Forced to change from prozinc to caninsulin
- Thread starter C1gar
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Critter Mom
Very Active Member
There have been a few exceptional cases here, Eliz, where the caregiver used a fast-acting in conjunction with the regular insulin but they were cats with major complications, IIRC, and it required the caregiver to be extraordinarly well-experienced. (Posts were by one or more of the uber-experts from L&L, perhaps Wendy or Sienne? Can't remember exactly who it was.)
As you note above, the only regular use of bolus insulins is in a clinical setting when treating the likes of DKA, a life-threatening emergency. It's only safe then because it's an intensive care setting where sugars can be administered intravenously as needed and the cat is constantly monitored.
Mogs
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Critter Mom
Very Active Member
"... dose below what is required to avoid a hypo ..." - in other words she proposes giving a sub-optimal dose of the long-acting insulin.
"... then top up as required with a fast-acting insulin" - Then she proposes to add in an insulin more likely to induce a hypo? After every meal???
Maybe I'm reading it wrong, but to me that is just NUTS. Human diabetics are regulated that way. Cats are not humans.
For the overwhelming majority of feline diabetics, the advice about topping up the long-acting insuiln with a faster acting insuiln is wrong.* Dangerously so, as I said earlier, if she considers what she proposed to you to be a suitable everyday method of treatment for feline diabetes.
Most cats only need a small dose of insulin twice daily. A single insulin. Some cats have what are referred to as high-dose conditions (e.g. acromegaly) and may need quite a big dose in cat terms - but of a single insulin. (There are exceptions - as mentioned in my reply to Eliz above - but my understanding is that those cases truly are exceptional.)
Lantus is a depot insulin. With each successive dose it builds up a store in the body - a sort of 'chemical pancreas' - which gives Lantus its longer duration of effect. For the vast majority of diabetic cats - and in simplified terms - the starting dose of Lantus should be low and the dose gradually increased in small increments until the dose and the size of the depot match the cat's needs. If the cat's needs lessen, the dose is reduced in small increments. Nothing more required - including at mealtimes.
In all of the professional feline diabetes treatment guidelines I've ever read, not one of them proposed regular treatment of FD with basal and bolus insulins. Not a single one.
Quite rightly so. I would have been very worried too.
Mogs
* Veterinary specialists are humans and, like the rest of us, they are not infallible. Some are fantastic and really at the top of their game. Sadly, some of them are not. The latter do get things wrong at times.
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Critter Mom
Very Active Member
Pabs&Ro
Member
Thanks all. You have all answered my main concerns. Alarm bells went off when I was given that advice. I did not go down the glargine route because I did not like what was proposed. There is no way I would inject Pabay more than twice a day even on advice with more than one type of insulin because it would stress him out and me and adversely impact upon his quality of life. I am very pleased that the norm as described by you is perfectly feasible and I am cautiously optimistic . Thanks for all of your informed advice.
Elizabeth and Bertie
Very Active Member
I think it is. And I truly 'hope' it is... However I expect we do get a very particular view of things on feline diabetes forums which may not entirely reflect the situation in the wider world...
One of the advantages of feline diabetes forums is that people talk about feline diabetes...endlessly, hehe! So there is a huge amount of shared experience. Also, many people here keep spreadsheets with their kitty's numbers on. So this is a truly fantastic resource for really 'seeing' how kitties respond to different insulins. When someone can really see evidence that an insulin isn't working for their kitty then that can give an impetus to try to get the vet to prescribe an alternative, and they have the evidence to show their vet too. It's not always easy. But I'd think that cats on feline diabetes forums are very much more likely to be on insulins that are working optimally for them...
Many vets don't even seem to be aware of the current guidelines regarding prescribing insulins for feline diabetics. I guess they're busy people and can't keep up to date with everything. But that is another reason for us to be proactive and try to keep up to date so that we can draw our vet's attention to things they may not have had time to be aware of... But, even then, in the UK it ultimately all comes down to what a vet is 'willing' to prescribe, and vets still vary enormously in that regard.
Pabs&Ro
Member
Thanks. I have spreadsheets for Pabay but they are not in the form you use but I am changing over. I do take 15 min readings when heading to a nadir that I am worried about so my husband is looking at how I can adapt your template to include more frequent readings.
I have two vets: general and specialist. I think all of us have been on a learning curve.
PS - the purina md wet pouches arrive today. Cheers for that.
I have two vets: general and specialist. I think all of us have been on a learning curve.
PS - the purina md wet pouches arrive today. Cheers for that.
Critter Mom
Very Active Member
Hi Ro,
I can really understand - and I've experienced - the conflicts that may arise when a veterinary professional advocates a particular course of action and a crowd of strangers on the internet call it into question (and scepticism is a vital aspect of interacting with the web in general - there is a lot of absolute bilge out there, some of it toys-in-the-attic, some of it downright dangerous) so I've been thinking about how to better explain the basic mechanics of why a single, long-acting insulin is effective in the management of feline diabetes. I think perhaps taking things back to first principles might be of benefit.
Put simply, there are two ways that BG levels increase:
1. When food is ingested.
2. When the liver releases glucose from its reserves into the bloodstream to provide the body with energy to maintain metabolic processes between meals.
Humans are omnivores. When we eat, the carbs which form a regular part of our diets spike blood glucose levels for a couple of hours after meals. That's why human diabetics need bolus insulins. (Their basal insulins deal with the sugars released from the liver between meals.)
Cats are obligate carnivores. Their metabolisms are completely geared towards a high protein diet with moderate fats and negligible carbohydrates. The cat's body can utilise other macronutrients to produce all its glucose needs.
Feeding a cat a species-appropriate, low-carb wet diet means that it won't get big spikes in BG after meals. (Feeding smaller, more frequent meals also helps minimise food rises.)
Because the rate at which glucose enters the bloodstream - from ingested food and from the liver - is relatively even in cats fed a low-carb diet, the 'steady trickle' from the insulin depot formed by basal-type insulins like Lantus and Levemir is perfectly adequate to meet the cat's BG regulation needs right throughout the day. A single insulin is all that's needed. (Note: it does take a little while from start of treatment to arrive at the dose which establishes a depot sufficient to meet the individual cat's insulin needs.)
By way of comparison, intermediate-acting insulins (e.g. Caninsulin/Vetsulin, Novolin N) typically drop BG levels quite hard and fast in the hours immediately following administration but then peter out several hours before the next injection is due. Rather than feeding mini meals throughout the cycle, a substantial feed is given 20-30 minutes before dose administration to 'front-load' the cat with food - essentially forcing up the amount of glucose entering the bloodstream - in readiness for the insulin's most powerful period of action. The rest of the food for the cycle is usually given in the next 6-7 hours before the dose fades. This is sufficient to support normal metabolic functions and helps keep weight on the cat (the body can get the full benefit from nutrients while the insulin is active) but the cat may spend part of each cycle in higher than ideal numbers. Regardless, even here a single insulin is all that's required, you simply adapt the feeding schedule to match the insulin's action profile.
I hope you find the above helpful.
Mogs
(Note: The above is somewhat simplified and ignores factors like bouncing which may temporarily elevate BG - because they are temporary. It applies to the overwhelming majority of diabetic cats, not those with exceptional complications, as briefly touched upon earlier in this thread.)
Your spidey sense is working very well, Ro!
I can really understand - and I've experienced - the conflicts that may arise when a veterinary professional advocates a particular course of action and a crowd of strangers on the internet call it into question (and scepticism is a vital aspect of interacting with the web in general - there is a lot of absolute bilge out there, some of it toys-in-the-attic, some of it downright dangerous) so I've been thinking about how to better explain the basic mechanics of why a single, long-acting insulin is effective in the management of feline diabetes. I think perhaps taking things back to first principles might be of benefit.
Put simply, there are two ways that BG levels increase:
1. When food is ingested.
2. When the liver releases glucose from its reserves into the bloodstream to provide the body with energy to maintain metabolic processes between meals.
Humans are omnivores. When we eat, the carbs which form a regular part of our diets spike blood glucose levels for a couple of hours after meals. That's why human diabetics need bolus insulins. (Their basal insulins deal with the sugars released from the liver between meals.)
Cats are obligate carnivores. Their metabolisms are completely geared towards a high protein diet with moderate fats and negligible carbohydrates. The cat's body can utilise other macronutrients to produce all its glucose needs.
Feeding a cat a species-appropriate, low-carb wet diet means that it won't get big spikes in BG after meals. (Feeding smaller, more frequent meals also helps minimise food rises.)
Because the rate at which glucose enters the bloodstream - from ingested food and from the liver - is relatively even in cats fed a low-carb diet, the 'steady trickle' from the insulin depot formed by basal-type insulins like Lantus and Levemir is perfectly adequate to meet the cat's BG regulation needs right throughout the day. A single insulin is all that's needed. (Note: it does take a little while from start of treatment to arrive at the dose which establishes a depot sufficient to meet the individual cat's insulin needs.)
By way of comparison, intermediate-acting insulins (e.g. Caninsulin/Vetsulin, Novolin N) typically drop BG levels quite hard and fast in the hours immediately following administration but then peter out several hours before the next injection is due. Rather than feeding mini meals throughout the cycle, a substantial feed is given 20-30 minutes before dose administration to 'front-load' the cat with food - essentially forcing up the amount of glucose entering the bloodstream - in readiness for the insulin's most powerful period of action. The rest of the food for the cycle is usually given in the next 6-7 hours before the dose fades. This is sufficient to support normal metabolic functions and helps keep weight on the cat (the body can get the full benefit from nutrients while the insulin is active) but the cat may spend part of each cycle in higher than ideal numbers. Regardless, even here a single insulin is all that's required, you simply adapt the feeding schedule to match the insulin's action profile.
I hope you find the above helpful.
Mogs
(Note: The above is somewhat simplified and ignores factors like bouncing which may temporarily elevate BG - because they are temporary. It applies to the overwhelming majority of diabetic cats, not those with exceptional complications, as briefly touched upon earlier in this thread.)
Pabs&Ro
Member
Hi Mogs. V helpful thank you. Pabay is a grazer and i think that's why caninsulin is not working.
Pabay knows all about the impact of bouncing. He has just hit 33.8 mmol! We know why and just need to get him off caninsulin asap.
Thanks for all of you valued assistance. Very kind of you.
Ro is Pabay's sister rona. I am Julie.
Thanks
Pabay knows all about the impact of bouncing. He has just hit 33.8 mmol! We know why and just need to get him off caninsulin asap.
Thanks for all of you valued assistance. Very kind of you.
Ro is Pabay's sister rona. I am Julie.
Thanks
Pabs&Ro
Member
Mogs Can i ask your view on this please? My vet advises to do a bg curve not before 7 days after a change in dose. I appreciate caninsulin will have a build up in the system even though its fast acting. Do you think a meaningful bg curve can be done earlier than 7 days? JulieHi Ro,
Your spidey sense is working very well, Ro!
I can really understand - and I've experienced - the conflicts that may arise when a veterinary professional advocates a particular course of action and a crowd of strangers on the internet call it into question (and scepticism is a vital aspect of interacting with the web in general - there is a lot of absolute bilge out there, some of it toys-in-the-attic, some of it downright dangerous) so I've been thinking about how to better explain the basic mechanics of why a single, long-acting insulin is effective in the management of feline diabetes. I think perhaps taking things back to first principles might be of benefit.
Put simply, there are two ways that BG levels increase:
1. When food is ingested.
2. When the liver releases glucose from its reserves into the bloodstream to provide the body with energy to maintain metabolic processes between meals.
Humans are omnivores. When we eat, the carbs which form a regular part of our diets spike blood glucose levels for a couple of hours after meals. That's why human diabetics need bolus insulins. (Their basal insulins deal with the sugars released from the liver between meals.)
Cats are obligate carnivores. Their metabolisms are completely geared towards a high protein diet with moderate fats and negligible carbohydrates. The cat's body can utilise other macronutrients to produce all its glucose needs.
Feeding a cat a species-appropriate, low-carb wet diet means that it won't get big spikes in BG after meals. (Feeding smaller, more frequent meals also helps minimise food rises.)
Because the rate at which glucose enters the bloodstream - from ingested food and from the liver - is relatively even in cats fed a low-carb diet, the 'steady trickle' from the insulin depot formed by basal-type insulins like Lantus and Levemir is perfectly adequate to meet the cat's BG regulation needs right throughout the day. A single insulin is all that's needed. (Note: it does take a little while from start of treatment to arrive at the dose which establishes a depot sufficient to meet the individual cat's insulin needs.)
By way of comparison, intermediate-acting insulins (e.g. Caninsulin/Vetsulin, Novolin N) typically drop BG levels quite hard and fast in the hours immediately following administration but then peter out several hours before the next injection is due. Rather than feeding mini meals throughout the cycle, a substantial feed is given 20-30 minutes before dose administration to 'front-load' the cat with food - essentially forcing up the amount of glucose entering the bloodstream - in readiness for the insulin's most powerful period of action. The rest of the food for the cycle is usually given in the next 6-7 hours before the dose fades. This is sufficient to support normal metabolic functions and helps keep weight on the cat (the body can get the full benefit from nutrients while the insulin is active) but the cat may spend part of each cycle in higher than ideal numbers. Regardless, even here a single insulin is all that's required, you simply adapt the feeding schedule to match the insulin's action profile.
I hope you find the above helpful.
Mogs
(Note: The above is somewhat simplified and ignores factors like bouncing which may temporarily elevate BG - because they are temporary. It applies to the overwhelming majority of diabetic cats, not those with exceptional complications, as briefly touched upon earlier in this thread.)
Critter Mom
Very Active Member
Hi Julie! So sorry about getting your name wrong. 
I'll do better going forward.
Mogs
.
I'll do better going forward.That's fair enough advice from your vet. Julie. It does take a few days for a dose adjustment to 'settle' before you can get a proper picture of how effective it is, so vets normally recommend waiting a week before running a full curve. You can still get your preshot and nadir checks for each cycle as usual to make sure it's safe to give the insuiln injection and that it's not taking Pabay too low. Obviously if you'd feel more comfortable, there's nothing preventing you from doing an additional full curve earlier than 7 days if it would give you more peace of mind.
Mogs
.