Dosing advice for Manu

Discussion in 'Caninsulin / Vetsulin and N / NPH' started by MsF & Manu, Apr 14, 2022.

  1. MsF & Manu

    MsF & Manu Member

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    Mar 20, 2022
    Hi, my sweet 14-year-old Manu started on insulin on 3/19/22. He was put on 2 units Vetsulin, twice/day. Then after his first BG curve @ 2 weeks (done at the vet's office), he was increased to 3 units, twice/day. I am doing his BG curve at home today, now that I've gotten a bit better at it. I have been testing him sporadically as I could (sorry, I don't have a spreadsheet). Tests I was able to do had always been in the 300 - 400s at different times throughout the day. Two days ago, he had his first result under 300. He tested at 263 before his evening shot.

    So, here's my current question! I started his BG curve this morning. Before his morning shot, he tested at 175! I was really hesitant to give him the entire 3 units, so I called the vet's office. I was told to give him his usual dose after encouraging him to eat more -- which I did. I will continue to do the curve today. But what would you have recommended? What if he tests under 200 tonight after dinner? The vet won't be available for consultation at that time. Thanks in advance!
     
  2. FrostD

    FrostD Well-Known Member

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    May 27, 2020
    Hi there,do you have a spreadsheet you could share with us?
     
  3. MsF & Manu

    MsF & Manu Member

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    Hi, sorry I don't have a spreadsheet. I have been struggling to get adept at testing and have only sporadically tested so far. But every time I did test, it was in the 300s & 400s. Those were also the numbers in the first BG curve which was done at the vet's office. Going forward, I should be able to test more often.

     
  4. FrostD

    FrostD Well-Known Member

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    May 27, 2020
    Ah sorry I see that now, was skimming while kids eat lunch.

    A link for getting started with generic forum stuff (spreadsheet, signature, hypo kit, etc) - https://www.felinediabetes.com/FDMB/threads/new-how-you-can-help-us-help-you.216696/

    Unfortunately it will be hard to give advice without a spreadsheet or more data.

    Did you get a preshot before his shot last night?

    Are you withholding food 2 hours before preshot test? The proper sequence is fast for 2 hours, do preshot test, feed, then give the shot 20-30 minutes later (if the preshot test indicates it's safe to do so).

    Please post curve results here today. 3U is a pretty high dose for Vetsulin, and I get nervous when I see whole unit increases - especially on Vetsulin. I suspect you might have missed a good dose, and I suspect he needs a reduction as well
     
  5. MsF & Manu

    MsF & Manu Member

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    Mar 20, 2022
    Thank you! Yes, I will post the results here. At 2 weeks, the vet wanted to increase from 2 units to 4. I told him I didn't want to increase that much, so he said 3 would be ok!

    I am going to ask about switching to ProZinc or Lantus. Are there dosing adjustments when switching from one insulin to another?
     
  6. MsF & Manu

    MsF & Manu Member

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    Mar 20, 2022
    At 4 hours after his insulin, he tested at 47! I gave him 4 greenies and 1/2 small can of wet food (that's all he wanted). Can a cat go into remission after a month? I hope that's enough. I'll test again in 2 hours. I'm wondering if his diabetes could have been induced by a horrible drug they put him on when they thought he was having cognitive problems (Selegeline). UGH.
     
  7. FrostD

    FrostD Well-Known Member

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    May 27, 2020
    Holy cow ok - if this is a human meter you need to reduce by 0.5U at your next shots and hold that dose.

    If it is a pet meter please reduce by 0.75U.

    Any time they are under 50 on human meter or 60 on pet meter you need high carb food (ideally wet) and honey
     
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  8. FrostD

    FrostD Well-Known Member

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    May 27, 2020
    Oh sorry I replied in a mild panic trying to get you before shot time -

    About the insulin, we need more data before recommending the starting dose for another insulin. It is often close to the same dose on another insulin, but in this case we would start more conservative. Once you can get a spreadsheet up and running I can also tell you whether ProZinc is even worth a try or just go to Lantus. Often, but not always, they respond similarly to ProZinc, just get longer duration. So if he's seeing big swings all the time once he's on a good Vetsulin dose, it's best to just go straight to Lantus
     
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  9. MsF & Manu

    MsF & Manu Member

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    Mar 20, 2022
    Thank you! I've entered every test I've taken so far. Now that we are BOTH more comfortable with testing, I will do it regularly going forward. If his test is still in the 200's before the dinnertime shot tonight, I am thinking I will reduce it to 2 units. Manu's spreadsheet - Google Sheets
     
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  10. FrostD

    FrostD Well-Known Member

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    May 27, 2020
    I think 2.25U will be ok but go with what you are comfortable with. Remember to withhold food 2 hrs before your preshot test.

    If you get a number under 200 stall without feeding and ask for help on the main forum. I would not shoot anything below 150 at this point in time. With Vetsulin it is usually best to give a reduced or token dose when that happens, but you'll get solid advice if/when that happens.
     
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  11. MsF & Manu

    MsF & Manu Member

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    Mar 20, 2022
    He tested really high before his shot -- 395. It's not surprising since today he ate several greenies, Purina DM kibble and higher-carb wet food throughout the day in my attempt to get his BG up. He had his usual low-carb wet food for dinner.

    I decided just to give him 2 units tonight and see what happens. I will make sure to just give him the low carb wet food during the night (a tsp. or so in a couple hours, and then once or twice in the night, as I have been doing). I will test him first thing in the morning. I updated his spreadsheet. Thanks for all your help today!
     
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  12. FrostD

    FrostD Well-Known Member

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    May 27, 2020
    Posted on Facebook as well, that 68 is another reduction. That's lower than we want for Vetsulin on a pet meter, so perhaps another 0.5U reduction with your next shot. If you already shot please keep a close eye; if you will be gone please leave high carb food out
     
  13. FrostD

    FrostD Well-Known Member

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    May 27, 2020
    If he's under 150 I would skip. 150-174 try 0.25U if you can monitor, otherwise skip. 175-199 try 0.5U. Above that try 1.5U I'm hoping that's conservative enough
     
  14. MsF & Manu

    MsF & Manu Member

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    Mar 20, 2022
    Well, it shot back up this morning (just tested at 7:30 am PST). It was 378. So I was thinking I should stick to the 2 units for now?
     
  15. MsF & Manu

    MsF & Manu Member

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    Mar 20, 2022
    Hi, just to clarify, you would recommend an additional reduction to 1.5 (rather than stick to 2)? My syringes do not have 1/2 units, so I'd have to estimate with my bad eyesight!
     
  16. FrostD

    FrostD Well-Known Member

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    May 27, 2020
    Yes, 1.5U and just do your best! I know it's hard. Some people use their phone camera to zoom in
     
  17. MsF & Manu

    MsF & Manu Member

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    Mar 20, 2022
    Ok... I gave him 1.5 units, and I'll keep him on the low-carb good stuff! I won't be home all day again today, but I will definitely test him again in 4 hours...which was when he was at the low point yesterday. Thank you!! I am leaving a small amount of "Young Again" kibble for him to snack on while I'm not here. I've been feeding him small meals approx. every 4 hours.
     
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  18. MsF & Manu

    MsF & Manu Member

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    Mar 20, 2022
    I've just tested Manu at 10:30 am my time (2-1/2 hours from 1.5-unit injection) and he's back down to 101 again! Geesh! I fed him a tsp. of higher-carb wet food (his old kind with gravy), and 2 Greenies -- since yesterday he kept dropping for up to 4-1/2 hours after injection. Any advice? This is nerve-wracking!
     
    Last edited: Apr 15, 2022
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  19. FrostD

    FrostD Well-Known Member

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    May 27, 2020
    Wow. I know you said you can't be home all day, but if you're around a test in an hour would be good.

    At this point I would go down to 1U tonight.

    When was he diagnosed?

    You are so unbelievably lucky you asked for help when you did, I can't believe it
     
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  20. MsF & Manu

    MsF & Manu Member

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    Mar 20, 2022
    Hi, I'm grateful I chose yesterday to do his BG Curve! I was going to do it earlier in the week. I'm staying around as much as I can today. I will test again in an hour. He was just diagnosed on 3/16/22, and insulin started on 3/19/22. He was first put on 2 units, twice/day; and after his first BG Curve at the vet's office on 3/29/22, the vet increased it to 3 units, twice/day as it was running almost exclusively in the 400s. Thank you!
     
  21. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

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    Sep 21, 2018
    Here is a link helping us to help you link. If you noticed, our members have some basic information about their cat's in their signature. This helps us to not pester you by asking the same questions (your cat's name, insulin type, date of diagnosis, etc.) repeatedly. We also have a link to our spreadsheet in our signature. We are very numbers driven. The spreadsheet is a record of your cat's progress. By linking it in your signature, we can follow along and provide feedback should you need the help
    The signature is at the end of everyone's post in gray


    I see you have your spreadsheet on your post above #9
    Members will not see it there
    After you fill out your signature you need to attach the spreadsheet to it
    If you need help doing this just ask, we have a member who will help you
     
    Last edited: Apr 15, 2022
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  22. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

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    Sep 21, 2018
    Here are syringes U-40 with half unit markings for vetsulin
    You can call them and they will contact your vet for a script, give your vet a heads up
    https://www.adwdiabetes.com/product/16363/carepoint-vet-u-40-syringe-29g-half-unit
    DIA10
    [​IMG]
    10% off your next order!
     
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  23. MsF & Manu

    MsF & Manu Member

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    Mar 20, 2022

    Hi, I tried to do that yesterday; but see it did not work. I posted under the "information" tab in my profile. I'll try to figure it out again! Thanks.
     
  24. MsF & Manu

    MsF & Manu Member

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    Mar 20, 2022
    That's awesome. Thanks!
     
  25. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

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    Sep 21, 2018
    You're very welcome, Maus is such a handsome boy :cat:
     
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  26. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

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    Sep 21, 2018
    Tap on your name up top and you will see the word signature , fill in the information. Then you have to attach your spreadsheet to it
    Just ask if you need help, like I said we have a member who will be happy to do it for you
     
  27. MsF & Manu

    MsF & Manu Member

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    Mar 20, 2022
    I found it! Thank you. :)
     
  28. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

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    Sep 21, 2018
    Lol I just saw you found it, you don't have to put how many units you were giving in your signature members will see it on your spreadsheet. You need to add the meter you are using
    I see you added what you are feeding and linked your spreadsheet great

    @MsF & Manu
     
    Last edited: Apr 15, 2022
  29. FrostD

    FrostD Well-Known Member

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    May 27, 2020
    What is the brand and flavor of food you gave him? Just trying to find specific carb % to pinpoint tonight's dose. The 1.5U is close, just not sure if 1U or 1.25U is better (I know that will be hard to measure but I have some ideas)
     
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  30. MsF & Manu

    MsF & Manu Member

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    Mar 20, 2022
    Thank you for your advice! I posted this message on Facebook too. Your advice was right on. I am keeping him on 1.5 units (1/2 of what he had been on!) The vet is out of town this week, so I'm just doing it! You can check his spreadsheet, but he runs normal mid-day. I just tested him at 98 at noon AGAIN. It's high in the morning, but it seems like that's because the insulin wears off and he has two small snacks overnight (he demands one about 1-1/2 hours before breakfast). It was spiking late afternoon/evening I'm sure because I overcompensated with too many high-carb foods! I'm not doing that today. Just two small wet food, low-carb snacks during the day. Manu sends purrs. [​IMG]
     
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  31. FrostD

    FrostD Well-Known Member

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    May 27, 2020
    That is wonderful! Now we're not sure if that 98 was nadir, and remember reductions are by 0.25U any time he goes below 90. So, you may want to consider a 0.25U reduction. If he were my cat I'd probably hold the 1.5U a few days and try to test in the +3 to +6 range to see what he's doing. But if you won't be around with the holiday, work, etc the 0.25U reduction may be a good idea. Completely up to you and your comfort level
     
  32. MsF & Manu

    MsF & Manu Member

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    Mar 20, 2022
    He's back up to 403 this morning! I only tested once during the day yesterday, but it was at the hour in which is was the lowest the previous 2 days. I'm feeling like 1.5 is too low. I think I may go up to 1.75 today (as best I can with my syringes). What do you think? You can see my spreadsheet. This insulin is clearly not working for him. I'm going to start a new post. Thanks!
     
    Last edited: Apr 17, 2022
  33. FrostD

    FrostD Well-Known Member

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    May 27, 2020
    This very unfortunately is the problem with Vetsulin. It drops then hard and fast, which often in turn causes another bounce. Repeat forever. But also it does not have the appropriate duration for most cats

    Nadir is the important part, hold the 1.5U for at least a week to see how he settles into it. Of course, take a reduction if he goes below 90.

    We may end up needing a sliding scale (where you give a slightly different dose based on the preshot) but let's see how he does this week.

    We usually say give any insulin about 2 months before making a decision, he's just past the 1 month mark. Give it a month of the regular testing and trying to keep nadir between 90-110 and see where he's at. He may come down overall, he may not. In which case you'd want to switch insulin
     
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  34. MsF & Manu

    MsF & Manu Member

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    Mar 20, 2022
    Thank you. That makes sense. Considering it's Easter and I was supposed to go out today, I will stay at 1.5 to be on the cautious side. I'll set up his automatic feeder and test him when I get home, probably late afternoon. I appreciate your reply! Thanks!! Happy Easter!
     
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