BEGINNER’S GUIDE TO CANINSULIN (VETSULIN) FOR DIABETIC CATS This guide was developed by FDMB members to help you safely manage your cat’s diabetes using Caninsulin (called Vetsulin in the USA). Finding out that our beloved kitty is diabetic can feel a bit overwhelming at first. But the good news is that, with appropriate care, a diabetic cat can very often live as long and as happily as a non-diabetic cat. And some cats will go into ‘remission’ from their diabetes, and be able to have their diabetes controlled by diet alone, temporarily or permanently. Right now it may seem that managing Feline Diabetes (FD) is a steep learning curve to master. But be patient. Your confidence in managing your cat’s diabetes will soon grow. There are three important elements to FD treatment: 1. INSULIN 2. HOME TESTING OF CAT'S BLOOD GLUCOSE ~ Much easier than it sounds! (See below) 3. APPROPRIATE DIET (See below) ABOUT CANINSULIN (VETSULIN) A number of different insulins can be prescribed for cats. They work in different ways, but are almost always injected twice a day, every 12 hours. Your vet has prescribed Caninsulin (Vetsulin). Originally developed for dogs, it is also often prescribed for cats. Because of cats’ faster metabolism, Caninsulin (Vetsulin) may not last in the system a full 12 hours. Typically, it may remain effective for 8 - 12 hours. How long it lasts depends on the individual cat. As we often say, Every Cat Is Different (ECID). Caninsulin (Vetsulin) is s a ‘U40’ insulin (40 units of insulin per ml). It is available in cartridges for use with a ‘VetPen’, and also in vials for use with syringes. If using syringes ensure that these are also ‘U40’. Try to get U40 syringes with half-unit markings. Mixing before use. Caninsulin (Vetsulin) is a suspension and must be mixed before use. Some people invert the vial/cartridge a few times before using; others roll the vial several times, between the palms of the hands. In some countries the manufacturer’s advice is that the insulin should be shaken until a uniformly milky suspension is obtained. Any foam from shaking should be allowed to subside before using. Storage and shelf life: Keep Caninsulin (Vetsulin) in the fridge. Don’t allow it to freeze, and don’t store in the fridge door (temperature too variable). Store vials upright. For cartridges and the VetPen, the Vetsulin website recommends ‘...keep cartridges refrigerated. When VetPen is loaded, it can be stored on its side’. Note: Depending on country, the product label may say the insulin should be discarded 21, 28 or 42 days after first opening (however the insulin is the same). Caninsulin (Vetsulin) was tested by the USA manufacturer for 42 days after first use. But some countries’ regulatory authorities do not allow product labels that permit the use of sterile products for more than 21 or 28 days after first opening. Many FDMB members find they can use the insulin for longer than is suggested on the label. But don't assume that you can do this. Sometimes the insulin does lose potency sooner. If you are home testing, and see increased BG levels in your cat, this may mean the insulin is losing potency. If there are white ‘floaties’ in the insulin, it needs to be replaced. Technical information: Caninsulin (Vetsulin) is produced by Merck Animal Health (MSD Animal Health outside the USA). It is an intermediate acting (lente) porcine insulin, comprised of 30% ‘amorphous’ and 70% ‘crystalline’ insulin. The amorphous insulin takes effect quickly, the crystalline is released more slowly. In dogs this can result in two peaks of activity. But in cats, because of their faster metabolism, there is usually a single peak. http://www.vetsulin.com/vet/default.aspx STARTING DOSE - CANINSULIN (VETSULIN) Usually it’s best to start with a low dose of not more than one unit, twice a day. For those new to dealing with feline diabetes we recommend that no insulin is given if the BG is below 200 mg/dL [11 mmol/L] on a human glucose meter. (For more information on what these numbers mean see ‘Home Blood Glucose Testing’ information below.) If you’re using a pet meter, such as Alphatrak 2, be aware that these usually give slightly higher readings than human meters, so you may wish to have a slightly higher ‘no shot number’. Note: There is no general formula for converting human meter numbers into pet meter numbers (or vice versa). You are therefore encouraged to perform your own side-by-side comparisons with a human glucose meter, and/or to consult your vet for information about the specifics of your particular meter. If, after a week, and having reviewed your cat’s BG levels, the dose doesn’t seem sufficient, dose increases can be made in small increments of 0.25 or 0.5 of a unit. (If you use a VetPen the smallest increment that can be measured is 0.5 of a unit.) If you have reason to be concerned about hypoglycemia, or if your cat won't eat, decrease the dose immediately and contact your vet. Never inject insulin twice! Sometimes we may not be sure if we’ve given an insulin shot correctly. Perhaps we notice that the fur seems wet where we’ve injected (a 'fur shot'). If this happens, never repeat the shot/ injection. You may give too much insulin and your cat’s BG may drop too low. A note on measuring very small insulin doses. If you are having trouble measuring a small insulin dose in a U40 syringe, you may find it easier to use U100 syringes along with a special conversion chart that explains how to measure the correct dose. Before attempting this it is vital that you understand how the conversion works, otherwise you could give your cat the wrong dose of insulin. Don’t attempt this without first getting advice on the forum. UNDERSTANDING 'ONSET', PEAK / NADIR and DURATION' Caninsulin (Vetsulin) can quite often start to have an effect quite quickly after it’s been injected. The point at which the insulin starts to drop the BG is called onset. After onset, BG will continue to drop for a time, and the process may speed up. Be aware that Caninsulin (Vetsulin) can sometimes drop the BG quite fast. The lowest BG level of the cycle is referred to either as peak (peak insulin activity) or nadir (lowest BG). With Caninsulin (Vetsulin) you may see the peak/nadir of the cycle at around 4 - 4.5 hours after the shot. But it may be earlier or later than this. It may occur as early as 3 hours after the shot, and as late as 7 hours after. The length of time that insulin remains active (lowers BG) in your cat’s system is called the duration. Caninsulin (Vetsulin) typically has a duration of 8 - 12 hours (depending on the individual cat). If you learn to ‘home test’ you should be able to identify when onset, peak /nadir, and duration typically occur on a given dose of insulin. Knowing these patterns can be extremely helpful. FEEDING SCHEDULES - CANINSULIN (VETSULIN) Do not be tempted to reduce the amount of your cat’s food in hopes that this will reduce her overall BG levels. This could be detrimental to your cat’s health. Your cat needs to eat an appropriate amount of food for her size and weight. There are certain circumstances, however, when it is helpful to temporarily withhold food (or rather, to delay feeding): these circumstances are explained further down this section. There are particular considerations when using faster-acting insulins such as Caninsulin (Vetsulin), - especially for newcomers or for those with little or no data about how their cat responds. This is because the insulin can sometimes drop the BG fast in the first few hours of the cycle. It can be a good idea to feed your cat 20 - 30 minutes before giving insulin. This ensures there is food on board for when the insulin starts to work. So, the sequence would be: 1. Test BG. 2. Feed. 3. Wait 20 - 30 mins. 4. Give the insulin shot. (If you are not yet home testing it is still advisable to feed and then wait before giving the shot). Some caregivers feed a snack (or part of the main meal) an hour and a half to two hours after the shot, to slow down the rate at which the BG is dropping. If you can determine when your cat's nadir (lowest BG) typically occurs during a 12-hour cycle, you can try to make food available at that time. Timed feeders can be helpful for folks who can’t be there in person to feed their cat. ‘Bouncing’: If the BG drops too fast this may be sensed as ‘dangerous’ by the body whether the cat is actually in danger or not. (‘Too fast’ could mean faster than 100 mg/dL [5.5 mmol/L] per hour - although the ‘trigger’ number varies from cat to cat.) When this happens the body may seek to protect itself by releasing stored glucose, thereby raising the BG to a much higher level. We call this ‘bouncing’ - a common phenomenon - and bouncing can happen when the BG drops too fast and/or too low. As said above, it may be possible to slow down the rate that the BG is dropping by feeding a snack. It may also be that a dose reduction is appropriate. DO post on the Main Health forum if you need further advice Some caregivers using Caninsulin (Vetsulin) withhold food for the second half of the cycle, to slow down the rate at which the BG rises as the effect of the insulin wears off. If your cat’s BG rises fast after the peak of the cycle you may find this technique useful. In any case it can be helpful, if possible, to withhold food for the two hours prior to a pre-shot BG test. This is just to ensure that the test result is a ‘true’ reading and isn’t influenced by food. Q: Why is my cat so hungry? When initially diagnosed your cat may behave like she is starving. That’s because prolonged high BG, and insufficient insulin, make it hard for her body to utilise her food. Once her BG is under better control her appetite should return to normal. Your cat may need feeding more than twice a day. Many cats do well on a number of smaller meals fed throughout the day. Some cats can be ‘free fed’ for much of the time. Multi-cat households It can be helpful to get all cats in a household onto diabetic-friendly food if possible. The best diet for diabetic cats is great for most non-diabetics too. HOME BLOOD GLUCOSE TESTING Blood glucose testing at home (‘home testing’) makes managing your cat’s diabetes much easier and may save your cat’s life. It’s not hard to learn, and most of us use ordinary glucose meters made for human diabetics. Home testing can save you the cost of BG curves and/or fructosamine tests done at the vet’s clinic. You can even do your own BG curves at home, record your results in our colour-coded spreadsheet, and share that with your vet. *See below for details on how to set up our spreadsheet (‘SS’)*. Your cat will probably be calmer at home than at the vet’s clinic, which often results in a more accurate BG test. The stress of a vet visit can cause your cat’s BG to rise by 100 mg/dL [6 mmol/L] or more, compared with what it would be at home. Does testing sound scary? RELAX! Your cat’s outer ears have very few nerve endings, so the sensation is nothing like if we pricked one of our fingers. It is simply a matter of warming the ear to increase blood flow and get a small sample of blood which is transferred to a test strip in a glucose meter. Many cats come to look forward to being tested if they are rewarded with a treat! Here’s a great how-to link with instructions, photos and video: Hometesting Links and Tips Q: How often should I test my cat’s BG? As a minimum, for your cat’s safety, always testing the BG before you give an insulin shot. This is called a ‘pre-shot’ test. We call the morning test ‘AMPS’ (a.m. pre-shot); and the evening test ‘PMPS’ (p.m. pre-shot). Pre-shot tests are to ensure your cat’s BG is high enough to warrant being given that dose of insulin. Sometimes they surprise us! Important sequence: Test - Feed - Shoot: Test to see what the BG level is; feed to make sure the cat has food on board; and then shoot/inject insulin. With shorter-acting insulins like Caninsulin (Vetsulin) we suggest waiting for 20 - 30 minutes after feeding before giving the shot. (For more information see ‘FEEDING SCHEDULES’ above.) Thereafter, test as your schedule permits or as your cat requires. A test two hours after the shot can be very helpful and can give important clues about what may happen later in the cycle. Some additional mid-cycle tests are always useful, especially when there has been a change in insulin dose or food. If you work during the week, weekends are a good time to get additional BG testing during the day and evening cycles. A blood glucose curve can give very useful information, especially early on in the cat’s treatment. After the pre-shot test (and insulin shot) tests are typically done every two hours throughout the cycle. But with Caninsulin (Vetsulin) it can be helpful to do tests every hour until the cat's BG has passed the lowest point (nadir); this is especially useful if there is reason to believe that the cat's BG is dropping too low or too fast. A curve can help us see the pattern of how the insulin works in the cat’s body. It can help us to identify when the insulin starts working (onset), when the lowest BG of the cycle tends to occur (peak/nadir), and how long the insulin lasts in the cat’s system (duration). Be aware though that a curve is just a snapshot of a given day, and every day will be different; sometimes a little different, sometimes very different. (See also, ‘Understanding ONSET, PEAK / NADIR and DURATION’ further up the page.) Note: On FDMB we describe BG tests in terms of the number of hours since insulin was given. So, a test one hour after a shot will be ‘+1’; a test two hours after will be, ‘+2’; etc. This system makes things easy to understand if we post on the forum for advice, especially as members live in different time zones around the world. BLOOD GLUCOSE REFERENCE INFORMATION In most of the world, BG is measured in mmol/L. In the USA, BG is measured in mg/dL. Many FDMB members are in the USA so you will usually see people referring to BG ‘numbers’ in mg/dL. To convert mmol/L to mg/dL just multiply by 18. To convert mg/dL to mmol/L just divide by 18. On FDMB the normal BG range for a non-diabetic cat is generally deemed to be 50 – 120 mg/dL [2.7 to 6.6 mmol/L] on a human glucose meter. Some cats may naturally have blood glucose levels that run slightly lower or higher than the typical normal range. A newly diagnosed diabetic cat may have significantly higher BG levels. Levels in the 400s mg/dL [20s mmol/L] are not uncommon. Don’t be alarmed if your cat’s BG levels are high at diagnosis. Things can turn around quickly once a cat is on insulin and eating an appropriate diet. Q. Is my cat’s BG high enough for insulin? For those NEW to treating feline diabetes, and/or those who don’t have much data about how their cat responds to insulin, we generally recommend that a shot isn’t given if the pre-shot BG, is below 200 mg/dL [11 mmol/L] on a human meter. If you use a pet meter, such as AlphaTrak2, you may want to raise the initial ‘no shoot’ threshold. This gives an added margin of safety when using a pet meter. (If in doubt seek advice from your vet.) Q. It’s time for my cat’s shot, but the BG is a little too low. What now? If your cat’s BG is a bit below 200 mg/dL [11 mmol/L] on a human meter, consider ‘stalling’. Stalling is waiting - without feeding your cat - for 20+minutes, then retesting to see if the BG has risen to a suitable level. If using a pet meter, such as Alphatrak2, you may want to raise number above 200 mg/dL. (If in doubt seek advice from your vet.) You are looking for a number that is rising, not falling, and is high enough to give insulin. Note: As you gain experience with home testing, and have gathered data to show how your cat responds to insulin, you might consider it safe to reduce the ‘no shoot’ threshold, and to give insulin at lower pre-shot numbers. If you have time, you can repeat the stalling process to see if the cat’s BG reaches a number you can shoot. If in doubt, skip the shot. However if your cat has history of ketones or DKA, or other health issues, or you are concerned, DO post on the Main Health forum for further advice. Ask for help on the forum before giving insulin if you are unsure, as you can never ‘un-shoot’ insulin. Q. How low should my cat’s BG drop on Caninsulin/Vetsulin? Usually it's best that newcomers aim for a nadir no lower than 90 - 100 mg/dL [5 - 5.6 mmol] at the peak action of the cycle (as measured on a human glucose meter). This insulin can drop the BG quite sharply. Trying not to let the BG drop below this level gives an initial buffer of safety while the caregiver is learning the ropes. If you are using a pet meter you may want to keep the nadir higher than is suggested for human meters. (If in doubt seek advice from your vet.) Q. My cat has quite variable pre-shot BG levels. Do I use the same dose of insulin each time? Possibly. Or it may be that your cat would be more suited to ‘sliding scale’ dosage. With ‘sliding scale’ the dose varies according to the pre-shot number and the typical rate of drop from a given dose of insulin. This varies in every cat, so do post on the forum for advice regarding your cat. Q. The insulin isn’t lasting very long in my cat, nowhere near 12 hours. What can I do? Some cats do get only a short duration with Caninsulin/Vetsulin. If this happens consistently you may want to consider switching to a longer lasting insulin. Alternatively, if you have gained sufficient experience - and if your schedule permits - it might be possible to give three shots a day instead of two. This needs to be done with great care and is not a technique for a beginner. Don’t attempt this without first getting advice on the forum. Note: Remember, we are not vets. If in doubt do get advice from your own vet. 'REGULATION' - WHAT IT MEANS The initial aim of treating diabetes is to get the cat into a better and more stable BG range (‘regulated’). In the FDMB FAQs the degrees of regulation are suggested as follows (based on data from human glucose meters; pet meter numbers would typically be a little higher). But your cat may not fit exactly into one of these ranges. Feline diabetes can be very variable. Not treated - BG typically above 300 mg/dL [16.7 mmol/L]. Poor clinical signs. Treated but not regulated - BG often above 300 mg/dL [16.7 mmol/L] and rarely near 100 mg/dL [5.6 mmol/L]. Poor clinical signs. Regulated - BG generally below 300 mg/dL [16.7 mmol/L] with glucose nadir near 100 mg/dL [5.6 mmol/L]. Good clinical signs. No hypoglycemia. Well regulated - BG generally below 200-250 mg/dL [11.1-13.9 mmol/L] and often near 100 mg/dL [5.6 mmol/L]. No hypoglycemia. There may also be an extra category of "mostly above 300 (16.7) but with good clinical signs" which occurs with some cats who are getting insulin. We don't know why it happens, but such a cat probably should not be considered to be regulated. On FDMB you may read about a cat’s BG being ‘Tightly Regulated’. The aim of Tight Regulation (TR) is to keep the cat’s BG in normal levels for as much of the time as possible. But we don’t recommend attempting TR with Caninsulin (Vetsulin); this insulin can drop the BG very steeply and fast, and there could be a danger your cat’s BG may dropping too low. HYPOGLYCEMIA BG that is too low can be VERY dangerous. Low BG numbers need to be taken very seriously even if your cat is not showing symptoms. Some cats show symptoms early on; some show symptoms when the hypo is moderately advanced; some show symptoms only when the hypo is severe. And some do not show any obvious symptoms at all. Remember: ‘Absence of symptoms may not mean absence of hypo’. (For a list of common hypo symptoms see the link 'Emergency HYPO Instructions' further down the page.) Q. What is ‘too low’? As a general rule - to prevent hypoglycemia - we want to keep a diabetic cat’s BG levels above 50 mg/dL [2.8 mmol/L] on a human glucose meter. If you are using a pet meter it would be wise to keep the BG a bit higher. On an AlphaTrak2 meter, for example, you are advised to keep your cat’s BG above 65 mg/dL [3.6 mmol/L] according to the meter’s manufacturer. If you see these numbers you are advised to take action to ensure that your cat’s BG doesn’t drop any lower. If the cat’s BG drops lower it risks becoming hypoglycemic. (A very small minority of cats may actually show symptoms of hypo at these numbers or even slightly higher.) Remember too that with Caninsulin (Vetsulin) it is usually best that newcomers aim for a nadir no lower than 90 - 100 mg/dL [5 - 5.6 mmol] at the peak action of the cycle as measured on a human meter (see ‘Blood Glucose Reference Information’ above.) If you get a BG of 100 mg/dL or 5.6 mmol/L or less on a human meter, and there are still several hours or more before the insulin peaks, you may need to monitor your cat’s BG carefully and take any necessary steps to keep the BG at safe levels. Note: If you are using a pet meter you may need to keep the nadir higher than is suggested for human meters. (If in doubt seek advice from your vet.) Raising blood glucose in an emergency: The fastest way to raise BG in an emergency is to give a simple sugar such as glucose syrup, honey or karo. But be aware that the effect of this can wear off quite quickly, and you may need to repeat this process. See the document ‘How To Treat A Hypo’ (linked below) for further information; and post on the Main Health forum if you have questions. Essential hypo reading: Emergency HYPO instructions, Hypo Toolkit Hot tip: Read through and print off BOTH of the above documents; the first is a great shopping list. And it's a good idea to print off the ‘How To Treat A Hypo’ document and keep it for reference in an emergency. If you need help with low numbers, post right away on the Main Health forum. If you don't feel comfortable dealing with the hypo at home, or if hypo symptoms are severe, give syrup/glucose and go to the nearest ER vet clinic immediately. TESTING FOR KETONES It is highly recommended that you monitor your diabetic cat’s urine for ketones, especially if your cat is newly diagnosed and/or has very high BG. If your cat has a history of ketones or of DKA (diabetic ketoacidosis) it is extremely important that you test. The test is simple. You just dip a ketone test strip (ie. Ketostix or Keto-Diastix) in a tiny pee sample, time the test, and check the result. Be sure to time accurately and view the result under good light. You want to see a ‘negative’ ketone result. Anything above a ‘trace’ reading is a reason to contact your vet, ASAP. An easy way to get a pee sample is to crumple plastic food wrap over the litter tray. Or, slip a shallow, long-handled spoon under the cat’s backside while she’s peeing. Be aware that not all ketones are picked up by the strips. So also have an awareness of how your cat’s breath smells. It should smell like normal cat breath (!). A fruity smell, like acetone, could indicate ketones. There are also blood test meters available, for example the Precision Xtra and the Nova Max Plus. These can test for both BG and ketones; but the ketone strips must be purchased separately, and are very expensive compared to BG test strips. Testing blood gives a more reliable result than testing urine, so do consider a blood testing meter if your cat has been diagnosed with DKA (diabetic ketoacidosis) Useful link for more information: Ketones, Diabetic Ketoacidosis (DKA), and Blood Ketone Meters DIET: LOW-CARB WET IS BEST - BUT PROCEED SLOWLY IF CAT IS ALREADY ON INSULIN Low-carb food is key to effective feline diabetes treatment. It's best to feed only wet foods that have less than 10% of calories from carbohydrates. Some cats do best on carb levels lower than that, for example 4% - 6%. You will find out what works best for your cat. HOWEVER, for cats already on insulin, only transition to a lower carb diet if you are home testing and can monitor your cat’s BG levels to see the effect of diet change. The switch to lower carb food can result in a BG drop of 100mg/dL [5.5 mmol/L] or more, so BG monitoring is essential. It may be that the insulin dose needs to be reduced to avoid hypoglycemia. Make any food switch slowly to avoid stomach upsets. DRY FOODS Dry food is not recommended. It can be very high in carbohydrate. And a dry diet may mean that the cat doesn’t get sufficient water in her diet. Water-depleted diets can cause other health issues. If your cat cannot be transitioned to eat wet food, there may be some lower carb dry foods available in your country, depending on where you live. In the USA ‘Young Again Zero Carb’ is available online from the manufacturer only. (However, it is not actually ‘zero carb’, but is low carb). In Europe there are currently no dry foods that are definitely less than 10% calories from carbs. ‘Porta 21 Feline Finest Sensible’ and ‘Thrive ‘premium plus’ chicken’ may be the lowest carb dry foods currently available (and these seem to be a little over 10% calories from carbs.) Note: New foods are coming onto the market. Ask on the Main Health forum for the most recent information regarding any new foods that may be suitable. FOOD INFORMATION & LISTS Dr Lisa's USA Food List 2017 Dr. Lisa's Phosphorus Cat Food List (2012). Food list under 10% carbs, under 1% phosphorus (2016) UK Diabetic Cat Food Info and UK Cat Food List CANADIAN Food Chart AUSTRALIAN canned food suitable for diabetic cats Home prepared diet for CRD cats- Think Tank Discussion TRACKING YOUR CAT’S PROGRESS It is immensely helpful to track your kitty’s progress over time. FDMB has a process for this, using a Google spreadsheet (‘SS’). Other FDMB members will be able to answer your questions much more easily if you keep your cat’s spreadsheet up to date. Once you type in the numbers, the SS will automatically update. If you are outside the USA choose a ‘World’ template. There are templates for human meters and for pet meters. If you'd like help creating your spreadsheet, DO ask for help on the forum. • How to create the spreadsheet: FDMB SPREADSHEET INSTRUCTIONS SHOPPING LIST / SUPPLIES BLOOD GLUCOSE METERS & TEST STRIPS A wide choice of human glucose meters is available. There are also pet-specific meters; the most popular of which is the Alphatrak 2 (AT2). Pet meters usually show slightly higher test results than human meters do (and possibly closer to lab results from your vet). Be aware that most of the info documents on FDMB are based on BG data from human glucose meters. Both human meters and Alphatrak 2 are fine; it’s a matter of understanding the test results from your particular meter. (Post on the forum if you need advice.) The main cost of testing is test strips. Human meter test strips are much cheaper than the AT2 test strips. Human meter strips may be cheaper on Ebay. Popular meters used by FDMB members include: Alphatrak 2: Some vets sell both the meters and the test strips (check with your vet). But if you can only get the test strips online, do plan ahead so that you have a good stock of strips available to use in an emergency! USA: FDMB members like either the ReliOn Confirm or the ReliOn Micro from Walmart. Both are inexpensive and test strips are among the cheapest. UK: Many people use the Accu-Chek Aviva. It’s widely available and only requires a small blood sample. Canada: It is possible to get a meter free with the purchase of test strips. But test strips are expensive in Canada so check prices of strips (for ongoing costs) before choosing your meter. Australia: Meters include the Bayer Contour Next and Accu-chek (several types available). Blood glucose test strips: PLAN AHEAD! Stock up so you don’t run out of strips when it really counts. If your cat has a hypo (dangerously low BG) and you’re managing the situation at home, you may get through a lot of strips. AlphaTrak2 (AT2) users: If you have to buy strips online it is especially important to plan ahead. OTHER SUPPLIES Syringes: Much cheaper online than from vets. If possible, get U40 syringes with half unit markings: Ketone test strips: ‘Ketostix’ or ‘Keto Diastix’, from pharmacies or buy online. Vaseline and /or Neosporin, Polysporin: A tiny smear of Vaseline where you want to prick the ear will help the blood ‘bead up’. Some people in the USA use Neosporin ointment (not cream) for pain relief. However, some cats have an allergic reaction to Neosporin so Polysporin (which doesn’t contain the allergen) may be better. Polysporin is also available in Canada. Rewards for BG tests: Low-carb treats to give your kitty, whether the BG test is successful test or not. List of Low Carb Treats (USA) High-carb food for low BG situations: The gravy from these foods can be particularly helpful. Many folks in the USA use Fancy Feast ‘Gravy Lovers’ foods. The equivalent foods in the UK are the Gourmet Gold ‘in gravy’ foods. It’s helpful to mark the carb content on the tin with a marker pen so you don’t feed it by accident. Adding a little honey or syrup to low-carb food works if no higher carb food is available. Glucose or syrup for hypo emergencies: The fastest way to raise BG. Glucose syrup, karo, and honey are all suitable. Disclaimer: These are general guidelines which have worked for many cats. However, ‘Every Cat Is Different’. Learn how YOUR cat responds to the combination of food and insulin. Please be aware: There are no ‘dose advisers’ on the FDMB. This is an open board subject to peer review where laypersons with varied amounts of knowledge and experience share their own thoughts and opinions through explanation and by making suggestions. We are not vets. It is not our intention to take the place of your vet. Please discuss dosing, methods, medications, and care for your cat with your vet. Written by: Diana & Tom, Elizabeth & Bertie, JanetNJ, Kris & Teasel, MrWorfmen’s Mom, Squalliesmom, Tuxedo Mom, and Yong. With acknowledgments to Sue & Oliver, Robin & BB, and Sweetgrass & The Furries. .