Question about starting insulin

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SusanandOwen

SusanandOwen

Member Since 2013
I had taken Mac into the vet on the 9th for a check up and a full senior panel of bloodwork. His numbers were all fine except the BG which was 270. The vet wanted to do a curve which I was hesitant about because he does get stressed with car travel/being at the vet's. I asked the vet if we could monitor him at home for a week or so to see what the numbers were like, and she was fine with that.

So, since then I have been really strict about Mac's diet. He's been on canned food only for years, but he is a semi picky eater so we had let him have some of the higher carb flavors in an effort to get him to eat; since getting the news from the vet he has been on < 5% carb food only. I have been testing him daily and he is routinely between 180-200 or so. I know that most on this board would not recommend shooting insulin below 200 ... but he probably can't stay at 200 indefinitely either, right?

He goes back to the vet for a dental on Thursday, but I am trying to be prepared with questions as I am pretty sure she is going to tell me he needs to be on insulin going forward. I know a lot of you here manage all that really well but my work schedule is insane and I truly can't imagine how I am going to pull that off.

So what do you think the options are for a cat that "naturally" is in the 180-200 range?

Thanks in advance for your help.

Susan
 
Hi Susan,

This is just my '10 cents' but...

Mac's numbers really ain't that bad. It will be interesting to see what effect the dental has on his BG levels (maybe there is some infection present that is raising his BGs?). Also, now that he's on lower carb food his numbers may continue to drop for a few days.

If, however, it turns out that he does still need insulin, then maybe it would be better to go with a PZI insulin that is more forgiving of shots that can't be given exactly 12 hours apart (folks here find that Lantus and Levemir work best adminstered 12-hourly).

Like I said, this is just my '10 cents' (or actually, since I'm in the UK, my 'ten pence'....)

Eliz
 
There is a misunderstand over the "dont shoot under 200". That only applies for new members until we have data to know how he would behave. However if a cat is sitting over normal cat levels ie 130-200 then the cat would probably need insulin and the newbie would just need help to shoot at those levels. Probably with a very low dose.

No matter though, I would definately wait till after his dental. If there is any infection there it can spike his BG and once that is cleared his need for insulin may drop again.

So do the dental, get him recovered from that - wait maybe a week but keep him on LC food and keep testing - and then we can reevaluate.

Wendy
 
Wendy&Tiggy said:
..There is a misunderstand over the "dont shoot under 200". That only applies for new members until we have data to know how he would behave...
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Quite right. The 'no shoot under 200' guideline is for people and cats new to diabetes. Many of us do give shots below that number.
 
Thanks, all. The dental is going to be done Thursday so I will have that done and then see where we are, I guess.

Although I have been dealing with the diabetes thing for many years now, neither of my guys was ever on insulin (except for Owen, right before he died last month.) Oh boy,it's still very hard to type that. :YMSIGH:

So when it comes to insulin, I guess I am still very much a newbie. I don't have too many concerns about the shots themselves, as I've had no trouble doing the home tests and I am comfortable giving a subQ injection, it is just my fear that Mac is frequently alone while I am at work - and that could easily be 14-15 hours at a stretch. With a number so close to the "no shoot" (or "shoot with caution") level, I am concerned because I will not be there to monitor him afterwards as I see others here doing with their +1, +2, +3... values. I work too far from home to be able to go back to check on him during the day.

So I guess for now I will just have to hope that the dental is the cause of our issue, and that we can keep Mac well controlled with diet alone. So weird to be hoping there is an infection (that can be resolved with the dental treatment.) Yikes.

Thanks for the support.
 
Elizabeth and Bertie said:
Hi Susan,

This is just my '10 cents' but...

Mac's numbers really ain't that bad. It will be interesting to see what effect the dental has on his BG levels (maybe there is some infection present that is raising his BGs?). Also, now that he's on lower carb food his numbers may continue to drop for a few days.

If, however, it turns out that he does still need insulin, then maybe it would be better to go with a PZI insulin that is more forgiving of shots that can't be given exactly 12 hours apart (folks here find that Lantus and Levemir work best adminstered 12-hourly).

Like I said, this is just my '10 cents' (or actually, since I'm in the UK, my 'ten pence'....)

Eliz
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Thank you Elizabeth, that is very good to know. I am definitely not routinely home every 12 hours so I will keep that in mind.
 
hi Susan,

when Honey was on lantus, I did shoot low - sometimes in the 50s but had lots of data and could be home to test, but also by then she was on a tiny dose of insulin and it didn't cause the same drops as the bigger doses do.
She surfed a lot more and had much flatter cycles.
 
Honey, thank you, that is really interesting. Can you help me understand a little more...why would you want a number lower than 50? I thought that was in the normal range, but maybe I have misunderstood. Or was it that you needed to give insulin to *keep* the numbers in that range?

I am just so worried about not being home to monitor Mac in case he has a big response to the insulin and I am not here to monitor it.

Thanks for your help!
 
When you know you cat's glucose will rise (appetite is normal, food is eaten, etc), because you have lots of data showing that, you shoot low to stay low.
 
BJM said:
When you know you cat's glucose will rise (appetite is normal, food is eaten, etc), because you have lots of data showing that, you shoot low to stay low.
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That makes sense, thanks. But I imagine that is the kind of situation where you would want to be able to monitor the situation pretty closely, right?
 
Yes, you would be monitoring closely and you would already have a lot of data that would give you a good idea of what the dose would do. We urge new diabetics not to shoot under 200, but to wait 20 minutes, without feeding and retest. You want to be sure the number is rising, not falling.
 
Sue and Oliver (GA) said:
Yes, you would be monitoring closely and you would already have a lot of data that would give you a good idea of what the dose would do. We urge new diabetics not to shoot under 200, but to wait 20 minutes, without feeding and retest. You want to be sure the number is rising, not falling.
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That makes a lot of sense, thank you. I guess we are not anywhere near that point yet, but I am trying to educate myself a bit more.

Unfortunately that is exactly the issue that concerns me most, as I am simply not home enough to do that kind of waiting/re-testing etc. Since Mac has routinely been in the 180-200 zone (without insulin) I am fearful that he would drop significantly with a shot, and then I would not be there to know about it.
 
Sue and Oliver (GA) said:
In that case, I would wait until you can be home to start so you can monitor, at least the first day. Are you off on weekends?
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I can definitely take a day off to monitor him the first day (and will do so.) However, my "normal" schedule is at the whim of the hospital so I am not reliably home on weekends; I can be called in pretty much anytime. Between that reality and the fact that I typically work more than 12 hours a day, (and then have commuting time on top of that,) I am very worried about how I would manage Mac on an insulin program. Sigh.
 
It may be useful to recruit a high school student interested in veterinary technology or medicine to check when you're not available. Treat it like a job and interview for candidates. It may be helpful if the person belongs to a youth group of some sort - ex Girl/Boy Scouts, Future Farmers of America, a church youth group, etc.

If the student does it for credit/service learning, there would be more incentive to do it right and responsibly.
 
Dont worry yet - we can try and work out a schedule - but for now lets see where the dental gets him.

Are you taking any vacation soon? If you can take a week or so you will be able to see how he responds to the insulin and maybe will feel more comfortable leaving him alone or not shooting exactly every 12 hours. The latter may never mean remission and his regulation wont be fantastic but it could be good enough to keep him controlled.

But paws crossed he wont need it!
 
Wendy&Tiggy said:
Dont worry yet - we can try and work out a schedule - but for now lets see where the dental gets him.

Are you taking any vacation soon? If you can take a week or so you will be able to see how he responds to the insulin and maybe will feel more comfortable leaving him alone or not shooting exactly every 12 hours. The latter may never mean remission and his regulation wont be fantastic but it could be good enough to keep him controlled.

But paws crossed he wont need it!
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Thanks, Wendy, as always you have good advice. As you can tell I am a worrier and a planner so "waiting" is not my strong suit, but your point is well taken.

Unfortunately taking that much vacation is not going to be possible anytime soon. I can and will take a day off here and there sometimes but I haven't taken more than a long weekend in probably five years. I do love my job and find it very rewarding but the schedule is unfortunately rather demanding.

For now I am going to try to take your advice and hope that it is the dental issue that is causing the elevated BG. It would be fantastic if we were able to go back to a scenario where Mac could remain diet controlled.

Thanks for all the good thoughts and advice. :)

Susan
 
Well... Mac had his dental procedure this morning and wound up needing a couple of his teeth pulled :( The tech very kindly called to tell me that he did fine during the procedure and was recovering well. I can go pick him up in an hour.

She also said the vet wanted to talk to me when I got there so I am not anticipating good news. I am guessing that they are going to tell me he needs to start on insulin and to be honest, just the prospect of it is pretty upsetting. I don't know how on earth we are going to be able to manage that.

I know, you are most likely thinking, "wait till you hear what the vet has to say before getting upset," (which is what I would say if I were reading this...) and of course that makes sense...but frankly my gut is not usually wrong about stuff like this. :YMSIGH:
 
Wendy&Tiggy said:
Hey there - wondering how the vet went? Hope everything is ok?

Wendy
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Hi Wendy, thanks for checking on us. The news was so-so, I guess. The good news is that Mac tolerated his dental procedure OK and seems reasonably comfortable tonight. He is blinking one eye a bit which the vet said was common and expected to clear up on its own (but if not he will likely need drops, sigh.)

He did have several teeth extracted which must be painful, poor guy. He was sent home with antibiotics and pain meds. Surprisingly his appetite was fine when he got home and he gobbled up his dinner with relish - I was shocked but happy. The vet was concerned though that Mac had lost weight in the couple of weeks since he was seen for his wellness exam (about a pound). I explained that when his partner had seen him for the wellness check up, she told us he was several pounds overweight and needed to lose at least two pounds, so we've been working on that. I feel like the weight loss is a combination of going back to a very strict low carb diet ... and running around a LOT more with his new little buddy, who is like an energizer bunny in a cat suit. :lol: Anyway, the vet who saw him today is the senior guy in the practice and he told me -nicely, without throwing his junior partner under the bus -that once a cat is Mac's age (9) he'd prefer to let him stay at his old weight. Soooo... he wants us to put that pound back on. He was upfront about the fact that he does not think that will happen; he thinks the weight loss will continue and that Mac is almost definitely going to have to be on insulin. <sob> He was at 300 today at the vet's.

I did tell him that Mac has been between 180--209 routinely at home, and that we had just added a tiny bit of the zero carb dry food mixed into the low carb canned stuff to get him to eat better (which has been a spectacular success so far; he LOVES his crunchies!) Mac has NEVER had a problem maintaining his weight (somewhat the opposite, in fact) and I really do feel like the weight loss is due to diet change and maybe all that extra exercise. I am afraid to put him back on the higher carb food although I am certain he would gain weight quickly on it. He is eating the low carb (wellness CORE) really well now that it has a teaspoon or so of the zero carb dry in it.

In any case, the vet did feel like we should give him a week or ten days to recover from the dental procedure before we put him on insulin. I did ask him if he thought there was any likelihood that having the dental completed would help lower the BG but he does not think so.
 
Oh that's all good news! I am glad the surgery went well.

First I disagree with your vet, if there was any infection it could spike his BG.. My vet told me most dentals result In a drop in insulin needs.

Does he seem at all stressed with his new buddy? Until the hierarchy is all settled he may feel a little stressed which could also spike BG.

I do agree with the weight, a change in diet, diabetes and running around with his new friend could make him lose weight but that's a lot in a short time. Maybe look at the food chart and see if you can find a similar carb food but with more calories, and/or feed him a bit more to gain slowly.I have realized recently that I prefer my animals to be 1lb or so overweight too because when they get sick they lose weight so fast.. You could also try a food with a little less carbs like fancy feast pâtés which might help lower his BG further and they tend to love it and eat more of it.

Can you post your readings so we can see how things progress?
 
Wendy&Tiggy said:
Oh that's all good news! I am glad the surgery went well.

First I disagree with your vet, if there was any infection it could spike his BG.. My vet told me most dentals result In a drop in insulin needs.

Does he seem at all stressed with his new buddy? Until the hierarchy is all settled he may feel a little stressed which could also spike BG.

I do agree with the weight, a change in diet, diabetes and running around with his new friend could make him lose weight but that's a lot in a short time. Maybe look at the food chart and see if you can find a similar carb food but with more calories, and/or feed him a bit more to gain slowly.I have realized recently that I prefer my animals to be 1lb or so overweight too because when they get sick they lose weight so fast.. You could also try a food with a little less carbs like fancy feast pâtés which might help lower his BG further and they tend to love it and eat more of it.

Can you post your readings so we can see how things progress?
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Well, I hope you're right about the dental ;) That would be great news if his BG would improve now that he's gotten through the procedure. He will be on antibiotics for 5 days, so I guess I will just keep testing and see what happens. The vet does not want to start the insulin until he is recovered from today's adventure. How long do you think it would take to see an improvement in the BG if it was influenced by infection previously?

I don't think Mac is stressed with the new cat. Occasionally annoyed... yes ;-) But they hang out together for the most part, and Mac has been very playful, chasing mousies with him and so forth which I haven't seen him do in forever. New kitty is only a year old and kind of wild, LOL, all he does is run around and play until he's ready to drop. Mac is definitely the senior cat in the house and the new cat hasn't challenged that, though he reallyreallyreally wants Mac to play with him, curl up with him and so on. Mac mostly lets him and seems happy to have the company.

I did increase the food a bit and I do have some FF pates which he will eat (less enthusiastically than the wellness) as long as it is mixed with the zero carb dry. Trust me when I tell you Mac is NOT skinny, even having lost a pound he is pretty fluffy (just like his mom...sigh.)

I took the day off tomorrow so I could hang out with him and make sure he does OK plus I have a colleague covering my call this weekend at the hospital so I should be able to really monitor him well between now and Monday. I will post the numbers as I do that.

Thanks for your help.
 
Maybe within a few days to a week. And meanwhile try lower carb food to see whatever you can do to get him low enough so you don't need to shoot.

Paws crossed..

What meter are you using?
 
Wendy&Tiggy said:
Maybe within a few days to a week. And meanwhile try lower carb food to see whatever you can do to get him low enough so you don't need to shoot.

Paws crossed..

What meter are you using?
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OK, hopefully we'll see an improvement over the next week. I will keep my fingers crossed.

He is already on a low carb diet... his canned foods are generally between 4-6% at most. Not sure we will see much more improvement on that score..

ETA: Bayer Contour meter
 
So, Mac was at 223 this morning ... and he ate OK. He didn't like the oral meds (bupe and clavamox) though. And now his stool is reallly runny. I spoke to the vet who said it was loose when he arrived at the vet's yesterday and that it was most likely stress related, but they want me to stop the clavamox for the moment in case it is bothering him from a GI standpoint. Sigh.

He does otherwise seem comfortable and he slept fine. He was his normal self this AM until I gave him the pain meds, and now he is understandably a bit sleepy, curled up on his favorite chair in the garden.
 
Antibiotics kill off both bad AND good bacteria; this may trigger diarrhea, too.

A bit of plain yogurt with active cultures may help, or FortiFlora (available online or from vet).
 
I sure hope it improves soon...

Mac's been pretty lethargic most of the day. I chalk that up to the pain meds that I was instructed to give him this AM, because he was certainly his normal self this morning - bright eyed, happy to be pet, etc. His BG has been steady ~ 220 all day. He's gone to the door to go outside once or twice to do his "patrols," (gotta keep the yard safe from the neighbor cat, don't ya know...) Otherwise he's been curled up on the bed snoozing for the most part, although he's sitting at the door looking outside now. His temp/respiration etc are all fine.

Under the circumstances, I am sort of reluctant to give any more pain medication tonight. He has not acted at all painful since he got home, and ate well last night when we returned from the vet's, including the sprinkling of dry (zero carb) food that I put on his canned to get him to eat. He was in good spirits this AM and was anxious for his breakfast (before the meds.) Less interested in food now, which I am chalking up to the clavamox (antibiotic) which I am guessing is bothering his stomach a bit.

What do you guys think? Would you give pain meds (due in a little over 2 hours.)
 
The pain meds may dull the appetite a bit, and if he hasn't been very active, his insulin need may slightly reduce (id watch out!)

A workable compromise would be to do half/part of the dose. If they pre-filled the syringes, you could use an empty syringe to split the dose.
 
BJM said:
The pain meds may dull the appetite a bit, and if he hasn't been very active, his insulin need may slightly reduce (id watch out!)

A workable compromise would be to do half/part of the dose. If they pre-filled the syringes, you could use an empty syringe to split the dose.
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Well, I just got home and Mac is looking better - more alert, and hungry (although I had to feed him some of the higher carb stuff, as he wouldn't eat either the FF or the zero carb dry.) He dove right into the bowl of the "regular" food though, so at least he has something in his belly now. And he's watching his little brother run around with a toy with some interest (new kitty is still a bit of a baby and has a LOT of energy.)

I think for now I am going to skip the pain meds. I will give him a half dose before I turn in for the night if he seems at all uncomfortable.

PS - Mac is not on any insulin at the present time...
 
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