Vetsulin/Caninsulin user guide

Caninsulin/Vetsulin User Guide

You have been given a diagnosis of Feline Diabetes and now you are home with this powerful thing known as insulin and you are wondering what now?

For starters, please make sure you take the time to read through the resources offered here starting with the health links Frequently Asked Questions List for the Feline Diabetes Message Board (FDMB) and introduce yourself on the Feline Health - (The Main Forum) where there is usually someone to help 24/7.

You are here because you are using Caninsulin also known as Vetsulin, or, you are considering using this. You may even have heard that this insulin is not a "good" insulin, that it was made for dogs and that it won't work. The right insulin for you is the one that works for your cat. Experience will show whether it is right for you and your cat or not.

Learning the insulin basics, home testing and "feeding the curve" will help your kitty thrive.
Arming yourself with knowledge, asking lots of questions and learning to "read" your cat will make you the best sugar bean possible, and that means great things for the future health of your kitty. This insulin has already helped with that for many of us.

These are some helpful tips developed by FDMB members that have successfully used this insulin to see their cats become regulated and/or diet controlled and are now all here in one place in this User guide.


Tip #1, "Know Thy Insulin"

Insulins work in very different ways; some start to work immediately; Humulin N and Caninsulin are examples of this. Others have their action start hours later like PZI, Lantus and Levemir

Caninsulin/Vetsulin is what is known as an intermediate insulin. It is 30% fast acting insulin and 70% intermediate acting insulin. It is diluted as a U-40 insulin, please check your syringes are also U-40.

This results in an insulin that starts to work quickly in your cat, on average within about 60 minutes, that peaks/nadirs (lowest point of blood glucose) approximately 4-6 hours after shot is given and tends to run out of steam between 8-10 hours after shot in some cats, some also get a full 12 hours of duration. Every Cat Is Different!

A cat's normal blood sugar ranges from 60-120. Our first goal is getting the blood sugar to a range around 100 at peak and preshots of 300 with this insulin, and refining from there.
There are some things you can do to help this insulin do this.

*Learn to home test: Hometesting Links and Tips.
Having preshot tests, spot checks and curves, will allow you to respond to changes in the insulin needs, Please refer to this home testing info page. If this is not possible, have a look at our alternative monitoring section for more tips...

*The starting dose...
Many vets believe that this insulin works best when dose is in relation to the weight of your cat, this can result in starting doses of 2-4 units of insulin twice a day... Yikes...that has been seen repeatedly to be too much!

Practical experience here has seen that 1 unit twice a day is a great way to start and only slowly increasing as the information you are gathering shows you, about .5 of a unit at a time.

The 12/12 BID ( shooting insulin twice a day, twelve hours apart) is not a perfect system for everyone with busy schedules. However, until you have been able to gather info and understand this insulin and how it is working in your kitty, it is an excellent starting place.
Please read through this document about starting low and going slow, it is especially important with this insulin as sudden changes can cause rapid drops.

*an extra note about handling your insulin...
"Store refrigerated at 2-8ºC (35-46º F). Protect from light. Store in the upright position. Following withdrawal of the first dose use the product within 28 days. Discard unused material."

When in doubt and if numbers start to climb, think about replacing your insulin. Insulin poop out has been known to happen before 28 days and also after and is worth thinking on if numbers are going up and nothing else has changed.


Tip #2, Be Prepared and Proactive

Often our kitties have high blood glucose when diagnosed. This insulin works fast to bring that blood sugar down and sometimes a fast drop can be interpreted by the cat's body as a hypo, even when not in hypo numbers. A drop from 460-180 in 2 hours for example could cause this. The feeding schedule below helps to balance that drop and monitoring will show you what that drop actually looks like.

*Please read and print the following information on Hypoglycemia and stock your tool box. Hypoglycemia is scary but treatable and knowing what to expect before it ever happens is key.

How to treat HYPOS - THEY CAN KILL! Print this Out!!
jojo and bunny's HYPO TOOL BOX

*When our kitties are first diagnosed they may have had high blood glucose for awhile. Testing daily for ketones is essential as you work to find the best dose to your goal of regulation.


Tip #3, Understand the role diet and diabetes play together.

Please make sure that there is always food on board before you inject this insulin. Schedule is best with test, feed, shoot, within about 30 minutes.

You will read a lot about the benefits of a low carb diet and it is true. However, please do not make any quick changes from what you are currently feeding until you are testing and have some data.

A low carb diet can dramatically decrease the amount of insulin needed. Be prepared with data and know your onset, peak and duration before making those diet changes. Dr. Lisa has a great site with info on the role diet and diabetes play: CatInfo.org

Food Lists - The following food lists can become outdated quickly because pet food companies are known to change formulas. Manufacturers have six months to reflect these changes on their labels.

• Dr. Lisa's Cat Food Nutritional Composition List (2012)
• Dr. Lisa's Phosphorus Cat Food List (2012).
• Food list under 10% carbs, under 1% phosphorus (2016)
• UK Diabetic Cat Food Info and UK Cat Food List
• CANADIAN Food Chart
• AUSTRALIAN canned food suitable for diabetic cats
• Home prepared diet for CRD cats - Think Tank Discussion
• Hobos Guide to Nutritional Values - cat food values (includes date values were obtained)
• Pet Food Nutritional Values Comparison (August 2010) - values for cat foods
• Janet & Binky's Food Charts (March 2008) - what you need to know about cat foods
• Gluten Free, Low Carb Wet Cat Food - Fancy Feast Varieties (November 2010)

• List of Low Carb Treats

A feeding schedule as follows has served many very well. "Every Cat Is Different" though so tweaking to suit your cat's needs is always encouraged once you gather some info. This is based on a BID shooting schedule of 7:00am and 7:00pm.

If you must leave the house, (once again that darn life gets in the way) a timed feeder or freezing "pucks" of canned food to thaw for that snack can really help.

6:30am
-20-30 minutes prior to shot, test and give 2/3 breakfast , ideally a low carb canned food, please refer to food charts.

7:00am
-give insulin dose,
(if test showed numbers under 180, refer to FAQ 4.4 and ask members of the board for advice, cross posting on health)

Q4.4. My cat's pre-shot level was way below the usual value. Should I give the injection?
A4.4. There's no hard and fast rule, but if you don't have data on how your cat responds to insulin, here are some general guidelines. Below 150 mg/dl (8.3 mmol/L), don't give insulin. Between 150 and 200 (8.3-11.1 mmol/L), you have three options: a.) give nothing; b.) give a token dose (10-25% of the usual dose); c.) feed as usual, test in a couple of hours, and make a decision based on that value. Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise. In all cases, if you are reducing or eliminating insulin, it's wise to check for ketones in the urine. Above the normal pre-shot value, give the usual dose, but if the pre-shot value is consistently elevated, it's a good idea to schedule a full glucose curve to see whether a change in dose or insulin is appropriate. In most cases, the target "peak" value should not be below 100 mg/dl (5.6 mmol/L), and for some cats it might be higher. Keep in mind that these are general guidelines, and they should be personalized to your own cat's reactions to insulin. If your experience is that your cat does not became hypoglycemic with a dose which is close to her usual, then your experience should be your guide.

8:30am-9:00am
-1 and 1/2 hours later or what we refer to as "+1.5", or 2 hours later, +2, offer a snack of 1/3 breakfast...(As the insulin works to lower the blood glucose, offering a snack will help balance a drop that is happening too fast.)

*edited-
I have changed the snack times to a little earlier than original post of +2.5, as have seen many with fast onset of this insulin and the need to have that snack in this +1.5 to +2 hours area to balance the drop more effectively.

~spot check through out the day (test) as you can eg: 1 hour after shot, 3 hours, 5 hours after shot and right through 10 hours after shot.
This does not have to happen all in the first day though , you can spread this out and many of us need to work ( I know it feels like managing this syndrome is already a full time job) and we do this in the evening and on weekends.

7:00pm repeat

The spot checks will show you when the insulin starts to work "onset", when it is peaking "nadir" and how long it is lasting in your cat's system "duration".
With that info you can move the snack up or down as necessary to avoid food spikes and to support the dropping blood glucose.

* Important note;
If your cat is recovering from DKA or other issues that involve a weakened liver, please note that extra calories are necessary for that liver to heal and you should be feeding when hungry and/or as advised by the Vet.


Tip #4, Understand Rebound

Sometimes, even doing all of the above, we end up with numbers that have high preshots and lower swings or a curve that looks flat and high. You ask yourself...what is going on?
What may likely be happening is Somogyi Rebound.

When this happens it is important to take a step back, look at how your cat is doing in the 12 hour cycle and possibly do a "rebound check" ie:
Lower the dose for a couple of cycles, vigilantly test for ketones and allow the cat's body to normalize again from the crazy swings. It takes a few cycles for the stress hormones to settle and the blood sugar to even out again.
Ask questions...there are many here who have experienced this and can help, again cross post to health.


Tip #5, Your cat is more than this diagnosis

***We spend so much time learning, and doing all of the above, it is easy to forget your kitty is still the same loving and funny member of your family it has always been.
Now that I have mentioned the importance of knowing thy insulin, home testing and feeding the curve, I hope you will see that it is to support basic observation, not replace it.
You know your cat, you know when something doesn't feel right, you know when they are well.
Trust your instincts....if something doesn't feel right, ask and ask again how to solve it.

Your cat doesn't care what kind of a preshot it has, it cares that you are loving, talking to it without stress, and allowing it to continue to be a cat.

Look to the behavior of your cat along with the data you are gathering to be your guide, and your kitty will thank you for it in leaps and bounds..





*For Abby GA, who graciously accepted her role as sugar cat and never complained about my learning curve!
Written by Kimmee Sweetgrass with contributions by jojo and bunny(GA) and Y