Need help with Vetsulin dosing please

Discussion in 'Caninsulin / Vetsulin and N / NPH' started by Martica and Fred, Nov 20, 2018.

  1. Martica and Fred

    Martica and Fred Member

    Joined:
    Jan 15, 2010
    HI, I used to be on here for 7 or 8 years almost daily. but since I have not had a DB cat in at least 5y, I have not been on in years. But I'm giving my neighbor's cat his insulin while she is away for Thanksgiving.

    Her cat is about 12 lbs and maybe 12y old, has been diabetic for about a year. Apparently not totally regulated and she does NOT do daily BG reading. (I gave her my old glucometer...she does take him to the vet every so often for curves)

    Her other neighbor could not get a shot in tonight apparently (I am supposed to start tomorrow morning)

    Apparently she gives her cat 5 U of Vetsulin 2x day. So 10U a day.

    I don't know Vetsulin, but if this was Lantus, this would be an EXTREMELY RIDICULOUSLY HIGH amount!!!! Maybe her cat is doing Somagyi day after day and no one is capturing it. The fact that he tries to get away from the shot is fairly telling imho.

    Thoughts? I might run over there right now for the evening shot (but part of me thinks I can't possibly give him this much)

    I did ask her if I could lower his dose while she was away because I felt uncomfortable with such a high dose. She was ok with it.

    She is also feeding him the DM/MD food . I told her she could give him a better quality low carb food...

    anyway, please give me your advice on Vetsulin and dosing...

    thank you!
     
    Last edited: Nov 25, 2018
  2. Martica and Fred

    Martica and Fred Member

    Joined:
    Jan 15, 2010
    So I tried multiple times doing an ear test and I had a bunch of old meters and had a hard time getting blood out, had to burrito the kitty in a towel (he was OK with it) and FINALLY got some blood and the meter to pick it up--only it did not register so I did not get a number! So I did not give a shot and am going to try again in the morning. I figure on 5U already today, he's probably fine.
     
  3. Martica and Fred

    Martica and Fred Member

    Joined:
    Jan 15, 2010
    any feedback from regular Vetsulin users would be helpful!
     
  4. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
  5. Martica and Fred

    Martica and Fred Member

    Joined:
    Jan 15, 2010
    Yes, I know, I bet there have been so bad close calls that his mom was never aware of.

    I had a look at that link, thank you, and also sent it to Chewy's mom.

    I have him for the next 4d. So I will be conservative and be doing continuous curves and hopefully I can figure out a safe dosing for him by then. Last thing I have time to worry about though, but looks like another well-meaning vet who has no clue about how to manage this disease..

    So this morning I went there so it was about +24h (after that 5U dose the morning before.) His BG was +264! Great number and helping to prove the assumption...Also, apparently normally all the food is gone from both bowls by the morning. There was food leftover. So my guess is that this its he first night he hasn't gone into hypo and then ravenously eaten whatever he could find.

    So I gave him a 0.75 U shot. Decided to start VERY conservative. I assume that there is a 'shed' with Vetsulin? I'm about to go back now at +6 to test him. So we will see. I am giving him bits of Pill Pockets to bribe him to come to me, hopefully those are so small, not going to have much of an effect on him.

    Any feedback is appreciated. I"ll report the +6 number.

    Can someone please remind me how I do the online spreadsheet thing? (I will also post same thing in Vetsulin group)
     
  6. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Thank goodness you are there to help that kitty! :)

    There is no shed with Vetsulin. It's an In and Out insulin which in some cats doesn't last the full 12 hours. The curve is much sharper than with Lantus and the peak action time can be anytime between +3 and +7 depending on the cat with most peaking around +4 to +5.

    I wouldn't worry about a bit of pill pockets to help lure the cat and better he runs a bit high than too low anyway.

    The spreadsheet instructions are HERE.
     
  7. Martica and Fred

    Martica and Fred Member

    Joined:
    Jan 15, 2010
    Thanks for all that info. OK here is the update:
    +24 (previous 5U Vetsulin) - 264 amPS - gave 0.75U
    +06 203

    There was half the food from breakfast still there. (he's on the diabetics Hllls Canned--D/M or is it M/D)

    So he dropped a bit, not a huge amount. Is he going to be sensitive because of the likely year of continued hypos?

    What should my next dose be, assuming it's going to be a PS in the 200s range? I'm thinking just 1 unit and hold him there for next few days, depending on PS numbers...

    thank you for all your help!
     
  8. Martica and Fred

    Martica and Fred Member

    Joined:
    Jan 15, 2010
    By the way, one thing I forgot to mention...the test strips are way expired...from 2012. Do we have any experience on how inaccurate this might make them? (I'm thinking not terribly much). I will go get some new ones, but this ws all I had for now.
     
  9. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Before you increase the dose, I'd get new strips. I have no idea if or how much, expired strips could be off in the readings. Am I correct to assume you are using a human meter?

    The pre-shot is pretty darn good for no insulin for 24 hours and I would have expected it to be much higher. If the cat dipped dangerously low in previous days (before your involvement), you could potentially be seeing some bounce and it's also possible the cat is an early nadir cat and that 203 is actually a rising number. I think I'd stick with the 0.75u for today and then see how things are in the morning. A lot of cats go lower overnight too so better to take this slowly.
     
  10. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    One other thing, is it possible to get a +3 or +4 reading tonight after the shot? That might start to give you a clue about when the cat is hitting nadir. :)
     
  11. Martica and Fred

    Martica and Fred Member

    Joined:
    Jan 15, 2010
    Thank you!
    Ok at +25h he was 264 again

    Same number as last night. Hoping thats reliable and not a product of super old strips

    I gave him 0.75 again

    He did NOT want me to give him a shot and kept trying to get away. When i did, he nipped at me. Poor little guy, i think he has gone thru a terrible time.

    He moved as i injected it. Im pretty sure i got it in him. Because i did not feel wet or smell anything on fur (does vetsulin have the strong odor like lantus?) but i guess we will see

    Yes im going to come back in 3 or 4 h and test again. He is not hating me despite the repeated tests. I did manage to get blood on the first try. He has black ears so it's really hard to see it. I'm used to doing it on gray cats ha ha so much easier to see. I'm on my way now to go buy some new test strips so hopefully I'm not going to notice any drastic difference later on
     
  12. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    I'm not sure about the smell of Vetsulin but I would assume it probably has a medicinal odor of some sort.

    I can certainly empathize about the black ears! :arghh: Are you testing on the inside of the ear? I always found that a tad easier to see. You're an old hand at this but did you ever use a thin skim of Vaseline on the ear where you plan to poke? I found it really helped get a visible bead on my girl's ears.

    I'm so sorry to hear kitty got upset about his shot. Hope you're OK. It may be that he's come to associate it with feeling crappy (Vetsulin does that to some kitties) or may be he's feeling crappy due to major fluctuations in his BG. If he's been overdosed and going low, suddenly being in higher numbers could be making him feel off too.

    See what his BG is in a few hours and if he's not dropping much, then I think it's safe to raise the dose to 1u tomorrow. Post if you have any concerns/questions.

    I just noticed the time. What a kind soul you are to be running to the store at this hour to get strips for your neighbour's kitty and then planning to get another test tonight! :bighug:
     
    Yong & Maury GA likes this.
  13. Martica and Fred

    Martica and Fred Member

    Joined:
    Jan 15, 2010
    Thank you for the kind words, Linda. Well, I'm going above and beyond more for the kitty than the neighbor! I'm a vegan and hate to see an animal in distress! (My neighbor is a good friend though, too!)

    So, bad news. As I mentioned, I was using really old test strips because that's all I had. I assumed they would be somewhat accurate. But apparently not. Tonight I went out and bought the CVS Health Advanced Glucose Monitor and also with the same blood from 1 prick, used the Precision Xtra with 6y old test strips.

    My number with the Precision was 205 and the number with the CVS AGM was 397!
    I don't know what the feedback on the CVS one is, but I got it cuz it was the cheapest one and I had to buy test strips too and they were most affordable.

    I am doing the top/back of the ear, not the inside. I don't want to do the inside, makes me more nervous. He just has a little more hair there than my cats in the past so I have to have the lancet be longer, I've decided. It is pretty hard to see. I have not tried that vaseline trick.

    So then the numbers today were
    AM PS + 24 - 264 (so probably 425ish) -- gave him 0.75 U
    + 6 - 203 (so probably was about 390
    PM PS +13 - 265 (which I now know must have been 425ish?) ---gave him 0.75 U
    + 4.5 - 205 on old meter but really 397 on new CVS meter

    So...perhaps I should do a 1.25 shot? Or should I do 1?

    Tomorrow, Tgiving day, I'll be able to do a check at around +4 but then will be with family all day and won't be able to do anything till next shot time..

    Don't know if there might be some adaptation going on from dropping from 10U per day, though?....
     
  14. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    I wouldn't jump from 0.75 u to 1.25 u. Try 1.0 u instead. Gather data on your new meter and watch the trends. It's crazy-making if you try to establish an equivalence for the two meters. It's obvious that poor kitty was on far too high a dose.
     
  15. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Sorry to hear your meter was off but I agree with Kris.....best not to try to guess what it should have read and just carry on with the new meter. Given your neighbour wasn't testing daily, giving a hefty dose of insulin based on vet curves as well as the missed shot the other night and reduced dose now, I agree taking this in baby steps is the safest way to proceed. Happy Thanksgiving!
     
  16. Martica and Fred

    Martica and Fred Member

    Joined:
    Jan 15, 2010
    Ok, last night at
    PMPS was prob 425 -gave 0.75
    then +4.5 was 397

    AMPS was 449 at +25

    I gave him 1.0 U
    And am waiting 30 min before i feed...

    Its Thurs AM. Do you think i can stumble upon right dose by Sunday night (when kitty mom returns)?

    Do not know if she will hometest. I stressed it heavily before and she didnt. She will be reluctant to go against vet advice. I have 4d to show some good numbers on low dose...
     
  17. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    If you have not fed the cat yet, I would do so immediately. With Vetsulin it is recommended that you feed the cat, then wait 20 to 30 minutes and THEN give the shot. If you need to keep kitty busy while shooting, you can give most of meal and save a bit to allow kitty to bury head in their dish while you shoot. You want to have food hitting his system before the insulin starts working and vetsulin starts working quickly.
     
  18. Martica and Fred

    Martica and Fred Member

    Joined:
    Jan 15, 2010
    Hmmm. ok i waited exactly 30 min. He did have ine pill pocket treat during testing. He is eating now. Should i worry? He was so high 449-- and we know its not a somagyi. Even it dropped him 100 pts, still plenty of wiggle room? I was going to come back at +4. Could come earlier.....?
     
  19. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    As for whether you can get kitty onto the right dose by Sunday night, that's probably a long shot. It really depends on just how far off the dose was in the beginning because without any previous data, it's too risky to make large dose changes without constant monitoring. His/her system is going to have to adjust to each new dose and it can sometimes take a few cycles to really see the result of your efforts. While 5 units was probably too high a dose, there is the possibility that the cat does in fact need a higher dose that you'd expect....perhaps over 3 units for example and you just don't have time to graduate up that much. It's a noble goal but difficult to achieve in that short period of time IMHO.

    With him being that high (449), I doubt there's a problem regarding the feeding schedule today. Just wanted to get that out there in the hopes the numbers come down for you in which case feeding after the shot could have an adverse effect. I think you are Ok to wait till +4.
     
  20. Martica and Fred

    Martica and Fred Member

    Joined:
    Jan 15, 2010
    Thank you Linda. I truly appreciate all your feedback. Ok here is the latest

    (*200 numbers incorrect; used very old strips; looks like it was high 300s/low400s)

    Prior to my taking care of Chewy, he was on 5U BID and apparently 'not controlled'. Other cat sitter could not give shot on TUES night cuz he ran away when she tried. I went over to take BG and was rusty and could not get a reading; was using an old meter. So First show I gave was WED am and it was 0.75U

    WED AM PS + 24 - 264 (so probably 425ish) -- gave him 0.75 U.
    + 6 - 203 (so probably was about 390
    WED PM PS +13 - 265 (which I now know must have been 425ish?) ---gave him 0.75 U
    + 4.5 - 205 on old meter but really 397 on new CVS meter
    THU AMPS +13 449 gave 1.0 U
    +4.25. 362
    THU PMPS +12. 386. gave 1.0 U
    FRI AMPS +14.25. 351. gave 1+ U
    + 3. 332

    I gave him a teeny bit more than 1 because I had to work and was a couple of hours late and also I think he's been consistently high. He didn't even finish all his food last night. At least it's clear he's not going into hypo and getting ravenous and devouring it all, like I think he was.

    At +3 he only dropped 20pts today

    I will be able to do curves today, tomorrow Sat and Sun. Chewy's mom returns Sunday night. I might be able to keep testing and regulating him even once she is back. As long as I can give some good numbers by then. I really am not sure if she will do the ear testing. So at the very least would be good to find a low dose for him that works...
     
    Last edited: Nov 23, 2018
  21. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Looks like you've made a spreadsheet for Chewy but it tells me I need permission to view it. You need to change the share permission so that anyone with the link can view only.

    Looks like this guy may very well need more insulin. The problem is you don't want to increase too quickly or you could skip over the best dose. I take it he has been on a hefty dose for awhile and you've indicated that even on that hefty dose he wasn't regulated. While that 5u sounds like a lot, there are cats that have high dose conditions that need that much and sometimes more and it's more common than previously thought. On the smaller doses, he's hardly budging although his AMPS did come down today which is encouraging. Still looks like he needs more than 1u. Can you get another test in today's AM cycle to see if perhaps he is a later nadir kitty? Not sure where he is the cycle now but a +6, 7, 8 or even a +9 would help fill in the picture a bit.

    What is his body condition like? Is he skinny and rough looking? A seriously unregulated diabetic would likely be losing weight and look unwell. If he isn't skinny and not rough looking, it may be he wasn't regulated but better controlled with the 5u. This really is a conundrum because with no data, it's impossible to guess what's going on and trying to sort him out in a few days is doubtful.
     
  22. Martica and Fred

    Martica and Fred Member

    Joined:
    Jan 15, 2010
    hi, I'll open up the spreadsheet, although currently it says exactly what is in the previous post.

    He is not too skinny, apparently WAS before he was Dx. His fur is nice. he seems ok. But I think the fact he was running away from the shots, and nipping when someone tries to give one tells me that the dose was causing hypos...anyway, we will see. I will see if she will let me continue to figure out the dosing. (I wish someone would do this for me--coming over and give my cat SubQ fluids...I need to do it but afraid he's so boney...he has CRF.) I'm going to go over there shortly at +6 and see what he looks like
    (in 15m)
     
  23. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    If the cat is looking good, then perhaps he hasn't been going close to hypo and hasn't been seriously unregulated . Vetsulin causes steep fast drops in BG and it's possible the cat has not been going anywhere near hypo on the 5u but rather eating all the food because of the steep drops in BG.

    You are definitely going above and beyond and to be commended for doing so. I understand your concern for this cat completely (ran into a similar situation when I tried to help someone out with shots for their cat) but the big question is whether the owner is going to follow through no matter what you do in the way of getting him/her to a better place. There are cats that just don't feel good with Vetsulin even if it is working for them and regulating their BG at reasonable levels. That could be the case here.

    Those of us from FDMB know the importance of home testing and we've seen far too many cats on too high a dose due to vet testing and the almost inevitable elevated BG they see in the clinical setting but sometimes it's difficult if not impossible to convince an owner that testing is a necessary step to keeping kitty safe, healthy and regulated because they put all their trust in their vet. :)
     
    Kris & Teasel likes this.
  24. Martica and Fred

    Martica and Fred Member

    Joined:
    Jan 15, 2010
    Yes, I have come across SO MANY vets who had no clue about how to manage this disease that I really have no faith in them. To be honest, the fact that the vet did not INSIST on testing, esp given the super huge dose, that tells me there all I need to know about this vet. My neighbor LOVES her vet and def. trusts her--and believes the vet over me (which is understandable, since if you've never seen all the tragic consequences of vets overdosing cats, then you wouldn't think it happens so often.)

    Well, let's see what happens over the next 2 days. The kitty is NOT running from me when I give the shot...seems to be that is telling, because he sure did the first 2 times I did it. He is even purring during the ear testing. I do have to burrito him int a towel but he is accepting of it. (He is also getting Pill pockets for a reward and he really likes those!) But I would like to think that he is feeling better than he had been.

    But to be honest, I have never met her cat before, except once when she brought him over when he first got diabetes.

    But the fact that he has stayed in the 300s on a dose that is 20% of what he was on, don't you think that is a positive sign? I wonder if being on 10U a day and then suddenly dropping to 2U a day will also require some adjustment (as might that one skipped shot)? The thing is that yesterday the 1U dropped him almost 100 its, whereas today it seemed to drop only 30 or so. Unless I missed some quick action up and down in btw +0 +3 and + 6, he seemed to flatline today.

    Oh, so at +6 he was 356...so had risen up. I'm going to give him his shot a bit early tonight. I'm not used to these 12/12 schedules anymore and it's a little bit tough on me navigating it!
     
  25. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    There's more flexibility with shot time with Vetsulin than with Lantus so no worries there.

    I agree it's quite possible that a lower dose would be better for Chewy and he could be wobbling a bit with his body saying "what's going on....I feel different". The problem is there are so many unknowns that to try to sort it out in a few days is a monumental if not impossible task.

    Like you, I tried my best with the cat I was assisting with , with the best of intentions but ran up against a caregiver who was nothing short of impatient and lax in monitoring or following any advice but the vet's. To boot, there was a roommate who I think was sometimes feeding the cat before I got there in the morning and a night time shot giver who wasn't testing. Sometimes there are too many variables to control when it's not your own fur kid. I wish you all the luck in the world and I salute you for what you are trying to accomplish but I do caution you about getting too invested given what I went through because it's downright heartbreaking.:bighug::bighug:

    If you are able to monitor more closely tomorrow, you could try booting the dose up and see what he does. His BG is obviously running too high now.
     
    Kris & Teasel likes this.
  26. Martica and Fred

    Martica and Fred Member

    Joined:
    Jan 15, 2010
    Thank you Linda. Yes, well I did a "+" this morning and last night. I will probably stick to that tonight and then see how it is in the morning.
    So 12/12 is not exactly needed? I have a weird schedule tomorrow and trying to figure out how I"m going to do it...

    It's 9:30pm now...his 12h shot time tonight is 12 midnight. But I was going to give it early...how early can I?
    I have to leave at 7:45am tomorrow morning at the latest and so could either give a shot before at like 7:15 (not my preference)
    or when I get back which will be at about....10:30 or 11... I guess if I do 11 and 11 then it could be 12h
     
  27. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    We usually suggest about an hour of leeway with shot times. With Chewy running so high a little bit more might not be an issue. You could do 11 or 11:30 tonight and then back up from there to 10:30 tomorrow morning without any problem. Because Vetsulin does not last a full 12 hours for many cats, some folks try dosing three times a day which sometimes works but also is very difficult to maintain.
     
  28. Martica and Fred

    Martica and Fred Member

    Joined:
    Jan 15, 2010
    3x a day. wow. Yes, I also have to try to get him back to an 8am/8pm schedule because my neighbor works and that's what she does. I work from home and pop out for short periods, so I'm pretty flexible. I'll be going back over there for my PM shot shortly! Thanks for all your help.
     
  29. Martica and Fred

    Martica and Fred Member

    Joined:
    Jan 15, 2010
    Do you do subQ fluid advice too?! One of my kitties has CRF and I keep putting off doing the subQs. I did it years ago to Fred but now I'm sort of freaked out by it, Benji is super boney and skinny. :(
     
  30. Martica and Fred

    Martica and Fred Member

    Joined:
    Jan 15, 2010
    OK, NOW I'm perplexed..
    at +11, Chewy DROPPED! He's 310 compared to 356 at +6 (and I KNOW he ate at +6 because I saw him.) I was fully expecting him to be close to 400 if not over by PMPS which was 1h early...

    So he got 1+ U again tonight. If I'm not too crazy late in the morning, I might be able to do a BG reading at like 7am-ish which would be around +8. And then I can be back by 10:30/11 which is +12 or earlier. I also need to start getting him back to 8/8 schedule.

    So this is a screenshot of his last 3 days of numbers. (Also note that the first 3 numbers on 11/21 were with the super old test strips and I was getting 200s; so modified them to what they most likely were by estimates from doing double tests with the same blood and 2 different meters/strips once I got the new meter. )

    But bottom line, he is trending downwards by day 3. Tonight...*almost* to high 200s! Hopefully this is a good sign!

    [​IMG]

    Trying to make sense of these numbers. I'm extremely excited about this 310. I wonder if this also might mean that, now that he's OFF friggin' 10U/d, his own beta cells are kicking in and producing his own insulin for him. When it's being practically pumped into him in huge amounts like that, I would imagine that the bodies endogenous production slows, if not ceases...

    I would like to start giving him a better quality food. But trying not to change too many variables at a time.
     
    Last edited: Nov 23, 2018
  31. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Sorry I have no experience with subq fluids but there are lots of folks here that do. Do a separate post for Benji in Health and I'm sure someone will be able to offer some help. There is also a video HERE that may be helpful.

    That +11 is encouraging and it may be that his BG is coming down because his body is no longer panicking about the steep drops from the hefty dose. It can take a few cycles to get that excess glucose dumped to "correct" low BG to clear from the system. I think this is the more likely scenario than his own pancreas being more active but anything is possible. It will be interesting to see where he is at AMPS this morning.

    Is the DM/MD food the wet or dry varieties? The dry in both cases is too high in carbs and would necessitate a higher dose of insulin than if the food is canned. Also I think there are 2 varieties of DM canned and one of them is higher than 10% carbs too. Not sure what the carbs are in the MD canned. If the food is high carb, changing to lower carbs would require good monitoring as it can in some cats have a profound effect on BG.
     
  32. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    I've seen the product specs sheet for DM canned food at my vet's office: the pate version is around 6% carbs and the "Savory Selects" chunks in gravy is around 10%.
     
    MrWorfMen's Mom likes this.
  33. Martica and Fred

    Martica and Fred Member

    Joined:
    Jan 15, 2010
    His bg at+8 was 336
    So presumably i missed a drop or he still appears to be flatlining. Ill check his bg at +11

    Neither of them ate much food. (There are 2 cats)

    The reason i said pancreas thing is because its type 1, not type 2, where the pancreas makes little to no insulin. Our cats have type 2. The problem is insulin sensitivity in the cells -with type 2. Not sure of the mechanism but i think we give more insulin than is made and this may flood cells? Not sure. But, giving a lot exogenously may lower the bodys own endogenous production - as happens with dietary cholesterol and the body making its own. But not entirely sure what causes improvements in the self regulation...

    I think he is eating the pate because i dont see gravy
     
  34. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    I see what you are saying as far as type 1 vs. type 2 but I think if that were the case, especially with an insulin that often doesn't last a full 12 hours, a few days of lowered doses would clear the system of any overload and you'd see a little more movement in the readings than you are. I also think if the dose was severely exceeding his/her needs, the cat would have crashed by now.

    The "bounce" mechanism is protective but there is a limited store of excess glucose the body has to deal with an overdose of exogenous insulin and bring BG back up to safe levels. I would suspect that while Chewy's BG is likely flip flopping between highs and lows, the lows are not dangerously low. A lot of cats have insulin antibodies and in some they are tougher to control. My cat had Immune Auto Antibodies and was on 16u twice daily (albeit Lantus and then Levemir) before we finally overcame the problem. The more likely possibility is acromegaly which is thought to be present in somewhere between 25 and 33% of cats. That condition interferes with the body's ability to utilize insulin effectively and can cause kitty to need astronomical amounts of insulin in some cases.
    Both the antibodies and acro are just speculation but could explain the cat being on a hefty dose.

    Interesting that neither cat is eating well. Might be because the owner is not there and that only serves to add to the variables you are dealing with. Maybe it wouldn't be a bad idea to grab a few cans of Fancy Feast Classic or Friskie pate to see if the cats will eat better. I've also seen a lot of folks indicate their cats seemed to get sick of the DM and get fussy.
     
  35. Martica and Fred

    Martica and Fred Member

    Joined:
    Jan 15, 2010
    Woohoo! AMPS is 290!!!!!

    Unf i could not get there early so it was +12.5

    It appears that vetsulin is longer acting...? Or something in his bidy is responding better as time goes by ( more endogenous insulin production or better receptivity by the cells...?)

    But we are still on the downward trajectory!

    Not sure when to test today. Wouldnt mind leaving his ears alone...

    lso yes, my guess is that they are sick of that food and it doesn't taste that great. When my neighbor was there and she was giving him or them the next food can I said they haven't finished the earlier food and she said oh over the night they will eat it by then it will be goneโ€ฆ So my guess is that was when Chewie was going hypo and devoured it allโ€ฆ Just a guess. I have yet to come back and it has been devoured at either feeding. But I am sprinkling Forti Flora on it and that makes them eat it right away
     
  36. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    You just made me jump out of my seat with a big Whoop! Great to see that 290. :joyful: You could grab a +4 and see where he's at and decide then if any more testing is needed based on amount of drop by then. If he's finally turning a corner, you may find yourself needing to test more rather than less.
     
    Martica and Fred likes this.
  37. Martica and Fred

    Martica and Fred Member

    Joined:
    Jan 15, 2010
    OMG. +3.5 is 237!

    Now, should I worry? What seems to be happening is that he may be drops and then rises and then drops again but all within a flat rangeโ€ฆ Not sure though of course.

    Do I need to do a test again before p.m. PMPS? And what is the range we are aiming for again what is the very lowest not any lower than 150 correct?
     
  38. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Range wise with Vetsulin, you don't want him dropping below 80 or 90 and unless you are able to keep an eye on him, I'd probably try to keep him at 100 or more for safety purposes. You've still got a ways to go and some kitties do see two dips with Vetsulin due to the mix in the insulin, the latter drop sometimes around +7 or +8 being less dramatic.

    His nadir could be anytime between now and +6 so I would suggest testing again in an hour or at +5 to see where he's at. While that 237 is really encouraging, he really hasn't dropped that much compared to what Vetsulin can do in some cats by +3.5 so he may have a later nadir.
     
    Kris & Teasel likes this.
  39. Martica and Fred

    Martica and Fred Member

    Joined:
    Jan 15, 2010
    Ok could not get there earlier but

    +6.75 is 290

    But my guess is that he may dip again by PMPS time. That is interesting about Vetsulin double dipping-didnt know that. But im very happy with numbers in the 200s all day

    Im not coming back till shot time, although going to try to di it earlier. I have the timing problem again tomorrow as im out from 9-12:30...shot will be due 11 or 12

    ( i keep forgetting to hit 'post reply' each time so post later than i intend!)
     
  40. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    He may be an early nadir kitty but the nadir can move so again you are up against the fact that you have no historical data on which to base any solid conclusion.
     
  41. Martica and Fred

    Martica and Fred Member

    Joined:
    Jan 15, 2010
    So +12. Was 465
    So that was a fast rise back up-nearly 200pts in 5 hours
    I gave him 1.5- (as opposed to 1+, smudgen more)

    I cant get there till +12 tomorrow

    Turns out my neighbor came back tonight-thought it was tomorriw. She is fine with me continuing on...
     
  42. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Definitely looks like he needs more insulin. Chewy is so lucky to have you in his corner and I'm glad your neighbour is going to let you continue to work on getting him in better shape.
     
  43. Martica and Fred

    Martica and Fred Member

    Joined:
    Jan 15, 2010
    So in theory he dropped yesterday between +3-5 and then steadily rose for next 7-8h? On 2 of the previos days he seemed to dip again later.

    Im going to hold him steady at this dose for a week if i can
     
  44. Stella and Ciara

    Stella and Ciara Member

    Joined:
    Apr 12, 2018
    You are amazing what you are doing for that pusscat
    Wish you were my neighbour lol
    Well done !
     
    Martica and Fred likes this.
  45. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    I suggest you hold doses for 3 days at most if you are not getting Chewy's numbers down until you start seeing a decent drop in BG in a cycle. Holding too long risks glucose toxicity which may already be in play to some extent.

    While he may have hit nadir between 3 and 5 hrs. post shot yesterday, it's possible he had a little dip later too. Without more testing, it's pretty hard to guess what chewy is doing.
     
    Kris & Teasel likes this.
  46. Martica and Fred

    Martica and Fred Member

    Joined:
    Jan 15, 2010
    Chewy was 365 at +13.5 today (I couldn't get there any earlier). I"m going to check him at +4 or so.
     
  47. Martica and Fred

    Martica and Fred Member

    Joined:
    Jan 15, 2010
    Previously on 5U BID; skipped 1 dose then started here:
    WED AMPS + 24 - 264 (old meter, so prob 425ish) -- gave him 0.75 U.
    + 6 - 203 (old meter, prob 390)
    WED PMPS +13 - 265 (old meter so 425ish?) ---gave him 0.75 U
    + 4.5 - 205 (old meter) 390 on new CVS meter
    THU AMPS +13 449 gave 1.0 U
    +4.25 362
    THU PMPS +12. 386 gave 1.0 U
    FRI AMPS +14.25 351 gave 1+ U
    + 3 332
    +8. 356
    FRI PMPS +12 310
    +8 336
    SAT AMPS 290. gave 1+U
    +3. 237
    +7 290
    SAT PMPS +12 465
    SUN AMPS +13.5 327 gave 1.5-U
    + 4 193

    Yay, he was 193 at +4.5!!! He did get to 465 last night after being in the 200s all day.

    His lowest numbers seem to be occurring at the +3-4.5 ish range based on what I've taken thus far.
    I'm not going to test him till PM shot time today, and I have to do it a bit early to start shifting him to a different time range
     
    Last edited: Nov 25, 2018
  48. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Liking that 193 a lot! You seem to making some headway. I love your dedication and determination! :D
     
  49. Martica and Fred

    Martica and Fred Member

    Joined:
    Jan 15, 2010
    IMG_7504.JPG Ok held off onbposting for a coule days to just allow him to settle. Things looking good. His spreadsheet is updated but it doesnt record the exact timing so im attaching my paper log. This morning at AMPS he was 288! Im trying to decide whether to test him at +3-4 or 5? Hoping to catch a nadir...
     
  50. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    Are you home today? Best way to catch a nadir is with a full curve. He's certainly improved thanks to you. It looks like he needs a slightly higher dose. Next step up would be an eyeballed 1.75 u.
     
    Last edited: Nov 27, 2018
  51. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Looks like his lowest so far was at +4.5 so either a +4 or +5 would be my suggestion for testing today but as Kris says a curve would be the best way to catch it. I also agree it looks like time to bump the dose again. Nice start to this cycle!
     
    Martica and Fred likes this.
  52. Martica and Fred

    Martica and Fred Member

    Joined:
    Jan 15, 2010
    Well he hasn't gotten to 1.5 yet, so would not want to bump it to 1.75. I'm actually going to hold on where I am for now for a few more days. I have to shift his cycle back to an earlier schedule. I freelance and so have a very flexible schedule and somehow got him on a very late shot schedule. But his mom works a normal job so she has to do an 8am/8pm schedule. So I'm going to shift him gradually back down to that and keep him on the same dose. Just in case there are any effects from circadian rhythms.

    According to her, I'm the first visitor/friend that Chewy has every liked. And she said that when I leave he goes to the door and waits for me! Pretty funny. He also comes and sits with me and purrs and snuggles. She said he has never done that with anyone but her. I guess he is grateful that I saved his life!

    Yes, you're right, I need to do a proper curve, but just wanted to give his poor ears a break and then I'll do it. Do you suggest every 2h or every 3h? I think I'll wait till I have him on the 8/8 shift which will be a few more days still. Today's shot was at 10:20am. That way I'll be able to hand him back over to mom at some point. I think she will do the home testing.

    ONE QUESTION. I use the BD 31 gauge very fine needles with 1/2 markings. I had given her some initially and she brought them to her vet who told her that THESE NEEDLES DO NOT WORK FOR THIS INSULIN....

    Huh???? Well clearly they do as they are working for me...but wondering if anyone has ever heard this? She THEN sold my friend a big box of Monoject 29 gauge (no 1/2 unit) needles....I'm thinking she only recs the ones she personally sells and had no interest in ordering another kind...? That 29 g needle is twice the length of the one I have and clearly that was also contributing to Chewy's not enjoying the experience.
     
  53. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Vetsulin is a U40 insulin and the syringes she got from the vet would be specifically for U40 insulin. Most of them (if not all) do come with a longer lower gauge needle which seems to be standard veterinary supply and most vets don't bother with or maybe don't know that 1/2 unit markings are available. The BD needles you have, if they are the ones you used with your kitty on Lantus, are for U100 insulin.

    I'm a bit confused when you say you haven't got to 1.5u dose yet. That is the dose written on the log sheet in the picture you posted or does the "-" sign mean you've been giving a skinny 1.5u? If you have been using 100u syringes and drawing insulin almost to the 1.5u line, then you have only been administering approx. 0.5u (at the 1.5u line would be a dose of 0.6u) of insulin to Chewy since Saturday night. Is that why you are saying he's not a 1.5u yet? HERE is the conversion chart for using U100 syringes with U40 insulin. When stating dose, even when using the U100 syringes, we state the actual dose in U40 terms rather than where you measure to on the U100 syringe. Sounds like you have been using the U100 syringes but can you please confirm which syringes so we are all clear on dosing up to this point and going forward.

    It's wonderful that Chewy has warmed up to you so quickly and so well. He obviously has good taste and knows who to trust! :D
     
  54. Martica and Fred

    Martica and Fred Member

    Joined:
    Jan 15, 2010
    Yikes, uh oh. Now I"m totally confused. I knew nothing about U40 vs U100. Yes, I"m using BD U100, what I used with Lantus.

    And I've been giving a 1+ (which is a teeny space above 1...so I estimate like 1.25U) and then bumped it to a 1.5- ('minus' or skinny) and I estimate that to be about 1.35 or 1.4 U

    So, YES< it appears I have been given the equivalent of 0.5U (or less) of Vetsulin if it were a U40 syringe, but I'm using the U100, so it's been 0.75- 1.5- (skinny) since I started.

    Wow, he was getting 10x more than he is getting now!

    I did not realize u100 units different than u40 units?

    But is there a reason to use the U40 syringe? Does it matter? I don't understand why the difference. Do they make the U40s with 1/2 unit markers (my neighbor's box doesn't have them)

    The U100 31 gauge is smaller and easier and he doesn't feel the needle going in.

    SCARY to think what might happen if one did it in the other direction--and overdosed rather than underdosed like I did, because of not realizing that the needles differ in size...So I REALLY baby-stepped it for Chewy. Probably just as well cuz his body must have had to recover from those constant hypos...
     
    Last edited: Nov 27, 2018
  55. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    U100 syringes are for U100 insulins like Lantus. There are 100 units of insulin in each mL of liquid insulin. The syringes are constructed so that when you draw up insulin to the (for example) 1 u line, you have exactly 1 unit of Lantus in that little bit of liquid.

    U40 syringes are for U40 insulins like Vetsulin. This insulin is less concentrated than U100 Lantus and there are only 40 units of Vetsulin in each mL of liquid insulin. The U40 syringes will look thicker in the barrel because they're built to hold a less concentrated (therefore larger volume) insulin. When you draw to the 1 u line (for example) on a U40 syringe you've actually drawn up more liquid but it contains only 1 unit of Vetsulin.

    So: U100 Lantus is 2.5 X more concentrated than U40 Vetsulin (100 รท 40 = 2.5). You need the appropriate size of syringe to ensure you're drawing up an amount of liquid insulin that contains the number of units you want.

    There are makers of U40 syringes with half unit marks. Many people also start using U100 syringes with a U40 insulin to be able to dose in smaller fractions. This requires a special conversion chart: http://www.felinediabetes.com/insulin-conversions. You'd want to hide the U40 syringes if you try this so no mistakes are made.

    I hope this helps. Ask again if it wasn't clear. :)
     
    Last edited: Nov 27, 2018
    MrWorfMen's Mom likes this.
  56. Martica and Fred

    Martica and Fred Member

    Joined:
    Jan 15, 2010
    Thanks, Kris. that is pretty clear. But, the thing is, it's been fine using the U100...any reason to NOT continue using them? (Other than she has a big box of the U40s...) The U100 is certainly is a nicer needle I think and it's 'fine' so goes in easily I believe.

    so I'm giving him a pretty teeny dose as it turns out (which I am thrilled about, actually.)
     
    MrWorfMen's Mom likes this.
  57. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    Absolutely use the U100s. Do you have the conversion chart printed out so you can easily look up the volume you want in a U100 to correspond to a certain dose?

    It's amazing that he's doing as well as he is on that tiny dose! :woot:
     
    Last edited: Nov 27, 2018
  58. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    I have to second that thought! Chewy is one lucky kitty that you have taken him under your wing! :joyful:
     
  59. Martica and Fred

    Martica and Fred Member

    Joined:
    Jan 15, 2010
    Ok so today he was
    AMPS +11 288
    +4.25. 319
    + 11.75. 334

    So i missed any dip. Still trying to inch his time schedule forward. Will hold steady
     
    MrWorfMen's Mom likes this.
  60. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    Just so I'm clear on this - what was his exact insulin dose now that we've cleared up the syringe confusion? Are you using U100s now? Let us know what the dose was, not the level on the U100 syringe you drew to. I only mention that because it's been a point of confusion for others in the past. I'm so glad you're helping Chewy! :)
     
  61. Martica and Fred

    Martica and Fred Member

    Joined:
    Jan 15, 2010
    Thank you. So i have been using the U100 the entire week, since I took over on 11/21.

    I started at 0.75U (0.5+) using U100. Then increased to where i am now ~1.35U (1.5- on the U100)

    So it appears that using the conversion chart im giving what would be 0.5U if using a U40 syringe

    Prior to 11/21 my neighbor was giving 5.0U BID using yhe U40 syringe

    Is that what you mean by clarifying the dose?
     
  62. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Just to clarify dosing to date for anyone following:

    11/21 - 0.3u am & pm
    11/22 - 0.4u am & pm
    11/23 - 0.5u am & pm
    11/24 - 0.5u am & 0.6u pm
    11/25 to present - 0.6u

    I think Chewy needs an increase and you could safely take him up to 0.8u (2.0u mark on U100 syringes) for a couple of days. Don't want him losing momentum by sitting in high numbers for too long.
     
    Kris & Teasel likes this.
  63. Martica and Fred

    Martica and Fred Member

    Joined:
    Jan 15, 2010
    Hi Sorry, I missed your post earlier. Was giving it a few days and not doing nadirs to give his ear a rest, and me a rest with my schedule and shift him closer to the 8am/8pm time zone before I tweak further.

    But he is getting better and better numbers on the same dose.
    Yesterday

    11/29 - 0.5U am & pm he was 261 and 301
    11/30 - 0.5u am & pm he was 261 and 299
    so I'm pretty sure during the last 3d he would have been staying in 200s if not dipping to 100s

    12/1 - AMPS 259. 0.5u
    12/1 + 4. 217
    12/1 +12 PMPS 250 ! 0.5U


    [​IMG]
     
    Last edited: Dec 1, 2018
  64. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Those numbers look like an improvement indeed! Sorry but your image link isn't working. Was it a pic of Chewy?:)
     
  65. Martica and Fred

    Martica and Fred Member

    Joined:
    Jan 15, 2010
    Oh sorry, no, it was a screen shot of my excel sheet! This morning he was in the 200s again. Didn't write it down yet, will when I got back shortly for the PMPS shot. I will do a curve in the next few days and see about possibly bumping it up. I'm sick right now (a cold) so trying not to overburden myself cuz already so much other stuff to do as well as this!
     
  66. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    I hope you start feeling better very soon. When you do, I think Chewy needs a dose increase to 0.75u+ or 0.8u (on 100u syringe 2.0u). Those yellows are a big improvement but you don't want to let him stay in those still high numbers too long.
     
  67. Martica and Fred

    Martica and Fred Member

    Joined:
    Jan 15, 2010
    Feeling like crap. Had fever last night. Just came to check Chewy and his AMPS was 208!

    I would increase to 1.5 first. I need to start doing curves again to see how low he isgetting. As soon as i feelbetter i will.

    What do you recommend the range should be ideally?

    Im not afraid of higher numbers since the damage takes years to kick in. My Fred was consistently in the 300s and 400s for like 6y, occ 200s. Ironically, it wasnt till i lowered, rather than raised his dose that he got better numbers.

    Ive regulated several cats on 0.25u lantus only once a day. I think their own insulin starts kicking in...chewy is def feeling good. He is being very affectionate. My neighbor saud shes never seen him be like that towards anyone but her. Once hes fully regulated i will go to her vet visit with her abdctryvto educate the vet
     
  68. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    What a time of year to get sick.:( Hope you feel better very soon.

    Loving that 208. Ideally you don't want Chewy going below about 80 and topping out at 150 or so. I'm not concerned about organ damage so much as him developing some glucose toxicity that makes getting the numbers down a bit more challenging but by all means you don't want to be increasing until you know you can monitor. You have to look after you first so you can look after Chewy.

    Doesn't surprise me that lowering the dose improved Fred's numbers. We see that quite a bit around here. I myself ran into that a few times with my girl. Totally counter intuitive and hard to get novices to wrap their heads around. :rolleyes:

    So nice to hear Chewy is feeling better and being affectionate. Their behaviour and demeanor is often just as good a gauge as their glucose numbers! He's definitely improving! Your neighbour and Chewy are so lucky you came to the rescue!:D
     
    Martica and Fred likes this.
  69. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    Ideally you want the nadir to be in the 90 to 110 range for Caninsulin. If you can get PSs to drop into the low to mid 200s max that's great but the nadir range is more important.
     
    Martica and Fred likes this.
  70. Martica and Fred

    Martica and Fred Member

    Joined:
    Jan 15, 2010
    He was up a bit this morning at AMPS was 309. I'm still getting over this cold so not going to go whole hog into it again for a few more days.

    getting below 100 makes me nervous. I'm a little bit unsure of his mom being as meticulous about this when she takes over. Although I guess if he survived 10U /day for a whole year maybe I'm being overly cautious.
     
    MrWorfMen's Mom likes this.
  71. injuredrabbit

    injuredrabbit Member

    Joined:
    Dec 8, 2018
    I am not a regular Vetsulin user but a new one. My cat was put on a starting dose of .5 unit 2x/day. Are you sure it's 5 and not .5? Even as a newbie to this but as one who has done a fair amount of research on feline diabetes beforehand, 5 units per dose sounds scarily high, as other posters have said. Can you call the vet to confirm?
     
  72. Martica and Fred

    Martica and Fred Member

    Joined:
    Jan 15, 2010
    YES he was on a full 10U per day (5U BID) !! Crazy, I know. NOW he is on 1.5U (u-100 needle) which apparently is the equivalent of 0.6U on the u-40 needle.

    Tonight he has ketones. 'Low to moderate' acc to the color picture. She is taking him to ER right now. Don't know if this is serious, have never dealt with ketones before, but today his BG was very high--higher than it's been. She gave him a new food yesterday (he has been on prescription M/D) I posted on main board for help, although now the ER will deal with it...worried that they are going to jack up his dose again..
     
  73. Martica and Fred

    Martica and Fred Member

    Joined:
    Jan 15, 2010
    They had to put Chewy to sleep yesterday. Hepatiic lipidosis. I'm shattered and in shock. My neighbor (his mom) is worse. I posted the details on the main FDMB forum under a 911 ketones thread...

    thank you for all your help. At least the vet said that the dosing I had been doing was the right thing, thank god. She said his 5U BID that the other vet had put him on was 'crazy'.

    But I should have known to watch out for hepatic lipidosis. Apparently he had pancreatitis..not sure my neighbor knew this, if so, she did not tell me. He had a UTI too. :(
     

Share This Page