Newly diagnosed. Questions on diet.

[Dmn]

Hi all, my 17 year old was just diagnosed with diabetes and we've been prescribed 2 units of caninsulin twice daily. (which I'll reduce to 1 unit based on the recommendation here)

However, I would like to ensure that I've gotten his diet correct.
Last night he measured 436 pre-shot and 327 post-shot. This was his first shot of insulin ever which the vet gave him 2 units of.

He was then fed his diet of boiled chicken breasts and liver mixed with tuna with brine and fish oil. He's been on this for the last week.

12 hours later, this morning he measured 490 pre-shot.

Does this indicate an issue with his diet? Or is it normal for the body to produce some glucose to compensate for the dose of insulin at the start.
I'm struggling to find more ways to cut down carbohydrates even further.

Thanks!

 

[Bron and Sheba (GA)]

Hi and welcome to the forum.
I am glad you have reduced the dose of caninsulin to 1 unit twice a day. Caninsulin is a fast acting insulin, which is really a dog insulin and not the best choice for cats. Much better insulins are lantus (glargine) or prozinc).
With caninsulin you need to be feeding your kitty 30 minutes before you give the insulin dose. This is because caninsulin hits fast and the cat need food aboard to counter this.
It sounds as if you are hometesting which is great!
So the order of doing things is test, feed, wait 30 minutes, feed in that order.

Last night he measured 436 pre-shot and 327 post-shot. This was his first shot of insulin ever which the vet gave him 2 units of.

12 hours later, this morning he measured 490 pre-shot.

It is normal for the blood glucose (BG) to drop after insulin. Caninsulin drops it quickly. You need to be getting another test in around the +4 mark...that is 4 hours after the insulin is given. That will tell you how much the dose is dropping the BG,
The preshot this morning of 490 just indicates that the BG probably dropped quite a bit last night, and the BG is bouncing back up higher this morning...very normal in newly diagnosed cats.
Keep giving the 1 unit twice a day unless the BG drops under 90 in which case you need to reduce the dose by 1/4 unit, and documenting everything. Here is a link to our spreadsheet, signature and hypo box, which you need to get setup asap (the hypo box I mean). Try and get the spreadsheet and signature set up so we can help you with dosing. If you need help setting up the SS, just ask us.
HELP US HELP YOU

In regards to the food. I am a bit concerned with what you are feeding...boiled chicken breasts and liver mixed with tuna with brine and fish oil which he's been on this for the last week is not a nutritionally balanced diet. Who told you to use that diet? The food itself is OK except you should not feed too much tuna. And liver should only consist of 5% of the total amount given in one day.
Diabetic cats need a low carb diet which is nutritionally balanced. A home made diet is fine...I use one...but it needs to be balanced.
There is also a lot of canned food to choose from this FOOD CHART... look for foods 10% or less carbs.
I would also recommend you feed at least 2, preferably 3 snacks each cycle ... during the cycle...as well as the 2 main meals before the insulin. So give the main meal 30 minutes before the dose, then I would give a snack at +2 +4 and +6. That is 2 hours after the dose, four hours after the dose and 6 hours after the dose. And do this every cycle.

Not sure if I have answered all your questions or concerns, so please keep asking questions.

 

[Bron and Sheba (GA)]

INTRODUCTION TO CANINSULIN AND n/nph NOTE link to caninsulin and another insulin n/nph

BEGINNERS GUIDE TO CANINSULIN

 

[Dmn]

Hi thanks, will look at the food again, but no not I'm not feeding tuna everyday. We're just in between swapping his wet food pouches (with gravy) for something with less carbs.

I took your advice and did a 4hr reading post shot ( 11am) and was surprised to see a high reading of 563. Should I carry on with the 2 units for a while more?

 

[Ale & Bobo & Minnie (GA)]

You’re adjusting too fast. Please read the info on the links Bron shared. Feline diabetes is a marathon not a sprint and according to the dosing method we follow here for caninsulin, you hold the dose for at least 7 days before making any adjustments. We also make dose adjustments by 1/4 units. Not full units and not 1/2 units. When you do, you risk speeding right past the ideal dose. You need to give the insulin time to work and your cat’s body to adjust to it. Since you’re at 1.5 units, I’d stay there for a week and see how it goes. We also base the dose adjustments in how low the dose is taking your cat not the preshot numbers.

Some cats do okay on caninsulin, but most don’t do keep in mind you may have to consider switching to a better insulin. Caninsulin doesn’t work for the full 12 hours so your cat is not protected 24/7. Here are the guidelines from the American Animal Hospital Assn for the treatment of diabetes in both dogs and cats. the AAHA no longer recommends Caninsulin/Vetsulin for treating feline diabetes.

 

[Bron and Sheba (GA)]

Those high black numbers are most likely due to bouncing, which is very normal in newly diagnosed cats, and especially using caninsulin which drops the BG fast and doesn't last 12 hours.
Here is an explanation on bouncing:

• Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

So I would stay with the 1.5 unit dose unless the BG drops under 90.
By feeding a snack at +2 or even +1 if the BG is dropping fast early on, can help slow down the drop and also bouncing.

 

[Dmn]

Those high black numbers are most likely due to bouncing, which is very normal in newly diagnosed cats, and especially using caninsulin which drops the BG fast and doesn't last 12 hours.
Here is an explanation on bouncing:

• Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

So I would stay with the 1.5 unit dose unless the BG drops under 90.
By feeding a snack at +2 or even +1 if the BG is dropping fast early on, can help slow down the drop and also bouncing.

Got it, thanks for the explanation. Will hold the 1.5u.

Assuming it stabilizes with lower degree of bouncing in future, is it possible to have a stable reading when the doses are 12 hours apart with caninsulin?

Are there ever situations where 3 smaller doses (8hrs) are considered? I'm assuming no?

 

[Bron and Sheba (GA)]

Got it, thanks for the explanation. Will hold the 1.5u.

Assuming it stabilizes with lower degree of bouncing in future, is it possible to have a stable reading when the doses are 12 hours apart with caninsulin?

Are there ever situations where 3 smaller doses (8hrs) are considered? I'm assuming no?

Caninsulin is not a great insulin for cats. It is a dog insulin and dogs have a slower metabolism than cats.
I would not consider 8 hourly dosing.
You would be much better to think about swapping to lantus (Glargine) or prozinc, which are both recommended for cats by the American Animal Association. These two insulins are slower acting, longer lasting and more gentle than caninsulin and you will get better results with them.

 

[Dmn]

Thanks - im uk based and not sure if Glargine is prescribed for cats here though

 

[Sienne and Gabby (GA)]

I believe that Prozinc is now approved in the UK as a first line choice of insulin for cats. I'm tagging one of our UK members who is a great resource for food and supplies that are readily available. @Elizabeth and Bertie

There are cats that have gone into remission with Caninsulin. However, remission is much more likely with either Prozinc, glargine, or Levemir and these insulins are longer acting and far more gentle than Caninsulin. In the US, the American Animal Hospital Assn no longer recommends Canisulin/Vetsulin for feline diabetes.

An 8 hour shot schedule is miserable for a caregiver. (For example: First shot at 8:00 AM, #2 is at 4:00 PM, #3 is at midnight.) While that schedule may be feasible, if you need to be out of the house before 8:00 or if you're normally asleep by midnight, it's not going to work. It especially won't work if you're the solo caregiver and you work outside of your home. It also means you're testing more than you might otherwise need to if you're administering insulin twice a day. We've had only a handful of members over the years who were able to accommodate dosing 3 times a day.

 

[Elizabeth and Bertie]

Thanks - im uk based and not sure if Glargine is prescribed for cats here though

Hi, waving from Surrey!

In the UK a veterinary insulin - either Caninsulin or Prozinc - is prescribed first. It's slightly more likely that Caninsulin will be prescribed than Prozinc.
Caninsulin has been around longer, and more vets are familiar with it. They're also more likely to have it in stock because it's used a lot for dogs. And it is cheaper than Prozinc so will be used if cost is an issue.

If a veterinary insulin doesn't work sufficiently well a human insulin such as Lantus/glargine or Levemir/detemir can be prescribed under the 'cascade' system of prescribing. There are UK cats on these insulins, but not a large percentage. Vets vary a lot in their willingness to prescribe human insulins. It's 'more likely' that a vet will prescribe Lantus/glargine, very few will know about Levemir/detemir.

Well done for learning to test, and for getting your spreadsheet set up.

Eliz