bbwyo
Member
Testing today and if you look at SS she probably is hitting her nadir around 2+/ 3+ hrs? Would giving her the additional .25 cu in evening help hold the nadir longer? or just drop it lower in the beginning?
Update - Remission?
- Thread starter bbwyo
- Start date
- Status
bbwyo
Member
I don't understand steering up? If you mean feeding? I give her something LC every time I test. She is more active during the early morning then comes in and sleeps until later in the afternoon. I have given her a bad habit by feeding her when she comes inside and acts hungry. The Vet said to let Kitty tell me what she needs so early in morning when she comes in and I know her BG is low I give her a little (less than TBSP) LC-NC wet food. In the evening again she goes out more when the weather is nice and I think this may account for her bg holding through the night??
bbwyo
Member
News flash. I might be part of the problem. I thinkI should ease up on the early morning feeding. I have been worried about hypos because of lows on the higher dose, also the Vet recommended leaving dry food out because the kitty would self regulate by eating more if she felt the lower bg# (free feeding). Also because she lost so much weight I thought when her bg's were better she would utilize the calories better. So when she came in and seemed hungry I should feed her...Now i think I should slow that down and stretch out feeding. That might help hold lower #'s longer??? Am I getting this right?
JanetNJ
Very Active Member
You can feed her if she's hungry, but not dry food. It's OK to leave low carb wet food out.
JanetNJ
Very Active Member
Vetsulin is ment to be dosed twice a day because it only lasts about 8-10 hours. Your cat is staying high in the evening because the insulin is out of her system.
bbwyo
Member
Yes I understand that but I guess I'm feeling cautious about dosing in evening because her bg seems to stay lower and stable? With Vetsulin is that what a bg curve would look like short sharp down (1-2hrs) then coming up so quickly? And with her bg going down so far so rapidly a larger dose doesn't seem like a good idea. So how to get her and keep her in that healing range?
JanetNJ
Very Active Member
No your curve is not typical. Usually vetsulin starts working around 2 hours and his it's lowest between +4-+6. I've never seen curves like yours before.
JanetNJ
Very Active Member
I'm not saying to give her a larger dose.... I was suggesting dosing in the evening as well. There is no more vetsulin in her system at the pmps time.
What do you think, @MrWorfMen's Mom ?
bbwyo
Member
yes I didn't understnad you to say a larger dose. I was only wondering how insulin worked and wondering what someone would do to achieve more stable #'s.
And also you are saying that Vetsulin does not have an accumulating effect, that it normally clears the body in the 12 hr cycle. Not a 4 hr cycle
Does arthritis complicate diabetes treatment? that you know of?
JanetNJ
Very Active Member
I don't think arthritis really complicates treatment. I suppose if the pain was severe it could raise bg. My cat has arthritis. I give cosequine but it hasn't effected her diabetes treatment.yes I didn't understnad you to say a larger dose. I was only wondering how insulin worked and wondering what someone would do to achieve more stable #'s.
And also you are saying that Vetsulin does not have an accumulating effect, that it normally clears the body in the 12 hr cycle. Not a 4 hr cycle
Does arthritis complicate diabetes treatment? that you know of?
bbwyo
Member
does your cat "creak" ? Currently on 1 capsule of Dasuquin but might up it to 2x. Kitty doesn't creak all the time so will be interesting to see how the b-12 m works? or if just helps her stay stronger. Either way good. Appreciate your comments. It's turned cold and windy (57) here today so not so much exercise. will see if it makes a difference. she hasn't eaten much today so will do PMPS before feeding tonight. See what tomorrow morning brings. She's pretty chill tonight so thinking her arthritis might be bothering her more than I thought.
JanetNJ
Very Active Member
She doesn't creak, but limps after sitting awhile and needs a boost now to the top of her favorite spot in the cat tree.
Yong & Maury GA
Very Active Member
"Insulin is a hormone made by one of the body's organs called the pancreas. Insulin helps your body turn blood sugar (glucose) into energy. It also helps your body store it in your muscles, fat cells, and liver to use later, when your body needs it. After you eat, your blood sugar (glucose) rises."
With cats, they do better with dosing twice a day, 12 hours apart because they metabolize about three times faster than people.
Vetsulin is an in-and-out insulin so it should not have any accumulating effect. If it looks like that, it may be Kitty's pancreas spurrting and doing a little work
I think she needs the PM shot, even if it's less then 0.25U. You hold the syringe though
With cats, they do better with dosing twice a day, 12 hours apart because they metabolize about three times faster than people.
Vetsulin is an in-and-out insulin so it should not have any accumulating effect. If it looks like that, it may be Kitty's pancreas spurrting and doing a little work
I think she needs the PM shot, even if it's less then 0.25U. You hold the syringe though
bbwyo
Member
please take a look at the SS and see that the AMPS was actually lower than the bedtime test...and I didn't give the additional dose? I guess if I give the evening shot at 6pm I'd have time to watch bg but what happens during the night? It looks like her pancreas must kick in sometime in the wee hours?"Insulin is a hormone made by one of the body's organs called the pancreas. Insulin helps your body turn blood sugar (glucose) into energy. It also helps your body store it in your muscles, fat cells, and liver to use later, when your body needs it. After you eat, your blood sugar (glucose) rises."
With cats, they do better with dosing twice a day, 12 hours apart because they metabolize about three times faster than people.
Vetsulin is an in-and-out insulin so it should not have any accumulating effect. If it looks like that, it may be Kitty's pancreas spurrting and doing a little work
I think she needs the PM shot, even if it's less then 0.25U. You hold the syringe though
Yong & Maury GA
Very Active Member
It's possible her pancreas is helping a little but may be more likely to achieve remission if it gets some help in the evening. Her green numbers in AM cycle are pretty ideal but the insulin is not lasting the full cycle. Like I said, it was just my opinion that she should have PM shot too. Since you monitor as late as +4 on PM, I think she'd be OK. Let me repeat, I am not trying to pressure you to do anything . This is just my thought.
. This is just my thought.
JanetNJ
Very Active Member
Ditto. The more time in healing numbers, the greater the chance of remission.It's possible her pancreas is helping a little but may be more likely to achieve remission if it gets some help in the evening. Her green numbers in AM cycle are pretty ideal but the insulin is not lasting the full cycle. Like I said, it was just my opinion that she should have PM shot too. Since you monitor as late as +4 on PM, I think she'd be OK. Let me repeat, I am not trying to pressure you to do anything
bbwyo
Member
yes I agree but today I was gone through the day and didn't feed her a meal mid day and tonight after food her gb was 212? I'll test in the morning for sure but now I have to look up what the cut off is for giving the shot. If I remember right it's 200? Not that I expect something lower than that in the morning but will be wondering what to do if it does. I also think I am noticing when she spends the day sleeping (not just staring out the window) that her numbers are lower. I hope this might mean her body is healing. More and more I think a slower acting insulin might be the best answer? Thank you both for your oversight on this one.
Yong & Maury GA
Very Active Member
Sorry Bev, yes the cutoff number for no shot for newer members is 200 . It is very possible that a gentler insulin like Prozinc, Lantus, or Levemir could be better for her. Just seems like Kitty is flirting with remission 
so we want her to feel better and not burn a hole in your wallet . I'm going to tag one of my Prozinc members, she's looked at many a spreadsheet and see what her thoughts are for Kitty switching insulins @Djamila if you would please 
. It is very possible that a gentler insulin like Prozinc, Lantus, or Levemir could be better for her. Just seems like Kitty is flirting with remission so we want her to feel better and not burn a hole in your wallet . I'm going to tag one of my Prozinc members, she's looked at many a spreadsheet and see what her thoughts are for Kitty switching insulins @Djamila if you would please 
Djamila
Very Active Member
I think you have a few options. In general, I think the slower acting insulins are easier on the cat and on the human, and the numbers I'm seeing on your spreadsheet indicate high enough numbers that while Kitty looks like she may have a decent chance at remission, she has a ways to go to get there.
You're right that her evening numbers are stable, but they are still too high. She should be getting an evening dose of insulin as well as a morning dose. Her pre-shot numbers need to be below 120 to be considered in remission, and most cats will stay in the 50-80 range on their own once they reach remission. Getting numbers over 200 isn't terrible, but it's also not healthy. My cat developed neuropathy with numbers in the low to mid-200's, so if it was me, I would want to get those numbers quite a bit lower.
Sam would nadir at +2 during his first diagnosis, and now his nadir is +3. Some cats just have an early nadir. Sometimes it can be from too little insulin, but sometimes it's just the way the cat is. If Kitty was on prozinc I would suggest increasing the dose to get a longer duration, but on Vetsulin, that could end up pushing Kitty down too low. So instead of increasing the dose, I would just suggest adding in that second dose so she is getting insulin both morning and evening.
Once she's getting dosed twice/day, you may start to see some better overall numbers and a better chance at remission. Right now, she's staying in the yellow numbers most of the day which isn't ideal.
You're right that her evening numbers are stable, but they are still too high. She should be getting an evening dose of insulin as well as a morning dose. Her pre-shot numbers need to be below 120 to be considered in remission, and most cats will stay in the 50-80 range on their own once they reach remission. Getting numbers over 200 isn't terrible, but it's also not healthy. My cat developed neuropathy with numbers in the low to mid-200's, so if it was me, I would want to get those numbers quite a bit lower.
Sam would nadir at +2 during his first diagnosis, and now his nadir is +3. Some cats just have an early nadir. Sometimes it can be from too little insulin, but sometimes it's just the way the cat is. If Kitty was on prozinc I would suggest increasing the dose to get a longer duration, but on Vetsulin, that could end up pushing Kitty down too low. So instead of increasing the dose, I would just suggest adding in that second dose so she is getting insulin both morning and evening.
Once she's getting dosed twice/day, you may start to see some better overall numbers and a better chance at remission. Right now, she's staying in the yellow numbers most of the day which isn't ideal.
MrWorfMen's Mom
Very Active Member
Sorry folks! I never got the tag on Tuesday (double checked to see if I had missed it but no tag ?????) so I'm late to the discussion.
I am in agreement that it would be better to give shots twice daily to try to keep the numbers down for as many hours a day as possible. It does look like Kitty is close to possible remission or at the very least being well regulated but right now she is staying up during the night cycle and then ending up dropping a lot early in the day cycle. The roller coaster effect is probably making her feel poorly and that might explain why her appetite doesn't seem to meld with the BG numbers.
If I were you, I'd split the 0.25 dose into two equal doses. I'd draw up some coloured water in a used syringe to a dose between 0.25 and the zero line on the syringe and use that as a comparison to give consistent doses lower than 0.25u both day and night.
It does appear that Kitty is burning through the insulin quickly but that may be a product at least in part of doing the once daily shots. Her system is being bounced around a lot and until that stops, you really can't see how effective the Vetsulin is. I'd at least give twice daily shots a try before changing insulin.
I am in agreement that it would be better to give shots twice daily to try to keep the numbers down for as many hours a day as possible. It does look like Kitty is close to possible remission or at the very least being well regulated but right now she is staying up during the night cycle and then ending up dropping a lot early in the day cycle. The roller coaster effect is probably making her feel poorly and that might explain why her appetite doesn't seem to meld with the BG numbers.
If I were you, I'd split the 0.25 dose into two equal doses. I'd draw up some coloured water in a used syringe to a dose between 0.25 and the zero line on the syringe and use that as a comparison to give consistent doses lower than 0.25u both day and night.
It does appear that Kitty is burning through the insulin quickly but that may be a product at least in part of doing the once daily shots. Her system is being bounced around a lot and until that stops, you really can't see how effective the Vetsulin is. I'd at least give twice daily shots a try before changing insulin.
Yong & Maury GA
Very Active Member
There seems to be an issue with tags again, Linda . I'm not getting them either right now but it has happened before and worked itself out
. I'm not getting them either right now but it has happened before and worked itself out
MrWorfMen's Mom
Very Active Member
I don't think I always get all my alerts for watched threads either. It seems to be a random problem. It's giving my memory a good workout!
bbwyo
Member
If your Sam has a nadir of 3+ hrs does this indicate you should dose 3x a day?
bbwyo
Member
I also have a question about her being an indoor/outdoor cat. Right now she's out with a squirrel on her brain. I'm guessing this will make her bg# higher? or will it make it lower since she's using more energy? will snag her and get another test shortly but I am guessing that tearing her away from the squirrel will elevate any #'s.
MrWorfMen's Mom
Very Active Member
I am suggesting that you maintain a total dose of 0.25u per day but divide it in half and give it twice daily instead of once to get coverage over a 24 hour period from the 0.25u dose. She may ultimately need the dose raised to 0.25u twice daily but right now she has metabolized that dose quickly several times and had some pretty steep drops early in the morning cycles with once daily dosing so I think it is prudent to start by dividing the 0.25u for 24 hour coverage and see what that does for her. It's hard to say if the once daily dosing could be influencing those steep early AM drops but it is no doubt influencing her PMPS and AMPS readings. If you give the same daily dose split into two doses over the 24 hour period, it should bring down the pre-shot readings which means she will not have as much room to drop before it becomes unsafe. That is why I am suggesting you start by giving half of the 0.25u in the morning and half in the evening to see how that effects her BG levels.
I would hold off checking BG for a bit if Kitty is currently being excited by a squirrel because I would expect that to elevate BG to some degree. Activity will trigger other biological functions to pump more more glucose into the system as needed to keep up with the level of activity but so do stress or excitement and these are things over which you have little if any control so let Kitty settle a bit before you take a reading.
I would hold off checking BG for a bit if Kitty is currently being excited by a squirrel because I would expect that to elevate BG to some degree. Activity will trigger other biological functions to pump more more glucose into the system as needed to keep up with the level of activity but so do stress or excitement and these are things over which you have little if any control so let Kitty settle a bit before you take a reading.
bbwyo
Member
thank you for the clarification. wow half of .25 cu is going to be a trick. I will try the suggestion to figure it out using the colored water. I also getting the syringes with the additional markings will help. Can you clarify how the "squirrel thing" impacts the bg/insulin requirements. If the excitement from the squirrel makes the bg # go higher she would benefit from the higher dose of .25cu (i-o 1/2 of .25 cu) during the day? What if I gave the .25 cu dose in the morning but in the evening gave the 1/2 dose of the .25 cu?
MrWorfMen's Mom
Very Active Member
You should never alter the dose of insulin because of some outside uncontrollable and random occurrence. Your cat's BG can be elevated by seeing a squirrel, a clap of thunder, fireworks going off or a very noisy truck going down the street but you will not always be aware of whether something has occurred to excite or scare your cat. You cannot adjust insulin assuming there has been a BG increase as a result of outside forces because those outside forces are changing constantly and you have no way of knowing what if any impact they are having on BG. You govern your dosing by information you can consistently obtain which is BG levels at shot time and the lowest point in the cycle and food intake (consistent portioning and no shot if kitty is not eating). What you are proposing would only complicate matters considerably and make kitty feel horrible.
Right now I think the best option is to dose Kitty consistently twice daily for a few days as long as her pre-shots are 200 or higher and nadir is not below 90 and then re-evaluate. It will take a few days to see how the new dosing is working for Kitty.
Right now I think the best option is to dose Kitty consistently twice daily for a few days as long as her pre-shots are 200 or higher and nadir is not below 90 and then re-evaluate. It will take a few days to see how the new dosing is working for Kitty.
bbwyo
Member
Let me explain my question a little better. and thanks for info. I'm not suggesting dosing due to activity but knowing that she goes outside during the day wouldn't it be better to maintain the .25 cu in the morning and then drop to the 1/2 .25 cu in the evening?.. as a daily schedule. Also I just tested her and noticed when I went to fill in SS that she had had the exact same #'s at the same times? I guess it's just a coincidence?
MrWorfMen's Mom
Very Active Member
The same number at the same time of day is, as you said, just a coincidence.
Giving one dose AM and a different dose PM is just going to make getting kitty regulated more difficult if not impossible. The goal is to attain a more consistent range of BG across the 24 hour period. Giving one dose of insulin in the morning and a different one at night right now will likely lead to some low numbers in the day cycle leading to higher pre-shot at night and then higher BG's through the night and you will never know what dose is doing what for Kitty because while it's possible to assume bouncing is occurring you can't quantify how much is a result of bouncing and how much is because she is not on the correct dose of insulin. Keep it simple and consistent and you'll get to your goal of regulation much faster with a lot less head scratching.
Giving one dose AM and a different dose PM is just going to make getting kitty regulated more difficult if not impossible. The goal is to attain a more consistent range of BG across the 24 hour period. Giving one dose of insulin in the morning and a different one at night right now will likely lead to some low numbers in the day cycle leading to higher pre-shot at night and then higher BG's through the night and you will never know what dose is doing what for Kitty because while it's possible to assume bouncing is occurring you can't quantify how much is a result of bouncing and how much is because she is not on the correct dose of insulin. Keep it simple and consistent and you'll get to your goal of regulation much faster with a lot less head scratching.
bbwyo
Member
ok that sounds good but do you think giving her the same .25 cu dose 2x a day would be too much?
MrWorfMen's Mom
Very Active Member
See my post #76, 1st paragraph. Yes I think it might be too much. Because Kitty has had some pretty steep drops in BG in the very early hours of the day cycle recently (see June 11th & 13th) with pre-shots that likely have been high because no shot was given the night before, I believe it is unwise to give the 0.25u twice daily right now as that may very well push Kitty's BG too low and it's better for her to be a little higher and safe than too low. If the smaller dose proves to be too little it can always be raised later but start conservatively and see what the smaller dose does for her first to keep her safe.
bbwyo
Member
Thank you for that. I really appreciate your expertise. What do people do that don't get this help. Thank you so much.
MrWorfMen's Mom
Very Active Member
Bev, I think too many vets think of insulin as if it were a pain pill. More is not always the answer. It's not rocket science but it's also not always intuitive. A lot of it is trial and error but first and foremost is to keep the cat safe. The saying around here is that this is a marathon not a sprint. Slow, methodical dose changes will allow you to see what your cat is up to and then you can make decisions based on how YOUR cat reacts to the insulin. This is definitely not a one size fits all situation and too many vets seem to think it is.
Yong & Maury GA
Very Active Member
Essentially, what I think Linda and I are thinking is, don't dose 0.25U twice a day right now (but she may need that if she doesn't go into remission) and with new half unit marked syringes, aiming for 0.125U twice a day. Are you using U-40 or U-100 syringes? It is easier to draw a 0.1 U dose on a U-100 syringe and there is a conversion chart to explain how much of the U-40 insulin to draw up. I recently switched to U-100s and they are easier for tiny adjustments
MrWorfMen's Mom
Very Active Member
You will need to switch to U100 syringes (thanks for mentioning that @Yong ) in order to more easily draw up such a tiny dose. Here is a link to the conversion table you'll need.
http://www.felinediabetes.com/insulin-conversions.htm
Can you cancel your U40 order and replace it with U100 with half unit markings?
http://www.felinediabetes.com/insulin-conversions.htm
Can you cancel your U40 order and replace it with U100 with half unit markings?
bbwyo
Member
will see
Yong & Maury GA
Very Active Member
Walmart also carries U-100 syringes with half unit markings, as long as you don't have dim bulbs for staff at your local store 
MrWorfMen's Mom
Very Active Member
Oh that is too funny! I go to Walmart for mine with the front of the box to hand them so they don't keep handing me the wrong ones one at a time frustrating the daylights out of me! Dim bulbs are obviously a continent wide Walmart problem! 
Yong & Maury GA
Very Active Member
I just asked another member to send me a picture so I can do the same!Oh that is too funny! I go to Walmart for mine with the front of the box to hand them so they don't keep handing me the wrong ones one at a time frustrating the daylights out of me! Dim bulbs are obviously a continent wide Walmart problem!
Yong & Maury GA
Very Active Member
Bev, I found a picture that might help you with those tiny doses:
bbwyo
Member
is this a picture of the u-40 syringe or the u-100?The u-100 syringes I found were whole units on one side and half units on the other. The conversion chart says for .2 units using a u-40 you draw to the .5 mark. In the picture above the .25 (assuming this is the u-40 .25) looks like the .5 mark on the u-100 syringe? So what am I missing here? When the conversion chart says .2 is it the .25 in the picture?Bev, I found a picture that might help you with those tiny doses:
Djamila
Very Active Member
3x per day is rarely a good idea, although I've seen a couple of owners try it with some success.
Sam's numbers are low enough that even in his high range, he's still in pretty decent numbers. He often hits nadir and then "surfs" through the middle of the cycle meaning that he stays in roughly the same range for several hours. The curve I did on 6/10 during the AM cycle shows what I mean. However, I am switching to Lantus soon in the hope that an insulin with longer duration will help him a bit more.
Having an early nadir can be because of too little insulin, too much insulin, not the right insulin for the cat, or just a quirk of the cat. Time and data can help you figure out which one it is.
- Status