stragey help for rollie vetsulin march

http://www.felinediabetes.com/FDMB/threads/vetsulin-advice.174324/
Ok am doing my curve today and the results are not what i've expected. I've linked my first post to this one. I am wondering what my strategy should be for the coming week? I got some tiki cat this weekend and have been feeding that since last night. i am working on getting a urine sample to test. His numbers just aren't very good today. @Tuxedo Mom @Squalliesmom @Kris & Teasel @JanetNJ @MrWorfMen's Mom @Alexi @scoobydoox @Critter Mom

 

I am wondering if Rollie went lower last night leading to that higher AMPS this morning because he has had a nice drop of 200+ points as of +6 today. If you can get some readings during the evening cycle before bed, it should give you a clue as to how fast and how far he is dropping. For now, I'd stick with 3.25u for another day or so, to make sure any bouncing has cleared and get some evening cycle readings to see what he's up to. If after a couple more doses at 3.25u, he stays in the yellows or goes higher, you can up the dose to 3.5u. The problem is that you don't want to increase while Rollie is bouncing because that just sets off more bouncing and makes it impossible to see exactly what a particular dose is doing. It looks to me like he bounced after that 186 on the 11th and that may not have totally cleared by last night so if he hit another lower unfamiliar reading last night, then the bounce has just been extended. You can't force these guys into good numbers. Slow and steady wins the race and honestly I think today's curve is looking encouraging.

 

Thank you! I am glad you think this looks encouraging as i was disappointed in it so far.

 

Looks to me like he is still clearing the bounce which is why I think it would be best to stick with the same dose for the moment. It will be interesting to see what his PMPS is tonight.

 

I agree with Linda (MrWorfMen's Mom), and second her advice to stick with the 3.25 dose for a couple of days, to make sure he has cleared the bounce. Today's curve is definitely encouraging!

 

it really doesn't look bad... you are ALMOST in the blues. I'm confused by that 186 the other day. I'm wondering if that was an incorrect reading.... like if the drop was too small. that seems like a steep drop in two hours. the curve today looks like what i'd expect. keep where you are another day and if you aren't getting low enough bump it up to 3.5.

 

thank you all! i was discouraged but you all have encouraged me. I guess my question now is if he gets in the blues then we are doing ok? what about the high preshot numbers? or is that something he will always have?

 

It is not unusual to see higher pre-shot numbers with Vetsulin, but you may see them come down some when the rest of his numbers start to stay lower.

 

ok we will keep on this dose for a day or two and see what happens. his amps this morning was 400

 

That's not unusual. Many cats go lower at night and Rollie got down to 215 at +5 and could have gone a bit lower last night if he had a later nadir. Look at how much he dropped Sunday between +5 and +6. His body has to get re-familiarized with lower numbers so staying the course for the moment is best.

 

ok! so i should be happy with these numbers for now?

 

Give this dose today to see if the yellows drop into blue. The yellows might be bounce-ish numbers. Depending on the numbers today and this evening you might be able to go to 3.5 u tomorrow AM.

 

i am already at work so i won't be able to get any numbers until tonight but i will do my best to get some numbers tonight

 

I got some awesome numbers last night!! +5 was 100 and +6 was 86. This morning though we are back to 411.

 

The 100 and 86 were great!!!!

 

Which weruva food are you giving?

 

The 411 is probably a bit of a bounce from from the lower numbers, earlier. His body isn't used to seeing those low numbers so his liver dumped a whole bunch of glycogen into his system in a mistaken attempt to keep him safe.

 

i was feeding the paw licken chcken but this weekend i got green eggs and chicken and nine liver. i also got some tiki cat. he doesn't seem to like the tuna and crab but does like the tilapia!

 

My cats always go nuts for the Tiki Cat shredded chicken, I forget what it's fancy name is, lol, but they really love it!

 

i will have to try that! thanks!

 

Awesome numbers last night! Glad you stayed with the same dose again! Looks like Rollie just needs to get more accustomed to those great numbers again!

 

ok - his +5 this morning is at 270. is it possible that he's still staying high from going lower last night? Thanks!!

 

It sure is! This is the hard part of dealing with the diabetes. Some cats tend to bounce more than others. That is still a good drop today and it may take a few cycles to clear this bounce and come back down again so patience is the name of the game. It's frustrating but this is a marathon not a sprint.

 

ok!! thank you! i was so happy with last night and then today kind of burst my bubble but we will keep on this dose and see what happens! thank you for the encouragement and advice!

 

Know the feeling all too well! While kitty is just chilling, we humans are scratching our heads as to what is going on... thinking we are doing something wrong when in fact, what we are seeing is just normal biological function. With time, we all get to the point where each number is just a number whether high or low. It's the patterns over time that become meaningful and provide clues as to whether dose needs to be kept the same, increased or decreased.

 

well we are still up this evening. we will keep the faith though!

 

284 amps this morning!!

 

Good!

 

Awesome! Slow and steady wins the race!

 

ok now i am puzzled. i got a +5 of 301???

 

Could be a bounce or just a wonky number. It can be almost impossible to explain individual numbers. The trends tell the story.

 

Rollie could have gone lower at +3 to +4 post shot and then his system kicked in to bring numbers back up to what he is used to. Is there any way you can get a test tonight around +3 to see what he's up to? Normal nadir with Vetsulin is often earlier than +5. Getting random tests between +2 and +6 instead of always doing a +5 will give you more clues as to what is happening. I'm betting it's a bounce too.

 

yes i can do that!! he was back up to 409 pmps. we will be coming up on +3 here shortly

 

+3 is 259

 

That drop from 409 to 259 in 3 hours and then to 245 in four hours is quite the drop. Drops like that can trigger bounces which lead to the higher pre-shot numbers. Hopefully as he becomes more accustomed to the lower numbers mid cycle, the pre-shot numbers will come down a bit too.

 

ok! this morning was 329. so i should just continue on with this dose then right and see if he stabilizes? Thanks!

 

Three days ago this dose gave you a nice green. He's been bouncing since then so the effectiveness of the dose has been obscured. It can take up to 3 days (sometimes more) for bouncing to stop. Maybe give the 3.25 u again today and see what numbers he gives you. Tomorrow might be time to try 3.5 u if numbers warrant.

 

Sorry for the delay getting back to you. Given the lower AMPS this morning, I think you did the right thing sticking with the same dose. That said, it looks like Rollie may need a bit more juice (insulin). My personal rule with my girl is to only do dose increases when I can monitor closely. I agree with Kris that taking him up to 3.5u tomorrow if you can monitor may be in order but let's see what his numbers look like.

 

alrighty! i won't be able to get another reading until shot time but will monitor tonight a few times. Thanks!!

 

what numbers am i looking for to warrant an increase? thanks

 

You don't want Rollie to go below 90-100 unless you are there to monitor very closely as that level of BG if it occurs shortly before nadir suggests a possibility of Rollie going too low and may need some intervention on your part to prevent a hypo episode. The normal BG using a human meter for a cat is 50 to 120 but with a diabetic on insulin, you can aim a little higher without any adverse effect on your kitty. Nadirs don't occur at exactly the same time every day but usually you can get a pretty good idea of when it occurs. So if you can get Rollie dropping into the low 100's for a good portion of every cycle, he'll be in good shape. You want to keep his BG below renal threshold (sugar spilling into the urine) as much as possible and that threshold while different for each cat is somewhere between 250 and 280. Just remember, this is a case of gradually taking his BG down so his body doesn't panic and bounce.

 

okwe did get into the blue tonight at +4 179. back up to 246 at +5. do i go up on the dose?

 

he was 408 this morning. i didn't go up in dosage as i was unsure of what to do. do i need to go up? last night like i said earlier we did get in the blue

 

275-325 3.25, Over 325-375 3.5. Over 375 3.75

 

I'd take him up to 3.5u and monitor through the expected low period of the cycle ( between +2 and +6) to see where that takes him. That 408 may be another bounce from that blue last night but I think he does need a little more insulin. Until he gets more regulated and predictable (stops bouncing quite so much), I'd hold doses for a few cycles to get an idea of how low he goes on each dose. Janet has provided a sliding scale which can work well for some cats (Janet's cat went into remission!) but you must also take into consideration how low any particular dose takes Rollie so I would suggest if you go that route, be prepared to monitor closely through a couple of cycle at each dose.

 

ok thanks much ladies!! i will give it a whirl tonight and see what we get.

 

well we had some blues last night but so far this morning we are all in the pink ??

 

He's bouncing higher because of those blues. Keep the dose for today.

 

I'm with Kris. Stay the course with the dose for now! Yeah Blues!

 

thanks girls!!

 

i think we may be onto something here @Kris & Teasel @MrWorfMen's Mom @Squalliesmom @JanetNJ ! we had blue last night and some blues today! tonight is a bit higher but maybe because we got into the blues? i am encouraged with this and want to thank you girls for your help and advice!

 

I'm so glad you're starting to see some positive results! It's exciting, isn't it?!?! It sounds, too, like you are starting to get a better handle on things and are feeling more comfortable. That's great! You're doing a wonderful job!

 

Good news!

 

well not so good today - i will check him at nadir tonight and see what we have but we are back up to 314 now

 

well not good again today. started at 304 and +3 was 289. any suggestions please? @Kris & Teasel @MrWorfMen's Mom @Squalliesmom @JanetNJ

 

If you don't see any blues by tomorrow, I think it's safe for you to raise his dose to 3.75U. On the 3.5U dose his lowest numbers are still in very safe ranges.

 

thank you!

 

You're welcome!

 

well 429 this morning so we are going to 3.75

 

i am very confused to what is going on. a few days ago he seemed to be doing well on a lower dose and now it seems like there is no effect on him with the insulin? @Squalliesmom @MrWorfMen's Mom @Kris & Teasel @JanetNJ @Tuxedo Mom

 

He's bouncing from the blues a few days ago or possibly from a lower number you weren't there to "see" by testing. Keep on with the 3.75 u. Bouncing is a big pain but patience will keep you sane.

 

Looking at the spreadsheet it appears that your kitty is very bouncy. Every time he hits a blue number it takes 3 days to start to get into better numbers again. I would stay with the 3.75 units and give it a few days to see what he does.


ETA Looks like I was still typing when Kris posted basically the same thing I did.

 

My advice is the same as Kris and Mary Ann's, stay the course with the 3.75 for a few days and see where he ends up. I know it's frustrating; some days I felt like I might just as well have injected Squallie with water for all the good the insulin seemed to be doing him! But you ARE doing the right - and best - thing towards getting Rollie regulated.

 

Thanks ladies! your words of encouragement and your advice helps greatly and i appreciate it!

 

he was back up this morning but i think it may be because he went lower again last night? at +4 he was 208 so i suspect he got into the blues.....

 

Some cats are bouncier than others and react to the ups and downs more dramatically. Stick with the 3.75u for a few days and see what he does. Figuring these guys out can be tricky and patience is key.

 

we are climbing higher again this morning 496.

 

Just bouncing. You had blue last night so carry on!

 

We all know how frustrating these up and down numbers can be but try not to get fixated on one number. My girl surfed in some beautiful "normal" numbers most of yesterday and is now sitting higher than she has been in ages all because she is not accustomed to the lower BG she maintained for so long yesterday. I'd be much happier if those normal numbers had continued but she has other plans. All we can do is patiently follow kitty's lead.

 

we went sky high this morning. i was shot last night so i didn't get to test at nadir but am suspecting we got blue and he bounced this morning. i am wondering about a sliding scale perhaps? or should i keep on this course? @Tuxedo Mom @Kris & Teasel @MrWorfMen's Mom @Squalliesmom

 

The night of 23 March you had a similar bounce number on morning of 24 March. And night of 24 March, that nice green gave a bounce on 25 March morning. Bouncing can last a few cycles. I would think stay the course for a little bit but hopefully one of the veteran members will chime

 

I agree with Yong. It looks like Rollie tends to have a later nadir than some kitties usually do with Vetsulin. There have been a number of days that Rollie has hit his nadir (lowest number) at +6, so there is a good chance that he might have gone even lower last night, which could trigger the bounce into higher numbers today. When you have a day you will be home it would be good to get a curve...doing tests every 2 hours for 8-10 hours to get a better feel for how the numbers go through the whole cycle.

 

I agree, as well. Stay the course for now, and try to get a curve when you can. I'd like to see where his numbers are during the second half of his cycles. Depending on the results of the curve, he might be up for a dose increase.

 

sunday i will be able to do a curve. Thank you all!!

 

well we got into the blue on the curve. i am almost thinking though that his numbers looked better at a lower dose? also another question i have is can he become resistant to the insulin? @Tuxedo Mom @Yong @MrWorfMen's Mom @Kris & Teasel @Squalliesmom

 

For Maury, because he was kept on a dose for a long period, I think, he had some temporary insulin resistance. Sorry I'm not very good at explaining things
Glucose toxicity refers to the oxidizing and hypertonic (dehydrating) properties of hyperglycemia, both of which continually stress and damage tissues in the body. But the term is also specifically used to refer to the phenomenon of temporary insulin resistance brought on by this tissue stress.

There are also high dose conditions that cause some insulin resistance: http://www.felinediabetes.com/FDMB/...-other-high-dose-conditions-what-we-know.375/

What was his starting dose?

 

when he was first diagnosed we started at 1u. the vet kept upping it until we got to 9u twice a day. he hypoed. we went down to 8 then 7 and then 6. i stil felt 6 was too much and he was getting quite low so i started all over again at 2u twice a day. i finally started the spreadsheet when i got to 4.25. i then tried a trial of TID dosing which i did not see any benefit in my opinion. so the first pat of the spreadsheet is TID and i've gone back now to BID dosing. slowly going upward again. I am just frustrated and don't know where to go and how to help him.

 

I don't think Vetsulin is any different when it comes to preferred increases, meaning by 0.25U or 0.5U. I'm wondering if jumping whole units caused Rollie's ideal dose to be skipped. @JanetNJ , can you chime in?

 

That drop yesterday from 539 to 174 was a HUGE drop. The nadir (lowest number) is still well within a safe area, but it was a big drop from the AMPS. This would have started another round of bouncing, which is what is showing in today's numbers. Unfortunately some kitties (one of mine for sure) are much bouncier than others. The higher numbers from a bounce can take a day or as much as 3 days to "clear" My thoughts would be to hold this dose for the time being and see where he goes when the bounce clears. Hopefully some others will weigh in with their suggestions as well.

 

I think you can stay at 3.75 u for another couple of cycles and then try 4 u. The blue probably got the bouncing started but as an indicator of how low the current dose is taking him, it shows room to drop.

 

Wow, that's a massive drop from 539 to 174! Definitely expect to see some bouncing. I would hold your current dose at least until he clears the bounce.

Something to consider: It is my personal opinion that "bouncy" cats on Vetsulin will bounce incredibly frequently and dramatically, and take several cycles (more than you would expect) to recover from it. I base this on my own experience with Vetsulin and other instances of it that I have seen occur. Vetsulin is a good insulin, but maybe a little less forgiving than some of the longer lasting insulins. Squallie is very bouncy, and uber carb-sensitive; weathering the bounces and chasing his numbers while he was on Vetsulin became an exhausting exercise in futility.

 

@Squalliesmom are you suggesting that we try a different insulin? i did ask the vet when we started this whole thing about another insulin but she basically told me no

 

we dropped almost 200 in two hours this morning. i just don't get this......

 

Those big drops from a high preshot number are quite common with Vetsulin. So far, he hasn't gone too low so I'd hold that dose for today.

 

Kris is right about those big drops being common to Vetsulin.
I am not necessarily suggesting you change insulins at this point, just bear in mind that if Vetsulin doesn't seem to be working well for Rollie there are others out there you can try.

 

i went to 4u this morning. I am really wondering if we are dealing with the glucose toxicity? we were all the way up to 9u twice a day because he had stopped responding and then finally it seemed that something clicked and he plummeted. that is why i am still trying to find out the right dose. i am now wondering if he is back on that same track? or if this dose is too much as it seems like he had better numbers on the 3.25 dose? or else use sliding scale? @Squalliesmom @JanetNJ @MrWorfMen's Mom @Kris & Teasel @Tuxedo Mom @Yong

 

You could call it glucose toxicity but I just call it getting "stuck". When Teasel was on ProZinc he would bounce into high numbers on a dose and stop responding to that dose. I'd have to increase a tiny bit to get him moving again. Your kitty seems to be similar in his responses. Bouncy cats are very challenging because of being so unpredictable. I suggest you try 4 u to see what happens.

 

Just make sure to monitor him, in case he starts to drop too low. I think you'll be okay, though. I went through this SO many times with Squallie! I feel your frustration!!!

 

It would appear quite likely that Rollie's nadir (lowest point) is a bit later in the cycle then some Vetsulin kitties....but every cat is different. On April 2 he dropped from 539 at AMPS to 174 at +6. Even though the 174 was not a very low number it was still a very big drop through the cycle, which would have caused bouncing. There is a possibility that Rollie has other large drops since when you were not testing later in the cycle, which could have caused further bouncing again. If at all possible try to get a reading close to the +6 time to see how low the dose is taking him.

 

Apologies Renee, I did not have an alert I was tagged but glad you got some responses from the experts .

 

I look forward to seeing what the increase to 4 does

 

We got into the blues last night. Not as high this morning as the past few mornings. we will see how long it lasts. thanks @JanetNJ @Squalliesmom @Yong @Kris & Teasel @Tuxedo Mom

 

can I just offer one more suggestion that's rarely mentioned? Try to increase his activity. Get a shoelace to dangle, or a ball to chase... whatever his thing is. My diabetic cat likes shoelaces and to rip up strips of newspapers (called the rip it up game)... I found it helped with her bg levels, and made her happier... and helped her regain her muscle tone in her back legs back. when I first started she mostly laid down and just batted... after a few weeks she was up chasing the string. It was nice to see.

 

thanks!! i will try that

 

Oh I spy a blue number. Hold this dose a few days and lets see what it does.

 

I started doing the same with Maury. Play sessions, he seems happier and I'm hoping it will help get his muscle tone back in his back legs

That blue looks very nice

 

@JanetNJ @Squalliesmom @Yong @Tuxedo Mom @MrWorfMen's Mom @Kris & Teasel we got into the blue yesterday and today he is sky high. i am guessing a bounce? but the black numbers aren't good for him....do you think the dose is too much? back when he was on 3.23 and 3.5 he did not have any black numbers.......

 

Hi Renee! I think he's still bouncing from the blues yesterday . Can last a few cycles and the 504 is within the variation so it's similar to 477. I'm still not an expert but I would hold the dose a little longer.

 

Hi Renee,

Yes, he's bouncing. Always pay more attention to the middle cycle lows than the preshots with Vetsulin. This insulin often causes highs at the end of the cycle and much lower numbers mid cycle. The dose would be too much if he was down to 50 or lower mid cycle. That's why those numbers are so important in evaluating a dose.

 

Yep, looks like a bounce. I would hold this dose for the time being. He really wants those blues, doesn't he?!