Trying to find the magical dosage - questions

Hi everyone,

Thank you for your continued advice. I took today and tomorrow off (return to work Monday) in order to do more consistent home testing to figure out the correct dosage.

I gave Mitsy 2.5u of Vetsulin this morning at 7am (we are down from the vet's recommended "just give her 5u twice a day and come back if she starts acting weird, there's no need to home test"). She had her insulin after eating most of a can of Fancy Feast pate. I just tested her, four hours later, and her sugar was at 122 (she usually continues to snack on the rest of her Fancy Feast throughout the morning).

I believe 4 hours is usually the peak time, correct? Where it is the lowest?

So, I'm going to test again before I do her nightly insulin (after her two hour fasting). Maybe another one in between as well (I just feel bad for the poor thing getting constant pokes).

Is 122 at peak a good number? Does that mean her dose is a good one? Or does it usually get in the green (spreadsheet color) around peak time when you have a good dose?

I'll try to keep using this thread throughout the weekend with her progress. And I am also updating her spreadsheet whenever I test.

Thank you in advance!

 

From an info post on the Vetsulin forum: "With Caninsulin (Vetsulin) you may see the peak/nadir of the cycle at around 4 - 4.5 hours after the shot. But it may be earlier or later than this. It may occur as early as 3 hours after the shot, and as late as 7 hours after." +4 may not necessarily be the lowest point for Mitsy. Since you are home, could you get a test at +6 (and maybe +8 too if you feel really ambitious)? If you only want to do 1 or 2 mid-cycle tests, make them at different times each cycle so you can fill in the gaps to figure out when her lowest point is. (The lowest point can actually be different during different cycles, but at least you will have an idea of the general time frame when she tends to get there.)

122 is a pretty good number but a bit lower would be better... she may actually get lower.. you cannot judge anything by this one test.

 

My cat on vetsulin usually peaks around 5-6 hours after the shot. The only way to know is by testing.

 

Truffles is 6

 

"Acts weird" is a clinical term for what exactly? Distress, hypoglycemia, death? I am just fuming a little bit, and I am glad you care enough about Mitsy to home test, and especially to take time off work to test and see how the insulin is affecting her. I salute you for your love and dedication.

 

It definitely depends on the cat. Usually 4-6 hours is the peak time for Vetsulin, but my Lou didn't usually peak until 6-8 hours after his shot when he was on Vetsulin. Overachiever. Mini curves were my friend. I would test every two hours for a small stretch, usually at +4, +6, and +8, and then the next available day I'd test +5, +7, +9. Just move things around so you can get a good picture of how Misty processes her insulin.

 

Thank you. I think that vet's office is so overwhelmed that they want everyone in and out and don't really have time to talk to you. He said if she acts weird to stop insulin, so I'm guessing he meant hypo (which he never explained and I wouldn't have even known existed until this website).

I just did her test (7 hours after 2.5u) and she was 182.

 

Yeah I think she is an earlier peaker because it is up at +7. It was lower when I tested her +4. I am going to try to move things around like you suggested over the next few days.

 

I just noticed that Mitsy had black stool (not diarrhea). This is the first time she's had that. Anyone have any ideas what that could mean?

 

This morning her pretest was 248 and I gave her 3u. I am going to try to do some more tests throughout the day.

 

I suggest you do the first test this AM at +2. That can give you an idea of how the cycle will go. If it's quite a bit lower than AMPS (maybe 100+ points) you might have an "active" cycle where she'll go lower at nadir. If the +2 BG is similar or higher than AMPS there probably won't be too much drama. After that +2 aim for another test in the +4 to +6 range.

You're just starting to accumulate a database on your SS that will help you make dosing decisions going forward. It's important to gather numbers from various parts of a cycle to see how she responds. That's in addition to doing the odd curve when you think you've reached a good dose level and want to see her response to it over a cycle.

Have you read through the excellent Vetsulin user's guide? http://www.felinediabetes.com/FDMB/threads/beginners-guide-to-caninsulin-vetsulin.186099/

 

Thank you, I just read through that. I tested her at +2 and her level was 95. I'll test again at +4.

 

That’s a big drop. I would give her a small snack of her regular food right now. She’s where you’d want her to be at nadir and that would likely be 2+ hours from now. Don’t wait until +2 to test. Give the snack and test again at +3.

 

Depending on the numbers she gives you today it's probably a good idea to lower her dose to no more than 2 u tonight. It's better to lower too much and slowly increase by 0.25 u at a time that risk a hypo.

 

Post here when you get that +3 test. If it's lower you'll need to give more frequent tiny snacks to "steer" the BG away from being too low. On a human meter too low is below 50. At 50 you'd be giving higher carb snacks to raise the BG and testing more frequently to monitor (every 20-30 minutes).

This is worth reading - not saying you're headed there but important to have at your fingertips:
http://www.felinediabetes.com/FDMB/threads/how-to-treat-hypos-they-can-kill-print-this-out.15887/

 

I just did her +4 reading and it was 118. I wonder if she just peaks super fast for some reason?

Thank you for all of the help, by the way!

 

Mine likes to peak at +3 - he's on Vetsulin. I've been slowly decreasing his dose, now he's on 0.5. The first few days of that he peaked in the high-100s, but today he's down to the 70s. Hoping it's a good dose!

 

Here's my two cents that you didn't ask for . You may want to get some tests in a little later than +3 to make sure. With the data you have, it looks to me like the nadir could be a little later than +3. The only cycle where there is a +3 and +4, the +4 was lower. Also, you have some later cycle tests that are pretty low - for those, you didn't have a +3 so cannot say for sure, but I would not assume it is +3 just based on the data that is there right now.

 

At +8 she is at 166. Would you guys still suggest I go down to 2u for her next dose? Or do you think stick with 3u?

 

Other than that early steep drop these are good numbers. You could try 3 u tonight but make sure you get a couple of evening tests in. They often run lower at night.

 

Yeah, I just did her pre-insulin fasting test and she was up to 221. I'm wondering if this insulin just processes too fast through her. I read somewhere that Vetsulin was more for dogs than cats because it wears off fast, but the vet didn't even mention other types or anything, of course...I wonder if that's why he had me doing 5u twice a day, so it would last longer. But I don't want her going hypo!

I just wish I could make her feel better! I know she feels lousy when it gets in the 200s because she starts meowing and sitting with her head back and zoning out (which sounds like hypo but I tested her and she tests high). But that's how she was acting constantly before she was diagnosed so I know the high sugar makes her act weird like that.

Thank you all for your continued advice while I'm trying to get her regulated!

 

You do realize that low 200's is a fantastic preshot, especially for a newly diagnosed cat, right?

 

The low number was early today but the cycle today was very good.

Be prepared - this can take many, many weeks or months. You need a lot of patience treating FD and regulation can't be rushed.

 

Well that's good to hear!

 

Seriously my cat didnt even have a number under 300 for a couple of months.

 

*** I didn't want this comment to be missed: ***

Usually black stool means blood, up higher in the GI tract (whereas bright red stool would mean blood lower in the GI tract...as in, it hasn't had a chance to dry and get darker yet). There might also be some medications that cause black stool in cats, I don't know -- in humans Pepto Bismol will do that. But if you can't rule out medications that might have caused it in Mitsy, it probably does mean blood. I am sorry that I don't know full details of any medications she has been through to hazard a guess whether black stool could be a side effect.

We had black stool twice in two different cats, and it was due to a confirmed esophageal ulcer in one (and suspected in the other), and it was treated with Sucralfate (https://www.petcarerx.com/medication-guides/using-sucralfate-for-dogs-and-cats-to-treat-ulcers/1104). Sucralfate is a prescription -- I am not suggesting that you take it, just providing it for informational purposes so that you can read about ulcers higher up in the GI system. BTW, please do NOT EVER ATTEMPT TO GIVE HUMAN PEPTO TO A CAT AS AN ALTERNATIVE, it can be very toxic.

Please, other folks chime in if you can provide your experiences.

Sandi.

 

She was on clavamox for 11 days so I don't know if that could have caused it? I'm waiting for her to go again so I can look at it but she only goes every few days.

 

I like unasked for 2 cents, I really do!

On the late low day (7/21), if memory serves, I had a morning where I was gone and when I got home I found vomit (two cats, same good, couldn't tell who did it), tested him and got that low number. I was pretty shook

I'm doing a full hourly curve tomorrow because we have no plans, and he is seeing a new vet Monday! Hopefully one who isn't so old-school like the one who diagnosed him!

 

Finally got a +3 test done today and she was at 106. Before her shot it was 232. So far it looks like she might have a +2 peak based on past testing. I'm trying to test today and tomorrow to fill out my empty spots.

 

Good so far!

 

Tonight her fasting pre insulin test was only 181! I think I should drop her insulin from 3u to 2u, right?

 

Yes, I suggest you do that.

 

Thanks for the quick response!