Help!

this is our first day of the curve. He was just diagnosed eight days ago. His 6am number pre-food, pre-shot was 265 so he got his two units of Vetsulin. 8 am he was at 168 and now at 10 am he's at 50. He's eating his treat right now, he seems ok. Isn't 50 way too low?

 

Hi,
Yes that’s Low. Can you give some high carbs food and retest 15 mins later? Vetsulin has a nadir between +4 to +6. You have to keep testing every 15 mins till he goes up. Rub honey or syrup on the gum.

 

Waheeeda is correct. Keep testing. If you can't get him out of the hypo, then take him to the emergency vet. Since you are on top of it, then it is likely that you can get him thru this.

It is likely that dose of Vetsulin is too much. I would go to 1 unit/dose for future doses. Also, kudos to you for testing. I hope you keep it up.

 

How is it going? Have you given him food and test again?
Definitely have to reduce dose.

 

No I haven't - just got back home. He was acting normal when I left and he was up and awake, looking around outside when I got home. He's in the litter box now, I'll test in a bit. Thank you all for helping us get through this. If he needs a shot tonight I'll go to 1 unit unless his number is high again at that time?

 

Good news - he's at 71.

 

Hi Rhonda! Nice catch! If you're using a human meter, 50 isn't 'way too low' but it is at the bottom of the 'normal' range. It's not time to panic but time to do exactly what you did - just feed him some of his regular low carb food. That will naturally bring him up just like it did. GOOD JOB!

That's a quick steep dive tho' but what I can't tell since I can't see your previous numbers (spreadsheet) yet is if it was a 'bounce' breaking causing it or is your dose high enough to cause that steep dive. If it were a bounce breaking then the dose amount may not have really been an issue but if his numbers yesterday/last night was lower, the dose may indeed need to be backed down just a tiny bit. That spreadsheet gives us SO many clues!!!

HUGS! Good job! You're sailing now!

 

He was under 200 yesterday morning so he didn't get insulin. That's the only one I skipped so far. I'll see how the rest of the day goes.

 

I agree go to 1 unit for a few days.... If it's not enough you can do 1.5. 2 is definitly too much. Good job catching that!

 

Would you still only do 1 or 1.5 if his numbers go back to the 300s or 400s again?

 

Ah then that's likely what caused that high number. I agree with Janet, 2 is definitely too much - you don't want to give a high enough dose to drive the numbers down that steep. A steep dive usually scares the liver causing it to dump extra sugar to compensate for it. Either 1 or 1.5 - if I held the syringe I'd probably try 1.5 but I can test at any time.

 

I agree with above - dose 1.0 or 1.5.

You don't judge the dose by the high level of their BG. You determine the dose by monitoring what dose level brings their nadir into the correct range (80-140). For example, Leo goes to 250-400 pre-dose. During the day I dose him 4.5 units to drive him into the correct nadir range.

Some cats don't need much insulin, and some need a lot. But you can't tell the amount of insulin required by looking at pre-shot numbers.

 

And the nadir is the low point of the day?

 

Correct. The nadir value is the low point of the Blood Glucose (BG) value. If you look at a 12 hour curve of a treated diabetic cat, there are two high points on both ends, and the nadir trough in the middle. The nadir occurs between 4-7 hours depending on insulin type.

 

Ok, thank you. His low point today was 50. He's at 136 now.

 

That sounds good. Generally, most cats will have similar ranges at both ends of the curve. Since the AM Preshot (AMPS) was 265, you will generally expect 265 or similar for the 12 hour mark at PMPS.

 

I'm trying to post the graph I did - not sure it's working. Wondering if this is "normal" - it dropped from +10 to feeding time tonight. Obviously, no shot tonight.

 

Wow old school pen and paper graphing!

It's too steep of a drop. That's why we said to lower the dose.

 

Although Vetsulin is known for it's steep drops, that's a little too steep!!

Can we get you to start using our spreadsheet to keep track of his numbers? The color coding really helps and it's what we're all used to using.

Here are the Instructions on getting the FDMB spreadsheet but if you have any problems, I'd be happy to set it up for you. It only takes about 30 seconds once I have some information. You can just click on my name and choose "Start Conversation" to send me a private message

 

If he needs a shot in the morning I will lower it. I was a little concerned at the drop before feeding tonight. Maybe it's a good thing though.

 

You want to see a wide U curve, not a steep V

 

You're doing good Rhonda. It takes some time go get used to all this. That is indeed a sharp curve, but at least you know generally how well the vetsulin is working.

 

Glad everything went well last night. It was already 1am where I was and couldn’t keep awake to wait for your reply. Janet is good at dosing with vetsulin. She helped me a lot. You are in good hands here.

 

He was at 381 this morning so I gave insulin but I only gave one unit instead of two because of how steep his curve was yesterday. Should I test again at four hours or six hours?

 

When you're doing a curve it's best to test every 2 hours to see the full action profile of the dose. You can post a graph of your data again if you like. Setting up a spreadsheet like the one we use here is the easiest way for you to track data and for us to assess it before giving advice.

 

I did the curve yesterday. I thought I'd give him a break today, maybe test again at noon.

 

You could try some strategic testing in the middle of the cycle between +4 and +7 to see how low he goes.

 

Generally, yes, coinciding with the 'peak' action of the insulin.
However.....it may be that your cat's blood glucose dropped lower than that 5o earlier, and might already have been rising at that point...

For Vetsulin users that are new to diabetes it's safest to try to keep the blood glucose above 90 - 100 initially (as measured on a human glucose meter; the number would be even higher if you're using a pet meter). That's just until you get used to testing routinely, and have some data to show how the insulin is working in your cat's body. Given that Vetsulin can drop the blood glucose fast in some kitties keeping the BG above 90 - 100 helps to give some buffer of safety.

Here's a link to a document written by members here especially for new Vetsulin users:
Beginner's Guide to Caninsulin (Vetsulin)

And please ask if you have any questions at all.
.

 

I'd probably test in 3-4 and see where it is.

 

I just did at 10 am (4 hours after shot) and he's at 133. He was at 50 yesterday at this time. Today I gave one unit instead of two.

 

Good. That is what you are looking for. Since you are home today, it would be good to get that nadir value as well - 6 hours.

 

Perfect. Much better. Stick with 1 unit for a while.