Friday, July 10, 2015

My kitty was just diagnosed with diabetes. I read a lot of stuff on the internet but what do YOU do?

I get questions like that via email/Facebook PM several times per week.  While everyone has different experiences because every cat is different, I can share my experiences.  I will do my best to answer the most common questions I get.  This post is about insulin questions.

What insulin do you use?

I have three diabetic cats and I use three different types of insulin.

Pumpkin was my cat before he had diabetes.  I tried him on Prozinc and Novolin N and neither worked for him.  He has done very well on Lantus.  He did have several months of being in remission (aka "off the juice" or "OTJ) but after a third bout of nearly life-ending pancreatitis, his pancreas has not recovered and likely never will.

Tucker came to me for care after he was already diabetic.  I tried him on Lantus and it didn't work well for him.  I switched him to BCP PZI and it did work well.  I then tried Levemir and it was not good for him so he is back on BCP PZI.  He has periods of being OTJ that ranges from a couple of days to a few weeks.

Sunshine came to me twice.  I had her while her foster mom was on vacation.  She had been on Lantus for several years.  It didn't seem to be the best insulin for her and I switched her to Levemir.  She did great with Levemir and went back to her foster mom on it.  Unfortunately for Sunshine, she went into a very severe DKA and nearly died.  I took her home with me as a "last chance" and treated her as aggressively as possible.  Today, she is OFF insulin and has been for several months.

(Side note - switching insulin should be done in consultation with your veterinarian.  Your data from home testing, along with behavioral observations, is what will be used to explain why a particular insulin may not be working for your cat.)

While Novolin N and Vetsulin/Caninsulin are NOT recommended insulins for cats, with proper guidance from an experienced caregiver, they can be used and get a cat into remission.

So to sum up, the right insulin is the one that works for your cat.  There are several to try.  Don't be discouraged if the first one isn't working the way you expected.

(Another side note - Regular or R insulin should NOT EVER be used as a basal insulin and should be used with extreme caution under the direction of a veterinarian along with receiving guidance from an experienced caregiver.)

My cat is on ___ units of insulin and my vet says I can't go any higher.

Well, no, that's not true. A dose can always go higher but you need to look at anything contributing to a lack of results.  A higher dose isn't always the answer.

Is your cat completely off of dry food?  
Are you only feeding low-carb canned food?
Does your cat have bad teeth or an infection?
Is your cat secretly stealing high-carb dog food or people food?
Is your insulin expired?
Have you been using the same vial of insulin for more than 4-6 months?
Are you doing curves at home to see how your cat responds?

If you are literally doing every single thing "right" for your cat and can answer:
YES and they are ________ (flat, sharp, early nadir, late nadir, etc,), then you need to start looking for answers.  The curve can tell you a lot.  Maybe it's the wrong insulin for your cat.  Maybe the dose is too high.  Maybe it's too low.  Maybe your cat has another condition such as insulin resistance or acromegaly.

If your answers are something different, then post on one of the forums for caregivers of diabetic cats, send us a message. or post a question on our page.

My vet/pharmacist says I HAVE to use the pen needles for Lantus/Levemir.

Your vet/pharmacist is wrong.  The pens were designed for people.  They only can dispense whole units and their accuracy is not as precise as when correctly dosed in an insulin syringe.  

Pens must be primed before every use with the pen needles.  If your cat is getting 1u twice per day, you are literally wasting HALF of the pen on priming.  Lantus is insanely expensive.  Price wise, it's almost worth its weight in gold.  When you use insulin syringes, you waste a drop or two and can use every single drop of insulin in the pen.

When you correctly use an insulin syringe, your dose will be infinitely more accurate than using the pen needle would be.

If you have another question about insulin, please let me know and I'll answer you!  I would love to read your comments and questions.

Stay tuned for "My vet told me dry food is fine but the internet says 'No.' What do you feed your cats?"  -Jenna

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