Newly diagnosed

Nine days ago 12 yr old Sam was diagnosed. I missed 2 injections because after his insulin shots he became sleepy for about 6 hrs, and i was afraid he might be hypoglycemic (which is very scary). But he perks up by late afternoon or evening. Also, a few times he felt his shot. I would appreciate any feedback or advice.

 

WELCOME TO FDMB Irene and Sam, We are so glad you found us. You are right if Sam got lethargic holding off insulin is a good idea ...for now anyway.
Has Sam been tested for Keytones? Thats very important when withholding insulin. But for now I'm going to direct you here:
New? How You Can Help Us Help You!

Please know you have found a safe place for Sam here. There a lot of people who have been living with this disease that have a ton of experience and knowledge. WELCOME TO OUR FAMILY!
jeanne

 

Hello, Irene. Welcome to you and Sam.

I'm glad you've found us. We can help you with all manner of things feline diabetes.

First up, please can you tell us which insulin Sam is receiving and also the starting dose.


Mogs
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Sam is on 3 units of Vetsulin porcine insulin 1x/da. Yesterday and today things went pretty good except today he flinched when i gave him his shot, but i felt his fur and it was dry. I'm not doing BG testing yet. He didn't seem as lethargic yesterday and 2 hrs after his shot today he's a little sleepy but awake. He always sleeps for a few hours after his shot.

 

Just to confirm, 3 units is the starting dose???


Mogs
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Yes. His BG was 500 when diagnosed.

 

Did your vet run a fructosamine test? Or did he base the diagnosis on the single blood glucose result?

Also, did Sam show any of the following clinical signs:

* Drinking/peeing more.
* Eating more / very hungry all the time.
* Losing weight in spite of eating more.
* Lethargy.
* Depression.
* Poor hair coat condition.


Mogs
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PS: Did your vet check Sam's urine for glucose and ketones?


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I don't know

 

He definitely showed all the signs of diabetes. He was lethargic, peeing alot, excessive thirst and losing weight. I thought he might have had cancer.

 

Did your vet run a glucose curve at their office to determine the 3IU dose? I ask because:

1. The maximum the manufacturer recommends as a starting dose is 2IU.

2. Vetsulin is normally dosed twice a day.

I am concerned about the extent of your vet's knowledge of feline diabetes (a common issue, not a criticism of your vet) and also I am concerned whether the current Vetsulin dose may possibly be too high and therefore unsafe.


Mogs
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PS:

The normal starting dose of Vetsulin for a cat is 1IU.


Mogs
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Hi Irene & Sam
Just wanted to say hi & welcome from a fellow newbie (only been giving insulin since 15th August).
You have found the best help site ever - don't worry there is nothing FD related that one of the sugar baby parents on here can't help you with & they are always so willing to help.
All the best to you both.
Gill

 

Sam being sleepy after each dose tells me that dose is too high.

 

While possible, it's not necessarily the case here, Jeanne. Commencing insulin treatment, particularly with an intermediate insulin like Vetsulin which produces hard and fast drops, can be quite an adjustment for a cat's body to make. It can make them lethargic. This is why I'm asking Irene the additional questions.

It was a logical thing for Irene to be very concerned and skip the dose given the hours of lethargy exhibited by Sam (although ideally ketone monitoring would be part of the daily routine, given Sam's presentation at time of Dx). I went through an almost identical situation with Saoirse when she started on this insulin. She became extremely lethargic, and it was impossible to tell whether or not she might be having a hypo by clinical observations alone. I was absolutely terrified. (ETA: I hadn't yet started home testing.)


Mogs
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Thank you so much

 

I have been concerned about his lethargy after shots. I'm going to get an appointment with my vet. I thought maybe i was overreacting. I haven't felt like i know what i'm doing. So glad i found this website.

 

Irene, your observations are very good and your instincts are absolutely spot on. I have a very good idea of what you've been seeing in Sam because I went through exactly the same thing with Saoirse. However, she had been at the vets and had had curves run over several days to check that the dose was not taking her too low. She initially started on 1IU twice a day, but after the 3-day hospitalisation her dose was increased to 2IU twice a day (weight c. 9lb at time of diagnosis and her blood glucose levels were so high they were off the scale of the meter). That's the tricky part of this situation: Vetsulin can make some cats very lethargic even when the dose is OK. There's no way to tell if the cat's safe other than checking the blood glucose levels.

The best thing that you can do for Sam's safety - and your own peace of mind! - is to learn to home test his blood glucose levels. We'd be very happy to help you learn how. The vast majority of members here use a human glucometer (with a cat-specific reference range). Would you like that?

When will you be able to speak to your vet?


Mogs
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Understood Also I SHOULD have added " I'm not an expert"

 

Irene, one of the best thing you can do for your cat is to start testing his blood glucose levels at home.
It will give you the whole picture of what a dose of insulin does and it will allow us to help you better.

And welcome to the best place you never thought you would ever be. The people here live and have lived feline diabetes 24/7 and have done their research.

 

I'll let you off, Jeanne. Just this once, mind!


Mogs
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Thank you all for your good advice. I'm calling tomorrow to make an appointment with the vet.

 

I hope it goes well. Please be sure to let us know how you get on, Irene.

Even if you don't want to start testing yet, can I suggest you purchase a human glucometer, some test strips for it and some lancets (28 or 29 gauge)? The reason I suggest this is that if ever you needed urgent help, as long as you have a meter in the house someone here could talk you through how to test in an emergency. If you're in the US then a popular meter among members here is the Relion Prime (from Walmart). The test strips are very well priced compared to other meters on the market. Also please review these documents ASAP:

How to Treat Hypos

Hypo Toolkit

Print the first one out, familiarise yourself with it, and then place it somewhere you can grab it quickly should you ever need it.

Please make sure that you have some honey or karo syrup at home. The hypo toolkit makes recommendations about foods with higher carbs to include in it (e.g. Fancy Feast Gravy Lovers wet food). Also, I recommend you pick up some high carb treats like Temptations to add to the toolkit. (NB: The Temptations are very high in carbs and should not be given as a day-to-day treat. Freeze-dried protein-only treats like Purebites are diabetic-friendly.)

Since Sam's BG level was very high at time of diagnosis and because you've had to skip some insuiln doses, it is a wise safety precaution for the time being to test his urine daily for ketones. You can piok up the urine ketone test strips anywhere that sells supplies for diabetics. Here is further information and some helpful tips:

Testing Your Cat for Ketones

Tips for Collecting Urine Samples

If Sam ever comes to you demanding food, give it to him straight away (in case his blood sugars might be low). Give a moderate-sized meal initially. If he's really ravenous mix a little honey or karo into the food. If he continues to be hungry give him small amounts of food every half hour, with a little honey mixed in. Post here for help.

IMPORTANT: If you can't get in to see the vet straight away, I recommend that you try to get a telephone consult with them tomorrow to discuss Sam's response to the Vetsulin and also the 3IU dose. Say to them that it's impossible for you to tell whether or not Sam's blood sugars have gone too low.

Later I will post some key points about how Vetsulin works and times when you may need to pay special attention to Sam's behaviours. In the meantime...

QUESTION: Please can you tell us what food Sam eats every day (brand and variety, wet or dry).


Mogs
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Thank you so much for all the good information. You have been so helpful. I really appreciate it.

 

Glad I could help a bit, Irene.

Important safety note:

Whatever you're feeding at the moment, please do not make any changes to Sam's diet until you know more about how safe his current insulin dose is.

You will see a lot of advice here about changing a diabetic cat's diet to all low carb food. If a cat is already receiving insulin then it is vital that there is no change in food carb load unless the cat is being continuously tested throughout the transition because a reduction in dietary carbs can lead to a previously safe dose becoming too big. More info here.


Mogs
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Hi again, Irene.

Here's the information I promised you about Vetsulin.


The diagram below shows where the effect of Vetsulin peaks and the ideal response of a cat to it:





As you can see from the above, each dose lasts for 12 hours.

If you look at the red line in the graph you can see that blood glucose (BG) levels start lowering from about +1 hour after dose administration. BG can drop significantly by +2 hours after dose admin. Typically BG levels will be at their lowest between +3 and +6 hours after dose admin. From +7 to +8 hours the dose starts to peter out.

You might see Sam look for food somewhere between +1 and +2 hours, and that could be a sign of the dose kicking in (onset).

The time to monitor Sam most closely would be from +2ish to +7ish, when his BG is likely to be at its lowest.

It's helpful to keep a daily journal of Sam's behaviours, energy levels (especially times when he gets lethargic relative to the time the insulin dose was administered), how much he drinks, and what his appetite is like.

It really is worth measuring how much water Sam drinks each day. If it reduces significantly that could indicate that his overall BG levels are getting lower. If it increases significantly it could point to his BG levels increasing.

You could also test his pee for glucose, but this is a very crude way to monitor and only tells you whether his BG for the previous few hours was over or under the renal threshold (the BG level at which glucose starts to spill over into the urine). You might find some other useful tips at the following link:

Secondary Monitoring Tools

Be sure to shout for help any time you need it.


Mogs
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i would recommend Prozinc for insulin. Talk to your vet about it. Do you test the BG at home? you ll know if your cat need a nap or is in hypo