? REALLY needing dosage advice

Posted a couple days ago but hadn't gotten a response, so posting again in hopes it doesn't get buried. My original post...

""Lando's been trending downwards with his numbers (yay!) And even hit below 70 with .25u last night from a 180ish PMPS. I have a feeling he may have dropped so low last night is because he was being so playful, we played for over an hour together and I think that exercise was good for him! (He's been feeling great lately and numbers have been fantastic!)

Now 24hrs later, bouncing from his low drop.

Do I keep holding .25u?

Do I lower the dose since he hit below 70?

Do I increase his dose for now? (I assume I just patiently wait out the bounce but I just wanted to be sure because .25u isn't gonna do much for his 300+ he currently has)

I've been wanting to get in a curve back when he was at .75u but the day I was going to I gave a furshot, but then we started decreasing. Was hoping to do a curve tomorrow but haven't held the dose very long at .25u and now that he's bouncing I'm unsure if there will even be a point.""

I got a response that gave what I already know to be true about numbers and when to increase, hold, or decrease, but when he dropped to 70 at .25u I can't decrease by another .25u anyways.

Now a couple days later, his numbers are just trending higher, when before when he'd bounce he'd slowly start to come down. I couldn't take it anymore this morning after potentially catching trace keytones on his urine, he was starving for food right after eating, and even tried pushing through a closed door to get at his brother's dry food. He cried and cried all morning. I know if he's still potentially bouncing I shouldn't increase the dosage but I did it anyway somewhere between .25u and .50u... he'd only been at .25 for a couple days after going down from .75 which I couldn't tell if that was too little insulin too quick...

The last 2 shots I've given him a *TEENY* bit over .25u and he was doing really well (I guestimated at maybe .35?) And yesterday he seemed to do great on that. I wish I got a test in last night closer to nadir but I was just so tired from work I couldn't get one. I held .25u as long as I could stand while waiting for guidance but just couldn't do it anymore and I feel like I kinda caved in without waiting for help.

I'm also using the same insulin bottle that I got at the very end of November, but it's been kept refrigerated and haven't noticed it losing potency, if that's relevant.

 

I think you are getting the best you can using Vetsulin insulin. I would ask your vet to change to generic glargine insulin. Lantus is a name brand glargine insulin but is very expensive. You can use a GoodRx coupon and get pens of generic glargine for about $160 for 5, 3ml pens.
https://www.goodrx.com/lantus?dosag...ulin glargine&quantity=1&sort_type=popularity
Make sure min the drop down menus you select generic and carton

 

Previous post
https://felinediabetes.com/FDMB/thr...now-vetsulin-pm-shot-due.273368/#post-3038345

 

I can try tagging Melissa and Suzanne for you again
@FrostD

@Suzanne & Darcy

 

Thank you! I've discussed with my vet changing insulin soon but I still have another unopened vial of Vetsulin I hate to waste she's completely on board and said she just gave us Vetsulin to start with because she had it immediately on hand and he needed something right away. If it's what Lando needs to do then I guess we'll do it! I'll discuss it with her soon after giving Lando some time to even out and after I hear from some other suggestions

 

The general strategy with Vetsulin is that if the numbers drop below 90, decrease the dose by 0.25u. That being the case, I'm not sure why you decreased Lando's dose on 1/22. The following day, when he dropped to 67 did warrant a dose reduction from the 0.75u to 0.5u.

I strongly suspect that you reduced the dose by too great of an amount. I would encourage you to go back over the guidelines for using Vetsulin.

I also agree with Larry. Vetsulin has not been recommended for treating diabetes in cats since 2018 by the American Animal Hospital Assn. They recommend either glargine (generic/biosimilar Lantus) or Prozinc.

 

I see some members will call CVS, Rite Aid, Costco, Walgreen's, to get the price for 5 pens
Posted by another member
One members posted this
. I paid $175 for a box of 5 pens at Walmart pharmacy, but GoodRX coupon says you can get it for around $90 if you have a Rite Aid pharmacy near you.
If you do switch to Lantus you will need to use U-100 syringes with half unit markings

 

Well, what had happened was he was consistently getting too low of a preshot where I was having to drop his dose and even got a skip one morning, and was recommended by someone else to try .25u to see if I could get a consistent dose I could give regularly... I was thinking the same thing that I should have tried .50u instead but tried the .25 anyways since it was recommended... That's why I was wondering if I should increase to .5u instead and try that for awhile and give it time to see if that's a better option?

While I wait to talk to the vet about switching to Lantus and getting the prescription (she's always been on board with that change she just wanted to get something in Landos system as quickly as possible) should I stick with .25u or try .5u? Should I wait for the bounce to clear before doing so? I'm not even sure if he's bouncing or if it's just cause the dose is too low. But once we got the nadir under 70 at .25u that's where I got really confused lol.

 

When reductions are earned, they are done in .25 unit increments. So it would have been from .75 to .50 as Sienne said. If Lando drops below 90 then he would have earned a reduction per SLGS. So the reduction wasn't earned in the a.m. cycle but he did go below 90 in the p.m. cycle, I see. Fortunately, 67 is a completely safe number. Are you using a pet meter? I am trying to figure out whey the 67 is color coded with lime green. If you are using a human meter, that should be a regular green color. Not a big deal, but I am just trying to determine if your meter is pet or human since the "take action" number is different for each.

For a bounce, I would just ride it out and not increase. You should have held the .25 dose since he had already been on it for several days... then see if an increase is warranted. I do not think in the long run it is worth it to keep using the Vetsulin (I started on it as well). Vetsulin is harsh and as you see can drive him down too low unexpectedly. I would definitely try to get some generic insulin glargine (Semglee) ... an Rx from the vet. It is a much more gentle insulin and can give nice flat cycles especially when your cat has nice low preshots. It's best for Lando by far!

 

I couldn't figure out how to get the color to match since I did it manually it was the closest color I could find as I'm still learning to use spreadsheets... I'm using a human meter. It wasn't our take action number, but since he still had time to drop in his cycle I just gave him a snack of his normal low carb food FF pate. We'll be switching to Lantus soon, it was recommended on my last post to try .25u by another person here to see if that'd be a number I could more consistently shoot so I stuck with the advice even though I was thinking the same thing about .5u, but wasn't sure as I'm still new so I just followed what I was told. I'm worried I messed up bad as he's been doing so well :,( I hope he moves out of the wonky numbers soon, I feel like I failed him after he was doing so well

I'll call the vet today about working to switching him over! I'm sure I'll need guidance going forward about how the switch will work.

 

There we go I think I fixed the color to look better. Sorry bout the confusion!

 

So just so I'm clear 100%, today I'll just give .25u and STICK to the .25u for awhile and see where we are and THEN determine if I should increase to .5 (since we're already at .25u)? And NOT jump to .5u yet, just ride out with the .25u.... early next week, Tuesday, I'll be off work and can run a full curve and decide from there how to proceed? So I'll have a full week at .25u.

I already texted the vet about switching, so hopefully within the next week we can get the ball rolling on switching to Glargine.

 

It sounds like you are getting a handle on "feeding the curve" with the snacks. You are doing well. Yep, stay with the .25 unless he drops below 90 again, then post for advice. Hang in there, you are doing great!