BG Down to 84???

@Marje and Gracie, @Panic, @JanetNJ Susie's +4 test was down to 84. Should I check it again in 30 minutes? Also, I had just increased her Vetsulin from 1 unit to 1.25 units last night. I've been giving her 1.25 units in the morning. Should I reduce back to 1 unit at night since I don't test much at all at night? How low before I start taking steps to increase the blood glucose?

Just checked again @+4.5 and she is back up to 98 so I am relieved. But, once again, on Vetsulin - when do I start to get nervous about the blood glucose? Is it at <90 or <70?

 

Hello--

I'm not a Vetsulin user, but I didn't want your questions to go unanswered too long, so I'll do my best!

My understanding is that, with an insulin like Vetsulin, you are "aiming" for numbers no lower than the ones you are seeing today. The main dosing method used for vetsulin in the insulin-specific-board, BEGINNER'S GUIDE TO CANINSULIN/VETSULIN, recommends that any number under 90 means an immediate 0.25U dose reduction.

Beyond that, with a human meter like the relion, any number under 50 requires carbs and every-30-mins testing until she comes up. However, with Vetsulin, often you want to be more proactive when they start hitting greens, well before they get to that point. I think what you did today (starting to test more aggressively once she went into greens) was perfect; if it had happened earlier in the cycle I'd probably have added some carbs to the mix to try to slow her down. The vetsulin folks may be able to be more specific than those general recommendations, but that's my take.

Nice to see the greens! I'd keep testing to be certain she keeps going up, just in case.

 

Thank you so much! I appreciate the info. I keep forgetting to look at the Caninsulin/Vetsulin info. The greens make me nervous with Vetsulin. I have to watch carefully if the BG goes down below 90. I will reduce her insulin back to 1 unit for both shots. She has been very bouncy. I get better results with the 1.25 units in the morning but just cranked it up from 1 unit to 1.25 last night. Maybe it was too much. Her nadirs are coming early these days and I don't really understand why but I really don't understand much of this diabetes disease to begin with. I am learning - slowly. Thanks again for your support!

 

Nadirs do tend to shift, especially on Vetsulin.

But you are correct to reduce the dose based on the 85 you saw. If at 1U she swings back up to numbers more like the last few days, you may want to try holding the 1.25U for a bit longer (it may be that 1.25U brings her down to around 80s and no lower). Or doing a slightly different AM vs PM dose.

I think yesterday may have been a small bounce from the lower numbers on the 7th.

I suspect she may also bounce from seeing greens today, so don't be surprised if she's higher than expected tonight and tomorrow. Just hold the 1U dose for the next few days, provided it's safe to give (PS in the right range, no tests below 90 again)

 

Do you think I can keep her at 1.25 units in the morning and reduce to 1 unit at night? That is what I have been doing for a few days now and, other than yesterday (2/8), she was getting some comfortable blues. I just think I jumped the gun raising her night unit to 1.25 last night. Besides, I don't do much testing at night so maybe I should not be taking the risk. Does the bouncing ever end?

 

Gah it wiped my reply

Its a bit hard to say without as much night time data...for now I'd hold 1U for a few days and see what happens. I still think 1.25U is likely a good dose for her both AM and PM, but better to go slow and safe.

One of the things you appear to be "fighting" is she doesn't seem to be going as low at night. Which results in a higher AMPS, then a faster/bigger drop with the higher AM dose, then a bounce back up.

Some cats really are just bouncy and do eventually even out...but with Vetsulin being as harsh at it is on some cats (yours appears to be one of them maybe), you may need to go with a more gentle insulin like ProZinc or Lantus.

You could try slowing the drops by playing with her feeding schedule. For example, a smaller meal at AMPS, then some additional food at +2/+3. But I say one step at a time, let's see what happens at 1U for a bit.

 

I'm definitely going back to 1 unit at night. Will look at her AMPS tomorrow. If it is really high I might stay with the 1.25 in the morning. I'm not sure if she is not going lower at night. I tested last night at +5 and she was at 208. Based on today's results I think I need to check earlier than +5 tonight. Maybe at +3 or +4. She is really hungry at AMPS and PMPS. I think she needs a full, 3oz can of food at this time. Maybe I should go back to the mini meals (1/4 can) and spread them out during the morning/day instead of giving her a full 1/2 can at +6 and nothing in between. I go to bed early so have been giving her a 1/2 can around +2 in the evening. Will check her around +4 tonight. Thanks, FrostD.

By the way, I spoke with the pharmacist earlier today and she has 5 Lantus Solarstar pens ready for me to pick up. I just got a new vial of Vetsulin a couple of weeks ago so I am not in too big of a hurry to transition unless the folks on this site really feel I need to dump the Vetsulin ASAP.

 

Just keep in mind the different dosing may be contributing to the bouncing, but do what you're comfortable with.

Ideally the daytime and night time nadirs will be around 90-100...based on the night tests you have, it doesn't seem like it, but.you never know! Some extra night tests will definitely help!

I don't think you need to rush and ditch the Vetsulin, just give it a bit of time (2-3 weeks maybe?) and see how well you can get her numbers controlled. If she just continues to drop hard and bounce though, I'd say transition to Lantus sooner.

One of Lantus' strengths is managing lower numbers, it has a little harder time with higher numbers (but will get it over time). So the lower you can get her numbers overall, the easier it will be for Lantus to work.

 

Thanks. I have at least three more weeks of the Vetsulin before I need to toss it so I thought I would start the Lantus at that time. Will get a +4 tonight. Reduced her night shoot to 1 Unit. I generally liked her curve today although it was weird. To go from 280 at +8 to 285 at PMPS is confusing. What do you mean that Lantus has a little harder time with higher numbers? Thanks.

 

The spreadsheet isn't loading right now (my phone's fault), but I think I saw she had food around the 6 hr mark before? That likely brought up the numbers for the +8, and then she kind of leveled off as the food and insulin both started to fade.

Lantus' goal/purpose is flatter curves, not nearly the big dips you see on Vetsulin. So if your cat is around 100, it'll help keep them there and bring them down slowly. But if they're at 300, with a more flat curve it takes a bit longer to get the numbers down.

If you peek at my spreadsheet, compare when Mr Kitty was on Vetsulin last year to the last few weeks on Lantus. I suspect he has glucose toxicity which isn't helping...but I'm going to have to keep raising the Lantus dose until we hit a "breakthrough" and numbers start to fall.

 

Looks like Mr. Kitty still has really high numbers. I was having a hard time scrolling through his spreadsheet but I commend you for being so opptomistic. I thought I was dealing with some issues but your poor kitty is really in high numbers. Prayers for his recovery and management. You are a dear soul to be helping me with my issues. Let's just pray we can get both kitties into control and management. Thank you so much, Melissa.

 

By the way, I want to thank @Nan & Amber and @FrostD for responding to my post. I was feeling a little alone with my concern today.

 

Yep, and no problem!

We'll get there eventually, we did it before just have to get it back. Susie's looking pretty good! You'll get it figured out in no time.

 

Oh! I like those nice healing greens!!! Awesom.