? Caninsulin question

Am I right in thinking that as Caninsulin is an in/out insulin, I adjust the dose according to preshots, as have data knowing how he should react? Romulus appears to be all over the shop. 2 units is usually his dose, but then he will throw a low or high pre shot number into the mix, so I adjust. Am I doing something wrong?

 

Hi Sue,

Caninsulin is technically an in-out insulin in that it doesn't build up a depot in the cat's body in the way that Lantus and Levemir do. In principle each dose of Caninsulin should be out of the cat's system by the time the next dose is due BUT some cats may experience some carryover of effect into the next cycle (or possibly longer). In such instances the current dose would be potentiated by the carryover from the previous one.

When I was treating Saoirse with Caninsulin, I did not use a sliding scale for dosing with the exception of a couple of days when she was transtioning to low carb food (she runs lower at night so I halved the PM dose so I could get some bit of sleep). Using the same dose AM and PM helped me to better know how a dose was working for Saoirse. As she got lower I placed more emphasis on the nadir than the preshot BG level when making dosing decisions.

I had a quick gander at Romulus' spreadsheet data for December and January. Last month a 2.5 IU dose of Caninsulin took him to a very low hypo number (2.7 Alphatrak). He also went to 4.5 (Alphatrak) on another PM cycle; although technically in the normal reference range for a non-diabetic (according to my vets 3.9 - 8.3mmol/L on pet-calibrated equipment) if it were my cat I would be uncomfortable with a nadir that low if she was being treated with Caninsulin - too little of a safety margin.

I notice that you've started a new vial of Caninsulin in the last couple of days. How long had the previous one been on the go? It is worth considering whether the previous vial was losing potency and the same dose from the new vial might be too strong, perhaps.

If they were Saoirse's numbers, I think I would look at whether there were any variations in carb levels if I was feeding her different brands/varieties of food. I would also consider dropping the dose to a level that produced a safer nadir on her lower cycle (night time in Saoirse's case) and give that dose both AM and PM to see if that might even out her responses and yield a better picture of how that dose was working. If that improved things but there was room for manoeuvre on the nadirs, I might then ease up the AM/PM doses by the same amount to see whether that might optimise her regulation.

That's my two penn'orth. I suggest you tag Sue or BJ to have a look at Romulus' numbers. They might be more familiar with dosing Caninsulin on a sliding scale.


Mogs
.

 

@Critter Mom. Thanks for that. The last vial was started on 10th December until 4th January, so not even a month. I will try and shoot consistently at 2 units then and see where he nadir's on that. Not in good numbers if I go by his latest figures. His lowest cycle is the morning one, so I will go on nadirs for that. Not easy when I'm at work and the pet sitter comes in at +4 to test, but I am off until Monday so will give it a go until then. He stays on the same food all the time, so the carb levels shouldn't vary. Not sure who Sue or BJ are so can't tag them.

 

Glad some of the above was useful to you, Sue.

It might take a few cycles for the dose you decide on to settle. Watch out for bounces (harder to spot with Caninsulin's 'cup-shaped' curves, but they do happen).

A note on food: sometimes different batches of the same food can affect BG differently. Being a product with natural ingredients, there is never complete certainty about carb content. Also, sometimes different batches can affect digestion and that can affect BG numbers, too.

For future reference, Sue is member 'Sue and Oliver (GA)' and BJ is member 'BJM'.


Mogs
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There certainly are people who use sliding scale with Caninsulin. And I did that with Bertie.
But there are also cats that generally do better on a fixed dose.
And there are differing schools of thought as to whether or not a dose needs to be maintained for a length of time so it can 'settle'. (My own vet thinks a dose needs time to settle.)
Confusing isn't it?
I guess it probably depends on what works best for the individual cat.

Cats with variable BG numbers can benefit from sliding scale dosage. That was why I tried it in the first instance. Bertie's numbers were all over the place.
(But I agree with @Critter Mom that it could be helpful to try to ensure that the carb level of your kitty's food is fairly consistent so that you can try to have some control over that particular variable.)

Sue, did you actually give Romulus 2 units last night at a preshot of 8.1? (Just wondering if there's an error in that data..?)
If you did give the 2 units at 8.1 then two things immediately come to mind. Firstly, that pre-shot number was too low (it was a normal blood glucose number on an Alphatrak). And secondly, it was a falling number: There was no indication that the blood glucose was actually rising. I managed to give Bertie his first ever hypo by shooting a falling number, so I'm kind of cautious about that kind of thing!

It must be tough going managing TWO diabetic kitties.
Huge hugs to you for all that you're doing for them.

Eliz

 

I did shoot 2 units on Rom last night. The thing is I know that, falling number or not, food spikes Rom hugely for a couple of hours then the insulin seems to kick in. That's why I tested at +4 and gave him his final meal. I tested again later and as expected was on the rise. If I hadn't given him his dose, he would have been in the high 20's this morning. (I've done that before!). Plus his lowest cycle is his morning cycle (he's never gone too low at night as far as I can remember) so his PMPS is usually on the low side compared to AMPS.

 

Is that all food, Sue? Or just some foods? Any chance he has a food intolerance....?
.

 

It's all food unfortunately, the food he is on now just spikes him less than everything else, although it's still a lot.

 

[QUOTE="Sue484, post: 1576013, member: 12546"]... food spikes Rom hugely for a couple of hours then the insulin seems to kick in.[/QUOTE]

And how! I spotted that on his spreadsheet. Reds at +1!


Mogs
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I saw on another post the 11/13 schedule where AMPS is consistently higher than PMPS. Do you think this is suitable for Romulus?

 

I replied on the other thread, Sue. 11/13 might be an option. Can you get a curve in this weekend so you have a better idea of how he is reacting overall. The food reaction is wild - never heard a cat with that big of a change.

If you get a low pre shot, you can always stall to be sure the number is rising. Wait 20 minutes without feeding and retest.

 

Too late for a curve today and I am busy tomorrow, so it looks like I will have to postpone for another weekend. At least he can get into normal numbers when I vary the dose, so it can wait another week.

 

Some ya lose, Sue.