HELP For a New Member ampS 201, +4 - 3.8, +4.75-36

Hi members.....

My Vet referred a client to me who was here this morning and needs HELP WITH DOSE, ETC. but I've given her a review on dosing, food, and testing..........she is using a "One Touch" human meter and soon switching to a Reli-On Prime meter

What I know: Male, 11 yrs old, 14.7 Lbs, Vet Prescribed Caninsulin 2.75u twice daily

DX Feb/18, full blood work done and no known issues other then FD (she's getting records), no Ketones
Shot time is 07:00am _ 17:00pm
Drinking over 1 liter/quart water per day min. and peeing tons
Difficulty feeding (Vet told her to use HC with gravy - now using LC FF from today) and uses a syringe when kittie doesn't eat
Has gone into HYPO (shivering, lethargic, almost coma) and she's not sure why (now knows symptoms)

She is going to change from Caninsulin to Lantus once her insulin is used up.

*** I've got her testing as often as possible, but she works full time so she's going to adjust her shooting times so she can get some more test in.

LOW BG'S OF 36-38 OVER PAST FEW DAYS - OUCH!!!

Therefore, I suggested she reduce the dose to 2.5 which she did tonight.

QUESTION: do you reduce the dose the same way we do with Lantus? Meaning, if the kittie goes below 50 then it's an automatic reduction by .25??? I'm well versed with Lantus and trying to help her out since she has no experience at all

I've given her all the printed matter from this forum and suggested she read up as much as possible, get lots of tests, make a profile and detail her cats records asap.............

ANY FEEDBACK I CAN GIVE HER IS A HUGE STEP CONSIDERING HER VET DID NOTHING FOR HER.

 

With a newly diagnosed cat and inconsistent testing and vetsulin, I wouldn't shoot anything if BG is below 200

 

Oh, wait, you don't mean at shot, you mean at peak/nadir! I would definitely lower it by at least .25. That's scary low.

 

Caninsulin is very different. You have to allow for its very fast onset, ability to drop BG steeply and, of less critical importance, its shorter duration in many cats. Here’s my take on it:

• the current dose is likely far too high and is causing hypo lows and (probably) big rebounds
• I’d drop the dose immediately to no more than 2 u BID
• I would have a no shot number of at least 250 for now
• the safe nadir range for Caninsulin is 90 to about 110 and no lower.

From your post it seems the owner is dosing at 7 AM and 5 PM. Is this correct? There’s more timing flexibility with Caninsulin but staying closer to 12/12 is preferred.

Re dose decreases: like Lantus you need to watch the nadir numbers. If nadir is below the safe 90 - 110 range, drop by 0.25 u immediately. That’s a separate issue from assessing PSs for “shot or no shot”.

 

Thanks Kris..........she's at 7/7 for shooting and is moving back 15 min. at a time to then be 5:30/5:30 so she can at least get a couple of tests done in the morning before she goes to work. She's on the 12/12 schedule. She dropped the dose last night to 2.5, and left a msg she had a long night so most likely I will advise to drop dose to 2.25 or as you mentioned 2 units.

* I thought a shot number of 180 as many of her numbers from what she gave me since starting insulin are below the 250 which means never getting insulin. It's only the last couple days with the hypo area, however the cat was fine and no signs of hypo. I advised to decrease if BG went under 50 which is what we do in Lantus Land - is that okay as can't tell when nadir is since she doesn't test all day as leaves for work at 07:30..........

I'll see what she says when she calls me this evening and provide her with your suggestions.

Rgds
Shawna

 

If that's been the case the dose of 2.75 u is definitely too high. You just can't dose as "close to the bone" with Caninsulin as you can with Lantus. I would suggest that a "no shot" of 180 is the absolute lowest and only if the dose is significantly less than 2.75 u. There has to be a bigger safety margin at nadir because of this insulin's harsher action. This is from the Caninsulin user's guide listed at the top of this forum:

Remember too that with Caninsulin (Vetsulin) it is usually best that newcomers aim for a nadir no lower than 90 - 100 mg/dL [5 - 5.6 mmol] at the peak action of the cycle as measured on a human meter (see ‘Blood Glucose Reference Information’ above.)

http://www.felinediabetes.com/FDMB/threads/beginners-guide-to-caninsulin-vetsulin.186099/

Given that this person is new to the FDMB way of doing things, doesn't have a computer to participate of the forum (I thought I read this elsewhere?) and has a kitty who has hypoed, an extra degree of caution is required. If she was an experienced member with a ton of data on her kitty's responses to Caninsulin the no shot number could be lower and the goal nadir could drop a little. That isn't the case, though.

 

Truffles went hypo from 268 on 1.5u and I then had to rethink all my dosing. He became more sensitive to the vetsulin.

 

GREAT!!! Thanks and I'll let her know.........never met anyone in over 20+++ yrs who didn't have a computer or internet (nada) but guess I did now, LOL.

 

Cat is still going into Hypo numbers (no issues with health) and she's switching to Lantus tonight - so, told her to give 1.5u now (shot time) so while she's working Darcy will be safe. Still tons of bouncing no doubt cuz of fast acting Caninulin and wrong dose.

** When switching to Lantus, should she start at 1.5u?

I'll post in my Lantus forum to see what others think as I'm not sure if switching will have an effect and we don't want that.

Thanks again for your valuable input

Shawna

 

My vet recommends no shot if BG below 150. Looking at your worksheet, perhaps you can try skip a shot or try stalling.

Vetsulin normally does not last 12 hours do if you are seeing low PS, and if it's similar experience with my kitty, it would look like Kitty is trying to go into remission.

 

This post is NOT for my cat, I'm on Lantus and well aware of how the process goes, this post is for someone who lives in my area that needs held with Caninsulin, but thanks for replying and this particular cat is far from remission - he's just been diagnosed with FD and the owner has no experience............like you, just trying to help them...............

 

The switch to Lantus went well and thanks for all the input rec’d here