and us…

 

[shanny_c]

It is possible to use a syringe with an insulin pen allowing for 0.25 unit adjustments. That is how many of use the pens. An experienced member will help you with finding an insulin dose that will be effective AND SAFE for your cat. Changing the dose by a whole unit at a time is dangerous. One unit for a human isn't a big change, but it is for a cat! Your insticts were right on!!!

For Lantus you will need U-100 Syringes. The size is important. If you geat a huge syringe, you won't be able to do tiny doses. Look for Size: 3/10cc. You want a short, fine guage needle, like 31G x 5/16’’. You need Half Unit Markings to do the fine dosing. Walmart and Sams have these BEHIND the counter at pharmacy. I have also used this kind from Amazon:
UltiCare VetRx U-100 Pet Insulin Syringes, Comfortable & Accurate Dosing of Insulin for Pets, Compatible w/Any U-100 Strength Insulin, Size: 3/10cc, 31G x 5/16’’, w/Half Unit Markings, 60 ct Box
Buy it againView your item
The ones from Walmart, Sams, and the Ulticare ones from Amazon are all good.

This group saved my cat. We will help you!!!

Thank you so much for the syringe link!! Buying right now!

 

[shanny_c]

Yes! The members that give dosing advice recommend to increase/decrease in 0.25 units at a time and it usually takes 3 cycles with the same dose to begin to see changes and a pattern, this is where the spreadsheet becomes very important for you and the members that assist you
Also, once Hannah is fully on 0-10% carbs you will see less pooping, maybe every other day, there’s to waste anymore, all cats are different thiscIS in case Hanna’s litter box behavior changes is not out of constipation, Corky and Coco grew up from babies with MeauMix dry grazing, when Corky was diagnosed both were transitioned to Fancy Feast, they used to poop sometimes even twice a day, now is every other day, fish tends to constipate a bit, liver and giblets Feeding 1/2 a can in each meal is good.

To be honest with the current can diet, her pooping has been kind of inconsistent like once a day or once every other day… We found it kind of weird but her poop doesn’t seem unhealthy or anything so we haven’t given it too much thought yet…Hannah also grew up eating Meowmix dry food! But after we got her from my husband’s late mother in 2022, I have been giving her half wet half dry food as I mentioned in the previous reply

 

[shanny_c]

Welcome to FDMB
you are doing all the right things, however your vet is wrong about the Purina Pro Plan chicken and beef wet/dry food this food contains 25.5 % Dry Matter Carbs, which is what you want to look for, he gave you the carbs as fed; cats cannot digest carbs, most likely the high numbers, I see are because of this food here’s the calculation of the nutrients, and yes cats are very sensitive to stress, and there's nothing that can stress them more than a visit to the vet, now, have you always fed low carb food? diabetic cats need to have a diet of wet can or raw food between 0-10% carbs, most member feed Fancy Feast Pate, or Friskies Pates, most feed up to 5%, if you were not feeding the food you described before, the vomiting could be the cause, transitioning of food needs to be a slow process, especially from dry, high carbs, not to upset the stomach and it also causes a dive in the glucose level. is important for Hannah to have a feeding schedule and feed between 3-4 times during the day, plus the two main meals before shot, Lantus is a Depot insulin and food keeps the insulin in check (no food 3-4 hours before shot) so grazing is out of the question the protocol for Lantus TEST/FEED/SHOOT of course using the Libre, you just check the monitor, with the sensor/monitor also you should have a hand held monitor, most members use the ReliOn Premier human monitor and strips, (Walmart), in case the sensor falls off or stops working before the 14 days, that's how long a sensor lasts, also if you get a 2 digit reading you need to test manually, the Libre tends to read the low numbers lower than reality, so you will take the human monitor BG as value, if your vet discusses a "Curve" please do not take Hannah to the vet for that, a curve is simply testing every 2-3 hours for a cycle (12 hours ), the Libre does that by itself, at the vet you would be wasting your money and placing Hannah under stress, so the BG numbers will be unrealistic which can cause an unnecessary increase in dose. below are several links, We are very numbers oriented, and we all want to be on the same page, so we would like you to create your signature and Hannah's spreadsheet, you do not need to insert every hour for the day, the important BG numbers are the prior to shot and 3-4 other BG readings during the day, also a link for a Drs. approved food list, the third column will contain the carb %s, a carb calculator, you can calculate the food with the nutrient %s, in the food, remember we are looking for the DRY MATTER CARBS. We are here for you; Hannah is lucky to have you. I do not give dosing advice, but I will tag a member that can assist you with dosing, you m are in the right place
@Sienne and Gabby (GA)

Sticky - New? How You Can Help Us Help You!
https://felinediabetes.com/FDMB/threads/how-to-create-a-spreadsheet.241706/
https://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf
Cat Food Nutrition Calculator | Elizabeth C Scheyder

Sorry here’s the screenshot of the wet food we are using:

 

[squeem3]

That's the Catinfo.org chart which many people use. Just look at the column for carbs and choose foods that have under 10% carbs. Do keep some higher carb foods on hand to use in case your cat has hypoglycemia. The high carbs will raise blood glucose levels and keep them more stable than honey / syrup will.

Since your cat has a Libre that monitors blood glucose levels constantly, there's no need at all to bring the cat to the vet for a curve that will be $$$ and most likely show elevated blood glucose levels. Many cats get super stressed out at the vet's office and stress elevates levels.

 

[shanny_c]

That's the Catinfo.org chart which many people use. Just look at the column for carbs and choose foods that have under 10% carbs. Do keep some higher carb foods on hand to use in case your cat has hypoglycemia. The high carbs will raise blood glucose levels and keep them more stable than honey / syrup will.

Since your cat has a Libre that monitors blood glucose levels constantly, there's no need at all to bring the cat to the vet for a curve that will be $$$ and most likely show elevated blood glucose levels. Many cats get super stressed out at the vet's office and stress elevates levels.

Yep I picked the one with 2% carb content, hopefully that will help her throughout this journey! And thank you for the tip on the higher carb food, my other cat Cheeky is on a higher carb can (about 9%), I’ll use that as emergency food for Hannah.

I totally agree with you on the curve monitoring at the vet, we will never bring Hannah in for 12 hours just for that and some inaccurate high-stress data, it’s not worth it in any aspect

 

[CORKY]

1- go to CHEWYCOM look for the food, click n the can or bag, scroll down to ingredients, click use the chart on the calculator, I send you, and compare yourself
2- please note that low carbs are 0-10% carbs, you can buy some can foods, but if they have gravies, most are high carbs - 0-10% LOW CARBS /11-15% medium carbs / 16-24% High Carbs
3-Feeding Hannah1-3 hours before shot, will alter the BG level, especially if the food is high carb, what hours do you shoot? you should give a small snack 2 hours after shot, then every 4 hours, her lst meal before shot should be at least 4 hours before the nest shot, of course when she sleeps at night you wait for the following shot, (see Corky's spreadsheet, below in blue) scroll eft and under remarks you can see what when and what I feed, Corky will be a lifetime diabetic, but he is tightly regulated.
4- I explained to you what a curve was, no need to take Hannah to the vet for that, you are already doing a daily curve with the Libre sensor
5- We feel more pain that our cats do, when pricking, just make sure you insert the lancet forward, not downward, if you look t the lancet with a flashlight you will see it's end is lifted a bit, trust me once the capillaries swell, it will be much easier to draw blood, take a small sock, fill the end with rice, large enough to cup the ear, tie it, this you will use to cup the ear so you have a better hold of the ear, holding the tip of the ear with your index finger, or thumb is all about trial and error, you will find the most comfortable way, once you get the droplet right on the strip, most important I was told at the beginning a very wise phrase " Breath in, breath out, cats are very sensitive to stress, you stress, they stress" those were the magic words I needed to hear.

6-And you got #6, please keep posting all your concerns, no matter how simple, complex or stupid you my think it is, there's no such thing in this Forum, you know Hanna better than anyone. I am here for you, We are here for you, You GOT THIS!!

 

[squeem3]

You'll want a range of higher carb food to have on hand: some medium carb between 11% and 15% carbs and high carb over 15%. Reserve the high carb foods for hypos. These tend to be gravy based like the Fancy Feast Gravy Lovers. I've used junky Science Diet canned at like 30% carb before. The medium carb foods are good to give if your cat is trending a bit low but not quite at hypo level and your cat is not showing symptoms.

Sticky - How to treat HYPOS - THEY CAN KILL! Print this Out!!
Sticky - jojo and bunny's HYPO TOOL BOX

 

[Sienne and Gabby (GA)]

@CORKY - please look at what Shanny_c posted. They are feeding an all canned diet and the particular Pro-Plan they are using is 2% carb.

If you don't want to buy a food that's higher than 9% carb, you can always add corn or maple syrup (a few drops) to your cat's food to raise the carb level. Squeem3 gave good information about the carb levels and to have some high(er) carb food in stock to help if numbers drop.

Poop issues: When you switch your cat to a species appropriate diet (i.e., low carb), their poop changes. They are absorbing more of the nutrients and there is less bulk due to the lack of carbs. They tend to have fewer bowel movements and the litter box isn't as smelly!

Making a food transition slowly is the way to do things. A rapid transition from dry to canned and cause a GI upset.

The basic approach to feeding is no food in the 2 hours prior to shot time. However, if you happen to get a blood glucose test and your cat's numbers are low, you do need to intervene to bring numbers up. I had instances where my cat's numbers were below 50 in the hours before shot time and she got some high carb food to raise her numbers.

One VERY important note -- under no circumstances give a shot twice. It doesn't matter if you poked your cat and saw the insulin squirt across the room. You have no way to know how much insulin may have gotten into your cat. If you keep trying to give a shot, there is a risk of overdosing your cat. We do our best to ensure safety always comes first. It is better to miss a shot than not know how much insulin your cat got.

Please keep asking questions. We're here to help.