? Bounce or dose too low ??

[Wandering with Sammich]

Previous thread about dropping below 200 PMPS

Hi everyone! Sammich has been doing pretty well with eating and acting more like his old self. Thank you for all of the support over this first very stressful week!

I notice his numbers are all over the place though. How would I distinguish a dose that is too high and causing a bounce from a dose that is too low?

Work has been crazy but I can try to fill in more of the sheet today. I do not like that 500+ number from this morning

 

[CORKY]

Previous thread about dropping below 200 PMPS

Hi everyone! Sammich has been doing pretty well with eating and acting more like his old self. Thank you for all of the support over this first very stressful week!

I notice his numbers are all over the place though. How would I distinguish a dose that is too high and causing a bounce from a dose that is too low?

Work has been crazy but I can try to fill in more of the sheet today. I do not like that 500+ number from this morning

@Bron and Sheba (GA)
perhaps she should try to change insulin to Lantus or ProZinc?

 

[Wandering with Sammich]

I would really like to but I travel full time and I suspect most vets would not want to prescribe long term treatment when they won't see me again. (The vet that diagnosed Sammich is in Mexico, so can't prescribe for me in the States.) I can try emailing my old vet from before we went on the road and see if he'd be willing, but it's been ~2 years since he last saw us. Chances are we will be on caninsulin for a while longer while I figure this out

 

[CORKY]

I would really like to but I travel full time and I suspect most vets would not want to prescribe long term treatment when they won't see me again. (The vet that diagnosed Sammich is in Mexico, so can't prescribe for me in the States.) I can try emailing my old vet from before we went on the road and see if he'd be willing, but it's been ~2 years since he last saw us. Chances are we will be on caninsulin for a while longer while I figure this out

Caninsulin is a dog insulin the Lantus and ProZinc are feline insulin that lasts for 12 hours , perhaps if you go to a vet and show the spreadsheet request a PRN prescription(1 year refill) it will be better for your cat considering that you travel often

 

[Kobe (Dean and Lesley) MO]

Caninsulin is a dog insulin the Lantus and ProZinc are feline insulin that lasts for 12 hours , perhaps if you go to a vet and show the spreadsheet request a PRN prescription(1 year refill) it will be better for your cat considering that you travel often

My vet took my requests MUCH more seriously once I had data to show that something wasn't working for my cat. It doesn't hurt to try.

I notice his numbers are all over the place though. How would I distinguish a dose that is too high and causing a bounce from a dose that is too low?

A dose that leads to a bounce isn't necessarily too high. It’s often the right dose, but Sammich's body is not accustomed to having a lower BG anymore. His system reacts to the BG that it perceives as too low (though it isn't) by releasing chemical signals into the bloodstream that raise the BG. This mechanism is supposed to protect your cat from hypoglycemia, but it can also cause the bounce.
I'm not sure if the dose is too high or not.

Tagging someone knowledgeable about Vetsulin dosing
@Suzanne & Darcy

 

[CORKY]

My vet took my requests MUCH more seriously once I had data to show that something wasn't working for my cat. It doesn't hurt to try.



A dose that leads to a bounce isn't necessarily too high. It’s often the right dose, but Sammich's body is not accustomed to having a lower BG anymore. His system reacts to the BG that it perceives as too low (though it isn't) by releasing chemical signals into the bloodstream that raise the BG. This mechanism is supposed to protect your cat from hypoglycemia, but it can also cause the bounce.
I'm not sure if the dose is too high or not.

Tagging someone knowledgeable about Vetsulin dosing
@Suzanne & Darcy

You are in control of your cat, remember that you did great!! keep asking and inquiring your questions to him let him know you know what you are talking about, what you have learned here, many vets are very preceptive to our forum, so do not be afraid to refer it to him!

 

[Christie & Maverick]

Hello and welcome! While I am not a Vetsulin user, I would like to offer a few suggestions, which might be helpful since they are general and applicable regardless of the insulin being used.

I would encourage you to get into the habit of getting at least one test regularly at night. A before bed test will let you know it is safe to go to bed or whether, depending on where you are in the cycle and how low the BG is, it requires further testing. You have seen on some cycles during the day that you can start off in pink or red, and Sammich drops down to blues by +4. Many kitties like to go lower at night, so a before bed test is important.

Regardless of the insulin being used, what is helpful for all new caregivers is to do what I call “spot the nadir”. Generally with Vestulin because it often starts to work to drop BG quickly, you may find onset (the point at insulin starts to drop the BG) very much shortly after you give Vestulin, which I believe you already know, is why it is important to feed the cat, wait 20-30 minutes then give insulin to make sure there are carbs on board before the BG starts to drop. In general, you’d expect most cats to hit nadir around 4 hours after giving insulin, but you may find that nadir (the point at which BG is lowest in the cycle) could be as early as 3 hours after dosing, or could be as late as 7 hours from dosing. With any insulin, nadirs can and do change, which is why gathering data and tests is important in order to establish Sammich’s patterns. All that is to say, since you are new to dosing and testing, I would recommend doing some tests in each cycle (at least one in addition to pre shots) morning and evening to get a feel of how this insulin is working for Sammich. The higher preshot today could be an indication that he went lower last night or had a steep drop in BG and you just didn’t see it.

It may be helpful too to offer some smaller snacks in the earlier part of the cycle when the insulin is having the most affect in dropping BG levels, from onset through to nadir, if you aren’t already doing that.

Hope this helps.

 

[Wandering with Sammich]

I have started incorporating snacks in until about +7. For testing, does it make more sense to always test at the same time slot or to vary it every day? And should I dedicate a day to doing tests without feeding any snacks which might throw off the numbers?

 

[Christie & Maverick]

I like the idea of changing up testing times on different days, since it helps to gauge things. Do you have time tomorrow perhaps to run a curve, which would involve testing BG every 2 hours for the am cycle starting at preshot? I wouldn’t recommend not feeding any snacks at all, since the idea is to see how Sammich normally does with insulin and carbs during the cycle, and for many cats, it’s helpful to feed small snacks, since that can actually help slow down the BG drop and flatten the cycle out, which for bouncy kitties is one of the triggers to a bounce (steep drops).

 

[Wandering with Sammich]

Tomorrow is a travel day but I will try my best! I did not like seeing numbers in the 500s for both PS values today. Maybe I need to do more frequent and smaller snacks?

 

[Kobe (Dean and Lesley) MO]

I would really like to but I travel full time and I suspect most vets would not want to prescribe long term treatment when they won't see me again. (The vet that diagnosed Sammich is in Mexico, so can't prescribe for me in the States.) I can try emailing my old vet from before we went on the road and see if he'd be willing, but it's been ~2 years since he last saw us. Chances are we will be on caninsulin for a while longer while I figure this out

I was thinking about you and Sammich today and wondering how you are doing. How is his appetite? are you seeing any lethargy? Have you thought any about taking him to a vet? How are you holding up? It's been almost a week since we heard from you on your own thread! We need a Sammich update!!!

 

[CORKY]

I was thinking about you and Sammich today and wondering how you are doing. How is his appetite? are you seeing any lethargy? Have you thought any about taking him to a vet? How are you holding up? It's been almost a week since we heard from you on your own thread! We need a Sammich update!!!

Are you feeding high carbs? ( kibbles, gravies?

 

[Wandering with Sammich]

He’s been doing good! He has the occasional day of low appetite but overall he’s walking around and playing and sleeping on the dash (his favorite spot). His coat doesn’t look as greasy as it did when he was super sick. I picked up some more enticers for appetite and ordered methycobalamin. Got a vet appointment for the location I should be in next week, mostly to get anti-nausea meds but will also ask for a prescription for a longer acting insulin.

As for the diet, he’s currently on all home cooked as I try to figure out what is triggering his allergies. He was a bit constipated on the super low carb 100% meat and pumpkin diet, so I added some carb for more fiber. I had calculated to make sure it stayed under 10% but possibly it’s still too high. I just diluted it last night with more meat so hopefully we see lower numbers if that was the cause of the recent high numbers

 

[Wandering with Sammich]

I would post some pictures but I’m getting a permission denied error when I click “Upload a file”

 

[Wendy&Neko]

The Upload a File is not currently working. You can copy and paste into the text box, or drag and drop if on a computer.

 

[Kobe (Dean and Lesley) MO]

Very happy to hear that you are seeing improvement in his appetite! I have my fingers crossed for the vet visit, that you can get those prescriptions and a longer acting insulin.

 

[CORKY]

He’s been doing good! He has the occasional day of low appetite but overall he’s walking around and playing and sleeping on the dash (his favorite spot). His coat doesn’t look as greasy as it did when he was super sick. I picked up some more enticers for appetite and ordered methycobalamin. Got a vet appointment for the location I should be in next week, mostly to get anti-nausea meds but will also ask for a prescription for a longer acting insulin.

As for the diet, he’s currently on all home cooked as I try to figure out what is triggering his allergies. He was a bit constipated on the super low carb 100% meat and pumpkin diet, so I added some carb for more fiber. I had calculated to make sure it stayed under 10% but possibly it’s still too high. I just diluted it last night with more meat so hopefully we see lower numbers if that was the cause of the recent high numbers

Low numbers is not the case, MIRALAX over the counter a 1/4 tsp in the food twice a day for 4-5 days or until the first poop, sometimes the food change can cause either constipation or diarreah it does the trick and is unflavored

 

[Wandering with Sammich]

 

[Wandering with Sammich]

Weird that it double posts but it worked! Thanks @Wendy&Neko !

 

[Wandering with Sammich]

 

[Kobe (Dean and Lesley) MO]

View attachment 73568View attachment 73568

That's perfect! We love double Sammich!!!

 

[Wandering with Sammich]

Update to the update (need to start a new thread soon)

Sammich threw up this morning then stopped eating again. Took him to the nearest urgent care. Fructosamine was over 500 But no ketones or pancreatitis! He got an anti nausea injection and subq fluids. But exciting news: I got cerenia to take home and prescriptions for lantus and freestyle libre! What a fantastic vet! It’s such a crapshoot when you travel!

 

[Kobe (Dean and Lesley) MO]

Update to the update (need to start a new thread soon)

Sammich threw up this morning then stopped eating again. Took him to the nearest urgent care. Fructosamine was over 500 But no ketones or pancreatitis! He got an anti nausea injection and subq fluids. But exciting news: I got cerenia to take home and prescriptions for lantus and freestyle libre! What a fantastic vet! It’s such a crapshoot when you travel!

I am sorry that he was vomiting, not eating, and that the Fructosamine was so high. The rest of the news is great. It helped me a lot to go to the Lantus forum and read those stickies. Lantus is different than Canisulin. Post, post, and post! and ask lots of questions. On your Spreadsheet you'll want to add a row to mark where you've switched to Lantus. You can look at Kobe's sheet if you need an example.

 

[Kobe (Dean and Lesley) MO]

What a fantastic vet! It’s such a crapshoot when you travel!

How do you keep that vet? I guess kidnapping is out of the question because it's a federal crime...

 

[Sienne and Gabby (GA)]

Fructosamine values are not the same as blood glucose numbers. This is information on the reference ranges for a fructosamine test. The results indicate that there's not good control over Sammich's blood glucose numbers. However, your spreadsheet should tell you that. Are you sure the vet ran a fructosamine level? Usually those labs are sent out.

A couple of observations... With a fast acting insulin like Caninsulin, you really need to test within a few hours of having given a shot. Caninsulin can drop numbers hard and fast and you risk hypoglycemia if you're not testing. This is one of the reasons that it's important to get at least one test during the PM cycle every, single day. Given the pharmacology of Caninsulin, as expected, you're not getting great duration. In other words, Caninsulin doesn't last 12 hours. As a result, your pre-shot numbers are high.

It's great to hear that the vet you saw made some changes. Lantus is a far better insulin for cats than Caninsulin. However, Lantus works differently than Caninsulin so you will need to think about dosing differently. This is the link to the dosing methods sticky for Lantus and this is a link to the Lantus forum. Please review the sticky notes at the top of the board so you have an idea of how Lantus works. One big difference is that you can test, feed, and shoot all within a few minutes. You do not need to have food on board before giving a shot. Lantus typically has about a 2 hour window before it starts to work. The same issue of getting at least one test during each of the two daily cycles applies. You can start at roughly the same dose of insulin.

One BIG issue... You need different syringes. Lantus is a U100 insulin so you need U100 syringes. See if you can get syringes that are marked in half unit increments.