? Assistance with Vetsulin Needed - ? too high a dose

Thank you and good night, Tuxedo Mom!

 

Um I know Im far away but I do have a great vet here. He could possibly give you advice over the phone given all info you have until you find a vet in your area. let me know if you want his number.

 

Did +2+3+4. Numbers are on the spreadsheet. Gave him snack (regular food) after +4. Now he is cleaning himself.
Good night!

 

I'm not sure in which topic I should post my messages. I posted one in the other topic just now ...

 

Nederland posted her observations about last night's numbers in the original thread:

http://www.felinediabetes.com/FDMB/threads/please-help.156777/#post-1663515

This was her post:

If you test your cat, don't test at +6, test at +4 in the future. That the level you need.

I think at April 22 he was too low at +4 (probably even at April 21), the body needed to take counter measures and released stress hormones (glucose), and the level went up and up. It may have happened again, and the body may have decided to realease those stress hormones continually, so the curve became high and reasonably flat (flatter every day).
After such an episode, the dose must be lowered by at least 1/3 (which you have done). During the following 5 days (max) the body recuperates, but in that period you can see all kind of levels, from very high, to even very low preshot values. This could also explain the relatively low preshot level in the morning of April 22, so probably the 3 units of April 21 did their job far too well .... It's probably that day when everything went wrong. And April 22 did not help. The bouncing levels could also still cause the level to go up at +4 this evening.

I advise you to test preshot levels, and +4's. Do not increase the dose for at least 5 days, because high levels can still be caused by stress hormones and you don't want to shoot against stress levels, only against diabetes levels.

If your preshot level is low, don't shoot the normal dose, because you will bring back the survival mode in that case.
I will think about a safe sliding scale for the next days, although I have little experience in making them (just reading them in the posts on our dutch forum). But maybe it's better than nothing.



I think to keep all information in one spot that continued posting should be done here. That way all the informationis available in one place without going back and forth between two different postings.

 

Thank you for copying my post. I new here on the forum, so have to find out about such things. I will use this topic from now on.
I have here a link to our forum, to the topic with two graphs of the curve of a cat on caninsulin, when he is on the right dose. It may be informative.
You can see, that the average cat has the low point at +4, and basing a dose on the level at +6 can be dangerous, because you don't know what the low point was. Every cat is different, so it's an example, it's the average cat (most cats have the lowest point on +4 or +4.5, though). It's in Dutch (sorry), and in mmol. You can multiply the level with 18 to get mg/dL levels.
http://www.diabeteskatten.nl/forum/showthread.php?t=782

 

Thank you. Often new members will post on the Introduction and then later on the Health forum and people will respond to both threads, Since this is becoming more involved with figuring out the data I thought it would be best for everyone to just post here.

Your input is very appreciated, since there are not a lot of experienced Vetsulin (Caninsulin) users here and the actions of Vetsulin is much different than the long acting insulins. It is very helpful to know the low point is usually at +4. This was what had been mentioned earlier to Kako about Tux's tests and the vet continuing to up the dose based on later cycle readings.

Thank you for your link to the forum. The more information that is available on these "less used" insulins the better. People could use a translator is they want to read more on the site. Some of use (such as myself) use the mmol/l system and those that don't can just multiply by 18 as you suggested.


ETA What does the second graph display. It is a 24 hour graph?

 

About food with the insulin caninsulin/vetsulin. The advised feeding pattern is different than with the long acting insulins.
The cat must have eaten before the shot: (test), eat, shoot. A preshot test is not always necessary, but for now, after the 'incident' please continue doing preshot tests.
The advised feeding pattern is: 35% of the total food per 24 hours to be given before the shot, 15% 4 hours later (to help against a too low point). Again in the evening, so it totals to 100%. Leave the food that is not eaten, but he should at least eat 75% of the preshot meal to feel safe to shoot the normal dose.
100 grams of wet food equals 25 grams of dry food. So you have to make a calculation if you give both types of food.

Every 12 hours should have the same kind of food on the same moments. So no wet food in the morning before the shot and dry food before the evening shot.
When the cat is out of the danger zone, the feeding could be a bit free-er. E.g. let the cat eat the 15% whenever he wants.

If you change the food to low carb, you have to adjust the dose of insulin immediately. I would not do that yet. First we have to find out if the dose of 2 units is okay or too high. Or too low, for that matter.

Please, ask questions, any of you, if you need clarification. I will be away on a long holiday from May 6, so I still have about 1 week to give information. I will be off line during my holiday (although I will be in the USA...)

 

PERFECT!! This is the sort of information that we need to be able to give Caninsulin/Vetsulin users.

 

Both are 12 hour graphs. But the first counts from 1 tot 12, the second one from 8.00 to 20.00 hours.
The second one shows the working of the second peak of caninsulin (in some cats). The level rises very slowly and stays stable around 6 to 8 hours after the shot. The first one is how most cats respond.

 

Thank you. It is good to know about the usual second peak with this insulin. I am assuming this is because of the two "types" of insulin in the mix...the faster acting and the intermediate acting? The fast acting would act first and drop the numbers a lot, then the intermediate would keep the numbers lower and perhaps drop them further?

 

We also have vets that test at +6. But that is the low point for dogs. They think the metabolism of both animals are alike ....

 

Yes, correct. But few cats show an actual second peak. Some do, and that is really nice, they will stay below the renal threshold longer.

Edit: not completely correct. The second low point is never lower than the first low point.

 

We all know that ECID, but knowing the possible reactions that some kitties have is good information.

 

I did introduce myself on the Introduction forum, but I came here to get information on Prozinc, which is new in The Netherlands. The help is terrific, and I thought I could do something in return when it became clear to me that vetsulin is not well known here.

I have more info, e.g. on hypo treatment, which is definitely not the same as with the long acting insulins. Where should I post that kind of info? It's probably better to keep this topic for Kako and Tux. They must not drown in the info, they need actual instructions at this moment ....

 

I would suggest that you do one combined post in the Vetsulin forum with all the main information that you have been supplying. That post could be regularly "bumped" up to keep it active and maybe eventually we could get a sticky note made out of it if the admins think it would be helpful. I won't discuss this any more on here so as not to get off topic for Kako and Tux

 

I think it would be great to have the sticky in the Vetsulin forum but, as it has such low traffic, it would be really helpful to announce the addition of the sticky on Feline Health. That way regular contributors would know where to find it and then, through repeated posting of the link a greater number of members would learn to advertise the link to new members using Vetsulin/Caninsulin.


Mogs
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Very true (I've used both Caninsulin and Lantus). It would be fantastic if you could post recommendations on managing hypos when Vetsulin/Caninsulin is in use.

I'm very glad you've joined FDMB! Thank you for your contributions thus far, and I look forward to reading more of your posts.


Mogs
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Hi Kako,

Great job with the testing.

I see where @Nederland is coming from with the recommendation to test at +4 but, having looked at Tux's spreadsheet, I wonder whether he's a fast metaboliser of insulin; he was lower at +2 and +3 than +4. (My Saoirse metabolises insulin very quickly and Tux's data from last night looks similar to the the response Saoirse had a lot of the time when she was on Caninsulin - most notably when she was getting a little too much of it.) For the time being I would recommend you test at +2 and +3. If the +3 is lower than the +2, test at +4 as well.

To get an idea of the duration you're getting, throwing in the odd test at +7 would be helpful if you can manage it.


Mogs
.

 

I share Mogs' sentiment. Your information and experience is so informative!

 

I too am very grateful for your help. Although there is very little chance I will ever personally use Vetsulin/Caninsulin I am thrilled to be able to learn more of the logistics of this insulin from an experienced source. Perhaps this knowledge will help me to help others.

 

Good morning ladies! It's 713 this morning.

 

@MrWorfMen's Mom, @Tuxedo Mom - It'd be a good idea to 'follow' @Nederland.

@Nederland - If you care to share, it would be really nice to know your name.


Mogs
.

 

That's really high. But it's still the second full day after lowering the dose, and if the 3 units were too much and the body is in a reaction, the numbers still can go all over the place. Please, shoot no more than 2 units.
It may still be too high a dose, but we need more info and tests. A +4 and a +7 would indeed be informative today. Maybe, if you're up for it, a +2, too.

 

Jennie

 

That's the idea. I saw some comments on the caninsulin forum on some topics and I thought: they need more info ...

 

Goetenavond, Jennie! Alles goed?


Mogs
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Ja! It's goedenavond, by the way, but I suppose that's a typo?

 

Yep!

I only know a few Dutch phrases. I worked out of Amsterdam (Sloterdijk) for the best part of a year but I didn't get to learn much of the language because everyone spoke such wonderful English.


Mogs
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Yes that's our problem. Nobody learns our language because we know theirs ....
Nice you worked here! I live near Utrecht.

 

Dear Jennie and ladies.
I gave 2. And I will do multiple readings today again.
Which should I follow strictly?
-No food for two hours before testing.
-Have Tux eat/munch as often as he wants. (no meaning of over feeding.) Let him stay with his eating habit.
Depends which is more important, times I can test be different.

Also right amount his regular food means? I am going with recommended cup measurement per weight of cat following the package of the food say. Is it correct?

By the way, I am Japanese. After living in the US for 20 years, it is still hard to communicate in English.

 

Kako, I thought you were Japanese when I first saw your name.

I've lived in the UK all my life and still sometimes find it "hard to communicate in English".....

Eliz

 

Today, if the cat ate enough before you gave the insulin (which should be about 35% of the quantity you give per day, see the package of the food) no food before the +4 test. But how much did he eat just before the shot? It's important he ate enough.
If he ate enough before the shot, you can feed him 15% of his daily quantity after the +4 test.

Mind, if he starts wobbling, having glazy eyes, falling over etc, TEST. Always test if his behavior is strange. And if he is too low, feed him, no matter what.

 

Nowt wrong with your communication skills, Eliz. You must be playing to a lousy audience.


Mogs
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Hi, just wanted to pop in with a couple of additional thoughts. I am Kimmee, member since 2006 and mod since 2009, though absent in recent times due to life, you know how that happens
Ps. Kako, you are doing great

The second drop happens as the body actually runs out of insulin, not because it is still working and dropping the sugar at +9 or so. It is a fast acting insulin,and tends to run out of steam by about +10.

The faq, written and posted in the vetsulin/caninsulin forum, make a couple of different suggestions for offering food.
For example... feeding 75% of meal about 20 minutes before shot, anf then offering that last 25% of the meal about 90- 120 minutes after the show, has been shown to really help slow the drop and get a more stable curve. It has also kept kitties out of dangerous lows, whena big drop happens, and know one is around.

Here is the faq, I realize it is need of an update, but the basics remain strong and the same http://www.felinediabetes.com/FDMB/threads/vetsulin-caninsulin-user-guide.302/

 

Quite a significant drop by +1. Good job getting that test in, Kako.

(BTW - I think your English is fine!)


Mogs
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It was actually +1.5, 2 hours after eating. I will try to test +1 by feeding Tux one hour before insulin injection tonight or tomorrow morning.
+3 was 672.

 

Up again....

 

Yes.

Wonder if his system is a bit different because of his eating habit from the past. Tux was stray. He was 5-8 years old when he showed up my front door, asking for help. He weighted 4.8 Lbs., he was filled flea and flea poos, his fur was sticky and smelled like kitchen garbage.
He didn't know cat food nor toilet. He appears grew up eating or licking human food (or garbage). Since he got a home (here!), he just eat, sleep, go to toilet, eat, sleep.... he is very mellow. At first I thought he was in recovery from hard life. And he has been the same way for the 3.5 years.

 

I think he's really happy to have found a loving home and enjoys the care he gets from you. You're doing a great job in caring for him. The cats, they put their little claws in our hearts, never to let go.

 

What I am seeing here, but anyone with a different opinion is welcome of course, is a curve of insuline resistance. I put a picture of that in my topic in the think tank.
I also see in the sheet, that he was responding correctly to the 1 unit he was on initially: a normal curve. Still too high, but as no +4 level was tested, we don't know how low he got. But he showed that he could do it, he can respond normally. But he doesn't at the moment.
It can normalise in a few days, but it can also mean that 2 units is still too much.
I think., if you keep on testing today (in my opinion you don't have to, but opinions can differ), the level will stay high. It will vary of course, as a cat is no machine, but I think it will stay high.

 

Jennie,
I am glad to hear that the curve was good when Tux was with 1 unit.
I feel so too.... BG would stay high today. I will take a break from testing until evening.
Hope, really hope he recovers from the bouncing shock on 4/22. It's been 5 days since...........

 

Was the fructosamine tested when he was diagnosed with diabetes? If yes, what was the level? And the glucose at the diagnosis was 596 as in your spreadsheet? Or was he diagnosed earlier?
How much is his weight now?

Considering the curve today, if he were my cat, I would start anew.

Yes it has been 5 days since the bounce, but it's only two days since you lowered the dose.

 

That's true... only two days since the dose is lowered. I feel like it's been two years. LOL
I need to learn patience. Thank you Jennie, and all ladies. I am blessed.

 

I'm going to bed now. Thinking it over, I would advise a fresh new start and to lower the dose to 1 unit. He needs to let go of the stress hormones quickly.
And test for ketones, please.

I will look again tomorrow.

 

Oh... Tux's weight has been 10.4 lbs (4.7 kg) last 7 days. He weighted 13.8 Lbs (6.26 kg) beginning of Feb. Then I strictly stopped him from stealing my food and sugar.
His weight started to drop... I was thinking diet's working. Then he started to drink more water. I thought he was hunger from human food so that drinking more water at first.
Hope his weight loss is from good reason.

I looked at the papers but fructosamine isn't mentioned.

Good night Jennie.

 

Jennie had suggested going back to the 1 unit and starting from there with proper testing during the early hours after shot to see how Tux responds. This might be a good idea if there is a suspicion that Tux is "bouncing" from what could have been lower numbers yesterday morning. Since you weren't able to test it is hard to see what might have happened.

If I remember correctly Tux has not had a problem with ketones? If not then trying the 1 unit and seeing if that settles the numbers down might be a good choice. You could shoot the 1 unit and do a +2 and +4 test tonite. Then in the morning a preshot test and post with the numbers. If the 1 unit does not seem to be working it is easy to go up higher.

 

I didn't answer all. So here are answers.
He was diagnosed on 4/5. Glucose was 582. He started insulin on 4/13. Glucose tested 596 before the first injection.
On 4/5, Ketones tested negative. Not tested since then. Tux goes outside for pee unless raining very hard. Haven't had a chance to test.

Jennie, how much dose are you giving to your kitty? What was BG when she/he was diagnosed?

PMPS was 668 tonight. Gave 1 unit. And I will test one or two more before bed. Good night.

 

My kitty passed away about 18 months ago. He was very ill (not from diabetes), had corticosteroids to keep him alive but also gave him diabetes. I used caninsulin (0.75 unit max, he was diagnosed with a level of about 350 I think) for a while than moved over to lantus. But he had one big problem, he wouldn't eat. I force fed him almost every day. Pills for the appetite didn't help. And diabetes combined with not eating is a disaster. Then he was also diagnosed with a heart disease that would cause him to die from asfixiation (I'm not sure how to spell that word), he hardly could walk anymore because he ate so little, he was down to 6 lbs. He would sleep and sleep and sleep. When he started to look at me with eyes that said: "I've had enough, my life here on earth is over, please help me", I let him go.
Ever since I've continued on on our forum, reading every post that is posted (as moderator) and seeing lots of cats with diabetes on caninsulin or lantus. I learned. I only had time to really learn about the treatment after my cat passed away. Until then I spent my time caring, feeding, caressing and talking to my cat. And of course testing and shooting insulin.

 

Oh I am sorry, Jennie... for what you went thru.
Though your kitty was very well taken care. You were a wonderful Mom to him.


1 unit injection. +1: 541, +2: 346, +3: 404 tonight. Oh I am so happy to see the pink and the red.
Thank you for the advise. Good night Jennie and ladies!

 

Sleep well.
He's responding, though he's rising too early. But we have to wait out a couple of days to let the stress hormones disappear. Only then we can see what is really happening on this dose.
But, for my information, did you feed him before your +3 test? Because that could have caused the rise in numbers.
I know such a feeding pattern is advised here on this forum.

 

Me, too. Fingers and paws crossed for things to improve for Tux over the next few days, Kako.


Mogs
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I'm very sad to hear about your kitty, Jennie, and I'm so sorry for your loss: it shines from your words how much you love him. I know how hard it is to manage a diabetic with eating difficulties; your little one was blessed to have such a loving Person to care for him.




Mogs
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Thank you. He was the love of my life. I still miss him. And I'll never forget him.
I have a 'new' shelter cat now, aged 10, healthy but for a flea allergy. He's a sweetheart. If it were up to him , he would sit on our laps 24 hours a day, but for the occasional stroll in the garden to go pee etc. (which makes it impossible for us to do anything useful....).
But my feelings for him don't go that deep, they are completely different. I love him too, but ... As you all will probably recognise ....

 

I understand this very well indeed. All cats are wonderful, but Soul Cats are in another league altogether. And they leave such big, aching holes in our hearts when we're parted from them.




Mogs
.

 

Good morning ladies!
Since I got up unusual time, did +9. it was 549.

 

That is somewhat normal for Vetsulin. In most cases it does not last 12 hours...some people will only get 8-10 hours before the numbers jump back up.

Most probably the prehot number will be even higher. Do not feed for at least 2 hours before doing the preshot. You might want to do another cycle at 1 unit and do the same monitoring you did last night, with a +2 +3 and +4 if you can. This will give more data in order to make a decision whether a dose change is needed.

 

Not an abnormal number.

 

Good morning Jennie!
Yes, he snacked (regular food) one hour before (right after +2 test) +3. I was so tired... so I planned to go to bed (couch with Tux) after +2.
I gave him before bed snack. Though I couldn't go to sleep. So I decided to do +3.

Your earlier post can read as feed 35% food before injection. It sounds very correct. (I now have a bit of understanding of Vetsulin )
Though, Tux never eats dry food that amount in one time. He doesn't like dry food much.
I used to feed him cooked meat or fish (no oil/salt/any flavors) once a day. He loves soft (wet/human) food. Then he was using dry food to munch through the day and night as snacks.
When I was told by the vet "No human food, no meat even no oil/salt/any flavors. For now stay with the dry food only", his food became dry food only.
Again... he doesn't eat dry food a big portion in one time. So I need to wait for him to go eat at least twice. And total amount still doesn't reach 35%.
Then wait 30min. before injection is hard too. Sometimes I can't... this is why two nights ago I ended up giving him injection only after a few minutes he ate.

I got responses with big NO NO regarding to change food to can at this time. I was eager to switch because I know Tux would love can food. He would eat 35% if I feed him can. Timing of testing, and injection will be much easier.
If switching to can food isn't ideal at this point, should I feed him human food... fish or meat (no salt/oil/any flavors) before injections?

 

I know, I'm not English either. But we will get there. I suggest you wait a few days more to see what his levels are doing. He has to get out of the stress mode and then we can see how low his low point is on 1 unit. If it's 60, you want to change food very carefully, adjusting the dose. If he doesn't get lower than 250 you can change easier without risk.
My plan would be to wait out the stress mode, then see what the level at the low point is, then (if it is too high) change the food on the same dose of insulin, see what the effect is, and then adjust the dose if still necessary. If the low point is low, the change must be done more gradually, at the same time also adjusting the dose downward.

Cooked meat or fish will lead tot shortages in time. There are no bones (calcium) or organ meat (usually) in what you would cook for him (never feed him cooked bones, though, never, they splinter and that is dangerous). And there is a chance that other vitamins are cooked out, like taurine. If anything, give raw meat (not too much fish). In The Netherlands we have ready to go raw meat for cats (in the freezer), it contains everything a cat needs.
Or else: low carb wet complete food (with all he needs in it, including calcium, taurine etc.).

No human food either at this point, as meat has no carbs. It would be just as dangerous to give him that as canned food. But you could give him a snack (1 small piece of meat) after every test you do? And after the shots? He would really like the reward!

This explains the too early rise.....

 

Changing to all wet was not advised until you had more data on how Tux responds to the Vetsulin. You are at a lower dose now and getting more data so a switch to canned low carb could be started in the next few days depending on the data

 

Please try to find a way to test ketones in Tux while you are keeping the dose low, feeding high carb, and staying in such high numbers. There are blood ketone meters if you cannot do urine testing. They are a bit different than the urine strips, but they can alert you to a problem surfacing and a need to get to the vet.

I think doing your switch to wet food right now would be fine. The concern is always that the dose will be too high and the cat will drop, but you are at a pretty low dose for Vetsulin. Get your switch over going and see how it affects the numbers before you start raising the dose back up.

For those used to using lev and lantus , remember a dose of 1U of Vetsulin is not the same as 1U to us, it contains the equivalent insulin molecules of 0.4U of Lev or Lantus. This is a fairly low dose of insulin and it is an in-n-out insulin, not a depot insulin. The 3U of Vetsulin is a normal starting dose. 2 of the cats I have had were on it before Lantus (not long after going into our care before I switched them). I verified that the 3U of Vetsulin or 1U of Lantus was correct with 2 other vets before I started giving the 3U. 3U of a U40 insulin contains the same insulin molecules as 1.2U of U100 insulin.

 

I do not agree with Melanie, but maybe the info in The Netherlands on caninsulin is different from the info on vetsulin in the US. The manufacturer of caninsulin states that the starting dose should be 1 or 2 units of caninsulin, depending on the level at diagnosis and depending on the weight of the cat. They also state not to increase the dose above 2 units the first 3 weeks of being on caninsulin. So 3 units is definitely not a normal starting dose for cats for caninsulin. But again, maybe the info provided by the manufacturer of vetsulin is different. Most cats will never need 3 units in our experience.

You cannot say that 1 unit of lantus is the same as 2.5 unit of caninsulin. Both insulins work completely different in the body. Lantus is put in a depot under the skin, a buffer, and the body takes out what it needs during the day. That way an almost horizontal curve can be reached, on a healthy level. Caninsulin starts working all at once, the full load (in 2 different fractions). There is always a relatively fast drop with the chance of a hypo if the dose is too high or less than normal was eaten, or whatever reason. And then the levels will rise again.
It's like apples and pears, both fruits, but completely different.

About a switch to other food now, it requires careful monitoring. The first days on caninsulin the levels were only taken preshot and at +6. If Tux has the nadir at +3 or +3.5, the level could easily have been under 200. Maybe start in the weekend, when Kako is at home to monitor? She could go shopping for low carb canned food today or tomorrow. In the weekend the possible stress in the bsl should be gone or nearly gone. On our forum we wait 3 to 5 days before we assume to see unstressed levels again and start regulating to an ideal dose again.

And yes, test for ketones. You can also smell his breath. If it smells like acetone, he probably has ketones. That can change overnight, so a test of a couple of weeks ago doesn't say anything about today.

 

your Jennie right?
I can scan and send you the information thats with my vetsulin if that would help?

 

Vetsulin:

For cats, the initial recommended dose of Vetsulin® (porcine insulin zinc suspension) is 1 to 2 IU per injection

http://www.vetsulin.com/vet/Cats_DosingOverview.aspx

ETA:

Found a different section for Caninsulin:

Baseline blood glucose concentration
(mmol/L) Baseline blood glucose concentration
(mg/dL) Initial Caninsulin dose (rounded down to the nearest whole unit)
<20 mmol/L <360 mg/dL 0.25 U/kg body weight 1 unit
>20 mmol/L >360 mg/dL 0.5 U/kg body weight* 2 units

*The maximal dose should ideally not exceed 2 IU per injection in the first 2-3 weeks of treatment.

http://www.caninsulin.ca/insulin-dosage-cats.asp

 

i scanned the paper work from my vetsulin vial @Nederland

 

Hello ladies! I have been testing BG hourly this morning.

Jennie, my office is at home. And I have been staying very close with Tux to keep eye on his behavior. We are always together besides when I vacuum or when he goes out for pee.

I doubt he has ketones but I will find a way to test.
Thank you ladies for concerning about Tux, and time spending to help us out.

 

I thought that is why there are U40 syringes for U40 insulins and U100 syringes for U100 insulins. They correct for the concentration of the insulin. That's why you need a conversion chart if you use a U40 insulin with a U100 syringe.

 

Mogs, Thank you for caring for Tux.

 

And we care for you too, Kako!

.

 

Here is a good news. Ketone tested negative.

 

Oh how sweet of you, Mogs! I really don't know how we were dong without your help. We are so thankful.

 

Great, negative for ketones! That's one worry less.

That's basically correct, I think. 1 unit of U100 insulin is 0,01 ml, 1 unit of U40 insulin is 0,025 ml. So the 1 unit on the syringes is another quantity of fluid. But the insulins have a completely different working, so no comparing can be done. We've had cats that needed more than 10 units of lantus twice a day before they turned. But 25 units of caninsulin would surely kill (unless an underlying disease would have caused insulin resistance)

 

Thank you for the scans, they are a bit blurry but I could see enough to see the info is basically the same as for caninsulin. 1 to 2 units starting dose for cats. (I still wonder why the manufacturer would not include 1.5 unit ...). By the way, my cat started on 0.75 unit .... the day the dose was raised to 1 unit he immediately had a hypo. Fortunately I had found my way to our forum in The Netherlands already.

 

Agreed, you can't compare the two insulins. However, it appeared that the poster was confusing the concentration (units/ml) of the insulin with the amount of insulin/unit. I think I was agreeing with you .

 

I think so, too.

 

Kako, if you have your office at home, you can monitor closely. That's great!
Could you tell me which low carb food you will give and how much Tux is allowed to eat of that food per day, considering his ideal weight?

 

Ooh, we like this sort of news! You're doing great, Kako.


Mogs
.

 

I need to ask some more questions.
You should know that caninsulin/vetsulin is a rather unstable insulin, the quality appears to vary from bottle to bottle. In The Netherlands we are very careful with it. So I want to check some things:
- do you keep the bottle (or is it vial?) upright in the refridgerator at a temperature of 4 degrees Celsius (39.2 Fahrenheit), on a shelf (not too close to the back or front of the fridge), without moving it about too much?
- is the bottle clear or is there a ring of white stuff on the neck (?) of the bottle?
- are there little white things floating in the substance?

 

748 this morning. Highest ever...
Fed then gave him 1 unit injection.
He is acting/looking fine.
Since I tested ketones last night, he wants to run away from me when I get close to him to do testing.
So I need to go easy on testing today. (will do around +2)

Jennie, I got Friskies Classic Pate. But I can get different food if better. I am not going with prescription food, though.
How much he allows to eat? I don't know. He weights 10LB this morning. His appetite is fine.
Starting yesterday, I am giving him one spoon of Friskies Classic Pate every after testing. On preshot, mix a little amount of pate with his dry regular food.
I found that this way he eats 35% amount.

 

I hope someone can advise you on food, because we have different food in the Netherlands. If I calculate correctly, the Friskies classic pate is still 11% in the dry matter, too high in my opinion. Doesn't it say on the can how much you should feed every day? I can't find it on the homepage.

I would only test his next preshot number and a +4 if possible. Nothing more. We don't want him to get afraid of testing. he won't have a hypo with this levels.

 

I'm thinking of what to do. First I really need the info I asked in message #181 about the insulin.

I know you want to give him some rest from testing. You can do so, because he is not in danger of a hypo.

If possible, I would like you to switch tomorrow to the wet food. The carbs in the wet food you have are still higher than we wish for, but it's lower than in the dry food. So maybe it's a safe 'in between' switch, while others could advise you on good food for the future.

I know the approach on the forum in The Netherlands, where I am from, is different from the approach on this forum. In a week time I will be on a holiday and completely off line, and I really want to help you and Tux the coming week to really get started on caninsulin, but I can only do so if the Dutch approach is followed, because then I know what I should be seeing in Tuxes numbers. If necessary, I will consult our caninsulin specialist and show her your sheet.

I can understand if you want to follow someone elses advise, no problem at all. I only think that following two approaches at the same time won't work.

By the way, if you choose to follow my advise the coming week, that doesn't mean nobody is allowed to say anything anymore. All help is welcome.

 

Hi Jennie, here are answers to our question.
- I was keeping inside the door of refridgrator. (We are just back from a new vet. Advised to store inside, not the door. So I just moved the insulin bottle to middle of the refridgrator)
- The bottle is clear. no white stuff. (does "on the neck of the bottle" mean on the top of liquid line?)
- No white thing floating. All white things is on the bottom of the bottle, sinking.

I will write what I was told by a new vet we tried today.

 

Okay. Yes, I mean a ring of white stuff just above the liquid line.

Good that your new vet told you to keep the insuline in the middle of the fridge and not in the door. It will not move as much and the temperature will remain more constant, also when you open the door. That's important for caninsulin.
It looks like your vet has more knowledge of vetsulin than your last one, that must be a relief!

 

Since the BG was the highest ever this morning, I took Tux to a different vet, bringing all the papers and spreadsheet.
Here are what we were told:
- She likes long lasting insulin better. What she prescribes is Lantus in a pen (not a whole bottle).
Plans and directions:
- Slowly switch his food into food that made for diabetes. Strongly recommend Dr.Hill's dry food and wet food W/D.
- Give 3 units Vetsulin. Give injection while he is eating or within 15 min after eating.
- Test BG every other day. Before and after 6 hours of injection. (After I mentioned about 4 hours, she said between 4-6 hours be fine)
- If BG drops to under 100, then contact her.
- After two weeks, one day, test BG every two hours for 12 hours. (can be done at the vet place, or I can do at home and email her the results)
- Go from there. If Vetsulin is not ideal, then switch to Lantus.

Addition: He is a bit dehydrated. Drinking a lot of water wouldn't help keeping moisture inside the body. Wet food would help.

Ah....... back to 3 units!? I explained that we lowered the dose and we have been waiting for the stress hormone goes down. I mentioned that Vetsulin site says 1-2 unites the first 2-4 weeks.
She responded that Doctors note says 1-3 units, so 3 is fine.
5 units that was recommended by the previous vet is NO good.

 

These foods are very high in carbohydrates, Kako.


Mogs
.

 

Well, a switch to lantus is what I would do. If I would have another diabetic kitty I would start on lantus right away. So. that's good advice.

Hill's w/d is a disaster for diabetics, very high on carbs, also the wet food of Hill's w/d. The m/d would be better, but only the dry is reasonably acceptable for carbs. So that advice is absolutely not my advice, to say it mildly.

3 units is also not what I would give him, considering the reaction he had last time you gave him that. But I understand why the vet would say that, his high levels worry me too.

The timing of the shooting the insulin (15 minutes after eating) is what I would also do.

My plan of testing would also be different, because the +6 is not the level you need for decisions. That's for dogs.

The day curve (every two hours) I would also recommend, maybe a bit earlier then in two weeks time. But I would also recommend a minicurve to find the moment of his low point.

So far my comments.

 

According to the vet, it would be quicker to adjust his BG with those Dr. Hills W/D.
Though.... me neither... I don't trust those prescripten food. I can't afford anyway!!!!!!
I have 6 cans of Friskies Classic pate, so I use them first. I may try Fancy feast and Sheba that someone recommended too after that.

I don't know....... I feel wrong to make another 1 to 3 jump.
I trust what Jennie says.

I feel: Stay with 1 unit, add more of wet food in his diet and go less dry food, monitoring. Then increase insulin as needed.

Please share what you would do.

 

Since it's almost time for my bed, I will write down what my plan would be for tomorrow. You don't have to follow my advice, of course, Tux is your cat and you must have the feeling that you are doing the right thing for him. It's all your decision.

I would switch him to the wet food you bought, tomorrow morning (during daytime you can better monitor him). Usually the feeding advice is about 350 to 400 grams a day? I'm not familiar with your weight indications, I'm used to grams. No dry food anymore. So 35% would be appr. 140 grams wet food. I suppose he's hungry as he is so high in his numbers, so I take the 400 grams as a starting point. Please, convert the amount to the weight indication you are used to.

My advice is:
- test his preshot level
- give him 140 grams of wet food (35% of day quantity)
- after eating at least 100 grams (but preferably all), give 1 unit caninsulin 15 minutes after eating.
- do NOT feed him afterward, take away the leftovers (if he ate at least 100 grams of wet, it's enough)
- test +3, +4, and so on every hour until the level rises again on its own (without food or snacks, you may only give him 1 small chunk of meat, cooked or raw, after a test)
- when his level has risen without help of a snack or food since the shot, you can give him 60 grams of wet food (15% of day quantity)
- only if he drops under 72, you should give him the food immediately and not wait until the level rises again. But I doubt he will drop that low.

This way we will have an indication of where and how low his low point is at this moment, although it could change some time after the food is changed.

We'll decide on a new dose after seeing tomorrow's levels. If the food is changed to even lower carbs, maybe we'll stay on 1 unit, or go only to 1.25 unit. It all depends on waht we'll see tomorrow.

I will be online tomorrow around this time and earlier, but it's 11.30 PM now here, so I'll be off to bed soon. If tomorrow he drops under 72, I'll stay online longer to help.

Buy enough cans of food to last a few days.

 

Do wet food have carbs?
If so, how different Friskies classic pate, fancy feast, or Sheba from Dr. Hill's W/D?
I have a lack of knowledge in nutrition.

 

http://www.felinediabetes.com/FDMB/threads/shortcut-shopping-list-all-8-or-less-updated.117688/

here is short list of low carb wet foods, just click on the top post where it says expand...

 

Kako,
My cat started out on vetsulin and did not get better. Spent almost all of his time in one spot. The blood glucose numbers stayed high etc. I told the vet I wanted to switch to Lantus pens. Once on lantus he started feeling a lot better and more like himself. You will need different syringes for the lantus the vetsulin ones won't work. I got my syringes at walmart 100 for 13.48. I started out on fancy feast patetes and switched to sheba patete.

 

kako, the perscription diabetic dry foods are too high in carbs. My cat was borderline diabetic so the vet put him on dm dry. His BG went way up over renal threshold. I removed the dry and switched to ff wet and his BG dropped about 230 pts over about three days and even more over the next few weeks. The biggest drop was the first 24 hrs (130 pts). Not every cat drops that much (ECID) but some do. That's the reason why people here have been doing one thing at a time and being cautious. Also you said he was dehydrated. You want to use wet food. Dry is dehydrating.

 

That would be a "no" from me too. Both of those foods, as Mogs and Billysmom say are much too high in carbs.

With the exception of the Mixed Grill flavor, which does have 11% of the calories coming from carbs, the Friskies Classic Pates are fine. They come in at 6-9% of calories from carbs depending on the flavor (the % of calories from carbs is the significant number when calculating carb percentages). Many people, including me, have used Friskies pates to get our cats to diet-controlled status. If Tux likes the Friskies, then it's fine to stick with that. If not, then Fancy Feast classic pates or similar are also good.

 

My kitties get Friskies pate. Buzz has a very sensitive stomach so he can only eat one brand, one flavor. Both of mine were on prescription diet w/d dry and when I removed that they both went into remission. Neither one of them were ever as high as Tux, though.

ETA. Woody weighs 13 Buzz is 12. They get 2 cans each/each day. I know that seems a lot compared to others, but both have lost weight since the switch. Matter of fact Buzz is sitting beside me growling to go feed him and Woody is crying at the back door to be fed. They get fed approximately every 6 hours.

 

Thank you Sarah! I went out to get 10 cans of fancy feast today.

 

How much Friskies classic pate or Fancy Feast or Sheba do you feed your kitty per day?
Also Sheba Perfect portions means perfect portion for a day? Morning and night half and half? It looks so small!

 

I allow for one 5.5 oz can per cat per day as an average. Though if they have a particularly hungry day, I just give them a bit more - none of the cats here are overweight so I don't really restrict the amount of food they get.