Further Dosage Advice

[Cherish4]

So Little B has now been on Caninsulin (Vetsulin) for a week, at 1u twice a day (less than the vet recommended). However I don't really know if it's having much effect. He's seemed a lot hungrier the last couple of days and I don't know if that means the insulin isn't working or what.

Home testing has been a nightmare as he's really not reacted well to it and I've managed a total of one AMPS, one PMPS and one +4 test over the last seven days. He's taken to spending a lot of time tucked right under the hedge outside as he knows I can't get to him there to test him. Even his injections have become a mammoth task as he's very suspicious and distrustful of me right now.

He's due at the vets on Friday for a blood curve so do I keep him at 1u until then or do I increase slightly to 1.25u twice a day?

I'm at a loss as to what to do so any advice would be greatly appreciated (I have tried every trick in the book re home testing by the way and nothing has worked).

 

[Diana&Tom]

Lauren, we can only say what we've said already, I'm afraid, which is that we can't say with any certainty whether you should increase or not because there is no bg data to back up the current dose. As testing is such a nightmare, and as Little B seems to be ok on his current 1u, you have two options really - one, increase a little, but only a little, since the numbers you have got are very high and we assume that he needs more insulin; or two, stick to the 1u until he goes to the vet for a curve and see what kind of results they get.

I think you will have to be completely up front with the vet and tell them what dose you've been giving. If not, this starts to get complicated as the vet will expect to see curve results based on two weeks at 2u bid, so if the readings they get are high, they will probably advise you to increase, maybe by a whole unit which would be 3u - and you really wouldn't want to be giving that much without any data at 1u... and so the disparity continues.

Trying to think what I'd do in your shoes... I think I probably would increase by 0.25u, but only because the very few readings you've got are high and we're guessing that he probably needs a little more - but we really are only guessing and to be completely honest, I don't think many of us here would encourage you to go ahead and increase while you're not testing. It may well be fine, but none of us want that responsibility, I'm sure you can see that. So - try a small increase if you feel that's warranted and you'll be around to keep an eye, or wait till the vet does a curve and see what the data is on 1u...

 

[Elizabeth and Bertie]

Lauren, without blood glucose data it's hard for anyone to give you advice about dosage.

If you really can't test his blood then you can still get 'some' information about how he's doing by testing his urine. If you can get Keto-diastix strips (or another similar brand) from a pharmacy these will test for urine glucose and for ketones.

The urine glucose test isn't the same thing as a blood glucose test, but it will show you how much glucose is being excreted in the urine since the last time Little B peed. If it's 'negative' then you know that the blood glucose has been below the 'renal threshold' (anywhere between normal blood glucose range and about 14 mmol (the 14 mmol is a sort of average but it varies from cat to cat))
If the test is 'positive' for glucose then you will get an indication (by comparing the test strip to the coloured samples on the product container) how much glucose is being excreted.

With the ketone test you want to see a 'negative' result. Anything more than a 'trace' result is a reason to talk to your vet, ASAP.

Crumpling clingfilm loosely over the cat litter tray is often a fairly easy way to catch a little pee sample. Or, if you use clumping litter you may be able to push the end of a test strip into a freshly wet pee clump. Or, you can try using a really, really shallow layer of litter in the tray, and he may leave a pool of pee on the bottom of the litter tray.

You can also keep an eye on how much water your kitty is drinking, and how much he is peeing. If he's drinking and peeing a lot, you know his blood glucose is high for at least some of the time. If he seems to be drinking and peeing more normally then it's likely his blood glucose isn't terribly high.
What is his appetite like? Is he eating normally or is he really hungry?

Also check his clinical signs; his coat condition, his weight, etc.

In the absence of testing blood glucose these are the kinds of things that you will need to keep an eye on if you want some indication of how he is doing.

 

[Cherish4]

Lauren, without blood glucose data it's hard for anyone to give you advice about dosage.

I understand. I will keep trying but for now we seem to have reached a bit of an impasse when it comes to testing.

If you really can't test his blood then you can still get 'some' information about how he's doing by testing his urine. If you can get Keto-diastix strips (or another similar brand) from a pharmacy these will test for urine glucose and for ketones.

The urine glucose test isn't the same thing as a blood glucose test, but it will show you how much glucose is being excreted in the urine since the last time Little B peed. If it's 'negative' then you know that the blood glucose has been below the 'renal threshold' (anywhere between normal blood glucose range and about 14 mmol (the 14 mmol is a sort of average but it varies from cat to cat))
If the test is 'positive' for glucose then you will get an indication (by comparing the test strip to the coloured samples on the product container) how much glucose is being excreted.

I've already ordered some glucose urine strips, just waiting for them to arrive.

You can also keep an eye on how much water your kitty is drinking, and how much he is peeing. If he's drinking and peeing a lot, you know his blood glucose is high for at least some of the time. If he seems to be drinking and peeing more normally then it's likely his blood glucose isn't terribly high.

His drinking and peeing are normal as far as I can tell. I am putting a little bit of water in with his food but his excessive thirst disappeared completely three weeks ago.

What is his appetite like? Is he eating normally or is he really hungry?

The last two or three days he's definitely been hungrier. Normally he has a tin a day but at the moment it's a tin and a quarter to a tin and a half. That's why I wondered about increasing his dosage to 1.25u as I thought that the increased hunger meant it wasn't working but I'm not sure.

Also check his clinical signs; his coat condition, his weight, etc.

His coat is actually in fantastic condition. It's really shiny and smooth, the best it's been in ages. As for his weight, he still needs to lose a little (about 1kg) but it's gradually coming down.

 

[Cherish4]

Lauren, we can only say what we've said already, I'm afraid, which is that we can't say with any certainty whether you should increase or not because there is no bg data to back up the current dose. As testing is such a nightmare, and as Little B seems to be ok on his current 1u, you have two options really - one, increase a little, but only a little, since the numbers you have got are very high and we assume that he needs more insulin; or two, stick to the 1u until he goes to the vet for a curve and see what kind of results they get.

I think you will have to be completely up front with the vet and tell them what dose you've been giving. If not, this starts to get complicated as the vet will expect to see curve results based on two weeks at 2u bid, so if the readings they get are high, they will probably advise you to increase, maybe by a whole unit which would be 3u - and you really wouldn't want to be giving that much without any data at 1u... and so the disparity continues.

Trying to think what I'd do in your shoes... I think I probably would increase by 0.25u, but only because the very few readings you've got are high and we're guessing that he probably needs a little more - but we really are only guessing and to be completely honest, I don't think many of us here would encourage you to go ahead and increase while you're not testing. It may well be fine, but none of us want that responsibility, I'm sure you can see that. So - try a small increase if you feel that's warranted and you'll be around to keep an eye, or wait till the vet does a curve and see what the data is on 1u...

I understand, thanks for your input.