? I need help dosing the insulin

Discussion in 'Caninsulin / Vetsulin and N / NPH' started by M-Kuqi, Feb 4, 2020.

  1. M-Kuqi

    M-Kuqi New Member

    Joined:
    Dec 13, 2019
    Hi everyone, first of all I would like to thank everyone who posts on this website, I've learned so much thanks to you all!

    I'm here because I have a diabetic cat with values mostly over 300 (usually over 500), I started giving him insulin 2 days ago. The initial dose I gave him was 2 units twice a day, but this doesn't seem to be enough. The first time I tested him was 2 hours after the initial shot and the value went from "High" (as the glucometer displays) to around 500. The shot after this didn't have any effect as the glucometer reading kept giving me "High". Today I upped the dose to 4 units and 2 hours after the shot his glucose fell to 450, which went back up to High after another 2 hours.
    The vet told me I should have started with 5 units twice a day but I was hesitant to start with such a high dose. Now though I think he might be right.

    What do you think I should do?
    Thanks in advance for any response :)
     
  2. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Please put your first post over in the Feline Health Welcome & Main forum, as these instructions advised you to do when you joined.
    New? How You Can Help Us Help You!

    This forum is very sparsely monitored, and not as many people around to help you.

    You didn't even tell us what insulin you are using for your cat.
    All the protocols for insulin that I am aware of say starting dose for insulin should be between 0.5 Units and 1.0 Units.

    You can cut and paste what you wrote here and "Post New Thread" in Main Health forum.

    Thank you.
     
  3. Sarah&Soph

    Sarah&Soph Member

    Joined:
    Jun 18, 2019
    Welcome! I’m assuming you are using Vetsulin or NPH, correct? 2 units is a fairly high starting dose, which means the 5 units your vet recommended is a whopping starting dose! Additionally, I would definitely not recommend increasing the dose from 2 units to 4 units. Cats are very small animals, so that is a huge increase for them. We recommend only increasing by 0.25 units at a time.

    What kind of meter are you using? It is highly recommended that you test before every injection if you are not already. With Vetsulin or NPH, it is also helpful to test at +2 (two hours after the injection) because that is typically when the insulin starts working and at +4 or +5, which is typically the “nadir” or when the insulin is the strongest (although this varies by cat). Knowing how low the dose is taking your cat will help show if he needs more or less insulin.

    High numbers do not always mean the dose is too low. There is something called “bouncing” which can be very common with harsher insulins
     
    Elizabeth and Bertie likes this.
  4. JanetNJ

    JanetNJ Well-Known Member

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    Jun 8, 2016
    What are you feeding your cat? If you set up a signature with basic info that would be helpful. Click on your name on the top right and choose signature. Add info such as your pets name, date diagnosed, insulin type and dose, food you're feeding and any other health concerns.
     
  5. M-Kuqi

    M-Kuqi New Member

    Joined:
    Dec 13, 2019
    Hi everyone, sorry for not giving enough info.
    I'm giving my cat Caninsulin and I'm using the Freestyle Optium Neo to test his glucose.
    He was diagnosed 2 months ago with both diabetes and kidney disease. Initially the vet only wanted to address kidney disease so I gave him food aimed at helping with that. He had 2.3 creatinine level at the time. The blood results from 1 week ago though showed that his creatinine had gone down to 1.2, so now the vet told me to give him the Caninsulin and phosphate binders to keep the kidney disease in control.
    He went from 6kg ( 13,2277 lbs ) to 3.5kg ( around 7,7 lbs ) in a period of 6 months.

    To recap what I did:
    Day 1: 2U twice a day. I tested both times at pre-shot, 2 hours after shot and 4 hours after. In the first test 2 hours after the first shot his glucose level went to 499mg/dl , the rest of the day the glucose level remained high (500-600 mg/dl ).
    Day 2: I thought I was giving him too much so I reduced the dose to 1U but every glucose test gave readings of "High".

    Day 3: In the morning I upped the dose to 3U, but it didn't have any effect on the glucose level. Later that day I went to the vet who told me to give him 5U, and probably even more than that later because otherwise it would be ineffective.
    Later that day I upped the dose to 4U, the reading after 2 hours gave a result of 450mg/dl and 4 hours later it went up to "High" again.

    I'm giving him Royal Canin Diabetic https://www.royalcanin.com/uk/cats/products/vet-products/diabetic and sometimes boiled chicken.
     
  6. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Increasing the dose will not lower the blood glucose numbers down any quicker.
    Doubling the dose from 2U to 4U will cause the BG levels to drop so low your cat may have a hypoglycemic episode and need an emergency visit to the 24 hour vet hospital/clinic/office for emergency care.

    Feline diabetes should have been addressed concurrently with the kidney disease. At the same time would have been so much better.

    The high dose that your vet is suggesting could kill your cat. Please, please do not give your cat that much insulin.

    It took time for your cat to become diabetic also. It takes time to get the blood glucose regulated.
    This is a marathon, not a sprint. You can not "hammer down" the blood glucose with more and more insulin. It will take time to get your cat Kuqi's blood glucose measurements regulated and then back to normal.

    Context is very important with blood glucose readings. We express time in a + hour format.
    AMPS is your am or morning pre-shot test. +1 is 1 hour after the dose of insulin. +2 is 2 hours after that , etc.
    PMPS is your pm or evening pre-shot test. +1 is 1 hour after the dose of insulin. +2 is 2 hours after that , etc.

    Caninsulin should be given 2 times in each 24 hour period. Every 12 hours. But , please, please not in the high doses you are giving your cat. That is risking Kuqi's life. I'm pleading with you not to give your cat such a high dose.

    You don't know me. You may not think you can trust me. I'm tagging a couple of our UK members to help you. You may ask them anything you want about me and my experience with diabetic cats and using insulin.
    @Elizabeth and Bertie @Georgiana & Perlutz
    It's late evening in the UK. Around 12:30 Thursday morning for you. They may not read this post or respond until tomorrow or even a couple of days.

    Has your vet treated other cats with Feline Diabetes?
     
    Last edited: Feb 12, 2020 at 9:20 PM
    Elizabeth and Bertie likes this.
  7. JanetNJ

    JanetNJ Well-Known Member

    Joined:
    Jun 8, 2016
    Omg that dosing is unsafe. Most cats never need more than 3 units, and it should be raised gradually.

    OK first off the royal diabetic dry food is 25% carb and totally not appropriate diet. Crazy since it's marketed as HELPING with diabetics. Ideally you want to feed a low carb wet food. Since your cat is early ckd(so it's mine) you will want to look for less than 10% carb and under 200 (under 1%) phosphorus. I personally feed my diabetic ckd cat Weruva. There is a link to the food chart in my signature. There is a link somewhere to a UK list as well


    If it were my cat I would change the diet. I would go back to one unit. Hold the dose for at least a week, maybe two weeks in the beginning esp if you change to more appropriate food. Start a spreadsheet so we can advise. If there's not enough of a change raise the dose by no more than half a unit at a time and hold for several days before the next slight increase.

    Sometimes too much insulin can look like not enough and you are putting the cat at risk without even realizing it.
     
  8. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    This person is in the UK I believe. Dr. Lisa Pierson's food chart is for foods available here in the US and Canada mostly.

    This is a link to a food chart that some of our UK members have put together. Some of these foods are available in your local stores. Some have to be ordered on-line.
    Is your cat ok?
     
  9. Deb & Wink

    Deb & Wink Well-Known Member

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  10. M-Kuqi

    M-Kuqi New Member

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    Dec 13, 2019
    Hi everyone!
    First of all thanks for all your comments :)
    I need to explain a few things to you now xD
    When I bought the syringes, in my total ignorance, I believed I had bought the type U-50 ones. I was calculating thinking I needed 1U insulin * 1.25 on the syringe. Today though I realized I had the U-100 type syringes..
    So the doses I wrote earlier are all wrong. What I believed was 5U was actually 2U. Hence the maximum dose I gave to my cat is 2U. My cat has been fine all this time thankfully, the only symptom he shows is the neuropathy on the hind legs.
    Sorry for confusing you all.

    Now that I read more posts on the blog I realized the mistakes I have made. But now I want to do it right.
    I've removed the royal diabetic dry food and I'm trying to find some good alternatives right now. In the meantime I fed him some boiled chicken.
    Later today I'm going to give him only 1U (2.5 on U-100 syringe, if I'm not wrong).
    I live in Italy by the way :)
     
  11. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    Hello member from Italy. You have not shared your first name with us, good sir. Would you be willing to do that?

    Changing the food to lower carb only can drop the BG (blood glucose) levels 100m/dL basis points or more. (5.5 mmol/L basis points). Please be very careful with the insulin dose and home test those blood glucose levels. Frequently.

    What line on the U100 syringe does the dose go up to? Would you take a picture and share it with us please?
    Caninsulin is a U40 concentration and is best dosed using U-40 syringes. There are both U40 and U100 syringes available in Europe that have 1/2 unit markings on the barrel (clear part) of the insulin syringe.

    We have another new member from the Canary Islands, Spain. There is some discussion and recommendations in there about insulin syringes available in Europe and where to buy them. You might want to read that thread. Here is is:
    New Member 2/1/2020 Help me help Sabrina

    p.s. Italian your primary language? ESL or non-English speaker/writer? Using google translate to understand what we are replying to you?
     
    Last edited: Feb 7, 2020
  12. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    That "thread"/post/discussion I linked you to also has some information on food and where to order it.

    In the meantime, see if any of the foods listed on this European/UK food list are available in Italy where you live.
    That list was created by several of our United Kingdom members and is the best I know of for foods in the UK and Europe.
     
  13. Sarah&Soph

    Sarah&Soph Member

    Joined:
    Jun 18, 2019
    Whew! That certainly sounds a lot better! 1u is a much safer starting dose. I think it would be good to stick with that dose for a few days and get some tests when you can so we can get an idea of how Kuqi is reacting to the insulin. I definitely recommend always getting a preshot test, and then at least one more test between 3-5 hours after you give the injection to see how low the insulin is taking him. But the more tests you can get, the better, especially if you change his food. Starting a spreadsheet to log your test data will be extremely helpful as well. Here is the link on how to do that. If you need help, please let us know :cat:

    http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
     
  14. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    Here is another option for you with the food transition. And the why behind my reasoning for suggesting this.
    • You have not been treating your cat Kuqi for 2 months while he was diabetic. (per advice from your vet)
    • An option for you would be to stop giving the insulin entirely for now. Switch to a low carb canned or wet food available in Italy where you live.
    • Test every day, in the AM and the PM and a couple of times during the 12 hour cycle.
    • Then start up the insulin again.
    • If your cat loves the canned food, great. If not, then you'll have to monitor the BG levels carefully during the food transition while your cat is on insulin. (My cat took 6 weeks to decide he liked canned food.)
    • There are risks, there are always risks.
    • Mainly the risks are your cat Kuqi will not eat enough food, may have an infection/inflammation, may develop ketones from burning off fat to produce energy. Ketones can lead to DKA (diabetic ketoacidosis.)
    • Get ketone test strips to test Kuqi's urine. Daily if possible.
    Let us know how else we may help you. For us, we need that SS (spreadsheet) setup to see how Kuqi is doing.

    How to instructions for the spreadsheet setup are here. FDMB Spreadsheet Instructions
    What it all means is here. Understanding the Spreadsheet/Grid
    In Italy you use mg/dL to measure blood glucose, so using the US version of the spreadsheet would be the appropriate one.
     
  15. M-Kuqi

    M-Kuqi New Member

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    Dec 13, 2019
    My name is Mattia :D Yes italian is my primary language. No I don't use google translate. I understand everything that's said here but I don't know if my writing is that good, sorry if I make any mistakes.
     
  16. M-Kuqi

    M-Kuqi New Member

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    Dec 13, 2019
    Hi there :) I gave him 1U 5 hours ago. The morning pre-shot, the +2 and the +4 tests all gave the same reading, "High", so all of them 500+ mg/dl. Sould I keep the dose 1U for the evening shot?
     
  17. M-Kuqi

    M-Kuqi New Member

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    Dec 13, 2019
    As I said in my reply above, I gave him 1U this morning but it didn't have any effect. I fed him boiled chicken and a tiny bit of this https://www.prolife-pet.it/en/catalog/veterinary-formula/gatto-vet/diab/diabetic-cat-wet. What do you think I should do now?
    For the ketone strips, I will buy them one of these days and update you with the results.
     
  18. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    Hi Mattia!

    Thank you for letting me know that Italian is your primary language, but you do understand English. You are someone that we think of as an ESL (English as a Second Language) member. I will try to write more clearly and not use too many abbreviations or "slang" or idioms. Your written English is clear and understandable to me.

    Would you please test again today at +6?
    AMPS is the morning or AM pre-shot test. This is the first test before you give insulin for the cycle.
    2/7/2020
    AMPS HI 1 unit Caninsulin
    +2 HI
    +4 HI

    Insulin does not have an immediate effect. It can take weeks to find the right dose and get your cat regulated. Insulin is a hormone, and it takes time to adjust the dose. It's not like taking an aspirin and having a painful headache go away.

    If you would set up our standardized spreadsheet, we could follow your tests and insulin doses better. The spreadsheet is a simple way to record the blood glucose tests you take, what insulin dose you are giving your cat, lets us see any notes in the Remarks column on issues of note, such as your cat vomiting, or how much he ate for a day.

    Having that spreadsheet is a good way to have us help you better. Directions again on how to set it up.
    http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

    Be right back with more information. I want to see if that food you mentioned is a low carbohydrate food, <10% carbohydrates and is good for a diabetic cat. Be patient please. It takes time to write my responses.
     
  19. Sarah&Soph

    Sarah&Soph Member

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    Jun 18, 2019
    Excellent on getting those tests in! Also, your English is perfect :cat:

    Would you be able to set up the spreadsheet and enter the numbers? People do not really like to give dosing advice here without having the data in the spreadsheet for safety reasons. Also, has your cat ever had ketones? Those high numbers are ugly but I’m not sure if I would increase just yet, based off only one cycle of tests. Another consideration is when you plan to do the food switch, since that could also cause numbers to come down. I usually do not like to give dosing advice, but unfortunately the experienced Caninsulin user on the board is taking some time away after the passing of her kitty.

    @Elizabeth and Bertie

    also has Caninsulin experience but she is not around quite as often
     
  20. M-Kuqi

    M-Kuqi New Member

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    Dec 13, 2019
    Hi :) I'm setting up the spreadsheet right now. Here's the link: https://docs.google.com/spreadsheets/d/e/2PACX-1vRpKJ9BMeUKAxp_HmKWbrPwBznXd-w1dN60tG-lNLLbscXTaV1W0L4Dxv82oLR-3aXsNT3M9QTVD-_F/pubhtm. I just tested his +6 right now and it's HI again.
    The food I mentioned says it has no carbohydrates in it, but he's not eating much of it anyways.
     
  21. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    Ok Mattia, I looked on the website you linked me to for that wet cat food you are feeding. Thank you by the way for linking me to the English version. (have been learning a bit of Spanish the last month or so and some Italian words are similar).

    Is your cat overweight? Under weight? at the correct weight? I'm asking because this food is for a cat to lose weight. Many diabetic cats have already lost a lot of weight before they were diagnosed. If that is the case, and your cat needs to regain weight, you may need to find another food for your cat.

    The ingredients or Composizione looks good. Chicken and Beef with some vitamins and minerals.
    Pollo fresco 47%, Manzo fresco 21%, Sostanze minerali, Carbonato di calcio, Cicoria (fonte di FOS 0,02%), Mannano-oligosaccaridi 0,1%.

    Next item I looked at was the analysis (also called the min/max values or GA or Guaranteed Analysis) or in Italian Componenti Analitici.

    Proteina 6,5%, Tenore in materia grassa 2,2%, Materia inorganica 2%, Fibra grezza 2,5%, Umidità 80%, Calcio 0,27%, Fosforo 0,18%, Magnesio 0,03%, Potassio 0,19%, Sodio 0,10%.

    I used a basic, simple carbohydrate calculator to find the percentages of the ingredients. These types of carbohydrate calculators account for the water being removed to find the percentage of carbohydrates. The carbohydrates are around 8-9% in the Diabetic Prolife Veterinary Formula wet food. That is appropriate for a diabetic cat.

    I used these 2 simple carbohydrate calculators to find the carbohydrate percentages in that food.
    http://fnae.org/carbcalorie.html
    http://www.scheyderweb.com/cats/catfood.html
     
  22. M-Kuqi

    M-Kuqi New Member

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    Dec 13, 2019
    Thank you
    About the spreadsheet, I'm doing it now :D
     
  23. M-Kuqi

    M-Kuqi New Member

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    Dec 13, 2019
    Thanks so much for dedicating me your time like this, I really appreciate it :) Also thanks for the carbohydrates calculators, they'll come in handy!
    My cat is underweight right now. He was around 13 lbs last year and now he's about 7,7 lbs. Is it fine if I feed him this kind of food to him while I find some better alternatives for making him gain weight?
     
  24. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    Thank you very much for creating the spreadsheet. It will really help us to help you better. There is a way to link the spreadsheet into your signature. That way you do not have to put the link in every thread or post you create. It will be there in your signature in read-only access for those of us helping you.

    Please put any test results you have from previous days in the spreadsheet. Even if you do not think they were accurate.
    If you have any blood glucose (BG) test results from your vet visits, put those in the spreadsheet also.

    Saw your note in the spreadsheet (SS) that your cat Kuqi has neuropathy. It is possible to improve and even reverse the neuropathy with better control of the feline diabetes. First, we need to get Kuqi regulated.

    Are you working closely with your vet? Has your vet ever treated a diabetic cat before?
     
  25. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    Yes, that food is fine for Kuqi now.

    It's very important that Kuqi eats. Especially with the HI BG readings.

    What does he like to eat? Will he eat his old cat food?
     
  26. M-Kuqi

    M-Kuqi New Member

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    Dec 13, 2019
    I've put 2 test results that were noteworthy since they were the only 2 that showed glucose levels below 500, I put them in the remarks column.
    I am not really working closely with my vet right now. I'm not even sure if I should, since he told me to start with 5 units (and, as I understood from here, that's too high) instead of 1 so I don't think he has a lot of experience with diabetic cats.
     
  27. M-Kuqi

    M-Kuqi New Member

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    Dec 13, 2019
    He has no problem eating right now. He eats most of the food I give him. With wet food though, except for the ProLife Diabetic food I mentioned above, he basically just licks it without actually eating.
     
  28. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    I don't know if any of these foods are available in Italy. All the foods on this chart are ok for a diabetic cat. Since Kuqi also has kidney disease and is on phosphate binders, look for foods that have low phosphorus content also. Where that phosphorus content was known, the phosphorus content is listed in the blue shaded column.

    European and UK cat foods. Look for foods as low in phosphorus as you can find.
    What stage kidney disease does Kuqi have? I.R.I.S stage 1, early stage 2, stage 3?
    Phosphorus less than 1% is ok, but phosphorus less than 0.6% is better.

    The most important single concern you should have with the food, is to find something that Kuqi will eat.

    p.s. I'm retired, so my time is my own to decide what I want to do each day.Right now, it's cold on northeast coast of US, snow on the ground, icy and rainy today with temperatures barely above freezing. Too cold to be out in my gardens for a few more months. Of course, I have to take care of my own cats and feed and entertain them with cat toys.
     
  29. Deb & Wink

    Deb & Wink Well-Known Member

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    What time is Kuqi due for the PM (evening) testing and dosing cycle?
     
  30. M-Kuqi

    M-Kuqi New Member

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    Dec 13, 2019
    His creatinine level was 1.23 last time we tested his blood. I'm going to give him 1U insulin in about 10 minutes :)
     
  31. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    I think you would be ok to give 1.5 Units of Caninsulin.
     
  32. Deb & Wink

    Deb & Wink Well-Known Member

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    There is a CKD resource that people here in the US use. It's all in English. It can be very complicated to understand, even for a native English speaker. Tanya's CRF website. These quotes are from her website section where she directly discusses CKD and diabetes in a cat at the same time.
    • It is not uncommon for a CKD cat to also have or develop diabetes.
    • The dietary needs of a diabetic cat may seem incompatible with the needs of a CKD cat but the diabetes must take precedence.
    Tanya was the name of one of her cats. Helen is a dedicated layperson who had 3 cats with kidney disease and developed this website to help other people that have cats with kidney disease. Thought it might be of some interest to you. Here is a link to the Home page of Tanya's Comprehensive Guide to Feline Chronic Kidney Disease.
     
  33. Sarah&Soph

    Sarah&Soph Member

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    Jun 18, 2019
    @Marje and Gracie

    I believe your experience is with NPH, but would you be able to give dosing advice on caninsulin?
     
  34. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    Mattia, would you please add your first name in your signature. Also the age of you cat and the name of the blood glucose meter you use for testing. Yes, I know the meter you use is on your spreadsheet, but we like to see it in both places.

    Kuqi needs to eat more food right now. To help him regain some of the weight he has lost. Diabetic cats may need twice as much food as normal.

    Feeding many small meals a day will help. Most of the food should be eaten in the early part of the 12 hour insulin dosing cycle. In the first 4-5 hours.

    With Caninsulin, the onset of the insulin, or when it starts to work can be very rapid.
    Because of that quick onset, it's important for Kuqi to eat at least 30 minutes before you give him the insulin.

    Duration in cats with Caninsulin can be short. Sometimes only 8-10 hours. We can suggest different insulins that work better in cats.

    Was a SDMA test done for the kidney disease diagnosis? Or any type of imaging such as ultrasound to look at the kidneys. Were any other tests done by your vet? Were the kidneys palpated by your vet to check for differences in the size of the 2 kidneys?
     
  35. Marje and Gracie

    Marje and Gracie Senior Member Moderator

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    May 30, 2010
    Sarah....I wish I could but I’m out of town on an urgent family issue and have not been able to spend time here working with anyone. I don’t get home until the 16th and am then gone to Europe until mid March so I’m not the best person to tag right now. So very sorry.

    Wendy used Caninsulin for a few days.
     
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  36. Deb & Wink

    Deb & Wink Well-Known Member

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    Mattia, Please remove the country from your signature. I mistakenly had you add it and it should not be there. Thanks. Sorry for the bit of extra work.
     
  37. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    Sep 6, 2010
    Hi Mattia, just did a few calculations using the data for this food ('a few' because I wanted to double check, and then double check again, haha!) and this food actually calculates as high carb according to the data for the product... While it is around 6.9% of carbs by weight (as wet food), on a percentage of calories basis it is over 35%, and we aim to feed diabetic kitties foods that have less than 10% of calories from carbs...

    A couple of things to explain, since I may have confused you (I actually confused myself at first)... :confused:
    The calculators that Deb has linked to above are very useful tools, but they don't go as far as calculating the actual 'percentage of calories' from carbs, and that is how we usually compare foods...
    To get the percentage of calories using these calculators you do the following, using the data from the calculation that you've just done: Divide the number of calories from carbs per 100g by the total calories per 100g, and then multiply by 100. That will give you the percentage of calories from carbs. :)

    Another possibility to consider is that the data given for the food may actually be wrong... There are no significant carb sources listed in the product ingredients, but the data for the product calculates as high carb. ...Either there are some ingredients not listed on the product, or...the data for the product may be wrong (this does happen sometimes...). ...The food is pretty low fat according to the data on the product, and it is 'possible' that the fat content is higher than that but is just listed wrongly on the label...

    Sorry if this is an unhelpful post. I feel I've raised questions rather than actually answering any... :nailbiting:

    Eliz
     
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  38. M-Kuqi

    M-Kuqi New Member

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    Dec 13, 2019
    Hi again everyone :)
    One thing I forgot to mention is that my cat has high amylase values. If you think it would be helpful I could also post a picture of his last blood test.
    In a few minutes I have to give him insulin. I will go for 1.5U this time since 1U doesn't have any effect on +2,+4 and +6. I'm tempted to give 2U instead but I'll follow your advice on not increasing the doses too much too soon.
    I still haven't found any food to replace the one I'm already giving him. Would it be a good idea to keep feeding chicken?
     
  39. M-Kuqi

    M-Kuqi New Member

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    Dec 13, 2019
    The vet hasn't tested the kidneys size.
    Which insulin do you think would be best to give him?
     
  40. M-Kuqi

    M-Kuqi New Member

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    Dec 13, 2019
    Thank you for calculating that :) I'll change his food as soon as I find something good for him.
    This is not an unhelpful post! You're all helping me so much!
     
  41. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    There is a tab on the spreadsheet where you can enter any lab test results. First, you have to add a column for the reference ranges used by the lab that does the testing. Those values are usually on the copies of the test results you have.

    Then, you add a column for the test results for which you have information. You will not have lab values for all the tests listed on that "LABS" tab. Only concern yourself with entering the values you do have.


    p.s Weekends are our busier days. Takes time to get back and reply to everyone.
     
  42. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    The one that works best for him. I'm not trying to be facetious or flippant or joking with you. But some cats do better on one insulin than another. Sometimes, it's a bit of a "trial and error" process to find the correct insulin for an individual cat.

    The right or correct insulin also depends on what insulins are available in Italy and what a vet will prescribe for your Kuqi. Do you have Prozinc or Lantus or Levimir available where you live? Which insulins are available?

    Cost and availability are only 2 factors to consider in choosing an insulin for your cat. It's best to discuss this with a vet knowledgeable about the different insulins used for cats.

    Right now, it's important that Kuqi eats and that he eats enough to gain some of his weight back. You can look for other food options later. You don't need to complete everything in a few days.

    It took time for Kuqi to become diabetic. It will take time to get him better.

    p.s. I know a fair amount about feline diabetes, but I'm still a layperson. A continuing ongoing discussion with your vet is important.
     
  43. M-Kuqi

    M-Kuqi New Member

    Joined:
    Dec 13, 2019
    I just inserted the lab values on the spreadsheet :)
    This morning, since I wasn't seeing any result from 1U and 1.5U, I gave him 2U.
    I tested him on +2 and his value was 500, later I tested on +7 and the glucose level was 290! That's the lowest vaule so far.
    What do you think, should I keep giving him 2U or should I go back to 1.5U?

    About the food, I'm giving him boiled chicken and fish right now. I also ordered Smilla Poultry on Zooplus.com, I found it on the UK Cat Food List link that you gave me. :)
     
  44. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Thank you for putting the lab results into the SS Labs tab. Do you have the name of the lab? That laboratoy name would go above the reference ranges you entered. Also, put a date for the lab results, above the values from this most recent test.

    Boiled chicken and fish are good as a short term solution for feeding your cat. On their own, they do not have enough vitamins or minerals to keep a cat healthy. They are fine for a week or two though. Simply not as a long term solution to feeding your cat a proper nutritional diet. There are recipes for raw diets too if you are interested. But I think with the kidney issues that Kuqi has, that is not a good option.

    For now, it looks like the 2 U of caninsulin is better for Kuqi. But you need to complete a pre-shot blood glucose test before each 12 hour cycle. Then you decide if the number is high enough for insulin or not.
    We suggest that newer people have a 'shoot/no shoot' threshold of 200 mg/dL when using Caninsulin.

    With Caninsulin, it's going to be those mid-cycle numbers, in the +4 to +8 hour ranges that are going to help determine how effective this dose is doing.

    Have you read and printed out the Beginner's Guide to Caninsulin (Vetsulin)
    It's a basic reference guide to using Caninsulin. It was put together by a number of members here, including many UK and USA members. It's a good document to have in hardcopy (printed out on paper) to read again and again.


    Would you please update your signature? I'd like to see the complete brand name of the meter in your signature. FreeStyle Optium Neo is what your spreadsheet (SS) says. Nice to see it in the signature also.

    Does Kuqi receive any other medications besides the phosphorus binders to help his failing kidneys? Such as subq (subcutaneous) fluid therapy at home? My cat with advanced kidney disease needed subq fluids for several years.

    It can be challenging to find an appropriate diet for a cat with advanced kidney disease like Kuqi has.

    p.s. You are able to change your user name if you would like to. Many people here use their first name and their cat's name as their user name. Ok to keep using aaaaaaaa as your user name if you prefer.
     
    Elizabeth and Bertie likes this.
  45. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Hi @Larry and Kitties
    Saw you commented on a post. Don't know too many people that can give some feedback on lab work.
    This person is in Italy. He put in the reference ranges but did not have the laboratory name.

    Would you take a look at the labs when you have a chance? It would be much appreciated.
    Mattia already knows his cat Kuqi has kidney disease and diabetes. Cat is getting a couple of phosphorus binders, (Renal P and Renal N).
     
  46. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Looks like Kuqi could use more insulin.
     
  47. M-Kuqi

    M-Kuqi New Member

    Joined:
    Dec 13, 2019
    Hi!
    Ok I've made the changes to the signature and username :)
    By the way yes I did read that beguinner's guide! Very helpful.
    No my cat isn't taking any other medication right now. I gave him subq fluids 2-3 times 2 months ago as the vet told me he looked dehydrated, but now he doesn't need it.

    How much do you think would be a safe dose increase? 0.5U or more?

    I bought him this food right here Animonda Integra Diabetes. It looks good to me, it says it's free of carbohydrates. What do you think?
     
  48. M-Kuqi

    M-Kuqi New Member

    Joined:
    Dec 13, 2019
    Hi, I just gave him 2.5U today and the +4 test gave me a High reading. Is the glucose bouncing or is there some other reason to this?
     
  49. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Hi Mattia,
    • Are you sure you are getting the insulin under the skin and not getting some or all of the insulin in the fur?
    • Where do you inject the insulin? What part of your cat Kuqi's body?
    • When you measure the insulin, are you being sure to get all the air bubbles out of the insulin syringe?
    • Do you use the tip, the trick to point the insulin syringe, needle up to the ceiling, give the barrel a quick flick with the fingers of your opposite hand to get any air bubbles to the top.
    • Then you slowly twist the plunger to "squeeze " out the air bubbles.
    • Small doses of insulin can be difficult to measure accurately.
    • You may need to draw a tiny bit extra insulin into the syringe, and then tap and twist the plunger to move the air bubbles out of the syringe.
    • Could you test more today?
    1. You need to test before every dose of insulin. Pre-shot test in the morning. Pre-shot test in the evening.
    2. +4 may not be the lowest point of action of the insulin.
    3. The nadir is how low this particular dose of insulin takes your cat during this particular 12 hour cycle.
    4. The nadir can vary in time.
    5. You need to test to find that nadir.
    6. Test at +5, +6, +7, and +8 (unless the BG levels have spiked back up to HI)
    7. You need to test at night. Otherwise, you are missing half your data.
    8. More tests at night than only the pre-shot (PS) test before you give Kuqi insulin
    9. You need to get at least 2 additional tests at night.
    10. The +2 test at night isn't giving you any useful information right now. I'd stop doing that test for now.
    11. I think a test at +4 or +5 and then a second test at +6 or +7 would be more useful.

    Could you please let me know if some or all of what I have said is possible for you to do?

    We know that people have work, social, life responsibilities. What I am trying to learn is if your life and schedule allow you to do some or all of this additional testing. It can be difficult, and we realize that. Let me know what is possible for you to do.
     

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