New Member - Need advice on starting insulin

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Aster

Aster

Member Since 2021
Our cat, Flora, was diagnosed with diabetes on Friday, 2/19. She tested 285 at the vet on Thursday and then 500-ish on Friday when we took her back in. The vet visit was prompted by another issue (an infection in her lip/jaw area). The abscess opened up on its own Thursday night and was cleaned at the vet on Friday. She was given injectable antibiotics, and the wound is almost healed as of today.

Pre-diagnosis: Eating wet food (with sauce/gravy) in the morning, access to grain-free dry food all day. Had recently lost weight and we noticed a lot of urine in her litter box over the last few weeks.

Post-diagnosis: We immediately switched her to low-carb pate wet food both morning and evening. Over the weekend, her drinking and urine output decreased dramatically.

For the last 2 days, we have been trying to get a glucose reading at home. We finally succeeded this evening - after she ate. The reading was 390 with the Relion Premier meter. We plan on trying to get another reading in the morning before she eats.

From my research, it seems like our best chance for remission is by starting her on insulin ASAP. I wanted to see how she reacted to the diet change before starting injections. That's why we waited. We have a prescription for Lantus and the vet is advising 1 unit, twice a day. She is a tiny cat - weighs less than 5 pounds.

Any thoughts? I am prepared to start injections. In a perfect world, I would love to have more BG data, but I am scared that waiting to start insulin will hurt her chances at remission.
 
Hi and welcome Aster and Flora to the forum.
Well done setting up the spreadsheet and starting testing. And swapping to a low carb diet.
If you are going to wait to start the insulin I would test for ketones in the urine which can form in diabetic cats who are not getting enough insulin and enough food. You will need to buy a bottle of Ketostix from Walmart or a pharmacy. Collect a urine sample and dip the test strip in and compare the colours of the strip against the colours on the side of the bottle. Anything above a trace I would start the insulin and tell the vet.

I’m glad you got the infection cleared up.

To get a cat into remission, your first goal needs to be to get Flora regulated.
Give her a meal before each dose and then a couple of snacks during each cycle in the first half of the cycle (the first six hours.)
So you test the BG, feed Flora , then give the shot.
If the BG is below 200 to start with post and ask for help. Don’t feed her but stall, and test again 20 minutes later.

With the dose, because you are feeding a low carb wet diet, I would start off with 0.5 units twice a day, 12 hours apart.
You need to hold the dose for 5 to 7 days to let the depot fill, unless the BG drops below 50 in which case you would lower the dose.

Always test before every shot and try and get at least one test in every cycle to see how low the insulin is taking Flora.
Dont feed for the 2 hours preshot as we don’t want the BG food influenced.
Do you have the syringes? U100 3/10 ml 30 or 31 gauge, 6 to 8 mm. With 1/2 unit markings?

keep asking questions.
Bron
 
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Thanks for the advice thus far. We picked up her insulin and syringes today but are really struggling to get blood for testing. I am warming her ear with rice in a fabric bundle, then using a lancet with 30g needle. I tried 3 spots in each ear just now and none brought up enough blood for testing. I try to rub her ear a little bit to get the blood moving, but just the tiniest bit of blood is coming out - not enough for the meter. And, unfortunately, she becomes uncooperative after the first couple of tries. Any tips? Or just keep trying?

Not really feeling comfortable injecting insulin until we have some numbers to go on.
 
A 26 or 28 gauge lancet is better as it makes a bigger prick and easier to get the blood.
It also becomes easier as time goes by as the ears learn to bleed as they grow more capillaries.
Are you giving a read each time you test even if unsuccessful?
If you are able to go out now and buy the 26 or 28 gauge lancets I would do that.
Let us know how you get on.
 
We tried one more time before feeding her. Success! 386 And this is 11.5 hours after she last ate.

I want to try to get a reading a couple hours after she eats to see how the food is affecting her. Again, this is all prior to starting insulin. And, yes, we are treating her with tiny bits of cooked chicken breast to try to make the experience more positive.
 
Aster said:
We tried one more time before feeding her. Success! 386 And this is 11.5 hours after she last ate.

I want to try to get a reading a couple hours after she eats to see how the food is affecting her. Again, this is all prior to starting insulin. And, yes, we are treating her with tiny bits of cooked chicken breast to try to make the experience more positive.
Click to expand...
Sounds like you have had success! Well done! It will get much easier.
It is normal to have a food bump of the BG a couple of hours after food, if the pancreas is not producing insulin. That is when the insulin will start to kick in and start lowering the BG.
 
So we started insulin tonight - just 0.5 units. Her pre-meal, pre-shot BG was 386. 2 hours post-shot it was 243. That's the lowest number we have seen since starting testing. So happy to see it coming down!

As I mentioned previously, she is a super tiny cat and very underweight - just under 5 pounds. She is eating every bit of wet food I put down for her: 1 can of Fancy Feast in the morning and 1/2 can of Friskies in the evening. Based on what I was able to find online, that should be exceeding her daily calorie needs based on her current size. I'm just wondering if I should try offering more since she needs to gain weight. Any tips on helping her gain in a safe way?
 
I would let her eat when she is hungry at the moment. Are you offering snacks during the am and pm cycles. Such as a snack at +2 +4 and +6 for example.
With the main meals I would give the same amount each time. Is the van of FF and the 1/2 can of Friskies the same amounts?

that is quite a drop from Preshot to +2 so make sure you get another test at +4 and post the result please. Also give her a snack now and when you test +4
 
So 12 hours after her first insulin shot of 0.5 units, she is at 119. I fed her but am not planning to give her any more insulin until this evening. Does that sound right?

I'm so thankful we found this site and decided to tackle at home testing. The vet had prescribed 1 unit, twice a day. If we had shot 1 unit this morning when her BG is 119, I feel like we could have inadvertently pushed her into a dangerous situation.

Regarding the food, the morning can is 3 oz. and the evening serving is 1/2 of 5.5 oz. So they are pretty close. I have not been giving her snacks, other than chicken when we are taking blood samples.
 
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I second (or third) the idea of the larger lancets. Going to a 28 gauge made all the difference for us and we can usually do it in one go. Our cat gets extra special treats for the testing and is starting to understand that after a week. My husband is better at testing than I am, but I am better at the injections than he is.
 
I am glad you are managing to test the BGs.
Next time you get a lower than normal preshot number, STALL, DONT FEED AND TEST AGAIN in 20 minutes to see if the BG is going up. Post and ask for help so we can help you.
If you get a lower BG at +2 than the preshot as you did last night, that is an indication that the BG is likely to drop further and you need to test again to see that the BG is not dropping too far. The BG did drop further last night but we don’t know how far. We don’t know if it was the lowest at the AMPS 119 or if it had dropped further during the night and it was just coming back up when it reached 119. By the look of the +1 211 this morning I would not be surprised if Flora is going to bounce......this is normal in newly diagnosed diabetic cats so don’t worry.
But do please test again if you see a falling BG.
Bouncing can happen when the BG drops too fast, too low or lower than the cat is used to. Bounces can last from 1 to 6 cycles and there is nothing you can do about them but wait them out.


I would also consider giving Flora some snacks during the first half of all cycles as well as the preshot meal. It will help stop the BG falling too fast.
If you don’t want her to eat more than she is eating now, give her a bit less at the main meal and use the extra for the snacks.
Bron
 
Thanks, Bron. I am wondering if she is bouncing. Her recent numbers aren't really showing much response to the insulin. I'm assuming it is best to wait, hold steady with the .5 units, and see what happens in a couple days?

We have started giving her a small treat when we test at +2 or +3.
 
Yes definitely looks like bouncing which can last for up to 6 cycles. Nothing you can do but wait.
You need to hold the current dose for at least 5 days to let the depot fill and stabilise unless it drops under 50 in which case you would reduce the dose.
Keep posting daily so we can see how things are going
Well done getting those tests in!
 
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