Do any Vetsulin users only dose once in the A.M?

[vbc2000]

Good Morning all
I haven't done a full day curve on Tigger since switching to lower carb food and decreased Prednisolone, but spot checking him seems to indicate one A.M. dose of 2 units might be enough. Yesterday was an unusual day and I have to update my spreadsheet but he ate a full can of Fancy Feast in the morning. His blood sugar before eating was around 260 so he got 2 units and then at +7 he was about 129. I was overjoyed. We had an evening party to go to so I left him with another can of Fancy Feast in a isolation room while we were out and he ate another full can't over a few hours. We came home later than when his p.m. shot would have been and he did not seem hungry again and his blood sugar was still 129. That was at about +14 from his morning dose and two cans of food. If I had been home and his pmps was 129 I would not have given him insulin when I fed him.

I'm wondering if he could possibly be regulated on one shot of two units in the morning? Has that happened with anyone?

 

[MrWorfMen's Mom]

There may have been some cats getting only one shot per day but I would venture to say that this has occurred when a kitty's BG was staying pretty close to normal much of the time and needed only periodic support with insulin to try to get to remission. Vetsulin does not typically last for 12 hours (more commonly lasts 8-10 hours) so doing one shot per day sets up a roller coaster of highs and lows and will make Tigger feel unwell. Drops of more than 50% of the pre-shot reading set off bouncing where BG becomes elevated because the body panics when the BG falls too quickly or too low. If you continue to set off bounces, you never really know what kitty's "real" BG level is and you risk giving insulin for a high pre-shot only to have the bounce break mid cycle setting off more bouncing or causing BG to drop to dangerously low levels.

Given what I can see on the spreadsheet and what you've indicated above, Tigger is frequently getting drops exceeding 50% of pre-shot numbers. I'd venture a guess that Tigger's BG was much lower than 129 at some point yesterday given that reading was at +7 post shot. Normal low point for Vetsulin is between +4 and +6 and from your data Tigger seems of often follow that pattern. With his BG still at 129 last night, I would be concerned that his natural defences against hypoglycemia are being pushed to their limit as a result of all the bouncing he's been doing on the 2u dose. You gave 2u on a pre-shot of 139 on the 26th of July and I suspect he likely went very low that night too. The reading of 55 the evening of the 28th was far too low and dangerous. On a pet meter 68 is the bottom of normal BG and with Vetsulin, I strongly suggest you aim to keep Tigger's BG no lower than 90 at nadir (lowest point in cycle) to allow a little extra cushion so you have time to intervene should BG be dropping quickly.

If I were you, I would not give insulin at any pre-shot below 250 at this point, immediately reduce the dose to 1u and give 2 shots per day when pre-shots and mid cycle BG readings dictate it is safe to do so. I am seriously concerned that Tigger's natural defences are getting tired and he is at risk of going too low on the dosing you are are currently giving him.

If you can get the spreadsheet updated, we would be more than happy to help you get Tigger on a smoother path toward regulation but right now, there is a lot of data missing and all we can do is guess at what is going on and caution you based on what data we have.

 

[vbc2000]

There may have been some cats getting only one shot per day but I would venture to say that this has occurred when a kitty's BG was staying pretty close to normal much of the time and needed only periodic support with insulin to try to get to remission. Vetsulin does not typically last for 12 hours (more commonly lasts 8-10 hours) so doing one shot per day sets up a roller coaster of highs and lows and will make Tigger feel unwell. Drops of more than 50% of the pre-shot reading set off bouncing where BG becomes elevated because the body panics when the BG falls too quickly or too low. If you continue to set off bounces, you never really know what kitty's "real" BG level is and you risk giving insulin for a high pre-shot only to have the bounce break mid cycle setting off more bouncing or causing BG to drop to dangerously low levels.

Given what I can see on the spreadsheet and what you've indicated above, Tigger is frequently getting drops exceeding 50% of pre-shot numbers. I'd venture a guess that Tigger's BG was much lower than 129 at some point yesterday given that reading was at +7 post shot. Normal low point for Vetsulin is between +4 and +6 and from your data Tigger seems of often follow that pattern. With his BG still at 129 last night, I would be concerned that his natural defences against hypoglycemia are being pushed to their limit as a result of all the bouncing he's been doing on the 2u dose. You gave 2u on a pre-shot of 139 on the 26th of July and I suspect he likely went very low that night too. The reading of 55 the evening of the 28th was far too low and dangerous. On a pet meter 68 is the bottom of normal BG and with Vetsulin, I strongly suggest you aim to keep Tigger's BG no lower than 90 at nadir (lowest point in cycle) to allow a little extra cushion so you have time to intervene should BG be dropping quickly.

If I were you, I would not give insulin at any pre-shot below 250 at this point, immediately reduce the dose to 1u and give 2 shots per day when pre-shots and mid cycle BG readings dictate it is safe to do so. I am seriously concerned that Tigger's natural defences are getting tired and he is at risk of going too low on the dosing you are are currently giving him.

If you can get the spreadsheet updated, we would be more than happy to help you get Tigger on a smoother path toward regulation but right now, there is a lot of data missing and all we can do is guess at what is going on and caution you based on what data we have.

Thank you for your input. I will update the spreadsheet and probably do a full curve this week.

 

[MrWorfMen's Mom]

Curves are fine and can be useful in some cases but with all the highs and lows you are getting currently, I don't think a curve is going to give you an accurate picture of how Tigger is doing. Curves give you a picture of one day and if they happen to be running high or low that day, it doesn't help much and can lead to the wrong conclusions. What you need to know is what is happening over a period of time to sort out how to adjust dosing. I would strongly suggest grabbing some tests around the +2 point in each cycle if you can, to see how quickly Tigger is starting to drop. If he has dropped a lot (100 points or more) then feeding him another snack of LC wet food at that time may slow the drop down and at least lessen some of the bouncing. Then testing again randomly, depending on the +2 reading, between +4 and +7 should give you a better idea of what Tigger is up to.

 

[vbc2000]

I have a question about bouncing...

If you look at my updated SS, on days like 7/24, 7/29 and 7/30, he isn't bouncing back up PMPS. He started the day kinda high, then during the day he went down but didn't bounce back up PMPS. That's not really bouncing is it? I was told to cut down on testing by the vet (I am assuming it's because Tigger's ears told a tale of too much testing) so that's why I don't have many readings lately.

 

[Kris & Teasel]

Spreadsheet patterns can be hard to decipher especially when a lot of changes have happened in a short time. The pattern you describe of BG starting higher and then declining to a lower number by next dose time can be related to a dose that's too high and the insulin has longer duration as a result. It can also happen when BG that has been propped up high by the bouncing phenomenon comes down because the internal processes that cause bouncing have settled. It's then that you can begin to see the true effect of a dose.

 

[vbc2000]

Spreadsheet patterns can be hard to decipher especially when a lot of changes have happened in a short time. The pattern you describe of BG starting higher and then declining to a lower number by next dose time can be related to a dose that's too high and the insulin has longer duration as a result. It can also happen when BG that has been propped up high by the bouncing phenomenon comes down because the internal processes that cause bouncing have settled. It's then that you can begin to see the true effect of a dose.

Thanks for the input. I'm hoping it's because of the latter, that he is settling down from bouncing.

 

[Elizabeth and Bertie]

If I were you, I would not give insulin at any pre-shot below 250 at this point, immediately reduce the dose to 1u and give 2 shots per day when pre-shots and mid cycle BG readings dictate it is safe to do so.
I am seriously concerned that Tigger's natural defences are getting tired and he is at risk of going too low on the dosing you are are currently giving him.

@vbc2000 , I absolutely second Linda's advice above.

The BG data shows that the 2 units is too high a dose.
And these repeated low numbers could be putting Tigger at risk. His body's glycogen stores may become depleted and make him susceptible to hypoglycemia.

Lowering the dose will help to keep Tigger safe, and may also even out the BG numbers.

Generally, we recommend that those new to diabetes (and using Vetsulin) aim to not let the BG drop below 90 - 100, as measured on a human glucose meter. So, those using pet meters - which usually 'read higher' than human meters - may even want to increase that to maybe 115 - 125 mg dL.

The fact that you are seeing some low preshot numbers could actually be good news. Tigger may be one of those who gets better than average duration from Vetsulin. Or it may be that his pancreas is beginning to produce a little insulin and is able to extend the cycle on some occasions.
.

 

[vbc2000]

@vbc2000 , I absolutely second Linda's advice above.

The BG data shows that the 2 units is too high a dose.
And these repeated low numbers could be putting Tigger at risk. His body's glycogen stores may become depleted and make him susceptible to hypoglycemia.

Lowering the dose will help to keep Tigger safe, and may also even out the BG numbers.

Generally, we recommend that those new to diabetes (and using Vetsulin) aim to not let the BG drop below 90 - 100, as measured on a human glucose meter. So, those using pet meters - which usually 'read higher' than human meters - may even want to increase that to maybe 115 - 125 mg dL.

The fact that you are seeing some low preshot numbers could actually be good news. Tigger may be one of those who gets better than average duration from Vetsulin. Or it may be that his pancreas is beginning to produce a little insulin and is able to extend the cycle on some occasions.
.

Thank you for taking time to respond. I absolutely will talk to the vet about a lower dose to leave more room to guard against hypoglycemia. I hope his little pancreas is starting to work better. The decreasing prednisone and switching to low carb food has made a huge difference. I am sorry I waited so long to switch. I was just very hesitant because of his skin allergies.