Steep Caninsulin drop, is it ok?

Hi everyone

I did a mini curve on Mousey today since increasing her insulin to 4.5u x2 daily, from 4u x2 daily.
Her first curve came down gently but didn't get into the ideal range.
This curve however showed a fast and steep drop (as I have been warned about with Caninsulin).
Her top BSL today was 17.5 (315) , her lowest 5.7 (103).

I am still very slowly getting her to eat more wet food so she's still grazing in-between meals on dry diabetic (Hill's), and I supplement her with the same if she doesn't eat enough wet. I feed her three wet meals a day (Royal Canin diabetic wet).

Question(s):

• Is this ok (the steep drop?)
• Is 4.5 units too much? (I think there isn't enough wiggle-room with her low for potential sickness, eating less on a given day etc).

Thank you : )

 

I don't think there's much wiggle room either. If she doesn't eat as much dry in a particular cycle that could take her even lower. Well done on catching the lower numbers with your home testing.

It would help to get a little more info:

1. Please can you post the type of meter you're using to measure Mousey's BG (and also add it to your signature ).

2. Please post whether you're feeding Hill's w/d or m/d dry (the carbs differ).

3. Please post the carb value of the Royal Canin diabetic wet food if you know it.

With the food transition in progress I'd recommend great caution with dosing. As soon as the dry goes out of her diet Mousey's BG levels could come down a lot. I'd also recommend that you get pre-shot and +3 tests morning and evening every day to keep her safe. If at any time she seems lethargic at all or suddenly quite interested in food test her to make sure she's in safe numbers and follow the hypo guide if you need to intervene with carbs (wet food will raise numbers faster than dry). Don't remove any more dry food from Mousey's diet for now (could leave her vulnerable to reaching hypo numbers). If she were my cat I would not give 4.5 units again.

Also, can you let us know how Mousey is behaving (e.g. playing, eating, sleeping, hiding):

1. Before the dose is given.

2. Between dose time and +3.

2. In the hours between +3 and +10.

3. In the period between +10 and the next preshot test as the dose is wearing off.

I'm in the UK so I need to try to get some sleep right now but I'll look in again in the morning.


Mogs
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Thanks Mogs, hopefully you have a good nights rest.

(Sorry, ,I don't know how to do that snazzy thing where you add in the person's post in a box).
2. Please post whether you're feeding Hill's w/d or m/d dry (the carbs differ).

• It's Hill's Glucose/weight management, m/d.

3. Please post the carb value of the Royal Canin diabetic wet food if you know it.

• It doesn't list the ingredients on the packets - may have on the outer case which I've thrown away. She doesn't eat a lot of it though, perhaps slightly < than 1/4 cup and mostly licks the gelatine like sauce from around the meat. Have tried Ziwipeak and the Science diet wet as well, but she won't touch it. She did have a few small bites today of Fancy Feast.

With the food transition in progress I'd recommend great caution with dosing. As soon as the dry goes out of her diet Mousey's BG levels could come down a lot.

• Agree with you.

I'd also recommend that you get pre-shot and +3 tests morning and evening every day to keep her safe. If at any time she seems lethargic at all or suddenly quite interested in food test her to make sure she's in safe numbers and follow the hypo guide if you need to intervene with carbs (wet food will raise numbers faster than dry). Don't remove any more dry food from Mousey's diet for now (could leave her vulnerable to reaching hypo numbers). If she were my cat I would not give 4.5 units again.

• Agree here, I'll go back to 4 units.

Also, can you let us know how Mousey is behaving (e.g. playing, eating, sleeping, hiding):

1. Before the dose is given.

• Rubs my face in bed, looking for food, but lethargic at the same time - as she often is. Lies around a lot, seems happy, played for 30 secs last night with a string, purrs, sleeps. Since being diagnosed (6 weeks or so), she has turned form a 'crabby tabby' to the most placid kitty - I could never kiss her tummy as she's wallop me, but now she tolerates being petted and kissed a lot. it's nice but also a bit sad as I wonder if its due to sheer lethargy that she's not herself. Happy though, and seems to enjoy it.

2. Between dose time and +3.

• Eats, drinks, sleeps. Not much grooming.

2. In the hours between +3 and +10.

• Will pop downstairs sometimes, occasionally wants to go outside and sit in the sunshine. Seems happy. Just wants to rest.

3. In the period between +10 and the next preshot test as the dose is wearing off.

• Most active time of the day, occasionally plays a bit, or wants to explore in our wardrobe (her way of having some fun). She can't sustain it for long though, and soon returns to resting on the bed.

I hope this helps some Mogs ; )

 

Addendum:

I didn't give insulin tonight, will wait & check tomorrow. She didn't eat a lot today and I feel quite shaken at how low she got. I feel bad at having not tested her earlier than what the vet recommended (10-14 days post insulin increase) and feel grateful she hasn't had a major hypo and worse.
Thank goodness for this message board. Thank you good people for the time you spend helping others, you really make a difference.

Mogs I use an Accu-Chek Performa glucometer.

 

Did we get you the Caninsulin/Vetsulin user guide?
One of the tricks with this insulin is to test, feed, wait, then shoot, per the guide. The food coming in helps buffer that steep drop. Optionally, feeding a mini-meal around +2 to +3 may help slow the drop a bit more. After you've passed the nadir, you want to minimize any food so you don't zoom back up quickly.

 

Evening, Surfcat!

That's good news. Mousey's BG, while lower than you're used to seeing, was well within the normal range for a cat as measured on a human meter (lower threshold is 2.8mmol/L / 50mg/dL on human meters). Albeit good news and something we all hope to see, it can be something of a shock to the system to see healthier numbers in a cat on insulin for the first time. (Scared the willies out of me. Even nowadays there are times when I completely bottle out of giving Saoirse insulin when I know I might pass out and not be able to monitor to keep her safe should she run on the low side during a cycle - especially as she runs lower at night.)

You're doing great with home testing Mousey. Now that she's starting to see better numbers as the food transition progresses you really need to test every cycle at preshot and also from +3 (or +2 if she starts showing increased signs of hunger earlier in the cycle). Make sure Mousey eats well after the preshot test and leave about 20-30 minutes before giving the insulin injection. This will 'preload' some carbs into Mousey's system prior to onset of the Caninsulin. For info, when Saoirse was on Caninsulin I used to give Saoirse half her daily food allowance in each cycle. I fed her half of the allowance for the cycle 20-30 minutes before administering the insulin injection so that the Caninsulin had something to work on. I fed her again after her +3 BG check and then gave her a small meal at at +6 followed by a small snack at +9. (Note: I'm disabled so I was home to intervene if required. If I had had to leave Saoirse unattended I'd have tried to work out a way for her to have free access to food in my absence if she was on Caninsulin.)

As Saoirse's treatment continued the onset time for the Caninsulin happened progressively earlier in the cycle; sometimes she would reach nadir at +2! Watching for an uptick in appetite early in the cycle is a good clue as to when the insulin is kicking in and it can act as a signal for you to start checking BG. The amorphous fraction of Caninsulin has the greatest BG lowering effect and nominally that reaches peak action at +3 (although it is possible to see nadirs even earlier in the cycle, especially if the dose is too high) and the period of maximum effect typically lasts for a number of hours thereafter. The crystalline fraction of Caninsulin has a later onset and a less powerful BG lowering effect; it reaches peak effect between +7 and +10 so sometimes you might get a second dip around that time. The possibility of a second dip in BG levels is of greater concern if a cat has already been running in lower numbers during the earlier part of the cycle, so it's important to test in the latter half of the cycle if at all possible. At minimum, you need to do preshot BG tests every cycle and a +2 (or preferably +3 test if you can only do one) before bed every night, and then supplement that data with full curves on days/nights when you are at home for longer periods. The full curves are important for determining the duration of effect that Mousey is getting and also whether there are any dips later in the cycle when the crystalline fraction of the insulin reaches its peak period of effect.

Thank you for the information on Mousey's clinical signs. The tiredness could be due to the higher numbers, or it could potentially be down to the BG roller coaster that is a very typical response to Caninsuln treatment; it can be very hard on the cat's body. Saoirse was absolutely miserable on Caninsulin with the exception of the hours when the dose hadn't kicked in or when it was wearing off. The rest of the time she was wiped out when she was being treated with it. It was like having two completely different cats. Lantus makes her a bit sleepy for an hour or so after administration but the rest of the time she was 'herself', if you follow my meaning.

I hope some of the above helps you. I'm sorry it has taken me so long to write this response (I'm struggling with chronic fatigue issues).


Mogs
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Thank you, that's really helpful - I haven't seen this guide so will read up. I have been feeding and waiting (30 mins usually) before insulin as advised by someone on this message board (thanks!).

 

Thank you for taking the time to reply with all your great information. It is truly helpful and so much more than I could get at the vet! I'll look for the signs of appetite, Mousey seems to hit her lowest times around +5. It is good to know this can change and come closer to + 2-3 as you mentioned. I have really struggled getting the blood, not so much 'getting ' it, but the angst it is causing her. I wake up in the night dreading what I have to do in a few hours!! I know it is for her benefit though, it is just a bit sad. I tried with my husband helping, but it seems she is better with just me as tricky as it can be sometimes. She is not one of those kitties who lies on your lap...!! Her yowling today woke our son up... I'm at home all day too, so can easily monitor her which is great.

Take care, chronic fatigue is difficult - I struggle a bit with that as well