Discussion in 'Caninsulin / Vetsulin and N / NPH' started by Cherish Gallagher, May 9, 2017.
Are you still going to drop anything over 300 to 1.75U? These PS's today were close than they have been though! Maybe hold it a couple more days. That is a nice green nadir . Glad to hear her neuropathy is improving!
Not yet. Just trying to figure out how to get PM nadir down. Looking at SS she doesn't seem to respond well to anything under 2u regardless of preshot. Do you agree? Maybe after the week of trying this scale (Monday night will be 1 week, we can try giving 2u for both PM and AM as long as she's not super low.
Try it as long as you can monitor.
She was finally under 300 for her AM just now. Still stuck to the 1.5u for now. We will see how she does. But yes, Monday if she's still high for nadir going to try 2 units
I'm thinking as we balance her PS numbers, her PM nadir will get better because it won't be part of a bounce . Will check in tonight to see how her AM cycle went with that 1.5U
Same. High nadir. Thanks for checking in so often!
Just a bounce lasting into AM cycle today. Watch, tonight will have a nice PM nadir . Come on Ms. Angel, we want to see both good cycles
We will because she got 2 units. Hehehe. I swear she doesn't seem to get down to where she needs to be for anything under 2. But I hope you are right yong!
Good luck starting Lantus tomorrow!! We will be checking on Maury too
Thanks! I am nervous
Tomorrow will be the 1 week point of doing the new sliding scale. What are your thoughts? I think she needs an increase again. But I'm not the expert
Neither am I but I see 3 days where PS were 300+ and the 2.0U was still too much, then last night she had a nice nadir and was pretty much back where she started. I think we're just seeing what the dose can do. BUT ironically, I am thinking tiny decrease for higher PS:
100-125: 0.25U If she gives PS 100 - 225 as a result of previous cycle dose being higher, you can try to give 1.0U and make sure to check at +2/+3.
125-175: 0.5U If PS are naturally coming down, stick with tiny scale dose. We haven't seen how she does on a naturally low PS
225-299: Fat 1.5U
300+: Skinny 2.0
As always, we'll see what @JanetNJ 's thoughts are and if anything I wrote is confusing, just ask and I'll try to clarify more
Thanks as always! I'm so upset though. She's almost at 400 tonight. I guess I still don't understand because if she has a high nadir followed by a not so great PS why would we lower her dose? Wouldn't we give more to try and get her down? I trust you guys and will do and try anything you suggest but I feel I'm a way we are taking a few steps backwards.
A high flat nadir is a bounce. Ideally aiming for a nadir around 90. 22 June is the ideal day that we'd like to see more often . I do wonder if she could go off the sliding scale, to like 1.75U for any PS over 200. Just another thought I had. Maybe @MrWorfMen's Mom can take a peak
I was thinking the too! Maybe even 2u as long as we can monitor first few days. ???
Also, grabbing a fresh bottle of insulin after work. It's been about 6 weeks. I know people have told me I can use it until it's gone but I still wonder if it's losing some of its efficacy.
She gave me a good AMPS! kinda wish I would have given 1.75u but we will see how this plays out. Probably won't pick up new insulin yet since I'm broke and this bottle is clearly still working.
I used a vital for 4 months with no problem. My vet said they can last 5-6 months if kept refrigerated.
I see you are giving evo dry. What would you think of switching to young again or Dr elsley's clean protein (4.7%)? Evo's new formula is about 12% I've heard.
Hi Janet! She doesn't eat a whole lot of it and we had to find something in our budget that our other non diabetic picky cat would also eat.
But yes it is 12%. I'll look into the others!
Both companies will send out free samples if you ask.
While all those lovely green 50's, 60's & 70's on the spreadsheet may look good, I would caution you against aiming for such low numbers with Vetsulin. Your goal with Vetsulin should be to have the nadir no lower than 90 to low 100's. Vetsulin can and often does, push the BG down quickly and steeply. Leaving yourself a slightly larger safety margin gives you and Angel more time to intervene should BG be dropping quickly or too much. At best, aiming for low normal BG can and does cause bouncing and at worst, could lead to Angel's defences not being able to bring BG back up quickly enough which is dangerous and could potentially be fatal. I'd pay more attention to whether the point drop between pre-shot & nadir is exceeding 50% of the pre-shot reading and try to keep the bouncing at bay. It's the relationship between the pre-shot and nadir rather than either number on its own that should guide dosing.
I also think it would be helpful to get some tests between +2 and +8 randomly whenever you can rather than testing at exactly +6 every day. Nadirs are not static and can move from day to day so you may or may not be seeing the lowest reading in any given cycle. Early cycle readings will often tell you if the cycle is going to be particularly active and give you time to feed more early in the cycle to slow the drop down and extend the time Angel spends in low numbers. The goal is to get Angel into optimal numbers (90 to low 100's) for as long a period as possible through each cycle rather than trying to push her as low as possible for an hour or so during each 12 hour period.
Angel has had a significant number of cycles with nadir dropping well over 50% between the pre-shot and nadir readings. This is a recipe for bouncing. She has also had what appear to be very extended periods of being in " normal" BG range. (June 20th through to June 22nd). This is very unusual and concerning to me with Vetsulin. The lower pre-shot on June 22nd could possibly be attributed to a diminishing supply of glycogen from all the low BGs the previous 2 days rather than just the dose of insulin given. The pre-shots are again going up when the glycogen supply is replenished. The other possibility is that Angel's pancreas is pumping out some endogenous insulin at times leading to low PMPS readings but if that's the case (and it's purely speculation), it makes it even more important to tread lightly and not aim for such low nadirs.
The body stores glycogen to be used when needed to keep BG from falling too low but if that glycogen is being used up repeatedly/continuously over extended periods, the supply dwindles and the defences become less effective and could eventually become unable to keep the BG from falling to unsafe levels. It's like a car with gas......the more you speed the more gas you use and once the gas is gone, the car doesn't work anymore. The body needs time to replenish the stores of hormones and glycogen to keep the defences working at peak efficiency. In a diabetic the defences against low BG are activated prematurely because they have become used to being at higher than normal BG numbers so they perceive danger when none exists. Easing BG down rather than forcing it, allows the cat to become reacquainted with more normal BG levels and stops the bouncing. When the bouncing stops, the pre-shot and nadir numbers will come down without a defence system panic being set off.
While a sliding scale is great in a cat that has demonstrated "A" dose drops BG by "X" points, "B" dose drops by "Y" points etc. it's difficult to see any pattern to how any particular dose is working for Angel because of all the dose changes, bouncing and what suggests to me, a defence system that may not always be working at 100% efficiency possibly due to being overtaxed repeatedly.
Finding the right dose(s) can take a lot of experimentation. For now, I would suggest not exceeding a dose of 1.75u no matter what the pre-shot is, to see if that helps minimize/stop the bouncing. I definitely would not give insulin at all if BG at pre-shot is below 100. One skipped shot is not going to set Angel back. Vetsulin is an in and out insulin and Angel will get back on track in the next cycle or two. I also would be careful not to give the higher dose just because a pre-shot is higher than expected when that pre-shot is obviously the result of a bounce from a very low mid cycle number in the previous cycle. Otherwise the bouncing just becomes a vicious circle.
Thank you for all of this information. I'm still trying to take it all in. Soooo much I didn't know and still don't really understand. I feel terrible because I thought the goal was to be seeing blues and greens. And she seems happy and healthy so I haven't been worried or concerned and now I am. I don't really know what to do moving forward. What would you suggest? Trying 1.75 or 1.5 consistently for a week or so? And try to get more BG readings through out the day?
Linda has a lot of FD experience under her belt and I know she wouldn't want you to feel terrible. She's giving you a heads up to keep Angel safe while using an insulin that can, indeed, drop them like a stone. Her key takeaway is to leave more of a "cushion" at nadir by erring on the side of slightly lower doses. I like her idea of trying no more than 1.75 u on any shootable PS for now to see if it'll calm down some of the bouncing. I see she's also recommended no shot if a PS is below 100. I think that's prudent with an insulin like Vetsulin.
I can't help you much with the issue of a sliding scale because I really have no experience with doing that. What I do know from experience with my bouncy cat is that consistency can be a calming technique. Maybe it's worth trying 1.75 u consistently AM and PM for a bit and attempting to get a more scattered array of tests if you can.
Again - please don't be too hard on yourself. You've doing an excellent job with your kitty. An outsider's perspective can often be really useful in tweaking a few things to get it all working even better.
Thank you . I'm going to try the 1.75 idea and see where it takes us.
Cherish, I am quite impressed with how well you've done and I don't want you to feel bad about any of your dosing because that certainly was not my intention. You have kept Angel safe and she is doing very well. It just scared me a bit to see the aggressive dosing when pre-shots have been within normal range. I sat staring at the SS wondering what was going on and why there didn't seem to be any dramatic upswing of the numbers after that long run of low normal numbers when Vetsulin typically doesn't last more than 10 hours per cycle in cats. While every cat is different, I've never seen a run of green numbers that long in any cat on Vetsulin unless they were on the edge of remission and getting extremely small doses of insulin to support a pancreas that was sputtering back into action or coming out of a long hypo episode. The numbers in later days suggest Angel is not at the edge of remission, at least not yet. It puzzled me and it's the low pre-shot the following day that makes me wonder if the defence system was getting exhausted.
Those blues and greens are a thing of beauty and you can still have them but I would try to keep the numbers up a little bit to give yourself more of a safety margin. I just wanted you to be aware of what to consider when you are dosing at low numbers and striving to keep numbers that low. We all want our kitties regulated ASAP but this is a marathon, not a sprint and often trying to make it a sprint only slows regulation down. A cat will go into remission if a cat is meant to go into remission and while you can guide that process and coax it along, you cannot force it. If kitty's numbers are in the upper range of normal or even just north of the normal range, kitty will be just fine. I just want you to know what could be attributing to some of those wonderfully low numbers and use that knowledge to temper your dosing just a bit. My opinion is just speculation but it is based on biology and your data.
I would definitely not give insulin for any pre-shot at 100 or less and I would lower your top dose to 1.75u. I'm not a sliding scale fan without some clear cut data as to how much a specific dose drops the BG. That said it does make dosing decisions easier. I've seen sliding scales work in some cases but usually only after determining how much each specific dose is dropping BG because until a cat gets reacquainted with "normal" BG and their defences stop revving up at the first sign of a dropping BG, bouncing can muddy the picture. If you can get the pre-shots to level out and come down, the nadirs will come down as well. . Pay attention to how much a dose is dropping Angel from pre-shot to nadir remembering that nadir does not occur at exactly the same time every cycle. If the drop is more that 50% of the pre-shot , you'll likely see a bounce with the next pre-shot being higher and increasing the dose based on that higher pre-shot may just increase the bouncing. Bouncing can take up to 6 cycles to clear so sometimes patience and not reacting to one high number pays off in the following cycles. Remember every reading is a moment in time. It's the pattern over time that should be used to determine dosing.
Use your sliding scale but adjust your top dose and pay attention to the drops and temper your dosing accordingly.
Thank you for taking such time and Eddie on us. You've really been helpful and the more and more I read what you wrote the more it makes sense. I still have so much to learn. Right now we are on 1.75u twice a day. If her BG is below 100 she will not get a shot. Do you recommend trying this consistency for a week or 2 and then make changes if necessary?
I'd say let's see how she's doing by end of week 1 before making suggestions and I know it's not a greatly different number but might temporarily raise the NS number to like 150. If she naturally gets to this PS we don't know how a low dose works on her without the lower PS getting ready for a bounce
Sounds good I don't anticipate her getting to that low a PS tho. She's been consistently in the 300's since the dose decrease.
This was a good experiment to try. If nothing else, you're learning more about her responses. You'll get the blues and greens back.
I think it might be her body adjusting to consistent dosing / bounce from blue last night. The bounce shows differently possibly because of consistent dosing. Going to see if she clears it tomorrow then decide which way to move dose. Let's see if anyone else has some insight. You're probably tired of hearing from me
No I'm not lol you've been very helpful! I'm on day #3. I figure I'd give it 1 week before any change. But it sucks to have red
Yeah I understand. Come on, Angel give momma 399 instead! lol
So this morning she was 401 and I put on her SS 399 just so it wouldn't be red but then changed it later lol
haha you could have taken a second test just to see if maybe it would read two points lower. lol
I know the red is not a desirable colour but I too think it's a bounce so don't get discouraged. Those nice blues last night are to blame but the red will pass and you'll be back in the pink for pre-shots and fingers crossed, into yellow soon.
I don't think 1.75u is enough but I think 2u might be too much. Oh the joys of FD. Day #5 today so 3 more full days before we switch anything. It just breaks my heart that she's back in the 400's as it's been over a month since we've seen any reds. Will higher #s affect the progress of her nueropathy?
Try a skinny 2... Just under the line
I think you could try 2u again but only when you are able to monitor for a cycle or two. I think those times when you got low numbers on 2u previously, there may have been some bouncing involved and dosing was being changed frequently so the effect of 2u may have been a bit blurred. Some kitties can be very sensitive to even teensy dose changes so the other alternative is to just fatten up the 1.75u as Janet suggested.
Also when you can, I'd get a reading at +3 or +4 on a day cycle to see how quickly BG is dropping. Sometimes it's not just how low kitty drops but also how quickly that will set off bouncing and nadir isn't always at exactly the same time each cycle.
I like Janet's idea of trying the skinny/fat doses, so the skinny 2.0. Maury was a fan of those finer doses . As for her neuropathy, it shouldn't since we're still seeing blues and you are still giving Zobaline, correct? Even with Maury's mild bounciness (I say mild because there are other big bouncy kitties ) his neuropathy is almost completely gone now . He only had Zobaline for 4 days because then his pancreatitis flare showed up and I wasn't 100% sure until we got to the Vet, so I knew only new thing was Zobaline. Needless to say, the supplement was not the issue so don't worry about that .
Teasel is a kitty that reacts strongly to very tiny doses changes, even on Lantus. The fat/skinny dosing is very useful.
Yep still using the Zobaline. It will be 3 months soon. will be able to monitor the next 2 days because I'm off work so I think I'm going to go ahead and start her back on 2u tonight and if she drops too much tomorrow morning I'll try the fat 1.75. I will get some day time tests tomorrow and Monday! It's just hard since I work 6:30-2:30pm and she gets her shot at 5am. My bf is a night worker so he sleeps until 11am when he gets a +6 for me. but will get more readings next few days! Thanks so much for all the help. So greatful.
What the heck cat. Insulin pooped out maybe? The bottle is almost gone.
Patience! I think Angel is bouncing from that 120 mid cycle last night and she may have gone a bit lower. That bounce can last a few cycles. How old is the insulin? It seemed to work fine last night so I doubt that has anything to do with the numbers today.
May 12 is when I started the new vile.
So it's just over 2 months which should still be fine. If there are no floaties (white specs) there should be no problem as long as it's been stored in the fridge.
Does anyone think we can go up to 2.25 or is she just bouncing?
The blues are what I'm looking at to judge this dose. They tell me that you can go to 2.25 u.
I think you're OK to move to 2.25U now too
She decided to throw me a curveball this morning so we will hold the 2u for awhile longer.
Those inevitable curveballs! Just when you think you need to increase they decide otherwise. It will be interesting to see where that takes Angel today. Definitely get that mid cycle BG today as the pre-shot was considerably lower this morning. I think I would have reduced the dose a bit based on previous drops on a dose of 2u.
Beautiful and welcome blue! Yeah!
Very nice Ms. Angel!
I see a beautiful green last night! . This is looking good (ANTI JINXING!)
Yippee! Looking good!
Hurray! This way of sneaking up on a good dose takes longer but you learn a lot about your kitty's responses along the way.
Not understanding these numbers. Any ideas?
I think it's bouncing. The drop between the pre-shot and mid cycle yesterday was more than 50% of pre-shot. I wonder if you should try 1 u for a few cycles to see if that brings those pre-shot numbers down.
Are you available to get a test around +2 today? That is a low pre-shot and while the dose is lower too, it would be a good idea to track him early and slow down the drop if +2 is down a fair bit. If not, I'd leave food out for her.
Whenever I've given small doses she's always been crazy high for preshots. I'm at work but food is out and bf is home to keep an eye out.
Just made bf check. she's all good. 250.
How long post shot is that 250? Seems odd she's go up that much that soon.
Food spike? A bounce already under way?
+2. And 2 hours after she ate.
Must be a bounce + a bit of a food bump. Too big a rise for a food bump alone.
I'm beginning to hate the word bounce! Lol but looking at her SS, each time she had a low preshot and I checked at +2 or 3 she had a large rise. But only on low preshots. What's that tell you? BOUNCE? hehehe
You are certainly not alone hating the dreaded "bounce". While we all deal with them to some extent, just ask Kris about them. Her Teasel is the trampoline champ of all time. He got the "Best Bouncer" award awhile back! Maybe Angel is trying to get in on the competition!
I wonder if the 2.25U should've been held a little longer . PS's got a little lower each time (I know meter variance kind of makes them the same ) but the one evening she kind of had the ideal nadir for Vetsulin. She may just need a fat 2.25U before staying with the 2.5U. What do you ladies think? Maybe I'm hallucinating
Yes I'm thinking the same thing. It looks like there was still some bouncing going on from the 2.25 and the 2.5 has just added to it and I think Angel is a bit of a bouncer. I'd back it up to 2.25u and hold it for 6 cycles to get a clear view of how that dose is working. Some cats are very sensitive to miniscule dose changes so it might be that a fat 2.25u would help but I'd go back to a normal 2.25u for now and see if you can't get those pre-shots down to yellow levels.
She has shown to be a little bouncy but she also seems to clear them within the typical 3-6 cycles .
Back to 2.25 it is! Unless she has a low preshot like today?
Correct but she's probably bouncing so I don't think she'll be lower like this morning. Don't let her read this
Lol well I guess we will start back at 2.25 tomorrow morning. High as heck tonight and bf thinks he gave her a FS. darn.
Ok no problem. Back on the plan tomorrow. Just monitor as you can tonight to see what Angel does.
First yellow preshot in awhile! Maybe that FS did her some good lol. My gut told me to give 2u even tho we are on 2.25 right now. So we will see
I am wondering if Angel would do better on the Fat 2.0U
I agree it might be an idea to try the fat 2.ou. She's alternating between 2 and 2.25u now and interestingly sometimes seems to have a lower nadir on day cycles than nights. She may be a cat who is sensitive to very small dose changes so that small change might be the ticket to smoothing things out a bit more.
That's is my thinking
I'll give it a try
A fat 2 u is a good plan. I like what I see on your SS!
We've passed the streak of red numbers I hope. Would love to see all of her preshots under 300.
You'll get there. Patience is one of the hardest parts of this journey!
I'm trying the fat 2.0 but can you explain why I should decrease the dose from 2.25 on higher preshots?
The 2.25U got her into green, which is nice but caused a bounce. So we're trying to go a teeny bit more gentle so we can see more cycles like PM 19 July
I jinxed us. 404 this morning.
No you didn't. I am wondering what Angel does in the evening cycle between +2 and +6. We really don't know if she is on her way up or down at +6 right now so it appears she is staying higher at night. Maybe she's not. Can you get some random tests in earlier in the evening cycle?
Not at all, Cherish! She might've bounced again. I think it might help to see some before the +6 like Linda suggested. Is BF up for it ?
Yessss will get evening before +6 tonight and next few days. It's harder during the day because I work at 6:30a and bf sleeping until her +6 but I will try harder on my days off to get more curves in and get random tests before and after +6 starting today!
You are both doing great
Thanks! She gave me a 201 for PMPS
Just ordered a 4lb bag of Young Again zero for the kitties. Giving it a try. highly recommended by a lot of you and maybe it will help Angels numbers.
Hope everyone is doing well. Been back and forth to vet with bfs cat. He was diagnosed with megacolon and a motility disorder. Poor guy. faith in humanity was restored today after we got an invoice for $550.00 but the vet only charged us $100.00. He said he can tell we really love him and are doing a lot for angel and her diabetes (he was so impressed to learn about us testing at home and our SS) so he was going to help us out. So thankful.
On another good note. Angel seems to be doing well on the 2.0F!
Also, we got our YAZ today and it's Angels 5 months of being on insulin
That was so kind of the Vet! . Happy Insulin-versary Angel!
What a wonderful compassionate vet you have. Obviously appreciates seriously dedicated pet parents and loves animals much more than the money!
Happy Insulinversary! Angel does seem to be doing well with that little tweek of the dosage.
What a lovely gesture from your vet!
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