Worried Vetsulin user - food switch in progress - need help

Hello everyone,

I started the process of switching Radar's diet from Hills w/d to FF and had planned to do it slowly. However, Radar has other ideas. In the last few days he has started not really being very interested in the kibble. He used to eat about 1/2 cup in the night and now he's eating less than 1/4 cup. When he eats it at all he will eat about 10 bites and stop instead of what he used to do which was eat most of it. Because he's hungry and I know it's important for him to get his calories, I've been giving him more FF. This has probably caused him to be even less interested in the kibble.

When you look at his chart, you will see that his numbers are dropping more every day at his low point in the cycle. After a scary drop on Sunday night at +3 to 58, I decided to only give him 6 units of insulin yesterday morning. But at +3 yesterday morning he was pretty low so I had to feed and give honey to coax that number up. Then last night the same type thing happened at +3 but the number was even lower at 50. Thank goodness I have my hypo kit well stocked. Today the same thing has happened. even though I tried to stop it with a feeding at +2. I'm scared because his numbers are lower and lower... although his symptoms are only mild so I guess that's good.

In the midst of all this, I've also been forced to switch vets... nothing is ever simple is it? Yesterday I met with her and was satisfied that she was a good fit as she is familiar with this website and agrees that low carb wet food is an important way to help Radar.

As I read Nikki's experiences with Melty recently, I am wondering a few things for Radar:
1. I think the dose is too high still. The vet said all the recent green readings are a concern but she wanted me to stick with the 6 units so Radar can adjust and curve again in 10 days. I called to talk with her this morning after our really low reading and have still not heard back from her and it's been several hours
I think 10 days is too long to wait to change the dose. I want to change it today. Any thoughts?? Am I on the right track?
2. I see that Melty is being well supported with food well before the low point in his cycle. I've only been giving a snack an hour before what looks to me like his nadir at +3. Maybe I need to give Radar more high carb FF to support him earlier and stop or at least slow down that scary plummet. ?? Any thoughts??
3. Since Radar is much more interested in wet food these days, I was thinking about feeding him the higher carb wet foods for his preshot meals instead of the lower carb food. I still have the Hills w/d available to him but he's just not eating very much of it.

I would like to stop this current pattern as it's gotta be hard on his system. Thanks in advance for your thoughts.

 

Hi Jan,

I'm just having a gander at Radar's spreadsheet for you. Back soon.

 

thank you

 

Hi Jan,

I can't get a long post to you tonight - keep getting errors.

You need to drop the dose. You're transitioning from w/d dry to FF or other wet. Dose requirements are likely to drop - probably quickly and repeatedly - as Radar eats less w/d (it has an INSANE amount of carbs). The sharp drops are going to be hard on Radar's system - and dangerous. You've done so well with home testing and getting him through teh lows.

I hope other members will chime in on this, but if Radar were my cat I would consider halving the dose, running AM and PM curves and if necessary go back up a little. As the food transition progresses, it may be necessary to further drop the dose. Only testing will give you the steer you need to make those decisions.

 

Thanks for your thoughts., critters mom.
I will continue the testing regiment we've been on and watch him closely. Thank goodness school has not started or I wouldn't be able to watch him so closely day and night.

I would much rather have him high than so low. It's too scarey.

 

(contd...)

Radar is nadiring early in the cycle. He may be like Saoirse. She metabolizes insulin quickly even by cat standards and had early nadirs on both Caninsulin and Lantus. I'd suggest giving Radar at least half of his food allowance for the cycle prior to the insulin injection being given. The Vetsulin/Caninsulin insulin has a very hard, fast onset and needs to have some carbs to 'work on'. The rest of the food can be given during the cycle (e.g. small meal at +3, another at +6, and a snack at +9) - the numbers will guide you about when to feed, but you need to make sure that the pre-shot meal and earlier meals in the cycle are the richest in carbs.

I hope that gives you a bit of guidance. Your instincts are spot-on and you've done brilliantly to keep Radar safe in very challenging circumstances. If you're needing to feed him honey on every cycle then the dose is too high. End of. Your vet isn't completely off the mark because with the likes of Caninsulin it can take a little while for a cat's body to acclimatize to a particular dose. (I had similar advice from our current vet). Trouble is that a lot of vets follow what I call the "Caninsulin Doggy Protocol" - two carb-stuffed meals a day immediately prior to injection time. It may work for dogs, but it ain't that great for a lot of cats. My vet explained to me that a lot of owners who don't home test work like this. The only thing the protocol has going for it is that it's a way for owners who cannot monitor BG closely to treat their cats' diabetes without the need to home test. The downside is that the typical objective is to keep the cat under the renal threshold, instead of aiming to keep the cat close to - or within - the BG range of a non-diabetic cat (as is the case with those practising tight regulation with longer-acting, gentler insulins like Lantus). The cat ends up in higher - but regulated - numbers and most likely remains insulin-dependent.

 

I didn't get great professional dosing advice when Saoirse was on Caninsulin. The vet who diagnosed her (eventually - after I put my foot down about testing Saoirse for diabetes) didn't support home testing at all. Thankfully, shortly after Dx we moved to a new practice and things have been better. Our main vet has a diabetic cat and that makes a great difference to the management of Saoirse's health issues. When I first started giving Saoirse Caninsulin I had to do it with only the diagnosing vet's say-so that she'd be OK. It was nightmarish.

I went through similar to yourself, being absolutely terrified that something would go wrong, even when I was home testing. But thankfully my little Alphatrak meter helped me to save Saoirse's life when she was put on too high a dose,just as your Alphatrak has helped you to save Radar's. I have health problems that mean I'm at home all the time (agoraphobic among other things). Like you, I was very grateful that I was able to be home to monitor my girl and keep her safe. I LOVE my glucometer.

IMPORTANT: You're using an Alphatrak - the hypo threshold is 68, not 50. (The latter value is the threshold on a human meter).

With the 68 cut-off value in mind, you'll see that Radar is way overdue for a dose reduction. Also you mention in his notes that he was groggy during the low yesterday. That sounds like mild hypo symptoms. I'd err on the side of caution and work on the principle that Radar's body is likely to be more sensitive to his insulin as a consequence.

I hope that helps a bit. To summarise:

1. Reduce the dose.

2. Give a substantial feed before each injection.

3. Get pre-shot and in-cycle tests for every cycle till you work out the dose that Radar actually needs.

4. Keep your vet in the loop, but work with your cat and his numbers - protocols are guides, not absolutes.

And have a big hug! You've done really brilliantly to keep Radar safe and well. It's lovely to read how his clinical signs are improving.

 

@BJM - If you have a moment, could you review my suggestions above and flag any howlers or naff advice. I'd really appreciate it - don't like being the only bod chipping in to discussions on dosing.

 

This makes so much sense. I will try this strategy and see what the numbers say.
I did talk to the vet finally and she agreed that dropping the dose is a good idea.

 

Glad to hear your vetty bean is onside.

 

I like this new vet and was so glad that she agreed with me. I probably would have lowered the dose anyway (LoL) but I would've been really scared.
Thanks for reminding me about the hypo threshold on the AlphaTrak. I'm slowly but surely finding my sea legs as I dance around on the deck of this diabetes ship. Learning what to pay attention to and when has been my biggest area of growth and I couldn't do any of this very well without the support on this forum.

 

Having a partnership-type relationship with one's vet makes such a difference. I'm glad that you've had such an auspicious beginning with your new vet.

I know exactly what you mean about the support we receive here. I'd have been absolutely lost - and I might have lost Saoirse - without the education and help I've received here.

 

Have we given you the link to the Caninsulin/Vetsulin Guide? It is here.
Most importantly, feed 30 minutes before you shoot.
Anytime the glucose goes below 50 mg/dL on a human meter, he gets a 0.25 unit reduction, too.

 

Thank you for the link to the guide for vetsulin.
I am feeding 30 minutes before I shoot and also giving more food at +2 to try to support but it just hasn't seemed to be enough. I was really spooked with the low readings in the last 2 days.

 

@Jan Radar I certainly can't give you dosing advice but gosh I love your notes in Radar's SS.

I ran into the same thing with Genghis and her food switch -had a real scare 6 days in - thank goodness I was on vacation and home all day the week after she started insulin, found this place and did home testing with the support of my vet. If you look at Genghis' spreadsheet, but under the World chart, I have feeding info I'm tracking with her. I don't know Radar's weight situation but I am feeding Genghis up to three cans of FF a day, spread out throughout the day - she needs to gain weight. Interestingly, her curve numbers are quite nice and I'm wondering if it's because she truly gets "mini-meals" when I do curves (I always poke her ear when she's distracted with even a tablespoon of food -- she'll have virtually none of it otherwise the stronger she gets!). Not sure if this works with your situation or even for Radar specifically but I thought I would mention it.

I'm so glad you are developing a good relationship with your vet.

BJM gave me some advice to start using a sliding scale (see my notes) based on Genghis' pre shot number combined with good data on her nadir - point to ponder for the future? I am finding this is working very well with Genghis and her numbers are really improving.

 

What dose are you going to give, Jan?

 

Thanks for sharing. I will study your notes and see what else I can learn from your experience. Radars weight is a little low for him at the moment. Before diabetes dx in March he was a big guy at 16 pounds but not overweight. With the stress of diabetes he was down to a rather boney 10 pounds. I could actually feel every bone in his spine. Thankfully he's back up to 14 or so which makes me feel so much better.

 

I thought about giving only 4 units but ended up giving the 5 the vet told me to do. I really loaded him with food for two hours before the shot. He walked away from the food dish with a bite still there which he's never done before. I'm hoping that maybe I've given him enough carbs to give the insulin something to work with. I will be watching him like a hawk tonight and testing frequently.

 

If your gut says don't shoot that amount, listen to it.
You're the one who will be up all night trying to feed a cat enough to keep him out of hypoglycemia and prevent him from dying, not your vet.

 

Excellent point BJM. But I Can't really take that unit back now... Good to remember for the future though.

 

That's for your discussion with the vet, too!
Anytime you have a concern like that, broach it tactfully by saying you are concerned because of how fast he drops with the Vetsulin and you don't want to have him wind up in hypoglycemia.

 

Hey Jan - was looking at Radar's numbers today. Wow. Are you noticing any less drinking and peeing or that he's feeling better at these numbers?

Just checking in on him!

 

Melanie, how sweet of you to check in on us. it has been a whirlwind of dose reductions around here in a very short time. My head is spinning a bit, but I've learned a lot in the process. Radar is not peeing oceans. He is not begging for water at faucets. Even the soft stools have cleared up and returned to normal. He chases his ping pong ball around and runs for the open door to the garage in the morning. It's so nice to see him return to his normal happy vibrant self. I really think in his case when I introduced him to meat that he knew this was a better choice for him and he was just waiting for me to make the rest of the switch. He never used to pay any attention to the refrigerator but now when the door opens he'll sniff at the contents and even stand up on his back feet to check the air above for any sign that his meat is in there. And he can have some. I'm on alert for signs that he needs another adjustment but am hopeful that we can ride for now.

 

What a wonderful SITREP! Whatever about the numbers, seeing Radar return to wellness is what this sugardance is all about.

To think that only a few weeks ago he was on 9 IU BID! It's amazing what the diet change can do. Well done, Jan!

 

Thanks for all your encouragement, Aine as well as countless others who've been helping me navigate especially in the past week when Radars dose was dropping almost every cycle. I am not confident that I could have survived without all the help I've received here.

 

I did warn you!

It was a real white knuckle ride when Saoirse went through the transition. Scared the living bejeebers out of me. It wasn't helped by my disordered sleep (I frequently go for days without being able to sleep). Saoirse went low two nights on the trot. The second night I was in danger of passing out (no control over it) when Saoirse was heading low again. I was frantic. The members of FDMB helped me to stay conscious so that I could keep my girl safe. I'll never forget it to them. (((FDMB)))

After discovering first-hand how quickly a high-to-low food transition can impact numbers - sometimes on a cycle by cycle basis - and how scary that can be (especially when using a harsher insulin like Caninsulin) I do try to do my bit to help new members navigate the change in a more manageable, less frightening and less stressful fashion.

 

Just yesterday we met with the vet and all got on the same page with my AlphaTrak BG meter's readings and adjusted the dose back to 2 units. Radar did not prefer leaving his favorite napping place and trembled like a leaf in the wind for the whole visit which I think probably raised his numbers yesterday, but the humans found the visit useful.

Today his BG started out at 346 and in spite of feeding the largest portion/load of his food for the cycle before insulin and at +2 ,when I tested at +3 he had dropped like a rock to 59. I got out the Hypo kit again and gave him honey and food which he happily gobbled right up. So tonight when his preshot test was only 191 I just didn't feel I could give him any insulin based on his drop earlier today!! I followed the guidelines on the FAQ and decided to feed and wait a couple hours and test again. His test 2 hours after eating was only 192. I'm worried but am so glad that I'm not feeding honey to him again tonight. I think I did the right thing but don't know what the consequences of no insulin is for Radar. Is all the insulin from today out of his system? In the morning I hope my preshot test tells me something conclusive. I feel the need for guidance...

 

Another dose reduction due for Radar. He does like his roller coaster, Jan! I hope you managed to get some rest. Radar should be fine for the skipped PM dose (given that he's not got a history of ketones) but his AMPS may be a bit higher this morning because he has missed a cycle. I think that you need to dose based on NADIR now more than ever because of Radar's fondness for nosediving.

When Saoirse's dose was getting lower on Caninsulin, I'd watch her clinical signs like a hawk and quadruply so at the beginning of the cycle. I'd particularly keep an eye out for how quickly she asked for food after her injection was given. As her numbers improved, the appetite 'uptick' started happening earlier and earlier (e.g. moving from +2 after dose to +1.5 and then +1.25). I also tested her earlier in the cycle. I think it might help you with Radar to do similar. I'd also strongly recommend that you test Radar's BG at +2 before giving him his 'second brekkie'. It is possible to hit nadir earlier than +3. It does look like he's metabolizing his Vetsulin really quickly. With the +2 test you should hopefully get a good idea of where Radar's going on the dose and if he's already low you should be able to intervene to steer the curve BEFORE his numbers really go south. Those readings in the forties are MUCH TOO LOW.

If Radar were mine, I'd reduce the dose down to one unit and monitor closely. Other members may have different suggestions. (Note: even if Radar is a bit higher at AMPS today, it doesn't follow that the same dose as he had yesterday won't take him as low simply because the pre-shot BG is higher. You must reduce the dose for safety.)

EDITED TO ADD:

I'm waiting to see how Radar does today with great interest. I forgot to ask earlier about whether you have foods with a range of carb levels to hand. I'd be grateful if you could post a note about same.

 

I did sleep, Aine I hope you've also gotten some rest.

Thank you for the reassurance about skipping the dose. When I woke up this morning earlier than usual Radar was prowling for grub. I just now tested and the BG is 211. I'm not sure what I expected but I think this is a duck. LoL. Now what? My instinct is not to shoot him because of his enormous drops yesterday of 150 per unit given. One unit of insulin would put him at 50 ish which is wayyyyyyyy to low for comfort.

Rest assured that the cat food cupboard is organized by C load and there is a range available, although perhaps the current roller coaster demands a bit more range.

 

Nice AMPS, Radar!

I'm really glad to hear that you got some sleep, Jan. Just looking at Radar's spreadsheet and also Saoirse's from last year. Back very shortly...

 

Hi Jan,

I can't fault you in the slightest for trusting your instincts. I followed mine most of the time when Saoirse was on insulin and she did OK. The only time when I didn't was when I followed my vet's advice in the early days and it's the only time she had a symptomatic hypo - if I hadn't been home testing I might have lost her that night. (*shudder*)

Here are some options:

(a) Give one unit and see how it goes.

(b) Give half a unit (ditto).

(c) Give the tiniest drop possible (see below).

(d) Skip and do some mid-cycle BG checks anyway (before a feed, then at +1 and +2 after the meal to see how food's affecting Radar's BG).

To give the tiniest drop possible:

1. Prepare the insulin.

2. Push the plunger right down to the bottom of the syringe barrel then insert the needle into the vial and invert.

3. Squeeze down on the plunger and then release the pressure. A tiny drop of insulin will be sucked up into the needle.

4. Insert the needle into Radar's skin tent, squeeze down on the plunger and hold for about 5 seconds then withdraw the needle.

If you want to see how tiny the drop is you could try drawing up a little water into a spare syringe then squeezing it out so that you can see the droplet.

Let me know what you decide to do.
.

 

Your options are interesting and so appreciated. Thank you so much.
At this point my decision is not to administer any insulin. He has gone up only 20 points since last night. I'd much rather be high than low.

I can't reach the vet for another hour.... When I emailed her yesterday about the mornings really low number her response was to stick with 2 units. ???? Why??? I asked her if she thought Radar was headed for remission and her answer was no I don't think so... Although that was a few days ago... Is my next move.

 

'Cause she's a typical vet?

I 100% disagree with your vet on this occasion. That 46 you got is irrefutable proof that Radar needs a dose reduction. There's no room for debate about it: the 2 IU is too high.

I am very pleased with our current vets but I had similar issues when Saoirse was getting lower on Caninsulin. As mentioned above, I regretted the two occasions I followed the vet's recommendations (not our main vet at the practice, BTW). I didn't have much confidence at the time, but after the two real white knuckle lows I went with my cat and my meter. When it came time to start Saoirse on Lantus I shoved a copy of the Roomp/Rand protocol under our main vetty bean's nose and said I wanted to use that for dosing guidelines. By that stage, he knew that I was well able to monitor Saoirse's levels at home and make dosing adjustments accordingly so he let me get on with it. He doesn't agree completely with some of the choices I've made along the way, but after all these months he does trust me to do what is best - and what is safe - for my beloved girl.

It is possible that Radar may continue to need a small drop of insulin going forward (and maybe a gentler insulin). It is also possible that the diet change may be enough to control his sugars without the need for insulin. One thing is certain: he's a lot closer to potential remission than he was a mere few weeks ago. If it is any comfort to you, in the early days a vet referred Saoirse's curves to their practice's external diabetes consultant. At this time she was on w/d dry and 3IU Caninsulin. The (ahem!) 'expert' pronounced Saoirse a "true diabetic" who stood "no chance of achieving remission". Saoirse became diet-controlled in mid-November. Same expert a few months later said to me in no uncertain terms that it is not safe to give ANY cat insulin if it's numbers are below 11 mmol/L. (One of her treatments triggered a minor pancreatitis flare in Saoirse and I wanted to temporarily reinstate Lantus treatment to support the pancreas through it, but I was refused the Rx. ) Said 'expert' only rarely uses Lantus, and she can't have paid proper attention to Saoirse's spreadsheet data; data that proved conclusively that I could safely administer Lantus at BG levels lower than 11 mmol/L.

 

11 mmol/L = 198? Essentially 200? My vet didn't say it wasn't safe, but said they were satisfied with below 200. Me, not so much.

 

The 11/200 'no shoot' level isn't safe when you're not closely monitoring BG and when you don't have enough data to know how your kitty is responding to the insulin.

As you will no doubt read here, FDMB recommendations are to stick with the 11/200 cut-off until such time as you are 'data ready' to be able to administer insulin safely at lower numbers. It also depends heavily on the insulin being used. I used 10 mmol/L as my cut-off for Saoirse. Like you, I kept a close eye on how many points she was dropping from pre-shot to nadir as my guide in making that decision. Saoirse's body told me what to do. I only gave her insulin at lower numbers when she was switched to Lantus (which didn't drop Saoirse's BG like a rock in the way that Caninsulin did) and after I had amassed several months of BG data for her.

I did have a chat with our own treating vet about the specialist's actions. To his credit, he said that most vets aren't used to caregivers who give as much time and dedication to the care of their diabetic pets as we do here. Many people just can't manage that. He said that sometimes vets don't take into account that some caregivers are in a better position to give certain treatments than others, and sometimes don't place enough weight on - or trust in - the caregiver's inputs to their cat's treatment.

Again, I say your gut is making good decisions. I'm also very glad that you're now more au fait with the difference in the reference ranges for Alphatrak meters cf. human meters.

 

It sounds like your experience with Saoirse has been harrowing at best. The good news is that you did enough things right that your little friend purrs nearby and provides you with abundant joy. The rewards we reap are so delightful.

I'm confident with my decision not to shoot at this point. I am also in strong disagreement with the vet. I will be looking into another professional opinion at another practice as soon as it's possible. 2nd opinions can be so valuable.

Right now what I see is a cat who is completely normal. He runs and plays. He pounces. He watches the birds with great interest and commentary. He eats a little, washes his face and settles for a nap in his favorite chair. Although appearances can be deceptive, especially with a cat, I'm going with the information and evidence I have at hand.

Today my plan is to monitor him closely and make it up as I go.

It would be useful to my future decision making if I better understood the ranges of blood glucose readings and what they can indicate about what's going on in the body. What are the dangers at the different levels ? At this moment the numbers are all pretty confusing and I feel the need to read and absorb information. So that's my other plan. I will keep you posted...

 

I have also wondered about a more gentle cat friendly insulin but at the prices I've been quoted my budget just can't support the expense. Would it be wise to get the other kind of needles (U100) I think and consider giving fractions of a unit?? Of course using the conversion chart which I've seen posted for someone in past couple of days. I have a streak of the "always be prepared" sayings of my dad echoing in my head.

 

Sounds like a good plan, Jan. I have to tootle off for a while, but I'll come back later and answer your questions for you, if that's OK.

Blessings and scritches,



Mogs

 

Check out BCP PZI. If your vet will fax in the Rx, you can pay them directly. It is less than Vetsulin if you pay BCP directly.

 

Aine, go enjoy some time away from the screen, get some sunshine and a hug from the kitty. I'm good.

 

Great suggestion!!! I will look into it. Thanks.

 

Hi Jan,

Some answers.

The U100 syringes make it easier to measure small doses, but for the smallest doses you can learn how to do drop doses (practice producing a consistent number of drops from a given amount of insulin - you can get advice on this later if you need it).

See BJ's signature - click on the 'Glucometer Notes' link - it has a description of the reference ranges. Be sure to ask if you need help understanding them. The euglycaemic (normal) range for a cat not on insulin is 3.9/70 (the hypo threshold) to 8.3/150 as measured on an Alphatrak. , and the renal threshold is variously quoted as 12.8 (230) or 13.9 (250) on an Alphatrak depending on the source. The renal threshold is the point where blood glucose gets so high that it starts spilling over into the cat's urine. Too low and a cat may have a seizure or lapse into a diabetic coma. Too high without insulin and the cat risks organ damage and diabetic ketoacidosis (DKA). Note that DKA can occur at lower numbers, too. The conditions for DKA are usually expressed here as:

Inappetence + not enough insulin + infection = DKA.

That is a wonderful WCR - Whole Cat Report. This is the most important measure of how well Radar is doing. The BG numbers are only a guide to restoring him to wellness.

Bj has already mentioned one option for a more cat-friendly insulin. I know that there is a big problem with the price of Lantus in the States. However, some members get their Lantus from Canada. I believe it's cheaper there. Check out the forum stickies for further information on this. I don't know anything about Levemir pricing.

Hope some of the above helps.
.

 

An afterthought.

One option that you might think about is SID dosing instead of BID dosing. If it gets to the stage where Radar is low but doesn't quite hold into good numbers, one tiny dose of insulin a day is another option that you may wish to investigate.

 

As always I'm grateful for the encouragement and information.
I'm especially grateful for the explanation about DKA which has been a bit of a mystery other than knowing its serious business. I have friends in Canada who might be able to help me with getting the less expensive insulin as I'm really feeling the harshness of the vetsulin right now. For the moment, I'm content with a happy napping kitty who just had a rousing game of chase the feather.

 

Another really great suggestion. Hmmmm I will have to consider that.

 

I suggest you have a look at Saoirse's spreadsheet from last year (link in my signature). I used SID dosing at times for both Caninsulin and Lantus.

 

Hi Jan - learning a lot from this thread and just thrilled at how well Radar is doing. It's great to hear he is feeling so great, chasing feathers and doing cat things.

 

If Radar could type his comments to you I think he'd say that no one is happier than he. He has missed playing with da bird. We are particularly amazed today that he's feeling better than he has in months and with not one drop of insulin on board since yesterday morning. Those last two are Radar's additions, Melanie. Glad my questions and thoughts are useful to someone else.

 

Jan, keep an eye on the FDMB Supply Closet - sometimes you can get Lantus supplies there for much less, or even free.

http://www.felinediabetes.com/FDMB/forums/supply-closet-for-sale-or-free.15/

 

Sooooo my little kitty project throws yet another surprise. I expected Radars BG number to be a little higher tonight at preshot time, but instead it dropped to 175 on my AlphaTrak. I'm thinking about his vigorous romp this afternoon with DaBird -his most favorite toy in all the world and thinking that perhaps this is what helped him drop. He hasn't asked to play that game in months. Watching him today it was plain to see, he was totally into his game and the normal happy spunky guy we love so much had returned.

He prowled in the kitchen and stalked the refrigerator asking for dinner so after I tested I gave him some grub. He ate 2/3 of a can of lc chicken. I will test again in a little bit and see what his numbers say. The vet said to give him 1 unit if he's above 190. We'll see...

 

With numbers that good, I'd be more inclined to do the smallest drop, or 0.5 units max (and only if I could monitor BG closely).

It's wonderful hearing how much better Radar's doing, Jan.

 

So 1 hour after eating his BG is 224. I feel good about a half unit. My math is as follows. 224 take away 75 puts him at an approximate BG of 149. I subtracted 75 because that is half as much as he dropped per unit given last time he had insulin injected. We will be monitoring closely as needed...

 

It's not quite as straightforward as that, Jan. The 224 is food-influenced and the BG may very well drop back again after a little while. (If there's any function in the pancreas beta cells they will pulse insulin in response to the feed.) The recommendation is to have a 2-hour fast before a preshot test because it reduces the likelihood of the reading being influenced by the previous meal. Working from the fasting BG, you get a better idea of which point to 'guestimate' the drop from. Also, the time in better numbers may be allowing Radar's pancreas to recover a little, particularly as it's not dealing with the heavy carb load now. Just look at the steady stream of reductions Radar has needed. It is possible that the 0.5 unit dose may take him lower than your rough estimate.

In general, if a preshot value is too low you can elect to stall (i.e. don't give the injection at the regular time), DON'T FEED, then retest in 30-60 minutes to see if the BG is rising without any food influence since that makes it easier to see whether the last insulin dose is wearing off.

 

All That information makes lots of sense and is good to know going forward. I guess we will see just what his pancreas might be doing as we monitor. I can test as needed tonight. Will let you know how he does

 

Have a look at Saoirse's spreadsheet values for the last week of July last year to see just howmuch variation there can be on exactly the same dose; and also how big a drop even 0.5 units is capable of producing.

 

I wanted to let you, Aine, especially,... but anyone else out there following the micro dosing at my house needs to know that Radar has done well tonight. His +3 reading was 219 which I'm pretty sure I steered successfully with food for the first time. It's a project that will still need tweaking but I'm glad to have a little success in that arena of the cooking show. I'm of course continuing to monitor.

 

Hi Jan,

Just had a gander at Radar's spreadsheet comments. Looks like you caught the 'appetite uptick' at +2 on yesterday's PMPS cycle.

I do wonder whether Radar's getting a little carryover on the Caninsulin (see the blue on the PM cycle of 25/7). The numbers on yesterday's AM cycle look promising as well, since Radar's BG lowered after meals - could very well be signs of his little pancreas helping out. Fingers and paws crossed ...

Are you planning to stick with the 0.5 IU for the next dose?
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I'm also thinking that Radars little pancreas may be coming out to dance with us. . I've been watching the litter box closely for any signs that he's peeing more since we've reduced his dose soooo much and last nights cleaning revealed slightly bigger portions than we've had. The combination of that along with the numbers in the 200s last night made me think that his pancreas needs more support. I don't know if that's correct and only time and testing will tell the tale. We started this morning at 275 so I gave him 1 unit and am crossing my toes and paws.

 

The 275 AMPS is above the renal threshold so may explain the extra pee.

 

His +3 is 88 which suggests that things are moving in the right direction. It seems like it's been forever since I've had a +3 reading that didn't involve honey. In the meantime, I'm continuing to practice micro dosing with water in case my roller coaster cat wants to dip closer to zero.

 

We are keeping fingers, toes, paws and eyes crossed that Radar's pancreas is indeed coming out to play!

Go Radar!!!

 

That appetite uptick at +6 this evening may be the crystalline fraction of the Vetsulin starting to kick in. Or it could just be that Radar's hungry (he is, after all, a cat!). Are you going to snag a +7 or +8 test, Jan?

 

I had errands to run so no testing this afternoon. I did just test the little guy and he's at 164. This is not food influenced I don't think because I picked up all the food before I left the house Several hours ago. I'm stalling at the moment....

 

... and withholding food, I assume?

He's doing great, Jan, and so are you.

 

Yes. There is loud complaining.

 

Thank you for the reassurance that my education is proceeding well. I just tested again and it's down to 154. Does that mean the mornings dose is still working or are we doing a jig with the pancreas?? Or is there some other complex process working??

 

How long before those tests did he eat, Jan?

 

He had a spoonful of lc food 3 hours before first test. There was 45 min between the two tests.

 

He seems to get a real bang for his buck from the Caninsulin a lot of the time. Meter variance is usually around +/- 20% - so in essence the 164 and 154 could in theory be around about the same as each other.

If he were mine, I'd be a bit cautious about the PM dose. Radar has shown he can run quite low at night.

@BJM - If you're around, BJ, is there any chance you could look at Radar's spreadsheet numbers and dosing, please? (I've got to head for the leaba - about to pass out again.)

 

OK. Give me a minute.

 

Thanks for your help Aine. As always it's much appreciated.

 

Thank you, BJ.

Glad to do a little to help, Jan. Hope you and Radar have an uneventful and restful evening. Catch you on the morrow, DV.

 

Thanks, @BJM, for your assistance. I've just tested him again 2 hours after eating and his number is 180. I don't know what that might mean but I'm feeling reluctant to give any insulin. I don't know what any of this might mean but the vet is thinking his pancreas might be starting to work again.

 

I'd be hesitant to give any tonight. Maybe go with mini-meals to spread out the impact on the pancreas and see how morning is.

 

Agreed. He has always been a grazer and seems to be responding well to the small meals I've been giving him recently. Thank you for peeking at Radars ss. I appreciate your time and opinion.

 

If he's higher in the morning, maybe go with 0.5 units and note what kind of drop he gets on that. He's really running down the dosing scale.

 

This roller coaster ride is going straight down to 0. My nose is in danger of being smashed into the ground in cartoon fashion as we fall. Radar on the other hand is doing better than he has in months. I'm in complete awe of the power of a diet change.

 

I'm sure his pancreas thanks you!

 

This mornings preshot number was 170. He ate 4 hours prior to that test. Yacked up a big hairball overnight too. It's all that bathing he's been doing. At this point I'm feeding him every couple of hours as he asks and holding off on the insulin. I'm waiting to hear back from the vet. Stay tuned for the next adventure on our way to zero.

 

Hi Jan,

That's a pretty good AMBG this morning. A bit early to be sure, but it looks like Radar may need a little more support from insulin. I'd be looking at a gentler, longer-acting insulin if he doesn't get all the way on the diet change. Granted, there's the option of using U100 syringes and a conversion chart, then drop dosing; but at the rate Radar's leaping down the dosing scale I think even that might be too much Vetsulin for him. Saoirse hit the Vetsulin dosing wall like that, too, but she couldn't hold the low numbers. The extra bit of support she got from her time on Lantus made a huge difference. I don't think she'd have achieved diabetic remission without it.

Looking forward to hear how your discussionings go with your vetty bean.



Mogs
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Great suggestions. Thanks. I'll keep you posted.