Help with low BG on Vetsulin

Hello all, posted in the Vetsulin forum earlier today but not much traffic.
QRD: Vet prescribed 15U of vetsulin after keeping him for 8 days, first got Lionheart home yesterday, dosed today at 8U out of fear 15U was too much. Now at +2 he measured 58 (mg/dL I think, US units) from a 346 AMPS and then 44 at +2.5 (30 minutes later).
I gave him about a spoonful of corn syrup along with more of his new wet food, one of the FF classic cans at +2.5 hours.
He is very lethargic right now at ~2.75 hours, do I need to give him more? We are far away from any vet hospital that would be open right now to treat him, but if it's what is needed please let me know.

 

Yes, more syrup now and test again. That's a steep drop and a lot of insulin. Vetsulin hits hard and fast. The syrup can wear off quickly, Continue to test every 20 Minutes, and intervene with more syrup if he is still under 50. Lethargic isn't good, please test again now. You may need vet assistance if you can't keep BG up.

 

@Heyzeus I note you just changed from dry food to just low carb canned food. That can significantly affect insulin needs, and some cats can actually become diet controlled. Please do test as soon as you can, I'm worried with the diet change recently, and low numbers. I'm here to help if you need, please post next test as soon as possible.

 

Thank you for the help, it's been a process to test him, but I finally got another reading and it was up to 57.

 

Sorry the testing is a bit difficult, when is that 57 from when you shot insulin? Around +3.5? If you have some high carb food, can you feed a couple of teaspoons now? As I said earlier, the syrup can bring their number up quickly, but doesn't last long. I'd get another test again in about 30-45 minutes to make sure he's still staying safely above 50.

 

Yes about +3.5 hours. I'll get him some higher carb stuff going and report back with the next reading, thanks again.

 

You’re welcome! Happy to help, I remember those lower numbers being quite the shock in the beginning. You are doing great. Just keep a close eye since we want to keep him nicely above 50.

 

Ok, this one went a lot easier (I think he decided the last fight wasn't worth all the effort). Measured a little after +4 and he was at 83. I got him a wet food that is something like 20-25% carb and mixed a little more syrup in with it so hopefully he'll stay up high enough.
He's camped out under my desk now so I'll definitely keep watching him close.
After the 44 reading and him refusing to get tested I was freaking out lol!

 

Did the vet give you a rationale for such a high starting dose? If you take a look at the information on the Vetsulin forum, we don't start cats at such a high dose. I'm really glad you tested when you did.

Part of why you may be seeing high pre-shot numbers is due to a large dose that's dropping the numbers earlier in the cycle. Vetsulin wears off relatively quickly (around +8, give or take). As a result, numbers may rise by your next shot time. In addition, if numbers are dropping into a low range, the liver and pancreas release a stored form of glucose along with counterregulatory hormones that cause numbers to spike back up. Getting those tests during the cycle will tell you how the insulin is fetching your cat.

You're also correct, the Vetsulin forum isn't always very busy. Posting here may be a quicker way to get help or input.

 

That 83 is much better, but if it were me, I'd still check again maybe around +6 or +7. As for dose tonight, I'm not a Vetsulin user, but I think I'd be considering going down to what the sticky notes for starting dose, and especially considering you've removed dry food and switched to LC canned food. At the very least with that 44 earlier today, that tells me the dose is too high.

https://www.felinediabetes.com/FDMB/threads/beginners-guide-to-caninsulin-vetsulin.231587/

I'm curious how was your kitty diagnosed? Did they run blood tests and urinalysis, or a fructosamine test? You've noted he was at the vet's from Sept 9-17th, was that just for BG testing or was he admitted at the vet's due to some health issues? They really did start off on quite a high dose, and increased more quickly than I have seen in the past here with kitties on Vetsulin.

I believe @JanetNJ has used Vetsulin, perhaps she can have a look and advise best dose going forward.

 

We didn't really think much of it when we were hearing the numbers so we didn't press at first, but he kind of just shrugged it off and said every cat is different (other than a paper handout that is more in line with this forum and contradicts what he actually did, there hasn't been a whole lot of communication, partly our fault for not researching more beforehand and asking questions).
When we went and got him yesterday, Friday, they said they wanted us to bring him back in so they could test his glucose again on Monday (we would be leaving him there around 9AM, and they would call when they are done testing).
While he was up there, they were feeding him Hill's Metabollic Weight Management dry food and they sent us home with some of that to give him over the weekend, but after reading enough to be dangerous it seemed kind of high in carbs to be feeding a diabetic kitty - hence the abrupt switch to a wet food that at least seemed okay.
If I'm testing at home is it still a good idea to take him up there? Kind of worried that they would hit him with 15U again without remembering what I mention when I drop him off.
And regarding the Vetsulin, is it possible to switch him to something more friendly to a cat (and to get the vet to go along for that matter)? I read a little more and it seemed like there were better insulin formulations for their metabolism.

I checked again around +5.50 and got a reading of 110, he's alert if I go to pet him and resting comfortably now after all the excitement of today.
I was thinking about just resetting down to a reasonable starter dose and going from there especially since we switched foods and everything now, I'm glad you mention it as well.
On the diagnosis, again a lack of communication on both the vet and our side, so I'm not sure exactly what clued him into it being diabetes - but the invoice has a "Urinalysis-Idexx with Sedivue" and "General Health Profile-Idexx" listed as being performed the first day we brought him in on 09-09-21. Lionheart had been peeing excessively, drinking a lot of water, going in the livingroom instead of his litterbox, and wouldn't go outside since our other baby Jayfeather died from heart disease in July (thought Lion was just stressed from that and might "get over it" but he was getting more lethargic until we finally took him up there).
Other than the diagnosis of diabetes and a high BG reading, nothing else was wrong or needed treatment.
When we called later in the day, they told us he was diabetic and that they wanted to hold him until his BG numbers were below 250 (at first, then they said below 300 two days ago). They gave one injection of insulin on 09-09-21. And starting on 09-10-21 they note down "Glucose Blood Level Check" once a day with 2 insulin injections per day until released to us on the 17th - the dosage and BG numbers in my SS are just what I roughly remember from the receptionist/nurse saying over the phone when we would call each day.
I don't quite understand how he got to 15U in the span of a week.

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Sorry for all the questions and the novel, sort of working through everything as I type.

 

I’m wondering if the dose was supposed to be 1.5u and somehow the decimal point was lost. Starting at 15u is absolutely crazy; I’m glad your kitty is ok and that you learned to home test when you did and intervene quickly. We’ve seen bad outcomes in similar situations.

What syringes are you using, by the way? The only other explanation I can think of (and I think this is very unlikely) is that the vet gave you u-100 syringes. Vetsulin is a u-40 insulin, so drawing to the 15 line on a u-100 syringe would only be 6 actual units, but that’s still a very high starting dose.

Sometimes cats who experience hypos can be extra sensitive to insulin for awhile after, so it warrants extra consideration in monitoring and dosing.

 

Went and checked to make sure, they are u-40's. And that might actually be it regarding dosing... The only person who directly communicated his BG and insulin dosage to us when we would call in was the receptionist/nurse/technician (never know what to call them) and she was also the one who showed us how to inject him, not the vet himself - and there isn't actually a dose 15U, 1.5U, or otherwise written on the label/bottle. Maybe she was just reading the number wrong the whole time?

 

Ok so on the other post you just mentioned first can of low carb today. It may take a few days for the dry food to leave his system. Changing to low carb wet can have a drastic effect on numbers, so I'm curious where he'll be at PMPS. I likely will not be up at that time, so trying to give what guidance I can.

Are you able to test during the next couple cycles, both morning and night, at anytime? I know you already have your hypo kit.

Were you going to give any more dry? Or are you switching cold turkey? We usually recommend a phased approach where the dry is removed over a couple of days.

Mr Kitty was on dry food when I started testing, he made the decision for me to switch cold turkey ha you can see that in his spreadsheet from 2019.

If you can stay up to monitor and preshot is above 200 (remember to withhold food for 2 hrs before test, feed, then shoot 30 mins after feeding):
- If you will not give any dry, I'd go with around 0.5-1U. The sticky here recommends 0.5U if transitioning diet, I am just hesitant to drop his insulin down that far because he's been getting a much higher dose for awhile. I don't want to risk ketones, even though he has no history.
- If you are giving dry, I'd lean more towards 1U.

If you cannot monitor, I'd lean towards a skip or 0.5U to be safe.

If preshot is below 200, I'd recommend a skip. You can also stall without feeding for 20 minutes and ask for help, but there usually aren't many Vetsulin users on late.

His numbers will likely be high at preshot and through the next couple of cycles as he bounces from today's low numbers. Do not let this scare you, he'll be ok. I'd just recommend testing for ketones once a day until we work out a stable dose.

 

We should be able to, there's always someone in the house awake with me being more of a night person / easy to wake up and get back to sleep as well.

I wasn't originally planning to continue dry food other than for longer acting carbs on hypo's. I have almost no knowledge here, so recommendations are definitely appreciated on the switch. I'm sure he would continue to eat his old Meow Mix if offered, the other bags of food he won't touch unless completely starving, even with something like fortiflora topping it.

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I'll try and make sure he gets some dry and transition from there if we end up needing to dose him after the PMPS reading.

Sounds good, been learning a lot the last 2 days and it's definitely been a little scary haha.
Thanks for helping out!

 

Given that you plan to cut way back on the insulin dose and monitor BG carefully, you can probably eliminate the dry food immediately as long as the abrupt switch doesn’t cause GI upset.

 

Okay, it's looking like that's going to be the play. I've tried all 3 flavors of the wet food we bought and he likes them all, so much so that he's turning his nose up even at his old faithful dry food - only ate a few nibbles after sprinkling some fortiflora on to encourage him.
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His PMPS reading ended up being 319 and I dosed him at 1 unit of insulin 30 minutes after feeding to be on the safe side with the big swing down in units. Figured I would check again at +2 hours since that seemed to be just before he dropped under 50 the last time, and it came back as 190 so at least we squeaked into the blue after all this! Will be checking again at +4hr since that's supposed to be about the typical nadir of vetsulin from what I've read.
I also managed to catch him peeing and got a ketone strip wetted, showed as negative so there's a baseline for it now.

 

15 u???????? Do you mean 1.5? Because most cats never need more than 3-4. You need to immediately find another vet if he is perscribing 15 units. The recommended starting dose is 1 unit twice a day. Hold it for a couple weeks. If it's not enough is raised in 0.25-0.5 increments.


If this were my cat I would give 1 unit and continue to test. One unit is a tiny amount... Just a few drops. If after some time it proves to not be enough you would raise it just a tiny bit (1.25-1.5). We can help you with that. I'm so glad you found this site. ❤️

 

Given the results you saw last night, stick with 1.0u especially if you've changed Lionheart's diet.

I actually had the same thought as @JL and Chip - that whoever told you the starting dose missed reading a decimal point. Personally, I would be on the phone and demanding to talk to the vet explaining that you went home and did some research and a starting dose of 15u is unheard of. I'd be asking if the goal was for you to be managing a hypoglycemic crisis. If the vet says the dose was meant to be 1.5u, you need to let him know what error his staff made. I'm amazed that this kind of "error" occurred and you were wise enough to avoid a tragedy. And if the vet gives your a hard time for listening to the 'crazy people on the internet', I'd point out that we aren't trying to kill your cat.

Regarding your question about insulin, this is a link to the American Animal Hospital Assn's guidelines for the treatment of diabetes. The AAHA recommends either Prozinc or Lantus (glargine -- and there are now biosimilars/generics available -- Semglee or Basaglar -- that are less expensive) for the treatment of feline diabetes. Vetsulin (also called Caninsulin) was developed for treating dogs. Cats have a considerably faster metabolism and as a result, Vetsulin does not have a long enough duration to last a 12-hour cycle. In addition, Vetsulin is harsh in that it drops blood glucose levels hard and fast. Prozinc and Lantus are longer in duration and much gentler. It's nothing short of amazing how many vets are still prescribing Vetsulin. I suspect they do so because they keep in in stock in the office. It may also be an issue of cost -- Prozinc and Lantus are more expensive. (Although Chewy's has decent prices for Prozinc and using either a biosimilar or ordering Lantus through Canned -- we can recommend a good Canadian pharmacy -- makes the cost more reasonable.)

 

Looks like 1U was a good call. Be sure to hold this dose at least a week, provided preshots are safe (above 200 after a 2 hr fast). Any time you get a number under 90 it's a 0.25U reduction...if you get below 70 I'd ask for advice, may need a larger reduction. There's no harm in doing a cold turkey food switch if he's willing, just may get some diarrhea or vomiting.

If you do end up switching insulin, keep in mind our suggestions are very specific to Vetsulin and the way it works. The way you'd use ProZinc or Levemir is slightly different, and depending on the numbers you're seeing at the time of the switch may call for a lower starting dose on the new insulin (so ask for opinions!).

 

Went ahead and gave him another shot today, but I think I might have missed since the floor is a little wet next to him. Watched some more videos and I think I'll be able to get it easier for the next time (wasn't pulling up enough skin I don't think).
Other than that he seemed to be doing a lot better last night and didn't wake us up meowing for food so that was a blessing!

Yeah, after reading more I'm kicking myself for even giving him 8 units at first... Hopefully it was just a mistake on the part of the nurse and not actually the dosage the vet prescribed, but then that's still a pretty big issue in itself.
I'm definitely going to call tomorrow and ask to speak with the vet directly since they wanted me to bring him up there to test his glucose again.

I'll talk to the vet about switching to one of those, the generics would certainly be helpful on the wallet and from looking at Semglee it seems to be pretty well the same thing as Lantus (haven't looked at Basaglar yet).

Okay! I'll be sure and read up some more incase we do swap over.

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Thanks again for all the advice guys!

 

I'm not sure where you're located, but if in US or Canada a lot of us order from Marks Marine Pharmacy in Vancouver. I think it may be expensive by Canadian standards, but much cheaper than buying insulin in the US.

Also be sure to change syringes to U100 if needed, based on whatever insulin you choose.

 

Wow that's crazy how much lower the price is in Canada...
I do live in the US, so I would just get the vet to give me a paper confirming the prescription and then upload it to the website and call to finalize it with them?
I don't know if typing in the name of outside websites is allowed here, but just to make sure... is it the canshipmeds(dot)com website?

 

This is the website: https://canshipmeds.com -- the same one you found. Lots of Lantus users purchase from them. Although, the generics/biosimilars are only recently available and people are using them with increasing frequency. All you need to do is either send Mark's a PDF or a photo of the prescription.

 

Coupon for semglee a box of five pens
https://www.goodrx.com/semglee
Just call and make sure they have them