I'm new here and boy do I have a trillion questions

Hi Everyone,
I am Lisa, mom to Fluffy and 5 other cats. Fluffy is 9 and was diagnosed a couple of weeks ago. She has been losing weight and always hungry, so I took her to the vet and her glucose was 295 so they said she was diabetic. I had been previously feeding her dry food, and I switched her to wet. (I have 6 cats - they have been traditionally grazers)

She just started vetsulin last Thursday. The vet told me to give her 2 units one time a day. On Monday she had a hypoglycemic episode and late that night I went out and got the glucose monitor and have been testing her for only 2 days now.

Her first test yesterday morning was 205. I tested her around 2 pm and it was 156. I tested her prior to her dinner and it was 151 so I did not give her any insulin. I called the vet in the afternoon about the hypo and to let him know I bought a kit and he said "well 2 is a very tiny amount, so she should be ok, but if you want to cut it back it is ok, but don't give her any today since it was 156" and now I am concerned that this guy doesnt know what he is talking about after posting some questions over in the FB group.

I did NOT give her a shot last night, fed her wet food as usual, tested her this morning before I fed her and it was 125. I fed her dry food mixed with cooked chicken and water this morning. She ate it up.

First of all, I did not know about testing, then feeding then waiting a half hour before sticking her, which is probably why she had the hypo. She weighs only 5.2 pounds so 2 units may not be a lot for other animals, but hello. she is only 5.2 pounds.

Here are my questions to start:
Can I skip shots if her bg is good? What is a bad number?
What range am I looking for?
How do I get her to sit still while I am trying to stick her in the ear?
How often should I test her?
Shouldn't I be giving her a shot twice a day since I have learned that vetsulin is only good for 12 hours, and maybe I should give her .5 in the am and .5 in the pm if her bg is high?
Where is this spreadsheet you speak of? I am trying to navigate this board, but my brain is going a million different directions (my daughter passed her drivers license test yesterday - doing college applications and other stuff)

Sorry this is long. I just want to cry I am so confused and worried about Fluffy.

 

@Panic

@JanetNJ

@Deb & Wink

@Wendy&Neko

Thank you ladies

 

Breathe! You're heading in the right direction, and daresay you seem to be understanding how insulin works better than your vet.

Let me get some extra info from you.

What food specifically is he on? Wet and dry brands please!
What glucose monitor are you using? Is it Alphatrak or a human meter?

I'm going to paste a general info list that I keep on-hand with info for spreadsheets, Vetsulin, testing and emergency supplies. Please go through it and ignore anything you already know, it's just copy+pasted

Spreadsheet Instructions (if it's too confusing we can have a mod set it up for you)
Signature Instructions

Vetsulin Notes:

Vetsulin is a canine insulin, it does not work well in felines. That said, it's not impossible to use or get into remission with, but if the cat will require insulin therapy for a long time, we recommend switching to a feline-appropriate insulin such as Prozinc or Lantus from Marks Marine Pharmacy. Lantus is obscenely expensive in the US so most of us buy from Canada at a third of the cost. In the meantime, Vetsulin should be used with food already on board prior to administering insulin. Test, feed, waiting 20-30 minutes, then give insulin. Since Vetsulin hits felines hard and fast, it has a relatively short duration, so for many cats it only lasts 3-5 hours instead of the full 12, so Vetsulin will drop down very quickly and be very high by next shot-time. Because of this you want to be testing 1-2 hours after administering and feed small meals every hour the first few hours to help slow the drop of BG. This includes the night-time cycle, so an auto feeder is a great benefit.

Hometesting Kit:

Hometesting Tips and Tricks
ReliOn Prime glucometer - $9
ReliOn Prime test strips - $18 for 100
ReliOn Lancets 26 G (or 28 if unavailable) - $1-2 for 100
ReliOn Lancing Device (optional) - $5
Travel-size Vaseline - $1
Neosporin Ointment + Pain Relief (ointment only, NOT cream) - $6
Cotton Pads (optional) - $2
Rice Sock or Pill bottle w/ warm water (optional) - homemade

You can use any kind of human meter, however the one listed above is Walmart brand and has the cheapest strips available. Same goes for lancets. You do not need a lancing device if you prefer to poke freehand, it's just personal preference. Vaseline is for helping the ear to bead up, neosporin is for helping the ear to heal/prevent bruising after the poke. Just a little dab of each. Cotton pads are optional, some people like to use them as backing so not to poke themselves, then to hold the ear a moment after to prevent bruising and stop bleeding. You can use a paper towel or your fingers if you prefer. Rice socks can be used in the microwave a few seconds to heat up and rub on the ear to draw the blood to the ear; it can also be used as backing when poking the ear. A pill bottle with warm water in it is another alternative to warm the ear, whichever thing you prefer to use.

Hypo Kit Supplies:

Hypo Kit Toolbox
Karo Syrup - $3
Ketone Test Strips (Ketostix) - $6
A few cans of Fancy Feast Gravy Lovers Marinated Morsels/Sliced in Gravy/Grilled in Gravy varieties - $0.60 each (these are your medium-carb cans)
A few cans of Fancy Feast Gravy Lovers/Medleys Tuscany/Medleys Gravy in Sauce varieties - $0.60 each (these are your high-carb cans)

Medium Carb is 11-15%
High Carb is 16%+

You can also search through the catinfo chart while you're at the store to check which cans available are the ones you need. They don't HAVE to be Fancy Feast but they're fairly easy to find.

I'm referring to a human meter, but non-diabetic numbers are 50-120. If Fluffy is below 200, we recommend skipping the shot when you are first learning and collecting data so you'll learn how Fluffy reacts. Any time you get a number below 90 - no matter what time during the cycle - you drop the dose by 0.25 units and keep it there unless it warrants another reduction OR after a week the BG creeps back up.

Generally you want to see pre-shots over 200, you'll see a dip, preferably no lower than 90 on Vetsulin, then it go back up by next shot-time. If it is higher than this, do not fret, do not give more insulin than recommended. The numbers will come down when they're ready if you are patient and following a dosing protocol. For Vetsulin that is Start Low, Go Slow, which has you starting at a fairly small amount (2 units is a LARGE starting amount - your vet needs to remember that you have a kitty, not a dog!) and doing spot-checks every cycle and after a week increasing the dose if numbers are consistently above 150.

Depends on the kitty! Some people have to burrito their cats with a towel, others kind of kneel and keep them between their knees. Offer treats when you're testing and make testing a rewarding time. Some people sing to their kitties. I just put my girl in my lap. Whatever is comfortable for Fluffy - remember with cats and resistance, less is more.

Every time before feeding/giving insulin, and then ideally if your schedule allows, 1-2 hours after administering and a couple more times earlier in the cycle to make sure he is doing okay. A low number all of a sudden is an indication for you to step in and intervene with food and post here for help! At night we recommend getting in at least a "before bed" test.

Yes and yes. .5u might be a good place to start actually. Make sure you are checking for ketones when you do this though.

I pasted the link near the top.

 

Hi Lisa,

Welcome you and Fluffy.

If a cat doesn't need 2 units of insulin then such a dose is anything but small. Indeed, 2 units is a high starting dose for a cat - even for bigger cats. The manufacturer's current dosing guidelines for a cat running around the 295 mark at time of diagnosis indicate a starting dose of ONE unit of Vetsulin (aka Caninsulin) twice a day.



I can fully understand your urge to cry (and you wouldn't be the first one to arrive here feeling that way!). You've had a bit of a baptism of fire, but it will get better. I'm glad you've found FDMB, and very well done for starting to home test.

Before I start answering your questions, please can you let us know:

* the meter you are using to monitor Fluffy's BG levels.

* the wet food you're giving now, and also the dry food Fluffy was eating before diagnosis. (If you already know the carb levels that would be helpful, but we can find out for you if you don't.)

* whether Fluffy has any history of testing positive for ketones or any episodes of diabetic ketoacidosis (standard safety question).


Mogs
.

 

@Panic thank you Elizabeth

 

• when you get a chance ,It would be helpful if you can set up your signature so we don't have to ask you the same questions over again. Members will look at this first . Members would have to look up your previous posts to see what insulin you are using
• It appears after each post in gray, look at mine,

• On the left, under Settings, Click on Signature. This is where you will put information that helps us give you feedback.
• • There is a limit of two lines which may include two links; you may separate pieces with commas, dashes, | etc. This is where you paste the link for your spreadsheet, once it is set up.
  • Add any other text, such as
  • Caregiver & kitty's name (optional)
  • DX: Date
  • Name of Insulin
  • Name of your meter
  • Diet: "LC wet" or "dry food" or "combo"
  • Dosing: TR or SLGS or Custom (if applicable)
  • DKA or other recent health issue (if applicable)
  • Acro, IAA, or Cushings (if applicable)
  • Spreadsheet link. Please put the signature link on the bottom line of your signature information, on its own, so it is easy to find.
  • Please do not put any information about your location in the signature for security reasons. If you wish to add your country location, please add it to your profile.

Be sure to click the 'Save Changes' button at the bottom. If you need help urgently it is important we know these things at a glance. We don’t want to waste valuable time finding out information.


tap on your avatar where it says your name ,then hit profile page ,tap on that ,then go up to the very top, upper right hand side and tap on your name ,it will bring down a drop box, tap on signature, the signature will be under settings, tap on the signature then and you can start to add what I posted above, make sure you hit save ,
Welcome to the best place you could ever be and an awesome group of people
You can also add where you live in your profile, not your signature

This is at the bottom of every ones post in grey

 

In case you decide to switch



https://rxcanada4less.com Marks Marine pharmacy

Here is the link for Canada with the pens we use them like a vial because with the pens you can only increase or decrease by whole units, so you would just take your syringe and stick it in the little grey rubber stopper and just draw the insulin from that







Lantus Solostar Cartridges 5x3ml per box (temp. gauge. ice pack, express-air mail) Brand 100u/ml 15 ml $159.99 USD

Lantus Solostar PEN CAN (temp. gauge. ice pack, express-air mail) *single pen open box* Brand 100iu/ml one pen 3 ml $49.99 USD

Lantus Solostar PENS 5x3ml per box (temp. gauge. ice pack, express-air mail) Brand 100u/ml 15 ml $164.99 USD

Lantus VIAL Insulin (10ml per vial) (temp. gauge. ice pack, express-air mail) Brand 100u/ml 10 ml $110.99 USD


Like I said you are better off buying the 5 pack of pens
They will last you way over a year depending on how many units you give
After your vet writes the first script you won't ever need another script.
Call them and will tell you what to do
They are very nice people

Oh when you buy the pens they will have an expiration date on them
Most likely 2022 or 2023 by now.
Put them in the frig , a middle shelf
As long as you don't puncture them they will be good until the expiration date
So you are actually saving a ton of money


We also use syringes with half unit markings.
We increase or decrease by 0.25 units at a time.
It makes it easier using the half unit syringessyringes
For Lantus you will be using U-100 syringes
Have your vet write the script for the 5 pack of pens

 

Marje very recently updated the spreadsheet templates and instructions. Here are the new links (from the Tech Support section):

How to Create a Spreadsheet

How to Use the Spreadsheet


Mogs
.

 

@Critter Mom
Thank you Mogs was just about to do that

 

If you need help with setting up the spreadsheet let us know , we have a wonderful member that will do it for you

 

You snooze, you lose.




Mogs
.

 

Lol you are making me laugh
Mogs how is noodles doing, I have been reading your posts on Blues threads

 

If you don't mind, Diane, I'll keep the updates to Blue's threads. I don't want to hijack Lisa's thread.


Mogs
.

 

Okey Dokey Mogs you are absolutely right, I will always look for your updates on Blues threads

 

Hi Lisa , just wanted to make sure you are testing, then feeding , and then wait 30 minutes to shoot vetsulin .
Only withhold good 2 hours prior to testing AMPS and PMPS , you don't want the BG to be food influenced

 

Lisa, I posted on your thread in the Facebook group. If you'd like some help with setting up a spreadsheet, please just send me a private message. I'm happy to help you! I do them for lots of people! I know you're already under a lot of stress with everything that's happened with Fluffy already, so if I can reduce some of that stress by helping with the spreadsheet, I'm happy to do it!

Just let me know! This is ME on Facebook or you can click on my name here and choose "start a conversation" to send me a message here.

 

This is an accurate determination. This dude is an idiot. I am sure the posts above have explained it all but yeah he’s clueless. Double the starting dose that is recommended, and vetsulin needs to be dosed twice a day. Dry is super high carb and your cats bg at the vet wasn’t excessively high. If you changed to all wet your cat may only need a tiny bit of insulin 0.25-1u) or none at all. Im so glad you came here.

 

the monitor is CVS True Metrix

the dry food is Meow Mix regular.
I have the Aldi brand wet
There is no history of the last question and sorry- I don’t know what that even is.

 

Thanks. I will take a look at the spreadsheet and let you know.

 

What is AMPS AND PMPS?

 

AMPS is the am (morning) preshot test number. The number you take before the feeding and shot. On the spreadsheet it is labled AMPS. The PMPS is the pm (evening) preshot test number.

 

And I totally did not even post that right. ugh.

 

Happens all the time!

@Diane Tyler's Mom -

Here's Lisa's reply to you from post #21:

Thanks. I just set up the signature. I will be figuring out the spreadsheet when I get home from work. I am also trying to figure out how to navigate the message board! It has been a long time since I have been on something other than FB. Ha.​

Mogs
.

 

Hang in there, Lisa. This group will help you. I too was very confused and I am fairly new. Some things are sinking in and some are still a mystery. You might try feeding Fancy Feast Classic Pate morning and night. They are low carb 3 oz cans and there is a variety. Try buying Whole Life Treats (freeze dried treats) to give her occasionally when she is really hungry and has to wait 12 hours between meals and maybe as a treat after you have to test her glucose. It was and still is a struggle for me but I am better than what I was in the beginning. Your vet doesn't sound like someone you should be trusting. When I started on the Vetsulin I was giving only 1 unit in the morning (20-30 minutes after she ate) and 1 unit 12 hours later in the evening after she ate. Good luck!

 

Thanks for the additional info, Lisa. (FYI, if Fluffy had had a DKA episode, you'd know about it because it requires hospital treatment.)

First, congrats to your to your daughter on passing her driving test.

Next, to your questions.

Can I skip shots if her bg is good?

For human meter users of cats who are only just starting to test, the FDMB Guide to Vetsulin/Caninsulin gives 200 as the 'no shoot' threshold. If you get a preshot reading below 200, do not feed, wait 20-30 minutes and test again to see whether the BG will rise high enough to give the next dose. While you're waiting post for help on the Feline Health. In the title to your thread, include the info that you are stalling and need help with Vetsulin dose (so members will know you need help promptly).

If you don't get a reply in time, then you have the choice to skip the dose. I asked you about ketones earlier because skipping is not advisable for ketone-prone cats. For such kitties, a token dose may need to be considered (tricky if dose is small, and close BG monitoring may be needed depending on the range the kitty is currently running in).

It is a good general safety precaution for newly diagnosed cats to have urine checked for ketones once a day. If needing to skip one or more doses - and given the numbers you've been seeing already this may well be the case with Fluffy - ketone monitoring at least once a day is strongly recommended. You can get urine ketone strips at any pharmacy (human ones are used to monitor cats). Tips for collecting urine samples here.

I certainly would not give a cat Vetsulin with a preshot BG of 125 (human meter).

What is a bad number?

As you may often read here, the general rule is: Better too high for a day than too low for a minute.

The normal feline BG reference range as measured on a human meter is 50-120mg/dL.

High numbers are bad for the internal organs and the nervous system but they take time to do damage. Numbers above c.200 are in the range where glucose starts tipping over into the cat's urine (the renal threshold). The higher the BG above the upper bound of the normal range, the less desirable. Higher numbers may increase the risk of a cat developing ketones (although it is possible for them to form at lower numbers).

The real 'baddies' number-wise are under 50 because that is hypoglycaemia territory. If numbers get too low they pose an immediate threat to life. It's strongly recommended to print out the hypo guide and familiarise yourself with methods described therein for raising BG levels if they drop too low (link provided above by member 'Panic'). If ever you get a number below 50 act straight away to raise BG levels and post for help. Most of the time there will be someone on the board who can offer support while you're getting numbers to come back up and stay up.


What range am I looking for?

Regulation is typically a gradual process. In the initial stages of treatment, you are looking to establish a safe dose and then, over a period of time, make small adjustments to the dose based on Fluffy's BG data to a better range. A good initial treatment goal would be to get Fluffy to a stage ehre her BG is under the renal threshold most of the time and high enough at nadir (lowest BG in each cycle) not to become hypoglycaemic. When using Vetsulin and monitoring with a human meter the FDMB guidelines indicate the dose should be immediately reduced if BG levels fall below 90. (Note: It is possible to regulate a cat more tightly on gentler, longer-acting insulins.)

There is much more information on ranges and dose adjustments in the FDMB Guide to Vetsulin/Caninsulin. Remember that you can always post for help. (Note: More cat-specific dosing suggestions are reliant upon the data available in a kitty's spreadsheet.)

How do I get her to sit still while I am trying to stick her in the ear?

In a word, bribery.

It helps to choose a single place as your testing station and build up an association with positive things happening there (e.g. special food treats or an activity your cat particularly enjoys, such as grooming). Here's a good training video (focus is on getting a cat to accept injections but the techniques can also be applied to BG testing):







How often should I test her?

* Preshot tests morning and evening (AMPS and PMPS).

* At least one test per day in the hours between preshots (mid-cycle), but ideally one mid-cycle test on both AM and PM cycles each day. Depending on the time relative to dose administration readings are taken, they will give you information on the nadir range and also the duration of a given dose. The most important information for safety is the nadir. With Vetsulin, the nadir is most likely to occur between +3 and +6 hours after dose administration, although some cats may have earlier or later nadirs, and nadir times can move around. As you gather more BG data for Fluffy, you'll be better able to determine her particular response to this insulin.

Shouldn't I be giving her a shot twice a day since I have learned that vetsulin is only good for 12 hours...

Vetsulin is typically dosed twice a day PROVIDED numbers are high enough and dose is considered safe to give. Vetsulin typically has a relatively short duration in cats. They metabolise insulin quickly. I have yet to see a cat here get a full day's duration out of a single dose.

... and maybe I should give her .5 in the am and .5 in the pm if her bg is high?

I can't give you any specific input on dosing without adequate data, Lisa, but bearing in mind that you got a pre-food preshot BG of 125 the other day, I would strongly recommend a very conservative and extra-cautious approach to dosing. You can seek help here on a cycle by cycle basis, Lisa.

Another reason to be extra-cautious is that you've just transitioned off the Meow Mix dry food (which, according to chewy.com, has a carb % well into the 30's). Aldi don't have any nutritional analysis for their wet cat food on the website so I've not been able to check the carb value for you.

-------------------------------------------------------

IMPORTANT: Please can you look at the nutritional analysis (protein, fat, fibre, ash, moisture) on the can labels for the Aldi cat food and use the info in the following thread to get a rough calculation of the carb values and post the result back here.

How to Calculate Food Carb %

I'm asking for this so that we can get an idea of the change in carb load of Fluffy's diet. If it's a low carb food, then BG levels may continue to improve due to the diet change. Some lucky cats can go into remission extremely quickly following transition to a low carb diet. Fluffy's already seeing some quite good numbers since you removed the Meow Mix dry food so I think great care will be needed with her insulin. To give you an idea of what I'm on about, here's the spreadsheet for Harrison, another recently diagnosed cat treated with Vetsulin and who was switched to a low carb food after diagnosis:

Harrison's Spreadsheet

As you can see, Harrison thus far has only had two weeks' insulin treatment. When his numbers started getting better (the blues and dark greens on the sheet) his insulin dose needed a very quick succession of reductions and he is currently on a remission trial. There's no guarantee that Fluffy's treatment will follow a similar pattern, she's already seeing some very good numbers (would be in the blue range on a spreadsheet) so I think extra care is needed when it comes to her insulin dosing.


Mogs
.

 

OK, I tried to figure out the carbs in the food and I think I came up with 2.45%? But I have no clue what that means. Sorry!
These are the numbers on the 5.5 oz can:
Crude Protein, min 10%
Crude Fat, min 5%
Crude Fiber, max 1.5%
Moisture, max 78%
Ash, max 3%
Taurine, min .05%

Calories 186kcal/can

 

Hi Lisa,

Thanks for the nutrition info. The 2.5% value is the 'as fed' carbs so you're part way there! We go further to calculate the % of kilocalories that come from the carbs in a food and the target value for a feline diabetic is to have that come in at under 10%.

To save you the aggro, I've done the rest of the calculation for you and the Aldi wet food comes in at approximately 10% kilocalories from carbs so borderline. (I say approximately because the guaranteed analysis used in the US has maximum and minimum % values for the nutrients in the food. It's a good enough guide to be getting on with.) It's still a huge reduction in carb load compared to the Meow Mix dry food. I'm loath to recommend other lower carb food options for you at the moment without getting a better picture of what's happening with Fluffy's blood glucose levels.

Given the very substantial reduction in carb load, there is the possibility that Fluffy's BG levels may improve markedly within days to weeks (see Harrison's spreadsheet for an example of what is possible) so again I suggest a very cautious approach to insulin treatment. Sorry to sound like a scratched record, but if you could get a spreadsheet with Fluffy's BG readings and dosing info up and running we'd be able to help you much more on that side of things.


Mogs
.

 

Per my most recent post above, for safety I'd strongly recommend not reducing Fluffy's carb load further till you get a few more days' worth of data to see how low her BG goes when you give an insulin dose.


Mogs
.

 

https://www.felinediabetes.com/FDMB/threads/how-to-create-a-spreadsheet.241706/

If you need help settings up the spreadsheet , just ask, we have a member here that will be glad to do it for you