BEGINNER’S GUIDE TO NOVOLIN N & HUMULIN N (NPH) FOR DIABETIC CATS This guide was developed by FDMB members to help you safely manage your cat’s diabetes using Novolin N or Humulin N. 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 live as long and as happily as a non-diabetic cat. And some lucky cats will even 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) Humulin N and Novolin N are both brand names for the same drug, called insulin NPH. Throughout most of this document, and for simplicity’s sake, these will collectively be referred to as ‘N/NPH’. Caution! Be absolutely sure that you are using Novolin or Humulin ‘N’. Do not use Novolin or Humulin ‘R'. (The ‘R’ (‘regular’) insulins are used by vets in medical situations when the blood glucose needs to be brought down very quickly.) ABOUT N/NPH A number of different insulins can be used in cats. They work in slightly different ways. They are almost always injected twice a day (every 12 hours). In cats, N/NPH tends to be a faster-acting insulin, often with a rapid ‘onset’ and a short ‘duration’. It may not last in the system a full 12 hours. Some cats only get around 8 hours duration. How long it lasts depends on the individual cat: as we often say around here, Every Cat Is Different (ECID). N/NPH can start acting quite soon after it’s injected, and it can drop the blood glucose very steeply in the first hours of the insulin cycle. It is therefore very important that the caregiver learns to test the cat's BG at home (‘home test’) as soon as possible, and becomes familiar with the effects of N/NPH in their cat’s system. N/NPH is a ‘U100’ insulin; it has 100 units of insulin per ml. It needs to be used with corresponding U100 syringes. Try to get U100s that have half-unit markings. Make sure you are using the correct syringes, otherwise you could give your cat too much insulin. U100 syringes have an orange cap. But some other insulin syringes (‘U40’) also occasionally have an orange cap, so do check on the pack or syringe barrel that it actually says ‘U100’. Mixing before use: N/NPH is a suspension and must be mixed before use. This is usually done by rolling between the palms of the hands and/or inverting the vial or cartridge a few times. The colour should be evenly ‘milky’ after mixing. If there are white specks in the insulin, or deposits stuck to the inside of the vial, the insulin needs to be replaced. Storage and shelf life: The different brands of NPH, Novolin N, and Humulin N may, on the package inserts, have slightly different instructions about storage and shelf life. So do refer to the package insert for information about your insulin. STARTING DOSE - N/NPH Usually it’s best to start with no more than 1 unit of insulin, twice a day. Post on the forum for advice specific to your own situation. Generally speaking, for newcomers to N/NPH it’s recommended that no insulin is given if the BG is below 250 [13.8] on a human glucose meter. And you may wish to use a slightly higher ‘no shoot’ number such as 300 mg/dL [16.6 mmol/L] in certain circumstances. (See ‘Blood Glucose Reference Information’ further down the page). 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 shoot’ number. 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. Note: Because the ‘no shoot’ threshold levels are often slightly higher for N/NPH insulin than for other insulins, it is particularly important that you monitor your cat’s urine for ketones. See ‘Testing For Ketones’ section further down the page. If, after at least a week, and having reviewed your cat’s BG levels, the dose doesn’t seem sufficient, dose increases may be considered in very small increments. Increasing doses of N/NPH needs to be done with great care. DO post on the forum for advice if you are considering dose increases for your cat. And if in doubt consult your vet. If you have reason to be concerned about hypoglycemia, or if your cat won't eat, decrease the dose immediately and contact your vet. Don’t ever 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. We have a saying regarding BG levels: “Better too high for a day than too low for a minute.” Safety first! UNDERSTANDING 'ONSET, PEAK / NADIR and DURATION' N/NPH can start to have an effect soon after it’s been injected. It may start to drop BG well within 60 minutes. The point at which the insulin starts to have an effect is called onset. After onset, BG will continue to drop for a time, and the process may speed up. Be aware that N/NPH typically drops the BG fast, but this is not the case in all cats. ‘Home testing’ will help you to determine how the insulin works in your cat. The lowest BG level of the cycle is referred to either as peak (peak insulin activity) or nadir (lowest BG). Experience of N/NPH on this forum has shown that the time of the peak can be quite variable, and, depending on your cat’s own response to the insulin, you may see this anytime between 2 - 6 hours after the insulin shot; though in most cats it will be between 3 - 5 hours after the shot. With N/NPH it is particularly important to know when the peak/nadir of the cycle typically occurs in your cat. The length of time that insulin remains active (lowers BG) in your cat’s system is called the duration. N/NPH typically has a shorter duration than other insulins, with some cats only getting around eight hours. But your cat may get a longer duration. ‘Home testing’ will help you to determine when onset, peak /nadir, and duration typically occur on a given dose of insulin. Knowing these patterns can be extremely useful, and will help you to keep your cat safe. FEEDING SCHEDULES - N/NPH 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 N/NPH. This is because the insulin can drop the BG fast in the first few hours of the cycle. (Note: It may not be the case that your cat’s BG drops fast with this insulin, but we suggest you assume this to be the case until home testing data has shown you otherwise.) 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. It's a good idea to feed your cat an hour before giving insulin. This is to ensure there is food in the cat’s system for when the insulin starts to work, and to help ensure that the BG doesn’t drop too fast or too low. Not all cats will experience a fast BG drop with N/NPH, but until your testing data shows otherwise, it is wise to assume that this may be the case with your cat. The sequence should be: 1. Test BG. 2. Feed. 3. Wait for an hour. 4. Give the shot. If your cat is known to sometimes regurgitate her food, waiting that hour will also give some assurance that she is likely to keep her food down. If you do a BG test an hour or two after the shot, and find the BG is dropping too fast, you can try to slow down the rate of BG drop by feeding a snack. If the cat’s BG is actually in danger of dropping too low, DO post on the Main Health forum for advice immediately. (Or contact your vet if you are concerned.) ‘Bouncing’: When 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. Manipulating the insulin cycle with food to slow down the rate that the BG drops (or to steer the BG away from low numbers) is called ‘steering the curve’. Some people using N/NPH find it helpful to withhold food for the second half of the cycle (after the peak/nadir) 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 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. 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, or in the time leading up to that. Timed feeders can be helpful for folks who can’t be there in person to feed their cat. 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. 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 With a fast-acting insulin like N/NPH it is extremely important that you learn to home test as soon as possible. BG testing at home (‘home testing’) makes managing your cat’s diabetes very much easier, and may well even save your cat’s life if you find yourself dealing with hypoglycemia. Home testing isn’t hard to learn, and most of us use ordinary glucose meters made for human diabetics. As well as helping to keep your cat safe, home testing has other advantages: 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? Firstly, for your cat’s safety, we recommend always testing the BG before you give an insulin shot. This is called a ‘pre-shot’ test. Pre-shot tests are mainly to ensure your cat’s BG is high enough to warrant being given that dose of insulin: sometimes they surprise us with a lower than expected number! Note: on FDMB we call the morning test ‘AMPS’ (a.m. pre-shot); and the evening test ‘PMPS’ (p.m. pre-shot) With N/NPH a lot can happen in the first few hours after giving the shot. So, testing the BG during the first half of the cycle is particularly important. If you can work out when the insulin starts working (‘onset’), and you know how fast the BG typically drops, and when the lowest BG of the cycle typically occurs (‘peak’ or ‘nadir’), you can work out the most useful times to test your cat’s BG on a regular basis. But be aware that patterns don’t necessarily stay the same and can change over time. Things such as change of dose, change of diet, stress, appetite, and illness, can all make a difference too. If you work during the week, weekends are a good time to get additional BG testing during. A full blood glucose curve or a partial curve can give very useful information. A curve is a series of BG tests done at intervals throughout the insulin cycle, which show us how the insulin is working in the cat’s system. (See ‘Understanding ONSET, PEAK / NADIR and DURATION’ above). With Novolin N/NPH it can be helpful to test hourly until past the peak of the cycle, and then two-hourly after that. 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. Note: On FDMB we describe 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 members on FDMB are in the USA so you will most often see people referring to blood glucose ‘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? There are several things to consider. First, it's generally recommended (especially for newcomers) that a shot of N/NPH isn’t given if the pre-shot BG is below 250 mg/dL [13.8 mmol/L] on a human meter. If you use a pet meter such as AlphaTrak2 you may want to raise the ‘no shoot’ threshold. This gives an added margin of safety when using a pet meter. (If in doubt seek advice from your vet.) It’s also important that the BG is definitely rising at the time you give the shot. Second, there are some situations in which you may wish to be even more cautious, e.g. if you are new to diabetes, or you can’t test much, or you’re increasing the dose, or reducing the carb content of the cat’s diet. In any of these situations you could consider raising the ‘no shoot’ threshold initially until you’ve been able to do a BG curve, or at least a partial curve, where you are testing hourly until past the peak of the cycle. A more suitable ‘no shoot’ threshold in these situations might be 300 mg/dL [16.6 mmol/L] on a human meter. If you use a pet meter, such as AlphaTrak2, you may want to raise this ‘no shoot’ threshold. This gives an added margin of safety when using a pet meter. (If in doubt seek advice from your vet.) Third, if you’ve gathered a lot of data about how your cat responds to insulin, and this shows that the BG doesn’t drop very fast or far on a given dose, you might consider lowering the ‘no shoot’ threshold to below 250 mg/dL [13.8 mmol/L] on a human meter. If you use a pet meter, such as AlphaTrak2, you may wish to keep the threshold slightly higher. (If in doubt seek advice from your vet.) However, you need to have a LOT of data to show that it may be safe to give shots at lowered pre-shot levels. Also you must be confident that you can monitor your cat’s BG and take action if it drops low. Cats who fit in this category seem to be in the minority. And if you are considering reducing your ‘no shoot’ threshold DO post on the forum first for advice. 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 250 mg/dL [13.8 mmol/L] on a human meter you can 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. You are looking for a number that is rising, not falling, and is up to at least 250 mg/dL [13.8 mmol/L] on a human meter. If using a pet meter, such as Alphatrak2, you may want to raise the number above 250 mg/dL [13.8 mmol/L] to give an added margin of safety. (If in doubt seek advice from your vet.) If you have time, you can repeat the process to see if the cat’s BG reaches a number you can shoot. But you may not want to continue more than an hour, as this may throw your schedule out (and your cat will become increasingly hungry!). If in doubt, skip the shot. If your cat’s pre-shot level is significantly lower than usual, post on the forum for advice about how to proceed. Note: If your cat has had ketones or DKA (Diabetic Ketoacidosis) then DO please post on the forum for further advice if you are considering skipping a shot, or raising your ‘no shoot’ threshold. Q: How low should I let my cat’s BG drop on N/NPH? It's advisable to not let the BG drop lower than 100 - 120 mg/dL [5.6 - 6.7 mmol], as measured on a human meter, at the peak of the cycle. 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.) N/NPH can drop the BG very sharply indeed. Trying not to let the BG drop below these levels helps to give a buffer of safety. If you get a BG of 100 - 120 mg/dL [5.6 - 6.7 mmol] on a human meter, and there is still some time to go until the peak of the cycle you may need to take action to ensure that the BG doesn’t drop much lower, and monitor closely until past the peak of the cycle. 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.) Important: Ask for help on the forum before giving insulin if you are unsure, as you can never ‘un-shoot’ insulin. 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). But your cat’s BG may not fit neatly into one of these ranges. Feline diabetes can be very variable. And N/NPH does present additional challenges. The cat’s BG may move through a greater range of numbers during the insulin cycle. You may be able to achieve a reasonable number at the peak of the cycle, but still have to contend with high pre-shot numbers. 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. HYPOGLYCEMIA BG that is too low can be VERY dangerous indeed. 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 document ‘How To Treat A Hypo’, linked to further down the page. Q: What BG numbers are considered hypoglycemic? As a general rule we want to keep the BG of all insulin-dependent cats - whatever insulin they are on - above 50 mg/dL [2.8 mmol/L] on a human glucose meter in order to avoid hypoglycemia. If you are using a pet meter it would be wise to keep the BG a bit higher. If you are using 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 we see these numbers we need to take immediate action to raise our cat’s BG or to ensure that it 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.) A particular challenge with N/NPH is the sheer speed at which it can drop the BG in some cats. For this reason, we want to keep cats on N/NPH well away from low BG numbers in order to keep them safe. Remember: With N/NPH the aim is to not let the BG drop below 100 - 120 mg/dL [5.6 - 6.7 mmol], as measured on a human meter, at the peak action of the cycle. 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.) 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 It's a good idea to print off the ‘Emergency HYPO’ document and keep it for reference in an emergency. • If you need help with low BG numbers, post right away on the Main Health forum. • If the situation is one you don’t feel able to manage at home, or if you see severe hypo symptoms, give syrup/glucose and go to the nearest ER vet clinic. TESTING FOR KETONES It is wise to 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. It involves dipping a ketone test strip in a tiny pee sample, timing the test, and and checking the result. Be sure to time accurately and view the result under good light. 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. Ketostix and Keto-Diastix strips are available from pharmacies. Ketostix strips test for ketones, Keto-Diastix strips test for both ketones and urine glucose. You want to see a ‘negative’ ketone result. Anything above a ‘trace’ reading is a reason to contact your vet, ASAP. Be aware that not all ketones are picked up by strips. So also be aware 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. Note: 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. Many cat foods are too high in carbs and can increase BG levels, sometimes quite dramatically, so we recommend that, if possible, diabetic cats only eat a low-carb diet. There are usually plenty of options; many ‘ordinary’ cat foods are fine. Always make any food switch slowly so as to avoid stomach upsets. Diabetic cats do best on wet foods that have less than 10% of calories from carbs. Many cats do best with carb levels lower than that, for example 4% to 6%. You'll 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. You may wish to raise your ‘no shoot’ level slightly while transitioning to lower carb food. DRY FOODS Dry food is not recommended. It can be very high in carbohydrate. And feeding dry food may mean that the cat doesn’t get sufficient water in her diet. Water-depleted diets can cause other health issues. However, if your cat cannot be transitioned to low carb wet food, there may be lower carb dry food options available, 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. And there are templates for human meters and for pet meters. If you have difficulty 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 pet meters such as Alphatrak 2 are fine; it’s just a matter of understanding the test results from your particular meter. 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 the 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 bought online than from vets. Be sure that you are buying U100 syringes. (Any other syringes may cause your cat to be overdosed.) 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 a better alternative. Polysporin is also available in Canada. Rewards for BG tests: Low-carb meat 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. The gravy in these foods is especially useful. It’s helpful to mark the carb content on the tins of high carb foods 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. Fastest way to raise the 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 acknowledgements to Sue & Oliver, Robin & BB, and Kimber & Bunny. October 2017 .