Hello all, I am reposting this from the main forum, so I can remove the other post if needed! I am looking for some help with dosing. Sophie was initially diagnosed in May 2018 and started out on 6 units of Prozinc twice a day, which she did well on for quite a while, but we have had a heck of a time regulating her diabetes since about last October. After MANY food changes (she also has IBD and chronic pancreatitis), an insulin switch, and finally getting the hang of home testing, she has been doing much better. She was previously on 0.5 units of Vetsulin, and then most recently 0.25 units. This is where I need some advice: some of her preshot readings have started to be kind of low ish (last night's PMPS was 170 on a ReliOn Prime meter), to where I don't feel quite comfortable giving the entire dose. I've seen that some people do a sliding scale, which is what I did last night, giving her a VERY small amount, about maybe 0.15 units. Is this appropriate to do, and if so what is the best way to go about deciding how much to give? What kind of numbers should I definitely not shoot at? This morning she was 138 at +11, and then 208 preshot, but that was after a small amount of food after the 138 reading, so I skipped the shot. Here is her spreadsheet for reference. The notes on the side are important to consider, as I am still just recently learning the ins and outs of home testing and have made some goof ups lol https://docs.google.com/spreadsheets/d/1yUL6SpNOBAC8Q11HXmDwF03hFMJB2Q0v5fhh_Lxu9Sw/edit?usp=sharing
one thing that might help, would be to tell us when you feed, and what you feed, and how much you feed, since the concept of "steering BG levels with food" is one technique with vetsulin, since it tends to drop the BG hard and fast, fairly soon after the shot it's something I've been trying to do, with Linda's advice and consulting, so Catcat stays at lower numbers for longer, without flirting with hypo however as you can see, we're new at this, and seems that vetsulin wears off, with us, several hours before the next shot is due
Sophie has always been a “scarf and barf” cat, so she gets multiple meals throughout the day, with a feeding 2 hours after shot time to help reduce the drop. Shot time is 6:30 am/pm so she gets fed at 6:00am/pm, 8:30 am/pm, 12:30pm, and 10:30pm. So usually 6 feedings a day, although sometimes she gets a 4am snack if she wakes me up (the brat....). She eats Instinct rabbit formula wet food, about 180kcal per day, and gets freeze dried salmon and fish treats
Sorry you haven’t gotten much input on dosing strategies. I’ll tag a couple members that might be able to help, and I’ll try to think of others that have experience with vetsulin @JanetNJ @MrWorfMen's Mom
@Sharon14 Thanks for the tag. Just reviewing message and SS now. Been out most of the day. Be back soon!
Hi Sarah and Sophie. Welcome to FDMB. I must say, Sophie is looking pretty good and you seem to have an excellent handle of things. Your food timing seems ideal (early to slow drop) and mostly in first half of the cycle which helps a bit with the duration of the insulin. And your gut feelings are obviously very keen. I admit I freaked out a bit when I saw the first sentence about starting ProZinc at 6u twice a day. That is a huge dose for a newly diagnosed kitty and I am amazed Sophie did so well up till October. Is that when you switched to Vetsulin? What was the reasoning behind the change to Vetsulin? Asking because ProZinc tends to be a bit gentler and often provide better duration. It's somewhat rare to see a cat move from ProZinc to Vetsulin...it's usually the other way around. That said, you are the second one making that switch here recently. I notice on your SS you've indicated normal BG at 80 to 150 for a pet meter. We consider 68 to 150 as normal here and some pet labs designate 175 as the top end of normal. Are you still using the AT2 for curves or spot checks? I was a diehard AT2 user for quite some time but like so many folks, I switched to a human meter. For everyday decision making a far as dosing is concerned it's best to pick a meter and stick with it. Using both can get a bit mind boggling although I admit I still used my AT2 for double checks on low readings. With Vetsulin, we generally suggest aiming to keep BG around 80 or above (on a human meter) to provide a little extra cushion in case of fast drop in BG. Sophie has been achieving that goal very nicely on 0.25u and even 0.15u with a lower pre-shot number. Sliding scales do work for some kitties once they get fairly regulated and the trick is to know how much a particular dose drops BG to determine what sliding dose works best for your kitty. Interestingly, despite no shot today, Sophie's AMPS and PMPS are pretty much the same which suggests to me her pancreas is working better to some degree. It would have been nice to know what her BG did during the day cycle today in relation to her meals. If you are working during the day on weekdays, it's difficult/impossible to get mid cycle tests. If that is the case then we are going to have to use your evening/ weekend tests to fill in the blanks here. I am curious as to what Sophie's BG is 2-3 hours post shot with no further food influence. If BG 2-3 hours post meal is lower than pre-shot, then her pancreas is getting back to business. Can you grab a few extra tests for the next couple of cycles when you are available at +2 and +3? Then we can look at what dosing might be best for Sophie.
Thanks so much for the reply! Yes, knowing what I know now I’m shocked she did well on such a high dose in the beginning, until she had a very bad hypo in October (seizures, CPR, the whole shebang). After that, we started her on a low dose of Prozinc but she was not responding really at all and we kept needing to up the dose (although she was still on dry food at that point), so another vet suggested we try switching to Vetsulin. He prefaced by saying that switching in that direction is not typically done, but since she wasn’t doing well on Prozinc it was worth a try and it seems to be working well I think. I’m not necessarily opposed to switching back, I’m just a little hesitant to rock the boat right now. Someone else from a Facebook group I’m in actually set up my spreadsheet for me, so I can certainly adjust the ranges! I just got more strips for my AlphaTrak and plan to just use it for spot checks and stick with the ReliOn Prime now that I’m more assured of the accuracy of the ReliOn Prime readings (I’ll admit I was sure it was a fluke how good her readings were....) since it’s MUCH cheaper. I haven’t yet done any full curves, as Sophie is not a willing participant at all in BG checks, which is why I don’t have a whole lot of readings other than preshot and nadir. Although I will try to nab some more +2 and +3 readings to get a better picture. Unfortunately I do work during weekdays, so day time mid-cycle tests aren’t possible. I’ll start getting some on the weekends, which I will start Sunday since we have a mid morning vet appt this Saturday which will throw things off. I suspected her pancreas *might* be getting back to business, so I’m hoping she continues to do well. Any other advice or insight is very much welcomed!
@MrWorfMen's Mom Do you mind taking a peek at Sophie's spreadsheet when you get a chance? I don't have a whole lot more data for you to look at, but I do have a little more. I'm having trouble with one, measuring out these micro doses of insulin and doing it consistently and two, deciding what should be her 'no shoot' number. If I don't think I can measure out a small enough dose I've just been choosing not to shoot and it doesn't seem like she's been getting too high without insulin, but I'm not sure how skipping shots might affect her regulation if it becomes a consistent thing.
Not all that great to be honest :/ I scheduled it because Sophie's been having problems with constipation, and also because we just moved and I'm currently looking for a new vet. The vet tech scruffed her straight off the bat, which made her too mad for the vet to even be able to handle her at all, so we won't be going back there. But they were very impressed to hear about her blood sugar numbers!
Hope you find a good vet soon. Seems they are getting to be a rare breed... What are you doing for Sophie’s constipation?
Yes, they sure are... She was previously on fortiflora probiotics and Metamucil, and I also add water to her food to make to pretty soupy. The vet recommended adding ground flaxseed to her food, but I also posted about it on a Facebook group for cats with multiple medical conditions, and several people there suggested switching out the Metamucil for Miralax so I’m going to try that and see how she does
Yes I used Miralax for Colin. Have you looked into Slippery Elm Bark for her IBD? It can also help with constipation.
I was actually looking into it yesterday as well, but I was having a tough time finding where to buy it. Where do you get it from for Colin?
I got it off amazon https://www.amazon.com/NOW-Slippery...pery Elm bark&qid=1561330421&s=gateway&sr=8-3
Hi Sarah. My apologies. I seem to have missed your tag. First of all, you are doing a fantastic job of making decisions re: dosing but I have to be quite honest that I am not at all clear on how you are differentiating between a dose of 0.10u vs. 0.15u vs. 0.20u. It's also difficult to determine a sliding scale dosing regimen when the dose is changing so much. THIS DOC explains how to draw up smaller doses using calipers. This allows you to do so consistently which is what I am a bit concerned about when suggesting dosing. This document is using U100 syringes but the principles are the same...you'd just have measure your syringes and calculate accordingly. Are you using U40 syringes with half unit markings?
Yes, that’s the problem I’m having, any number less than 0.25 is more or less just arbitrary and up to me making the best estimate I can, which is obviously not preferable.... I will definitely look into trying the calipers, but I am admittedly very bad at using them lol. Yes, I use U40 syringes with half marks!
The other thing to consider would be to get u100 syringes with half unit markings which allow for a little finer dosing options with use of a conversion chart that we have here. Not sure what the laws are in OK regarding syringe purchasing but if there are no restrictions, Walmart has Relion U100 syringes with half unit markings but make sure to check the package as it seems a lot of the pharmacy employees don't know they have them or may try to sell you the full unit syringes.
Unfortunately Oklahoma is annoyingly strict with medical laws, and I need a prescription to order syringes. I can look into that as well, it just might be a bit difficult since I’m currently looking for a new vet and I’m not sure how smoothly I could convince them to give me a script for U100 syringes for U40 insulin
Well then the calipers might be a better option for now since Sophie is a pretty small dose gal. I know many vets think pet parents will make serious mistakes dosing if they don't use the correct syringes so even if you were planning to stick with your current vet, they might be against the idea.
@MrWorfMen's Mom Hi Linda, would you mind taking a look at Sophie's spreadsheet? Not sure what to do about my problem child - we've been having lots of no shoots lately because her preshot BG numbers have been juuuust low enough that I don't feel comfortable shooting, BUT without insulin her +4 has been getting quite low! I think her PM +4 for today (July 6) probably would have had a similar pattern to the previous two days as well, but I'm pretty she was a little stressed because my boyfriend was over and he stresses her out lol. Any thoughts? Should I just keep doing what I'm doing?
For some reason, some tags don't work unless they are on a separate line. Thx @CandyH and Catcat I got your tag but not Sarah's. Actually Sophie isn't doing too bad at all but it would be nice to see more very low blues or high dark greens on her SS. What is your shoot cut off BG right now? Looks like about 150 from the SS. I think you can take that down a bit more and if she is between 130 and 150 try a drop dose. If she is 150 or above try 0.10u. If you are trying a shot at a lower pre-shot BG (between 130 & 150) only do so on a cycle where you can monitor her. Let's see if we can get her down just a tad more.
It’s been awhile since I used it, but I mixed 1/4 tsp with water to make a slurry then syringed it. 2-3 times a day. You want to space it a couple hours from any other meds as it can possibly block absorption. Another good thing for IBD is Aloe Vera Juice. George’s brand has no flavor and can be syringed.
So the initial plan was to try a drop dose if Sophie's blood sugar was between 130-150 when I was home to test, but Sophie has decided that she does not like that plan She hasn't gotten a PM shot in 9 days now and I've skipped most of those mornings as well. So now my question is: what's considered an OTJ trial? I haven't been able to find any stickies on it, and none specific to Vetsulin. A lot of the kitties I've seen usually have BGs in the 80s and 90s without insulin, and even though Sophie's are higher than that, I don't think I can safely give her insulin without her getting TOO low. I'm going to get some more AM cycle test this weekend that will hopefully help out as well! @MrWorfMen's Mom
Well isn't she being a pickle! Unfortunately, there are no specific instructions for OTJ trials for Vetsulin users. Ideally and for safety reasons, you don't want to push BG below about 90 with Vetsulin because it can cause sudden drops so you need to leave more of cushion than with some other insulins. It doesn't look like a drop dose is causing any big drops for Sophie so you could try giving the drop dose if BG is 120 instead of 130 when you can monitor and sees if that brings her down just a tad more. She is looking very good but it would be nice to see those blues a bit lower and some high dark green mixed in. I think you are going to have to gradually just keep lowering your no shot limit with monitoring until you see those numbers come down just a smidge more.
We were SIX days without insulin and then Sophie’s pancreas decided to take a little break this morning
I'm wondering if Sophie is going a teensy bit lower than we know about at night and the AMPS is up a bit like a mini bounce. Many cats if not most cats go lower at night. I know it's tough to do, but if you get up to use the washroom at night, try to grab a test to see what Sophie is doing a little later in the night cycle. Or you could set an alarm to grab a test at +5 or +6 periodically. It might provide a clue to her current pattern.
So yesterday was 14 days without insulin - what do we think? I'm a little hesitant because her numbers are higher than a lot of the other kitties in remission that I see, especially in the mornings, but she's definitely able to them down on her own... @MrWorfMen's Mom
Overall Sophie is looking pretty good. Her BG isn't bad, and is often within normal limits, but it is on the higher end of normal and a bit high more often than ideal. BG without insulin would ideally be mostly in the dark green range/very low blue occasionally. I think it would be prudent to try a little more insulin support with a tiny dose when you can monitor Sophie. The tests done a few hours post meal in some instances are suggesting that her pancreas is not yet working to full capacity. Normal BG is 50 to 120 and you've seen a fair number of readings above that. It's sometimes a bit tough going the last little step with Vetsulin because you can't give insulin at low pre-shots. I'd try a drop dose if pre-shot reading is above 140 but be prepared to monitor Sophie when you do so to ensure she doesn't drop too low. If she doesn't drop too low at a pre-shot of 140 you can then back that up a tiny bit and again monitor. I would not attempt dosing her at these low pre-shots if monitoring is not possible.
