Cat keeps swinging between hypo and hyperglycaemia

Discussion in 'Caninsulin / Vetsulin and N / NPH' started by sweetcherrypie, Jul 18, 2010.

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  1. sweetcherrypie

    sweetcherrypie Member

    Joined:
    Jul 18, 2010
    Hi,
    My cat has been on caninsulin (3 units twice a day )for a year. She was being fed Hills feline m/d(canned food) twice aday until her delivery of cat food never arrived two weeks ago and I was forced to change it. I had to give her Bozita (canned food)which I give my other cats and this is much higher in protein. At first she seemed much happier on this food, however her blood sugar levels kept dropping too low so I have been decreasing her insulin. A couple of days ago however her ( she was down to 2 and 1 unit of insulin, morning and evening respectively) blood sugar dropped to 2.5 and then it had shot up to 20 by the end of the day. I reduced the morning insulin to 1 unit but I have found that even if her blood sugar was 16 before the insulin within 3 hours her blood sugar has dropped to 5 and then by her evening injection it has shot back up to 16. I use a blood sugar monitor and her insulin should peak at 6 hours but find her blood sugar having dropped dramatically is already climbing rapidly after 4 hours. Can someone please advise me on the best course of action? My cat is clearly starting to become quite poorly again :sad: .
     
  2. Pam and Layla

    Pam and Layla Member

    Joined:
    Dec 28, 2009
    Hi. Has your kitty ever had 12 hours duration on the caninsulin? I think this insulin (haven't used it myself) is more intermediate-acting, so that might account for some of the lack of duration you are getting.

    It does seem your kitty is ready for the lower dose of 1unit instead of the 3u given previously. The 2.5 (45 US - multiply/divide by 18 to convert mg/dl mmol/l) is on the low side, and the rapid rise was the body's response (probably) to being so low. Combine that with an insulin that doesn't last 12 hours and the result could be the higher numbers you are seeing.

    Do you have numbers - preshots for the past week or two that you can post? This might help people see the bigger picture in order to help you.

    Have you discussed other insulin options with your Vet? Lantus (glargine) and Levemir are both longer duration insulins that might help with your current situation.

    I hope I haven't confused you - I do not have experience with your specific insulin, but my cat had shorter duration on most insulins prior to switching to Levemir.

    It seems your cat did better on the Bozita food, so it is probably lower in carb count than the dm you were feeding. To reverse things you want to keep your cat's numbers as stable as possible, so feeding the lower carb diet will help with that aspect. I might say getting on another insulin would be your next step.

    I'll try to find someone with experience in your insulin and point them this way.

    Best,
    Pam & Layla
     
  3. Mary & Stormy Blue

    Mary & Stormy Blue Member

    Joined:
    Dec 29, 2009
    When Stormy Blue was on Vetsulin, (caninsulin), I noted that with him, it did NOT have 12 hour duration. Ever. Usually an 8 hour duration was what he had. I also noticed that even with a 1 unit dose, he was crashing far too low on it. So, I got some u100 syringes and reduced him to .5 units of the Vetsulin. Still too much, he still kept crashing low and rebounding high. So, I further reduced him to .25 units, which seemed to do the trick, for awhile. Then is was further reduced to .125units.... Right before he went off of the insulin, I was shooting fat zeros.

    My suggestion would be that you get some u100 syringes with half-unit markings and reducing him to .5 units and see if you get a better response.
    It is VERY possible that the high numbers are due to rebound since he is now on low carb foods and the dose might be too high.

    Also please note that Vetsulin, (caninsulin), is having serious issues and the manufacturer is suggesting it not even be used at this time. http://www.vetsulin.com/vet/Vet_ProductAlert.aspx

    ~M
     
  4. kate and lucky

    kate and lucky Member

    Joined:
    Jan 3, 2010
    Hi,

    can you confirm where in Europe you are?
    If you look on the back of the cat food your using you'll see % amounts for protein, fat, ash, fibre etc-should add up to around 100.

    It's not a cat food I'm familiar with but if it's very differnet to the Hills it could to some degree account for the changes your seeing.

    Caninsulin typically peaks at 4 hours and because it is an intermediate acting insulin you often have to accept higher preshot numbers to get a better curve.3u is not too bad a dose with this insulin but is affected by how high the carb value of the cat food is.

    Vetsulin is the international equivalent of Caninsulin (european name, but they are made by the same manufacturer).There have been serious problems with vetsulin, though no one has definitively stated (including manufacturer as far as I'm aware) that the same problems exisit with Caninsulin. Saying that, I find it hard to believe that they can't be having the same difficulty. Please read the stickie at the top of this forum which explains what the problems are.

    By far on this website, Lantus and Levemir have been having the best results in FD management.
    In the UK, Prozinc (came out about last October) seems to be an insulin that is now being prescribed. Not a huge number of people have posted here about it, but those that have generally are positive about it.
    As Lantus and Levemir are Human insulins, not many British vets seem to want to prescrie it (we're also not sure if they are allowed to under the respective rules-you would need to speak to your vet).
    Although I'm British, I'm based in Germany and was able to get Levemir-amazing regulation after struggling for a while on the caninsulin (very poor regulation).

    Can you tell us your routine in respect of preshot number, when you shoot and feed through a 24 hour cycle?

    Do you test for keytones? Need to do this when a cat isn't regulated and changing dose.
    Any other health issues?
    Sorry, I know it's a lot of questions, but you can see your kitty we can't and helps us to try and help you.
    This is a quiet forum as like I said the majority of posters on FDMB are using other insulins.
    Please keep asking questions. :mrgreen:
     
  5. sweetcherrypie

    sweetcherrypie Member

    Joined:
    Jul 18, 2010
    :smile: Thank you so much for all your responses they are all most helpful. I am based in the UK, in Yorkshire.
    The problem is I have not kept a record of my cats blood sugar readings since I managed to regulate her last year. However, as they are all over the place at the moment, I have taken your advice Pam and started recording these again. I do think that you are right Mary that the Caninsulin is not very consistent and does not last the 12 hours that it is supposed to. Unfortunately my vet is going to tell me to put my cat back on the Hills. I did try feeding my cat a raw food diet when she was first diagnosed and I could not regulate her. When I finally succumbed to feeding her the Hills and I was more successful with the regulation, the vet was most condescending. The Bozita is Swedish and is supposed to be 97% pure meat. I think it is possible that I have been underfeeding my cat, should she have more food now that she is on a low carb cat food? A vet told me that I could halve the quantity prescibed on the bag/tin. Carbonel was being fed 234g a day of the Hills and I just fed her the same of the Bozita. I increased her food by 30g's last night and decreased her Insulin by 1/2 a unit which was probably a mistake. I should not have done both. However after 3hrs her blood sugar levels had not dropped dramatically as before, but her blood sugar level was a whopping 16.9 this morning, oh dear. I am used to 8 or 9 as a pre shot reading.
    Carbonels routine is as such: I give her her shot at 8am ( this morning 1unit) with about 1 tablespoon of food. After 1 hour exactly I feed her her main meal ie. half of her daily quota of food and then I do the same again at 8pm in the evening.
    I am not testing for keytones Kate as I do not know how to do this . Carbonel has no other health issues other than IBS when fed the wrong food. The vet prescribed dried Hills for this condition and I may be wrong but feel that this food caused the Diabetes. I am going to see if I can get my cats Insulin changed to the levemir or Prozinc. Thanks again, Carol and carbonel
     
  6. Mary & Stormy Blue

    Mary & Stormy Blue Member

    Joined:
    Dec 29, 2009
    Hope this helps,

    ~M
     
  7. kate and lucky

    kate and lucky Member

    Joined:
    Jan 3, 2010
    For everyone's benefit and with Carols agreement I have copied and pasted our pm's

    Hi Carol,


    To your other questions.
    I see you didn't record readings, but could yu give a ball park highest/lowest reading when Carbonel was regulated?
    Caninsulin lasts only 10 hours and then is gone from cats system. Lantus and Lev (can't comment on te prozinc as hav no experience of it) stay in the system and build a shed(just a phrase we use,like apetrol tank).
    This is why you get high preshot numbers-my post in your thread.
    I don't know a great deal about IBS either, but have you tried;

    Felix 'as good as it looks'?This is 3.4% carbs
    That is what I was asking if you knew for yur bozita.
    There are also some Tesco brands that are low in carbs. I will go and source them and post on your thread. People here recommend under 10% carbs, I prefer under 5% as this is the natural carbs a cat wold get in the wild from it's natural food source-mice.
    Whiskas Mmmm used to be around 1% but I think they have stopped making it!
    As for your vet being condescending, it actually takes time to regulate a cat and that could of been a factor. I perdsonaly have little faith in vets. We went through 4 and the army one I ended up with wasn't brilliant but did prescribe the Lev and let me do it my way. They don't spend any timeon diabetesand most don't seem to keep on top of research.America is way ahead.Thereis also the difficulty with the licencing authorities (you know like NICE?-Not sure if it's them that cover insulin as well)
    If Carbonel isn't regulated, feed her what she wants-her body won't be able to metabolise the nutrients.You'll soon know if your over feeding. Just need to bear in mind food in relation to test times as obviously the bg goes up and thus you get an artificially high number.
    Have you read the stickies? Especially the bit about rebound?Don't want to verload you, but it's something worth getting your head round.
    They work in mgdl here, so need to times your number by 18 to get that.
    Which by my reckoning was that Carbonel was around 144-150 at preshot.That is an excellent number for a preshot but also very low to then shoot 3u(that's why I've mentioned reading the rebound)
    I'd try and stay away from the Hills dry-dry is just no good full stop for any cat. Cats have a really low thirst drive anyway. Lucky was on dry food for most of her first 14 years of life-it definitely caused her diabetes in my view.
    Keytones-just need to go to Boots or Llods and ask to buy a tube of keto-diastix. Not expensive. Just a strip that you pop under Carbonels pee stream and then count 15 secs for keytones and 30 for glucose (think that's the right way round-it does tell you). Then you look at colour of yourstick to colour on the chart.Keytones mainly caused by nt enough insulin, hence why important right now for you to test for. Expensive and potentially life threatening so good to be on topof it. That's not tosay you go back to 3u.
    My suggestion would be:
    Get the keto-diastix
    1U am and pm.Get bg readings-preshot, 1 hour, 4 hours and 9 or 10 hours after insulin shot (described here as +1,+4 etc)
    Record when you feed to. With Caninsulin cat should eat straight after shot because it works fast and can drop bg dramatically.
    You also say her numbers didn't move much last night. What dose did you give her?If it was more than 1u, this might be the dose to do just for the next 3-4 shots.Then you look at increasing. I assume you use u40 syringes? Good to convert and use u100 (using the conversion chart)because then you can incrase in smaller doses. Stops you missing the ideal dose.Can help with this if you want to try it.
    Anything not clear or confusing,jst say and I'll try and explain itbetter.

    Hello Kate,
    Thanks again for your response. Carbonels bloods before were lows- between 5-8 and highs under 12 -15.
    The vet is now suggesting a shorter acting Insulin. What would be the benefit of that? She said they won't prescribe Levemir!
    I did not give the carb value of the Bozita as I cannot find it. The tin is in Swedish, German and French and the website only mentions 97% protein. Do you know the word for carbs in German? This food really suits her and I am not sure I want to change it again as I might get something that upsets her stomach and then I really will have problems. I still can't really understand what has happened here as the 1 unit now does not seem enough whereas before she was dropping so low. Does this rebound thing take awhile to settle? I will read the stickies? as you suggested.I will also wait a few days before increasing by half a unit as you suggested. Where do you get the syringes with smaller increments as I have not been able to find a supplier here? Problem is I go on holiday in 10 days and my daughter is going to be looking after Carbonel. I hope I can get her regulated before then.
    I normally give Carbonel her main feed 1 hour after her Insulin because that is what the vet told me to do. Perhaps if I had fed straight away on the Bozita her blood sugar wouldn't have plummeted as it did. I did notice when I did the graphs when she was first diagnosed that it took a couple of hours before her blood sugar began to drop.
    Thank you again,
    Carol and Carbonel

    Hi Carol,

    is it ok with you if I copy and paste most of our pm's? I just think it is good for others to be able to chime in.
    That's a real 'git' that your vet won't prescribe Levemir. Would you consider ringing around any other vets and asking? Also Lantus.
    If not, the only other option to try is the Prozinc. I and others can tell you the basics, but other than that you wuld need to post in the PZI isg-some good peeps there.
    Please don't let them give you Humulin-it's considered even worse than Caninsulin.
    If you have a printer, you could print off the info from the manufacturer about transitioning cats to other insulins-may persude your vet?
    May also be because you don't need them to order the insulin in, so they lose commision. It's scary what these drug reps do and how vets can be quite money orientated. My friend was a rep after we finished uni and after a number of years has just retrained as a vetinary nurse-the stories!! But even she had no training on diabetes!
    That's fine about bozito if it's working for you.
    Rohprotein-protein in German (Felix this is 14.%)
    Rohfett-fat (2.5%)
    rohasche-ash (2.2%)
    rohfaser-fibre (.05%)
    Feuchtigkeit-moisture (80%)

    so adds to approx 100%
    Do you think you could set up a spreadsheet? Not sure what time you have, it sounds complicated but isn't too bad. You can post in technical forum and ask for help. Alternatively just post your numbers each day
    amps
    +1
    +2+4
    etc
    then pmps
    That way we can track Carbonels numbers with you.
    The only company you seem to be able to get u100 1/2 unit syringes is BD microfine. Do a google search (I got mine from a German on-line pharmacy called sanicare.Not sure if they would deliver to England)
    )
    If you can you want: 0.3cc, 31 gaugex 5/16" length syringes u100.
    I will find the conversion chart for you.
    The higher the gauge number, the thinner the needle and thus less painful for Carbonel.We were given 26g!!!initially, no wonder Lucky wasn't a happy cat!
    Yes, try giving a good meal of Bozito after shot (or during shot whichever way you work it).It takes between 1-2 hours for insulin to start working on bg's so yes your right on that vein.Caninsulin peaks at +4 ish whereas Lev/Lantus it'saround +6. That's why Caninsulin runs out after around +10.
    I'm not sure if you will solve this in 10 days-it's a marathon not a sprint (that's the phrase).
    Don't panic if you don't, as long as you can get Carbonels swings down and avod hypo numbers, your daughter should manage fine. Have you educated her on hypo signs? There's a list somewhere on the board. I think it's posted intermittently in health so if you scroll back a few pages you should find it. Either write out or print on your fridge and go through with your daughter (another acronym DD=Dear daughter )

    I'llbe watching for you.Hang in there.

    Hi Kate,
    Thanks for all the info. The Bozita seems okay, perhaps not as good as the Felix you mentioned.
    protein -10%
    fat - 5%
    fibre -.5%
    Ash - 2%
    water - 82%
    There seems to be .5% missing as it does not add up.
    Yes I am happy for you to cut and paste.
    I have just spoken to my vet who asked me to do a blood glucose curve yesterday.
    I checked her blood every hour and started at 7.45am just before her 1 unit of Insulin. I fed her main meal at 8.45 having only had a tablespoon of food at 7.45. Someone posted a note in one of my posts asking what happens if she does not eat. I can tell whether she is going to eat or not by her behaviour!
    Her bloods were as follows 17, 16.6, 13.4, 10.7, 10.5, 10.5, 12.9, 14.7, 14.0, 16.7
    I still have 2 more tests to go but I will probably only do one before her next meal at 7.45pm.
    This is a very poor show and my vets response was that I should increase the Insulin by 1 unit!
    What she could not explain is why I was getting readings under 5 ( scary) a few days ago at 2 and 1 unit morning and evening respectively. So how come the excessive readings on one unit less? I am very concened about this. Which numbers do I put on a spreadsheet her bloods? I am not very good at this computer thing I am an artist!
    I asked the vet if Carbonel could be changed to Lantus and she said did I mean Lentis? Is this the same, as she said it was a shorter acting Insulin? I also asked her abou PZI and she said I could change her to this but she thought the Caninsulin was working, but it just was not enough.
    I am afraid I was not assertive enough and also wanted to ask you your opinion of what she said. Why is she plugging the Insulin? I even mentioned the Vetsulin site you sent me and she did not comment!
    I could not get Keto -stix at Boots they only had Litmus paper is that the same thing? Sorry about all the questions. The syringes are another problem but I have found a company in the uk
    who seems to have them but I am not sure whether they supply the public! I have sent them an e-mail. Thanks so much for all your time and trouble. Carol and Carbonel sweetcherrypie

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    Joined: Sun Jul 18, 2010 6:34 pm
    Private message

    Going to add another post in a mo
     
  8. kate and lucky

    kate and lucky Member

    Joined:
    Jan 3, 2010
    keto diastix and glucose curve

    Hi Carol,

    I've looked for these. Best bet seems to be Ebay-cheap as £6.32 and it's on a 'buy it now' basis.
    I've rang my friend in UK who sent me a pot (unfortunately I posted it to another newbie a while back)but she's not in at present.

    This is the conversion chart you need for mmol to mgdl (what is used here)
    http://www.felinediabetes.com/bg-convert.htm

    17 306 AMPS
    16.6 299 +1
    13.4 241
    10.7 193
    10.5 189 +4
    12.9 232
    14.7 265
    14.0 252
    16.7 301 +8

    It does look as if the Caninsulin peaks at +4 for Carbonel

    Insulin is powerful stuff and one unit can have a huge impact. I would NOT increase by 1 u.
    How old is the insulin?
    (28 days is usually peak and then efficacy is affected)

    I haven't heard of Lentis but if it's short acting, don't go there. Looking at Carbonels numbers you have given so far she will fair better on a longer acting insulin.

    Rather than PZI, I'd try this Prozinc (PZI in various forms ahas been stopped and then reissued using different constituents-bit out of my league as I haven't used it).You would still post in PZI forum.
    I'm going to post a link to this thread in their forum and see if anyone can offer pointers and see if any of the UK users using Prozinc are posting there.

    She may be plugging Caninsulin because you can only get it from a vet. All the insulins (I think) are obtainable from a pharmacy (and hence probably cheaper)

    I'll also ask where others have got u100 syringes.

    Any thoughts on approaching other vets?
     
  9. sweetcherrypie

    sweetcherrypie Member

    Joined:
    Jul 18, 2010
    Hi Kate and mary,
    Thanks for all your efforts. :smile: I spoke to another vet this morning to get another opinion. She uses PZI- Insuvet. She says that the vet reps are all plugging Caninsulin! I got the name of the short acting Insulin wrong, it is called Lente.
    I would like to change to the Insuvet(PZI) as the Levemir does not seem to be an option (not at least from either of these vets) but it seems to be very expensive. I don't know how much it costs from our vet but it ranges between £40-£50 per 10 ml bottle on the Internet. Does anyone else buy Insulin over the Internet? I had a bad experience ordering Insulin on the Internet - the cold pack had burst and the Insulin was very badly shaken up ( It came with our postman and we live down a farm track) and I have heard that this denatures the Insulin. Needless to say the Insulin did not seem to work properly and I had 10 vials of the stuff. Also how long does it last when opened, or should I be asking this on the PZI board. Some sites seem to say 90 days and others 28! Perhaps these are different PZI's.
    Thank you for the info on the Keto-stix Kate, I will buy them on the Internet. Carbonel is not house bound though and does not use a litter tray, so I will have to race after her when she goes out to pee in our vegetable bed!
    I have found a supplier of the BD Microfine needles on the Internet as well, Yay! I am a little confused though and some sites have said that some needles are not to be used with Caninsulin, so think I will change needles when I change the Insulin.
    I still cannot make up my mind as to whether to do this now or when I get back from my holiday. Both vets suggested I do this when I get back in August. I have also been told to increase the Insulin to 2 units as you know, however I am going up in halves as you have suggested.
    The Caninsulin is about 18 days old so unfortunately I will need to get another bottle before going away on the 29th.
    Thanks again
    Carol and Carbonel
     
  10. Mary & Stormy Blue

    Mary & Stormy Blue Member

    Joined:
    Dec 29, 2009
     
  11. kate and lucky

    kate and lucky Member

    Joined:
    Jan 3, 2010
    Hi Carol,

    Definitely no to Lente!!! Really old insulin and not considred particularly effective.

    PZI is the beter option (do wish you coud get Lev/Lan but seems to be lie of the land).
    I will post this thread link in a thread I started for you yesterday in PZI forum (was asking about the Prozinc). You can use PZI on a sliding scale, but again you need the beans that use this stuff to help you.

    As for longevity, again not sure. Need to ask them if you can get it in smaller vials (3ml-like Mary said about Lev/Lan) each cartridge lasts for like 2 years or something if unopened, but minte it is your on countdown. Hence Caninsulin being wasteful (thugh fairly cheap I know)

    I'm with Mary, if you can swap now, go for it, but discuss with DD as she needs to be comfortable too. Would she be willing to post on here? She can ask for help too if she needed it.

    Totally uderstand about the needles, not a problem waiting till you swap to a u100 insulin.

    I wish there was some way we could levy(?) the vetinary association about the insulin choices available, can not believe the ignorance!!

    Let us know how you get on.

    ps-nice vision of you chasing Carbonel through the vegetable patch-made me think of Peter Rabbit! :lol:
     
  12. Cat girl

    Cat girl Member

    Joined:
    Sep 29, 2015
    I found Caninsulin that can be bought without a prescription from a Canada pharmacy called the pet pharmacy
     
  13. BJM

    BJM Well-Known Member

    Joined:
    Oct 6, 2010
    What is the link?
    Is the packaging identical?
     
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