Vetsulin bouncing, seeking assistance.

Hi everyone! I was wondering if anyone had any advice as to what I should do next. Audrey's glucose seems pretty high at both amps and pmps. Not sure if insulin I've been giving isn't enough? Any advice is welcome! It's hard for me to get am checks throughout. I've been using her spreadsheet. Alphacat thought it looks like Audrey is "bouncing". Does anyone have any experience with Vetsulin and their kitties bouncing on it? I'm super new to all of this.

 

Welcome to the club!
Poke around in here for advice others have gotten, and look for similarities to Audrey to help along your path.
Someone will be along soon to offer up some dosing help.

The first thing they are going to want to know is about Audrey's food and feeding schedule, so if you do a proactive comment with that info, it will help them.

 

I just switched Audrey's food to all fancy feast classics, various flavors. She used to eat mostly the gravy lovers fancy feast, so she's getting a significantly lower carb food than she's used to. I have been feeding her every 12 hours and giving 4 units with meals. Vet wanted me to move up to 7 units, but sought help here instead. Was giving her 6 units for approx. one month. Have moved from 4 units up to 5,6, and then vet suggested 7.

 

Welcome Rebekah and Audrey!
When was she diagnosed and start insulin? What was her starting dose? How often were the increases done? Have you tested for ketones? Sorry for the bombard of question first

 

Hi there! Audrey was diagnosed about 5 months ago. The vet started her on 4 units at home. He has gradually raised it about 2 months after initial diagnosis up to 5, about a month later up to 6 and most recently up to 7. I never gave 7 at home and came here instead. I haven't tested at home for ketones and I'm not sure if they've done that at the vet. We've gone a few times for curves and that's resulted in the increased insulin doses.

 

4.0U is an extremely high starting dose . How did the Vet arrive at such a dose? We usually recommend a starting dose of no more than 1.0U twice a day. And increases done in small increments of 0.25U or 0.5U. You can test for ketones at home as well as do your curves. If she has no other health conditions or prone to ketones, would you be willing to kind of start over with her dosing? I'll see what Linda thinks too @MrWorfMen's Mom .

Here are a few members who were also started on too high of a dose:
Abby, started on 7.0U and was at 3.0: http://www.felinediabetes.com/FDMB/...oming-maybbe-only-option.176007/#post-1992732
Sammy is another one, started 8U and is down to 2.75U right now: http://www.felinediabetes.com/FDMB/threads/high-glucose-9-units-on-vetsulin.178050/
Cloud is another, started 5-7U and now down to <0.25U: http://www.felinediabetes.com/FDMB/threads/bouncing-numbers-kinda-worried.179116/

Not guaranteeing the same will happen for Audrey but to help see she may be on too high of a dose.

 

I'm absolutely willing to start over with her. Reading everyone's comments, I'm seeing that her starting dose was probably too high. I have no idea why the vet started at 4 units. I would've asked a lot more questions had I known better. Right now I have regular u40 insulin needles without the half unit markings, but I can get different ones for sure.

 

I used these: https://www.adwdiabetes.com/product/16363/carepoint-vet-u-40-syringe-29g-half-unit

 

Hi Rebekah and Audrey. I agree it looks like Audrey is yet another example of vet over dosing. It boggles the mind why the vet suggested 4 units as a starting dose. No doubt Audrey was stressed at the vets which raised her BG even more and the vet based the starting dose on that stress elevated BG.

The drops Audrey is getting are quite substantial, well over 50% of pre-shot in most cases and that no doubt is leading to bouncing. Audrey has become used to her BG being elevated so these large drops are setting off her defence system even though her BG is never reaching dangerously low levels. With the recent diet change, her insulin requirement has no doubt lessened even more.

I agree you'd be wise to reduce the dose and gradually increase in 0.25u increments as needed. As long as Audrey has no history of ketones or DKA, then you could take the dose back to 1u, hold it for 3 to 6 cycles barring any pre-shots or mid cycles that suggest even 1u is too much or it's unsafe to give insulin, then re-evaluate. If there is any history of ketones, I'd back up to 2u and see how that effects the BG before backing up further. I'd back up the dose on a cycle you can monitor. It's likely going to take a few cycles for the bouncing to clear before you will see the true effect of the reduced dose so don't be surprised if you get higher numbers mid cycle. This is exactly what you want to happen. Once the bouncing eases off the pre-shot numbers will come down along with the mid cycle numbers.

I'd also check for ketones just to be on the safe side given the high BG right now when reducing the insulin.

I am really glad you didn't follow the vet's advice and raise the dose higher! Audrey is obviously in good hands!

 

What's the process like to check ketones at home? I noticed ketone testing supplies next to the testing strips at the store. Is that what I'm looking for? If I drop down to 1 unit what should I be looking for as far as testing at home? Is one cycle 12 hours or 24?

 

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Our first vet told us to start on 3 units of Caninsulin admitting he was only guessing which we did as you should listen to your vet and follow instructions but it didn't feel right and Josie looked overdosed most of the time so I read up more about dosing. On official website they said start on 1 unit and the ladies here were strongly against the 3 unit starting dose as well.
We ended up changing vets as he was very clueless about FD and provided us with irresponsible advice throughout.
New vet specialises on FD and working very well together with us.
She was extremely impressed with my spreadsheet and regular home testing numbers which has been very helpful to establish patterns and adjust the dose either way if needed.
We had bouncing issues as well but with regular testing and great advice from here I think we managed to get to the bottom of it. Obviously every cat is different ( ECID) but in our case we had to gradually reduce the dose down to .25u to eliminate the bouncing and now we are building it up again.
I would definitely encourage you to do home testing as often as you are able to.
I must admit we struggled with it a great deal at the beginning for many reasons but in time things got better and now I'm a pro at it and Josie became a dream cat to test! Well most of the time..

 

Yes the ketone testing strips you saw are what you need. Read the instructions and follow the timing for reading the sample as the strips are time sensitive. Some folks can use a long handled ladle/spoon under kitty's butt to grab a small urine sample (very small sample needed) while others put plastic wrap wadded up in the litter box where kitty usually pees to try to catch a few drops in the creases of plastic.

No matter the dose, ideally you would test pre-shot to make sure it is safe to give insulin, and once again in each 12 hour cycle (there are 2 cycles per day) randomly between +2 and +8. Your goal is to find the lowest point in the cycle so you know how much the dose is dropping BG. While some cats reach their low point early in the cycle, others reach it later and it does not stay exactly the same every day in the same cat. When changing dose, getting a test at +2 gives you an indication of whether kitty is dropping swiftly or taking their time on the new dose and then you can decide when it's best to test to find that lowest point and keep Audrey safe. Random tests let you see a pattern over time which helps to make dosing decisions. Tests in the earlier hours of the cycle give you an opportunity to steer kitty with food if they are dropping a lot and/or quickly. Depending on that early reading, you can then determine when to test again. I realize this is not possible on workdays but you have been getting good data during the evening cycle and quite often we find our cats go lower at night than they do during the day so evening data can sometimes be the most useful data.

 

Hey Rebekah, just checking in on you and Audrey. Noticed SS hasn't been updated for last night or today and you may just be busy . Give us an update when you can

 

Hello everyone! I must apologize for not updating this weekend/week. I worked midnights this weekend and it's just rough on our schedule. I noticed her numbers were running high, in fact my glucose monitor just read "hi". I discovered that Audrey was breaking be into my cat food cabinet and eating dry food whenever she wanted. So that explains her high numbers. I'm trying to get her back into some readable numbers. She's doing very well though.

I'm curious, what's the process like when starting over from 1 unit? I don't have half unit syringes yet, but I'd like to try as soon as I get them. I will try ordering some tonight.

Thank you all for assisting us on our journey to better health for my girl!
Rebekah

 

As long as she isn't prone to ketones (like previous hospital stay for DKA), you would drop back to 1.0U twice a day and hold the dose for 3-6 cycles and gradually increase by 0.25U.

Sneaky little kitty getting into contraband! I posted a link earlier for you, are those the one's you're ordering?

 

Can you add what she's eating to your signature?

 

Are you still using the original vial? If not, how old is the vial you are using?

 

That's the exact reason I decided to quarantine Fabby in the beginning. With her diabetes not well managed she was extremely food aggressive. She would even eat the dog food if left unattended (none of the other cats bother it at all. I've recently let her out of quarantine, and noticing some "hunting" type behaviors for food that just weren't there in quarantine. (Quarantine was just a baby gate on our bedroom door, as she chooses not to jump. The other cats could and did come for visits, but this way she also got to sleep with us and have human interaction, opposed to being alone all the time. But I could also control food issues better, no mice, no breaking into cabinets, etc...)
Cats are problem solvers, one of the many reasons I appreciate them! Lol, just not when they are getting in trouble.

 

The vial I am currently using is about 5 to 6 weeks old.

We have not had problems with ketones that I know of. It's nothing the vet has ever mentioned. Yes, I will be ordering the ones you posted about!

Audrey definitely exhibits some hunting behaviors. She has gotten into the trash a few times too!

I certainly can do that! I have been feeding her FF classics since I transitioned her to a low carb canned food.

 

I see she's getting 2 cans a day of the ff. I wanted to let you know that it's OK to feed in between meals as long as it's two hours prior to the preshot test. Most diabetic cats (just like people) do better with several smaller meals ratger than 2 larger meals. Also while her numbers are still being regulated she may need more food than that. Diabetic cats can't utilize the nutrients properly so they are literally starving even though they are eating. I would recommend giving another half can mid day and a half just before bed. Many of us even use automatic feeders for these extra meals.


Is hard to recommend a dose suggestion with little mid cycle data. Are you home this weekend to do a curve? (Test every 2 hours for 12 hours)

 

My first vial of vetsulin I got from the vet pooped out at the 6 week mark. So watch your numbers. She wasn't dropping in the middle like she should if the insulin was working. Got a new vial and we got our midday drops back.