Newly diagnosed on Vetsulin- question

Hello,
My Bengal Malachai was recently diagnosed. I've just started using this message board and am slowly learning...several questions here.
Malby has been on 2units of Vetsulin 2x a day for 9 days. I haven't seen much of a change in his energy (he was extremely playful before being diabetic, he's 7 years old), he's still drinking a lot, and he still urinates in large amounts.
My question is, for those of you who used Vetsulin (or in general) how long did it take for you to see a "change" in your cat? I'm concerned I should be giving him 2.5units?
I have the AlphaTrak2 meter. Malby has always been food obsessed. He's psychotic in the mornings, all fluffy and trying to climb up my leg for food. I'm finding it very hard to calm him down to test his glucose before he's been fed. Any suggestions? I'm trying to make testing a regular thing and would love to do a glucose curve to see if his numbers are still very high at 2units and if dosage possibly needs to be increased? Any help would be appreciated but specifically wondering how long it took for people to see an improvement in their cats behavior/mood? Thanks!
Deena

 

Hi Deena. Every cat is different as far as the time frame in which you will see a change. In some cats it can be almost instantaneous while in others it can take some time. Some cats seem to need a bit of time to adjust to insulin and that alone can make them less active and even a bit lethargic in the early days. Many people report their kitty sleeps for quite awhile immediately after their shot. Other things factor in too, such as diet. What are you feeding Malby? Ideally his diet should be wet food with no more than 10% carbs. In some cases a change of diet to a low carb wet diet can significantly lower BG and in some lucky cases a diet change alone will put a cat into remission.

As for testing, you could try giving him a few low carb treats to tide him over till testing is done or if you absolutely have to, you could give him his part of his food and test immediately after before it starts influencing his BG to any appreciable degree and then offer up the rest as a treat for being a good patient. He's probably very hungry right now because diabetics don't utilize what they eat very well so his "psychotic" need for food should calm down as you get his BG under better control.

If Malby just started on insulin 9 days, 2u of Vetsulin is a larger dose than we would recommend. Normally we'd suggest starting a cat off at 0.5u to 1u. Insulin is a hormone not a medicine so if the dose is too high, it can appear to be too low so please don't increase the dose. If I were you, I'd seriously consider backing him up to no more than 1u. As testing becomes easier and you get more data to see how Malby is reacting, then you can slowly increase the dose if needed.

I don't know if anyone pointed you to the spreadsheet we use here but it is a wonderful tool that keeps all the data readily available for you and for anyone on the board to view should you need any advice going forward. The instructions for setting up the spreadsheet is HERE and THIS DOC explains how to use the spreadsheet. If you need any help setting up the spreadsheet, just holler and we'll assist you.

 

Thankyou for the information! The vet put him on Hills wet W/D but he wasn't on it for more than a single day after doing some research and realizing how high the carbs were. I tried feeding him Core Welness but he didn't like it (and for a cat who will try and eat anything these days, I knew it wasnt the right food for him). After extensive research, I currently have him eating Fancy Feast Classic Turkey Pate. I think it's 4% carbs. He's strictly on wet food right now and eats 2X a day.
His first curve at the vet showed high numbers until later in the evening 567-431-435-393-357-284. The last number (284) was taken at 6pm. I found it odd that the lowest BG wasn't midday but was in the evening? Is this normal?Yesterday, at 1:15pm I did a midday test (when I was told it should be at it lowest) and it was 371 (similar to the 435 BG taken during his curve at 1pm).
Clearly I don't have enough data yet to see how the insulin is working and when his highest and lowest BG numbers are but I would like to start using the graph when I can get him to let me test him. Unfortunately, it looks like the most important test times are right before injection times (7:15AM/Pm) but that is when he is the most difficult to handle because he's hungry (physho kitty time).
I did try feeding him half his food this morning before I tested him (I called the vet last night and she suggested I try the same as you mentioned) but he wolfed it down in a matter of bites. I tried the other half (pricked him twice at this point), but he was just all over the place. Im not sure I will be able to get him to sit still but I will try again tmrw and maybe wait a bit longer.
I was just worried it was the wrong dose because his drinking has continued to be high and it almost seems to have increased the last 2 days. I started giving him his shot on the side of his chest as of last night has I have read that there is poor absorption/circulation in the scuff area. I was hoping that would help?
Thanks again for your input. I'm a little overwhelmed and just want to do everything right.
Deena and Malby

 

We've all been where you are....feeling overwhelmed and wanting to see some results ASAP but unfortunately, this sugar dance is a marathon rather than a sprint. It takes a lot of patience and self control not to want to push things too quickly.

The fact that the lowest BG reading was at the end of the cycle strongly suggests to me the dose is too high. The body has a defense system whereby if it perceives the BG going too low too quickly, it pumps out hormones that cause glucagon to be released into the blood to bring the BG level back up to what the body perceives to be normal and a diabetic's perception of normal is off because they have become use to the higher BG levels. Vetsulin usually causes the BG to drop very early in the cycle (by 2 hours post shot the drop is usually well underway) and it can be a dramatic drop. The body kicks out glucagon to try to stop the drop leaving you staring at numbers that seem to defy explanation. The peeing will diminish once better regulation is attained because whether the high BG is being caused by too little or much insulin in the system, excess glucose is spilling into the urine and the body keeps trying to get rid of it.

I really do think it would be wise to decrease the dose and see if that brings about any improvement. If my theory that the dose is too high is correct, Malby's defense mechanisms will keep his BG from going too low for a time but eventually the reserves will get tapped out and that could cause Malby to become hypoglycemic which can be fatal if not caught and dealt with in time. My main concern right now is that you are still having some issues testing Malby so you could potentially be giving him insulin when it is unsafe to do so if you can't get a pre-shot reading. If he were to have a hypoglycemic incident, you may have no choice but to rush him to a vet ER for help if you can't test consistently....needless to say, a harrowing experience for both of you not to mention the expense . It's better to have Malby running a little high to keep him safe until you can monitor him better which I am sure you will be able to do very soon.

Just a thought. When I started testing I did some dry runs to practice getting my equipment setup and testing routine down to a science so when it came time for testing I could get it done in seconds. Maybe finding somewhere away from the food service area to use as your testing station would help if you are using the kitchen right now and you can work on getting Malby trained to go there with treats. Thankfully I have a very co-operative cat but I was glad I did those dry runs when I helped out another member with her cat who liked to walk in circles and shake his head when you tried to test him. .

 

Deena, Just now as I was testing my girl, I had a good bead of blood to test but stupidly forgot to push the strip into the meter before dunking and ruining it DRAT! . I grabbed the bead of blood on a clean finger nail so I wouldn't have to poke again and then tested from there with a new strip. If you are getting blood but Malby doesn't give you time to get the meter strip into position, perhaps you could try this method.

 

Great suggestion! That may come in handy one day! Thank you!

 

Thankyou for this information but just to clarify, you think I should lowed his insulin but WOULDNT do it until I get the testing down. Is that correct? Would you suggest going down .25 (injecting 1.75units), or .5 (injecting 1.5)? Thanks again! You've been a lot of help!

 

No. I'd lower it immediately and I'd be inclined to give him 1u or even just 0.5u. Looks like you just recently got Malby onto an all wet diet and it can take up to a week to see the full effect of the lower carb food which could cause some lowering of his BG numbers. That and the data you provided of his numbers is why I am suggesting lowering the dose by at least half. Once you can test more reliably and have a few days of data at the lower dose, we can help you figure out if the dose needs to be increased or decreased.

 

He has actually been on wet food for roughly 3+ weeks now. As soon as my vet thought he was a diabetic I switched him over. The curve was done after he had been on the Fancy Feast for roughly 12days so the curve #'s are with the low carb food. Would you still do such a dramatic decrease in insulin now knowing he has been on the low carb food for 3+ weeks?

 

Oh! And I also forgot to add that the vet said his fructosomine average was 710. I guess they put him on a high dosage (2 units) as his numbers have been so high.

 

Yes that is a high fructosamine but I personally don't find fructosamine a reliable tool for anything but helping to confirm diabetic status and perhaps that an already regulated cat is staying regulated. My cat was getting steady high BG readings and I test a lot but her fructosamine came back saying she was in good regulation. A few very low or very high numbers can throw the fructosamine right off balance. I've had one done and won't waste my money on it again. Daily testing is much more reliable. It's also not reasonable to be basing dosage on the fructosamine result. The dose should be started low and then gradually raised so that the right dose is not missed. This is a common practice with vets and I've seen far too many folks arrive on this forum in a panic because the dose prescribed has been too high and the cat has gone hypoglycemic.

 

More good info thank you. I just tried testing again with no luck. I tried warming the ear and rubbing it for a while. I'm able to prick the ear (I've done it by hand and also with the lancet) but enough blood never comes out. This is where it gets tricky. I find myself trying to grab his ear (trying not to show the cat I'm stressed) and squeeze to get more blood but he's just so squirmy I can't keep him still. Is this a two man job possibly with a cat like this!? Clearly his ears don't bleed very well. :/

ore

 

Deena, the good news is that the more you poke the better he will bleed. I can usually get blood out of my girl even if her ear is ice cold now but it's a tiny drop about the size of a pin head and that's all you need with the AT2 meter. Don't squeeze Malby's ear as that could cause some bruising and you don't want to make his ears sore. Try massaging from the bottom up toward where you poked. It's not usually a two man job except in rare cases but some cats take a bit longer than others to co-operate.

What colour is Malby and how much hair does he have on his ear? Are you poking on the inside or outside of his ear? Inside usually is a little less hairy so you can see better. I can attest to a dark coated cat being harder to test because you can't always see the blood bead. You could also try putting a tiny smidge of Vaseline on the spot you intend to poke. This helps the blood bead stay intact rather than getting caught up in the hair so you can see it better.

How is he with you handling his paws? You can also try to get a test using the centre paw pad for testing.

This usually doesn't require two people but there are rare cases. You could try wrapping Malby up like a burrito in a towel or small blanket but if he's anything like my sugar, you might find that makes him fight you more.

 

Rather than squeezing, try stroking... Like milking the ear. And don't be afraid to poke all the way through... On my experience They still barely feel it. Give a treat after trying for a reading so they start to associate it with something positive. Also get him used to having his ears touched and played with when you aren't testing.

 

Sorry for the delay getting back to you. Been busy and missed alert of your post!

I'm assuming the curve was done at the vet's given you are still having some trouble home testing consistently. If the curve was done at the vet, there is a good chance that the numbers were elevated due to stress. Some cats have readings 100 points or more (based on US readings) higher than their "normal" when stressed and most cats are stressed at the vets. Given that possibility, I would lower the dose immediately, work on the home testing and once you can home test consistently, you can increase the dose slowly if needed based on stress free home readings. I have seen far too many cats prescribed doses of insulin that were too high as a result of vet curve information. It's far safer for kitty to run a little high than too low because hypoglycemia if not caught and dealt with promptly can be fatal.

 

Hello there,
I just saw your response myself So last week was rough but I'm slowly getting better at taking his glucose. I warm the ear before with a rice sock and that seems to help. Malby is slowly understanding that "this is gonna happen" and although he growls, he's a little less wiggly. His poor ears are bruised though he must have very thin ears as I know I have punctured through them at leasts twice poor baby let out a Yelp this morning and it just crushed my heart. So although I have not gained the confidence to take a curve... I do have some numbers. I dropped him to 1.5units (from 2). Below is his original curve numbers and then you can see what time I tested him on different dates and his BG ratings.
I know testing him at different times (2hrs apart) on different days does not make up for a curve as he could have different BG ratings everyday say at 9am but I am still learning how to do this so just wanted to test once a day as to not overwhelm myself and Malby.

Original Curve- 567- 431–435–393–357–284

12/13 Still on 2units 1:15pm- 371

Started 1.5
12/18 9:30am 433
12/20 11:15am 441
12/19 4:50pm 531
12/20 5:50pm 583

These numbers might not represent anything but the only time it was in the 200's was with his original curve and the only 300's I have seen was at 2units. Any suggestions moving forward? Numbers seem high. Should I go back up a bit? I'm still confused on how fewer units could drop his BG? Did I misunderstand you previously that that can actually happen?
Thanks again for your time and input!

Deena and Malby

 

Assuming these readings were taken at 2 hour intervals they indicate that Malby was continually dropping all the way to the end of the cycle with his lowest reading right at the next shot time. This frequently indicates the dose is too high and especially with a cat on Vetsulin which usually doesn't last a full 12 hour cycle. When you change doses, the benefit or lack thereof is not always obvious on day one. If Malby has been bouncing because of too high a dose, it can take up to 3 days for the high numbers to start coming back down to reality. I'd hold the lower dose for at least six 12 hour cycles (as long as he has pre-shot readings high enough to give insulin) and work at getting readings before each shot and one sometime in the early part of each cycle. It's how low the dose takes Malby that matters when deciding dose. The pre-shot tests tell you it's safe to give the insulin. The mid cycle tests tell you whether a dose reduction or increase may be needed. The only caveat to this is when you see numbers like that initial curve that wasn't a curve at all. It was a falling line and it shouldn't be if he was on the right dose. With Vetsulin, you should be checking Malby at pre-shot and then again at +2 or +3 to see how far he is dropping. Many cats reach their lowest reading on Vetsulin around 3 or 4 hours post shot. Some will be a bit later but by +6 you may see his numbers start to rise slightly. There could be another less obvious drop around +7 post shot and then a rise to the PM post shot test. Ideally the curve would look like a smile.

I could be wrong about the dose but my gut tells me you need to be careful in case it is too high given that initial curve. Malby I assume is a large cat so he may need slightly more insulin that the average domestic but Vetsulin can cause significant drops in BG soon after the shot so starting slow and working up dose wise rather than starting high is much safer and may prove to be a lot less frustrating for you in the long run.

The numbers you've provided for the 1.5u dose need a little more context to be meaningful. You've provided clock times but we need to know how long after shots those readings were taken and what the pre-shot numbers were to be able to comment on them much less interpret them.

Malby is a stunning guy. Is he a Bengal or a Savannah? I'm not good at telling the difference even though I absolutely love them both.

 

Oh yes...I forgot. When you are testing Malby hold the lancet or the lancing device at about a 45 to 60 degree angle to his ear. This should stop you from accidently poking right through. It happens to all of us so don't beat yourself up. Just make sure you put some pressure on the poke after testing to keep the area from bruising. If need be you can get some Polysporin with pain relief to put on his ear but make sure it's ointment not cream and use it very sparingly. I If you use before testing it might help get the blood to bead up more for you.

 

Malby is a Bengal. he has a brother too, Basil who is also a Bengal. Malby definitely got overweight at one point but his increased drinking, urinating and rapid loss of weight is what raised a red flag. He currently weighs 10.9lbs which is just average for a male Bengal (grew up with the breed). I can feel his ribs on his side though so he is still brining through his fat.... Or not gaining any anyway.
All of my first shots were given at 7:15am. I haven't been able to pre-test but that's just because he's a maniac in the morning before breakfast and no amount of treats or snacks will calm him down enough for me to test. He's in panic mode until he is fed. On 12/18 his BG was 433 at 9:30am (so roughly 2 hours after his first injection). I'm assuming his number would have been much higher at 7am, correct? Also, i tested tonight around 6pm ( I inject him at 7:15 PM) and his BG was 583, super high! So even though My numbers are scattered all over the place my concern is I'm never seeing anything below 400 no matter what time I test.

 

Just to clarify diet....you are feeding the Fancy Feast Classics right? I'm askng because other varieties of Fancy Feast are not low carb and that could make a big difference in readings. Without pre-shot tests and knowing that the curve showed the lowest reading at the end when it was time for the next shot, I am concerned that what you are seeing is bouncing from going much lower than Malby is used to or even lower than is safe.

I wouldn't be as concerned about the dose if Malby was a big 20lb cat but he's smaller than many domestics and 2u of Vetsulin is a big starting dose. This sugar dance is a marathon not a sprint and rushing it either makes it harder to get regulation or worse, can be risky especially when testing is still a bit iffy!

Have you tried testing Malby immediately after he eats? If you do it right away, food won't have had a chance to have much if any influence.

 

This seems to indicate to me that the dose is too high. He might have dipped very low earlier in the day and bounced up high as an overreaction. The 433 you saw at +2 on 12/18 might have been lower than his 7 AM number was or it could have been higher because of a spike from his breakfast. Unfortunately, scattered BG readings can't tell any of this.

 

I like Linda's suggestion of testing him right after he's finished eating. It's a compromise but better than no test at all before injecting.

 

Deena, I just noticed your other post in the thread entitled "Wits End Again" and you mentioned having tried the 1.5u and then raising the dose again to 1.75u. I am SERIOUSLY concerned that the dose is too high and raising it again is likely going to just make things worse. If the 1.5u was still too high (I originally suggested backing up to no more than 1u) then 1.75u is just going to make things worse and may make Malby go hypoglycemic which is very dangerous and could be disastrous.

I know it sounds totally counter intuitive to lower the dose to get the BG down but insulin is not a drug like an antibiotic or an analgesic. It's a hormone and it sets off other hormones if too much is given because the body defences perceive the BG is dropping too fast or too much. That in turn causes the body to panic causing stored glucagon to serge into the bloodstream to get the BG back up to an acceptable level which in a diabetic means they go way beyond a normal BG level because they've become used to higher than normal BG numbers.

You can't push Malby into good numbers with more insulin. The only way to get Malby regulated is to do so is slow tiny steps.

 

Hi,
Yes, he is eating fancy feast Classics. I believe the turkey and giblets is only 4% carbs so pretty low. I've heard I can test right after I feed him, I will definitely give that a try.
In regards to your comment below, could you clarify what you mean?
"I am concerned that what you are seeing is bouncing from going much lower than Malby is used to or even lower than is safe." I'm reading a lot of people talk about bouncing and I'm not sure what that means. Also, he has never had anything lower than the high 300's and I've tested him throughout the day 9:30, 11:15, 1:15pm, 4:50, 5:50), when are you referencing he might be going lower than is safe? I just feel like his numbers aren't going low at all at any point?

 

Deena, the problem is that in the early days, the defence system kicks in so quickly that you may not SEE the low number onset. Perhaps if you were testing every 30 minutes or so you might catch it but who can do that and doubtful any kitty would tolerate it for long. Bouncing is just the term used for the phenomenon of the body's defence system raising the blood glucose level. Your tests have been sporadic at best so until you can test more consistently including before shots, and have more data to show a pattern over time, it's impossible to say for sure what is going on but it sure looks to me like caution is your best strategy to avoid the possibility of any catastrophic hypoglycemia.

I know only too well how frustrating those high numbers and seeming lack of response are. I have a rare high dose cat whose numbers did not move for months and I too initially tried to push doses too fast. By testing consistently, and being slow, steady and methodical with her, I kept her safe and her numbers have improved immensely and her dose of insulin has reduced by over 50%.

 

So do you suggest I drop him to 1unit starting tonight or does this need to be a gradual reduction? Also, if I do put him down to 1unit, How long should he be on that before I possibly would see lower numbers in testing him? Within 3-4 days or would it take several weeks? Thanks!!!! I'm just wondering at what point do I start increasing his units if I don't see any change in his numbers.

 

Deena if he were mine, I'd reduce to 1u, try to consistently get pre-shot tests and test him at +1, +2 & +3 post shot to see if he is getting any drop at all as Vetsulin usually results in the biggest drop early in the 12 hour cycle. If he suddenly has any reading below 200 for a pre-shot test, do NOT give insulin and post for help. Likewise if his BG should drop by 100 points or more at any of those early readings or go below 120, post for assistance as you may need to intervene to slow him down. If my theory that the dose has been too high is correct, it may take up to 3 days for the effects of the higher dose to completely dissipate so I'd hold the 1u dose, barring any low readings for about 5 -7 days. Post here with any and all questions.

If you can get a spreadsheet set up, that will help us help you and there are numerous folks here who can help you work out how to get Malby on the path to regulation.

 

I replied where you posted on the other thread to ask about bouncing.

 

Hello there,
While I still haven't gotten a full blown curve done, I did have a little more luck testing Malby last week. I know that i really do need a pre-shot BG test but I can't get him to stay still for at least an hour after breakfast. He is becoming a little more tolerant though and I will try again soon. Anyhow, yes, I went down from the original prescribed 2 units to 1.5. He was on that for about 5 days ( I didn't see any change in his energy levels or lack there of during this time and he was still drinking and peeing a lot). Knowing that every cat has his "sweet spot" for the right amount of insulin, I decided I should have started at 1.75, then down to 1.5, then 1.25 etc.
Last week I was able to get a "mini curve." Here are my numbers. His insulin shot was given at 7:15am.
10:15am-443
12:30pm-330
2:30pm- 249
4:45pm- 427
This seems like a little more of a "normal" curve compared to the original curve done at the vets office where he dropped all day long and was at his lowest 10hrs later (those numbers are somewhere in this thread above). It seems as though Malbys lowest numbers are 6-7hrs after the shot.
I am curious as to what you think of the BG numbers I took above? I know these numbers are still high and ideally he should have lower numbers throughout the day. I am out of town (husband is taking care of Malby), but I sent the numbers above to my vet today as well. I am curious what they will suggest but I did tell them everything I have learned on this site as well as my concerns about the insulin being to high. I will let you know what they say and still know you are suggesting for me to go down to 1unit. I personally just prefer to work backwards. I might put him back on 1.5 and then try and do a curve next week. I'm just curious besides the curve numbers, how quickly do most people see a change in their cats behavior once they are on the correct unit/s of insulin? Should I see an improvement within a few days or few weeks or is every case and cat different? Thanks again for all of your help and happy holidays to you and your family!
Deena

 

Hi Deena, Every cat is different so no one can give you a timeline. Some cats have gone into remission in a matter of a few days while others take years to get regulated. I still think starting low and going slow and methodically with the dosing is the only way to get a cat regulated. Vet's don't even seem to know or perhaps acknowledge that it is possible to make dose changes in 0.25u increments. Malby may need 1u or even less and the 1.5u dose may still be too high or he may need more and 1.5u is too small. Without more testing, it's going to be pretty hard to figure out what is going on.

If you want to get Malby regulated, getting random tests every day is far better than doing a curve. A curve tells you what happened one day out of many whereas regular testing gives you an overview of what is happening over time. It's the overtime data that really helps figure out what is going on. I've had my girl giving me low numbers, done a curve one day and it was much higher than my random tests. BG is not the same day to day and some days control may be better than others so if you do a curve on a good or bad day, you really didn't learn anything useful.

I would strongly encourage you to start a spreadsheet (see post #2 for instructions) and to keep trying to get Pre-shot and random mid cycle tests between 2 and 6 hours post shot. Tests later in the cycle are helpful too but this period is when the insulin is the most active.

 

Malby's nadiring very late for a Vetsulin kitty. (It's typically between +3 and +5 hrs.)


Mogs
.

 

Hi Mogs,
Any suggestions as to why this might be? I've read that some Cats on Vetsulin do peak later. I'm going to re-test this week on a new dose but he seems to be at his lowest in the day 7+hrs

 

I think that different cats may metabolise insulin at different rates. For example, Saoirse had a very marked tendency to nadir early - on Caninsulin and on Lantus.


Mogs
.

 

My cat would peek around 5-6+... Yours might peek at 6... You took readings at 5 and 7.

 

I'm so glad I read this thread! I didn't know that it takes time for them to get used to the insulin. I wanted to keep increasing the insulin...until I read all of this. I did take him up to 1.5 U. now I know to stay there. I was ready to go higher. Kitty seems like he's ALWAYS high. like you said it could be his body on the defense. He always takes a nice long sleep after shot and meal. should I be concerned? He seems like it's a happy, content sleep..snoring/purring. I also need to do a curve.

 

If I could take a nap after a meal I would too. Lol. Our mama bear instincts just want to make them instantly better, but it doesn't work that way. It takes time and patience.