New Member and Pre-Shot testing question.

Hello,

I have to apologize for my poor Englilsh.

My cat's name is Ninja. He's approximately 14 years old (He was a stray and I took him from the street). I am Thai and live in Thailand. Which does not give me much of an insulin choice. It seems Caninsulin is the basic for every vets.

U-40 syringe is very hard to find here, so the vet recommend to use U-50 syringe. The amount I am told to give my cat is four little bars before a big 5 on U-50 syringe. I belive it is around 0.04 cc

My cat was diagnosed on May 13th. Before that, around a month. I noticed he urines a lot and drank a lot of water also. At first the vet suspects Chronic Kidney, but after a week of prescribe kidney diet. His kidney value came back to normal. That's when I asked the doctor to do glucose test and found out my cat has diabetes.

I have a few question please.

My cat is a slow and bit by bit eater. He never had a big pile of food and finished it all at once before. So, in order to meet a daily prescribe diet. (Royal Canin Diabetic) I feed him 2 hours before an insulin shot. Let him slowly finish his food at his pace. Is this ok? Force-feeding by syringe is too harsh in my opinion.

I know that it's best to test before the shot. But I have a problem. I have a lazy eye and cannot see the depth very well so, I cannot prick on the side of the ear. Since my cat is black, it made everthing harder. So I have to fold his ear up and prick the inside of his ear, give him a little squeeze to get the blood. This need an assistant from other every time. He seems to hate this pre-test part. I'm afraid my cat will hate me for doing this. But deep inside I know it's for his very own good. Does any of you feel this kind of guilt? I am thinking about not doing pre-shot testing anymore.

I also have problem filling the spreadsheet. What is dosing method? and How I convert 0.04 cc to units. Any help is really appreciate.

 

Ask your vet to write a script for Glargine (Brand name Lantus) pens. This is a human insulin so should be available at any human chemist/pharmacy. Lantus is the gold standard for treatment and since it's also a very popular insulin for people, you should be able to get it.

In the meantime, I would get some U100 syringes, not the U50's. You can use this conversion chart to get the correct dose. Lantus is also a U100 insulin so the syringes will work for that insulin if you can get your vet to write the script for it. Again, since U100 syringes are used on humans, you should be able to get them. You preferably want 3/10ml, 30 or 31 gauge insulin syringes with half unit marks, but finding them with half unit marks can be challenging.

These BD U100 0.3ml '+ demi' syringes ('+ demi' means they have half unit markings) are perfect but you may have to ask if your pharmacist/chemist can order them if they don't have them.

The Royal Canin "diabetic" food is actually too high in carbs for a diabetic cat and there's absolutely nothing special in it that treats diabetes. Most of us feed our own cats foods like Fancy Feast pates or Friskies pates. Not sure what's available there, but although they may be called a different brand name, many of the Fancy Feast pates are sold in lots of other countries. They are made by Purina. They are low enough in carbs too. (We want them eating foods that are under 10% carbs...unfortunately, labels don't give us the carb percentage but if you look at the ingredients and see mostly protein and fat sources, with no grains, starches (like potato, sweet potato, pea, chickpea), vegetables or fruits, it's probably going to be a good choice. Foods "in jelly" or "in aspic" are usually low carb too, but it's always good to look at the ingredient list and watch for those no-no's like grains/starches/vegetables/fruits.

Weruva and Tiki Cat are also sold in Thailand but are more expensive. Weruva also has the complete nutritional breakdown of all their foods on their website so you can choose foods that are under 10% foods (Metabolized Energy= M.E.)

You can return the Royal Canin for a refund! It's 100% guaranteed! Most of us just told our vet that our cat refused to eat it anymore.

With Caninsulin, it's important that he eats a good sized meal at least 30 minutes before the shot, but we also don't want them to eat the 2 hours immediately before you do the Pre-shot test so it's not influenced by food. If you can change to Lantus, it's much gentler and doesn't usually start to "kick in" for about 2 hours so if kitty wants to eat slowly, it doesn't matter as much as it does on Caninsulin. Maybe Ninja will like one of the better foods and will eat them better! That would really help you.
Only thing I can think of that may work with the Caninsulin would be to put his food down 3 hours before shot time, leave it down for 1 hour and then pick it up so that when you test at shot time, it shouldn't be influenced by the food he ate earlier....and then at shot time you could give him the rest of his food if he didn't eat it all in that 1 hour.

We all feel guilty so you're perfectly normal, but trust me, your cat won't hate you, especially if every time he gets tested, he gets a special treat that he doesn't get any other time. You can also use the pawpad for testing.

No matter where you poke, you want to make sure you warm up the area really well before poking. Heat brings blood into the area and makes it easier. You can use a small sock, put something like dry rice, beans, oats in it, tie it shut and microwave it to warm it up. Test how hot it is on your wrist to make sure it doesn't get too hot and burn your cat.

Also, make sure you are using lancets that are 25-28 gauge. Most human lancets are 31-33 gauge which are too thin right now. The lower numbered gauges poke a slightly bigger hole so you're more likely to get that blood drop. As you poke more and more, the body will start to grow new capillaries into the area to "heal the wound" and it will get easier and easier to get that blood drop. We call it "Learning to bleed".

Cats have the unique ability to have their pancreas heal and start producing insulin again so making sure he's high enough to safely give the insulin is very important so please don't stop Pre-shot tests. It's also important to get tests in between the shots to see how low the dose is taking him.

Don't worry about that right now. There are 2 dosing methods we use but they are for Lantus, Levemir and ProZinc, not Caninsulin. If you haven't already read it, there's lots of information about using Caninsulin in this INTRODUCTION TO CANNISULIN/VETSULIN & N/NPH

Can you take a picture of where you are pulling the plunger? We need to see where the plunger is and the markings on the syringe. If you can get some U100 syringes, it will be a lot easier because you can use the conversion chart I linked above.

Keep asking questions! If you don't understand something, please let us know so we can make sure you are understanding what we are telling you!

 

Do you know or can you find out if continuous glucose monitors (CGM) are available in Thailand? From a quick Google search, it looks like they are. The CGMs have a temporary sensor that is attached to your cat and can give you blood glucose readings on your phone. You won't have to prick your cat's ear. There are some limitations with the CGMs but it will allow you to test and keep your kitty safe even with a vision problem.

If your vet is unfamiliar with using a CGM with a cat, there is a Facebook group on the subject. It's called Freestyle Libre for Dogs and Cats. The Freestyle Libre is one brand of CGM that is popular in the US.

 

if you tap on this link and look at post #32 I listed some Weruva pates for another member that's low carb/ low phosphorus.
https://felinediabetes.com/FDMB/threads/new-member-11-8-and-i-am-tired.283363/#post-3124085

Just wanted to let you know on your spreadsheet where it says Diagnosed we can see the year ,it's cut off If you can fix that , it would be great
@Freo

Testing
Always aim for the sweet spot warm the ears up first, you can put rice in a sock and put it in the microwave, test it on the inside of your wrist to be sure it's not to hot, like you would test a babies bottle. You can fill a pill bottle with warm water and roll it on the ears also.Just keep rubbing the ears with your fingers to warm them up

6. As the ears get used to bleeding and grow more capilares, it gets easier to get the amount of blood you need on the first try. If he won’t stand still, you can get the blood onto a clean finger nail and test from there.
When you do get some blood you can try milking the ear.
Get you finger and gently push up toward the blood , more will appear
You will put the cotton round behind his ear in case you poke your finger, after you are done testing you will fold the cotton round over his ear to stop the bleeding , press gently for about 10 or 20 seconds until it stops
Get 26 or 28 gauge lancets
A lot of us use the lancets to test freehand not the lancing device
I find it better to see where I'm aiming
Look at the lancet under a light and you will see one side is curved upward, that's the side you want to poke with

Try putting a thin layer of Vaseline on the ear so the blood will bead up

You might want to set up what we call our signature
It's information about Ninga
Tap in this blue link
Here is a link helping us to help you link. If you noticed, our members have some basic information about their cat's in their signature. This helps us to not pester you by asking the same questions (your cat's name, insulin type, date of diagnosis, etc.) repeatedly

I know I gave you the link but to make it easier for you

• Add info we need to help you:
  • Caregiver & kitty's name
  • DX: Date
  • Name of Insulin (do not include dose or frequency)
  • Name of your meter
  • Diet: "LC wet" or "dry food" or "combo"
  • Dosing: TR or SLGS or Custom (if applicable)
  • DKA or other recent health issue (if applicable)
  • Bexacat or Senvelgo (if applicable) and dates
  • Acro, IAA, or Cushings (if applicable)
  • Spreadsheet link. Please put the signature link on the bottom line of your signature information, on its own, so it is easy to find.
  • Please do not put any information about your location in the signature for security reasons. If you wish to add your country location, please add it to your profile.

Be sure to click the 'Save Changes' button at the bottom. If you need help urgently it is important we know these things at a glance. We don’t want to waste valuable time finding out information.
Just tap on your name up top , tap the word signature add add the information then tap save

 

Thank you very much for the information. I am really appreciate. I will ask my vet about the lantus.

 

@Freo
Can you please add Caninsulin to your signature also
Thanks
Just tap on your name up top , tap the word signature and add that information then tap save.
Thanks for fixing you're spreadsheet so we can see the date diagnosed

 

Thank you!

I talked to the vet regarding human insulin. The vet said he had bad experience with it and strongly not suggesting to use them. I went shopping to find treats and alternative to Royal Canin's. The food's label here in Thailand do not mention about percentage of carbohydrates at all. They have only protien, fat, ash, fibre, moisture and calories per 100 grams.

So I chose dried fish treats with no flour or starch as an ingridient. But for food, I think I will stick with Royal Canin's since my family seems to be happier giving him prescribed food than changing to normal food.

My goal is to make him happy with pre-shot test and able to test everytime before insulin injection. For safety of my cat and safety of my wallet. 24 hrs Vet hospital is very expensive. If he went hypo in the night and I have to take him there, it's going to cost a lot.

Thank you everyone again. I am gald to find this forum.

 

Pet food manufacturers in most countries are not required to put carbohydrates amounts on their labels. The Royal Canin diabetic food (Glycobalance) has 14% carbohydrate. We consider a low carb food to be below 10%. High carbohydrate is 15% or above. There are cat food carbohydrate calculators available on the web. The issue with the calculators is that the manufacturers typically only provide the "guaranteed analysis" data. These are numbers that are minimums or maximums thereby making the calculations somewhat inaccurate. You really need the "as fed" values to do an accurate calculation. You may also want to look at this website that's written by a vet on feline nutrition. Please consider that if you feed your cat a diet that is high in carbohydrates, it's very unlikely that your cat will go into remission. It would be like feeding a human diabetic a diet of ice cream and candy.

There has been a considerable amount of research on the use of glargine, a human insulin, in cats. In a sentence, it works. There are two insulins that are recommended by the American Animal Hospital Association in their guidelines for the treatment of diabetes. These guidelines were initially published in 2018 and updated in 2022. This is a link to their guidelines. At the top of page 4 they note that the preferred insulin for the treatment of feline diabetes is either Lantus (glargine) or Prozinc. If your vet continues to object to glargine, Prozinc is a pet-specific insulin. You may want to share the linked paper with your vet.

 

@Freo I gave you a list of Weruva foods in one of my links above post #4

Sienne is absolutely correct when she said
Please consider that if you feed your cat a diet that is high in carbohydrates, it's very unlikely that your cat will go into remission. It would be like feeding a human diabetic a diet of ice cream and candy.


I found this posted by one of our members to another member that lived in Thailand about low carb food
She said and I quote I looked up the Avoderm brand on our food chart and it has some flavors and types that should be ok.
Chicken 9%
Salmon 10%
Ocean Fish 8%
Chicken Chunks/Gravy 8%
Salmon/Consomme 0%
Sardines/ Consomme 1%
Swordfish /Consomme 1%
Tuna & Prawns 0%
Tuna & Chicken w/vegetables 2%

 

Your kitty wouldn't go hypo if you are testing him more often ,including Pre shots, and as long as you have med and high carb food and honey in the house .Plus it's not good to keep your kitty in high BG numbers
I hope you will start testing before giving caninsulin and getting 2 to 4 tests in during each cycle
Best of luck with whatever you decide
@Freo

 

Thank you very much Diane. I have temptation treats and honey ready. I do really hope I won't need them.