? New member on very high starting dose of Vetsulin need watching

Carolee posted on a much older thread from another member and I am afraid her comments will get lost. I have advised her to start a new thread on here. She has just started Vetsulin and is on 5 units BID which is WAY too high.

Her posts are at the end of this thread:

http://www.felinediabetes.com/FDMB/threads/sliding-scale-for-cat-insulin.137190/#post-1925205

I will post a link to this thread in case she can't start a new thread herself.

 

AAArrgghhhh! Why do vets keep doing this?????

 

Unfortuntely she is not on right now and her posts on the other thread were:

"I am using vetsulin . I have not given it yet I tested his bd st 1530 today and it was 61. I fed him 3oz of fancy feast wet low carb . I will recheck at 2330."

"He was given 5 units at the vets this morning it is his second day on insulin"

"I am so freaked out about him being diabetic . I gave another day and I fed him the same today threw the dry good away and feed chicken thighs but up for in between the am and pm meals"

So I am really lost for where in the cycle her kitty is, At least it sounds like she is home testing, but a 5 UNIT STARTING DOSE And with a diet change that could drive the numbers down much more.

 

Yeah, I put a post in that other thread; I agree, this is a pretty terrifying situation. The worst is not knowing what is going on-- I hope she comes back on, and if not, that her kitty stays safe tonight.

 

I have been seeing that 5U starting dose a lot lately. I don't understand why vets are suggesting such a high starting dose - 5U is extremely high!

 

Does anybody know if maybe she is on the FB FDMB group?

 

I haven't seen any posts about someone just starting Vetsulin and it is hard to know what her FB name would be, but I will keep checking on FB. I am worried about that 5 unit dose and want to make sure she does not shoot again before getting more information from here and doing some heavy duty testing.

 

I checked 5 other FD groups on FB and can't see anyone that would fit into the description that Carolee posted. Hope she comes back soon.

 

That's really scary . Isn't Vetsulin one of the more fasting hitting insulins? And that after the 61 reading she couldn't retest for 8 hours.

 

Yes Vetsulin can bring glucose down quite quickly early in the cycle.

 

Hi this is Carolee I did not give my cat any more insulin tonite . I did feed him 3ounces of fancy feast and I am rechecking his sugar at midnite.his schedule is 12noon And 12midmite

 

I fe him around 400 pm

 

My cats Blood sugar was 380

 

Should I give him insulin ?

 

Is anyone still up that can advise me what to do?

 

Do I give him the insulin and come food after?

 

As you've read several times, we think the 5 unit dose is far too high. I'm going to be the person to go out on a limb and suggest that you give only 1 unit of Vetsulin tonight. Test him again two hours after the dose to see what's happening.

Here's the sequence:

1. test BG
2. feed
3. wait 30 minutes
4. give insulin.

There must be food on board because Vetsulin hits hard and fast.

 

I am giving him 4units on a sliding scale and some wet food

 

I would NOT give 4 units. I suggest only 1 unit until you get more data and have switched all meals to low carb wet food only.

 

So the 4units is to high I am going by the sliding scale?

 

He did not have any dry food since 1200 I only fed fancy feast 3ounces

 

A sliding scale is one where the insulin dose AM and PM might change in response to the BG level. You're not there yet in your kitty's treatment. You're in the early stage of trying to figure out the approximate dose range that will be effective. Unfortunately, you've been thrown in at the deep end with the prescribed dose of 5 units BID. That's dangerously high. The Vetsulin manufacturer recommends a starting dose of 1 to 2 units BID per cat.

Please read the sequence I gave for testing, feeding and injecting.

 

So fed him first then give 1Unit and retest in two hours

 

Yes. This might well be too low a dose but it's likely a safe dose. The retest in two hours is to see if the Vetsulin is starting to kick in and, if so, how strongly. You said his BG was 380. That's high but not outlandish. If at 2 hours it's down a lot (100 points maybe) that's a sign that he might be heading lower than you'd like. The low BG point (called the "nadir") for Vetsulin usually happens around 4 to 6 hours after the injection. It wears off in 8 to 10 hours in many cats which is why the BG can be quite high just before the next dose is due.

 

Thank you

 

And if the bs is still high after two hours then what?

 

http://www.vetsulin.com/vet/Cats_DosingOverview.aspx

The link above is to the Vetsulin manufacturer's info page on dosing in cats. Over time you'll have to learn more about this insulin's characteristics and how your kitty responds uniquely to it. Testing at home and gathering data on the spreadsheet we use here is a great way to build up a reference for dosing decisions down the line.

This is what we recommend in the early days:

• start at 1 unit twice a day, dosed 12 hours apart
• gather BG test data (just before each shot and near the middle of a cycle) to see how kitty responds to this starting dose for 3 or 4 days
• if BG stays high, especially at nadir, raise the dose by 0.25 unit (eyeball on the syringe barrel)
• continue that dose for 3 or 4 days and assess BG data to see if dose should be raised another 0.25 u.

This is how the good dose is found. Increasing by small fractions means you're not likely to pass by the good dose.

 

If it's still high, don't worry. Just continue the 1 u dose again tomorrow morning and evening. The goal first and foremost is to keep your kitty safe. Second, you want to establish the proper dose range by starting low and increasing slowly and carefully in 0.25 unit fractions over many days.

 

Here's the BG testing routine we recommend:

1. test BG AM and PM before feeding and giving insulin (no food for at least 2 hours before these tests) to see if the planned dose is too high
2. at least one other test near the middle part of a cycle (the 12 hours between doses) to see how low the dose takes him
3. a test before your bedtime if you can't test mid day
4. extra tests scattered through the cycle on weekends or days off.

 

Here's another tool you need in your diabetes kit - urine ketone test strips. You can buy them at any human pharmacy. The brand I use is Bayer Keto-Diastix but there are others. When a kitty is in high BG numbers, urine ketone testing is a good idea. Here are some ways to do it:

1. put the testing end of the strip right in the urine stream when he's in the litter box OR
2. put a shallow long handled spoon under his backside as he pees OR
3. cover his favourite part of the litter box with a few layers of plastic food wrap and push little depressions into it to catch urine.

 

I have to sign off now - long past my bed time. Your kitty should be OK for tonight on this low dose. Take some time to read the info stickies on the Caninsulin/Vetsulin forum and go over the other stuff I've posted to familiarize yourself with what you need to do going forward.

 

It is two thirty in the am retested his bs and my boy Clarance is 400. I will retest in am

 

Thank you Kris❤️️

 

Carolee

I'm glad to see that Kris was here and able to give you some good information on Vetsulin.

This link:

http://www.caninsulin.ca/faq-answers-p.asp

has a lot of information on Vetsulin also called Caninsulin in countries outside of the US. If you read through you will see important points. This link is from the Canadian site but just remember that Caninsulin IS Vetsulin with a different name.

"
How does Caninsulin work in cats?

A lente (intermediate-acting) form of insulin, Caninsulin contains approximately 30 percent amorphous insulin for rapid onset of activity. The remaining approximately 70 percent of the formula is crystalline insulin which is absorbed more slowly. This formulation allows for a more continuous utilization of glucose to support the body's basic functions. In cats, the peak activity following subcutaneous administration of Caninsulin occurs between 1.5 and 8 hours (with an average of about 4 hours), and a duration of activity varies between 8 and 12 hours. Caninsulin should be administered subcutaneously twice a day in diabetic cats."

"In cats, the initial recommended dose is 1 to 2 IU per injection, and the injections should be given twice-daily (BID) at 12-hour intervals. Initial dosing is based on a per animal basis. The duration of activity of Caninsulin in the cat is between 8 to 12 hours – this is shorter than in the dog. Peak activity level occurs between 1.5 to 8 (average of about 4) hours in the cat."

When first starting any sort of insulin it is suggested to hold the initial dose for 5-7 days..unless the numbers drop too low...in order for the body to become acclimatized to using external insulin. Dose increases should only be done once adequate data (testing) has been done to see how your kitty is responding to a specific dose. Using a sliding scale with Vetsulin/Caninsulin is a more advanced approach and should only be done once there has been adequate data to show how your kitty responds.

Because Vetsulin has a faster onset time testing in the earlier hours after the shot is a good approach in order to catch any fast or low drops in the glucose levels. When a kitty drops too fast or too much the body produces counter-regulatory hormones which cause stored glucose to be released into the blood stream, since the body "thinks" that this is an emergency situation. When this happens the glucose levels can be elevated for up to 3 days, something referred to as "bouncing" This does not mean that more insulin is required since this will simply cause more bouncing. Recording regular glucose readings over the first week of treatment will show if there are any large ups or downs in the levels and make it easier to determine what dose changes are needed.

Also from your earlier post it appears that you are removing dry food from the diet. Dry food is high in carbs and once it is removed from the diet and out of your kitty's system ( which can take a few days) glucose numbers can drop sometimes quite a bit, depending on the kitty.

The one thing that this forum is always concerned with is keeping any kitty safe.

Please do continue testing and asking for advice. The people on here live and breathe feline diabetes daily and have lots of personal experience and understanding in treating feline diabetes. Not to be unkind, but if your vet gave a starting dose of 5 units, then they do not have a good understanding of how insulin for kitties should be approached. A serious hypo event that is not treated properly can cause neurological damage and even possibly death.

 

Hi Carolee,

How is your kitty this AM? How are you? That was a stressful evening but you got through it. I said that the 1 unit dose might be too low but it was at least a safe dose. Your kitty has only been on insulin a couple of days so your task right now is to read all about the insulin, set up a BG testing routine like I outlined in post #29 above and (hopefully) organize a spreadsheet like we use here. If you need help with the spreadsheet there are techie people here to do it for you.
http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

If you're off today and can manage it, testing every three hours or so between the 1 unit doses will give a much better picture of what you need to do next dose-wise.

 

So glad you stepped in last night, Kris! Lots of good information from you and Tuxedo Mom about Vetsulin here.

Quick question: was Clarance at the vet's for ketones or diabetic ketoacidosis (DKA)? Kris mentioned doing at-home testing for ketones-- it's important for any diabetic cat but especially one with any history of ketones. Also, if he does have a ketone/DKA history, that will change some of the advice we give, so it's important for us to know about that (or any other major health condition that needs to be managed simultaneously with the diabetes).

I do want to highlight one more thing that Tuxedo Mom mentioned: when a cat that has been diabetic for a while first starts to see low numbers again on insulin, often the body reacts to try to get the BG back up to where the cat has gotten used to being. We call this "bouncing", and I'm mentioning it because, while we don't have enough information to really know yet what is going on with Clarance, I think it's very likely that the high numbers you saw last night were (at least in part) a reaction to the 61 you got yesterday afternoon. You may also see some more high numbers this morning that are still part of the reaction to the 5U dose. Don't be alarmed-- it's perfectly normal.

It's also genuinely very confusing, especially at first, but don't worry, we can help you figure things out and get to the right dose to get Clarance feeling better. I just wanted to highlight the bouncing phenomenon for two reasons: 1) you are likely to see it, best to be prepared!, and 2) it illustrates why it's so tricky to dose on a sliding scale in the beginning-- the high number you see doesn't always mean more insulin is needed, sometimes it means less is needed!

 

So my cat bs this morning was 384 I did not give insulin because it not until 1230 I did give some wet food not much will test again at noon

 

Thus sugar was at 9:30

 

That is not a bad reading for 9 hours after last night's shot. It is still high, but it does take some time for the body to adjust to having "outside" insulin. '

A few things that will make it much easier for members to offer information/advice. Since we are all in different times zones the timing for shots and tests is referred to as AMPS (morning preshot test) and PMPS (evening preshot test) The readings in between shots are referred to as "+" numbers. For example the 384 reading you just got was 9 hours after the shot so it would be "+9".

Also a valuable tool is setting up a spreadsheet to record all preshot tests and readings done between shots. This link:

http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

has directions on how to set one up. If you have trouble with the directions just ask and there are some people on here who are "spreadsheet gurus" and can help you get one set up. I had to have help when I first started...not too techie savy

Please do post with the preshot number when you get one. If it is possible and you are home today, it would be good to schedule some tests for +2, +4 and +6 hours after the shot to give a better picture how the Vetsulin is working,

It is rather overwhelming in the beginning but there are lots of people here to help you on this treatment journey.


ETA Also putting information into your "signature" gives a snapshot of information that is important for anyone giving advice to know. This link has information on setting upyour signature:

http://www.felinediabetes.com/FDMB/threads/editing-your-signature-profile-and-preferences.130340/

 

Thank you you have all been extremely kind and helpful. I di give a small amount of food at 9:30! And will retest at 11:30

 

This is his blood sugar now

 

I will feed him and wait a half hour and give 1 unit of insulin

 

Sounds like a plan!

Can you say more about how the vet arrived at the 5U dosage? How long was Clarance at the vet being evaluated, and what did they do?

 

So I gave him 1 unit of insulin I wil. Check in 4 hours to see where He is at.

 

He was there all day and nite on Thursday he did a curve of bs and started him out on 5 units

 

Friday at 0800 am he was given 5inits and when I checked him at 1530!hebwas 61

 

So the reading at the vets was 61 after 7 1/2 hours. This means the numbers could have been even lower earlier in the cycle (time between shots). Vetsulin "usually has a nadir ( lowest number) around +4-+6 hours after the shot. A drop into lower numbers and maybe even much lower numbers (hard to say without tests done earlier than the vet did) could very well have caused "bouncing" into higher numbers as I talked about in an earlier post. This could cause the numbers to stay higher for up to 3 days. I am very glad you decided to start with the 1 unit and monitor the readings.

 

So I feed him and rechecked at 2330'amd he was 380and then I feed him waitedhor gave 1 unit and I rechecked him at 2:30 am he was 400

 

The 61 was at home with my glucometer

 

OK, so it doesn't sound like the 5U was based on anything other than the vet-office curve (no DKA or other underlying condition). It sure does look like the 5U was waaaay too much, given how low it took him 7.5 hours in! I agree that the high numbers last night and today are likely due (at least in part) to bouncing, so it will take a little while to see what the 1U can do.

"Vet stress" can raise a cat's BG numbers, in some cases by hundreds of points (!). It's likely that his numbers were higher at the vet's office than they would have been at home-- it's a common cause of setting a too-high initial dose, though 5U is an outlier even then.

 

He was diagnosed with symptoms blood sugar of 539 on Tuesday for his annual clinical I noticed increased thirst and large volumes of urine

 

I am going to start low and see how he does it is hard I have another cat do I put him on wet food also got rid of dry my boyfriend does not get the seriousness of this he thinks him going for two hours past insulin time is okay no way I told him so this is going to affect my home life too

 

I see that you've had people here to help you. That's one of the many great things about FDMB - you're not alone.

It would be a lot easier for you if both of your kitties ate the same low carb wet food. It's good for all cats. Dry isn't - it's only convenient for people. You can let them free feed if that's what they like to do. Just make sure there's no food out for 2 hours before Clarance's pre shot BG test. Yes, you'll need to create a new routine at home and it'll feel strange at first. We've all gone through it and it becomes second nature after a while. Insulin works best when dosed at 12 hour intervals.

 

Yup, classic diabetes signs!

Not sure what this means, exactly? Do you mean it's going to be tough to keep on a regular schedule with the shots? You do want to keep them as close to 12hrs apart as possible, although Vetsulin is somewhat more "forgiving" of schedule changes than some other insulins. Or do you mean food? It is definitely very important that the cat has a full meal when you give Vetsulin-- it is a fast-acting insulin and can cause some dramatic drops, so there needs to be food on-board for it to work on. [Edited to add: as Kris says, you do want to keep the 2hrs before the shot free of food, so that the pre-shot test isn't food influenced]

 

Getting rid of dry food is definitely the best route for a diabetic kitty and is a better choice for a non-diabetic kitty as well. Trying to keep the shots as close to 12 hours apart right now is best so that you can see what sort of pattern develops.

 

Okay no dry at all ! I am waiting to check my cat at 1800 that will be 6 hours in between insulin coverage

 

His sugar at 1830 was 31 7

 

It has not been under 300 yet I think that is not good for his renal function

 

That blood sugar of 317 was +6 for him

 

That's correct. High numbers aren't good for renal function - if they stay high a long time. The problem is that too high a dose of insulin can cause a hypo episode that can kill very quickly. You have default to the evil that's less dangerous in the short term. Please consider setting up a spreadsheet like the one we use here and enter all the BG numbers you have in it. The dosing for today and tomorrow is aimed at setting a baseline from which a better dose can be approached.

 

When should I start to give more than 1 unit of insulin?

 

wouldn't it be safe by now to move up to 1.25 units?

 

Hi Carolee,

Do you have more data? Your +6 number of 317 last night was high but not terrible. You could speed it up and give 1.25 u today but we really need to see enough data on a spreadsheet to be able to advise. Until you get one set up please post your BG results for the day in a vertical column like this example:

AMPS __________
AM dose __________
+? BG __________
+? BG __________

It's almost impossible to give guidance when we have to search several posts to find single numbers. It's also much more useful to give time BG timing as the number of hours after as shot instead of a clock time because we're in many different time zones.

 

Good morning I have done my spreadsheet I am having trouble posting in the url. his sugar was 320 at 0930 + 9.

 

Yeah, I can't see the spreadsheet yet. Is the problem getting the link address itself or figuring out how to put it into the signature?

To answer your question, I think it's best to hold the 1U for at least 2-3 days to make sure the bounce has cleared after that 61 he got on the 5U at the vet's.

Have you done any ketone tests yet?

 

No not yet he has not been peeing as much and he seems to have slowed down on water consumption. I just rechecked his bs and it was 392 I am feeding him his 3 oz of wet food and then wait half hour and give him his insulin at 1220 pm.i am having trouble with the URL address.mist of his sugars have been around the 300+ mark

 

I'll tag @Marje and Gracie , our spreadsheet guru, to help with this. It may take a little while before she's on again and sees the tag.

Glad he's showing some better clinical signs!

 

Amps-_392___
Am dose___1 unit___
+ 9 BG _320___
+ 11 BS 392

 

Hi Carolee,
Would it be possible for you to test his BG and post the results at say +2 hrs, +4 hrs, and +6 hrs after his shot? I see you have a +9 and +11, all data is valuable and helps you and us to see the bigger picture.

What I do with Smoky sometimes is a mini curve. I check his BG at maybe +3 hrs, +6 hrs, and +9 hrs after his shot. This gives me a pretty good idea of how the insulin is working on him. I work full time so can only do curves like this on my days off.

 

Thanks for listing this. Those readings are for the tail end of a cycle (cycle = the 12 hours between doses) and that might be why they're high-ish (I've seen much worse!). As Lisa suggested just above, getting BGs near the middle part of the cycle is key to know the full picture of a dose's action.

You'll get the SS sorted. For now, just list data as you have done.

 

@Carolee
Here's Djamila's video on how to link your spreadsheet:

 

Hi Carolee,

Do you have any more BG numbers to share?

 

Hi I just got home from work and at 1230 am Clarence bs was 199

 

I fed him and I will give 1 unit of insulin

 

That's not a bad number at all. How many hours was that after his last shot? What was his BG before that? I would agree that 1 unit is not a bad dose for that BG of 199.

 

@Carolee ....you still have a problem regarding the spreadsheet

If you'd like some help with it, please send me a private message by clicking on my name and choosing "Start Conversation"

I'd be happy to set it up for you and get you started but will need some information from you first

 

I work. Second shift and I only got his before bs +12 was 199 for the last 12 hours

 

Thank you Chris I appreciate the offer

 

No that is the only one since his 1230 pm shot

 

I just noticed a lump in my cats shoulder area where I gave insulin anyone else ever get a lump

 

I thought you worked night shift for some reason. Sorry about the mix up.

 

Smoky had one as well when I started giving him shots. The members on here asked me if I was giving shots in the same area all the time. I was doing that until someone suggested alternating the places where I give the shots. I hope that helps.

 

Yes, there can be fluid build up in the injection site if you tend to use the same area. My guy was like that when I was using the scruff/shoulder area all the time. Now I use many places along his side and there's no fluid deposit happening.

That 199 after the previous shot 12 hours before is great! He was probably lower in the middle part of the cycle so if you can get tests in that time period when you're at home, it would really help to flesh out the picture. I'm so glad you went with my recommendation to drop to 1 u. It took a few days for the high bounce numbers to drop and now you're in some very nice pre shot BG territory.

I see that Chris has offered to get your spreadsheet set up so we can all see it. That's great!

 

Thank all of you for all your valuable input and guidance.!❤️

 

I am having trouble changing my password any suggestions?

 

Carolee

post a new thread (message) on this forum:

http://www.felinediabetes.com/FDMB/forums/suggestions-tech-support-testing-area.6/

with a title "Need help can't change password" You would need an administrator to help you with password problems.

 

Sorry I can't help with the password issue but I can see your spreadsheet. Hurray!

 

Still have to put my info in.

 

I'm glad Carolee was able to get the SS going. Sorry I've been off the board this week....my kitten had two surgeries on Monday and I've been helicopter mom this week.

@Carolee please let me know if you have any issues with the SS. Just send me a PM.

 

Hello,
I finally have some free time! I have posted my spread sheet. I am pleased to say Clarence's BS have come down a lot. He has not had any insulin for a day. They have been low enough not to give. They have been below 100.He is not symptomatic of hypoglycemia.

 

According to the information I read cat's blood sugars should between 61-120. I am pleased with his progress.

 

Nan I hope everything is okay with your kittens

 

WONDERFUL!!!!

I am SO SO glad you decided to take the advice on here and not shoot the dose your vet had suggested. That could have been deadly Maybe the switch to a low carb food was a big factor in getting the numbers back into normal ranges. After 14 days of no insulin Clarence will be officially OTJ (off the juide..insulin) and in remission.

Fingers crossed for many more good days!!

 

Wow!!!!! Those are some amazing numbers! And like TuxedoMom, I am so glad you went with the lower dose!!!!

Clarence is looking fantastic!

 

Thank you alll for the help and support. I have been feeding 1.5 oz in the am after I check his sugar and then 3 oz at 1200 after I check his sugar and what is left over I put in the refrigerator and add warm water around 1700 my boyfriend feeds them and at midnight I check again and feed 1.5 oz.

 

It seems to be working so I am thrilled

 

His numbers are looking amazing, so soon!

 

Thank you.

 

This is wonderful!!