New members - G and Panter - diagnosed last month

Discussion in 'Feline Health - (Welcome & Main Forum)' started by Panters-mom, Jan 16, 2020.

  1. Panters-mom

    Panters-mom Member

    Joined:
    Jan 15, 2020
    Hi everyone,

    My name is Goeril and my furry handsome friend is Panter. Panter is a 9 year old male. He has been living semi-wild for years until he came to us about two-three years ago. He loves to be outside chasing mice. He has a cat door so he basically does what he wants when he wants:) He has turned in to be a very friendly and easy going guy. Luckily, as it makes it easier to treat his new status as a diabetic. He was diagnosed last month, December 2. 2019. Took him to the vet as he started to get very skinny and was drinking a lot. His blood sugar level was up in 30. We started with insulin (Insulatard) 2’ - twice a day. After one and two weeks his BG was 25 both times. Raised insulin to 3' in the morning and 2' in the evening for two weeks. BG down to 24. Raised insulin to 3' + 3' for a bit more than a week. Down to 17. Then I learned to take BG at home - and that was a relief - and of course much more useful and accurate. Panter gets really stressed going to the vet. But he went up to 21 again. We raised the insulin to 4' + 3' - this is where we are right now. This is the history in short.

    Right now - I'm planning to make a BG curve. The vet say that they would recommend to do this in the clinic over 24 hours. But I had to refuse, first of all, I don't believe it would be beneficial as Panter would be really stressed, he wouldn't eat the same food and then I can't afford it either. And now we can take our own 'BG'. So this is where we're at. - so far I've not got it very detailed - first try on a curve was just 4 blood samples during yesterday - but I'm getting better in drawing blood - so it will improve.;)

    Again Im using Insulatard - 4' in the morning and 3' in the evening. I measure on Accu Check for humans. He gets mostly wet food (regular patee, not sauce (Purina Gold, Miamor, Animonda, Latz/Felix(well this one in gelé)(He doesn't like the diabetes wet food) - and some dry - but only Royal Canin diabetes. He is too skinny right now - this is of cause also a challenge. Otherwise he is in good shape and as far as we know he has always been healthy.

    I will try to list what I've done the two last days - sorry I'm not familiar with the different terms on things yet - I hope you'll understand what I'm trying to say:)

    Yesterday:
    7.30 - 13 h after last insulin - before food - BG 25.1 (strangely high)
    7.30 - insulin 4' + wet food
    13.30 - 6 hours after insulin - BG 15.3
    13.30 - wet food
    18.30 - insulin 3' + wet food
    20.30 - 2 h after ins - BG 18.3
    22.30 - 4 h after ins - BG 15.5
    00.00 - dry food 20 gram for the night (he has a feeder with timer - he also get some small nibbles timed during the day - mostly to train him to come home for meals and shots)

    Today:
    7.30 - insulin 4' + wet food
    9.30 - 2 h after ins - BG 18.6
    12.30 - 5 h after ins - BG 13.8
    13.30 - wet food
    16.00 - 8 h after ins - BG 21.4
    18.00 - 10,5 h after ins - BG 23.8
    18.00 - insulin 3' + wet food (I normally wait to 18.30-19.30, but I shot it now because GB was so high...?)
    20.30 - 2 h after ins - BG 19.6
    22.30 - 4 h after ins - BG 17.8
    00.00 - dry food
    7.00 - 13 h after ins - BG 26.1
    7.00 - ins 4' + wet food

    I'm thinking - it looks a bit 'yo-yo' here doesn't it? My vet says insulin 4' + 3' is already high, so she don't think is a good idea to raise it at the moment... Should I adjust his meals somehow or do you have any suggestions? Any advice would be really appreciated!

    Thanks for reading this. I'm very happy to find this site. My former experience with groups similar as this has been amazing. I had a CDK kitty and got a lot of help from Tanyas Comprehensive guide. He lived 5 years with Hyperthyroid and three years with CDK. He turned 18 years old. So now it's Panters turn to get a bit extra help on his journey.

    Look forward to learn from this forum!

    Best regards, Goeril and Panter :)
     
    Last edited: Jan 17, 2020
    Reason for edit: updated new number
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  2. Juls and Billy

    Juls and Billy Member

    Joined:
    Dec 28, 2019
    Welcome Goeril! My, Panter is such a handsome boy! And I see that you have already set up a spreadsheet for him, which is awesome.
    It might be helpful to let us know what country you and Panter live in, as this will help greatly with food recommendations.
    I'm a newbie myself, so I'm not going to make any dosage suggestions, but I will say that my Billy showed huge improvement after switching his diet to only wet food with less than 10% carbs. You can check out his spreadsheet and see how awesomely he is doing. The problem with the Royal Canin dry food is that it's basically made of carbs. Just look at the top ingredients: Chicken meal, corn, brewers rice, corn gluten meal, wheat, chicken fat, wheat gluten, natural flavors, brown rice, pea fiber, rice hulls. Yes, many vets prescribe it, but this message board has taught me that a slow switch to a truly low carb wet diet can make big positive changes possible.
    You rock for taking such good care of Panter! There's tons of good information on this site that will help you. You might want to start here with New? How You Can Help Us Help You.
     
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  3. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    Welcome!!

    One very quick question. Insulatard is not available in the US. From a quick search, it sounds like it's a long acting insulin. Is there any way for you to find out from your vet or a pharmacist what other insulin Insulatard is most similar to?
     
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  4. Panters-mom

    Panters-mom Member

    Joined:
    Jan 15, 2020
    Hi Juls and Billy, thanks for the warm welcome! We are living in Norway. Well, I have tried to start a spreadsheet but not very successfully yet. A lot to learn for sure. Look forward to that. And yes, I wondered a bit about this dry food, even it is for diabetes cats. He has the opportunity to a portion of this dry food from midnight - and that's it for about 7-8 hours - and the BG was really high in the morning yesterday. Of course, the insulin is at its lowest as well. I also heard that it can be good to fast for some hours - is this through or only for humans maybe? With other words, maybe stop giving food in the night time? Any ideas?
    Thanks again, Juls! G+P
     
    Last edited: Jan 16, 2020
    Reason for edit: wrong name;)
  5. Panters-mom

    Panters-mom Member

    Joined:
    Jan 15, 2020
    Thank you Gabby! Nice to be here! I will ask my vet about Insulatard. This is what I found on the net in https://www.medicines.org.uk/emc/product/3848/smpc. What I know is that it takes about 1,5 hours before it starts working and has effect up to 24 hours...(it says on the package). Best, Goeril
     
    Last edited: Jan 16, 2020
    Reason for edit: spelling
  6. Sarah&Soph

    Sarah&Soph Member

    Joined:
    Jun 18, 2019
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  7. Panters-mom

    Panters-mom Member

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    Jan 15, 2020
    Thanks Sarah! This sounds about right. "Cats seem instead to experience a 1-2 hour onset, a peak action of 4-6 hours, and a total duration of 8-12 hours maximum, according to user surveys on Felinediabetes.com"
     
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  8. Sarah&Soph

    Sarah&Soph Member

    Joined:
    Jun 18, 2019
    If it is similar to NPH (I’ll let others see what they think), it tends to be one of the more harsh insulins for kitties and it usually does not last a full 12 hours, usually more like 8 hours
     
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  9. Juls and Billy

    Juls and Billy Member

    Joined:
    Dec 28, 2019
    Some members stop giving food half-way through a cycle, so 6 hours after injection. Other members take food away 2 hours before injection. This makes sure you aren't giving insulin on a BGL that's been upped by food, and that your cat is hungry enough to eat when he gets his insulin. I leave extra wet food out at night for Billy, and make sure I take up any food that's left 2 hours before AM testing. I'm not sure why some members do a 2 hour period of no food, and some do a 6 hour. Perhaps it depends on which type of insulin is used, or maybe it's because every cat is different.
     
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  10. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    I'm not familiar with NPH but the description given for Insulatard also sounds very like Caninsulin/Vetsulin which is indeed a harsh insulin. It can and does work in some cats but other insulins may be more suitable, depending on what's available in Norway of course.

    Good luck Goeril and Panter! There is loads of help here so keep asking questions :)
     
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  11. Panters-mom

    Panters-mom Member

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    Jan 15, 2020
    Thanks Diana! Have to check into that. Unfortunately I find it hard to ask my vet - as I believe she feels that Im questioning her decision... I know she don't like me to seek advice on the net. But 'my oh my' has that helped me before. :) G
     
  12. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    Goeril, just to clarify - if the package says that this insulin lasts up to 24 hours, that may be for humans. The link from Sarah above is more specifc about how dogs and cats metabolise the insulin. Basically, cats metabolise at a faster rate - which is one of the reasons that this insulin may not be ideal. But it may be the first insulin of choice in Norway. Here in the UK, Caninsulin is often the first insulin a vet prescribes. It's a question of gathering data to see how any particular cat responds.
     
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  13. Diana&Tom

    Diana&Tom Well-Known Member

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    Dec 29, 2009
    A pretty frequent comment here! Vets don't like their advice questioned, obviously. Some vets mellow over time if you can show that your research findings are from a reliable source. Others will be more stubborn and outright refuse to even listen. A good vet will listen, discuss and work with you to get the best outcome.
     
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  14. Sarah&Soph

    Sarah&Soph Member

    Joined:
    Jun 18, 2019
    I believe NPH and Vetsulin/Caninsulin work fairly similar (they’re in the same ISG so at least somewhat similar lol), I think the main difference is that NPH is a U100 human insulin and Vetsulin is a U40 pet insulin. So I agree it’s also possible that the info on it lasting 24 hours is for humans
     
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  15. Panters-mom

    Panters-mom Member

    Joined:
    Jan 15, 2020
    I googled and this are the types of insulin available in Norway:

    Different types of insulin (in Norway) - (google translation)

    Extra fast-acting insulin is taken with meal. Set either when you start eating or immediately after the meal.
    Examples are
    • Apidra (contains insulin glulisin),
    • Humalog (contains insulin lispro)
    • NovoRapid (contains insulin aspart).
    Fast-acting insulin such as
    • Actrapid (containing human insulin) is added 15-30 minutes before a meal.

    Insulin with medium long working time and fast onset effect is taken with meal. It is important to mix well before use by rolling the insulin between your hands and / or turning gently upside down sometimes.
    Examples are
    • Humalog Mix25 (contains insulin lispro and insulin lispro protamine)
    • NovoMix 30 (contains insulin aspart and protamine crystallized insulin aspart).


    Medium-long-acting insulin is usually used in the morning and / or evening, giving effect after approx. 1- 1½ hours. How long the effect lasts varies from one type to another. This type of insulin should be mixed before use by rolling between the hands and / or turning gently upside down sometimes.
    Examples are
    • Humulin NPH,
    • Insulatard
    • Insuman Basal (contains insulin isophane human)


    Long-acting insulin is taken 1-2 times a day, depending on the type of use.
    Examples are
    • Lantus / Toujeo (contains insulin glargine)
    • Levemir (contains insulin detemir)
    • Tresiba (contains insulin degludec).
     
  16. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    Ok so you do have more options, if the Insulatard doesn't quite do the job. It's quite early days really to say, and once you get more regular data you'll build up a picture.

    My slight concern at the moment might be that your current dose is quite high and you've been increasing in whole units - it is better really to increase by 0.5u at a time to make sure you're not giving too much or skipping over the "ideal" dose. As you'll come to see, treating FD is a marathon not a sprint - it can take a while to find just the right dose in conjunction with the right diet.

    And on the subject of food - try to get rid of the dry if possible. Even a small amount can raise bg quite significantly in some cats. You don't say what proportion of dry you're feeding but if you do take it away, be aware that bg may drop and therefore the insulin dose may be higher than needed.
     
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  17. Ann & Scatcats

    Ann & Scatcats Well-Known Member

    Joined:
    Dec 31, 2009
    Hej Goeril,

    Jag heter Ann och finns i Göteborg i Sverige. Och har lång erfarenhet av kattdiabetes.
     
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  18. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Lantus and levimir are good insulins for cats. Used twice a day.
    NPH insulin in cats often only lasts 6-8 hours. Used twice a day.
    Caninsulin/Vetsulin 8-10 hours in many cats. Used twice a day.

    Never heard of Insulatard.
     
  19. Ann & Scatcats

    Ann & Scatcats Well-Known Member

    Joined:
    Dec 31, 2009
    Insulatard is used in Nordic countries. Simba was given that in the beginning too, before the Animal Hospital changed it to Lantus.
     
  20. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Thanks Ann
     
  21. Panters-mom

    Panters-mom Member

    Joined:
    Jan 15, 2020
    Thanks Diane. But I've got this pen that only goes in whole units...? Every 'click' is a unit...
     
  22. Panters-mom

    Panters-mom Member

    Joined:
    Jan 15, 2020
    Hei Ann! Great! Then you might have some food recommendations. From Animail and Zooplus maybe? :)
     
  23. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    You should be able to get syringes with half unit markings, maybe Ann will know.
     
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  24. Panters-mom

    Panters-mom Member

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    Jan 15, 2020
    I have given him about 20 gram (a portion) for the night - the feeder opens up at 00.00. Then he gets about 10-20 gram divided in small portions during the day. He gets about 4 potions (350g) of wet food - 1,5 in the morning 7.30, 1 around 13.30, 1 around 18.30. 1/2 around 22.00. (+ the mice he and his "brother in arms" are catching, or rather his younger cat brother is catching - he is eating:) It's a bit much maybe, but he is very hungry and has lost quit some weight. To stop the dry food in daytime is easy, but if I stop dryfood at night - should I replace it with wet or let him fast do you think?
     
  25. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    Unregulated diabetics are always hungry so don't deprive him of food. A little wet left out overnight is fine.
     
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  26. Larry and Kitties

    Larry and Kitties Well-Known Member

    Joined:
    Dec 28, 2009
    I say it is very similar to ProZinc (ProZinc® (protamine zinc recombinant human insulin) (http://www.prozinc.us/content/dam/internet/ah/prozinc/us_EN/documents/ProZinc_Product_Info.pdf)
    since:
    "Insulatard is a long-acting insulin. It can be given once or twice a day, with or without a fast-acting insulin (given at meal times), according to the doctor’s recommendation. "
    "Insulatard contains insulin mixed with another substance, protamine, in an ‘isophane’ form which is absorbed much more slowly during the day. "
    https://www.drugs.com/uk/insulatard.html
     
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  27. Sarah&Soph

    Sarah&Soph Member

    Joined:
    Jun 18, 2019
    I was also basing it off the link I posted which, under “Also Known As”, lists “Novolin N, ReliOn/Novolin NPH, Protaphane”. Although I can’t comment on the credibility of the page!
     
  28. Panters-mom

    Panters-mom Member

    Joined:
    Jan 15, 2020
    I've finally got some sort of a curve here - unfortunately I don't understand how to put it in the spreadsheet...

    Insulin 4' in the morning and 3' in the evening - four meals a day (1 dry) + some snacks after BGtests.


    7.30 - 13 h after insulin BG 25.1
    7.30 - insulin 4' + wet food
    13.30 - 6 hours after insulin - BG 15.3
    13.30 - wet food
    18.30 - insulin 3' + wet food
    20.30 - 2 h after insulin - BG 18.3
    22.30 - 4 h after insulin - BG 15.5
    00.00 - dry food 20 gram for the night

    7.30 - insulin 4' + wet food
    9.30 - 2 h after ins - BG 18.6
    12.30 - 5 h after ins - BG 13.8
    13.30 - wet food
    16.00 - 8 h after ins - BG 21.4
    18.00 - 10,5 h after ins - BG 23.8
    18.00 - insulin 3' + wet food
    20.30 - 2 h after ins - BG 19.6
    22.30 - 4 h after ins - BG 17.8
    00.00 - dry food 20g
    7.00 - 13 h after ins - BG 26.1
    7.00 - ins 4' + wet food

    So it looks like the insulin is working - but not long enough? Or is it to early to tell? He has now been on it for 6,5 week - the last week increased one unit (from 3 to 4) in the morning, still 3 in the evening.

    Goeril.:)
     
  29. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    If you can, do please get your data onto a spreadsheet so we can see at a glance what's going on. I'm no expert but I'll tag a couple of members who are and they will help @Marje and Gracie and @Chris & China (GA)

    Meanwhile, it would help us to see what's what if you could log your data using the following simple system - don't use times of day, just what bg was before insulin, and again what it was a certain number of hours after insulin, eg:

    AMPS (morning pre shot): bg 20.5 - 3u given
    + 2 (2 hours after insulin):
    + 4 (4 hours after insulin):
    + 6
    +8
    + 10

    Or whatever intervals you can get a test, then

    PMPS (evening pre shot): bg 22.2 - 3u given
    -+ 2
    + 4
    +6
    +8
    + 10

    Then the next day start again with
    AMPS - bg xx - x units given

    Does that make sense? These readings would form a complete curve (not something you need to do every day) and would make it easy for everyone to see clearly how the insulin is working. When you have a spreadsheet set up that will help further as the numbers fall into colour-coded categories so the experts at analysing data here will be able to get the picture very quickly.

    Shout if you need further explanations!
     
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  30. Panters-mom

    Panters-mom Member

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    Jan 15, 2020
    Thanks Diana! Yes I have a hard time filling out the spreadsheet unfortunately. I'll try your recipe in the meanwhile. Very few tests the first day, more detailed yesterday. And right now - it was down to BG 9 (before food) - a bit too low compared with the other numbers or....? He basically gets food right after every insulin shot and about AMPS +6 and PMPS +6 - as well as treats after I've been testing BG (maybe not so smart, but...)
    Hope this looks right.

    PMPS: 3u given
    +13: 25.1

    AMPS: BG 25.1 - 4u given
    +6: 15.3

    PMPS: BG ? - 3u given
    +2: 18.3
    +4: 15.5

    AMPS: BG ? - 4u given
    +2: 18.6
    +5: 13.8
    +8: 21.4
    +10,5: 23.8

    PMPS: BG 23.8 - 3u given
    +2: 19.6
    +4: 17.8
    +13: 26.1

    AMPS: BG 26.1 - 4u given
    +4: 13.4
    +7: 9.0
     
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  31. Ann & Scatcats

    Ann & Scatcats Well-Known Member

    Joined:
    Dec 31, 2009
    Yes! Diabetics and Cat Foods - The importance of finding the best and most suitable foods. A super topic.

    We have an international wellknown and proper Cat Nutrition expert veterinarian named Vet Lisa Pierson who have done an extensive work on the topics and all her Cat Nutrition information and knowledge is on her www.catinfo.org . I suggest you read through it. She has also done our proper Diabetic Cats Food Chart I suggest you read through also and look for a food with high protein, medium fat and only 5-6 max 10 % carbohydates https://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf

    I will look at Animali.no what they have. Besides bought food, you can either make your own fresh raw cat food, using Vet Lisa's recipy on her www.catinfo.org - especially good to make for us Nordics who have such fine natural wilderness meats as wild hare, moose, reindeer, deer, and farm animals as beef, chicken e.t.c
     
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  32. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Here are directions on what to enter on the spreadsheet(SS):

    Understanding the Spreadsheet/Grid

    You do not live in the USA, so enter your information on the tab labeled World mmol/L.
    Scroll over to the right side to add Notes.
     
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  33. Panters-mom

    Panters-mom Member

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    Jan 15, 2020
    Great Ann! I will study!

    And look at that! Thanks Deb! I've got it - I think...;)...
     
  34. Panters-mom

    Panters-mom Member

    Joined:
    Jan 15, 2020
    From GB 26 down to GB 9 in 7 hours(+7) and then up to GB 22.4 in 3 hours (+10)...
    after GB-test 26' he ate 1,5 pk wet food (100g) Latz/Felix/Purina in gel,
    after GBtest 9' he ate 1/2pk (50g) wet food (Latz/Felix/purina)
    ... is this kind of jump 'normal' at this stage??
     
  35. Ann & Scatcats

    Ann & Scatcats Well-Known Member

    Joined:
    Dec 31, 2009

    Not really. Because the 4 and 3 Units of insulin is rather high dosage and in spite of that Panter remain in the high 18's with his bg.

    Do you know what the foods Latz, Felix and Purina have in % Carbohydrates?
     
  36. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Good job on getting your data entered on the spreadsheet!

    Panter did get into the blues at mid-cycle. I think that is encouraging. Have to take the duration and mid-cycle tests into consideration also. Yes, still high pre-shots and likely bouncing but we'll work on getting that better.

    "This is a marathon, not a sprint". It took time for the feline diabetes to develop. It will take time for Panter to get better.

    We can help you calculate the carbs in the food, if you don't know.
     
    Last edited: Jan 17, 2020
  37. Ann & Scatcats

    Ann & Scatcats Well-Known Member

    Joined:
    Dec 31, 2009
    Goeril

    I thought it was the old Pussi cat on the Latz - and it is, Purina is the manufacturer and it is the old Pussi cat food renamed to Latz https://www.purina.se/katt/latz/kattmat/produkter/utbud/all

    I 'hate' when they don't use the same name on foods worldover

    In your first post you wrote he eats these regular patee foods:

    - Purina Gold

    - Purina Latz/Felix (in gele)

    - Animonda

    - Miamor

    - Royal Canine diabetes dry (at night)

    'He gets mostly wet food (regular patee, not sauce (Purina Gold, Miamor, Animonda, Latz/Felix(well this oneingelé)(He doesn't like the diabetes wet food) - and some dry - but only Royal Canin diabetes'


    I wonder if any of them are on the UK Food Chart. I will see if I find them and their carb content in any of Food Charts.

    In the UK Food Chart I find both Miamor and Animonda and they have a good low carb content so they are all fine, and some Felix is mentioned too https://docs.google.com/spreadsheets/d/1J5JpMe6TDXrHq_aTl9hUtHy6Gs9oRBqlz4nPGKxtySA/pubhtml
     
    Last edited: Jan 17, 2020
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  38. Chris & China (GA)

    Chris & China (GA) Well-Known Member

    Joined:
    May 10, 2013
    Yes....It looks like a "bounce" to me. Bounces happen when 1. they drop too low, 2. they drop too quickly, 3. they drop into numbers their body isn't used to anymore (or any combination of all 3)

    #3 is probably the most common early on. Our cats are so good at hiding that they're sick, so usually by the time we get the diagnosis, they've had diabetes for awhile. Their body has become used to living in those higher numbers, so when the insulin drops them down, the liver releases stored sugars and hormones to bring them back up again. They "bounce" high, quickly. It can take up to 6 cycles (3 days) for those sugars and hormones to clear out of the body.

    Also, the type of insulin you're using isn't a really good one for cats. It tends to hit hard and early and wear off before the end of the cycle. Might see if your vet will prescribe a gentler insulin that works better in cats like Glargine (Lantus or Basaglar). They are human insulins that work well in cats and you should be able to get it anyplace you can buy human prescription meds

    You're also giving a really high dose for so early in treatment! What dose were you started on?
     
  39. Panters-mom

    Panters-mom Member

    Joined:
    Jan 15, 2020
    Thanks again you all.

    Do you think we should reduce the insulin? To 3+3? - together with the vet of course.

    This is basically what is filling my closet right now. Some he likes better than others.

    This Latz or earlier called Felix is a brand under Purina, it is a regular 'store food' - doesn't tell carbs though...
    raw protein 11.5 %
    raw fat 2.5 %
    raw fiber 0.05 %
    raw ash 2.5 %
    moist 82.0 %
    omega-6 fettsyrer 0.4 %

    He loves this one. And he also eats

    Purina Gourmet Gold paste (biff (this one), chicken, tuna and turkey):
    protein 10.5%
    fat 7%
    raw fiber 0.05 %
    raw ash 3.2%
    moist 77,5

    Miamor paste
    rawprotein 11%
    raw fat 6.5%
    raw fiber 0.2 %
    raw ash 2.0%
    moist 78%

    Almo nature pate grain free
    rawprotein 9.5%
    raw fat 6.0%
    raw fiber 0.4 %
    raw ash 2.0%
    moist 81%

    Animonda pate
    rawprotein 12 %
    raw fat 4.4%
    raw fiber 0.3 %
    raw ash 1.8%
    moist 81%

    Animonda pate - diabetes (kind of like this one - not really)
    rawprotein 11 %
    raw fat 5.2%
    raw fiber 0.3 %
    raw ash 1.6%
    moist 80.5%

    Sheba filet in saus
    rawprotein 7.7 %
    raw fat 4.8%
    raw fiber 0.3 %
    raw ash 1.7%
    moist 85%

    Proplan vet diets in sauce - diabetes (this one also)
    rawprotein 13 %
    raw fat 5.5%
    raw fiber 0.8 %
    raw ash 2.4%
    moist 77%
    Stivelse (Startch? Carb?) 0.5 %
    taurin 1200.0 mg/kg
    total sugar 0.5 %

    Yarrah pate grain free
    rawprotein 10 %
    raw fat 6%
    raw fiber 0.5 %
    raw ash 2%
    moist 80%
    carbs 2%
     
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  40. Panters-mom

    Panters-mom Member

    Joined:
    Jan 15, 2020
    Thanks Ann and Chris too. Yes Latz was also called Pussi before. We started on 2+2 units.
     
  41. Panters-mom

    Panters-mom Member

    Joined:
    Jan 15, 2020
    I think what I just called raw protein etc - suppose to be crude protein in english.
     
  42. Ann & Scatcats

    Ann & Scatcats Well-Known Member

    Joined:
    Dec 31, 2009
    Thank you Goeril

    Now we have scrunitized his food and all the wets seem to be low carb. So that's all good. And not the cause then for his high BGs.

    If you are interested in yet another low carb wet food I saw your Norwegian Animail.no also have the Swedish made Mjau/Bozita. They are the same product with Mjau being the Swedish name and Bozita the international name.
     
  43. Panters-mom

    Panters-mom Member

    Joined:
    Jan 15, 2020
    Fantastic! Thanks Ann! Alright I look into that one too. I just saw another new one I ordered from Zooplus. Its called
    Catessy fine paté:
    protein 9.5%
    fat: 5%
    ash 2%
    fiber: 0.3%
    moist:83%

    But we have not tasted it yet! :)
     
  44. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    If that information is correct, I'd say it's closer to Caninsulin/Vetsulin than NPH insulins.
    Goeril, first i wanted to say you have been doing a fantastic job. We have been giving you a lot of information. It takes time to absorb all that we are saying and understand it well.

    The important part about this insulin is that it is what we call an "in-and-out" insulin, generally not lasting into the next 12 hour cycle. Not a "depot" type insulin like Lantus(glargine) or Levimir(detemir). If we proceed along those lines, then it doesn't really matter if its more like Caninsulin/Vetsulin or NPH or Prozinc. Basically those in-and-out insulins have the same general guidelines for use. I know some of those guidelines, not all but some.

    Test, feed, wait a set number of minutes before feeding, test again, shoot can be more important if this insulin is more like NPH insulin. If NPH type, then it drops the BG (blood glucose) levels like a rock thrown into a deep fjord earlier in the cycle, and it's more important to balance when food is eaten with when the insulin is given. Give more time to let the food be digested before the onset of the insulin. With NPH type insulins. 45 minutes to an hour between Pre-shot test and insulin shot becomes more important. I've seen cats go from high 400's (> 22 mmol) to <100 (<5.5 mmol) at nadir with the NPH insulins. That is going to cause severe bouncing and may need more frequent monitoring earlier in the cycle to slow the bounce, give a little bit of food and head off hypoglycemia.

    Reading through the comments, these are some things that caught my eye and I wanted to give my feedback.

    1. Testing before every pre-shot needs to be done. AMPS in the morning and PMPS in the evening. To keep your cat safe, you need to know that the BG (blood glucose) is before every insulin shot. Will you be able to do that?

    2. The reason for taking away the food for 2 hours before the Pre-shot test is so that test is not influenced by food. You only need to have a 2 hour window before the AMPS and PMPS tests without food to get a more realistic BG (blood glucose) number. To determine if the BG is high enough to give insulin int he first place.

    Other testing times, we expect some food to have been eaten sometime in the 12 hour cycle.

    The 6 hour time that Juls mentioned is no food after the mid-point of the cycle. That is because the insulin is beginning to wear off and food after +6 will simply cause the BG's to rise faster. Not enough insulin left to balance the food intake. (Exceptions of course, especially if low numbers. Every guideline has nuances.)

    3. The Royal Canin Diabetic Veterinary food is around 27-32% carbs (depends on what cat food calculator I used). Too high in carbs for a diabetic cat. Please DO NOT change the food yet. Would like you to start getting a preshot test before every insulin dose first.

    4. Would you please make notes in the Remarks column to record the food you are feeding. Note which foods are given in each 12 hour cycle. This is easy to do if you put the notation AM and then list the foods and PM and list the foods. That helps to interpret the numbers and see some of the patterns on why the BG (blood glucose) test numbers are varying when food is changed.

    5. Please confirm the Royal Canin dry cat food looks like this picture below.

    royal canin diatetic dry.jpg

    6. Treats can be any type of plain meat. Many cat food treats you buy at the store are going to have ingredients like grains, potatoes, peas, beans, tapioca which are all sources of carbohydrates.

    7. Use those pure meat treats at test time. We call them "bribes", to get your cat to come at testing time. Conditional behaviour training works.

    8. We have videos on using an insulin syringe with an insulin pen. Let me know if you want a link to those videos.

    9. Is that Insulatard insulin a U40 strength or a U100 strength insulin? Should say on the pen you are using.

    Goeril, would you please let us know how good your understanding is of the English written language. Do you use google translate to read what we have written to you? I try to write more clearly. Put any abbreviations in parentheses when needed. Trying to help people where English is not their primary language however I can. Feline diabetes is difficult enough to treat, without added language misunderstandings. If there is ever something you do not understand, please ask us about it.

    (I'm helping someone who speaks Spanish right now. He's in Argentina and he said he can understand written English a bit better than he speaks English. All our communication has been in English and he is able to respond fairly quickly. Sometimes, I have to clarify some points, or word my responses differently.)

    Take your time. Reread all we have written to you. It's a lot. Let us know what questions you have.
    Most importantly of all, take good care of yourself. Do whatever you need to do to relax and re-energize yourself. Pamper and treat yourself well, so you will be able to take good car of Panter. I've always liked a small piece of chocolate as a treat for me. :bighug::bighug::bighug:
     
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  45. Ann & Scatcats

    Ann & Scatcats Well-Known Member

    Joined:
    Dec 31, 2009
    Deb et al

    Insulatard is a 100 IE/ml NPH human isophane insulin made by the Nordic company Novo Nordisk, similar to Humulin NPH
    The Swedish Pharmacy products in Swedish https://www.fass.se/LIF/product;jse...dA!-300631965?userType=2&nplId=20021007000385

    Simba was first prescribed that by our Animal Hospital and it's a good learner insulin but before a year had ended Simba was prescribed the Lantus instead which we have stayed on.
     
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  46. Panters-mom

    Panters-mom Member

    Joined:
    Jan 15, 2020
    I'm impressed. Thanks a lot for the time you're putting into this!
    English is okay. I will ask if I'm stuck. First I have to ask - and I have an appointment with my vet on Monday - should I ask to change insulin to Lantus? It's sounds complicated with this "in-and-out" insulin. I feel I have to share a bit of life situation, we - my husband and I - are traveling quit a bit in our work - our kind neighbour is helping out with Panter when we're both gone - she have already done a small week with insulin injections (not BG test) - and it went great. But I feel strongly that if it turns very complicated, she might back out. Even my husband - I'm not sure if he can handle constant BGtest...I work from home so I'll do it, but that wouldn't be enough... I can see we have a big problem here.

    But the road is built as we go - and to sum up so far: I will take the BGtest 45 min to 1 hour before every insulin shot. Food before or after the shot? - after would be easiest as that would be his bribe kind of... but if best before I can do that. I take away the food 2 hours before BGtest. Or more ? - it's here the BG is getting high. I will put his feeds in the remarkline. RC dry food in picture is correct. I can give meat treats as bribe for BG. Insulin shots is okay, it's easy. As Ann added, Insulatard 100u. Wet food in my cupboard is okay. Eat chocolate!:) Have I forgotten something? Thanks again!
     
  47. Ann & Scatcats

    Ann & Scatcats Well-Known Member

    Joined:
    Dec 31, 2009
    You can always ask your vet if you can switch to Lantus. Maybe it will be your vet who is inexperienced in using Lantus, but it has been used for cats for 13 years since 2007. The Lantus start dose should not be more than 1 Unit BID twice a day. Lantus is a pH-sour depot insulin, it depots under the skin and gets released little by little.

    It works like this.
    The skin has a pH on 7-7,5 pH.
    Lantus has a very sour pH on 4 pH.
    When injected under the skin this sourness and PH difference makes the Lantus insulin form a little depot pool, and from that depot pool is released out in the body little by little.
     
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  48. Panters-mom

    Panters-mom Member

    Joined:
    Jan 15, 2020
    Is it easier to manage Lantus - I mean is it more stable - last longer (12 hours or more)?
     
  49. Ann & Scatcats

    Ann & Scatcats Well-Known Member

    Joined:
    Dec 31, 2009
    Every cat is different to how they respond. Lantus can be easier and more predictable. With all insulin you always have the risk of hypos, so too with a too high dose of Lantus.
    I however never changed back to any other insulin after we switched to Lantus.
     
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  50. Panters-mom

    Panters-mom Member

    Joined:
    Jan 15, 2020
    I was wondering - when you see these numbers on Panters Spreadsheet - do you think it's safer to go back to 3+3u? While deciding on an evt. change of insulin.
     
  51. Ann & Scatcats

    Ann & Scatcats Well-Known Member

    Joined:
    Dec 31, 2009
    From the bg's you have so far, he has really never been under 13. And with the 4 Units a.m and 3 Units p.m, the nadir period seem to fall between the +4 to +6 hours. 13 is the renal threshold and he has not been in any unsafe numbers so far.
    So I don't know if 3+3u would be better.
     
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  52. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Slight correction on the step by step, as this is an NPH type insulin:
    BG test at +11 (So if doing AM test, this actually goes on your SS in the +11 column for the previous day.)
    Feed at least 1-2 ounces wet food. 30-60 grams. 3 ounces would be better, 60-90 grams if Panter will eat that much
    Wait 45-60 minutes for food to digest
    BG test at +12 (Also known as your AMPS or PMPS test)
    Insulin shot and feed again. 2 ounce 60 grams (food amounts are approximate.)
    Take away food 2 hours before +11 test. So no food after +9

    This is my best guess at how much to feed Panter in the early part of the cycle. I have not accounted for all the food he eats each day. Can you give me those food amounts again please? We can adjust food amounts later.

    There is more testing at the beginning of treatment of feline diabetes. That is because we are trying to find out how it affects your cat. Need to see when onset, nadir, duration occur. So you test at different times during the 12 hour cycle to find out.

    Since this is a NPH insulin, the duration may be really short. From a quick look at the SS, that is what I'm seeing, short duration.

    Each insulin has advantages and disadvantages.
    p.s. You don't have to put the BG readings in the remarks if you don't want to. They are already in the cells on the SS.
     
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  53. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    I also don't know if 3U am and 3U pm would be better.

    When do you travel next? So we can try to figure out if the food change to all low carb wet food can be done before that.

    Thanks Ann for helping here. Valuable knowledge you are sharing.
     
  54. Panters-mom

    Panters-mom Member

    Joined:
    Jan 15, 2020
    So this 9 yesterday is nothing to worry about? What does 'nadir period' mean?
     
  55. Chris & China (GA)

    Chris & China (GA) Well-Known Member

    Joined:
    May 10, 2013
    The nadir is the lowest point in the cycle. Each cycle is 12 hours and the "nadir" is the lowest blood glucose reading you get in that 12 hour period.

    It's usually between 4 and 6 hours from the time you give the insulin (but can be earlier or later...Every Cat is Different)
     
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  56. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    The 9 yesterday is a nice number! Getting blues is a good response. It does illustrate how that dose of that insulin worked on that day though - the insulin dropped bg quite nicely for the first half of the cycle but then "petered out" completely, ie with no insulin in his system his bg shot up again. The ideal would be a dose that would produce a slightly gentler curve showing nadir about halfway through the cycle and then slowly rises again (if you draw a simple line in the shape of a little smile you'll get the idea).

    As Chris has said in answer to your question, nadir is the lowest point in the cycle. The other terms you'll hear in context of how a dose works are "onset" - when it begins to take effect - and "duration" - how long it lasts. The same dose of the same insulin may not work in the same way every day but with regular monitoring you will build up a picture - that's the way to come to decisions about changing the dose or the insulin. Knowledge is power!

    Hang in there, you're doing great and have come a long way already :)
     
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  57. Panters-mom

    Panters-mom Member

    Joined:
    Jan 15, 2020
    Hi Deb,

    The cells AMPS and PMPS - should I transfer the the number at +11 to these cells?

    Food - Panter will eat any amount right now if I let him - he is so hungry - so this is a challenge. So I have been given big breakfast after insulin shot - about 150g wet food, then during the day 150 g wet food (+4 and +8 or sometimes one +6), evening after insulin 100-150 g, night 20g dry RC. And he doesn't gain weight.

    So now I will - to repeat -
    Feed 60-90 grams
    wait 45-60 minutes for food to digest
    BG test at +12
    Insulin shot and feed again. About 60 grams.
    Take away food 2 hours before +11 test. So no food after +9
    This I will do two times - AM and PM.

    Travel - I'm afraid a travel is coming up on Thursday (1,5 week) - so my husband will be the one taken care of Panter. And he is about to learn the insulin shots today (but no worries there). But to take BG test - I do worry. And he worries - a lot...
    This is where I need to take a deep breath - and a chocolate. Because I really don't know how we're going to do this.
     
    Last edited: Jan 18, 2020
    Reason for edit: took away something I just understood and changed the question:)
  58. Panters-mom

    Panters-mom Member

    Joined:
    Jan 15, 2020
    Thanks Chris and Diana! Yes knowledge is power!
     
  59. Panters-mom

    Panters-mom Member

    Joined:
    Jan 15, 2020
    I was wondering - is there a way to see the SS as a curve, if you know what I mean?
     
  60. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    I don't think there is on this particular ss (other people may know for sure) but I have seen other members using their own versions where the time and bg numbers are plotted like a graph. There's nothing to stop you doing that if you want to but you'll find that most people here are used to seeing the colour-coded one - you'll soon start to see patterns.

    Ref your husband being wary about testing bg - this is quite common actually, some men are a bit squeamish or just don't want to do it. Really, when you are giving insulin, you do need to be able to test bg, so if you're going away your DH needs to step up.. Can you work out a little learning plan to introduce the process to him gradually so he feels able to test? Maybe a little treat after each attempt?!
     
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  61. Panters-mom

    Panters-mom Member

    Joined:
    Jan 15, 2020
    I guess I have to be clever here and figure out something...;)
     
  62. Panters-mom

    Panters-mom Member

    Joined:
    Jan 15, 2020
    What to do - when he is so desperately hungry?? He is up in BG 21.6 and has already got 60 g (after) - but he wants more - he is all over the kitchen searching...
     
  63. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    It's OK to feed Panter. When blood glucose (BG) numbers are high, the end product of metabolism (i.e., glucose) isn't getting from the blood stream into the cells. As a result, your cat is starving. It's OK to give some food. You don't want to feed Panter 2 hours prior to your shot time since you don't want food to influence the pre-shot test..

    I honestly think we are all guessing about which insulin Insulatard is most similar to. With all of the possibilities, it is not most similar to an insulin that we know is recommended for cats. If you can discuss this with your vet, Lantus is available and recommended as a good insulin for cats. We will be able to offer a great deal more help with your managing Panter's diabetes if we are knowledgeable about the insulin you are using.
     
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  64. Panters-mom

    Panters-mom Member

    Joined:
    Jan 15, 2020
    Thanks Sienne! I will talk to the vet on Monday about Lantus.
    So if I give more food on this high number (21.6 - with next insulin in 3 hours) - the BG want jump higher? Well no it's too late as I will test in two hours, but thinking more in general.
     
  65. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    There's no way to know for sure what the effect of food will be. You may want to spread Panter's food out over the first several hours of the cycle when insulin is most effective. You can then increase the amount of food but not feed past nadir which is when the insulin starts wearing off.

    I would also try to discontinue the dry food. The RC dry will cause Panter's numbers to rise. Almost all of the RC dry foods are very high in carbohydrates.
     
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  66. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Yes, discontinuing the dry food would be good, but this insulin is a NPH type insulin. (See post #45 in this thread). Risk with taking away all dry food at this point is that the BG levels will drop very low and risk of hypoglycemia. More monitoring needs to be done, and I'd even suggest dropping the dose of the Insulatard down lower.

    Goeril uses an insulin pen, so dose adjustments can only be made in 1U increments for now. She does know about the possibility of using syringes with the pen but has no syringes at this point. She'll want to get U100, 3/10 cc, 30 unit, 30-31 gauge syringes. Those same syringes can be used with Lantus if she switches to that insulin.

    She is traveling in 1 and a half weeks, husband does not yet give insulin or know how to home test. Goeril will figure out a way to teach him she said.

    @Ann & Scatcats provided this info and she has used the Insulatard for her own cat. (Ann, I actually understood about 1 in 4 words in that document from context and knowing German)
     
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  67. Panters-mom

    Panters-mom Member

    Joined:
    Jan 15, 2020
    Syringes - haven't thought of that I can just draw it from the flexpen, right? What does this mean U100, 3/10 cc, 30 unit?
    I'm traveling on Thursday, will be away 1,5 week...
    but guess what - my husband took his first BG test a few hours ago! I think I actually underestimated him. And of course when your arm is twisted..;-) So tonight he will do the insulin and another BG. But these 10 days want be max testing of things, more in a maintaining stage I'm afraid. How will that work do you think? Set back or?
     
  68. Panters-mom

    Panters-mom Member

    Joined:
    Jan 15, 2020
    About the dry food - he only gets about 20g in the night at 00.30(+5) PM through a timed cat mate and now I will close it +9 (to test GB +11) - I can switch it for wet....? What do you think?
     
  69. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Not a setback. Maintaining is good.

    More food is fine. I learned that tørr is Norwegian for dry. Thanks for the notes in your SS in the remarks column. Helps us to see what is going on, and interpret the numbers.

    Goeril, I was writing another reply while you were also. Maintain doing the things you are doing now. We will help you when you get back on February 1st.

    My recommendation (my opinion) would be to NOT change the insulin at this point from Insulatard to Lantus. Don't eliminate the dry food either yet.

    My reasons being:
    • Husband needs to learn to home test. He just did his first test and shot!!!
    • If vet doesn't use lantus for cats, she may need to find another vet that does.
    • If vet doesn't use lantus for cats, but is still willing to prescribe it, vet may not have much experience and may prescribe too high of a dose.
    • Your upcoming travel for work is very soon. (How long are you gone Goeril?)
    • Lantus is different in how it works and the test, feed, shoot sequence is different. Steep learning curve.
    • Ideally, I'd like Goeril and her husband to be home testing before eliminating the dry food from the diet.
    With all these things happening in a very short time, I'd be worried. I certainly would not start the Lantus at the current 4U am, 3U pm dose that is being given now.

    p.s. Be right back with syringe explanation
     
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  70. Panters-mom

    Panters-mom Member

    Joined:
    Jan 15, 2020
    Okay, Deb. I hear you. Thanks! We will maintain. I can still work on the BG tests up to coming Wednesday. I will be back home Tuesday 4. evening (actually not 10 but 12 days). I will also figure out on Monday if our Vet have any experience with Lantus, so we know till I'll be back.
    This recipe of BG testing +11 - food - BG testing +12 - ins + food AM and PM - how many days do we do this?
     
  71. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    U100 is the concentration of insulin you are using. There are also U40 concentrations of insulin. You want to get syringes that match the concentration of the insulin you use.

    cc is the capacity of the syringe. Syringes are available in 3/10cc, 1/2cc, 1cc and 2cc. Any syringe more than the 3/10cc capacity is much harder to use to draw up those tiny doses our cats need. 3/10cc and 30 unit is the same thing. They hold the same volume. (My first diabetic cat was a foster cat from my local cat shelter and they gave me 1cc syringes to use. They didn't know any better but I learned from here).

    Insulin syringes have different gauges. The higher the number, the finer the needle and the less it hurts. Gauges can be from 27 to 31. Try to find a syringe in the smallest gauge that meets the concentration and capacity requirements.

    You also want insulin syringes that have half-unit markings on the syringe barrel (cylinder). Easier to use when you want to dose by 0.25U and 0.5U increments.

    BD, Monoject, Sure Comfort are 3 of the manufacturers that make insulin syringes in the US. Not sure what you have in Norway. Not sure if you need a prescription from your vet to buy syringes or if you can walk into a pharmacy to buy them. Different rules, different countries, different rules for different states here in the USA even. (Drug epidemic concerns)

    p.s. you are 2 fast for me. Replies on other questions in next post from me.
     
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  72. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Keep that schedule for now with the insulin you are currently using. Every day until you change insulin.

    Ok to increase the amount of food if Panter wants to eat more.
     
  73. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    No, do not change to wet food now. Risk for hypo (hypoglycemia) with food change to lower carb and high dose of insulin.

    Linking a few documents for you to read. (You seem to want to/need to know so much but it takes time to learn all this. Glad you are so interested.) Don't know if you have a printer, but printing out these 3 documents could help you next time. The old boy scout motto "Be Prepared".

    How to treat HYPOS - THEY CAN KILL! Print this Out!!
    jojo and bunny's HYPO TOOL BOX
    New? Seeing Low Numbers? How You Can Help Us Help You

    Just in case the power goes out, or your cell phone doesn't have a charge, or you get those lows and ask yourself "Now what was I supposed to do if I get low numbers?" Or you can't sign on to the message board for some reason.
     
  74. Panters-mom

    Panters-mom Member

    Joined:
    Jan 15, 2020
    Great! I will read! :) I'll bring it with me on my travel. Thanks!
    To make sure - (sorry my need for taking it in with a 'teaspoon' as we say in Norway..) but you want me to BG test 4 times a day - before and after food that are given before insulin morning and evening until we change insulin. That means my husband has to do this as well... oi...
     
  75. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    You can change the title on your post at any time. Go to the top right of your 'thread'. This one you are in now. Over on the right hand side, you will see "Thread Tools, Edit Title". Click on that. A smaller window pops up on your screen where you can change the title on your post and to the left of that title is a box where you can change the prefix on your post. No prefix is fine for most situations but that is where you can select the Question mark icon or the 911 for severe emergencies. Save your changes. you might want to try this.

    For now Goeril, "Please, pretty please, pretty please with sugar on top." Keep all your posts in this one thread. It's easy for us helping you to look back through all that has been written. Would you also add your first name to your signature? I might be helping multiple people at the same time and that helps me not to mix things up.

    You can always change the title on your post if you would like some guidance when you get those first low numbers. I'm not up that late at night, but there is often someone on the board later. Not always, but often enough. And people do scan the boards for people in more immediate need. You could also post over in the Lantus forum, since there are often more people hanging out over there later at night (and during the day too). Simply a fact of more people using lantus.

    Write something like… “BG level xxx, 1st low number <100 (5.5), please HELP” to alert people to your situation. If you don't get a response, reply to your own post with the word 'BUMP', to move your post to the top of the list. Posts are all in order by the most recent timestamp on the post, so your post may have fallen farther down in the list but needs more attention sooner than others.

    If you get a BG under 30 mg/dL (1.6 mmol/L) on a human meter, change the prefix icon on your post to 911. That really gets people's attention. "Using the 911 prefix. 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 a very sick cat potentially needing ER care."

    It's like calling your police, fire, medical emergency number for help for humans. It will get our hearts racing and coming to you and your cats rescue.

    Did I leave anything unanswered? More questions? Understand everything? Take your time and read back through everything. There is a lot here. It's good you want to know so much, but you have other responsibilities too as do all of us here. My cat is begging for more food in fact. :)
     
  76. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Yes. Testing 4 times a day. And maybe more testing if you or your husband notice some of those hypo(hypoglycemic) symptoms.

    Is that possible for you to do? Let us know if anything does not work for you and we will try some other ideas.
     
  77. Panters-mom

    Panters-mom Member

    Joined:
    Jan 15, 2020
    Thank you!!! Time for feeding here to - but first BGtest! :)
     
  78. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    While you are away for work, your husband could post here. Just have him let us know he is the one posting on behalf of your cat Panter. Use the same user name, have him sign on using your account. Bookmark this thread. Have him try it first, before you go away.

    It's only noon here. You are 6 hours ahead of where I live in the USA, east coast.

    Black eared kitties can be so hard to test and see the blood. Do you need any tips to help with that?
     
  79. Panters-mom

    Panters-mom Member

    Joined:
    Jan 15, 2020
    Good idea. I will introduce him to the site. And yes, I appreciate all advises - and right now in this moment - yes please - for some tips about GBtesting. We do manage, but it's not really smoothly. I found some advice on the net - so I do use this rice bag to warm up his ear to draw the blood more to the surfus - and I can see the bloodline around his ear, and I stick the needle - and no blood - or too little - sometimes too much - so my poor buddy peeps for every needle stick - but actually sits more or less still. He is so far very helpful...thanks for that! But yes - if it doesn't work on the first try - I get a little stressed... and that doesn't help. So we are all practicing...puhh
     
  80. Ann & Scatcats

    Ann & Scatcats Well-Known Member

    Joined:
    Dec 31, 2009
    Goeril,

    I'll take pictures of the two different syringes I use and tell the difference in them. I'll be back.
     
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  81. Ann & Scatcats

    Ann & Scatcats Well-Known Member

    Joined:
    Dec 31, 2009
    First the different insulins,

    Picture 1 - Our Insulatard vial/flaska

    Picture 2- Our Lantus vial/flaska

    Picture 3 - Our smaller Lantus Ampuller.i.e cartridges

    Picture 4 - Overall picture Insulatard, Lantus, Lantus cartridges


    If you shift to Lantus you should ask to get the presciption for the 5 small Lantus ampuller.
    This is because while Insulatard lasts for 5 weeks before it gets old, Lantus last for 4 weeks before it gets old, and it becomes more expensive with the big bottle of Lantus when we never use that much insulin as such a big whole Lantus bottle.
    Therefore we get the prescription for the 5 small Lantus ampuller and draw up the insulin we need from one small ampull with a syringe and we hardly use a full small Lantus ampull in 4 weeks. It becomes cheaper with the 5 small Lantus ampulls.
     

    Attached Files:

    Last edited: Jan 18, 2020
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  82. Ann & Scatcats

    Ann & Scatcats Well-Known Member

    Joined:
    Dec 31, 2009
    Insulin syringes

    Picture 1 - What the syringe brand BD Micro-Fine + Demi with Half-Unit markings Insulin syringes box looks like. They are also thinner needle, 30 gauge, and the shortest needle 8 millimeter, so they don't hurt so much.

    Picture 2 - .The different needle thick and needle length BD Micro-Fine insulin syringes.
    To the left is the thinner needle, 31 gauge, and shortest needle length 8 millimeters.
    To right is the thicker needle, 29 gauge, and much longer needle length 12,7 millimeter.
    I first used the longer syringe but changed to the thinner and shortest for Simba's sake so it didn't hurt so much.

    In Sweden we need prescription for the insulin syringes too.
    And BD is a big diabetics brand, so you can check with your Norwegian pharmacy if they have these BD Micro-Fine syringes.
     

    Attached Files:

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  83. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Ann, Those pictures will be very helpful to Goeril.

    In picture 2 of the syringes, you can see the difference in how close the lines are in the 30 cc volume syringe (on left) and the 50cc volume syringe on the right.

    I highly recommend the 30 cc volume (3/10 cc) syringes. Insulin doses are hard enough to measure in the tiny units we give our cats.

    Needle length is a personal choice. The syringes with the half unit markings are a higher priority in my opinion than the needle length. But the slightly longer needles can be useful if you have a longer haired cat.
     
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  84. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Oh yes! When it's winter time in the cold north and the temperature is below 0 C (32 F) warming up the katt's ear is essential. Before BG testing. Especially if your cat has been outside. Where it is even colder. (Like 5F (-15C) when I got up this morning.)
    Basics
    • Warm the ear with a rice sock or a warm washcloth wrapped in a plastic bag.
    • Either freehand or use a lancing device; new members usually start with a larger gauge lancet such as 28g or 29g until the ear learns to bleed; then progress to a 31g or 33g which are finer. If you can find a lancet that is labeled "for alternate site testing" you can sometimes find them in a 26g. I never switched from 28g (g is the gauge) The smaller the number, the bigger the metal needle part you use to prick the ear.
    • Be sure to poke in the "sweet spot" and not the major vein that runs along the length of the ear. Poking the vein will not only hurt, but will result in a lot of blood. The sweet spot is on the edge of the ear.
    • Here is a diagram of the best place to poke a cat's ear.
    [​IMG]

    • Poke twice, right next to each other to get a slightly bigger blood drop.
    • Do you hold the lancet in your fingers or are you using a holder for the lancet? Sometimes called a lancet device or pen.
    • Angle, the lancet bevel side up (see picture below) if free handing (holding the lancet in your fingers).
    • Hold the lancet device straight or flush against the ear. Some lancet devices have a depth adjustment. As you get better at testing, you can change the depth.
    • Do you use something firm against the opposite side of the ear? Many people use a small piece of facial tissue or kleenex folded over many times to provide a more solid backing for the ear. Cat ears are thin and this will give you a firmer surface.
    • Do you test on the inside or the outside of the ear? Inside may be easier to see, unless you have a long haired kitty with lots of ear hair.
    • Strong light, a little flashlight you can hold in your mouth, your cell phone light, a clip on light you can shine and aim down at the ear. Good lighting let's you see the vein and the 'sweet spot' area better.
    • Panter has black ears. Black ears make it difficult to see the blood drop in the fur. You could try shaving a tiny spot on the ear with a safety razor. Very, very lightly as you don't want to nick his ear as you might when you shave your own legs.
    "But did you also know there is a particular way for the lancet to be used? It has one side that is beveled so the sharpest part goes in first, if used correctly. In the photo below, you can see the lancet is angled. When you poke the ear, it should be held in the position shown below so the longest side of it is on the bottom. Lancets should only be used once to ensure they are at their sharpest." It's ok to use the same lancet for the same test time. Or even the same test cycle (a cycle is 12 hours)
    [​IMG]


    I copied these 2 pieces of information from this document: Marje and Gracie's Testing and Shooting Tips

    Let me know if that helps.

    p.s. Deb, the Reference Librarian, is what I've been calling myself on the message board lately. I know where to find things.
     
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  85. Panters-mom

    Panters-mom Member

    Joined:
    Jan 15, 2020
    You are just amazing! Thank you so much! I feel really pampered. Feels great!

    On the flexpen I use needles 29g 12mm. And right now anyway, it feels good that they are a bit long, then I know I get through, kind of. And I use the same needle for about three days before changing it. When you use the syringe - you draw up only the morning/evening dose right - do you then have to switch needle everytime or?

    Just hits me - I feel reliefed about that the insulin shots feels easy. The BG test not so easy yet, better and better though.

    I will look for these needles at the farmacy. Dont need prescriprion here in Norway. Thanks again!
     
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  86. Panters-mom

    Panters-mom Member

    Joined:
    Jan 15, 2020
    Hah..amazing yes - and I hadn’t even read this last one! And I had got it wrong - I thought I should go for the vein, but the sweet spot. Alright! I use free hand lancet. Same as flexpen 29g 12mm. I’ve been using the rice bag on the opposite side. You say; ‘Angle, the lancet bevel side up’ - does this mean straight down or little angled to the skin? And no, haven’t thought of the angled head of the needle. Great! Thank you!!
     
  87. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    You are very welcome. We like to give personalized attention to each new member. It's why for now, we want to keep you posting in only this thread, your first thread here on FDMB. Ann and I want to keep our attention on you and keep helping as much as we can.

    There is a lot of information to understand here. Re-read when you have some down time, some free time.
    • Insulin pen should have new pen needles used each time. Risk of infection in your katt and of contaminating the insulin. It's so easy for a tiny bit of air with some bacteria to move back into the insulin cartridge (mini-vial) that you use after injection.
    • Insulin syringes are one use only. The needle gets dull with time, very quickly. Higher risk of contaminating your insulin if you reuse needles. Bacterial contamination mostly.
    • With a cloudy type insulin like the Insulatard you are using, it can be hard to see if it's contaminated. With a clear insulin like lantus, you can look for floating particles.
    Insulin is very expensive here in the US. And some supplies too. Stories of people rationing and dying because they can't afford insulin. Hopefully insulin is not as expensive where you are in Norway.

    Your thirst for knowledge is incredible. Don't try to learn everything in one day. You are doing a fantastic job helping Panter.

    Lunch time here. Going to have a late lunch myself and give my cat a mid-afternoon snack.

    p.s. Snow storm with high winds for us here tonight. Might lose power here. Hopefully not, but Ann and other people will be around just in case.
     
  88. Panters-mom

    Panters-mom Member

    Joined:
    Jan 15, 2020
    Sounds like you should get your candlelights ready. Hang in there in the storm! Thanks again.
     
  89. Panters-mom

    Panters-mom Member

    Joined:
    Jan 15, 2020
    Last night he didn't eat his RC dry food - the feeder is open from 0.30-4.30am - so no dry food involved in the next GBs... but he did eat a big fat mouse just before I went to bed...he came in with it and wanted to trade it for some more Felix...

    ...and his BG is up from +11:25.2 to +12: 27.6 after food... thats one step from black cell..Oh...
     
    Last edited: Jan 19, 2020
    Reason for edit: added a line
  90. Chris & China (GA)

    Chris & China (GA) Well-Known Member

    Joined:
    May 10, 2013
    Ahh...the purrfect food for a cat!!

    I always wondered why somebody didn't make a canned food out of mouse.....a mouse mousse!
     
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  91. Panters-mom

    Panters-mom Member

    Joined:
    Jan 15, 2020
    Hehe...You might have a business-idea there! ;-)
     
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  92. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    We talked about this already, but if Panter does not eat his dry food, the BG levels could drop dramatically. 100 basis points or more (5.5 mmol/l) Just wanted to reiterated that. You may need to do more testing to see if Panter is dropping very low in the middle of the 12 hour cycle.

    Be careful and keep a close eye on Panter. Watch for hypo (hypoglycemia) symptoms.
     
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  93. Panters-mom

    Panters-mom Member

    Joined:
    Jan 15, 2020
    I will! It's just that suddenly it seems like he is not so hungry as he has been... today was the first time in a long time that he has turned up his nose to food so I had to change his bowl to something else... but he did it that... might be a good sign or...?
     
  94. Panters-mom

    Panters-mom Member

    Joined:
    Jan 15, 2020
    ...to add...strangely - he did not eat the RC dry last night - and his BG was up in 27.6 +11 this morning... what in earth is that?
     
  95. Ann & Scatcats

    Ann & Scatcats Well-Known Member

    Joined:
    Dec 31, 2009
    It was the little mouse perhaps :cat:
     
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  96. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    You know your cat better than anyone else. Know what to look for if he seems unwell. Maybe he was too full from the mouse. Does he eat them, or only bring them inside to say "Look what I brought you mom! I'm such a good hunter. We'll never go hungry as long as I'm here to provide for you."

    Cats are cats. They can change from one minute to the next. If Panter had refused to eat any food, that would have been more of a concern.

    "Bouncing" maybe.

    "Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's,(11's mmol, 16's mmol) or higher for a long time, then even a BG that drops to 150 (8.3 mmol) can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast. The pancreas, then the liver, release glucagon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles)."

    Panter may have had a low. Doesn't have to be a hypoclycemic low, just a BG that was lower than his body was used to.
     
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  97. Panters-mom

    Panters-mom Member

    Joined:
    Jan 15, 2020
    Sent my curves and questions - among other about Lantus - to the vet today. Have to admit that I was somehow kind of nervous for her reaction...but totally without reason. She was rather impressed by my work. Puhh...very nice to know that we have a vet that is willing to cooperate. She suggests to go down on insulin to 3+3u. And we will look into Lantus when I'm back. She also briefly mentioned something called acromegaly even though too early to say - I googled it - not so good - but we take no worries in advance.
     
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  98. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    Glad to hear you have a supportive vet, it really does make all the difference. I wouldn't worry about acromegaly for now - that's a condition that does usually require high doses of insulin, it's true, but it's not as if the doses Panter is getting now are doing nothing - he does drop. A different longer-lasting insulin might suit him better so that's something to hang on to and hope for!
     
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  99. Panters-mom

    Panters-mom Member

    Joined:
    Jan 15, 2020
    3+3u starting from tomorrow - sound good to you? At least it's less worries for big bouncing or what?
     
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  100. Panters-mom

    Panters-mom Member

    Joined:
    Jan 15, 2020
    ...and yes - we will not worry yet for acromegaly. I believe what you say about changing to a longer lasting insulin.
     
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