Dosing help..need advice URGENT

Hi guys. Once again Sam is keeping things interesting. Decided to do a curve today and see if her insulin is still working and the correct dose.

-Fed her Purina DM dry this morning at 7 am and she tested at 245 BG
-Gave 1 unit of Vetsulin at 7:30 am
-Sam vomited between the injection and +4 BG
-BG at 148 at +7
-BG at 91 at +10

I planned on giving her her insulin at 6:30 to get back on the work schedule for the rest of the week but I think 91 is way too low for a full 1 unit even after she eats.

I assume she is dropping so low since she vomited earlier in the day and doesn't have enough food in her system to slow the insulin's drop?

Is it better to give a half dose or quarter dose than none at all to try and keep her pancreas happy?

 

Indeed 91 is too low for full dose. Post your PMPS tonight and someone should be able to help . I don't want to give advice when I can't stick around

 

Thanks Yong. 91 was pretty much her PMPS it was at 10.5 hours. I need to give her the injection at 6:30 pm Central to get her back on our work schedule. Or I could wait until 7:30 and retest then she could get the insulin earlier tomorrrow morning.

 

You could test again at 7:30 your time and see if her BG rises enough for a shot. If her BG is still low I would skip shot and wait until morning. That's just what I would do if she were my cat,

 

What level would you say would be high enough? She already ate so I know it will be higher

 

Usually we tell someone new to the board not to give a shot if BG is under 200. Vetsulin can drop BG fairly quickly so just be mindful of that.

 

I see that the 91 was at the end of the cycle so it doesn't appear she dropped too fast. You don't have a lot of data just yet so I would err on the cautious side. Could you test her and post BG? You said she had already eaten so her BG will be higher. I would give either a reduced dose or skip shot for tonight depending on her BG. Its hard to give dosing advice without knowing her current BG.

 

I use cansulin. Canada's version of vetsulin. Once I started feeding Charlie high protein she is only getting micro doses now. The #s I've seen are good early on. Just not enough info. Before I tested at +3 +4+5 ect... Charlie might have been slightly hypo. she ate alot during the day. Then was not hungry at night.

 

Smoky reacted in this same way when he was on vetsulin

 

I'm going to test in a minute since she ate and see where she is

 

Her BG at exactly 12 hours from injection is now 72. Plus she ate a little middle range carb food. Going to syringe feed her some Hill's A/D and make sure she doesn't go lower.

 

72 is a good #. That's a normal BG Reading. Does she like wet food at all? Charlie has improved so much since going to high protein.

 

She is super picky and seems to like the A/D but will only eat it off of my finger after I syringe feed her some. It's like she doesn't realize its food until I put some in her mouth. Even then, she wont eat it out of a bowl.

 

How long has it been that way? Not eating well

 

Did you try feeding her some wet food off a dish raised slightly off the floor? When smoky was nauseous I gave him wet food off a flat plate a few inches up from the ground. Is there a chance she might be nauseous?

 

Wow, interesting. By now the canisilun is out of her system, so you don't have to worry about hypo, but you do need to make sure she's eating enough. If she's still of eating tomorrow id bring her in and have her tested for pancreatitis or some other reason for her lack of appetite.

 

At the end of 12 cycles, Caninsulin (Vetsulin) should be out of her system. Congrats on your first NS . Definitely want to get a before bed test though to see how she's doing on her own.

 

Yea I know the insulin should have run out at 12 so that's why I was worried she might be going lower and possible hypo.
Got her to eat a syringe and a little more of A/D. Just checked her BG and she is 126. I feel like I can sleep now. I will check her BG in the morning and go from there.

 

She developed some ulcers I her mouth that seemed to be the reason she stopped eating a few weeks ago. I have a thread about all of that if you are interested. She hasn't eaten 100% like she used to since but I figured that was because BG was better regulated and her mouth was still not 100%

 

Sorry that should have said "At the end of 12 hours" lol. I was thinking 12 hours in a cycle and being tired combined them. Glad you can get some sleep, I'm going to do the same! 126 isn't bad for a couple hours and eating . If she gives a similar PS tomorrow morning, you may want to give a reduced dose.

 

Lol. No worries. I understood what you meant.
Yea, I thought 126 with food and no insulin was pretty good! Thanks!

 

A cat with no insulin in their system can't hypo.

 

Thanks Janet. I thought that was the case but it seemed like it was possibly still in her system for some reason. She is back at 297 this morning.

 

Andrew, that's really not that bad considering her NS last night . Since it's probably a slight bounce, may have been better to slightly reduce her dose this morning. BUT I think you already gave her insulin, so can you get a mid cycle to see how she's doing? It's what I meant last night but I clearly see I had a couple miscommunications

 

The issue is because of our work schedule, I test and feed Sam before I leave for work and my wife gives her the shot before she leaves. That all takes place at 5:30-6:30 am. I get home first which is usually about 5 pm. It's difficult to get mid day because I have to miss work to go home at lunch and do it. I may try today since she may be bouncing just to get a data point for the SS. Thoughts?

She did eat the AD out of her bowl this morning after I held up to her to smell for a few seconds. Hoping that means she will start eating it on her own.

 

It's good you guys can work as a team to do the shot schedule! Mid day numbers may not be possible often, but if once or twice a week you could get a +4-6 at night that might help, and if anyone is home weekends, so checks and curves then. . If he gets a shot at 5 pm and you could get a 10 pm test before bed that would be good.

 

Yea, weekends are the only time we can do curves. I try to give her her shot at around 6:30 pm to try and keep them at 12 hours apart. I know I have a little wiggle room with the Vetsulin

 

Sam's numbers are higher than normal today. I assume she may have eaten some of her dry food within 2 hours of me doing her +5 test.

My wife accidentally fed her at 5 instead of waiting until 6 so her PMPS was after she had eaten so it was higher naturally. Just can't seem to get a good routine going.

On a side note, Sam ate her AD from the bowl on her own both AM and PM, ate her dry food during the day, and drank from her brand new water fountain. At least she is cooperating with the food now and drinking water on her own again.

 

It's OK to feed before mid day tests, just no food 2 hours prior to the preshot test so the number is not food influenced to make sure it's high enough to shoot.

 

Can you give fancy feast classic as amid day meal instead of the dry? Because unless it's Young Again or Dr Elsley's it's high carb.

 

Ah I wasn't 100% sure if you might be off today too . Looks like you went home at lunch to get a test and she's spending a little time on the trampoline, as expected. So no need for a full curve every weekend but definitely use those days to get more mid cycles and during the week you can try to get some before bed tests (usually between +2 and +4).

There was a discussion to getting a note system down to communicate between two caregivers but I can't find it and I'm sure you and Cassie can figure something out on your own .

 

I'm waiting on some more Dr. Elsey's to come in tomorrow. All I have is Purina DM right now.

 

I normally text her from work and let her know Sam's BG before I fed her and if she should get insulin or not.

 

Sam is at 148 this morning and ate some Hill's AD before I left. I'm thinking half of her normal insulin or less? @JanetNJ @Yong

 

If you aren't going to be home to test I would say either skip or do just 0.25. I think 0.5 might be too much... That's a really low preshot that you have no data for

 

Thanks Janet! I was thinking .25. It just seems like she is bouncing the last two days and I don't want to skip completely and lose any ground. The bouncing is from having too high of a dose correct?

 

generally yes. You could try 0.75 when the preshots are in the 200's.

 

Thanks. You and many others here have been so much help. I don't think I could have done a good job with Sam with just the vet.

I feel like Sam is getting close to being regulated with her diet and minimal insulin. I think I will try and step down to .75 when her pre shots are in her normal range of 200-240.

 

I agree.... Sam is doing well!

 

Just seeing my tag, Andrew . Is there a chance for grabbing a test at lunch today? Would be nice to see how she's doing with 0.25U on your lowest PS yet .
I like the idea of trying the lower dose of 0.75U when she goes back above 200 PS range

 

My wife is actually home sick today so I will try and get her to test at +6. She is late on giving her insulin though. Sam ate at 5:30 and she is giving the shot at 7:30.

 

Try to have her give Sam a little snack, like 1-2T of some wet food since she last ate 2 hours before shot. I know you're still trying to get her off dry so if she absolutely won't eat the little bit of wet food, give 1T of dry food. Hope your wife feels better!

 

Well, wife is still miserable and in bed so Sam didn't get a shot. Just going to have to wait until this afternoon to get her insulin.

 

I would just wait until her PMPS schedule otherwise you will mess it up and have to go on another new schedule. Could use this morning's NS to get you back on 06:30/18:30 schedule tonight.

 

That's the plan. She hasn't eaten since this morning and her BG at +6 of feeding is 219. Seems pretty good without insulin.

Whats your thoughts on afternoon dosage?

 

Definitely not terrible without insulin since yesterday morning . If she stays above 219 for her PMPS, I think you're OK to try the 0.75U. If she's lower (<200), go ahead and post as soon as you get the test and don't feed right away. Are you CST zone? I will try to hop on as soon as I get my boy set up. If you're testing at 18:00 your time, that's the same time I'll be getting my boy's PMPS

 

She got 1 unit of insulin last night but none this morning. Will do. I am in the CST time zone. I will be testing about 18:00. I will post here. Thanks so much!

 

Ah right, I was thinking the other night with NS . Ok, yes you're test will be happening about same time as mine but it will be 19:00 here

 

Sam is at 280 this afternoon. Going to feed and give a shot about 30 minutes after. Does .75 of a unit sound right? @Yong

 

Yes 0.75U and try to get a before bed test

 

She seems to be only wanting to eat a little bit of food. How much wet food do you normally feed? Sam is 10 pounds and seems to only eat 2 1/2 tablespoons of food at a time. Sometimes not all of that. I know the AD is calorie dense so maybe that is why. She has always been more of a grazer throughout the day than a 2 meal cat but we have had her on 2 meals a day since the diagnosis. I don't mind leaving food in the bowl all day but there is no way for me to know if she ate within 2 hours of her PMPS everyday when I get home from work.

 

There is an automatic pet feeder that you could use and have it close 2 hours before her PS. Most kitties don't do well on 2 meals a day, it's an old school of thought. @JanetNJ can confirm if 2.5 T of food is enough for Vetsulin.

 

Not sure. Ad is high in calories but if the cat is dipping low you may need to lower the dose until the appetite improves.

 

Are you testing for ketones?

 

I have been trying to catch her going to the litter to check, but haven't been successful. She has never tested positive for ketones though.

She ate some more food about an hour ago and I tested her again since I am going to bed. Her BG was 374. I'm hoping this is because of the food she just ate.

 

Sam came in at 188 PMPS. I don't have much data on how she reacts on Prozinc since we just switched to Prozinc. I want to still give her .25.

I'm stalling her right now and about to test again. Suggestions on dosage? @Yong @Kris & Teasel @JanetNJ @MrWorfMen's Mom

 

Withhold giving food for 20 minutes and retest

 

@Yong Stalled and retested and she is at 177

 

Since it's a work night, you wouldn't be able to monitor her past +3 right? I'm leaning towards skipping because it's a new insulin AND she's never had a dose below 200. Still get a before bed test as I'm thinking she may bounce but never want to assume and don't want you try to give her a <0.25U yet.

 

I agree with Yong's advice.

 

I can probably get a +4 at the latest. She didn't eat as much as normal just now. I agree with not giving the shot. I just didn't want to start the bouncing all over again.

 

Skipping is a safe option. At least you won't have to worry about it. If you are around id say do 0.25 or just slightly under.

 

Another good AMPS. 186 She didn't drop much the other day with .25 dose. Thinking .25 or slightly less than that. Skip and see if she stays 180-240?

 

Sorry no one was around to provide any input this AM. I see you decided to go with the 0.25u. Let's see how that works today and it will be good data for going forward. If you get a lower pre-shot than expected like today, then you can stall without feeding and retest to see if Sam is staying flat or rising. If she is staying flat you can stall a second time if time permits and then make a decision. If she is rising and is close to 200 then 0.25u might be OK but let's see what she does today.

 

Yea, it didn't seem like she dropped too much on the .25 and she stayed at pretty good numbers the last 24-48 hours so I figured we would see how she reacts to the .25 on a lower number. She is at 242 at +3.5 so she hasn't hit the biggest drop yet. My wife left some food out for her if she needs it. I may go check on her at lunch which would be +6.5

 

Sam is cranking out 180-190 AMPS lately. I gave her .25 again. If my wife is home again today I will get her to take a +6 and see what is going on at NDAIR. I tried yesterday but she must have eaten some of the food my wife left out for her before I got home.

Good thing is Sam seems hungry again at AMPS and PMPS and sometimes cries for food around lunch. She seems more alert and playful so I think we are on the right track. We are leaving town tomorrow and have a sitter coming by to feed her and hopefully give insulin. Sam isn't the friendliest when it comes to new people and she was hissing at the sitter yesterday. The sitter is a Vet tech so she may have just smelled the other animals on her.

 

wow, Sam is doing SO GOOD. enjoy your trip!

 

Thanks. Hoping we can stay on track and hopefully get into remission one day!