Random hypos and where to go from here.

Hello, first of all this is my first time posting - although I have done a fair bit of poking around - so my apologies if this is in the wrong place/I do something else wrong

Our cat, Toby, is 15 years old and was diagnosed with diabetes approximately 6 months ago. His original, natural glucose levels were around 33-37mmol. He was put on Caninsulin, starting with doses of 2, going up to doses of 3, and then onto doses of 4 (admittedly quite quickly because he responded so well). This was when he had his first hypo. He very suddenly couldn't stand up and started sounding off, sounding very distressed. We rushed him to the vet, who later told us Toby started fitting as he was putting the glucose drip into him, his levels were too low to be read. He stayed there for the rest of the day and overnight, and then - putting it down to an accidental overdose of insulin because his blood results were consistently excellent - he came home with us and worked back up from 3 and 3.
Some time later, back on 4 and 4, he did almost exactly the same thing and we rushed him to an emergency vet. It took around half an hour from the start of the hypo until the vet saw him, and by then we'd stabilised him with sugar and his reading was 4.5mmol ("Not too bad," the vet said, although I wasn't too inclined to agree). He stayed overnight for monitoring anyway. After another consultation with his own vet, he crept back up to 4 in the morning and 3 at night, instead of the previous 4 and 4, and he was fine for several weeks.

I should have mentioned, but at first we were talked out of at home testing (our vet is wonderful in every other way, for the record). Anyway, we had two "mini-hypos" at home, where we realised he was showing some earlier symptoms and got a little syrup into him and some food, and he was fine. We bought a glucose meter at this time.

He started to show symptoms of low blood sugar every day for almost a week, and after checking his blood and finding levels between 1.7 and 3.1, we told the vet we were going down to 3 and 3. He agreed this was probably the right thing to do.
That takes us to Sunday night, where Toby went from looking perfectly fine to crying and fitting on our living room floor in a matter of seconds. We rushed him to an emergency vet again, and I'm not entirely sure where it went, but glucose was injected directly into his side, between his ribs, because we were that close to losing him. He went on a drip again, stayed overnight with the vet again, and I'm now terrified to put an insulin injection anywhere near him. I've never seen him like that before, and I just don't know what to do at this point.

I'm sorry that this is a bit haphazard, but I imagine you know how it is :cry: I'll try to fill in some blanks, but please let me know if I've missed anything vital. He has insulin at 8:45 and 8:45. Apart from the first hypo, all of this low blood sugar is happening between 1:30 and 3:30am. He has had problems with his 'plumbing' for most of his life and has always eaten Royal Canin Urinary SO dry food. For this reason, our vet originally recommended he stay on that food. Since he came home on Monday, we've only fed him the wet food instead. We're collecting data, although we can't do a full, on the hour curve until Saturday. He is happier right now than he has been in weeks, but his sugar is just too high. He's had glucose curves done at the vets several time, and apparently the results have always been "excellent". He's had several fructosamine tests, and apparently the results are "excellent". I just don't know what to do.
Thank you in advance.

EDIT: He's seeing the vet on Tuesday, it's just that he's currently abroad.

 

If I were you, I would go out and buy a ReliOn meter, strips, a lancet device with 25-27 gauge lancets. I would start testing him tonight and not give another shot until I had a preshot number. You are incredibly lucky he is alive. He is most likely getting too much insulin and the only way to determine what the right dose is, is to get numbers at home. (Numbers are affected by stress and most cats are very stressed at the vet. Often the numbers are 100 points higher at the vet and doses based on those numbers are too high.)

Our premise is that we would not take our child to a doctor, get a prescribed dose of insulin and shoot blindly until the doctor checks her again in a couple weeks. We treat our 4 legged children the same way.

We have taught hundreds of people how to test over the internet and would be glad to teach you. You may be saving your sweet Toby's life. Please let us help.

 

We do have a meter now, after two hypos with seemingly no rhyme or reason we decided the vet would just have to cocoa on the no at home testing. We had too few strips left to dare to use them (just in case!), but just this morning more strips and lancets have arrived. We're all ready to go, just not entirely sure where we're going

We can't refuse to leave his side until Saturday, when we plan to do a curve. Even if we check his levels first, I'm far too scared to reintroduce when we can't stay with him all day. Other than that, we're open.

 

So you have some tests? That's great. If you are still struggling, here's some great info to help:

http://www.felinediabetes.com/FDMB/viewtopic.php?f=14&t=287

Maybe some general guidleines will help. We suggest new diabetics not shoot under 200. Instead wait 20 minutes, without feeding, to see if the number is indeed rising and over 200. (you don't want to add a new dose of insulin if the old one is still working). We generally consider a cat regulated if they are in the mid 200s at preshot and 100 or under at nadir (midcycle). Under 40 is our hypo range, when you need to add food and sometimes honey.

Canninsulin is not a popular insulin here. We like milder, longer lasting insulin like Lantus, Levemir or ProZinc. In most Cats, Canninsulin is too fast acting (taking the cat on a steep fast drop) and doesn't last a full 12 hours. There are cats here who have become regulated or gone into remission on Canninsulin BUT it requires a lot of monitoring.

How about if we start with some numbers. Anything you have gotten at home, when was it and how long after the shot? Then test before the next shot and post your number.

One thing that complicates this whole sugar dance is the bouncing that can occur if a cat goes into low ranges. Their body can release extra glucose and send their numbers high. This results in a roller coaster of highs and lows. Giving us some numbers to work with will help us figure this out.

 

I'm in the UK. I've been doing some reading around, and I'm not sure I have many options beyond Caninsulin. That's one to be brought up with the vet on Tuesday, but I'm not sure I should be holding out too much hope.

As for the numbers, we haven't done preventative hometesting in the past, only used the meter to check his levels when we've already been suspicious that there is a problem. I'm going to gather data over the next couple of days, and I'll report back with it. When it comes to the insulin, I plan to start very safe with a dose of 1, even though he started with 2 even for the very first time.

Thanks :smile:

 

I like the idea of starting with one unit. Then you can increase slowly, as and if needed, based on his blood glucose levels.

I think that UK vets do insist on trying Canninsulin first. But we have several members who tried and demonstrated tht Canninsulin wouldn't work and then the vet prescribed another insulin. They have a ProZinc type insulin in the UK that has worked well for some cats.

 

WE have several UK members here and it is challenging to get the vets to change the insulin - I believe you have to first try using the Caninsulin and when that doesn't work, then you can ask for Lantus.

I'm going to ask the UK peeps to pop over and help you.

 

Hello from Surrey!
And welcome to FDMB.

(And thanks, Hilary, for drawing my attention to this thread. :smile: )

Gosh, what a tough time you've had with Toby. (Here's a big reassuring (((HUG))) for you.) Things will get better though. Honestly. And you will find a lot of help and support here at FDMB.

Sue is right: Vets in the UK have to start out with Caninsulin because they are obliged to prescribe a veterinary medicine before they can prescribe a 'human'' one. And currently Caninsulin is the only veterinary insulin available for cats. However, if it can be shown that Caninsulin is not working well for the cat then (under the 'cascade system') the vet is permitted to prescribe another insulin (if they are willing to). An insulin that is becoming increasingly popular in the UK is 'Hypurin Bovine PZI'. And some vets will also prescribe 'Lantus/Glargine' or 'Levemir'.

Well done, you, for starting to hometest!!! :thumbup
It's highly likely that switching from dry food to wet food could have reduced Toby's insulin requirements quite a bit so testing will be very important. It's especially important to test before each insulin shot. That test lets you know that it's OK to actually give insulin. For newcomers to feline diabetes we suggest that no insulin is given if the blood glucose level (at the time of the shot) is less than 11(200 (US)).

Are you doing Toby's curve at home tomorrow (Sat)? (I'm happy to PM you my phone number if feel you might want to talk anything through during the day.)
And which wet food are you feeding Toby BTW?

Eliz

 

If you get comfortable with testing, you wil be able to show that the current insulin is not working effectively for your cat.

Then, you may choose from Levemir(detmir), Lantus(glargine), and a PZI insulin (Hypurion seems to do well).

Since you are now home testing, here are some glucose reference ranges used for decision making using glucometers. Human glucometer numbers are given first. Numbers in parentheses are for non-US meters. Numbers in curly braces are estimates for an AlphaTrak.

< 40 mg/dL (2.2 mmol/L) {< 70 mg/dL for an AlphaTrak}
- Treat as if HYPO if on insulin
- At nadir (lowest point between shots) in a long term diabetic (more than a year), may earn a reduction.

< 50 mg/dL (2.8 mmol/L) {< 80 mg/dL for an AlphaTrak}
- If before nadir, steer with food, ie, give modest amounts of medium carb food to keep from going below 50 (2.8).
- At nadir, often indicates dose reduction is earned.

50 - 130 mg/dL (2.8 - 7.2 mmol/L) {80 - 160 mg/dL for an AlphaTrak}
- On insulin - great control when following a tight regulation protocol.
- Off insulin - normal numbers. (May even go as low as the upper 30s (1.7 mmol/L){60s for an AlphaTrak}; if not on insulin, this can be safe.

= 150 mg/dL (8.3 mmol/L) {> 180 mg/dL for an AlphaTrak}
- the lowest level pre-shot for ProZinc, PZI, or other non-depot insulins.

> 150 mg/dL (8.3 mmol/L) {> 180 mg/dL for an AlphaTrak}
- At nadir, indicates a dose increase may be needed when following a tight regulation protocol.

200 mg/dL (11.1 mmol/L) {230 mg/dL for an AlphaTrak}
- no shot level for beginners; may slowly reduce to 150 mg/dL (8.3 mmol/L) {180 mg/dL} for long-acting insulins (Lantus, Levemir, and ProZinc) as mid-cycle data collection shows it is safe

180 - 280 mg/dL (10 - 15.6 mmol/L) {may be 210 - 310 mg/dL for an AlphaTrak}
- Any time - The renal threshold (depending on data source and cat's renal function) where glucose spills into the urine.
- Test for ketones, glucose is too high.

>= 280 mg/dL (15.6 mmol/L) {may be >=310 mf/dL for an AlphaTrak}, if for most of the cycle between shots
- Uncontrolled diabetes and thus at risk for diabetic ketoacidosis and hepatic lipidosis
- Follow your insulin protocol for dose adjustments
- Test for ketones; if more than a trace level of ketones, go to vet ASAP.

 

Thank you for the replies and the support, everybody. It's starting to feel less scary already

Right, I'll be approaching the vet with a list of insulins on Tuesday and we'll see what he has to say. From what I've been reading, even if we get on okay with the Caninsulin I'd really like to get a hold of one of the 'better' ones anyway. Although we've only been with him for approximately a year, he really is a very good vet and he's been very accommodating with Toby and our other pets (and we've had a bad year with the poor things!).

I think it'll take some working up to it for me to inject him when he's as low as 11 :shock: But I'm sure ditching the far too high dosing and the hometesting is going to build the old confidence, I'm just used to seeing him rest in the high twenties/low thirties.

We're doing the curve tomorrow, yes. Thank you very much for the offer, I'm feeling quite confident now that I've read up, but that would be excellent for the extra peace of mind :smile: Would you like me to send my number, too, so that you don't receive calls from strange numbers in case I happen to use it?

He's currently eating Royal Canin Urinary SO still, just the wet food instead. His habit of staring death in the face started maaany years ago with his plumbing issues, so it is something he needs =/

Thanks again!

 

Hiya,

Have PM'd you my home phone number. Do please call tomorrow if you want to talk anything through. I'm working from home tomorrow so should be around all day. :smile:

Regarding doing a Caninsulin curve, here are some things you may see if the pattern is 'typical':
You will probably find that most of the action happens in the first five hours after giving the insulin (although I expect there are some exceptions to that rule!).

So, for example, you may find that the insulin begins to starts to lower the blood glucose about an hour and a half after the insulin shot (or a little sooner or later). Then, if it's a typical Caninsulin response, you'll see the insulin working at it's strongest over the next 2 - 3 hours. In many cats, a Caninsulin curve can reach it's peak (ie lowest blood glucose level) at around 4.5 to 5 hours after the insulin shot, after which the blood glucose will start to rise again. The blood glucose may rise slowly at first and then speed up as the Caninsulin leaves the system (maybe 8 hours after the shot). This is a fairly 'typical' Caninsulin pattern; but, we have no way of knowing at the moment if Toby is going to have a 'typical' response, so tomorrow's curve should provide a lot of useful information!

If you see that Toby's blood glucose is dropping fast (ie in excess of 5 mmols an hour) then you may well find that feeding a small snack will slow the speed of the drop. (In fact, many people using Caninsulin for cats aim to feed a snack a couple of hours after the insulin shot in order to slow the blood glucose drop.)

Good luck for tomorrow. I'm sure you'll do just fine. But please do call me if you want to chat about anything.

Eliz

 

He's been 'typical' when he's had his curves done at the vets (although I know that's subject to change!) and his low sugar issues have all happened around 4.5 to 6 hours after his shot. We'll soon find out! Thank you again.

 

Mr Tobe started the day at 25.3. He had his insulin at 8:45, and then had a pouch of his Urinary SO for breakfast. We checked his blood again at 10:45, getting a reading of 18.1. He had half of another pouch 'cause he's a hungry little man right now. We've checked just now, at 12:45, and he's down to 5.9. And 2 pouches of food ;-) I'm trying to be wary of overfeeding him, but I'm also aware that he must be very hungry. We're going to check again in an hour, since that is a bit of a drop.

EDIT: 1:45 and 11.2. Interesting.

 

Pretty typical Canninsulin curve, unfortunately. In US numbers (multiplied by 18):

amps 355.4
+2 324 Fed
+4 106.2 Fed
+5 201.6

The food may have kept or brought the numbers up (I am not familiar with your food and don't know if it is low carb) so that may be an influence on the curve. But in general, he dropped more than 50% at +4 ( a gentler curve would have a 50% drop around +5-7 or so) and then started back up a little before the typical midcycle point on other insulins. Your +7-8 number may show you that the insulin is not lasting 12 hours....... If the food is higher carb, you might have had a more drastic curve - same general movement but to lower numbers - on a lower carb food.

If you are willing, we have a great Google document - a color coded spreadsheet that will help you (and us) see his numbers. It converts from British metric to US automatically so be sure to use the World document. Here are the directions:

http://www.felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207

I'd show these numbers to my vet (in spreadsheet form is a way to represent the fast drop, the fast move back up and the short duration) I don't know how long he needs you to "experiment" with Canninsulin, but he might accept a curve as good documentation.

 

I can't find much information on the food myself, unfortunately =/ I get the impression that the Urinary food is low carb in general because carbs are bad for crystals, but I can't find any actual data on it. Another one for the vet, maybe?

Toby was diagnosed in May and he's been on the Caninsulin since then, so hopefully the vet will agree that it's been long enough. I'll start putting that spreadsheet together now.

Looking at his numbers today, I feel pretty stupid for persevering with the old doses for so long. Every time he had a hypo, because his numbers were otherwise "good", we could only explain it as an accidental overdose or a shot into fat. And I had read that low carb food was better, but just accepted "It's not worth bothering with, he needs the Urinary SO". Sigh. Hopefully we'll crack it now though.

 

Well done on the curve! Top job!

And it does look like it was a pretty steep drop between 2 and 4 hours after the shot (what in FDMB-speak would be called '+2 to +4'). In some cats the speed of that drop alone might cause the blood glucose to subsequently swing up high as a result.

And please be kind to yourself, there's no need whatever to "feel stupid", you're doing a great job!

The ingredients for the Royal Canin SO wet cat food are these (note that the second ingredient is 'cereals'):
Ingredients COMPOSITION: meat and animal derivatives (including beef 5%), cereals, oils and fats, eggs and egg derivatives, derivatives of vegetable origin, minerals, molluscs and crustaceans, various sugars.

ADDITIVES (per kg): Nutritional additives: Vitamin D3: 260 IU, E1 (Iron): 2 mg, E5 (Manganese): 0.6 mg, E6 (Zinc): 6 mg - Technological additives: Pentasodium triphosphate: 1.3 g.

ANALYTICAL CONSTITUENTS: Protein: 7.5% - Fat content: 5% - Crude ash: 1.5% - Crude fibres: 0.6% - Moisture: 80% - Calcium: 0.15% - Phosphorus: 0.14% - Sodium: 0.15% - Magnesium: 0.01% - Potassium: 0.27% - Chloride: 0.3% - Sulphur: 0.15% - Taurine: 0.13% - Urine acidifying substances: calcium sulphate (0.3%), DL-methionine (0.02%).

I've just run the label 'analysis' through my carb calculator and according to this the percentage of calories from carbs is a stonking 21.6%.
For diabetic cats we generally recommend that a cat food has less than 10% calories from carbs...

Was Toby always on dry food until recently? I'm just wondering if it was actually the dry diet that was causing his urinary problems....? And also wonder whether switching to wet food might actually resolve that problem...? I'm pretty sure that somewhere on Dr Lisa Pierson's website she makes the comment that 'the solution to polution is dilution' (ie, water in the diet)

I don't know if the additives in the Royal Canin food have any especially therapeutic properties (but someone here will surely know that..?)
But I'm thinking....wouldn't it be great if it were possible to switch to an ordinary good quality low carb wet cat food, and help the diabetes and the urinary problems.... confused_cat

Eliz

 

My immediate thought was that it was because of the sudden drop and I was going to have to deal with a 'bounce' (is that right?), so it was a bit of a relief to hear that it was 'typical'. We're just going to check him again now, hopefully we'll get an idea of which it was from that.

He spent most of his life eating primarily dry food, with one meal of wet food a day. I understand your thinking, but I am very reluctant to stray from the Urinary because when he was first diagnosed with the diabetes, we started to give him more meals of meat (due to having read about low carb diets) and for the first time in years he had a bit of a cystitis flare-up. Coincidence? Only possible because he was still on dry food too? I don't know, but it's something I want to watch very closely. As we get the sugar a little more stable, I might try throwing in some very low carb food alongside the wet Urinary and see if anything happens, but I'm sure you understand my reluctance. As for the foods properties, it basically causes very acidic urine.

He's at 16.1 now. Here's the spreadsheet.

Thanks again, everyone.

 

Re 'bouncing', yes, there are a number of things that can cause it. It can happen because the blood glucose drops too fast, or if the blood glucose drops too low (either dangerously low or sometimes just lower than the cat has become used to). It's also possible to see a sudden rise in blood glucose (that looks like a bounce) simply because the insulin is no longer acting in the system and the blood glucose returns to it's default (high) level. My cat has also appeared to 'bounce' for what has seemed to be no apparent reason, but I later found he'd got into the tub of food for the pond fish...(Ouch!)

Hmmm...impossible to know what caused that flare up of cystitis... Sometimes there is no obvious reason for it (our little tortie girl gets bouts of 'ideopathic' cystitis from time to time.) But diabetics are more prone to UTI's....

I absolutely understand your reluctance about changing Toby's food. I'd probably feel exactly the same if I were in your shoes. I was just musing as to whether it might be possible to get the necessary therapeutic elements into Toby withouth the high-carb that comes with it (ie, wondering if the therapeutic elements could be given separately in a different form (a supplement?). (And in fact, if you were to feed lower carb food then the insulin dose would need dropping even more...)

Well done for setting up the spreadsheet. (I've never managed that in all the time I've been here! :lol: ) But I couldn't access it. When I tried to I got a message saying I 'needed permission'. So, maybe there's a box somewhere that needs ticking in order to make the document publicly available...?

You've done amazingly well today. I would think a nice glass of wine should be in order as a reward.... Or chocolate... Or both... ;-)

Eliz

 

There's an option in the spreadsheet File menu list to publish to the web and another option for sharing. Both must be done.

When you select sharing, you select "share with anyone who has the link". The link given allows others to see, but not edit, the spreadsheet.

When you select "Publish to the Web", it allows the link to be used.

 

And if you include the spreadsheet link in your signature (the url that goes with "Publish to the web") it will come up each time you post, updated.

This website by a vet has some interesting ideas on urinary issues and food: http://catinfo.org/?link=urinarytracthealth She is a great resource and one of the early advocates of wet low carb food.

 

Ah, thank you for that. Should be all good now.

Signature all loaded up and I'll check out that website, thanks.

And we have no idea how long Toby's been struggling with diabetes. I mean, he's lived this long so surely it's not been (fully-fledged, at least) too long, but he was only around 2 years old when he started having problems with his urinary tract and he's always been a very hungry boy. We took him to our old vet around three years ago now, because he seemed to have completely lost interest in cleaning himself (not that it was ever very far up his 'to do' list :lol: ) and was developing a rather matted coat, only to get a diagnosis of "clinically lazy" because he was otherwise in good health :shock:

It's definitely something I'll be looking into. When it comes to cystitis with Toby, what we got was a couple of bouts of rather mild cystitis which were promptly treated by a vet, and then coming home to him one day, unable to stand and crying. My Dad's reaction was that he'd been hit by a car, and he was rushed to the vet only to discover he was close to popping. Now, I'm only 23 now so I don't really remember it happening, but apparently he seemed perfectly fine before then. No blood, he used to urinate outdoors so nobody had noticed a lack of it, no sign of discomfort until then... The little guy doesn't do things by halves.

Yes, I'd dropped the ball and missed that box :?

Thank you! We do have some 'cake pops' waiting around to be devoured :mrgreen:

 

Spreadsheet is working great! Don't you love the colors? It makes it so easy to see exactly what is going on.

Not bad to only have a 70 point rise between +5/7. That is slower than we sometimes see with Canninsulin. It would be nice if it lasted longer than customary.

 

When are you feeding and how often?
I can't see where it's been mentioned that Caninsulin is harsh, pulling cats' numbers down hard, and fast by +4, so what you want to do is manipulate the numbers with feedings at certain times.

You are feeding at shot time, yes? Now, you also want to give food at about +2.5 or +3 because you want to slow down, delay the drop and then you won't have such a bounce to higher numbers later.
If you wanted, you can divide the food into mini meals at shot time and then a Tbsp every hour for the first 4 hours of the cycle which will delay the drop and give smoother numbers that will feel better to your cat.

Gayle

 

Yup! It's great. I had a spreadsheet going on my PC, but it's definitely nice to have one all colour coded and ready to go.

It would, but I fully intend on asking about a 'better' insulin anyway, and I'm not opposed to going elsewhere for it if need be.

Sorry, did you mean what? If so, he's eating Royal Canin Urinary SO wet, but I am looking into lower carb alternatives. As for how often, today he ate at shot time, 2 hours after, 2 hours after that, and then at his second shot time. And he's just now (around 2 and a half hours after that) demanded some more grub. It seems he knows exactly what he's doing :mrgreen:

Thanks for the pointers.

 

Does anyone know how fast cats respond to stress? As in, it is only really being at the vets that can push glucose up, or if you have a little bit of a scrap to get a sample, is that enough?
Toby's a very good boy about treatment in general, but he can be a bit fussy about samples because he just plain old doesn't like his ears being touched. I don't intend to fight him too hard for it anyway, but it got me wondering.

 

While you work on the home glucose testing, you might find it helpful to use some of the Secondary Monitoring Tools in my signature link to assess your cat.

 

Is he sure getting a treat after every poke? This is the secret to testing. Once he realizes he will get a treat every time he lets you poke his ear, he should eventually decide it is worth it for the treat. (You do want to find something low carb that he REALLY likes)

Here are some choices: http://www.felinediabetes.com/FDMB/viewtopic.php?f=14&t=9172

 

Thank you. We are currently getting all of the blood we need, but I'll have my eye on these things too.

I think he realises that already, he starts looking for the food when he hears the beep :lol: He's just not quite accepted that the poking bit is a completely necessary part of the process. We'll get there.

 

Toby had to have his insulin an hour late today (not because of his BG, because something came up =/). We're out in the morning and he will have to have his shot at 8:45 (we're available to check him at 12:15 and he will have a watcher in the morning, just not someone who can give him his shot). If his BG is high enough tonight, can we resume at 8:45 or am I better off skipping a dose? He's burning through the insulin today and has had pretty high numbers when we've checked him (they're on his spreadsheet).

Thank you!

Oh, oh, also... I have it in my head that ears are the preferred site for testing (less chance of infection, maybe?), but we tried a paw with Toby and he seemed to tolerate it a fair bit better. Should we persevere with the ears or give the man what he wants?

 

Hi,

Sometimes stuff just crops up, and giving insulin an hour late ain't the end of the world. Given Toby's (often high) blood glucose numbers I would not recommend missing a dose.

Can I just clarify that I've understood you correctly? (Sorry, was up at 5am and have had a looooong day so my brain is a bit tired....) Are you saying that you gave Toby insulin this morning (an hour late) and are asking if it's OK to resume shooting schedule this evening 12 hours after the morning shot...? If so, then yes, absolutely.
Caninsulin usually has a short duration in cats and is often 'done and dusted' after about 8 hours. So it may not even be necessary to wait until 12 hours after the previous shot. (Although I realise, as I now look at the clock, that it will have been more than 12 hours anyway...?)

Actually, some people give 3 shots a day with Caninsulin because of the (typically) short duration (perhaps initially splitting the entire daily dose into 3 shots instead of 2). I gave my cat 3 shots a day (every 8 hours) for about a year and a half. Long term, it is quite a hard schedule to maintain; but some people find it worth doing short term in order to keep some insulin in the cat's system for longer, and keep the blood glucose levels more stable. I expect it's especially beneficial if a cat is a candidate for remission. (Remission means that a cat's diabetes can be diet-controlled). An alternative, of course, would be a longer lasting insulin....

As for testing sites: Absolutely do whatever you and Toby are most comfortable with! Most cats tolerate tests done on their ears better; but a minority seem to prefer paw testing.

Sorry if this is a vague rambling message. I'm totally done in and in need of some Zzzzzzzzz's.....

Oh, by the way, what is your name?

Nighty night...

Elizzzzzzzz.......

 

I was wondering if I could give the shot after only 11 hours, because the only time I'll be able to do it in the morning is his usual 8:45 time. As luck would have it, it's the very first time we've had to give him a dose more than 20 minutes late (and he's only ever missed one shot :smile: ), so I just got a little worried. I went for it in the end though. I have my trusty glucose meter and he was at 29.3 so he'll be fine :smile:

As for the longer lasting insulin, that's still top of my list to bring up with the vet on Tuesday. After spending the weekend on here, I'm starting to think that appointment is redundant We're still going though, it'll be nice to check weight and BPM and harass the vet a little :mrgreen:

We've done two on the paw now, and it definitely looks like the way to go.

Doh, I keep meaning to share my real name. It's Becky. EDIT: In fact, I've changed the username now.

Goodnight, and thanks for taking the time to respond despite face-on-keyboard issues :mrgreen:

 

Welcome Becky!

Sure don't like seeing those blacks. If you can monitor, I'd consider raising the dose by a little bit. With Canninsulin, it won't mean a nice general improvement overall, but it might help with those 500 preshots numbers. Just be sure to monitor the first cycle.

Do you have ketone strips? If not, I'd get some and start testing for ketones.

http://www.felinediabetes.com/ketones.htm

When they are in higher ranges, it is something you want to be careful about. You buy the same strips humans use and stick it in his urine stream. (if this is a problem, we have ways to get it done)

 

Thanks for the welcome :smile:

They are a worry, and he's had a bad day today =/ It was my partner who gave him his shot this morning, and I really don't think it was a furshot, but when we got to do our first check, at +4, he was right back where he started :shock: My partner gives him his shots all the time but of course we don't know if this has ever happened before because we've only just started to hometest >_< It's the first time we've left him for several hours since starting to hometest though, so maybe he got into something =/

We can monitor him properly on Wednesday, but not before then. I'm hoping to get the go ahead on a better insulin tomorrow, but if the Caninsulin is still around come Wednesday we'll bump him up a little. I'm going to take a look at those ketone strips. Oh, Toby :sad:

Hm, looking at his spreadsheet, maybe we need to try a little harder/sooner with switching to more of the low carb food. He does better left to his own devices than he does post-food. Cystitis is still a worry though =/

 

The more moisture in his diet, the better for the cystitis - it helps flush out irritants.

 

Yup Not one dry biscuit passes his lips nowadays, and he drinks like... well, a diabetic. We're weaning off the higher carb Urinary (just taking a little time; he almost 'popped' as a baby so we have a healthy dose of paranoia), and keeping an eye on him to see if moisture alone will do the trick.

It's just curiosity, not a substitute for the ketone sticks, but is it possible to have an issue with ketones without any of the listed symptoms?

 

Usually ketones are a combination of an infection, high numbers and not enough insulin. But every cat is different and there are cats on the forum that are very ketone prone. For them, a ketone test every couple of days is necessary, even without any visible symptoms. The only factor Toby seems to have are the high numbers. But it is a cheap test to get and if you can figure out how to test him, it is worth its weight in relief for you. Our Oliver would not let us watch him in the litter box. He would refuse to go until we left the room. So we got aquarium gravel, cleaned out the box and put it in. Then left him alone with it for awhile. He hated to see a clean box so he would go. We could then go in and get our sample, because it wouldn't absorb into the gravel.

 

Toby has a "If you want to watch me pee, you're the one with the problem" attitude (I guess cystitis from a very young age did have one perk) so I'm not too worried about getting the samples, it's just that it's 8:30 at night here and I'm trying not to fret :mrgreen: Thank you for the information.

 

Hi Becky,

I tested Bertie's pee for ketones quite a bit when he was first diagnosed. He had pretty high blood glucose levels (rather like Toby). You can get Ketostix (that measure ketones) for about a fiver from most pharmacies, or Keto Diastix (that measure ketones and glucose) for about a tenner. Keto acidosis is a nasty and dangerous condition and very expensive to treat, so it is good to have some reassurance that all is OK while the kitty is still in high blood glucose numbers. At the same time as testing for ketones though it's still worth keeping an eye open for any symptoms (especially for breath that smells of pear drops/nail polish remover).

Here's a link to the Sugarpet page on urine testing:
http://www.sugarpet.net/urine.html

When buying Ketostix some folks have found that the pharmacist wouldn't sell them if they'd been told they were for a cat! (Crazy but true...) I used to say that I was buying them for a diabetic friend.... ;-) You can probably get them on Ebay or Amazon too.

Eliz

 

Turns out Amazon and eBay both have them, but I'll try the more immediate option and take a look in the pharmacy tomorrow, and be sure to bend the truth a wee bit just in case =]

16.6 just now. An improvement, but still looking forward to trying with something else.

 

Hello Becky and Toby! Great job so far! For what it's worth, my Buster was on Urinary SO dry when he turned diabetic. Initially, my vet said to stick with that diet it and try the insulin. We couldn't get his numbers to go down and the insulin dose kept going up. After reading about food on the catinfo.org site, I took a leap of faith and switched to non-prescription, low carb canned food only. I also add a bit of water to the food just in case. It's been over a year and he hasn't had any urinary issues at all. Buster only had one bout of struvite crystals and never had any other urinary issues once we put him on the SO.

I hope we can help get Toby back on track soon!

 

Thank you It's helpful to know other people have overcome similar.

I forgot to mention, but Toby has had some on and off issues with constipation (since becoming ill enough to go to the vet and eventually get the diabetes diagnosis). It does seem to be evening out with the wet food and the insulin, but it's another little thing that makes me reluctant to mess too much with his diet. If he hops in a tray and back out, it's hard to know which is bothering him and I really wouldn't want to miss trouble related to cystitis. I'll continue with the slow incorporation and try and get his BG a little more level... and then start the maths all over again when he can eat more LC :lol:

 

You might find this site on Feline Constipation helpful. It explains how the GI tract is supposed to function, how it may become dysfunctional, and options on managing the problem safely and correctly when it happens.

 

Thank you. I'm currently on lunch break, but I'll take a good look later.

Toby had comprehensive blood tests when he was diagnosed with diabetes (the vet was actually looking for kidney failure or hyperthyroidism, and skipped right to them on his results, and when he found they were both looking good he said he thought "Nope, there is something wrong with this cat", and read the rest to get a bit of a shock when he saw BG of 33) and he's doing rather well, so I'm quite sure it is just a side effect of the diabetes. Touch wood, but he's not had any issues recently

He's almost definitely finding something to eat when we're out though, hmm.

 

Automatic feeders work really well to keep hungry cats eating small, frquent meals during the day (thought to be good support for the pancreas). I love my Petsafe5. You can order it online; it is available at PetSmart stores in the US- not sure about the UK.

 

The only problem is, we have two other moggies and a dog (Toby can't really get himself up to high places right now). He'd need to be kept locked up somewhere, and I don't think he'd appreciate that =/


We went to see the vet and spent almost an hour with him. He had a good "Oh, get you" laugh at me and 'my' colour-coded spreadsheet, but - despite initially saying not to hometest - fully approved of it. We discussed different insulins, and he's not opposed to the idea but needs some more consistent evidence before he'll prescribe one (looking at Toby's spreadsheet right now, that's fair enough). He's slightly alarmed that Toby gets as low as he does on 1U when he starts off so high (especially because he was "okay" on 3 and 4U...), and says he really can't recommend a dose increase at this point. He suggested that with Toby's glucose under control he might not need the Urinary SO but... yeah, 'diabetic food', twice a day. We'll skip that one. I've been using a Codefree monitor and haven't been able to find any information on it, so I took it along and we compared it to the Alphatrak. When the Alphatrak read 29.2, the Codefree read 27.5, so that's not bad at all.

I'm basically thinking that whatever I do with Toby's diet, I need to make it consistent, I need to stop him from getting at whatever he's gotten at over the last two days (Kitten knocked some biscuits down from up high? Secret stash somewhere? Learnt to use tesco.com?), and I need enough data to show that he is just burning through the Caninsulin quickly. Overall, I'm quite happy though.

 

Can you get some baby gates and set them up with just enough clearance underneath that the cat can get under them but the dog cannot?

And the same low carb food may be fed all your moggies. (I had to add the word to the dictionary for my browser, LOL!)

 

It's certainly possible, size-wise, to keep the dog entirely away from the cat food (she's a big ol' border collie), and I have no issue with the girls eating LC (all these issues with Toby are actually steering me towards that anyway =]), but baby gates would be an issue because we have a family member with some quite serious mobility problems and it wouldn't seem fair on them. Hmm. I need to think of something, though. I'd use some sort of hop-up so that Toby could eat up high too, but knowing the dog she'd go all Crufts on me and use it to her advantage too :lol:

As it happens, I have almost two whole weeks with nowhere I need to be now Perfect time to monitor Toby closely, and hopefully I'll have a system by the time we need to leave him.

Mine yells at me about certain words, but it accepted moggies no problem... A British thing, maybe? :lol:

 

Toby's vet did seem a little skeptical that it could be food alone pushing him up as high as he has been for the last couple of days, and suggested that his numbers were so low on the first two days because he was more sensitive to the insulin after his little break from it, but looking at his numbers today... go, Toby

 

They make some baby gates that you install like a half-door. It swings all the way open for complete passage. That might work if you can find one there.

 

Yeah, that's the kind I had in mind, but the issue is Parkinson's and it's doors, corners... starting and stopping in general that's the issue. Maybe if I can find a gate that swings both ways, but there'd still be the issue of stopping to unlock it. I'll get him trained to eat up high or feed him in an area such as behind a couch where the dog can't get.

 

I've heard of people who fashion a box with a hole for a door big enough for the cat but not the dog?

 

Yeah, something like that - or a similar set-up courtesy of furniture - sounds like it could work.

Toby has had a very strange day today, I'm not sure what to make of it. They're excellent numbers, but what's caused them? And I know it's recommended that 11 is safe to shoot at, but because it's so abnormal it certainly doesn't feel it.

 

Hi Becky,

It's not so much that "11 is safe to shoot at" but rather that we don't recommend that folks new to diabetes give shots at less than 11, until they've gathered some data about how their cat responds to shots at lower numbers.... If that makes sense.... Once people have gathered data on how their cat responds to insulin they may well give their cats shots at numbers lower than 11 (I often give Bert shots as soon as he gets above 8).

Your Toby is a tad tricky in that a unit of insulin can drop his blood glucose from 21.7 to 4.7 in 4 hours. That's not what he typically does but we know that it can happen. And neither do we know why it happens. That may become clearer later on....

Have you given Toby insulin this evening yet? And if so, was his preshot number 17.6? And did you give one unit?
You don't have to stick to the one unit dose. If you are concerned (and if you're not going to be around to monitor his response) you could always give a reduced dose.

Eliz

 

Yes, sorry, I understand that. I meant it more like "I know that it's generally accepted that even newbies can shoot at 11, but right now I don't feel safe shooting even at 17, because he's been so unpredictable today". Sorry I didn't make that clearer.

And whilst we're on the subject, when I say things like "But why? What's causing it?" it is purely rhetoric... I'm not expecting clairvoyancy from anyone, just thinking out loud :mrgreen: I've just had the realisation that it makes me look a wee bit demanding, so I thought I'd throw it out there.

I've not given him his insulin yet, no, because he couldn't afford to drop 17 again =/ And now I'm having a glucose monitor malfunction! Gahhh...

(Thank you for your input.)

 

He hasn't been tested - nor received insulin - since yesterday morning due to an issue with his Codefree monitor. We bought an Accu-Chek Aviva today, and just checked him and got 18.6. I chose to shoot him with 0.5 due to his unpredictable nature and not really knowing if the Aviva reads the same. What a strange little gentletom you are, Toby.

 

Hi Becky,

The Accucheck Aviva is quite popular in the UK (and, just in case you don't already know this, the test strips are usually available on Ebay far more cheaply than in the pharmacies. (Hooray for Ebay!))

Gosh, 18.6 after a day (?) with no insulin? That is quite an improvement, isn't it? Is Toby eating more of the low carb food now..? What sort are you feeding him?

Oh, re your previous post - you don't seem at all "demanding"! :lol: Your pondering of why the blood glucose numbers vary so much is entirely natural and understandable! Bertie had a very similar pattern to Toby for quite a while after he was diagnosed (high numbers interspersed with sudden inexplicable drops. I spent a lot of time puzzling over that.... :roll: )

You're doing a great job, Becky. Toby is very lucky to have you looking after him. cat_pet_icon

Eliz

 

I plan to transition back to a Codefree (checked it against the Alphatrak at the vets, got 27.5 and 29.2 respectively so it ain't half bad) because it's still way cheaper than the Aviva, but it'll certainly be nice to have the Aviva around the house as a back-up (for one thing, it's so simple to just stroll into a pharmacy and get anything you need for that one).

Yeah, it's confusing, but I guess it can only really be in a good way. He's probably been eating a slighter higher LC:USO, but I wouldn't have said it was that dramatic. Then again, people do say the effects of LC can take a week to really kick in, no? Hm. He's been eating Butcher's Classic and Gourmet. He's also been looking really well, so I plan to trial all LC soon and keep a close eye on that litter box.

Thanks Have you hometested Bertie from the start, by the way? If so, was it at a vet's suggestion or your own research?

Thank you :smile: He's a lucky little man in general.

 

Just a quick note... managed to check the Tubs with the Codefree and the Aviva, got 15.3 and 14.3 respectively.

 

Checking for ketones was never suggested to me until this forum, so I only got the strips a few days ago. Until now, I hadn't caught Toby peeing at a time when I didn't forget all about ketones and simply do a happy dance over his constantly improving toilet habits. Anyway, just checked him and got absolutely nothing Also, we're trialing NO USO right now, so it's good for him to get used to everyone following him to the toilet ;-)

 

Looking at Toby's spreadsheet, is it paranoia making us decrease his dose or does it seem the best course of action? =/ We checked that 14.7 twice because it was hard to believe, but couldn't bring ourselves to give him the full 1U. I know at the end of the day it's up to us, but I was just looking for some opinions regarding if we're short-changing him or not.

Thanks!

 

Can you get a test around PMPS +4 or +5? I wouldn't want to do a dose change without checking how low he is going on this one!

 

Oh yes, we'll be getting a +4 as usual because that appears to be his lowest point. It will be in approximately 90 minutes.

 

Eeesh, way to confuse me, Mr Tobe.

 

Maybe cos you just gave 0.5?

 

Yeah, but I'd still expect more of "his numbers generally aren't as low" rather than "they're not low for as long". Seems it doesn't work that way. He's just so unpredictable with how much each dose drops him, and I'm definitely still paranoid about hypoglycemia... I guess intracardiac injections will do that to you =[

 

"Intracardiac injections"...??? :shock:

 

Yeah, remember I said in my first post that at Toby's last hypo an injection was administered to him at roughly his ribs? I got to read his notes from that a few days ago, and it says that the vet gave him diazepam in an attempt to stop the seizures, and then attempted to insert an IV, failed, and gave him an intracardiac injection. That's how bad a shape he was in. I feel guilty as hell that it ever got that far, and we're NOT going to be having any hypos again.

In brighter news, his numbers are getting better and better, however.

 

Oh, (((Becky))), please don't beat yourself up about that. We all have 20/20 vision in hindsight. Your were doing the best that you could for Toby at that time. But now you've found more information and you have the benefit of your own experience of hometesting Toby.

Yes, the blood glucose numbers are looking better and better! Great job! :smile:

Eliz

 

Thank you. I can mainly accept that we really were talked into it, but it's still left me a bit paranoid!

We got a 9.9 this evening. 0.5 for the whole day it is. Hmm, Toby.

 

Becky,

Just took a peek at Toby's chart and his numbers are just getting better and better! Very exciting stuff indeed! (And those coloured charts are a great way to actually 'see' the progress, aren't they?)

You are doing a fantastic job. You've clocked up quite a bit of hometesting experience now and I get a sense that you're really beginning to develop a 'feel' for what works best for him.

Looking at those numbers, it would seem at the moment that Toby IS doing just fine on Caninsulin too....(so maybe it won't be necessary to switch insulins...?)

How is Toby in himself? Does he seem to be feeling better?

Eliz

 

I know, I'm so impressed He'll be 16 in April and whooo knows how long he's been diabetic, so I wasn't really expecting such an improvement. The charts are great, I was remarking just yesterday that it's awesome to see whole new blocks of different colours

I am, but I'm also aware that I might be erring on the side of caution just a little too much. He is unpredictable, but I think I need to learn to shoot just a little bit lower. Maybe implement some .25 doses, and maybe even .75 instead of .5 in some cases. Might need some different syringes for that though...

Bit of a surprise too, yeah. He was definitely metabolising it pretty fast at first, but even with it completely out of his system it's pretty smooth sailing now, so maybe that's partly why it's working :razz:

He's very well His coat's looking good, he looks more alert and brighter-eyed, he definitely has a healthy appetite, but he's not constantly after food and acting like he's starving. He runs between rooms now It means he raises more hell now, but hey, fair trade-off :lol:

 

Hi Becky,

Are you using the 'vetpen' thingy or the Caninsulin syringes? I've only ever used the .5ml Caninsulin syringes but, from what I've heard/read it can be easier to vary the doses more accurately with the syringes than with the vetpen (and with .25 and .75 dosages it's a matter of 'reading between the lines' ...literally....). But I've not used the 'vetpen' so don't have actual experience to compare....

Another alternative, methinks, could be to further reduce the carb content of Toby's food... What are you feeding Mr Tobes at the moment?

I have to say that it is just SO encouraging to see his blood glucose numbers drop like this. With a cat who's been diabetic for a little while it's tempting to think that this can't happen - but it can! :smile:

I'm guessing (and it is only a guess) that Toby's pancreas is healing and producing more insulin of it's own. And not only does it seem to be producing more insulin but it seems to be producing it more consistently, hence a) the more stable numbers, and b) the fact that the numbers aren't flying up after the Caninsulin has left the system. This is only my theory, based on what I have seen/experienced/'thought to be the case' with my own cat; but whatever the reason for what's happening with Toby, the results are very promising indeed! :smile:

Eliz

 

Haha, we're currently using the syringes but were actually considering the vetpen doodah because we were told it's easier with that! Well, also because when Toby had issues with very low numbers we were repeatedly asked if we were sure we hadn't given him more insulin than we thought :roll: It sounds like that's another crock, so may as well eyeball those .25 and .75s too.

He hasn't had USO since 27/10. He's eating Butcher's Classic most of the time, with the occasional pate at about 2.7% when he seems to fancy a change. He really isn't a picky eater, it's just nice to distract him with something when he feels he's missing out on something the girls have got :lol: Again, that isn't often because they mainly eat with him, the kitten just really wants a few biscuits sometimes, and the other moggy is a bit of a Dreamies addict. I'm still reading up on food and am definitely open to feeding him something else, I'm just slightly overwhelmed by the options. I mean, Toby definitely likes the pates, for example, but I can't really find any information on them.

I agree. I definitely think a part of it is that we're putting less sugar into the cat, but his little body certainly seems to be having a good go at it too! It really is wonderful to see :smile: As is that 11 we got tonight

 

Hi Becky,

Re the "vetpen doodah", I heard/read that it's considered an accurate way to give a specific dose (the dose is set on the dial so there's less opportunity for 'user error') but that the doses on the cat vetpen are in .5 unit increments and so it's not so easy to do less than .5 of a unit, or to do 'between' doses, such as .75. (But I could be wrong about this......)

There is some general info on the Caninsulin vetpen here.
http://www.caninsulin.co.uk/vetpen/about-vetpen.asp

I don't use the same insulin or syringes as you but I regularly shoot doses that aren't a full unit or a half unit. Our typical dose is currently .75 of a unit. But, depending on Bert's numbers (and the 'pattern' of how his body seems to be dealing with insulin at any given time) it could be anything from a 'skinny half unit' up to a 'fat whole unit'. And it is a matter of 'eyeballing' it. A light behind the syringe and/or a magnifying lens can help!

Some folks using very small doses of Caninsulin actually find it easier to use different syringes (made for different insulin) with a conversion chart. Using different syringes (made for different insulin) is not generally recommended because of the errors that can occur if people haven't fully understood the conversion method, but some folks do find it very helpful.

Quick explanation: Caninsulin is a 'U40' insulin. That means it contains 40 units of insulin per ml. Most insulins are 'U100' insulins. They contain 100 units of insulin per ml. So, a U100 insulin is 2.5 times as 'strong' as a U40 insulin. That means, for example, that a unit of U40 Caninsulin would measure to the 2.5 unit mark on a U100 syringe, and .4 of a unit of Caninsulin would measure as 1 unit on a U100 syringe, and .2 of a unit of Caninsulin would measure to the .5 mark on a U100 syringe.
The conversion chart is here if you want to see how that works:
http://www.felinediabetes.com/insulin-conversions.htm

This may be more info than you either want or need. Sorry. I've had a lot of coffee this morning, he-he! @-)

Will try to post some cat food info later.

Eliz

 

Becky, if Toby likes smooth (rather than chunky) style foods there are quite a few low carb foods that might be worth a try, especially if you're willing to buy online. Prices vary quite a bit.

The following have a finely minced consistency.

From Zooplus: Bozita canned food is popular and very economical. I think it's about 4% calories from carbs. (Bozita also do a chunks in jelly type food, slightly higher carb, in tetrapacks). The link is here:
http://www.zooplus.co.uk/shop/pet_food/ ... ita_canned
Bozita is also available from some independent pet stores and garden centres.

Also from Zooplus are Catz Finefoods and Grau 'grain-free'. Some of the Catz Finefoods are very low carb indeed. And Zooplus have mixed trial packs of it available at the moment, so it's a good chance to try out the different flavours.
The Grau 'grain-free' has about the same carb content as Butchers Classic, I think (about 8%), but it is a premium food with high meat content. It's pricey though, but can be quite economical in the huge 800g tins. There is a trial pack of Grau grain-free available at the moment too (but the yellow tin in the pack works out too high in carb for diabetics...)
http://www.zooplus.co.uk/shop/cats/cann ... z_finefood
http://www.zooplus.co.uk/shop/cats/cann ... uches/grau

Zooplus offer free delivery on orders of over £25. The parcel will need signing for. (Or I think there is the option of getting the parcel delivered to a post office to be collected from there).

The Happy Kitty Company also have some good foods that may be worth a try.
Some of the Mac's grain-free varieties are very low carb. It's a good quality economical food too. Ropocat is also available from the Happy Kitty Company, as is (going up in price range and quality) Granatapet. Granapet is popular with many cats, and most varieties are very low carb.
Delivery costs for orders over 5kg (equivalent of around 13 x 400g tins) is £3.95. But The Happy Kitty have some special trial offers going on too (including postage costs) which may be worth considering.
http://www.happykittycompany.co.uk/pages/special-offers

There are lots of other good foods out there too. For specific varieties and carb values do have a look at Juliet's (AKA 'Dr Schrodinger' here at FDMB) 'Useful Food Chart For Brits'.
https://docs.google.com/spreadsheet/ccc ... mWmc#gid=1

Eliz

 

Ah, we must have only been discussing it with the vet in terms of those .5 doses then. That makes sense. Also, the whole 'there's no possible way he's had a hypo because he's on EIGHT UNITS a day. Must be something else'.

Our vet has actually told us that he has some 'skinnier' syringes so that, to the eye, the space between units is larger. I am familiar with the U40/U100 conversions too (but thanks for taking the time all the same!) and have considered that as an option, but my partner - who does a lot of the actual putting the needle in the cat - is uncomfortable with the idea. Paranoid about messing it up. That happens to be the main problem with .25 and .75, too, he's worried about misjudging it. It looks like our best option is simply to practice and get him comfortable with the regular syringes, however, or have me draw the insulin even if he's going to do the sticking. Now I just need to evaluate what calls for a .25 or a .75 nailbite_smile


As for Toby liking smooth food, he just likes food :lol: I'm definitely willing to buy online though.

The Bozita is one I've been seriously considering, I'm just slightly put off by the one flavour, just in case Toby does happen to throw a diva-fit :lol: I guess I could go for a couple of smaller packs instead, or even two huge ones... but that's a whole lot of cat food if no one wants to eat it! I'm not very familiar with the others you've linked, I'll take a look at those now, and I'll pore over that list, too.

Thank you very much for all the help! :RAHCAT

 

Ahaa.... Have you been using the 1ml syringes that hold up to 40 units? There are .5ml ones available too, so these would certainly look skinnier by comparison. There's a pic of the (3) available sizes here:
http://www.vetmedsdirect.co.uk/caninsul ... 0-x-0-5ml/

And have you been buying syringes from your vet? They can be a lot cheaper to buy online, and worth shopping around for... (ie vetuk.co.uk, medicanimal, viovet, vetmeds direct... Some sites offer free postage too.)

Becky, it might be worth your starting a new thread asking for 'sliding scale' help, and getting some more eyes and expertise on Toby's chart.
And in fact you are already beginning to work out a 'sliding scale' for Toby (for example you've worked out when it might not be appropriate to give a full unit and have tried .5 instead).

You are certainly seeing more consistency lately in Toby's response to insulin (no sudden steep drops (touch-wood, anti-jinx!)), so maybe this is the time to start experimenting with slightly different dosages if you and your partner are comfortable with this (it sounds like you're a great team, BTW! Toby is very lucky).

One thing I'm wondering is - if you could get the hang of measuring a .25 unit dose then that could give you an alternative option for some of the evenings where you're skipping a dose (because the evening preshot number is too low for you to feel comfortable to give .5 unit...?)

Oh, re the cat foods I linked to, yes some of them will seem very unfamiliar. Quite a few really good foods have only recently become available in the UK. Most of these are from Germany, where they make exceptionally good cat food for some reason! (And some of us are thrilled that these are available here now because it's a lot easier than importing from German websites... ;-) )

Lowering the carb content of Toby's food could make quite a difference to him. It certainly looks like his body is really trying to heal itself...

Eliz

 

I'm with Elizabetn - new thread as this one is two pages. Toby is doing very well!

You might ask in the new thread if Canninsulin U40 could be given with U100 syringes if the conversion chart is used. PZI users (U40 insulin) often get 1/2 unit U100 syringes so they can dose under .5 units. But they have to convert the dose. See this chart:

http://www.felinediabetes.com/insulin-conversions.htm

It seems like it should work for Canninsulin, but I don't know if anyone has done it.....