INSULIN PENS AND BOTTLES

As I have already mentioned in this blog, it is shown that insulin Lantus (Insulin Glargine) is the ideal for feline diabetes, so I want to give some simple information about this insulin.

But first of all, I would like to make a little introduction about diabetes:

The meaning of diabetes

Diabetes Mellitus (DM) is characterized by an increase in blood glucose levels, called hyperglycemia. It is caused by several disorders, the main one being the low production of the hormone insulin, secreted by the pancreas, or its inadequate use by the body.

The main symptoms of diabetes mellitus are: excessive emission of urine (polyuria), abnormal increase in the need to eat (polyphagia), increased thirst (polydipsia) and weight loss for no apparent reason.

There are two types of diabetes:

• Type 1: The pancreas does not generate insulin

• Type 2: The body is unable to use insulin effectively

But how do I know if my cat is diabetic?

Cats, when they get nervous, for example in the veterinary clinic, have a rise in sugar that can give erroneous values ​​and make us think that they are diabetic. Their glycemia can even reach 160 but if we check their blood glucose level again with a glucometer at home, when the cat feels calm and safe, we will see that their blood sugar has returned to normal levels although it may take a few days for their body to eliminate that excess sugar.

If the glucose level exceeds 300 U/l, we should perform a blood fructosamine test to know its blood values ​​in the last 15 days. This test would confirm diabetes. However, if the glucose has values ​​above 400 U/l, would mean that we should start giving insulin to our cat as soon as possible.

Another possible disease that we should check is hyperthyroidism. To do this, we must check the levels of T4, the hormone thyroxine. If our cat has hyperthyroidism it is possible that the insulin does not work because this disease causes insulin resistance.

For all these reasons, it is advisable to ensure that the cat receives a complete blood and urine analysis.

But what is insulin?

It is a hormone created in the pancreas which regulates glucose levels in blood needed to create energy. In some people or animals, the pancreas is unable to generate such insulin and we must use  synthetic insulins such as Lantus, Caninsulin or Insulatard which are the best known in the world of feline diabetes and must be administered subcutaneously.

Lantus insulin

Lantus insulin contains the active substance "insulin glargine", which differs very slightly from human insulin and once injected, the body absorbs it more slowly and has a longer effect. In humans this insulin works 24 hours but since the metabolism of the cat is faster, this insulin acts in their body for about 12 hours. Therefore in most cases, it is recommended to give a dose every 12 hours, although there are cases in the long term, in which this dose is reduced to one injection per day.


This insulin acts in the same way as a naturally produced insulin and helps glucose pass from the blood into the cells by regulating blood glucose levels. When injected, it penetrates the muscles, adipose tissue, liver, etc. helping the normal functions of the organism and providing the necessary energy in all its cells.

However, tests with Lantus in humans showed that there is a risk associated with this insulin: hypoglycemia. This happened in 1 out of 10 patients who were given Lantus. Therefore, in cats, we must be careful not to go over the doses and as I always say: Better to give them less than more than needed. 

Do not forget: with an adequate dose of insulin and a diet of low fat intake and high fiber content, our cat can live for many years.

INSULIN PENS AND BOTTLES

Here you have pictures of all types of Lantus insulin containers. 

 

This is the Lantus insulin box, which I bought in Belgium. I understand that in many other countries unfortunately these vials are not sold. It contains 5 vials. They are from the Sanofi Aventis house.

These are the vials that the box contains, which come in individual packets.

THE SYRINGES:

For those who have to handle syringes for the first time, as was my case, you have to know that there are many types of syringes in the market and each one is for a different disease, or a different substance, so you have to be very careful at the time of buying them.

To use Lantus, the syringes you will need are 100 IU/ml.

The syringes come in these plastic bags that are bought at pharmacies. These bags bring 10 syringes and their use depends on each one, I mean that I used to reuse them and each syringe used to last up to 5 days, but I know people who prefer to get rid of them after a single use.

I put the pictures of the syringe bags that I used. 

This is the pack of ultra thin and super long needle syringes. For me, it is the best at the time of using it with animals.

This is the package of ultra thin but short needle syringes. 

One very important thing that you must take into account is that you can not use Caninsulin syringes with Lantus since they are totally different. Those of Caninsulin are 40 IU/ml and those of Lantus are 100 IU/ml. This means that if you use Lantus with a Caninsulin syringe you could cause your cat a hypoglycemia and on the contrary, it could produce hyperglycemia.

This is one of the vials that I used, along with the long needle that I mentioned above. 

If you do not manage to puncture your cat with the pen as it comes, you can use the BD Microfine syringes to extract the necessary insulin according to the dose you give to your cat, as if it were a vial. This is what most people do.

This is the 10ml insulin bottle whose design is more suitable for humans or big dogs, since the amount of insulin that is usually given to a cat is about 4-6 units per day, so once the bottle is opened, its period of expiration is usually 3 months what means that the rest should be discarded. I do not recommend its use because as I say, you have to throw more than half of its content. It is much better to use the vials or the 3ml pens before spending the money on the 10ml bottle. Keep in mind that the pen box would come to last about 10-11 months and the bottle of 10ml only 3 months.

THE SYRINGES AND THEIR DOSE 

Insulin is administered per unit and not per milliliter or cubic centimeter. The most used sizes of syringes are those of 1ml (100Ul), 0.5 (50Ul) and 0.3 (30Ul).

The insulin syringes of scales 1 unit x 1 unit means that each line corresponds to 1 unit.
The 0.3ml syringes have a capacity of 30 units.
Those of 0.5 ml have capacity for 50 units.
The 1ml syringes have a capacity of 100 units or 100 units of insulin per milliliter.

The most common used syringes for Lantus insulin are these two:

HOW TO KNOW THE EXACT DOSE:

If your cat has a glucose above 160, he can be diabetic. As a general rule, you must first know how much glucose your cat has and the limit for its use is marked at 360. Your veterinarian will tell you what dose is recommended for your cat, according with his weight and glucose level. Then, it is recommended to keep that dose for at least a week to see if it is working. And the golden rule that should never be forgotten is: Better to give him less insulin than too much, because we could cause him a hypoglycemia that could kill him. 

To sum up: The exact dose, as I said, will depend on the weight of the cat and blood glucose, but as a rule, is not recommended to give a cat more than 4 units every 12 hours unless the cat weights more than 17 lb (8 kg), and the average, once stabilized, is less than 3 units every 12 hours.

I have read in some forums about people who do not trust, first in veterinarians because like me, they have found  disastrous veterinarians who have caused hypoglycemia in their cats, and secondly, in insulin Lantus, because they have gone through all kind of insulins, like in my case and with Lantus the situation has not improved. In those cases, I would tell you that what fails is not insulin, but the doses that have been administered to your cat and I know it from experience. If you find an inept veterinarian who gives your cat weighing 6,6 lb (3 kg), about 12 units of insulin a day (as they did with my cat), no matter what insulin you use, your cat is going to suffer hypoglycemia, I have no doubt about it, and if you give your cat 0.5 units every 12 hours, his body is not going to feel any change or improvement, so the insulin will not work.

I won't get tired of repeating that the daily doses should not exceed 8 units (4 units every 12 hours in a cat with an average weight of up to 11 lb (5kg). You can do that only for 2 days for extreme cases with high blood glucose. In this case we speak of levels close to 600. Injecting, for example, 5 units of insulin to an animal that weighs 8,8 lb (4kg) on average, can be very dangerous, whatever level of glucose he has.

Two tips about insulin:

1. Cold insulin hurts, so it is advisable to take it out of the fridge about half an hour earlier, or at least, to warm it with your hands for a while before injecting.

2. If our cat has vomited, unless it is a hair vomit or have eaten some strange plant, it would be advisable to inject only half of the dose that we are normally using, but you should never stop giving him insulin. We should skip his dose only in case of hypoglycemia.

THIS IS A MESS... BUT THEN, HOW MUCH INSULIN SHOULD I GIVE MY CAT ?

Well, I must say that it is not so difficult, really, at first it seems that you are not going to manage the dose or use the syringes and scares a little. At first, we all believe that we will  make mistakes with the dose causing our cat a hypoglycemia, that is normal, but you will see that once you know the exact dose your cat needs, everything will be easier.

As I know that this is a tremendous mess, I want to make a brief and indicative summary about how much insulin you should give your cat, and I repeat, is indicative because we would also have to take into account the weight, age and even the breed of the cat to know the dose more accurately.

• Blood glucose levels below 250: In this case, what is usually done is not to give the cat any insulin at all. Since that sugar level is not too high, it has been demonstrated that only with the food suitable for diabetic cats, glucose levels usually stabilize. Of course, each cat is different, but I would certainly try it. If it works or not, we'll know right away and since the glucose level is not too high, we will not put our cat's life in danger.

• Blood glucose levels between 250 and 350: You have to start giving your cat insulin but since these glucose levels are not too high, it is possible that a dose a day is enough. In fact, in most cases it is, and the animal is stabilized. The dose will depend on the weight of the animal, but with these levels you should not exceed 2 units with an average weight of about 11 lb (5kg).

• Glucose levels between 350 and 500: You have to give your cat insilin twice a day. The dose, again depends on the exact level of glucose and the weight of the animal but surely it will be above 2 units every 12 hours. If the glucose level is close to 500, you will need at least 2.5 or even 3 units every 12 hours.

• Glucose levels above 500: Urge to administrate your cat insulin in case you have not done it yet. Of course you must do it twice a day, always every 12 hours, and especially during the first days you will have to check his glucose to make sure the it goes down because if it reaches 600 your cat could have a diabetic coma that would lead to death.

My cat was of course in this glucose range when we first discovered that he was diabetic.  He had 580 and when I started with Lantus I gave him 2.5 units every 12 hours. His weight at that time was 7,7 lb (3,5kg) because he was skeletal. This dose was enough to improve his state and soon he recovered the weight he had lost until he reached 11 lb (5kg), which was his normal weight. After two years, we took it down to 2 units every 12 hours until the end.

NOTE: We must bear in mind that the cat's glucose should be close to 90-100. Therefore, the dangerous levels are: below 50 and above 580. Those are the high risk levels that could lead our cats to death.

ADVICE ON HOW TO OVERCOME THE DAILY TREATMENT 

Many people are obsessed with checking their cat's glucose every few hours and they get scared because they are giving their cats the insulin and their glucose is still high. My advice is that when you start treating your cat with insulin, let him be, and only at the beginning of the treatment check his glucose once every two days. It is not healthy, neither for the animal nor for the owners to be constantly pricking the cat so often. Otherwise the cat will end up stressing and his glucose will shoot like a rocket, besides it is not necessary. When you start to give him insulin, help is already on the way and you have to let it work in his body. Insulin will do its job, but contrary to what many people think, your cat will not be cured from one day to the next. He will show high and low peaks, which is normal, and it will take about two to three months to fully regulate his level of glucose, so please don't torture your animal unnecessarily. I always advise people to check their glucose only when you see that your cat's behavior is abnormal (urinates or defecates outside his sandbox, walks like a drunk, lies down in the sandbox or in places where he has never been lying before, he falls down when he tries to walk, etc) otherwise, leave it alone.

In summary:

• When you start giving your cat insulin, do it every 12 hours and let him be the rest of the time. Do not excite him more than necessary. His water consumption and behavior will inform you if the insulin works.

• Two or three days after starting to give him his first shot, check his glucose to see his level to know if you have to readjust the dose.

• During the treatment at the beginning he will show glucose peaks, this is normal and you do not have to be scared. His body is adapting to insulin.

• Do not get obsessed about checking his glucose every two minutes. Do it only if you notice that your cat is not right: if he wobbles when walking, if he lies down in his sandbox, if he urinates or defecates outside the sandbox, if he does not eat, if he is very lethargic, etc. That will be the time to check his glucose.

• Your cat will take an average of 2 to 3 months to be completely regulated, so you have to be patient.

HOW TO USE THE SYRINGE:

For the person who uses insulin for the first time, all this handling of the syringes can be a nuisance, but in reality it is not. Here, I explain the steps to follow assuming we had to give him 2 units:

1. The first step, obviously, is to remove the plastic caps from the syringe.
2. Then, we will fill the syringe body with the same amount of insulin that we will give him, so pull the plunger back to the amount of insulin you want to draw out. In this case, 2 units. 
3. Introduce the needle into the vial, puncturing the rubber top part, and introduce the air into the bottle.
4. Without taking out the syringe, turn the vial upside down to drop the liquid and again take the plunger to measure 2 units, which is our dose. If you see air bubbles, tap  the syringe gently with the fingers (before removing it from the bottle). If these bubbles do not disappear, I advise to re-introduce the insulin and repeat the filling process with the two units.
5. Once the syringe is ready with the dose of insulin we need, approach to the cat and let him smelling the syringe. The, grab the top part of the cat (as in the photo) squeezing the skin, creating a "little mountain" of skin, which is the part where we are going to insert the needle. When the needle goes through the skin, you have to push the plunger slowly.
6. After removing the needle from his skin, what I normally did was to give him a quick massage of about two seconds with my fingers in the area where I inserted the needle to help distribute the insulin.

VIDEOS 

Here you have two videos of how I gave the shots to my cat. From the beginning, I always  let him smell the syringe before giving it on and since it has a strong smell, the cat already knew what was coming. You will see that he does not seem to feel pain (contrary to what I thought at the beginning) and in fact, as soon as he smelled the insulin, he would lie down and stay totally still until I was done, as if he was waiting for his dose as the insulin surely made him feel better.

https://www.youtube.com/watch?v=ZhPZLVF-ohw

https://www.youtube.com/watch?v=E8y8EHdmAfE

PILLS

Metformin

It is an oral antidiabetic drug. It is used for the treatment and prevention of type 2 diabetes mellitus (non-insulin-dependent diabetes), especially if they are overweight and have normal renal function.

It reduces high blood glucose levels and the good thing is that it does not cause hypoglycaemia on its own. It also reduces the levels of LDL (low-density lipoprotein) cholesterol or bad cholesterol and triglycerides in the blood and helps to lose weight.

What this drug does is that it reduces the normal production of glucose in the liver.

However, in tests conducted in the United States with this drug in diabetic cats, it has been shown that after 8 weeks of treatment, it has only worked in 1 in 5 cats and another cat died. It also produces vomiting, drowsiness, lethargy, loss of appetite and weight loss. This medicine can not be used in cats with kidney failure. The dose would be 1/4 tablet every 12 hours.

I have to say that many experts advise against Metformin in cats because of the amount of contraindications that it presents and because apparently, as I explained above, it does not work well in cats. I am in favor of administering these medications only in specific cases and not for long periods of time because, in my opinion, there is nothing better for the treatment of diabetic cats than injected insulin, badly for us.

Glipizide

There are some pills that we can give our diabetic cats in case we have to go out several days and in the meantime no one can give the shots to our cat. I myself have used these pills several times since the friends who used to take care of  Dunkel when I had to be absent more than a day, knowing that they had to administer insulin with a syringe, refused to take care of him, so I had no choice but to use this type of pills that I introduced crushed in the wet food. Otherwise, he would have eaten the wet food and leave the whole pill. For this, we bought some special feeders with a lid where we introduced the food. These feeders had a clock in which we entered the time at which we wanted to open the lid and voilá, the food with the well mixed tablet appeared before him. Thus, we could leave the cat alone for a maximum of two days.

This is the electronic feeder that I used with my cat but in the market there are many other models, types and sizes. This one has a little wheel to set the time we want the lid to open, so what I did was crush the pill and mix it with the food. The lid would open every 12 hours after the previous shot. In this device I could only put two meals but in the market you can find feeders for 4 meals.

Continuing with the pills, this oral medication activates the production of insulin when the pancreas is still functional, so it is not a substitute for the injection, but an aid in an extreme case in which we can not administer injected insulin. It is always better to give out cats this type of pills than to give nothing. In our case, Dunkel had no side effects or increased or decreased glucose by administering these pills and I think we only use them three times for a maximum of 4 days in a row.

Dosage: The dose for a cat of about 11 lb (5kg) is between 1/4 or 1/2 of a 5mg tablet every 12 hours. If your cat weighs more or less than 5kg you will have to adjust the dose.

Serious side effects:

And again I remark, that this type of pills can only be administered in cases of urgency and in short periods of time, not as a substitute for injected insulin which, of course, is much more effective. Studies have shown that Glipizide has a large number of side effects, some quite serious, such as damage to the pancreas, damage to the kidneys, loss of appetite, etc. Anyway, if someone is very interested in using them, ask your veterinarian. 

Some people have written to tell me that their veterinarians have prescribed Minodiab to their diabetic cats as treatment on a regular basis and the condition of their cats has worsened. Well, Minodiab is a compound based on Glipizide, so everything explained above about Glipizide is applied to Minodiab and therefore, this medication can not be prescribed as a long-term substitute for insulin because the results, as we see, are dangerous.  

I do not really understand why some veterinarians prescribe Glipizide on a regular basis instead of insulin because it acts quickly and the improvement is noticed almost from the first dose, while with oral medications, we must wait a month for the glucose to begin lowering down (if it goes down), in which our cat continues with high levels of sugar and to top it off, some of its organs can end up seriously damaged.

HYPOGLYCAEMIA

When the glucose drops to values ​​of 20 or less, the cat will suffer from hypoglycaemia. But what can I do if this happens? Well, we will notice it because:

• The cat does not seem to recognize anything or anyone, looks everywhere with a panicked expression as if he did not know where he is, moving his head from side to side without stopping.
• The cat does not stand on all four legs when we lift him up and let him fall.
• Loose balance when walking
• When walking, the cat drag the back legs, almost as if they were paralyzed.
• The cat obsesses with something insistently, like, for example, climbing somewhere. If we remove him or pull him back, he will desperately want to climb back to that place and if we take him in our arms, trying to remove that obsession from his head, he will try to get away desperately to return to the same place, as if there is nothing more important in the world. It is an obsessive behavior that will catch our attention immediately and I can tell you that because I have suffered it with my cat.
• It is hard to get up off the floor as if the back legs were too heavy.
• The cat shows signs of abnormal behavior, such as lying on his litter box, which in a cat, this is always an alarm signal. It is also possible to urinate or defecate at any point of the house.

As soon as you notice any of these symptoms, run for sugar and either you put it in his mouth directly, or mix it with water and inject it into his throat with one of those big plastic syringes  without a needle, until the cat reacts. If you do not have sugar, surely you have jam, honey or any sugary food. Normally, the recovery is immediate but if not, continue giving him sugar until he focuses his gaze and stops moving the head. To make sure that  the hypoglycemia is over, lift him and let him fall on his legs to check that he doesn't fall down. If he can walk normally, it means that it is over, although for me, the easiest symptom to check, is that he fixes the look and his lateral head movements cease.

Once recovered, it is advisable not to give him any insulin in at least two days, or at least, a day and a half. After these two days, start to give him the insulin normally but remember that you should lower the dose you gave him earlier because a hypoglycemia occurs because you have been given too much insulin, which means that the dose was given before, was too high.