? Assistance with Vetsulin Needed - ? too high a dose

Kako started a thread over in Welcome and to some of us non-Vetsulin users it looks like the dose of 3u currently being given is too high. She just contacted her vet and is now being told to increase the dose to 5u. I have asked her NOT to increase and that I was referring her situation over here to the Health board. Here is the link to her original post.

http://www.felinediabetes.com/FDMB/threads/please-help.156777/#post-1661721
@Sue and Oliver (GA) @Critter M @Squalliesmom can you provide any advice here. I am trying to get Kako to set up a spreadsheet but she needs help now. Thanks so much.

 

Sue is not available for the time being.

I will tag @Elizabeth and Bertie she is familiar with Caninsulin (Vetsulin)

 

@Marje and Gracie Marje, could you please set up a spreadsheet for Kako? She is having trouble doing so and we really need to get it going for her. Thanks so much!

 

@Marje and Gracie can you help Kako's Mom with setting up a spreadsheet. Thanks This is the link to her initial posting:

http://www.felinediabetes.com/FDMB/threads/please-help.156777/#post-1661721

 

@Tuxedo Mom -what a tag team we make!

 

I will send her a PM to get the info and if she provides it, I'll be happy to do the SS.

 

Have replied in the other thread, Mary Ann.
.

 

Thanks Elizabeth

 

Linda

You might like this post I did in the Think Tank. It really applies in these sort of situations.

http://www.felinediabetes.com/FDMB/...ced-users-for-different-insulin-types.156789/

 

After just a quick read-through, I have to agree - I would not increase Tux's dose! Does she have a spreadsheet up and running yet?

 

It looks like most of the posting is still going on in the Intro thread:

http://www.felinediabetes.com/FDMB/threads/please-help.156777/#post-1661721

Marje has sent her a PM about getting a spreadsheet set up.

 

Kako, here is a link to some vet interview questions one of our members compiled (Thank you BJM). These should help you find a vet who can help you get Tux feeling better!

http://www.felinediabetes.com/FDMB/threads/vet-interview-topics.156663/

 

Thanks for the heads-up!

 

Thank you ladies.
Sorry, I am having hard time to understand how to use FDMB.
Is there a way to save this forum?

I rejected to give 5 unit Vetsulin.
And I completed the spreadsheet.

I am facing another difficulty.
I am using AlphaTRAK, and I am out of the test strips.
This is why: I went back to the vet office 6 days ago to purchase a bottle of strips. I paid for 100 strips but the vet had 25 to give. So I brought home 25 of them, and used up the last one this morning. The vet still don't have rest of strips. I was told to skip readings, it's totally fine.

Until I get more strips, or find a good vet, what is the best I can do?
-Stay in 3 units Vetsulin
-Lower to 2 units
-Lower to 2 units and change food from dry "Taste of the Wild" to low carb wet food

Please advice.

 

Hi Kako, It is possible to use Freestyle Lite human meter strips in the AT2 meter. Can you get to a local pharmacy or Walmart? If so, let us know and we'll give you some further details to use them to get as accurate as possible readings. It's really important that you be able to test Tux right now.

 

In another post there is info for a vet referall for your Kako.

 

BTW, Good job getting the spreadsheet done. That is a great help for those who provide assistance!

 

I will go to Walmart for the Free style human strips tonight.
While there, I want to purchase some food too. Recommendation on the food that Walmart have?

How can I find the post for recommended vets in my area?

 

I will send it to your inbox. top right of forum check there. will send you coupon links for food at walmart to

 

Nevermind here is vet info from @billysmom

I might have a vet referral for you. I just called a friend in Eugene that has a cat. Her cat is not diabetic but she loves her vet and has been going to her for about 20 years. The vet's name is Dr Samsell. She is the owner of the practice, Cat Care Limited on Willamette St. It's a cat only practice. You should call them and ask about their experience with feline diabetes, if they support home testing, what type of insulin they recommend, etc. I hope this helps!

coupons- you want fancy feast classics, sheba its patete or perfect portions
Fancy Feast- http://www.couponsherpa.com/grocery-coupons/manufacturer/fancy-feast/

Sheba perfect portions- http://www.sheba.com/Home

walmart coupons- http://www.walmart.com/store/2588/c...ontentZone10 | 2016-03-01 | 1 | LN-FC-Coupons
there is afancy feast one one there clip it and print it

 

Kako, You can pick up some Fancy Feast Classics (the pates) or Friskies at Walmart as they are good foods for Tux. I'm sorry but I'm in Canada so I don't know what else your Walmart might carry that is appropriate for Tux. Make sure the food is pate and not chunks or gravy as those are higher in carbs.

That said, I would advice against changing Tux's diet just yet. Let's see if we can figure out why his readings are so high first. Changing to a low carb diet will be needed but right now if the dose is too high, the food change could cause Tux to drop too low and cause the opposite problem to what you are currently seeing and even put him in danger. I know it's hard to be patient and you want to do the best for Tux ASAP, but patience is key here. One step at a time and we'll help you figure this out and get Tux on the road to better health.

 

They must be the Free Style Lite strips to use in the Alpha Trak 2 meter. Also do not change the meter setting on the AlphaTrak2. Leave it at the same setting you were using with your last batch of strips.

 

I see. I will purchase some can food tonight, but I won't feed them to Tux until we figure out.
I am still thinking if I should lower dose to 2.

 

Have replied on the Welcome thread:

http://www.felinediabetes.com/FDMB/threads/please-help.156777/#post-1662050


Mogs
.

 

Yes it would be best to stay with the same food until you get a good testing pattern set up. You need to know how Tux is handling the insulin now with the higher carb food so that you can figure out what sort of dosing would be best once you start to switch him to low carb canned food.

 

Kako, let's see what Tux's pre-shot test is before deciding on doses.

@Critter Mom any thoughts on Kako's proposal of dropping back to 2u taking pre-shot reading into consideration of course?.

 

- Test urine every day for ketones.
- Ask your vet about lowering the dose. Seek a second opinion if necessary.
- If you can't monitor both cycles every day, seriously consider stepping down the dose for a few days (subject to being clear of ketones).
- DO NOT ATTEMPT A TRANSITION TO LOW CARB FOOD UNTIL YOU SORT OUT THE DOSE.


Mogs
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Considering that the vet changed the dose from 1 unit to 3 units I would tend to agree with that. However I am not experienced with Caninsulin, but the dose seems too high and the vet upped it far too much in such a short time period. If you go to a lower dose you can always increase later as needed.

That is just my thoughts. Let's see if anyone else can offer their ideas.

 

Cross-posted.

Have posted here and also on Welcome thread (see link above).

If it were my cat and ketones weren't an issue I would be inclined to have a strong discussion with the vet about dropping the dose to 2 units. I'd also do whatever it took to start getting +2 and +3 tests in every cycle to see if there's an early nadir. A 2-unit increase from 1 to 3 units BID is, IMO, nuts. To further propose a jump from 3 units to 5 units is, IMO, positively unhinged.


Mogs
.

 

The vet strongly told me to increase to 5 units. After I gently disagreed couple times, she said I could stay with 3 units if I come back and purchase dry and wet food (DW? I don't remember) that are made for diabetic cats they sell. I asked if they are low carb, she said they are for diabetes.
No... she wouldn't agree to lower dose.
I will look for a good vet. I will call and ask the questions.

 

Good plan. Your vet should be willing to work in partnership with you, not act as a dictator.


Mogs
.

 

Your current vet is wrong on everything. Increasing to 5 units could very well put Tux into a hypo which could very well prove to be very expensive for you if not deadly for Tux. Prescription foods have nothing magical in them (other than a high price tag) And any vet that suggests dry food of any sort hasn;t kept up to date with veterinarian studies.

Definitely time for a new vet.

 

Well the vet is not holding that syringe now is she? My vet wanted me to go up to 15u because my Woody's BG was consistently over 200. Well, when the wonderful people here looked at his spreadsheet numbers they told me to half his dose. I did and then another, and another. He was HYPOING at every shot. The only thing keeping him from dying was the dry!!!! Long story short, he's in remission now with wet canned food.

DO NOT start changing his food until you can get a +2, +3 and +4 . You have to know how low this 3 u is taking Tux. Look at Woody's SS and notice how low he goes then how high, until we get his dose right.

Did tux have and infection at all when he was diagnosed?

 

I wonder if the secret protocol that vets have read is to feed prescription dry food and diagnose diabetes and just keep cat owners in a vicious cycle, and have a steady income. I see red every time I read about a vet telling an owner to feed prescription dry and then have their insulin at an high dose.

And, yes, I can be crude, my old vet just drove by my house driving a 2016 Ford 250 and if I wouldn't have found this forum I doubt that my kitties would have survived to now.

And, he and his wife drives past my house 6 times a day and neither one has called to check on my cats and the last day we saw them was February !!!! They don't even know they have gone into remission.

 

Back from Walmart. A bottle of strips was $81. Sadly, after spending a lot of cash at the vet, I couldn't afford.
Can't do reading until the vet has the strips that I paid already. I got 6 cans of Friskies classic pate.
What's the best I can do for now?

 

15 units insulin!?!?!?!? I am so glad that Woody was saved here. Hoping Tux's dose may adjusted too.
Infection... the vet didn't say anything about that. Tux seems fine besides drinking a lot of water.

 

$81.00 for test strips?

 

For safety I recommend you get a human meter that uses more reasonably-priced test strips. You could get a small quantity of strips to tide you over, and perhaps you may choose to stick with the human meter once you've tried it. The main thing is to be able to monitor Tux and keep him safe.

Walmart Relion meters are very popular with US members here and the strips cost much, much less than the Freestyle and Alphatrak strips.

Just looked at the latest prices on strips from Walmart's website:

Relion Confirm/Micro 100 strips: USD 35.88 (uses a very small blood sample)

Relion Prime 100 strips: USD 17.88 (needs a larger blood sample)

Both meters are under USD 15.00.

http://www.walmart.com/search/?query=relion

If you do go for a human meter then you'll need to check the readings against a cat-specific reference range for BG measurements done on human meters. We can give you all the information you need about this. (Note: when measuring BG on a human meter the numbers are typically lower than on an Alphatrak.)


Mogs
.

 

I don't have strength left to go back to Walmart. No reading.

Tux needs insulin injection at 8pm. I have 30 minutes to decide what to feed him.
Feed him dry Taste of the Wild, and give 3 units insulin. (stay)
or
Feed him dry taste of the Wild, and give him 2 units insulin.
or
Feed Friskies classic pate, and give him 3 units insulin.

 

I would start at 2 units of insulin and feed his regular food

 

DON'T change his food!!! You need to keep the carbs high at the moment until you can sort out his dose.


Mogs
.

 

Tomorrow will be better.


Mogs
.

 

Kako, can you call that vet referral that was posted earlier tomorrow? You should ask your current vet for a refund of your money since you didnt get the strips you paid for and you bought more tonight.

 

Ultimately you hold the syringe.

If it were my cat and I was in any doubt about keeping her safe I have always been cautious about her insulin dose and reduced it. The general maxim here is: better too high for a day than too low for a minute.


Mogs
.

 

@MrWorfMen's Mom, @Tuxedo Mom -

Ladies,

Is there any chance you could keep an eye on @Kako and Tux for a while, please? I've got to sign off; about to pass out.


Mogs
.

 

@Critter Mom

Will do. I'm just going to do a quick check on Menace and will be back here in 5 minutes.

 

I would do 2u and feed regular food is Tux were my kitty.

Please get a human meter tomorrow so the members here can help with the dosing. They are experienced with the readings of human meters.

If you have amazon prime I order my 50 Free style lite strips from there for 32.00. The alphatrax I can get 50 for 52.00

 

Sounds like my pharmacy in town...85.00 for 50 freestyle lite strips. That's why I buy mine through amazon now!

 

Why not just buy a human meter with the cheaper strips and save some money?

 

Because as of now both my kitties are in remission. If those numbers start going up you better believe I will save my strips for readings to give my vet and get a human meter for my use.

And depending upon the cost of the strips, and seeing how walmart is 40 miles away, and amazon delivers right to my door I might stay with my alphatrax 2

 

Ok I'm back and all my kids have had their bedtime snacks! Go rest Mogs!

 

@MrWorfMen's Mom -

Linda, you're a star.

Oiche mhaith, a cara!


Mogs
.

 

Ok... Tux is now eating his regular food, with 3 drops of Blood Sugar Gold.

(((Has anyone tried Blood Sugar Gold? It has many wonderful reviews and some bad reviews.... don't know yet if it works)))

 

Kako, have you decided on what to do as far as his insulin tonight?

You can reduce the dose to 1 or 2u or even just give .5u if you are feeling real uneasy but since you are not testing for ketones yet, it would be best to give him at least a token dose. You can skip the insulin but with those high numbers he's been getting it might not be the best decision. As said above, you hold the syringe and must do what you are comfortable with.

The Blood Sugar Gold is not going to bring his numbers down overnight and I seriously doubt it would do anything even if given for the long term.

 

Tux didn't like smell of the Blood Sugar Gold! He hardly ate, so I gave him another bowl just regular food in it.
Then gave 2 units insulin.

I have been sleeping with him on the couch, touching him all night, to keep eye on him. I will do so tonight again.

 

Just to clarify, Tux did eat his usual amount of food? Is that correct?

 

Yes. Regular food regular amount.
He has appetite.

 

Useful info on buying smaller quantities of strips for some of the Relion meters here:

http://www.felinediabetes.com/FDMB/threads/fur-shot.156732/#post-1662149


Mogs
.

 

If the Blood Sugar Gold works even close to how the manufacturer claims, that might not be a bad thing as you're not currently able to test Tux's BG level. It's a fairly big claim and I have no proof whatsoever that it's accurate, but for tonight I'd say better to be safe than sorry and wait until you have new test strips before adding anything like this. The manufacturer claims that Blood Sugar Gold may heighten the effect of blood-sugar-lowering drugs. Monitor blood sugar levels closely if administering the product with blood-sugar-lowering drugs.

 

I sent a message to the reffered Dr. asking some questions. Thank you for taking time to call your Eugene friend.

 

Hi Kako, Just checking in to see how you and Kako are doing?

 

Good morning! We are fine.
Gave regular food, and 2 units insulin.

 

Thanks for the update Kako!

 

@ Kako In case you are not getting alerts of updates on your threads, I wanted to refer you to your Welcome forum thread because a moderator from another support board with lots of experience with your insulin has provided a very clear concise explanation of what was happening with Tux.

 

Here's a link to the Welcome thread post @MrWorfMen's Mom is referring to:

http://www.felinediabetes.com/FDMB/threads/please-help.156777/#post-1663027

Glad you're both OK.


Mogs
.

 

No problem! I just saw her last weekend, which is why I thought about her to ask. It's a cat only practice, so I hope that's a possitive. My friend said there's another vet in the practice but they've only seen them once. They like Dr Samsell. I hope it works out for you. Also, if this doesn't work out, check OSU vet school. Perhaps they have a study going on or can give a referral. I know it's a bit of a drive, but could be a fallback. Let me know how it goes.

 

I didn't hear back from the Dr. but I spoke with a receptionist. Insulin what they have is Prozinc, some clients do home BG tests. Other than that clear answers weren't given. There are three doctors at the place and it depends on Dr. and Tux's condition. I was recommended to see a Dr. to find if the place would fit us. It would cost $52 so I will wait until next time Tux needs to see a Dr.

 

BG this evening is 582. What should I do?

 

Kako, I know you don't like that number but don't sweat it! You didn't test last night or this morning before his shots and it doesn't appear there were any mid-day tests today so we still don't know how low the 2u is taking him. He may be bouncing which is quite normal and takes up to 3 days (6 cycles to clear). If you can get the suggested +2, +3 and +4 post shot tests in tonight it should give you a better idea of what's happening with Tux.

 

If tux were mine I would give 2u now, feed then get test at +2 +3 and +4 tonight so you know what his numbers are doing.

ETA. Yes Scoobydoox is correct, test, feed at least 30 minutes before shot, then shoot. I am sorry I messed that up. When mine were getting Novolin I would shoot while they were feeding and I had to switch my habit the last week of giving insulin.

 

Kako, I agree with Mum of two felines. I would stick with the 2u and get those post shot tests in.

 

I also agree with Mum of two felines. Without doing the +2 +3 and +4 shots you have no idea is the dose is taking him lower and then he is bouncing back up at the next preshot.

 

Did 2. Since we are testing +2, +3, and +4, no more snacking (his regular dry food) tonight, right?

 

He ate correct? And what meter are you using? Could we get you to put that in your signature along with the type of food you're feeding?

 

Do you usually leave out dry food overnight? If so, then do that tonight. We don't want to muddy the waters by changing his diet right now and the higher carb dry food will give him something to bring his numbers up if he is going lower than he should. We have to figure out the dose, then change his diet.

 

Yes, he ate correct. The meter is AlphaTRAK2. Food is Taste of the Wild (dry). I need advice when to switch to wet food. So please add those info. Thank you!

 

you need to feed 30min before you give a vetsulin shot.

 

I have no experience but my own, so please follow MrworfMens, Tuxedo Mom, and Crittee Mom advice. They have experience you can trust!

 

Kako, it may take a couple of days to figure out exactly what dose is going to work best for Tux, so be patient. One step at a time here. It's the only way to keep Tux safe.

 

People with experience in vetsulin should really be answering Kako. I only have 20 days exp with it. Feeding 30min before shot is a must though. Switching to wet food needs to be gradual while you are testing and keep the dose at the 2 units. Are you still going to a new vet and trying to get lantus Kako?

 

Our Motto "it's a marathon, not a race"

 

MrworfMens and Tuxedo Mom has had experience helping kitties on all types of insulin. They would tag other members if they felt they needed more help.

 

tuxedomom has been asking for a list of members with experience to tag for vetsulin for awhile.

 

@scoobydoox you are correct that the routine should be to feed, wait 30 minutes and then shoot and I believe that is what Kako is doing. As for the diet, we do NOT want to change it right now because we are trying to determine if Tux is getting too much or too little insulin. Until we get more mid cycle tests, there is a suspicion of Somogyi which means Tux may be dropping too low and then bouncing. So until we figure out what the problem is, it's best to not make any diet change because lower carb food could put Tux in danger. Once we figure out what dose works for Tux on his current diet, then the diet can be changed gradually.

 

I used to leave the food all day and night. Total made correct amount per day.
He was allowed to eat morning and night before insulin for 10 days while I was following what the vet says.
Last couple days (since I found this board) I am leaving the food until we go to bed (11pm-midnight), and making sure he doesn't eat 2 hours before morning test.
He can go either way. He ate pretty good amount tonight before insulin. (He ate and munched)
I've been with him, and sleep with him head to head, so I can notice and give him honey in case he shows extream low BG.

 

This was a post @Nederland posted. She has a lot of experience with Caninsulin:

"In the Netherlands we have lots of experience with caninsulin. I've been moderating a forum for diabetic cats for 18 months now, and have learned quite a bit (not yet all, though).

The lowest point with vetsulin (if it is the same as caninsulin) is between +3 and (sometimes) +6, but mostly around +4 or +4.5. Caninsulin is designed tot act fast and has a first peak around the mentioned +4, and after that a second peak at +6/+7. The numbers tend not to rise back quickly, but stay in the 'low' numbers for a couple of hours. Not all cats do that second peak (peak as in peak of the working of the insulin).
Dogs have the lowest point around +6, and some vets think cats are dogs. They are not. A test of a cat 6 hours after the shot is NOT a good base to make decisions on about the dose.

But first needs to be determined whether the dose is too high or too low. If there is a Somogyi effect, the drop will be very fast, and the rising again will also be very fast, to very high numbers. If the 3 units was too much for a longer time, the numbers will hardly or not drop at all (insulin resistance).
You home test apparently. Could you please test the preshot value, a +2, +3 and a +4?"

Her suggestions on testing are very important to get a good idea of how fast and well the insulin is working

 

@scoobydoox many of us would like a list of members using each type of insulin so that when we are unsure of how to advice someone, we can tag/collaborate. Unfortunately we don't have a lot of Vetsulin users so there isn't always someone available. Those of us with some but not a lot of experience try to help and do so with excess caution erring on the side of safety. The dose Kako is giving was given blessing by very experienced Vetsulin people yesterday and today as was the decision not to change the diet just yet. The high level principles of figuring out if the dose is too high or too low are not that different between the insulins. I would not tell anyone to increase their Vetsulin dose because of my lack of experience but I would tell someone to skip a shot or lower the dose in specific situations where I thought a cat's safety was at stake.

 

Well said Linda. The main point is to do no harm. It is better to have a kitty stay high for a day or so until there is more data to justify dose changes, than to advise someone to increase or change feeding habits without the data and risk causing a hypo event.

 

So you haven't been leaving food out overnight anymore and that is fine as long as you get a test before turning in at night so you can see how fast Tux's BG is falling and steer him if need be.

Just be aware that some cats do not necessarily "show" any symptoms of low BG. Testing and knowing how your cat responds to insulin is key.

 

I was told (by the vet) to give insulin right after he ate. So I was doing so the first 10 days. Tonight I waited only a couple minutes after he ate the second time to be sure we have the time to do +2+3+4 test before we go to sleep.
Now on I will be sure to wait 30 minutes!

 

This is very true. My Maxie hit 45 on a pet meter..which reads higher than a human meter...2 days ago and had no outwards signs of being low. If I wasn;t testing I would not have known.

 

I have only been around for a short while, and, Shaak has been in remission for over a month now, so obviously I did not deal with giving insulin for very long, however in a total emergency situation and if no one else better is around, I dealt with Shaak dropping really low a few times and with the great help I got here I became pretty good at getting her back up in safer numbers quick. So I wouldn't mind helping if it were ever needed. I have a pretty good idea on how to feed. I tend to lean towards lower doses if in doubt on the insulin, Shaak was actually on Novolin N and she would drop by +3 to 50 even on less than 1u. That however was after we switched her to wet FF from the terrible DM dry food the Dr gave us a prescription for. Her BG was really high on that stuff and would only drop to about 190 at the lowest on that food. Once we switched her to wet FF and she began dropping below 100 a lot we began to lower her dose, a few hours in we would notice she would crawl back up, but slower each time. She began dropping low enough that we decided it was time to try something different, so we skipped a shot when her previous PMBG was under 150 and fed her every three hours, so 8 small meals a day (we used a rotating battery operated feeder) and discovered she was dropping on her own one to two hours after she ate every time she ate. Once we completely changed over her feeding system to the mini meal every three hours she steadily began to have her BG drop lower and lower. Now OTJ she is always in the 55-68 range.

This is just my experience and certainly don't expect this to happen with Tux. However I have to say, the more diligent you can be, and I spent many a day napping in one hour increments 24 hours a day for a few weeks. It was worth it though. The attention I paid to Shaak got her into remission and I would suggest anyone try the mini meal idea.

Anyway, feel free to tag me anytime you want. I won't advise anything I don't know about, which includes telling someone to up a dose. I just don't know enough. I think I am pretty knowledgable on feeding during low numbers though.

Just my two cents.

extra note: I shot Shaak one hour after eating for every shot. It helped keep her from falling too low faster.

extra note: Never change diet if you are not testing!

 

Ok so starting tomorrow morning, Kako, you should change your routine to test, feed, wait 30 minutes or so and then give insulin. This will ensure the food is in fueling Tux's system by the time the insulin starts working.

 

Just as an example this is the spreadsheet of another newer member whose kitty is on Vetsulin. She has been doing testing at earlier hours. You can see that the preshot numbers AM & PM are all fairly high, but with the earlier testing times you will also see that her kitty dropped quite a bit in between.

https://docs.google.com/spreadsheet...X4zlSydVp1lHXPfeLdxCUaLCc/edit#gid=1225352397

This is why testing in the earlier times when using Caninsulin/Vetsulin is very important.

 

I meant by.... we are testing +2+3+4 tonight so I will know if BG goes down. If it happens I can give him honey quickly.

 

Will do so!

 

Good luck with your testing. I am off to bed for 4 hours sleep but I will check and see how you did in the morning.

 

Kako, I will be turning in soon too so sweet dreams to you and Tux and I too will check in tomorrow . @Tuxedo Mom sweet dreams to you too!

 

I will be writing the numbers on the spreadsheet. Good night! And thank you!