Still trying to get right insulin dose!

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koloagirl

koloagirl

Member Since 2015
Aloha from Kaua'i!

I have been reading here that it can take a long while to find the correct insulin dose to regulate your cat's diabetes.

We started at 1 unit, one week later (last week) the vet increased it to 2 units and today (after her being at vet for day to monitor her BG levels) increased it to 3 units.

Is this in any way unusual? We are leaving for a vacation on June 5th and have hired a vet tech to pet sit our 3 cats and give Mochi her medications and injections.

I am hoping to have it regulated by then - I guess there is no assurance how long it can take - correct?
 
You might have mentioned it before and I've missed it, but what insulin is Mochi on? That seems like a fairly quick increase and is a bigger increase each time than we would normally do here to avoid accidentally skipping over the best dose.
 
Hi Koloagirl,

Are you able to add some info to your 'signature'. That will make it a lot easier for folks to help you (otherwise folks have to go back through your previous posts to find that info) :)
Here's the instructions that BJ posted in one of your other threads:
Aloha from Kaua'i

Eliz
 
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koloagirl said:
I am hoping to have it regulated by then - I guess there is no assurance how long it can take - correct?
Click to expand...
Correct.
Some cats get regulated pretty quickly, some take longer, some cats never get regulated.
However, quite a few lucky cats will actually go into remission from their diabetes (ie have their diabetes diet-controlled) either temporarily or permanently.

You may find the following info from the FDMB FAQ's helpful in giving a context to the blood glucose numbers you're getting. (Are you hometesting....???):

"Q6.1. What is regulation?

A6.1. There are different definitions of regulation. As hometesting becomes more common, we've been getting a better understanding of what cats and their humans might be capable of. Janet & Fitzgerald propose the following "regulation continuum":

· Not treated [blood glucose typically above 300 mg/dl (16.7 mmol/L), poor clinical signs]

· Treated but not regulated [often above 300 (16.7) and rarely near 100 (5.6), poor clinical signs]

· Regulated [generally below 300 (16.7) with glucose nadir near 100 (5.6), good clinical signs, no hypoglycemia]

· Well regulated [generally below 200-250 (11.1-13.9) and often near 100 (5.6), no hypoglycemia]

· Tightly regulated [generally below 150 (8.3) and usually in the 60-120 (3.3-6.7) range, no hypoglycemia, still receiving insulin]

· Normalized [60-120 (3.3-6.7) except perhaps directly after meals -- usually not receiving insulin]"

"There may also be an extra category of "mostly above 300 (16.7) but with good clinical signs" which occurs with some cats who are getting insulin. We don't know why it happens, but such a cat probably should not be considered to be regulated. On the other end of the spectrum, it is possible for a cat who is not getting insulin to have blood glucose as low as 40 mg/dl (2.2 mmol/L) on a home glucometer. If you have a non-diabetic cat, try testing her with the same meter to get a safe comparison figure."

The above info is from this document:
http://www.felinediabetes.com/fdmb-faq.htm#regulation

Eliz
 
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Aloha from Kaua'i!

Sorry, I went to the area for my profile as mentioned and tried to add the information about Mochi, etc. that was suggested.....I'm guessing it didn't work? I'll have to go back and try again I guess..

Mochi is taking 3 units of "ProZinc" (protamine zinc recombinant human insulin) twice a day.

Her BG level was higher this week than last when the vet tested her Tuesday (in the 400 range) - so he increased it from 2 units to 3 - he said that they don't do more of an increase since the cat could go into shock.

I have to take her back to the vet again for testing next Tuesday - also he sent out another blood panel to check her thyroid level (she has hyperthyroidism) to see if the medication for that is working.

I hope that he can regulate her insulin dosage fairly soon......he wants to have her at the vet for weekly testing for now.....
 
Hi

Something I've done a couple of times when I've been putting information on my signature is to forget to press "save changes" when I'm done - that's an easy one to miss and might explain why nothing's showing up in your signature. :)

I have to admit, I'm not sure about adjusting the dose in whole units only or based on one reading per week as most of us here adjust in smaller increments and base those adjustments on tests we get at home so we're sure that the numbers aren't being affected by vet stress. ProZinc is one of the better insulins for cats, so you're off to a good start there. :) If Mochi's numbers keep increasing in spite of dose increases, it may be worth considering that her ideal dose might have been somewhere between the 1 unit starting dose and the 2 units where you saw higher numbers - it's almost impossible to tell if that's likely to be the case with only one test per week but it is something to bear in mind to discuss with your vet if things don't seem as though they're heading in the right direction with this latest increase.
 
Here are 2 screenshots for editing your signature. In the upper right corner, hover over your user name and the first screen comes up. Click on the Signature item listed on the left.
editing your signature pic 1.jpg
After you have put in what you want, click to save your changes.
editing your signature pic 2.jpg
 
Would you be willing to learn how to test at home? It would be very helpful for you to see how lo the dose takes him mid cycle and how that impacts his pre shot numbers. We think tests at home are not only much less expensive than those from the vet but are more accurate. Most cats are stressed at the vet and stress raises blood glucose levels, in some cats more than 100 points higher. We've taught hundreds of people how to test and would be glad to help you learn

The protocol we put together for ProZinc is in blue in my signature. It might be helpful
 
Aloha......

Well I went back and did all the steps to edit my signature and put in information as above - hit "save" - so hopefully it is done.

As far as testing at home - my vet feels at this point it is better to have her tested at his office until a correct dosage is determined - I can ask him about home testing next week when I take him in, but I don't want to second guess his treatment because as I said before, he is a very well known and trusted vet here and I have "vetted" him thru "The Cat Doctor" in Philadelphia in regards to her treatment for her IBD issue and they said he was using all the most current testing and medications, so gave him a thumbs up. I will say that Mochi does get very stressed to be in his office almost all day - but he is factoring that into his decisions also.

And if he feels comfortable raising her level by one point - I am not going to question him on that - he feels that is correct, so I'm going to go with it. I don't have any reason at this point to question his treatment - so I'm just going to go with what he says.

I guess it is just a matter of time to get a dose that is right for her - at this point I am just hoping that it is adjusted to that point when we leave for vacation on June 6th - since we will be having the vet tech we hired staying at our condo caring for Mochi and our other 2 kitties as well (they don't have medical issues)......but she is experienced and I'm sure can handle anything that comes up.

I'm glad to know that ProZinc is well regarded.....that is good news!
 
Home testing is a safety issue. Your vet can make his best guess, but things happen. Like fur balls. A bad batch of food. Catching a kitty cold. And more. When you don't test at home, it is like driving a car with a bag over your head. You have no way of knowing if you're headed for a crash. And a crash in diabetes can be fatal. Furthermore, home testing is your decision, not your vet's.
 
I'm going to say some things here that you might not like. Feel free to disregard them if you so choose, but I can't say nothing at all - if I don't say something and anything happens to Mochi, then I'll feel bad for you and for her. We all get pretty attached to all the extra sweet kitties on this board and we really do care about their wellbeing.

I have no idea who the cat doctor in Philadelphia is beyond finding their website and seeing that they're a vet that only treats cats. But what I do know is that many, many vets seem to feel that people won't want the bother of home testing and managing their cat's diabetes themselves. Many more are not fully up to date on diabetes management in cats. Vets have to know pretty much something about every possible disease and condition in at least all of the animals that they see frequently. This naturally means that they can only know so much about any given condition - there's a limit to how much any one person can know about that many different things. Vets can only go on what they can see in their office. You're the person who sees Mochi every day and YOU are the only person who can take control of her diabetes properly because YOU are the only person who has the ability to test her every day and keep her safe. It doesn't matter how good you think your vet is - I think the vet we use is great, but I went against pretty much everything they told me with Rosa's diabetes management because they hadn't given me the best information available...and that was after doing my own research, finding this site and getting advice from everyone here. If I'd followed my vet's advice blindly (like they wanted me to) she likely wouldn't have survived the first week (or if she had it would have been after ER vet treatment for a hypo). Right now, she's OTJ and doing really well - following the advice I was given here, not the advice from my vet who, as I said, is excellent in many other ways.

Home testing is not a question of "whether or not your vet thinks you need to do it". It's for Mochi's safety. Would you give insulin to a 2 year old child without knowing what their blood glucose level is first? Or without checking to make sure that the insulin you gave them isn't taking them too low? I'm going to assume the answer to those questions is "no". Which then leads to the question - why would you be prepared to do that to your cat?

The dose increases you're being given are very big increases - people here increase by 0.25 to 0.50 of a unit each time. And that's based on readings over several days in the cat's own home where the cat isn't stressed. Increasing by 1 unit, without monitoring to see what that extra unit per shot is doing is dangerous - there's no other way of putting it. It's a huge increase - 1 unit to 2 units is a 100% increase in the amount of insulin - and you've currently got no idea what it's doing to Mochi for a whole week until you get her tested again - at the vet where she's stressed and her numbers are likely higher. Does that really sound safe to you when you think about it like that? Your vet can't possibly fully factor the stress level into Mochi's numbers because the effect varies in individual cats - it might be nothing or it might be 200 points and he (and you) have no way of knowing which of those it is or if it's something in between.

Getting a cat regulated is a case of "it takes as long as it takes". But you've more of a chance of getting good regulation more quickly if you actually know what's going on in her body before, during and after her shots on a daily basis. The more data you have, the more you can work out what needs to happen with her doses and make those adjustments more frequently if necessary to get her to where she needs to be.
 
Amen, amen, amen @manxcat419 and @BJM! Please be aware that if you read the first few posts of almost ANY member here, back when we started, you will see that vets do not have the knowledge and experience of what you'll learn here from these members (as it relates to feline diabetes). The protocols used here are based on treatments coming from doctors who did prolonged studies on cats with diabetes in controlled settings. The reason more is not known about feline diabetes is that it is expensive to get the vet tests and glucose curves in their office; many owners get disheartened or simply can't afford it and put their cats to sleep. Dosing that is not managed on a daily basis leads to short case studies for the vet until the next patient comes along. If you take some time and look through member spreadsheets (at the bottom of each of our posts) I have no doubt you will see how BG fluctuates and if you look further for the increases (dose column) you'll see how there are bounces (highs and lows) that are a natural response to the increase in insulin (and the majority of those increases are only .25 -- not a full unit). This is empirical evidence (based on observation and experience, not logic). It's really scary for all of us who live this to read that you're going to increase by a full unit and not test. I sure do hope there's something somewhere in some of these posts or spreadsheets that will help persuade you to reconsider putting so much blind trust in your vet and at the least, learn how to home test so you will have the necessary information when the need arises. There's nothing worse than 2:00 in the morning and not knowing what to do because your cat is hypoglycemic and you don't KNOW what that BG is. If you know, you can save a life. Best wishes to you.
 
Aloha......

I am thinking that there is a miscommunication on my part in terms of the increases in insulin my vet is doing each week (two weeks) - I am using the U40 medium insulin syringe -(1/2 cc syringe with 20 units) - the units are marked off in black bars (very very very little space between each bar) - with the 5 units being a large black bar - Mochi started at the first black bar - (I call this one unit) - then went to the second black bar (2 units) and is now at the third black bar (I call this 3 units).

There is no way you could do a dosage between these small bars - the amount is infinitesimal. At the very end of the needle (it says 20 units) and it is marked 1/2 milliliter.

So I think my ignorance in communication on this is why you all think she is getting some huge dose.
 
That sounds like whole unit dosing to me - if there are 4 small black bars then a bigger one marked 5 then each small bar is a unit. So if Mochi is at the third black bar then she's getting 3 units per dose. It is possible to get a dosage between the bars - it requires practice and possibly measuring with calipers, but it definitely can be done.
 
Aloha!

I will compile a list of questions for my vet that will be based on information I am getting here - such as home testing, insulin increase amounts, etc.

When I take Mochi in next Tuesday I will ask him the questions - as I said before, he has treated 5 (including the ones we have now) of our pets and has been excellent over the 17 years we have used him - so I do trust him. You have to understand that this is all brand new to me, and I am trying to do the best I can for Mochi - but I can't discount the treatment that our vet is giving her - no offense to anyone here at all please - but I don't know all of you yet, and I do know him and he has given excellent care to my pets and those of my friends - since this is a small island, almost all of my friends in this area go to him, and none have any concerns over his care. I work with feral cat colonies here and so I am "clued in" to all the cat people more or less and communicate with them by phone or in person. Many of them care for ill kittens, etc. that have been "dumped" and have a lot of experience themselves with cat medical care. Believe me when I say I have spoken to all of them (some of whom have had diabetic cats) and they don't find anything unusual about her care.

So, I am not disregarding your suggestions, but rather will be asking my vet these questions next week - he has never been anything but cooperative (when I was getting a second opinion from the Cat Clinic in Philly, etc) - so I'm sure he will be happy to answer them for me.

Thank you again for your concern - I do truly appreciate it and am not disregarding it - just being cautious!
 
Cool - sounds as though you have a plan for moving forward with this. :) And hopefully with agreement from your vet too - while many of us don't dose according to the way our vet would prefer, we do all of course need sufficient approval from them to get prescriptions for insulin etc, so alienating them completely and needing to find another vet is a last resort!

Just so you have it available, here is a link to the AAHA Guidelines for managing diabetic dogs and cats. This document actually does stress the importance of home testing and states that it is more accurate than testing in a vet office environment, so if you need something more official than "a bunch of people on the internet said this" (and yes, I really do understand your concerns over that and fully appreciate that you've known your vet a lot longer than you have any of us here), you can maybe base some of your questions on the information in this link. :) https://www.aaha.org/professional/resources/diabetes_management.aspx#gsc.tab=0

Please don't ever, ever think any of us are trying to alienate you or tell you off - we really do have your and Mochi's very best interests at heart! And no matter what route you decide to go with treatment, you will always have support here. :)
 
Aloha from Kaua'i........

Mahalo for your post "manxcat419" - it is hard to read here that what my vet is doing is wrong when I do trust him and don't have a reason to think he is incapable of dealing with feline diabetes - and while I understand that people here have a lot of experience dealing with feline diabetes (and I certainly do not - it is all new and I'm learning every day) - I don't want to tell him what to do. But as I said, I will ask him questions that were brought up here when I bring her in.

In the meantime, she is acting 100% healthy, eating really well and we are getting a pretty good "handle" on how to do her injections - although she has caught on to the tactic of giving her treats in her food bowl and then approaching her - she always knows the needle is coming! But we are managing - hubby did her injection this morning while she was sleeping - that worked well!

Mahalo again for all your concern and suggestions......since our pet sitter we have hired for our one week vacation in June is a vet tech and has a diabetic cat herself - I can also ask her some of these questions as well.
 
Koloagirl, I think most vets simply are not used to having clients that are willing to put in the extra time to properly monitor their diabetic cat. So they handle it the best they can. You could think of any test data you gather as more info for your vet to go on. And you can catch any changes so you would have a heads up as to when you might need to contact the vet. Love the picture of your cat. She looks like such a sweetie.
 
Aloha from Kaua'i....

Yes - Mochi is a sweetheart - of all the 3 cats we have she is the most laid back and non aggressive. She gets picked on by my 1 year old "kitten" who likes to jump on her and wrestle her to the ground - Mochi is good about it but I have the water bottle closeby when I am at home to keep things from getting crazy!

She is very good about her insulin shots also.
 
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