Looking for some feedback

Discussion in 'Caninsulin / Vetsulin and N / NPH' started by Danielle & Goose, Dec 27, 2018.

  1. Danielle & Goose

    Danielle & Goose New Member

    Joined:
    Dec 21, 2018
    Hello, my cat Goose was diagnosed on Dec. 11. At the clinic his glucose was 26.68mmol/L / 479mg/dL. I've voraciously read all the FAQs and beginners guides and once I had everything to start testing him at home, I started building his spreadsheet. I worked as a veterinary nurse for a few years about 10 years ago, but it was in a state that allowed learning on the job. I only encountered one diabetic cat during that time, so didn't get to learn much about feline diabetes.. the learning curve has been steep especially as it seems I haven't gotten the best advice from my veterinary clinic (plus dealing with the differences from US to Europe and some of this needing to be done in Dutch as I'm in the Netherlands now. :eek:)

    I was told to give him 2.5 units of Vetsulin BID. We came back to the clinic 3 days later for the first +4 test and his number was around 5.2/94. 4 days later another +4 test was 137. During both of these visits he was incredibly stressed. I told the nurse that he had been seeming quite lethargic and was suspecting maybe the dosage was too high. She assured me his numbers were in normal values, so to keep going, I could test again in another week. Whilst the clinic does advocate home testing, they only recommended testing every few days, then weekly, or even monthly. No pre-meal testing was ever advised. I was also talked into getting a VetPen which I really regret getting now due to no .25unit adjustments available.

    (The clinic sold me wet and dry Hills MD which thanks to Dr. Lisa, I now see still isn't good enough. I moved him to Purina Gourmet Gold pate, which is the European version of Fancy Feast. I feed him about 20 minutes before giving insulin, allow him 6 hours to come and go eating his portion, then don't let him eat 6 hours before the pre-meal blood test.)

    When I did that first test at home and saw the 2.9/52, I freaked out a bit. The spreadsheet tells the rest. For what it is worth, his energy levels have been much better after I stopped the high dosage. He's been much more like his old self, which is important.

    So I've been trying to ascertain what the correct dose for him is. Sometimes 1.0unit does very little for him, other times it works great. Sometimes the 0.5 works great. It seems he reacts more to insulin in the evening. He's also had quite a few times when he's been at the threshold of giving insulin or not (per the beginners thread recommendations.)

    The last 3 times I've given no insulin... but even those numbers aren't what a normal cat would have pre-meal.

    I am wondering if I should get some u100 syringes and try 0.25units (and yes, I'm aware of converting from u40 to u100)? I'm just not sure what to do when he's around the numbers he's been at for the last day and a half. I'm paranoid about plunging him into hypoglycemia, but I very much want him to be well regulated. (edit: just tested him and he's at 6.2/112 after not receiving insulin for 2 days. Is his pancreas waking back up? I hope it's not teasing me!)

    Apologies for the mini essay! :bookworm:
     
    Last edited: Dec 27, 2018
  2. Sharon14

    Sharon14 Well-Known Member

    Joined:
    Aug 16, 2015
    Welcome! I’m so glad you found us and lowered Gooses dose! I’ve never used vetsulin, so I’ll let @Kris & Teasel and @JanetNJ answer your dosing questions. I just wanted to say hello
     
  3. Danielle & Goose

    Danielle & Goose New Member

    Joined:
    Dec 21, 2018
    Thank you Sharon. I'm relieved I happened upon you all as well. It's scary to think what could have happened if I'd kept on giving him the higher dose. I'm so thankful for all the resources and advice that's been accumulated here.
     
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  4. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    Welcome! Yes, he seems to have a sputtering pancreas. I suggest you skip insulin for a couple of days and get AM and PM tests before feeding (hold the food two hours before) to see how he does with no food on board and then test again about 2 hours after a meal to see what his reaction to food is. As a precaution I suggest you buy some human urine ketone test strips at any human pharmacy and test his urine once a day while he isn't getting insulin. Here are some ways to do it:
    • put the end of the test strip right in his urine stream as he's peeing
    • slip a shallow, long handled spoon under his backside to catch a little pee - you don't need much
    • put a double layer of plastic wrap over his favourite part of the litter box and poke some depressions in it too catch pee.
    Most test strips have to be dipped and allowed to develop for 15 seconds before viewing the colour change in very good light.

    If he stays in the roughly 3 to 8 mmol/L range without insulin he might well be in remission because of the low carb diet. Still a diabetic but diet controlled. If he's above that more of the time hew might need a tiny dose like 0.25 u to help him. If you need to microdose like that U100 syringes with half unit marks are the way to go - after a proper conversion of course. http://www.felinediabetes.com/insulin-conversions.htm

    Re diabetes diagnosis: had he been treated with steroids prior? Was the diagnosis based on one BG measurement or a fructosamine test?

    Goose is very handsome! :)
     
    Last edited: Dec 27, 2018
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  5. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
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  6. Sharon14

    Sharon14 Well-Known Member

    Joined:
    Aug 16, 2015
    He’s a happy little fella! Thanks for asking:cat:
     
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  7. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    Photos whenever you can, please. :smuggrin:
     
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  8. Danielle & Goose

    Danielle & Goose New Member

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    Dec 21, 2018
    Thank you Kris for your feedback. :cat:

    Re his diagnosis, it was full bloodwork, urinalysis, and presenting symptoms (drinking much more, urinating much more for a couple of months, weight loss... which I thought was kidney related, until the neuropathy started.) I do remember them saying they would do a fructosamine test, but I don't have those results. He's never had any other medical problems. Aside from him picking a fight with another cat and landing himself with an abscess that needed antibiotics, he's never been on any medication.

    I went to the clinic today to talk about switching to syringes and received frustrating information. The nurse said that you can't use insulin syringes with the VetPen cartridges (I still have about half of the cartridge left in the VetPen.) I don't understand why. Both the cartridge and the vial contain the same insulin, no? Looking at this it shows both the cartridge and vial both have 40 units per ml. Maybe this is just because they are worried about people messing up? As I believe I've seen that people who use Lantus for their cats buy the small cartridges for human insulin pens and draw from those?

    I also learned that I won't be able to ever switch him to Lantus, if he still needs insulin. Apparently it's not approved for use in cats in this country so the veterinarian can't just write me a prescription to take to a pharmacy. :/

    Keeping my fingers crossed and knocking on wood that his numbers stay where they are and the food will be enough.
     
  9. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    The Vetsulin vial and Vetsulin VetPen contain the same U40 insulin. I know about VetPens but I don't know how they're constructed. Lantus pens can be opened to expose the inner cartridge. The end has a rubber seal through which a syringe can be inserted to draw insulin directly from the cartridge. That eliminates the need for the Lantus pen's special needle which doesn't allow fractional doses. Can you open the VetPen? Do you have refills for it or is a new pen purchased when one is empty?

    Yes, many vets are reluctant to allow clients to do anything non-standard with dosing. They worry that serious errors will be made and in many cases they're right to worry. :confused: They see a wide variety of clients with highly variable levels of skill, knowledge, comprehension and so on so they will default to lowest common denominator. Fact of life ...

    I know other countries have strict rules about what insulin a vet can prescribe. We're lucky here in Canada: Lantus is a first choice for many vets but not all. Vets don't see a huge number of feline diabetics in their clinics so they aren't all well informed on how to treat effectively. That's not their fault though. They have to learn a lot about many different conditions in many species.
     
  10. Danielle & Goose

    Danielle & Goose New Member

    Joined:
    Dec 21, 2018
    Just got a message from the nurse... not sure she realised the numbers I was talking about were pre-meal testing with no insulin. She got in contact with the Merck office here and this is the advice they gave her:

    I don't want to be one of those people who goes and does their own "research" and doesn't trust professional advice... but really... still giving him 0.5U when he has a pre-meal number in the 6s? And not being able to give a 0.25U because it might be off by 0.01U? I'm not fully trusting this. :(
     
  11. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    I say this is nonsense! They're concerned about a dose being 0.24 u or 0.26 u but not concerned about the possible effect of a dose double that size??!! Does Merck sell VetPens?

    I truly understand the reluctance to deviate from professional advice. I have a really good vet but learned that I need to treat Teasel's FD differently from the way she started me. She knows what I do, is willing to work collaboratively and trusts my judgment.

    When Teasel was started on insulin (Lantus) I was sold U100 syringes with half unit marks because it a half unit dose fraction was within the realm of possibility in the vet's eyes. She said there was no way that a quarter unit dose could be estimated reliably. Well, here I am three years later and not only do I tweak Teasel's dose by quarter units when needed but also use what are called "fat" or "skinny" doses. A fat dose is syringe plunger touching the underside of a syringe line and a skinny is a hair above a line relative to the needle if the syringe is held vertically needle pointing up. Why do I do that? Because Teasel reacts to dose changes that small!
     
    Last edited: Dec 28, 2018
  12. Danielle & Goose

    Danielle & Goose New Member

    Joined:
    Dec 21, 2018
    The VetPen is something you refill with individual cartridges. ( shows replacing it.) There's a rubber bit at the end that the specially designed needle tips poke into. You can sorta see that in this picture.

    Yeah, I get that. I worked as a veterinary nurse so saw it first hand. It's also why I want them to trust me more, especially as I seem to be helping them learn.

    I talked to an old colleague of mine and she said they don't use Lantus but ProZinc (which doing a search just now, I have found a Dutch document about it's use in cats... so I suppose that's an option if needed.. but it seems my clinic isn't aware of that) and don't use Vetsulin with cats.

    And yes I do realise it is tough for vets, having to know so much about different species, it's not very possible to be experts in it all. It's just difficult for those of us at home, trying to do the best for our pets.
     
  13. Danielle & Goose

    Danielle & Goose New Member

    Joined:
    Dec 21, 2018
    It's tough... because I know they encounter the very anti-scientific, I want to feed my cat a vegan diet and heal her with essential oils type of people. It's those types that make it harder on those who do want to trust professional advice, yet also have the senses to look at scientific data we are gathering and know something is not right.

    I will trust the numbers I'm getting from all his blood tests. It's already going well I think and that's due to me who used intuition and feedback from the data to adjust his dosage. Maybe I will look at bit non-compliant, but I do have some experience (I was drawing blood, running all the tests, administering anesthesia, assisting in surgies, etc... I think I can convert from u40 to u100 and draw insulin properly! :confused:) and have discovered good, reliable resources, plus it's obvious many of you have loads of experience as well.

    Thank you for being a sounding board and offering some support.:cat: I've got some u100 syringes on the way and will use those if his numbers start to creep up again.
     
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  14. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    It looks to me that you can indeed use the VetPen cartridge as a mini vial. You should see a rubber seal on the metal end of the cartridge that goes in first. That's where the pen needle pokes to pull out insulin. If you have U40 syringes or U100s and a conversion chart you can take it upon yourself to try the smaller doses. The U100s with half unit marks are best for this. They allow a wider array of dose fractions even using the syringe lines, dose fractions like 0.2 u, 0.4 u, 0.6 u , 0.8 u.

    We also understand feeling uncomfortable doing something different from the vet's advice. However, Goose is your kitty so ultimately it's your choice.

    Re ProZinc: yes, it works well for many cats and is a cat-approved insulin. It's action is gentler than Vetsulin and it usually has longer duration. It's U40 like Vetsulin but might only come in a 10 mL vial. It's very expensive. You'd still be up against the same attitudes toward dosing from your vet clinic. Teasel was on it many, many months but he was too bouncy. He's better on Lantus.
     
  15. Danielle & Goose

    Danielle & Goose New Member

    Joined:
    Dec 21, 2018
    Have some more data on Goose.

    From browsing other people's threads, I got a little freaked out that maybe I took him off insulin too early and was endangering his chance of remission and maybe his BG could be a bit lower, so we've had a couple days of me giving him 0.25U. The nurse was wanting me to do a GC (and also wanting me to give him 0.5U but I don't think that's safe based on his PSs) so I did that today. I knew this insulin was fast acting, but it really seems to not last long in him at all. Vetsulin doesn't seem to be great for him, though at least it does seemed to have woken up his pancreas.

    I did find out that there are veterinarians in the Netherlands who use Lantus. I found a Dutch feline diabetes message board and see people posting about using it back in 2006! Yet the nurse at my clinic said it wasn't approved. o_O I'm wondering if I should go to one of the clinics I found on that Dutch message board and speak with a vet who has experience with feline diabetes as I've gotten too much wrong information from my current clinic.

    I've been continuing to do reading, trying to see what's normal for a cat. Is 60-100/3.3-5.5 the range? If so, I don't know... does he need insulin or not? He is often *just* above that range (which is why I was experimenting with the 0.25U.) I'd rather not subject Goose to 20 minutes of trams and metros each way to see a new vet if I can help it . The 5 minute walk to our usual clinic is quite enough for him. I'm leaning towards no insulin, but I'm a worrier and want everything to be perfect for him. I hate all this guesswork. :confused:
     
    Last edited: Jan 5, 2019
  16. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    From the Lantus forum but it applies here:

    OTJ TRIALS:

    Prior to starting an OTJ trial, one wants to see kitty mostly in the range of a healthy cat (50 - 80 mg/dL), but under 100 overall... with only occasional readings in the 100 - 120 range.

    Remission is achieved when kitty can go 14 days without insulin while maintaining normal blood glucose values under 100 overall. Most will stay in the 50 - 80mg/dL range. Although, some will occasionally experience BG numbers up to 120 mg/dL.
     

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