Sticky INTRODUCTION TO CANNISULIN/VETSULIN & N/NPH

Discussion in 'Caninsulin / Vetsulin and N / NPH' started by Sienne and Gabby (GA), Jun 28, 2020.

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  1. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    If you're new to the FDMB, please start on FELINE HEALTH: The Main Forum where you'll learn all about hometesting, the basics of feline nutrition, and feline diabetes. Please be sure you read “New? How You Can Help Us Help You!"

    FEELING OVERWHELMED? BEWILDERED? WE’RE HERE TO HELP!

    We’re all in this together: You came here because you love your cat; we love our cats, too. Our common bond in this forum is diabetic cats who are getting N/NPH, Caninsulin, or Vetsulin insulin. Welcome!

    NOTE: We use the terms N/NPH or Caninsulin/Vetsulin interchangeably. These are different types of insulin but are included in this forum as they are both short acting. (FYI: Caninsulin is the name of this insulin outside of the US and it is called Vetsulin in the US.

    Please note: The current guidelines for the treatment of feline diabetes (FD) published by the American Animal Hospital Association (AAHA) in 2018 no longer recommend N/NPH or Caninsulin/Vetsulin for the treatment of FD. These insulins continue to be recommended for dogs but the AAHA noted these types of insulin have insufficient duration to be recommended for the treatment of FD. However, given the cost of longer acting insulins in the US, N/NPH or Vetsulin/Caninsulin may be a more economical option if finances are a concern. (Many people in the US buy their insulin from a Canadian pharmacy. If you prefer to use Lantus or Levemir, information on buying from Canada is available on FDMB.) In some countries, vets are limited in which insulins they can prescribe, with Caninsulin being a common option. This was the case in the UK for some time. Prozinc is now a first line choise, as well.

    It can be challenging to treat diabetes in a cat. Whether you’re giving that first shot or figuring out which food is best, we’re right here with you. This guide was developed to help you get started. You are also welcome to open a new thread/topic on the forum. Chances are you’ll get some answers within a few hours.

    Everyone here was once a “newbie” at treating a beloved kitty’s diabetes. So whether you’re feeling shocked, sad or even scared since your own cat’s diagnosis, we understand because we’ve all been there. Right now it may seem like managing FD is an awfully steep learning curve to master - and that’s why we’ve developed this guide. Its purpose is to equip you with the basics to help you safely treat your cat’s diabetes. Yes, there’s a learning curve involved, and treatment is more of a marathon than a sprint. It requires what we call "The 3 C’s":
    • Commitment: To learning how to more effectively treat FD and keep your kitty safe while on insulin. (You’ll likely end up better educated about FD than some veterinarians are!)
    • Consistency: By diligently applying the time-tested treatment and monitoring practices explained here, you’ll be on your way to getting your cat’s blood glucose (BG) better regulated and restoring your favorite, lovable fur-ball to good health!
    • Communication: Through your active involvement on this forum - posting your questions about dosing, your concerns, even how you’re feeling, and by consulting with the broadly experienced members here - you can more easily navigate any bumps in the road. (P.S. There are no “stupid” questions, either!)
    There are 3 basics to feline diabetes treatment:

    1. A mild long lasting insulin. (As noted above, a long-lasting insulin such as Lantus, Levemir or Prozinc is preferred but there are reasons for opting for a shorter acting insulin.)

    2. Wet low carb food. (Details follow.)

    3. Home testing. (“Must-know” details below.)

    Your confidence in your ability to manage your kitty’s diabetes will grow in time - thanks to a great group of people who are here to provide you the same kind of daily guidance, encouragement, and moral support that we’ve all found here after getting a diagnosis of FD from the vet.

    So onward, gentle reader! And welcome to the “club” that none of us wanted to join - but once you have been with us for a while, you’ll be so glad you did!

    HOW N/NPH AND CANISULIN/VETSULIN INSULINS WORK

    All insulins are prescribed to supplement an insulin deficiency in a diabetic cat. There are several types of insulin that work differently. N/NPH is a human insulin whereas Caninsulin/Vesturlin is a pet-specific insulin that was developed for dogs but many people have used with great success.
    • These are “in and out” insulins, however, it is possible for one cycle to affect the next. By "in and out" we mean that the insulin does not build up in the system and stay there.
      • Onset is when the insulin starts working. With these shorter acting insulins, onset is rapid. In some cats, onset can be almost immediate which is why it’s important to feed your cat at least 30 minutes prior to an injection.
      • Duration is how long the insulin lasts. NPH generally lasts 8 hours whereas Caninsulin last about 8 – 10 hours resulting in a “curve” of BG numbers, downward around mid-cycle, then back upward toward the end of each 12-hour cycle. For this reason, it’s dosed twice a day.
      • Nadir is the lowest point in the cycle. With NPH, this can vary with members reporting nadirs ranging between 2 – 6 hours post-shot. For Caninsulin, nadir is at 4 – 4.5 hours post-shot.

    • Since these are the first insulins that were available for use with cats, many cats have gone into remission using these insulins.

    • Dosing can change more often than other insulins since it is relatively ‘in and out’. But generally - especially at the start of treatment - it’s advisable to stick with a dose for at least 3 cycles; changes can be made after that, as needed.

    • We recommend starting low: 1 unit is a good starting dose for cats that are still on a dry food diet. If your cat has been transitioned to a low carb, canned food diet, a starting dose of 0.5u is recommended. Then, insulin changes can be made by 0.25 units.
    Please read the specific dosing methods guidelines for a full discussion on options for dosing either N/NPH or Caninsulin/Vetsulin.

    Technical information:

    Caninsulin (Vetsulin) is produced by Merck Animal Health (MSD Animal Health outside the USA). It is a U40, intermediate acting (lente) porcine insulin, comprised of 30% ‘amorphous’ and 70% ‘crystalline’ insulin. The amorphous insulin takes effect quickly, the crystalline is released more slowly. In dogs this can result in two peaks of activity. But in cats, because of their faster metabolism, there is usually a single peak. http://www.vetsulin.com/vet/default.aspx or http://www.caninsulin.com/ which has a menu for each different country.

    Novolin or Humulin The N insulins are U100 insulin

    Novolin or Humulin is a man-made insulin whose origin is recombinant DNA. It is also referred to as NPH (Human Insulin Isophane suspension) and it is structurally identical to the insulin produced by the human pancreas.


    Caution! Be absolutely sure that you are using Novolin or Humulin ‘N’. Do not use Novolin or Humulin ‘R'. (The ‘R’, also referred to as “regular”, insulins are used by vets in medical situations when the BG needs to be brought down very quickly.) Also, be sure you are using Humulin N and not Humalog. (Humalog is the brand name for Lispro which is also a fast-acting insulin, similar to R.) These guidelines do not support the use of combination insulin such as Mixtard nor do we recommend a combination short- and intermediate-acting insulin in cats.

    Be sure your syringes are calibrated for the same concentration as your insulin. (That’s what the “U” refers to in either U100 or U40 insulin.) You can adapt dosing with a U40 syringe to a U100 insulin but not vice versa. This is a conversion chart if you wish to use U100 syringes.

    • A note on U-40 syringes: If you are using a U40 insulin, you must be sure you are using the correct U40 syringes. In the United States, these syringes usually have a RED cap, but the cap color may vary, depending on the manufacturer or where you live in the world. U40 syringes are also available that show half-unit markings, making dosing easier as you are fine-tuning the dose.
    • A note on using U100 syringes with the Conversion Chart: Many people find that using U100 syringes with half-unit markings makes it easier to fine-tune a dose in smaller increments. (You MUST use the Conversion Chart; the link appears both above and below.) In the United States, the U100 syringes (designed for use with the more concentrated U100 insulins) usually have ORANGE caps - but again, the cap color may vary with the manufacturer or where you live in the world.
    PLEASE make sure you are using the correct syringes. Either the U40 or the U100 (again, the conversion chart is required when dosing U40 insulins such as Vetsulin/Caninsulin with U100s.)​

    PLEASE NOTE: Both Caninsulin and N are suspensions. This means you need to physically mix the insulin before using it.

    HOME MONITORING

    Consistent blood glucose (BG) testing can save your cat’s life.
    • In-home testing saves you the unnecessary expense of vet clinic BG curves and/or fructosamine tests. You can even do your own BG curves at home, record your results in our handy spreadsheet (SS) and share that with your vet. See below for SS info. (Your vet will probably be duly impressed, even though it means less money in the vet’s pocket and more in your own!)

    • Your cat will likely be calmer when you test at home, which often means a far more accurate BG test result. “Stress hyperglycemia” during a visit to the vet can actually cause your cat’s BG to rise by 100 mg/dL {6 mmol/L} or more than it would normally read when your cat is relaxed in his own home. Yet another reason to test at home before shooting that first dose of insulin!

    • Does testing sound scary? RELAX! Your cat’s outer ears have very few nerve endings, so for kitty, it’s more like a mosquito bite when poked with a lancet (unlike the sharp pain you’d feel if you pricked your fingertip.)

    • Here’s a great how-to link including written instructions, photos and video: Hometesting links
    How often should you test blood glucose?
    • A daytime cycle pre-shot test (AMPS) and a nighttime cycle pre-shot test (PMPS). For your cat’s safety, always test before you shoot insulin, no matter how small the dose may be.

    • Tests (as your schedule permits) to determine your cat’s nadir, which is the expected mid-cycle low BG level that occurs usually 4 to 7 hours after insulin is administered. Some cats nadir earlier, some nadir later. ECID - Every cat is different.

    • Some additional mid-cycle tests are always useful, especially when there has been a change in dose or food. Every few weeks, a curve (tests every 2-3 hours) is very useful.

    • If you work during the week, a weekend is a good time to get additional BG testing in during the daytime and nighttime cycles. (Yes, this means setting alarms to get up overnight, but you’ll see a payoff by helping to get your kitty regulated.)
    When in doubt, ask the Forum or your vet for advice BEFORE dosing your cat.
    • The proper sequence for dosing insulin is: Test/Feed/Wait (30 – 30 min for Caninsulin/Vetsulin and an hour for N/NPH)/Shoot. In the beginning, if your cat’s BG is not up to at least 200 mg/dL {11 mmol/L}, if your schedule allows, you can stall (without feeding) for 20+minutes, then retest the BG. You are looking for a number that is rising, not falling and up to 200 mg/dL {11 mmol/L}. If you stall once, but can’t do another round of stalling and your cat hasn’t reached a BG of 200 mg/dL {11 mmol/L}, you’ll need to skip the dose and wait until the next cycle. NOTE: Because pet-specific meters (such as the AlphaTrak2) often read higher than human meters, you may want to adjust the NO-SHOOT/Ask for help number to 225 mg/dL {12.5 mmol/L} or even 250 mg/dL {14 mmol/L} This gives you an added margin of safety when using an AlphaTrak2 or other pet-specific meter.

    • IMPORTANT NOTE: Do not feed your cat within the two-hour window right before your pre-shot test time; doing this can raise your cat’s blood significantly, giving you a higher BG number based on food. This could result in your giving insulin when you should not, or giving more insulin than you should. (We realize this may sound confusing. You want to not feed your cat 2 hours prior to your pre-shot test. Test and THEN feed your regularly scheduled meal, wait (depending on which insulin you’re using) and then shoot.

    • FDMB has general BG references for use with human meters: A cat is considered regulated if BG is in the mid-200s mg/dL (mid-11s mmol/L) for pre-shot and in low 100s mg/dL (low 5.6s mmol/L) or double digits (U.S. mg/dL) for nadir above 50 mg/dL (2.8 mmol/L). Below 50 mg/dL (2.8mmol/L) is approaching hypoglycemia range, which is too-low BG. If you are using an Alpha Trak2 (pet meter) the “potential for low numbers” starts below 68 mg/dL (3.8 mmol/L) and below. Again: You may want to consider raising your No-Shoot/Ask for Help number to as much as 250 mg/dL (14 mmol/L) in the beginning of this sugar dance when using a pet-specific meter. That’s your and your vet’s decision.

    • If you need help with a hypo, post right away in this ISG and on the Health forum with the title: 911 HYPO - Need Help ASAP to get the maximum guidance to help you steer your cat back to safer levels. You should also put the 911 prefix on your thread by selecting “911” from the Dropdown-Menu box to the left of the thread title. The 911 prefix in the subject line should only be used for emergencies such as symptomatic hypos, very low numbers (below 30 on a human meter), and/or very sick cats potentially needing ER care. Please remove the 911 as soon as someone has responded and you have received help.

    • If hypo symptoms are severe (seizure/loss of consciousness, etc.) go to the nearest ER vet clinic immediately. Bring corn syrup or honey with you especially if you have a long drive to the vet.
    Essential Hypo Reading: Hypo toolkit link and HOW TO TREAT A HYPO
    • Hot Tip: Print BOTH of the above documents out; the first is a great shopping list - and we strongly suggest you post “How To Treat A Hypo” in a prominent place (like your refrigerator door).
    Ask for help on the forum before giving a shot if you are unsure as you can never “un-shoot” a dose. PLEASE - indicate you need help in your subject line and when asking for dosing or hypo advice, make sure you indicate:
    • which type of meter you are using;
    • if your cat is on any other drugs and/or has health problems;
    • if already dosed, amount of that dose, time of day given and your Time Zone (such as Eastern, Pacific, etc.);
    • how much time has elapsed since you did the last BG test and your last shot;
    • when your cat last ate, type of food and how much.
    Never give an additional amount of insulin during the same 12-hour cycle, even if you think you missed and gave a fur shot. Even if you are sure your pierced both sides of the skin tent and saw the insulin fly across the room, DO NOT SHOOT TWICE IN ONE CYCLE. You can never be certain if any insulin was given. Better to be too high for a day than too low for a minute. Safety first!

    These are the FDMB guides to dosing either N/NPH or CANINSULIN/VETSULIN. Please read through the relevant sticky and keep it handy.

    ARE YOU TESTING FOR KETONES? IF NOT, DO IT!


    BLOOD GLUCOSE (BG) METERS: HUMAN OR PET-CALIBRATED? YOU CHOOSE

    • Blood glucose meters test the amount of glucose in the cat’s blood.
    • Human BG meters are the type most commonly used by FDMB members; they’ve been used successfully for many years to monitor cats’ BG. Inexpensive human meters and test strips are widely available at pharmacies (Walmart, Walgreens, etc.) as well as online (Amazon, Ebay, American Diabetes Warehouse).
    • The pet-calibrated AlphaTrak2 (AT2) is widely considered by vets to be the “gold standard” for testing BG for cats because the results are closer to that of veterinary lab equipment. An AT2 meter must be purchased either from a vet clinic or online. Most vets don’t carry the test strips. They are much more expensive than human meter strips. Some additional info: Alpha Trak2
    • In the UK, many people use the Accu-Chek Aviva. It’s widely available and only requires a small blood sample.
    • Blood Glucose Meter Ratings, Comparisons, & Recommendations
    'REGULATION' - WHAT IT MEANS

    The initial aim of treating diabetes is to get the cat into a better and more stable BG range (‘regulated’). In the FDMB FAQs the degrees of regulation are suggested as follows (based on data from human glucose meters; pet meter numbers would typically be a little higher). But your cat may not fit exactly into one of these ranges. Feline diabetes can be very variable.

    • Not treated - BG typically above 300 mg/dL (16.7 mmol/L). Poor clinical signs.
    • Treated but not regulated - BG often above 300 mg/dL (16.7 mmol/L) and rarely near 100 mg/dL (5.6 mmol/L). Poor clinical signs.
    • Regulated - BG generally below 300 mg/dL (16.7 mmol/L) with glucose nadir near 100 mg/dL (5.6 mmol/L). Good clinical signs. No hypoglycemia.
    • Well regulated - BG generally below 200-250 mg/dL (11.1-13.9 mmol/L) and often near 100 mg/dL (5.6 mmol/L). No hypoglycemia.
    There may also be an extra category of "mostly above 300 (16.7) but with good clinical signs" which occurs with some cats who are getting insulin. We don't know why it happens, but such a cat probably should not be considered to be regulated.

    On FDMB you may read about a cat’s BG being ‘Tightly Regulated’. The aim of Tight Regulation (TR) is to keep the cat’s BG in normal levels for as much of the time as possible. We don’t recommend attempting TR with Caninsulin (Vetsulin) or N/NPH; these insulins can drop the BG very steeply and fast and there could be a danger your cat’s BG may drop too low. Rather, the preferred method with short-acting insulin is similar to the Start Low Go Slow (SLGS) approach with modifications that are appropriate to this type of insulin. The SLGS method was developed by FDMB members and was the primary method for treating FD before TR was published.

    LOW-CARB DIET IS BEST, BUT PROCEED SLOWLY
    IF KITTY IS ALREADY ON INSULIN


    A low-carb, high-protein diet is a key component to feline diabetes treatment. Not only is a higher carb diet likely to result in higher levels, it is also contrary to a cat's metabolism. Lisa Pierson, DMV has devoted years to understanding cats' dietary needs and explains it all on her website devoted to feline nutrition.

    Dr. Lisa also has an excellent food chart that lists a number of important elements, including the carbohydrates, in a broad range of canned foods. We suggest feeding your cat a diet that is below 10% carbohydrate. If your cat is already on insulin, be sure you are confident about home testing your cat’s BG before you switch to low-carb food. The switch can result in a BG drop of more than 100 mg/dL (6 mmol/L} or even lower, so BG monitoring is essential! Also, make the switch slowly to avoid stomach upsets. These pages have useful threads for low-carb treats and transitioning from dry to wet food:
    • Low carb treats
    • Transitioning your cat from dry food to wet food
    • These Links to Food Charts provide the links to food charts for the US, Canada, UK, Australia, New Zealand, Mexico, and Argentina.
    • A recommendation from the Netherlands is to feed Felix (As Good As It Gets) in conjunction with Cosma Nature, a supplementary food.
    • Porta 21 Feline Finest Sensible and Thrive ‘Premium Plus’ Chicken may currently be the lowest carb dry foods available in Europe (for dry food addicts only).
    If you ever are in doubt about a possible food and its low-carb values, please ask on the forum.


    GOOGLE SPREADSHEET: TRACKING KITTY’S PROGRESS

    It is important to track your kitty’s progress over time. FDMB has a process for this, using a Google spreadsheet (SS). Other FDMB users can provide you better help if you keep your cat’s SS up to date. Once you type in the numbers, the SS will automatically update. The spreadsheet is color coded to help you see trends.

    Make sure when setting up your spreadsheet that you choose the correct type: We have one sheet for human meters and another for AlphaTrak2 pet meters.

    If you are not from the United States: Make sure you choose the World version so that your numbers will automatically convert to what most members are used to seeing. We have a World SS for human meters and another for pet meters.


    • Create a signature block and post the spreadsheet in your FMDB signature. Once you create the spreadsheet, put it in your FDMB signature block along with the additional information indicated in a post on creating and editing your signature which includes easy instructions on how to update your signature block.

    POSTING INSTRUCTIONS FOR THE INSULIN SUPPORT GROUPS (ISG)

    • Please start a new thread whenever your current one reaches 25 posts so the thread does not get too long. When starting a new thread, please be sure and include the link to the previous thread (instructions below):
      • open the current thread and copy the browser address
      • open a new thread and in the text box below the subject title box, type a reference to the previous thread such as “Last Thread” or “Previous Thread”.
      • highlight what you typed
      • click on the hyperlink above the text box (7th icon from the left that looks like a sideways paper clip)
      • paste the copied browser address in the box that opens
      • click “insert”; your typed reference for the link should now appear in blue in the text box.
    • Please use one thread for all the comments and questions you have. This will keep all information pertaining to your cat together in one thread until you reach 25 posts and start a new thread.
    • Your thread will be bumped to the top of the list when you or anyone else posts on your thread.
    • If you need dosing advice, tag your thread this way: Dosing Advice ASAP. Remember, if no one responds right away and it is shot time, stalling without feeding is the best thing to do. In the event that no one comes to your aid after a reasonable amount of time and your schedule will be too far off-kilter the next day if you were to stall, it's best to just skip the shot when in doubt if the pre-shot BG is too low. If your cat has ketones or a history of DKA, it’s very important to get assistance and advice before you skip a shot.
    • The Caninsulin N/NPH Forum is a small group and not as active as the Health forum, especially at night. You can "tag" people that you see are online to get more eyes on your thread ASAP. (To do this, use each member's screen name preceded by an "@" symbol, like this: @Sue and Oliver (GA). ).
    HANDLING PROBLEMS

    • Multi-cat households/ Kitty “Contraband” Foods:
    It might be helpful to get all cats in your household on diabetic-friendly food if at all possible, and on the same feeding schedule. We realize that some cats have other health issues that would not allow that to happen, for instance cats with kidney issues. But if at all possible, get all dry food out of your house to make it easy on your life and not have your “sugar cat” get into “contraband” food. (It only takes a few pieces of dry food to cause a big rise in BG's!)

    Until your diabetic kitty’s BG is well-regulated, your cat will likely behave like he or she is starving, but that’s just the diabetes “talking.” Dealing with a newly diagnosed cat is a bit like child-proofing your home. You'll need to be careful since contraband food opportunities for your kitty can include your dog’s or other cat’s food dishes, dishes left unrinsed in the sink, the kitchen trash can - or even a single potato chip accidentally dropped by the sofa while watching a favorite TV show! So be aware: Even a small amount of contraband food that your diabetic cat gets into can spike BG numbers. Sit family members down and explain that you’re treating a serious disease and need everyone’s cooperation to help in restoring your kitty’s health.
    • Juggling work and having a Feline Diabetic:
    It is a challenge, but doable with some careful planning and having your shot schedule reflect when you know you can be home. Some people will wake up a bit earlier so that they have time to get at least a +1 test before they walk out the door. Also, it's a good idea to have someone else trained to test and shoot insulin in the event you are not able to be home on time. Sometimes this is another family member or it can be a pet sitter who is trained to help you.
    • Feeding Schedules:
    There is no "right" or "wrong" approach to feeding; rather it's a personal choice. Some people like to feed twice daily, before the shots. Others like to give several small meals during the day (and perhaps the night). With fast-acting insulins, it might be necessary to feed at least one other small meal after the insulin has onset. Again, ECID, so determine what is best for your kitty.

    We would recommend that you base your feeding schedule on your own particular situation (whether you're able to be around to monitor BG or not, etc.) and your own cat's response to the insulin. It is very helpful if you can determine when your cat's nadir (lowest BG) occurs during a 12-hour cycle. If you work outside the home during the week, this might best be discovered over a weekend when you can be around to do a a curve (feeding at pre-shot time, dosing the insulin, then testing every 2 hours until you see where in the cycle your cat's nadir happens while on insulin). Taking the extra time, early in treatment, to find out when your kitty's nadir occurs can help you determine when to have extra food available for those times when you're not around, so that your kitty stays safe if the BG were to drop lower than a safe range.

    When you can’t be at home to monitor BG levels, making food available in the event that the BG drops low adds a measure of safety, as most cats will search out food during those times. There are several timed feeders on the market that make doing this easy: One that allows 5 different feeding slots is the PetSafe 5; there are other models that have fewer food compartments. (Amazon has a selection of timed feeders to consider). Some of the models have a depression under the food tray that will allow for an ice pack to ensure that food does not spoil. Another idea is to freeze your cat’s serving sizes in ice trays, then pop them out into the feeder in the time-slots you select. By the time the feeder opens, the food is thawed!

    INSULIN RESISTANCE/GLUCOSE TOXICITY: Worth knowing about

    If, after months on insulin, your cat’s diabetes still remains unregulated, glucose toxicity may be something you should discuss with your veterinarian. If you have followed all the recommended treatment steps to the letter and your kitty’s numbers remain high, it’s time to rule out any and all conditions that may be complicating and impeding your cat’s progress toward good BG control and better health.

    The following brief explanations (italicized excerpts) about insulin resistance, glucose toxicity and the effects of carbohydrates and obesity in relation to type 2 diabetes (which is the type most diabetic cats have) are from Dr. Lisa Pierson’s Catinfo.org website:

    Type 2 is characterized by two problems. The first, as in Type 1, is a diminished ability of the pancreas to secrete insulin. The second issue is one of insulin resistance. In other words, the receptors on the cell wall that would normally open the door to the cell to let the glucose in when insulin 'knocks', stop 'listening' to the insulin. The cells 'resist' the signal that the circulating insulin is sending and the glucose is not transferred to the inside of the cell, resulting in an elevated blood glucose (hyperglycemia) and cellular 'starvation'. The elevated blood glucose, in turn, sends a signal to the pancreas telling it to secrete more insulin. The elevated insulin may somewhat override the insulin resistance resulting in more glucose entering the cells, but eventually the pancreas can become exhausted or 'burned out'.

    Glucose toxicityresults from chronic hyperglycemia. Glucose toxicity wreaks havoc on the entire body - especially the pancreas and its insulin-producing cells. A vicious cycle then ensues as the insulin-producing cells are damaged resulting in less insulin being produced.



    This is how we use this concept on the forum: If your cat has been on Caninsulin or N/NPH for quite a while, remaining in “high and flat” BG numbers throughout his/her 12-hour cycles at the current dose, the dose may need to be increased every 6 cycles by a small amount, until you reach what we call a “breakthrough” dose.

    Carbohydrates, Obesity and Diabetes (Again, from Dr. Pierson at Catinfo.org )

    Most people are aware that diabetes is more common in overweight humans than it is in people closer to an optimal weight. The same is true for cats. Fat (adipose) cells produce a substance that causes the cells of the body to become resistant to insulin. This increase in insulin resistance is the hallmark of Type 2 diabetes. As mentioned above, this is the most common form in the cat.

    Cats are designed to utilize proteins and fats for their energy - not carbohydrates. They are lacking the necessary enzymes to efficiently utilize carbohydrates to meet their energy needs. When the carbohydrate level of an obligate carnivore's diet is higher than it should be - remember that a bird or a mouse is only 3-5 percent carbs and that most dry foods contain between 35-50 percent carbs - the excess carbohydrates are stored as fat. The increased fat cells, in turn, promote Type 2 diabetes via an increase in insulin resistance. That said, if calories in exceed calories out - no matter whether the calories come from protein, fat, or carbohydrates - the cat will gain weight. This is why portion control is important no matter what diet you are feeding.



    Causes of Insulin Resistance in Cats
    Common concurrent diseases that can cause or exacerbate insulin resistance/glucose toxicity in diabetic cats include:
    • pancreatitis
    • hepatic lipidosis
    • cholangiohepatitis
    • urinary tract infection
    • chronic kidney disease
    • hyperthyroidism
    • inflammatory bowel disease
    • acromegaly
    • Cushing’s disease
    • Insulin auto antibodies (IAA)
    • heart disease

    Please note: Treatment with steroids can precipitate what is known as “transient diabetes” in cats. This “drug-induced” diabetes can resolve fairly quickly once the prescribed drug is stopped and/or insulin treatment has begun. In this situation it is especially important to monitor BG levels closely before each dose of insulin is given, and to do some mid-cycle testing as well. This is because a cat’s BG can rapidly return to more normal levels after the effects of the drug have fully worn off. In these cases, careful monitoring is especially important to help avoid a sudden hypoglycemic event after the steroid therapy has stopped.

    Of the above-noted causes of insulin resistance/ glucose toxicity, here are two of the most commonly seen and discussed on the FDMB forums:

    Pancreatitis
    Pancreatitis is a common and frustrating problem; it often complicates treatment of diabetes. Because both the body’s demand for insulin and the appetite can fluctuate with the severity of inflammation of the pancreas, clinical signs of poor glycemic control often coexist with an increased risk of clinical hypoglycemia. If your cat is diagnosed with pancreatitis, post to this forum for support, as there are others here who have had experience of this in their own cats.



    Bacterial Infection
    Bacterial infection is an important cause of insulin resistance in diabetes. Diabetic cats are at increased risk of bacterial infections, especially of the urinary tract. (Some of us only learn that our cats are diabetics when we’ve taken them to the vet because we’ve noticed symptoms of urinary difficulties in our cats.) In studies though, it’s been shown that only 40% of the cats with urinary tract infections exhibited clinical signs. Some studies also have noted that bacterial infections are common concurrent diseases in diabetic cats. Bacterial infections commonly occur in the oral cavity (bad teeth, gum inflammation/ gingivitis), the skin, and the biliary tract. Getting any infection diagnosed and treated can result in a significant shift downward in your cat’s BG numbers - so again, careful monitoring of BG levels during and after treatment for infections is important to help ensure against a sudden hypoglycemic event while your cat’s BG levels start to improve as the infection clears.

    SHOPPING LIST

    Here is a shopping list for home-testing:
    • A blood glucose meter. You may have left your vet’s office when your cat was diagnosed with an AlphaTrak2 (pet-specific) meter already in hand (or have been advised by your vet to get one) as it’s widely considered the “gold standard” for home-testing among veterinarians. However, most FDMB members do use human glucose meters because the test strips cost so much less. Human meters have been used by our members for many years with good results. So whether you use a pet-specific meter or a human meter is your personal choice: Either type will work effectively; however, dosing methods have been developed using human meters. The most important point: that you DO home-test your cat’s BG before shooting a dose of insulin!

      Any human meter that “sips” up the blood droplet and takes a tiny sample (0.3uL) is fine. Lots of FDMB members like the Relion Prime brand meter from Walmart. The Relion Prime is only available in the United States. The meter is inexpensive and the test strips are among the cheapest around. Some human meters are free in drugstores when purchased in a kit along with the test strips, as the strips themselves are the ongoing expense. You can, however, find strips on Ebay at less than half the price you’d pay in stores. There are often deals on Amazon, as well. We also recommend a back-up meter of the same type just in case of unexpected failure of the original one. Be sure you have an extra battery or two on hand as well. Regardless of which meter you choose, try it out on yourself or someone else before you try it on your cat. You want to be familiar with exactly how it works before you poke your kitty.

    • Blood glucose strips: PLAN AHEAD! Stock up so that you don’t run out of test strips when it really counts (like pre-shot test time or in the event of a hypo). While you can usually dash off to a 24-hour WalMart for ReliOn or other brand strips, you may not be so lucky finding some other name brand strips in stock. Special note to AlphaTrak2 (AT2) users: These test strips are generally available via online vendors only; most vet clinics do not sell AT2 strips, nor do pharmacies or WalMart or other similar stores stock these - so is especially important that you plan ahead when using this meter! Make sure you have a meter whose test strips you can source locally.

    • Lancets and a lancet device. Usually, until the ears “learn” to bleed, a 26-28 gauge lancet is good to start and, after the ears bleed better, 31g lancets may be preferred. Any brand will work as long as the lancets will fit in your meter brand’s device.
      (Some of us don’t even bother with the lancing device, preferring to do the ear-poke “freehand” - do it whichever way works best for you!) Hot tip: Lancets come in boxes of 100, and you’ll usually go through them even faster than you do the BG test strips, so is a good idea to stock up with at least 2 boxes on hand for each vial of 50 test strips. (Don’t reuse the same lancet for more than one poke, either.)

    • Ketone strips (Ketostix). Just like human diabetics use. You will sometimes need to test urine if the numbers are high. If you’re unable to test your kitty’s urine for ketones, there are meters available, called Precision Xtra and Nova Max Plus which can test blood for both BG and ketones. The ketone test strips must be purchased separately and are very expensive compared to the BG test strips.

    • Rice sack. Make this out of a lightweight sock filled with raw rice or oatmeal, and then knotted. You heat this in the microwave until warm, but not hot. Then heat the ears before poking. You can also use a prescription bottle filled with very warm water; it provides a good surface to poke against.

    • Flashlight: So you can look at the ears and find the little capillaries that come off the vein running around the edges of the ear. You want to poke a capillary.

    • Vaseline: Put a tiny smear where you want to poke. It will help the blood bead up.

    • Reading glasses: Even if you don’t really need them to read, these handy magnifiers can be a big help - both in detecting the blood droplet when it forms after an ear-poke, and when you’re loading the syringe for a shot!

    • And some low-carb treats to give your kitty. Our kitties learn to associate treats with testing which makes the process much easier. Remember to give your kitty a treat regardless of whether the test is successful or not.
    FDMB’S FELINE DIABETES ACRONYMS

    There are plenty of acronyms in use at FDMB, so is a good idea to familiarize yourself with all of them! More acronyms are located here: FDMB acronyms

    These are "general" guidelines which have worked for many cats. However, "Every Cat Is Different". Learn how YOUR cat responds to the combination of food and insulin. Please be aware: There are no "dose advisers" on the FDMB. The FDMB is an open board subject to peer review where laypersons with varied amounts of knowledge and experience are free to share their own thoughts and opinions through explanation and by making suggestions. We are not veterinarians. It is not our intention to take the place of your veterinarian. Please discuss dosing, methods, medications and care for your cat with your veterinarian.


    It really did "take a village" to create this Introduction. Many thanks to a great team of co-writers/editors: Sienne and Gabby (GA), Marje and Gracie (GA), Wendy Neko (2020) and the accumulated knowledge and posts from our members.
     
    Last edited by a moderator: Jan 23, 2021
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