? To inject or not to inject now - please help

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BacardiTheGreat

BacardiTheGreat

Member Since 2018
Hello everyone, I am new to cat diabetes (taking over my mums care). My 11 years old devon rex was diagnosed a couple of months ago (used to have over 30 mmol) and was getting 5 units of insulin twice a day. He is a bit overweight, so he needed higher dosage. However, rarely did my mum measure his blood sugar after the initial period. Two days ago he went into hypo at night, we had to give him glucose. After registering on this forum I understood the importance of measuring blood sugar much more often, but now I have to improvise a bit before I will know how he operates. Morning after the hypo episode my mum just gave him 3 units and in the evening his BG was over 30 again- so he got his usual 5 units. That was yesterday. This morning he had 16, so he got his usual 5 units again. We tested him now, as it is time for his next shot, but his BG is only 6.6. We fed him his usual and haven't injected him, as I am scared that he'lll go into hypo again at night...do you guys have some advice on what to do now? I am at the very beginning of a regular monitoring of his BG now (scared from having to prick him so many times - he's quite hissy and nervous, has always been) and don't want him to go into hypo again...should I skip his evening shot and measute his BG im the morning?
 
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BacardiTheGreat said:
Hello everyone, I am new to cat diabetes (taking over my mums care). My 11 years old devon rex was diagnosed a couple of months ago (used to have over 30 mmol) and was getting 5 units of insulin twice a day. He is a bit overweight, so he needed higher dosage. However, rarely did my mum measure his blood sugar after the initial period. Two days ago he went into hypo at night, we had to give him glucose. After registering on this forum I understood the importance of measuring blood sugar much more often, but now I have to improvise a bit before I will know how he operates. Morning after the hypo episode my mum just gave him 3 units and in the evening his BG was over 30 again- so he got his usual 5 units. That was yesterday. This morning he had 16, so he got his usual 5 units again. We tested him now, as it is time for his next shot, but his BG is only 6.6. We fed him his usual and haven't injected him, as I am scared that he'lll go into hypo again at night...do you guys have some advice on what to do now? I am at the very beginning of a regular monitoring of his BG now (scared from having to prick him so many times - he's quite hissy and nervous, has always been) and don't want him to go into hypo again...should I skip his evening shot and measute his BG im the morning?
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Yes, in my opinion skipping this shot is safest. Try to get a pre shot BG in the morning. It's quite possible that the dose is too high but we need data to know.

What insulin are you using? A dose of 5 units is quite high and the dose is rarely related to the kitty's weight. There are tiny cats here on high doses and vice versa. Weight *might* figure into deciding on a starting dose but most will be put on 1 unit twice a day to start, regardless of which insulin is being used.
 
I thought so, we skipped his evening shot. Bacardi is on Caninsulin. I was living in a different country and came back home to take care of him last week. As I said, I am new to learning about diabetes, but my suspicion is this: my mum has 9 cats and she told me that it was really hard to keep Bacardi from eating uncontrollably, as there was always food for the other cats. Thats why I believe he needed 5 units to control his blood sugar (as I said, his readings used to be over 30 for a very long time. He was even on 7(I know!!) units for a while, but then got into a hypo and I managed to convince my mum to lower it and watch his diet instead. So, now my idea is to test him tomorrow morning as you said and try to lower his dosage (maybe start with 4 instead of 5 tomorrow morning?), and measure him before every shot. I want to make the curve for him, but I need to wait a couple of weks, he is slow in getting used to me being back and handling him. Thank you for your links, I’ll have a look. And I’ll probably be back tomorrow morning with his BG reading
 
Is he living with you now or still with the other cats? Low carb wet food is ideal for diabetics. Try to keep the carbs as fed below 10%. There are very few dry kibbles that are this low in carbs. If he's on higher carb food, a diet change alone can have a significant BG lowering effect. Testing is very important if you embark on a food switch.
 
At the moment we are still with my mum for a transition period - Bacardi is a cat personality (he makes sure to let you know what he likes and especially what he does not ;) and even before his diagnosis he was slow in getting used to changes. This has gotten worse since all the poking started, so we are trying to make it as comfortable for him as possible. Now I am learning to care for him while my mum is still present to give him comfort - but! Now there is two of us to feed all the cat separately - which for now means that Bacardi does not have 24/7 access to food. He is still fed the same food.

So, our morning situation: after not getting his last shot because of his low reading of 6.6 this mornings reading was... H1 :( which is too high to measure I believe. To be honest, it was very emotionally hard for me to find out, as it just seems to be super random. He got his shot and we'll see tonight, hopefully it won't be too low or too high. I am going to have a look at the spreadsheet that I noticed some of you use, to record everything.

Regarding to food..I read a lot here yesterday about diets and am sure now that I will change his to low carb as soon as I move houses (in 1 - 2 weeks). At the moment he's on:
- Animonda Carny Adult wet food
- Applaws Adult Cat chicken and Hill´s Canine Dry Oral Care dry food (I read here that dry food is not the best, but I am glad that he eats for now)
I don't know how to find out the carb content, I searched online and so far haven't found it.

I live in Europe, so I can not feed Fancy Feast or Friskies, it's not available here. So I am still researching what to get for him, even contemplating making his own food, which I found here too. I would really appreciate any tips here! He's quite fussy and does not eat everything, so far he liked samples of
- Royal Canin VD Feline Diabetic and Animonda Integra Protect Adult Diabetes for wet food
- Hill's Prescription Diet Feline M/D Weight Loss for dry food

I have milion of questions and worries right now, but instead of writing all in one long post I'll study more for now and maybe later open separate topic for them, so that it's not lost here. Do to for now is: the spreadsheet, measure him before his next injection (or should I measure him 6 hours from his morning shot?) and I'll see where to go nexst - does it sound OK?

Thank you a LOT for your help!
 
One more thing: frequency of feeding. We now try to feed him only twice a day, together with his shot. But he (although fussy in food selection) LOVES to eat and begs all the time. He always look so hungry that I feel sorry for him (even with low BG, so it's his behaviour rather than his diabetes. He has been really fat his whole life even though I put him on a diet, which was probably the cause of his diabetes). Do you think it's OK to start feeding him 6 hours after his shots, so that he has 4 meals a day? Or should I keep it at 2 for now?
 
BacardiTheGreat said:
One more thing: frequency of feeding. We now try to feed him only twice a day, together with his shot. But he (although fussy in food selection) LOVES to eat and begs all the time. He always look so hungry that I feel sorry for him (even with low BG, so it's his behaviour rather than his diabetes. He has been really fat his whole life even though I put him on a diet, which was probably the cause of his diabetes). Do you think it's OK to start feeding him 6 hours after his shots, so that he has 4 meals a day? Or should I keep it at 2 for now?
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Most of us feed several small meals a day. My vet, like many, told me to feed Teasel only twice a day with his shots but I knew that wouldn't make him happy. He's fed 4 times a day - morning, around mid day, evening and before I go to bed. Some people here use automatic feeders and program them to open at intervals through the night as well. That is harder if there are multiple cats in the household.

One general piece of advice is to avoid giving food (if you can - varies with the kitty) in the second half of the insulin cycle because it can reduce the duration of the insulin. Another bit of advice for users of Caninsulin is to wait 20 - 30 minutes after a meal before injecting the insulin. The reason is that it's better for kitty to have food in the bloodstream at the onset of this insulin. It can onset quickly and strongly.
 
thank you Kris, that sounds more like it - I hate feeding all the other cats and watching Bacardi trying to get something too.

I tested him this morning (HI reading, so I don't really know how much), he got 3 units with his morning meal. Then I tested him after 6 hours and to my big surprise his BG was only 4.6. I fed him again and we'll see about his evening test. I now think that you guys are right about his dosage (5 units) being too high, when he was so low on 3 units today.
 
BacardiTheGreat said:
thank you Kris, that sounds more like it - I hate feeding all the other cats and watching Bacardi trying to get something too.

I tested him this morning (HI reading, so I don't really know how much), he got 3 units with his morning meal. Then I tested him after 6 hours and to my big surprise his BG was only 4.6. I fed him again and we'll see about his evening test. I now think that you guys are right about his dosage (5 units) being too high, when he was so low on 3 units today.
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In my opinion that's too low for comfort when using Caninsulin. I'd try 2.5 units tonight to see how he does on that.

It would help us to help you if you'd set up the spreadsheet we all use here:

http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
 
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I am going to - I just started testing, so I need to transfer the values from my notes to google. I looked at those of yours and some other nice peoples here and I believe I know how to do it now.
 
Also, 2.5 might not be a bad idea - from what I've read here, if his BG is above 11, then it's safe to inject, right? (And if it's too high? sometimes he has 30 - should I still go for 2.5 you think?)
 
BacardiTheGreat said:
I am going to - I just started testing, so I need to transfer the values from my notes to google. I looked at those of yours and some other nice peoples here and I believe I know how to do it now.
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I hope I didn't sound bossy. It's just that the spreadsheet is our go-to when offering advice. :)
 
BacardiTheGreat said:
Also, 2.5 might not be a bad idea - from what I've read here, if his BG is above 11, then it's safe to inject, right? (And if it's too hight? sometimes he has 30 - should I still go for 2.5 you think?)
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My approach is always to look at how low a dose has dropped the BG when assessing doses. I put very little emphasis on the pre shot numbers except to see if the BG is high enough to safely give the planned dose. Knowing the nadir number is very important when using an insulin like Caninsulin that can act quite strongly - fast onset. rapid descent of BG, low nadir.

And yes to skipping the dose if BG is below 11 - for now. There's more latitude in what you can do once you've learned Bacardi's tricks. ;)
 
BacardiTheGreat said:
haha not at all! I figured that it is the most important tool, and actually don't understand why my vet never told me about it.
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Vets wouldn't know about it unless they're familiar with FDMB. I respect vets and I know they try hard to do their best but it's impossible to be an expert on every disease in every animal. That's why FDMB is so valuable - it's full of people who live and breathe this daily. :)
 
Kris & Teasel said:
My approach is always to look at how low a dose has dropped the BG when assessing doses. I put very little emphasis on the pre shot numbers except to see if the BG is high enough to safely give the planned dose. Knowing the nadir number is very important when using an insulin like Caninsulin that can act quite strongly - fast onset. rapid descent of BG, low nadir.
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That makes sense. And I don't even know if 4.6 was his lowest today - I only measured once (still getting used to it, I definitely want to measure more often over time). So, 2.5 and I'll measure him again before I go to bed. Thank you for your help, I feel so much calmer now when talking with someone experienced!
 
Thank you Bron - just putting together Bacardi's spreadsheet and ordering some food. Testing his blood this morning was a nightmare, I needed to prick his poor ears 4 times before I got a blood drop big enough. The poor kitty is more patient with me than I imagined he would be :)
 
I used to give Sheba home made chicken stock to lap up while I was testing her. You might like to try that with Bacardi. It distracts them and he might stay still for you. The chicken stock has no carbs so is fine to give when testing.
To make the chicken stock.... buy about 8 chicken drumsticks and put in some water. Simmer until the chicken is cooked then strip the chicken off the bone and use either to feed Bacardi later or use yourself. Put the bones back in the water and simmer for about 4 /5 hours. When cooked, Throw away the bones and put the stock in the frig. Next morning skim off the fat...... hopefully the stock will be like jelly. Then put the stock into IceCube trays and freeze. When frozen store in plastic bags and use as needed. Don’t add anything at all to the water and chicken. Especially not salt.
Sheba used to love the stock. Hopefully Bacardi will like it too. Always give him a small low carb treat after every test, even failed tests.
Have you tried warming his ear before testing. What sized lancet are you using? 26 to 28 is best. After pricking his ear try milking the ear up towards the prick to encourage bleeding. It gets easier as the ears learn to bleed
Bron
 
Bron and Sheba said:
I used to give Sheba home made chicken stock to lap up while I was testing her. You might like to try that with Bacardi. It distracts them and he might stay still for you. The chicken stock has no carbs so is fine to give when testing.
To make the chicken stock.... buy about 8 chicken drumsticks and put in some water. Simmer until the chicken is cooked then strip the chicken off the bone and use either to feed Bacardi later or use yourself. Put the bones back in the water and simmer for about 4 /5 hours. When cooked, Throw away the bones and put the stock in the frig. Next morning skim off the fat...... hopefully the stock will be like jelly. Then put the stock into IceCube trays and freeze. When frozen store in plastic bags and use as needed. Don’t add anything at all to the water and chicken. Especially not salt.
Sheba used to love the stock. Hopefully Bacardi will like it too. Always give him a small low carb treat after every test, even failed tests.
Have you tried warming his ear before testing. What sized lancet are you using? 26 to 28 is best. After pricking his ear try milking the ear up towards the prick to encourage bleeding. It gets easier as the ears learn to bleed
Bron
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That sounds yummy, no wonder Sheba liked it - I would too! Great idea, I normally make beef bone stock for us humans, so I’ll try to make a cat version :)

I don’t know the lancet size, I got a couple of them from my vet and they were out of the package - when I run out, I’ll make sure to get the suitable ones. Thankfully Bacardi is patient and just waits for the torture to end, even with me literally milking his poor earsies.

Anyway, we are now on 3 units (down from 5) and his evenings reading was HI again ;((( I don’t know what to do...keep giving 3 units?
 
BacardiTheGreat said:
That sounds yummy, no wonder Sheba liked it - I would too! Great idea, I normally make beef bone stock for us humans, so I’ll try to make a cat version :)

I don’t know the lancet size, I got a couple of them from my vet and they were out of the package - when I run out, I’ll make sure to get the suitable ones. Thankfully Bacardi is patient and just waits for the torture to end, even with me literally milking his poor earsies.

Anyway, we are now on 3 units (down from 5) and his evenings reading was HI again ;((( I don’t know what to do...keep giving 3 units?
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The 3 units dropped him too low yesterday and probably caused that rebound to high numbers. I'd try 2.5 u for the next couple of days.
 
Kris & Teasel said:
The 3 units dropped him too low yesterday and probably caused that rebound to high numbers. I'd try 2.5 u for the next couple of days.
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My mum is in charge today and tommorow, I’ll drop her a message. It’s still so scary for me, giving him less and hope for his numbers to go down, but it makes sense with the curve, doesn’t it. Bacardi is feeling good, eating and sleeping comfortably on his back, so thats what makes it easier for me:) Thank you for your help!
 
Guys, I am happy today! Morning value was high, but +5.5 was very nice - 7.2 (I fed Bacardi wet food) and now his evening value was 11.8 ! Which is beautiful for him :))) I know that it's just this evening and tomorrow might be high again, but today was so beautiful. I am thinking about testing him today at midnight and if he's in blue or even green, I'll give 2,5 units tomorrow morning (although I'd have to eyeball it, as I only have 40 syringes).

Do you thing we're getting better already? I've updated our spreadsheet, have a look :)
 
Very nice! Get some later tests this evening because he might drop low-ish after getting 3 u on this PS. At some point you'll have to practice eyeballing quarter unit fractions. It's hard to do with U40 syringes that have only full unit marks. One thing to try is using some coloured water and draw up your best estimate of a dose that has quarter units. Use that syringe as a visual guide for all similar doses. Consistency in dosing is more important than absolute accuracy.

Later on you can use U100 syringes with half unit marks and this conversion chart to make small fraction dosing possible:
http://www.felinediabetes.com/insulin-conversions.htm
 
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Kris & Teasel said:
Very nice! Get some later tests this evening because he might drop low-ish after getting 3 u on this PS. At some point you'll have to practice eyeballing quarter unit fractions. It's hard to do with U40 syringes that have only full unit marks. One thing to try is using some coloured water and daw up your best estimate of a dose that has quarter units. Use that syringe for all similar doses. Consistency in dosing is more important than absolute accuracy.

Later on you can use U100 syringes with half unit marks and this conversion chart to make small fraction dosing possible:
http://www.felinediabetes.com/insulin-conversions.htm
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Thats what I wonder - is he going to drop too low tonight? If yes, then it would probably be a confirmation of 3 units being too high for him. So I'll do what you said - getting ready to stay up late to test him tonight. It's so reassuring that I can consult it with you, thank you Kris :) What is the trick with coloured water about? I have never read about it, would you please give me some link? Thank you :)
 
BacardiTheGreat said:
Thats what I wonder - is he going to drop too low tonight? If yes, then it would probably be a confirmation of 3 units being too high for him. So I'll do what you said - getting ready to stay up late to test him tonight. It's so reassuring that I can consult it with you, thank you Kris :) What is the trick with coloured water about? I have never read about it, would you please give me some link? Thank you :)
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There's probably no link anywhere about the coloured water trick.. It's something practical that people have done and then shared it here on FDMB. I've edited my post above to make it clearer. You use the syringe with the fractional dose in coloured water (eg. 2.75 u) to put side by side with the syringe that you've drawn the same volume of insulin into. It's a visual guide to ensure that you're always drawing the amount of insulin that corresponds to your estimate of the dose volume. The coloured water is easier to see in the reference syringe. Make sense?
 
Kris & Teasel said:
There's probably no link anywhere about the coloured water trick.. It's something practical that people have done and then shared it here on FDMB. I've edited my post above to make it clearer. You use the syringe with the fractional dose in coloured water (eg. 2.75 u) to put side by side with the syringe that you've drawn the same volume of insulin into. It's a visual guide to ensure that you're always drawing the amount of insulin that corresponds to your estimate of the dose volume. The coloured water is easier to see in the reference syringe. Make sense?
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It does, together with your remark on consistency! Thats very clever actually, I am learning every day. Curious about our +6 test this midnight!
 
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