Personal notes and interpretations for Butterscotch and CaninsulinEdit
The following are personal notes from a single cat owner. They are not to be taken as general advice. Many would disagree with these conclusions.
1. Caninsulin has an interesting mechanism, which even though it is mostly long acting insulin, generally has an early peak in cats. My cat Butterscotch peaked anywhere between 3 and 4 hours, but from the peak, it took quite a while for his blood glucose to start the rise back up, generally after 6 hours. The graph below shows how the insulin is metabolized in most cats, and when it has been completely drawn in to the system. As you can see, the effect starts almost immediately, bringing levels down, and after two hours it steepens to peak drop at approx 4 hours. Then there is a nice flatter period of about 2 hours, after which the levels curve back up. REMEMBER THE BLUE HARD DROP IS OF INSULIN NOT OF BLOOD GLUCOSE. The glucose drops much less harshly.
2. I found that after about 2 days on a dose, the curve up was much flatter and I had short ended curves. For example, if my cat had a blood glucose level of 30 mmol/L (540 mg/dL), before his morning shot, 12 hours later he would be about 23-25 mmol/L (414-450 mg/dL) before his evening shot. As he responded, his next preshot blood glucose level would go from 25 mmol/L (450 mg/dL) to 15 mmol/L (270 mg/dL), and so on. Caninsulin gives good remission results, if you monitor closely. My cat Butterscotch has been insulin free for 1 month, and had a number of "mini honeymoons" before that of 2 or 3 days. (Of course this cat may have been a transient diabetic to begin with and might have responded well to any insulin.) In hindsight and looking at weight loss and the dramatic decrease in litter since regulation, vets are convinced he was diabetic for at least 2 years, since I got him.
3. Because of the last two hours with no insulin left in the body, if necessary and on consultation with your vet, it is possible to give a dose a little early if glucose levels are sky high. When Butterscotch hit 31 mmol/L (558 mg/dL) after 1 unit, at +10 , I called the emergency vet, and was told not to wait, to give 2 units immediately and to monitor closely (with home tests).
4. Caninsulin gets a good response, once the "glass floor" allowing lower levels (possibly due to glucose toxicity) is broken. But this may not be possible with every cat.
5. Because of Caninsulin's good response, home testing is very important. You may well find that after a few days on a dose, curves become L shaped, and make it necessary to reduce the dose. Hypoglycemia is a concern, if you dose blindly and aren't prepared to lower doses as needed. However, lower doses mean the cat is responding to the insulin.
6. You may also find that a cat that has not responded initially will shock you with the next increase of dose, and a strong positive response. Dont panic. Then you will be starting a dance of dosing on based on preshot blood glucose readings and hopefully end with remission. Or, you at least have a cat that can be controlled for a number of hours a day
7. Skipping a dose of Caninsulin due to low blood glucuse levels does not seem to result in a much higher level the next preshot. The next blood glucose level is generally around the same or lower than the last one you dosed at.
8. With Caninsulin, it is very easy to adjust dose times if needed. Because of its 70% long-acting portion, and its 2 hour window of no insulin in the body after 10 hours, when you have to miss a dose, or change the time to later due to an appointment, don't panic but DO monitor. Changing shot times is not recommended but life does happen.
8. Caninsulin is a scary insulin if you don't examine its mechanism and do curves. Once you get a grip on what your cat is doing, you will find it a terrific help in regulation.
9. Don't assume the early drop is too fast. This is due to the 30% intermediate portion, and kick-starts the body, after which the long lasting takes over.
10. Caninsulin is a gentle insulin, so long as you remember its doesn't work like others. Cats tolerate it very well. Caregivers of those cats tolerate it less well. Just breathe and look at your curves and levels.
11. One note from the Caninsulin web site. Somogyi and its associated insulin-sensitivity changes can continue for a few days after a hypoglycemic episode, so do NOT shoot unless you are certain that it's not happening by looking at your curves.
12. Caninsulin is great insulin that gives good results in many cats. Home testing is in my opinion even more important with this insulin due to its good responses.