New member Vetsulin dosing advice please

Hello,

I would really appreciate some dosing advice please.

Admittedly I am a terrible sugar kitty Mom as Marvin was diagnosed 7 months ago but I am only starting to test now. Lots of reasons/excuses why but none of them valid. For this reason his spreadsheet is lacking in data and only has a 4.5 days worth of testing.

Backstory:

He was diagnosed in Sept 2021, stayed with the vet for 3 days and put on Vetsulin with a dose of 2u once a day. I questioned why only once a day and was told it is what was working for him. I also didn’t need to home test and we would check his levels when I needed a new vial. I wanted to trust that my vet knows what he is doing.

I transitioned him from dry food to Fancy Feast and Friskies and quickly got over my fear of having to give an injection. His behavior returned to normal, eating well 4 times a day, drinking less water, grooming and playing.

Fast forward to roughly 2 weeks ago. He stopped eating and drinking and received a renal failure diagnosis. He didn’t have food or insulin when I took him in and had a BG reading of 156, presumably on a pet monitor. Also a temp of 104. We did a course of antibiotics. I was a bit scatterbrained at the time because I had a second sick cat in as well for other testing so I didn’t get all the info I should have. I am hoping to get him in today for fluids and will get all the info. I need a better vet but this is what I can afford at the moment.

He is doing much better, drinking and eating. It not as much as I would like so he is being fed more often. Working on switching him to low carb and low phosphorus wet food and have a phosphorus binder for his regular low carb food as I educated myself on CKD as well. He does have some neuropathy which seems to be improving some in the last week.

I have been going through this forum for BG numbers and dosing for Vetsulin and after seeing what Marvin’s numbers have been with the 4.5 days of testing so far and I am now worried I may over dose him and he goes too low. I do have a hypo kit ready.

Sunday I skipped his shot as I couldn’t be home to monitor him for the entire day but tested as often as I could. His poor ears with how much testing I have done.

Skipped his shot again today (Monday) as he is getting nowhere near 200, which it is my understanding that he should reach before giving Vetsulin. Should I keep skipping with these low numbers? Is this possible remission or is he too low? Should I lower his dose and do 2 shots a day? I was worried about skipping the AM dose altogether since we don’t do a PM dose but his numbers stayed pretty consistent.

Any advice would be greatly appreciated!

Thank you so much for your time!!

Kwyn & Marvin

 

Hi there and welcome! I'll get to the other stuff in a bit but want to address the most pressing stuff first - when did you start the diet change? How much of what brand/flavor of food is he currently getting?

Or perhaps I misunderstood, just want to verify - he is currently completely low carb? You are just switching from low carb to low carb + low phos?

How was he diagnosed? Fructosamine? Symptoms? Any recent steroids? Do you have any prior curve info from the vet since diagnosis?

2 shots a day is best BUT not safe to shoot right now...and definitely not 2U. You are very fortunate your vet was mistaken enough to prescribe once a day dosing, or you might not still have Marvin (also unfortunate that your vet prescribed 2U to begin with...).

His numbers are very good off the insulin, I'm leaning skip insulin for a little while and see how he does but I need more info. Has he ever had ketones or DKA in the past? Usually it would be mentioned when lab work is done (or you'd KNOW if he had DKA, no doubts with that one).

Also - is it renal failure or CKD? It would be immensely helpful.if.you have any lab results.you can post, just scrub out any personal info. We have a lot of.people here with CKD experience as well

 

@Suzanne & Darcy tagging you as well, especially with the kidney troubles

 

Thank you so much for responding!

He is currently completely low carb and has been since his diabetes diagnosis in sept 2021. Working on switching to low carb + Low Phos now.

In all honesty I have no idea how he was diagnosed, if it was just a blood glucose reading. I took him in for weight loss, excessive thirst, excessive urination and hunger. My vet is very low tech, no electronic records, all my cats files are written on index cards. He took over his fathers practice and I guess has never changes anything. I am probably going to have to ask to take pictures of their cards.

No recent steroids, only 6 days of antibiotics. No curve from my vet. I feel terrible that I have not been more proactive about this.

Thank you again for responding.
Kwyn

 

Sorry I missed some of your questions.

He has been eating Fancy Feast Classic Chicken pate, that's the flavor he prefers and friskies chicken or mixed grill pate. usually around 9-10 oz a day. He weights around 12 pounds

I tested for ketones this morning and there was no trace, but of course now I am worries since I stopped shooting. No DKA in the past.

My vet said renal failure but I am leaning towards having a retest if he was fighting an infection and he was very dehydrated that could have affected his results.

I don't have any results unfortunately, I will call my vet and see if I can go and get copies of his files.

 

No worries, you're here now, and you're doing all the right things.

You can do fluids at home by the way, will probably save you quite a bit of hassle (and money). Suzanne will be better to help with CKD, if that's what it is...from what I understand renal failure and CKD can be different things.

Let's start here - skip insulin for the next 2-3 days and check back in (you can tag me using the '@' symbol - just as you see here @FrostD ). Continue to test at what would be your normal shot times, and try to get another about 3 hours after he eats. No need to test all day - no insulin, no hypo with Vetsulin. If you get a reading higher than 175 let me know as well.

In the meantime, go out and pick up some urine ketone test strips (like Ketostix), if you're in the US should be over the counter at any store with a pharmacy, like Walmart, CVS, etc. Try to get one test a day - if it shows anything other than negative, let us know ASAP. Follow the directions on the back of the bottle, the read time has to be exact because the syrup can change over time. Some people slide a (dedicated!) soup ladle under them to get a sample, others cover the box with Saran wrap. I have an empty litterbox I use for collecting urine, I just sprinkle a tiny bit of litter in one corner and for whatever reason that's enough to convince him to go. Cannot dip it in the litter, as the litter itself may mess with the readings. I'm not expecting any ketones with these numbers but always good to check when there's a drastic reduction in insulin.

 

Oh look already ahead of the game with the ketones! Making my life so easy.

In these BG numbers I would not expect ketones, but it's always a safe thing to do to check, especially with recent infection.

At this point, just ask about the kidney labs - wait for Suzanne to chime in, but I think she'll want to know BUN, Creatinine, phosphorus, urine specific gravity, and SDMA if they did it.

 

Thank you so very much for your time and help, I really appreciate it!! I will follow your advice re insulin and testing and get in touch with my vet.

 

I agree with Melissa. Looking at his spreadsheet, I would not be shooting insulin right now. He seems to be doing very well without it. It will be good to see how he does over the next few days with no insulin. His numbers are pretty much in the normal range. It would be very good to know the lab results for Marvin. And yes, you are right that an infection can affect those kidney values. What kind of antibiotic did he receive? For how long? When did he stop the antibiotic? Has he had blood work done since the antibiotics were finished to make sure that his white count has returned to normal and (hoping) maybe his kidney values are better? How old is Marvin?

 

If his phosphorus is high, then this can cause lameness/weakness in the hind legs because the phosphorus will interfere with signals getting through to the nerves. Perhaps it's your phosphorus binder that is helping. You know, I am sure, that you need to use phos binder with every meal. What kind of binder are you using?

 

I'm still thinking about the labs.... your vet may be old school, but the labs that receive the blood will not be. At the very least, they will fax results to your vet from the blood. Hopefully, he did not run the blood "in house." I would ask next time for it to be sent to an outside lab (results should be available the following morning for all standard blood work.)

 

And ... sorry for so many question. Are you feeding the Fancy Feast Classic Pates that are low carb? I am sure you are and probably already know that the gravies are not low carb.

I ended up finally having to feed my diabetic boy renal food at the end. He did fine on it and it didn't have a huge impact on his BG (but he had acromegaly and seemed to have a functioning pancreas.) It looks from your data that Marvin also has a functioning pancreas. Just my take on it anyway

 

Hi Suzanne,

Thank you for responding,

I just returned from the vet with sub-q fluids and a photo of his kidney labs that I will try to attach here.

He was heading out to a house call as I arrived so his assistant/receptionist is going to compile all his diabetes tests and email them to me.

Yes he has been on Fancy Feast low carb pates, no gravy cat food.

I don't know the antibiotics as I have since thrown out the label but will call and find out. Also no follow up blood work. Ugh I am really of no help at all here am I. I figure I am just going to have to bite the bullet and find a different vet.

Thank you!

 

Also 6 days on antibiotics and finished on April 16th

 

I have only just started using Epakitin phosphorus binder as well as starting to introduce Weruva low carb low phos food.

 

Well now that is interesting, that amylase is high (other than the kidney stuff yes very high, Suzanne is better at reading those labs). I wonder if he actually had pancreatitis when you took him in...did you get any sort of actual diagnosis? That's not a definitive indicator of pancreatitis, but something going on with pancreas usually

 

I would definitely try to do fluids at home, how often are you taking him in for fluids? It's scarier than it actually is, especially that darn needle. But I've heard of many people just buying a case at CVS and the tubing/needles or similar for pretty cheap. Much easier and cheaper than vet visit.

I'm guessing this is website you found, but just in case - https://felinecrf.org/fluid_therapy.htm

Edit - adding this link as well http://www.felinecrf.org/how_bad_is_it.htm#how_bad_numbers

Do you know if he's had BP checked?

 

Well since I don't know the phosphorus number I can't say whether Epakitin is the best at this time, but I have used it myself in my cats if their phosphorus was not "off the charts" high. They seem to tolerate it well. I have also used Aluminum Hydroxide and Niacinamide.

 

With a temp of 104 and only 6 days on antibiotics (do you remember which one?) and kidney involvement, I would have opted for a longer course of antibiotics. Where does the vet think the infection was located? It's just important because if the infection was a urinary tract infection it can travel up into the kidneys and really wreak havoc there. So it's important to make sure he still doesn't have an infection (a vet recheck with blood work and temperature check, urinalysis -- all sent out to a lab).

 

The only diagnosis he gave me was renal failure. When I called today I asked him if it was renal failure or CKD he said they are basically the same. I do have a second vet clinic that I have used and wish I could take my cats there all of the time but when finances are tight I use this one. I feel I am going to have to go there for a second opinion.

 

Yes, those kidney values are not good at all. But you say that he is feeling better? Eating better? Drinking? I would definitely start sub-q fluids (Lactated Ringers solution) at home with those numbers. The vet needs to check his heart out first to make sure it's safe to give fluids. How much does your kitty weigh? They can show you how to do this at the vet. I would not take home the harpoon needles that they always try to give you at the vet. Don't use anything higher than about a 19 gauge needle (20s are a little smaller and are good if your cat is patient enough to sit still -- the fluids will flow a little slower).

 

I don't necessarily think you need a second opinion, those labs are pretty clear there's definitely an issue. IRIS Stage 4 I believe, significant loss of kidney function (some say up to 90+% loss). Some cats can hang out awhile up there, but the changes you're making are definitely necessary.

 

I am so sorry. (HUGS) You are doing the best that you can. At this point, if you can swing it, I would go to the other vet if you think they are more competent. You can bring those blood results with you and try to gather as much other info as you can like the antibiotic name and any other pertinent info from his recent vet visit(s.) I know what this feels like. It's very overwhelming.

 

If an infection caused those high numbers then it is possible that they can come down -- we can't know how much until you try. I got my kitty's numbers down from very high like that (he passed of a different issue).

As for the terminology, I think the vet was just using the older term of renal failure instead of CKD.

I think you should join the support group that is affiliated with the felinecrf.org site. The people over there are wonderful (I'm on it... not that I am wonderful... but the moderators are very knowledgeable and kind and responsive.)

 

And with that high of a phosphorus, you probably should be using Aluminum Hydroxide. I can say that I would be very surprised if he wasn't having trouble walking with phosphorus that high. The Weruva foods (which I also use for my cats) are moderate phosphorus (not low like a renal food.) At this stage, it is probably a good idea to use renal food. You could try just binding everything, but either way, you'd have to re-check phosphorus in a couple of weeks to see if it's working since high phosphorus will just further damage his kidneys. You want the phosphorus to be about 4.

 

Fluids can really help. How much did they say to give Marvin? I would do daily fluids at this stage.

 

Also, sorry to add something... but Melissa mentioned blood pressure. It's important to have the BP checked as a lot of CKD cats do have high blood pressure.

 

I agree. The kidneys are a much more pressing issue - if he needs to end up on a higher carb renal food to take care of that, so be it. We can manage any BG increases with insulin.

 

No, unfortunately I don't remember which one

Yes he is definitely feeling better, not 100% though. He still sleeps a lot. He is eating but not as much as he was and is drinking some as well as I add a little water to his food. Just double checked his weight and he is 13 pounds.

I wish I had waited till you responded before going to the vet. I have Vetivex fluids, which I am assuming is what he gave him when we initially went in.
Thankfully he is a very patient kitty and does well with injections and ear pricks.

 

Thank you, I will join that group as well. I think you are wonderful and I am so appreciative of your help!!

 

He said 100 mls

 

Now I am curious about the labs at the FD diagnosis....I am wondering if perhaps it was a lazy/misdiagnosis and the kidneys were completely missed (either not checked, or written off). I don't know a whole lot about CKD yet but i would have expected some elevation in numbers 7 months ago given where he's at now.

What's past is past, but just adds to the list of issues with the vet himself.

 

Ok, thank you I will do that. Can I get renal food OTC or do I need a prescription?

 

I am curious myself, I will post the labs when his assistant sends them.

 

I think you need an Rx for it. I'm sure you can get it from the vet (a prescription that is.) What I have always done is to get a few cans of different flavors at first from the vet, to see which flavors are most popular. Royal Canin makes several different flavors (like E for enticing, D for Delectable, etc.) and Hill's makes a few that my cats have liked, such at K/D Tuna and Vegetable Stew and K/D Chicken and Vegetable Stew.

 

Then if you can find some flavors that he likes you can order from a place that is cheaper. My vet will take back and refund me for unopened cans.

 

How much does Marvin weigh?

Edit: Okay... I see he weights 13 lbs. so he is a big boy. As long as the vet doesn't hear a heart murmur or anything then he's probably okay to get 100 mL daily. This should help him to feel better. Just make sure that the fluid from each session is completely absorbed before doing it again. And watch for signs of overhydration like rapid breathing (bad sign, usually pleural effusion .. water around the lungs). It's sometimes difficult to do, but you can also split up the fluids into two sessions 50 mL twice a day.

 

Thank you so much for all your help!!

 

He is 13 pounds

 

Thank you, I will talk to the vet.

 

Yes. Sorry. I just saw that you posted that he is 13 lbs. I just edited my post above about the fluids... here's what I wrote:
Edit: Okay... I see he weights 13 lbs. so he is a big boy. As long as the vet doesn't hear a heart murmur or anything then he's probably okay to get 100 mL daily. This should help him to feel better. Just make sure that the fluid from each session is completely absorbed before doing it again. And watch for signs of overhydration like rapid breathing (bad sign, usually pleural effusion .. water around the lungs). It's sometimes difficult to do, but you can also split up the fluids into two sessions 50 mL twice a day.

 

With a BUN as really high as Marvin's is, you should try to get some anti-nausea medication from your vet. Those uremic toxins will make him feel lousy. Vets like to give Cerenia (and I use it) but Ondansetron is better for nausea. You can try the Cerenia first, of course. I'm really shocked that the vet would send you home without a plan of action to help Marvin feel better (anti-nausea meds, an appetite stimulant, etc.)

 

I really can't thank you enough, you are really helping to calm me down and keeping me from being overwhelmed by all the information. I am sitting here in tears and appreciation. You are an amazing human!

 

So the first thing to do in addition to the fluids is to start him on some anti-nausea meds (per my message above) and then to add in an appetite stimulant. There are several options for an appetite stimulant. An old one is cyproheptadine. A newer one if Mirtazapine, which comes in pill form of also a Trans-Dermal ointment that you apply to the inside of their ear. I have only ever used the trans-dermal ointment before. If the vet give you this, go very slowly with it at first. The box that it comes in has a little measuring line on it that shows you how much to give (1.5 inch strip). This is way too much for most cats and will make them very anxious/fractious (meowy, restless, even aggressive in some cats, like mine). Start with a small amount like 1/3 to 1/2 of the recommended length of the strip and see if that helps Marvin's appetite. A lot of cats only need this every other day, but it can be done every day. You have to kind of play around with the dose to see what works.

It's very important to address nausea first before adding in any appetite stimulants though. Imagine feeling really sick and then also being hungry! This can also cause food aversions.

Sorry to dump all this on you at one time. If it were me, I'd try adding in the new medications gradually to see what works. First some Cerenia or Ondansetron. Then an appetite stimulant after you see if those help him to feel better.

 

I am rapidly realizing just how terrible of a vet he is. I hope I can get an appointment at the other clinic quickly.

 

Aaaw. That's sweet. I just love cats and I have a real empathy for people who are going through all this. I wish I could wave a wand and make Marvin get all better! He is just adorable in his picture. I was just showing my daughter his picture... she agrees that he is a cute boy!

 

I do already have some Mirtazapine that was used for another kitty but I will get an anti-nausea med first.

 

One more thing for right now. Marvin will be dehydrated just due to the problems with his kidneys. Please, please, please keep track of how often he is having a bowel movement. Cats can quickly become constipated when they have CKD. The fluids should help, but some of these medications that make our kitties feel better can also contribute to constipation. Watch to make sure that he's pooping regularly and that he's not passing little hard balls of stool. If he is, you need to jump on the constipation right away to get ahead of it. Miralax for starters, but a lot of cats need Lactulose (which the vet would have to order for you probably.)

 

I definitely will! Thank you!

 

Some vets do not like to prescribe Ondansetron for some reason. It is a human medication that is very effective at controlling nausea. You would have to get it from a pharmacy. I have had to use both in my cats before. For vomiting, Cerenia is very good and it will help a little with nausea. If it's not really making him feel better, I would get the Ondansetron. When he eats, does he go up to his food and sniff it and walk away? Does he maybe just do a lick or two and then walk away? Does he every make strange sounds when he is eating that sound like tooth grinding or similar sounds?

 

No he doesn't sniff and walk away or take a few licks and walks but he is probably only eating maybe half of his normal amount each time. Yes he does make the tooth grinding sounds sometimes.

Before diagnosis he let me know when he was hungry, now it is only in the morning that he asks for food but eats whenever I offer.

 

That is one of the signs of nausea that a lot of people don't understand.

 

Wow, thank you, I did not know that.

 

@FrostD

Double checked his ketones and this is what we have at the 15 second timer mark.



Double checked on Ketones and this is what I have at th

 

I seriously hate when that happens, like that wasn't even a color option! Can you dip one in just regular water and see how it comes out?

 

No color change at all with water

I tested the urine with 2 different sticks and got the same result

tested his blood 30 mins ago and it was 113

 

Ok. Don't exactly like the purple even though it doesn't match anything. How's he acting? Can you get a BG test in soon?

 

I did about 75 mL fluids 3 hours ago
Tested his BG 30 mins ago and it was 113 but will do again if needed.
He had a little bit of food 20 minutes ago and now he has gone back to sleep.

 

Ok. I am asking a few people so hold tight. We don't consider that purple negative but it doesn't really match anything either. It's not safe to give insulin right now.

Is he lethargic at all? I know you said he hasn't been eating as much but was it "normal for him" today?

What color was the one you did this morning?

 

Yes his eating was his "normal for him" today, he does sleep a lot since he has been diagnosed. Still gets up to eat and use the litter box. Gets up when he hear's the freeze dried treats jar. Other than that he is always on the bed. Yesterday's test was the negative color.

 

I don’t know what to make of that color either. So strange. I used a blood ketone meter called the Nova Max Plus. That doesn’t help now. How old are your ketone strips. Do they have an expiration date on the bottle?

 

BTW, I use Vetivex lactated ringers solution too. I order them from Chewy.com.

 

They have an unopened expiration date of 2023 and I just opened it a couple of days ago.

 

That's great, I will look at ordering a blood ketone meter as well. Thank you!

 

Ok. At this point I have to assume he does have some ketones, which puts you in a bit of a pickle.

The ideal first step is finding a blood ketone meter to get an actual value and confirm, but I am guessing your vet may not have one or may not be open. They aren't usually sold in stores but you can look online to see if a store nearby maybe has one. You could try a different brand of ketones strips as well.

The official recommendation would be to take him to vet to get checked out. He may need even more fluids if there are ketones present. What we don't want is for this to progress to DKA. So need to keep him eating, keep him drinking.

I'd also keep an eye out for infection returning. It's possible the antibiotics didn't fully clear it, which makes DKA risk higher.

Now comes the question of insulin - it guards against DKA. So normally at these numbers I would say skip because it's very close to normal range and we just don't have the data. But given the potential ketones, the recent infection, it may be better to try 0.1U - just a hairline of insulin drawn up into the syringe, barely anything. The problem with this is I have no idea how low it may take him. You have a hypo kit, the 2U didn't drop him too horribly low (just much lower than we like for Vetsulin, and not a lot of data before you started the testing).

So unfortunately you really have to weigh your options and risks, and decide what path to take. You could take him in, but you mentioned financial constraints. You could just keep him eating and drinking as much as you can and skip insulin, but the risk of DKA is there. You can keep him eating and drinking and give that small dose, but still no guarantee against DKA and risk of low BG/hypo.

 

Ok, I think I am going to go with a hairline of insulin and I will monitor him closely. Should I see if he will eat again before I do? It has been an hour since he ate last. I just looked for a test kit locally and can't find one but ordered one that will be here tomorrow, I know that doesn't help me now.

Thank you again so much for your time and advice.

 

Yes, try to get him to eat at least a 2 tsps, then go ahead and give the shot (that last meal will help keep him afloat as well). I wouldn't let him gorge himself because if he does drop lower, you do need him a bit hungry then. You'll want to test him hourly for sure, I'll stay with you as long as I can. I'll also tag @Bandit's Mom and @Bron and Sheba (GA) who are usually around at night

 

Ok, thank you!

 

Another thought, if your vet is still open you can call and mention the ketones and see if it's possible to give him more fluids. Although I don't exactly trust your vet...

I'm not sure how much he's had today or recently, I'm not sure how his heart is, etc.

 

Well they’re fresh then.

 

I would not exceed 100 mL per day.

 

I ordered my Nova Max Plus from ADW Diabetes Supply.

 

He isn't open. I am not trusting him either. We did 75 mL about 4 hours ago.

 

I promise I won't go over 100 mL

 

The concern about potential infection is the reason that I said you need to take him back to check his white count and other blood work. My boy went into DKA due to an infection of unknown origin. His temp was 105 when I took him in. Of course, he was vomiting a lot as well. But Marvin is eating. Honestly, a cat with numbers so high (that BUN) who is still eating gives me good hope. Marvin is not vomiting.

 

Yes and how many times have we seen antibiotics not fully clear whatever is going on. My worry as well.

 

The safest water for him is to get him to drink on his own. That water cannot pool in the wrong place. Water his food if he will eat it. If he likes tuna water you can get him to drink some watered down tuna water.

 

Please let me know what time you shot, and which time zone you are. I would start with a test 45 mins after the shot

 

Ok I'll be back around then

 

Yes I do add water to every meal and he does drink some out of the water dish on his own but I am not sure it is enough. His urine output is getting smaller. I wanted to have fluids here more so as a "just in case" and have no problems giving him less or even every few days or weekly as needed.

 

I shot at 7:53pm CMT and will check again at 8:30pm

 

Canadian Mountain Time???

US would be EDT, CDT, MDT or PDT (eastern daylight time, central daylight time, etc.)

 

I do believe that he needs the 100 mL per day. Some vets would recommend more.

 

Haha, shows you how frazzled my brain is right now, CDT

 

100 mL a day it is then

 

I understand your ketone strips are only a few days old....how old are your BG strips?

 

They also have a 2023 expiry date and the batch I am using now was opened 2 day ago.

 

BG was 114 at 8:30pm

 

Ok good. Let's do another in 45 minutes.

 

Ok, thank you!

 

OK....one more question....on the ketone strip with the funky purple color....did you take the picture at exactly 15 seconds? Every second past that will also cause the strip to get darker and darker

 

Where do you live Kwyn?

 

Yes, right at the second that the timer hit 15. I did 2 strips and got the same result at 15 seconds.

 

Nashville

 

I am a Canadian living in the States so the Canadian Mountain Time made me laugh

 

This is troubling to me as it is not the normal thing for a cat with kidney disease to do. I guess the vet assistant did not give you any of the other blood work from his file today. I wish we had some earlier results to compare to. I don’t even know what his hematocrit is and if he may be anemic. He probably needs some B-Complex and B-12 injections. If he’s anemic he may need some other medication. I can’t stop my mind from thinking about Marvin and what’s going on with him. But he seems better than his numbers (at least on April 11) would seem to indicate. I am concerned that he needs IV fluids. I’m hoping for better things for tomorrow.

 

I am in Georgia. We’re neighbors.

 

BG is 91 at 9:15pm

 

Ok what foods do you have on hand? I would give him 2 tsp of medium carb food (10-15% carbs). Test again in 45 mins.

Carb counts - https://catinfo.org/chart/index.php

Nadir (lowest BG) is usually by +4 on Vetsulin