#DiabeticCatWatch on the Wirral, UK

Hi,

my name is Mue and a week ago my cat Pedro the Spaniard, (the youngest of a litter of 3 cats I adopted when they were 5 weeks old in March 2001. Sadly we lost Sylvester, the oldest of the litter, in May this year.) was diagnosed with Diabetes, following fairly drastic weightloss and a few other symptoms which all of a sudden fell into place.

Following the diagnosis and the first couple days on diabetic wet cat food pouches from Royal Canin and insulin injections twice a day (U40, 2 units twice a day) a whole new world opened up to me as I read more about feline diabetes and when we realised that the supposedly healthy dry complete food from Hills Science Plan might very well have contributed to him getting diabetes. Gutted and shocked and so angry about this, about us not ever once questioning this and reviewing our feeding regime. >.<

Anywhoooo, friends mentioned a raw diet and we even have a couple companies locally who distribute and sell frozen raw cat food but after much consideration and talking to the vet we agreed to let Pedro and us settle into this new routine of insulin injections and all in a (wrongly perceived?) less stressful situation by sticking to the prescribed pouches and when we all have a better handle on it see to changing both his and Enzo Ferrari's diet.

As I read more about feline diabetes I also realised that the only way to get a REAL sense of how he is doing will be to home test him, so after watching a few videos on youtube I went to the pharmacy today and got a glucometer (*whispers* for free!!! I went in to BUY one and the kind pharmacist explained they had free glucometers for patients with diabetes. I explained I was going to use it for a CAT and he still gave me the machine. I was most grateful!!! Bought some extra strips though as the machine Freestyle Optimum Neo only takes Freestyle strips and I read to start off with you're likely to use more.) and so here I am trying to work out when and how we test since we are also all working full time. The vet we saw at the weekend said we can feed him the required food in smaller portions to prevent him throwing up. He said to inject 20 - 30mins after the final portion to make sure that these injection times stay constant (8am and 8pm for using the moment). Also started a sheet to note down his feeding times and injection times. And I am hoping to arrange to meet the vet at the weekend to arrange a mid day joined glucose test with their and my blood machine to check if they come out the same or if there are differences.

The injections are going really well, no problem at all (that placement at a hospital all those many, many, many years ago where I was permitted to inject heparin clearly paying off now!!!) and a week in we can already see a change in Pedro's behaviour. He started gaining a little bit of weight already (want to get baby scales to be able to monitor his weight more closely), his coat is in much smoother, I think we got there just in time.

He is however always hungry, ALWAYS! The vet says the insulin makes them more hungry...? It's unbelievable to what lengths he would go to get some food. I think we ought to give him a bit more food, but obviously I can't do that just yet without being able to monitor his blood sugars and respond to it accordingly? *sigh* Quite a bit more reading and understanding to do here.

Also have yet to work out how quickly to pre-order the next lot of food, we're going through a box of pouches like nothing! >.<

So, that's us.
Looking forward to the exchange here on the board and learning more about it all.
Wibke x

Welcome to FDMB!

You're using Caninsulin, as vets in the UK must start with that first and must show evidence it isn't working well before switching to another, and likely better, insulin for your cat such as Lantus or Levemir. The way you'll be able to document this is by home testing, so its great you've jumped right in! Caninsulin is a mixture of 2 different duration insulins and tends to have 2 peaks in effectiveness. One is around +3 to +4 hours after the shot. The 2nd may be around +5 to +7 hours after the shot. Total duration may be less than 12 hours; you'll see that with increasing test numbers from +10 hours post-shot.

Many cats are hungry because they can't use the food that they've eaten without enough insulin. When you get the food and insulin balanced, the appetite should be more normal. Until balanced, you may need to feed as much as 50% more food.


Can we get you started using our grid to record your glucose tests? It will help us give you better feedback. Instructions are here.

Understanding the spreadsheet/grid:

The colored headings at the top are the ranges of glucose values. They are color-coded to clue you in as to meaning.

Each day is 1 row. Each column stores different data for the day.

From left to right, you enter
the Date in the first column
the AMPS (morning pre-shot test) in the 2nd column
the Units given (turquoise column)

Then, there are 11 columns labeled +1 through +11
If you test at +5 (5 hours after the shot), you enter the test number in the +5 column
If you test at +7 (7 hours after the shot), you enter the test number in the +7 column
and so on.

Halfway across the page is the column for PMPS (evening pre-shot)
To the right is another turquoise column for Units given at the evening shot.

There is second set of columns labeled +1 through +11
If you snag a before bed test at +3, you enter the test number in the +3 column.

We separate day and night numbers like that because many cats go lower at night.

It is merely a grid for storing the info; no math required.

HI Mue and Pedro. Welcome to FDMB!

I'm in the UK, too. Great that you're home testing, and that Pedro's already feeling a bit better. I'm about to head to bed in a minute but I just wanted to say a quick hello! to you both. I'll check back in a few days to see how you're getting on and whether there's anything I can do to help you (moving house at the moment). Two quick things: assuming that diabetes is Pedro's only health issue, it's not necessary to feed a prescription diet. There are many commercial pet foods suitable for diabetics; and there are good deals on digital baby scales on Ebay.

Hi mue and pedro

Welcome to the forum. I live in the UK too (in dorset) and my cat remi was also started on caninsulin.

It agree its great that you are testing yourself and would be fantastic if you could get that spreadsheet up and working so we can see how he is going).

With regards food the online places are a lot cheaper places to buy the food and I really wouldn't worry about giving him more that you would do normally at this stage. If the glucose is not getting to where it needs to be then he will need more to keep going. I tend to give remi lots of small meals.

My routine tends to go like this

Test blood
Feed
Shot insulin
+2 test blood- feed
+4 food (I tend to test again)
+6 food

Repeat in the evening.

I am lucky that my situation at home allows someone to be around to give him the food but most people on here use a timed feeder. You can get them off amazon. You can also get the wet food off places like amazon, VETUK, zooplus and quite a few other places. I don't think you need to feed him it but I wouldn't change it immediately. Do some research and find a wet food that is low in carbs (less than 8% of calories from carbs) and slowly introduce it into his diet and monitor the effect on the insulin required. When I get to work I will find and. post the links to the UK pact food charts.

Ask as many questions as you like. You are with friends now

Hello hello!!

Thank you for the warm welcome and yes, will work the spreadsheet, definitely!!

Just called the vet to arrange the mid day glucometer appointment for Sunday and they are trying to push the alphatracks glucometer. I explained that this isn't necessary but she insisted that the freestyle one is calibrated for humans and not cats and that they use the alphatracks one and so do I. confused_cat

Is it true?
All the research and data pointed at the the human one being just fine. And even that the alpha tracks one tested too high. Is there anything I can take with me on Sunday to help make my case and convince them otherwise?

Mue x

Good morning, Mue. How are you and Pedro doing this morning?

There's no need to use an Alphatrak meter to test. It is true that human glucometers will give a different reading to pet-calibrated meters like the Alphatrak, but by using appropriate, scientifically determined ranges of reference numbers the human meters can be used very successfully to monitor blood glucose at home. Click on this link, then download and print the PDF entitled Management of Diabetic cats from the destination page. It's a copy of the published, peer-reviewed, scientific study by Roomp and Rand. Although the dosing protocol is for long-acting insulins like Lantus and Levemir, the study recommends use of human meters for home monitoring and will provide you and your vet with an example of scientifically determined human meter reference numbers and a guide to their Alphatrak equivalents. Rand is a world authority on the treatment of feline diabetes. I use an Alphatrak and they are expensive to run due to the cost of the test strips (cheapest I've found are £39.99 for 50 at Animed Direct online). I went for the Alphatrak solely because I have an anxiety disorder and it suits me better to use the pet meter. I've recently purchased a human meter so that I have a backup in case there was ever a problem with the Alphatrak. You can get strips for human meters much cheaper on Ebay than in bricks 'n' mortar pharmacies or supermarkets.

Following on from what Sarah said above about diet changes, I would add an important caveat. Now that Pedro is on insulin you will need to be very conscious of the percentage of calories that come from carbohydrates in his food. If the food he is currently on is relatively high in carbs then if you switch to a lower carb food you should test Pedro's blood glucose very frequently during the transition, especially in the first 24-36 hours since his insulin dose may need to be reduced. If you look at the sticky posts at the top of the Feline Health board, you'll find one that tells you how to calculate the carb content of foods. If you get stuck with working out carb values, post and ask for help with the calculations.

See my signature link Glucometer Notes for some feline glucose reference ranges using human meters in mg/dL or mmol/L, and for pet meters in mg/dL.

This website by Dr Pierson has loads of great info about swapping to wet food and there is a chart but it is geared for the US market and so some of the foods aren't available over here.

http://catinfo.org/

Here is the link to one list of UK foods. I am sorry but I forget who did it. I found it one this forum but it might be taken on Tayna's CKD website

https://docs.google.com/spreadsheet/lv? ... GtSd1dmWmc

Here is tayna's list
http://www.felinecrf.org/canned_food_uk.htm

and another by Dr Clark

https://docs.google.com/file/d/0B-mMJBQ ... view?pli=1

Does Pedro have any other health issues?

re the alpha trak. I was going to get one but it just worked out too expensive and the human one has been fine.

Since our UK members have already weighed in and given you a ton of great advice.

I'm only going to add one thing, and that is about insulin making him ravenous..No! it's not the insulin that is making him eat like a horse, it is either one of two things, either he is very low and his body is demanding that he eat to bring his blood sugar back up to normal levels, Or he is very high from not enough insulin and he is starving because his body can't process the food he is eating correctly. A well regulated diabetic cat on insulin eats no more and no less than a normal cat. Insulin is a hormone that is naturally produced in a mammal's body (any mammal, be that human, dog, cat or ferret) it is the key that allows the cells in the body to pick up and use the nutrients from the food they consume to fuel the body. Insulin has one job, and that is to unlock the cells of the body so it can convert glucose from the food digested into energy. That's it, that is all it does. When food is eaten and digested it becomes glucose, but glucose will just bounce off the body cells until the pancreas produces insulin, the insulin becomes the glue that sticks the glucose to the body's cells so they can absorb it and use it. Just with a diabetic their pancreas either isn't producing enough insulin or has stopped producing insulin altogether so we have to add it back in with shots.

If insulin increased appetite we would all be ravenously hungry all the time, because our pancreas just keeps producing insulin in response to us eating.

Mel and The Fur Gang

Hello,welcome,from another North of UK'r
I see you are getting good help and advise from other members of the forum,it's all very daunting when you first begin on this FD journey,but I am sure I speak for everyone on the forum when I say it does get easier,and what you thought you could never do or handle soon becomes routine.
You will find the experts that come to your quidance on this forum more experienced than most vets in dealing FD (words spoken by my vet! ) but should the need arise (and I don't know how far away from Chester you are) there is a specialist practise there with a feline vet that specialises in FD who has a very good reputation in the North West of England,the practise is called ChesterGates,and the vet is Ellie Madell.
Good luck. Diane & Bailey

Another option maybe for you to see if you can join the feline diabetes remission trial that is being run at the royal veterinary college. Give me an hour or so and I will find you the face book page. It is a really great trial and if remi wasn't on his asthma meds I would get him on it.

http://www.rvc.ac.uk/News/PressReleases ... clinic.cfm

https://www.facebook.com/RVC.Diabetic.Remission.Clinic

BaileyUK said:

Hello,welcome,from another North of UK'r
I see you are getting good help and advise from other members of the forum,it's all very daunting when you first begin on this FD journey,but I am sure I speak for everyone on the forum when I say it does get easier,and what you thought you could never do or handle soon becomes routine.
You will find the experts that come to your quidance on this forum more experienced than most vets in dealing FD (words spoken by my vet! ) but should the need arise (and I don't know how far away from Chester you are) there is a specialist practise there with a feline vet that specialises in FD who has a very good reputation in the North West of England,the practise is called ChesterGates,and the vet is Ellie Madell.
Good luck. Diane & Bailey

Click to expand...

I love the "north of UK'er comment" - I am originally from the Highlands of Scotland so that's very North!! Any of UK'ers from Scotland on this board?

Welcome Mue! You will find a tonne of helpful advice here...

Juliet and Silver

Oh, so many kind and warm replies, thank you so much!!! It really means so much and helps immensely!! Thank you!!

So yesterday I armed myself with a rice sock and my test kit and thought let's try!! It's surprisingly much harder than anticipated to draw blood from a cat. A problem which the other side certainly does not have... :lol:

Pedro was most patient with me as I tried to work up a drop of blood from his ear but I must have been a bit feeble in my pokes (two pokes a la buddy, still not enough blood) and eventually he looked at me with his head slightly tilted as if he was saying "Well, that was fun. Great effort Mue!! Let's try again tomorrow, shall we? I have to go now."

Went on to test the lancet pen on myself (had poked him "free hand" without the spring-loaded pen, and I had to go to the highest setting to actually pierce my skin. Glad to report that my blood sugar levels are just fine. ^_^

Well and then I read up and watched videos about the back paw pad and that's whay we tried this morning and yay!! Success!!!!! Pen even on highest setting wouldn't break the skin (tough pads...) but I then took the cap off and poked him by myself and voila, we had a beautiful drop of blood forming!! Test workedsuccessfully except I did it AFTER feeding him which then obviously showed as a crazy sugar high, like literally "HI" it said and 16.9 ohmygod_smile but I shall consider this first successful stab our test and we shall progress from here.

My question is, can I keep using the back paw pad instead of the ear? It was so easy to do, I was so worried about piercing his ear accidentally when I tried the ear... Not to mention that he has a kink in the edge on one ear *remembers the blood splatters up the kitchen wall when he came home after a fight with a small piece of ear missing and shook his head* and I was worried how that would feel for him.

Something else I read on here is about that new kind of partnership with our cats people noticed and goodness, that is true! He really is most open and it appears appreciative of me manhandling him, poking him, the injections. He purrs all the time and he really looks better already it seems.

What a journey!!
Right gotta dash to work!!!
Mue =^.^=

You can use whichever location to test that works for you.

And yes, I've pierced the ear. It does heal up. You've got to blot both sides to reduce scabbing and bruising on both sides.

Going in at an angle, instead of straight down, helps prevent that.

Woohoo Welcome to the Vampire Club, bet first you never thought you would hear that and secondly that you would ever be so proud to be a member!!! :lol:

My Autumn has a pretty kinked up ear herself, she was a farm cat before I adopted her as a diabetic, so she has a few battle scars. She doesn't seem to mind me poking her ears at all, I just try to avoid the scar tissue not because it seems to hurt her any just because it doesn't bleed well.

But if the paw pad works better for you two then go for it. As I told someone else recently about using the paw over the ear, Hey at least you have 4 to choose from, we who use the ear only have 2. ohmygod_smile :lol: Just make sure you clean it well before and after poking since he is going to use those footies to walk in his litter tray later.

Mel and The Fur Gang

Morning!!

I spent most of the night up to do some blood tests (although not regularly enough for a proper curve as it was in between reading more about curves, the spreadsheet [which kicks out the conditional highlighting on my mac. *cries*], and just generally about other people's experience here on this board). The more I read the more I realise just how complex all this is. And then when I mix in the first readings we get I beginning to see how the insulin we're giving him is working to some degree but not actually getting him as low as we would need to.

Am trying to work round the spreadsheet issue by keeping it online but then google messed me about last night with app passwords, resulting in me swearing profusely on FB, so will have another look later but just to share some data we have so far:

Friday evening:
PS (7pm): 22.8 mmol/l, then food and 2 units insulin
+2 10.6 mmol/l
+7 15.6 mmol/l
+9 25.5 mmol/l At this stage Pedro was pawing me and was ravenous, looking at any crump and fluff ball on the floor to check if it was food, so I gave him 1/3 of his food 'ration'

Saturday morning: (Accidentally slept past my alarm, damn snooze button!)
PS (8.30am): 23.4 mmol/l, then food and 2 units insulin
Will be testing every two hours from here for the day until the next shot but pulling this forward to 8pm again! Hoping to get a better (read: actual) curve for tomorrow's meeting with the vet at lunchtime.

I was wondering how the night numbers and day number will differentiate since in the human body at least the hormone release/composition is different. With cats being nocturnal I wonder how this is will show up. Anyone noticed differences?

Right, off to work again!
Mue x

Typically you will have a lower AM preshot value than a PM preshot

Larry and Kitties said:

Typically you will have a lower AM preshot value than a PM preshot

Click to expand...

I guess that's where the every cat is different cones in - my Silver's AMPS is always higher than the PMPS.

Juliet and Silver

KittyMom777 said:

Larry and Kitties said:

Typically you will have a lower AM preshot value than a PM preshot

Click to expand...

I guess that's where the every cat is different cones in - my Silver's AMPS is always higher than the PMPS.

Juliet and Silver

Click to expand...

Could be "dawn phenomenon". And some cats do better with a small snack overnight.

KleineMue said:

Morning!!

I spent most of the night up to do some blood tests (although not regularly enough for a proper curve as it was in between reading more about curves, the spreadsheet [which kicks out the conditional highlighting on my mac. *cries*], and just generally about other people's experience here on this board). The more I read the more I realise just how complex all this is. And then when I mix in the first readings we get I beginning to see how the insulin we're giving him is working to some degree but not actually getting him as low as we would need to.

Mue x

Click to expand...

It does take a while to get to the right dose and you might find that caninsulin doesn't last the whole 12 hours. The current advice is to treat diabetic cats with a long lasting insulin Lantus or levemir. caninsulin is an in and out insulin, can cause quick drops but also quick rises. You can see the effects of the two insulins if you look at my spreadsheet. Remi was first put on caninsulin and then we switched to lantus. I don't know if you saw my link to the diabetic remission clinic but it is worthwhile contacting them as even though I couldn't get on the trial because of remi's asthma Ruth from the trial spoke to my vet and she explained the benefits of lantus and the results they were getting at the clinic. This helped in my request to change to lantus. If you do get on the trial all treatment, medicine is free.

If you don't want to try to get on the trial but are interested in swapping insulin then you could print out and show your vet this document

http://www.felinediabetes.com/AAHADiabe ... elines.pdf

I don't want you to think caninsulin isn't going to help because it should do and you are doing great.

phlika29 said:

I don't know if you saw my link to the diabetic remission clinic but it is worthwhile contacting them as even though I couldn't get on the trial because of remi's asthma Ruth from the trial spoke to my vet and she explained the benefits of lantus and the results they were getting at the clinic. This helped in my request to change to lantus. If you do get on the trial all treatment, medicine is free.

Click to expand...

Definitely interested in the trial! I had a look at their website and facebook page and will email them today. ^_^

OH managed to get a couple readings and we now have our first little curve!! Yay!! *opens 'Numbers'*
Mue x

Critter Mom said:

Good morning, Mue. How are you and Pedro doing this morning?

There's no need to use an Alphatrak meter to test. It is true that human glucometers will give a different reading to pet-calibrated meters like the Alphatrak, but by using appropriate, scientifically determined ranges of reference numbers the human meters can be used very successfully to monitor blood glucose at home. Click on this link, then download and print the PDF entitled Management of Diabetic cats from the destination page. It's a copy of the published, peer-reviewed, scientific study by Roomp and Rand. Although the dosing protocol is for long-acting insulins like Lantus and Levemir, the study recommends use of human meters for home monitoring and will provide you and your vet with an example of scientifically determined human meter reference numbers and a guide to their Alphatrak equivalents. Rand is a world authority on the treatment of feline diabetes.

Click to expand...

Hi Critter Mom,
ignore me! Found it!!

*print*staple*prepare for vet*

Mue x

See also ny signature Link Glucometer Notes for a summary of reference values.

Hello, hello!! Quick update from us!

Spent Saturday 22nd doing our first daytime curve (although SOMEone in this household, who was left in charge of testing Pedro's blood while I was in work apparently can't read the clock and so +2 was more like +2 and 1/2 and then there was no +4 but a +5 instead and then I was home and things got back on track. *gnarl*hiss*growl*)

Aaanyhoooooooo, took a break from testing Saturday night and did another curve Sunday daytime to compare the data with the previous day and then of course to have that shared blood test with the vet to compare their AlphaTracks with my Freestyle Optium Neo.

I was armed with lots of info for the vet, printed out articles, the research study, and my curve on the iPad mini. The vet was 'new' to us but quickly caught up with Pedro and his diagnosis and what we have been up to the previous 10 days, and he was mighty impressed by it all and the amount of reading and work I had done, explaining that not many of his patients have owners who do this. I have been shattered and exhausted recently with work and life and family, and in addition to it all learning about and truly understanding feline diabetes, and so I felt really happy hearing this. I meant a lot. o He also understood that using the human glucometer was no problem at all and whisked Pedro off to take some blood and then brought me a syringe with some blood to use on my meter. Theirs (an Alphatracks) got 16.7 and I had 13.1, so pretty much the 30 - 40% higher reading as expected. Judging by the curve he recommended to increase the insulin to 2.5 units and he recommended to do another curve in a couple days.

For assorted reasons I was distracted Sunday evening and didn't complete the daytime curve and I didn't do a PMPS. *kicks self* Lost in work for the last couple days and didn't test again until this evening and was most astounded to see that the PMPS was now 17.7 as opposed to 22.8 and 24.4 a few days ago. Oddly though at +2 it hadn't come down and was still 17.10. 4.2 at +4 and just before at +6 we were on our way up again 9.4.

The sheet is brilliant and although I lost the conditional highlighting when I downloaded it I can instantly see what is going on. However, uploading it is a complete headache. My mac seems to be doing some unspeakable things to the formatting and no matter what I do I end up with a 44 page document ignoring my print margins, and blacking out the highlighted numbers and whatnot. Bah! I will keep tinkering with it but for now I added our data below.

So, here we are now, 1/2 a unit up and our first tests show a good response to this although it's not quite under control yet, vet was supportive and I felt we can do this and for a moment I thought: "well, if this is how it works and we can do this, maybe this is what we do for future cats, take in diabetic cats that would have no home otherwise." I must be mad, no? dancing_cat

Pedro is doing really well, but is still really really really hungry. We cannot leave any food or plates lying around, nothing. He will go for it with such determination and vengeance that it's only his meagre 3.2kg feather weight that makes it very easy to pick him up and put him on the floor and prevent him eating anything he shouldn't.

He is also immensely cooperative when it comes to the BG tests and the insulin shots, so much so that he comes when I call him for a BG test, he even jumps up on the sofa. Often I can do it with him remaining curled up for his sleep, I just hold on to his paw, I don't need to restrain him or anything. Same with the insulin shots, we can do them super quick and easy. My cat rocks!

After reading another thread on here before I thought I will have to test Enzo as well, just in case... *eak*

And I wanted to ask: my vets don't seem to charge me for the consultations I am having with them. I get charged for the syringes (20 for £13), the first day when I had him at the vets for the glucose tests (£6/test), the bigger blood works of course, I imagine for the insulin also (only had 1 bottle so far that was part of that first big bill), I think the sharp spin was free? Not sure, but what puzzled me the most was that I did not have to pay for the 2 follow up consultations I had, both at weekends so far. One veterinary nurse even asked the vet if they don't charge me and the answer was 'no'. Does anyone else have that? Not that I'm complaining, I am just stunned. It's great of course! Long may it last!!! This way I might actually seriously consider taking in another diabetic cat! Is it because it's diabetes?

Oh, and one more thing: When I spoke to the vet about the research study he was a bit apprehensive, saying that if the insulin we give Peds works than he wouldn't bother. He explained that the insulin used in the study is one that has been taken off the market for vets across Europe and that they would be frowned upon for prescribing/using it as people would say (and I quote) "We can't give it to pets while there are people dying from diabetes". So, surely the insulin for cats is not the same product as is used for diabetic humans, no? I couldn't quite read where he was going with it, if he felt joining the study would mean taking business away from them (but then they don't charge me for consultations?) or what exactly was going on there. Thoughts?

Well, time for the last test of the night and then off to bed for a couple hours. *sob*

Hope you're all well with you and your cats!!
Mue & Pedro x

ps: +8: 20.7 >.< That's a bit of a climb...


22/11
AMPS: 23.4 U: 2 +2: 16.8 +5: 10.8 +7: 14.4 +9: 21.1
PMPS: 24.4 U: 2

23/11
AMPS: 24.4 U: 2 +2: 17.1 +4: 13.1 +6: 17.0 *mutters something about being distracted by clearing out clutter and cooking dinner and stuff...*
Vet advised to change to 2.5 units and do another curve in a couple of days.

25/11
PMPS: 17.7 U: 2.5 +2: 17.1 +4: 4.2 +6: 9.4 +8: 20.7

I believe with Lantus coming off patent and generic versions becoming available, using an insulin developed for humans which works for cats may be less of an issue.

Nice 4.2 nadir! (75.6 mg/dL for US folk). Right where you want him to go, without getting too low.

Hi

I will reply more fully later on but you dont need to buy your syringes from the vets. I get mine from VETUK and they are a lot cheaper. I actually have nearly a full box of caninsulin syringes that you can have. PM me with your address and I will pop them in the post.

Best wishes

Sarah

If you continue with Caninsulin, we have a conversion chart for using U-100 syringes with U-40 insulin.

The math is like this:
U-100 means 100 units per mL
U-40 means 40 units per mL, 40% of the concentration of U-100.
That means you have to adjust the values on a U-100 syringe to 40% of what they indicate
% * Mark = U-40 dose
0.4 * 0.5 = 0.2 units of U-40
0.4 * 1.0 = 0.4 units of U-40
0.4 * 1.5 = 0.6 units of U-40
0.4 * 2.0 = 0.8 units of U-40
0.4 * 2.5 = 1.0 units of U-40
0.4 * 3.0 = 1.2 units of U-40
etc

The sheet is brilliant and although I lost the conditional highlighting when I downloaded it I can instantly see what is going on. However, uploading it is a complete headache. My mac seems to be doing some unspeakable things to the formatting and no matter what I do I end up with a 44 page document ignoring my print margins, and blacking out the highlighted numbers and whatnot. Bah! I will keep tinkering with it but for now I added our data below.

Click to expand...

Not sure why you downloaded the spreadsheet doc. You can simply open a Google account, save the spreadsheet template under a name unique for your kitty and then sign on to your google account to keep the SS updated.

phlika29 said:

...I will reply more fully later on but you dont need to buy your syringes from the vets. I get mine from VETUK and they are a lot cheaper.

Sarah

Click to expand...

Like Sarah, I get my syringes from VetUk which makes them cheaper than from the vets; and they also do their own 'generic' version of some syringes too, which may or may not suit your purpose. They sell their own version of U40 syringes which are much cheaper than Caninsulin syringes (but do check as to whether they have half unit markings....). And if you switch to U100 insulin (Lantus, Levemir, or Hypurin PZI) then they do BD half-unit syringes at a good price too.

Oh, and welcome to another UK'er! (Sorry not to welcome you sooner, but my old computer 'died' so I've not been around here much lately (but I've just got a new one (Woohoo!))

Eliz

Heyup from Leicester!

Any advice on how I can get Nipper switched from Caninsulin to Lantus?

At my appointment for the diagnosis, I did not realize that UK vets have to prescribe Caninsulin first. When the vet suggested Caninsulin, I said that it was my understanding that cats' metabolisms are too fast for Caninsulin and it doesn't last 12 hours. She cut me off and said that that was not her clinical opinion and she'd been treating diabetic cats for years etc etc.

I'm trying not to do too much testing since Nipper only puts up with so much in a day, but I plan to get a few data points today and tomorrow and then increase her dose from 1 U to 1.5 U this weekend and do a curve. (Vet wants me to increase from 1U to 2U.) Based on her first curve it wore off by +6, but that could have been her body freaking out about its first insulin dose.

Just trying to figure out how much data I need to get her switched to Lantus.

Cheers,
Lor

All you need is data BG that show that the Caninsulin is not work sufficiently well.
To do that yo will need both many preshots as well as curves or mini curves. You need to show how the cats's BG changes with respect to time. Thus you need both a preshot and BGs measure hours after the shot.
You also need to try different doses of insulin but have to wait at least three days before changing the does.

I did a couple of weeks on canninsulin and made it clear to my vet that I was concerned about the low peaks and fast in and out action of the insulin. I phoned Ruth who is running the RVC remission trial and she kindly explained the benefits of lantus (which I wrote down and used as further reasons) but more importantly I asked Ruth to phone my vet and discuss the benefits of Lantu with him and she kindly did just that. This helped immensely and she would no doubt do this for you as I know she has done it for others.

Alternatively just refer yourself and you cat to the trial and get all of your medicine, food, testing equipment and support for free THe only reason remi didn't get on it was because he has asthma and needs inhaled steroids.

Since you're having some testing issues, take a look at my signature link Secondary Monitoring Tools for some additional assessments you might note on the spreadsheet - water and food intake, elimination notes, weight, dehydration, and beahvior observations. These can provide important clues to evaluate your cat and are useful when visiting the vet as they can refine treatment.

Just caught up with the thread! This board is just amazing!!! You all totally rock! :RAHCAT Every post I learn something new and more pieces fall together into a bigger picture!!! ^_^

will pm you, Sarah!! Thank you so much!
Mue x

For anyone in the UK I was reading that the Royal Veterinary College are also looking for blood samples from diabetic cats that aren't on there programme. They don't have to be recently diagnosed

We are also interested in receiving blood samples from all diabetic cats, regardless of duration of diabetes mellitus. In return we are offering free fructosamine, cholesterol and triglycerides, please see the sample submission form below. Newly diagnosed cats (diagnosis within the last 6 weeks) are also eligible for follow up samples for 4 months.

http://www.rvc.ac.uk/research/research- ... ion-clinic

Sorry Mue for sort of hijacking your thread with this info.

A working spreadsheet. I has it!!!

dancing_cat

Mue x

ps: Do you all know Adam Koford's Laugh-Out-Loud cats? Kitteh and Pip? (http://hobotopia.com) A while ago he regularly took requests for cartoons he'd draw and publish, I got a couple of them. Maybe we should ask him to do some feline diabetes related ones!! To raise awareness or raffle off to raise funds or similar?

I can see your spreadsheet. PLEASE TEST AGAIN NOW.

We recommend folks not shoot below 200 mg/dL or 11 mmol/L.

Do you have high carb food? Karo syrup?

If it has been more than a couple of hours, you may need to go to a veterinary emergency facility asap.

I kept checking your spreadsheet for updates and haven't seen any over several hours. I hope your cat is OK.

Oh, gosh!

I do so hope your kitty is OK. Please do update us and let us know how things are...

Eliz

Mue

How is Pedro?

His preshot level was very low last night and as BJM said it would have been better not to have shot on that level. It is likely that he went very low afterwards. You need to start getting one or two evening tests, maybe a + 1 and a +2 and then people can advise as to whether you will need to test more.

This is the trouble with caninsulin you get some very steep drops. You do with other insulins too but caninsulin can be harder on the kitty.

I would recommend that you don't shot the 2.5 unit this morning but ask advice from the board. Start a new thread and make sure the title indicates what you want ie the date, his preshot number and request advice on dosing.

Do you have your hypo kit ready?

Oh poop! Only just seen this. Stressful and complicated evening yesterday for various non-cat-related reasons.

Did give insulin last night and this morning as well, he was AMPS 16.5
I double checked to see if I didn't just twist the numbers but he was really that low last night. And now I understand why he desperately wanted to steal Josie's Nutella bread. >.< He managed to get a wee bite before we took it off him and shortly later had a sneaky lick of a smudge of Nutella from her plate, that might have been enough to help him boost his blood sugar levels a bit to see him through.

He was fine this morning, slightly lower BG than the last couple of mornings.
Must be more vigilant and put printed glucometer notes into my testing kit!

Thank you all for your help! Will start new thread after work and keep you posted!
Mue x

Mue

It could also be a bounce from where he went so low. Have you left food Out for pedro?. Little meals and often work better. Remind me are you using a low carb wet food. Do you have a higher carb food available. Is there somone at home to watch over him today and feed him.

Begging for food, wide pupils and more vocal can be a sign he is dropping very low. Once my cat remi gets to 3.8 I start to be on alert for a hypo situation. I personally crack out the high carb or honey and low car food once remi gets to 3.2 and certainly go into full hypo mod once they get to3.0.

Without testing during the cycle it is hard to tell what happened but it is likely he went low enough to earn a dose reduction. Other more experienced members will be able to advise more.

From now on ideally you want to post up your blood glucose results each day and ask members for advise to enable you to get the dosage right and keep pedro safe. You also should sim to get more tests in your cycle to see what is happening.

If you go the bottom of your thread you can see that you can both bookmark and follow this thread and any other thread. That way you get notified by email if someone replies.

I'm glad he survived! Please be careful - he may be more sensitive to insulin from going low. That has been reported by numerous folks on this board.

For safety:
- Don't shoot under 8.3 mmol/L (150 mg/dL).
- Make sure he eats 15-30 minutes before you shoot, so there is food on board to buffer the drop.
- I think I'd reduce by 0.5 units, given he may be more sensitive to insulin now.
- When you get a chance, run a curve and test every 2 hours from preshot to preshot
- Read, maybe print out this Vetsulin Guide. Discuss it with your vet.

High morning numbers can be from too much insulin, going too low and/or dropping too fast. This triggers the release of stored glucose (glycogen) by protective compensatory hormones. As long as the reserve can outpace the insulin, the cat can survive.

A hypo can cause permanent neurological damage or death. Better too high for a day, than too low for a moment.

*sigh*

I feel we have just unlocked the next difficulty level of feline diabetes.

Just home from work, starving cat, so fed 1/2 a pouch, 1/3 of his evening meal. Tested him before I gave him the food and he was 4.7, which is technically the +8. Would be a fairly long nadir, god knows how low he came earlier if this is him on the way up again. >.<

Having re-read the glucometer notes I reckon a lower dose of insulin is definitely in order.

So, how does feeding him in small increments influence the BG levels? Surely I now will get a completely different BG value than I had before when he had no food since the morning, no?

I wonder if I should check him again before the next increment of food and again before the final third...? Poke central. And then +2 and +4 and throughout the night really.

Also wonder if I should lock him in while we're out to avoid him getting food elsewhere or not to since he is clearly clever enough to seek high carb when he needs it like he did last night.

I should just put him in a sling and have him on me all the time! I run a small business helping parents find the right sling, wrap or carrier to carry their babies. He could become a shop cat... He'd hate it, no doubt. >.<

Anyhoooooo, will feed kitten the next lot of food and if he lets me take his blood sugars although it's 1.5 hours since his last check, that's a bit in the middle. Waaaaaaaaaaah.

Mue x

Most cats on the forum are either free fed ie wet food down all the time or feed in small amounts as this eases the stress on the pancreas.

You must make sure you don't feed him 2 hours before his next insulin dose so that the reading is not affected by food. This is what I do:

Test before his next dose, feed and give insulin all within 15 minutes of each other.
Test at +1 to see what is happening. If he is dropping even with the previous meal I will give more food to slow down the drop
Test again at +2 and give his second meal if I didn't give any at +1
Test at +4 and feed
Test at +6 and feed again (at night I don't retest at +6 I usually just feed)

A lot of people can't test as much as I do but as long as you get some tests in that will be useful. The only time it matters about food affecting the test is the pre shot one. Other than that it all just adds to the picture and you can see how food influences his levels.

You are right you have reached the next difficulty level. As his numbers drop lower you are getting close to hypo risk and this is where it becomes important to monitor closely, adjust the dose and ask the advice of members here. I think you have had a couple of close calls and now is the time to adjust how you monitor him, feed and the amount of insulin he is given.

I find it easier to do all of this by giving his shots at 6 am and pm. If you do change the time this has to be done slowly only 15 minutes per day.

Tonight I would test at +10 (no food afterwards) and then +11 and 15 minutes before his insulin is due. Start a new thread and post his numbers in the title and ask for advice about dosage if you are not sure what to give but please follow BJM advice to decrease by 0.5 unit and don't shoot if he is below 8.3. You can always delay giving the dose by waiting another 15 minutes without giving food and seeing if his numbers come up by itself. They often do and then it might be safe to give it.

Don't worry about giving more food that he is officially due, until he is fully regulated he probably needs a fair bit anyway. Vets often think it is better to only feed at shot time but this advice as far as I am aware if more appropriate for dogs (what caninsulin was designed for). If he is hungry after his dose then I would give him food.

Hope that helps. I know it is difficult to fit it into your lifestyle but it does get easier.

With Caninsulin or Vetsulin or any of the "in and out" type insulins, you have a lot more flexibility on changing your shot time. With the longer lasting insulins like Lantus or Levimir, we do suggest that people try to only change the shot times by 15 minutes each cycle or 30 minutes each 24 hour period. That is because these longer lasting insulins can stick around longer than the 12 hour shot cycle and you can get overlap and an early nadir. That is what happened for me when my kitty Wink was still on Lantus.

So, go ahead and change your shot time with the shorter acting insulins, even an hour or 2 should be ok. Just be sure to get those pre-shot tests so you know if you need to stall the shot and food, reduce the dose this time, or skip the shot entirely.

Deb & Wink said:

With Caninsulin or Vetsulin or any of the "in and out" type insulins, you have a lot more flexibility on changing your shot time. With the longer lasting insulins like Lantus or Levimir, we do suggest that people try to only change the shot times by 15 minutes each cycle or 30 minutes each 24 hour period. That is because these longer lasting insulins can stick around longer than the 12 hour shot cycle and you can get overlap and an early nadir. That is what happened for me when my kitty Wink was still on Lantus.

So, go ahead and change your shot time with the shorter acting insulins, even an hour or 2 should be ok. Just be sure to get those pre-shot tests so you know if you need to stall the shot and food, reduce the dose this time, or skip the shot entirely.

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Thanks deb for the correction I am so focused on the lantus I had forgotten that caninsulin was more flexible in dosing times. I would hate to give out the wrong advice and it stay out there.

Cheers.

Apologies for bumping this thread, just that i saw this reply and wanted to ask about it. my own cat was fine until oct/nov time when suddenly she began to drink more and more. glucose is in her urine when we test. she was on 3 1/4 units twice daily (caninsulin) and the vet did a glucose curve (without feeding like we feed her - found out afterwards they are supposed to do curves with the same food regime she would get at home - so her numbers will not have been correct since her diagnosis in feb 2013, i believe) and decided that she needed to drop to 2 units twice daily. it hasn't curbed the water consumption and after toing and froing she is now on 2 3/4 units twice daily. we have tried and been unsuccessful a couple of times in home testing (the cat won't bleed, lol, and then she gets annoyed with us prodding at her) so we have to rely on the vet's numbers.

anyway, the vet is insisting that we feed her only when she gets her insulin, and that we should not be feeding her at any other time. i informed the vet that was how they told us to feed her, as she was used to being fed this way. and try telling a 15 year old cat her food regime is going to change
so she has been meowing quite a lot for either food or water. during the day is annoying, but not as much as during the night when we are trying to get sleep, and she is meowing often.

she is on royal canin diabetic and she gets 72 grams of dry food per day, and upto 2 pouches of wet (on occasion it has been more, but no more than 3). over 12 hours we gave her 24g dry and 1/2 pouch wet at insulin shot and then 12g at +6 hours, and the rest of the wet food (1/2 pouch) is given whenever she gets too noisy (we do ignore her for a while, ha!) and usually in 1/4 pouch increments.

like i said, she was fine for the 18 months previous, but come oct/nov last year, she changed. we had swapped the amount of food she gets +6 hours after insulin shot around, as she seemed to be hungry at this time, in comparison with insulin shot time. so she got 12g dry with 1/2 pouch wet with insulin and 24g dry at +6 hours.
we have a schedule sheet and we note what she gets (but not always the times of her in between insulin nibbles, only the amount). when she gets near 10/11 hours after insulin shot, she seems more hungry.

now, i saw this reply and it strikes a chord with me.

MommaOfMuse said:

I'm only going to add one thing, and that is about insulin making him ravenous..No! it's not the insulin that is making him eat like a horse, it is either one of two things, either he is very low and his body is demanding that he eat to bring his blood sugar back up to normal levels, Or he is very high from not enough insulin and he is starving because his body can't process the food he is eating correctly.

Click to expand...

how do we figure out if this is an issue, that she might be too low, or too high?? we keep trying to tell the vet the cat needs a higher dose, but when i spoke to her last week, she insisted we feed her less, cut out the wet food, as she was eating too much. we will gladly do that if it shuts her up meowing all the time, i can't remember the last time i had a proper night's sleep!!
she is a big cat, bigger than a 'normal' cat, we think she is part maine coon. so she does weigh quite a bit, but she has lost weight recently (i wonder how, if we are feeding her too much?). we know she is bigger than most cats, but like humans, we are all not built the same, and should therefore not be treated the same! my opinion anyway, maybe i am wrong!!

during the last glucose curves (she got one on monday, insulin was reduced to 2 and we had to get a repeat curve on friday to make sure that dose was ok) the vet said her blood sugar was 'normal' until around 1pm, which would have been about +5 after insulin, when it went high. i really can't remember numbers, and what this even means...

it annoys me that the vet it basing her ideas of diabetic treatment on her other patients - quote 'all our other diabetic dogs and cats eat twice per day'. i have seen plenty of people on here mention they give their cats food throughout the day. who do you listen to?! i am more inclined to listen to this forum, as you guys have a LOT of experience. i just wish we could get home testing done, but Kizzy is not the most patient cat, she doesn't like us doing things to her. if i cut her claws, my sister will hold her and i get a few claws done, then she wants put down, so this takes a few attempts, haha! she growls, spits and swipes her claws at us if we try to brush her! i'm painting a bad image of my cat, but she's so affectionate otherwise! you can look at her across the room and she will start purring at you and she LOVES getting attention, she loves head rubs and belly rubs!

apologies for the long thread, i'm just frustrated (everyone in the house is) that we can't get her back under control. it won't be doing her any good, i don't think, to be uncontrolled.

i wonder, if getting her curve numbers from the vet, would help you guys help me?? i'm sure the vet would give me them?!

any advice greatly appreciated!

The secondary monitoring link i had previously looked at, and the main one is obviously the water consumption and therefore urine output. As she uses a litter tray atm (she is mostly an indoor cat in winter) we are able to catch her pee in a little container before it hits the litter, for testing. No ketones, just glucose. So on the one hand, no ketones is a great sign.

She meowed about 20mins ago, so I gave her some food, she meowed 10mins later (she needed to pee - sometimes she just has to tell us first, lol) and then she meowed a few minutes later and so she was brought upstairs and is now lying purring beside me. So of the 5 Ps list, she is only down on 1!
And despite her water intake and urine output, she is not dehydrated, so that is a good thing, too.

As for weight, I'm not sure what her ideal weight should be. I've used calculators online and they don't give a perfect idea. Usually you have to choose what type of body they have, and there is not one that fits Kiz! I can feel her ribs and spine no problems, but she does have a 'belly'. Under all the fur, she has quite a skinny neck, no double chins, lol! She is still bald under her chin, from a fructosamine blood test, it keeps taking longer and longer to grow back! But so lovely to touch! Pretty sure if we shaved her all over she would lose quite a bit of weight, lol!
As I've said, we think she is part Maine coon, so putting just a domestic cat into the type of cat on a calculator, said she was overweight, but saying she is Maine coon, says she is an ideal weight. I would split the difference! We are going to try and weigh her at the same time every week, to see how she does in that respect. A little off slowly would be great, of course it would, we just don't think she's as overweight as the vet thinks she is. To be fair, the vet we are speaking to now, has never seen Kizzy, only going on her notes. We don't always see the same vet at the practice, and each would contradict the other, so this vet now seems to have taken charge and claimed Kiz. We have not seen her before as she is only part time and only works certain days, days we have not taken Kizzy in. I had mentioned to her something I was told by another vet there and she said straight away that he was wrong, so hopefully if we can stick to the same vet, we will get more consistent advice.

Onto blood testing! We have tried both ear and pad. I used a back foot pad, gave it a clean, pricked it and even squeezed it and hardly any blood came out. I am using the lancet pen that came with the glucose meter and is obviously intended for human use.

Maybe I am not using a big enough lancet? You know, to create a big enough whole for enough blood to come out? Or maybe it is not going deep enough? I do have it set on the deepest setting. But I would assume that paw pads are a bit thicker skinned than human fingers! We do have another couple of lancet needles, just hand held ones, I will look them out tomorrow and see if there is a size on them, maybe they will prove to be better.

Thank you.