How much insulin is too much?

kei_stone

kei_stone

Member
First time poster, so I apologize if I make mistakes.

My kitty, Mii-chan, is three years old now and was diagnosed with diabetes at under a year old. She developed pancreatitis and had a brush with death but survived thanks to a blood transfusion. She has since been diagnosed with chronic pancreatitis.

I live in Japan and just moved to a new city and have a new vet. When I moved in April of this year, she came down with pancreatitis again (third time) and ever since then my vet and I have been having trouble with the dosage of insulin.

In mid-June she was 4.4kg, on 2.5 units of PZ twice a day. Her fructosamine level was over 450, so the vet upped her insulin to 3.0 units twice a day.

As of Monday, she’s 5.04kg and her fructosamine was over 550, so the vet upped her insulin again to 3.5 units twice a day.

She’s on a dry food high-fiber diet (royal canin) because if she doesn’t feel full she eats non-food items like plastic, clothing, books, cat toys, etc. I was recommended this food by a specialist. 45g twice a day, and she eats all of the food within half an hour.

I don’t home test because BG meters in Japan are extremely unreliable and can be off by 100-200.

I was wondering what a typical dosage of insulin is like for cats her size. By the numbers, it seems like more insulin is the right choice, but I really have no concept of what is a high or low dose of insulin. Weight gain is also a concern. Should I get a second opinion?

Thanks for reading this far! Any advice is appreciated.
 
Hello. Welcome. You've had a rough time with your kitty. I read this post earlier and have been pondering it. Really, the thing that worries me is that you have no way of knowing what your cat's blood glucose is at any given time. There's just no way to be sure and safe about giving insulin without home testing. I know you said the meters are inaccurate. Isn't there any way you can import a meter from outside of Japan? Obviously you need test strips as well. This is so difficult and I am quite ignorant of what would be available for you to purchase.

In Japan, do they use sensors like the Freestyle Libre sensor that are placed on the cat and give you BG readings?
 
I am glad that you have been getting Fructosamine tests, in the absence of home testing, but this only will give an AVERAGE of the blood glucose over a period of a few weeks. It's not a substitute for home testing and really is not a safe way to make dosing adjustments. I'm not criticizing you at all. I'm just concerned.
 
I second Suzanne's suggestion about the Libre. I'm actually really surprised about your comment of unreliable meters. What brands do you have available there for human meters? We've had members here from Japan before.

To answer your question on "typical dose", I'm going to reply with a saying we use a lot, ECID or every cat is different. Your cat has chronic pancreatitis and is eating super high carb food. Both of those will likely mean a high insulin dose is needed. But without testing, we don't know how high is correct.
 
Suzanne & Darcy said:
Hello. Welcome. You've had a rough time with your kitty. I read this post earlier and have been pondering it. Really, the thing that worries me is that you have no way of knowing what your cat's blood glucose is at any given time. There's just no way to be sure and safe about giving insulin without home testing. I know you said the meters are inaccurate. Isn't there any way you can import a meter from outside of Japan? Obviously you need test strips as well. This is so difficult and I am quite ignorant of what would be available for you to purchase.

In Japan, do they use sensors like the Freestyle Libre sensor that are placed on the cat and give you BG readings?
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Thank you for your thoughtful reply. I looked up Freestyle Libre and will ask my vet about it. Initially I was suggested to use Alpha Trak 2 (but when they did testing at a university veterinary hospital, that’s when they found the discrepancy and told me not to use it).

I’m concerned as well… I live in the countryside of Japan, so it might be different other places, but the protocol I’ve been told to follow is biweekly fructosamine tests. The university hospital told me that things like lancets need to be purchased through your vet, but I’ll definitely double check about this with my new vet.
 
Wendy&Neko said:
I second Suzanne's suggestion about the Libre. I'm actually really surprised about your comment of unreliable meters. What brands do you have available there for human meters? We've had members here from Japan before.

To answer your question on "typical dose", I'm going to reply with a saying we use a lot, ECID or every cat is different. Your cat has chronic pancreatitis and is eating super high carb food. Both of those will likely mean a high insulin dose is needed. But without testing, we don't know how high is correct.
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I haven’t looked into human BG meters. I was told by the university hospital when she was first diagnosed that human meters aren’t as accurate in pets. Is that incorrect? They suggested Alpha Trak 2 but that’s when they found the discrepancy.

I don’t know how high super high carb food is, but I looked at the paperwork the university hospital gave me. Royal Canin Satiety Support has 37.4g/400kcal of carbs while Royal Canin Diabetic has 27.3g/400kcal. The wet food diabetic food has 13.4g/400kcal but I’d need to give her three pouches a day and can’t because I work.

I’ll ask my vet about home testing protocol in Japan. I know at least for the syringes and insulin bottles, I need to dispose of them at the vet. I suspect it might be the same for lancets.
 
When FDMB first started (25 years ago), there were no pet meters. Everyone, including vets, used human meters. Our dosing methods are written using human meter numbers. Most important, the test strips for human meters are both way cheaper and easier to come by. We have dosing protocols in the Sticky Notes at the top of this forum. People world wide use them.

Here we consider foods under 10% carbs to be suitable for diabetics. You don't need to buy expensive vet foods and might be to find appropriate foods commercially available. As far as feeding foods during the day, many of us buy automated feeders that can give food at programmed times during the day.
 
Wendy&Neko said:
When FDMB first started (25 years ago), there were no pet meters. Everyone, including vets, used human meters. Our dosing methods are written using human meter numbers. Most important, the test strips for human meters are both way cheaper and easier to come by. We have dosing protocols in the Sticky Notes at the top of this forum. People world wide use them.

Here we consider foods under 10% carbs to be suitable for diabetics. You don't need to buy expensive vet foods and might be to find appropriate foods commercially available. As far as feeding foods during the day, many of us buy automated feeders that can give food at programmed times during the day.
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Update: Thank you for your reply. I took Mii-chan to a different vet today and they are going to order me a home testing meter that they use there for consistency. After some blood work, they found out that her liver is inflamed. They said they suspect her might have a hormonal issue or other that could be making the insulin less effective (or she’s just gotten used to this brand), so more vet visits to come.
 
Suzanne & Darcy said:
I was really happy to read this. Now you will really be able to help your baby. Check back in with us when you get the meter and get started.
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Update: Mii-chan has been hospitalized. For some reason the insulin isn’t working as it should and she became dehydrated and anorexic. Her BG was over 550 even without eating. Hepatic lipidosis and possible Cushing’s suspected. Will update once she is discharged.
 
kei_stone said:
Update: Mii-chan has been hospitalized. For some reason the insulin isn’t working as it should and she became dehydrated and anorexic. Her BG was over 550 even without eating. Hepatic lipidosis and possible Cushing’s suspected. Will update once she is discharged.
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Oh, I hope Mii-chan will be okay. I am so sorry she's in the hospital. She may be in diabetic ketoacidosis. I am so very sorry. I will be thinking of you and Mii-chan. Please let us know how she does. Hugs to you.
 
Suzanne & Darcy said:
Oh, I hope Mii-chan will be okay. I am so sorry she's in the hospital. She may be in diabetic ketoacidosis. I am so very sorry. I will be thinking of you and Mii-chan. Please let us know how she does. Hugs to you.
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Thank you so much for your support. Mii-chan is officially out of the hospital. Acute pancreatitis and hepatic lipidosis (both have resolved). The vet is still having trouble regulating her insulin because she gets so stressed when she goes to the vet that even 6 hours after 3.0 units of insulin her BG was a little over 430. (This was after a 15g reduction in food.)

I’ve ordered the Alpha Trak2 through the vet, but all of the necessary items in the testing kit will only arrive at the end of the month. In the meantime, I’ve ordered the One Touch Verio which should arrive in a couple of days.

Can you please point me to the differences between human and pet glucose monitor numbers?
 
The Alpha Trak meter usually reads higher than a human glucometer. They tend to give readings that are closer together in the lower numbers though.
 
She will be much less stressed with you at home. I am very happy to hear that she is home and healed up from pancreatitis and hepatic lipidosis. Now you must keep her eating and also watch for signs of a pancreatitis flare up (I hope this won’t happen though.)
 
You should seriously consider finding wet food that is low in carbohydrates for Mii-Chan. This will reduce her glucose numbers. It really will help.
 
I have diabetic wet food that I got from the vet. You’re probably right that giving her that would really help as it’s only around 3% carbs. What she eats now is about 9% carbs.

Even when her diabetes was controlled, she just gets so hungry, which is why my vet suggested satiety support food. In the past, I’ve tried automatic feeders and she broke two of them because she was so hungry and could smell the food. She didn’t break the third, but that one doesn’t have an option of keeping wet food cold until feeding time.

I’m hoping to at least switch her to dry diabetic food (she won’t eat wet unless she isn’t feeling well). It just all depends on her appetite. Last time I tried the dry diabetic food, she got so hungry that, among other things, chewed the head off a plastic toy mouse and swallowed it, landing us at the vet.

I really do appreciate your advice and hope to at least switch her to dry diabetic food (6% carbs) in the near future.
 
kei_stone said:
I have diabetic wet food that I got from the vet. You’re probably right that giving her that would really help as it’s only around 3% carbs. What she eats now is about 9% carbs.

Even when her diabetes was controlled, she just gets so hungry, which is why my vet suggested satiety support food. In the past, I’ve tried automatic feeders and she broke two of them because she was so hungry and could smell the food. She didn’t break the third, but that one doesn’t have an option of keeping wet food cold until feeding time.

I’m hoping to at least switch her to dry diabetic food (she won’t eat wet unless she isn’t feeling well). It just all depends on her appetite. Last time I tried the dry diabetic food, she got so hungry that, among other things, chewed the head off a plastic toy mouse and swallowed it, landing us at the vet.

I really do appreciate your advice and hope to at least switch her to dry diabetic food (6% carbs) in the near future.
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Hi there. Really, anything less than 10 percent carbohydrates is considered to be low carb. Some cats do better with a few more carbs and some do better with less. I hope that you and Mii-chan are well.
 
Thank you for the advice and well wishes. Mii-chan has recovered from her hospital stay and the pet BG Alpha Trak2 finally arrived.

I’ve been testing her throughout the day (before feedings, and 6 hours after insulin injection) and am starting to notice a pattern. Her BG is much higher when I’m not around (eg. when I come back on lunch break to test vs. working from home and testing). It’s higher than pre-feeding levels. (Today was 408 pre-feeding and 488 six hours later.) Could this be separation anxiety causing her BG to go up? She’s still on 3.0 IU twice a day.
 
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