? Is it the insulin, the dose, or the food???

Evening all.
I just need an opinion or two about my buddy Lou's current situation. We are at the point where a larger dose does seem to get some results when he's in the higher ranges (200s-300s). When he's below 200, the insulin doesn't seem to work like you'd expect it to. My biggest issue seems to be this massive jump in BG from the preshot value to +2 - +3, sometimes even at +4. So it seems like the insulin gets to work right away when he's at a higher number, but it seems to be delayed at BGs less than 200.

So I guess the real question is: is it the dose is too small at the lower numbers (it's already weird enough giving more than 1 unit when he's under 200), or do you think it's the food? With how much his BG can go up after eating, can it be the food? We've been trying some Friskies pate for his preshot meals simply because the cans are bigger.
Any advice or suggestions would be welcome! Thanks in advance!

 

I'm not pro with vetsulin, but I will say (as I've had said to me in the past) your dosing is all over the place. If I were you I might refer to the user guide http://www.felinediabetes.com/FDMB/threads/vetsulin-caninsulin-user-guide.302/ and post over in the Vetsulin forum. I'm sure there are lots of experienced members that could help Lou get back on track. Personally, I might "start over". For instance one night at PMPS 193 you gave 1.25u and the next AM at 114 you gave .2u. Those are very different doses. Consistency in dosing works best with our sugar cats. I'm not sure Lou's ideal weight or current weight but is what is in your notes all that he is eating?

 

Thanks for your reply! Unfortunately, Lou has not been responding well to smaller insulin doses, as he ended up spending a month in the 200s-300s, only going into the 100s rarely. We "started over" at least twice before I started increasing. We finally found a dose (2.0 units) that will consistently get him into the 100s at least, but he doesn't always climb back up to his "normal" PS BGs. Since I can't always give him his 2.0 units when he's below 200, I've been trying to develop a sliding scale to use to keep him under renal threshold as long as I can (which is a battle on its own right now).

I can certainly go to the Vetsulin forum for dosing advice, but my biggest question right now is the "normality" of such big increases in BG after his PS meals. That's why I figured it might be a good idea to post in the Main Forum. It seems like he jumps so much higher from his PS BG, that the dose seems to have a delayed start. When the insulin is delayed, he doesn't go as low as I'd expect based on his dose. So I thought I'd see if anyone has experienced this before. Is it possible his preshot meals (Friskies) are too high in carbs or just pushing him higher? Or would you think it's just he needs a bigger dose to combat the increase in BG after eating?

 

BG volatility can increase with frequent dose changes which is why many of us like to give a consistent dose AM and PM to get a kitty settled. Sliding scale dosing is useful when you are honing in on the good dose range but the dose changes are usually fairly small then. Why not try something like 1.25 u both AM and PM for a couple of days to see whether he'll settle?

A food spike is very common and generally shows up at a +2 test. That's why the +2 test is such a good forecaster of what might be ahead in a cycle. If +2 is higher, that's quite typical of an uneventful cycle. If it's the same or significantly lower, that often means an active cycle ahead.

 

Hiya Kris. I've been used to his food spikes right after his preshot meals, but they were only an increase of 20 maybe 30 points tops. They might affect the +2 BG number, but it didn't seem to last much after that. In the last 2-3 weeks or so, his spikes have been upwards to 50 points higher and they've been affecting +2, +3, and sometimes even the +4 BG numbers. Is this normal? I've heard some folks say that their kitty didn't react well to a food or that they were sensitive to higher carbs, etc, on the forum, so I wasn't sure if I should be concerned or if it was time to change something. Or if I should just stop worrying about it

 

Maybe wait and see? I'm not sure what else to suggest. Is he acting normal?

 

Yep. Ever since I've been dosing higher (and he's been spending more time in the blues), he has been doing so much better. Not perfect, but not exhibiting the obvious signs of FD he had been when he was stuck in the 200s-300s. So tonight is the perfect example of what I'm talking about. His PMPS was 203. I gave him 1.5 (1.25 just didn't seem enough, so I was hoping 1.5 would be a good dose to try for a few cycles). When I checked him at +2.5, he was at 262 (a 60-point difference is now the new record for after meal increases ) When the insulin finally starts to work, it's starting from such a higher point that it seems to render the dose almost useless (as far as getting a proper nadir). Basically it seems like the only doses that actually do anything are the 2.0 units. Anywhoo... I'll try to see what the 1.5 u does for the next few cycles. I think it may be worth stopping the Friskies for a bit as well and see if that has any bearing on the steep food spikes. :/ Otherwise I'm flummoxed.

 

I still vote for an intermediate dose (1.5 u? 1.75 u?)and hold it for several days both AM and PM. When I scan your SS without considering your details, it looks like BG volatility from frequent dose changes and overall too low a dose. It's always better to judge trends and not individual numbers or drops in BG. That's why squinting at the SS is helpful.

 

Well I'd prefer a higher dose to hold, but I started with 1.5 u last night and this morning. He's back at almost 300 this morning, so I doubt it will do much good. I understand changing doses too much isn't the best, but quite frankly, I'm desperately trying to get him to have a proper nadir. He's gotten into the greens one time since July. Absolutely nothing I am doing, except trying to dose him higher, gets him even close to a normal cycle, so I've been going with his numbers since it at least gets him out of the high 200s - low 300s. It just seems at the end of the day that I can't find a good dose to hold when he's in the 100s that will keep him from climbing back to the 300 range. I am honestly at the end of my rope.

 

Some of what you're describing is typical for Vetsulin. Because it's a faster-acting insulin, it can drop them quickly and set the scene for bouncing, even if this all happens in a higher BG range. The PM cycle on Sept 13 was pretty good and kept him in blue much of the next day even with an AM mini dose. He bounced up to pink in AM Sept 15 and you boosted his dose in response. He appears to clear bounces quickly which is good.

Before you give up on Vetsulin, why not try a 4 day experiment of consistent AM/PM dosing? He might settle and you can make tiny tweaks from there. If none of that works you could try ProZinc, another in and out insulin that's gentler than Vetsulin or you could consider a depot insulin like Lantus. Let's see what @Djamila @Rachel @Yong @StephG think.

 

Hi,
I'm no expert, only having done this since April but I do use Vetsulin and from your spreadsheet, it seems like 2 units given the last few times is a good dose. It doesn't look like you got many readings in between shots but the AMPS and PMPS look good on 2 units. I see the 2 unit readings back a few months, but the recent ones look good.

Vetsulin can tend to dip them pretty low at times so but I would try it. With careful mid-cycle monitoring. That way you can intervene if necessary. If 2 makes you too nervous I think a consistent 1.5 or 1.75 as Kris suggested for a few days would give you good information. Again with frequent testing mid-cycle.

What is your Vet saying? My boy was finally stabilized on 1.25 units, Fancy feast low carb food and a decreased dose of Prednisolone that he needs for his skin allergies. If you check out my spreadsheet though, we were up to 5 units on the way to 6 at one point. It was a blessing in disguise, but he had some appetite issues which resulted in us dropping him down to 2 units, then ultimately fine tuning that to 1.25. It took us months to get it right. Relax and do your best, monitor your kitty closely and you will get there. We can be so hard on ourselves when the numbers don't do what we want. He's not on any medication is he?
Stephanie

 

I'm with Kris on this one. I tend to feel consistentcy is key so I think I'd try that for a few days to see what it does. You could certainly move to ProZinc which is dosed similarly since it's not a depot insulin. I think I'd give the consistent dosing a try first though...see what that does and go from there!

 

No other medications. Thankfully he is otherwise perfectly healthy, if you except him not working with his insulin as I would like, haha. The 2 units seemed to work perfectly for getting him down into the 100s. Weird thing is, he doesn't automatically go back up to his PS BG. So he tends to stay down for a cycle, and then (since I can't find a dose that works well enough when he's lower), he climbs back up in a cycle or two. It's a vicious cycle. I'll try the 1.5 units, but considering his starting point, I think he'll need to go up to 1.75 to really see any progress.

 

I agree with Kris too.
Chuck was like that on prozinc. He had BIG food spikes. Spiked by the hundreds. I tried dosing based on ps and nadir but we would see action for a few cycles then back to staying high.
I think 50 points from eating is pretty good but that's because I've seen so much worse.

 

Did you ever determine a cause for him failing otj trial at the last second?

 

Hiya Steph! That actually makes me feel much better. I was really starting to wonder what I was doing wrong. I will definitely give steady doses more of a go. Does Chuck still have high food spikes that you notice?

Unfortunately not, and I think (not to sound overly dramatic) that it's haunted me since. I've been trying to figure out some reason, but nothing has really been popping out... so if it's something, I'm guessing it's not overly obvious.

 

He does still have food spikes. But not as big and sometimes he just stays the same. The long acting lantus really helped with his food spikes.