When to increase dose and how

I'll start by saying I don't plan to change anything without consulting with the vet first. I'm just wondering how you know when a dose increase is needed. I've only had Peanut on insulin for 3 days so I'm new to everything. I've been reading here a lot.

Peanut started at 2 units given by his vet on Sunday morning. He did so well that morning! The vet has me only giving him 1 unit every 12 hours though. He's still chugging water and missed the litterbox a little bit.

Am I supposed to keep him at 1 unit for at least a week? I worry about him. I know he still feels sick. I think he's dehydrated still.

 

Hi Kait and Peanut! And welcome!!!

Yes, you should stay at one unit for about a week, especially since your curve shows a 50% drop from the pre-shot number to the nadir (lowest point in the cycle). That's a pretty good insulin response for starting out.

It looks like Peanut dropped early in the cycle, and then surfed along for a few hours before starting to rise. If you can, try to get a test during the cycle (not as many as the vet did, just one or two), so you can see how he is responding at home. Sometimes they go lower at home because they are more relaxed.

It takes a little time to heal and get regulated. Remember that he didn't become diabetic overnight, so he won't get better overnight either. But he will get better. Before you know it, he'll be eating, drinking and peeing in normal amounts and starting to feel better.

What are you feeding, how much, and when? I noticed the comment on your spreadsheet about the vomiting. Sometimes the timing and quantity of food can help with that.

And in answer to your main question, you know a dose increase/decrease is needed based on the mid-cycle numbers. You watch the nadir and if it's too high you increase the dose, if it's too low you decrease the dose.

 

He has 2 vets. One says he is clearly diabetic. The other says he isn't. From my testing, I believe he is.

He has had 2 Fructosamine tests that have both been normal. Now I'm being told by the vet who says he isn't diabetic that he isn't responding well to the insulin. I think he is responding great. They are saying his symptoms don't match diabetes (excessive thirst and urination, peeing accidents, lethargy) and that he might be insulin resistance. I don't know how they came to this conclusion after 3 days of insulin with seemingly good response.

I am the most confused pet mom ever. I will test a few times today. I'm trying to get him used to the ear pricks. He eats a full 6oz can of tiki cat food at 9am and another at 9pm. He's used to get more smaller meals throughout the day. I think the change is hard for him.

 

I had a hunch that is what was going on. Please feed him the smaller meals he's used to. Feeding two meals a day is pretty old school thinking, and is not what the current research recommends. Just like in humans with diabetes, (or really any human), feeding scattered smaller meals keeps their blood glucose steadier during the day.

As far as the warring vets...most vets, because they need to know a lot about different conditions in different animals, really aren't experts in feline diabetes. The numbers on your spreadsheet do indicate that Peanut is diabetic. But they also indicate (at least for that one cycle) that he's responding to the insulin. As you gather more data at home, that will become clearer.

If Peanut is struggling with the testing, it's okay not to over-test, especially at first. Test before each shot, and try for one test during the cycle. Based on the curve, I would aim for somewhere around +4, but whatever your schedule allows will be fine.

Also make sure you give him a low-carb treat after each poke so he starts to associate the pokes with something he loves.

And please keep asking any questions you have. We have all been at this dance for a long time and we are here to help.

 

I'm still confused about the testing. The vet who believes Peanut isn't diabetic is relying on the Fructosamine results. I think the most recent one was 317. She says it's normal. I believe they are looking for zebras and missing horses. It's costing me a fortune for her to chase these zebra, and I really don't have it to spend but I desperately want to get Peanut feeling better.

The other vet just flat out said Peanut is clearly diabetic and urgently needed to start insulin.

I'm doing my best, but I've spent at least a month worried that he's dying and it's taking a toll on my emotions to hear that he's diabetic but also not diabetic.

On a brighter note, he learned how to eat bonito flakes today after his tests. Up until now he thought I was trying to feed him paper.

 

Fructosamine tests measure the average of blood glucose over time. They are a good screening tool, but not as helpful as regular testing in determining insulin therapy. A normal healthy, non-diabetic cat measured on a human meter will usually be between 50-120 with most of the numbers under 100.

There is no need to keep paying the vet to run a test that isn't particularly helpful. I love your zebra/horse analogy! That's perfect.

And seriously cracking up about the bonito flakes! It does take them a little while to learn that healthy food is really food!

 

Huh...I don't blame you for being confused! I would be too...for what it's worth, I never did a fructosamine. I just did home testing, like you are. The numbers you're getting show that Peanut is definitely diabetic and that the insulin IS doing something. I'm not sure why your first vet doesn't see that. Vets aren't usually well versed in feline diabetics, but that's pretty crazy still.

If I was you, I'd stick with the home testing. Did your second vet say anything about testing at home? Some vets are super open to it, but not a lot of them...but if he is open to it, he might be more willing to work with you on things. We'd be happy to help out as much as we can and give what advice we have on dosing.

I love the zebra/horse analogy too! And I think you've got it right...

 

I'm glad to see fructosamine isn't the deciding test.

I'm thinking the first vet is now just trying to cover the fact that they missed diabetes even though I told them I think he's diabetic. I literally handed them the diagnosis and they still messed it up, so now they cover the mistake. That's my impression. It's either that or they know I'm desperate to help him and they just want to add tests to get money.

The second vet thinks I'm off my rocker. I showed up with a binder full of the food chart from this site with color-coded sticky notes poking out. He was pushing prescription food until I made him look at the chart. Now he leaves me alone about the tiki cat food. I told him I'm testing at home. I don't think he was surprised after seeing the binder. He wasn't judgemental and he's been having me update him on Peanut's results. I was going to home test whether he liked it or not, so I'm glad he didn't argue. I wonder what he'll think of the spreadsheet when he sees that!

 

Sounds like you can drop the first vet and just go with the second vet. The first vet sounds either unethical or incompetent, and I'm guessing you have better things to do with your time and money than mess with that nonsense.

My vet thinks I'm a little nutty too, but he loves looking at the spreadsheet whenever I go in.

How is your weekend looking? Will you be around during the day(s)? I'm thinking Peanut will be ready for an increase this weekend, and since this will be the first one, it would be good if you are around to keep an eye on things.

Also, when is your PM shot time in relation to your bedtime? How many hours between the injection and sleep? Do you work during the week, or are you usually able to test during the day? Sorry to ask so many personal questions, just trying to get a sense of the best way manage dose changes for you.

 

The first vet is done. I'm not having it. They called me, but I just can't even handle that nonsense right now. I'm sure they will have some other diagnosis and many tests they want to do. Nope.

The second vet is so good! He had me call yesterday with results and again today. Peanut has earned a dose increase. He will now be on 1.5 units twice a day starting tonight. I'm happy because he even uses half units. I think that will make Peanut feel better. I feel great about this vet and I love that he keeps having me call with updates even though I feel like a pest.

I am home most of the time unless I need to run errands or appointments. I'm trying to schedule everything around his medicine now. I go to bed usually 2 or 3 hours after his pm dose. I have cleared my weekend schedule so I can stay home with him except for a quick grocery trip.

 

We usually recommend increases of 0.25u at a time, unless the nadir is over 200, and then you can increase by 0.5u. The reason for the small increases is that increasing a large amount all at once can cause their numbers to bounce up and down which can both feel lousy for the cat, and also make it take longer to see if the dose is good or not.

Peanut did have a nadir in the blues the other day, so I'm a little torn, but mostly I think the 0.5u increase will be okay, as long as you are comfortable getting tests in during the cycle in case he starts to drop quickly.

If you are going to do the increase tonight, do make sure to set an alarm to get up and test and make sure he's okay. Cats often run a bit lower at night, so you'll want to keep an eye on him given that this is his first increase.

 

I just gave him his 1.5 units. He was at 326 for a pmps. I don't think I'd be able to eyeball 1.25 units I had to try really hard to do 1.5 units. I hope I did it right.

I think the blue was from the 2 units the vet had him start with. I rented some movies and I'll be staying up with him to watch them and keep an eye on him. I can probably get a +2 and a +4.

 

It looks like he dropped nearly 100 points in two hours. That is pretty steep. Definitely get that +4.

 

Looks like he slowed his drop some...that's good. Interested to see where he is at AMPS.

You can get syringes with half unit markings on them. You might look into that for next time you need to buy syringes. There are also u100s that you can use to dose more specifically with a conversion chart we have. Let us know if you want to do that and we can help!

For now, you might want to draw up some colored water in an extra syringe and use that to compare every time you do a shot. That way, even if it isn't exactly the right amount, it's the same amount each time which is most important.

 

He's doing so good this morning. I'm exhausted. I will have his AMPS soon. He's been cuddling, purring, and freaking out about the bird noises outside. I feel like I'm getting my baby son back!