Hello from The Dude

Hello, I am new to this forum and to treating feline diabetes. Our 14 yr old male, Dude, was diagnosed with diabetes about 6 weeks ago. We are having trouble finding the right dose for him as his readings at the vet's office are always in the 400 range, no matter what we try. Here is his history.

Diagnosed with initial BG reading in the mid 500's and mild UTI. Started antibiotics and switched to Royal Cannin diabetic dry food and numbers dropped 100 points to the mid 400's immediately. Since this was still too high we started him on 1 unit injections twice a day on Vetsilin. Spot testing at the vet showed no change. So we upped him to 2 units. Spot checking at the vet still showed no change. At this point Dude is getting sick, vomitting, diarrhea, etc. Vet checks him in to give IV fluid and do BG chart for 24 hours.

The vet tells us that charting Dude's BG at the office showed great results and his BG was in the 150's with NO medication (his fasting number in the morning was this low). They sent him home and told us to only give 1 unit once per day. Next time we spot check at the vet he is back in the 400s. Back to 1 unit twice a day. Another spot check, still at 400....Back to 2 units twice per day, another spot check, still in 400's.

At this point everyone is totally confused. The vet has monitored us giving the injection (they even shaved a few spots so we could see the skin easier), so I don't think we are doing the shot wrong. They have diagnosed him with pancreatitis and so he is back on another round of antibiotics.

I finally bought a human meter, a ReliOn and started home testing. The numbers I got ranged from 370 fasting to 185 at lowest numbers (roughly every 2 hours for 12 hours for 2 days). I tested him at home at 185 and 30 minutes later at the vet they tested him it at 429. I tested him at home about an hour later and got 379. The vet somewhat dismissed my testing and said the numbers wouldn't compare to the ones he got in the office. He was glad to see the trend and that he was reacting to the insulin, but that I shouldn't rely on the actual number value.

Is Dude just getting so stressed out that his numbers spike that high at the vet? Just carry on with the two units per day? I keep asking the vet if we shouldn't switch to canned food instead of Royal Cannin dry food, but he doesn't think that will help much.

Thanks

 

Hi and welcome to you and Dude. I have to disagree with your vet about the food change. A low carb canned food such as Friskies Pate or Fancy Feast Classic (no gravy!) can lower BG's significantly. I'm glad that you are home testing. Your vet is correct in that your human meter will read lower than his pet specific meter, but most of us here use the human meters due to cost. We are interested in if and how the insulin works, so exact numbers aren't as important. The most important thing is that you test before giving insulin to be sure he's not too low to get his shot. If you could set up a spreadsheet, it will help people here to advise you better. Here are the instructions
http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
If you need help, just ask and someone will help!

 

Thanks for the reply. I did attach the graph I made in Excel. The data is based on elapsed time since the shot was given. First test taken after eating but just prior to shot being given.

 

Welcome to you and Dude to FDMB.

It is well documented that cats usually experience some stress elevation of their BG levels at the vet's office and in some cats it can be very significant. Elevation can be 100 or more points. I'm surprised your vet is not acknowledging that fact. You can clearly see the vet stress elevation on your graph. If not for that stress elevation those two days of reading patterns would very likely be quite similar.

Likewise, while the pet meter your vet uses will read higher than your human meter, if you were to graph readings with both meters for a day, the pattern would still look similar. There is lots of information here with reference guidelines for using a human meter and as Sharon said, individual numbers are not that important unless you are dealing with readings that are too low making it dangerous to give insulin or warning of possible/existing hypoglycemia or in this case vet stress induced hyperglycemia. It's the pattern over time that gives you a good picture of how Dude is doing on any given dose of insulin and the most reliable pattern will be the one you get in Dude's normal comfortable environment.

Very few cats are ever regulated on once a day dosing due to their fast metabolism. The goal should be to find a dose that allows twice daily dosing that keeps Dude in optimal numbers for as much of the 12 hour cycles as possible. With Vetsulin, that may be more difficult than with some longer lasting insulins because Vetsulin often doesn't last the full 12 hours in cats due to their fast metabolism. This is evident on your graph where you can see that Dude has risen to his pre-shot levels and is leveling off again at about 7 hours post shot following a significant drop in BG at roughly 4 hours.

There are other insulin options available such as Lantus, Levemir, ProZinc and PZI that provide longer action and smoother cycles.

 

Thank you for that info. I should rephrase what I said about the vet. He dismissed the number, not the testing. He agrees that the trend is what is important, not the absolute value. He also agrees that Dude's numbers would go up during stress. It was just shocking to test Dude at 186 just 2 minutes before he knew we were going to the vet, to the 429 the vet measured a half hour later. Even if you account for 50 points off between my meter and the vets, that would be 190 points from stress.

Our vet did a fructosamine test yesterday, we should hear on that tomorrow. The next step will be changing insulin brands. The vet mentioned using a human insulin? I don't recall any name though.

If I did switch him over to wet food only, I assume I should test him closely to make everything is ok? If my meter is so different than the vet, than what range am I looking for?

 

I am using the same insulin and the curve you have posted is a typical shape for caninsulin/vetsulin, if you set up the spreadsheet on google drive as recommended it automatically colour codes which makes monitoring trends a lot easier, to start with if you are getting the lowest reading of the cycle in the blues/dark greens that is showing a good response to this particular insulin. What is important is not so much where he starts but where he drops to. You should always test pre food though as they can throw odd numbers at times but if you know how far and fast he typically drops it makes it easier to manage. Stress can raise the readings by that much - I now do home curves only as the readings at the vet were always a lot higher. You will need to test closely with a change of food as that is likely to drop his numbers and be prepared to reduce his dose if necessary, make the transition gradually. Run a curve once he is transitioned fully on to the wet food and before changing insulin. The numbers on my kitty's spreadsheet look high but her recent fructosamine test was fine. We are also looking at changing insulin but I am changing her food first as recommended by the specialist vet who saw her this week.

 

This is not unusual at all. A lot of people find their cat's BG skyrockets at the vets.

That narrows down the insulin choices to Lantus (also known as Glargine) and Levemir (aka Detemir). I'd guess that your vet is talking about Lantus, the most common human insulin used for cats. Lantus can seem very expensive in comparison with Vetsulin, so before you suffer from sticker shock, as so many before you have, you can order the insulin from Canada. Many folks order from Marks Marine Pharmacy HERE at considerably less cost.

Also you should purchase the Solostar pens which come in packages of 5 - 3ml vials rather than the 10ml vial. Our cats take much smaller doses of insulin than humans so by purchasing the 5 smaller vials you will be able to use up all the insulin. The 10ml vial on the other hand will result in considerable waste. When stored and handled properly, the one purchase of the package of 5 will last a year or more for the average cat.

You absolutely MUST be testing regularly before making any food changes. The change to an all wet food diet can significantly lower a cat's need for insulin. On your human meter, a reading of 50 is your alert that Dude is heading too low and you need to intervene with food to bring his numbers back up. If I were you, I'd be inclined to hold off making the change to an all wet diet until you start the human insulin. The sharp drops in BG with Vetsulin could become even more pronounced from the diet change making the monitoring required even more intense.

Since this is the introduction forum, I suggest you post any further questions over in the Health Forum. There are more folks viewing and helping over there and there are also folks more familiar with the Vetsulin which you are currently using. Once you switch to the human insulin, then you can join the folks in the Lantus/Levemir forum for the help of folks very experienced using those insulins.

 

Thank you again for all your responses. I will look into the spreadsheet now that it is the weekend and I have some time for it. I will let you know what the fructosamine test results are.

 

Bandit has gone up as much as 300 points at the vet before, so it is definitely possible that number was because of stress. This is why we adjust the insulin dose via home testing and not with numbers from the vet.

 

There are several things that can affect glucose levels. Pain from pancreatitis and infection can raise the BG levels.

Vetsulin is a short acting insulin and most cats do not respond well to it. Longer acting insulins are Lantus, Levemir, ProZinc and PZI. The first two are human insulins. If your vet prescribes either of these ask for a prescription for the pens instead of the vials. You will be able to use them much longer than the vial and in the long run, save money. The other two are pet insulins your vet can order. All of these last longer in the cats system and make it easier to maintain glucose levels.