Dosing advice

Discussion in 'Caninsulin / Vetsulin and N / NPH' started by smidge&smudge, Apr 2, 2017.

  1. smidge&smudge

    smidge&smudge Member

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    Again thanks to the wonderful people on here, if it weren't for the advice that I received when we were struggling at intial diagnosis I'm not sure I would still have my kitty with me.

    So now throughout March Smudge's numbers have been trending down, today they were at the lowest, I haven't been putting them on the spreadsheet but did put it on today. I think it's time to lower her dose?
     
  2. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Yes, that 47 tells you that 2 u is too much at this time. Maybe try 1.75 u? Are you using a human meter? I'm asking because "too low" cut off is 50 on a human meter.
     
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  3. Tuxedo Mom

    Tuxedo Mom Well-Known Member

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    Since you don't have a lot of data lately and with a lower than usual (as far as the spreadsheet shows) preshot these are the suggested guidelines for Vetsulin:

    "
    Q4.4. My cat's pre-shot level was way below the usual value. Should I give the injection?
    A4.4. There's no hard and fast rule, but if you don't have data on how your cat responds to insulin, here are some general guidelines. Below 150 mg/dl (8.3 mmol/L), don't give insulin. Between 150 and 200 (8.3-11.1 mmol/L), you have three options: a.) give nothing; b.) give a token dose (10-25% of the usual dose); c.) feed as usual, test in a couple of hours, and make a decision based on that value. Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise. In all cases, if you are reducing or eliminating insulin, it's wise to check for ketones in the urine. Above the normal pre-shot value, give the usual dose, but if the pre-shot value is consistently elevated, it's a good idea to schedule a full glucose curve to see whether a change in dose or insulin is appropriate. In most cases, the target "peak" value should not be below 100 mg/dl (5.6 mmol/L), and for some cats it might be higher. Keep in mind that these are general guidelines, and they should be personalized to your own cat's reactions to insulin. If your experience is that your cat does not became hypoglycemic with a dose which is close to her usual, then your experience should be your guide."

    http://www.felinediabetes.com/FDMB/threads/vetsulin-caninsulin-user-guide.302/

    I would tend to be more conservative with a lower pershot when using Vetsulin since it is faster acting and can bring numbers down quite quickly with many kitties.
     
  4. smidge&smudge

    smidge&smudge Member

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    Hey there, hope you are doing well! I thank you so much during my crisis time when we were struggling!

    I use the relion confirm, that was the reading. Strange throughout March her amps pmps were starting to go down to the 300s and in this last week in the 200s. Not sure why her bg is going down so quick. I had to dose her just a bit ago and gave 1.5. I hope this is a trend, thank you I feel so much better now!
     
  5. Tuxedo Mom

    Tuxedo Mom Well-Known Member

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    If you gave a dose of 1.5 units with a lower pershot, please get a +1 and +2 test to make sure you can catch any big drops early.


    ETA It would also be helpful if you could fill in some of the data from the last week or so to give a better picture of how the insulin is working
     
  6. smidge&smudge

    smidge&smudge Member

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    Jan 27, 2017
    Thanks Tuxedo Mom!
    Unfortunately I don't have a lot of data last week other than the am/pm which have started to show in the mid 200s. It's strange just when I thought I found the perfect dose at 2u she throws me something else! I will check for ketone when she pees, though she dropped so low honestly, her behavior and demeanor were normal?
     
  7. smidge&smudge

    smidge&smudge Member

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    I have the reliom ketone test strips, hope they are reliable.
     
  8. smidge&smudge

    smidge&smudge Member

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    These
     

    Attached Files:

  9. Tuxedo Mom

    Tuxedo Mom Well-Known Member

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    A kitty's needs can change which is why consistent monitoring is needed. If all you have is the AM and PM preshots then you could add that to the spreadsheet. Dosing needs can change on a daily basis. Since insulin is a hormone you cannot always predict what and how it will work.

    Do get tests in at +1 and +2 with that lower preshot. :bighug:


    Relion meter and strips are fine. Many if not most of the US members use the Relion.
     
    Last edited: Apr 2, 2017
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  10. Tuxedo Mom

    Tuxedo Mom Well-Known Member

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    With Vetsulin you ideally would like to know just how low the dose is getting Smudge. As you can see from today's number that 2 units got the numbers down too low, so it is definitely too high. Without more current information with AMPS and PMPS and some mid cycle tests, it is very hard to say how much would be a good dose. The guidelines I posted above would have suggested even skipping this shot, without more current data so do make sure you get those early tests in.
     
  11. Tuxedo Mom

    Tuxedo Mom Well-Known Member

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    You may see higher numbers tonight from hitting that lower 47 this afternoon. If you do see higher numbers don't be concerned...that would be a "bounce" which is normal when a kitty hits a lower number, or drops a lot within a cycle.

    I won't be around for much longer so if you do have any problems or concerns you can edit your title and add the red "911" icon to get quick attention.
     
  12. Tuxedo Mom

    Tuxedo Mom Well-Known Member

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    @smidge&smudge

    Did you get a +1 test? I am just a little concerned with shooting a lower than usual number, especially with Vetsulin.

    I will be signing off in just a couple of minutes but if there are any problems see my post right above this one.
     
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  13. smidge&smudge

    smidge&smudge Member

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    Just did a test it is at 250 which is even a bit higher than todays pmps! But I read what you had said about a bounce. She lucky she is so cute, because she is driving me crazy! ☺
     
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  14. Kris & Teasel

    Kris & Teasel Well-Known Member

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    I'm glad you got a 250. I'd do a few more tests to see where she goes. I apologize - I should have paid more attention to the blue PMPS but was too focused on that lime green. If at +2 she's lower than you'd like I suggest you give a teaspoon of high carb food to steer her away from too big a drop.
     
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  15. smidge&smudge

    smidge&smudge Member

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    Thank you ☺
     
  16. Tuxedo Mom

    Tuxedo Mom Well-Known Member

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    Glad to see that Smudge didn't drop down low again last night. Since the preshot numbers have been dropping down lately it would be good if you could keep the readings up to date on the spreadsheet in order to make it safer to give dosing advice. If she is bouncing the numbers may be a bit higher for a day or two, but you do want to be cautious about the dosing if she is showing those sort of lower numbers especially if you are not home to test during the day. :bighug:
     
  17. Kris & Teasel

    Kris & Teasel Well-Known Member

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    I agree about needing to keep your SS up to date. It seems that your girl needs a dose decrease but we need data to judge it better. I'd also aim for changes of 0.25 u at a time unless numbers indicate otherwise. How was she the rest of the evening?
     
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  18. JanetNJ

    JanetNJ Well-Known Member

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    Oh I see she went into hypo numbers yesterday.... I am glad you caught that. Did you steer it up? Because she still had an hour or more to drop. She could have been in very dangerous numbers n.
    2 u is way too high a a 200 preshot. I would have said 1 u... What is the preshot this morning?
     
  19. smidge&smudge

    smidge&smudge Member

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    Sorry not sure why I wasn't getting notices, I know I shouldn't have gave her a shot, she was 251 this morning and I gave 1.5, not knowing what to do at the time, she did well last night, but she was super extra hungry this morning! I will post later before her normal pmps time maybe if anyone is on maybe they can let me know, but if not if I gave her 1.5 this morning, if she is under 200 don't give her a shot tonight?
     
  20. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Did you get any more data last night? Did you give 1.5 u this AM? If you could update your SS ASAP it would be very helpful.
     
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  21. smidge&smudge

    smidge&smudge Member

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    Oh geez! Just got home (about 5:10 pm) and tested and she is at 450! And this was before food. Extra pee as well. We haven't had a reading that high in weeks. I fell asleep last nigh so I wasn't able to get anymore readings. I am going to test again at arounf 700is and see where we are.
     
  22. JanetNJ

    JanetNJ Well-Known Member

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    that's a bounce from the hypo yesterday.
     
  23. smidge&smudge

    smidge&smudge Member

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    I know, it's weird?
     
  24. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Actually, bouncing after a low number is quite common. What can vary a lot from kitty to kitty is how high the bounce is and how long it lasts, anywhere from, one cycle to 3 days. Gathering test data is the only way to track its progress.
     
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  25. smidge&smudge

    smidge&smudge Member

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    If anyone is on, just rechecked and she is at 359
     
  26. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Her high numbers today are bouncing and don't give an accurate view of what the 1.5 u dose can do. I suggest you get a before bed test tonight. That test plus the AM pre shot test tomorrow will have to be used to decide whether you stick with 1.5 u or not.
     
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  27. smidge&smudge

    smidge&smudge Member

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    Thanks Kris! Just tested at 318, we'll see what tomorrow brings☺
     
  28. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Still bouncing. If it continues tomorrow AM you can keep the 1.5 u dose a bit longer.
     
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  29. smidge&smudge

    smidge&smudge Member

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    Updated spreadsheet, sticking with the 1 or the 1.5, good idea?
     
  30. Kris & Teasel

    Kris & Teasel Well-Known Member

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    I think you can stay at 1.5 u. There's still some bouncing going on. It can last up to 6 cycles (generally) and this is now cycle 5 or 6 since the green/blue cycle. Can you get a test or two between +3 and +7?
     
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  31. smidge&smudge

    smidge&smudge Member

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    Thanks for your input! Thanks, so I am going to give her 1.5 now, unfortunately I won't be able to do another until +8 because of work, but will updatemy sheet, hope this is a trend!
     
  32. Kris & Teasel

    Kris & Teasel Well-Known Member

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    I like that blue you got yesterday. There's lots of room to go lower though. I suggest that after today you raise the dose to an eyeballed 1.75 u (not 2 u because of that lime green a few days ago). Aim for a +8 test weekdays if that's what your work schedule allows and another evening test as late as you can manage before bedtime.
     
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  33. smidge&smudge

    smidge&smudge Member

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  34. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Big black bounce number! You need more data to see what's going on. Maybe keep this dose and do a curve on the weekend?
     
  35. smidge&smudge

    smidge&smudge Member

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    I know! Now yesterday I had some car trouble and didn't get home until way later than usual so I freaked out and ran to give her medicine and was nervous and in a hurry that I think she didn't get it all and felt some wetness. I just gave her 1.75 and hopefully her pm will be way lower, I am so hoping.☺
     
  36. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Yes, life gets in the way, doesn't it?! How about a curve on 1.75 u this weekend? :)
     
  37. smidge&smudge

    smidge&smudge Member

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    I'm going to get more readings on Saturday, only have one place to take the kids on satuday, so can't do a full curve but can do a lot more readings. Sunday, oh between two egg hunts, boy scout hike, etc. I'm going to get in as many as I can tomorrow. Again thank you I do need help!
     
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