PLease help me, becoming unsure of dosage to administer

Hi, my cat Frazzle was diagnosed as diabetic last fall. I've been home monitoring for a while now, but I am becoming unsure of how much insulin to administer. He is currently about 20 pounds, and I just did a reading on him which came in at a low 49. The current syringe I am using (on the label) reads 3/10 ml.; the dosage numbers on said syringe (the dosage line, I guess you'd call it) goes up to 12, I have been filling it to 3. I don't know if I should be giving him more insulin than this. I don't want to O.D. him, he originally started off at 1.5 on the syringe back in the fall. His last reading before the 49 was 65, at that time I was filling the syringe to 2.5. Should I increase the amount of insulin beyond the # 3? Please note that I am currently a basket case due to the unexpected death a week ago of another dear cat (not diabetic). Is there anybody out there who can help me?

 

Are you in the US? If so, and you are using the US units of mg/dL to measure blood glucose, those numbers are too low to give insulin. If the numbers were taken in the middle of a cycle (between shots), they're actually very good, but if the numbers are that low at shot time, that is too risky to shoot unless you have a ton of blood glucose data. Whenever you are taking those readings you definitely do not want to increase the dose!

What kind of insulin are you using? It sounds like you have one of the U-40 insulins (Vetsulin/Caninsulin, ProZinc?), which I don't have a lot of experience with, but other folks here should be able to help you on dosing. One thing you could do that would be extremely helpful would be to set up a spreadsheet and enter all the blood glucose data you have collected in the past. We use a standardized template (click on the links in people "signatures" to view examples). Set-up instructions are HERE.

Hang in there, we will do what we can to help sort this out!

 

Nan, thank you so much for responding. Yes, we are in the U.S., & I took that reading halfway between shot times. We do use Vetsulin. My vet has suggested doing the spreadsheet thing of taking readings every 2 hours, but this would be pretty impossible. It takes me several tries to hit that ear vein just once, during which time Frazzle gets extremely frustrated with me & of course my own frustration level goes up accordingly, as I do my level best to talk to him in a calm, soothing tone while desperately trying not to burst into tears. I should probably look into drawing blood from a paw pad, at this point. As soon as he sees the monitor he tries to head for the hills, and to that end I'm only doing readings every 2 weeks or so. I need to get this to at least once a week.

 

I'm so sorry it's been so frustrating! It is definitely a steep learning curve on the testing, but just by getting those first few tests done you are well on your way. We have lots of tips for making things easier for both you and Frazzle, starting with: does he get a treat after every attempt (successful or not)? It's amazing how motivated our kitties can be to put up with pokes if they know there's a reward! Doesn't have to be food-based, could be cuddles or catnip or extra playtime, whatever he likes best.

Some people try singing a silly song while testing-- part calming, part just distraction. That might help on your end. It is hard, because it seems like it must be hurting them, which is of course the last thing any of us want to do. In reality, there are very few nerve endings in the ear, so as long as you aren't hitting the vein it shouldn't be painful for them. And you can do things to minimize the pain and speed healing after the pokes. Applying a small amount of pressure after the poke to stop bleeding and prevent bruising, and a dab of neosporin ointment at the end of the day helps a lot.

I'm going to tag @Kris & Teasel for help with Vetsulin. When is your next shot time?

 

Some good info here:
http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/
Re dose: Those are very low numbers. I would decrease to 2 units twice a day immediately. Please try hard to get more testing done at home and set up the spreadsheet we use here. It's the only way you can keep your kitty safe and for us to help you. Unfortunately testing only once a week isn't enough. Here's the basic routine we recommend:

1. test every day AM and PM before feeding and injecting (no food at least 2 hours before) to see if the planned dose is safe
2. test at least once near mid cycle or at bedtime daily to see how low the BG goes
3. do extra tests on days off to fill in the response picture
4. if indicated by consistently high numbers on your spreadsheet, increase the dose by no more than 0.25 u at a time so you don't accidentally go right past a good dose
5. post here for advice whenever you're confused or unsure of what to do.

 

Thank you Nan, & thank you Kris! That's a great idea w/ giving Frazzle a kitty treat at testing time. He gets grain free treats, & I've been making everyone's food for a few months now, using Dr. Pierson's recipe. I'll be dosing him again at midnight & I will decrease his dose per Kris's recommendation. I will screw up my nerve & start testing him daily, I know the kitty treats will make the process less stressful for my poor boy. When I've seen his numbers go down I've increased his dosage, but then I started becoming unsure if that was the correct procedure or not so much. I will test him tomorrow AM before feeding & dosing him. I feel a bit better since you folks have come to my rescue, I don't feel quite so alone out there. I'll keep you posted, & THANK YOU again!

 

You’ve definitely come to the right place to get help and lots of information on FD (feline diabetes). What will also help others help you, would be setting up a profile. You will notice at the end of someone’s post, a bunch of info in grey. This is our signature. It’s is important information we add about our kitty. i.e. age, type of insulin, any other health issues, what they eat, etc. Here is the link to get you started.

http://www.felinediabetes.com/FDMB/threads/creating-a-fdmb-profile.159626/

 

There's actually a bit of science behind this, as well; it forces you to use a different part of your brain so it helps you to be calmer and more relaxed.

 

@Kris & Teasel, I managed to get a reading this AM on Frazzle, which came up to 66, so it's at least heading in the right direction. I just now discovered that I made one mistake, though: I thought I read last night on your suggestion to decrease BY 2 units, & just realized you wrote TO 2 units. To that end, last night I gave him 1 unit, but earlier this AM I did up it to 1 1/4. Will attempt another reading this eve @ 6. Thank you again for your help!

 

Wait! Are you saying that his BG was 66 this morning BEFORE you gave insulin? Please let me know ASAP. We need to talk.

 

This is from one of your posts above. This is part of why we need to talk at length.

 

Yes, it was 66 before breakfast. Last night at the midway point between shots it was 49.

 

Please let me know if this summary is correct:

• kitty diagnosed in the fall of 2017
• Vetsulin prescribed at a dose of 1.5 units twice (?) a day The usual starting dose is 1 u twice a day but he's a large kitty.
• recent dose is 3 u twice a day
• BG test result last evening was 49 midway between shots (?) That BG is too low and tells you that 3 u is too high a dose
• previous BG test result was 65 when dose was 2.5 u When was this test taken relative to the time of the shot?
• dose of 1 u given last night
• BG reading this AM of 66 Was this before the shot?
• dose raised to 1.25 u this AM Will discuss.

 

I'm going to throw a lot of info at you so bear with me:

What Vetsulin should do:

This is from the Vetsulin manufacturers website:

• It should drop the BG gradually from the high point just before a shot to the low for that cycle (the 12 hours after the shot) and allow the BG to rise again to a high that's similar to the starting point.
• It can drop BG fast and low so dosing safeguards HAVE TO be in place: 1. no shot given unless BG is above 200 until you have more experience; 2. a dose that's LOW ENOUGH to prevent BG from dropping to less than 90-110.
• The only time you raise a dose is if the BG test numbers show you that he's staying too high on a dose. You said you increased his dose when his numbers came down - that's what got me worried!

This is why I wanted clarity from you on your BG test results. Your kitty has likely been on too high a dose and he's received insulin when he probably shouldn't have. I'm not blaming you. There's a lot to this dosing stuff and many people come here after being told little to nothing by the vet. We can help!

How do you get the best test numbers to help with evaluating doses:
I gave you this testing routine above but here it is again. This is how it's done:

1. test every day AM and PM before feeding and injecting (no food at least 2 hours before) to see if the planned dose is safe
2. test at least once near mid cycle or at bedtime daily to see how low the BG goes
3. do extra tests on days off to fill in the response picture
4. if indicated by consistently high numbers on your spreadsheet, increase the dose by no more than 0.25 u at a time so you don't accidentally go right past a good dose
5. post here for advice whenever you're confused or unsure of what to do.

How you can get the best help from us:

• start that regular testing routine
• set up the spreadsheet we use here to log all the BG test results:
  www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
• read up on Vetsulin and how it works: http://www.felinediabetes.com/FDMB/threads/beginners-guide-to-caninsulin-vetsulin.186099/

I hope this helps. Please ask A TON of questions. No question is silly. I'd be pleased to clarify anything you aren't clear on.

 

That summary is correct, and to answer your question as to when the test was taken relative to the time of the shot (regarding a result of 65 BG when his dose at that time was 2.5 units), that reading of 65 was taken at 6 PM, the midway point between shots.

 

Thanks for that! That tells me the dose of 2.5 u is too high. With Vetsulin we'd recommend a lower dose if the low value (nadir) is below 80-90 for the reasons I gave above.

 

Thank you SO MUCH for taking the time to share this info w/ me. I feel a huge sense of relief just knowing that I'm not out there all by myself trying to make sense of it all. And I was doing exactly as you said, increasing the dose when seeing his BG numbers drop.

 

You've come to the right place! Frazzle is awfully cute!

Here's some more homework for you - setting up your signature (light grey text under a post). Here's how:

• click on your name in the upper right corner of this page
• click on "signature" in the men that drops down
• type the following in the box that opens: kitty's name/age/date of diabetes diagnosis/insulin you're using /glucose meter you're using/what he eats/any other meds or health issues he has/ your approximate location (we're all in different time zones)

 

I'll get that Signature set up shortly. I was going to do it last night, but it was like 3 AM & looked like something that was going to take some time to put together so I decided to do it today instead. Thank you, I can't argue, Frazzle is a big, cute boy .

 

Hey there everybody who responded to my plea for help back in April. I wanted to share an update with you kindly folks regarding my Frazzle. Over the last few months I became a lot more proficient at drawing a drop of blood, and I got to doing it nightly. On Frazzle's part, he learned to become much more tolerant of the evening routine, eventually getting to the point of racing me to the bathroom (where we did the reading), but that was because he knew that after I finally got a drop out of him he would be rewarded w/ (grain free, of course) kitty treats. Things were finally going relatively smoothly, although I was troubled by the low numbers I was getting, mostly in the 50's & 60's. Last week I brought Frazzle to our new vet, who wanted me to bring him in for a day so they could do hourly readings on him, but using a pet-specific monitor, not the ReliOn brand which I & so many others use (& was even recommended to me by or last vet). After just a few hours she called to let us know that Frazzle's numbers are PERfect, & thanks to Dr. Pierson's magic recipe he is NO LONGER DIABETIC!!!!!!!!!!!! I wanted to share this wonderful news with you good people, and thank you again for being there for me & helping me out when I was simply desperate. I will never forget your kindness.

 

Hooray for Frazzle, and hooray for you! That is so exciting!!!!!

 

Congratulations Frazzle and Lady3kgt!

 

Congratulations on Frazzle's remission. We call it Off the Juice (OTJ). Frazzle will always be diabetic, but may not need insulin support and that's remission. Idjit also is OTJ and it's important to keep testing, to ensure the remission is holding. In my reading here on the board, an infection, illness or injury can upset the remission. So, you may want to keep a close eye on Frazzle, keep testing maybe once a week, then every 2 weeks and so on. Note any changes in behavior, eating habits, drinking etc. It's just a nice thing to be able to test and reassure yourself that your kitty is doing well without the insulin.