Advice please - skeptical of vet

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Matthew Brennan

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Hey folks,

Would appreciate any advice as I am looking to home test my cat. He is 15, and about a year ago was diagnosed diabetic. His symptoms where a bad coat, drinking a lot and always hungry.

After a lot of vet appointments they "got it under control". Currently I give him 4 units of caninsulin twice a day. However, his symptoms still remain, bad coat, drinking a lot etc. The vet tell me though his levels are "fine".

Id love to believe them but I dont. For that reason I would like to start home testing, but im out of my depth. What do I need (meter wise) to start, and how do I test him and use the results to alter the units of caninsulin he gets.

Any and all advice would be great! Thanks!
 
Welcome! Sorry you had to find us under these circumstances, but don't worry, this is a great place to learn!

There are some great resources on the main page for home testing at
http://www.felinediabetes.com/bg-home-test.htm
and http://www.felinediabetes.com/bg-test.htm

It looks a bit overwhelming at first, but feel free to ask any questions as you go along. There are many very experienced people here to help.

Pretty much any glucose monitor will do. If you're in the US, a lot of us use the Relion confirm or Relion micro (from Walmart). There are other options available from Walgreens, CVS, etc. There's a pet specific one, the AlphaTrack, but the strips are more expensive so most people here don't use it. There are some conversions between the numbers of a human reader vs a pet reader, but most of what you'll read on this site is based on using a human reader.
But since you're using Caninsulin, I'm guessing you might be located in a different country? If so, let us know where you are and someone can probably recommend a meter you can find nearby.

Testing is nerve wracking in the beginning, but it's pretty straightforward. You just need a meter, test strips, and lancets (some people also use the lancet gun, some of us just poke freehand).
You make a small poke in your kitty's ear, and then put the test strip against it. In a few seconds the reader will spit out the current blood glucose level. There are a lot of tips in the pages I linked above about how to be more successful, and how to make it a more pleasant experience for both you and your cat. Or ask here if you run into any issues. We've all been overwhelmed at first, so you can get a lot of advice on how to work through any part of it you struggle with.

Home testing is a great idea. It's the only way to truly know what's going on with your cat, as the numbers change constantly throughout the day, and numbers read at a vet's office may not reflect those at home due to stress (increases BG levels).

Once you are testing, be sure to check out the Caninsulin specific forum at http://www.felinediabetes.com/FDMB/forums/caninsulin-vetsulin-and-n-nph.19/
They can give the best advice about working with your specific insulin, and how to adjust the dosage.
 
Matthew Brennan said:
Hey folks,

Would appreciate any advice as I am looking to home test my cat. He is 15, and about a year ago was diagnosed diabetic. His symptoms where a bad coat, drinking a lot and always hungry.

After a lot of vet appointments they "got it under control". Currently I give him 4 units of caninsulin twice a day. However, his symptoms still remain, bad coat, drinking a lot etc. The vet tell me though his levels are "fine".

Id love to believe them but I dont. For that reason I would like to start home testing, but im out of my depth. What do I need (meter wise) to start, and how do I test him and use the results to alter the units of caninsulin he gets.

Any and all advice would be great! Thanks!
Click to expand...
4 units is a fairly large dose.... More than most cats ever need.... I would be nervous dosing that much without careful testing, so I'm glad you are going to try it.

I use an Alphatrak pet meter, but the strips are pricy.... If cost is a concern, many on here use a Walmart relion micro or confirm human meter. Testing is fairly simple... You can watch how I do it on the video in my signature.


What you'll want to buy is the meter,
About 100 test strips
A box of 28 gauge lancets
Cotton rounds
And neosporin ointment with pain relief


Once you start testing set up a spreadsheet and we can advise on dosing.
 
Welcome, and good for you for taking control of your kitty's health! Your story is a common one around here, sad to say. I don't know why, but many vets seem to think that pet owners just won't be willing to put in the time to properly care for a diabetic pet, and as a result they take a very limited approach.

You'll soon find that home testing your cat's glucose is a really powerful tool for getting control of his diabetes and (hopefully) get him feeling better. It feels awkward at first, but soon becomes second nature for both of you. Most important tip: always follow up test attempts (successful or otherwise!) with a treat. My cat has been in remission for a year so I only test her occasionally, but all I have to do is walk by the spot where we do our tests and she will go running over there eagerly!

Last thing: I agree with Janet about the dose. Very glad you are testing!
 
I'll let someone else answer on the meter, since I'm not familiar with UK equipment.

For testing, you want to do periodic curves, test before every shot to make sure they're in a range that's safe to shoot, and as much possible test close to nadir (the time when the blood glucose drops the lowest in between shots - will vary based on type of insulin and your specific cat, but after doing a couple curves you should know when that occurs. The caninsulin forum can give you an estimate of where to expect it).

Test any time you see suspicious behavior (possible hypo).

Then a lot of people throw in random other tests whenever they can. The more data you have, the easier it is to figure out correct dosing.
 
Matthew Brennan said:
Hey guys, (UK Member)

Would something like this be ideal?
https://www.amazon.co.uk/Exactive-B...re&ie=UTF8&qid=1495537236&sr=1-2&keywords=kit

Or is there better (UK based - Amazon Uk would be great) that can match up correctly to the spreadsheets here.

So when I buy the meter, should I do a full day of testing every 2 hours while giving him his Caninsulin 4units at 9am / 9pm?
Click to expand...
See if you can find a meter that takes a 0.3 blood sample. This one requires 0.6 which is large for a cat.
 
Matthew Brennan said:
Last question! Once you do the curve, how often do you test the blood glucose?
Click to expand...
Most important tests are daily AMPS and PMPS (morning/evening pre-shot tests) to make sure they are safe to give current dose :). I'll tag some of our UK members to see which meters they use. Only Elizabeth and Bertie had hers listed: One Touch Ultra but @Diana&Tom and @Anthony Morgan are also UK. One of my Prozinc buddies is in Scotland, she uses Bayer Contour XT meter @Blair & Freya :cat:

Matthew, please check out the links in my previous post on setting up your Signature when you have a moment ;)
 
Hi Matthew! Sorry I'm a bit late to this. You're in the right place to treat your kitty for FD, that's for sure. What's your kitty's name and where are you in the UK? There aren't a lot of us on this board but we always try to help with "local knowledge" as much as we can so keep asking questions. It is sometimes a good idea to write UK in the title of a thread, if you're asking for specific UK-based info - foods as well as meters and any other equipment - otherwise the advice you'll get is the same from everywhere.

You ask specifically about meters. The One Touch Ultra is good and reliable, and additional strips are readily available on ebay (don't pay full price at the chemist or you will soon bankrupt yourself!). Members here also like the Code-free (from Amazon) which I've read is easy to use and is good for getting more strips (the main cost you will incur when testing). You'll also need a supply of lancets.

Once you have your meter, you can practise on yourself a few times to get the hang of it - it really is just a knack and you'll be fine, but keep coming here and asking any questions you may need.

As far as a curve is concerned - a full curve is every two hours of a 12-hour cycle, but whilst you're still practising the knack, you might just want to take pre-shot (before insulin) tests, otherwise it can get quite stressful for you and kitty! With Caninsulin, an insulin with a fairly quick "onset", it is interesting to note the blood glucose drops in the early part of the cycle, and then about halfway through to try to identify a "nadir" (lowest point). Once you start to collect data and keep a spreadsheet, we can look at how the insulin is working and discuss an adjustment if necessary. Four units is a high dose and it doesn't sound from what you say that your kitty is regulated (whatever the vet says) so depending on your data, it may be worth reducing the dose and seeing if that makes an improvement.

The other thing that can help is food. What are you feeding? The ideal for diabetics (and all cats come to that) is a good quality low-carb wet food. If your kitty currently eats dry, switching to wet may drop BGs, BUT you should be home-testing to make sure numbers don't drop TOO much... on 4u it is quite possible that numbers could go too low with a lower-carb diet. @Elizabeth and Bertie has a link on her signature that can help with foods and she is also a very experienced member who may have something to add about meters as well.

Good luck and keep us informed!

Diana
 
Great info guy thanks. I am in Northern Ireland.

Basically the vet upped his dosage fairly quickly from 1unit, 2 unit .. until we hit 4. He did have an "episode" about 6months ago where he took a fit/siezure - which was highly unpleasant for him and me. He has seemed fine since, but the past few weeks very hungry and thirsty. I suspect the vet will simply up his dosage again - so time to take control of it myself and treat him correctly!

A big issue (maybe) is he will only eat chicken. He will not eat cat foot, or dry food. This is not a favourite food thing, he simply will not eat cat food. And he cant really eat dry food as he hasnt very many teeth left. So its just cooked chicken he eats.

Any thoughts about chicken diet and his diabeties. He is fed 9am, 2pm and 9pm. Sometimes around dinner time too if he is looking.
 
Well, kudos to you Matthew for taking the initiative! We are delighted here when we see new people being pro-active and wanting to do the very best for their cats! You will get as much help as you need.

It sounds as if the vet has raised insulin dose too quickly. You would usually start at 1u and give it a couple of weeks to see what effect that has, and if numbers aren't budging much, work up in maybe 0.5u increments until you find a dose that does what you want. It MAY be that 4u is ok, but it also MAY not be... we don't know until you start testing. I am guessing that the vet is going by the results of sporadic fructosamine tests, which simply give an average of a cat's BGs over a period of time... not ideal at all, as there may be some very high and very low numbers in there which is not a sign of a regulated cat. (Vets, it has to be said, are not all experts on FD... they have very little training on it and tend to go by the rule book which is not really appropriate with a disease like FD. But luckily it is manageable at home.)

So first, get a meter. I think I'd give the Code-Free a go, in your shoes.

As for diet - chicken is certainly better than dry food, but the problem is that it is not a "complete" food in itself... it doesn't contain some of the nutrients cats need. I'm not an expert on this but I think there are supplements you can get... I will tag another of our UK members, @Marlena , who is very good on this subject!
 
Hello Matthew, I am new so will leave the advice to those with more experience. I think it's great that you are you want to take charge of this. This forum is excellent, and the people are great. You will get a lot of advice, and sometimes may feel overwhelmed, all cats are different and you know your cat best. just remember that. Hugs and wishing you both the best.
 
Yong said:
Most important tests are daily AMPS and PMPS (morning/evening pre-shot tests) to make sure they are safe to give current dose :). I'll tag some of our UK members to see which meters they use. Only Elizabeth and Bertie had hers listed: One Touch Ultra but @Diana&Tom and @Anthony Morgan are also UK. One of my Prozinc buddies is in Scotland, she uses Bayer Contour XT meter @Blair & Freya :cat:

Matthew, please check out the links in my previous post on setting up your Signature when you have a moment ;)
Click to expand...
Yeah, I use the Contour XT, which takes the Contour Next strips. There's no coding. When I looked, the strips seemed cheaper than the Accu-Chek ones that a lot of people use, and I order them online -- whether from Amazon (in a bind, as it's more expensive that way) or from reputable eBay sellers (which is much cheaper).

I saw the CodeFree mentioned, but I guess I was a bit skeptical of it. I've heard good things about the One Touch Ultra, though.
 
Contour XT purchased. I guess when I do a full day curve and show you guys, you will be able to help me going forward.

On the food front. Can anyone recommend a supplement to make sure he is getting all the nutrition he needs? (Although, he's 15 and only ever ate chicken, so that's not my main concern).
 
Matthew Brennan said:
Contour XT purchased. I guess when I do a full day curve and show you guys, you will be able to help me going forward.

On the food front. Can anyone recommend a supplement to make sure he is getting all the nutrition he needs? (Although, he's 15 and only ever ate chicken, so that's not my main concern).
Click to expand...
@Marlena
 
Hello Matthew, welcome!
Matthew Brennan said:
Can anyone recommend a supplement to make sure he is getting all the nutrition he needs? (Although, he's 15 and only ever ate chicken, so that's not my main concern).
Click to expand...

There are some members who used to serve home made raw food using the premix supplement from THIS site. @Wendy&Neko
I believe is one of those members and maybe she can help you further with the issue. The site says that supplements are ok for the cooked food, too but I'd make some more research and wait to get more responses re:cooked food supplement.

THIS blog by renowned US vet/cat nutrition guru has lot of info on feeding kitties properly. It's very informative good read - cooked v. raw and also in the recipe section there is list of all supplements necessary to make cat's food complete/balance at home.

I am very glad to hear that you are starting home testings - no more hypo events for your kitty! (What's his name?)
 
Hi Matthew,
Sorry I am late in responding and I see you now have a meter. I am in the UK and my cat is on 1.0 u of Can insulin twice a day.
I bought the Alphatrak 2 from my vets. It was over £100 and the testing strips are over £80 for 50.
I have found them on line at Animed for half that price. But the meter does work well and will read from the tiniest sample.
Shelley had a hypo earlier this year and her BG levels are constantly changing so I have a problem knowing how much to inject.
Just thought I would make contact and would be happy to exchange information on the subject.
Kind regards, Anthony
 
My kitty got up to 5 units of Caninsulin - some cats need larger doses of insulin than others. Home testing the blood sugars will tell you whether 4 units is a good dose or not.

Tanya gave you a link to one website that sells premixes for cooked food. Alnutrin is another that offers low carb premixes for either cooked or raw chicken. Both FoodFurLife and Alnutrin are in the US. TC Feline is another premix, that is sold from Germany to other parts of Europe. But their produce is primarily for raw food. Dr. Lisa Pierson has a page on making cat food, and you can make your own premix with that recipe.
 
Yeah, Timmy (my cat) is fairly large, so I can kinda see why the dosage may be so high.

However, his night hunger and his bad coat gives me cause for concern. The Bayer supplier said there was a delay, so went ahead and ordered the AlphaTrak - the expense doesnt bother me so much. Will wait for delivery, do a 24hour test and report back!
 
Matthew, thanks, I will be interested to see how it goes.
My cat Shelley is not very agile and fairly compliant so getting the blood samples is not too bad.
Hope it goes OK!
 
Sounds like you are on top of things!

Testing is going to get you the information you need about Timmy's dose and its appropriateness for him. It can be tough to figure out when you've already been giving insulin for a while and have an established dose, though, so please do post when you get some numbers-- we're always happy to help try to sort these things out!

It can take a little while to get "up and running" with testing, so on the first few days I'd focus on just getting pre-shot numbers plus (if you can) a test about 3 or 4 hours after the shot to see how it's going. I don't know how long it's going to take to get the meter, but in the meantime you might want to practice the pokes so that both you and Timmy will be used to the process.

Another thing to keep in mind: don't expect the patterns from any one day to give you the answer about the appropriateness of a dose. What you'll be seeing over a given day is not just the reaction to that day's insulin dose, but also (possibly) the aftereffects of what happened to blood glucose on previous days. Most importantly, there is a phenomenon we call "bouncing", in which a cat's body reacts to low BG on one day by releasing a bunch of glucose into the blood and raising BG, sometimes by hundreds of points. This phenomenon can last up to three days, so if you happen to be testing on a "bounce" day, you'll be getting an incomplete picture.

The "bouncing" phenomenon is also why the clinical signs you're seeing (eating, drinking, poor coat), which on the surface look like the effects of a too-low dose, could actually be from a too-high dose-- if the dose is too high, the cat will be spending a lot of time in bounces with high BG and all that comes with it. Really, it could go either way, though (too high or too low)-- the best way to tell is from testing, it's such a good thing that you are going to start doing that!
 
Just got the machine and ran a test.

Alphatrak(US) read 97mg/dl about 3 hours after his shot.

Where can I find information about these numbers and what is a good range?

Thanks
 
Hi Matthew,
You might find this link useful;
http://petdiabetes.wikia.com/wiki/Blood_sugar_guidelines

I use the UK number system which I am more familiar with.
I think 97 is about 5.3. That is in the right area but wouldn't want to drop much lower depending upon when your cats nadir is. With Shelley it is around 4 hours but can be up to 6.
With Shelley I would encourage her to eat something at 4 hours just to keep the BG up a little.
Hope this helps but I am not an expert.
Anthony

PS . I was advised to use the ? Icon in my post title if I was asking a question. Might help with more responses but I think it is just quiet on here at the moment.
 
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Well, you're doing an amazing job to be testing with zilch fusss, Matthew. "Just ran a test..." - we hardly ever hear that from a newbie to testing so well done!

OK so to convert US numbers into numbers the rest of the world uses, divide by 18. And to convert world numbers to US ones, multiply by 18. If you have time, because this is a global (albeit mainly US board), you can use both numbers in your posts, so maybe stick to one version first and put the other in brackets. Be consistent if you can.

97 at +3 is a good number *in itself* but lowish for early in the cycle, as Anthony says. The higher number at +5 would either suggest that the insulin has all been used up, or it might be a food spike, or the cat is "bouncing", ie reacting to too high a dose.

A clearer picture/pattern might emerge after a few days of testing, and we can see whether this was an unusual reaction or in fact quite a common one. Cats do vary a lot, anything can happen!
 
Awesome advice as always guys. Doing every 2 hours now for the next 24 hours. He usually sleeps all day, and meows for food all night - so I am really interested to find out how his levels fluctuate during the night! Will keep you all posted.
 
Just checking in-- looks like you're getting great input from others here! I'll just add a couple things: first, I think the "normal non-diabetic cat" range is usually given as something like 70-150mg/dL on the AT2. So as Diana says, that 97 is a great number, just maybe a little low for being early in the cycle. Once you get a bit more data under your belt we'll better know what a number like that means for your kitty, but if you start dipping below 100 early again, one thing you can do is give him a little snack of low-carb food. That can help to slow down any dives, which also helps to reduce bouncing.

Second: yeah, that 297 is a little extreme, but not an impossible bounce (especially with the AT2, which runs higher than the human meters a lot of us use). If it is a bounce, he's likely going to stay high for the rest of the day, but we'll see!

Great job testing!
 
Levels have went 97 - 297 - 524 - 568 (and yes I checked the calibration).

So it looks like his caninsulin is wearing off too quickly throughout the 12 hours? I guess once he gets his 4units in a few hours time, the resulting few tests will tell a story.
 
Matthew Brennan said:
Levels have went 97 - 297 - 524 - 568 (and yes I checked the calibration).

So it looks like his caninsulin is wearing off too quickly throughout the 12 hours? I guess once he gets his 4units in a few hours time, the resulting few tests will tell a story.
Click to expand...

Yes, it will be interesting to see how the evening cycle goes, but for right now, wowza, it sure looks like Timmy is not only not getting good duration from the caninsulin, but that he is a champion bouncer!
 
Looks like it, yes... and although we've been saying that 4u is a high dose, it's always possible that your cat does need higher than average doses. There are some conditions that might present in that way. Or yes, he could be bouncing.

Yes, the more data you get the better. Could you give us the results in this format:

AMPS (morning pre-shot) - xx (bg number)
+2 - xx
+4 - xx
+6 - xx
+8 - xx
+10 - xx
PMPS (evening pre-shot) - xx

That's a curve at a glance and enables us to see quickly what's going on. If you can give both world and US numbers as I explained earlier, so much the better. This will soon be second nature!
 
Im just spouting numbers as I record them for now. By 12 tomorrow I will have a full 24 hour curve done, that will tell all.

Forgive the lack of knowledge on that subject. My thinking is that if he is ging from 97 to high 500's over the course of 12 hours that the dose of insulin is wearing off too quickly? Is that not correct?

Secondly, can someone explain bouncing to me, and the causes for it?
 
This is a VERY steep ascent you're seeing and it would suggest that the insulin is wearing off quickly. Caninsulin has what's called a fast onset - it starts working quickly - but not a very good duration. It's very common to see numbers rise after the first half of the cycle, but this is very steep. Your poor kitty won't be feeling too great with these fluctuations.

So he MAY be a big gulper of insulin.

OR he could be bouncing. If a cat is given too much insulin, the body may try to counteract that as a defence mechanism against going too low (hypo) and this can result in higher numbers than would be seen if the "correct" dose was given. I'm not very good at explaining this but that's the simple version.

Have you read any of the other threads on this forum with similar queries in the heading? That might give you some insight.
 
Yes, indeed-- I sent off a quick post just now, but Diana is exactly right, we can't assume that this big climb is due to a bounce. He could just be one of those cats that needs a lot of insulin. It's likely going to take more than one day of readings to help sort this out.

We speak of readings in terms of "+" times-- number of hours that have passed since the most recent shot. You mentioned the first two readings were taking 3 and 5 hours post-shot, so assuming you're going every two hours, here's what I have so far in this notation:

+3 97
+5 297
+7 524
+9 528

If those times are wrong let me know and I'll correct them. We find it helpful to use this notation because we have people all over the world, in a lot of different time zones!
 
Spot on Nan, those times are correct. Thank you. I think im filling out the spreadsheet correct too. Timmy is just about to have his PM 4units insulin, so going to do a pre shot test, then one in two hours etc.

Quick question. Would a higher dose of insulin stabalize his glucose over the 12 hours. Or would it be a case of moving to a shot every 6 hours? Im still learning, but surely if you increase the units to increase the length of time it lasts, you are also increasing the initial "hit" of insulin and could push him into low blood glucose?
 
Ah yes, I can see your spreadsheet! Either I missed it before or that is new, either way it looks great!

Matthew Brennan said:
Quick question. Would a higher dose of insulin stabalize his glucose over the 12 hours. Or would it be a case of moving to a shot every 6 hours? Im still learning, but surely if you increase the units to increase the length of time it lasts, you are also increasing the initial "hit" of insulin and could push him into low blood glucose?
Click to expand...

Those are really tough questions to answer, but I'll tackle the second one first. I don't know of anyone who does every-6hr dosing in a home situation-- unless you have a lot of help and/or are some kind of superhuman who doesn't need sleep, the schedule would be absolutely brutal. I have heard of every-8hr dosing, but it's not something we currently do around here (no direct expertise at present). It's also a brutal schedule. If it turns out that Timmy is consistently getting a too-short duration out of the caninsulin, before considering either of these schedules I think a better option would be looking into switching to a longer-acting insulin like ProZinc, Lantus, or Levemir.

Back to the first question: is there a caninsulin dose that's going to work for Timmy to keep his glucose in a better range for most of the day? The answer to that is, we don't know yet (we don't even know yet whether that "good" dose is likely to be higher or lower than his current one), but it is possible-- we've had some cats do quite well on short-acting insulins, even occasionally going into remission. The short duration of caninsulin makes things harder, but it's not impossible. You'll be fighting against his body's tendency to shoot up (as he did this afternoon), but on the other hand, the more time he spends in "normal" numbers, the more used to those numbers his body will get and the more chances his pancreas has to do some healing. It becomes a virtuous cycle-- the more time in the normal numbers, the easier it is to get him and keep him in those normal numbers. He's been diabetic for a while, which makes it harder, but if you can get that healing process started, good things can happen!
 
Higher doses don't necessarily mean longer duration, they may mean steeper drops which as you say might cause hypo. But higher doses MAY last longer also. The whole thing about FD is that every cat is different and there is no one formula that applies to every cat, nor one formula that applies to any one cat every day. This is called a "dance" and it will certainly keep you on your toes.

There is no one protocol that suggests dosing every six hours... Caninsulin is usually doses twice a day at evenly spaced intervals. But when you are more experienced you could if necessary look at sliding scale dosing which would mean regular testing and giving a variable dose depending on the BG.

If after a while you aren't getting good results you can talk to your vet about switching to a longer lasting insulin. Not all insulins suit all cats.

There is a lot to learn but you can pick up a lot from reading all over this site.
 
Just looked at your ss, Matthew... that last number you got is worrying, it's almost off the scale. Some meters may give you a reading of HI in such an instance.
These numbers today definitely show that Timmy is not regulated so where your vet got that from is a mystery. These very high numbers are almost undoubtedly what is causing the poor coat condition and hunger.
Have you had Timmy checked out for any other conditions that might be causing these high BGs? Infection can do that, or teeth problems. I think if it was me I'd be challenging the vet with these numbers and asking him to justify what I think you said he called "fine". If it helps you to know - quite a few people here change their vets after being on this board for a short time, to one who actually knows what they're dealing with in FD.
 
He does have a cold at the minute if that would affect it, although his number was low (97) earlier in the day. Anxiously waiting to do him post insulin shot here in an hour or so to see what it is at.
 
Yes, this next test may give some important clues.

Diana&Tom said:
.
These numbers today definitely show that Timmy is not regulated so where your vet got that from is a mystery. These very high numbers are almost undoubtedly what is causing the poor coat condition and hunger.
Click to expand...

I agree. I'm thinking the vet's assessment might just be based on a spot-check in the office in midday (when Timmy might be in the 100-300 range, based on today's numbers). Lots of vets consider anything in the 200's "regulated", whatever else is happening with the cat :banghead:.
 
Took a peek at the spreadsheet, and it looks like Timmy is dropping a lot-- from 602 at pre-shot, to 273 at +2 and 153 at +4.

If you haven't done so already, please make sure Timmy has a little snack-- low carb food for now, and not too much (just a snack)-- to try to slow him down. If his evening cycle is like his morning, he's about to reverse course and shoot to the moon, but I'm not comfortable with the current downward trajectory and don't want to take any chances.

With this, and knowing that it is still early days, I'm leaning more towards the "too much insulin" hypothesis. We didn't know where he started when he hit the 97 this morning, but now we have seen him have a very strong reaction to insulin. It's not that he isn't getting enough to bring his numbers down-- he clearly is.

I'm not experienced enough with Caninsulin/Vetsulin to make any specific dosing suggestions, and I'm interested to hear the opinions of those who do have more experience, but just based on what we've seen today I would be inclined to try a dose reduction tomorrow morning, even if he's back to being sky-high at pre-shot.

So glad you are testing now!!!!
 
Important addendum: if you do end up reducing the insulin dose, definitely also start testing for ketones (a good thing to do with a diabetic cat regardless). The last thing you want to do is trigger a DKA (very very serious-- and expensive-- health crisis). Especially since he currently has a cold-- the "recipe" for ketones is: not enough insulin + not eating/drinking + an infection or other systemic stress, so if you reduce insulin you potentially have two out of three going.
 
Alright guys, as you can see from the spreadsheet, a full day has been done. Here is his morning and nightime curves.

Timmy_Morning_Curve.png


Timmy_Nighttime_Curve.png


He has 4 units this morning again. I just wanted to see how it went during the day again to back up yesterdays results.

Do you guys think I should start by lowering the dosage? If so but how much, half a unit?
 
Well, these curves are very typical of Caninsulin's action... steep drops and steep rises. We really need to work out how to smooth things out somewhat so the curve is gentler. It is very difficult to say how much to reduce the dose... a reduction might just mean that the climb starts earlier in the cycle because the insulin is used up faster. This is very much trial and error. Sometimes we suggest going back to a starting dose of 1 or maybe 2 units, just to start over and work from that basis. But with high pre-shots like you're getting that might not do much. I think I'd be inclined to try 3u for today and see what that does... keep a note of numbers and we can discuss again. BTW when you are changing a dose it is better to stick to it for a few days to allow the cat's body to get used to it... too many dose changes too quickly just confuses the picture.

I'm off to work now but will check in later, and our friends over the pond will be around in a few hours too.
 
Matthew Brennan said:
Spot on Nan, those times are correct. Thank you. I think im filling out the spreadsheet correct too. Timmy is just about to have his PM 4units insulin, so going to do a pre shot test, then one in two hours etc.

Quick question. Would a higher dose of insulin stabalize his glucose over the 12 hours. Or would it be a case of moving to a shot every 6 hours? Im still learning, but surely if you increase the units to increase the length of time it lasts, you are also increasing the initial "hit" of insulin and could push him into low blood glucose?
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There are people who have done 3 shots a day such as @cashy ... It would require a lot of monitoring and is hard for most to be home that often, but it is an option. So you would take the total units and divide it by three... So you might do 2.5 every 8 hours
 
Have been doing some more thinking about these patterns, and what I'm struck by most is how well-behaved those curves are-- they really do look like "classic" Caninsulin curves, just on the extreme end of range across the day. In a way, this is really good-- it makes Timmy's patterns more clear and easier to interpret than they otherwise might be. It's really just duration of the shot and range of BG numbers experienced that are the problems. No wonder Timmy is still showing poor clinical signs-- he's not only spending lots of time in (very) high numbers, being yanked around like that every day has got to feel really yucky.

I defer to the experts like Diana on how to adjust Caninsulin to try to get a flatter curve (I simply don't have any experience with this), but I'll put a plug in here for the longer-acting insulins like Lantus as another option to explore in the future if that proves difficult. Lantus isn't as good at bringing high numbers down, but it is better at keeping low numbers low and (eventually) producing very flat curves. I'm hopeful that there will be a "good" Caninsulin dose for Timmy, but if not, there are other options.

JanetNJ said:
There are people who have done 3 shots a day such as @cashy ... It would require a lot of monitoring and is hard for most to be home that often, but it is an option. So you would take the total units and divide it by three... So you might do 2.5 every 8 hours
Click to expand...

Glad you just posted this, Janet. I was thinking about this as well, after seeing these curves. The thing is, the 3x/day dosing is just so hard on the caregiver-- I could see doing it for a limited time (recovery from DKA, or perhaps for a cat you had hopes could be bumped into remission quickly), but as a long-term dosing strategy it would be really rough. It definitely is one way to "fix" the short duration issue, though, and that does seem to be a big problem, if not the big problem, here.
 
Just testing today again, his "low" doesnt seem to be going anywhere near 97. I think testing for a few more days before making any changes might be wise, to get a more "average" daily pattern.

3x a day injections is no issues for me - I work from home (if that is indeed the cure to stability).
 
Matthew, you might have to be prepared for the long haul here... all our suggestions are only that, starting points to collect data, from which point it becomes easier to see what the insulin is doing etc. So if one suggestion doesn't work, we try another, etc etc until we start to get somewhere and can fine-tune. I hope this makes sense?

Dosing with Caninsulin is tricky in some ways and ok in others... because it does have a fast onset (ie gets to work quickly), it is often used up quickly (short duration), leaving the second half of the cycle without much if any insulin in the cat at all. (FYI - Caninsulin is actually designed to work in dogs, not cats... cats' metabolism is different which means that some cats don't do too well on this insulin. But here in the UK it is prescribed first, so worth giving it your best shot.) So in that sense, it's not easy to work with because we need to cover as much of the 12-hour cycle as possible. But on the plus side, it's an "in and out" insulin - once it's gone, used up, that's it, it's pretty much out of the cat's system which usually makes it safe to dose again when numbers start to rise at an appropriate point in the cycle. Eight-hour dosing is probably ideal for a lot of cats on Caninsulin, but as Nan has said, it's hard work for the care-giver and needs a lot of commitment on an ongoing basis.

Nan, I'm not really an expert on Caninsulin at all, I just know from my own experience, and that of many others on this board over my ten-year membership of FDMB, how tricky it can be to get that gentle "smile" of a curve rather than the big "grin" that Timmy demonstrates so graphically above. I thought about it too before my earlier post today - some people would recommend going back to 1u but I just can't see that doing much at all with such high pre-shots. If the pre-shot numbers were lower, we could suggest a lower dose, but readings verging on HI need to be brought down as quickly and safely as possible.

So as I've been saying, it really is trial and error at the moment, until we start to see these high numbers budging. You could try shooting a token dose when numbers are very clearly on the rise, but I couldn't recommend that to someone just starting out home-testing and without more data.

If, further down the line, you can't get better numbers for Timmy on Caninsulin, there would probably be a case of asking the vet for a longer-lasting insulin.

FD is a marathon, not a sprint!
 
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