Need Some General Questions Answered Before We Start Insulin

Hey everyone.

So as some of you know, Little B will be starting insulin some time in the next few days and there are some general questions about insulin, food and his routine that I'd like answered if possible before we see the vet. I've been told it'll likely be Caninsulin he'll be started on, although I am aware of the better options like Prozinc and will certainly discuss this with the vet. However, I am hoping that a local charity will help cover the cost so there may not be much wiggle room in which one we use. I have read a lot of the information on this forum (like not shooting if he's 11 mmol or below), I have printed off the info about hypoglycemia and I have put together a little kit consisting of some high carb food and some glucose solution. However if anyone can give me answers to the following, I would be very grateful. I want to be able to show my vet that I have enough knowledge to take care of him at home, rather than him staying there:

1. Can anyone give me a general idea of what dosage of caninsulin cats without any other complications or ketones are usually started on?

2. Our cats current feeding schedule is as follows: First bit of breakfast between 5.30 am and 5.45 am (when we let them out), if I'm not at work then they usually have the rest of their breakfast between 8.15 am and 8.30 am, then they have a small meal sometime between 12 pm and 1 pm, then their evening meal is spread out between 4 pm and 8.30 pm and then finally another small amount of food around 11 pm before I go to bed. Will this still be okay for Little B or will I need to adjust it?

3. I know that it's usually 'Test, Feed, Shoot' and this is usually done 2 hours after any food he had last, is this correct?

4. Do I need to test him before his first bit of food at 5.30 am or can I wait to test him when I get up again just after 8 am (this will have been over 2 hours since he last ate), give him the rest of his breakfast and then give him his insulin 30 minutes after that?

5. Similiarly can I do the same with his evening shot (let him have his first bit of food, test 2 hours later, rest of food, then shoot)?

6. How long after he's had his shot is he allowed to eat again?

7. Will he be safe to be left alone overnight? If I give him his usual bit of food at 11 pm before bed, can I then leave him be until the morning?

8. I have to leave early for work on a Monday which means that I won't be able to test or give him any insulin until the evening. Will this be okay?

9. Currently I'm having real trouble home testing but assuming that eventually I get a handle on it, when should I do a blood curve and how often should they be done? I am on a low budget so I would have to be careful how quickly I got through test strips.

10. Finally, how soon after his shots is it safe to leave him? So at night, how soon afterwards could I safely go to bed? In the day time, how long after his shot could I go out if I needed to? Would it be okay if I went out for a few hours in the afternoon?

Sorry, I do realise that's a lot of questions! I just think it's important to know these things before we get the insulin so that then I can just concentrate on establishing our routine.

 

A good starting dose is usually 1 unit every 12 hours.

You can feed as many meals a day as you like BUT it's important to withhold all food in the two hours prior to doing the pre shot BG test. You want to know that the BG is high enough on its own to support the planned dose. Food would cloud that picture because it can raise BG.

Yes, that's correct (as said above). Caninsulin is a strong acting insulin that starts working quickly so it's best to wait about 20 to 30 minutes after a meal to give the shot. You want some food in kitty's bloodstream before giving the insulin.

Test him just before his meal, wait the 30 minutes then give the shot.

Yes. Same routine as the AM.

Whenever he likes. You can feed multiple small meals a day or let him graze if he likes that. Just take away all food for two hours before the pre shot BG test.

He should be OK with a bedtime snack. That's what I do with my diabetic.

Do you mean you'll have to skip his shot on Monday? Is this a regular occurrence? It's best to have insulin twice a day every day. You have about an hour's leeway with dose timing if using Caninsulin. If necessary he could get his shot an hour early on Monday.

It's actually better to do a few tests every day at a variety of times to slowly build up a picture of how he responds to insulin. Have a look at a variety of other spreadsheets to get an idea of what I mean. A curve gives you data from only one day and if it's an atypical day you might misjudge the insulin dose. Here's the basic testing routine to try:

1. test every day AM and PM before feeding and injecting (no food at least 2 hours before) to see if the planned dose is safe
2. test at least once near mid cycle or at bedtime daily to see how low the BG goes
3. do extra tests on days off to fill in the response picture
4. if indicated by consistently high numbers on your spreadsheet, increase the dose by no more than 0.25 u at a time so you don't accidentally go right past a good dose
5. post here for advice whenever you're confused or unsure of what to do.

This is useful: http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/

Once you have a spreadsheet of enough test numbers you'll begin to see what his patterns are, how dramatic his BG ups and downs are, etc. If things are quite stable you can leave soon after a shot if necessary. Most of the action happens between 3 and 6 hours after a shot on average. There'll be times when his response might be more dramatic and you might have to test a bit more to monitor. If you need to leave you can feed higher carb food before you go. It takes time to learn how to make these judgment calls. Post here often for advice.

I hope that helps!

 

When I was giving Sox insulin I slightly adjusted his am and pm meals. His 100g morning/evening meals were split into 2.
I'd test, give 50g at 7am/7pm to line his stomach before the insulin. Then the additional 50g at 7.30am/pm with his insulin shot.
He would then get another 50g of food at 12.30 lunch and 9.30pm before bed

Yes that's correct.

 

After Sox shot at 7.30pm I would retest before feeding at 9.30pm before going to bed just to make sure his was at a number I felt happy with to leave him through the night.

Day time wise he would be left 15 mins after his insulin some days due to work .I'd just leave the automatic feeder set to 5hrs post shot which is when he would start to reach his lowest numbers.

As @Kris & Teasel has said the further along you get and the more data you collect you will start to notice patterns and that makes your decision making alot easier.

 

Thanks for the info, I appreciate it. I had thought about testing him again before bed so I'll defintely do that now. As for the daytime, it's not like I have a hectic social life or anything but I just want to know that I can pop out to grocery shop or maybe occassionally go to the movies as long as his numbers seem okay.

 

That's good to know thanks. I've seen a few posts on here from people with vets who wanted to start on a much higher dose than was necessary, so at least now I can say this is what I want to begin with.

This is what I thought but it's good to have it confirmed.

Okay, so forgive me because I'm probably being a little slow but does this mean then that it is alright for me to test when I get up again just after 8 AM, as it'll have been over 2 hours since his first bit of food at 5.30 AM?

That's a relief to know! Obviously I wouldn't leave him if he tested quite low just before bed but as long as he's okay, it's nice to know I can go to sleep.

Yes, I mean I'll likely have to miss his morning shot on a Monday as I have to leave for work quite early. I work in a gift shop at my old school, so during term time this would be a regular occurrence and then obviously during the school holidays, I would be home on a morning.

This all helps! Thank you so much for taking the time to respond and for giving such a detailed reply, I really do appreciate it.

 

You can test when you get up if you want that extra data point. The main test, though, is the one just before you feed him because it's your baseline for the dose given that cycle.

 

If there's any way you can have a special Monday shot schedule so you don't miss the AM dose it would be better for your kitty. Maybe give the dose earlier. How much earlier do you leave on Monday compared to other days?

 

But when I feed him when? At 5.30 or at 8? Normally I go back to bed after the first feed so I was hoping that I could test and shoot around his second feed just after 8. Or is that not possible?

 

I only work there on a Monday then I do voluntary work on a Tuesday morning but that doesn't start until after 10 AM and then I am home the other mornings. I usually have to leave just before 8 AM on a Monday but it's always a scramble to get out on time so it would be hard to fit testing and shooting in as well. Plus I would worry about leaving him and not being able to test until I get home again around 5 PM.

 

Maybe test him just before you feed him at 5:30 if you feel like it. It's optional. Definitely test before you feed him at 8 AM.

 

What about shifting his test/feed/shoot to 7 AM that one morning and skip the 5:30 AM food?

 

There's a lot of detail here Lauren, and I'm sure you're taking it all on board, so I won't repeat too much. Right now the important thing is to remember that the starting insulin dose should be low, usually 1u. Some vets recommend starting higher, based on bg or weight, but the issue there could be that you might be skipping over the ideal dose and creating problems further down the line. If, after an agreed time, bg isn't coming down, you can increase in increments of 0.25u - finding the right dose can be a fine-tuning exercise and may be for the duration of a cat being in diabetic numbers.

The other thing I'd say is don't let the vet suggest keeping Little B in for a day, or few days, to "get him regulated". Vets do occasionally want to do this but it's not necessary and unlikely to be successful. You'll do much better at home if you can master testing, so as well as getting that under control, another thing you can be doing in readiness in setting up a spreadsheet to log bg data. If, when you start giving insulin, you have questions about its effect, we will need to see that data to determine its onset time, lowest point and duration.

Finally, if you haven't already, print out the beginners guide to Caninsulin and highlight any areas you want to remember. If you do that, you'll be more than prepared for the vet visit and could probably get a higher mark in a Feline Diabetes exam than he/she would!

 

Okay thanks.

 

Problem is all three of ours get fed at that time so it would be hard not to feed him too. Plus he'll have gone all night without any food so he might need it by then. I'm honestly not sure what I'm going to do about it at the moment. I can't change when I have to leave as I'm soley responsible for the shop on Monday so have to be there to open up and I have a set shift which doesn't change.

 

That's good to know thank you. I'm assuming if I need to raise the dosage it's best to let the vet know what I'm changing it too? Also, do you know if I can ask specifically for syringes that have half measures? I've read on here that it's best to have those, for those small incremental changes.

I'd already decided a while back that I didn't want him to stay there so I will definitely stand my ground on that one! I will get the spreadsheet up in the morning in readiness. Would it be worth adding in the three readings I've managed to get so far even though they're pre-insulin? If so, what column would I put them in?

Still struggling with the home testing but am now trying the 'de-sensitization' technique as suggested by @Elizabeth and Bertie, so fingers crossed.

I haven't done this but it's an excellent idea!

 

I would think the vet will expect you to follow his/her recommended dosing change, rather than you doing so independently! You may or may not want to explain about this board and all the knowledge/experience here, and that you'd get dosing advice here if necessary - but remember, we are not vets. Some vets are very wary of a bunch of people on the internet, others may be more open-minded. Of course, you don't want to upset the vet so play this carefully. Work at establishing a good relationship with the vet and discuss any changes with them in the early stages at least, making your judgements based on what you've learned here.

Yes, ask for syringes with half-unit markings, you may need to measure smaller doses. As for the spreadsheet, there's no real need to include pre/insulin readings - the point of a ss is that it gives a picture of how an insulin dose is acting at given points in the cycle. Random readings without context before insulin is being given aren't really adding much information.

Keep going with the de-sensitisation!

 

Not gone so well today, he has let me touch his ears a bit more but he ran a mile every time he saw the lancet device.

 

Sudden thought I had tonight when Little B decided to randomly go off for a couple of hours: What do I do if he's not around in the evening when it's time for the 'Test, Feed, Shoot?' Obviously if he's about just before I can make sure he stays in till we're done but what if he goes out an hour or an hour and half before and he doesn't come back in time? What's the best thing to do in a situation like that?

 

Having a cat that goes outdoors adds a complexity to the schedule for sure. You have about an hour's flexibility with dose timing when using Caninsulin. For example, if you regular time is 6 PM , you can dose as early as 5 PM or as late as 7 PM without causing a problem with overlapping of doses, etc.

 

That's good to know thanks. I think that most of the time he will probably be around but as the nights get lighter and the weather gets better, they all start going more so it's good to know there's a bit of leeway just in case.