Vetsulin dosage help

Discussion in 'Feline Health - (The Main Forum)' started by smidge&smudge, Jan 27, 2017.

Thread Status:
Not open for further replies.
  1. smidge&smudge

    smidge&smudge Member

    Joined:
    Jan 27, 2017
    Thank you for your reply, I copied and pasted from my intro thread
    Forums>...>Welcome to the Group - Post an

    smidge&smudge

    Hi,
    I am so happy to find support and information on this site! My cat Smudge was diagnosed on January 16th her blood test was at 599 and started on 2 units 2x a day, one week later on follow up she was at 592 and increased to 3 units 2x a day, today was first time I successfully home tested and she was "Hi" which is off the meter. We go back to the vet on Monday. She is peeing everywhere except her litter box which is difficult to handle and I'm constantly cleaning her pee. She has switched to canned food which she likes much better anyway.

    Sorry for the long post, I look forward to learning as much as I can and I hope she starts to get better soon.
     
  2. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    Two units twice a day is higher than we'd recommend as a starting dose. One unit twice a day is better. Raising the dose to 3 u twice a day after only a week is a very large increase - 50%. We recommend increasing by only 0.25 u at a time so you don't pass right by a good dose. It's quite possible that the dose your kitty is on is too high.

    This usually settles down after a kitty is on insulin for a while and the blood glucose numbers start to come down.

    Canned food is recommended. Are you feeding low carb canned food? That's important because carbs in food can raise BG significantly. There's no need to buy expensive prescription food. Grocery store brands like Friskies and Fancy Feast pates version are fine (no sauce or gravy types - too high in carbs).

    Congratulations on home testing! What testing schedule do you follow and what meter are you using? We recommend that you set up a spreadsheet like the one we use here that's viewable by all members. It'sthe first thing we look at before giving advice.
    http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
     
    Last edited: Jan 27, 2017
  3. smidge&smudge

    smidge&smudge Member

    Joined:
    Jan 27, 2017
     
  4. JanetNJ

    JanetNJ Well-Known Member

    Joined:
    Jun 8, 2016
    Glad you found your way here Petrina. :). Lots of knowledgeable people here.
     
  5. smidge&smudge

    smidge&smudge Member

    Joined:
    Jan 27, 2017
    Thank you for your reply, I am using the relion confirm and she is on fancy feast classic, when we go back on Monday I need to ask a bunch of questions, I just hope she starts peeing in the litter box again, I am constantly cleaning her pee! I will see if I can figure out the spreadsheet!
     
  6. JanetNJ

    JanetNJ Well-Known Member

    Joined:
    Jun 8, 2016
    Is she peeing in the same spot each time? Is she just outside the box? Do you have more than one box in your house?
     
  7. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    I agree with Kris. It appears very likely the dose of insulin prescribed is too high. While that sounds totally counter intuitive, too high a dose of insulin can look the same as too little and that is a mistake many vets make. It has to do with a natural defense mechanism that causes the cat to pump out hormones to get the liver to push glucagon into the bloodstream to bring blood glucose levels up to what the cat perceives as normal. The problem is that a diabetics defense mechanism is out of alignment and thinks "normal" blood glucose numbers are abnormal because they have become accustomed to high BG levels and therefore it works to increase them. The only way to get the cat past this problem is by starting the insulin at a reasonable dose of 0.5 to 1u and gradually increasing it by quarter units until you find the dose that keeps kitty in better numbers.

    The urinating outside the box could be a sign of a urinary tract infection which diabetics are prone to or it could be that she is getting caught short. In all likelihood, getting the diabetes under control will help with the litter box problems but I would recommend getting your vet to take a urine sample to check for an infection.
     
  8. smidge&smudge

    smidge&smudge Member

    Joined:
    Jan 27, 2017
    She has several spots, one is right by her litter box, not sure why she just won't go in it, she poops in there, she has another favorite spot and I just recently got another box and put it in that spot, but she just pees near it too. She has other spots as well. Last weekend since I thought she would be getting better I deep cleaned all the floors, boy was I wrong!
     
  9. smidge&smudge

    smidge&smudge Member

    Joined:
    Jan 27, 2017
    I forgot to mention she has a uti and has been on amoxicilian, she has one more day left.
     
  10. smidge&smudge

    smidge&smudge Member

    Joined:
    Jan 27, 2017
    What a confusing disease, once I think I'm starting to under
    Just when I think I'm starting to understand this disease......☺
     
  11. JanetNJ

    JanetNJ Well-Known Member

    Joined:
    Jun 8, 2016
    That definitely explains some things. A combo of diabetes and UTI.


    She's made a negative association between the box and the painful UTI. There's a litter called Dr. elsley's cat attract that could help.


    If all else fails you can do what I did and put a puppy training pad down outside the box.
     
  12. JanetNJ

    JanetNJ Well-Known Member

    Joined:
    Jun 8, 2016
    My favorite cat accident cleaner is called anti icky poo unscented.... Works great and had no scent at all.
     
  13. smidge&smudge

    smidge&smudge Member

    Joined:
    Jan 27, 2017
    Now she is constipated, off to get some pumpkin and a ton more paper towels, I am going to try and home test when I get back before I give her lunch.
     
  14. smidge&smudge

    smidge&smudge Member

    Joined:
    Jan 27, 2017
    Just worried she looks terrible
     
  15. Tuxedo Mom

    Tuxedo Mom Well-Known Member

    Joined:
    Dec 2, 2014
    Petrina

    I jusy noticed that you posted on another FB group that you got a reading of HI on your meter. That means the glucose level is over 600 which is dangerously high. Do you have more readings?? Is Smudge eating properly?? With high readings like that there is much more of a possibility of ketones developing which can be very dangerous. Since you said he does not look well I am quite concerned about this possibility. Are you testing the urine for ketones?
     
    Last edited: Jan 28, 2017
  16. JanetNJ

    JanetNJ Well-Known Member

    Joined:
    Jun 8, 2016
    Sorry to hear that. :( hopefully the pumpkin will help.
     
  17. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    Petrina, are you still worried that Smudge looks "terrible"? You might like to put in a call to your vet to describe the symptoms and the HI reading - see what they say?

    Keep us posted.

    Diana
     
    Tuxedo Mom likes this.
  18. Tuxedo Mom

    Tuxedo Mom Well-Known Member

    Joined:
    Dec 2, 2014
    Diana&Tom likes this.
  19. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

    Joined:
    Sep 6, 2010
    Hi Petrina @smidge&smudge , how is Smudge doing now? And how are you doing?
    I do hope all is well. Please update us when you feel able to.

    Eliz
     
  20. smidge&smudge

    smidge&smudge Member

    Joined:
    Jan 27, 2017
    Just came back from vet, they tested like I would at home, and got the high 600 or over reading, was told to increase 4 units 2x a day, maybe I should start at 3 1/2? Still peeing anywhere besides her box, parked at water bowl , she didn't always keep her antibiotics down so now have some liquid amoxicilian. I was unable to download the spreadsheet on my phone, so I started a notebook. Hope she gets under control soon!
     
  21. Chris & China

    Chris & China Well-Known Member

    Joined:
    May 10, 2013
    To get it on a phone/tablet, you have to download Google Chrome, Google Drive and Google Sheets from the Play Store or App store (for Apple) first

    You might want to check on that liquid amoxicillin .....most of the liquids contain sugar
     
  22. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    4units of Vetsulin is a very large dose for a kitty that was just diagnosed 2 weeks ago and I am still very concerned the reason for the very high numbers is too high rather than too low a dose of insulin, Have you been giving 3 units? Have you been getting any tests during the cycle or just before the shot? Has the constipation problem been resolved? That too can cause some elevation of BG.

    Vetsulin should be dosed based on both pre-shot and mid cycle tests. Testing done at the vets is known to be cause high BG due to stressBG elevation. I would strongly recommend you back off the insulin dose to perhaps 2u and get a test at 1.5 to 2 hours after the shot to see how much her BG has dropped. Any large drop in BG can set off the defense system that elevates BG so if you have not been testing mid cycle, it's quite possible what you are seeing is bouncing which happens when the BG drop to levels kitty has become unaccustomed to or steep sudden drops which can occur with Vetsulin.

    It would also be most helpful if you could set up a spreadsheet. I see you tried and didn't have any success. You must have Chrome, Drive and Google Sheets installed on your phone in order to use the spreadsheet. If you still can't get it to work, we can have someone assist you.
     
  23. smidge&smudge

    smidge&smudge Member

    Joined:
    Jan 27, 2017
    Thanks, still trying to get it going, I am going to try on my work computer tomorrow, I can't get my phone to do much!
     
  24. smidge&smudge

    smidge&smudge Member

    Joined:
    Jan 27, 2017
    Our vet said to wait a few days to test again after increasing to 4 units to see the effect, tested for first time today, unfortunately because of work I couldn't test until about an hour and half before her shot, had not eaten and again got that damned "hi" reading. This has to get better?
     
  25. Chris & China

    Chris & China Well-Known Member

    Joined:
    May 10, 2013
    Your vet is wrong.....especially with Vetsulin .....it's one of the harsher insulins and can bring the numbers down fast and far on the first shot.

    Without testing, it's impossible to know what's going on, but it's entirely possible that that high a dose is taking Smudge too low and then her liver is trying to "save" her by releasing stored sugars and hormones to bring her back up quickly......we call it "bouncing". 4U is a really high dose for so early in the treatment. Most cats don't need more than 1.5-2 units

    Yes, it will get better, especially once you're able to get more tests in and we can really see what's going on with Smudge! If what we suspect is true and she's getting too much insulin, it will show up in those numbers!!

    Here's something I wrote up for others that needed help with testing...maybe it'll help you too! (substitute "her" for "him"...LOL)

    It can be really helpful to establish a routine with testing. Pick one spot that you want your "testing spot" to be (I like the kitchen counter because it's got good light and it's at a good height....it also already blocked 2 escape routes due to the wall and the backsplash) It can be anywhere though...a rug on the floor, a table, a particular spot on the couch...wherever is good for you. Take him there as many times a day as you can and just give his ears a quick rub and then he gets a yummy (low carb) treat. Most cats aren't objecting so much with the poking..it's the fooling with their ears they don't like, but once they're desensitized to it and learn to associate a certain place with the treats, they usually start to come when they're called! Or even when they hear us opening the test kit!

    You also have to remember...you're not poking him to hurt him
    ...you're testing him to keep him safe and understand what's going on inside his body. There's just nothing better than truly understanding what's going on inside your kitty's body and with this disease, the more knowledge you have, the more power you have against it. The edges of the ears have very few pain receptors, so it really doesn't hurt them. Also, if you're nervous and tense, it's going to make your kitty nervous and tense too. As silly as it might seem, try singing! It forces you to use a different part of your brain!

    It's also important to make sure his ear is warm. A small sock filled with a little rice and microwaved or a small pill bottle filled with warm water (check temp against your wrist like you would a baby bottle) works well.

    When you're first starting, it's also important to use a lower gauge lancet, like 25-28 gauge.
    Most of the "lancet devices" come with 33 gauge lancets and they are just too tiny to start with. The bigger lancets (that are lower numbers) make a bigger "hole". As you poke more and more, the ears will grow new capillaries and will be easier and easier to get blood from...we call it "learning to bleed"

    Finding the right "treat" will be a great help too!
    Freeze dried chicken, bonito flakes, little pieces of baked chicken...whatever low carb treat you can find that he really enjoys will help him to associate the testing with the treat! China's Achilles heel was baked chicken, so I'd bake a piece, chop it into bite sized pieces, put some in the refrigerator and freeze the rest to use as needed. It didn't take long for her to come any time I picked up the meter!
     
  26. smidge&smudge

    smidge&smudge Member

    Joined:
    Jan 27, 2017
    Thank you si much, is there a way to see if that is happening? Should I test after a shot? Sorry for so many questions I just want to get hee better.
     
  27. Chris & China

    Chris & China Well-Known Member

    Joined:
    May 10, 2013
    You should always test before the shot....We call it the Pre-shot test....there's an AM Pre-shot (AMPS) and PM Pre-shot (PMPS)....and your cat shouldn't eat for the 2 hours immediately before the PS test.

    That's the only way to know they're high enough for any insulin at all!!

    With Vetsulin, you want to Test, Feed, wait 20-30 minutes and shoot (so there's food on board when the insulin "hits")

    Then if you can get a test at +2 (2 hours after the shot) that can tell you a lot about how active that cycle is going to be....if the +2 is lower than the PS, that's a good indication that she might be going a lot lower later in the cycle and it's important to plan on getting more tests in

    If it's impossible for you to get tests in on the AM cycle, it's even more important to get them on the PM cycle....most cats go lower at night so you should always get a "before bed" test in ....depending on your schedule, if it's possible, a +1 or +2 AND a "before bed" test will help to see what's going on with Smudge

    We have a spreadsheet program that we all use that's very helpful in seeing what's going on. We depend on it quite heavily so I hope you'll get it started. Here are Instructions on getting the FDMB spreadsheet

    You need a Google account to access it (and if you have any problems getting it set up, feel free to send me a private message and I'll be happy to set it up for you!!....just click on my name and choose "start conversation"

    It will also help for you to go ahead and fill out your signature. If you go to the top right and click on your sign on name, there's a drop down menu where you'll choose "Signature".....a new box will pop up for you to put some information in. We like to see Your name/Cats name, age, sex, date of diagnosis, type of insulin, type of meter, type of food, any other health issues?, a general idea of where you live and then when you get it set up, the link to your spreadsheet. (you'll see all this information below our comments)

    It keeps us from having to ask the same questions over and over again.
     
    Elizabeth and Bertie likes this.
  28. smidge&smudge

    smidge&smudge Member

    Joined:
    Jan 27, 2017
    Thank you so much, this is so unbelievably helpful!
     
    Elizabeth and Bertie and JanetNJ like this.
  29. smidge&smudge

    smidge&smudge Member

    Joined:
    Jan 27, 2017
    I
    I am going to work on her profile, thank you, was not sure how that was done ☺. I read your baby's, I am also in Missouri, St. Louis.
     
  30. Chris & China

    Chris & China Well-Known Member

    Joined:
    May 10, 2013
    Nice to have another Missourian in the group!! There are a couple of us from MO here
     
  31. Chris & China

    Chris & China Well-Known Member

    Joined:
    May 10, 2013
    The Profile and the spreadsheet are different....the spreadsheet you need to get using the instructions above.

    If you want to do a profile like China's, you can, but most of us just put the majority of that information into our signatures
     
  32. smidge&smudge

    smidge&smudge Member

    Joined:
    Jan 27, 2017
    Sorry, still a noob, just need an opinion before I update vet today. Yesterday's Pre-shot was hi which is 600+ on my meter. Today I did the 20min after injection and she was 498, does this mean the insulin is at least doing some good?
     
  33. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    That major drop of over 100 points in about 20 minutes is indicative that the dose of insulin is indeed dropping Smudge's BG very fast and substantially. This basically sets the cat up for a lot of bouncing and suggests very strongly that the dose of insulin is too high! Smudge's body will compensate and attempt to raise the BG when the insulin is pushing the BG down that much that quickly. Eventually, Smudge may not be able to compensate adequately and that could cause a hypoglycemic episode. While we all want our kitty's BG numbers down to more normal levels, they cannot be forced and taking the BG down more gradually allows the cat's body to get reacquainted with lower BG levels.

    With a drop that large in such a short period of time, I would suggest you retest now and see where Smudge BG is. If you are unable to continue testing please leave lots of food down for her so she can eat as needed. A drop that fast and that early is worrisome.
     
  34. smidge&smudge

    smidge&smudge Member

    Joined:
    Jan 27, 2017
    Just retested 187!!!! Should I ask about a different insulin?
     
  35. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

    Joined:
    Sep 6, 2010
    Hi Petrina,

    Can I check...

    How many hours ago did you give the shot?
    Did you test before the shot? - And if so what was the number?
    What dose of Vetsulin did you give?
    How long after that did you get the 187?
    .
     
  36. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Ok she is dropping extremely fast and you are going to have to monitor her very closely. How many hours ago did you give her insulin? What dose did you give her? Feed her something with high carbs now to try to slow down the drop in BG. Do you have any food with gravy in it? If so give her a tsp or two of gravy. If not mix a bit of honey or karo into a tsp of food.
    .
     
  37. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    What we know so far

    Pre-shot was HI (600+) No pre-shot reading taken
    +20 min - 498
    ?? - 187
     
    Last edited: Feb 3, 2017
    Reason for edit: correct pre-shot info
  38. Tuxedo Mom

    Tuxedo Mom Well-Known Member

    Joined:
    Dec 2, 2014

    It looks like that preshot reading was from yesterday.

    " Yesterday's Pre-shot was hi which is 600+ on my meter"

    We need to know the preshot reading today as well as how long after the shot the 187 was taken
     
    Diana&Tom likes this.
  39. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Good catch Mary Ann! I didn't notice that. Still a major drop between 498 and 187 in just over an hour!.
     
  40. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    Good spot, Mary Ann. Petrina, to avoid confusion and make it easier for everyone to know how best to help you, do try to get a spreadsheet set up as soon as you can... I know it's one more thing to think about but it will be really helpful. There are people here who will help!
     
    Tuxedo Mom likes this.
  41. Tuxedo Mom

    Tuxedo Mom Well-Known Member

    Joined:
    Dec 2, 2014

    Definitely.

    Also need to know what dose of Vetsulin was given. The dose increases have been large and quick. Really need to have more data either on a spreadsheet or just listed from the last few days at this point
     
    MrWorfMen's Mom likes this.
  42. smidge&smudge

    smidge&smudge Member

    Joined:
    Jan 27, 2017
    I wish I did but I didn't pretest today, the 187 was about an hour and half after shot this morning. She is on 4 units of vetsulin. The 498 was about 20 min after. I'm going to report to vet when they open, should another insulin work better?
     
  43. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    I would say that you need to give this insulin a chance before looking at others... it's the DOSE especially that might need tweaking.
     
  44. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    It's not whether another insulin would work better. It's about dosing appropriately with what you are using. Dose increases by 1 unit at a time and based on vet office readings all too often lead to too much insulin being prescribed. That is why we have been cautioning you. If you find the right dose for Smudge, the Vetsulin may work just fine for Smudge. Giving too much of any insulin is going to lead to problems.
     
    Tuxedo Mom likes this.
  45. Tuxedo Mom

    Tuxedo Mom Well-Known Member

    Joined:
    Dec 2, 2014

    It may be that Smudge is on too high a dose. That is a very big drop in 1 1/2 hours. It would be most useful to get preshots before every shot and a number of tests early in the cycle (time between shots) to see if the dose is dropping the numbers too fast. A fast drop or a drop into low numbers will cause Smudge's body to released stored glucose and that will cause numbers to be high afterwards. In that case giving less insulin would be the correct approach rather than more insulin, but until you have more data it is hard to make that call.

    Can you test again and post the number. Do you have higher carb food, such as gravy types?
     
    MrWorfMen's Mom likes this.
  46. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    Petrina, we're all saying the same thing... it's possible that the dose is too high. Can you discuss this with your vet and ask why the current dose has been prescribed?
     
  47. smidge&smudge

    smidge&smudge Member

    Joined:
    Jan 27, 2017
    I know I don't know what is going on with her, makes sense because she really hasn't been back to normal self after starting the insulin on 1/16. I am going to try and get a spreadsheet going when I get to work since I can't get it going on my phone. And will be calling to vet when they open soon to report. I love her so much, hope I can get her regulated!
     
  48. Tuxedo Mom

    Tuxedo Mom Well-Known Member

    Joined:
    Dec 2, 2014

    If your vet is basing the dose increases on one number taken at the clinic, they do not have enough data to make that call. First a kitty at the vets can have a higher glucose reading from stress...much like the human "white coat syndrome" that causes some people to have elevated blood pressure at their doctors.

    Also if Smudge is "bouncing" from lower numbers or too fast of a drop in glucose levels, the "emergency" glucose the body releases can cause numbers to be quite high for up to several days. If a test was done at this time it would be a wrong decision to increase. That is why consistent home testing shows a much clearer picture of what is actually happening.


    ETA The drop today of at least 300 points in 1 1/2 hours will most probably cause a "bounce" into higher numbers. That is too big of a drop in such a short time.
     
    MrWorfMen's Mom and Diana&Tom like this.
  49. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    We want the best for her too! When you call the vet, ask if the dose was prescribed on the basis of one BG reading, as Mary Ann says above. If they say yes, you may have to be prepared for a discussion about re starting at a lower dose, probably 1u twice a day. Then if you are home testing as well, it will be much easier to see the true picture.
     
    MrWorfMen's Mom likes this.
  50. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Petrina, there is no reason to think you cannot get Smudge regulated but right now you need to understand that Smudge's BG could drop too low today and she needs to be monitored to keep her safe.
     
    Tuxedo Mom likes this.
  51. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

    Joined:
    Sep 6, 2010
    Petrina @smidge&smudge , it's about 40 mins since the 187 test, I think.
    Can you please get another test now and update us with the result?
     
    MrWorfMen's Mom and Tuxedo Mom like this.
  52. Tuxedo Mom

    Tuxedo Mom Well-Known Member

    Joined:
    Dec 2, 2014

    Linda is absolutely correct..you need to make sure Smudge is not dropping too low right now.

    Can you do another test and post the number along with how long it has been since the shot
     
    MrWorfMen's Mom likes this.
  53. Tuxedo Mom

    Tuxedo Mom Well-Known Member

    Joined:
    Dec 2, 2014
    Petrina

    I don't see you online right now, but if you see this post please continue testing Smidge's glucose levels. Vetsulin can continue dropping the glucose levels quickly for 4-6 hours depending on the kitty. With a big drop like you had earlier you need to make sure that Smidge is not dropping too low.
     
  54. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Getting worried. I hope Petrina didn't take off and leave Smudge alone.
    A drop of over 300 points in 1.5 hours is indeed very worrisome! :nailbiting:
     
    Tuxedo Mom likes this.
  55. Tuxedo Mom

    Tuxedo Mom Well-Known Member

    Joined:
    Dec 2, 2014
    She had mentioned doing a spreadsheet when she got to work, so it may be that she has left for work. A bit scary since there is no further tests and it was never said whether there was any HC food given. :nailbiting:
     
    Diana&Tom likes this.
  56. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    Maybe she was going to work or to the vet? Not sure what time of day it would be for her.
    I will back off from this for now as we are all saying much the same and I know what it's like trying to keep track of loads of messages on a phone!
     
    Tuxedo Mom likes this.
  57. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Thanks for chiming in Diana. I think Petrina was putting her faith in her vet and not necessarily trusting us which is understandable but we all know that as much as we'd like to think that is the best MO, it often isn't. I wish there was some way to educate the vets!
     
    Diana&Tom and Tuxedo Mom like this.
  58. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    And if I recall, the kitty has/had a UTI so that could have elevated the BG reading as well... I wonder if the vet took that into account...
     
  59. Tuxedo Mom

    Tuxedo Mom Well-Known Member

    Joined:
    Dec 2, 2014

    You are correct Diana. It looks like she finished the last AB on January 28 PLUS she has switched to wet food...not sure what type. With clearing an infection and a switch to wet food those alone can cause glucose levels to drop.

    Smudge was started on 2 units and in just over 2 weeks is already up to 4 units. Even without seeing a lot of data this is far too high a dose increase in such a short period of time...especially with clearing a UTI at the same time and a food switch. I really don't think the vet has weighed in all the other factors when he made such large dose increases.
     
    Diana&Tom and MrWorfMen's Mom like this.
  60. smidge&smudge

    smidge&smudge Member

    Joined:
    Jan 27, 2017
    Oh no, now so worried, had to take kids to school and stopped into work, just seeing all the messages and feel bad for leaving her. I didn't test her so often because I felt guilty for doing it to her, now I see with her numbers that she probably has been out of control like this for awhile, hopefully I can try to leave work early. I left a message for the vet with her numbers, do you think I should ask for a different insulin? Sorry if I'm a bit out of control today. Believe me I do trust all of you, in my short time with this I do not know what I would do without this board and the wonderful website. Worried!!!
     
  61. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    Petrina, take some deep breaths and read back on today's posts... get them to sink in and make sense... you need to hear what we're saying... we think the insulin dose is too high...
     
  62. Tuxedo Mom

    Tuxedo Mom Well-Known Member

    Joined:
    Dec 2, 2014

    Testing is one of the most important things you can do to keep Smudge safe. It is the only way you can catch too low of a number and takes steps to make sure she doesn't get into a hypo range. Did you leave out any higher carb food before you left?
     
    MrWorfMen's Mom likes this.
  63. smidge&smudge

    smidge&smudge Member

    Joined:
    Jan 27, 2017
    I have been doing wet food, but from reading one of the posts from this morning about eating I was worried if I left out the wet her sister would eat it all, so I left out dishes of the dry food, but it was the royal canin diabetic food, so hopefully that would be okay. Sorry one more question, do you think I should stick with the vetsulin and reduce the dose? Or try another insulin?
     
  64. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    Stick with the insulin but reduce the dose. Take more BG readings,especially before dosing. Don't feel guilty about testing - it shouldn't hurt and you NEED to get this data.
     
  65. Tuxedo Mom

    Tuxedo Mom Well-Known Member

    Joined:
    Dec 2, 2014

    OK if you left out the dry food it is higher in carbs and will hopefully help keep the numbers from dropping too low.

    Vetsulin can work well with some kitties. Right now you really don't know how it is working for Smudge since the dose has been increased too much in some a short time period. Without seeing more data it is hard to suggest what dose you should be using, but as was mentioned before if Smudge is getting over a UTI and is mainly eating a lower carb wet food that can cause the glucose levels to drop. Too high a dose will cause the numbers to drop too fast or too low which will cause a "bounce" and take her back into high numbers again. It might be worthwhile considering going back to perhaps 2 units and doing as much testing as possible. You would NEED to test before each shot and several times early on to see how fast or how low the numbers drop.

    Hopefully some others will offer an opinion on what might be a good dose for right now.


    ETA Smudge's numbers will most likely be quite high for her evening reading because of the big drop she had today. Dosing always takes into consideration how LOW the dose is taking your kitty and not just how high the preshot number is.
     
    MrWorfMen's Mom and Diana&Tom like this.
  66. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    The normal starting dose for Vetsulin would be 1 unit twice a day which should be safe whilst the caregiver is getting the hang of testing and collecting regular data. Even with that "small" dose, Vetsulin can work fast and produce a steep drop. After a couple of weeks the data can be used to tell whether an increase is called for, maybe 1u or 0.5u.

    It really is worth going back to the start in this situation but the sticking point looks like the vet... ideally he/she should be on board with this too.
     
    MrWorfMen's Mom and Tuxedo Mom like this.
  67. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    I agree with Diana. I'd take Smudge down to 1u and numbers permitting, hold it for 3 days or so to ensure any bouncing from today has stopped. Then the dose can be gradually increased if necessary ideally by 0.25u but by no more than 0.5u and held again, numbers permitting. If you get any low numbers pre-shot or mid cycle with the 1u dose, then a decrease of dose might be in order. The only way to see if the dose is adequate, too low or too high is to consistently get pre-shot tests and get some mid cycle tests in whenever possible. With Vetsulin, the drop in numbers is generally most pronounced during the early part of the cycle so testing during the first 6 hours post shot will give you the most telling data.
    Do not give insulin if Smudge's BG is 200 or less until you have a lot more data.

    While it would be nice to have the vet on board, what you do at home is up to you and with that drop today, I'd dose on the conservative side even if the vet is not on board.
     
    Tuxedo Mom and Diana&Tom like this.
  68. smidge&smudge

    smidge&smudge Member

    Joined:
    Jan 27, 2017
    Thank you for all the information, I am going to present this once the vet calls me back, at initial diagnosis she was at 599 and was started on 2 units 2xday, would I slowly go down by 1/2? Will update once vet calls me back, I am going to test once I get home, she does pretty well with the ear stick it's the whole holding her down and trying to rub on her ear she gets irritated. I have had her since a kitten so she is my baby and I want to take care of her and hopefully nurse her back to health. Thank you once again, you are wonderful people.
     
  69. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Petrina, please keep us posted. You probably noticed we kind of "adopt" each other's kitties around here! :D
     
    Diana&Tom and Tuxedo Mom like this.
  70. Tuxedo Mom

    Tuxedo Mom Well-Known Member

    Joined:
    Dec 2, 2014
    Petrina when talking to your vet keep in mind what has been mentioned already:

    1. Some kitties read higher at the vets because of stress

    2. Smudge had a UTI which now (hopefully) is cleared up. Infections can cause glucose levels to run much higher

    3. You are feeding Smudge a wet food diet...mainly...rather than dry food. Feeding lower carb food can drop glucose numbers quite dramatically with some kitties.

    4. A test done at the vets when Smudge is "bouncing" does not give an accurate picture of what the glucose levels are doing within each cycle (time between shots). Only regular home testing can give the correct information on how Smudge is responding to the insulin and the dose.

    Last but not least, try to relax and ask LOTS of questions. Everyone here cares so much for each and every kitty on this forum and will do their best to make Smudge and your journey as easy as possible.

    :bighug: :bighug:
     
    Diana&Tom and MrWorfMen's Mom like this.
  71. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    That is precisely what is causing the problem Petrina. The 599 could be a very elevated number (by 100 points or even more) because it was taken at the vet's office. You appear to be getting similar numbers at home now because Smudge is bouncing. In all likelihood, her pre-shot numbers are going to come down when you decrease the dose but it may take a couple of days to see that happen. Treating diabetes is a marathon not a sprint and unlike a pain killer, you can't throw a bigger dose at it and expect to see the BG instantly drop. Dosing has to be done slowly and methodically so kitty gets used to being at more normal BG levels again.

    Our advice is drop right back to 1u. Trying to slowly take the dose back is far more difficult and will still leave you scratching your head about what to do because she may continue to bounce.
     
    Tuxedo Mom and Diana&Tom like this.
  72. smidge&smudge

    smidge&smudge Member

    Joined:
    Jan 27, 2017
    Will update once the vet calls back and will retest when I get home. She is such as sweet girl and it breaks my heart, she has a sister, Smidge, who has hyperthyroidism, and that's what I thought Smudge had since it presented as the same symptom, but no....diabetes. I am more than happy to be adopted by you all, I am a mess :)
     
    MrWorfMen's Mom and Diana&Tom like this.
  73. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    Petrina, if it's any consolation, ALL of us were upset and confused at the start of a feline diabetes diagnosis... it's not the easiest thing in the world to get your head round as a newbie... but if you relax and are willing to spend time learning the theory, you really will be well placed to manage things. This message board has talked countless numbers of people through the initial stages of treatment, continuing on with all sorts of questions as they come up from day to day....you are one of us now and we will look out for your posts and help you as much as we possibly can. This is a worldwide board so there is usually someone around at most times of day.

    So remember - try to take on board what we've said about the need to start on a low dose of insulin... don't let the vet fob you off with a lot of waffle as to why the dose was prescribed because it is almost certainly too high. If necessary ask for a second opinion. The fact is that most vets do NOT have a huge amount of training in FD so it is up to us as caregivers to educate ourselves and work out the best plan for our kitties. Some vets are great - maybe once you've had a good chat with yours you can work together, and with us here, to get this under control.

    Sending you hugs! You can do this!
     
    Tuxedo Mom and MrWorfMen's Mom like this.
  74. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    I couldn't agree with Diana more. You can do this! It's not rocket science but there is a steep learning curve that we can help you navigate.

    Your vet probably doesn't have many diabetic cats in their practice and probably hasn't treated that many during their career. This board is nothing but feline diabetes with a smattering of other kitty ailments thrown in just because everyone here is so involved in their cat's care. This community has helped thousands of diabetic cats and their caregivers and the amount of knowledge amassed here is more than any vet is ever going to know. While this community is made up of lay people, it's also a peer reviewed board which means you get a consensus of opinion rather than a singular view of what is happening with and what you should do to help your cat. The final decision about what you do is always yours and yours alone and should be with your vet too because you know your cat better than anyone else and you are the one who holds the needle.
     
  75. smidge&smudge

    smidge&smudge Member

    Joined:
    Jan 27, 2017
    Basically in tears, they want me to up her dose to 4 1/2 units and do a curve on Sunday with every two hours blood test on the 4 1/2. I asked a million questions and they thought it is too soon to change insulins, and I asked about her getting too much, etc.
     
  76. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    Oh dear... what did they say when you asked if the dose was too high? Did they give a reason?
    I'm so sorry you have this dilemma... it is not easy to argue with the vets, but all our experience here suggests that 4.5u is not going to help matters. Let's see what others say about how you can handle this.
    Tagging @Elizabeth and Bertie who always has a good take on thes things.
     
  77. smidge&smudge

    smidge&smudge Member

    Joined:
    Jan 27, 2017
    I asked about the drop and they said that is what the insulin is supposed to do. I asked about the dose and she just said that is what she needs, and that it is still early on with the diagnosis and it takes awhile to get regulated, she has an appointment on Monday.
     
  78. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Petrina, it is obvious you are dealing with a vet who is not willing to listen to what you are telling her and she doesn't have a good handle on the finer nuances of diabetes. :mad::banghead::arghh: It's not her fault an doesn't make her a bad vet but it's not fair to you to not be heard either. You HAVE to be comfortable with the treatment plan. Vets often let their egos get in the way of their advice and I am seriously afraid that is what is happening here if she was not willing to reconsider given the info you passed on to her.

    My opinion is that the drop Smudge had in BG today is only going to get worse if you up the dose to 4.5u which is likely to seriously endanger Smudge's life. You hold the needle and have to decide what you are going to do. If she were my cat, I would NOT even consider increasing the dose despite the vet's advice.

    Again what you do at home is entirely up to you. Something to think about......your vet is not going to be there with you if Smudge gets into trouble and she obviously isn't going to call you back immediately to help either! You are going to be the one dealing with the consequences of what the vet is recommending.

    Take a deep breath and do what you feel is the right thing for you and Smudge. This is not about the vet's ego. It's about you and Smudge.
     
    Diana&Tom likes this.
  79. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    That's a very basic explanation of what insulin does. Yes, she does need to drop but not that steeply, and 4u was already a BIG dose... trust us... hoping that others will add their opinions here so we can work out what to do...
     
  80. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Well dah! Obviously that is what insulin is supposed to do but it's not supposed to send Smudge nose diving off a cliff toward unsafe numbers either. That drop today was monumental and far too swift to be safe. Upping the dose is going to make the roller coaster steeper and steeper until Smudge has no reserve and can't get her BG back to safe numbers. The only way to figure out how much insulin Smudge needs is to do slow methodical increases starting at a REASONABLE starting dose which in your case was not done.
     
    Diana&Tom likes this.
  81. Tuxedo Mom

    Tuxedo Mom Well-Known Member

    Joined:
    Dec 2, 2014
    I have to disagree with the vet. As you saw today the current dose dropped Smudge's numbers A LOT. They may even have gone further down, but without more tests you don't know just how low she may have gone. If a kitty gets too low they can have a hypo episode which is a medical emergency and is also very costly to treat. Your vet does not seem to understand how insulin is used for feline diabetes. If you continue increasing the dose Smudge could end up in danger of a hypo. Here is some information on hypos:

    http://www.felinediabetes.com/FDMB/threads/how-to-treat-hypos-they-can-kill-print-this-out.15887/

    Until you are doing a lot more home testing and getting lots of data the safest approach would be to go back down to 1 unit and track how that works, It is easy to increase a dose if it is not doing what it should.
     
    MrWorfMen's Mom and Diana&Tom like this.
  82. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    Absolutely. Start low, go slow is what we say here because we want our kitties to be SAFE. Vets seem to have an altogether different rule book.
     
  83. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    Petrina, are there any other vets in your area who you could call and ask if they have experience dealing with FD? Quite often people have to switch vets to one who really understands this disease.
     
  84. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    There are others on FDMB who would have killed the kitty if they'd listened to the vet's advice. There are also members who decided to do their own managing of kitty's FD with our help after the kitty had to be treated in the ER for a hypo. Please don't think we're pressuring you ... we're trying to help you avert a disaster.
     
    Diana&Tom and MrWorfMen's Mom like this.
  85. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Petrina, it's clear your vet doesn't have a clue what she is doing. You can't regulate a cat overnight no matter how much insulin you give them. She seems to think insulin is like a pain killer.....if one aspirin doesn't help, take two next time. Problem is you can't keep taking more and more aspirins or eventually the aspirin will make you sicker not better. That is what is happening here. The high dose of insulin is causing the high readings.

    You need to ask yourself what you and Smudge have to lose by trying the lower dose for a few days. Your vet doesn't need to know you are doing it. Are you afraid the vet will get upset with you or are you afraid the lower dose is going to hurt Smudge?

    If you lower the dose starting tonight and through the weekend, by Monday it should be clear whether the lower dose is working better or not and you'll know whether to trust the vet or not. If our theory that the current dose is too high is correct, you will have your proof for the vet.

    If you follow the vet's advice and Smudge goes too low overnight or over the weekend, you are going to have to deal with the consequences should they occur (and I personally think they are VERY likely to occur) and those consequences could lead to a major vet bill for emergency treatment or worse, be fatal, if not caught on time.

    I understand you wanting to believe/trust the vet but please don't let blind faith because she has a few letters behind her name make you trust her implicitly. She is after all just another imperfect human being.
     
  86. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    Basically, Petrina, it is ALWAYS better to be safe than sorry... if you follow our advice and dose conservatively you are keeping Smudge as safe as possible right now... one day at a time...
     
  87. smidge&smudge

    smidge&smudge Member

    Joined:
    Jan 27, 2017
    Should I drop her down to 3 1/2 and still do the curve?
     
  88. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    We were suggesting starting over, so 1 unit... 3.5 may still be too high.
     
    MrWorfMen's Mom likes this.
  89. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    If you go down to 1 u starting at her next dose (this evening) you might well have evidence one way or the other by tomorrow's PMPS. If you feel you need to explain to your vet why you didn't go up to 4.5 u, say you were afraid of a hypo. She might disagree but she can't argue about your feelings.
     
  90. Tuxedo Mom

    Tuxedo Mom Well-Known Member

    Joined:
    Dec 2, 2014
    Petrina

    A number of experienced people have suggested using 1 unit as a dose right now. If you can do some testing over the weekend you will see very quickly if 1 unit is a good dose or whether it may need to be a bit higher. When using insulins like Vetsulin which act fairly fast and sometimes quite "hard" you don't want to risk having the numbers drop too fast or worse too low. which could lead to a hypo episode, which is serious at the least. The idea of continuing to raise a dose based on a few tests at the vets office is certainly not the correct way to determine the right dosing. With Vetsulin you need to test before the shot and then again at +2 and +4 hours after the shot to see how it is working. Once you have more data the proper, safe dosing can be determined
     
  91. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    Yes - you could say you've been reading a lot about the danger of too much insulin and you were too scared to increase the dose. We DO understand that it's hard to contradict what the vet says but in this instance it is important to err on the side of caution... please read what Mary Ann has said above.
     
  92. Tuxedo Mom

    Tuxedo Mom Well-Known Member

    Joined:
    Dec 2, 2014
    Petrina

    How much does Smudge weigh?
     
  93. smidge&smudge

    smidge&smudge Member

    Joined:
    Jan 27, 2017
    Is it okay to take her down to 1 unit starting tonight? Oh and she is 11 pounds, which is down a couple of pounds from before she got sick.
     
    Diana&Tom likes this.
  94. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Absolutely Ok and a good choice to take her down to 1u tonight!
     
    Diana&Tom likes this.
  95. Tuxedo Mom

    Tuxedo Mom Well-Known Member

    Joined:
    Dec 2, 2014
    Thank you for the weight information. Smudge is not an overly large kitty at 11 lbs.

    You could drop the dose down to one unit for tonight and do some extra tests after shooting. Ideally you would test before the shot, then feed and give the shot about 20-30 minutes later. Then at +2 hours after shot do another reading. "Usually" vetsulin will start acting around +1 or +2 hours after the shot.. although that can vary with each kitty. Then do another test at +4 hours after the shot. "Usually" the peak effect of vetsulin is around +4-+6 hours after shot. This will show how much 1 unit is bringing the numbers down. If you are home this weekend it is the perfect time to do some extra tests and get some good data.
     
    Last edited: Feb 3, 2017
    MrWorfMen's Mom and Diana&Tom like this.
  96. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    Yes - test her BG first and let us know... it is likely she will still be quite high but it's always good to have a BG number before shooting any dose of insulin. If you can then test her two hours after the shot, that would be great - again let us know if you can so we can keep an eye.
     
    MrWorfMen's Mom and Tuxedo Mom like this.
  97. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    I'm SO relieved that you'll try this! :) We worry about all kitties here, not just our own.
     
  98. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    You're getting there, Petrina! Give the 1u a go and we can see what happens to Smudge's BGs and go from there.
    Try to relax and look after yourself - have some chocolate or a glass of wine and sit back and have a breather...
     
    Kris & Teasel and Tuxedo Mom like this.
  99. smidge&smudge

    smidge&smudge Member

    Joined:
    Jan 27, 2017
    Like the wine idea!
     
    Kris & Teasel likes this.
  100. Tuxedo Mom

    Tuxedo Mom Well-Known Member

    Joined:
    Dec 2, 2014

    There are two things that every petparent with a diabetic kitty needs. One is a pre=prepared hypo kit (just in case)

    http://www.felinediabetes.com/FDMB/threads/jojo-and-bunnys-hypo-tool-box.2354/

    And the other is a nice caregiver kit, complete with fancy chocolates and some nice wine or other spirits. ;) ;)

    So do make sure you have both kits stocked and on hand :D
     
Thread Status:
Not open for further replies.

Share This Page