Vet didn't explain U-100 syringes & U-40 insulin

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franman95

franman95

Member Since 2011
Newbie here. My cat Mandy (gray tortie) was diagnosed as a type 2 diabetic over a month ago. Our vet put her on U-40 Prozinc insulin. But he didn't explain (as I learned in my internet research) that U-40 insulins need U-40 syringes. He gave us U-100 syringes and we have been using U-100 syringes this whole time. So this is making me think that this could be why she's not regulating. She eats really well, is on the Purina DM wet and dry foods, and acts like her old self again. But her numbers are still high, in the 300's. Any idea what they do in this situation? I know there's a conversion chart on this site but I don't want to mess with her insulin dose until I talk to the vet. Any help or advice would be appreciated.
 
Oh, and she's currently at 3 units of insulin twice a day. Initially the vet found no ketones in her urine.
 
Here is the conversion chart: http://felinediabetes.com/insulin-conversions.htm. If you haven't been using it, you probably have been giving a very low dose.

We would also encourage you to drop the dry. A vet explains here: www.cat info.org

Are you testing at home? If not, don't change the food yet. It can drastically lower the bg levels.

Edited to add: actually you have been giving a nice safe dose. 3 units is a large starting dose.
 
She's currently at 3 units of insulin. I only test her once on the weekends, as I work out of town during the week. My mom cares for her during the week. The vet got me the glucose reader and just said to use it once and a while, but I'm not sure if I'm testing her enough. :?:
 
You *can* use U100 insulin syringes with U40 insulin. You just need to convert the dose so that your cat is getting the right amount of insulin. Sue posted the link to the conversion chart above. To give 3 units of ProZinc, measure to the 7.5 unit line on the U100 insulin syringe. If your insulin syringes don't have half unit markings, then you'll have to eyeball between the 6 unit line and the 7 unit line. Buy half unit marked U100 insulin syringes next time.

**But** if you're currently only drawing up to the 3 unit line of the insulin syringe, then the actual dose your cat is getting is 1.2 units which is a good low dose. 3 "true" units is too much for most new diabetic cats.

Stick with giving 1.2 units of ProZinc for now.

Always test before giving each insulin injection. So that's twice a day at the very minimum. Do a few random blood gluccose tests whenever you can. One or two a day is plenty, if you can do that. This will give a general idea of how the insulin is working.

Next time you go to the vet, tell him/her that you were given U100 insulin syringes to use with U40 insulin and had been giving not enough insulin until you found out from FDMB. Print off the conversion chart and give it to the vet. Vets try their best but somtimes do make mistakes and not realize it.
 
We really urge you to test before each shot to make sure it is safe to give the insulin you are planning to give. And you want some midcycle numbers(around 6 hours after the shot) to see how the insulin is working. Can your mom learn how to test? It is really the only way to keep your kitty safe.

We suggest you give about one unit if you get a preshot of above 200. (under 200, we urge newbies not to shoot but to retest in20 minutes and shoot a reduced dose if the number is rising) You don't want them to be below 40 at mid cycle.

I know it sounds overwhelming at first (it did to all of us) but it becomes routine.
 
Wait.....
The vet said 3u, but gave you u100 syringes. So you've been drawing up to the third line close to the needle on the syringe, right?

If so, you've actually been dosing 1.2 units and like Sue said, that's actually a good starting dose.

Please don't "fix" this right now. Continue at that dose for at least another day so we can help you sort all this out.

Others have said, the best thing would be to change to an all canned low-carb food and ditch the dry food. That is true, but you SHOULD NOT do that until you are able to regularly home test. You need to test before each and every shot. It's the only really safe way to know that the dose is not too high. One day, for whatever reason, kitty's blood glucose number could be lower than it normally is, and if you just continue shooting the same amount because you don't know what the BG is, it could be dangerous or even deadly.

So first thing we need to do is figure out how we can help you make that happen. How can you (or Mom or somebody) test the BG twice a day (at least) before giving the shots?

Once we figure that out, then we can talk about transitioning to a better low carb diet, which will help lower the BG all by itself.

THEN, we can talk about either getting you the right syringes, or adjusting up OR down depending on where the BG is at that time.
Actually, the very first thing you should probably do is get some U40 syringes. Hold on to the U100's because they might come in handy later if you get to a point where you need to give really tiny doses. Can you call the vet in the morning and ask for the correct syringes? I would think they will "give" them to you since it was their mistake apparently.

Carl
 
That's okay. The conversion chart will guide you and the U100 syringes can come in handy when you want to give less than .5 unit.

Here is a HUGE document on ProZinc. It has a lot of info so take your time reading through it. It should be really helpful.

viewtopic.php?f=24&t=32799
 
U-100 means there are 100 units in 1 mL (mL aka 'cc')
U-40 means there are 40 units in 1 mL

If you're OK with a little math (multiplication), take the U-100 syringe marking and multiply time 0.4 to get the U-40 dose
ie
1.0 on U-100 syringe * 0.4 = 0.4 units U-40
1.5 on U-100 syringe * 0.4 = 0.6 units U-40
2.0 on U-100 syringe * 0.4 = 0.8 units U-40
2.5 on U-100 syringe * 0.4 = 1.0 units U-40
3.0 on U-100 syringe * 0.4 = 1.2 units U-40

and so on.
 
As everyone has mentioned, you are actually giving 1.2u of insulin, not 3u, which is a good starting dose. Did the vet say you were giving 3u, or just say "draw to the 3u mark"? (I am hoping he knew it was a nice low starting dose, although it would have been good of him to explain about the U40/U100 thing!) Just remember, when you are posting, give the "true" dose, not the U100 number.

In any case, it is a good starting point, so you can use it to start increasing if the numbers are running high. And daily blood glucose testing is your best tool, so we can see what's going on. Can you post some numbers for us to take a peek at? Preshot BGs and midpoint BGs are the ones we need to see the most right now. Ditching the dry food may also make a big difference ... and we will talk about food when you get all this handled. ;-)

Yo're doing great, by the way! You have a lucky kitty - he's in good hands.
 
KarenRamboConan said:
As everyone has mentioned, you are actually giving 1.2u of insulin, not 3u, which is a good starting dose. Did the vet say you were giving 3u, or just say "draw to the 3u mark"? (I am hoping he knew it was a nice low starting dose, although it would have been good of him to explain about the U40/U100 thing!) Just remember, when you are posting, give the "true" dose, not the U100 number.

In any case, it is a good starting point, so you can use it to start increasing if the numbers are running high. And daily blood glucose testing is your best tool, so we can see what's going on. Can you post some numbers for us to take a peek at? Preshot BGs and midpoint BGs are the ones we need to see the most right now. Ditching the dry food may also make a big difference ... and we will talk about food when you get all this handled. ;-)
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Yeah, the vet actually said "3 units." She was at 2.5 units at first. Then he moved her to 3 because she was at the vet for 16 days and he couldn't get her regulated. So he sent her home on 3 units, and he said he thought she would regulate better at home within 10 days or so. I've only been able to test her on the weekends because I work out of town. One weekend she was 314, the next 325, and I tested her last night and she was at 207.
 
It would be best if Mom can test before each shot. You need to know that it is safe to give insulin and in what amount.

Cats typically test higher at the vet. Stress raises bg levels and all the strange noises, smells and people causes stress. The dose determined at the vet can be too high once the cat gets home and relaxes.

207 is a nice number. When in the cycle did you get it?
 
Stress can raise BGs in many cats. It's for that reason that regulation cannot be done at the vet's. Also, a dosage adjustment curve should be done in the cat's normal environment- where he sleeps, plays, eats, etc.- not where he is in a cage all day, stressed and scared.

Those numbers are good to know, thanks, but what's more important is *where* they are on the daily curve. Were those BGs prior to her shot? Midcycle? How many hours after the shot? If they are preshot levels (PS BG), they're not that bad. But what we need to know is how low does she go when the insulin peaks (typically 4-6 hrs after the shot).

Does that make sense?

And yes, you need to give your vet the conversion tables. :sad:
 
Just a tad annoyed with my vet. I've been taking my pets to him for 20 years, since I was 8 or 9. I'm guessing he's not that schooled in the diabetic area? Why would he give me dry food if it was bad for her? I assumed that because it was prescription food and low carb that it would be fine? Forgive me all, as I am still new to this, and the fact that my job being out of town complicates things.
 
Vets are like gps. They know a little about a lot of things. They have to treat many different species (from lizards to hamsters to diabetic cats) for a myriad of different disease. They probably get one workshop in feline diabetes and their nutrition class is often presented by Purina. I have never minded if a vet was not immediately knowledgable about fd, as long as they are willing to listen and willing to learn. Many of us have taught our vets a lot about diet and hometesting.

This site is over 14 years old and has a protocol that works. We see about 5 new diabetic cats a day; some vets see two a year.
 
My own vet told me that feline diabetes (FD) was a one-hour class in her 4th year of school. There's only so much they can learn about all the species they treat. What sets a good vet apart is ongoing education and a willingness to learn. Most of us have the advantage of only needing to learn about FD and very little else (verterinary, speaking!), so we can stay up to date and well informed. Your vet should be open to learning as you learn, and do some independent research.

As for food, most vets are not taught nutrition in their training, so they repeat what they learn in the presentations from the pet food salesmen. Purina DM wet is a low carb food, but has low quality ingredients, and can be expensive. There is nothing magic about it - Janet and Binky's food charts will show you a lot of alternatives if he gets tired of the same food (and a lot of cats grow to hate the wet DM quite fast!). Regular ol' Fancy Feast has lots of better quality, low carb canned food, for example.

Purina DM dry gets about 13% of its calories from carbs, which isn't bad, but is still higher than the 5-10% we recommend. It becomes hard to regulate insulin when feeding too much dry (like a human diabetic who won't give up sweets).

This may be the most important reason of all to switch to canned or raw food: a cat's most vulnerable organ is their kidneys - kidney failure is the leading cause of death (by disease) in cats. Moisture intake is VITAL for good kidney health. ESPECIALLY diabetic cats. Dry food is... well... dry. And cats have very low thirst drives, so never get enough water by drinking. The moisture has to be in their food. A cat at a water bowl is already dehydrated.

Here's my favourite website by a vet who has specialized in feline nutrition : http://catinfo.org/ It is common sense, very informative, and VERY eye opening. Your vet may be interested in reading it, as well!

Stay and learn along with us, and then help us teach. ;-)
 
Yeah, I had a cat pass away four years ago from kidney failure. There was nothing else wrong with her except bad kidneys. She was 14. :( I hate how misleading the major pet food brands are. I was thrilled to see that alot of folks on here feed their diabetic kitties Fancy Feast exclusively because both Mandy and Frankie LOVE it. And yes, it is MUCH cheaper than the wet DM. And the dry DM is $40 bucks a bag!
 
And $40 bucks a bag is just the upfront cost. Think about the lifetime costs when fed that over the long haul when urinary problems could develop.

Carl
 
franman95 said:
I was thrilled to see that alot of folks on here feed their diabetic kitties Fancy Feast exclusively because both Mandy and Frankie LOVE it. And yes, it is MUCH cheaper than the wet DM. And the dry DM is $40 bucks a bag!
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When you next talk to your vet, tell him that your cat won't eat the DM anymore. He should take it back and refund your money.
 
franman95 said:
Yeah, I had a cat pass away four years ago from kidney failure. There was nothing else wrong with her except bad kidneys. She was 14. :( I hate how misleading the major pet food brands are. I was thrilled to see that alot of folks on here feed their diabetic kitties Fancy Feast exclusively because both Mandy and Frankie LOVE it. And yes, it is MUCH cheaper than the wet DM. And the dry DM is $40 bucks a bag!
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Great ! Just be sure not to feed the ones with gravy (high carb). The "classic" varieties are great.
PetSmart carries a good selection of Fancy Feast.
 
Glad you looked on the vial, as my PZI BCP is u100.
207 sounds like a good lower number, under 200 it is recommended not to shoot insulin. Were you able to get your mom to test Mandy for you?? If you take away the dm and only feed low carb wet, she could drop drastically and not need much insulin or none at all.
Keep us posted!
 
I told my mom "classic" Fancy Feast only. If it doesn't say classic, don't buy it. I will have to talk to my mom about testing Mandy. So far, only I have done it, the lancing pen is a godsend. I couldn't do it manually. I like to have that little contraption to "do it" for me. She's seen me test her several times, I actually have her hold Mandy for me while I test her. I almost feel bad asking her to do more than she is already doing, considering she handles all of Mandy's care during the week. But I do understand how important testing is.

I spoke with my vet this morning and he apologized for the U-40 insulin/U-100 syringe error. He told me to increase her dose by .5 and to watch her and test her. So she'll be at 3.5 units now. (U-40 insulin in a U-100 syringe units).
 
franman95 said:
I told my mom "classic" Fancy Feast only. If it doesn't say classic, don't buy it. I will have to talk to my mom about testing Mandy. So far, only I have done it, the lancing pen is a godsend. I couldn't do it manually. I like to have that little contraption to "do it" for me. She's seen me test her several times, I actually have her hold Mandy for me while I test her. I almost feel bad asking her to do more than she is already doing, considering she handles all of Mandy's care during the week. But I do understand how important testing is.

I spoke with my vet this morning and he apologized for the U-40 insulin/U-100 syringe error. He told me to increase her dose by .5 and to watch her and test her. So she'll be at 3.5 units now. (U-40 insulin in a U-100 syringe units).
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It is important to state the TRUE DOSE of insulin in discussions here.

U-40 insulin drawn to the 3.5 MARK in a U-100 syringe is a TRUE DOSE of 1.4 units of insulin.

Multiply the MARK on the U-100 syringe by .4. 3.5 times .4 = 1.4 units.

If you ever have to take her to a different vet, and you say "3.5 units", they might use an
actual U-40 syringe at 3.5 units and she would get an 2.5x over-dose !!!
 
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