Feb 18/21 New Member - What dose of insulin is needed?

Discussion in 'Feline Health - (Welcome & Main Forum)' started by Tanya Katolyk, Feb 18, 2021.

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  1. Tanya Katolyk

    Tanya Katolyk New Member

    Joined:
    Jan 12, 2021
    I have been member for over a month, but this is my first post. I think I have finally figured out how to do the spreadsheet for Coors. We did a curve on him a couple weeks after starting him on insulin. He was started on 3 units of Caninsulin. We weren't home testing regularly right away, but we felt his levels dropped too low during his curve, plus he was very lethargic on 3 units. After joining this group, we also realized this was a large starting dose. We dropped him to 2 units and he was a different cat after one dose. Much more energy and acting more like his old self. We did a curve again last week and we aren't sure what dose to put him to. He also had a few pre shot numbers that were lower than usual and only gave him 1 unit of insulin the times he was low. We are a bit confused if he should stay at 2 units or not?https://docs.google.com/spreadsheets/d/1fUTC2pX1akJcv2p10FTNRAL6IGiRI3QYMDO9ptiQksU/edit#gid=5
     
  2. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    Hi and welcome to the forum.
    Three units is a very large dose to start a cat on.
    One unit is the normal starting dose.
    I don’t use caninsulin so I’ll tag a couple of people who do @Critter Mom @JanetNJ Not sure when they will be online.

    Can you tell us what food you are feeding Coors?
    Are you giving snacks during the cycle as well as the Preshot meals?
    Are you feeding 1/2 hour before the insulin shots?

    It is better to stick to one of the meters and not chop and change as it is confusing. Personally I would stay with the human meter as our dosing methods are based on the human meter.

    Are you able to get some tests in during the cycles as well as Preshots because it is important to know how low the dose is taking Coors. With caninsulin it will drop the BG quickly and not last for 12 hours so the next Preshot will be most likely high again.

    Do you have a hypo kit set up incase of low numbers? Here is a link which has information about hypos as well as other information.
    https://www.felinediabetes.com/FDMB/threads/new-how-you-can-help-us-help-you.216696/
     
  3. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Feb 21, 2015
  4. Tanya Katolyk

    Tanya Katolyk New Member

    Joined:
    Jan 12, 2021
    Thanks for responding.
    We are feeding Friskies Pate. We leave bowls of it out all day for our 4 cats. We pull what hasn't been eaten 2-3 hours before testing.
    We feed cat and wait 15-30 mins before giving insulin.
    I realize it is confusing to swap between meters, but our vet wants curves done on the alphatrak and we still have strips left, so for now we are doing curve days with the alphatrak and daily test with human meter.
    Yes, we have a hypo kit done up.
     
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  5. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    Sounds as if you are well organised!
    I would wait 30 Mins after food to give the shot to make sure there is food aboard.
     
  6. Tanya Katolyk

    Tanya Katolyk New Member

    Joined:
    Jan 12, 2021
    I am do thankful for this board and the Facebook group as that is how we got somewhat organized. I don't think I have ever done a much research or found a more informative group. I was so stressed initially, but am starting to get into the groove of it all. Now the next step is figuring out the right dosage for him.
     
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  7. Tanya Katolyk

    Tanya Katolyk New Member

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    Jan 12, 2021
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  8. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    May 10, 2013
    One thing you're going to hear a lot around here is "This is a marathon, not a sprint". As much as we all want our babies to be cured yesterday, it just doesn't work that way.

    What you can do to help us to help you is to try to get at least 1 mid-cycle test on the AM cycle (about 4-7 hours after the shot) and at least a "before bed" test on the PM cycle (around 2-3 hours after the PM shot)

    We want to know how low the 2U dose is taking Coors since that's what tells us how he's responding to treatment.

    Just an FYI...since you're in Canada, you might want to seriously consider switching to Glargine insulin (Lantus or Basaglar). They are human insulin's that don't require a script in Canada (they do in the US). Glargine is a much better insulin for cat's than Caninsulin which is a better insulin for dogs (thus the "canin" prefix).

    Happy to see you posting over here from the Facebook group too!!
     
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  9. Tanya Katolyk

    Tanya Katolyk New Member

    Joined:
    Jan 12, 2021
    We did a curve on Coors with the 2 unit dose last week on the 12th of Feb that is documented in the spreadsheet. Is that enough info? I also did some random tests on days his pre shot numbers were low.
    I have read a lot about other insulin. We bought a box of 10 vials of caninsulin before knowing any better. At this point we have started with that and are going to give it a go. I am too overwhelmed right now to switch that around, but will consider it down the road depending on how things go.
     
  10. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Hi Tanya and Bron,

    I can't really give much feedback on the dosing because there are very few mid-cycle tests so no visibility of how low the doses have been taking Coors. Two readings of concern are:

    12 Feb 2021 AM Cycle - Dose 2.0IU Caninsulin

    Assuming this is a curve day and the readings were done on an Alphatrak, the 4.8 reading is below the 5.0mmol/L recommendation for dose reductions in the FDMB Caninsulin/Vetsulin Guide. (Also of more concern because the guide threshold is based on a reduction threshold of 5.0mmol/L | 90mg/dL as read on a human meter so there's less of a safety buffer if a cat's BG reads at that level or below on a pet meter.) Even if just looking at the straight reading, the guide recommends an immediate dose reduction of 0.25IU.

    The big bounces into black on the 2.0IU dose would also be a flag that this dose could be too high. If it was my cat I would not give 2.0IU, even for higher preshots, particularly as Caninsulin can be quite effective at pulling down the higher preshots to significantly lower nadirs. Because there is typically no linear "if x amount of insulin is given then BG will drop by y points between preshot and nadir" relationship I don't recommend sliding scale dosing for this insulin. (Note: Other members have a different view on this, but to the best of my understanding they consider that first a lot of data is needed to understand the response of the particular cat to Caninsulin before attempting to use such a dosing method: a case of 'know thy cat'.)

    13 Feb 2021 PM Cycle - Dose 1.0IU Caninsulin

    Assuming this is a non-curve day and reading was taken on a human meter, again the mid-cycle reading was below the 5.0mmol/L | 90mg/dL threshold for dose reductions. Of additional concern is that this was a +6 reading. Given that this was relatively far on in the cycle it is possible that BG may have been even lower than this earlier in the cycle. Again, the relevant FDMB guide would recommend an immediate dose reduction of 0.25IU.

    Given that there have been yellow preshots on the 1.0IU dose I would suggest a conservative approach to dosing since some of the higher preshot BGs could possibly have an element of 'bounciness' to them, as can be the case due to the fast steep drops earlier in the cycle that are often seen in cats on this particular insulin. Note that this is pure conjecture here based on typical action of this insulin. It is impossible to say whether or not this might be happening in Coors' case because there's not enough mid-cycle data upon which to base a more solid appraisal of how he's responding.

    Tanya, if it's at all achievable for you, it would help you get a much better picture of the safety and efficacy of Coors' dose if you could get mid-cycle tests AM and PM every day. Grab them wherever you can. If that's manageable then, with extra readings available, we'd be able to give you more specific feedback and suggestions.

    The best I can suggest at the moment:

    - hold the 1.0IU dose for a few days. (Based on my experience and the data available, I think the 2.0IU dose is likely to be too high, especially as you got a reading below 5.0 on a 1.0IU dose.)
    - get mid-cycle tests (even a +2 'before bed' test on PM cycles would help).
    - check urine daily for ketones (general safety precaution, especially when reducing the dose).
    - post again to request feedback.

    Hope some of the above helps. What do you think yourself, Tanya?


    Mogs
    .
     
    Last edited: Feb 19, 2021
  11. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    This warmed my heart. Shows how much you love your boy. :)

    Great pic of Coors in your avatar. :cool:

    :bighug:


    Mogs
    .
     
  12. Tanya Katolyk

    Tanya Katolyk New Member

    Joined:
    Jan 12, 2021
    Thank you so much for the thorough response. That is so helpful.
    We had no intention of doing a sliding scale on Coors. He just stated giving multiple low numbers at preshot times and we were not wanting to give him his full dose. It has been happening a lot lately. Could the low number mean his pancreas is healing? Or is more related to bouncing?
    Your suggestion to stay at 1.0IU sounds very logical. We will try that for a few days and try to get more in between readings and see how he does.
    Don't have urine sticks at this point. We will get some this week, but I don't foresee being able to test him very easy. We have multiple litter boxes and styles. He likes to go in the small covered one and keeps his head out the front when he goes. There is no way to get in there with him while he is peeing.....but I will see what I can do.
     
  13. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Hi Tanya,

    As treatment progresses then, yes, the pancreatic beta cells can start to recover some function, hence the need for regular testing so that downward trends can be caught quickly and the dose adjusted accordingly. The wide range between PS and nadir BGs and also a mix of lower and higher preshot BGs are typically due to the characteristics of Caninsulin (aka Vetsulin). Here's an example of the ideal response of a feline diabetic to this insulin (for a cycle not influenced by bouncing):


    [​IMG]

    The above graphic illustrates how Caninsulin typically works in cats. Just as too low a BG level - or a safe but unfamiliarly low BG - may trigger the liver to temporarily release extra glucose into the bloodstream (bouncing), so too can fast, steep drops early in the cycle. Sharp drops are very much a hallmark of Caninsulin's mode of action in probably the majority of cats treated with it, and they feed into the steep increase as the dose effect wanes, giving rise to typical 'bucket-shaped' curves as shown above.

    As you can see from the graphic, Caninsulin typically has inadequate duration of effect in cats so numbers start climbing quickly up to preshot levels about halfway through the cycle. If there's a bounce, that rise might be even faster (and possibly earlier). Also, the following preshot may be higher than that for the current cycle, and this might possibly be a reason why sometimes you're getting preshots well into the pink range, but as mentioned above all I can do is speculate based on .

    Sometimes too high a dose may lead to a lower preshot at the beginning of the following cycle.

    These are general styles of response to Caninsulin. With more mid-cycle data, we may be able to better help you interpret how Coors is responding.

    Forgot to add above that if Coors drops below 90 at any time then, according to the FDMB Caninsulin guide, the dose should immediately be reduced by 0.25IU.

    There are also blood beta ketone meters available that work the same way as a glucometer does (using a sample droplet from the ear). More info:

    FDMB ketone primer

    Also see this recent post:

    https://felinediabetes.com/FDMB/thr...ontrolled-bg-since-april.243188/#post-2742212


    Mogs
    .
     
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