? Little Cat - Big Dose

Discussion in 'Caninsulin / Vetsulin and N / NPH' started by Panic, May 16, 2019.

  1. Panic

    Panic Member

    Joined:
    Apr 10, 2019
    My kitty has been in the 500-600s for weeks now. She started on NPH and went from 1 to 2 to 4 to 5 units twice a day. When 5u still wasn't affecting her numbers, I requested an insulin change and we went with Vetsulin. Her first curve on Vetsulin was 2u and it was even higher than the NPH results, she went home on 3u and there was no change. Still ravenous, etc. The vet did another curve a week later at 5u and she dipped all the way down to 73. The vet sent her home on Monday at 4u on Vetsulin.

    The next morning we could see an IMMEDIATE difference. Prior to this she was ravenous and easily eating 2 cans of Fancy Feast per meal, with snacks in between. However after the dose change to 4 she has gone almost completely back to normal in attitude and appetite. The problem is, she doesn't have a very big appetite normally! She has never been the kind of cat to finish a meal, she's just not a big eater.

    Tonight she didn't even eat enough for her shot. She ate maybe a fourth of a can of FF and maybe half an egg yolk after much prompting. After about an hour or so of trying to get her to eat even more, I gave her 2 units. I hope that was okay, she did eat a normal amount for herself pre-diabetes, but it just doesn't feel like enough for 4 units.

    The other problem is she is only 4 lbs! Prior to diagnosis she was more of an 8 lb cat, diagnosed at 5 lbs, and over the past couple months is down to 4.1 despite her large appetite until recently. I'm just so afraid to give her such a big dose when she's so tiny and not hungry, but until a few days ago we just couldn't get her glucose levels down.

    Does anyone have any advice? I am calling the vet in the morning of course.
     
    Last edited: May 16, 2019
  2. BBelshan

    BBelshan Member

    Joined:
    Feb 11, 2019
    Do you have supplies to test her at home? That is so helpful in figuring out what dose is best. That does seem like a lot for such a small kitty - her numbers might be artificially high due to stress at the vet and sometimes too much insulin looks like too little. As soon as you are able, try to set up a spreadsheet to record any test you can get at home. It's best to test before shots to make sure it is safe to give and a test 4-6 hours later to see how far down they drop. Hopefully others can chime in with more specific advice. Some cats are resistant to some insulins due to other medical reasons.
     
  3. Panic

    Panic Member

    Joined:
    Apr 10, 2019
    I am collecting supplies for home testing now, hoping to start next week when everything is in. Do people typically just do three tests a day? Pre-breakfast, midday, and pre-dinner? I took her in this morning after she wasn't interested in eating more than a skimming off the top of her can of FF and she was around 618, so the vet told me to give her 4u.

    She is very much a grazer; she likes to munch a bit every couple hours vs. an actual "meal" with snacks in between. How much would she technically have to consume at breakfast/dinner to warrant a shot, considering her natural eating habits?
     
  4. Kitty Anderson

    Kitty Anderson Member

    Joined:
    Feb 27, 2019
    We generally do a minimum of 4 tests a day when I'm not home and DH is solo, 5 to 6 if I'm home. With curves regularly.

    After some time the BG tests became super easy, like 15 seconds except the AM and PMPS tests when she wants her food and is a bit squirmy.

    I cant advise really on food and dosing, but depending on the cat then high numbers can either decrease or increase appetite.

    Were her kidney and thyroid levels checked?

    I know dosing advise here is generally based on spreadsheets, here is info on setting up a spreadsheet.
    http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

    And here is info for creating a signature. http://www.felinediabetes.com/FDMB/threads/editing-your-signature-profile-and-preferences.130340/
     
  5. Panic

    Panic Member

    Joined:
    Apr 10, 2019
    Thanks for the info!

    On 3u she still acted like she was starving, at 4u she went back to her normal appetite, which is just a casual muncher.

    Do you mean were her kidney/thyroid levels checked today or in general (sorry not sure if this is a common test)? The only thing they did this morning was check her BG. Overall when she was diagnosed and they ran all the tests the only issue was the glucose.
     
    Last edited: May 17, 2019
  6. Kitty Anderson

    Kitty Anderson Member

    Joined:
    Feb 27, 2019
    I just mean relatively recently, just to rule out any comorbities. Both are part of a senior wellness panel. If she had proper blood work drawn to diagnose she likely had at least a kidney check.

    50% weightloss is a lot of weight lost, and both kidney disease and hyperthyroidism can also cause weightloss, although thyroid would probably be less likely with recent appetite change.

    Going from ravenous to normal appetite (for her) could indicate the insulin is starting to work on her levels. Meaning home testing is very important to not shoot numbers that are to low.

    Getting some ketone urine sticks would also be a good idea to rule out ketones. Just catch some pee in a spoon and pour it over. Super easy. Especially when they are still peeing more.
     
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  7. Panic

    Panic Member

    Joined:
    Apr 10, 2019
    Oh I understand now, thank you. She definitely had her thyroid checked because it was actually what we thought the problem was originally (she was diagnosed the end of March). I believe her kidneys were tested then as well.

    Originally I brought her in because after she turned up very sick one morning and smelling of horrid diahrrea, she didn't eat ANYTHING but water for nearly three days. This is how the weight went from 8ish to 5, in those three days.

    I took her to a vet (not the same one she had now) and he just gave her penicillin, next day her appetite came back a bit and then shortly after became ravenous. She is outside a lot so it took me a few weeks to realize she was still having diahrrea so I took her to her current vet about it. We think the original illness was just an infection (we never did find anything wrong, like bacteria infection or a wound) but it may have been what pushed her over the fence into diabetic.

    Since she was diagnosed in March she has lost another pound. Sorry if that was too much info haha.
     
  8. Kitty Anderson

    Kitty Anderson Member

    Joined:
    Feb 27, 2019
    No need to apologise.
    My advice would be start home testing as soon as possible, especially given the change in appetite. Canininsulin is a hard hitting and fast acting insulin that is processed out of the body quite fast. From everything I've read on here dosing should be based on Nadir (lowest blood glucose point).

    I would try to set up the Spreadsheet and signature as soon as you can as well. The spreadsheet is an absolute wonder as a tracking tool. You just input the numbers and it will auto colour code them!! And if you are measuring in mmol/L get the world to US chart and it will convert all readings for you into mg/dl. And vice versa for US to world. It really is genius. My vet actually got a copy from the creator for some of her patients.

    Mmol/L readings are numbers that are like.. 5.2, 7, 9.8.
    Mg/dl readings are numbers like 89, 112,250.
    You just multiply world numbers by 18 to get US.

    Attaching the spreadsheet in your signature with info suggested .. Basically is like having a medical chart meaning those who are experienced enough to advise have all the info they need. :)
     
  9. BBelshan

    BBelshan Member

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    Feb 11, 2019
    It is fine for her to be a grazer as long as you take the food up 2 hours before the pre-shoot test in the morning and evening. The rest of the tests she can eat normally. You want to see what the numbers are like without the influence of food. Anything above 200 you can shoot. As you get more experienced and get closer to the ideal dose, you can adjust a bit. It is not ideal to shoot blindly. You can't be too sure if it is safe. If your kitty were to be below 200 and you shoot 4 units, they could drop below 50 and be hypo. It is also good to get an idea of how much the insulin drops the numbers, how quickly it happens and how soon it wears off. You don't want the lowest number (nadir) to go below 70-80 on vetsulin. If it goes that low, you may need to reduce the dose. Typically for vetsulin we try to start at 1 unit. If after a few days the numbers are still high we increase by .25 units at a time. You don't want to skip over the ideal dose. 4units might be her ideal dose for now (hard to say without tests yet) but over time her pancreas might start working again and she may need less.
     
  10. Panic

    Panic Member

    Joined:
    Apr 10, 2019
    Just curious, what happens if you leave food down 2 hours before the shot, would the numbers go up or down depending on the food or? Just wondering why you guys don't want to see food-influenced numbers. ^-^

    I would definitely say 4u (right now) is her ideal dose, 3u wasn't affecting her at all. So with that in mind, do I test to wait for her nadir to start getting close to 70 before lowering the dose or? Do most people themselves change doses from their own observation or do they let the vets have the final say? Basically what numbers in theory should I be hoping to see consistently to determine a lower dose?
     
  11. CandyH and Catcat

    CandyH and Catcat Member

    Joined:
    Apr 23, 2019
    think of the scenarios, re food and the preshot test

    if the effect of the insulin from the previous shot had worn off, cat would show numbers above normal, you don't want the cat to eat and then experience increased blood glucose

    if the effect of the insulin from the previous shot had NOT worn off, if it was still acting, you need to know that, and you don't want food to increase the BG when you test, giving you perhaps a "good" number to shoot, which would then react with the insulin still in cat's system and put the cat at risk for hypo

    you can figure out anything else that might happen (hope this makes sense to you)

    in other words, you are checking to see what has gone on with the cat during the +10.5 and +11.5 periods since the previous shot, unmodified by food intake

    cat eats food during that time = preshot number is deceptive = fails to give you the information to plan your next step
     
  12. CandyH and Catcat

    CandyH and Catcat Member

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    Apr 23, 2019
    caveat -- disclaimer -- I'm still a newbie, I had to figure this out, hoping to save you the brain strain ...
     
  13. Panic

    Panic Member

    Joined:
    Apr 10, 2019
    That makes perfect sense actually, thank you for explaining! :D
     
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  14. BBelshan

    BBelshan Member

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    Feb 11, 2019
    Preshot numbers let you know if it is safe to give a shot. Nadir lets you know if you need to increase or decrease a dose. Although some cats can achieve remission - your goal for now is to get your cat regulated. (see below)

    Not treated - BG typically above 300 mg/dL [16.7 mmol/L]. Poor clinical signs.
    Treated but not regulated - BG often above 300 mg/dL [16.7 mmol/L] and rarely near 100 mg/dL [5.6 mmol/L]. Poor clinical signs.
    Regulated - BG generally below 300 mg/dL [16.7 mmol/L] with glucose nadir near 100 mg/dL [5.6 mmol/L]. Good clinical signs. No hypoglycemia.
    Well regulated - BG generally below 200-250 mg/dL [11.1-13.9 mmol/L] and often near 100 mg/dL [5.6 mmol/L]. No hypoglycemia.

    There may also be an extra category of "mostly above 300 (16.7) but with good clinical signs" which occurs with some cats who are getting insulin. We don't know why it happens, but such a cat probably should not be considered to be regulated.

    If your nadir is consistently above the mid 100s you might want to increase by .25 units. If your nadir is dropping below the 80s you might want to reduce by .25 units. Most people adjust based on the numbers they get from the tests. Eventually, you get a feel for how your cat is reacting. You can consult with your vet, but some vets want to stick with the dose they prescribed and don't trust you to test at home. Some like to increase or decrease by whole units - that might make you skip over the ideal dose.
     
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