?Dose Advice Needed, New to Vetsulin

Really Riley (GA)

Really Riley (GA)

Member
I used to give Riley Glargine insulin, but switched vets and the new vet insisted on Vetsulin (plus I must use AlphaTrak2). Just started Vetsulin with the evening injection on February 2. When the vet gave me the insulin and syringes she didn't give any instructions other than telling me to give him one unit twice a day. I didn't "shake" the Vetsulin because you don't shake Glargine. I wasn't near any internet connection. If I had been, I would have checked here before starting. I gave him one unit twice a day morning and evening three times, watching his glucose climb higher and higher. I decided this morning to increase to 2 units because he's never had blood glucose this high for this long and increasing that much with Glargine in the past has not had a huge effect. I turned the vial over in my hand a couple of times because it seemed to be "cloudy". When I did this I mixed the ingredients so the insulin would have proper effect, but I didn't know it at the time. When I checked him mid-cycle, his glucose was 29. I gave him Karo syrup on top of some canned Friskies. After an hour he was OK. Now I'm not certain as to what to do this evening. I've read the information for newcomers regarding glucose and dosing levels, but this Vetsulin is evidently SOOO different from Glargine I'm having difficulty wrapping my head around it. Thanks for any advice.
 
Hi. That was quite the scare you got today. How long ago did you get that reading of 29 and have you checked Riley's BG since. If not please check it again now and let me know the reading. More to follow.
 
Was Riley showing symptoms of hypoglycemia before the reading of 29 or did you just happen to test at that time?

I'm glad you treated him with karo and the Friskies but you need to keep an eye on him as Vetsulin can have another slightly BG lowering effect later in the cycle (around 8 to 9 hours post shot) in some cats. You also need to make sure Riley's BG is staying up on its own as the karo will boost BG but it won't last. The Friskies will certainly last longer but might not be high enough in carbs to keep BG from dropping again.

Vetsulin is known as an in and out type of insulin whereas Lantus (Glargine) is a depot insulin. Vetsulin acts on the BG very quickly and can cause very dramatic drops in BG (what you saw today) whereas Lantus takes a couple of hours to start having an effect and it's much gentler at bringing BG down.
If you did not mix the Vetsulin before previous shots, it's quite possible, even likely, you were not seeing the "real" effects of the 1u dose you initially gave. It's abundantly clear that 2 units is too high a dose.

With the AT2 meter, normal BG range is 68 to 150. While using Vetsulin, you need to allow yourself a bigger safety margin than when you were using Lantus and with the pet meter, I'd suggest that right now it might be prudent to skip the shot if BG is below 250. That number can be lowered later but for safety purposes until you see how Riley reacts it's better to keep the no shoot number up a bit higher.

That said, a low reading of 29 on the AT2 meter is very low and that can make kitty more sensitive to the insulin so I it might be prudent to skip the shot tonight but before we make a final decision about that, can you please tell me if Riley has ever had an issue with ketones or DKA (diabetic ketoacidosis).
 
He did not show any symptoms. I was testing at 6 hours, figuring that would be close to nadir. I did check him one hour after giving him the Karo and Friskies, and the reading was 150. I figured that he would continue to climb after that. I did not know that Vetsulin could lower his BG again later as I thought that once past the 6-hour period, his BG would continue to climb. Right now he is about 11.5 hours post AM shot. I have been watching him, but since he didn't show any signs previously, he probably wouldn't now. He's been nibbling at more Friskies, but I took it off him planning to not have him eating close to pre-shot testing. I did read about the fact that a serious low could make him more sensitive to the insulin and that had me concerned for tonight's dosing. He has not had an issue with ketones in the past. I used to test for that frequently but he was always negative so I haven't for a while. Hope I've answered all your questions - if not, let me know. Thanks.
 
Great! Glad to know ketones &/or DKA have not been an issue for Riley.
We recommend withholding food for at least 2 hours prior to pre-shot testing so you can be sure the pre-shot number is not food influenced so I am glad to hear you removed food for that purpose.:)
Are you using syringes or the Vetsulin pen to give injections?
 
I realize that I'm going to have to do a lot more testing. His ears are getting harder to get blood from. They still have a lot of little hard red spots from the last curve. That stresses us both out.
 
When testing make sure you hold light pressure on the poke spot after testing for a few seconds. It will prevent bruising and ear soreness. You can also apply a tiny skim of Vaseline where you intend to poke to make the blood bead up rather than spread out into the fur.

If you can test before every shot to make sure it is safe to give Riley insulin, and at least once again each cycle, you will be fine. This isn't about filling up the SS with readings. It's about doing appropriate testing to keep Riley safe and healthy.

How far after this morning's shot are we now? (hours not time).
 
13 hours - This morning's shot was an hour earlier than normal because we had to leave for an appointment. I am going to test now to see what's happening.
 
Unfortunately tomorrow morning we have to leave again for another appointment and I won't be around to test him for at least 6-7 hours post shot. If I don't give him a shot tonight, his BG should be high enough for a shot tomorrow morning, but I don't want to spend the next 6-7 hours worrying about what's happening with him. The difference between his reaction to glargine and vetsulin is scary.
 
One more question. The next time I do give him a shot, should I go with one unit or scale it back to 1/2 a unit and leave it there for a couple of cycles to see what happens? I'm just wondering if he now will be sensitive. The vet made a guess at one unit because of his weight and his resistance to the glargine I think.
 
For some reason I didn't get notifications on your posts. :mad: Glad @Kris & Teasel was here to help you.
Given that low today, I would be inclined to reduce the dose tomorrow to 0.5u and give it only if BG is 300 or above. After that low today, chances are his BG will be high and will remain so for at least a day and possibly a few 12 hour cycles but I wouldn't chance giving the 1u dose again until you can monitor thru the cycle. I am a bit concerned that the 1u dose might be too high as it looks to me like those black numbers could possibly be a huge bounce potentially from another low not caught with testing or just Riley's unfamiliarity with the lower PMPS of 190 on the 2nd of Feb.
 
One request.......can you add a line to your spreadsheet to indicate you are using the AT2 meter and also add that information to your signature so anyone helping you will have that information. It plays a crucial role in interpreting the numbers on your spreadsheet and in making any suggestions about dosing. Thx. :D
 
Thanks for getting back to me. Your assistance is really appreciated. I made the changes - spreadsheet could use some work I guess. Just tested him and his BG was 497. Going with .5 because I have to leave him and won't be back for 6-7 hours. Hopefully his system can handle that. Another issue - do you have any advice regarding how to get him to have a normal bowel movement? He was totally backed up in November and needed an enema. The vet at that time put him on Lactulose - 2 ml twice a day. He has seen a specialty vet since then who kept it the same, and our new vet also agrees with that. But he is not having regular bowel movements - maybe every three days and only one or two firm ones. Had him to the vet last week thinking he needed another enema because he was straining and straining and producing nothing but some drippings. But she said the stool was soft. Only problem was that he didn't release any until she inserted her finger!
 
Thanks for adding the meter into your signature. :D

On the BM front, I thankfully have little experience with that problem so I suggest that you post a question over on the Health Forum where there is more traffic and you will get more eyes on your query. One thing I've seen often recommended is adding plain pumpkin (not pie filling) to the food. It seems to work for both loose stools and constipation. Sometimes constipation can result in leakage of watery stool so I wonder if there is some hard stool a little further up than the vet was able to examine.
 
With all the straining he was doing (and everywhere, even when I was holding him in my lap), when I saw the watery stuff coming out I figured there was something blocking the way. But the vet said he had a good, normal movement after the "inspection". Which could be the absolute truth or not (I wasn't invited into the exam room and that always makes me suspicious). I'll try to put something "intelligent" together and post on the Health Forum.

Anyway, just checked BG and it's gone up to 551. Did you say he may have highs for a couple of cycles? I would suspect that his pre-shot this evening BG will be even higher. If so, temptation is strong to go with the one unit dose. Maybe this experience has made his body resistant to the Vetsulin as it appeared to be with the glargine. Funny thing happened once with the glargine when I could not dose him for 2 cycles. When I was able to again give him insulin his BG was a little higher than it should have been (of course), but in the 12-hour period after that injection he dropped lower than he had been for quite a while (not too low, just right). And I thought at the time that his body was "surprised" by the insulin after having not had any for a spell, and therefore did not fight back against it.
 
Really Riley said:
it's gone up to 551.
Click to expand...

That is not unexpected after the seriously low BG he dropped to yesterday and the reduced dose of insulin this AM. Let's see where he is at PMPS before making any decisions about dosing tonight. How many hours till his shot is due?
He could drop off more if the bounce starts to clear or he could remain high for a few cycles. If he is having problems evacuating his bowels, that too could be causing some of that BG elevation.

Really Riley said:
Funny thing happened once with the glargine when I could not dose him for 2 cycles. When I was able to again give him insulin his BG was a little higher than it should have been (of course), but in the 12-hour period after that injection he dropped lower than he had been for quite a while (not too low, just right). And I thought at the time that his body was "surprised" by the insulin after having not had any for a spell, and therefore did not fight back against it
Click to expand...
While it's an interesting theory that his body was surprised by the insulin, it sounds to me like whatever dose he was on was likely too high. By not giving insulin for 2 cycles, you had drained the depot that glargine leaves behind after each shot to some degree and so you saw a better cycle based on what would be essentially like a slightly lower dose of insulin. You had Riley on a large dose of glargine and while there are cats that need that much and more (my cat was at one time on 16u twice daily), it's usually due to a high dose condition of some sort or a very high carb diet.

To be honest I was surprised the vet had suggested only 1u of Vetsulin given the dose of Glargine you had been giving but yesterday's reaction seems to support my theory that the glargine dose was too high. The interesting thing about insulin is that too much insulin can look exactly the same as too little and without small incremental dose increases of 0.25u usually and definitely no more than 0.5u except in some exceptional cases, it's very easy to totally bypass the right dose and end up with worse rather than better BG numbers and to think that the dose needs to be increased even more. :eek:
 
His next shot is due in about 5 hours. Would so love to see the BG a little lower, but we'll measure then and go from there. Does the Vetsulin create a depot? Or is it just that it lasts longer for some cats than others?

MrWorfMen's Mom said:
While it's an interesting theory that his body was surprised by the insulin, it sounds to me like whatever dose he was on was likely too high. By not giving insulin for 2 cycles, you had drained the depot that glargine leaves behind after each shot to some degree and so you saw a better cycle based on what would be essentially like a slightly lower dose of insulin.
Click to expand...
I so wish I had figured this out then.

Just FYI - The U-40 syringes that the vet sold me don't have any 1/2 unit markings so I hope I'm getting the correct measure at .5 The U-100s I used for glargine had half unit markings but I couldn't find them anywhere and the vet always ordered them for me.
 
Ok I will check in a half hour before shot time. You are on the same time as me I think... EST.

Vetsulin does not leave a depot behind. It often doesn't last a full 12 hours in cats.....some it lasts 8 hours some 10 and others get the 12 hours out of it. While there is no residual insulin still at play after a cycle, there is more of a propensity toward bouncing because of the faster and sharper drops in BG. The curve with Lantus looks like a smile while the curve with Vetsulin will look more like a broad spike.

You should be able to get U100 syringes at any pharmacy (Walmart Relion brand are often used and reasonably priced) with half unit markings. You don't need a script in PA from what I can see unless the laws changed again since 2009. Ask for 3/10ml syringes, 31 gauge 8mm length needle (6mm is fine too but some find them more prone to furshots) with half unit markings. Walmart staff don't know they have syringes with half unit markings so ask to see what they have to check. You can use the U100 syringes with a conversion chart for the Vetsulin.
The other option is to order from ADW diabetes. They have U40 syringes with half unit markings. For now, you could use a used syringe to draw up some coloured water at an eyeballed 0.5u dose and use it for comparison when drawing up a half unit in the future. The dose doesn't have to be 100% accurate but consistency is important.
 
I am EST. How long before shot time should I be checking his BG?

I tried a CVS pharmacy when I first needed the U-100s and they gave me a serious run around so I gave up and let the vet charge me for them. I will check ADW - just started ordering AT2 test strips from them. Where can I find a conversion chart? I've got lots of U-100s with the half unit markings if I just knew how much one unit in a U-40 meant in a U-100.
 
With Vetsulin, you should test about 20 to 30 minutes before you intend to give the shot. Test, feed Riley, and then wait until shot time. The point of this is to have the food entering his bloodstream by the time the insulin starts taking effect which with Vetsulin can be almost immediate. It also ensures you don't end up in a scarf and barf situation having kitty throw up right after you shoot.

HERE is the conversion chart. Any questions, just holler.

I imagine some pharmacies might give you a run around but from what I read, you are allowed by law to buy them without a script in PA. It was changed in 2009 I believe to try to avoid drug addicts using dirty needles etc. and perhaps for other reasons.
 
Absolutely. This is not unusual at all and part of the problem is that Vetsulin pushes the BG down fast that it has a tendency to cause some bouncing in many cats too. I think you best to stick with the 0.5u dose tonight and it would be very helpful if you could test Riley again at +2 post shot to see where he is heading. It a really good idea to get a test in at night even if it's just one before bed. It helps to fill in the picture and offer some clues as to what is going on at night.
 
OK - .5 it is. I will test him at +2 to see what's happening. After that, he is probably good until morning, right? Unless his BG goes down real fast. If his BG is still high tomorrow morning, should we up the dose then?
 
Assuming Riley doesn't do anything too dramatic, yes he should be fine till morning. I'd like to see if those numbers drop some on the smaller dose right now but it's a two edged sword. We never know how much of those numbers is normal BG elevation from the diabetes and how much is from the bounce. Let's play this step by step right now and see where he is at +2. Hopefully that might shed some light on how the 0.5u dose is working for Riley.
 
Ok. That is good to know. The depot left over from the Lantus should be pretty much gone at this point in time. I think the depot contributed to the massive drop the other day. And now we are seeing high numbers for a number of reasons.
I'd suggest you try either 0.75u (if you found your U100 syringes) or you can try the 1u. Either way, I'd definitely want to monitor the cycle to watch what is happening.
 
I went with the 1 unit. What are the best times to check? I'd love to do every 2 hours but I only have about 15 test strips left until a new batch gets delivered Friday (hopefully). So I can't really do every 2 hours, but you probably know which time periods will give the best info if not doing a curve.
 
Here's the basic testing routine we recommend:
  1. test every day AM and PM before feeding and injecting (no food at least 2 hours before) to see if the planned dose is safe
  2. test at least once near mid cycle or at bedtime daily to see how low the BG goes
  3. do extra tests on days off to fill in the response picture
  4. if indicated by consistently high numbers on your spreadsheet, increase the dose by no more than 0.25 u at a time so you don't accidentally go right past a good dose
  5. post here for advice whenever you're confused or unsure of what to do.
 
I'm a bit concerned about you only having 15 strips left till Friday. You need 4 of those just to get pre-shot tests before the order of strips arrive leaving you 11 strips for mid cycle testing. If you use 1 strip per cycle, till order arrives, that only leaves you a supply of 6 strips should Riley decide to do anything dramatic. For future I would suggest you try to keep an extra vial of strips available at all times. A lot of us leave an extra vial in our hypo kits.
So let's check the BG +2 and then based on that reading, decide when to next check. I'll check back in around 11:30am to see what Riley is up on the 1u dose.
 
His BG is 638 - doesn't look like he'll be going too low. Could it be that what he ate after his shot this morning is still influencing the reading?
 
Yes the food "bump" could still be in play but most of that number is not a food bump. Riley is still in a bounce and he's not moving much. I think we can hold off until +5. Hopefully by then we'll see a little more movement downward and unless it's a substantial drop, you can then probably hold off until the pre-shot tonight. I'll check back around 2:30pm to see what he's up to.

In the meantime, if he asks frantically for food or starts to act oddly, test again. He took a very sudden and huge drop the other day so just be vigilant for any suggestion he might be experiencing a dramatic drop again.
 
He's at 475. Do you think the bouncing is over and that his BG will continue to be lower? Not too low, but closer to where it needs to be?

On another note, tomorrow afternoon I am leaving my hard-wired internet access behind. I really like accessing the net via laptop where I can actually see what's on the screen without a million advertisements. And using the laptop keyboard for messaging is also a good thing. Plus there's that reception thing when you are wireless in a remote area. I won't be able to access the spreadsheet (well, I could access it but changing anything on it might be a problem). I'm going to have to try and see if I can communicate with you on FDMB by way of cell phone.
 
Ok it looks like Riley is safe for this cycle. Get a pre-shot test as usual. I do not think the bouncing is over. It may be breaking but without more testing over the course of a few cycles it's really difficult to guess how much of Riley's BG readings are being affected by any particular dose of insulin vs bounce wearing off. I'm certainly glad to see the BG coming down a bit but it's still far too high.

There are lots of folks here that use their phone for communicating and looking at their spreadsheet. I'm not sure if anyone is updating their spreadsheet on the phone because the small screen definitely does make it harder. The SS is vital for us to be able to visually see and track what is going on with Riley. Will you be able to access Internet with your laptop in any way......ie at a library or another public WIFI spot nearby?
 
I will be back by Monday. In the meantime I'll try to find some way to update the spreadsheet before then, but not sure if I will be able to.

How long do you think he is going to continue to bounce? Could his being constipated again cause high BG?
 
Constipation can definitely cause an increase in BG. As far as the bounce is concerned, it could break at any time but in some cats it can take 3 days to completely clear.

So the lack of hard wired internet will only be a temporary issue?
 
Ok so while you are away, you can just put the readings into your communication and then update the sheet when you get home. I was a bit concerned it was going to be a permanent thing which could hamper seeing what Riley was up to long term. ;)
 
And now he is at 628. I don't think I need to worry about him going too low tonight. It would be good if I get a reading in 3-4 hours, but if I sleep through that, I don't think he is in any danger.
 
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