? BG 81, should I be worried tonight?

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Today's numbers look like a bounce cycle. I find it hard to recommend a dose based on bounce numbers so i'm looking at yesterday's non-bounce BGs. The 1.5 u dose resulted in a low of 115 (might have been lower before that). On that basis, I think it's worth trying 1.5u again.
 
Kris & Teasel said:
Today's numbers look like a bounce cycle. I find it hard to recommend a dose based on bounce numbers so i'm looking at yesterday's non-bounce BGs. The 1.5 u dose resulted in a low of 115 (might have been lower before that). On that basis, I think it's worth trying 1.5u again.
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K, I will stay with 1.5 for a couple of days. I thought today was a bounce too. I think that my vet thought that staying with the same units for sometime was better than changing it from day to day. But then again changing the dose makes sense as BG numbers fluctuate.When I looked back at marmalades spreadsheets his numbers weren’t that bad, yellows and purples and even blues, I am so afraid that the vet will be annoyed at me if I deviate from her suggestion of 1.5
 
Kris & Teasel said:
Today's numbers look like a bounce cycle. I find it hard to recommend a dose based on bounce numbers so i'm looking at yesterday's non-bounce BGs. The 1.5 u dose resulted in a low of 115 (might have been lower before that). On that basis, I think it's worth trying 1.5u again.
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Do you feel that 1/2 can of food twice a day is enough? I think that 1 3/4 - 2 cans would be more like it
 
mary hornbeck said:
Do you feel that 1/2 can of food twice a day is enough? I think that 1 3/4 - 2 cans would be more like it
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Most of us feed several times a day. My vet originally told me twice a day but I knew it wouldn't work. Teasel gets 4 meals a day and a total of almost two 6 oz. cans a day. He weighs about 12 pounds.
 
Had a quick gander at Marmalade's spreadsheet.

I'm very conservative and traditional in my approach to using Vetsulin. In particular:

1. I don't go for dosing off the preshot with a sliding scale. I look to find a consistent dose which doesn't take the cat too low (both cycles) and which will keep it below the renal threshold for as much of each cycle as possible.

2. For dosing decisions, I take into account the preshot but place more emphasis on nadir BG, especially when the nadir gets down into the medium to lower part of the normal BG range (low 100s as measured on a human meter - see point 3). My reason for this is based on a given dose of Vetsulin's ability to really yank numbers down from even unusually high preshot BGs to potentially worryingly low nadir values.

3. Because there isn't really any linear correspondence between Vetsulin dose and steepness of drop from PS to nadir BG (hence my antipathy toward sliding scale dosing methods) if I were treating my cat with Vetsulin I would be targeting nadirs in the low 100s to allow a very good safety cushion against any BG curveballs the cat might throw. Should a given PS BG be a bit higher than usual I would not increase the dose. (ETA: Vetsulin is rather good at pulling down unusually high preshots without making changes to the current dose.)

4. Once a dose meeting the above criteria was established I would not subsequently increase Vetsulin dose unless there was a clearly identifiable upward trend in average BG levels over a significant number of days.

Looking at the spreadsheet I think that some of the higher PS BGs that result from the higher doses may be a bit bouncy (dropping too hard and bouncing right back up again to compensate). Marmalade's BG levels seem to be smoother on doses in the 1.25 to 1.50 IU range (yellow PS BGs with nadir in low 100s). I think if my cat were responding this way I'd be inclined to set the dose in this range and hold it for several cycles to see if she would even out.

My two penn'orth. Other members may have very different suggestions.


Mogs
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PS:

If, after a reasonable period of treatment, I could not maintain my cat under the renal threshold for most of the day AND with safe nadirs on Vetsulin, I would be looking to discuss switching to Lantus or Levemir with my vet.


Mogs
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Critter Mom said:
PS:

If, after a reasonable period of treatment, I could not maintain my cat under the renal threshold for most of the day AND with safe nadirs on Vetsulin, I would be looking to discuss switching to Lantus or Levemir with my vet.


Mogs
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What would his renal threshold be? Should I consider this change with vet by the numbers on his spreadsheet?
 
mary hornbeck said:
What would his renal threshold be? Should I consider this change with vet by the numbers on his spreadsheet?
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To determine renal threshold you can test urine multiple times using urine glucose test strips. Any BG readings that are associated with a negative urine glucose are below renal threshold. What BG range this is varies with the cat but is somewhere around 200.
 
Kris & Teasel said:
To determine renal threshold you can test urine multiple times using urine glucose test strips. Any BG readings that are associated with a negative urine glucose are below renal threshold. What BG range this is varies with the cat but is somewhere around 200.
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Oh my god, there is no way I could do that
 
mary hornbeck said:
What would his renal threshold be?
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It varies from cat to cat. Also I've never seen a definitive reference range for it anywhere. For example:

From Petdiabetes Wikia:

In diabetic contexts, the renal threshold refers to the blood glucose level at which the kidneys begin to extract glucose from the blood and excrete it into the urine, causing glycosuria.
This level varies considerably among individuals. A pet's renal threshold is usually somewhere between 180 and 270 mg/dL (10 to 15 mmol/L). Once you have determined the threshold for a given animal, it will likely remain there. The threshold is likely higher for cats than dogs -- The Animal Emergency Center of Milwaukee, WI[1] uses these renal threshold values for interpreting their lab results: dogs: 180 mg/dL, cats: 290 mg/dL. The Merck Veterinary Manual has the same 180 mg/dL value for dogs, but listes 240 mg/dL as the feline threshold[2]
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From the Vetsulin Website:

The duration of insulin action is measured from the time of Vetsulin® (porcine insulin zinc suspension) injection, followed by a fall in blood glucose concentration, to the time that blood glucose exceeds the renal threshold concentration of 200 to 280 mg/dL in cats.
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The vets I've dealt with here tend to use 11.1mmol/L / 200mg/dL (as measured on pet-calibrated equipment) as a nominal renal threshold.

You can have a stab at establishing a rough idea of a given cat's renal threshold by testing its urine at home and analysing results alongside home BG tests but it's fairly crude. If the cat remains consistently negative for glycosuria over a series of tests then the highest BG values for the corresponding period will be under the renal threshold for that cat. As I said, crude.


mary hornbeck said:
Should I consider this change with vet by the numbers on his spreadsheet?
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Didn't I read above that your vet already recommended the 1.5IU dose? (Sorry if I've got this wrong.)

ETA: Mea culpa! I misunderstood your question. I see now that you're asking about whether you should consider discussing a change of insulin with your vet.

I think if I were in this position I'd try holding the dose recommended by the vet for several days (up to a week) unless it needed reducing, and then re-evaluate.

Vetsulin can work well for some cats, others not so much. Much of the time the problem is very often one of inadequate duration; the dose peters out too soon and numbers at preshot tend therefore to be a good deal higher than desirable. This then leads to setting doses which either drop the cat too fast (and often too far) or which don't move the BG into sufficiently effective ranges during the insulin's peak period of action.

The L insulins (Lantus and Levemir) typically don't tend to produce such wide swings in BG (when a 'good' dose is established) and they have greater duration in cats. This means that they're better at keeping numbers down (cf. the likes of Vetsulin and Novolin N which typically yank numbers down) and the range in BG levels between PS and nadir tends to be narrower on average.

Choice of insulin depends on the cat's response (is the current insulin keeping the cat properly regulated?) and the caregiver's situation (can caregiver test frequently enough and dose on a consistent 12/12 basis the vast majority of the time (as required by depot insulins) or is more flexibility required (an in-out with better duration such as Prozinc might be more suitable).

A given vet's view of what constitutes satisfactory regulation in a diabetic cat will influence how they interpret a cat's BG data and the judgments they will make about the effectiveness of the insulin in use. Regulation goals can vary from vet to vet. For example, some vets are happy if BG levels stay under 300mg/dL for most of the day with the cat spending at least a fair proportion of each day under the renal threshold. Other vets may only consider the cat to be well-regulated if it remains under the renal threshold.

Your objectives for Marmalade's treatment may perhaps be more ambitious than those of your vet, especially as you're home testing. It might be helpful to discuss treatment objectives with your vet so that you'll both be on the same page. With this established it should provide a good foundation for evaluating Vetsulin's effectiveness (or possible lack thereof) in adequately regulating Marmalade's blood glucose levels. Thereafter you could discuss other possible insulin choices.


Mogs
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Critter Mom said:
It varies from cat to cat. Also I've never seen a definitive reference range for it anywhere. For example:

From Petdiabetes Wikia:



From the Vetsulin Website:



The vets I've dealt with here tend to use 11.1mmol/L / 200mg/dL (as measured on pet-calibrated equipment) as a nominal renal threshold.

You can have a stab at establishing a rough idea of a given cat's renal threshold by testing its urine at home and analysing results alongside home BG tests but it's fairly crude. If the cat remains consistently negative for glycosuria over a series of tests then the highest BG values for the corresponding period will be under the renal threshold for that cat. As I said, crude.



Didn't I read above that your vet already recommend the 1.5IU dose? (Sorry if I've got this wrong.)


Mogs
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Yes, she did. I tend to repeat myself, sorry
 
Hi Mary,

Just popped in to have a look at Marmalade's spreadsheet. Marmalade seems to be settling somewhat and getting better mid-cycle numbers on the 1.5IU dose. How is he feeling/acting? Any better?

What times do you feed Marmalade on the AM and PM cycles? (Times relative to insulin dose time.)


Mogs
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Critter Mom said:
Hi Mary,
PS
Just popped in to have a look at Marmalade's spreadsheet. Marmalade seems to be settling somewhat and getting better mid-cycle numbers on the 1.5IU dose. How is he feeling/acting? Any better?

What times do you feed Marmalade on the AM and PM cycles? (Times relative to insulin dose time.)


Mogs
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Hi a Critter Mom:
Thank you for taking a peak at marmalades SS. He seems to be doing very well on the 1.5IU dose. I have even gotten some blues inbetween the AMPS and PMPS. He is alert and hanging a lot with me on my bed. He is getting fed at 6a and 6p which seems to be working well. I have changed the amount of food to 1/2 cans twice a day. Prior, last week I was feeding him up to 4 cans of the friskies per day. It seems like the half can twice a day is keeping his numbers down. At first I didn’t think that this would hold him over but he is keeping the weight on and is showing no signs of bowel problems. He is always Hungary in his head so that’s nothing new. I just updated his SS if you want to take another peak.
 
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Hi Mary,

Glad to hear that Marmalade's doing well on the new feeding routine and that the 1.5IU dose seems to have evened him out a bit. Check out those improvements in the preshot BGs! :)

Is there any time when you'd be able to snag some more BG checks between +3 and +6? These are the hours when nadir is more likely to occur in a Vetsulin kitty, although ECID. Especially with those lower PS values you're seeing you need to keep a close eye to see how low the dose is taking Marmalade mid-cycle to make sure he's safe. The Vetsulin seems to kick in fairly early in the cycle in Marmalade's case, as you can see by the drops in BG between the preshot and +2 readings.


Mogs
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Critter Mom said:
Hi Mary,

Glad to hear that Marmalade's doing well on the new feeding routine and that the 1.5IU dose seems to have evened him out a bit. Check out those improvements in the preshot BGs! :)

Is there any time when you'd be able to snag some more BG checks between +3 and +6? These are the hours when nadir is more likely to occur in a Vetsulin kitty, although ECID. Especially with those lower PS values you're seeing you need to keep a close eye to see how low the dose is taking Marmalade mid-cycle to make sure he's safe. The Vetsulin seems to kick in fairly early in the cycle in Marmalade's case, as you can see by the drops in BG between the preshot and +2 readings.


Mogs
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I can try tomorrow to get some +3 and +6, would that be at both am and pm, right
 
mary hornbeck said:
I can try tomorrow to get some +3 and +6, would that be at both am and pm, right
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Critter Mom said:
Hi Mary,

Glad to hear that Marmalade's doing well on the new feeding routine and that the 1.5IU dose seems to have evened him out a bit. Check out those improvements in the preshot BGs! :)

Is there any time when you'd be able to snag some more BG checks between +3 and +6? These are the hours when nadir is more likely to occur in a Vetsulin kitty, although ECID. Especially with those lower PS values you're seeing you need to keep a close eye to see how low the dose is taking Marmalade mid-cycle to make sure he's safe. The Vetsulin seems to kick in fairly early in the cycle in Marmalade's case, as you can see by the drops in BG between the preshot and +2 readings.


Mogs
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back in the purple, PMPS
 
mary hornbeck said:
I can try tomorrow to get some +3 and +6, would that be at both am and pm, right
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A +5 might be more helpful than a +6, BTW, as it will help 'fill in the picture' a bit more. :) If you get the +3 and +5 on the AM cycle and a +3 on the PM cycle that would be great. :)


Mogs
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Nice to see Marmalade back in blues. Will try to check back in tomorrow evening to see how you both get on. :)


Mogs
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Hi Mary,

Just had a gander at Marmalade's spreadsheet. What a sprag that he was too low to dose on yesterday's AM cycle! :rolleyes: I had hoped you'd be able to get a look at whether Marmalade goes lower earlier in the cycle on the current dose. Nevertheless, the data you gathered is still helpful because it gives you a snapshot of how he'd be doing if he wasn't getting any insulin at all. There's no such thing as bad data! :)

The PM +3 was a little higher than in recent cycles but that may be due to the skipped AM dose. Although technically the effect of each Vetsulin dose is supposed to be out of the system within 12 hours it is possible to get a slight carryover of effect into the next cycle in some cats. Since Marmalade didn't have any insulin yesterday morning it is possible that he may be getting a teensy bit of carryover effect between doses and if so absence of that effect could account for the slightly higher than usual PM+3 yestereve. Or he may just have eaten a bit more early in the PM cycle. Impossible to draw any conclusions on only a few data points.


Mogs
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Critter Mom said:
Hi Mary,

Just had a gander at Marmalade's spreadsheet. What a sprag that he was too low to dose on yesterday's AM cycle! :rolleyes: I had hoped you'd be able to get a look at whether Marmalade goes lower earlier in the cycle on the current dose. Nevertheless, the data you gathered is still helpful because it gives you a snapshot of how he'd be doing if he wasn't getting any insulin at all. There's no such thing as bad data! :)

The PM +3 was a little higher than in recent cycles but that may be due to the skipped AM dose. Although technically the effect of each Vetsulin dose is supposed to be out of the system within 12 hours it is possible to get a slight carryover of effect into the next cycle in some cats. Since Marmalade didn't have any insulin yesterday morning it is possible that he may be getting a teensy bit of carryover effect between doses and if so absence of that effect could account for the slightly higher than usual PM+3 yestereve. Or he may just have eaten a bit more early in the PM cycle. Impossible to draw any conclusions on only a few data points.


Mogs
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Got a +3 today, the 15th, and he’s definately not going lower, which is a good thing.
 
It's great that you got the test, Mary, but this AM cycle it was only a dose of 1.0 IU; unfortunately it doesn't shed any light on how Marmalade responds to the 1.5IU dose on the AM cycle. I was hoping that yesterday you might have been able to see whether Marmalade goes to a low-ish AM nadir on the 1.5IU dose, and whether as a consequence there might be a little bit of bounce influence to send him higher at PMPS.

Looking at Marmalade's spreadsheet, on the 1.5IU dose of Vetsulin he seems to have a pattern of having AMPS values on the low side (too low to give Vetsulin yesterday AM), but then he has those high PMPS values.

>> Is there any difference in his feeding routines between AM and PM cycles (particularly the 2nd part of each cycle)?

>> Is there any way you might be able to get some BG tests done between +6 and +10 on the PM cycle some time over the next few days? (Suggesting this to better understand whether Marmalade is rising or falling when he gets blue AMPS numbers.)

Sometimes when a cat has a pattern of 'lopsided' PS values where one of the PS BGs is frequently too low to safely dose, then dropping the dose down a little can sometimes lead to two 'shootable' PS numbers and more consistent dosing of insulin. PS levels and cycle nadirs (and ketone status, if applicable) all need to be assessed when considering such dosing decisions. There are still gaps in Marmalade's 'picture' so you don't know whether or not such a dosing strategy would help (1.0IU looks like that's too little insulin for him) but hopefully with a little more strategic testing you'll be able to fill in those gaps and better understand what's happening. This should hopefully make treatment decisions more straightforward. :)


Mogs
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Critter Mom said:
It's great that you got the test, Mary, but this AM cycle it was only a dose of 1.0 IU; unfortunately it doesn't shed any light on how Marmalade responds to the 1.5IU dose on the AM cycle. I was hoping that yesterday you might have been able to see whether Marmalade goes to a low-ish AM nadir on the 1.5IU dose, and whether as a consequence there might be a little bit of bounce influence to send him higher at PMPS.

Looking at Marmalade's spreadsheet, on the 1.5IU dose of Vetsulin he seems to have a pattern of having AMPS values on the low side (too low to give Vetsulin yesterday AM), but then he has those high PMPS values.

>> Is there any difference in his feeding routines between AM and PM cycles (particularly the 2nd part of each cycle)?

>> Is there any way you might be able to get some BG tests done between +6 and +10 on the PM cycle some time over the next few days? (Suggesting this to better understand whether Marmalade is rising or falling when he gets blue AMPS numbers.)

Sometimes when a cat has a pattern of 'lopsided' PS values where one of the PS BGs is frequently too low to safely dose, then dropping the dose down a little can sometimes lead to two 'shootable' PS numbers and more consistent dosing of insulin. PS levels and cycle nadirs (and ketone status, if applicable) all need to be assessed when considering such dosing decisions. There are still gaps in Marmalade's 'picture' so you don't know whether or not such a dosing strategy would help (1.0IU looks like that's too little insulin for him) but hopefully with a little more strategic testing you'll be able to fill in those gaps and better understand what's happening. This should hopefully make treatment decisions more straightforward. :)


Mogs
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So that would be at 12a and 4a?,on the PMPS, he gets fed at 6p
 
I don't know the clock times (we're all in different time zones). The reason we use the '+' notation is because of the need to know what the BG is doing at a certain time after the insulin has been given, since there are variations in the way different insulins work (their 'action profiles').

In saying that, it would be very helpful to you to get readings in the period +6 to +10 it could be a +6, +7, +8, +9, or +10 reading. The time of day depends on the time you give the dose.

mary hornbeck said:
on the PMPS, he gets fed at 6p
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Does he get any food later than that? If yes, then when?

Also, when does he get fed on the AM cycle?


Mogs
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Critter Mom said:
It's great that you got the test, Mary, but this AM cycle it was only a dose of 1.0 IU; unfortunately it doesn't shed any light on how Marmalade responds to the 1.5IU dose on the AM cycle. I was hoping that yesterday you might have been able to see whether Marmalade goes to a low-ish AM nadir on the 1.5IU dose, and whether as a consequence there might be a little bit of bounce influence to send him higher at PMPS.

Looking at Marmalade's spreadsheet, on the 1.5IU dose of Vetsulin he seems to have a pattern of having AMPS values on the low side (too low to give Vetsulin yesterday AM), but then he has those high PMPS values.

>> Is there any difference in his feeding routines between AM and PM cycles (particularly the 2nd part of each cycle)?

>> Is there any way you might be able to get some BG tests done between +6 and +10 on the PM cycle some time over the next few days? (Suggesting this to better understand whether Marmalade is rising or falling when he gets blue AMPS numbers.)

Sometimes when a cat has a pattern of 'lopsided' PS values where one of the PS BGs is frequently too low to safely dose, then dropping the dose down a little can sometimes lead to two 'shootable' PS numbers and more consistent dosing of insulin. PS levels and cycle nadirs (and ketone status, if applicable) all need to be assessed when considering such dosing decisions. There are still gaps in Marmalade's 'picture' so you don't know whether or not such a dosing strategy would help (1.0IU looks like that's too little insulin for him) but hopefully with a little more strategic testing you'll be able to fill in those gaps and better understand what's happening. This should hopefully make treatment decisions more straightforward. :)


Mogs
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There is no difference in his feeding routines. I’ll try to do some +6 and +10 done over the next couple of days if not the weekend. I have also been wondering if he’s rising or falling by the later end of
PMPS but it’s rough when I am early for work
Critter Mom said:
I don't know the clock times (we're all in different time zones). The reason we use the '+' notation is because of the need to know what the BG is doing at a certain time after the insulin has been given, since there are variations in the way different insulins work (their 'action profiles').

In saying that it would be very helpful to you to get readings in the period +6 to +10 it could be a +6, +7, +8, +9, or +10 reading. The time of day depends on the time you give the dose.


Does he get any food later than that? If yes, then when?

Also, when does he get fed on the AM cycle?


Mogs
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sorry this is so late. After 6p he doesn’t get any food. On the am cycle he gets fed at 6a and in the evening he is a 6p. I just got a BG this evening and posted in main health forum but nobody responded so I went ahead and gave him 1.5u, see SS. Correction, someone just got back to me.
 
Critter Mom said:
It's great that you got the test, Mary, but this AM cycle it was only a dose of 1.0 IU; unfortunately it doesn't shed any light on how Marmalade responds to the 1.5IU dose on the AM cycle. I was hoping that yesterday you might have been able to see whether Marmalade goes to a low-ish AM nadir on the 1.5IU dose, and whether as a consequence there might be a little bit of bounce influence to send him higher at PMPS.

Looking at Marmalade's spreadsheet, on the 1.5IU dose of Vetsulin he seems to have a pattern of having AMPS values on the low side (too low to give Vetsulin yesterday AM), but then he has those high PMPS values.

>> Is there any difference in his feeding routines between AM and PM cycles (particularly the 2nd part of each cycle)?

>> Is there any way you might be able to get some BG tests done between +6 and +10 on the PM cycle some time over the next few days? (Suggesting this to better understand whether Marmalade is rising or falling when he gets blue AMPS numbers.)

Sometimes when a cat has a pattern of 'lopsided' PS values where one of the PS BGs is frequently too low to safely dose, then dropping the dose down a little can sometimes lead to two 'shootable' PS numbers and more consistent dosing of insulin. PS levels and cycle nadirs (and ketone status, if applicable) all need to be assessed when considering such dosing decisions. There are still gaps in Marmalade's 'picture' so you don't know whether or not such a dosing strategy would help (1.0IU looks like that's too little insulin for him) but hopefully with a little more strategic testing you'll be able to fill in those gaps and better understand what's happening. This should hopefully make treatment decisions more straightforward. :)


Mogs
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Hi, got somewhat of a curve last night but couldn’t keep my eyes open past 3a, any thoughts would be welcomed at this point. Updated SS for interpretation from any members
 
Hi Mary,

You did great last night! I'm so glad that you caught that 82! Good job getting the additional tests today, too. :)

I'll respond tomorrow (I've got chronic health issues and I'm in a lot of pain right now). When you next get a chance, it would be great if you could get some tests on the AM cycle between the hours of +4 and +7 after the dose, as your schedule permits.

How is Marmalade feeling/behaving on the 1.5IU dose, BTW?

Nice PMPS tonight, BTW. Be sure to get a 'before bed' test for safety - at +3 after PM dose.


Mogs
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Critter Mom said:
Hi Mary,

You did great last night! I'm so glad that you caught that 82! Good job getting the additional tests today, too. :)

I'll respond tomorrow (I've got chronic health issues and I'm in a lot of pain right now). When you next get a chance, it would be great if you could get some tests on the AM cycle between the hours of +4 and +7 after the dose, as your schedule permits.

How is Marmalade feeling/behaving on the 1.5IU dose, BTW?

Nice PMPS tonight, BTW. Be sure to get a 'before bed' test for safety.


Mogs
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He is doing great, alert and feisty. He is a little uncooperative with the ear sticks so I think that I’ll give him a break for now. It seems that the 1.5IU is working well for him. I hope you feel better. He loves to,play with hair ties. I think over the weekend I’ll work on your suggestions for the am cycle in terms of data. Looking forward to hear your interpretation of last night.
 
Kris & Teasel said:
So far the 1.5 u dose seems to be a good one. :)
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Glad to see you here, Kris, because I'd appreciate it if you would review my thinking re Marmalade's current status.

Holding the 1.5IU dose has, IMO, been far more successful than the 'sliding scale' approach. We're now getting a much better picture of Marmalade's response, and he has evened out a fair bit. However ...

I've been keeping an eye on Marmalade's spreadsheet recently. Before Mary got all the recent, very helpful data I was already thinking that he might even out more on a lower dose (see post #235 above) and have more balanced preshot BGs which would, in turn, lessen the likelihood of needing to skip a dose. I was also very much wondering whether he might be going a bit low mid-cycle and getting bounce-influenced PS BGs as a consequence. As you can see from the spreadsheet, Marmalade has started seeing some PS BGs in much better numbers since Mary has been holding the dose at 1.5IU, which also lends weight to the suspicion that bouncing may be elevating some of the other PS readings.

Mary has done a great job of monitoring over the last few days (great catch on the 56 last night, Mary!). The 82 nadir the night before last was, to my way of thinking, already too low for comfort for a cat on Vetsulin but last night's 56 nadir is, in my considered opinion, definitely way too low a nadir for a Vetsulin cat and therefore I think Marmalade's current dose of Vetsulin is now too high.

If it were my cat, I would not be at all comfortable with Vetsulin nadirs as low as we now know Marmalade has been getting. I would instead seek to adjust the dose to target a nadir BG in the low 100s (human meter). This would leave a good safety buffer in case anything unexpected might cause a dip to a lower BG.

This would be my approach:

* If I was able to monitor closely I would reduce to 1.25IU BID for a few cycles and then reassess UNLESS the nadir got below the 90-100 range, in which case I would reduce again on the next cycle.

* If I was not able to monitor closely, I'd be inclined to reduce to 1.0IU BID for a few cycles and then reassess the situation (again assuming that there were neither too-low nadirs nor sky-high BGs in the meantime).

* I would monitor urine daily for ketones as a precaution.

ETA: I would religiously do 'before bed' checks every night for safety. Indeed, I'd do my level best to get a nadir BG check on each cycle. (Obviously people's schedules vary but getting nadir data whenever possible is becoming increasingly important here).

My hope would be that a reduced dose might reduce bounce influence on the PS BGs and also keep Marmalade in a safer range at nadir, evening him out overall.

Kris, I'd very much welcome your feedback and comments on the above.


Mogs
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Critter Mom said:
Glad to see you here, Kris, because I'd appreciate it if you would review my thinking re Marmalade's current status.

Holding the 1.5IU dose has, IMO, been far more successful than the 'sliding scale' approach. We're now getting a much better picture of Marmalade's response, and he has evened out a fair bit. However ...

I've been keeping an eye on Marmalade's spreadsheet recently. Before Mary got all the recent, very helpful data I was already thinking that he might even out more on a lower dose (see post #235 above) and have more balanced preshot BGs which would, in turn, lessen the likelihood of needing to skip a dose. I was also very much wondering whether he might be going a bit low mid-cycle and getting bounce-influenced PS BGs as a consequence. As you can see from the spreadsheet, Marmalade has started seeing some PS BGs in much better numbers since Mary has been holding the dose at 1.5IU, which also lends weight to the suspicion that bouncing may be elevating some of the other PS readings.

Mary has done a great job of monitoring over the last few days (great catch on the 56 last night, Mary!). The 82 nadir the night before last was, to my way of thinking, already too low for comfort for a cat on Vetsulin but last night's 56 nadir is, in my considered opinion, definitely way too low a nadir for a Vetsulin cat and therefore I think Marmalade's current dose of Vetsulin is now too high.

If it were my cat, I would not be at all comfortable with Vetsulin nadirs as low as we now know Marmalade has been getting. I would instead seek to adjust the dose to target a nadir BG in the low 100s (human meter). This would leave a good safety buffer in case anything unexpected might cause a dip to a lower BG.

This would be my approach:

* If I was able to monitor closely I would reduce to 1.25IU BID for a few cycles and then reassess UNLESS the nadir got below the 90-100 range, in which case I would reduce again on the next cycle.

* If I was not able to monitor closely, I'd be inclined to reduce to 1.0IU BID for a few cycles and then reassess the situation (again assuming that there were neither too-low nadirs nor sky-high BGs in the meantime).

* I would monitor urine daily for ketones as a precaution.

ETA: I would religiously do 'before bed' checks every night for safety. Indeed, I'd do my level best to get a nadir BG check on each cycle. (Obviously people's schedules vary but getting nadir data whenever possible is where at all possible getting nadir BG data is becoming increasingly important for Marmalade's safety).

My hope would be that a reduced dose might reduce bounce influence on the PS BGs and also keep Marmalade in a safer range at nadir, evening him out overall.

Kris, I'd very much welcome your feedback and comments on the above.


Mogs
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Your analysis is spot on, Mogs. :) I admit that I scanned the data quickly and neglected to factor in the insulin. Yes, I agree that a bit of a cushion at nadir is a good thing when using Vetsulin. I also think that consistent dosing has calmed things down. Thanks for doing this!
 
@Kris & Teasel - Thank you very much for reviewing and commenting on my input. I really don't feel comfortable being a voice in the wilderness when it comes to matters dose-related.


Mogs
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@mary hornbeck -

I'm about to sign off but I just wanted to say that if Marmalade was my cat I would reduce his Vetsulin dose because I don't think the 1.5IU dose is safe. See my earlier post (#245) for reasoning, and suggestions on how to proceed. If you get stuck tonight, I suggest asking for help on the Feline Health board.

ETA: I'd recommend getting tests at +3 as often as possible (especially on the PM cycle) and if he's already dropped a good bit by then I'd recommend further tests in that cycle to make sure Marmalade isn't going too low.


Mogs
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Critter Mom said:
Hi Mary,

How many hours are you away from tonight's PMPS?


Mogs
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Hi mogs,I’m so sorry that I missed you. I was really nervous last night when he got low so,I gave him some fancy feast with gravy and that brought him up to safer numbers. I was kind of thinking the same thing that the 1.5u was taking him to low.

Since I didn’t see this message earlier I updated his SS and went with his 1.5Iu dose tonight. I also gave him a can of beyond pheasant and sweet potatoe food to see if his scratching would ease up. I plan to get at least a +3 tonight.
 
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