Increase dose every 2/3days?!

Discussion in 'Caninsulin / Vetsulin and N / NPH' started by KyraCat, Sep 21, 2020.

  1. KyraCat

    KyraCat Member

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    Jul 1, 2020
    @Elizabeth and Bertie @Panic

    Me again, after more advice...again! Sorry!

    I was wondering what you thought to me upping Kyra's doses by 0.25 every 4 cycles/2 days or 6 cycles/3 days. I feel like I read in the info that you can change every 3 days but I know guidelines for SLGS/Caninsulin is every 7 days but I just don't feel we are getting anywhere lately...

    Please tell me if I am just being impatient - I am just hating seeing so many reds (and some blacks) morning and night for the last 3/4 dose increases.

    The vets want us back up to 5 (but I don't think they know that we were back down to 2 at one point) so I almost want to get Kyra back to that dose (safely!, hence the advice needed) then if we are still getting undesirable numbers I will feel I have more backing to ask the vet to let us try Prozinc. I feel if I ask for that now I'll just be told to get back to 5 and see how we go from there...

    I am still working from home so I can monitor Kyra really well if you did think it was OK to up that quickly. The only hiccough would be we are testing out a night away, on Friday, for the first time & employing a cat sitter so we would be dropping his dose for that PM and AM shot that she was here in our place.

    Thanks in advance - I already know you will be so helpful!
     
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  2. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    Sep 6, 2010
    Hi Jemma, just had a look at Kyra's SS.

    What jumps out at me first is that Kyra is getting some pretty steep drops in blood glucose early on in some cycles. And this rate of drop would easily be enough to trigger bouncing in many cats. As a broad guideline, drops of over about 5mmol an hour will often trigger a bounce (but of course it varies from cat to cat..) ...But a cat can just get stuck in a cycle of bouncing that can be hard to break out of...
    If you look at last night's PM cycle. The blood glucose had dropped by 11 mmol by +2. And if we consider that it may take half an hour for the insulin to start working then it would have dropped by 11 mmol in just an hour and a half, equating to 7.3 mmol per hour...
    If you increase the dose at this point then this may indeed result in some lower numbers at nadir (lowest number) but the speed of the drop will likely still be causing bouncing. (You may quite likely have the same situation that you had on 7th and 8th August when Kyra was on 5 units; lower nadirs but still very high preshots).

    The main issue, as far as I can see, looks to be one of bouncing. A secondary issue, I strongly suspect, is that Caninsulin simply isn't lasting long enough in Kyra's system. So, once it's out of the system there is nothing to hold that blood glucose down...

    It may be possible to use food to manipulate the cycle somewhat to slow down the drop in the initial hours of the cycle, by feeding 20 - 30 minutes before the shot, and also giving snacks (or part of the main meal) through those first couple of hours. Or you could use a slightly higher carb food (but still low carb) to see if that slows down the drop. ...Then no feeding at all during the second half of the cycle (once the blood glucose starts to rise) until it's close to the time of the next shot.

    But....my best guess is that Kyra would probably benefit enormously from a change of insulin, to something with a longer duration and gentler action.

    I truly do sympathise, I know how immensely frustrating this can be.... :bighug:

    Eliz
     
  3. KyraCat

    KyraCat Member

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    Jul 1, 2020
    Thanks Eliz!

    Since you last helped me we have made sure to have a 20-30min gap between test and injection and I did think that did slow down his drop a little (we didn't seem to get so many 200drops at the "bedtime" test).

    I think you may be on to something here with the food! Just looked at the SS again and back when Kyra was on half and half or 3:1 Whiska's wet food and Feringa we had pink AM and PM (and a few reds - lets be fair) and the drops were anything from 2 to 11 (but the higher ones maybe due to us not being strict on the 20-30 gap between food and injection) Can you see this too or am I seeing what I want to see?!

    I wonder if I need to get him back on to whiskas - if he will have it again haha!
     
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  4. KyraCat

    KyraCat Member

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    I feel like I have had a break through here @Elizabeth and Bertie (all because of you, of course!) Could me thinking Whiskas isn't good enough and taking it out of his diet actually taken us in the wrong direction?!.....hmmm
     
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  5. Panic

    Panic Well-Known Member

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    Apr 10, 2019
    I agree with Eliz ... there is only so much Caninsulin can do, and allow you to do. At some point it really is just at its limit and that's as good as it gets. Time for an insulin change for sure. I don't actually know if it's safe to increase every 3 days with Caninsulin ... it probably is, but again, it's not going to help the second half of the cycle any. Is there a reason you haven't looked into switching to Lantus (if possible, not sure how hard is it to get approved for in the UK) or Prozinc? I'm usually eager to get people off the fast-acting insulins ASAP.
     
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  6. KyraCat

    KyraCat Member

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    Jul 1, 2020
    Thanks Elizabeth!

    The old vet we were with didn't see the point in changing and we would be "starting from scratch"!!! The new vets just wanted us to give caninsulin a bit longer to see how we got on. Basically we had a perfect (but higher than wanted) curve the day before we saw the new vet.

    I think I could maybe get them to switch but I feel like at the moment they will bounce me back as I haven't gotten him back up to 5units yet which is when they had last given Dosing advice.
     
  7. Panic

    Panic Well-Known Member

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    Apr 10, 2019
    My vet wanted me to stick to Caninsulin longer as well when I asked for Prozinc to see how it did. When I told her it just isn't working and there's no point in staying put she started saying "well it's a waste having to buy a new insulin with such a new vial of Caninsulin..." I told her it's a waste of money either way and I'm not concerned about the cost of a vial, I'm more concerned with getting her better. The faster you get a cat regulated the better chance of remission and stopping further pancreatic damage, waiting doesn't do any good. That's how I saw it anyway. :p The reality is you know that Caninsulin doesn't need a "chance to work", it doesn't work. Humoring them stunts Kyra's health.

    We have several UK members here ... I wonder if someone could recommend a good vet to you who will help.
     
  8. KyraCat

    KyraCat Member

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    Jul 1, 2020
    You're right!!

    I think the vets would do it I just need to put my big girl pants on and be a bit more forceful - not my manner at all - but I do feel it growing inside of me the longer this goes on and Kyra isn't getting regulated!!
     
  9. Panic

    Panic Well-Known Member

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    Believe me I get you - Panic was the only reason I even got a pair of big-girl pants. :woot: Had to put them on when a vet tech slid a can of Fancy Feast across the counter at me and told me the vet said I can't use it. I slid it back and said I'd email them Dr. Pierson's chart for them to review ... was proud of myself but also terrified! They still used their own can of Purina DM and charged me for it though. :mad: It helps to remember you are Kyra's advocate! If Kyra could speak he'd say give me the good stuff!!

    I'm not sure if there's a UK-equivalent, Eliz should know, but we stick with the 2018 AAHA Diabetes Management Guidelines for Dogs and Cats ... vets can't really argue against the AAHA saying not to use Caninsulin. :p
     
  10. Hercule's mum

    Hercule's mum Member

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    Jul 27, 2020
    Jemma, I know nothing about caninsulin or cat nutrition, really; but if you don't mind my two cents... have a look what is in the whiskas food. The more ingredients the more complicated it is to figure out what is doing what. Maybe play with the feringa timing, or different flavours? I think the fish one is a bit higher in carbs? Or pehaps there is another food altogether that is a bit higher in carbs that mightbe better?
     
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  11. KyraCat

    KyraCat Member

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    Thanks @Panic! I think I just assume everyone on here is amazing & so much better than I am at asking for what they want. It's good to hear that's not the case and we're pretty similar - you can inspire me to get those BGP on and ask for what I want. To be honest I am already armed with Prozinc was designed for cats, caninsulin was not! haha

    @Hercule's mum I appreciate your 2 cents!!

    I have looked up the Whiskas content and it is 3% and the Feringa they are on is 2% - not a huge difference I know but I just want to see if that brings us in to some better AM and PM numbers, on a relatively cheap test, then if it does I can start to look for 'better' higher low carb food....I have no idea if I am making sense at all anymore!! haha.

    I will say I am not going to speak to the vet this week as we are away on Friday night and testing out a cat sitter so I don't want to work Kyra up any more with a vet visit on top of that. I'll look at speaking to the Vet end of next week about it, once I have some more score under my belt on the food test front :)
     
  12. Hercule's mum

    Hercule's mum Member

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  13. KyraCat

    KyraCat Member

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    Thank you so much!! I have just been pouring over Kyra's spreadsheet ( I still see it when I close my eyes :p ) and it has driven me to just ring the vets and ask for a discussion about prozinc!!

    The receptionist was lovely, said she hadn't heard of Prozinc (so I used my line about it being newer but out for a few years and designed for cats), she has taken notes that I don't want a fructosmine test (as we test at home all the time) and that we did a Ketone test last week that was negative. I should be hearing back from the vet tomorrow or Thursday. Keeping everything crossed it is a straight forward conversation!

    Doubtful, but if we do get new insulin I won't change him on to it until Sunday - out usual change in dose day.

    Oh It's made me all nervous guys!! haha
     
  14. Panic

    Panic Well-Known Member

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    Ahh fingers crossed!!!
     
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  15. KyraCat

    KyraCat Member

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    So a couple of days back on Feringa and Whiskas and no difference at all. Still reds and blacks in the am and pm and big drops in the first 2hours after injection.

    Hopefully the vet comes back to me soon about prozinc.

    Kyra seems well in himself I'm just sad he seems to have gone backwards in his numbers :(
     
  16. Hercule's mum

    Hercule's mum Member

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    :bighug:

    It is so hard, isn't? Hang in there! It can only get better with perseverance.
     
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  17. KyraCat

    KyraCat Member

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    Exactly! I think it's time for me to repeat my diabetes mantra....

    IT'S A JOURNEYYYYY!!!!!
     
  18. KyraCat

    KyraCat Member

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    Jul 1, 2020
    So, I have been a little bit of a push over and have agreed, as before, to get Kyra back up to 4.5 (safely) and see how we get on with the numbers and the same if we have to go up to 5.

    I have said to the vet though that 5 is where I draw the line, if we aren't getting the numbers we want by then this is when I want to change to Prozinc.

    I think the problem is the vets haven't used Prozinc before and they worry they won't have all of the support that they can get from Caninsulin.

    They had asked me to go on medical signs (weight, amount of water drank etc) which luckily we keep a note of anyway so that was good to have available for the phone call

    I know non of you would be but please not criticism, I already feel a bit emotional writing this. I really struggle to go against people who 'know what they're doing' but I do feel better that I have had a good chat with the vet and drawn my line in the sand. She is willing to switch over but was honest about her hesitation of it just with not having used it before, hence the plan to stick with caninsulin just a little bit longer.

    Now I am going to ask a ridiculous question, but what's new...I feel like I have read that salmon is present in Prozinc and that cats can be allergic to it, is this something I can test in the mean time by buying Kyra some salmon and checking to see if it agrees with him? Imagine me (eventually) getting him on Prozinc only for him to be allergic to it!
     
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  19. Hercule's mum

    Hercule's mum Member

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    Hi Jemma, Is Ok to be patient, since... IT'S A JOURNEYYYYY!!!!! ;):smuggrin:

    I did a very small research about determining allergies in cats, since hercs takes prozinc. It seems difficult to spot, without continuous exposure. I.e is not quite pople with sesame allergy that might immediatly go all red.... But it seems like IF you start giving prozinc and he start developing stomach issues, or skin problems, that it would be a possibility.... not very helpful, sorry!
     
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  20. Panic

    Panic Well-Known Member

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    Safely is the key word here. If Kyra does not need 5 units don't push her up to it to get your vet to make the switch. You'll have to ask yourself, what if we never get up to 5 units? Do you stay on Caninsulin forever? I'm frustrated at your vet (not you) for not wanting to try something different simply because they don't have experience with it. That's not how you learn. :p If Kyra continues to struggle with short-duration you'll want to dust off those BGP again!

    Salmon in Prozinc ... hadn't heard about that but did a quick search, I think most people think its concentrated enough it won't cause issue. Certainly wouldn't hurt to check but if Kyra has never shown allergy issues I wouldn't be concerned. There's probably salmon in a lot of food, way down the label list. :rolleyes:
     
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  21. KyraCat

    KyraCat Member

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    Thank you guys <3

    I may have imagined the bit about Salmon and Prozinc. I read so much on here I get myself tied up in knots lol

    Definitely keeping Kyra's best interests in mind and prepared for the BGP again and I think the vet is prepared for it too. It is partly that I buckled at the last minute but also that the vet is soo comfortable with Caninsulin.

    In other news we will be going back to a Fergina (and chicken, tuna, low carb treat) diet once the Whiska sachets run out (Sunday PM). They haven't made a difference being a bit higher in carbs so no point carrying on with those.

    Thanks again for the support it means so much :bighug:
     
  22. Critter Mom

    Critter Mom Well-Known Member

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    Jun 16, 2014
    Hi Jemma,

    I am just wondering whether it might help your vet information-wise to get in touch with the feline diabetes clinic at the RVC? They've done trials with Prozinc and they might be able to give her info on action profile and dosing protocols for this insulin. I found them very friendly and helpful when I contacted them a few years ago. Don't know how you'd go about suggesting the idea, mind.


    Mogs
    .
     
    Last edited: Oct 12, 2020
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  23. KyraCat

    KyraCat Member

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    Thanks so much Mogs! I'll keep this to hand ready for when the next discussion comes up :)
     
  24. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    Hi Jemma,
    Saw you replying to SashaV's thread over in the Prozinc forum, and thinking you might want to switch to Prozinc.

    Not sure if you have seen this article, from the RVC Companion Animal Clinic.
    https://www.rvc.ac.uk/Media/Default/small-animal/documents/feline-diabetes-guide.pdf

    Don't know if anything there will help you, but thought I'd post it anyway, in your most recent thread from a couple of weeks ago.
     
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  25. KyraCat

    KyraCat Member

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    Jul 1, 2020
    Thanks Deb! I'll take a look!

    Everyone has been really helpful with links and info - be nice to have some stuff to send on to the vets :)
     

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