? We now have to start giving insulin to Mouse

Hello (again),

After sending our first `not-so-fancy' Glucose Curve to our vet for her to interpret, she is wanting to get Mouse on insulin ASAP...which we expected to hear, actually. We knew that she was going to need this, but still feel a bit saddened, which we know will subside.

I've attached the GC to show the numbers that we captured during our home testing (2 hr intervals) producing numbers ranging between 22.8 (~410 mg/dl) [1st test] and 14.7 (~265 mg/dl) [3rd test]. Ironically the last two tests (6 PM and 8 PM) produced exactly the same numbers - 21.1 (~379 mg/dl).

Our vet wants to order the insulin pen and insulin (we told her that we liked the idea of a pen, versus syringe and vial) since it seems a bit easier to deliver to Mouse, as well as more control for us. She hasn't told us what type of insulin or what regulation she is going to be using. When I asked her if we could get insulin OTC here in Canada, she didn't seem to know that it was possible...but apparently, it is; at least some types of insulin.

She wants us to bring Mouse in for a full day to get her started on the proper dose, but...with our numbers being not quite `through the roof', combined with most credible information that I've found, seeming to corroborate that testing cats (especially) in animal clinics/hospitals may not be the best place for reliable results, due to the added stress, could we do this at home. I do understand that it would be the best place for Mouse to be, should there be any issues/risk for a hypoglycemic event, which would be if the insulin dose was too high, correct? If we purchase a FreeStyle Libre system so that we can monitor like crazy here at home, without having to stick her with needles...and if we take the SLGS over TR regulation approach, hoping that the dosage will only be 1-2 units 2x per day...does the risk of a hypoglycemic event make this a bad decision to do at home? It's not a matter of cost, really, but questions and concerns about having her in a clinic all day, with her BG numbers that, while not ideal, may not be really high that could be an issue with an overdose.

As always, the thoughtful sharing of knowledge and information here is a real blessing to us. Thank you.

 

I would strongly advise you to go for the syringes over the pen because the pen will only deliver in 1 unit increments whereas we recommend going up or down in 1/4 unit increments. It is much safer for the cat and you won’t go past the best dose. You can get 1/2 unit syringes and it will depend on the insulin prescribed as to the syringes you get.
In Canada you can get Lantus OTC which is an excellent insulin for cats. I would ask for that insulin.
It is not necessary for her to be in the clinic all day if you are able to test at home. While the Feestyle libre is a good starting point, I would highly recommend you look at home testing yourself. It will be a lot cheaper and Mouse will get used to it very quickly...as will you. And you will be in control and the guesswork will be out of the picture. A human meter is cheaper and just as good as a pet meter.. most of us use human meters here and our dosing methods are based on the human meter numbers.
You don’t have to decide which method you want to do straight away. You can decide in a week if you like.
Home testing link https://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/
The vet will not be able to ‘get her started on a proper dose’ in one day. It can take weeks to find the best dose and it is only after testing you can see how the cat reacts to a particular dose. A good starting dose is 1/2 to 1 unit depending on the weight of the cat and what food she is eating.

I would get a spreadsheet set up to put the data into https://www.felinediabetes.com/FDMB/forums/spreadsheets-tech-support-testing-area.6/
If you have any trouble we can help you with it.

I would also get a hypo kit set up. Here is a link with it in it plus other useful information https://www.felinediabetes.com/FDMB/threads/new-how-you-can-help-us-help-you.216696/
Make sure you have some honey and high carb food at home in case of low numbers before you start.

Have you looked at starting Mouse on a low carb wet diet ? Here is Canadian food chart. Look for canned food 10% or under carbs.https://docs.google.com/spreadsheet...ZVTk_tYNVRaoG_3Dfy64/edit?pli=1#gid=964479244

keep asking questions

 

This chart is for Canadian-specific foods only. For foods like Fancy Feast, Friskies, Tiki, and so on, you need to reference this chart.
n.b. in Canada, Fancy Feast and Friskies pates are called Classic.

• Cat Food - Nutritional Composition, data compiled by Dr. Lisa Pierson, DVM (2017)

And yes, you can get Lantus over the counter in Canada. Humans need a prescription, cats do not. Just explain that it is for your diabetic cat.

And it's easier than you think to test by poking. The Libre tends to fall off and/or not last the full 14 days.

 

@Bron and Sheba (GA)
@Red & Rover (GA)

Thank you!

I had asked our vet about dosage of insulin, mentioning partial units, but was told that she feels that whole units are fine and that the pens would be a good option...especially if we order them from her. Hmmm...this is yet another inconsistency that we've identified with her advice and what we've gleaned from helpful members here. Perhaps the most alarming was when I mentioned that we would be needing to test Mouse daily, pre-shot especially, when we start her insulin therapy. She said that it's not really necessary to test every day. Huh?! The other issue was that when I asked if insulin is available for Mouse OTC, she didn't think so and said that it probably is in the U.S., which it is NOT.

We had already decided to test/monitor at home, which is why we purchased a BGM (Ascensia Contour next One) and while the FreeStyle Libre seemed like a good revised option, your remarks make perfect sense. While we don't enjoy doing the MEV stab on her, we will have to just succumb to the fact that it's probably not too offensive to Mouse and really is in her best interest to test at home, rather than a canine friendly vet clinic where she's stressed even more.

The one thing that I find rather confusing, is the range shown on the test strips bottle for `Normal Control Solution Range' being 6.1 - 7.7. Since we are not using any CS, per the pharmacists recommendation, does that reduce the accuracy/quality of our first Glucose Curve numbers that were all between 14.7 - 22.8 mmol/L?

Mouse has been on a low carb wet diet (only) for a few weeks now. For the past week or so, we've seen a marked improvement in her (much less water/urine, more alert and social/vocal). We've actually started giving her dry kibble (Dietetic Management food) to the birds outside...which seems like a twisted joke; feeding cat food to birds that are often seen as being `cat food' themselves. It made us chuckle, which is a nice contrast to the angst and stress right now. I suspect that the other wildlife that visit our yard is also partaking in the free food. LOL!

We have decided to consult with a holistic vet (phone consult) to, in essence, get a second opinion to the aforementioned questions that were asked to our vet. We understand that insulin is now needed, but just need to be confident in the treatment plan.


Again, we thank you both for your time and guidance.

 

Get your cat used to having a reward in the form of a bit of tuna or chicken or freeze dried treats (zero carbs) after each test shot.

Sadly, vets do not get a lot of training in diabetes. Testing at home is the only way to keep a cat safe. Also, increasing insulin by whole units is far too much. Going from 1 unit to 2 units, for example, is doubling the dose. That's potentially dangerous and you stand the chance of going right past the best dose.

I never used control solution so I can't answer your question. If I needed to double check a number, I poked Rover again. I sometimes even poked my own finger as a control solution. The numbers should roughly be between 4-7.

You can return any prescription food to the vet for a refund. The pet food company guarantees that. Just tell your vet that your cat stopped eating it or enough of it. Blue Jays steal the kibble left out for a neighbourhood cat. Blue Jays like to steal food.

 

I agree with Bron and Red Rover about the pen. You can only adjust by full units.
Get the syringes with half unit markings , we either increase or decrease by 0.25 or 0.5 units at a time
You just take the top off the pen and insert the syringe in the rubber stopper and draw from there

If the vet prescribes Lantus I wonder how much she will charge you for one pen
Getting it from Marks Marine in Canada will be much cheaper, I see members have mentioned this to you in your previous posts

You must test before every shot, and get a few more tests in during each cycle to see how the insulin is working and how low he's dropping

I never used the control solution either it has nothing to do with the accuracy of your first glucose curve
Please set up your signature when you find out what insulin you will be using
and the spreadsheet

 

Also you need med and high carb food on hand in case he drops too low and you need to bring his BG up to safe numbers

Such as

Fancy Feast Gravy Lovers Gourmet Beef Feast in Gravy 20% High Carbs



Fancy Feast Gravy Lovers Gourmet Chicken Feast in Gravy. 15% Med Carbs




Fancy Feast Gravy Lovers Turkey Feast in Gravy. 15% Med Carbs


Fancy Feast Gravy Lovers Chicken and Beef Feast in Gravy 15% Med Carbs

Or any other ones listed in this food chart

https://felinediabetes.com/FDMB/threads/dr-pierson-new-food-chart.174147/

 

In Canada, Fancy Feast Classic and Friskies Classic are called pates.

 

Yes, Blue Jays do steal food...so do the seagulls here! The ocassional Bald Eagles that fly by don't seem to care.

We just spoke to someone at our vet's clinic that said that we cannot get/use Lantus because cats use Glargine. Isn't Lantus the brand name of Glargine?

Also, what about one of the pens that delivers 1/2 units:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5505427/

 

Pens don't half half unit markings only syringes see above

 

You can get LANTUS at Marks Marine in Canada and yes I'm pretty sure Lantus and Glargine are the same

 

We have found 4 companies producing pens with 1/2 unit dosage: HumaPen Luxura HD, Junior Star, NovoPen Echo and NovaPen Junior. No idea if they're available in Canada or even a real option for us yet.

We would prefer to use pens, but not if it compromises our treating Mouse safely.

 

Glargine is the generic name for Lantus.

!/2 units syringes. A lot of people use the BD ones.
The box looks like this or this:

 

Many thanks.