? Need help, unable to keep regulated.

Does anyone know how long it may take for Vetsulin to start working? Smoky has been on it since Sept 6 and his numbers have been climbing lately.
I am taking him for an appt tomorrow to see his new vet. She suggested doing a curve on smoky the day before and bring a copy of his SS in with me.

I am wondering if I should increase his dose from 1 unit to 1.5 or just wait until tomorrow when I take him to the vet? He seems to be bouncing all over the place. He did much better in the earlier days when he was on a lower dose but am questioning the effectiveness of the insulin.
His AMPS was 545 which is the highest it's ever been. His new vet suggested lowering his dose from the 2.5 to 1 unit as she said that was probably far to much for him.

 

I have no experience with Vetsulin myself but a few things caught my eye when I read your message. You said he did much better in the early days on a lower dose and you said that your new vet thinks 2.5 u is too much for him. I also see you have a good array of blues and greens in the evening on the higher doses.

What I think would help you is to be consistent in testing BG before every dose. Your SS has some of this data missing. This is the best way to know whether a dose you want to give is a safe one. It's great that you're doing some evening testing to see the effect of a dose. If you could do more mid-day tests at, say, +5 and +7 or even an every 2 hour curve on a weekend or day off, you'd have a more complete picture of Smoky's response to a dose. For example, on Sat. 10/08 you gave 2.5 u as his PM dose and got a BG of 79 at +4. He might have gone lower after that if the Vetsulin is lasting 10-12 hours in him. He might have bounced and had high BGs in the cycles that followed but there's no way of knowing.

Regarding size of dose changes: 0.5 u is a large change in dose, especially at the low dose level you're at with Smoky. Vetsulin is a U40 insulin I believe and if you have U40 syringes with half unit markings, you can eyeball half way between those to estimate 0.25 u. Sounds risky but many here do it and you get good at it with practice. Another option that many use to be able to give small dose fractions is to use U100 syringes and a conversion table. This allows 0.2, 0.4, 0.6 and 0.8 unit fractions of a dose. http://www.felinediabetes.com/insulin-conversions.htm

It sounds like your new vet has the right idea and wanting to see your SS tells me she's OK with you doing home monitoring. It's still early days for you and Smoky so try not to get discouraged. I really think that a more systematic approach will get you moving forward.

 

Without more data it is impossible to say what is happening, but I would not be tempted to change doses so often unless the numbers indicate a need to. You need to get into the habit of test, feed, shoot. The +2 test is a useful one to try to grab as well. Some cats take time to settle into a dose and a few days with limited data is not really long enough to determine if a dose is suitable or not. This is a marathon, not a sprint and patience is needed. You need to be getting consistent testing started and get a curve done to determine the lowest point in the cycle and how low that point is. Dose decisions are made on how low the sugars go and the rate of drop. I would stick with one unit until you have seen the vet and try to get some more tests in.

 

Thanks for that great advice. I do try to test smoky on a regular basis but there are times I work all different hours. It's difficult because it means I might go to work in morning too early to test him first. My roommate has given him shots for me but there is no way she will test him for me. The new vets advice to lower dose was due to smoky seeming to be ill on the higher doses. I do have off Sunday and Monday every week so can do a curve on those days.
Also, smoky is very thin, now at 8.6 lbs, so he has to eat every 3 or 4 hours. He was 14 lbs before his diagnosis. The new vet also wants me to do a test for ketones tonight and bring urine sample in to make sure he doesn't have any infections going on. His last test for ketones was 3 days ago and was negative. Smoky also has allergies and can form crystals in urine so it's hard to find food to combat all three of his conditions.

 

This is the reason I am getting a new vet, his old one was always changing his dose all the time, usually raising it every five days by 0.5 units. I'm not sure is vetsulin is the best insulin for him as he seems to have sudden drops with it. The new vet usually tries cats out on Lantus first.

 

Yes, work can get in the way, can't it? If you can maximize the number of preshot tests and do it faithfully on the days when you're off, along with more through-the-cycle tests, you'll get a better picture of how Smoky is doing. I do think smaller and less frequent dose changes would help too. Something to discuss with your new vet.

Congrats on doing ketone testing! You must have found a way to collect urine that Smoky will tolerate.

 

Good for you being proactive for Smoky!

 

As long as he has not eaten for the 2 hours prior you could get a test before you leave for work - so an hour before feeding would be a +11, 2 hours before a +10, etc, all data is valuable.

 

Good idea!

 

Unfortunately, that would not work for me. I would have to get up at 3 in the morning some days and if I work late the night before I would be going to work on three hours of sleep. I might then have to work a 12 hour shift.

 

I don't understand - what I was suggesting is getting a test as you leave for work, and then working out where in his cycle it is for the spreadsheet, and leaving the rest to your roommate if they can't do a pre shot test and it isn't his feeding time when you leave. What times does he normally get fed?

 

I usually feed him as I'm going out the door. Some days I work a regular day shift but sometimes I work split shifts which can make it hard to test him. I just meant that there are times I get called into work without any notice. I barely have time to feed him and give him his shot before running out the door. I'm going to a regular day shift on Oct 25 so I will be able to maintain a consistent schedule of test, feed, and then shoot. It will be so nice to have a regular work schedule.

 

I made it a habit of testing each time I went out the door. Using an auto feeder helped as it allowed me to set it ahead of time so I could run out at a moments notice. Maybe you can think of something that will work for you.

 

Isn't an auto feeder for dry food? I can't give smoky any dry food due to his urinary issues and the diabetes. It is hard to get smoky to eat much in the morning, I might get an ounce of food in him before his am shot. My roommate works second shift and will put more food down for him after I leave. She puts it down about 30 minutes after I walk out the door. Of course, the little stinker will eat a lot more after I go to work.

 

One of the favorites around here is the PetSafe 5 meal feeder

It's saved a lot of people's sanity!

 

I read on here that many use an automatic feeder for wet food. Do a search for their hints.

 

OK, I'm a little baffled here, trying to do a curve on smoky today. He started out with a AMPS of 545, dropped down to 270 at +3, and went back up to 320 at +6. To me this says the vetsulin is lasting him half a cycle. Am I wrong to come to that conclusion?

 

Thanks for the tip, I didn't know such a feeder existed!

 

Keep going, it's just one number. We all get odd numbers at times.

 

Too soon to tell and not necessarily. You'd need more days of data to conclude that the Vetsulin isn't lasting long enough.

 

Now if I can just keep her cat Toby out of it somehow. At least her other cat Lillie doesn't like canned food.

 

This is a fairly normal curve for Vetsulin. What usually is seen is that the AMPS and PMPS are very similar with a steeper drop usually around +3-+5 and then the numbers rising again by the next shot time.

 

I'm trying to decide if I should increase his pm dose by 0.25 or not depending on his PMPS. He is going to his new vet tomorrow afternoon. She is the one who asked me to do a curve on him today.

 

You might want to discuss everything with your new vet before you do anything different.

 

Thank you. That's good to know.

 

Without more data it is hard to say if today's numbers are due to a bounce from possible lower numbers last night. On this cycle Smokey did drop 50% from preshot to nadir, which is a good size drop. I would not increase without more data and also discussing with your vet.

 

I think that's a good idea too. I was leaning in that direction.

 

ETA If you look at Oct 8 PM cycle, Smokey dropped from 427 to 79 which is a huge drop. When big drops like this happen or if the numbers get much lower than normal, the body releases stored glucose (glucogen) which causes the glucose levels to rise sometimes quite a bit. The higher levels can take several days to clear the system and increasing a dose would be a bad choice with a bounce.

 

I questioned my old vet about that same example in your post and he just kept saying he needs more insulin. His dose was 2.5 units that day. I stupidly listened to him for a few days but smoky was feeling so sick that I lowered the dose. Probably not my brightest idea yet.

 

Another 90 minutes and I will test him again at +9. I'm trying not to panic over the idea that he might bounce and his BG will be sky-high again.

 

The biggest hurdle to determining whether a kitty is bouncing or actually needs more insulin is not having enough data. Your life schedule makes it difficult, but at the VERY LEAST you should try to get a test before each shot. It would be best to have another during the cycle, but with at least having preshots you know if it is safe to give the shot.

 

I am getting a promotion at work which starts at the end of this month. I will finally have the same work hours all the time, 8 am to 4 pm. It will be so much easier on me and my kitty to get regular testing done each day. Sending hugs to everyone today

 

That will make treating Smoky SO much easier.

 

Congrats on the promotion, Lisa. I'm glad that it will make things much easier for both of you.




Mogs
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Congratulations on the promotion it will make it easier. A few feeders can accommodate wet food. The petsafe 5 and petsafe 2 meal compartment allow for cold pack placement under the trays. I also got reusable mini ice cubes that fit under the dishes (I used the 2 compartment feeder). For overnight I put an ice cube right in the food. When it melts it gives extra water which was the first thing he lapped up. You can also put frozen food in it. I used rechargeable battery and changed it every month so I knew the battery wouldn't die (it did once).

 

I'll have to google it online and check it out. Oops, I forgot to pick up smokys bowl again. I guess it will be OK if I check his PMPS 1 and a half hours after eating instead of two.

 

There might still be a food effect going on at 1.5 hours.

 

I know but I wanted to get a +2 and +4 before having to go to bed. If I waited two hours I wld only be able to get a +2.

 

Smokys AMPS was 485, I miss those lower numbers he had before. I called his new vet and she suggested giving him 1.25 U this morning instead of the 1U. He goes to the vet late afternoon so she can get a +6 reading on him. I am taking my meter to compare it to the in house one they use.

Smoky is being very picky with his food lately? Any ideas on getting him to eat more? He has meds for both nausea and an appetite stimulant . I think he gets bored easily with his food choices. Either way it's hard to do his am shoot when I have to coax him to eat more than a ounce at a time.

 

Have you ever tried sprinkling some FortiFlora on his food? It's made of the same thing they spray on kibble to make it so irresistible to cats and just a little sprinkle will get most cats eating

 

I haven't tried this yet. Is it available in local stores or is it sold only online?

 

I've been able to buy it from my vet in the past.

 

One of my kitties gets sick with the fortiflora, the other one doesn't mind it. When I have one of my kitties being fussy with their food I will add a bit of tuna juice on top and that usually gets them going.

 

Smoky went to his new vet today, she wants to try him on Lantis, one unit twice a day to start. She wants me to wait until I am off work next Sunday and Monday so I can monitor him on the new insulin.
I'm taking him back tomorrow to have an ultrasound done. She wants to make sure there is nothing else going on. He lost another pound down to 7.5 lbs from 8.5 lbs. That is why I have to get him to eat more. The vet wants him to eat at least 8 oz per day.

 

That's a great idea!

 

I will ask her about

I will ask my vet about it tomorrow.

 

Some vets offices sell it....of course it's usually a little more expensive

Some other ideas you can try are sprinkling a little parmesan cheese, oregano or catnip on top of the food

 

Oregano? Wow, I never would have thought a cat would ear that.

 

Oregano is related to the catnip plant!