Help! Suggestions

Discussion in 'Caninsulin / Vetsulin and N / NPH' started by Lindsay & Smokey, Sep 11, 2018.

  1. Lindsay & Smokey

    Lindsay & Smokey Member

    Joined:
    May 9, 2017
    My Smokey has been on 3 units of insulin, and PS he has been between 450 and 300... I haven't seen him go lower than 230 ( between meals). He gets 2 meals 12 hrs apart (low carb wet food). The vet wants to keep him on 3 units for 2 weeks to do a fructosamine and then possibly increase to 3.5 units. He said he doesn't want to go much higher. I think we need to go higher until he is under waaaaay better control. I feel his numbers are still way too high. Is there a max amount of caninsulin you can give a cat? I feel like I have seen cats on here on 9 units plus... Any suggestions? I will be calling the vet and expressing all of my thoughts to him as well! Thanks! (Sorry our sreadsheet isn't up to date, I haven't been checking as much as i know he is high, and going for fructosamine...)
     
  2. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    There are many cats on doses higher than 3.5 units. Some of them have other medical issues that cause the need for a high dose but not all. As we often say here, "A cat needs what he needs."
     
  3. Lindsay & Smokey

    Lindsay & Smokey Member

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    May 9, 2017
    That is What I thought too... I will have to question him on why he doesn't want to go higher....
     
  4. Bama Kitty Mom (AL)

    Bama Kitty Mom (AL) Member

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    Jul 16, 2018
    High numbers are frustrating. Some vets have one way of doing things and don't want to vary their recommendations. Many people here research and find better ways of dealing with diabetes and other issues than what their vets seem to think is set in stone. When was Smokey diagnosed? Did the vet start him at 3 units?

    How much is he eating and drinking? Some cats do better eating more often than 2 meals per day. Bama's meals are split into 4 meals--2 larger meals just before his injections and two mini-meals two to four hours after his main meals.

    Tried to look at your spreadsheet but got "access denied". You may need to change the link in your signature. If you go to your spreadsheet, click the "Share" box in the top right. Copy and paste that link in your signature line. I think the one that's currently there is your personal link.
     
  5. Lindsay & Smokey

    Lindsay & Smokey Member

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    May 9, 2017
    So he was started on Lantus at the end of May. That didn't go well. He was switched to Caninsulin and his # are now much more level.. he was bouncing all over with lantus.. (if I get my spreadsheet fixed up you will see that...) we started caninsulin at 2 units, after a week increased to 3 units and we will be 2 weeks at 3 units on Thursday. He eats 1 and 1/4 5.5oz cans 12 hours apart, and will get a couple freeze dried treats in between (but not always). He was Diabetic about 3 years ago and quickly went into remission (about 3 months). After all reading I have been doing on here, my opinion is we need to increase his dose. He doesn't seem to be gaining weight back (not losing either) and isn't quite walking on his hocks, but almost (not hypo). I add some water to his wet food, but he doesn't seem to drink a whole lot other than that.
     
  6. Lindsay & Smokey

    Lindsay & Smokey Member

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    May 9, 2017
    I have changed the settings on my spreadsheet... hopefully the link works now?
     
  7. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    Yes, I can see your spreadsheet. I recommend a full curve at 3 u before you change anything. If not that, then get as many tests between +3 and +7 as you can for the next few days. The most valuable data in assessing a dose are the low numbers.
     
  8. Bama Kitty Mom (AL)

    Bama Kitty Mom (AL) Member

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    Jul 16, 2018
    Those 500s that seemingly come out of nowhere and the 400s do scare but you have gotten some blues so maybe you are getting close to the ideal dose. Full curve @ 3u before any changes as Kris says is probably best. I hate when the vet wants to do a Fructosamine when you already know the BG is not being controlled. To me it is just an expensive method of confirming what we already know.
     
  9. Lindsay & Smokey

    Lindsay & Smokey Member

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    May 9, 2017
    I agree that the fructosamine is just going to be a waste of my money!! I think we are getting closer, but not quite there yet. I will talk with the vet, do a curve this evening (to at least +7) and likely increase from there. He has had one really good day on Caninsulin (Aug 29) but has went back up since then. We had one good +4 (178) but since that was the lowest I have seen between doses (usually over 250 when I do a random check between doses..)
     
  10. Lindsay & Smokey

    Lindsay & Smokey Member

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    May 9, 2017
    Please disregard the curve I did. I don't know why, but I am questioning myself if I gave him his insulin tonight ... I will re do this weekend. (Would explain the crazy #s)
     
  11. Lindsay & Smokey

    Lindsay & Smokey Member

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    May 9, 2017
    Ok I must have given his shot last night. His AMPS was his "3 unit normal". So I will be increasing this evening so I can watch him. Should I increase by a full unit? If I miss his shot I would have expected him to be higher this am
     
  12. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    Last night's numbers look like they're bounce elevated. He might have dropped low during the day. I wouldn't use those numbers to assume the dose is too low. It might, in fact, be too high. Your numbers overall where a little better around 2 u and then the dose went up by a full unit and you've had a lot of highs since. We recommend increases of no more than 0.25 u (eyeballed, preferably on a syringe with half unit marks) at a time so you don't go past a good dose.

    So - I recommend that you don't increase tonight. Is there any way you can get a daytime curve done or at least some daytime readings between +3 and +7?
     
  13. Lindsay & Smokey

    Lindsay & Smokey Member

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    May 9, 2017
    I can this weekend. We both work during the day unfortunately. When increasing is it 0.25u per 6 cycles (3 days)? We do have half unit syringes at home so 0.25 is do able... We had one good day at 3 units and yah now its back up :( (Sept 3/4...) so .I will report back on Saturday.
     
  14. Lindsay & Smokey

    Lindsay & Smokey Member

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    May 9, 2017
    So I started a curve today. However he was only 176 AMPS.. He is usally 360 or higher. I went ahead with his 3 units. Went low at around +4.5... So fed him. As suspected above maybe we are too high...

    I can do a curve again tomorrow too if needed
     
  15. JanetNJ

    JanetNJ Well-Known Member

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    Jun 8, 2016
    135 is not too low. What kind of meter is it?
     
  16. Lindsay & Smokey

    Lindsay & Smokey Member

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    May 9, 2017
    He went to 41... I agree 135 is good! We have a GE200 meter (human meter)
     
  17. JanetNJ

    JanetNJ Well-Known Member

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    Jun 8, 2016
    Oh ok I didn’t see that on your spreadsheet. Yes, 41 is a little too low. Can you add to your signature the meter?
     
  18. JanetNJ

    JanetNJ Well-Known Member

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    Jun 8, 2016
    Ah yes, there it is. ;)
     
    Lindsay & Smokey likes this.
  19. Lindsay & Smokey

    Lindsay & Smokey Member

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    May 9, 2017
    He came up a bit...48.6 now.
     
  20. Lindsay & Smokey

    Lindsay & Smokey Member

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    May 9, 2017
    Next question for this evening. I have a family member coming to do his insulin injection as we have a dinner to attend. They don't know how to Check his sugars. Should I decrease him to 2.5 for tonight?
     
  21. JanetNJ

    JanetNJ Well-Known Member

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    Jun 8, 2016
    Yes. How late will you be able to test before leaving?
     
  22. JanetNJ

    JanetNJ Well-Known Member

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    I ask because depending what it is, even 2.5 may be too much.
     
  23. Lindsay & Smokey

    Lindsay & Smokey Member

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    May 9, 2017
    Probably about 2 hours before his dose
     
  24. JanetNJ

    JanetNJ Well-Known Member

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    Jun 8, 2016
    Ok that will give a pretty good picture of how it’s going.
     
  25. Lindsay & Smokey

    Lindsay & Smokey Member

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    May 9, 2017
    Well, my fingers are crossed! We were at 14 (257) pmps!! I will check him a couple times around +4-+6..
     
  26. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    Stressful but you've learned that 3 u on a PS of 176 is too high a dose. Your insulin can drop BG quickly and low so a little bit of extra caution is needed.

    BTW - this information in your grey signature text would help us a lot:
    • kitty's name/age
    • date of diabetes diagnosis
    • insulin you're using
    • glucose meter you're using
    • what he eats
    • any other meds or health issues he has.
     
  27. Lindsay & Smokey

    Lindsay & Smokey Member

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    May 9, 2017
    I feel like we aren't doing so hot on 2.5 units :( I can tell he is high as he is begging for food and drinking more water than usual)
     
  28. Bama Kitty Mom (AL)

    Bama Kitty Mom (AL) Member

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    Jul 16, 2018
    @Lindsay Dziwenko

    Did you decrease to 2.5 units because of the lows experienced on the 15th? I had a similar result when I shot 3 units on 173 a few weeks ago. Bama went low and I had to intervene with gravy food, prayer and cold sweats. Scary, I know. Granted my insulin is different from yours and each situation is different. What I learned from the episode is that I can't shoot 3 units on a reading under 200. Should it happen again, I would shoot 1.5 or 2. As it turned out, I had a 135 reading a few days ago where I only shot 1 unit and he continued to go high afterwards so he must have been starting a bounce from an overnight low.

    You may have better results with increasing in .25 increments rather than a full unit or even 1/2 unit. What I did after my scary mild hypo incident was to decrease his dosage by .25 increments and leaving it there for a week and then increasing it back to the 3 units he was on when he went low. Looks like you have gone through 6 cycles at 2.5 since Smokey's low. If you want to increase, try going up only .25 units and monitor as you have been doing with mid cycle tests. Maybe @Kris & Teasel or @JanetNJ can advise.

    Whatever you do, don't get discouraged. Keep reading the forums, testing the BGs and asking questions. People are here for you.
     
  29. Lindsay & Smokey

    Lindsay & Smokey Member

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    May 9, 2017
    I did decrease, and went up to 2.75 this am. Will stay there for a bit and see what happens!
     
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  30. Lindsay & Smokey

    Lindsay & Smokey Member

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    May 9, 2017
    I talked to our vet today. He wants me to keep him at 2.75 for a week and not bother checking him. I really don't like this idea. We are having a hard time finding a good dose for him, and he isn't gaining weight back yet either. He thinks maybe we are "looking too hard". Ugh! I will definitely be checking PS at minimum.
     
  31. JanetNJ

    JanetNJ Well-Known Member

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    Jun 8, 2016
    Ask him if the cat goes hypo and had to be rushed to the er or if he is willing to pay the entire bill. Unsafe. Do what you want to do.
     
  32. Lindsay & Smokey

    Lindsay & Smokey Member

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    May 9, 2017
    Well I hope I'm not getting excited for nothing! The last 4 cycles have been better!! Fingers crossed!
     
  33. Beck and Grandpa (GA)

    Beck and Grandpa (GA) Member

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    Jun 4, 2018
    I don't get the advice not to check. I had two vets at my vet practice advise me not to check and to only feed twice a day. A third vet always asks to see my spreadsheet and asks me what Grandpa is eating. I bet you can guess which one gets all my business.
     
    Bama Kitty Mom (AL) likes this.
  34. Lindsay & Smokey

    Lindsay & Smokey Member

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    May 9, 2017
    Right?! makes no sense to me. I am a pharmacy tech, so this is mind boggling that you would tell someone not to test and just see how it goes based on how he acts.... I'm doing my own thing, as long as he keeps giving me insulin, I will continue on. I was considering getting a second opinion as this guy seems odd. Our vet that we had seen when he was first diagnosed is off doing her Veterinary Dermatology course, she was so good but I can't see her :(
     
  35. Lindsay & Smokey

    Lindsay & Smokey Member

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    May 9, 2017
    Hey all!! So I did a partial curve last night. Everything looked good, but he was high this am. Any ideas? I don't think he would have went low and bounced... We are finally gaining weight back slowly, so I know we are headed in the right direction. But still can't get Smokey regulated.
     
  36. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    It's possible he continued to drop last night and that resulted in his rebound to a higher AMPS. Hard to know for sure. If that's not the case. you could bump him up to 3 u tomorrow AM. Last night's 167 is still high enough that there's room for a small increase in dose.
     
  37. Lindsay & Smokey

    Lindsay & Smokey Member

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    May 9, 2017
    Thanks for the input! We will give 3 units a try for a bit! And yah his last reading of 167 could definitely still be decreased.
     
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  38. Lindsay & Smokey

    Lindsay & Smokey Member

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    May 9, 2017
    I did a curve today.. Is it odd for him to continue to go down after +6? I would have thought he would start to go back up, but I last checked at +8 and he was still going down. And from what I can see we are ok to increase by 0.25 units? He did have a low, so I know not to give a full dose at that PS. It was weird when he was low as he was running around playing. Not lethargic, or running into things (but I still gave food and honey to get him back up). Thanks!
     
  39. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    No, I would not increase right now. That 4.3 today is as low as you'd want to go with Caninsulin. In fact, those lime greens a couple of evenings ago were a good reason to drop the dose to 2.75 u. We usually say a nadir in the 90 to 110 (5 to 6) range is good because it gives a safety margin for this strong acting insulin. You just can't push the dosing envelope as aggressively with Caninsulin.
     
    Red & Rover (GA) likes this.
  40. Lindsay & Smokey

    Lindsay & Smokey Member

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    May 9, 2017
    ok! Yes that makes sense. I realized after I gave the 3 units the other evening I should have stalled longer or decreased his dose. If his nadir is good, then should I not be as worried about his PS numbers? Like are the pinks ok? I know the vet said he is ok with like 16 for PS...
     
  41. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    Yes, that's correct. The nadir trumps the PS when assessing the effect of a dose. A big drop from PS to nadir can trigger a rebound back up to another high PS. That large swing *might* diminish over time but not always. Caninsulin's fast action can cause these big swings. The goal is to achieve a good but SAFE nadir. The guideline is a BG of 5 to 6 (90 to 110) at nadir.
     
  42. Lindsay & Smokey

    Lindsay & Smokey Member

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    May 9, 2017
    Ok makes sense! He was 12.4 PMPS so I dropped back to 2.75 units
     
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  43. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    I suggest you get a +2 test to see how he reacts to this dose on a yellow PS.
     
  44. Lindsay & Smokey

    Lindsay & Smokey Member

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    May 9, 2017
    Ok! I will try to get a few this evening...
     

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