Looking for dosing advice

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Mikec

Mikec

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Hi everyone, my name is Mike my cat Mickey (4yo) was diagnosed 2-2-2018 bg was upper 500s. My vet put him on vetsulin and recommended I give him 2 units once a day. Mickey had been eating 2 cans of fancy feast a day plus dry food, vet suggested I take away dry food and told me to try dm wet. After a week I returned to the vet he tested him again bg was again upper 500s. He suggested 3 units once a day. At this point I started looking around for more info but still continued with the vets recommdation of 3 units once daily. I read about home testing so ordered an alpha trak which arrived on 2-15. I contacted the vet after first home test on 2-15 he said to increase dose from 3units once a day to 2 units twice a day. I began home testing as often as possible and reporting the bg#s to my vet who in turn. Are suggestions about dosing. Having found this board and reading some of the vetsulin dosing threads I quickly began to lose faith in my vets advice. It seems like he had me increasing the dose too quickly. I started a spreadsheet this morning. It began 2-15 the first day I got my alpha trak. One thing to note the increase from 3 units twice daily to 3.5 units was my decision as my vet suggested to go from 3 units twice daily to 4 units twice daily. This morning mickeys bg was only 104 so I skipped his dose. Any suggestions would be greatly appreciated as I have no faith in my vet at this point. Thanks, mike

Mickeys spreadsheet
 
Hi Mike. Good to see you posting on the Vetsulin Forum. :bighug:

Just going to throw a few thoughts out. As you already realized your vet was increasing the dose too quickly. Home testing...that you have started ..YAH!!...gives a much clearer picture of how a dose is working. Dosing with Vetsulin is based partly on the preshot numbers but more important is how low a dose gets Mickey. On Feb 16 you had AMPS of 413 and shot 2 units which brought the numbers down to 185. That is a good size drop without getting too low.

When a kitty drops too low or too fast the body releases counter-regulatory hormones which cause 'glucose' stored in the body to be released, which in turn drives the numbers up higher again. Tests done during this 'bouncing' period can make it look like more insulin is needed, while it may need just what is being given or even less. It takes some time for a diabetic kitty's body to adjust to having external insulin (the shots) and some patience is needed as the adjustment is going on. That is where home-testing fills in the blanks as to what is happening through each cycle.

My own thought is that Mickey was doing well on the 2.0 unit and would benefit from trying that dose and doing testing in between each shot. Vetsulin usually will start onsetting at between +1-+3 hours after shot, with +2 used as an average. A test at this time after each shot can show if the cycle could be active.

Also the type of food you are feeding is very important. Your vet was correct in telling you to remove the dry food, since that can cause glucose numbers to be much higher because of the high carb in dry. Fancy feast or Friskies is fine as long as it is the pate and not the ones with gravy. With Friskies, the Indoor Cat pate, with the green lid is a high carb food even though it is a pate.

Just re-entering the link to the Vetsulin information sticky I posted on your other thread:

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

Hopefully there will be more members along soon to add some more information/suggestions/advice.
 
Thanks tm I started transitioning him away from the dry food as soon as the vet suggested it. I tried mixing the dm wet food in with his usual fancy feast pate but he didn't seem to like it. So then I used cooked chicken to get him to eat more as I tranisitikned off the dry. Now he's eating 3 cans fancy feast a day and a small amount of cooked chicken. I think you're right about the lower dose being more effective as he had stopped drinking and urinating so much on the low dose and last few days he's gone back to drinking/peeing more. Not quite as much as pre insulin but noticeably more than last week. I was following the vets advice on all dose increases, as I pointed out in my original post he suggested even higher increases than I made. Thank you for you're feedback!
 
I agree the dose is too high. I would try 2 units for 5-7 days and see what happens, then if it's not enough try 2.25 or 2.5 and hold for a week and see what happens. Definitly bouncing going on here.

Your vet had good advice getting off the dry. Make sure the fancy feast is ff classic.... No gravy.
 
Thanks Janet, I will try 2 units. It's the classic fancy feast, luckily he was already eating the classic ff most of his life. Unfortunately he also ate a lot of dry food. Im very surprised he's doing so well with only eating wet food now.
 
How often should I test him on the 2 units? He's been very cooperative so far with the testing I just don't want to cause him any more stress than necessary right now.
 
Mikec said:
How often should I test him on the 2 units? He's been very cooperative so far with the testing I just don't want to cause him any more stress than necessary right now.
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I think you are testing a good amount. If you don't already, giving a small low carb treat for each test will have him associating testing with a snack and he'll look forward to it more. I used to give a little bite of cold cuts, or fresh chicken, or cat nip. Many cats also like freeze dried meat treats like fancy feast pure bites or bonito flakes.
 
OK, so the next thing I'm going to recommend you do is set up info in your signature. This will eliminate the need for us to ask you the same questions over and over, because the info will be right there. So go back into your signature (click on your name at the top right and choose signature) and add info such as

  • your pet's name and age
  • date diagnosed
  • type of insulin
  • type of meter you are using
  • food you are feeding
  • and any other heath concerns or medications/supplements he's taking.
 
Welcome! You're doing all the right things for your boy. :) I definitely agree with the advice to keep the 2 u dose for several days and gather more numbers. As Janet said, that can go up by small fractions (0.25 u) if/when needed.
 
Amps was 173 this morning, I fed him at his normal time and retested 30 min later was 230 so I gave him 1.5 instead of 2. At +2 he is 113, I gave him more food starting to worry with such a low reading only 2 hours after his shot.
 
Mikec said:
Amps was 173 this morning, I fed him at his normal time and retested 30 min later was 230 so I gave him 1.5 instead of 2. At +2 he is 113, I gave him more food starting to worry with such a low reading only 2 hours after his shot.
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Good call to lower his dose. If you're home to monitor get a +3 and more if he's into dark green by then. Your goal is to have a nadir BG range in the high double digits or low 100s.
 
Thanks for the advice I will be home to monitor him all day. I'm thinking maybe I should have skipped this mornings dose.
 
Mikec said:
Thanks for the advice I will be home to monitor him all day. I'm thinking maybe I should have skipped this mornings dose.
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Every dose is an experiment. As you accumulate a lot of data you'll get better at anticipating what he might do.
 
Mikec said:
+3 is 263
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That is a big jump from +2 to +3. Two things...the +3 test might not have been correct..sometimes test strip are 'wonky'... or you gave higher carb food at +2. Vetsulin generally will have an onset at +1 to +2 and a peak at +4 to +6 depending on the kitty, so you would expect to see the numbers falling during that time. I would do another retest.
 
I did give him more of the same low carb food at +2. I'm thinking he is bouncing again maybe the 2units last night was too much as his bg was under 200 this morning
 
Mikec said:
I did give him more of the same low carb food at +2. I'm thinking he is bouncing again maybe the 2units last night was too much as his bg was under 200 this morning
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Vetsulin is an "in and out" insulin,with no carry over into the next cycle. With a bounce the preshot may be lower but generally will rise through the cycle as the bounce works through. Since Mickey had a lower +2 than the preshot I would question whether he is bouncing. Of course there is no fast and set rule with any insulin with any kitty, but the +3 reading seems out of place with the other two readings and it is always possible to have a bad strip in any type of meter. My rule of thumb is that if a number looks out of place then I do a retest.


ETA Vetsulin usually has a duration of anywhere from 8-10 hours before the effects wear off. This as with anything else depends on the individual kitty.
 
Mikec said:
+4 was 614
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YIKES!! Well then you are absolutely correct in that Mickey is bouncing. He may have gone down lower last night. Nadir (lowest number) with Vetsulin can occur between +4-+8...again depending on the kitty ;) As well the drop from PMPS to PM +4 was a very substantial amount. All data is good, since different kitties put their own 'spin' on how they react.
 
Mikec said:
Maybe I should just start over with 1 unit this evening
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The best thing to do is wait and see where the numbers are this evening. You want to see when Mickey is breaking the bounce. The ideal is to find a dose that drops him 50% over the cycle and still gives decent numbers. The numbers do not have to be perfect, since it takes time for the body to adjust to exogenous insulin. If you can test and then post the numbers after the test you can get some feedback on what dosing may be advisable. You can change your title to include the blue"?" icon to get more attention on the posting.

As well the procedure for Vetsulin is test, feed, wait 20-30 minutes then shoot. Since Vetsulin tends to act faster than some other insulin types it is important to have some food on board before the shot.
 
Mikec said:
How can you tell when he is breaking the bounce?
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If the PM preshot number is lower then the bounce would be starting to break. Since Mickey is going up higher right now he is bouncing. When glucose numbers drop too low or too fast the body's counter-regulatory system causes stored glucose to be released in what the body perceives as an emergency. It can take any where from 12 hours to 3 days for this excess glucose to clear the system..again depending on the kitty. With Vetsulin, since there is no carry over in the dosing it is more flexible than long acting insulins and you can shoot based on the preshot number as well as the nadir point.
 
Mikec said:
He's back down to 508 at pmps.
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He may be breaking the bounce. If you haven't fed him yet you could hold off with the food and retest in 20 minutes to see where the numbers are going. Not sure if it was mentioned that you should not feed for at least 2 hours before you do a preshot test, so the numbers are not food influenced.

If you have already fed, you could go with 1.5 units and try to get a =2 or +3 test in after the shot.
 
I gave him 1.5 units i can test tonight, unfortunately I work long days during the week so I won't be able to test during the day all week.
 
Mikec said:
I gave him 1.5 units i can test tonight, unfortunately I work long days during the week so I won't be able to test during the day all week.
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See if you can get a +2 and if possible a +4 test tonight. If the 1.5 units drops the numbers but not too quickly or too far then you can use that dose during the week. Not sure if you have time in the morning before work, but if you shoot early enough, getting a +2 before you leave should give a good indication of what the cycle may look like. If the numbers are dropping too fast you can always give a bit of higher carb food to slow the drop before you leave.. When you get your tests you can post them to get some feedback on how he is doing.
 
Mikec said:
I'll be able to get +2 and +4 tonight during the week it's not possible to test after shot
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If you get a +2 and +4 tonight it will give an idea whether the 1.5 unit dosing will work for you during the week when you are not able to get tests in between shots. If you have time in the morning...depending on how much time from when you shoot and leave..a +2 can show whether the numbers are dropping a lot at the start.
 
Mikec said:
+2 was 357 so it dropped 151 points in 2 hours
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That is a good size drop, but not too scary. If possible could you get a +3 or +4 tonight? Mikey seems to have broken the bounce so the next test may show how 1.5 units will work with him. This will give you a better idea how he will be responding when you are not home to monitor.
 
I will get a +4 and hopefully +6 tonight. What is the the ideal range for the amps # when regulated
 
From the Vetsulin Beginner's Guide:

'REGULATION' - WHAT IT MEANS

The initial aim of treating diabetes is to get the cat into a better and more stable BG range (‘regulated’). In the FDMB FAQs the degrees of regulation are suggested as follows (based on data from human glucose meters; pet meter numbers would typically be a little higher). But your cat may not fit exactly into one of these ranges. Feline diabetes can be very variable.

Not treated - BG typically above 300 mg/dL [16.7 mmol/L]. Poor clinical signs.
Treated but not regulated - BG often above 300 mg/dL [16.7 mmol/L] and rarely near 100 mg/dL [5.6 mmol/L]. Poor clinical signs.
Regulated - BG generally below 300 mg/dL [16.7 mmol/L] with glucose nadir near 100 mg/dL [5.6 mmol/L]. Good clinical signs. No hypoglycemia.
Well regulated - BG generally below 200-250 mg/dL [11.1-13.9 mmol/L] and often near 100 mg/dL [5.6 mmol/L]. No hypoglycemia.

There may also be an extra category of "mostly above 300 (16.7) but with good clinical signs" which occurs with some cats who are getting insulin. We don't know why it happens, but such a cat probably should not be considered to be regulated.

On FDMB you may read about a cat’s BG being ‘Tightly Regulated’. The aim of Tight Regulation (TR) is to keep the cat’s BG in normal levels for as much of the time as possible. But we don’t recommend attempting TR with Caninsulin (Vetsulin); this insulin can drop the BG very steeply and fast, and there could be a danger your cat’s BG may dropping too low.

http://www.felinediabetes.com/FDMB/threads/beginners-guide-to-caninsulin-vetsulin.186099/
 
Thanks tm he never dropped below 300 last night and was back near 500 this morning I felt ok with 1.5 this morning. Someone will be around to check in on him but he won't let them test. Hoping I can give him 1.5 for the week without any bouncing
 
Mikec said:
Thanks tm he never dropped below 300 last night and was back near 500 this morning I felt ok with 1.5 this morning. Someone will be around to check in on him but he won't let them test. Hoping I can give him 1.5 for the week without any bouncing
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The 1.5 unit will be safe but he may need to go higher but without being able to test between shots it is difficult to be sure. Are you able to get one moe test in during the morning before you leave for work? If not can you get a test or two in after the PM shot? Trying to see how far the dose takes him will help with finding a good working dose.

ETA From what data you have already Mickey seems to have his nadir between +4-+6, although that can always change
 
Another low preshot # 230 this evening after 1.5 units this morning. Waited 20 min retested 260 so I fed him not sure if I will dose tonight. Last time this happened he had a severe bounce
 
Mikec said:
Another low preshot # 230 this evening after 1.5 units this morning. Waited 20 min retested 260 so I fed him not sure if I will dose tonight. Last time this happened he had a severe bounce
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This was a safe number to give 1.5 u. Then you would follow up with a test at +2 to see where he's heading.

Bouncing is part of what many cats do and it's almost impossible to prevent. You've had several dose changes in a short period of time and that can contribute to erratic BG numbers. If you can find a safe dose to give both AM and PM for several days in a row that can help to settle him. At this point 1.5 u looks like a dose to use.
 
Things seem to be improving on 1.5 last few cycles. Still don't know what's going on during the day but the +2 and +4 last night were encouraging as well as the amps today
 
I see you skipped the other night when it was 230. Next time you get a lower than expected number try stalling withought feeding for 20-30 min and retest. If the number is going up go ahead and shoot out of you are worried or can't test so a reduced shot.
 
Thanks Janet I was worried that night bc I did that the morning before and he had a severe bounce. Also I got home from work a little late and by the time I had gotten the 2nd test to see he was headed in the right direction it was already + 13 so I figured it was too late to feed and shoot. I'm hoping I can keep up the 1.5 for a couple more days without any crazy readings, I have off fri so I can test during the day and see where he is at
 
Mikec said:
Thanks Janet I was worried that night bc I did that the morning before and he had a severe bounce. Also I got home from work a little late and by the time I had gotten the 2nd test to see he was headed in the right direction it was already + 13 so I figured it was too late to feed and shoot. I'm hoping I can keep up the 1.5 for a couple more days without any crazy readings, I have off fri so I can test during the day and see where he is at
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It's so much easier when your home, I know.
 
This is really tricky at the beginning. The fact that you're testing at home is a big plus in keeping Mickey safe and getting his BG under better control. :)
 
Does anyone have an option on switching from vetsulin to prozinc. A friend of a friend said she had good luck using prozinc to regulate achieve remission with her cat. From what little I read it seems prozinc comes on slower maybe that would help with the bouncing issues?
 
Ugh back in 500s this morning, things seemed to be headed in the right direction at +3 last night
 
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