Using Caninsulin...need dosing advice

Hello,

Dinah (15) has been diabetic (off and on) for about 2 years. Here are the details:

Food: Friskies, low carb varieties
Insulin: Caninsulin (2 units)
Testing: Freestyle blood glucose meter
Other health issues: heart murmur

Some mornings we test, and her blood sugar is 4-5. Other mornings, she tests around 15. My questions are:

1. Should we continue to administer insulin on the 4-5 blood sugar days?
2. Should we reduce the insulin on the high blood sugar days?
3. If we do a blood glucose curve, should it be done on a day where she starts 4-5, or around 15?
4. My husband administered insulin today, and when I woke up and tested her, she was 4.8 (we don't test every day right now). I'm sure this isn't the first time it's happened, but I know it has happened now and I am worried about her going hypoglycemic while I am at work. Is there anything I can/should do right now?
5. Our last visit to the vet was a few months ago. Is it time to go back?

Thanks in advance!
Katie and Dinah

 

Welcome.
- Vetsulin/Caninisulin is usually not that good for cats since it does not last 12 hours. Usually only 8-10 hours.
- It is good that you are home testing. Most of us here record our reading and other info in a spreadsheet. See:
http://www.felinediabetes.com/FDMB/...te-a-ss-and-link-it-in-your-signature.130337/
- Dose is based on the lowest BG between shots which is typically 4-6 hours after shot for your insulin.
Giving a full dose with a preshot (PS) of 6 (USA 90) especially with your insulin could mean that Dinah is going too low.
You should do a cure with both high and low and I would not give 2 units with PS of 6.

 

Hi Katie!

Larry already answered your questions, but I'll clean it up for you a little bit...

1. I would not shoot that insulin into that number.
2. There are members here with vast experience that can help you with dosing. You'll need to start recording BG readings on our spreadsheet for them to see just what's going on.
3. Again, I wouldn't shoot that particular insulin into that number - so do the curve on a higher PS (PreShot reading) day.
4. If ever concerned of hypo and having to leave home, put out high carb (preferably canned) food to snack on.
5. It's recommended that FD kitties get a quarterly or tri-annual checkup, because of all the complications that can come from hyperglycemia.

 

Hi Larry and Andy,

Thank you so much for your advice! The spreadsheet is great - I've started one here. I'll do a full curve on the weekend - in the meantime, I'll aim for 4-6 hours after the shot and track in the spreadsheet.

I love the suggestion about high carb canned food - I've got some Friskies in gravy that Dinah loves. That is much better than force feeding honey!

Thanks again for your support. It can be discouraging getting these erratic readings and I really appreciate that there is a community willing to share their experiences.

Cheers,
Katie

 

Hi Katie and welcome.

I just took a peek at your spreadsheet and I notice that you've got a reading of 47 just 2 hours after Dinah's PM shot. I'm not sure if you are aware, but 47 is a little too low, especially that early in the cycle. I'm not sure how far you are after your shot time now but can you please check Dinah's number again - she may well need some high carb food to raise that number a bit.

 

Hi Dinah -
@manxcat419 grabbed my attention to keep an eye on you. I'll be checking in every so often ok? Did you happen to get a retest of that 47?

 

Thanks Andy - much appreciated.

 

Hi Katie and Dinah - waving at you from across the water on the North Shore. Please give Dinah some high carb food or food with honey/syrup on it and test her again in 1/2 hour. She's too low tonight and it's early in the cycle.

Here is our Caninsulin Guide for your reference. You should be reducing the dose when you get low preshot numbers like that 4.3 today, if you give insulin at all. Always test before giving insulin, even if it's only 1 unit.

 

Hi Wendy!

 

Hi Max, Wendy, and Andy,

Thanks for looking in on us I gave Dinah 1 Tbsp of high carb food after the 4.6 reading and went to bed (didn't get your message til this AM). I did not give insulin this morning and I am planning to test ~ 4 hours after feeding tonight. If it would be helpful, I could test earlier on my lunch break.

Wendy, thank you so much for the guide - this is great information. Do you have any local shopping tips for diabetic cat supplies? I currently use the Freestyle glucose meter and it's easy to use, but it was over 70$ for 100 strips at Shoppers - as a result, I don't test that often. Syringes are also running ~ 40$/100 at Shoppers. I visit the North Shore Walmart regularly to get Dinah's Friskies

Cheers,
Katie

 

Hi Katie

Just a suggestion. I am in Canada (Winnipeg) and buy my FS Lite strips at Shopper's. If you are 55 or someone you know is 55 every Thursday is seniors day and you can get 20% off on regular priced items, such as diabetes testing supplies. Sometimes they also have a gift card rebate on Thursdays seniors days...spend $50 or more get a $10 gift card (card expires but is usually good for 2 or 3 weeks). I will buy 3 boxes of strips separately...get the $10 card from the first purchase, use it on the second box of strips, get another $10 card, do the same again for the third box and still end up with a $10 card left over. THIS one I usually will buy myself some chocolate or other treats . Also if you have a Shopper's optimum card you can save up points and use them towards the purchase of supplies. Last year I saved $540 by using Shoppers Optimum points.

 

Please get a pre-shot test tonight, and then a +2 (if she's high enough to shoot!)

 

Try shopping at the Safeway pharmacy. Odd I know, but with being bought by Sobey's last year, their prices are the best I've found. A box of syringes is $34. Second best price is Real Canadian Superstore at $38. I've heard Costco is around the same. Lancets are also cheaper at Safeway. Should you ever get onto a better insulin for cats (Lantus or Levemir), Safeway has the best insulin prices I've seen. I find the Shoppers Drug Mart here charges about 10% more than anyone else so never shop there, though maybe the 55+ discount would make it worth it. Occasionally London Drugs will have sales on test strips, about $10 off a box.

I use the Arkray Glucocard 01 meter and strips or the Relion Confirm meter and strips. I cross border shop. The Relion I get at the Bellingham Walmart. I buy the Glucocard 01 meter and strips from ADW. The best price for strips there is now here and you get free shipping with that. ADW only ships to the US, so I have a postal box in Point Roberts or get it shipped to a friend in Bellingham if I happen to be going there anyway. The last shipment took 3 days to get there. Blaine is another option if it's easier for you to get to a postal box there. With the rising cost of the US dollar, it's cheaper, but less than it used to be. I usually wait until they have a 10% off sale. Another option is the Bravo meter and strips. It needs a little bit larger blood drop (Arkray and Relion are the same size as the Freestyle), but will ship to your door. I know of one other Canadian member who used the Bravo.

I feed my cats raw food so can't help you with the Friskies. I think my aunt feeds it to her feral colony and gets it at Safeway, but I've never price compared stores. I think they have sales too. I find that raw food is cheaper than good quality canned food.

 

Thanks for the shopping tips Tuxedo Mom and Wendy. That syringe price at Safeway is really good, and the 55+ discount + rebate at shoppers is amazing! I can probably get someone 55+ to do some shopping for me. I'll check out the other two meters and compare.

Andy, Dinah was 5.9 pre-shot tonight and I didn't shoot. What is the minimum BG level that you would inject at?

I'll do another pre-shot test in the AM.

Cheers,
Katie

 

5.9mmol = 106mg/dl so I'm glad you didn't! The no-shoot number for kitties on fast-acting insulin is 200, or 11.1mmol

If you're going to be up for a bit yet it would be good data collection to get another test later. I'm curious if her pancreas will sputter after a meal.

 

Hi Andy,
It's been ~ 3 hours since Dinah's dinner time (and earlier test). She is now at 7.4 (133).
Cheers,
Katie

 

We're back down a little to 7.1 this AM.

 

I wouldn't shoot.

 

This is all good news...she seems to be able to keep herself fairly flat without insulin. I'm wondering if the high readings you've recorded in the past have been in response to dipping too low.

 

Thanks Andy, I didn't shoot. What could cause her to dip low (and then go high) on the days that she has not been having insulin - too much time between meals?

 

That's good question. I don't see that particular pattern on the spreadsheet - yet. Is that a phenomenon that you've documented in the past? If you have previous readings and times for them in relation to the shot, please add them to the SS. You can add new lines above by right clicking on the "3" on the left of the screen and select "insert one above". If you mess something up on the SS you can always use the "undo" arrow at the top left. You can also rename it to whatever you'd like by clicking on the title and typing

A bounce (sustained high numbers - read more here(the first bit about NDW doesn't apply to your insulin)) can be caused by numbers going too low, dropping too fast, or numbers just going lower than the cat's body is used to.
It could be the high numbers are bounces as a result of shooting at the lower numbers, with the lower numbers being her normal.
The more data you get into the spreadsheet, the better we can figure out exactly what's going on with her BG's.

Have there been any diet changes?

 

Hi Andy,

Thanks for the link on the bounce. I haven't been particularly diligent about testing in the past (or logging the times I shoot) - I have updated the spreadsheet the best I can based on the log in my meter. In the past, if she'd test low, we'd stop shooting, do a couple tests, and then if stable, wouldn't test until the next weekend or so. If we noticed funny behavior (lots of pee, excessive meowing, change in appetite, etc.) then we'd test, and start shooting again if high.

We feed Dinah Friskies marriner's catch, salmon, and turkey and giblets. I just bought a bunch of turkey and giblets and am feeding her that exclusively until we figure out what is going on (to remove one confounding factor from these experiments). She's been on these varieties of Friskies for about 6 months.

Her pre-test readings are creeping up - 7.9 before dinner tonight.

Cheers,
Katie

 

That is a distinct possibility. What you are describing sounds like impaired fasting blood glucose levels. Saoirse had this problem. As long as I fed her every 2-3 hours her BG levels would be good. If she went more than 4-5 hours (IIRC) she would get what I thought initially were hunger-related stress spikes (in the early days of her insulin treatment when she was still mildly polyphagic and suffering from pancreatitis-related nausea issues, hence the long fasts; she wasn't able to eat some of her overnight timed feeds. As her treatment progressed and after the nausea issue was resolved, I discovered that her BG levels would still spike after a long fast but would recover well following a feed.

For information, Saoirse was diagnosed with liver abnormalities and I started giving her a SAM-e and milk thistle supplement. It seemed to resolve the fasting spike problem. Might be worth checking with your vet whether a product like Denamarin would benefit Dinah.


Mogs
.

 

Thanks Mogs. Were Saorise's liver abnormalities diagnosed in her blood work?

Before she was a diabetic, Dinah used to free feed on dry food. She now eats a lot right when we give her her wet food, and then grazes between meals, but after a certain point she won't eat it. I'm going to track the times I see her eating in my chart to see if there is a long period that she doesn't eat. If she's not having injections, maybe a small mid-day meal is in order.

We're at 7.3 this AM.

Cheers,
Katie

 

Wow, she's actually gone down since last night!

Go Dinah!! I think this is a good sign!

 

They were picked up on ultrasound. In terms of blood work, she had slightly elevated bile acids. I can't remember the vet mentioning anything else liver-related about her labs.

You could try giving her smaller, more frequent meals using a timed feeder.

.

 

It's been a week since my first post and Dinah hasn't had any insulin since the first day. Last night we were up to 10.3, but she was fed 2 hours late, and it's been going down since. May need to look into a timed feeder - I had no idea that timed feeders for wet food exist (thanks Mogs!).

 

Recent discussion of timed feeders

 

Ugh, today I gave Dinah a snack before we went out for dinner, and we fed her the rest of her meal when we got home. She had eaten her snack really quickly and then proceeded to scarf down her dinner, making herself sick. She tested at 14.9. We gave her 1 unit and will retest in morning.

 

Can you test her tonight? It's a little spooky shooting insulin in a kitty that's just barfed. Did she eat anything later?

 

Thanks for the heads up Andy, I'll check her again before bed and encourage her to eat in the meantime. If there is a barf and a high BG reading, is it best just to leave alone?

 

If it happens again, I think the best option would be to stall the shot and see if she'll eat again. A little bit at a time so as not to pukis again!

Does she seem ok otherwise? Often high numbers can be caused by pain/swelling/sickness. I'm not implying that there's anything wrong with her, just checking. More than likely her pancreas just wanted a vacation day

 

It sounds like it was a "scarf and barf"....it can be helpful to spread the food out on a flat plate instead of putting it in a bowl to slow them down when they eat.

If what came up looked pretty much like what was just eaten, that's usually what it is...just give their stomach a few minutes to settle down and then offer small amounts of food at a time until they've eaten their normal amount

 

Thanks Andy, next time I'll hold off until she eats. She's had some more food now.

Chris, you are absolutely right, it was a "scarf and barf" situation. Thank you for giving a name to it!

Water consumption might be up today. Otherwise she seems normal - usually when she has a bad day she gets very vocal. To be honest, it's a bit hard to tell with her - she is old and overweight, and really just lies around and waits for her next feeding. Will keep an eye out for anything else out of the ordinary.

I'm trying to figure out what happened so I can avoid it again. Unfortunately we didn't test BG this morning. Either her pancreas decided to take a vacation, or something about the snack/dinner situation (small portion an hour early, followed by dinner 2 hours late) caused an issue . Perhaps her snack being all gone caused some anxiety (usually there is food left on her plate after she eats). Dinner, barf, and high BG reading were ~ 3 hours after the snack.

 

We're still at 14.9 roughly 1:20 post-shot. Hopefully she'll be back on the decline in the AM.

 

Back down to 8.8 today. Looks like we've learned that Dinah's BG goes up when:
a) she's fed late
b) she's fed a small portion

One thing I've failed to mention is Dinah is a bit of a nut. She plucks her hair on her arms and belly (and has for about 7 years). When she wants food or she's in a bad mood, she will walk over to us and pull out hair. It's starting to look like the BG increase is another part of the food-related anxiety.

 

We're a little unstable lately. About every 2nd shot we're above 11.1, and the other we are a bit below. Think it's time for a vet appt; the spreadsheet is going to be super helpful. In the meantime, if we're just above 11.1, is it better to give 1 unit or 2 (full dose for prescription)?

 

Are you still using the Caninsulin?

If you are, I'm not really familiar with it, but generally, I think that a lot of people who use it use a "sliding scale" with it...so if the Pre-shot is X, they give Y

It will really help if you can also start getting some mid-cycle tests on the AM cycle and at least a "before bed" test at night so we can see how low the dose is taking her

You might want to "edit" your subject line and change it to something like "Using Caninsulin...need dosing advice" so hopefully the people who use it can help guide you

 

Hi Chris,
Thanks for the advice. I've changed the thread title and will check with vet re thresholds for the sliding scale. Will get some mid-shot readings next time we do an evening shot or on the weekend.
Cheers,
Katie

 

We monitored all day on Saturday and Sunday. On Saturday I gave 2 units and the BG went down as low as 1.9. BG was still fairly low 11 hours later, which explains why we were getting low readings in the PM on previous days. Sunday we did 1 unit and didn't go as low. It's looking like 1 unit is the magic number; will continue to administer 2xday and monitor unless advised otherwise.