Trying to regulate and getting concerned with dose

Hi, I'm Shady's Mom and I just found this forum today. Here's our story, comments and suggestions are welcome, mostly I just wanted to say hi and introduce ourselves--this post is a duplicate from the introduction forum.

This is my first experience with diabetes and I'm concerned about getting my 13 yr old male cat regulated and on the proper insulin dose.

Shady was diagnosed 11/30/2018 and the vet started him on 1 unit of Vetsulin twice daily. Since then the dose has been increased at the following intervals due to continued high glucose test results at the vet's office and only moderate improvement is his symptoms:
11/30 - 1 unit twice a day
12/6 - went to 2 units twice a day
12/13 - went to 2.5 units twice a day
12/17 - went to 3 units twice a day
12/21 - went to 4 units twice a day
We just started 5 units twice daily on Friday 12/28

During this last visit on 12/28 I mentioned a concern about getting high readings in the office due to his stress of the car ride and visit. He said I could get a glucometer to test at home, but didn't advise on brand or how/when to test. I bought an AlphaTrak2 this weekend and started searching for information. I did the first test this morning 2 hours after his AM injection and plan to test going forward before injections and 6-7 hours after his morning injection. Every test, both at the vet and my first here at home with the meter show his BG in the 500s.

After reading some of the posts on the forum, I'm now concerned maybe we missed the proper dose and he's on too much insulin. I look forward to testing regularly to have a better idea what is happening.

A bit of history... earlier this year Shades started to appear paranoid, looking behind him all time, circling at times, and walking a bit wobbly. In July, I took him to the vet who indicated it was a tough thing to diagnose but was concerned that he either had an infection or was having seizures. He was started on Baytril in case of infection and when that didn't help, he was hospitalized for a few days for IV fluids and they started Phenobarbital for seizures. After a few weeks of no improvement, they stopped the Pheno and started him on Prednisolone, now concerned it was instead a brain tumor. Over the next 2-3 weeks, the vet increased the Prednisolone dose to 10mg/day. Then my 20 pound cat lost 7 pounds, started eating ravenously, and began excessive drinking and urination. He became weak and lethargic. As the meds weren't helping anyway, the vet had me lower the dose and ween him off. At that time his glucose was tested and the vet indicated he was pre-diabetic, which can be caused by the steroids, but she thought the symptoms would subside if we weened him off the prednisolone. He became so weak, I started keeping him indoors and that seemed to finally resolve his original "paranoia" symptoms, which have not returned. After weening him off the steroids, I waited monitoring his diabetic symptoms, hoping they would subside, but after several months, in November I switched vets and the new vet diagnosed him with diabetes.

Thank you!!!

 

glad to hear some of the other symptoms have subsided. It's not uncommon to get diabetes from being in steroids.


I think your dose was raised to fast. I'm so glad to hear you got a meter and have started testing!!! This will be a huge huge help.

It says your feeding wet and dry. The dry is too high in carbs. Skip it. If it were my cat here's what I would do.

I would switch to an ALL WET low carb food. Perscription food is not necessary.

Lower the dose to no more than 3 while you are still getting the hang of testing.

Start a spreadsheet with all your preshot readings and try to get mid cycle readings. Vetsulin tends to be lowest 4-6 hours after injection.

I'm going to tag Kris to give you basic instruction on getting started.

@Kris & Teasel

 

Hi and welcome.
You have had a hard time trying to figure out what was wrong with Shades.
I am sorry he has ended up with diabetes, probably caused by the prednisone
Yes the vet has increased the insulin too fast and in too large a dose each time. We recommend increasing the dose by only 0.25 units each time.
It might be worth while swapping over to a longer lasting gentler insulin like Lantus or levemir or Prozinc. Where do you live?
You could also try lowering the dose and seeing if that helps but I would not do that unless I was testing for ketones in the urine. With high blood sugars I would recommend testing for ketones anyway. To test get a bottle of Ketostix and collect a urine specimen and use the dipstick and follow directions as to when to read the result.
I see Janet has tagged Kris. She will be able to help you with the vetsulin as I am unfamiliar with that insulin.

 

Here's our basic testing routine:

1. test every day AM and PM before feeding and injecting (no food at least 2 hours before) to see if the planned dose is safe
2. test at least once near mid cycle or at bedtime daily to see how low the BG goes
3. do extra tests on days off to fill in the response picture
4. if indicated by consistently high numbers on your spreadsheet, increase the dose by no more than 0.25 u at a time so you don't accidentally go right past a good dose
5. post here for advice whenever you're confused or unsure of what to do.

This is useful: http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/

This is why they can stay in high BGs even as the dose is raised:

We call "bouncing". It explains why a kitty's BG can go from low to sky high:

1. BG goes low OR lower than usual OR drops too quickly.
2. Kitty's body panics and thinks there's danger (OMG! My BG is too low!).
3. Complex physiologic processes take glycogen stored in the liver (I think of it as "bounce fuel"), convert it to glucose and dump it into the bloodstream to counteract the perceived dangerously low BG.
4. These processes go into overdrive in kitties who are bounce prone and keep the BG propped up varying lengths of time (AKA bouncing).
5. Bounce prone kitty repeats this until his body learns that healthy low numbers are safe. Some kitties are slow learners.
6. Too high a dose of insulin can keep them bouncing over and over until the " bounce fuel" runs out and they crash - ie., have a hypo episode. That's why we worry so much about kitties that have had too high a starting dose prescribed by the vet and the owner isn't home testing.

 

Also, testing urine for ketones is quite easy:

• put the end of the test strip right in his urine stream as he's peeing
• slip a shallow, long handled spoon under his backside to catch a little pee - you don't need much
• put a double layer of plastic wrap over his favourite part of the litter box and poke some depressions in it too catch pee.

Most test strips have to be dipped and allowed to develop for 15 seconds before viewing the colour change in very good light.

 

You can also test for ketones by investing in a blood ketone meter... It can help if your cat is litterbox shy.

 

Hi Bron, Thank you for the reply. I live in the Kansas City MO metro (Blue Springs). I'll talk to my vet about switching insulin. Will search posts but wondering if there are vets in the area that the forum respects / recommends?

 

If you do decide to switch insulin, some are more expensive in the US such as Lantus. Many people here get insulin from Marks Marine Pharmacy in BC Canada, they ship anywhere and it is about 60% cheaper than in the states. They send air mail via USPS to the states and it takes 4-5 days, shipping is $25, but that is special packaging to ensure it arrives safely and unfrozen. You can find info on the forum about this if you plan to use that method.

 

To find out if there are any recommended vets in your area, I would start a new post with the subject line "looking for good vet in the Blue Springs/Kansas City Metro area" or similar. Hopefully someone will be able to help you. Good tip from @Julie and Honey about buying Lantus if you choose that insulin.

 

Update...
Having a heck of a time home testing. Shades hates anything to do with his ears being touched now let alone poked. Will keep trying and try the conditioning method with LC treats.
His ketone tests are negative, but after 6 days on all LC wet v. combo he's getting borderline ravenous again. I'm feeding 3-4 times per day 4 hours apart. He is spending less time at the water bowl now.
Talked to the vet yesterday and he recommended going up another unit to 6 units of Vetsulin. I expressed concern about the high dose, if we had gone up too fast and maybe missed his proper dose. I explained I had started home testing and the results I was getting. He said I only need to home test around +6 or 7 and said he almost never changes types of insulin so he isn't interested in trying that. I told him I was uncomfortable with jumping to 6 units, he said to do 5.5. Then he hung up on me.
I'm super worried and this vet is not helping. I know this is a marathon and I need to chill out but his numbers are so high! Overall he is better since he was diagnosed 5 weeks ago. He is drinking less, his third eyes have receded and are now normal, he looks perkier except at the +2 mark where he seems drugged and sluggish. His coat is a bit shinier and he's gained about half a pound. I have to keep these good signs in mind as I worry about his high dose and bounce.
Today...I started calling all nearby vets to ask questions about their FD protocols and see if I can make another switch to someone better suited to us. I only talked to one vet I liked, very patient and kind. He does recommend switching to either ProZinc or Lantus (would have started him on one of these initially). He sounds more inclined to go ProZinc but said he would do either. I've spent hours researching and can't decide. I've researched the posts in the forums here and opinions seem mixed. Thoughts welcome!
I'm less concerned about cost, more interested in what is best for Shades and what will yield the fastest and safest results and hopefully remission. One thing I'm concerned about across the board is none of the vets around here seem to think pre-shot tests or home testing at all are that important and certainly not 3-6 times per day. The new vet did mention fructosamine testing which the current one has not done. I'm going to revisit home testing with him during Shades appointment on Tuesday. It seems super important to me, but I want to make sure I have our vet's support and we're working together.
I also noticed some frothiness in the litter box after he urinated. Hoping we haven't hit a UTI or kidney issues. Lots to cover in the Tuesday second opinion vet visit.
His SS is updated, but like I said, having trouble getting him to cooperate so it is not as populated as I'd like.
Keep us in your thoughts and if you have advice, I'll take it. Thanks everyone!

 

I would not raise the dose until you can consistently get successful tests.

Fructosamine tests are valuable for diagnosing diabetes but they really aren't helpful beyond that.

 

I think you are wise to look for another vet. Hanging up on you is very unprofessional and shows no respect for your opinion. And as the owner of the cat, your opinion is important.
The vet you liked sounds promising. You don’t need their permission to test before all shots or during the cycle. What you do at home is your business. And we all know how important it is to test before shooting to see if it is safe to proceed, and getting the midcycle tests tells us if the dose is the correct one or if we need to increase or decrease. A lot of vets have not stayed pace with FD treatments and management.
If it were me, I would swap to Prozinc or Lantus. It could well suit Shades better. I have not used Prozinc so I favour Lantus but both are good. They have a longer duration than vetsulin and are gentler insulins.
That’s great you are testing for ketones and home testing.
It would be better if you have your vets support on the hometesting front but if he disagrees just say you have decided to do it and will show him the results if he wants. If he doesn’t that’s ok. As long as you are keeping Shades safe that is the important thing.
Good luck with the vet apt. Let us know how you go

 

You are doing the right thing for your kitty. You have every right to question something that does not seem right, this is your baby and you only want the best for him. There is no question people here have seen vets prescribing doses that are much too high.

See if you can get copies of his records from the old vets office if you feel comfortable doing that. If you don’t want to go in there, you can call the office manager and ask they be mailed to you. If they don’t know you are leaving yet, you could stop by and casually ask for the most recent labs saying you want to start keeping a copy of his records

New vet sounds much more reasonable and wants to do what is best for Shades

 

Shoot, no shoot, or shoot less?

I finally got my first test with Shady in a day and a half, this one was easier, so I feel better it isn't high because of stress. He's 7 days on wet only and I have been seeing differences, worried dosing too high but haven't been able to get a good bg test.

Test when you can, right? He was calm at +11.25 so I figured I'd try a PMPS 45 mins early and then feed and shoot. I just got the best results I've seen since this all started...a 209 (SS updated). I realize this may seem high for most of you but we've been running in the black pretty steadily.

So shoot, no shoot or lower tonight's dose?

 

I’ll tag @Kris & Teasel as I am not familiar with vetsulin

 

Going to stall for an hour after usual time and try to get another test.

If anyone else with Vetsulin experience has an opinion please weigh in. TY

 

Change you subject line to something like NEED HELP WITH VETSULIN DOSE. STALLING to get attention.

 

Stalled an hour, so nearly 2 hours since last test, this time got a 503. Going ahead with PM dose.

 

Make sure you get some mid cycle tests as Shades seems to be responding to the insulin. Sorry there was no one to help you.

 

Yes, Shady is definitely responding to Vetsulin - vigorously! Here are my thoughts:

• I think his dose was raised too fast and it's likely too high now
• Vetsulin by its action (fast, strong onset) can contribute to extreme volatility in BG readings and it's worse if the dose is too high
• I suggest you devote as much time as you can desensitizing Shady to the ear pokes - practice many times a day taking him to the testing spot, touching his ears, giving a treat and releasing him, etc. Others can advise better on this.
• because of your testing difficulties there are gaps in key areas of your SS - pre shot BG, middle cycle BG and it's impossible to know for sure what's going on. Those blacks are highly suggestive of him dropping too low and too fast.
• others have suggested trying Lantus or Levemir, the depot insulins. If your new vet is on board I'd definitely think hard about it. People can advise about getting those for a lower cost from Canada.

I certainly wouldn't raise the dose. Your main challenge right now is the testing. Do you have any low carb treats like freeze dried pieces of fish or chicken? Most cats like those and they should be used liberally in your desensitizing routine.

Have you seen this? http://www.felinediabetes.com/FDMB/threads/beginners-guide-to-caninsulin-vetsulin.186099/

 

Hi Kris,

Agree with all your points and have read the link several times. Now that he is responding, I'm just trying to make sure I don't dose him too high until I can get him switched to Lantus or Prozinc. Leaning towards Lantus at this point. I have 3 more shots to do before the appointment and want to make sure he doesn't go too low. Would you stay at the current dose and get as many tests in and if I see him nearing greens, just feed more? Or would you lower the dose more now?

 

I'd try Lantus. You gave 5 u this AM. Get a test somewhere between +4 and +6 if you can. That should be good info. It will help with the dose decision until your appointment.