Diabetes - Initial Treatment - Need Advice

Discussion in 'Feline Health - (The Main Forum)' started by Davey's Mom, Dec 24, 2016.

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  1. Davey's Mom

    Davey's Mom Member

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    Dec 8, 2016
    Hope I am posting this in the right spot! Our cat was diagnosed with diabetes a month ago and currently we are taking him to the vet once a week, they are testing his blood and then sending him home telling us to up his cansulim dosage by 0.1 every time. Last Thursday he went in and his blood was still well over 20.

    We ended up buying a pet sugar tester to use at home and we would like to test ourselves and up his medication more frequently than once a week but when I mentioned it to the vet she said not to. The reasons she gave was that the medicine takes a week to react and I shouldn't trust the tester we bought for home. I'm concerned though because it's been a month and he is still a mess. He's drinking like crazy and his litter box is full all the time. It seems like if we continue to go once a week this process is going to take a long time and he is suffering. We just tested him this evening and his bloods at 23.

    Does anyone have an opinion as to whether we really need to wait a week in between increasing insulin dosages?
     
  2. Red & Rover (GA)

    Red & Rover (GA) Well-Known Member

    Joined:
    May 18, 2016
    Welcome. This is a good place to post your initial questions.

    I was a Lantus user and know nothing about Caninsulin. Due to the holiday, the forum is not as populated as per usual, but someone knowledgeable with be along as soon as they can. In the meantime, you can start by reading this: http://www.felinediabetes.com/FDMB/threads/vetsulin-caninsulin-user-guide.302/

    It's great that you've decided to home test. A guide to home testing is here: http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/
    Data is what is needed to see how cycles play out. The more data you can get, the better.

    If you could start a spreadsheet, that would help tremendously. http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
     
  3. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    Could you please clarify this? I don't understand what you mean by 0.1. Is it 0.1 units? 0.1 mL? What is the total dose you're giving and how often are you giving it?

    Did the vet say not to test his blood glucose at home or do you mean she said not to increase the dose more frequently? We recommend testing at home before every shot to make sure that the dose isn't too high. The cat should not have any food for at least 2 hours prior to testing so that the BG number isn't influenced by food. So the sequence is: test, feed, wait 20 to 30 minutes (Because Caninsulin is fast acting and there needs to be food on board), inject insulin. The dosing is done twice a day 12 hours apart.

    At the beginning doses might be held longer as a cat adjusts to getting insulin. As you get more BG data and know more how your kitty is responding this can change to more frequent dose adjustments.

    Most people on here use a human meter because the test strips are much cheaper. These tend to read lower than the special pet meters but members here are able to advise based on human meter numbers.

    This is not necessary. You can test BG at home and get a better measure of how your cat is doing. They are often stressed at the vet's and this can raise BG a lot. If the vet prescribes a dose based on the clinic BG numbers it can end up being too high. It's also expensive to keep repeating these clinic visits.

    If the BG numbers stay high it can mean the dose is too low but it can also mean the dose is too high. You need to learn to test at home and log all your data at one dose to see what's going on.

    We can certainly help you to help your kitty.
     
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  4. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Feb 18, 2015
    Welcome to FDMB. There are a number of Caninsulin users here and we can help you as you work toward getting kitty's BG more regulated.

    Emphasis mine.
    Just to clarify, I think Kris meant to say we are able to advise based on Pet meter readings. We are familiar with both human and pet meter scales. :)
     
  5. Kris & Teasel

    Kris & Teasel Well-Known Member

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    I didn't communicate this very clearly. My intention was to say that if a person was using a human meter, the numbers would be understood by people here on FDMB when advice is being sought. Similarly, numbers obtained using a pet meter are also understood here. :confused:
     
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  6. Davey's Mom

    Davey's Mom Member

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    Dec 8, 2016
    Hi All! Thank you very much for the quick responses and advice. Especially since it's the holidays! Sorry for the confusion on the dosage I'm using U-40 caninsulin syringes and have been increasing by one unit per week. He is currently having 8 units twice a day. The vet asked me to bring him in once a week in the morning and so far we've done this four times. Each time they have tested his blood twice, told me his sugars way too high still and to up the dose one unit and come back next week.

    We are using a pet meter that I found and ordered from Amazon. It's called Fastacare pet I believe and I thought the price was decent but I don't know much about it. I got the meter and 70 strips for around $40 CAD

    Sounds like I definitely have some research to do and should be charting numbers at home thank you. I will review the spreadsheet after Christmas and get it started. Thanks for the help so far!

    Just to clarify the vet is saying she wouldn't trust a cheaper meter purchased at home. She is also saying not to up insulin dosages more than once a week because the dosage increase needs a week to see if it's working. This seems too long to wait although I'm no expert by any means but he still seems so sick. She said it could take four months to get him regulated and I was hoping there was an quicker way to get him feeling better. Also, it is expensive so we are hoping to do more at home.

    We were told that he needs to eat immediately before a dose so we do take his food away for a while before so he's hungry
     
  7. Olive & Paula

    Olive & Paula Well-Known Member

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    Sep 6, 2015
    Hello and welcome. 8 units in a months time WOW. You are definitely correct to home test. There are a few conditions that require that much but it is uncommon.

    We normally raise dose by 0.25 units. Normally dose is raised once a week. People familiar with caninsulin will help you with that.

    Please start home testing. There are some informational in the Vetsulin (US name for insulin) forum. Please read them. Your kitty could need more or less, won't know until you get some tests done.

    Kitties can be stressed at vets causing a significant increase in glucose. You cat could be in a bounce so your vet would get a high reading so of course they say to raise dose.

    Testing is done before each insulin dose so you know it's safe to give. With caninsulin you feed 30 minutes prior to giving insulin. It is a fast acting insulin so you want food on board so there is something for the insulin to work with.

    What kind of food are you using? Low carb wet food is best. That is usually the pate, or classic food. If you are using dry or food with sauce/gravy do NOT change unless you are home testing regularly. It could drop glucose dangerously low especially on that dose.

    Most cats do better feeding mini meals like every 4 hours. Pick up any food and don't feed 2 hours prior to giving insulin so you don't have a food influenced test reading.
     
  8. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Feb 18, 2015
    I did comparison testing of the Fastacare meter against an Alphatrak2 meter, the most commonly used pet meter. The Fastacare consistently read slightly lower in moderate to high ranges and slightly high in lower ranges. The differences were however all within the allowed meter variance.

    8u twice daily is a very large dose. The average cat needs no more than 2u twice daily. As mentioned above, there are conditions that can cause a cat to need large doses of insulin but they are the exception not the rule. Normally cats are started on a small dose and very gradually increased until an optimal dose is found. Unless increases are done very methodically and slowly, it is quite possible to totally miss the optimal dose.

    I would strongly suggest you decrease the dose of insulin immediately. As Kris mentioned earlier, too low a dose and too high a dose can both result in high BG readings. In your case, because the dose has been raised to 8u so quickly, the most likely explanation for the lack of any improvement is that the dose is too high. While I don't completely agree with your vet about holding a dose for a week as that might not be necessary if dose increases are being done carefully and in very small increments, in the early days it is sometimes necessary to hold the dose for a week to collect data and see how the cat is adjusting/reacting to insulin.

    Your cat may currently be in a bounce which is a term for a phenomenon caused by the body's defense system. If the insulin is taking the BG low the body's defenses go into action to bring the BG back to a level the cat is familiar with and a diabetic has become use to higher BG levels so the body pumps them up with lots of glucagon making it look like the insulin dose is not enough when in reality it is too much.

    If the dose is too high, and the defense system repeatedly gets turned on, the cat will eventually run out of reserves of glucagon and a hypoglycemic event will occur. For that reason if I were you, I'd back up the dose to no more than 1.0u and start over because it's highly likely you have missed the proper dose for your cat. We can help you sort this out if you would start one of our spreadsheets so we can see what is going on. The link to the spreadsheet is in Post #2 from Red & Rover.

    I really am concerned for you and your kitty and strongly suggest you let us help you sort this out.:)
     
  9. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    I strongly encourage you to follow the advice Linda has just given you. The dose of insulin you're giving seems extremely high. Restarting today at 1 unit is the best way to proceed. There are people here to help and if you can't get the spreadsheet up and running right away, just post your data in this thread. There are a few of us around to help.
     
  10. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    @emjb14
    Please respond as soon as you have read posts #8 and #9. We are very concerned about your kitty.
     
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  11. Nan & Amber

    Nan & Amber Well-Known Member

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    Mar 19, 2016
    I agree-- it's very likely that the 8U your kitty is on is far to much for him. Starting over at 1U twice a day and monitoring progress at home is the safest and (believe it or not) fastest way to get him feeling better. We can help with testing and making dosing decisions as you go forward, but the most important thing right now is to just back down on that dose so you can keep him safe!!!!
     
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  12. Critter Mom

    Critter Mom Well-Known Member

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    Jun 16, 2014
    IMPORTANT NOTE to members helping here:

    May be too big a dose decrease - see below.

    Ketone status needs to be established for this kitty. Please help caregiver with this as it's critical to cat's safety if dose is to be lowered. (Find an open pharmacy if no strips at home. Give tips on collecting urine straight away so sample can be gathered ready for when the test strips become available.)

    Please get STARTING DOSE info and ask caregiver to post a link to the amazon listing for the meter she has purchased (need to have a better idea of the reference range it uses - ask the CG to check the meter documentation to see whether this info is provided, ESPECIALLY a reference point for hypoglycaemia). Thank you, Linda, for your info.

    8IU Caninsulin BID is a crazy dose to be giving a cat 4 weeks into treatment and I think it is very likely far too high. Please help CG to do some tests ASAP to see what's happening to cat's BG levels. This data is needed before any dosing suggestions can be offered - I'm worried about dropping the dose back too far. (Ketone status needs to be established to avoid risk of ketosis/DKA.)


    (Sorry this is so clipped.)


    Mogs
    .
     
    Last edited: Dec 29, 2016
  13. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Very good advice, Mogs. Waiting to see if CG posts.
     
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  14. Critter Mom

    Critter Mom Well-Known Member

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    Jun 16, 2014
    Ask the CG to get BG readings for period +2 to at least +7. Need to establish how low BG is going as a matter of urgency. (High and flat is another red flag.)

    If it were my cat I would not give 8IU again.

    .
     
  15. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    Ketone test strips - eg. Bayer Ketodiastix - can be purchased at any human pharmacy and aren't expensive.

    Ways to get a urine sample onto a ketone test strip:
    1. If kitty holds his bum high while peeing, put the strip under him in the urine stream.
    2. If he squats lower to the litter, slip a shallow, long-handled kitchen spoon under his bum to catch a few drops - dosen't take much.
    3. Put a double layer of plastic food wrap in the area of the litter box that he prefers to pee in and push it down to make depressions that will catch some urine.
    4. Put a layer of dried peas or similar in a clean plastic litter (or other) pan and try having him pee in that. If this works you can rinse off and reuse the peas for the same purpose.

    Re ketone test strips: dip, shake off excess urine, wait 15 seconds (or whatever it says on the package) and view the colour change under a bright light.
     
    Last edited: Dec 25, 2016
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  16. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Totally agree! I've just posted a how to for urine ketone testing.
     
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  17. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    Here's what you need to do @emjb14
    1. Ketone status of urine needs to be established for this kitty. I've posted instructions for how to do this above.
    2. Give us your STARTING DOSE info (at diagnosis).
    3. Post a link to the amazon listing for the meter you have purchased so we can figure out how it reads relative to meters we know. Check the meter documentation in its instruction booklet to see whether this info is provided.
    4. Do some tests ASAP to see what's happening to your cat's BG levels. Testing every hour or two between now and later this afternoon would be good data. Said another way, test as soon as you read this and then every hour or two until you're about 7 hours post AM insulin dose. Are you in EST zone?
    Once you have done all this we'll advise you on how far to drop the dose. Dropping to 1 unit might be too much. This is how FDMB works: one of us responds to a post, offers suggestions on what to do and others will weigh in to agree or disagree. All the input is combined so we can give you the best assistance.
     
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  18. Olive & Paula

    Olive & Paula Well-Known Member

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    Sep 6, 2015
    @emjb14

    If you cat is acting drunk, stumbling, spaced out, lethargic get a glucose test immediately, post here and rub karo or honey on gums. Stay here for step by step advice until kitty is safe.

    Do not be nonchalant about that dose. Insulin is a powerful hormone and can be fatal.
     
  19. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    I've rewritten this into a list of step by step instructions for the CG.
     
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  20. Olive & Paula

    Olive & Paula Well-Known Member

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    They don't seem to be checking here.
     
  21. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Very worrying. Heck of a time to get hold of owner ...
     
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  22. Olive & Paula

    Olive & Paula Well-Known Member

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    Sep 6, 2015
    Yes it is. I really don't like when someone posts then never comes back, why bother posting to begin with.

    Maybe it's the holiday. They said earlier they would look at the ss after Christmas.
     
  23. Kris & Teasel

    Kris & Teasel Well-Known Member

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    I agree. I then worry about what happened, etc., etc., etc.
     
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  24. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Feb 18, 2015
    Thanks everyone for checking on this poster and chiming in. You're the bestest peeps! :bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug:

    I too hate when a thread like this goes silent. I have the Jaws theme song in my head right now and really hope they see this very soon! :eek:
     
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  25. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    FYI folks - I'm leaving in about 1.5 hours to get together with family. I'll be gone for about 4+ hours. Busy getting ready right now.
     
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  26. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Feb 18, 2015
    @Kris & Teasel Have a wonderful time with your family. Wishing you a very Merry Christmas!
     
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  27. Olive & Paula

    Olive & Paula Well-Known Member

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    Have fun Kris.
     
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  28. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Thanks! I know you said you don't make a big deal of Christmas at your place but are you thinking of posting some pix of PJ and Tux for our enjoyment?
     
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  29. Critter Mom

    Critter Mom Well-Known Member

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    Try sending the OP a private message. They may see an email notification.


    Mogs
    .
     
  30. Olive & Paula

    Olive & Paula Well-Known Member

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    Sep 6, 2015
    I will see if I can get some. So far today all they've done is sleep.
     
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  31. donnalea

    donnalea Member

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    Jun 18, 2016
    I'm praying that the OP has just been too busy with Christmas celibrations that the haven't checked their computer. I haven't checked my puter until 11 PM. Of course I'm not in OP position. Hopefully they will chech in soon.
     
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  32. Marlena

    Marlena Well-Known Member

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    Nov 25, 2015
    I'M REALLY WORRIED NOW THAT THERE IS NO ANSWER FROM EMJB!
     
  33. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    We all are.
     
  34. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Feb 18, 2015
    I sent a PM at about 04:00 am today and there has been no response. Like everyone else I fear for the poor cat but unfortunately there is nothing we can do but wait and hope. :(:(:(:(:(:(:(
     
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  35. Marlena

    Marlena Well-Known Member

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    Nov 25, 2015
  36. Davey's Mom

    Davey's Mom Member

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    Dec 8, 2016
    Hi All! It seems I have upset many of you by not answering right away I apologize. I didn't see the need to panic after my last post and planned to look at the links provided and do what I needed to do once things calmed down after the holidays. I have been seeing the vet weekly and didn't see this as a huge problem and was just looking for a little more guidance. I don't want to spill all my personal issues on here but my Grandfather is in the hospital in critical condition and I have small children among other things so this last few weeks has been hard and busy on the family.

    I have my usual appointment at the vet tomorrow and I will bring up all your concerns for sure. The starting dose my vet told us to give the first week was 3 units so needless to say I'm very confused on why my vet would have me starting on these high doses that you all find to be outrageous. I feel like I should be able to trust my vet and expect that they know my pet but you all seem very educated in the matter and are obviously extremely concerned so I'm lost for words. I definitely have a decision to make and will do so after I talk to the vet tomorrow. I hope you can understand that I'm very lost on who's advice I should take....

    I'm going to look through all your posts now more thoroughly. I just wanted to send a quick answer back before bed to give you some sort of update.

    I believe someone asked for the link to the monitor I bought here it is: https://www.amazon.ca/FastaCare-Blo...UTF8&qid=1482979169&sr=8-2&keywords=fastacare

    And he is easting fancy feast classic mixed in with a bit of dry food. He was eating dry food before we found out about his illness so I've been slowly getting him off of it because I read and was told that dry food is terrible for him.

    Please note that he is not acting wobbly, spacey or anything of the sort. He's himself with the exception that he drinks much more than usual and fills the litter box with pee all the time. It's gotten better than it was but is still not back to normal. This is what flagged us to bring him to the vet in the first place.

    He's an amazing cat that's absolutely wonderful to my kids and I really am trying to do what's right for him. Not sure if I mentioned this yet but he is almost 13 years old
     
  37. Beth 73

    Beth 73 Well-Known Member

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    Aug 2, 2016
    Hello ! Even tho I have only been at this since July I still feel like a newbie in many ways. Just wanted to encourage and reassure you that you have come to the exact right place for u and your kitty. These loving, experienced kitty lovers have saved Elmo's life, held my hand and guided me in the wee hours of the morning and given me the guidance that has caused great improvement in our diabetes journey. I don't know much but I do know that tests taken at vet will produce a stress influenced higher number. That is why u are so wise to start home testing and get a number not influenced by vet office stress. The members of this board will love on and look after your kitty as if it were theirs and give you sound, tested advice which you can weigh in with your vets. My vet is thrilled I am on this board because sometimes it takes minute by minute instruction at odd hours when there is no vet. I am glad you are here and wanted you to know without a doubt that this is a safe, reliable place for you and your sweet kitty!
     
  38. Beth 73

    Beth 73 Well-Known Member

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    Aug 2, 2016
    Also check out website catinfo.org, written by a vet with tons of great info that helped me formulate questions early on. It's a must read .
     
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  39. Davey's Mom

    Davey's Mom Member

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    Dec 8, 2016
    I'd like to mention as well that my cat is pretty big, he's 13 pounds and used to be 15 before he got sick. I was thinking maybe the vet started off at 3 units and is increasing by one unit each visit due to his size, is this possible in your opinion? I read on the caninsulin website something about starting off with 0.5 of a unit per kg (2.2 pounds) of bodyweight which pretty well works out to 3
     
  40. Davey's Mom

    Davey's Mom Member

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    Dec 8, 2016
    Hi Beth 73! Thank you very much for your response I appreciate it and will review
     
  41. Beth 73

    Beth 73 Well-Known Member

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    Aug 2, 2016
    Oh you are very welcome :). I just remember being in your shoes at the beginning..so many questions, wanting to fully trust your vet but seeing possible differing info here. And add in your full plate with a grandfather in the hospital AND small children...you r one very busy lady. I know you are so busy with all going on in your life but I really think reading the catinfo.org website will clear up a lot and reassure you since it is written by a vet. Will be watching your threads with interest and care. You are in excellent hands here...a truly knowledgeable,caring group of extraordinary people :bighug:
     
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  42. Beth 73

    Beth 73 Well-Known Member

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    Aug 2, 2016
    Som
    Someone far more knowledgeable than I can answer that question. I myself started out on vetsulin at a dose of 1 unit 2x a day for Elmo's 9 lbs....
     
  43. StephG

    StephG Well-Known Member

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    Sep 8, 2016
    I think most were under the impression that your kitty was getting 8 units twice a day.
    3 units is way more normal than 8!
    My vet started my boy with 7 units twice a day and it would have killed him if I didn't find this forum. I have since switched to a new vet.
    Home testing is the best way to get an idea of how well the insulin is working. Vet and car ride stress is enough to raise it by significant amount.
    Once you get completely off the dry food he might not need as much as he is getting now and your home testing will show that if that is the case.
     
  44. StephG

    StephG Well-Known Member

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    Sep 8, 2016
    It is best to test before every meal. Pick up all food 2 hours prior to test. There are caninsulin experts on that forum. I use prozinc and I'm not sure what best starting dose for your kitty would be. They can also walk you through when the best time to test him between meals would be and how long the insulin should work each cycle.
     
  45. Davey's Mom

    Davey's Mom Member

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    Dec 8, 2016
    Thanks so much this really is a lot to take in and this definitely does seem like an amazing group of people. The time everyone dedicates to this is incredible. I will read up tomorrow for sure. It's almost 12:30 here so I better get to bed.
     
  46. Davey's Mom

    Davey's Mom Member

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    Dec 8, 2016
    He is getting 8 units twice a day now that is correct but he started at 3. They up it one unit after each appointment because they tell me his sugar is still too high (over 20)
     
  47. Mum of two felines

    Mum of two felines Member

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    Dec 7, 2015
    Hi emjb14. 8 units twice a day is a lot. Have you checked for Ketones? You really need to check for those. Also, what type of food is Elmo eating? I also struggled with whose advice to follow 1. my vet that took such good care of my dog, or 2. people I didn't know. It took me about 3 weeks to finally get a meter (I'm a little slower than you) and then another week to finally post what was happening with both my cats. I almost lost Woody because my vet was increasing his dose. We were at 12 units on the first day I checked his BG and posted them. My alphatrax showed he was bottomed out and was in serious trouble (the only symptom he was showing was an increase in wanting food). After some very strong guidance from some very caring people here I reduced Woody's dose. After I switched to all Friskie pates both my cats went into remission. Look at my SS for Woody and Buzz. If I wouldn't have taken advice from this board my Woody would not be alive today. I am glad I followed critter Mom, MrWorfMen's Mom, Squalliesmom, and many others' advice. The first thing is to understand that some vets really do not know how to treat feline diabetes and that it does take a great leap of faith to follow the advice from this board. But I've seen some great things happen over the past year on this board and I trust these members with both my kitties.
     
    Last edited: Dec 28, 2016
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  48. Davey's Mom

    Davey's Mom Member

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    I'm going to take my cat to the vet tomorrow and tell her about this site and that 8 units seems to high after a month according to everyone here to see what she says.

    Afterwards, when he gets home I feel like it's best to follow the advice you have all given. From what I'm gathering I need to:

    1) Start a spreadsheet immediately using the world template for pet meters. Share it on my signature.
    2) Test 30 minutes before each shot, then after 2 hours, then after 5? This will be tricky to do on weekdays since I'll be at work but I can blood test all I need to Saturday and Sunday
    3) Get ketone test strips at pharmacy immediately (can do tomorrow) and post results

    Hope I got this right....
     
  49. StephG

    StephG Well-Known Member

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    Sep 8, 2016
    Oh!! Have you gotten any home testing done? My cat is on 6 units twice a day of prozinc but we moved up there from 1. They are different types of insulin so I'm not sure they can be compared.
    I strongly urge you to get some pre-meal/preshot home tests done as soon as you can. I see you're very busy but it will give more insight on how the insulin is working for him.
    He can be getting 8 units and dropping to very low numbers causing his liver to panic and cause a very high blood glucose by next dose. It's called a bounce on the forum.
    If you can test before his shot and then maybe 4 hours after his shot that would give a better picture. It's best to get the pre shot test after 2 hours of no food so it's not influenced by food.
    Ketones are very important to test for. With high blood glucose levels he can go into DKA and a ketone test will tell you if he's getting into trouble there.
     
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  50. Davey's Mom

    Davey's Mom Member

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    Dec 8, 2016
    He's eating fancy feast wet food normally a can a day and then a bit of dry food still but not much. I'd say 1/4 cup at the very most. I used to have him strictly on dry food I didn't realize how bad it can be until now unfortunately :(
     
  51. StephG

    StephG Well-Known Member

    Joined:
    Sep 8, 2016
    I believe with caninsulin you want to test, feed, wait 20 minutes then give shot. Please correct if I'm wrong! It's best to do it this way with any insulin just in case your cat decides to puke after a meal. Fancy feast classics are low carb. You want to stay away from any types with "gravy" because they have much higher carb levels. But it's good to keep one on hand for your hypo kit.
     
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  52. Davey's Mom

    Davey's Mom Member

    Joined:
    Dec 8, 2016
    Got it thank you! He will be at the vet tomorrow but I will start this tomorrow evening. He usually has shots at 7am and 7pm and I get him at the vet at 5ish so I'll be able to take the food away to do this.
     
  53. StephG

    StephG Well-Known Member

    Joined:
    Sep 8, 2016
    Mum of two-- I'm going to let you take over on this. I'm not familiar with caninsulin and looks like you have much more experience than I do.
     
  54. Davey's Mom

    Davey's Mom Member

    Joined:
    Dec 8, 2016
    Thanks! I did figure out how to use the meter but wasn't sure what the right times were to test. Now I have an idea.
     
  55. Davey's Mom

    Davey's Mom Member

    Joined:
    Dec 8, 2016
    I have to log off for now (almost 1am here) but as mentioned after the vet tomorrow I do plan to get ketone strips, start the spreadsheet and the blood testing. If anyone has further advice on when/how I should test please feel free to let me know and I will check this feed tomorrow evening after work and before I start anything. Thanks!
     
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  56. Mum of two felines

    Mum of two felines Member

    Joined:
    Dec 7, 2015
    You are doing great. My kitties were on Novalin N. But you ar correct- test, feed, then 30 minutes later shoot. My vet didn't give me those directions either.
     
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  57. Mum of two felines

    Mum of two felines Member

    Joined:
    Dec 7, 2015
    What was his reading? And, yes, it is late. Good night.
     
  58. StephG

    StephG Well-Known Member

    Joined:
    Sep 8, 2016
    You could test every hour if you wanted to. Personally I test before meal then feed and give shot. Then I try to test every 2 hours or at least two hours after his shot and 6 hours because that is typically when Prozinc peaks. Someone familiar with caninsulin can tell you when the best times to test during the cycle are and when it typically peaks.
     
  59. Capoo

    Capoo Member

    Joined:
    Jan 15, 2016
    Hi,

    I will just tell you my personal story with Caninsulin:

    My cat has been diagnosed in November last year. Of course, at the beginning, I wasn't aware that this board exists, and that it was possible to perform home testing.
    So, like you, I started Caninsulin with a reasonable dose (2 IU BID), and had regular appointments to the vet to adjust the dose.
    And like you, at one time, the dose was 8 IU at a time, and this time was when I discovered this board, and decided to buy a meter to home test.
    And such a surprise : my cat didn't really have the same answer to insulin at home compared to what was happening at the vet. His pre shot numbers were terribly high because between two shots, he was terribly low (less than 40 on a pet meter!). The dose of 8 IU was really too high, and my cat was bouncing all the time!
    I even encountered some hypo episode with symptoms!

    After that was discovered, we decreased drastically the doses, and found that the problem was that my cat was metabolizing Caninsulin too quickly, and we changed the type of insulin. But that's another story....

    All that being said, with Caninsulin, tests shall be performed before each shot, and in between: let's say 3 and 5 or 6 hours after a shot, as it's the peak action of this insulin, and that's when you can see terribly low numbers.
     
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  60. Marlena

    Marlena Well-Known Member

    Joined:
    Nov 25, 2015
    Dear EMJB,
    I'm so sorry that you feel so torn between the advice you receive here and from your vet's. It is very difficult as we, naturally want to trust and rely on the professionals which we are not but the vets are supposed to be.
    Unfortunately we have seen so many stories here when the vets killed or nearly killed cats (unintentionally of course due to lack of knowledge how to treat a diabetic cat, knowing more how to treat diabetic dogs and applying the same protocols to cats).
    The amount of information we have gathered here to help people to understand how to treat FD is a best tool to help with this very difficult and sometimes puzzling disease. I have a very good vet but when I first started treating my cat it was the same story as with the others - vet tells you to inject your cat with this very powerful substance INSULIN and tells you to to it in a blind fashion, doesn't tell you to slowly change your cat's food to a low carb one and they want to perform 2 weekly curves. This is all wrong. Do you know why they do it like that? Because they have no knowledge how to treat FD for starters (but specialists know) and they think you are a human being not capable of testing your cat and drawing any conclusions from that, it brings them more money if you keep bringing your cat for curves and also in order to explain and teach you how to treat FD they would have to spend a lot of time with you which is not a good business move for them. They make mega money on the prescription food they sell so they always push for that food.
    As I said earlier I attend a very good vet surgery but at the beginning they were like other vets. I put my foot down, learnt quickly about FD from this site and informed my vet that I'm going to do it my way and I need her support. Blank refused prescription diet despite her insistence that I need to feed Rocky special diabetic food. I have told my vet about this site and showed her printed spread sheet with Rocky's blood glucose (BG) numbers. It was 2 years ago and I can't believe how much my vets have changed!
    So, I will still insist that the dose of insulin you give is far TOO HIGH! Increasing the dose by 1 unit every week is INSANE (sorry)! Unless the cat has some other serious condition which requires high dose of insulin. So far you have not been informed by your vet about such a possibility.
    My opinion is very strong because I feel very passionate about FD and I don't believe that we should be blaze about it as wrong treatment can kill.
    I hope that you will manage to wrap your head around the problem and find a reasonable ground. If you prove to your vet that you are capable, have knowledge and explain that you are determined to work hard at it and work WITH the vet to get the best care for your kitty, I'm sure they will take it on board.
    Best of luck.
    Marlena:bighug::bighug::bighug:
     
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  61. Beth 73

    Beth 73 Well-Known Member

    Joined:
    Aug 2, 2016
    Good Morning !! I know you r probably at work and kitty is at vet but had a thot....when u go pick him up today, ask ur vet if there r any special reasons/conditions that r necessitating the high dose or is this because of hisBG alone. This info would greatly help the experienced people here understand and move forward with help. You r doing great and ur kitty is blessed to have you:bighug:
     
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  62. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    Yes, this is the way to start but you need to test, feed, wait for 30 minutes, then inject. :)
     
  63. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Thanks for the update and so glad your kitty is alright. As mentioned earlier, we have seen far too many very close calls as a result of high dosing instructions from vets and on occasion some tragedies. Hypoglycemia can kill and an unmonitored cat getting too high a dose of insulin is not safe. Most vets do not treat that many diabetic cats. They treat far more dogs and vets treat our cats like dogs who do need higher doses. We have 24/7 hands on experience and lots of evidence that starting low and gradually and methodically raising the dose is far safer and effective. Insulin is a hormone that triggers other hormones in the body.....it's not a pain pill where if 1 aspirin doesn't help you can take 2.

    As for your vets comments about the meter you purchased. I gave you some info on that meter based on my own testing of it and my feeling (and I'm pretty sure everyone here would agree) that any meter is better than no meter. What you do at home is entirely up to you but please do not have blind faith in your vet. They are after all just human and mistakes do get made. The vet wants to help your cat but they just don't have the experience and many are still relying on what they learned in a few short hours in vet school. What we offer, is years of experience with thousands of cats who have happily lived long quality lives. Experience is often the best teacher. :)
     
  64. Olive & Paula

    Olive & Paula Well-Known Member

    Joined:
    Sep 6, 2015
    I know it's very early in your diagnosis, but that dose your giving is awful high for a newly diagnosed cat.

    There are a few medical conditions that do require high doses and even higher than what you giving. There are uncommon but they are out there. Most vets do not order the tests (they are sent out to the only place that runs them (MSU). And they don't believe kitties can have them but they do. The tests are for insulin resistance and one for Acromegaly. It does take awhile to get results since the tests are only done a certain day of the week.

    FWIW, You might consider getting them done. If they are positive then the dose your giving is required and probably needs more. And probably a different kind of insulin as large doses start to sting or burn. If tests are normal then this dose can be super dangerous and changes in food and routine need to change.

    Before anymore increases I would get these tests done so you know what your dealing with and what direction to go in.
     
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  65. Davey's Mom

    Davey's Mom Member

    Joined:
    Dec 8, 2016
    Hi All! Thank you all for your advice, the vet just called so I am sneaking in an update at work... I told her about everyone's suggestions and concerns mentioned on this site and she said she would be completely supportive of me handling this at home if his levels still weren't still off the walls. She tested him today after his insulin injection and got a reading of 33 and then another at 27 a couple hours later. She said it's still really high and since he's still excessively thirsty and showing the same symptoms at home she does not find it possible that we've missed the appropriate dose. She mentioned that she would like to get him at a reading of 10 before I start testing and treating at home. Her advice is to up to 9 units for a week and if there's still no improvement to discuss other medications/alternatives next week.

    I got the ketone strips and am going to use those plus start the spreadsheet tonight and not up the dose. Afterwards, I'll give you an update and if you can please let me know what you think it would be much appreciated. From what I'm understanding doing regular testing at home and using the ketone strips should provide confirmation as to if I'm overdosing him correct?

    Thank you for everyone's advice and support thus far!
     
  66. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    If the BG is very high they will drink and urinate a lot. The BG can be high if they're untreated, if the dose is too low OR if the BG is elevated by that bouncing process we described to you. At the very least you could begin testing at home and regard it as practice for when the vet wants you to get home monitoring under way. There's no reason for not doing that and if you record all the test results you'll have something to compare your later records to. If you want to try this the best times to do it are:
    • AM and PM before feeding (no food for 2 hours beforehand)
    • somewhere about the middle of the time between AM and PM shots or late evening.
    It's very easy to miss the good dose if you start high and increase by 1 unit at a time. That's why generally we recommend starting at 1 u twice a day and only increase in 0.25 u fractions. My cat was around 13 pounds at diagnosis and he was started at 1 u twice a day.

    Did she say a reading of 10 before insulin or when the insulin is at its peak effect? When Caninsulin (Vetsulin) is working as it should, the BG will start at its highest point just before injection time, decline gradually to its lowest value about 4 to 6 hours later and then gradually rise to another high point just before the second injection of the day. It's the low value that can be a worry - too low can cause an episode of hypoglycemia that can be fatal.

    One of the other posters above mentioned a few conditions that can cause a kitty to need this much insulin. These are relatively rare conditions and special tests are needed to find out if they are present. If those are not factors in your kitty's health status then 9 units twice a day is a VERY high dose. That's what worries us. A kitty might tolerate it for a while because of internal processes that keep BG propped up - often artificially high - and then those processes can't do it anymore and the kitty crashes.

    I sincerely apologize if what I've said confuses you more because it runs against what your vet has said. We all understand that feeling of loyalty to a vet with whom you might have a long and productive relationship. Our focus here is always on what a poster has told us about their kitty, any proposed treatment and how it measures up against the combined experience of many people over a long time treating their own FD kitty 24/7.

    Let us know your thoughts. :cat:
     
  67. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    Confirmation of overdosing requires a log of BG data at a range of doses over a lengthy period of time. Ketone testing will tell you whether your kitty is at risk of developing a complication of unregulated diabetes called diabetic ketoacidosis.
     
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  68. Olive & Paula

    Olive & Paula Well-Known Member

    Joined:
    Sep 6, 2015
    Caninsulin/Vetsulin at that dose will burn and or sting. It's also possible that insulin just doesn't work for you kitty and another might be considered.

    Also don't agree that you can't begin monitoring until after you find correct dose. HOGWASH

    I think a second opinion by another vet should be considered. And getting those 2 tests mentioned for high dose conditions.

    I know when I used vetsulin and reached 5 units. My vet said they couldn't give anymore. So what do you do, he needs it? They said food change that's all. Found new vet.

    Your situation is extremely concerning.
     
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  69. StephG

    StephG Well-Known Member

    Joined:
    Sep 8, 2016
    Definitely start testing as soon as you get home. Don't wait for a certain dose level.
    My boy bounced today. He was 327 before his shot. I gave him 5.8 units and in 4 hours he was 130. 6 hours after his shot he was 128. Beautiful numbers! Then in a two hour time period (so 8 hours after his shot) he was up to 456! By the time he was due for his next shot he was OVER 600.
    His dose of 5.8 was too much for him this morning. So his liver panicked and started working to raise his blood glucose.
    So if I wasn't testing I would think wow that dose doesn't work for him at all! When it was just too much for that level.

    *NOTE* this is NOT typical behavior for every cat. But it shows how a "bounce" from a dose that is too much works.
     
  70. Davey's Mom

    Davey's Mom Member

    Joined:
    Dec 8, 2016
    I used the ketone strip and got a dark green color for glucose (I'd say close to 1/4 category) and the ketone section remained a beige color for negative. I only had a very small amount of urine to work with so maybe I will try again later just to be sure. It's a good thing from what I'm understanding if it's coming up negative right?

    Didn't test his blood yet but I will be soon!
     
  71. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    Negative on the ketones is great. Don't worry about the glucose part of the strip. Testing BG with the ear prick is the way to assess that.
     
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  72. Davey's Mom

    Davey's Mom Member

    Joined:
    Dec 8, 2016
    Thanks! I'll keep up with the blood tests and next week I will mention the testing Woodsywife suggested with the vet while discussing "further options".
     
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  73. Davey's Mom

    Davey's Mom Member

    Joined:
    Dec 8, 2016
    Hi All! I've done quite a bit of BG checks over the last few days and so far everything is still fairly high regardless of time. I haven't noticed him getting so low that he's in the danger zone at all but I do notice how his sugar drops after injections.

    Although the numbers are high I have noticed that they are quite a bit lower than the readings done at the vet so I'm assuming he must be stressed when he has to go there.

    I'm no expert but the numbers seem to suggest to me that caninsulin may not be the fix for him :( From what I understand 100-199 is the place to be and he isn't even close to there.
     
  74. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Hi @emjb14

    I, too, was very relieved to hear back from you the other day. Good news that you are now home monitoring BG and ketones; you're doing great! :)

    Others above have already advised you that if the starting dose isn't right it can set up the situation where subsequent dose adjustments may make matters worse, not better, for a diabetic cat on insulin.

    At 3 units, categorically Davey's starting dose of Caninsulin was too high.

    The following information on dosing is not from FDMB; it is straight from the manufacturer's own guidelines for the insulin you are using (i.e. the dosing information your vets should be following).

    There are two brand names for this insulin: Vetsulin (US) and Caninsulin (Europe and Canada - not sure about other countries). Below I have provided links to the dosing guidelines on both vetsulin.com and caninsulin.com because there is a slight variation between dosing recommendations on each of the sites but BOTH sites state clearly that the MAXIMUM recommended starting dose of this insulin for a cat - independent of body weight - is 2 units.

    From caninsulin.com: -------------------------------------------------

    Starting Dose Guidelines:
    • Pre-treatment blood glucose concentration is used as guidance for the calculation of initial insulin dose in cats.
    • To avoid overdosing particularly during initial stabilization, round the cat’s bodyweight down to the nearest whole kilogram and the calculated dose down to the nearest whole or half unit.
    Baseline Blood Glucose Concentration: <20 mmol/L <360 mg/dL [lab/pet meter values]
    • Units of Caninsulin per kg Body Weight (rounded DOWN to nearest whole kg): 0.25 U/kg body weight
    • Starting Dose (rounded DOWN to nearest whole unit): 1 unit twice daily.
    Baseline Blood Glucose Concentration: >20 mmol/L >360 mg/dL [lab/pet meter values]
    • Units of Caninsulin per kg Body Weight (rounded DOWN to nearest whole kg): 0.50 U/kg.
    • Starting Dose (rounded DOWN to nearest whole unit): 2 units twice daily.
    *The maximal dose should ideally not exceed 2 IU per injection in the first 2-3 weeks of treatment.

    Dose Adjustment Guidelines:
    • Dose adjustment should be based on the clinical response and the results of serial blood glucose samples and not just a single sample. Ideally a blood glucose curve should be made before the insulin dose is changed.
    • Changes in dose should be made after a period of adjustment to a particular dose or regime. In cats the dose can be adjusted as infrequently as after 1-3 weeks on a particular regime. Increases of 1IU per injection are recommended.
    From vetsulin.com: -------------------------------------------------

    Starting Dose Guidelines:

    For cats, the initial recommended dose of Vetsulin® (porcine insulin zinc suspension) is 1 to 2 IU per injection. Cats should be started on twice-daily injections of Vetsulin at 12-hour intervals. Note that in cats, Vetsulin dosing is calculated on a per animal basis; in contrast, initial dosing for dogs is based on body weight.
    Dose Adjustment Guidelines:
    • Reweigh the cat. Modify overall dosage of Vetsulin if significant weight gains or losses occur.
    • Ask for owner’s overall impression of the cat’s progress, especially in regard to polyuria and polydipsia.
    • Sample blood glucose level to determine if regulation has been achieved, keeping in mind that cats often present with stress-induced hyperglycemia.
    • Adjust dose in increments of 1 IU per injection twice daily, if needed, based on the glucose curve evaluation and clinical signs.
    • Allow at least 14 days between dose adjustments unless hypoglycemia occurs.


    Mogs
    .
     
    Last edited: Dec 31, 2016
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  75. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    I'm sorry to say this - again - but the numbers on your spreadsheet tell me that your kitty's dose is too high. I hope you have read the information posted above by Critter Mom about dosing Caninsulin/Vetsulin. Those are the manufacturer's guidelines. It would be a good idea to go directly to those websites, print out the dosing guidelines and take them to your vet. We really don't want your kitty to have a hypo episode.
     
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  76. Mum of two felines

    Mum of two felines Member

    Joined:
    Dec 7, 2015
    Please check Woody's spreadsheet. My vet started him on 3 then upped everyday until he got to 10. During this time he was at the vets and they checked him once a day which I am not even for sure if they checked a fasting BG or after he ate. When I finally got him home I took him in every week. Each week the vet raised his dose 1 unit. Mat 13 units I decided I needed this board's help. The first reading I took he was LOW. The reductions was on the advice of the people here.

    I really think your dose is too high. Please look at Critter Mom info. She has a lot of experience and she and others saved Woody.
     
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  77. Davey's Mom

    Davey's Mom Member

    Joined:
    Dec 8, 2016
    Ok understood sorry this is a lot to take in and I keep thinking that if his levels are still very high that the medicine is a) not working or b) not enough. I guess it's just what seems logical at first until you make sense of all this plus it doesn't help matters when the vet is saying the same.

    I do agree with you all and now I am wondering what to do next with his dosages. Do I start right back to one or do I slowly decrease from 8. It would be risky to make a big adjustment all at once right???
     
  78. Mum of two felines

    Mum of two felines Member

    Joined:
    Dec 7, 2015
    It is a lot to take in and it takes a leap of faith!!!! Let me tell you it was extremely hard for me. I remember crying in the car because I was so worried about my kitties. I was talking to myself why the heck I would take advice from strangers. I finally decided that I couldn't be hurting Woody anymore than what he was. I hated taking him in to get checked, they would snip a Claw until it bled, I was sick to my stomach every time. I am SO glad I decided that I would give this board a chance.
    I can't give dosing advice but I'll tag a few members that helped me @Critter Mom @Tuxedo Mom @manxcat419 @MrWorfMen's Mom @Larry and Kitties @BJM @Marje and Gracie Maybe they can help. On post #8 MrworfMens mom says what she would do.
     
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  79. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Please DO NOT give 8u again. If this were my kitty I would reduce the dose down to no more than 2u and probably even to 1u and start over. As Critter Mom said earlier., even the 3u that was initially was a high dose. Insulin is a hormone that triggers other hormones in the body. It a NOT a medicine. It's not like an aspirin where if one doesn't take the headache away you can take 2 at the next dose. To treat it in this fashion is nothing short of terrifying. Dose increases should be done in small increments of 0.25u to0.5u. These are small creatures so small amounts do make a difference.

    I know you want to trust your vet but this is a very common vet problem. They see your cat in their clinic when they are under stress which elevates their BG. This leads them to think that the cat needs far more insulin than it really does. Right now, you are likely seeing the result of a lot of bouncing as your cat's body fights the huge dose of insulin you have been giving and the readings on your spreadsheet seem to confirm that opinion.

    I hope I have caught you in time. Please test your cat at +1.5 hours post shot and see how much the BG has dropped. If more than 5mm (100 points US) you need to test again no later than +2.5 hours post shot and feed Davey a small snack to try to slow the BG drop. Repeat as needed. If Davey continues to drop and you need assistance, (any reading at or below 5.5mmol is a warning quick action is needed) post here with a 911 prefix to get assistance ASAP.

    Oh and please try to get pre-shot tests before ALL shots to ensure it is safe to give insulin at all!

    Happy New Year!
     
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  80. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    I echo the advice MrWorfMen's Mom just gave you. Please do not give 8 u.
     
    Last edited: Dec 31, 2016
  81. manxcat419

    manxcat419 Well-Known Member

    Joined:
    Jan 14, 2015
    OK, no direct experience with Caninsulin here though 8u is a big dose with ANY insulin, especially if you've got to 8u fairly quickly. Regardless of the fact that you're using Caninsulin (I'm much, much more familiar with Lantus as that's what I've used), I would drop back to the starting dose based on Davey's weight immediately - it's entirely possible, as others have already said, that he was overdosed from day 1 and the high numbers you're seeing are his body trying to protect itself from too much insulin. It may take a few days for Davey's numbers to settle - please don't be tempted to increase quickly again if you don't see better numbers immediately. In my experience, many vets do start out with too high a dose. When Rosa first started on Lantus, I was told to give her 2u twice a day and not to home-test. The dose was based on old starting dose calculations, which had been revised but the vet wasn't aware of that at the time. Thankfully, the wonderful people here showed me why this was too much for current guidelines based on Rosa's weight and talked me through learning to home-test as well. And, as luck would have it, when Rosa's dose did finally reach 2u through gradual increases, that was the exact dose that dropped her low for the first time and started her back down the dosing scale. I shudder to think of what could have happened if I'd just gone along with what I was advised by the vet!

    This...is disgraceful. Bearing in mind that we, as lay-people with no formal training, can get a blood sample without causing this sort of damage, I'm horrified that any vet or tech would test this way. I do sincerely hope this isn't common practice and isn't happening to anyone else here!
     
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  82. Mum of two felines

    Mum of two felines Member

    Joined:
    Dec 7, 2015
    I cringe at the thought of my little kitties getting that done. I am so mad over that whole episode. And do you know my old, **** vet drives by my house 6 times a day and not once have they called about my "diabetic" cats. It's been 11 months since they last saw them!!!
     
  83. Tuxedo Mom

    Tuxedo Mom Well-Known Member

    Joined:
    Dec 2, 2014
    DO NOT GIVE 8 units. Insulin is very unpredictable and does not work in a straight line. I am currently dealing with a hypo kitty so I can't stay on long. His PMPS test was 391 and 3.75 hours later he was at 23. This is on Levemir which is a gentler long acting insulin. I have got him to a workable level right now but it just shows how insulin can hit hard.

    Please listen to the others who have advised a low starting dose and slowly work up. Also home testing is IMPERATIVE!!
     
  84. Beth 73

    Beth 73 Well-Known Member

    Joined:
    Aug 2, 2016
    Please respond back as soon as you read these posts so everyone knows what is going on and can instruct from there. ASAP please :bighug:
     
  85. manxcat419

    manxcat419 Well-Known Member

    Joined:
    Jan 14, 2015
    That's awful. And really just goes to show that, although the majority of vets really do want to help our babies, there are some who just don't have the sort of caring and careful attitude we need. But you and your boys are doing awesomely well without them - and the credit for that goes to you for taking control of the situation and getting them well again.
     
  86. Mum of two felines

    Mum of two felines Member

    Joined:
    Dec 7, 2015
    With a bunch of help and support from you guys!!!!
     
  87. Chris & China

    Chris & China Well-Known Member

    Joined:
    May 10, 2013
    I hear you there....the vet that originally diagnosed China (and we never went back to because I'd spent the night reading here) has never once called to see why she didn't come back for more testing or to ask how she was doing on the new food (the dry W/D they'd convinced me she'd need to eat before I got online) or anything else. I had suspected for years that the only thing he cared about was his bank balance, but I know now that I was right in my original opinion
     
  88. Mum of two felines

    Mum of two felines Member

    Joined:
    Dec 7, 2015
    nits not like he doesn't know who lives here. We've lived on the same street for 18 years! And the population of our town is 3000.

    He drives by in his 2016 crew cab pickup! And of course his son drove a brand spanking new mustang throughout high school. I knew I was contributing, but geez. He did wonderful things for my dog, Kosmo, but was horrendous for my cats.
     
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  89. Davey's Mom

    Davey's Mom Member

    Joined:
    Dec 8, 2016
    Thank you and sorry I wasn't home to catch this yesterday but will start back at 1 unit today. Happy New Year to you as well!
     
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  90. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    That's a wise move. Have you tried urine ketone testing yet? :)

    Please post your BG numbers on your spreadsheet and if you can get some tests between AM and PM doses or through the evening that would be very useful. It shouldn't take many cycles (the 12 hours between doses) before we know whether the 1 u dose needs to be raised.
     
  91. Mum of two felines

    Mum of two felines Member

    Joined:
    Dec 7, 2015
    On your spreadsheet did you give 8 units this morning? It shows AMPS then an 8 in the units given column.
     
  92. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    [Emphasis mine]

    I have a different view. I would be very wary of dropping the dose back this far and this fast. (Been working on this behind the scenes.)

    I do agree that the dose of 8.0 IU is very high for a newly-diagnosed cat - but because dose started on the high side and got ramped up extremely quickly (and based on inadequate testing!) we don't have any reliable way at this time to determine how much insulin Davey actually needs. Dropping back to 1.0 IU with BG numbers as high as they currently are could increase risk of Davey producing ketones. (Very early days: minimal data; we don't know whether Davey might be ketone-prone; and we don't know whether or not he may have other undiagnosed issues which may either be elevating BG levels or causing poor response to insulin - although there has been some response to Caninsulin already.)

    Had the manufacturer dosing guidelines been followed for Davey then, even if the most aggressive dosing allowed for within those guidelines were used, the maximum dose he should be receiving right now is 6 IU BID Caninsulin. Had the guidelines been followed in a more judicious fashion (a better approach) the dose by now should be around 3-4 IU BID Caninsulin.

    It is vital that you do a urine ketone test today - before doing any reduction in insulin dose. If ketones are at all positive then vet must be contacted and appropriate treatment sought immediately. Insulin dose should NOT be reduced and vet should be briefed. High carb food could be left out at all times to improve safety and BG should be monitored closely.

    To determine whether insulin overdose is the actual issue here I would propose reducing the dose in stages and rigorously monitoring BOTH BG AND KETONES throughout the process. Dropping back to 6 IU BID might be a good place to start: within manufacturer guidelines; less risk of ketones developing; and somewhat safer than the 8 IU BID (if the 8 units is indeed too high). I would advocate against dropping the dose below 4 IU BID at this point: too many unknowns.

    NB - watch out for BG going unexpectedly very low during any dose reduction programme (especially in the early part of the cycle). PS tests need to be done prior to ALL doses of insulin. Mid-cycle testing from +1 - +4 hours post-dose (and later if possible) need to be done every day on at least 1 cycle for safety. (PM cycle if out of house during day.)

    For safety, dosing would need to be reviewed continually throughout any dose reduction programme. Adequate testing is critical for safety.

    Other members may have different views/suggestions.


    Mogs
    .
     
    Last edited: Jan 2, 2017
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  93. Davey's Mom

    Davey's Mom Member

    Joined:
    Dec 8, 2016
    Yes I have done ketone testing and it came up negative each time so far.
     
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  94. Davey's Mom

    Davey's Mom Member

    Joined:
    Dec 8, 2016
    I did give 8 this morning yes by the time I reviewed everything here his morning dose had already passed.
     
  95. manxcat419

    manxcat419 Well-Known Member

    Joined:
    Jan 14, 2015
    Can you do some mid-cycle testing on Davey today? While he might simply run high all day, it's also possible that he might drop fast to too low a number before bouncing back up.
     
  96. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    I agree with April. I'd suggest: PS test; feed; wait 20-30 minutes then give insulin; test at +1, +2 and +3 hours after the dose was given (and further tests if necessary/possible).

    Caninsulin hits quite hard and fast after the injection is given and may start BG dropping quite quickly - especially if the dose is too high. If the drop is too fast/steep then the cat's defences may then quickly kick in to push BG levels back up into high numbers again. This would be missed if testing were only done around the +4 - +6 period of the cycle. Getting the earlier tests in will help you build a better picture of what's going on.

    You can actually see an example of such an early dip in Davey's PM cycle on the first line of his spreadsheet (lower at +1).


    Mogs
    .
     
    Last edited: Jan 1, 2017
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  97. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    I recommend in the strongest terms that you do not make any changes whatsoever to Davey's diet for the time being: if the dose is too high then his current diet will be doing something to protect him from a potential adverse event. If you were to reduce the carb load in his food it could greatly increase his risk of having a hypo episode.

    Once the dosing side of things is sorted out then you'll be able to review Davey's food choices and manage any diet changes safely with your home testing.


    Mogs
    .
     
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  98. manxcat419

    manxcat419 Well-Known Member

    Joined:
    Jan 14, 2015
    I completely agree, Mogs. The first day Rosa was on insulin, I'd been told by the vet to give her 2u and remove all the dry food from her diet immediately! As luck would have it, I'd given her first dose and fought my way through trying to get wet food into her before I found the FDMB. :eek: Fortunately, the great people here were very quick off the mark to tell me that because the dose I'd been told to give was double what it should have been, and I had no way of testing until the following day, I had to give her the dry food back until I could make sure she was safe through a diet change.
     
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  99. Chris & China

    Chris & China Well-Known Member

    Joined:
    May 10, 2013
    I agree with Mogs here......dropping all the way back to 1U isn't a good idea because we don't have any data on Davey yet

    Usually when we get a high dose cat here, we suggest dropping back some, but not all the way back to the starting dose because it tends to just end up taking longer to get back to an effective dose and allows glucose toxicity to build up in the meantime

    If Davey were my cat, I'd drop back to 5-6 units and test as much as possible until we can actually see what's going on....if he's getting too much insulin, we'll know soon enough without risking his health by dropping back too much, too quickly

    You DO need to make sure you get tests in on the PM cycle too....Most cats go lower at night, so it's really important to get at least a "before bed" test at night to make sure he's safe while you're sleeping
     
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  100. Sootyca

    Sootyca Member

    Joined:
    Oct 3, 2016
    @emjb14 I bet your head is in a muddle with all the advice you are getting! I'm not going to add anything to the mix just wanted to say well done to you for trying everything you can.

    Sky's story is similar in many ways - started on a high dose and advised not to test. Her reaction to this was to go hypo very quickly. She did respond well to caninsulin but seemed to be too harsh for her - and it seemed to stay in her system longer than the 12 hours. I too wanted to trust my vet but with the best will in the world, they cannot be experts on everything they see. The combined knowledge of the people on here is amazing - I would never drop the vet advice but consider everything.
     
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