Newly diagnosed in the UK

Hello everyone. I am chief servant to a newly diagnosed diabetic kitty aged nearly 12 (the cat not me). So far so good and she seems to be stabilising on 2iu Caninsulin twice daily. I am a doctor and deal with diabetes every day but it is a little different when it is your pet. I have a multicat household so monitoring her food intake is a challenge as she seems to be hungry all the time still. She is putting back some weight quite quickly and is off to the vet for a glucose curve later this week. Would love to hear from others in the UK as not sure what is the normal practice here. We have not discussed monitoring as yet but I would feel more comfortable doing it. So far I have ordered some keto-diastix on line as well as an alert tag with the vets details on it and am putting together a hypo kit as well as instructions for my regular cat sitters who I will be teaching to do the injections. I am also giving her lots of attention and playing with her ears.

She is a real sweetie in every sense of the word.

 

Welcome to FDMB!

We strongly advocate home testing with an inexpensive human glucometer due to the prohibitive cost of pet meters and strips. Anything by Abbott is likely to be good. All the reference guidelines here are using values for human glucometers, which read slightly lower than pet meters. Once you're able to home test successfully, you'll be able to do curves at home - basically serial glucose measurements from pre-shot to pre-shot, taken every 2 hours for a full curve.

In the UK, vets are required to start with Caninsulin/Vetsulin, until it can be demonstrated that it isn't working well for the cat. Then, the vet may be able to prescribe a form of PZI, or to use Lantus or Levemir which have worked well for many cats.

A change to a low carb, over the counter diet may reduce the glucose levels 5.5 - 11 mmol/L (100-200 mg/dL), plus reduce the insulin requirement 1-2 units. Given the dose you're starting with, I'm sure you can see that a food change after insulin is started should be done slowly, with monitoring, to keep the cat safe from hypoglycemia. And for home management of a mild hypo, we have a guide here. We hope you never need it, but planning for contingencies is important.
For low carb over the counter foods in the UK, @Elizabeth and Bertie have put together a list of options in the signature block. Here.

And speaking of signatures,
When you have a moment, could you add a few tidbits to your signature? It will help us give you feedback.

Editing your Signature

In the upper right corner of the screen, within the dark blue bar, you will see ID, Inbox, and Alerts

Click on your ID.

On the left, under Settings, Click on Signature.
This is where you will put information that helps us give you feedback. You are limited to 2 hard returns, so separate pieces by | or -.
This is where you paste the link for your spreadsheet, once it is set up.
Add any other text, such as your name | cat's name | date of Dx (diagnosis) | insulin | meter general location (city and state/province) any other pertinent issues like if there are any food issues, history of DKA, hepatic lipidosis, pancreatitis, allergies, IBD, etc.

Click the Save Changes button at the bottom.

 

Thanks. I am looking at the Accu-check Aviva meter as it needs only a small amount of blood and I have a small cat. The food the vet recommended just happens to be the one she has anyway. Her liver function was slightly up on testing so I am hoping that will resolve in time once she is controlled. She is still doing loose smelly poops but no more diarrhoea, I am also hoping that will resolve in time! I am not that impressed with the caninsulin syringes as they don't seem that sharp compare to the u-100 syringes we use for human insulins, but have not been able to locate any other u-40 syringes and I don't want to try conversions to a u-100 syringe due to other people needing to dose her if I am not around. I will update my signature with more information.

 

You might print out our conversion chart for using the u-40 syringes and set up a reference syringe with colored water if others may be shooting.
And many pet syringes are 28 gauge, rather than the finer 30 gauge and up, so be careful not to harpoon yourself! (Been there, did that a couple of times!)

The smelly poop could be any food changes, however it also could be a sign of pancreatitis. Feline diabetics are a bit more prone to pancreatitis, plus whatever is impairing the islet cells may also be impairing the digestive enzyme producing cells, resulting in maldigestion and reeking feces.

 

Hello Alexi (waving 'Hi' to you from Surrey )

Here's the link to the 'conversion chart' that BJ mentioned above, just in case you change your mind about using U100 syringes...
http://www.felinediabetes.com/insulin-conversions.htm

Many of us with multi-cat households feed all the cats the same food as the diabetic. But as BJ says, it's important not to reduce the carb content of the diet until you're OK with monitoring the cat's blood glucose at home. Fortunately, 'hometesting' isn't that hard to learn and should be painless for the kitty. (The outer edge of the kitty's ear is nowhere near as sensitive as a human finger!)

UK vets vary enormously in their attitudes to hometesting. Some have never heard of it. Some discourage it. Some actively encourage it. My own vet said, "You shouldn't need to do that..." But I did it anyway; and I'm glad I did because hometesting has probably saved my cat's life a few times over...

Eliz

 

Hi Alexi,

Greetings from another UK denizen.

I use an Alphatrak 2 veterinary glucometer as my main meter but I have an Accu-Chek Aviva for a backup and found it to work well. Best price on strips for the Aviva recently was at Morrison's pharmacy (about £17 for 50 strips IIRC) but you can sometimes get good deals on ebay or Amazon (always check expiry dates if purchasing from these sites).

I buy lancets off ebay or Amazon (Freestyle 28 gauge because they are the same as the Alphatrak-branded ones and hence fit the lancing device). If you're happy freehanding the pokes you can get good deals on a range of 28-gauge lancets at those sites.

At the moment VetUK are still offering Caninsulin U40 syringes - just over £10 for 30. Here's a link:

http://www.vetuk.co.uk/insulin-syri...in-0-5ml-u40-insulin-syringes-box-of-30-p-295

Animeddirect.co.uk had Caninsulin syringes only a week or two ago but now they're not listing them any more. We have had a report from a recently-joined member who told us her vet said that the Caninsulin syringes were discontinued and she would have to use a Vetpen. (A marketing decision behind the drought, perhaps? Not great for diabetic cats who need dose adjustments in finer increments than the Vetpen can dispense. )

I've seen other U40 syringes offered for sale on Amazon but I've never used any but the badged Caninsulin ones (Saoirse wasn't on Caninsulin that long). If you're shopping around look for the smallest volume syringe barrels as they make it a little bit easier to measure the small doses cats need.

Re the loose, whiffy poops it might be worth asking your vet to run a SNAP fPL test for pancreatitis if it has not already been done: diabetes and pancreatitis often go together in kitties.


Mogs
.

 

Thanks for all the advice and support. Not such a good day today. I was working late today so asked my mum to pop in today and feed the cats so I could do Cappuccino's shot as soon as I got home to try to stick as near as possible to the 12 hourly regime. I got home to find no cat biscuits in the bowl, (Cappuccino has had a couple of episodes of looking a bit wobbly and doing her 'I don't feel well' miaow over the weekend which was sorted with a few mouthfuls of cat biscuits), nor had the cats been fed, as my mum decided to wash the bowls instead, so she had her shot late which means it will only be 10 hours to the next one as I have to be at work tomorrow. She is drinking more again. I am getting worried about her possibly going low when I am at work but fortunately I do only six hours tomorrow. I am hoping that she may be able to reduce her dose once she has had her curve done. Any tips for stopping the 5am 'feed me' alarm calls, she has the endearing habit of slapping me in the face until I wake up! I have decided to write a list of queries for the vet and I will ask about checking her for pancreatitis. She is getting a bit fed up of being injected in the scruff so I am am heading a bit lower towards the armpit where she has more loose skin which is helping with the 'dart' action and getting the needle in faster and she seems less bothered. She is still eating a lot but I don't feel I can restrict her feeding at the moment.

 

Hi Alexi,

Yep! A timed feeder. (Petsafe 5 feeders are excellent.) There's nothing like polyphagia to give weight to the old adage: "A hungry cat does not come with a snooze button." While Cappuccino's still unregulated the general view here is to feed extra (timed as best as possible to work with the action profile of the insulin being given), especially if the cat is underweight as well as unregulated.

From what you describe of Cappuccino's clinical signs above I'd be concerned about her going low (wobbly and looking for food) and maybe bouncing up to higher numbers as a consequence (increased fluid intake). Home testing will help you determine exactly what's happening to Cappuccino's blood glucose levels. I think it would be a good idea for you to let your vet know about these clinical signs asap and discuss Cappucino's dosing. In the meantime, making sure she has access to food all the time you're away from her is a wise move.


Mogs
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As in humans, the insulin dose is adjusted based on the nadir, or lowest glucose post-shot. Caninsulin, a mixture of 2 durations of insulin, actually has 2 nadirs, with the first around +3 to +4 hours after the shot. (We use the +hour designations because interpretation of the glucose depends on how long it has been since the insulin and we're a world wide group, so doing time conversions rapidly in an urgent situation is difficult. Using +hour solves that neatly.)
The nadir should remain above 2.8 mmol/L (50 mg/dL) on a human glucometer.

 

@Alexi -

Forgot to post these useful links for you earlier:

How to Treat Hypos - Print this Out

Hypo Tool Kit - What to Include


Mogs
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Thanks. Her curve is due to be done on Wednesday so only one more day to go. It is now 2 am here and she is curled up looking contented and I am wide awake! I did have pet safe feeders but got rid of them last year as I had found some reliable cat minders for when I have to be away overnight. Plus one of my other cats is a bit of a bully where food is concerned but she is a bit more food aggressive now, her normal used to be just to sit and wait patiently to be fed. My gut feeling is she should have her doses reduced now as she has put on more than 0.5kg in less than a week so the insulin is doing its stuff. She was looking really scrawny but is now looking more like a normal cat. She has a tendency to be overweight so I don't really want her back to be that, she is now +5 on her last dose so hopefully I can get some sleep now.

 

Great news that her ladyship has regained some weight already. I always love to read about kitties getting better!

I hope you get a good night's sleep, Alexi.


Mogs
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So I called the vet today as she needs to go in starved tomorrow to do the curve so she needs an 8 hour fast overnight. I did tell them about the wobbly episodes and they were fine with how I managed it and wanted to know how long after her shot they happened. It was around 8 hours - so could it have been her going low? They said they can check her for pancreatitis when she goes in tomorrow. Today she is more like her normal self and her internal body clock seems to be coping with 12 hours between feeds today, she has just demanded her dinner but is happily cuddled up until it is time. No eating between meals today either. I have said I will do a written report for them on progress so they can assess how she is doing. No 5 am wake up call either! I did tell them I was worried about her going low 'as I don't have a glucose meter' so I think they will be ok with me doing home curves and I'll discuss it more tomorrow. I hope we have turned the corner.

 

That's about an hour after the crystalline fraction of Caninsulin typically kicks in.

Kwestion: were you only feeding twice a day just before giving the Caninsulin injection when you noticed the wobbles later in the cycle?


Mogs
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Yes-ish , she generally has access to cat biscuits all the time but doesn't tend to eat them normally as she prefers wet food, this was at three full days of being on insulin, eating more than her usual 4 pouches a day (due to hunger) but she has had a strict 12 hour feeding today and seems fine. Generally I feed my cats twice a day anyway. It's a bit more difficult when I am at home as one of my other cats is totally motivated by food so I sometimes have to put down a little extra as he refuses to leave me alone until I have, but usually one pouch between three as when one eats they all want to eat!

 

Lovely pic of Cappuccino: she has beautiful markings!

Did you feed her a larger amount of food at the beginning of the cycle today, Alexi?


Mogs
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She had 2 1/2 pouches this morning and was supposed to have 2 this evening but she has just sneaked into the kitchen and finished off her sister's dinner so that makes 2 1/2 this evening as well. I am removing all cat bowls before I head for bed. Greedy rather than starving this evening and being a sweetie again.

 

Pre-loading the cycle with food seems to be suiting her!


Mogs
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First curve today. Unfortunately she decided to go on hunger strike at the vets so I had to bring her home in the end to feed and have her shot then take her back, so she didn't have her shot until 10am. She was very stressed but her levels are still running high even allowing for that - lowest was 13.7, 7 hours after her shot, the vet is happy for me to do a home curve to remove the stress factor then to review next week. She is now 3.8kg - an increase of 0.6kg in a week, target weight is 4kg. They recommend the Alphatrack meter. The staff at the vets have all fallen in love with her as she was no trouble at all (apart from refusing to eat). I have been asked to increase her to 2.5 iu twice daily now. I do feel more comfortable about being stricter with her quantity of food now. We did discuss changing her food but I am not keen at this stage, mainly because it would mean feeding her seperately to the others which she hates. There is no evidence of pancreatitis on her bloods. So all in all a good day.

 

Very encouraging update, Alexi.


Mogs
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I no longer have a starving cat! She is usually very leisurely about eating her food and is now back to that, and walks away when she is full and before she has eaten the full 2 pouches. Happily accepting her shots and no more 5 am alarms calls (she has shifted to 6am instead which is progress I suppose). Stinky poops subsiding as well. Hoping the meter will arrive tomorrow so I can start testing.

 

That's great news, Alexi! Delighted for you both.


Mogs
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First home glucose test, done as a check on technique more than anything else. Tried the ear a couple of times and although I got it to bleed I couldn't get enough blood out despite warming it with a rice sock and the blood went everywhere but on the strip. She got a bit fed up at this stage so I decided to try the paw instead as she has nice pink pads and very black ears (the videos made it look so easy but I couldn't even see where I was stabbing). Success! Took three goes in the paw but I finally got a reading. She got a small amount of food in a bowl. We are both very relieved! What I have learnt from this is that she is more relaxed when I'm cuddling her and holding the paw rather than the ear, it is easier to get blood from the paw, and always have a spare test strip handy for the error message, the bleeding cat, and the stressed owner! Fishing out a new strip from the bottle with one hand whilst hanging on to a fed up bleeding cat with the other is not an ideal pursuit for a Saturday evening. Home curve tomorrow. Onwards and upwards.

 

When needed, you can snag the blood on a clean fingernail and test from there.

 

Chalk it down!


Mogs
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Well done for doing the curve, Alexi.

I notice that you got quite a steep blood glucose drop between +2 and +3 today, and yesterday evening also. If that is a recurring pattern then it may be possible to slow that drop by giving a snack maybe an hour to hour and a half after the shot. Would that be a possibility.....?
.

 

Thanks - I am doing a full 12 hours today, mainly to see how she responds to the insulin under the strict feeding regime the vet wants. She didn't have an 8 hour fast overnight so I am going to do some pre shot testing the next couple of days until she goes back to the vet on Wednesday. I wanted to get an idea of how steeply she drops so I can make a judgement based on pre shot readings. Normally she has access to some sort of food all day but she is fed early enough that I could give her a snack an hour later before going to work, evenings wouldn't be a problem as she always asks for a bedtime snack anyway! The curve at the vet was on 2 units twice daily and she was very stressed. She started the higher dose of insulin Wednesday evening. Unfortunately they didn't write down the pre shot reading they did. The numbers from the vets are as follows:
10 am insulin given
10.25 31.5
11.15 31.8
12.15 24.1
1.15 23.3
3.00 16.4
4.30 14.4
5.15 13.7
6.20 15.6
The home curve is already looking better than the vet curve!

 

Just a tad!

Looking at Cappucino's numbers today the Caninsulin it seems to be giving her the same BG roller coaster ride that it gave Saoirse: that 16.3 point drop is heavy going. How is she in herself?


Mogs
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Apart from being slightly annoyed at her snoozing being disturbed by the testing she seems fine! That big drop did concern me as well and I would be reluctant to increase her dose again and feel that if the pre shot readings drop too far in the next few days I have to either change her feeding regime or her insulin. I weighed her today and she is now 3.85 kg versus a target weight of 4kg so still rising. She has now bounced up to 25.4 at +7 and maintained that level at +8.

 

When I saw that drop I must admit I thought to myself: "Thank goodness the dose wasn't increased to 3IU BID!"

Have a look at Saoirse's 2014 spreadsheet. It will show you the massive difference Lantus made to her regulation - and her day-to-day wellbeing: the huge swings in BG produced by Caninsulin absolutely hammered her little body and she was miserable on it. I got my cat back when I managed to make the case for a switch to Lantus for her.

Saoirse's 2014 Alphatrak Spreadsheet

For info, the vet with whom Saoirse was registered at time of diagnosis insisted she only be fed twice a day just before the injection. Within only a day or two of my (highly reluctant) imposition of this stricture Saoirse started having very painful vomiting bouts. I consulted with the vets about this and was told in effect that Saoirse would just have to put up and shut up; not acceptable in my eyes so I changed her feeding schedule regardless. (I also changed her vet very shortly afterwards.) I was intent on fitting the treatment to my cat's needs, not fitting my cat around the vet's shortcomings in terms of their apparent lack of ability or willingness to tailor their treatment recommendations to their patient's patently obvious need for a different approach. I took the amount of food that the vet specified for each 12-hour cycle and gave half of that 20-30 minutes before the injection, gave 1/4 at +3, another 1/4 at +6 (Hill's w/d Dry kibble at the time - prescribed despite my protestations that I thought it was plain daft to give a diabetic a food containing more carbs than the one she had been eating prior to diagnosis. ) I also gave a 6g snack at +9 to make sure Saoirse had something in her tummy to tide her over till the PS meal so that she would not get sick.

Delighted to hear that Cappucino's gaining back some weight.


Mogs
.

 

I think the vets insist on doing things a certain way because that's what the book says - but our cats haven't read the book
She has had a little vomit just before +9, I have found similar in the morning one day this week but one of my other cats is a regular vomiter and they don't leave flags in it so you know who is responsible, now I do. She has just asked for food but I'm going to take it to the full 12 hours so I can show the vet all the readings. The others are demanding dinner now as well.
It was me who suggested a home curve because she was so stressed at the vets and they seem very happy to work with me to determine the best for Cappuchino - even if it is a bit different to the book.

P.S. I can't access the spreadsheet

 

I thought exactly the same at the time Saoirse was on the 'doggy protocol'.

Just changed the sharing permissions. Try again, and please let me know if you still have problems.


Mogs
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Yes I can see it fine now - thank you. I suspect my little one may end up on lantus as well. I'm prepared to give the caninsulin a good go as she has no other health issues but I don't think I can stick to such a strict feeding regime. I'll do my usual thing the next couple of days before her vet visit and see what her pre shot readings settle out to. I can do a +3 in the evenings but not the mornings.

 

Glad to hear you can access the spreadsheet OK now, Alexi.

If you establish through your home testing that Cappucino's pattern is to run lower at night the PM+3 will probably be the more valuable test to get in terms of keeping her safe. BTW, the tests at +2, and +8 through +11 can be very useful if you aren't able to get the mid-cycle tests as they can yield valuable information about onset and duration of the dose.

I see Cappucino's on her trampoline this evening after that earlier precipitous drop ...








Mogs
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In more ways than one! She has been running around trying to pee in places that are definitely not allowed once she hit 30, and dashing back and forth to the kitchen but much happier once she got her head into a food bowl.

 

Joys of critter parenthood, eh?


ETA: Are you testing for ketones?

 

She is peeing normally - I think she was having a hunger protest! I have ordered strips but not arrived as yet, at a push I have some strips I use at work in the boot of the car if she seems poorly.

 

I'm sure they'd be fine. I use Bayer 10SG Multistix.

 

Hi Alexi @Alexi ,
Gosh, yes, quite a trampoline act yesterday!
Well done for getting that curve.

It may be that the blood glucose dropped too fast and/or too low for Cappuccino's comfort, and triggered a bounce (liver releasing stored glucose - the mechanism of which you probably understand way better than the rest of us do!).
As a guideline, it's been found that blood glucose drops over 5.5 mmols an hour may well trigger a bounce (though every cat is different). And Cappuccino dropped 7.2 mmols between +2 and +3 yesterday...
A snack given an hour to hour and a half after the insulin shot can sometimes help to slow that down.

It may also be that reducing the dose slightly would even the numbers out a bit. Sometimes it works. Sometimes it doesn't.

If it turns out that Caninsulin doesn't work for Cappuccino then there is now - as of last week - another animal-specific insulin in the UK - Prozinc.
Prozinc was created specifically for cats. It has a long track record in the US, and was one of those insulins trialled by the RVC in their recent remission research, with good results.
Or, there are the human insulins of course, Lantus/glargine, Levemir, and Hypurin bovine PZI.

Keeping fingers and paws crossed that Cappuccino soon gets off that trampoline....

Eliz

 

Thanks for the information. I am familiar with the profile of the human insulins which from what I have read are similar in cats albeit with a twice daily schedule. I'll pop over to the prozinc forum to see what others experiences are of how it behaves but because of my work schedule I can't risk her going low when I am at work but she does seem to be running high pre-meal readings and on a bit of a roller coaster at the moment which I'd like to get under control. I am seeing my vet this week and have to email them the results of the curve so I will ask about the prozinc and whether that might be better for her. I'll also ask if it might be helpful to reduce one of the doses by 0.5 iu to try to even things out. Unfortunately I was late home today ( I usually have a 12 hour day) so had to feed her straight away and give her shot so couldn't get a reading but tomorrow I should be able to get both. The water bowl was almost empty when I got in so suspect she has had another bounce today, I taught my mum how to do her blood sugar yesterday so she is going to pop in during the day and try to get a reading for me.

 

so I gave her a snack at +2 and the +3 reading is higher than before, if she is anything like yesterday then she will have started around 28 and has dropped to 23.7 now, behaviour is 100% normal. My instinct is to go for a small dose reduction. Will see what the vet says but definitely not happy to increase!

 

'tis the nature of the Caninsulin beast.


Mogs
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Back to the vet today and no charge for the consultation which was nice. I showed her the spreadsheet and she was very impressed but said I had found this site and it wasn't my work at all but the colour coding was helpful to me to try to find what colour I should try to get her into most of the time. She did comment that the drop in blood sugar was earlier than she would have expected. Good news is she is going to investigate ProZinc as an alternative insulin for Cappuccino but said they had no experience of using it and we would be learning together. I said I had no problem with that. In the meantime she is happy for me to experiment with the feeding regime and stick to her current doses to see if I can get her a bit evened out instead of going low then bouncing high. I have to do another curve and email it in to them but no more vet visits for now. She did comment that I was the best organised owner she had come across . Meantime we persist with caninsulin to see if we can get better control. My new supply of strips was not delivered today and has been taken back to the depot so I can't have them until tomorrow now , so no readings today as I am hanging onto my remaining few in case of an emergency and just observing her behaviour.

 

Delighted to hear you had such a productive consult with your vetty bean, Alexi!.


Mogs
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I was going to do another curve today but she decided to walk off mid shot this morning so only got a partial dose of am insulin, however, her AMPS was below 20 for the first time and no vomits overnight. Changes made since vet visit - giving her shot 30 mins after food and feeding 3/4 at meals, the rest a little later. What I also noticed today is she was more lively so the numbers tomorrow should be interesting!

 

So glad to hear that Cappuccino's feeling better in herself.

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