Sorry for the quickie post there
One of the things we quite frequently see are vets who treat diabetic cats as if they were small diabetic dogs. Unfortunately, cats react to insulin quite differently than dogs. Some of the mistakes we see due to this are:
1. Starting dose based on weight. Dogs get a starting dose based on their weight; cats should generally start at 1 unit per shot (unless ketones may be present).
2. Giving shots once a day. In dogs, insulin can last an entire 24 hours. Cats have faster metabolisms and almost always need shots twice a day.
3. Raising the dose too quickly. Most of the time, you need to give each dose 5-7 days to 'settle in' before you consider raising it.
4. Raising the dose by too much. Most of the time, when you increase the dose, you'll only do so by 1 unit at a time. (With some insulins, you'll only raise by 0.5units at a time.)
Assuming the George did not have ketones, if your vet started you at more than 1 unit of insulin at a time, had you give shots just once a day, or raised the dose without a sufficient 'settling in' time, you are probably giving George too much insulin.
The first thing I'd like you to read is Melissa and Popcorn's
post on how to recognise and treat hypos. Read it, print it out, and tape it to the side of your fridge. When you suspect a hypo is *not* the time to find that your internet connection has gone down. The second thing is to go over Jojo and Bunny's
post on stocking your hypo toolkit, so you know what you might need to have on hand.
Then, back to basics. The next thing you'll want to check out is the
Humulin N Primer. That'll give you an idea of how Humulin N works and how to best use it in your cat. I'll be honest: a lot of cats don't do very well on Humulin N, but there are some cats who do fantastically on it (there are cats who do well on each of the insulins). One of the reasons Humulin N isn't usually one of the top choices is that it takes effect quickly and has fairly sharp drops in blood sugar levels -- and it also wears off quickly in most cats, usually before it's time to give the next shot. But since you're already on it, it's worth trying, so read the primer to learn how to use it best. Any questions, please ask; we *know* this is a terribly confusing situation and we'd much rather answer a so-called stupid question than have someone actually *do* something questionable.
You'll note that one of the recommendations in the primer is get a pre-shot blood sugar reading (so you know whether it's safe to give insulin), then feed George some food (after the test so you don't 'contaminate' the reading with a food spike, and before the shot because you want the cat to have some food in it's stomach to help offset the drop in blood sugar that the insulin is going to induce), and then give the insulin. They also recommend to start at a low dose of insulin (generally 1u twice a day), and raise the dose slowly, after the cat has had a chance to adjust to the insulin. There's a lot more info there as well.
The other thing you should familiarise yourself with is
rebound. It's simple enough to see that not enough insulin can cause high blood sugar readings. It's not as easy to see that too *much* insulin can *also* cause high blood sugar readings. Basically, what happens is that the body notices that the blood sugar is going too low, panicks, and dumps a bunch of stored sugar into the blood sugar. Unfortunately, that panicked, uncontrolled release of sugar into the blood stream is going to raise the blood sugar levels the next time you test. If you see a high reading and increase the insulin without determining the real problem underneath (too much vs too little insulin), you risk making a bad situation worse. This is because, eventually, the body *will* run out of sugar stored in the body, and George *will* hypo.
So: please read up on rebound and hypos, and please at least *consider* dropping your insulin dose. *Sometimes* -- *very* occasionnally -- we do see a cat who needs that much insulin. But in the vast majority of cases, the cat was started at too high a dose, or the dose was raised too quickly, or the dose was raised by too much.
You'll get recommendations to switch to low-carb foods, which are *much* better for diabetics, but that's not a safe thing for you to do at the moment. You'll want to get a bit better at blood testing and also reduce the dose before you change foods. Switching a high-dose cat to low-carb food without reducing the dose can be Very Bad Indeed.
Does your vet have you checking for
ketones? Ketones are not-common but still possible side effect in any person or animal with unregulated / under-regulated diabetes. Small amounts of ketones may be treatable at home; large amounts of ketones may require hospitalisation in a 24-hour care facility. If you test for ketones at home, you can catch them early and hopefully avoid the expensive hospitalisation.
To test for ketones at home, pick up some ketostix from the diabetes section of your local pharmacy. (I've always found them in the aisle, though some folks report their pharmacist keep them behind the counter.) You test for ketones by sticking the the stick in fresh urine. If the stick changes color, ketones are present.
Finally, hints on home-testing: I assume you've gone through the
hometesting links and tips thread. In many cases, the problem is that the ear isn't sufficiently warm -- warm ears promote blood flow
. A lot of folks use a baby sock with a little rice in it, heat that in the microwave for a few seconds, then put it inside the ear, wait a moment and poke. The rice sock both warms the ear up and gives you a sturdy background to poke against.
I never had a lot of luck with the rice sock. I used to give Gwyn's ear a vigorous massage to get the blood moving instead, and I used a cotton ball on the back of her ear to poke against. Sometimes you can put a finger on either side of the poke-spot and push toward the poke-spot, kinda 'milking' the ear for blood.
Are you using the lancet pen device? There are different depth settings on the pens; it's possible you need to switch to a deeper setting for George. Gwyn hated the lancet pen, so I always just free-handed the lancet. If the problem is that the blood is being absorbed into the fur before you can get it, try putting just a tiny bit of Vaseline where you plan to poke; that'll help the blood 'bead up'. If the problem is that George moves his head before you can get to the blood, try scraping it off on your fingernail and testing from there.
Also, you're not looking to hit the vein; if you can, you want to aim for the sweet spot (there are several photos of it in the hometesting links and tips post I linked to above). You might also try moving up or down the edge of the ear a little bit or, if George has been sleeping with one side of his head down, use the ear that was on the 'down' side.
After you've got the blood on the test strip, put pressure on the poke-spot for a moment, to reduce the chance of bruising. Also, always give George praise and cuddles before and during testing, and always give him a treat afterward, even if you were unsuccessful in getting blood. We have cats who come running when they hear test meters coming out, and others who remind their humans that it's testing time
-- Jean and her Gwyn
![JJ & Gwyn [GA]](/FDMB/data/avatars/m/0/167.jpg?1419296044){kind=avatar}
