New Vetsulin Vial

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Are you still going to drop anything over 300 to 1.75U? These PS's today were close than they have been though! Maybe hold it a couple more days. That is a nice green nadir :). Glad to hear her neuropathy is improving! :woot:
 
Yong said:
Are you still going to drop anything over 300 to 1.75U? These PS's today were close than they have been though! Maybe hold it a couple more days. That is a nice green nadir :). Glad to hear her neuropathy is improving! :woot:
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Not yet. Just trying to figure out how to get PM nadir down. Looking at SS she doesn't seem to respond well to anything under 2u regardless of preshot. Do you agree? Maybe after the week of trying this scale (Monday night will be 1 week, we can try giving 2u for both PM and AM as long as she's not super low.
 
Cherish Gallagher said:
Not yet. Just trying to figure out how to get PM nadir down. Looking at SS she doesn't seem to respond well to anything under 2u regardless of preshot. Do you agree? Maybe after the week of trying this scale (Monday night will be 1 week, we can try giving 2u for both PM and AM as long as she's not super low.
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Try it as long as you can monitor.
 
Yong said:
Just a bounce lasting into AM cycle today. Watch, tonight will have a nice PM nadir :smuggrin:. Come on Ms. Angel, we want to see both good cycles :cool::D
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We will because she got 2 units. Hehehe. I swear she doesn't seem to get down to where she needs to be for anything under 2. But I hope you are right yong!
 
Tomorrow will be the 1 week point of doing the new sliding scale. What are your thoughts? I think she needs an increase again. But I'm not the expert :)
 
Cherish Gallagher said:
But I'm not the expert :)
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Neither am I :D but I see 3 days where PS were 300+ and the 2.0U was still too much, then last night she had a nice nadir and was pretty much back where she started. I think we're just seeing what the dose can do. BUT ironically, I am thinking tiny decrease for higher PS:
100-125: 0.25U If she gives PS 100 - 225 as a result of previous cycle dose being higher, you can try to give 1.0U and make sure to check at +2/+3.
125-175: 0.5U If PS are naturally coming down, stick with tiny scale dose. We haven't seen how she does on a naturally low PS ;)
175-225: 1.0U
225-299: Fat 1.5U
300+: Skinny 2.0

As always, we'll see what @JanetNJ 's thoughts are :) and if anything I wrote is confusing, just ask and I'll try to clarify more :cat:
 
Yong said:
Neither am I :D but I see 3 days where PS were 300+ and the 2.0U was still too much, then last night she had a nice nadir and was pretty much back where she started. I think we're just seeing what the dose can do. BUT ironically, I am thinking tiny decrease for higher PS:
100-125: 0.25U If she gives PS 100 - 225 as a result of previous cycle dose being higher, you can try to give 1.0U and make sure to check at +2/+3.
125-175: 0.5U If PS are naturally coming down, stick with tiny scale dose. We haven't seen how she does on a naturally low PS ;)
175-225: 1.0U
225-299: Fat 1.5U
300+: Skinny 2.0

As always, we'll see what @JanetNJ 's thoughts are :) and if anything I wrote is confusing, just ask and I'll try to clarify more :cat:
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Thanks as always! I'm so upset though. She's almost at 400 tonight. I guess I still don't understand because if she has a high nadir followed by a not so great PS why would we lower her dose? Wouldn't we give more to try and get her down? I trust you guys and will do and try anything you suggest but I feel I'm a way we are taking a few steps backwards.
 
A high flat nadir is a bounce. Ideally aiming for a nadir around 90. 22 June is the ideal day that we'd like to see more often :). I do wonder if she could go off the sliding scale, to like 1.75U for any PS over 200. Just another thought I had. Maybe @MrWorfMen's Mom can take a peak :cat:
 
Also, grabbing a fresh bottle of insulin after work. It's been about 6 weeks. I know people have told me I can use it until it's gone but I still wonder if it's losing some of its efficacy.
 
She gave me a good AMPS! :D kinda wish I would have given 1.75u but we will see how this plays out. Probably won't pick up new insulin yet since I'm broke and this bottle is clearly still working.
 
I see you are giving evo dry. What would you think of switching to young again or Dr elsley's clean protein (4.7%)? Evo's new formula is about 12% I've heard.
 
JanetNJ said:
I see you are giving evo dry. What would you think of switching to young again or Dr elsley's clean protein (4.7%)? Evo's new formula is about 12% I've heard.
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Hi Janet! She doesn't eat a whole lot of it and we had to find something in our budget that our other non diabetic picky cat would also eat.
 
While all those lovely green 50's, 60's & 70's on the spreadsheet may look good, I would caution you against aiming for such low numbers with Vetsulin. Your goal with Vetsulin should be to have the nadir no lower than 90 to low 100's. Vetsulin can and often does, push the BG down quickly and steeply. Leaving yourself a slightly larger safety margin gives you and Angel more time to intervene should BG be dropping quickly or too much. At best, aiming for low normal BG can and does cause bouncing and at worst, could lead to Angel's defences not being able to bring BG back up quickly enough which is dangerous and could potentially be fatal. I'd pay more attention to whether the point drop between pre-shot & nadir is exceeding 50% of the pre-shot reading and try to keep the bouncing at bay. It's the relationship between the pre-shot and nadir rather than either number on its own that should guide dosing.

I also think it would be helpful to get some tests between +2 and +8 randomly whenever you can rather than testing at exactly +6 every day. Nadirs are not static and can move from day to day so you may or may not be seeing the lowest reading in any given cycle. Early cycle readings will often tell you if the cycle is going to be particularly active and give you time to feed more early in the cycle to slow the drop down and extend the time Angel spends in low numbers. The goal is to get Angel into optimal numbers (90 to low 100's) for as long a period as possible through each cycle rather than trying to push her as low as possible for an hour or so during each 12 hour period.

Angel has had a significant number of cycles with nadir dropping well over 50% between the pre-shot and nadir readings. This is a recipe for bouncing. She has also had what appear to be very extended periods of being in " normal" BG range. (June 20th through to June 22nd). This is very unusual and concerning to me with Vetsulin. The lower pre-shot on June 22nd could possibly be attributed to a diminishing supply of glycogen from all the low BGs the previous 2 days rather than just the dose of insulin given. The pre-shots are again going up when the glycogen supply is replenished. The other possibility is that Angel's pancreas is pumping out some endogenous insulin at times leading to low PMPS readings but if that's the case (and it's purely speculation), it makes it even more important to tread lightly and not aim for such low nadirs.

The body stores glycogen to be used when needed to keep BG from falling too low but if that glycogen is being used up repeatedly/continuously over extended periods, the supply dwindles and the defences become less effective and could eventually become unable to keep the BG from falling to unsafe levels. It's like a car with gas......the more you speed the more gas you use and once the gas is gone, the car doesn't work anymore. The body needs time to replenish the stores of hormones and glycogen to keep the defences working at peak efficiency. In a diabetic the defences against low BG are activated prematurely because they have become used to being at higher than normal BG numbers so they perceive danger when none exists. Easing BG down rather than forcing it, allows the cat to become reacquainted with more normal BG levels and stops the bouncing. When the bouncing stops, the pre-shot and nadir numbers will come down without a defence system panic being set off.

While a sliding scale is great in a cat that has demonstrated "A" dose drops BG by "X" points, "B" dose drops by "Y" points etc. it's difficult to see any pattern to how any particular dose is working for Angel because of all the dose changes, bouncing and what suggests to me, a defence system that may not always be working at 100% efficiency possibly due to being overtaxed repeatedly.

Finding the right dose(s) can take a lot of experimentation. For now, I would suggest not exceeding a dose of 1.75u no matter what the pre-shot is, to see if that helps minimize/stop the bouncing. I definitely would not give insulin at all if BG at pre-shot is below 100. One skipped shot is not going to set Angel back. Vetsulin is an in and out insulin and Angel will get back on track in the next cycle or two. I also would be careful not to give the higher dose just because a pre-shot is higher than expected when that pre-shot is obviously the result of a bounce from a very low mid cycle number in the previous cycle. Otherwise the bouncing just becomes a vicious circle.
 
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MrWorfMen's Mom said:
While all those lovely green 50's, 60's & 70's on the spreadsheet may look good, I would caution you against aiming for such low numbers with Vetsulin. Your goal with Vetsulin should be to have the nadir no lower than 90 to low 100's. Vetsulin can and often does, push the BG down quickly and steeply. Leaving yourself a slightly larger safety margin gives you and Angel more time to intervene should BG be dropping quickly or too much. At best, aiming for low normal BG can and does cause bouncing and at worst, could lead to Angel's defences not being able to bring BG back up quickly enough which is dangerous and could potentially be fatal. I'd pay more attention to whether the point drop between pre-shot & nadir is exceeding 50% of the pre-shot reading and try to keep the bouncing at bay. It's the relationship between the pre-shot and nadir rather than either number on its own that should guide dosing.

I also think it would be helpful to get some tests between +2 and +8 randomly whenever you can rather than testing at exactly +6 every day. Nadirs are not static and can move from day to day so you may or may not be seeing the lowest reading in any given cycle. Early cycle readings will often tell you if the cycle is going to be particularly active and give you time to feed more early in the cycle to slow the drop down and extend the time Angel spends in low numbers. The goal is to get Angel into optimal numbers (90 to low 100's) for as long a period as possible through each cycle rather than trying to push her as low as possible for an hour or so during each 12 hour period.

Angel has had a significant number of cycles with nadir dropping well over 50% between the pre-shot and nadir readings. This is a recipe for bouncing. She has also had what appear to be very extended periods of being in " normal" BG range. (June 20th through to June 22nd). This is very unusual and concerning to me with Vetsulin. The lower pre-shot on June 22nd could possibly be attributed to a diminishing supply of glycogen from all the low BGs the previous 2 days rather than just the dose of insulin given. The pre-shots are again going up when the glycogen supply is replenished. The other possibility is that Angel's pancreas is pumping out some endogenous insulin at times leading to low PMPS readings but if that's the case (and it's purely speculation), it makes it even more important to tread lightly and not aim for such low nadirs.

The body stores glycogen to be used when needed to keep BG from falling too low but if that glycogen is being used up repeatedly/continuously over extended periods, the supply dwindles and the defences become less effective and could eventually become unable to keep the BG from falling to unsafe levels. It's like a car with gas......the more you speed the more gas you use and once the gas is gone, the car doesn't work anymore. The body needs time to replenish the stores of hormones and glycogen to keep the defences working at peak efficiency. In a diabetic the defences against low BG are activated prematurely because they have become used to being at higher than normal BG numbers so they perceive danger when none exists. Easing BG down rather than forcing it, allows the cat to become reacquainted with more normal BG levels and stops the bouncing. When the bouncing stops, the pre-shot and nadir numbers will come down without a defence system panic being set off.

While a sliding scale is great in a cat that has demonstrated "A" dose drops BG by "X" points, "B" dose drops by "Y" points etc. it's difficult to see any pattern to how any particular dose is working for Angel because of all the dose changes, bouncing and what suggests to me, a defence system that may not always be working at 100% efficiency possibly due to being overtaxed repeatedly.

Finding the right dose(s) can take a lot of experimentation. For now, I would suggest not exceeding a dose of 1.75u no matter what the pre-shot is, to see if that helps minimize/stop the bouncing. I definitely would not give insulin at all if BG at pre-shot is below 100. One skipped shot is not going to set Angel back. Vetsulin is an in and out insulin and Angel will get back on track in the next cycle or two. I also would be careful not to give the higher dose just because a pre-shot is higher than expected when that pre-shot is obviously the result of a bounce from a very low mid cycle number in the previous cycle. Otherwise the bouncing just becomes a vicious circle.
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Thank you for all of this information. I'm still trying to take it all in. Soooo much I didn't know and still don't really understand. I feel terrible because I thought the goal was to be seeing blues and greens. And she seems happy and healthy so I haven't been worried or concerned and now I am. I don't really know what to do moving forward. What would you suggest? Trying 1.75 or 1.5 consistently for a week or so? And try to get more BG readings through out the day?
 
Cherish Gallagher said:
Thank you for all of this information. I'm still trying to take it all in. Soooo much I didn't know and still don't really understand. I feel terrible because I thought the goal was to be seeing blues and greens. And she seems happy and healthy so I haven't been worried or concerned and now I am. I don't really know what to do moving forward. What would you suggest? Trying 1.75 or 1.5 consistently for a week or so? And try to get more BG readings through out the day?
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Hi Cherish,

Linda has a lot of FD experience under her belt and I know she wouldn't want you to feel terrible. She's giving you a heads up to keep Angel safe while using an insulin that can, indeed, drop them like a stone. Her key takeaway is to leave more of a "cushion" at nadir by erring on the side of slightly lower doses. I like her idea of trying no more than 1.75 u on any shootable PS for now to see if it'll calm down some of the bouncing. I see she's also recommended no shot if a PS is below 100. I think that's prudent with an insulin like Vetsulin.

Cherish Gallagher said:
I don't really know what to do moving forward. What would you suggest? Trying 1.75 or 1.5 consistently for a week or so? And try to get more BG readings through out the day?
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I can't help you much with the issue of a sliding scale because I really have no experience with doing that. What I do know from experience with my bouncy cat is that consistency can be a calming technique. Maybe it's worth trying 1.75 u consistently AM and PM for a bit and attempting to get a more scattered array of tests if you can.

Again - please don't be too hard on yourself. You've doing an excellent job with your kitty. An outsider's perspective can often be really useful in tweaking a few things to get it all working even better. :)
 
Kris & Teasel said:
Hi Cherish,

Linda has a lot of FD experience under her belt and I know she wouldn't want you to feel terrible. She's giving you a heads up to keep Angel safe while using an insulin that can, indeed, drop them like a stone. Her key takeaway is to leave more of a "cushion" at nadir by erring on the side of slightly lower doses. I like her idea of trying no more than 1.75 u on any shootable PS for now to see if it'll calm down some of the bouncing. I see she's also recommended no shot if a PS is below 100. I think that's prudent with an insulin like Vetsulin.


I can't help you much with the issue of a sliding scale because I really have no experience with doing that. What I do know from experience with my bouncy cat is that consistency can be a calming technique. Maybe it's worth trying 1.75 u consistently AM and PM for a bit and attempting to get a more scattered array of tests if you can.

Again - please don't be too hard on yourself. You've doing an excellent job with your kitty. An outsider's perspective can often be really useful in tweaking a few things to get it all working even better. :)
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Thank you :). I'm going to try the 1.75 idea and see where it takes us.
 
Cherish, I am quite impressed with how well you've done and I don't want you to feel bad about any of your dosing because that certainly was not my intention. You have kept Angel safe and she is doing very well. It just scared me a bit to see the aggressive dosing when pre-shots have been within normal range. I sat staring at the SS wondering what was going on and why there didn't seem to be any dramatic upswing of the numbers after that long run of low normal numbers when Vetsulin typically doesn't last more than 10 hours per cycle in cats. While every cat is different, I've never seen a run of green numbers that long in any cat on Vetsulin unless they were on the edge of remission and getting extremely small doses of insulin to support a pancreas that was sputtering back into action or coming out of a long hypo episode. The numbers in later days suggest Angel is not at the edge of remission, at least not yet. It puzzled me and it's the low pre-shot the following day that makes me wonder if the defence system was getting exhausted.

Those blues and greens are a thing of beauty and you can still have them but I would try to keep the numbers up a little bit to give yourself more of a safety margin. I just wanted you to be aware of what to consider when you are dosing at low numbers and striving to keep numbers that low. We all want our kitties regulated ASAP but this is a marathon, not a sprint and often trying to make it a sprint only slows regulation down. A cat will go into remission if a cat is meant to go into remission and while you can guide that process and coax it along, you cannot force it. If kitty's numbers are in the upper range of normal or even just north of the normal range, kitty will be just fine. I just want you to know what could be attributing to some of those wonderfully low numbers and use that knowledge to temper your dosing just a bit. My opinion is just speculation but it is based on biology and your data.

I would definitely not give insulin for any pre-shot at 100 or less and I would lower your top dose to 1.75u. I'm not a sliding scale fan without some clear cut data as to how much a specific dose drops the BG. That said it does make dosing decisions easier. I've seen sliding scales work in some cases but usually only after determining how much each specific dose is dropping BG because until a cat gets reacquainted with "normal" BG and their defences stop revving up at the first sign of a dropping BG, bouncing can muddy the picture. If you can get the pre-shots to level out and come down, the nadirs will come down as well. . Pay attention to how much a dose is dropping Angel from pre-shot to nadir remembering that nadir does not occur at exactly the same time every cycle. If the drop is more that 50% of the pre-shot , you'll likely see a bounce with the next pre-shot being higher and increasing the dose based on that higher pre-shot may just increase the bouncing. Bouncing can take up to 6 cycles to clear so sometimes patience and not reacting to one high number pays off in the following cycles. Remember every reading is a moment in time. It's the pattern over time that should be used to determine dosing.
Use your sliding scale but adjust your top dose and pay attention to the drops and temper your dosing accordingly.
 
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MrWorfMen's Mom said:
Cherish, I am quite impressed with how well you've done and I don't want you to feel bad about any of your dosing because that certainly was not my intention. You have kept Angel safe and she is doing very well. It just scared me a bit to see the aggressive dosing when pre-shots have been within normal range. I sat staring at the SS wondering what was going on and why there didn't seem to be any dramatic upswing of the numbers after that long run of low normal numbers when Vetsulin typically doesn't last more than 10 hours per cycle in cats. While every cat is different, I've never seen a run of green numbers that long in any cat on Vetsulin unless they were on the edge of remission and getting extremely small doses of insulin to support a pancreas that was sputtering back into action or coming out of a long hypo episode. The numbers in later days suggest Angel is not at the edge of remission, at least not yet. It puzzled me and it's the low pre-shot the following day that makes me wonder if the defence system was getting exhausted.

Those blues and greens are a thing of beauty and you can still have them but I would try to keep the numbers up a little bit to give yourself more of a safety margin. I just wanted you to be aware of what to consider when you are dosing at low numbers and striving to keep numbers that low. We all want our kitties regulated ASAP but this is a marathon, not a sprint and often trying to make it a sprint only slows regulation down. A cat will go into remission if a cat is meant to go into remission and while you can guide that process and coax it along, you cannot force it. If kitty's numbers are in the upper range of normal or even just north of the normal range, kitty will be just fine. I just want you to know what could be attributing to some of those wonderfully low numbers and use that knowledge to temper your dosing just a bit. My opinion is just speculation but it is based on biology and your data.

I would definitely not give insulin for any pre-shot at 100 or less and I would lower your top dose to 1.75u. I'm not a sliding scale fan without some clear cut data as to how much a specific dose drops the BG. That said it does make dosing decisions easier. I've seen sliding scales work in some cases but usually only after determining how much each specific dose is dropping BG because until a cat gets reacquainted with "normal" BG and their defences stop revving up at the first sign of a dropping BG, bouncing can muddy the picture. If you can get the pre-shots to level out and come down, the nadirs will come down as well. . Pay attention to how much a dose is dropping Angel from pre-shot to nadir remembering that nadir does not occur at exactly the same time every cycle. If the drop is more that 50% of the pre-shot , you'll likely see a bounce with the next pre-shot being higher and increasing the dose based on that higher pre-shot may just increase the bouncing. Bouncing can take up to 6 cycles to clear so sometimes patience and not reacting to one high number pays off in the following cycles. Remember every reading is a moment in time. It's the pattern over time that should be used to determine dosing.
Use your sliding scale but adjust your top dose and pay attention to the drops and temper your dosing accordingly.
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Thank you for taking such time and Eddie on us. You've really been helpful and the more and more I read what you wrote the more it makes sense. I still have so much to learn. Right now we are on 1.75u twice a day. If her BG is below 100 she will not get a shot. Do you recommend trying this consistency for a week or 2 and then make changes if necessary?
 
I'd say let's see how she's doing by end of week 1 before making suggestions :smuggrin: and I know it's not a greatly different number but might temporarily raise the NS number to like 150. If she naturally gets to this PS we don't know how a low dose works on her without the lower PS getting ready for a bounce ;)
 
Yong said:
I'd say let's see how she's doing by end of week 1 before making suggestions :smuggrin: and I know it's not a greatly different number but might temporarily raise the NS number to like 150. If she naturally gets to this PS we don't know how a low dose works on her without the lower PS getting ready for a bounce ;)
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Sounds good :) I don't anticipate her getting to that low a PS tho. She's been consistently in the 300's since the dose decrease.
 
I think it might be her body adjusting to consistent dosing / bounce from blue last night. The bounce shows differently possibly because of consistent dosing. Going to see if she clears it tomorrow then decide which way to move dose. :bighug: Let's see if anyone else has some insight. You're probably tired of hearing from me :smuggrin:
 
Yong said:
I think it might be her body adjusting to consistent dosing / bounce from blue last night. The bounce shows differently possibly because of consistent dosing. Going to see if she clears it tomorrow then decide which way to move dose. :bighug: Let's see if anyone else has some insight. You're probably tired of hearing from me :smuggrin:
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No I'm not lol you've been very helpful! I'm on day #3. I figure I'd give it 1 week before any change. But it sucks to have red :(
 
I don't think 1.75u is enough but I think 2u might be too much. Oh the joys of FD. Day #5 today so 3 more full days before we switch anything. It just breaks my heart that she's back in the 400's as it's been over a month since we've seen any reds. Will higher #s affect the progress of her nueropathy?
 
I think you could try 2u again but only when you are able to monitor for a cycle or two. I think those times when you got low numbers on 2u previously, there may have been some bouncing involved and dosing was being changed frequently so the effect of 2u may have been a bit blurred. Some kitties can be very sensitive to even teensy dose changes so the other alternative is to just fatten up the 1.75u as Janet suggested.

Also when you can, I'd get a reading at +3 or +4 on a day cycle to see how quickly BG is dropping. Sometimes it's not just how low kitty drops but also how quickly that will set off bouncing and nadir isn't always at exactly the same time each cycle.
 
Cherish Gallagher said:
Will higher #s affect the progress of her nueropathy?
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I like Janet's idea of trying the skinny/fat doses, so the skinny 2.0. Maury was a fan of those finer doses :p. As for her neuropathy, it shouldn't since we're still seeing blues and you are still giving Zobaline, correct? Even with Maury's mild bounciness (I say mild because there are other big bouncy kitties ;)) his neuropathy is almost completely gone now :cat:. He only had Zobaline for 4 days because then his pancreatitis flare showed up and I wasn't 100% sure until we got to the Vet, so I knew only new thing was Zobaline. Needless to say, the supplement was not the issue so don't worry about that :).
 
Yep still using the Zobaline. It will be 3 months soon. :) will be able to monitor the next 2 days because I'm off work so I think I'm going to go ahead and start her back on 2u tonight and if she drops too much tomorrow morning I'll try the fat 1.75. I will get some day time tests tomorrow and Monday! It's just hard since I work 6:30-2:30pm and she gets her shot at 5am. My bf is a night worker so he sleeps until 11am when he gets a +6 for me. :) but will get more readings next few days! Thanks so much for all the help. So greatful. :)
 
MrWorfMen's Mom said:
Patience! I think Angel is bouncing from that 120 mid cycle last night and she may have gone a bit lower. That bounce can last a few cycles. How old is the insulin? It seemed to work fine last night so I doubt that has anything to do with the numbers today.
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May 12 is when I started the new vile. :)
 
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