Advice needed on increasing insulin

I have an appointment at the vet later and just wanted some advice as every time we go they don't seem to listen to us.


We took Loki to the vets after we noticed an increase in urination and drinking over the course of a week and a half, from this he was then diagnosed with diabetes at the end September. He is on canninsulin, started at 2 units and is now on 2.5 units 2x a day. He only ever had one glucose curve carried out at the vets which was inconclusive due to stress. Since then they have monitored his glucose using fructosamine tests only. We wanted to home test but we were told there was no point as his glucose is consistently high and his diabetes unregulated.


He also has blood in his urine which after all tests is being caused by stress however, medication such a nutricyst have not helped.

Over the last 3 or so weeks he has become increasingly aggressive towards our other cat, they've never had any other issues before this. I've tried everything I can think of including using feliway and nothing is working. The bouts of aggression seem to come on suddenly and it's gotten to the point that I've had to separate them. I've rang then vets and had at 2 appointments (with the same vet) and it's been dismissed each time. They ran another fructosamine test, glucose was still high so suggested to up his insulin to 3 units. The vet said I would need to home test due to the increase and that they would supply me with the kit. As it would take a couple of weeks to get this kit, I've not increased his insulin.


Friday night Loki attacked our other cat quite severely with me having to physically separate them. He has also started to become suddenly ravenous and is actively hunting around the house for food. I rang the vets and got an appointment straight away. As our usual vet was away we saw a different vet who said it sounded like he might be having a hypo during these times. There could be a chance that he may not require insulin anymore as he is no longer frequently urinating or drinking and isn't showing other signs of diabetes so suggested it could have been stress related. I was told that she would call me on Monday with a plan, possibly taking him off insulin all together.


Yesterday the practice rang and said our regular vet had requested we come to an appointment today to see the diabetic nurse. I asked what the appointment was for and the receptionist couldn't tell me and they were not aware of me being due a call back from the second vet.


My worry is that they will try and convince us to increase his insulin and totally dismiss the recommendation of the second vet. Given what's been happening recently and the fact that they don't seem to take my concerns into account, would I be doing the right that by refusing to increase it? Also I'm unsure about what to do next, any advice would be greatly appreciated.


Sorry about the long post but I'm really stuck on what to do.

 

Can you get to a pharmacy and pick up a human meter so you can start testing right away?

 

I should be able to go out and get one (hopefully) this afternoon. Is there any specific types or brands I should be looking for or will any human meter do? (I'm in the UK).

 

I’ll tag U.K. member @Critter Mom
@Elizabeth and Bertie

 

My main meter is an Alphatrak but I got an Accu-Chek Aviva as a backup meter. (Grabbed what was available at either Morrison's or Boots.) Not sure whether it's the best value in terms of test strip costs. Whichever meter you buy, be sure to buy a pack of test strips, too, because there aren't many supplied with the meter itself.

I never used the pricking device that comes with the Aviva glucometer (would not have been able to see where to prick the ear).

You'll need 28 gauge lancets (ask chemist for 'alternate site' lancets if you aren't sure which ones to buy). There may be a small supply of lancets included with any glucometer you purchase (although some have proprietary discs to fit their pricking devices) but going forward lancets are far and away cheaper to buy on eBay. Best value is usually getting a box of 200 (You can freehand the ear prick using just the lancet so you don't need to rely on getting a match for the pricking device that comes with a meter.)

I hope Eliz may have further suggestions for you. (She's not very active on the board at the moment so it might be a while before you hear from her.) I could be wrong but I think I've heard her mention a One Touch Ultra meter.

Here are a couple of older threads which might give you some info:

http://www.felinediabetes.com/FDMB/threads/dosing-advice-needed-for-novolin.181608/#post-2018435

http://www.felinediabetes.com/FDMB/threads/which-test-kit-to-buy-in-the-uk.187602/#post-2082262


ETA: You may get better prices on human meter test strips via eBay or Amazon but always check the expiry date with the seller before purchasing!


Mogs
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I think this vet might be onto something. Very low BG can cause strange behaviour, including ravenous hunger. Your best tool to sort this out is a blood glucose meter so you can test him at home.

 

We have been given the Alpha track 2 by the vet and asked to carry out a glucose curve. However, they told us not to worry about the readings just to write them down. What sort of readings would indicate normal, high and low blood sugar levels? I'd rather i was aware of what's going on with his blood sugar levels incase we are giving to much insulin.

 

I use an AlphaTrak 2 meter. The normal cat BG reference range given to me by my vet for use with this meter is:

3.9 - 8.3mmol/L

For your own peace of mind I recommend you confirm this range with your own vet. (NB: This reference range is for pet-calibrated meters only. A different reference range is used with human meters.)


Helpful tips for Curve:

1. The kitty needs to be fasted for 2 hours prior to taking the first test (preshot test). (NB: If cat is not acting normally in hours before injection is due then don't fast the cat. Abandon the scheduled curve and do it on another cycle.)

2. Do the first test then feed Loki. Wait about 20 minutes then give the Caninsulin dose. Record time the dose was given and the size of the dose. (This is the 'start time' for the curve.)

3. For the next 12 hours check Loki's BG every 2 hours. Record the actual time, the time after the dose was given (e.g. +2 hours, +4 hours, etc., etc.) and the BG test result in your log.

It's normal to follow the cat's regular feeding routine when running a curve at home (so that you can get a better picture of where BG is likely to be over each a cycle on an average day for the current dose). I don't know whether your vet may have given you other instructions.

Running a curve is in essence an information-gathering exercise to shed light on how Loki is responding to his current dose of Caninsulin - and a safety measure, too. WRT your vets asking you to just record the BG results and not worry about the actual readings themselves, that's reasonable as long as Loki doesn't read too low on any test (in which case you'd intervene with food or glucose to move him to safe numbers).

Curve results help inform dosing decisions to be as sure as possible that a kitty is safe on a given dose of insulin. Over time, the curve data and additional daily test data help to refine dosing and improve regulation.


Mogs
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