6/4/20 New member: Slightly urgent, what to do with my cat??

Dear all,

Since yesterday, I have been studying things about feline diabetes. Pardon me if I ask something obvious or things I should be able to learn myself, because this is related to safety of my cat and it is slightly urgent. (I hope it is not too late).

My family member took my cat, Monkey, to the yet on 17/3/2020 (about 3 weeks ago). Monkey was diagnosed to have diabetes (I am not sure type 1 or 2). The previous blood test one month ago indicate that most of his organs should be fine, attached is the blood report. (I was not in the clinic so I can only rely on my family member's memory.)

His health is deteriorating quickly. He is losing weight, losing a lot of fur, have rough skin, his back leg is walking sloppily (I read from this website it is a common neuropathic disease for diabetic cat?), less active than usual, and meows loudly seemingly for food and water.

He is about 13 years old. Eat dry cat food for all his life, except occasionally we give him some chicken meat and seafood.

We gave him insulin (Caninsulin) for 3 weeks already, one 0.3mL injection per 12 hours.I start this thread today is that I trusted the discretion of the vet and my family member, but now I have serious doubt so I come to this wonderful website to learn more. As mentioned above, I started studying here from yesterday.

My questions:

1. I started to monitor his BG today. The first time is today, after Monkey ate around 7-10 am injecting insulin at 1pm (That's a mistake? I read I should inject insulin 20 mins after diabetic eat), my family member blood check him at 3:40 pm, the result is 475 mmol/L. I blood check him at 5:34 pm, the result is 196 mmol/L. At night Monkey ate at 9 pm and inject insulin in 9:20 pm, the BG at 11:00 pm is on average for four attempts (346+441+345+391)/4 = 380 mmol/L. May I ask is this an acceptable error for the BG testing device? Also, is these level appropriate given that I have injected insulin hours ago? How do I know I need to increase or decrease the volume of insulin injection?

2. How often should I monitor the BG? I am at home most of the time. I read I should get a BG curve to know the insulin onset, peak/nadir, duration. And "As a minimum, for your cat’s safety, always testing the BG before you give an insulin shot" What I think is that I should get at least 2 BG to 5 BG blood per day, in order to understand the effect of insulin, prevent hypoglycemia, know when to increase or decrease the insulin injection, monitor BG if I want to change his food to wet food.

But my parents object my idea because they thing one BG check per 2 week is enough. And blood checking is too painful for the cat, (What I observe is the cat calm most of the time). and said I am insane to have the idea of so many blood checks per day. May I ask, does my ideas make sense or not? For the health of Monkey.

3. Is changing to dry food to wet can good a important and urgent step to heal Monkey? I read that it can be dangerous according to Dr. Pierson since wet can food cause less increase in BG, and insulin can get the BG too low thus hypoglycemia. Please tell me how can I do the transition as safe as possible? How urgent is the transition? Do I need to change the food immediately or within weeks?

4. Most of the food in Dr.Lisa food chart is not available in Hong Kong. I bought a can today, the brand is Thrive Complete it emphasize no grain, gluten or meat derivative. and it writes" Chicken breast 70%, chicken stock, chicken Liver, 5%, sunflower oil, vitamin and minerals. Analytical Constituents: Crude protein 16%, Crude Oil and Fats 2%, Crude ash 1.5%, Crude Fibre 0.1%. Moisture 80%. Nutritional Additive per 100g. Vitamin A 2800 IU, Vitamin D3 29 IU. Trace element Zinc 12mg, iron 6mg, Maganese 1.4 mg, Copper 0.6mg, iodine 0.2mg, tarine guide 0.5g

I may want to try this can, because it seems that there is high chicken protein and not much carbs and plants product in this can. Does my idea make sense? Can it's claims be trusted?

I wholeheartedly appreciate any help, sorry if I write too long and ask stupid questions. I really want to make sure every tiny bit of my idea make sense for the health of Monkey.

 

No stupid questions when you don't know the answer!! Someone with more knowledge than I will be along shortly!! (I'm new here myself and I'm still learning.)
@Deb & Wink @Juls and Billy @Chris & China (GA) @Bron and Sheba (GA) @jt and trouble (GA)

 

Hi Peter and Monkey.

Glad you found us so early.


What insulin are you using, and how many units of insulin in the morning and evening are you giving?

 

First off your parents are wrong taking BG test is the ONLY way to regulate.

Changing to wet food is important because dry is PACKED with carbs the very thing you need to avoid. BUT BUT BUT you must do this slowly and ONLY if home testing the removal of dry food could drop his number significantly! You must test test teat when removing dry food.

The ONLY stupid question is the one NOT asked thats what we are here for.

Now to be honest I havent had a diabetic kitty in many years but there are PLENTY her who WILL guide you
The BEST hting you have done is found us. Hang in there more people will come to the rescue! They will be able to address the rest of your concerns.

WELCOME TO FDMB THE BEST PLACE TO HELP YOU HELP YOUR CAT!

 

ARRG my tags still arent working.

 

Thanks for your great help

We gave him insulin (Caninsulin) for 3 weeks already, one 0.3mL injection per 12 hours. However, my family members are not very precise in the timing of injection. So now i have to enforce for more precise injection

 

I can tell you this as far as testing...testing on the ear is the best place. There are fewer nerves there and it is NOT painful. I am part of a TNR group (Trap, Neuter, Release) where we trap feral (wild) cats and have them 'fixed' and the vet will either notch or tip the cats ear. A couple of times my vet has forgotten to notch the ear while the cat was still under anesthesia and I had to take them back, fully coherent. The vet tech took the kitties back, noted the ear, and brought back to me. No crying, no scratching, nothing. A little bit of blood. Honestly, I don't think they ever knew. All that to say, don't worry about hurting your kitty by testing his ear. They hardly know.

 

They may object but thats why God invented TREATS!

 

Hi Peter, Welcome. I'm going to start right in, asking you some questions and trying to answer some of your questions. Please, give me some time.

You said that Monkey gets 0.3mL which is 30 Units. Do you mean 3 units? Is that with a U40 syringe? Or are you using U100 syringes that are a 0.3mL volume?

Would you please take a picture of the syringe you are using, with the plunger positioned at the dose you give your cat.

Has the dose been increased, decreased, or stayed the same since you started the Caninsulin 3 weeks ago? Would you please tell us the insulin dosing history?

The insulin doses should be 12 hours apart. It looks like you gave insulin at 1 PM and then at 9:20 PM. That is only about 8.5 hours hour apart. Please do not give your cat insulin more frequently than every 12 hours.

Which meter are you using for testing your cat Monkey? I'm looking for the specific name of the glucometer.

That is 3 questions in 1, so I will give you three answers.
- Yes, those blood glucose tests you got are within what is known as "meter variance" which can be 15%.
- Those blood glucose numbers are reasonable. But that could partially be because you gave the insulin doses very close together. Or the insulin dose wore off. Or it's too early in the cycle for the insulin to have it's onset.
- dose changes are based on insulin dosing protocols.

 

First, please test the BG (blood glucose) before every dose of insulin given. That is to make sure the BG (blood glucose) level is high enough to give your cat insulin for that 12 hour cycle.

The number of BG tests is per insulin dosing cycle, not per day. Each insulin dosing cycle is 12 hours, so at least 2 tests per cycle would be good. More tests will be needed, when you do not know the onset, peak/nadir and duration are needed at the beginning. So maybe 5 BG tests per 12 hour cycle might be needed. Not always, not every day, but sometimes you will need to test more.

We have a spreadsheet template that you can copy and use. Directions are linked below, and what is means is the next link. Instructions include screen shots, and have directions for setting up the spreadsheet (SS) and linking it to your User ID "Signature". Directions include setup on a pc, tablet or smartphone.

• FDMB Spreadsheet Instructions
• Understanding the Spreadsheet/Grid

If you would please set that up, I'll work on getting more of your questions answered.

Yes, you want to be testing his BG's before you change the food from dry to wet.
Yes, you want to be testing Monkey's BG's to prevent hypoglycemia.
Yes, you want to be testing more than every 2 weeks.
We are big proponents of home testing, which you started to do this morning.

 

Get good with testing the blood glucose levels at home first. Then monitor the blood glucose levels more closely as you do the food change.

The transition to wet food depends on how much your cat likes the wet food. Some cats like wet food and are easy to transition. Other cats are more stubborn and it can take time to get them to eat wet/pouched/ canned food.

The transition to wet food depends on getting good at home testing first.
The transition to wet food needs to be done slowly, over a week's time, to minimize digestive upset for your cat.
Change a little bit each day, giving some dry food each meal, and some wet food each meal. Gradually decrease the dry food and increase the wet food during that week, until your cat is eating all wet food.

How much dry food does your cat Monkey eat now?

 

Hello and welcome!!!

Deb has given you a lot of fantastic information and asked a bunch of important questions, so I won't add to that, just wanted to say hi and to reassure you that you are doing the right things for Monkey. It is so hard to see them when they are in poor condition from diabetes, but you are in absolutely the right place to get him back to good health .

 

Ahhh Deb what would we do without you?
and of course the others that know how to answer these questions so proficiently!

 

Hello Peter! First, I want to say that you are wonderful to want to take such good care of Monkey. Monkey is lucky to have you. You can absolutely help Monkey feel better by studying on this site and making some changes to his care. I'll do my best to answer some of your questions, and I'm sure other members of the site will be in to answer anything I cannot. I admit, I don't know much about the insulin you are using. It is a fairly harsh insulin, and often prescribed by vets, though it isn't the best insulin for cats. To get more information specifically on Cannisulin, make sure you read The Beginner's Guide to Cannisulin.
Now, let's look at the questions you have.

1- Yes, that's acceptable variation for the testing device. If you test several times in a row, you will get a little variation. Yes, Cannisulin is a fast acting, strong insulin, and you should always feed 20 minutes before injection. This helps keep Monkey safe from the insulin dropping his blood sugar too low, which can be dangerous. The best way to know if it's time to increase or decrease a dose amount is to make a chart of your BGL test results. Look at my signature and click on "Billy's Spreadsheet." You can see how often I tested once I knew I needed to test more often. You can see how once Billy dropped into green numbers, we knew we had to lower his dose. This site has a template for that chart, and it's easy to make one for Monkey. Then members here can help advise about dose. Go to New? How you can help us help you! to read how to set up a spreadsheet and signature.

2- Testing before every shot is needed. In addition to that, getting at least a couple mid-cycle tests in helps paint a picture of how Monkey is responding to the insulin. It doesn't always have to be at the same time every day. One day you might get a test at +3 and +5 (3 hours after injection and five hours after.) and the next day you might get +5 and +7. In the evening, you might get one in right before bed, or set an alarm some nights so you can catch a +6. Once a week, you should get a "curve." That's a test every 2 hours for a 12-hour cycle, so six tests that day.

3- Yes. Changing to only wet food can have a big positive effect on Monkey's BGL. It is important to be testing his BGL when you do it, as the change to low carb wet can drop a cat's BGL over 100 points, and sometimes the dose ends up needing to be reduced. Make the change slowly, take a few days to slowly cut out the dry food, as this will be easier on his system. Sooner the better, but make the change slowly.

4- That food looks really good for Monkey. Honestly, you are just looking for food that has zero to very little plant sources. (grains, beans, peas, tapioca, corn starch, vegetables.) The food you are looking at seems to be mostly made of meat, which is great for Monkey.

You are awesome for doing your own research and helping Monkey!

 

Yes, the Thrive Complete canned food looks like a reasonable choice of food for a diabetic cat. No way to tell what the exact carbohydrate content percentage is, but the ingredients look reasonable.
Using the Analytical Constituents in a basic cat food carb calculator gives 1-2% carbs, which would be expected from the ingredients.

Are any of these foods in the following lists available in Hong Kong? The first 2 lists were created by one of our members in Australia.

• AUSTRALIA - LOW CARB CANNED AND AIR/FREEZE DRIED CAT FOOD (updated 07/2019) Complied by Bron & Sheba (GA)
• NEW ZEALAND LOW CARB CANNED AND AIR/FREEZE DRIED CAT FOOD)(updated 09/2019) Complied by Bron & Sheba (GA)

The second link is a list from one of our members in the United Kingdom. >>>>>> UK Cat Food List

 

Hi Peter and Monkey and welcome to the forum. I’m so glad you found us.
Do you think you could get a clearer picture of the pathology results for us to see please..?
That are blurry when enlarged. Thanks

 

Hi Bron and Sheba,

My apology, I have upload a clearer picture. Many thanks.

 

Hi Deb

My apology, I find out that it is my mistake. Please see the attachment, I think it is 3 unit of U40 syringe, see the image of plunger.

For insulin dosing history, I know it is the above volume, once at morning once at night. I find out my family members are being very inaccurate in the timing. As you have noticed, yesterday it was only 8.5 hours hour apart, that worried me a lot. Now I need to do it myself and be more accurate. I will post a spreadsheet later

The specific glucometer is Pet Control HQ Blood Glucose Monitoring System, please see the attachment.

I want to add that I will see a vet tmr, I am thinking how should I communicate with him. I heard that some vets are not well trained in treating diabetes cat, but at the same time very close minded. That's what I worry

 

Can I say I should use US Spreadsheet Template for PET METERS CALIBRATED FOR FELINE BLOOD?

My glucometer is Pet Control HQ Blood Glucose Monitor System, it writes "Suitable for Dogs/Cats Testing Only", for details please refer to my previous post in this thread. I have an attachment.

 

What kind of threat is safe to Monkey? I worry about food can be dangerous to diabete cats.

Monkey likes shrimp, and dry food treat (that should be avoided, right?) Is shrimp safe for Monkey to eat? I read that sodium in seafood can cause problem to cats

 

Hi Peter, I am going to tag @Marje and Gracie to look at your path results. She is excellent at interpreting them.
With your pet meter, does it read in mmol/ L or mg/dL? It will depend on that which SS you use.

 

Shrimp is Yummy! Just ask my Simba and Gustav and rescue babies Donna and Sessan.
And perfectly safe to give if not raw of course.

 

Well Peter what does Monkey like? It could be as simple as a small piece of cheese. Bonito flakes is a fave here...Small portions of shrimp like Ann suggested should be fine unless Monkey has kidney problems. I'm SURE others will add to this list.
You got this dude! Monkey is one lucky kitty to have you as his care giver!
jeanne

 

Freeze-dried meats (chicken, etc.) are a good option. They get the dry crunchy texture they like, but it's just meat, so it doesn't have the carbohydrates of other dry treats. You can get some that are just a single ingredient, or else there are some that are more processed, but still just basically freeze-dried meat (a brand you can get here is called Orijen, but I don't know if that's available to you).

 

Peter and Monkey lives in Hong Kong, Asia, were they don't have what's in U.S
, but it is definitely a Shrimp city. Also under coronavirus lockdown and right next to China.

 

It is in mmol/L.

 

That's true, I am not sure if Freeze-dried meats for human is available. I think I can find it in pet shop. My concern is, will there be too much bone mineral and unknown ingredients?

It seems that pet food industry involves in a lot of unethical practice. I will read the nutrition description carefully to minimize the risk...

 

Yes, since you are in Hong Kong, you use mmol/L. Same as China.
So when you set up the spreadsheet, choose the "World" template for pet meters.

If you are anywhere other than the US, please click on this link for the World Spreadsheet Template for PET METERS CALIBRATED FOR FELINE BLOOD (e.g. Alpha Trak):
World Spreadsheet Template for Pet Meters

Enter your data on the World version tab.
The spreadsheet will automatically populate the cells on the US tab that is in mg/dL. There is formatting behind the cells, that does this transfer of data automatically.

There is also a tab on the spreadsheet, where you can enter labwork results. First, you have to enter a column and add the reference ranges for the particular lab where the work was done. Then, you add a column for the actual lab work results.

Fresh or dried shrimp are fine as a treat for Monkey. Or any other type of fish, raw or cooked. Any type of plain cooked meat, no extra spices or salt are good too. Just rinse the seafood well, to get some of the salt off the seafood.

Thank you for the pictures. Yes, that is 3 units of insulin. Thank you for confirming that. U40 syringes have the red caps, but I see you also showed a picture of the side of the syringe with the U40 writing on it. Thank you so much! Nice clear pictures.

Stay safe while on lockdown Peter. We're all trying to, in many different countries. Physical distancing, face masks, staying at home as much as possible.

 

@Deb & Wink hey Deb just noticed if you look at the pic of the box the meter came in it say two code chipes one for dogs and one for cats, just wondering if he has to put the code in for the cats like you have to do on the alpha trak meter, meaning each set of test trips is coded with a number

 

Good point Diane. You have sharp eyes! Thanks for noticing.
Peter, did you put the correct code chip in the meter? The one for cats? I think it's a physical chip, not a code you enter into the meter, for your batch of test strips.

Worked with Teo from Argentina, and he had a meter that had a physical chip that needed to be inserted into the meter.

It's worth double checking that chip.

 

Thank you Deb I didn't know some had chips,

 

Oh, I was talking about the ones you might find in a pet shop! The ones I have here in front of me only list a single ingredient "freeze dried chicken" . If you can find the ones that are packaged as dog treats, that's usually more economical (they're the same thing as the cat treats, just larger pieces , and much cheaper).

 

Hi all, for many years Monkey like to go to bathroom or kitchen to drink droplets dropping from the hose, and for many years I do not understand why Monkey is meowing at me few times per day. But when fill water in a bowl, it seems that he hesitate a lot to drink them.

Yesterday, I read that evolutionarily cats like to drink moving water. So today I test the idea. I first gave a bowl of water to Monkey, he did not drink it. Then I pour water slowly from a pot, a water column was formed, Monkey LOVES it, he drank for like 5 minutes. When he meowed me today, I give him moving water again, then he stop pouring.

I have order a water fountain that should arrive within 2 days.

My question is, if he drinks a lot of water, is it perfectly healthy? Also, I heard that cat generally prefers cold water, even icy water, is that true? Is icy water healthy?

 

Cats drinking water is a GOOD thing! It also helps you visually SEE how his diabetes is controlled . It in NO WAY replaces bg testing. BG testing is imperative! But unregulated cats drink a lot of water. GOOD decision on the fountain! Let Monkey drink all he wants! Personally I would just stick to cool to cold water. I live in the low desert. We get some of the hottest temps on earth and NONE of my cats have ever taken to water with ice cubes in it. They wait till the cubes melt away.

 

Thanks jt! I have started formal blood checking today, please see my spreadsheet. I have two diabetic cat, Monkey and PenPen

The volume of insulin injection is decided by the vet yesterday, and he asked me to see him 2 weeks later to adjust the insulin. However, I would like to see him 1 week later because I want him to adjust the insulin sooner. I think PenPen's BG is not looking good. I am aware that insulin adjustment have to gradual. But may I ask does my thinking make sense? Is that too quick to adjust insulin within a week?

Please comment if I am doing things correctly:
9 am: Check BG, feed, wait for 20 minutes then inject insulin, retrieve the food after 40 minutes.
Then check BG once every 3 hours.
9 pm: Check BG, feed, wait for 20 minutes then inject insulin, retrieve the food after 40 minutes.

Also, the food I am feeding is Royal Canin diabetic feline dry food, and a little bit of fish as a treat. I would like to gradually transit to wet food once I have enough information on their BG.
My question is, everytime I feed, Monkey and PenPen eat a lot, should I allow them to eat until they don't want to eat anymore? I read that it is dangerous of diabetic cats to not eat enough, am I correct? I find that after they are done with dry food, if I give them meat snack, they would still eat them happily. Should I give them more meat snack to make them more full. If they are hungry in the middle of the day, should I give them snack if I still want to get accurate and not spoil them. If yes, what volume and type of snack is safe? Should I limit the variety of snack to one or two item, or should I diversity the snack I give them?

I really appreciate for the help. You people are beautiful.

 

Well I cant give advice on dosing. Deb or one of the others on this thread can speak to that ok?
But I DO know that unregulated cats are ALWAYS hungry. Feed them as much as they want. Once the BG numbers start coming down and get to a level they will process their intake better and they will crave less food. NEVER hurts to give more meat snacks! Cats are obligate Carnivores. Ive never seen a cat strolling through a garden and munching on the veggies. Have you?

And we think YOU are most beautiful for being such a GOOD caregiver for your kitties

 

I have to add that... the doctor recommend me to eat Royal Canin diabetic feline dry food, and told me meat may not be good for them. (Ironically, he told me I can buy their diabetic prescription Can wet food. Although I cannot understand because Can wet food is meat, he seems to have OK integrity.

Attached is a nutrition information of the diabetic dry food. It says "This feed contains a low level of rapid glucose releasing carbohydrate" I need to praise them they give out typical nutrition instead of guaranteed analysis. It has 46% protein, 3% fatty acid, 12% fat, about 18% starch, 6% crude ash (Sounds too much?) Sugar 1.8% (WHAT!? Sugar for DIABETIC? CAT?) Ingredients: dehydrated poultry protein(how much?), soya protein (thyroid problem causing?), wheat gluten (I thought it the trend of dry food was gluten free)...

Does my suspection make sense?

I have read a lot of materials linked to this forum, and read scientific literatures such as The carnivore connection to nutrition in cats by Debra L Zoran, who is a vet.

I am convinced that animal protein is good for cat, dry food is bad for cat, because of I believe in evolution and animal should eat things that is similar to the things they eat in nature. However, the vet told me to give them that diabetic dry food but not meat. What can I do with that conflict of ideas? Should I insist? If I insist, how can I work with the vet? What if he insist cats should eat dry food? How can I convince my uneducated family members that I take a approach that is different then the vet?

 

Hi Peter!

(my last paragraph is the most important, if you want to skip down!)

That's great you got the water fountain! I have one, one of my cats will only drink from that (the other one prefers a human's drinking glass, not a bowl, a glass lol, cats are so funny!). The important thing is that he is getting the water he needs, that is helpful, especially if you continue to feed dry food.

On the food: your vet is misinformed about proper nutrition for a diabetic cat. It's not really his/her fault-- vets do not get a lot of education on the topic in school, then the pet food companies step in to offer advice... In addition, I don't know what it is like in Hong Kong, but in the US vets deal with diabetic dogs much more than diabetic cats, and even though their treatment should be very different, too often vets will just treat cats as if they were very small dogs. You're right to think about different food options, but wait a little longer to switch food, as that can really reduce insulin needs and you currently have no safety margin on that (see next paragraph!).

Now for the most important thing: just looked at your spreadsheet, and wow!!!! That 70, on a pet meter, is very low if you are using Caninsulin!!!! I think you are definitely going to have to reduce the dose. Tagging @Deb & Wink (I know she will stop by, but it looks like you are about to shoot and I want to get her attention!!!).

 

Hey people, I have elaborate my last post, please see if you have any additional comments

 

Nan is right and so are you Peter. Dry is bad. The vet doesnt have to know you arent feeding dry. Now if its because he INSISTS you purchase THEIR food. You can always say you found a cheaper source. But HONESTY you SHOULD be able to work with your vet not against him. My fear is you will need to give huge amounts of insulin to compensate for the high numbers. That is no way to manage this disease. Maybe try asking the Vet(AND family members) "Have you ever seen a cat stroll through a vegetable patch just to eat the goodies there?"
You have a lot of people to educate. I just hope they LISTEN and GROW.
GOOD LUCK We are behind you 100%

 

OK, wrote that last paragraph hit "send" on that when I saw your spreadsheet, here are some really important points to emphasize:

1) if you have not yet given a shot tonight, don't until you hear from Deb or another Caninsulin person. If they don't get here in time, my (non-Caninsulin person) advice would be maybe a half dose, 2U, at most.

2) Eventually, you will want to change Monkey's food, but don't change yet, as it could be dangerous while he's getting so much insulin. What I was going to write in my last post, but didn't get to, was that a lot of us have taken the approach with our vet's food advice of "smile and nod when in the office, then feed what you think is best at home". Again, vets don't necessarily get a lot of experience dealing with diabetic cats.

I think the 18% starch is probably a bigger problem than the 1.8% sugar. I can't speak to the soya and wheat health concerns, except to note that I don't think cats are eating those things in the wild!

 

Well put Nan, thank you!

 

Monkey's cycle today is a really good example of why home testing is so important! Look at the range he went through!!!!! Any one test, such as one he might have gotten at the vet's office if you had taken him in, would have given a very incomplete picture about what was going on.

As for what is going on: that 70 he got at +5 is quite low. It is just above our "take action" number on a pet meter, 68. "Take action" means to feed some high-carb food or honey immediately in order to avoid hypoglycemia. Even though he didn't quite get there today, you can see why we are concerned that he is getting too much insulin! Especially with an insulin like Caninsulin, that does not leave you a big safety margin.

Right now, what is probably keeping him safe is actually the dry food recommended by your vet! You haven't been able to test to see how low he is getting and give him carbs to counteract, but the food he's eating regularly has enough carbs that it is doing the job on its own. But you don't want to rely on that, plus all the dramatic ups and downs are probably part of why Monkey isn't feeling well. Much better would be to have a smaller insulin dose and better diet. The important thing, though, is not to change the diet first-- it is what is keeping him safe!

I am soooooo glad you have started testing!

 

I will read every words you people write.

70 mg/DL is too low!? This is the amount decided by the vet yerterday. Monkey dose increases from 3.0 U to 4.0U. I need to inject insulin 10 hours later, which is next morning. What should I do? Wait for Deb for advice? Or call my vet urgently to ask?

Fyi, Monkey looks good today, more energetic than when I started to take care of him 2 days ago. Last week he slept in a fix position most of the time, and eyes appear sleepy all the time. (As I said, my parents inject insulin for him, but they do it in a imprecise, lousy manner). Now although he still stay in that fix position, he sometimes stand up and observe people, his eyes opener wider that it looks like he have normal mood. I guess the change may due to 1. I inject insulin correctly 2. I feed him a lot of water so he was less dehydrated 3. I give him meat snack.

I also want to ask, they vet told me if BG is lower than 80 mg/DL, then I should not inject insulin. If BG is slightly higher than 80 mg/DL, such as 90 mg/DL, I can still inject full dose. However, according to Beginner guide to Caninsulin "no insulin is given if the BG is below 200 mg/dL [11 mmol/L] on a human glucose meter", . What should I follow?

 

Hold off on the insulin Peter, while I try to catch up on what is happening. Give me 5 minutes please.

 

Peter, Please do not give Monkey insulin if the pre-shot BG (blood glucose) level is <200 mg/dL (11.1 mmol/L). Later, when you have more test data on the spreadsheet (SS) that threshold of 200 (11.1 mmol/L) can be lowered.

But for now, let's keep Monkey safe and not give him any insulin if the BG is <11.1 mmol/L.

What is the pre-shot BG test for this 12 hour dosing cycle? Is this the PM or AM dosing cycle for you?

p.s. When you get a chance, please update the SS with the data from the last couple of days. Last data was from the 5th? I think you have the wrong month in your dates. It should be 4 (April) not 8 (August).

 

1. Monkey used 3U for 3 to 4 weeks, and yesterday vet increase his dose from 3U to 4U. What do you think about that?

2. Yes, thanks for reminding me to be very careful in reducing his dry food.

3. Yes, starch is bad. I suspect that starch is not the healthiest food even for omnivores like human.

 

non-US date system, I think (day/month/year), but maybe a "fill-down" in the spreadsheet that assumed the US (month/day/year). Technology!

 

Thanks Deb. I have corrected the date. I injected 4U 2.5 hours ago, which was around 9 pm Hong Kong time. Hong Kong time is 12 hours faster than New York time.

 

This makes me really worried that your vet does not really treat a lot of diabetic animals. This is really dangerous advice, especially with Caninsulin!!! (Again, probably not exactly his/her fault, but still...)

Can I ask, what is the usual units used for BG in Hong Kong? I'm wondering if there's something lost in translation if your vet is not used to dealing with the (US-centric) mg/dL.

 

@Nan & Amber (GA) Hong Kong and the rest of China use mmol/L.

https://www.facebook.com/diavergeDi...asurement-of-mgdl-which-use-/625561337626529/

 

True. Hong Kong people use British format. Interestingly mainland Chinese traditionally use year/month/date, opposite of British.

 

Ok Peter, are you able to test the BG level soon? Say around +3 or 3 hours after you have injected the insulin?

I realize it's close to midnight where you live. But some tests in this PM cycle are important. To keep Monkey's BG from dropping low, and him having hypoglycemia symptoms. You may need to feed Monkey some high carb food to bring his BG levels up if he drops below 68 mg/dL (3.7 mmol/L) on the pet meter you are using.

I think that 4U dose is high. Too high for Monkey.

p.s. How is PenPen doing?

 

I guess it is mmol/L, because the BG report in the vet's screen is in mmol/L. We have communicate about difference in unit, and I am very sure that he says 80 mg/DL, as we speak the same native language (cantonese), and I do not think it can be my error, because I was very specific in confirming he says IF BG<80mg/dl, not inject. IF BG>80 mg/dl, INJECT IN FULL DOSE.

 

I can stay awake a midnight, for the safety of the cats. Let me plan this carefully.

 

All I can think is an error in conversion factor... It should be x18 to go from mmol/L to mg/dL, maybe he's thinking it's x10 or something like that????

Anyway. In answer to your question above, please listen to us (by which I mean Deb) on this. 70-80 mg/dL on a pet meter is too low to inject any Caninsulin!

 

The capital letters will stick in my memory. Should I free feed them dry food, plus meat snacks? Given that you people have suggest the insulin dose may be too high. I am thinking, if Monkey's 70 mg/DL is cause by he does not eat to the fullest before I inject insulin, and I withhold food for 12 hours except very small piece of meat as a treat for checking BG. Am I doing it wrongly?

 

Sure. I trust you people. I have the same idea, maybe the vet is not good at mental math.

 

@Peter H , were you able to get another BG test? What was that BG number/test/reading/level?

We change insulin doses in 0.25U increments. That way, we do not bypass a good, lower dose for our diabetic cats.
I think that your vet likes to increase in 1U increments, and that can be too much of an increase at one time, for a small animal like a cat.

Yes, mg/dL to mmol/L is dividing by 18. So 200 mg/dL is 11.1 mmol/L.
What your vet said about giving insulin if the pre-shot test is > 90 mg/dL does not make sense to me.
I think if you do what your vet says with the insulin dose for Caninsulin, that Monkey will drop too low and may have a hypoglycemic episode.

A mid-cycle test of > 68 (3.7 mmol/L) or higher is ok. But you do not want to give insulin if the pre-shot BG test is that low. The pre-shot BG (blood glucose) test is the test you take before you give your cat insulin for the current 12 hour dosing cycle.

A BG level at mid-cycle of <68 mg/dl (3.7 mmol/L) is when you want to take action, and feed Monkey some higher carb food maybe a teaspoon of the wet food that you have. Maybe a few pieces of the dry food that you have. Maybe a little bit of a simple sugar like corn syrup or honey or any sweet liquid you may have.
(@Nan & Amber (GA) , that 68 on a pet meter is equivalent to our take action BG of a 50 mg/dL on a human meter)

 

Now is +3, Let me check Monkey.

 

It's ok for a diabetic cat to eat most of the time. You do want them to be hungry, before you give them insulin. You do not want the pre-shot tests to be influenced by food. So we recommend that you do not have any food out for 2 hours before the pre-shot tests.

Also, with many insulins, the cat's body has used up the insulin by around the +6 hour mark in the 12 hour dosing cycle. So feeding your cat after that point in time means the BG (blood glucose) levels rise faster during the last half of the 12 hour dosing cycle. Small treats are ok to do, when you do a BG test after the +6 hour mark.

It's ok to split the meals into several portions. Feed the largest portion as the first meal of the dosing cycle, and then divide the rest of the food into smaller portions. You could have the dry food out from the pre-shot test time until +6. Meat treats when you do the tests are fine at any time. Those treats gain the cooperation of your cat, as they come to associate a tasty treat with the blood test.

Eventually, it would be better to eliminate the dry food entirely. But let's get you more familiar with the blood glucose testing first.

Do you have some canned food for Monkey and PenPen?

 

Most of us find that diabetic cats do better with frequent, small meals throughout the day. The "only feed 2x/day" is old pet diabetes thinking, I think.

 

I agree with Nan and Deb! THANKS guys!

 

Update: Monkey +3 BG is 435 mg/DL, I feed him wet food. Chicken and chicken liver, 1/4 volume of the can, please see this photo, is that appropriate?

Also, after I open the can and put in it in refrigerator, how long it will remain safe?

 

I think you are confusing mmol/L results with mg/dL results. 435 is higher than the range that mmol/L goes to.

Cover the can in the refrigerator and it will last for several days. I keep opened cat food cans in my refrigerator for 4-5 days without a problem. You want to cover the can, so the food inside, so the food does not dry out and so that the smell does not permeate your fridge. Plastic works fine, or aluminum foil, or a special cover to fit the cat food can may be found at pet stores.

 

Oh it is a typo, I know clearly 10 mmol/L = 180 mg/DL. Thanks for the advice. So what should I do now? Should I wait for next 3 hour for test? Or I can go to sleep and wake up 7 hours later?

 

Can you leave food out for Monkey tonight?

 

Yes, of course I can leave dry food out

 

Do you know whether that is low-carb or high-carb wet food?

I think that would be a good option tonight, let's see what Deb thinks, though.

Some context for the numbers you saw today, and what we're looking for in the future. Today's daytime numbers were in a perfect curve shape, just what you expect from Caninsulin when it's working-- start high, drop down quickly with a low around +4/+5, then back up as the insulin wears off.

So now one question is, does Monkey do that every day, and will he do that tonight? Or will he "bounce"? A bounce is when the cat's body reacts to an unfamiliar low BG, resulting in higher numbers. It may be that that was part of what was driving Monkey back up this afternoon/evening.

Here's the hard part: cats that bounce often do so on a multi-day time scale, up to three days. The good news there would be that if we think he's bouncing tonight... at least you will be able to get some sleep tonight, even if we don't know precisely how long that bounce will last!

Your +3 number was pretty similar to the pre-shot number, so if I had to guess I would guess he will remain high tonight BUT, again-- Deb is far more familar with Caninsulin than I am, so please listen to her on this!

 

For chicken and chicken liver wet food can. It is low-carb wet food. It is very high protein, relatively low fat, very low carb (not much carb or plant related ingredient).

I think I need to study the concept of bounce

 

The 435 mg/dL is a very high number for +3.
It's very unlikely that Monkey would drop to a dangerous BG level at mid-cycle.
Possible, but unlikely.
If you are worried, set an alarm to wake you at around +6.

Yes, ok to go get some sleep.

Leave out some dry food for Monkey. Or some of the wet food would be ok to leave out also.
Cats will often seek out food, if they feel their blood glucose levels dropping.

Get that pre-shot test in the AM, no food for 2 hours before that.
So you may need to wake up 2 hours before the AM test, to take away the dry food, or any leftover wet food.

What time, your time is the normal AM pre-shot test? Around 9 AM your time?

 

Update, the moment I fill the dry food, Monkey and PenPen come and eat a lot... they are still eating.

 

Hah!!!!!

A lot of us with "eat it if it's there!" kitties use timed feeders to force them to spread it out a bit...

 

Yes, 9AM my time. Maybe I need to get some sleep. I am thinking I would not have enough time to sleep if I wake up 2 hours earlier

 

Hi all, I have fed Monkey dry food and wet can this morning. I inject 3.25 U of insulin. As you people have said, 4.00 U is too much, and the change of 3.0 to 4.0 within 2 day is too sharp.
I think 3.25 U is safe for Monkey, since he has inject 3.0 U for at least 3 weeks, and his BG was higher than 250 mmol most of the time. Does it make sense?

I am thinking, 70 mg/DL for yesterday, the reason maybe:
1. Monkey eat breakfast and I withhold food for 6 hours except small piece of meat. Monkey does not eat enough thus not enough glucose.
2. 4.0 U Insulin is too high, as you people have said
3. glucose meter error, I find that my glucose meter is not an accurate device , it seems that the error is >+-25%

Also, I want to ask Monkey has been losing weight rapidly for 4 weeks, this may give me a good reason to free feed dry food, and give meat snack, am I correct?

 

Hi Peter!

Looks like Monkey had a pretty good day, getting some movement down to blues from the 3.25U. That's great!

I don't think it's meter error. +/- 25% is a bit high (they're not supposed to be off by more than +/- 15%, and that's bad enough!), but it's not enough to make that big an error. If the 70 had been a single green number in a sea of red and black, I would think it more likely that you got a bad strip or the meter just flubbed it, but Monkey had a very clear curve yesterday. He might not have been "truly" at 70 because of meter error, but he was still pretty low no matter what.

Withholding food, particularly carbs, during the day can definitely make a difference, especially with Caninsulin. They really need some food to act as a buffer, and in Monkey's case, it seems likely that what he's eating right now is playing a very big role in keeping his numbers up out of the danger zone.

Poor little guy! Losing weight rapidly isn't a good thing, we want to get his weight back up. About dry food: we have a bit of a conflict happening right now, because the rapid weight loss is likely due to his uncontrolled diabetes, and dry food certainly won't help with that! However, while we're figuring out the insulin situation, the dry food will give him some extra carbs and help keep him safe from hypoglycemia. That's the primary reason we recommended leaving dry out last night.

How is he acting today?

 

Today Monkey is doing good. He is moderately energetic. I find that he grows new fur, his skin improved and without bad smell. (Four days ago, the smell of his skin of his neck was stinky)

I agree with you. Now I am trying to give him extra animal protein in addition to dry food. My plan is to let him eat everything for the first 6 hours of insulin, then I restrict carbs and give only animal protein snack until next dose. My rationale is at 6 hours, the nadir (high risk time) would be reached. Then the BG would increase, and I restrict carb to slow the acceleration.

Of course, at night I free feed dry food to lower the risk.

I was thinking, since he lost a lot of weight and fur, and have skin problem, the safest and most important thing is do now to make him recover first.
Once he is healthy as before, then I can start to change his food and insulin.

 

One question, is it safe to switch from Caninsulin to PZI or Lantus? They seem like a popular choice that is safer and have less violent fluctuation in BG.
I do not understand why the vet give me an unpopular choice. It seems there is no advantage for using Caninsulin.

 

Hi Peter! As you know your questions will be addressed soon. Just wanted to say hello!

And btw I have seen many kitties change insulin! Its doable. Hang in there for how to do this safely
jeanne

 

Yes, definitely safe to make the switch! Both are good insulins for cats, with Lantus being by far the most popular here on the boards, so if you have a choice I would recommend that one. The Lantus boards are very active and have a lot of experienced users to help guide treatment. Not that you wouldn't be able to get support and advice if you switched to PZI, but we're currently somewhat light in ProZinc/PZI, particularly PZI. @Deb & Wink , any thoughts on this?

As for why your vet prescribed Caninsulin, it's a common starting insulin because vets are familiar with it, but as the name implies, it's a much better insulin for the dogs they treat than the cats. Hopefully your vet will be open to prescribing something like Lantus! Other possibilities in the same class are Basaglar and Levemir. All are "human" insulins, but they work very well for cats.

 

Another question, I cooked chicken breast to Monkey and he loved it and eat a lot. Can I feed him more as an extra nutrition? Is fully cooked meat perfectly healthy for diabetic cat?

 

Hello Jeanne!

 

Sure, just plain chicken (no salt or other seasonings) is very good for them. It's not a complete diet for a cat so they can't live on it alone, but it's low carb and has lots of good nutrition even if it's not complete!

 

Cooked chicken is always safe. Especially for treats!

 

I really appreciate your help people. I learn that it is essential to ask questions in this forum, the more the better. Even I read information in this forum. If I mistakenly assume all of my thinking (or the vet's thinking) is correct, that I pose risks to my cats like yesterday. You people are awesome.

 

Another question, my vet told me wet can food is bad because meat is soft and it does not prevent cat's teeth from deteriorating (I am not sure what he is talking), and dry food is good because it is good for cat's teeth. Given that my cats have no disease with their teeth, is my vet correct? How to maintain dental health?

 

My only thought about switching the insulin to Prozinc (PZI is a nickname) is that there is currently a manufacturing shortage of this insulin and it is not currently available in the United Kingdom. I know a few of our Prozinc ISG (Insulin Support Group) members had issues getting this insulin from their US vets for a short while, back in late January and early February 2020.

So Peter, you may want to check on the availability of the Prozinc insulin in Hong Kong before you decide on a switch.
For that reason, Lantus (glargine) may be a better choice.

But there are also reported shortages of the Lantus (glargine) insulin from the main supplier in Canada, Mark's Marine Pharmacy, that many of the people here use to buy their insulin. That pharmacy is recommending that people try the biosimilar Basaglar insulin.

If you do decide to change the insulin to glargine (lantus or basaglar), you should get the insulin pens. Basically, those are a miniature vial that holds 3ml of insulin. You can still withdraw the insulin from the insulin pen with a syringe.

Lantus is a U100 concentration insulin, so you would need different insulin needles.

 

This is a common myth. Cats do not chew the dry food, so the dry food does nothing beneficial for their teeth.

Here is one article about dry food and does it clean the teeth.
https://littlebigcat.com/does-dry-food-clean-the-teeth/

 

Thanks Deb. Do you think it is completely safe to switch? Is there any guide for that?

 

Yes, it is safe to switch insulin. Many members here have changed the insulin from one type to another type of insulin.

When you switch insulins, you take the current dose of insulin into consideration. You do not restart the insulin dose at 1U or 2U. Since Caninsulin is what we call an in-and-out insulin, meaning it's effects do not last beyond the 12 hour dosing cycle, you can switch directly from the old insulin to the new insulin at the next dosing cycle.

It's better to make the switch in the morning, because you will be awake to monitor the change.

There are different dosing protocols about the different insulins in the insulin specific forums. There are what we call "Sticky" or pinned posts at the top of the ISG (Insulin Support Group) forums. You might want to review them.

It's a lot of information, so take your time to review the "Sticky" documents. There are 4-6 at the top of each forum.
Lantus ISG forum Lantus / Basaglar (glargine) and Levemir (detemir)

Prozinc ISG forum Prozinc / PZI

 

There is also a thread here on dental procedures, and keeping your cats teeth clean at home. An initial dental cleaning at the vet may be needed, it the teeth are in bad shape.
Info on Dental Procedures (including pictures)

 

The benefits if can food far outweigh the benefits of dry food. I have a HELL of a time promoting that on other chat sites, to which I belong

Good luck with the switch!

 

Hi Peter! Just popped in to say that you are awesome and taking great care of Monkey. Everyone has already given you good advice. I agree n insulin switch would be a good idea, and the canned food instead of dry, with added plain meat for extra calories is a great plan. You can feed Monkey as much as he wants, which will help keep him from losing more weight. And while you are on the Cannisulin, you are smart to make most of his food in the first half of the cycle. That won't be as necessary after you switch insulins to a longer lasting one. On Lantus or Prozinc, you only have to withhold food 2 hours before injection time.

 

Hi all, Monkey's mood improved a lot today. Yesterday he was sitting in a corner observing people. Today he is sitting on the table to be with me. He starts to show curiosity to things and interact with other cats. He eats a lot, both dry food and cooked breast breast. Apart from that, Monkey is drinking water frequently, I think it is the most frequent that I have even seen in my life. Is that completely healthy? Can this cause excessive urination that lead to problem?

PenPen eat a lot less than Monkey, but still eat a moderate amount. Perhaps it is because PenPen has less severe diabetic. Does my guess make sense

 

May I ask, because I sting Monkey's ear vein for like 3-5 times a day, there are a lot of red thing (I do not know what) on his vein. Am I doing things correctly? I worry if I sting the ear too much, monkey would be uncomfortable or have other complication, what do you people think about that. (See the attachment)

 

Hi Peter
I dont know if you can get the product called Neosporin in Hong Kong. A lot of us use that (sparingly) to help heal little mistake pokes. (I know I had that issue at first. ) If not, maybe a thin layer of Vaseline. it will act like a bandage. Hold on for other replies. I no longer have a diabetic kitty and maybe there are more products on the market I'm not aware of.
BTW Give Monkey some chin scritches from us!
jeanne

 

Oh dear yes drinking water and excessive urination is a signal of uncontrolled diabetes. We need to get Monkeys numbers down some. Let him drink all he wants.
You need more specific guidance than what I can give PLEASE hold on for the experts to answer ok?

 

Are those little bruises? A couple things that might help, in addition to the neosporin (or polysporin) suggested by Jeanne:

1) Don't poke the ear vein itself, you want to aim for that little strip between the vein and the edge of the ear. It can be harder to get blood out of that area at first, but if you poke it repeatedly, over time new capillaries grow, and it heals faster than poking the vein.

2) After you make a poke and get your blood sample, apply pressure to the wound for several seconds (using a piece of tissue or cotton to soak up the blood). It both helps stop bleeding and helps prevent bruising.

 

Yes, it is available. Seems like a great product. Is that Neosporin, Multi-Action, Pain Itch Scar Ointment?

So it is completely safe for all cats right? (I have no idea how it works)

Monkey responded chin scratch with purring zzzz

 

Boy good question! I use to use the plain neosporin.(But that was before they came out with all the new pain relief, itch control)...Best to wait for others to chime in on this one ok? I used the plain neosporin.