Question About Dosing for Newly Diabetic Cat

[Beck]

My 9 1/2 year old cat Pepper was recently diagnosed as diabetic on 2/26. She initially tested with a glucose level at over 600. She was prescribed 3 units of the Humulin N twice a day to start. I've started testing her blood glucose levels with the Relion Confirmed once a day at home since 3/02. I'm hoping to move up to twice a day once Pepper and I get used to it.

The first day(3/02) I tested her I was startled to see it went down to 157 already(this is about 5 - 5.5 hours out from the morning insulin). I got a bit spooked and skipped her night time shot. After researching it later I realized this may have been where the number should be at its peak. The next morning I tested her right before eating and got 537(3/03). So it's possible skipping the shot made it jump. Problem is she got a reading of 505 this morning(3/06) and she's been getting steady insulin shots since.

I actually took her to the vet yesterday(3/05) and he seemed to think the dosage was okay as she hit 157 that one day(it was the only day I tested the peak at home). But she did test at around 400 at the vet's that day at peak time(2:00pm). While I'm sure her number was higher from stress, even if her true number was 300, it seems high. Basically he told me to keep testing her every day or two and see where the numbers are at and call as needed. Admittedly he is an older vet in an impoverished area, so normally they aim for more affordable/easier treatments. I'm sure most people in my area would balk at the idea of testing their cat's blood glucose at home.

Anyways after seeing the reading of 505 this morning I started researching more and read about the Somogyi phenomenon. I'm concerned her starting dosage could be too high. She's only been on insulin for 8 days now, so I'm not sure if it's too soon to see steady glucose levels regardless. She did weigh at half a pound heavier at the vet's yesterday(from 7.4 to 7.9lb). So it does seem the insulin is doing something. Her starting symptoms were high appetite and weight loss. And the appetite has stayed high.

Some other notes. She is fed at least half of a 5.5oz can of Friskies, 3-4 times a day. During her 1st and 3rd meals I give her insulin shot. For most of the day, I leave a small amount of dry food out for the other cats. She highly prefers the wet, but may be snacking on this overnight. Also, she has been getting around a dozen little cat treat kibbles when I take her glucose reading.

Finally to my question, should I give it some more time on this dosage and see how her numbers go? How alarmed should I be by these numbers?

Also any tips on feeding dos and don'ts are appreciated.

I'm new to diabetes and this forum so if I missed something please do tell me. Thank you

 

[Sharon14]

Welcome! I don’t have experience with humulin insulin, but I can help with the food question. If Pepper is eating any dry at all (other than Young Again Zero, or Dr Elsys) that could be contributing to the high numbers. I suggest you get all your kitties on low carb wet food or the above mentioned dry if you need to feed dry. The treats are probably high carb as well, so maybe try some poached chicken breast or Treats that are 100% meat such as Pure Bites. Having said all that, if you stop the dry, Peppers glucose could go way down and 3u could be too much, so if you change your feeding, I would cut the dose, test as often as you can and test for ketones. To really know how well the insulin is working, you need to test before food and shot as well as midcycle when you’re able. You can record these numbers on our spreadsheet so we can see what’s going on. Here’s the instructions for the spreadsheet
http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
If you need help setting it up, ask and we’ll help you.
I’ll tag a few members that are great with dosing advice to help you @JanetNJ @Kris & Teasel

 

[Kris & Teasel]

Welcome!

She initially tested with a glucose level at over 600. She was prescribed 3 units of the Humulin N twice a day to start. I've started testing her blood glucose levels with the Relion Confirmed once a day at home since 3/02. I'm hoping to move up to twice a day once Pepper and I get used to it.

That's a very high starting dose. Cats are stressed at the vet and that can lead to inflated BG levels and a recommended dose that might be too high. Congratulations on undertaking home testing. It's the best thing you can do to keep Pepper safe.

The first day(3/02) I tested her I was startled to see it went down to 157 already(this is about 5 - 5.5 hours out from the morning insulin). I got a bit spooked and skipped her night time shot. After researching it later I realized this may have been where the number should be at its peak. The next morning I tested her right before eating and got 537(3/03). So it's possible skipping the shot made it jump. Problem is she got a reading of 505 this morning(3/06) and she's been getting steady insulin shots since.

Until you gather more test data it's hard to know what's happening. It's very possible that the 3 unit dose is dropping her low and she's rebounding up to a high BG level. We call it "bouncing".

I'm sure most people in my area would balk at the idea of testing their cat's blood glucose at home.

Not just your area! Most people who aren't members here on FDMB aren't as hands on in treating their kitty's diabetes as we are.

She's only been on insulin for 8 days now, so I'm not sure if it's too soon to see steady glucose levels regardless.

You're correct about that. It takes a kitty's body some time to adjust to being given insulin. Getting them down into consistently good BG range can take weeks or months.

Some other notes. She is fed at least half of a 5.5oz can of Friskies, 3-4 times a day. During her 1st and 3rd meals I give her insulin shot. For most of the day, I leave a small amount of dry food out for the other cats. She highly prefers the wet, but may be snacking on this overnight. Also, she has been getting around a dozen little cat treat kibbles when I take her glucose reading.

Friskies and Fancy Feast pates are fine to feed diabetic cats because they're under 10% carbs. The insulin shots should be given as close to 12 hours apart as possible The dry food is likely high in carbs and that can certainly affect her blood glucose level. There are freeze dried meat treats in pet stores that make good "reward" treats because they're low carb. Pure Bites is one common brand.

Finally to my question, should I give it some more time on this dosage and see how her numbers go? How alarmed should I be by these numbers?

The first thing we recommend is testing BG at home and you have that covered. The second thing is to follow a basic testing routine that I'll outline below. The third thing is to set up a spreadsheet like we use here to track your BG numbers. All members can see it and we look at it before offering advice.

Here's something I wrote up for new people. It'll be confusing at first so read it a few times and ask any/all questions you have here and on the main health forum (a bigger forum than this one):

It would help us if you set up your signature (light grey text under a post). Here's how:

• click on your name in the upper right corner of this page
• click on "signature" in the men that drops down
• type the following in the box that opens: kitty's name/age/date of diabetes diagnosis/insulin you're using /glucose meter you're using/what he eats/any other meds or health issues he has.

Another thing that will help us help you now that you've started BG testing at home is to set up a spreadsheet like the one we use here. We can all see it and look at it before offering advice: http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

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Here's the basic testing routine we recommend:

1. test every day AM and PM before feeding and injecting (no food at least 2 hours before) to see if the planned dose is safe
2. test at least once near mid cycle or at bedtime daily to see how low the BG goes
3. do extra tests on days off to fill in the response picture
4. if indicated by consistently high numbers on your SS, increase the dose by no more than 0.25 u at a time so you don't accidentally go right past a good dose
5. post here for advice whenever you're confused or unsure of what to do.

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Here's an explanation of what we call "bouncing". It explains why a kitty's BG can go from low to sky high:

1. BG goes low OR lower than usual OR drops too quickly.
2. Kitty's body panics and thinks there's danger (OMG! My BG is too low!).
3. Complex physiologic processes take glycogen stored in the liver (I think of it as "bounce fuel"), convert it to glucose and dump it into the bloodstream to counteract the perceived dangerously low BG.
4. These processes go into overdrive in kitties who are bounce prone and keep the BG propped up varying lengths of time (AKA bouncing).
5. Bounce prone kitty repeats this until his body learns that healthy low numbers are safe. Some kitties are slow learners.
6. Too high a dose of insulin can keep them bouncing over and over until the " bounce fuel" runs out and they crash - ie., have a hypo episode. That's why we worry so much about kitties that have had too high a starting dose prescribed by the vet and the owner isn't home testing.

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Here are some tips on how to do urine ketone testing (VERY important of BG is high and kitty isn't eating well!):

• put the end of the test strip right in his urine stream as he's peeing
• slip a shallow, long handled spoon under his backside to catch a little pee - you don't need much
• put a double layer of plastic wrap over his favourite part of the litter box and poke some depressions in it too catch pee.

Most test strips have to be dipped and allowed to develop for 15 seconds before viewing the colour change in very good light.

 

[JanetNJ]

That is a super high staring dose. If it were my cat I’d back that down to 1 u twice a day until you really get the hang of testing. Then raise it in 0.25-0.5 increments at a time. Awesome you’ve started to learn how already.

 

[Beck]

Thanks @Sharon14 for getting me started with the spreadsheet and tagging the other members. I added info and a spreadsheet to my signature, but I'm afraid there's very little data so far.

At least 80% of her food intake has been canned food for 2-3 weeks now(over a week prior to when she started insulin). Hopefully if I remove the rest of the dry food from her diet, it won't have a big effect. I'll have to buy some chicken breasts for treats next time I go out.

Wow, thank you for the thorough response @Kris & Teasel! I'm actually still rereading it to make sure I got everything. From looking online I did get a vague idea of "bouncing" and that's why I became concerned enough to post. Getting all this info is putting me a bit more at ease. While my vet was very patient answering my questions, it's just not possible to fit them all in a vet visit.

You mentioned no eating 2 hours before testing. Would feeding during the blood test affect the results? She's been barely tolerating the blood tests now if I bribe her with treats, but I hope that's not skewing the results. It would be even easier if I could feed her the canned food during tests. She actually started happily mewing at me tonight when I got the insulin bottle out.

My vet had not mentioned anything about ketone testing. I'll order some strips tonight. Luckily Pepper eats like a champ.

That is a super high staring dose. If it were my cat I’d back that down to 1 u twice a day until you really get the hang of testing. Then raise it in 0.25-0.5 increments at a time.

Is there any harm in dropping her dose down suddenly like that? I'm assuming a possibly higher, but steady glucose level is safer in the short term?

I'm not totally confident in my glucose testing kit being super accurate. How many days minimum would you give between increment changes? Thanks!

 

[Kris & Teasel]

So long as you remove food 2 hours prior to the pre shot test you can give a little snack right as/after you do that test if it makes testing easier. The snack won’t influence the test because it takes 20+ minutes to hit the bloodstream.

 

[Sharon14]

Great on getting the spreadsheet set up! Kris and Janet gave you some good advice. Your meter (Relion confirm) is what many of us use. It will read lower than your vets meter, but that’s ok because we are using it to see trends and to be sure BG is high enough to give insulin. The Preshot tests are the most important ones. If you can get those 2 everyday and midcycle tests when possible that will tell us a lot. I get up in the AM, test, feed then give Colin his shot. It took a few days, but he now goes to the test spot as soon as I get up, ready for his test! Then I get a test 3 hours later (+3) when I leave for work, and he gets a snack. That test tells me if I need to leave higher carb food or regular low carb food out for him. Then repeat at night with a PS test, feed, shoot, and before bed test. We usually give at least 6 cycles (3 days)between dose changes, but without much testing probably a week. As far as dropping the dose as Janet suggested, the only harm would be higher BG’s if the decrease wasn’t warranted and you would need to test for ketones.

 

[Beck]

Unfortunately I only saw this post after the morning insulin. I gave her 2u last night to see if there would be any difference and her number actually went down slightly(removing the dry food may have helped too). I did give her 1u this morning, but I won't get the ketone test strips until Friday. I live in the middle of nowhere and have an ongoing blizzard at the moment. Getting any before Friday might not be an option. She doesn't show any physical symptoms of having ketones, but I'll keep a close eye on her until I get the strips.

Your meter (Relion confirm) is what many of us use. It will read lower than your vets meter

That's actually a bit of a relief to hear. I took my ReliOn to that vet appointment and from the same blood sample it actually gave 330 the first reading when the vet got 400. We tried a second time with the ReliOn and got 387. I'm a bit wary of accuracy because of that 330, but at least I know the lower reading is normal now.

 

[Kris & Teasel]

You've made a great start by testing and setting up a spreadsheet. If you're game, I suggest staying at 1 u for a day or two. If you're home today try to get at least one test between +4 and +6. It's important to know how low a dose takes her not just how high she is before she gets her shot. You'll be a pro in no time!

 

[Beck]

I did manage to get a +5 out of her at 338, which seems fairly high. I'll give her the 1u again tonight and see how she tests in the morning. Maybe I can try increasing her dosage by 1/4 tomorrow. Thanks again for the advice!

 

[Kris & Teasel]

I did manage to get a +5 out of her at 338, which seems fairly high. I'll give her the 1u again tonight and see how she tests in the morning. Maybe I can try increasing her dosage by 1/4 tomorrow. Thanks again for the advice!

Although high, that's a decent drop from PS. Yes, I think you can bump up to 1.25 u tomorrow AM. Do your syringes have half unit marks? They'd make it easier to eyeball half way between 1.0 u and 1.5 u.

 

[Beck]

I ordered some syringes with half markings, but they probably won't arrive until sometime next week. My up close vision is pretty good, so I'm hoping I can make due until then.

 

[Beck]

She tested at 506 this morning. I tried testing her a bit earlier this time at +4 and got a 173. That seems like an awful big drop and I'm not sure if it's her lowest. I haven't seen her act lethargic or anything else indicative of hypoglycemia. So she's probably not dropping super low at least. On another note, I did get some ketone strips and I'm glad to say it's showing neutral for her.

Is it too soon to tell if the Humulin N is working how it should? Is it possible she's still bouncing?

After reading on this forum more, I noticed Lantus and Levemir are more popular due to the duration. Is that something I should look into getting or should I give the Humulin N some more time first?

 

[Kris & Teasel]

Big drops like this are fairly common with Humulin N. It acts fast and can drop the BG quite low and then it's gone. It can be tricky to get to a dose where the nadir is a safe low (90-110) and the PSs aren't sky high. It might not even be possible for some cats.

The depot insulins are better able to flatten out the BG curve because they're gentler and longer lasting. The depot creates a type of time release effect so there's always a small insulin effect occurring. They're extremely expensive in the US - $300+ for a 10 mL vial. Many people order from a reputable Canadian online pharmacy, Marks Marine Pharmacy in Vancouver, and pay roughly half that amount. Your vet would have to fax a prescription to them.