Update - Remission?

Discussion in 'Caninsulin / Vetsulin and N / NPH' started by bbwyo, May 31, 2017.

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  1. bbwyo

    bbwyo Member

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    A update on Kitty's situation. The last shot of Vetsulin was on Saturday 5/27 morning. Her numbers are holding in the mid 200's. The Vet has said to keep monitoring her but not back on insulin. I will actually see the Vet the first of next week, June 5th. If things hold I will not be giving more insulin until that visit from the Vet...(Yes rural Vet comes to your house).

    She seems to be doing well overall. Possibly a little dehydrated at times but all else pretty normal...not quite her old self in that she doesn't have the energy. She has been a high energy kitty but is hitting the 10 yr mark this summer and with Arthritis.

    I have no idea what to expect from here on out. We have been suspicious that the FD was the result of a couple of steriod shots late last summer and fall. When this was first diagnosed the Vet said she would be happy if we could get BG#'s of 250. (which she has) Does it just depend on Kitty's overall health whether or not one tries to kick up her system a little in order to achieve lower BG? How unhealthy is a higher BG? Before this hit blood tests from 2-3 years ago showed her to be very normal for non-diabetic cat in the 51-120's.

    Last winter before she was diagnosed and she had lost so much weight I had tried to change her diet to a "high test" dry food. I think this may have been "the straw that broke the camel's back". She had dirhea and condition completely deteriorated ie. vet diagnosis etc. etc. After finding your site we are now successfully all wet LC. 3 FF Pure + 1 Classic FF. Over the last month I had slowly been reducing the W/D that the Vet had prescribed and even though it was a very small portion of her daily caloric intake may have accounted for her wild swings and low BG. As that has been settling down I have stopped feeding the W/D completely and if you look at the spreadsheet she seems to be pretty stable.

    I've only been doing spot checks and it doesn't seem to matter if she's eaten recently or not.
    I would love her to be her "old self" again but if she's getting along with higher GB would it be silly to rock the boat with trying to give insulin?

    I thank all you who volunteer on this site. You have literally been a Godsend. I will definitely be supporting this group.
     
  2. JanetNJ

    JanetNJ Well-Known Member

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    Your cat is not in remission and still needs insulin. With a human meter she would need to be consistently under 120(50-120) without insulin to be in remission. I'm not sure why you stopped giving it. You may need to give a smaller dose than before but he still needs it. Over time a high bg can lead to organ damage.
     
  3. JanetNJ

    JanetNJ Well-Known Member

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    Are you quite sure it's arthritis affecting her and not diabetic neuropathy?
     
  4. bbwyo

    bbwyo Member

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    Thank you Janet. I stopped with the insulin because Vet said to. I agree I think she could use some help. And No I'm not sure it's not Diabetic neuropathy because I have noticed that the creaking is non-existent some days. I don't know that much about arthritis but don't think it comes and goes so noticeably. She seems to feel pretty good. I have been monitoring per Vet's instructions. I am going to talk with her in the morning. I really appreciate your input here because I wasn't sure about numbers. The Vet had said she would be "happy" with BG under 250?
     
  5. JanetNJ

    JanetNJ Well-Known Member

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    She's probably not accustomed to people who actually home test.... If someone isn't home testing there's a risk of hypo with low numbers.

    We can help you with dosing if you want to get her lower. If there's ever going to be a remission you have to get her into healing numbers where the pancreas can heal itself..... And that's under 120.

    Keep in mind you are using a human meter....on a pet meter a reading like 278 like you had the other day could easily be a 330-350 on a pet meter. Plus I have a feeling these high numbers with no treatment are starting to cause neuropathy which is only going to gradually get worse.

    You need to get her numbers down and I would start her on b12 methylcobalamin supplements such as zobaline.

    She seems to drop a lot from a small dose of insulin. Id probably start trying with a half unit when over 200. Let's get her into those blues!
     
  6. JanetNJ

    JanetNJ Well-Known Member

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    Maybe it's a good idea to seek a second vets opinion.
     
  7. bbwyo

    bbwyo Member

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    I could but we don't have a lot of options out here in rural WYO. The Vet I have is very open to working with patients but is a little conservative. We are going to talk later on this morning but she texted we could try Lantis or smaller doses etc. Also said the b12 M is more effective with injections but will discuss more later. I'm sure she will be fine with Zobaline to start. Any idea if injection better? Would really like to try to get her stabilized lower. She's more of an indoor cat but if she happens to be outside and sees rabbit or mouse seems to effect GB even if she doesn't eat it. Genetics!
     
  8. JanetNJ

    JanetNJ Well-Known Member

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    For diabetic neuropathy the shots are not more effective. The shots are b12 cyanocobalamin.... The pills are B12 methylcobalamin which is better for this.
     
  9. bbwyo

    bbwyo Member

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    great! just got off phone with Vet who said go ahead with the B12 M, and start .25 cu Vetsulin and monitor. She also suggested using a little metamucil to slow down food absorption which might help with rapid metabolizing of insulin (or maybe just food)? I'm not sure I understood that correctly, she only offered it as an option. Do I have to order Zobalin or is it something they will have at Petsmart?
     
  10. bbwyo

    bbwyo Member

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    vet also said to see how this went that we could try the Levemir if this didnt work
     
  11. JanetNJ

    JanetNJ Well-Known Member

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    It used to be carried on amazon but I don't see it on there now.

    This is the b12 I use... You can just open the capsule and sprinkle it on the food. Vitacost Vitamin B-12 Methylcobalamin -- 500 mcg - 300 Capsules https://www.amazon.com/dp/B0046IET7C/ref=cm_sw_r_cp_api_ppynzb3ECKZ78
     
  12. bbwyo

    bbwyo Member

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    will find it. Also which pet specific glucose monitor is the best and do I have to order it as well?
     
  13. JanetNJ

    JanetNJ Well-Known Member

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    You want to switch to a pet meter? I like the Alphatrak 2 but just know the strips are very expensive. You can get it on amazon
     
  14. bbwyo

    bbwyo Member

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    I guess I don't need to switch to Pet meter as long as I understand the difference in the readings. I'm all for making things less complicated right now.
     
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  15. JanetNJ

    JanetNJ Well-Known Member

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    Totally up to you. Like I said I have and use an Alphatrak.

    Human meters run lower, with a greater difference between them at higher numbers. So in high numbers they might be 100+ numbers apart, but in low numbers they may only be 20-30 numbers difference.

    I personally like having the same numbers as my vet, but before my cat went into remission I was spending about $150/month on strips. So it is pricy.
     
  16. bbwyo

    bbwyo Member

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    Hmmm. will have to think about that one. I just want to be sure I'm understanding what I'm seeing. What you are saying is that on a human meter if I get a 50 reading it could be a 70 or 80 in reality? I've read about this but seem to need the repetition. The Vet does a fructosomine (sp) test so my # will not be relevant. Do you have any suggestions for syringes for smaller doses? We are going to try .25 cu of the Vetsulin and it looks like that is tiny. Thx
     
  17. Yong

    Yong Well-Known Member

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    Vetsulin is a U-40 insulin so you are probably using U-40 syringes? Those smaller doses can be difficult :smuggrin: but you could try using U-100 syringes with a conversion chart, which are apparently easier to do small doses. I just ordered some myself. My current insulin is also a U-40. Find syringes with half unit markings too. If your Walmart has not so clueless pharmacy associates, they carry U-100 syringes with half unit markings. I believe they are ReliOn brand (walmart brand too) U-100 syringes, 31g, 5/16" needle 3/100cc for about $9. The Walmart I went to try and get some has some dull crayons behind their pharmacy desk so I will try another one :p.

    This is probably just an opinion but Fructosomine tests are irrelevant anyways because they are an average of high's and low's. Not a good indicator of how controlled her diabetes is under. (that sentence sounds awkward, my apologies my brain isn't telling me how to fix it :woot:). Don't try to get a conversion of human BG readings to pet BG readings in your head, it will drive you nuts! Not necessarily a 50 on a human meter is the other in reality but most likely higher on a pet meter. Feline blood is composed differently, hence why they have a pet meter ;). Hope something in this comment was helpful :cat:
     
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  18. bbwyo

    bbwyo Member

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    I ordered the product you are using. How necessary is the folic acid? Also read on one site (?big orange?) that it wasn't a good idea to crush tablets?
    So does it matter if you just sprinkle the capsule? I do this with Dasuquin and it works great
     
  19. bbwyo

    bbwyo Member

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    I have started the Vetsulin again 1x daily .25 cu in the morning. Today is the first day I've pretested etc. because Vet said not to for a couple of days. I think she didn't want me to over-react AND also to give time for levels to settle down. So far so good. She is open to other insulins and on the Big Orange site it said that Prozinc was a good choice when trying to get a cat to level out at a low dose (maybe my interpretation) Also on this site they said that one shot a day was not going to be effective (again? maybe I didn't understand this). What are your comments on the above? Have I misunderstood something?

    Also I would very much appreciate your help in getting her on the right track. Yesterday was the first day of shooting .25 and I didn't test much.
    I guess I will know more in a couple of days but it sounds like prozinc 2x day would be a better insulin.
     
  20. Yong

    Yong Well-Known Member

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    Bev,
    *Just my thoughts again* Unfortunately, there's no absolute guarantee a specific insulin will level out a cat better than another. However, a longer lasting insulin like Prozinc may work better for Kitty since it doesn't look like (from the mid cycle data you have) Vetsulin is lasting 12 hours. Like the sticky's say, in some kitties it does not last the full 12 hours. If you want, peak over on the Prozinc thread and look for Susan and Timmy and Lisa and Smoky. They both switched from Vetsulin to Prozinc. Unfortunately, Smoky passed but I think Lisa still has his Spreadsheet up and he was on the smaller doses, like 0.2 - 0.6u range.

    As for the 1 shot a day, you are correct, generally speaking it does not work out due to a cat's metabolism being much faster than a human :). I will tag one of my Prozinc buddy's, @Djamila . She might be able to word things better about Prozinc and lower doses :smuggrin:. I don't know your schedule but definitely try to get every PS test and some extra mid-cycle tests so we can see more data on her :cat:.
     
  21. JanetNJ

    JanetNJ Well-Known Member

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    I've never had problems sprinkling it on. I give dasuquine as well. The folic acid is helpful but I can't speak to its being vital or not.

    Cats metabolize insulin quickly, that's why they get 2 shots and not one.
     
  22. bbwyo

    bbwyo Member

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    The Vet said that it takes awhile for her system to adjust to the insulin so not to test for 3 days? Why do they say this? I almost skipped yesterday but relented and checked after 1st shot. Also Vet recommended metamucil to slow things down? Haven't decided on this. Janet I see you use Vetsulin. Are you happy with results? Any thoughts on Prozinc?
     
  23. JanetNJ

    JanetNJ Well-Known Member

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    I had good results with vetsulin. My cat was in it for four months now and has been in remission for 9 months. The best insulin is whatever works for your cat.

    I have never heard of using metamucil for diabetic cats before.
     
  24. Yong

    Yong Well-Known Member

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    Thought Metamucil was a fiber supplement o_O. Haven't heard of fiber helping to slow a BG drop, mainly hairballs and poo help. Food can help slow the BG drops.
     
  25. bbwyo

    bbwyo Member

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    thnk the idea was to slow down food uptake? therefore metabolism. Think she said it might be worth a try.. so ??? wondered if anyone had heard anything like that?
     
  26. JanetNJ

    JanetNJ Well-Known Member

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    Oh, and there's no reason to not test. not sure why he would say that. :/
     
  27. Yong

    Yong Well-Known Member

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    I personally have not heard but you could try posting the question on Main Health to get more eyes :)
     
  28. Djamila

    Djamila Well-Known Member

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    There is research on one of the insulins (I'm afraid I'm forgetting which right now) that did indicate that you can't know the impact of a dose until a few days. I'm guessing that's what your vet was thinking about there. However there is a difference between waiting to judge the efficacy of a dose, and not testing. Sometimes a cat will have a dramatic reaction on the first cycle of a dose change, and then level off. So on day one, it might look like a great dose, but by day three you know that she really needs a bigger dose than that. We encourage testing even while you're waiting because a dramatic reaction can sometimes by a hypo (BG below 50 on a human meter) and the cat might need you to intervene to bring the BG back into safer numbers.

    And our protocols actually agree with that in that we recommend a dose be held for at least 3-6 cycles before the dose is changed in order to give time to see the real impact of the dose.

    You did a great job today, by the way! And you're doing a great job of asking questions and gathering information about all of this.

    As for the fiber supplement, I've heard of that in human diabetics, so maybe it's the same idea. It's not something I understand well enough to comment on though. okli,m

    Prozinc and Lantus/Levemir are both great choices. You really can't go wrong there. You might want to read the Sticky messages at the top of both forums and read through some of the message threads and get a sense of which protocols would best suit your lifestyle and how you'd like to approach treatment. Both options are good and have good outcomes so there really isn't a right or wrong there. As Janet said, the best insulin is the one that works for your kitty. There isn't really any way to know which is better until you try them. Either way, there are great people around here to support you in learning how to manage all of this!
     
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  29. bbwyo

    bbwyo Member

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    The Vita cost B-12 arrived today so will start in the morning. Do I understand correctly to use 1 whole capsule?
     
  30. JanetNJ

    JanetNJ Well-Known Member

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    Yep. You can do one in the morning and one in the evening. Just sprinkle it on the food and mix it in. Any extra b12 they just pee out. You can't overdose on it. By the way most adults are deficit in b12 as well so you can pop one yourself. Lol. I've tested the powder and discovered it has very little taste. None of my cats care when it's in the food.
     
  31. bbwyo

    bbwyo Member

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    You also give folic acid? I will watch to see when that is available agian. How much of that should I use?
     
  32. JanetNJ

    JanetNJ Well-Known Member

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    I don't give folic acid now but my cat never had trouble with neuropathy. I have given my other cat a b complex in addition to the b12 because he had kidney disease and anemia and needed the iron... That has folic acid in it. Nutrived B-Complex with Iron - 4 oz. https://www.amazon.com/dp/B000CQUCXC/ref=cm_sw_r_cp_api_WLvpzb8HHN3TM

    You would still need the additional b12 as the b12 in this formula is cyanocobalamin not methylcobalamin.
     
  33. bbwyo

    bbwyo Member

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    ok. The vet said the b12-m wouldn't necessarily help arthritis but would help muscle strength. (which she had lost before diagnosed). I am thinking of doubling the Dasuquin when I hear the "creaking". My thinking is that more muscle will alleviate some of the creaking/discomfort...but she never seems uncomfortable just "creaky". Your question about the possibility of DN was something I had wondered about.

    -Behavioral question. This morning AMPT was over 300. At +2 she had a big drop to 86. See SS. Her behavior is very normal, sleeping in sun, all 3 P's. When I look back at prior testing it seems like she has had a bigger drop after pretesting high in the AM. I know I need to do more regular before and after testing to confirm but have you noticed this with other Vetsulin cats? Also the other (6/10) evening she was very diabetic crazy ravenous eyes dialated and her bg test was lower than it was this morning? It's a sneaky disease but I'm trying to "watch and understand" what she is telling me. This is counter intuitive.
     
  34. JanetNJ

    JanetNJ Well-Known Member

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    Wow huge drop... Too big. Crazy for such a tiny dose. Test again at 3 and feed. I loved vetsulin for my cat but I'm thinking your cat needs a more gentle insulin. Ask your dr about switching to lantus or ProZinc.
     
  35. bbwyo

    bbwyo Member

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    Did you see that! 3+ bg 129! HMMM? Thoughts! Im wondering about a different syringe. I try to mark and measure .25 but it's pretty difficult with u-40 s. I just fed again and she's pretty happy. taking another bath, conversant. ???
     
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  36. JanetNJ

    JanetNJ Well-Known Member

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    Does your syringe have half unit markings? You could get u100's and use a conversion chart.
     
  37. bbwyo

    bbwyo Member

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    yes i was reading about those. I have to go to town this afternoon and will see what is available. It sounds like the walmart relion ones are not as popular as others and that may be all that is available locally.
     
  38. JanetNJ

    JanetNJ Well-Known Member

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    I ordered syringes from Adwdiabetes.com
     
  39. bbwyo

    bbwyo Member

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    i mean no they do not have half unit markers
     
  40. JanetNJ

    JanetNJ Well-Known Member

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  41. bbwyo

    bbwyo Member

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    thanks for info on ordering. I like the way you always say "if it was my cat":) Not sure if this should be a new thread.
    It has been just about a week on the new dosing .25 1x daily. It looks like she stays pretty stable at night but she has had a night or two when she gets the diabetic crazy hunger in the evening. I spread her meals out all evening with 1/2 FF Pure before bedtime (NC, HP) Is it too early to give up on the Vetsulin? we have talked before about how much she drops between preshot and +1/+2 test but she seems to be "Ok" during the day.

    My concern is the numbers aren't stabilizing in the 126-127 range to allow for healing? How do I get there?
     
  42. JanetNJ

    JanetNJ Well-Known Member

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    Curious how come you don't give insulin at night? If she's above 250 and you are around to test you might try giving a tiny bit more of a dose to get the nadir lower... Aim for 80-110 But make sure she's had a good meal first and test often.
     
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  43. bbwyo

    bbwyo Member

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    i know but the Vet said to try the smaller dose once a day since she seemed to hit a point where she was getting really low numbers about 10 days ago. I have read you should go at least 6 cycles before changing dosing. I'm going to test her tonight at bedtime and see where we are in the morning. If you notice this morning's test was about the same as last night? I think the Vet is thinking her pancreas might kick in. I'm going to talk to the Vet in the morning about maybe trying prozinc or levemir. As an alternative I could continue with the Vetsulin but add a .25cu at night. BUT it seems like it hits her system pretty hard and doesn't last very long. Is it possible this might also be the case with any other insulin as well? What do you think?
     
  44. bbwyo

    bbwyo Member

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    Do you mean adding another .25 cu dose at night? Then watching thru the evening?
     
  45. bbwyo

    bbwyo Member

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    Sorry but I have another question about having to be at the bg 126? number or lower for pancreas to start healing? Where does that number come from?
     
  46. JanetNJ

    JanetNJ Well-Known Member

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    Yes. Vetsulin is ment to be dosed twice a day (unless of course you get a preshot too low to shoot which would be under 200 when you are first starting).

    You don't have to her all night.... If you inject at 6 or 7 pm and do a quick check just before bed at 10 or 11 you will be able to see how the cycle is going.
     
  47. JanetNJ

    JanetNJ Well-Known Member

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    Normal for a cat is 50-120 on a human meter. So when the numbers are in that range it gives the pancreas a rest where it can heal. Cats are unique in that they can heal and go into remission.
     
  48. bbwyo

    bbwyo Member

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    thank you Janet. I agree with everything you say. I dont' know what to think about the night time bg staying so stable. Do you think her body is adjusting to the introduction of insulin and once things settle down she will ease into the additional .25 cu and have a more gentle drop?
     
  49. JanetNJ

    JanetNJ Well-Known Member

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    Is she a lot more physically active in the daytime?
     
  50. JanetNJ

    JanetNJ Well-Known Member

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    Actually hold off on the increase for now... When she's getting those greens at +2 are you steering up? I am trying to figure out why she's going low and then back up...hmmm
     
  51. bbwyo

    bbwyo Member

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    Testing today and if you look at SS she probably is hitting her nadir around 2+/ 3+ hrs? Would giving her the additional .25 cu in evening help hold the nadir longer? or just drop it lower in the beginning?
     
  52. bbwyo

    bbwyo Member

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    I don't understand steering up? If you mean feeding? I give her something LC every time I test. She is more active during the early morning then comes in and sleeps until later in the afternoon. I have given her a bad habit by feeding her when she comes inside and acts hungry. The Vet said to let Kitty tell me what she needs so early in morning when she comes in and I know her BG is low I give her a little (less than TBSP) LC-NC wet food. In the evening again she goes out more when the weather is nice and I think this may account for her bg holding through the night??
     
  53. bbwyo

    bbwyo Member

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    News flash. I might be part of the problem. I thinkI should ease up on the early morning feeding. I have been worried about hypos because of lows on the higher dose, also the Vet recommended leaving dry food out because the kitty would self regulate by eating more if she felt the lower bg# (free feeding). Also because she lost so much weight I thought when her bg's were better she would utilize the calories better. So when she came in and seemed hungry I should feed her...Now i think I should slow that down and stretch out feeding. That might help hold lower #'s longer??? Am I getting this right?
     
  54. JanetNJ

    JanetNJ Well-Known Member

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    You can feed her if she's hungry, but not dry food. It's OK to leave low carb wet food out.
     
  55. JanetNJ

    JanetNJ Well-Known Member

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    Vetsulin is ment to be dosed twice a day because it only lasts about 8-10 hours. Your cat is staying high in the evening because the insulin is out of her system.
     
  56. bbwyo

    bbwyo Member

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    Yes I understand that but I guess I'm feeling cautious about dosing in evening because her bg seems to stay lower and stable? With Vetsulin is that what a bg curve would look like short sharp down (1-2hrs) then coming up so quickly? And with her bg going down so far so rapidly a larger dose doesn't seem like a good idea. So how to get her and keep her in that healing range?
     
  57. JanetNJ

    JanetNJ Well-Known Member

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    No your curve is not typical. Usually vetsulin starts working around 2 hours and his it's lowest between +4-+6. I've never seen curves like yours before.
     
  58. JanetNJ

    JanetNJ Well-Known Member

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    I'm not saying to give her a larger dose.... I was suggesting dosing in the evening as well. There is no more vetsulin in her system at the pmps time.

    What do you think, @MrWorfMen's Mom ?
     
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  59. bbwyo

    bbwyo Member

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    yes I didn't understnad you to say a larger dose. I was only wondering how insulin worked and wondering what someone would do to achieve more stable #'s.

    And also you are saying that Vetsulin does not have an accumulating effect, that it normally clears the body in the 12 hr cycle. Not a 4 hr cycle:)

    Does arthritis complicate diabetes treatment? that you know of?
     
  60. JanetNJ

    JanetNJ Well-Known Member

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    I don't think arthritis really complicates treatment. I suppose if the pain was severe it could raise bg. My cat has arthritis. I give cosequine but it hasn't effected her diabetes treatment.
     
  61. bbwyo

    bbwyo Member

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    does your cat "creak" ? Currently on 1 capsule of Dasuquin but might up it to 2x. Kitty doesn't creak all the time so will be interesting to see how the b-12 m works? or if just helps her stay stronger. Either way good. Appreciate your comments. It's turned cold and windy (57) here today so not so much exercise. will see if it makes a difference. she hasn't eaten much today so will do PMPS before feeding tonight. See what tomorrow morning brings. She's pretty chill tonight so thinking her arthritis might be bothering her more than I thought.
     
  62. JanetNJ

    JanetNJ Well-Known Member

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    She doesn't creak, but limps after sitting awhile and needs a boost now to the top of her favorite spot in the cat tree. :(
     
  63. Yong

    Yong Well-Known Member

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    "Insulin is a hormone made by one of the body's organs called the pancreas. Insulin helps your body turn blood sugar (glucose) into energy. It also helps your body store it in your muscles, fat cells, and liver to use later, when your body needs it. After you eat, your blood sugar (glucose) rises."

    With cats, they do better with dosing twice a day, 12 hours apart because they metabolize about three times faster than people.

    Vetsulin is an in-and-out insulin so it should not have any accumulating effect. If it looks like that, it may be Kitty's pancreas spurrting and doing a little work :)

    I think she needs the PM shot, even if it's less then 0.25U. You hold the syringe though :bighug:
     
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  64. bbwyo

    bbwyo Member

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    please take a look at the SS and see that the AMPS was actually lower than the bedtime test...and I didn't give the additional dose? I guess if I give the evening shot at 6pm I'd have time to watch bg but what happens during the night? It looks like her pancreas must kick in sometime in the wee hours?
     
  65. Yong

    Yong Well-Known Member

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    It's possible her pancreas is helping a little but may be more likely to achieve remission if it gets some help in the evening. Her green numbers in AM cycle are pretty ideal but the insulin is not lasting the full cycle. Like I said, it was just my opinion that she should have PM shot too. Since you monitor as late as +4 on PM, I think she'd be OK. Let me repeat, I am not trying to pressure you to do anything :). This is just my thought.
     
  66. JanetNJ

    JanetNJ Well-Known Member

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    Jun 8, 2016
    Ditto. The more time in healing numbers, the greater the chance of remission.
     
  67. bbwyo

    bbwyo Member

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    Apr 24, 2017
    yes I agree but today I was gone through the day and didn't feed her a meal mid day and tonight after food her gb was 212? I'll test in the morning for sure but now I have to look up what the cut off is for giving the shot. If I remember right it's 200? Not that I expect something lower than that in the morning but will be wondering what to do if it does. I also think I am noticing when she spends the day sleeping (not just staring out the window) that her numbers are lower. I hope this might mean her body is healing. More and more I think a slower acting insulin might be the best answer? Thank you both for your oversight on this one.
     
  68. Yong

    Yong Well-Known Member

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    Jan 11, 2017
    Sorry Bev, yes the cutoff number for no shot for newer members is 200 :). It is very possible that a gentler insulin like Prozinc, Lantus, or Levemir could be better for her. Just seems like Kitty is flirting with remission :woot: so we want her to feel better and not burn a hole in your wallet :bighug:. I'm going to tag one of my Prozinc members, she's looked at many a spreadsheet and see what her thoughts are for Kitty switching insulins @Djamila if you would please :smuggrin:
     
  69. Djamila

    Djamila Well-Known Member

    Joined:
    Aug 1, 2015
    I think you have a few options. In general, I think the slower acting insulins are easier on the cat and on the human, and the numbers I'm seeing on your spreadsheet indicate high enough numbers that while Kitty looks like she may have a decent chance at remission, she has a ways to go to get there.

    You're right that her evening numbers are stable, but they are still too high. She should be getting an evening dose of insulin as well as a morning dose. Her pre-shot numbers need to be below 120 to be considered in remission, and most cats will stay in the 50-80 range on their own once they reach remission. Getting numbers over 200 isn't terrible, but it's also not healthy. My cat developed neuropathy with numbers in the low to mid-200's, so if it was me, I would want to get those numbers quite a bit lower.

    Sam would nadir at +2 during his first diagnosis, and now his nadir is +3. Some cats just have an early nadir. Sometimes it can be from too little insulin, but sometimes it's just the way the cat is. If Kitty was on prozinc I would suggest increasing the dose to get a longer duration, but on Vetsulin, that could end up pushing Kitty down too low. So instead of increasing the dose, I would just suggest adding in that second dose so she is getting insulin both morning and evening.

    Once she's getting dosed twice/day, you may start to see some better overall numbers and a better chance at remission. Right now, she's staying in the yellow numbers most of the day which isn't ideal.
     
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  70. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Sorry folks! I never got the tag on Tuesday (double checked to see if I had missed it but no tag ?????) so I'm late to the discussion.

    I am in agreement that it would be better to give shots twice daily to try to keep the numbers down for as many hours a day as possible. It does look like Kitty is close to possible remission or at the very least being well regulated but right now she is staying up during the night cycle and then ending up dropping a lot early in the day cycle. The roller coaster effect is probably making her feel poorly and that might explain why her appetite doesn't seem to meld with the BG numbers.

    If I were you, I'd split the 0.25 dose into two equal doses. I'd draw up some coloured water in a used syringe to a dose between 0.25 and the zero line on the syringe and use that as a comparison to give consistent doses lower than 0.25u both day and night.

    It does appear that Kitty is burning through the insulin quickly but that may be a product at least in part of doing the once daily shots. Her system is being bounced around a lot and until that stops, you really can't see how effective the Vetsulin is. I'd at least give twice daily shots a try before changing insulin.
     
  71. Yong

    Yong Well-Known Member

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    Jan 11, 2017
    There seems to be an issue with tags again, Linda :smuggrin:. I'm not getting them either right now but it has happened before and worked itself out :)
     
  72. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    I don't think I always get all my alerts for watched threads either. It seems to be a random problem. It's giving my memory a good workout! :woot:
     
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  73. bbwyo

    bbwyo Member

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    Apr 24, 2017
    I am a little confused about the evening dose? Are you saying that I should cut the .25 cu in half and give 2x daily or add a 2nd .25 dose in the evening? She is doing so much better and hopefully her pancreas is waking up a bit but remission would be wonderful.
     
  74. bbwyo

    bbwyo Member

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    Apr 24, 2017
    If your Sam has a nadir of 3+ hrs does this indicate you should dose 3x a day?
     
  75. bbwyo

    bbwyo Member

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    Apr 24, 2017
    I also have a question about her being an indoor/outdoor cat. Right now she's out with a squirrel on her brain. I'm guessing this will make her bg# higher? or will it make it lower since she's using more energy? will snag her and get another test shortly but I am guessing that tearing her away from the squirrel will elevate any #'s.
     
  76. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    I am suggesting that you maintain a total dose of 0.25u per day but divide it in half and give it twice daily instead of once to get coverage over a 24 hour period from the 0.25u dose. She may ultimately need the dose raised to 0.25u twice daily but right now she has metabolized that dose quickly several times and had some pretty steep drops early in the morning cycles with once daily dosing so I think it is prudent to start by dividing the 0.25u for 24 hour coverage and see what that does for her. It's hard to say if the once daily dosing could be influencing those steep early AM drops but it is no doubt influencing her PMPS and AMPS readings. If you give the same daily dose split into two doses over the 24 hour period, it should bring down the pre-shot readings which means she will not have as much room to drop before it becomes unsafe. That is why I am suggesting you start by giving half of the 0.25u in the morning and half in the evening to see how that effects her BG levels.

    I would hold off checking BG for a bit if Kitty is currently being excited by a squirrel because I would expect that to elevate BG to some degree. Activity will trigger other biological functions to pump more more glucose into the system as needed to keep up with the level of activity but so do stress or excitement and these are things over which you have little if any control so let Kitty settle a bit before you take a reading.
     
  77. bbwyo

    bbwyo Member

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    Apr 24, 2017
    thank you for the clarification. wow half of .25 cu is going to be a trick. I will try the suggestion to figure it out using the colored water. I also getting the syringes with the additional markings will help. Can you clarify how the "squirrel thing" impacts the bg/insulin requirements. If the excitement from the squirrel makes the bg # go higher she would benefit from the higher dose of .25cu (i-o 1/2 of .25 cu) during the day? What if I gave the .25 cu dose in the morning but in the evening gave the 1/2 dose of the .25 cu?
     
  78. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    You should never alter the dose of insulin because of some outside uncontrollable and random occurrence. Your cat's BG can be elevated by seeing a squirrel, a clap of thunder, fireworks going off or a very noisy truck going down the street but you will not always be aware of whether something has occurred to excite or scare your cat. You cannot adjust insulin assuming there has been a BG increase as a result of outside forces because those outside forces are changing constantly and you have no way of knowing what if any impact they are having on BG. You govern your dosing by information you can consistently obtain which is BG levels at shot time and the lowest point in the cycle and food intake (consistent portioning and no shot if kitty is not eating). What you are proposing would only complicate matters considerably and make kitty feel horrible.

    Right now I think the best option is to dose Kitty consistently twice daily for a few days as long as her pre-shots are 200 or higher and nadir is not below 90 and then re-evaluate. It will take a few days to see how the new dosing is working for Kitty.
     
  79. bbwyo

    bbwyo Member

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    Apr 24, 2017
    Let me explain my question a little better. and thanks for info. I'm not suggesting dosing due to activity but knowing that she goes outside during the day wouldn't it be better to maintain the .25 cu in the morning and then drop to the 1/2 .25 cu in the evening?.. as a daily schedule. Also I just tested her and noticed when I went to fill in SS that she had had the exact same #'s at the same times? I guess it's just a coincidence?
     
  80. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    The same number at the same time of day is, as you said, just a coincidence.

    Giving one dose AM and a different dose PM is just going to make getting kitty regulated more difficult if not impossible. The goal is to attain a more consistent range of BG across the 24 hour period. Giving one dose of insulin in the morning and a different one at night right now will likely lead to some low numbers in the day cycle leading to higher pre-shot at night and then higher BG's through the night and you will never know what dose is doing what for Kitty because while it's possible to assume bouncing is occurring you can't quantify how much is a result of bouncing and how much is because she is not on the correct dose of insulin. Keep it simple and consistent and you'll get to your goal of regulation much faster with a lot less head scratching.
     
  81. bbwyo

    bbwyo Member

    Joined:
    Apr 24, 2017
    ok that sounds good but do you think giving her the same .25 cu dose 2x a day would be too much?
     
  82. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Feb 18, 2015
    See my post #76, 1st paragraph. Yes I think it might be too much. Because Kitty has had some pretty steep drops in BG in the very early hours of the day cycle recently (see June 11th & 13th) with pre-shots that likely have been high because no shot was given the night before, I believe it is unwise to give the 0.25u twice daily right now as that may very well push Kitty's BG too low and it's better for her to be a little higher and safe than too low. If the smaller dose proves to be too little it can always be raised later but start conservatively and see what the smaller dose does for her first to keep her safe.
     
  83. bbwyo

    bbwyo Member

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    Apr 24, 2017
    Thank you for that. I really appreciate your expertise. What do people do that don't get this help. Thank you so much.
     
  84. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Feb 18, 2015
    Bev, I think too many vets think of insulin as if it were a pain pill. More is not always the answer. It's not rocket science but it's also not always intuitive. A lot of it is trial and error but first and foremost is to keep the cat safe. The saying around here is that this is a marathon not a sprint. Slow, methodical dose changes will allow you to see what your cat is up to and then you can make decisions based on how YOUR cat reacts to the insulin. This is definitely not a one size fits all situation and too many vets seem to think it is.:)
     
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  85. bbwyo

    bbwyo Member

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    Apr 24, 2017
    just ordered the u-40 syringes with smaller increment markings but will start with 1/2 .25 cu in the morning. thanks
     
  86. Yong

    Yong Well-Known Member

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    Jan 11, 2017
    Essentially, what I think Linda and I are thinking is, don't dose 0.25U twice a day right now (but she may need that if she doesn't go into remission) and with new half unit marked syringes, aiming for 0.125U twice a day. Are you using U-40 or U-100 syringes? It is easier to draw a 0.1 U dose on a U-100 syringe and there is a conversion chart to explain how much of the U-40 insulin to draw up. I recently switched to U-100s and they are easier for tiny adjustments :)
     
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  87. bbwyo

    bbwyo Member

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    Apr 24, 2017
    I ordered the u-40 pet syringes
     
  88. bbwyo

    bbwyo Member

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    Apr 24, 2017
    where do I find the conversion chart?
     
  89. bbwyo

    bbwyo Member

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    Apr 24, 2017
    I think the pharmacy has u-100s
     
  90. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Feb 18, 2015
    You will need to switch to U100 syringes (thanks for mentioning that @Yong ) in order to more easily draw up such a tiny dose. Here is a link to the conversion table you'll need.

    http://www.felinediabetes.com/insulin-conversions.htm

    Can you cancel your U40 order and replace it with U100 with half unit markings?
     
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  91. bbwyo

    bbwyo Member

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    Apr 24, 2017
    will see
     
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  92. bbwyo

    bbwyo Member

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    Apr 24, 2017
    was able to cancel. will stop a pharmacy this afternoon. thanks
     
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  93. Yong

    Yong Well-Known Member

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    Jan 11, 2017
    Walmart also carries U-100 syringes with half unit markings, as long as you don't have dim bulbs for staff at your local store :facepalm:
     
  94. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Feb 18, 2015
    Oh that is too funny! I go to Walmart for mine with the front of the box to hand them so they don't keep handing me the wrong ones one at a time frustrating the daylights out of me! Dim bulbs are obviously a continent wide Walmart problem! :rolleyes:
     
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  95. Yong

    Yong Well-Known Member

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    Jan 11, 2017
    I just asked another member to send me a picture so I can do the same! [​IMG]
     
  96. Yong

    Yong Well-Known Member

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    Jan 11, 2017
    Bev, I found a picture that might help you with those tiny doses:
    [​IMG]
     
  97. bbwyo

    bbwyo Member

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    Apr 24, 2017
    is this a picture of the u-40 syringe or the u-100?The u-100 syringes I found were whole units on one side and half units on the other. The conversion chart says for .2 units using a u-40 you draw to the .5 mark. In the picture above the .25 (assuming this is the u-40 .25) looks like the .5 mark on the u-100 syringe? So what am I missing here? When the conversion chart says .2 is it the .25 in the picture?
     
  98. bbwyo

    bbwyo Member

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    Apr 24, 2017
    is the .15 picture above the picture of what 1/2 of .25 cu looks like? in a u-40 syringe or the u-100 syringe
     
  99. bbwyo

    bbwyo Member

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    Apr 24, 2017
    The u-100 syringes would certainly make the .25 cu dose easier. according to the conversion chart .25 would be just a tiny bit more than the .5 on the u-100 syringe? correct?
     
  100. Djamila

    Djamila Well-Known Member

    Joined:
    Aug 1, 2015
    3x per day is rarely a good idea, although I've seen a couple of owners try it with some success.

    Sam's numbers are low enough that even in his high range, he's still in pretty decent numbers. He often hits nadir and then "surfs" through the middle of the cycle meaning that he stays in roughly the same range for several hours. The curve I did on 6/10 during the AM cycle shows what I mean. However, I am switching to Lantus soon in the hope that an insulin with longer duration will help him a bit more.

    Having an early nadir can be because of too little insulin, too much insulin, not the right insulin for the cat, or just a quirk of the cat. Time and data can help you figure out which one it is.
     
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