? Dosing help?

Could someone please assist in figuring out what dose to give Dennis?
He was wildly unregulated (very high) so a few people here advised me to stick to his 7u dose for at least 6 doses in a row (I was increasing and decreasing a little when I felt it was necessary).

He'd been doing great. He is due for the 6th consistant dose in a row at the full 7units but his BG is only 297. Usually he's OVER 600 which is why he was put on 7units. A couple nights ago he was at 414 before food and I gave him the 7 units and he dropped to 210 at +6 so I know he will go too low if I give him 7units now..... His chart is updated and he is due for insulin in a half hour. Any help would be appreciated.

My most recent post for reference:

http://www.felinediabetes.com/FDMB/threads/bg-still-high.163977/#post-1766019

 

Can you monitor this evening?

 

Yes, I can through the full 12 hours. I'm prepared to give him snacks through the night as needed to keep the BG from dropping too low but a full 7u will drop him much too low.

 

ok, if you are able to monitor you could try 6 units, or 5 if you are not comfortable with 6, but if you can grab some readings through the night that would be really helpful. I am in a totally different time zone so won't be able to look at them in real time but if you can keep the readings updated on the spreadsheet I can have a look before your APMS. We may be starting to turn the corner and be able to slowly start reducing his dose if he has a decent number at AMPS, don't be tempted to reduce too quickly though. Make sure you post his AMPS as I will be around at that time.

 

What you are looking for overnight is a blue number at +6 with a small drop at +2, if he seems to be dropping too fast you can steer the numbers with a small snack but if the +2 seems ok you can monitor and intervene if he is getting a steep drop.

 

Would you suggest taking his BG once an hour as it begins to drop?

 

I think I'll do 5 units......looking back on his numbers 6u would even be too much insulin.....but what are the consequences of giving 2u less in a dose? Is there some sort of rebound?

 

We know his nadir is around +6, so you could do a +2, +4 and then hourly until it starts to rise again. If you have a steep drop at +2 then switch to hourly from then. What I am hoping is that he won't need any intervention overnight and you are likely to find the AMPS higher again but still in the 400s and shootable with a 7 unit dose. By being conservative with dosing hopefully he won't bounce, which is what you don't want to happen, but we do want a comfortable number at AMPS so we can bring him back on track.

 

Okay that makes sense. I hope he doesn't bounce- he's been doing so well this week while he's been on the consistent 7u.

Thank you so much for helping.

 

That's what we are here for - just keep that spreadsheet updated!

 

Is Dennis a high dosed kitty? Because there are some ways to handle these kind of numbers. 7units is much insulin so that's why i'm asking! Also because it's not in your signature.

 

Dennis has not been tested, but his doses did rack up quite quickly so trying to ease him down again. I think there is a degree of insulin resistance going on but he is responding and hopefully this is the start of getting those dose back down again. More information in the previous thread.

 

His vet is trying to figure out if he's a permanently high dose kitty. When he was diagnosed a few months ago he was put on 1 unit of novolin and he was regulated perfectly. He climbed un to 3 units as his BG rose steadily. He stayed a 3units comfortably until he began to be in the 600+ zone before food.... Switching him off dry and wet D/M, and changing his diet to very low carb has helped a bit, although (with the exception of this week) was always above 600 before meals/insulin.

I think part of the problem was on my end. I would alter his dose a little if I felt that he was too low to get the 6u of vetsulin he was eventually put on. Since being consistent with the new 7u dose this week, I have seen improvements.

 

I have been monitoring Dennis's spreadsheet but can't see what you gave this morning? I think the high number was a bounce from those nice blues yesterday, how far are you from his PMPS as I think we can make another dose adjustment?

 

This morning I gave him the usual 7u. I just updated the chart. PMPS was about a half hour ago....BG was at 433 so I stuck with the 7u.
I'm VERY concerned that he was 157 at +6 but by +12 he was over 600 again.....I'm not really understanding why there was such a drastic jump in such a short amount of time.....
I'm worried that we were making progress but that we no longer are.

 

He is just not used to those blue numbers so he did a 'bounce' basically the body has a panic and releases glucose from the liver to bring the numbers up. It is because he has been high for such a long time. His numbers look fine so stay with the 7 for now, we are making progress - it was just one number, but he had 2 yellow pre shot numbers recently which is much better than before. How is he?

 

Okay, I hope that's what's going on. He's acting the same as he usually does when his numbers are high- kind of like he's down in the dumps...also drinking a lot and always thinks he's starving.....but no shaking! Yesterday, after a couple days of improved BG's, he was playful for the first time since he was DKA; it was fantastic to see him playing and running around!
The only other weird thing is that he's had odd poops lately. That's concerning me too, but I asked for some thoughts on a seperate post so I'm working on that.

With what you're seeing, do you think his BG is going to stay in a more acceptable range that it has been? At this point I'd be thrilled for him to be consistantly in the 400s before insulin- that would be a huge step!

 

That's what we are working towards, it will take a little time but he can do it, I am hoping he will earn a dose reduction soon and stop bouncing.

 

Dennis's numbers are looking good in the past 24 hours, if he is in a red number at PMPS how would you feel about trying a dose reduction?

 

If your vet really wants to know, he needs to draw blood for testing for acromegaly and IAA....the only place that does that testing is Michigan State University so your vet draws the blood and ships it to them...In about a week, you'll know if he has one of the "high dose conditions" or he's just going to be a high dose kitty

 

I had no idea. Thank you, it sounds like that could save me from a future full of unnecessary vet visits/tests/expenses. I'm going to call and ask about that!

 

He's at +11 right now and his BG is 295. I'm guessing he will be in the mid 300's when it's time for insulin. I'd like to reduce the dose but not so much that he bounces back up again...... Let's say he's at 350 in an hour....I'd LIKE to go from 7u to 5u but last time he was at 300 and I went down to 5u and but his next dose he was at 499..... Maybe I should do 5.5u. If you have any thoughts please let me know.

Also, here's an unrelated question.....lately, when I prick his ear (on the edge, where the vein is), there's either very little blood or it gushes blood all over the place. I'm wondering if you think that's normal? It stops bleeding after I apply pressure for a minute but I feel terrible!

 

Dennis's numbers are looking a lot better and what I was going to suggest is to reduce now to 6 units twice a day and try to hold that dose for another 3 days, his last few days numbers are good and his numbers now need to even up a bit between am and pm. The 7 units is now pushing him down quite a lot so I think he has earned a reduction. If he is under 400 at PMPS then 5.5 units sounds very reasonable.

Not sure about the ear question - I test using the paw pads but temperature seems to make a difference, and bizarrely - so do the numbers.

 

You may be accidentally hitting the vein when you get gushes....although it's also a possibility that you're just hitting a really "good" spot....as we poke more and more, new capillaries grow into that area....you could just be hitting that spot where there are lots of capillaries

 

I'm not sure if you'll see this soon, but Dennis is ready for his next dose but his BG is only 226......If I lower his dose too much I'm assuming he will rebound tomorrow, but he's CLEARLY too low for 7u.....I'm not sure how much to give :/

 

Its good news that he is dropping, maybe try a 4u as he dropped into the blue with a 5u a few days ago. Also you must reduce in the morning to 6u or possibly 5u as we may now be able to bring him down in dose a bit more. 7u is now too much which is good news.

 

Thank you! I'm so glad you responded so quickly. I think 4u would be good, although when he was at 286 a couple nights ago I gave him 5u and he rebounded to "HI" by the next morning. I feel like I'm starting to mess with his dosing too much. Oh boy.
Do you suggest dropping him in the morning even if his BG is high (like in the 500-600+ range)?

 

Yes he is starting to respond better to the insulin and we need to bring those morning doses down.

 

Hi Alexi,

Just on a flying visit to the board at the moment so want to give you my take on Dennis' data. I think the Caninsulin dose was upped far too fast in the early stages (compare response on 3IU BID dose 7-8 July with flat black BGs on 5IU BID on 15 July. Also look at the AM cycle on 19 August; 1 unit produced as good a nadir reading as 6 or 7IU has in recent days.

If it were my cat I'd drop back to 4 or 5 IU bid for a few cycles to allow time for any possible bouncing to clear and see how the land lies (obviously testing daily and digilently for ketones and being ready to increase the dose should the data support it). I'd also look at adjusting the dose in smaller increments than 1IU (safety permitting) once a more productive and positive insulin response is achieved. Also if it were my cat I'd be seriously looking at changing to a long-acting insulin.

Hope some of the above musings will be of help to you in your work to support Dennis and his bean.


Mogs
.

 

I agree it looks like a prolonged bounce, I am not clear if Dennis had ketones at one point, hence the cautious reductions, but it would *cough* help if his bean kept his spreadsheet up to date as I am monitoring it.

 

I've been updating his data each time I test, which is every 1-2 hours....are these updates not reflected on the spreadsheet? I'm seeing them on my end.
I think we're doing well on 6u, and I agree that I'd like to get him down further. He's on Vetsulin though- is that the same as Caninsulin? Unfortunately, the long acting insulins seems to be way too far out of my budget so I'm doing the best I can with this insulin.

So what exactly is a prolonged bounce and what does that mean for the immediate future?

 

For some reason it hasn't updated in real time - I've just reloaded it and I'm now seeing recent numbers - apologies. Vetsulin and Caninsulin are the same insulin. Basically his numbers have been high because the dose has been too high for him but the last 2 pre-shot numbers look good, no more red or black so you can continue to reduce the dose cautiously to keep the 2 pre shot numbers evened up. You are looking for blue mid cycle numbers, they may not happen every cycle but they are coming in.

Just hold the dose rather than increasing if you see high pre shot numbers as that will start him bouncing again. You can reduce every 3 days provided you continue to get good numbers.

 

Have you considered getting your insulin from Canada? Most of us here are buying our Lantus/Levemir from Marks Marine Pharmacy because it's so much cheaper than here in the states. All the information on it is in this "Insulin from Canadian Pharmacies" thread

A 5 pack of Lantus pens is 1500 units and will last up until the expiration date on the box...usually at least 2 years away and for only $149.99 plus $25 shipping, it's a lot more affordable

 

Okay thanks. I don't want to alter the dose too quickly so I think 3 days is a good time frame.

Thanks! I've heard that the shipments don't always make it to the US- do you know if that's true? Even though it's cheaper in the long run, I couldn't spend that much until I knew the insulin would definitely work well for him. I'd have to buy a bottle before hand. I think I have to use up the Vetsulin I have left before I switch. I'm also making weekly payment plans to the vet to clear up my $700 outstanding balance I can't get ahead financially right now.
I'll look into switching him in the near future and buying from Canada- hopefully I'll be able to do that instead of spending so much on Vetsulin so frequently.

 

just joining in....

trying to read all your info....

@Wendy&Neko is a great source for acro cats and high dose issues....


I can give you a vial of lantus if you would like to try it..... you'll have to "start a conversation" with me and give me your address privately. I can mail it to you on monday.... you should have it in two days....
that's why I mail it on monday so there is no weekend involved in case it doesn't get there in the 2 day frame.



on the food you mentioned, I am fairly certain it is higher carb than you want with his diabetes.
all the canned ones in that variety are too high..... so dry would be too.

there is one dry that is low ( and I can send you a sample of it to make sure your cat likes it) but it will cost you
$25 for an 8 lb bag) but it lasts a long time because 2 Tablespoons is a full days portion.
It's much much better if you can get your cat to eat wet food instead....
we have lists ....


finally.... especially with the peeing.....
I would get him checked for a UTI....
and has he ever had a dental?
those two issues will really make numbers crazy high or even less predictable....

 

Wow that's very generous of you. Would I have to discuss the change of insulin with his vet first?

I had him checked for a UTI about 2 weeks ago. The vet swears it's just a behavioral issue at this point but I'm open to other suggestions.

He does need a dental cleaning but I truly can't afford it. I'm in debt with the vet's office and keeping up with the cost of all the diabetic supplies is causing me to drown..... Do you think a dental cleaning is an absolute necessity right now?

The nutritional information is something I don't fully have a grasp on yet....but I have taken a look at the lists that are posted here. Here's the info for the canned food that he's on (his meals are 50% chicken breast and 50% canned food):

Calorie Content (calculated): ME = 1170 kcal/kg; 180 kcal/5.5 oz. can
Crude Protein 9.0% Min.
Crude Fat 5.0% Min.
Crude Fiber 1.0% Max.
Moisture 78.0% Max.
Taurine 0.05% Min
Venison, Venison Broth, Venison Liver, Ground Peas, Natural Flavor, Venison Meal, Salmon Oil, Canola Oil, Vitamins (Choline Chloride, Vitamin E Supplement, Thiamine Mononitrate, Niacin Supplement, Vitamin A Supplement, Pyridoxine Hydrochloride, d-Calcium Pantothenate, Riboflavin Supplement, Folic Acid, Biotin, Vitamin B12 Supplement), Dicalcium Phosphate, Guar Gum, Salt, Minerals (Zinc Proteinate, Zinc Sulfate, Ferrous Sulfate, Iron Proteinate, Copper Sulfate, Copper Proteinate, Manganese Sulfate, Manganese Proteinate, Calcium Iodate, Sodium Selenite), Taurine, Flaxseed Meal, Kelp Meal, Cranberries, DL- Methionine, Potassium Chloride, Calcium Carbonate, Carrageenan, Yucca Schidigera Extract.

 

the nature's balance info is on page 14
http://catinfo.org/docs/FoodChartPublic9-22-12.pdf

they are all 15% carbs or higher.....

I'm not one to be able to do the calculation from the can....
you have to get the as fed values from the food company and many of them won't give you that info....
altho' nature's balance did give it to us before.... that's why we have those numbers....


there are kitties here in the same situation.... needing dentals....
i think it's most important when there is a possibility of cracked teeth.... or you can see inflammation on their gumline...

but you work with what you can do....

if it's a high dose condition..... that may be all you need to deal with....

maybe you can ask for a dental for Christmas...



you don't have to ask the vet but I would tell him that you've had an offer so you'd like to switch....

many here don't go with the advice from the vet on dosing with lantus because only a few of them seem to
have real experience with it.....
it's best to post here daily and get input from the community.....

 

He doesn't seem to have those particular dental issues right now. The vet checked his teeth after he was diagnosed in April and she said the he would need a cleaning but it wasn't completely necessary yet. He had his annual check up 2 weeks ago and she didn't mention anything about his teeth. I meant to ask but I totally forgot to.

It looks like the chart is saying his food is 12 carbs. I posted about this particular food on another thread and the response was that it was a pretty good food for him to be on, so I stocked up- I bought out my local Petco lol

I'll send you a private message about the Lantus. Thanks for all the advice.

 

There are hundreds of us between this group and all the other diabetic cat groups that have bought from Marks since I originally found them and posted the information .....I haven't heard one person have any trouble at all getting their shipments

Marks is really great...I know of one person who's shipment was stopped at customs and returned to Marks....they sent out another and it got there fine (the pharmacy manager told me that but I don't know if it was for a human or cat!)

 

There are a few things we look for before testing for high dose conditions. Is kitty on low carb wet food or raw (doesn't have to be vet food, there are plenty of commercially available foods under 10% carbs)? Are there are secondary conditions (pancreatitis, hyperthyroidism, heart issues)? Are there any infections (UTI, dental needed)? Some people use on line fundraisers to raise funds for dentals. If yes to low carb and no to the second questions, then if kitty is over 6 units of insulin we suggest testing for acromegaly (IGF-1 test) and IAA or insulin auto antibodies. As was mentioned above, blood is drawn by your vet and sent to Michigan State University for those two tests. One in four diabetic cats has acromegaly. It's a common cause of diabetes and poorly regulated cats. Not all acromegalic cats are high dosers, some are on lower doses. If Dennis is a high dose cat, Levemir is typically a better choice of insulin than Lantus. And yes, insulin change should be discussed with your vet. I think you have room to open the discussion - you have plenty of data and Dennis isn't regulated on Vetsulin.

 

That's excellent news! If Dennis switches to Lantus I'll buy from them for sure. I can't believe the savings....

 

she's taking one of the vials I have to give away.....
I am mailing it monday so hopefully she will have it next wednesday and can see how he does on lantus.

 

Good point- with this data the vet can actually SEE what I'm seeing every day. This food is 12 carbs but I don't mind switching to a different food once he goes through these cans. I think he's loosing weight too quickly as well so I'd like to look into something that will keep his BG down but help him gain weight.

In terms of other issues, his kidneys don't function at 100% but the vet is not concerned with that. When he was DKA he had a heart murmur and the ER told me he could go into heart failure however, once they decreased his fluids the murmur faded. The vet told me he was just getting "too much too fast", and his heart couldn't handle he fluids. The vet listened to his heart 2 weeks ago and she said it sounded good.

He had some type of urinary issue about a month and a half ago, but that had cleared up too. The dental cleaning will have to happen soon but he does not have any odd dental issues; mostly some tarter and some very rough breath (gums and teeth otherwise look ok).

The acromegaly test is on my to-do list, but I was hoping to get him somewhat regulated with the help of everyone here. So far, he's been improving. Once I see his numbers even out I'd like to re-evaluate and see if his numbers are still too high. He's down to 6u of Versulin right now which is great considering the vet told me he had to go up to 7u two weeks ago, and that I should expect him to be bumped up to 8 soon. Seeing his numbers drastically drop is a great start.

 

Yeah, neither could I when I first found them! I'd seen all those internet Canadian pharmacies and the lousy reviews for them so when Marks popped up on my search, I was skeptical too. I spent over 2 hours on the phone with the pharmacy manager asking questions and finding out as much information as I could...then I had a friend of mine that lives in Vancouver check them out. Instead of being one of those "warehouse internet pharmacies", they're a real pharmacy next to a real doctors office

In Canada, the government sets the prices they can charge for drugs....that's why they can sell it so much cheaper than here in the states.

 

If you do decide to trial the Lantus it is important to let your vet know so that s/he will be fully aware of all treatments that your cat is receiving. The vet needs to know this so that s/he can make appropriate and safe recommendations in the future for any treatments that your cat might need (not just for the diabetes side of things).

WRT dosing, as has been mentioned above many of us manage our own dose adjustments on a day-to-day basis with the help of our spreadsheet data but it's still important to keep your vet up to date as well to keep your kitty safe in all circumstances.


Mogs
.

 

Well after lowering Dennis from 7u to 6u for the past four days, his numbers continue to rise. Anyone have thoughts? Continue to only give 6u? Go back to 7u? He does come down to yellow, which is good....but maybe by going back to 7u he will see blue....

 

Last night he dropped 250 points in 3 hours which is a lot, I would go for a lower dose to see if you can slow down those drops and continue to reduce the dose as planned, I think those higher numbers may be some bouncing.