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Discussion in 'Caninsulin / Vetsulin and N / NPH' started by Jmo625, Jul 24, 2017.

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  1. Jmo625

    Jmo625 New Member

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    Hi all,

    I am new at this and did my introduction on one of the other threads. To quickly recap, I have a 12 year old cat (Lulu) that was diagnosed in Jan. After many trials, the vet settled on 7 u of Vetsulin, 2xs a day. Everything appeared to be fine until an incident of low blood sugar where I had to rush her to the emergency vet. My vet then suggested I get a meter and test at home and said I should now give 5 u.

    I tested her yesterday for the first time and this is what I got...

    1pm - (I had just gotten the meter and decided to try it) 46 bg. Lulu ate at 7am and got her 5 units at 7:30am. She may have eaten a little bit more throughout the morning but I wasn't watching.

    6pm - 146bg. Ate at 6:30pm but didn't eat a ton and continued to nibble a little thru the night. I gave no insulin.

    11pm - 227 bg

    2am - I heard her get up and eat

    This morning - 6:00am - I fed her and she ate.

    6:30am - I tested her blood and she is 346. Clearly high, but I am afraid if I give her 5 units she will go low and I am leaving for work soon and won't be home until about 5:30. I am totally freaked out now about low episodes!

    She is on a prescription diet and gets Hill's diabetic dry food (1/2 cup) in the morning and continues to eat that throughout the day. At night, I give the Purina prescription wet food which she really only licks the gravy off of. I give her a little dry food to go with it. She also gets a little more dry food right before bed. In total, it's about 3/4 c dry food and a tiny bit of wet. She's 15 1/2 lbs. Diabetes is her only issue.

    Do I give her insulin this morning? If so, how much?? Help!!
     
  2. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Yikes!! That's far too low! Her dose is scary high.

    Good call!

    She hasn't had insulin in 24 hours so this isn't unusual.

    I'd drop her dose way down to 2 units. She's still eating dry food that keeps BG higher. In fact the dry food is likely what has saved her goose on the very high dose she's been getting. All dry food should be phased out over time but that has to be done carefully with a lot of BG testing because it can have a significant lowering effect on BG.
     
  3. JanetNJ

    JanetNJ Well-Known Member

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    I agree with kris. No more than 2 units.
     
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  4. Jmo625

    Jmo625 New Member

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    I ended up giving her 3 units and I think she handled it fine. I got home at 5pm tonight and tested her right away. She was 117. That's pretty good, right? She is going to get fed pretty soon, but she's not a big eater at dinner time. She usually will start eating a little later, right before bed. I think I will test her again before I go to bed tonight but if her bg is in the 200's, I'm going to skip her night insulin dose. Maybe she's been overdosed this whole time? Maybe she really only needs one shot a day? I know it's only been one good day, but she was awake and alert when I got home and even played for a bit. It's been a long time since I have seen that!
     
  5. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Yes, 117 is a good number. Do you normally give her insulin right before you go to bed? It would be best to skip if she's under 200 for sure. It's quite possible - very likely, in fact - that she's been overdosed all along. Home testing is the only way to sort that out. Once a day dosing doesn't work well for cats because they metabolize insulin too quickly. She's have poor BG control half of every day with only one shot a day.
     
  6. Jmo625

    Jmo625 New Member

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    I usually give her insulin about 30 mins after she has eaten which is typically around 7:00ish. However, she's not a huge night eater, so that's why I worry about giving insulin at night now.
     
  7. Kris & Teasel

    Kris & Teasel Well-Known Member

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    We recommend testing BG just before feeding (no food at least 2 hours before) and giving insulin to see whether the planned dose is appropriate - ie., if the BG level can support that dose. If it's below 200 we would recommend not giving insulin. If it's very near 200 you can stall without feeding for 20 minutes or so, retest to see if BG is rising and give insulin after feeding if it is. The stalling can be repeated up to an hour in 20 minute increments with a test after each.

    The systematic way we recommend you test is to allow you to catch the BG at important times - before giving insulin and also when it's likely to be lowest. This data is what you go by to assess the dose.
     
  8. Red & Rover (GA)

    Red & Rover (GA) Well-Known Member

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    How many hours late are you for shooting the night dose? I'm concerned that if you shoot too late, you will not be able to shoot in the morning before you go to work.
     
  9. Jmo625

    Jmo625 New Member

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    I think the timing of everything is going to be what is difficult for me! Before, when I was automatically giving her 7 units like the vet recommended, they were always about 12 hours apart. So it wasn't an issue. Now that I am learning to test her and actually look at the numbers, the timing is all off. She is also not a great eater when I feed her dinner. My other cat is super hungry by 6:30-7, but not Lulu. She didn't eat much dinner tonight at 7pm, but did eat a bit later. I waited a few hours and then tested her at 10 pm just to see what she was at. She was 257. I knew she was probably going to eat a bit more when I went to bed (she just did) and then again around 1am like she normally does. This is all from the 1/2-3/4 cup I feed her in the morning. It's just left in the bowl throughout the day. I gave her 1 unit to cover the night eating. She always wakes up hungry and eats a bunch, so I will test her again tomorrow morning before she eats and before I give her insulin. That usually happens around 6:30am.

    I am just totally guessing here though. I wish there was a chart that said if you cat's bg is this, give them this much insulin. I guess it can't be that standard for all cats though, eh?
     
  10. JanetNJ

    JanetNJ Well-Known Member

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    After several weeks of data it is possible to develope an individual sliding scale, esp as bg comes down. For now you are in the data collection stage. I hope you are keeping track of all these numbers? What I would love if you could do is constantly for the next week do 7 and 7 pm test, feed, shoot 1 unit and keep track of all the numbers in our spreadsheet. The only difference being if she's under 200 for the preshot hold of and wait 20 min without feeding and see if it's going up. If yes then give the shot, if no, skip. If unsure what to do, write on here. This will give us a baseline to know how she is reacting to the insulin. Please set up the spreadsheet and add it to a signature. so we can track the results with you. If you would like someone to help you set it up let me know.
     
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  11. JanetNJ

    JanetNJ Well-Known Member

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    BTW I think 3 units is too much of 10 hours later she was at 117.... That tells me she may have gone much lower during the day.
     
  12. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Since you are using a pet meter, your no shoot BG should be 225 to 250 mg/dl. to provide a little more safety margin. Once you get more data, you may be able to reduce that number but for now, it would be safer to skip a shot if pre-shot tests are below this range. I also agree the dose is too high and would reduce to no more than 2 units when pre-shot is high enough to give insulin.

    It's not surprising that Lulu is not enthusiastic about the prescription wet food. Seems to be a common problem. There are lots of other food options available through local retailers that Lulu will find much more palatable and you will find much easier on your budget. There is lots of information HERE about food options.

    The prescription dry food is too high in carbs and there are a couple of more appropriate options available in the US. Dr. Elsey's Clean Protein and Young Again are both under the recommended 10% carbs. That said, lowering the carb percentage in the food can dramatically reduce the amount of insulin a cat needs so any diet changes should be done slowly and only when you can monitor Lulu closely to ensure she stays safe.
     
  13. Jmo625

    Jmo625 New Member

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    Thanks for all of the advice, especially about the food as well! If someone could send me a link to a blank spreadsheet, I will put it together as I have been keeping track of her numbers. Thanks!!

    So she was 257 last night and I knew she was still going to eat a bit so I gave her 1 unit.

    This morning, before eating, she was 197. I know she will graze a bit during the day and then not really eat again until much later tonight. How much insulin should I give her this morning? I won't be home to monitor how she is doing until about 5pm.
     
  14. Yong

    Yong Well-Known Member

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  15. JanetNJ

    JanetNJ Well-Known Member

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    can you test one more time and see if it's going up? If it goes above 200 you can give 1 unit. If you are concerned since you won't be home you can always do a reduced dose (.5-.75)
     
  16. Jmo625

    Jmo625 New Member

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    Thanks for or the advice! And the directions for the spreadsheet. I will work on that tonight. :)
     
  17. JanetNJ

    JanetNJ Well-Known Member

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    the spreadsheet is really helpful.

    Anytime you get a lower then expected preshot like that you stall for 20 min without feeding and retest to determine if it's safe to shoot. Normally we tell new people if it's under 200 no shoot, but 197 is pretty much 200, ya know? If you want to play it safe, like I said, you could always shoot a reduced amount.
     
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  18. Jmo625

    Jmo625 New Member

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    Yes. I am leaving a little later today so I can check her again. She hasn't eaten a lot yet though, which is weird for her. Normally she is in here gulping it down.
     
  19. Jmo625

    Jmo625 New Member

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    Is that lower than expected?? She was 257 last night and I only gave her 1 unit. What should I have expected?
     
  20. JanetNJ

    JanetNJ Well-Known Member

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    not lower then expected but lower than we usually recommend for new people to shoot.... don't want you hypo'ing. how low does she go on 1 unit about 5 hours after a shot when the preshots start in the mid to low 200's?
     
  21. Jmo625

    Jmo625 New Member

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    I don't know. I haven't had that happen yet.
     
  22. Yong

    Yong Well-Known Member

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    Being at 257 for one PS and then 197 for the next can also mean the dose is a teeny tiny bit too much. The Spreadsheet will help us verify that. The numbers aren't super different so could just be a random cycle :). On your next day off try to get some mid cycle tests between +4 and +7 (4 - 7 hours after shot is administered). Eating a little less can also mean her body is starting to use the nutrients from her food more efficiently, so we don't dwell on all things bad ;). Obviously, if she continues to eat less and less, then we'll start suggesting a Vet visit and other possibilities.
     
  23. Jmo625

    Jmo625 New Member

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    Lulu was 197 this morning at 7am before she ate. I left her 1/2 c of food and I can tell she has eaten some. I just got home (6pm) and tested her and she is 392. She has not eaten any dinner tonight yet, but may not since she doesn't typically eat too much until much later. Should I wait to give her a shot until after I see her eat a bit?

    Also, I will try to work on the spreadsheet tonight to track all the data. Not sure if I understand everything yet with the amps and pmps and the +/-'s, but that may have been explained in the directions and I just haven't read it yet. Thanks!!
     
  24. Yong

    Yong Well-Known Member

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    Jan 11, 2017
    Sorry, just seeing this. It's probably a bounce number. Ideally you want her to eat a couple tablespoons 20-30 minutes before shot is due. You also don't want to go over an hour with shot being early or late with Vetsulin. The confusing steps of the sugar dance.

    Yes, everything about understanding the spreadsheet should be covered in the instructions ;)
     
  25. Kris & Teasel

    Kris & Teasel Well-Known Member

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  26. Jmo625

    Jmo625 New Member

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    Morning! I tried to set up the spreadsheet using my iPad last night and had trouble. So I am going to bring home my laptop and try with that.

    However, I still have questions. Lulu seems to be handeling the bouncing around okay and we have avoided any major low blood sugar episodes since last week. Yay. However, she is not eating as much as she normally does. I am wondering if it's the prescription food so I am going to look at the link of different foods that were sent above and try that before taking her in to the vet. Clearly she's eating some (and possibly late at night) but she seems to be not too interested. Last night I gave her two packets of FF treats. They are the Natural Hand Selected Treats...just a piece of chicken. She loved those! The package didn't say how many carbs though. Here are her most recent numbers...

    Tues - 7am - 197 bg
    6pm - 392 bg (out food out, but didn't eat)
    8pm - ate 2 FF snacks and gave 2 u Vetsulin
    10:30pm - 309

    Wed - (Today) 6:00am - 156 bg
    Gave a choice of dry and wet food, didn't eat much of either- a few bites of the dry. Not going to give her insulin today bc unsure of how much she will eat today.

    Is that okay to not give her insulin this morning?
     
  27. Kris & Teasel

    Kris & Teasel Well-Known Member

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    No insulin this AM until you have a lot of data on your SS.
     
  28. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Without more data, it's hard to say what is going on but with that low AMPS following an evening dose of 2u of Vetsulin I'm wondering if Lulu is going low at night leading to those low AM readings and the higher PM readings are reflecting some bouncing. If she is not eating well and going low at night then the dose of Vetsulin needs to be reduced. I'd be inclined to reduce to 1u until you get more readings and find food she is willing to eat.
     
  29. Jmo625

    Jmo625 New Member

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    Alrighty...I think I figured out the spreadsheet. I noticed that Lulu is kind of all over the place. It's only been a week since I have started to test her and I am testing her about three times a day on average. I think I saved it correctly to my signature, so please let me know if you can open it.

    I do have an important question...I am going out of town for three days for work. I do have the cat sitter coming over twice a day to give insulin, I am not comfortable with her testing Lulu with the meter (and neither is she!) so I am not going to have her do that. Should I go low and have her give 1 unit of insulin in the morning and at night? I haven't always given her insulin both morning and night based on her numbers. Should I only have her give 1 unit of insulin at night knowing that she will snack on the remainder of her food throughout the night? Or should I not give any insulin at all over the next three days and just keep her high and start over when I get back?? Help!
     
  30. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Yes, I can see your spreadsheet. When are you going out of town? It would be good to get some systematic dosing up and running before then so you have a better idea of how she's doing. Then, you can decide on a slightly lower dose that the cat sitter can give.

    She'll be less erratic if she gets insulin AM and PM at a dose that's low enough that her BG at the pre shot tests allows it. I suggest trying 1 u AM and PM for the next two days or so. Make sure you always get a non food influenced pre shot test every AM and PM. Also get at least one other test during the day time and evening.
     
  31. Jmo625

    Jmo625 New Member

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    I am leaving tomorrow afternoon around 4pm. The cat sitter will be coming around 6:30pm and 6:30pm. All of the morning readings are pre-food. I try to do the night ones that way as well. Its going to be hard to get two readings during the day now. I am back at work (a school) and I am trypically gone from 7am - 6pm. I get home in time to test her and then feed her and give her her shot. I can test her again before I go to bed though, around 10:00pm.

    I think I will tell the sitter to do 1 unit in the morning and night. I think Lulu will eat enough to cover that throughout the day. She is not one to eat all of her food at one time and instead will graze on it throughout the day.
     
  32. Kris & Teasel

    Kris & Teasel Well-Known Member

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    If you can't get daytime readings, get at least one before bed every day and extras on your days off school.

    For utmost safety while still getting insulin into her while you're away and no testing will be done, I'd drop the dose to 0.5 u twice a day. She might run a little high but that's OK for a few days. My thinking is that 1 u twice a day is probably fairly close to where she should be and there's no margin if she decides to dive when no one is around to test.
     
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  33. Jmo625

    Jmo625 New Member

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    Thanks for the help. I will tell the cat sitter to do that! Thanks!
     
  34. Jmo625

    Jmo625 New Member

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    Hi again everyone! I need some advice. I was out of town for a few days and had my cat sitter give Lulu 1/2 unit of insulin morning and night without testing her. She seemed to do well. I've resumed testing her since I have been back and most days she's been between 100-150. I have not given her insulin the last two days because her blood sugar has been on the lower levels. I don't think she is eating a lot or enough. She is still eating the dry prescription food in the morning and I am giving her wet food for dinner. She doesn't eat all of her breakfast so it site out during the day and she grazes. I'm now trying Fancy Feast Classics pate for dinner which she seems to like and will eat a good amount. However, it doesn't seem to raise her blood sugar a lot. I also have given her treats like FF real chicken bites. Same result. What's going on with her? I am surprised she isn't going higher. I just don't feel comfortable giving her insulin she is in the lower hundreds. Help!
     
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  35. Yong

    Yong Well-Known Member

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    Apologies, where are these numbers showing her BG raising a lot? Last two days I see you starting an OTJ trial countdown :woot::D:cool:. Definitely do not give insulin with these normal BG range numbers :)
     
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  36. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    Wow, yes, those are lovely normal numbers! Could be that remission is on the cards... (touch wood/anti-jinx)

    The fact that you're seeing these lovely numbers while still feeding some Hill's dry food is quite something.... That doesn't often happen....
    Is there any chance you could phase out the Hill's completely...?
    .
     
  37. Jmo625

    Jmo625 New Member

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    What is an OTJ trial? Whatever it is, I haven't been intentionally doing it. :). I realize the numbers are good, but I thought with a diabetic car, it was best to give insulin every day. I don't want to over do it...like the vet was having me do before. My vet also told me that cats can't ever shake the diabetes like a human could with Type 2. This morning she was 110, so again, I am not going to give her insulin.

    I haven't been home a lot lately bc I work at a school and we start tomorrow so it's been crazy. I don't know how much she is eating when I am not here. But clearly, it's been enough to keep her at good levels. I am trying to phase out the dry food by giving the wet food in addition to the dry food right now. She likes it okay, but if I am not there to monitor, my other cat gobbles it up. She loves it! :)

    Just wasn't sure what to do with not giving insulin daily.
     
  38. Yong

    Yong Well-Known Member

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    It's when you start counting down 14 days of not needing to give insulin and heading towards remission (antijinx!) :D
    I don't know that humans can fully get rid of the condition, they're still more prone to it coming back. Kitties are the same way when they go into remission. Lulu will remain on her low carb, diabetic friendly diet for life. You'll still be doing spot checks throughout her life as well so if she is falling out of remission, you'll catch it sooner. Kind of thinking if I adopt another fur baby I will spot test him too! ;)
    How much isn't a huge issue unless you have weight concerns for her :cat:. If you can completely get her off dry, it may lock in her remission even more! If not, there are 2 other much lower carb dry options available in the states. Young Again Zero and Dr. Elsey's Clean protein Chicken.
    Not have to worry about her dropping and counting your days! :woot::woot::woot:
     
  39. Jmo625

    Jmo625 New Member

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    Thanks!! That would be awesome if I didn't have to give her insulin anymore and just spot check her! I will continue to check her at least twice daily until I go back to the vet in September, but she seems like her old self to me. I will look into those two wet foods listed...Amazon or a pet store? She is still overweight. At the last checkup she was 15.3. She's 12 and mostly lays around with little spurts of running around after nothing and playing with balls. I will try to get her a little more active. Hard when all I want to do when I get home is lay on the couch! :). Thanks all!!
     
  40. Yong

    Yong Well-Known Member

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    Young Again Zero and Dr. Elsey's are actually dry foods. Suggested them to swap out for your Hill's :). I think the Hill's prescription dry food is like >20% carbs so getting a <5% dry food may help really lock in her remission ;)
     
  41. Jmo625

    Jmo625 New Member

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    Hi! Just checking in again to get some input. I've been checking Lulu consistently now for awhile and her numbers have mostly been in the low 100's with a few a little below 100. I see no reason to give her insulin with numbers this good. She doesn't seem to be drinking too much (like she originally did when she was first diagnosed with diabetes) and eats normally. She now really likes the wet food and I give it to her in the morning and at night. I still give her a bit of the prescription dry food bc I am afraid what will happen if I take it away. I haven't weighed her again , but she doesn't look like she has gained weight. In fact, she seems to have more energy and wants to play sometimes. She is 12 years old, so she does sleep a lot...but otherwise, seems to be doing well. I still wonder...is it possible she is not diabetic anymore? Could that really be possible? I have to take her to the vet to get her fructosamine test done. I assume that since her bg numbers are normal, that will be too. Could this all be real?? :)
     
  42. Yong

    Yong Well-Known Member

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    Jan 11, 2017
    Very good news! :D What are afraid will happen if you stop dry? Without giving insulin, her own body won't make her go hypo ;)

    She'll always be diabetic and have to stay on her low carb diet but she might have a nice remission :). You'll want to spot check her bg after 14 days without insulin so you catcher her if she comes back out.
    14 day OTJ trial still take AMPS and PMPS. Sorry if it has been 14 days, I can't open the SS right now. In which case, CONGRATS!!!
     
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