? Another possible fur shot

Discussion in 'Feline Health - (Welcome & Main Forum)' started by Lisa and Smoky, Oct 10, 2016.

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  1. Lisa and Smoky

    Lisa and Smoky Well-Known Member

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    Smoky has been very difficult to give shots to lately. I guess I have to have my roommate hold him down for me. I gave him a fur shot again but this time I didn't give him another one since I don't know if he got much of it. There was a big drop of insulin on his foot. I'm beginning to think the vetsulin is making him feel very crappy. He has been on it for a month now. Should I test him tonight yet or just wait until tomorrow before his am shoot? Also, how do I know if I should give him his usual 2.5 units? Does it depend on his AMPS numbers?
     
  2. Lisa and Smoky

    Lisa and Smoky Well-Known Member

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    Also, smoky doesn't seem to feel well and is hiding under the coffee table in my bedroom.
     
  3. BJM

    BJM Well-Known Member

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    Look at how much drop 2 units can get; it is possible, he is going too low post-shot and that has something to do with how he is feeling.
    Also, it is really important to test before every shot to make sure it is safe to give the dose you've selected. Have you read over the guidelines on using Vetsulin, over in that forum section?
     
  4. Lisa and Smoky

    Lisa and Smoky Well-Known Member

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    I did recently read that guideline. I have told my vet that he seems to be hitting his nadir at +4 or +5 hours post shot and that the vetsulin does not last more than 6 or 7 hours. Also, my vet keeps wanting to up his dose every five days. If you look at his SS he has dropped 300 to 400 points in four hours.
     
  5. Callie & Patches

    Callie & Patches Well-Known Member

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    If he is hard to manager, try wrapping him up in a large towel like a kitty burreto (so you don't get scrached. Have a treat ready to give him immediatly give him a yummy treat. My Callie loves freeze dried chucken. It doesent take long before they come running for a treat and not notice the shot. It helps to have a special place for tests, shots and treats. I find callie waiting for test or shot.'
     
  6. Tuxedo Mom

    Tuxedo Mom Well-Known Member

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    That is not really a good approach. Both the preshot number and the nadir (lowest number) need to be taken into consideration with Vetsulin. Because it is a harsher, faster acting insulin it can bring the numbers down very quickly, but those drops such as the AMPS 427 to 79 at +4 are not good. When your kitty drops that much it is going to cause a bounce into higher numbers. Increasing the dose will just cause a cycle of drops and bounces. Many kitties do not get a long duration with Vetsulin.
     
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  7. Critter Mom

    Critter Mom Well-Known Member

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    Hi Lisa,

    Never, never, NEVER give a second injection if you think you've done a fur shot or have had any other problem with an injection. ALWAYS wait till the next dose is due before giving any more insulin.

    With the hiding and also fighting the injections Smoky is trying to tell you something is wrong, Lisa. (Other members, myself included, have observed similar behaviours when treating their cats with Vetsulin/Caninsulin.)

    [​IMG]

    Those drops of over 300 - 400 points are HUGE, even by Vetsulin standards. If I saw them in my cat I would consider them to be highly dangerous. These data should have been a massive red flag to your vet that the dose is too strong.

    Based on what data you've managed to gather plus Smoky's problematic clinical signs my thoughts are that Smoky is on too high a dose of Vetsulin already.

    My thinking is that the really high BG numbers are coming from Smoky's body trying to compensate to protect itself from the effects of too strong a Vetsulin dose. If he's dropping down into double figures that's too low for comfort on Vetsulin (you need a bigger safety buffer).

    Thank goodness you didn't follow your vet's recommendation to aggressively increase the dose. If it were me, I'd be shopping for a vet who fully understands that regulation of a newly diagnosed diabetic is a slow and gradual process; it can't be 'forced' by increasing the dose. Indeed, that approach tends to lead to overdosing - as we so often see here. Note that some vets only look at making Vetsulin dosing adjustments based on preshot BG. This is not adequate. For safety weight should also be given to the nadir BG because Vetsulin can drop BG so hard and fast - especially when any given dose is completely tanking BG between preshot and nadir, and even more so when the Vetsulin nadir is in double figures (mg/dL) - as is the case with Smoky. I think that Smoky may very well be feeling awful at least in part due to those wide swings (human diabetics report that wide BG swings make them feel very unwell) but if, as it appears, the dose is too high that is also likely to be putting his little body under enormous strain as it tries to compensate to keep his BG levels up.

    Unless Smoky is making it completely impossible to test him, Lisa, to protect Smoky you need to test before EVERY dose to see if it's actually safe to give any insulin at all. Just because some PS BG values are high doesn't mean that all PS BG levels will be safe - especially in a cat whose BGs are swinging as wildly as Smoky's. Thank goodness that you have managed to get some data to show just how low Smoky is going. I strongly recommend you test at +2 and +3 on every cycle if possible but definitely on the PM cycle. (Smoky's data suggests he has a tendency to run lower during the PM cycle; many, many cats do.)

    I strongly recommend that you speak to your vet ASAP about reducing Smoky's Vetsulin dose immediately. Highlight that drop from over 500 down to double digits by +3 on the PM cycle of 2 October - and that was on 2.0 IU Vetsulin. Now you're giving him 2.5IU Vetsulin (and you got another huge drop on 8 October PM cycle). There is no way of knowing for sure without test data but given the data you have there is the possibility that Smoky is going low at times when you're not testing.

    Are you testing for ketones? If not, get some urine test strips today (e.g. Keto-diastix) and check them today. You should check ketone status regularly as a matter of course as part of Smoky's monitoring routine. You need to establish Smoky's ketone status now because that will have a direct influence on any dosing decisions that you and your vet make for him. If Smoky tests positive for ketones you need to immediately seek veterinary attention. If you are looking to reduce the dose you need to be especially vigilant about checking for ketones (recommend daily testing for the time being).


    Mogs
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    Last edited: Oct 11, 2016
  8. Critter Mom

    Critter Mom Well-Known Member

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    For information, if a cat that previously was fairly straightforward to inject becomes difficult to inject it is wise to treat such a behaviour change as a red flag that something may be wrong, let the vet know as soon as possible, and monitor more closely/investigate further.


    Mogs
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  9. Lisa and Smoky

    Lisa and Smoky Well-Known Member

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    Thank you everyone for all your recent posts. I don't feel comfortable with my vet as he gets upset when I question his advice on smokys treatment. My boy was doing so much better on the one unit of insulin than he is doing now. Plus my vet doesn't seem concerned about his low numbers post shot. I boarded him at an excellent pet hospital while I was on vacation. While he was there they ran tests to check his liver and pancreas which his current vet refuses to do.

    I am seriously thinking about taking him there. The senior vet there specializes in feline internal medicine. I forgot to put down his am pre shot test which was 450! Also, smokys appetite has declined in the last few days and he seems sick. He is usually a very laid-back cat who likes to cuddle with me. It is not normal for him to hide or stay in his kitty bed all the time.

    I realize not everyone is comfortable giving dosing advice but I don't trust what my vet is telling me to do right now. I may have to wait a week to take him to the other vet.
     
  10. Alexi

    Alexi Member

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    Apr 10, 2016
    That is a huge rate of rise of dose and I am not surprised he doesn't feel well and the numbers are all over the place. The change in behaviour suggests he is dropping into numbers way lower than he can handle. Diabetics can get hypo symptoms even if the glucose appears to be in a normal range if they are used to running high numbers. His numbers were looking much better when the dose was around 0.5 to 0.75 and I expect he was feeling better as well. Increasing every 5 days is faster than the manufacturer recommends, and should be done on the basis of a curve as if it is just based on the pre shot numbers he may be bouncing or just throwing an odd number - they all do that from time to time!

    I would be looking to reduce the dose provided he is ketone negative. You need to test before every shot - test, feed, shoot and get some mid cycle numbers in as well. While you are at it I would be looking for a new vet.
     
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  11. Critter Mom

    Critter Mom Well-Known Member

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    (((Lisa)))

    It is so tough when dealing with a vet who is not FD-savvy - and it is worse when a vet's ego gets in the way of proper, safe patient care.

    It's very difficult when it's someone else's cat. With Smoky showing signs of hiding I would worry about whether anything else might be causing him to hide or whether there might be any other health issues. Also anyone giving you suggestions about what to do would need to know Smoky's ketone status.

    I am willing to say that I think the 2.5IU Vetsulin dose is too high and I have similar concerns about the 2.0IU dose. Again I recommend that you test more (per my earlier post).

    I agree. I don't know whether it would be safe for you to reduce the dose to that level because of the reasons I've outlined above. I'm not a vet and even if I was I'd want to examine your cat and know his ketone status.
    Neither do I. I think it would be a good idea for you to check out the other practice with a view to having them take on Smoky as their patient. Maybe if you rang them to explain the situation, described Smoky's clinical signs and showed them his spreadsheet data they might be able to see you quickly?

    I'm sorry I can't be of more help, Lisa.

    :bighug:


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  12. Capoo

    Capoo Member

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    Hi Lisa,

    As a former user of Caninsulin myself, I would suggest as many others did, to reduce the dose immediately.

    And as the others, I suggest that you test BG more, before each shot and during the cycle, as well as for ketones.

    According to your SS, Smoky metabolises Caninsulin far too quickly, and I'm very concerned by these terrible drops in only a few hours...
     
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  13. Alexi

    Alexi Member

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    I am also surprised the vet didn't want to run blood tests as it is important to know the state of the liver and pancreas - both of which can make a cat unwell and affect behaviour. You could ring the new vet and send them the spreadsheet link to get some advice before your appointment. I find sometimes you have to go with your gut feeling. What is your gut telling you to do?
     
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  14. Lisa and Smoky

    Lisa and Smoky Well-Known Member

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    I am very concerned about smoky. I tested him a week ago for ketones and he was negative for them. I am keeping him in bedroom with me tonight so I can test him again for ketones. I spoke with the place that I boarded him at about my concerns and they will have the vet call me tomorrow. I don't know why my current vet thinks it is a good idea to rush into higher doses. The second opinion from the vet's office where he was boarded suggested he might benefit from an ultrasound. They sound as if they are more modern and more knowledgeable about FD.
     
  15. Critter Mom

    Critter Mom Well-Known Member

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    I am so glad to read this, Lisa! The new vets sound much more responsive and proactive.

    How has he been today, Lisa? What is unusual that you've noticed?


    Mogs
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  16. Lisa and Smoky

    Lisa and Smoky Well-Known Member

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    The more modern vet called me back. I have an appt for smoky next Monday. She advised me to check for ketones and to bring a urine sample with me to appt.
    She saw him once before when I went on vacation and boarded him and is the vet who ran tests to check his liver and pancreas.

    Smoky was hiding under the coffee table again. I took him out and put him on the bed with me. He is laying on my lap and purring. His appetite seems a little better.
     
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  17. Lisa and Smoky

    Lisa and Smoky Well-Known Member

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    The new vet also suggested lowering his dose from 2.5 units to 1.25 units provided he doesn't test positive for ketones. She also thought it was a good idea to test his BG at +2, +4, and +6 after pm shot.
     
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  18. Lisa and Smoky

    Lisa and Smoky Well-Known Member

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    Smoky was negative for ketones so that's good news at least. His PMPS was 352 but don't know if that's considered very high.
     
  19. Critter Mom

    Critter Mom Well-Known Member

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    It's better than some of the PMPS values you've had recently. Good news on the ketones. I really do recommend you test daily for the time being.

    The more that I hear about the new vet, the more I like. I'm pleased that she has already started giving you support via the telephone until you can get to see her next week. Be sure to test at AMPS and PMPS every day from now on, Lisa.
    What appetite problems has Smoky been experiencing?

    Glad the two of you are having a snuggle.

    (((Lisa and Smoky)))

    :bighug:


    Mogs
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  20. Lisa and Smoky

    Lisa and Smoky Well-Known Member

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    He has had some nausea and loss of appetite lately. He seems to be doing much better now since I gave him the lower dose tonight.
     
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  21. Critter Mom

    Critter Mom Well-Known Member

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    It's good that the new vet is considering doing further diagnostics. I suggest asking them to check for pancreatitis (because of the hiding and nausea/appetite problems); a SNAP fPL test together with physical exam and history of clinical signs would give a yes/no answer on the spot. For positive SNAP results it's advisable to also get the Spec fPL assay done (goes to an external lab) as it will give a numeric result indicative of severity.

    I'm pleased that Smoky's already doing better on the lower dose. (Anti-jinx!)

    :bighug:


    Mogs
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  22. Lisa and Smoky

    Lisa and Smoky Well-Known Member

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    I had a phone consult with my old vet today. I told him my concerns about smokys high dose and his numbers bouncing all over the place. He said to me that's not the information that he wants to know. Is he serious? He wanted me to bring him in today and I told him that I was taking smoky to see a specialist soon.
    Is that nervy or what? Sorry guys. I just wanted to vent.:mad:
     
  23. Critter Mom

    Critter Mom Well-Known Member

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    [​IMG]


    I am soooooooooooo glad you've found the new vets, Lisa.

    :bighug::bighug::bighug:


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  24. Lisa and Smoky

    Lisa and Smoky Well-Known Member

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    Sep 6, 2016
    I tested smoky PMPS and he went up from yesterday. I gave him 2 units of vetsulin and he was at 352, last night and this morning gave him 1.5 units and he went up to 384. Not sure of what dose I shld give him tonight. It's it's too high his BG will plummet about +4 after his shot tonight. I don't know what to do to avoid the bounces. I gave him 1.5 units tonight and can check him again later.
     
    Last edited: Oct 12, 2016
    Reason for edit: New info
  25. Critter Mom

    Critter Mom Well-Known Member

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    Lisa, you need to do AMPS and PMPS tests plus at least one mid-cycle test every day to better determine how Smoky's responding to his insulin and to be as sure as one can be that the dose is safe. Without the test data it is impossible to get a picture of what's happening. The before bed test seems to be one you can manage regularly. If you can't get a mid-cycle on the AM cycle on workdays it would help you to make every effort to get mid-cycle tests on both AM and PM cycles on days when you're at home.


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