? HELP! +4 BG 71, Should I continue to check?

Hey yall! Candi's BG pmps was 208; I waited until she ate then gave her the vetsulin 1.5u about 20 minutes later. +2 she was at 85; now +4 shes at 71. The vet has established her nadir was +4.5 to +5. In efforts to stop her from dropping lower I have fed her a quarter of a can of fancy feast gravy lovers. Of course she only ate the gravy. Is it okay for me to go to sleep or should I stay up? Also if she is low like that in the morning and I have to go to work after her shot, should I lower her dose?

 

Nadir time is not carved in stone: it can and does move - sometimes it can be as late as the PS time for the next cycle.

Yes, you do need to stay up (sorry!). Candi is only 3 points above the hypo threshold. Test in 25 minutes to see where she is after the gravy binge.


Mogs
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Will add more about dosing shortly...

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Yes I would test again in 30 minutes to see she is not dropping any further.
If you get a drop down to 85 at +2 from a preshot of 208, that is telling you that it is going to be an active cycle and you need to test again an hour later ( at the latest). I would have fed some food at +2 to slow the drop as well.

Candi has earned a reduction in dose down to 1.25 units starting at the next dose.

If you get a lower than normal preshot in the morning, stall, don’t feed and test again in 20 minutes to see if the number has risen. Post and ask for help. Do you leave food out for her during the day when you are at work?

I would encourage you to test again in the evenings if you get lower BG than the preshot as that is giving you a heads up that it is going to be an active cycle..for example last night you get a 93 at +3 and didn’t test again

 

Yes I do leave food out for her some LC and dry kibble. I thought the 93 was okay for the time period. I will test again, thank you!

 

Thanks!

 

+5.5 121. I just gave her a delectable bisque lickable treat, It's made by hartz, just incase.

 

Better. Don't feed anything else. Test again in 30 minutes please, Becca.

Bron beat me to it on the dosing: Candi definitely needs a reduction.


Mogs
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@Bron and Sheba (GA) -

Hi Bron,

Will you be able to check in on Becca for the next little while? (Only got up to answer the call of nature and I badly need to get back to bed.)


Mogs
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93 @+3 is good but it’s only at +3 and could well drop a lot further. It is always better to be on the safe side and test again in an hour to see it is on the way back up than to find your kitty has dropped too low.

 

Thanks! Sorry I fed it to her as I was getting a reading. She was on 1.25u but kept going into the 300's.

 

Thank u!

 

Sure Mogs!

 

I understand. It's my biggest fear to have that happen.

 

Looking back at the SS I can’t see where she was getting into the 300s on 1.25 U.
She was doing reasonable well and getting into some blues and green numbers during the cycles. Anyway, what she was doing A couple of weeks ago on a dose can change. She definitely needs a dose reduction now.

Is there any way you can do some tests during the am cycles? Either on your days off or before you go to work...getting a +2 for example or a +10 when you get home? It would help to fill in the puzzle

 

It was also taking her down below 100 on an Alphatrak meter, Becca, and that's on the low side for Vetsulin, particularly in a situation like yours where you've got such a demanding schedule and need to be confident Candi's safe while you're out. The FDMB Vetsulin guide recommends reductions for readings below 90 on a human meter, i.e. 40 points above the hypo threshold as measured on that type of meter (50). If a dose reduction threshold of 90 were to be used with an Alphatrak meter, then that's only a buffer of 22 points above the hypo threshold as measured on a pet meter (68) - not much safety wriggle room. I'd suggest considering dose reductions if you get a reading lower than 110 on the Alphatrak, and if it was my cat I would definitely reduce the dose if BG started dropping into double digits.

The few pinks she got were likely in response to lower numbers in the previous 12 hours. Vetsulin typically produces bucket-shaped curves so you really need to consider the nadir to guide dosing, particularly when it gets down into double figures, as mentioned above.

Well done catching the low. Leaving you in Bron's wonderfully capable hands now. (Thanks, Bron! )


Mogs
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I agree with what Mogs has said. I am not a vetsulin user so I would always listen to someone who has used it and be guided by what they say.

 

I agree...I was very hesitant to up her dose to begin with because of what happened last time I think in late Oct or Nov. She went low when I could check. But the vet assured me she was no where near hypos with 1.5u.

The am tests I would love too but I'm not able to come home as much as I like but I will try more. I feel like I have a good amount of numbers but when they're logged in the SS it looks like a feeble attempt.

 

Is around 300 preshot where we want her? I'm still having to eyeball 1.25u, but in the past week with giving her that dosage I think I have done pretty good. I'm a pharmacy tech of 10+ and deal with drawing up oral morphine syringes alot, but they have tick marks.

 

Vetsulin does not last as long as an insulin like Lantus, so you are going to get the BG rising up to higher levels at preshot times, than you would if you were using Lantus or Levemir or Prozinc which are much better insulins for cats as they are longer lasting and don’t give you the fast lows and then the highs at the end of the cycles that vetsulin does.
Have you thought about swapping to Lantus?

 

I have but with my schedule like it is, I would have to have an hour of wiggle room. Like yesterday was really busy. I left and hour and 15 mins after my scheduled time to leave. Its very frustrating at times to say the least. I am still looking and thinking about prozinc tho. When I emailed my vet for her thots she said I would have to start all over again if I went to prozinc and that was it. No other thots of whether it was a good insulin or not. I was expecting something one way or the other. I have called about 4 vets in my area and no one carries the prozinc. I know I can get it off line but I am really curious as to why they would not carry it.

Thanks for your help @Bron and Sheba (GA) @Critter Mom ! She was 230 amps and I think I forgot to take the pate up before I passed out last night so she wasn't that hungry. I went ahead with a 1u of vetsulin. I'll try to get a reading in this afternoon. I go in at 9am but my lunch is at 2pm thats the earliest.

P.S. my schedule is as follows:
My schedule rotates. This week I'm 9am to around 6pm. This rotates weekly and goes as follows:
Tuesday-Friday: 1st tech: 8am-5pm
2nd tech:9am-6pm
3rd tech:10a-7pm(closing) which could last beyond 7pm if busy.
Mondays- each tech comes in an hour early: 7-5, 8-6, 9-7 or closing.
Closing can go all the way to 9pm if were busy. No one is guaranteed to get off at their scheduled time. I am currently on the 2nd tech schedule and will go to the 3rd tech schedule next week. I dont feel like I'll have that room to play if I go to lantus. Usually I spend my weekends moving her earlier or later for the following monday depending on my schedule.

 

Yes I can see it must be difficult with the hours you work. All you can do is the best you can with what you have.

Regarding Prozinc: your vet is not correct saying you will have to start all over again if you use Prozinc. When swapping from one insulin to another you usually start the new insulin with the current dose of the other, or slightly less, depending on the insulin. We can help you with that.
With your schedule I think you would be better with Prozinc than Lantus as Lantus needs to be given 12 hourly give it take about 15mins. Prozinc is also a 12 hourly insulin but because it is an ‘in and out’ insulin you have a bit more leeway with the time.

 

Yes! It's a bit hectic but we get thru it. I wish I already knew everything and hate 'learning' with her, because she deserves so much better care in my eyes, as everyone's cat does.

Her pmps was 228. Shes still chowing on food. She the type who likes to walk away, groom, and come back 2 minutes later. But shes also been fed dry food for 10 years so shes trying to be tidy lol.

I was going to do the 1.25u after this morning of 1u but I think I'll still give her 1u of vetsulin. Any objections?

 

I don’t give dosing advice for vetsulin sorry as I have never used it but I will tag @Critter Mom for you.

 

I had to go ahead and give it to her. But thank you. I'll be looking out for her advice.
Tonight at work was another long one..get off an hour and 30 mins after the time i was suppose to. I had to either do give her the insulin or not. Tomorrow I hafta be at work earlier than schedule because we have someone off. So I'll be having to do it about an hour earlier than this evening. :-( i live in a constant state of change it seems.

 

Hi Becca,

I've only just seen the tag for this now. Sorry I didn't get to you earlier. Better a slightly lower dose if you're not sure, especially as you had to give the dose a little early. The PMPS was good this evening even though you only gave the 1IU dose this morning. Be sure to grab a +2 this evening to see where the 1IU dose is taking Candi.


Mogs
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Its fine! I feel comfortable with 1u. I had so much going on this evening. To tell the truth I had the needle set at 1.25u but after seeing her number I just shot the .25 out in the trash and put it to 1u. I will grab a +2. Thanks!

Really leaning towards the prozinc at this point. I have been doing some reading and still have some questions as to how the prozinc is different from vetsulin. I guess I'll ask them later. I'm totally spent today.

 

@Critter Mom @Bron and Sheba (GA)
+2 95..then a minute later 98...should I get another in before I go to bed? I fed her a fancy feast broths treat as well.