Wits end again

Discussion in 'Caninsulin / Vetsulin and N / NPH' started by CassAndGordy, Dec 13, 2016.

  1. CassAndGordy

    CassAndGordy Well-Known Member

    Joined:
    Sep 23, 2016
    It seems like nothing I do gets Gordys preshots out of the reds! He is having a nice stable drop during his cycle, but maybe he keeps going to low?

    I was doing a lot of furshots before, but now I have that under control.

    I tried my new vets idea and it made no difference either.

    Now Gordy is back to drinking and peeing a lot, almost like he is getting no treatment at all.

    I am going to insist on trying a new insulin.
     
  2. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    I understand your frustration! Trying a new insulin might help and it would be wise to start off at a low dose of 1 unit twice a day. Gordy seems to run lower at night like many kitties and that can lead to higher bounce numbers in the AM. His PMPSs are high too so it's possible the Vetsulin isn't lasting as long as another insulin might. Gordy might also be in that group of kitties who are more erratic in their responses to insulin. A different insulin might help but he might still show those tendencies. You won't know until you try. There are no quick fixes for this disease and cultivating patience is what will keep you sane.
     
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  3. CassAndGordy

    CassAndGordy Well-Known Member

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    Sep 23, 2016
    I am just getting paranoid that he is getting a resistance to it already. He was having better numbers at the lower dose. I'm going back to the lower dose for a bit to see if it helps.... At this point, it probably won't hurt.

    I sat around for 4 hours last night waiting for him to go to the bathroom so I could get urine for the new vet. No luck. Once I get some, I'll check for ketones too.
     
  4. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    You can certainly try a lower dose for a few cycles to see if it helps.

    No need to feel paranoid. Yes, resistance can build if they stay in high numbers. However, it's generally reversible by slowly raising the dose until you reach a "breakthrough" dose that knocks the BG down effectively. You'll then be in a situation where the increased insulin sensitivity will need a series of dose decreases. This can be a bit of a tricky time but it can be done. This is an issue that can come and go over time for cats that are more erratic in their response to insulin.

    It's disheartening when you can't seem to get a handle on a good dose soon after diagnosis, give that dose consistently and kitty is regulated. There are a few cats like that but many are on a long continuum all the way up to nearly impossible to regulate. My guy is at that end. "Marathon, not a sprint" as they say...
     
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  5. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Feb 18, 2015
    I agree a lower dose trial would be the way to go. It looks to me like somewhere between 1.5u and 2u gives you better cycles than higher doses. Are you using syringes with half unit markings such that you can draw up 0.25 dose increments by eyeballing them? (Looks like you gave 2.25u the evening of Nov 24th).The trick is to try to find a dose that doesn't take him too low mid cycle but also keeps his pre-shot numbers down as much as possible. While some cats can be controlled with scaled dosing, in the early days it makes it hard to tell what that scale should look like so consistency may help you figure out just what Gordy's insulin needs are. I'd suggest you drop back to 1.5u and give that consistently for a few cycles (3 days barring any low nadirs or pre-shot readings) to see how he does and then re-evaluate and raise doses by 0.25u if possible. He may be bouncing one cycle to another given all the different doses and the insulin not lasting long enough through the cycle but with all the dose changes, it's hard to tell how any given dose is really working for him.

    I too have a hard to regulate cat who also has a high dose condition and I completely understand the frustration and even paranoia. You are doing a great job looking after Gordy and you'll get this sorted out but patience is key and sometimes it takes a lot of it. :bighug:
     
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  6. CassAndGordy

    CassAndGordy Well-Known Member

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    Sep 23, 2016
    I have ones that have full markings so I can easily eyeball the 0.50 ones, but not the 0.25. I have to look into the laws here and see if I need a prescription for the u100 needs (NH has a big heroine issue, so I am thinking yes.)

    That's what I was thinking. I was going to do just a straight 2u for a few days. That way I know I am definitely giving him the same amount.

    Thank you!


    I am hoping I can easily convince my new vet to switch the insulins. To be honest, being able to give him his shot while he is eating would help me (and him!!!) tremendously. There are days where I literally have a 10 minutes window to do everything before having to go back to work. (30 minute breaks are a *****).
     
    Last edited: Dec 13, 2016
    Reason for edit: spelling
  7. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Feb 18, 2015
    I just checked and it looks like you can get them OTC but the info may be out of date. I'd call the local pharmacy and ask.

    It's entirely up to you how far back you want to drop the dose. Your comfort zone is a very important component here. My rationale for suggesting 1.5u was simply because sometimes it's easier to bump doses up bit by bit rather than trying to figure how much to drop them back if the dose is too high.

    I hear you on that one. The wait between food and shot does add to the time required and is inconvenient when on a tight schedule.
     
  8. CassAndGordy

    CassAndGordy Well-Known Member

    Joined:
    Sep 23, 2016
    I called my vet office and mine isn't in today. So I left a message and told the receptionist that I really want to talk about switching insulins.

    Vetsulin is working, just not working well.

    I'll hold off on the needle change for now. May change them anyway if I go to Lantus or another u100 insulin.

    I guess in the meantime I'll keep chugging along.

    I just feel bad for my little man. :(
     
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  9. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Feb 18, 2015
    Cassie, You are doing a great job looking after Gordy and you are trying your best. You will get things worked out and we can help you do that. Sometimes the road is a little bumpy but things will improve. Keep your chin up. Gordy is in good hands and he knows it! :bighug:
     
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  10. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    Yes, NH requires a prescription for insulin syringes. I had my vet fax the order to the Wal-mart in Seabrook NH and it was easy to pick up. It took a bit of talking to the pharmacy staff to get them to realize that yes they did carry Relion syringes in U100, 3/10 cc with 1/2 unit markings on them.
     
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  11. CassAndGordy

    CassAndGordy Well-Known Member

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    Sep 23, 2016
    Thanks for the info! Yeah, we our current drug situation, I would be surprised if you can buy any syringes without a prescription. Ill see what my vet says (and what Gordy does).

    He was at 504 for his pmps :(
     
  12. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Feb 18, 2015
    Cassie if the dose is too high, which it appears it might be, then Gordy is likely bouncing. Don't worry about the PMPS being a bit higher. While those pre-shot readings certainly play a role in determining dosing, the most important number is the nadir (lowest point in each cycle) because we try to find the dose that will take the numbers down to better safe levels and keep them there as long as possible based on that reading in concert with the pre-shot tests. A high pre-shot may not look good to you but if the rest of the cycle is good, that pre-shot number is really just a guide as to whether it's safe to give insulin and sometimes how much to give.:)
     
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  13. CassAndGordy

    CassAndGordy Well-Known Member

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    Sep 23, 2016
    I AM SWITCHING TO LANTUSSSSSS.

    So I guess Ill be spending time tomorrow reading up on it :)
     
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  14. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Feb 18, 2015
    Great news Cassie! You obviously made a convincing case. :D There are stickies over on the Lantus Board with all sorts of great information and there is a large group of users there who will be able to help you as you transition. You can post there and ask any questions you might have about making the transition and they will take very good care of you and Gordy.
     
  15. CassAndGordy

    CassAndGordy Well-Known Member

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    Sep 23, 2016
    Thank you!!!

    I didn't really have to plead. She called and left a VM saying she agrees that a change may help.

    So I called her immediately back and huddled in the corner at work to talk LOL. She was using the official name (starts with a 'G' but I am blanking... she confirmed its the same as Lantus). There is a local pharmacy that sells one small vial, instead of having to buy 3. So hopefully it wont hurt too much HA.

    But hey, if it helps Gord even out, I'll suck it up.
     
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  16. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Feb 18, 2015
    Glargine is what you are trying to recall. Sounds like your vet is a keeper! One small vial is a pen refill vial which contain 3ml or 300 units of Lantus. Shouldn't set you back too much but it may be more than a vial of Vetsulin . I'm in Canada so I'm just guessing here as I know your insulin is far more expensive than ours. Going forward, you can order insulin from Canada at a considerable saving. Many US users get their insulin from here.

    One thing I think we often forget to tell folks who switch is that you do not have to inject air into the tiny Lantus vial. The small vial mechanism is not vacuum based like the Vetsulin. You simply put the needle in and draw up your dose.

    Good luck with the change! I'll pop over to the Lantus board to see how you are getting on soon. :)
     
  17. CassAndGordy

    CassAndGordy Well-Known Member

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    Sep 23, 2016
    She is! She is a cat whisper LOL. And others in the office have experience with FD too! She told me on the phone that one of the other vets just went to a conference at Tufts and learned that the Lantus can last up to 6 months (which we all here generally know). But it's good to know that the office itself is getting themselves educated :)

    I was just reading this in the stickies... I know Lantus doesn't get shook (like Vetsulin), but we roll it, correct?

    Thank you!!!!! :bighug:
     
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  18. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Feb 18, 2015
    Nope! No rolling either. Just insert needle and draw. Like the other insulins though, any change in it's appearance is a sign it needs replacing.

    Refreshing to hear of a vet clinic that takes the time to get updated information. So many vets seem to still be back in the dark ages when it comes to feline diabetes. I lucked out finding my vet too. Had horrible experiences with a couple of vets when the vet I had used for over 35 years passed on. Took a bit of searching but I finally found my "keeper". :D
     
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  19. JanetNJ

    JanetNJ Well-Known Member

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    Jun 8, 2016
    I see you are switching to lantus. I hope it works for you. Looking at your ss I would have recommended going up 0.5 units as you aren't even getting him below 200.
     
  20. Deena Traina

    Deena Traina Member

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    Dec 6, 2016
    Hi there,
    I'm new to this site and was reading the thread above. My kitty was diagnosed about 3 weeks ago and is on Vetsulin. His original curve showed that he dropped throughout the day with his lowest reading being that last one of the day. Example, 568-497-433-397-284. A member on this site suggested that his starting dose (2units) was probably to high considering the numbers dropped throughout the day.
    My kitty had been on the 2units for about 10days. I really didn't see any decrease in his water consumpition, and he still had heavy urination, grumpy/not playful. She suggested I drop the dose to 1.5. I did that for about 3 days then second guessed everything and went up to 1.75units. He has been on 1.75 for the past 4 days now. Still lots of drinking, peeing.
    I read above something about a cats numbers "bouncing." Could someone please explain what that means?
    Also, im not sure what dose I should be giving him? Im JUST getting the home testing thing down but his numbers never seem to go lower than mid-400's. I've read that he can get LOWER numbers if I actually drop the dosage? Is this correct? Wouldn't it make more sense to increase the dosage if his numbers aren't going down? Just trying to figure this out but am wondering how long I need to be on a "new" dose before the numbers may start to stabilize.

    Any suggestions would help. He's 10.9lbs. Thank you!
     
  21. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    Bouncing is a non-scientific term we use here to describe the phenomenon of a kitty overreacting to situations such as:
    1. BG dropping too low during the cycle
    2. BG falling to lower levels than kitty's system is accustomed to even if those BGs aren't that low;
    3. a more rapid than usual drop in BG even if the BGs are still fairly high.
    The kitty's body interprets these situations as a BG emergency and through a complex set of processes involving the liver, etc. converts glycogen ("stored glucose") into glucose and dumps it into the bloodstream to raise BG in order to compensate. The problem is that it's often an overcompensation - a bounce. BGs will go higher than expected and if the too high insulin dose continues, BGs will stay stuck up there. That's what fools you into thinking the dose is too low.

    If high BG is the result of bouncing then a lowered dose will cause lowering of BG. That's why we use the protocol here of testing before AM and PM shots as well as at least one other time in a cycle and also why we recommend starting at a low dose (usually 1 unit twice a day) and raising it slowly by 0.25 unit at a time so you don't jump right up past the good dose. Vets often prescribe too high a dose to start - eg. 2 units twice a day - and you might already be well past kitty's good dose.

    As far as numbers stabilizing goes, that takes time. Achieving regulation where a dose keeps BGs in a good range most of the day every day takes time. There's a lot of trial and error involved and, as we always remind people, it's a marathon, not a sprint. Patience is essential.
     
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  22. JanetNJ

    JanetNJ Well-Known Member

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    Jun 8, 2016
    If the lower dose didn't help then you may be right that a higher dose will be needed. Without all your readings to see in hesitant to give specific dosing advice. Could you set up a spreadsheet and add info to a signature? (Like you see beneath most of our posts. Just click on your name at the top and go to signature. Add in info like type of insulin, date of diagnosis, and food being fed. I love that you are home testing already!!! Well done!
     
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  23. Deena Traina

    Deena Traina Member

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    Dec 6, 2016
    Okay this is very helpful, thankyou. I feel like everyone on this site is more informed that my veterinarian. I haven't even spoken to him that I have lowered Malby's dose. I went back last night and looked at my dosing chart. He was on the 2units for 9 days, then I dropped him to 1.5units for 4days, then I second guessed if I should be messing with his prescribed dose and started doing 1.75 which he has now been on for only 2 days.
    How long does it usually take before the new dose has a chance to "settle in?" For example, if you recommend I drop him to 1.units tonight, when should I start seeing a change in his numbers? 2 days? 5days.
    Also, is that what you would suggest I drop him to? 1units? He weighs 11lbs.
    Although I have not performed an entire curve yet (just getting a hang of testing as well as getting by Bengal to cooperate), I do have a few numbers.
    I always give his first shot at 7:15am. These are numbers I have got in the last week.
    9:15- 433
    11:15-411
    1:10-371 (this one was on the 2 Unit dose)
    4:50- 513
    5:50-583
    If you do suggest I go down to 1unit, is it safe to just drop it from 1.75 overnight? Thank you for your response! I really do appreciate everyone's help here.- Deena and Malby
     
  24. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    The weight of the kitty does not necessarily determine the dose needed. It's possible for a tiny kitty to need a high dose for good control and a large one to need a small dose.
     
  25. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    It's far safer to drop the dose by a large amount. Not so for increasing. As soon as you can get a testing regimen going, the better. I think the suggestion to feed and test immediately in the AM is the way around your problem of Malby being grumpy and uncooperative in the AM.
     
  26. Deena Traina

    Deena Traina Member

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    Dec 6, 2016
    Hello there,
    Malachai is still not regulated so I started re-reading all of my messages to see if there was some good advice that I made gut have missed. Since this last posting, Malachai has switched over to Lantus as was started at 1unit two times a day. I've been trying to hold the dose for a minimum of 10 days before increasing. We are now at 2.25. I was re-reading your message above about bouncing. Do you think I am not holding his dose long enough to possibly see numbers go down for his "correct dose" or am I holding a dose for to long? His numbers are still consistently high so I would assume he needs a dose increase but I want to make sure he's not bouncing. Any thoughts would be appreciated. I'm starting to get sad and frustrated at the same time. The poor little guy is just miserable. He never plays any more, hates his brother and his only focus in life is eating. He goes through 4 cans a day and still screams for more. Help!

    Thanks in advance,

    Deena and Malby
     
  27. JanetNJ

    JanetNJ Well-Known Member

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    Jun 8, 2016
    You just haven't found the right dose yet. 2.25 is not a high dose .. You will find it. I would move your questions now to the lantus forum and reread the protocols for dosing lantus at the top. Sounds like you are more comfortable with the go slow approach.
     
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  28. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    I agree with what Janet said. You haven't found the right dose yet. There are many very experienced people on the Lantus forum to help you. Holding an ineffective dose too long can create insulin resistance from the effects of glucose toxicity. Even the less aggressive dosing approach for Lantus (SLGS - Start Low Go Slow) recommends increasing after 5 to 7 days if numbers warrant.
     

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