Time management of meals and meds

I am new to this - my Wellington was diagnosed last week, and I am learning to manage his needs. He has to lose weight as well as get his insulin twice daily, and the vet has told me to give him tow meals of 30gm each morning and evening before giving him the injection. That is fine, and I understand the need for feeding him first. But what she did not say, and I can't find it online, is how long before medicating should he have his meals? Should I inject him immediately he has eaten? 30 minutes later? And what if he doesn't eat all his food at once? Should I inject him anyway or wait till he decides he wants more. Sorry if this is a stupid question, but I keep reading about the dangers of insulin on an empty stomach and I want to get it right.

 

What insulin is Wellington on?

 

Prozinc, 4units twice a day

 

With Prozinc, you test, feed and shoot. Some people even shoot while their cat is eating. My vet told me twice a day feeding too, but for Colin several smaller meals/day worked better. So as long as he eats some food and isn't acting ill like he won't eat more through the day, it should be fine. BTW there are no stupid questions. Ask anything!

 

Bonjour, Madame!!! Sharon is correct - the proper protocol is to check their blood sugar (by home testing), then feed them, and then give them the insulin. My cat is the same - he won't eat all at once, but I can tell if he is hungry and in his normal pattern and will eat more later. So if the cat is eating, give the insulin right after he eats at least some of this initial meal - if his normal pattern is to eat more later. With prozinc, you try to give the insulin 12 hours apart. If the cat isn't eating, the protocol is to either not give insulin or give only half the dose. But on a newly diagnosed cat, depending on what his blood sugar is, you would either skip the dose or give half if he is not eating. Does this make sense.
However, 4 units of Prozinc is a very large dose of insulin -most cats are started on only one unit twice a day - can you tell us how his dose came up to 4 units? I am concerned he is getting far too much insulin - Are you home testing his blood sugar?

 

Like Sharon said, there are no stupid questions. Especially at a time when we are so scared and trying to do the best for our little furry ones. Good luck to Wellington and YOU! This is the best place to be for information and support. This site has saved many lives. There are many great links about diet that help too.

 

Thank you all! When I say 4 units I think it is 4ml - 4 marks on the narrow syringe. I am not yet home testing him - he is going back to the vet on Thursday for blood and urine testing, to see if we have the dosages correct. I am more worried that I am not feeding him enough - he weighs 8kg and is not obese but big, and the vet says he must lose some weight. So she has him on 60gm a day of RC diabetic dry. I would also like to switch him to wet - maybe Purina diabetic management, but as the vet was adamant that he should have the RC dry, at the beginning, until I feel I have enough knowledge to argue the point, I thought I had better go along with her. I looked up the Purina meal amounts and for his weight it says 95-110 grams per day. He does eat almost all I give him at one time, but sometimes leaves a little to eat later.
Because I have other cats, I have set up a large cage for him where he stays from evening meal through to morning medication, so I can monitor his drinking and urine amount overnight. I let him out during the day, making sure there is no food around anywhere. The other cats complain, but it is probably good for them not to free-feed anyway.
How do you home test? I have read a little about glucometers but am not sure how to get one or what to get. BTW his glucose level was 350 last Wednesday when he was first diagnosed.

 

Here's some info to get you started. Not sure what brands are available where you are, but a human glucometer works just fine. Read through the stickie and ask any questions you have
http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/

 

No, ProZinc is a U40 insulin so each ml of insulin contains 40 units. 4 unis would be 0.1 ml
It also depends upon the syringe. Some syringes come with 1/2 unit marking so if you are using such syringes four marks is 2 units of insulin.
This also assumes that yo are using syringes with a red needle cap. Human syringes are U100 and have an orange needle cap

 

• 
  My syringes are U40, 0.5ml, narrow with red caps. But they don't have 1/2 markings. The first number on the scale is 5 - before that there are just line marks. So I guess he is getting 2 units x twice a day. That may be adjusted on Thursday when he gets his first control
• 
  
• Wellington is very laid back and I can do anything with him except touch his ears! For some reason they are a no-go area and he closes them up and leaps away if they are messed with, or even caressed. So this is going to be quite difficult.

 

If you are giving to the 4th line, that is 4 units - is there some way you can check with your vet because 4 units is very very high for a newly diagnosed cat. Is there any way you can take a picture of your syringe and post it (click upload a file)
there is a formula for calculating how many calories to feed http://petsci.co.uk/feline-calorie-calculator/

The only way you will know if Wellington is in safe numbers is to home test - it is very stressful at first but after a while it becomes easier too bad you are so far away from @Capoo - but maybe she can give you some tips and resources in France.

 

I will pop in to the vet tomorrow morning and check - I don't have anything written down from her except his chart of numbers. And I will go to my pharmacist and order a home testing glucometer.

 

I just found the paper she gave me on how to inject, and it does say '4 unites' twice a day. Now I don't know what to do.

 

I think the RC Diabetic dry is 23 carbs., so changing to a lower carb food may help his numbers to come down. Do not change his food until you are home testing! You may even leave some out for him to nibble through the night. Try to get a meter as soon as you can and start testing. Until then @BJM has some secondary monitoring tools in her signature
https://docs.google.com/document/pub?id=1r6ktdF7AMJCYHgPkVQWFUFy5Ag6OnbmfNfQqL3zX_88
Also read up on hypo symptoms
http://www.felinediabetes.com/FDMB/threads/how-to-treat-hypos-they-can-kill-print-this-out.15887/

 

Yes, I am terrified of hypos. I will check the dosages tomorrow - I don't understand what the lines on the syringe represent in terms of units etc, but the vet definitely said the fourth line, and that is confirmed by the instruction paper. I am going to keep with the dry food for now, though it goes all against my instincts and the way I have been feeding my cats for years. The carb in the RC seems high for a diabetic food - there are several that are lower. I guess all this will cecome second nature eventually.

 

@Rachel @Sue and Oliver (GA) @Robin&BB - what should we advise white kitty's mom - she is from France and he cat was Dx a week ago - she's giving 4 units of Prozinc 2x.day and not home testing

 

1 line = 1 unit unless the syringe has half unit markings
I'll try to find a picture - is there some way to take a photo of the syringe on your mobile phone and upload it (click on upload a file)

 

Since you don't have half unit syringes, each line represents 1 unit.
No surprise on the carb count of the RC food if you look at the ingredients, corn, barley, Tapioca starch...

 

I'm so sorry (what's your name)? I know that this is all horribly stressful and we don't want to contribute to your stress at all - we want to ease your stress in fact. But we want to keep Wellington safe. click on the Prozinc protocol here and you will see that the starting dose is usually 0.5 or 1 unit twice a day. I saw the photo of Wellington on your previous post and what a beauty!!

 

Seondary Monitoring Tools in the signature link at the bottom for you; read away!

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, country) 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.

 

As Carol says, we're not trying to scare you. I think Wellington will be fine as long as you don't change his food. Do try to get a monitor as soon as possible. Post and we'll help you get started testing.

 

You've gotten great advice. Yes, the carb count is high on his food and may be contributing to his high numbers, but I also would wait until you are confident testing at home, so you can know his numbers and adjust the dose downward as needed. If he doesn't like his ears touched, you can test on the paw pads. Will he let you play with his feet?

You might start getting him ready. Take him to the place you want to use for testing. (Bed, couch, kitchen counter, on the floor between your legs) and mess with his paws. Lots of praise and petting and a favorite treat. (We have low carb suggestions). Do that several times before warming his paws (with a sock filled with raw rice and heated in the microwave until very warm or a pill bottle filled with hot water). Again, praise, pets and a treat. The hope is that when you finally add the poke, he will be looking forward to the treat and not care.

Numbers gotten at the vet are usually higher than those you get at home. Most cats are stressed there and we know stress raises levels.

 

the top photo is a U100 syringe with 1/2 unit markings

 

My syringe is the bottom one. From that, he is getting 1.6 units per dose. I am sure I will get the hang of it, but the markings on the syringe bear no relation to the amount of insulin. Anyway, that is reassuring. Wellington is a very big cat - all vets exclaim at his size, and he weighs 8.7 kg without being overly obese, though he does need to lose a bit of weight.

I have arranged to see another vet on Thursday, a small animal specialist, whom I already know through my volunteer work with the local rescue. She and I disagree over the use of metacam for cats, but otherwise she is very good. The vet I took him to last week is not my regular vet, who is now on maternity leave, so I can't consult her, and I did not take to the substitute. It is one thing for little things but for something like this one MUST have a vet one trusts.
He did not drink much overnight and did not really want much to eat this morning, which is worrying - his appetite is legendary. I got enough into him to call a meal and gave him his insulin.

He trusts me absolutely and is extremely easy to medicate. His ears are the one area that is difficult. But you never know - I may manage it. I live alone so have to hold him at the same time. I have never had a problem pilling him or taking his temperature, pulling him into one arm while I do the necessary with the other.

I have started a spreadsheet for him and I will post more info. My name is Jenny.

 

The pictures Larry posted are u100 syringes. Do you have those or U40? For ProZinc, u40 are the proper ones unless you are using a conversion table. If you are using a u40 syringe with u40 insulin (ProZinc) then the 4th line is 4 units.

 

Since you won't see a vet until Thursday, is it possible to take your syringes to a pharmacist and confirm that you are giving four units, plus get the glucometer. Again I am concerned that is a very large amount of insulin to give - from the prozinc protocol I sent you, cats are usually started on 0.5 - 1 unit twice a day.
again, Larry sent you a picture of different syringes than you use, so don't let those photos confuse you.
Maybe you can test from the paw pads - some people do that - I think Sharon sent you the links on how to test

 

@Ruby&Baco do you know if there is a feline diabetes board in France like you have in the Netherlands?

 

What does a feline diabetes board do? I can ask the vet

 

It is a board just like this one, but just for people from France - there may be someone near you with a cat with diabetes who could help you (show you how to home test and the like) The vet probably wouldn't know anything about it
How is Wellington doing today? Is he eating okay?

 

Sorry - I was thinking of some official body! I don't think there is or I would have heard of it. I am a moderator on TheCatSite, a worldwide site devoted to cat welfare, and we have a few members in France, as well as myself. And I work in cat welfare with the local associations and my Commune. I feel so silly being out of my depth on diabetes, but I have never had a first-hand experience.

 

Don't feel bad- I went to medical school and I was totally lost with this the first 6 months (just switched insulins and now I am lost again) It's very stressful and takes a while to get used to it, but soon it is not very difficult. just ask lots of questions here. I would recommend you start posting on the Prozinc forum especially once you start your spreadsheet and can get some blood glucose tests entered. That is the forum where you will be guided with dosing - truth be told - this is too complicated for even most vets, especially with regards to dosing adjustments.

We really look forward to working with you in getting Wellington safe and regulated

 

I googled and came up with this:
http://www.diabeticcatinternational.com/france

Some very useful info on where to get various things, though some of it I do already, like buying my food in bulk through Zooplus. I even already feed my cats some of the foods they recommend like Bozita. That was one thing that annoyed me slightly when the vet took Wellington off that and put him on dry RC diabetic.

I am using U40 syringes -they look just like Larry's second one. I got my glucometer today. Do you test before every meal or just once a day? Wellington seems a bit perkier this afternoon, he was very lethargic this morning. I have not given him anything elsae to eat, though - I want him to be hungry tonight. Until I can get a definitive answer on syringes and dosage I shall halve the amount I give him. I should be able to get at least to a pharmacist tomorrow. But I think from what I have seen that he is getting 1.6 units per dose.

 

We recommend testing before each shot (to be sure the dose you plan to give is safe) and midcycle - 5-7 hours after the shot - to see how low he goes. We suggest new diabetics not get insulin if they are under 200 at preshot. Instead stall. Wait 20 minutes, without feeding, and retest - to be sure he is rising and 200 or over. After you have data and have an idea how the insulin impacts him, you can shoot under 200. And, on a human meter, our hypo range is 50 and under. If he would be 50, come on for advice about intervening with food, to bring up his levels.

We'd suggest starting at one unit of insulin. Our thinking is that you can always slowly raise the dose, as your home testing indicates, but you can't get the insulin out if it is too much!

 

Managed to take some pix but could not get closer

 

I do want to clarify again that the picture Larry sent were for different syringes than the ones you use - these syringes are for human insulin and the insulin is more concentrated You are using Prozinc, which is considered a U-40 insulin. There is a way to use the syringes Larry sent the pic of, but you have to convert dosing and do not worry about that now Definitely with your syringe, each mark equates to 1 unit, so if you go down to the 4th mark, you are giving 4 units. It is recommend that you get the 3/10 ml syringes, not 0.5 ml - but I am not sure of the issues around that @Sue and Oliver (GA) @Robin&BB @Rachel do you know the issue with the bigger syringes? I couldn't tell, but on your syringes - are the numbers 5, 10, 15 and 20?

 

In France, we don't have U40 syringues containing only 0,3 ml.
The smallest ones are those that Lechatblanc has, with 0,5 ml.
We can find syringues containing 0,3 ml, but only U100, for human insulin.

 

Comment vous appelez-vous?

 

So if I go to the fourth line I am giving 4 units?
Je m'appelle Jenny. Je suis Anglaise mais je demeure en Normandie

 

Yes, it seems so as the syringues you're currently using don't have half markings.

 

Enchantée Jenny!

 

Ok, so should I cut it back tonight and tomorrow to 1 or 2 units. The vet was adamant about the 4. His glucose was 320 last Thursday

 

Here is the link with the contacts of the department of endocrinology of the vet school located in Nantes (at the top right):

http://www.oniris-nantes.fr/fileadmin/redaction/LDHVet/fichiers_pdf/Insulinotherapie.pdf

If you have any trouble with the treatment of your cat, you can maybe contact them.

 

Thank you very much. I may do that. I have never yet needed to contact any vet department at a French university, but when I lived in Bosnia I used the University vets all the time as I did not trust the private vets at all. The Head of veterinary surgery at the university of Sarajevo saved the life of my Persil when she had a diaphragmatic hernia and I worked with him later on a big TNR program on the city's cats. It is funny, but I advise people on TheCatSite all the time to go to the local university vet or agriculture department if they cannot find a vet, but these days do not do it myself!

 

No Carol, I don't know if there is one... I guess there will be one because there is (I think) one in every country?

 

I don't really know what to tell about Prozinc dosing (I don't give dosing advise here) but let me tag @Sue and Oliver (GA) @Robin&BB @Rachel who are the Prozinc gurus to see what they think - You have probably already given the pm insulin shot. I don't know why your vet was so adamant about 4 units - is that the dose he told you to begin with or did you start with something lower and then work your way up? Did you read the Prozinc protocol

 

I hope you can get some data and we can see where he is, before the shot and at the lowest point. Any chance you get a number before the next shot?

 

She doesn't have a glucose meter yet She's getting one tomorrow and seeing a new vet on Thursday

 

Darn. Wish we had some data.

Carol's question is a great one. Did the vet start with 4 units or work his way up over time? Any other complications? Was he hospitalized at the beginning?

 

Here's a link to her introductory post He was only diagnosed a week ago

 

Hi! Reading over your introduction post, are you saying that the vet did a fructosamine? And it was 250? That's not a very high number really.

So you started right at 4 units?? That's definitely a lot of insulin. We've had very few cats get that high on prozinc, and starting at that dose is definitely high.

 

You can use the U100 syringes, I have used them because of the smaller doses I needed to give later on. The U40 ones, especially the once you have are harder to use when you need to give less, for example 2.5 or 2.25U. That makes it hard with the syringes you have now.

 

Jenny - please don't let what Ruby said above confuse you - you can use those syringes but you have to do a conversion - 4 units on a U-100 syringe (orange top) does not equal 4 units on a U-40 syringe (red top) I think we should first make sure that you are giving the right dose on the syringe you are currently using, then you can think about switching

 

yes that is for sure a fact, I just wanted to reply that she can use them it's not that with Prozinc you can't use them.

 

Jenny, I see in an above post that you got the meter. Any luck testing? As Carol and Ruby said the u40 and u100 syringes are different. You use the u40 for ProZinc and 4 units of insulin is drawn to the 4th line.

 

While you work on you glucose testing, see my signature link Secondary Monitoring Tools for some other assessments you may find helpful in evaluating your cat.

 

I tried to use the glucometer but couldn't get any blood from his ears with the needle. He endured it for a time, but when I switched attention to the pawpad he rebelled. SO I left it and decided to ask the vet today to show me how. To answer some of your questions, he was started on 4 units x twice a day. He was not hospitalised and the original vet discouraged me from getting a glucometer. I am using the U40 syringes and I can easily measure 2 units on them.

On Tuesday morning I found him all floppy and unco-ordinated. So I halved the insulin dose and 24 hours later he was back to 'normal', though still more lethargic than his healthy self. I have kept it at 2 units since.

Well, good news. Wellington's glucose is down to either 155 or 108, depending on which machine to believe. But either way, he was 320 last Thursday, so that is a terrific improvement. He has also lost 500 grams in weight, which is good, but much too fast in my opinion for an 8.7 kg cat. Today we went to two vets, the original one, who was pleased with his progress but cross with me when I told her I had changed the insulin dosage and why, and I showed her the charts I had made. She did actually say I had done the right thing, though I should have phoned her and asked. Since it all happened at 7.30 am and there was no-one to ask, and the cat was lying there all floppy, I took things into my own hands. She wants him to go into the clinic for a full day next week, so they can do a curved chart of levels against time of day.

So then I went to my 2nd opinion vet, whom I know through the Association for Cat Rescue. She immediately said he should never have been on such a high dosage at the start of treatment, and also that he was losing weight too fast. And she agreed with me that a wet diet would be better, and we discussed brands and amounts and I think he will be much happier as his daily diet will be increased and be more to his taste.. Then she showed me how to use the glucometer and it turns out I was given the wrong needles. So I think after the curve is done I will transfer all his treatment to the new vet - she is older and into nutrition, and I feel much more trust.

 

Jenny I am so happy to hear this great report!!
There's still a lot to do with fine tuning the dose and the food - all of us are in this together!!
Prozinc usually has the nadir about 5-7 hours - is that when the blood sugar of 155/108 was taken? We always test our cats before we give them insulin, and in newly diagnosed cats, we don't usually recommend giving them insulin if their blood sugar is 200 or less at the time of testing (12 hours after the last dose) From my experience, blood sugars can be all over the place when the cat is still trying to adjust to the exogenous insulin.
If you start posting on the prozinc forum, we can help you adjust the dose day to day
also, if you do the home testing, there is no need to take Wellington to the vet for the glucose curve - you can do it yourself at home and it will be much more accurate. Due to the stress of the vet office, the glucose can raise much higher than it would at home all you have to do for a curve is test Wellington before the shot, give the insulin, test every 2 hours until the next dose of insulin - and record the results and that's it!!

the prozinc forum is here

 

Thanks Carol&Murphy. Yes the testing was done at about 3pm, 7 hours after breakfast and 5 hours before supper. The lower dosage was at the first vet, and th ehigher one at the second, which I actually thought less stressful for him. But of course we can never know exactly what they react to.

Even though the numbers have gone down, the second vet told me to continue on 2 units per dose for the moment, and to do some interim testing myself until next Tuesday, when she wants to see his charts. So next week he will have both home and vet testing - it may be interesting to see the comparison.

 

It sounds like things are looking better. The second vet sounds like a better one than the first. We would urge you to get a test before each shot - to be sure the dose you are planning to give is safe and the number high enough to shoot (200 is our suggested no shoot number for new diabetics at first). Then get a test in that 5-7 hour range after the shot to see how low the dose takes him. That lets you know how well the dose is working.

If he let you touch his ears, I would concentrate on them. Find a treat he loves. Not sure what you have in France, but my cats love PureBites and Bonito Flakes (both are low carb). Figure out where you want to test him, take him there, give him a tiny treat and warm his ears. This part is vital - to get the blood circulating through the tiny capillaries. There is a vein running down his ear (put a flashlight behind it to see). You want to poke the tiny capillaries running off that vein toward the edge of the ear.

You can use a rice sack (thin sock with raw rice inside, knotted and heated in the microwave until very warm) or a pill bottle filled with very warm water to heat his ear. You want to leave either one for 15-30 seconds at least. Poke the capillary. If you get blood, you can put it on your fingernail and test from there. Give him lots of praise and a few more treats.

 

Really really old old timer here who wants to see how the OP is doing

How is the home testing going? Were you able to get a test or two done todat? Are you warming the ear first? That often helps as warm blood veins will expand slighlty and blood flows more easily through. You're not aiming directly for the ear vein, just between the vein and the edge of the ear. Here's a picture. Are you using a lancet device to poke the ear? Some lancet devices don't work well. You can freehand the lancet without the device. Do you know what gauge the lancets are? If the lancet is too fine (like 33 gauge), you won't get a big enough prick hole for blood to come out of. 28 gauge is a good size. Testing can be frustrating in the beginning but you soon learn what works for your cat and then it becomes super easy.

I've never heard of TheCatSite before. Is there a forum there or is it just articles and stuff?

 

Hi Jenny, Another home testing starting tip is about lancet sizes. If you are using the size that came with the meter it is probably a bit small starting out. Ask for alternative site lancets, they are bigger. They will have a Gauge number of 25-28 instead of in the 30s. After a bit of testing the ears will learn to bleed better because more capillaries will develop.