Vetsulin dosing advice

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Squalliesmom said:
I had to go out for a bit so I'm a little late in dosing tonight. I just tested Squallie, his BG is 383. Just wondered what you all thought for his PM dose; not sure I want to give 4 units as he seems to have such a sharp drop in the first 3-4 hours. I gave 2 units last night and he was pretty high this AM, I wondered about maybe giving him 3 instead?
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I would vote "no" on 4 units. I am thinking that both this morning's 442 and tonight's 383 are somewhat inflated by bouncing both cycles. (I don't necessarily thing that the 442 this morning was due to 2 units not being enough, in other words). Last night, he dropped over 100 points by +3. He might have dropped lower later on.

All that said, I'm thinking 2 or 2.5 might make sense tonight?
 
Four units dropped from 442 to 75 in 4 hours.
That's 367 mg over 4 hours and roughly 91.75 mg/dL per unit. That won't be consistent shot to shot.
Starting at 383 mg/dL, you might give no more than 3 units, possibly get down around 100-ish mg/dL and have a bit of cushion above 50 mg/dL.

And I like Carl's idea of 2 to 2.5 units, so you can sleep!
 
Okay, 2 units it is. I'm so thankful to you all for your knowledge and advice!

Little stinker knows he's got me over a barrel when it comes to food. He refuses to eat the lovely Tiki Cat, which even I think looks delicious, lol, and makes me bribe him with treats to eat more than a few nibbles of the FF. I finally got him to eat maybe a tbsp-full so I'll let him have a few minutes and then give him his 2 units.
 
The FF you are feeding. What flavor is it? Is it a "classic" style?
 
Lucy, as a former Vetsulin (Caninsulin) user and looking at his sheet, I'd be inclined to stick with 2 units. I think 3 will just make him dip lower and won't improve your AM or PMPS numbers - those higher readings are likely just Vetsulin not lasting past 8 hours. If he were mine, I'd shoot 2.

Whoops, you already said you would do that - darn second page didn't load.

Hope Squallie is going to eat more for you!
 
You may have already tried all the tricks. I found adding warm water to the pates and making them more "gravy like" helped my kitty. Sometimes the chunk texture is what they don't like.
 
Sue and Oliver (GA) said:
You may have already tried all the tricks. I found adding warm water to the pates and making them more "gravy like" helped my kitty. Sometimes the chunk texture is what they don't like.
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This was a huge help for Genghis. I think between the warmer temp (more aromatic as well?) and the liquid consistency, she eats the FF way better than she did when I just smushed the contents for her.
 
Okay, he just got his 2 units at 9:30, so he's an hour behind from this morning, shot then was at 8:30. I will keep monitoring him.
 
Sue and Oliver (GA) said:
You may have already tried all the tricks. I found adding warm water to the pates and making them more "gravy like" helped my kitty. Sometimes the chunk texture is what they don't like.
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I do that sometimes, but he had a tendency to lick up all the tasty water and leave this weird, mushy paste behind.
 
He is not above a hunger strike if he doesn't get the food he wants. Which is all the stuff he's not supposed to have.
 
Brashworks said:
Hope Squallie is going to eat more for you!
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We play "appetizers." I give him an "appetizer", a treat, and he eats a mouthful or two of food. On a good night I can get a whole bowl of food in him with just one or two "appetizers", other nights I 'm lucky to get him to eat at all. Tonight was one of the latter.
 
I agree with Sue and Rhonda. If Squallie was mine, I would give no more than 2 units and stick with that dose for several cycles unless it becomes clear that he's going too low on 2 units and then I'd move back to one. I found when Radar was on Vetsulin that he needed a few cycles sometimes for his little body to adjust to a particular dose. I hope this is helpful.
 
pevsfreedom said:
Luna's a big fan of my patented 'Pate Soup' since she had ketones and needed more water.
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Sadly, Squallie just isn't a big fan of canned food, in any brand or variety, although he did used to like the Friskies breakfasts with the eggs and all the lovely, high carb sauce!
 
Squalliesmom said:
He gets the classic pate', the lowest carb ones. His favorites are the ocean whitefish and the salmon. I can't believe he won't eat the Tiki Cat, my other guys LOVE it, and it actually does look like people food.
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That is plenty low as far as carbs go. All of the "classics" are low carb, so no problem if that what he'll eat, let him eat it.
 
Brashworks said:
Lucy, as a former Vetsulin (Caninsulin) user and looking at his sheet, I'd be inclined to stick with 2 units. I think 3 will just make him dip lower and won't improve your AM or PMPS numbers - those higher readings are likely just Vetsulin not lasting past 8 hours. If he were mine, I'd shoot 2.
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While I agree that 2 units is a good choice, I have to disagree with your take on the higher readings. Nothing on Squallie's spreadsheet indicates that the Vetsulin only lasts 8 hours. In some cases, it looks like he doesn't even reach nadir until +6 or +7. I think he's just one of those ECID cats, and he gets long duration on an insulin that isn't supposed to give him long duration. Some cycles it looks like he even goes beyond 12 hours on a dose.
 
Carl & Polly & Bob (GA) said:
While I agree that 2 units is a good choice, I have to disagree with your take on the higher readings. Nothing on Squallie's spreadsheet indicates that the Vetsulin only lasts 8 hours. In some cases, it looks like he doesn't even reach nadir until +6 or +7. I think he's just one of those ECID cats, and he gets long duration on an insulin that isn't supposed to give him long duration. Some cycles it looks like he even goes beyond 12 hours on a dose.
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Please help me understand - as clearly I have not interpreted what I have seen as a duration issue correctly - How should the higher AM and PMPS numbers be viewed?
 
Squalliesmom said:
Hi, all. Squallie's numbers have been all-over-the-place-crazy the last few days, and he's had two hypo episodes in two days. He was on 7 units twice daily; the vet dropped him down yesterday to 4 units 3x daily at 8 hr intervals. Well, he got his 4 units this AM, went fairly low around the +6 mark and was still low at +8 so I decided not to shoot at 8 hrs. Now we've come up on 12 hours and he's still pretty low, for him, at 226. I honestly don't know whether to give him 4 units now or not, I don't want him to go hypo again but I don't want his BG to soar way up, either!
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Read my post about Pretty Foots in ICU twice in 2 weeks 7 days total bad URI . Couldn't get his regulated on Vetsumln , or Lantus. Home since 8/3 giving Nov0lin R intramuscular every 4 hours.
 
I view them more as potential bounces from numbers that were low in the middle of the cycle. Given how much he has dropped during the cycles where Lucy caught the scary green numbers during the middle of a cycle, I think it is safer to assume that they are happening during the cycles when she hasn't been able to "see them happen".

Yesterday, he dropped from 370 to 70 on 4 units. And Lucy had to carb him up to stop him from going lower, indicating that he wasn't at nadir (timing-wise) when she saw that 70. Last night, she gave him 2 units. Isn't it reasonable to believe that he again dropped down into green numbers when his PMPS was 100 points lower than his AMPS was? If he did drop to 70 or lower, then this morning could be due to that happening. I don't believe it was because the 2 units just didn't last long enough.
If I believed that, then I'd believe her vet's advice that Squallie needs three shots a day instead of two. And I see absolutely no data on the spreadsheet that supports that way of thinking.
In my mind, advising he needs shots closer than 12 hours apart puts him at risk, and is irresponsible advice.
 
Pretty Foots said:
Read my post about Pretty Foots in ICU twice in 2 weeks 7 days total bad URI . Couldn't get his regulated on Vetsumln , or Lantus. Home since 8/3 giving Nov0lin R intramuscular every 4 hours.
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Can you give a link to that thread? I'm interested that you are giving IM shots, but this thread is probably not the place to discuss it. Interested because my cat got IM shots for 10 weeks, and other than in one other case that was short-term, I haven't seen any other kitty who was dosed that way (until you just mentioned it).
 
Duration issues will be seen if the high number happens well before the next shot time when there isn't anything else going on.
The day of the 419 at +9, for example, was a bounce from the day's low of 22 and being carbed to get the numbers up. If it had happened without going low any time in the prior 3 days, we might think there was a duration issue.
 
Carl & Polly & Bob (GA) said:
I view them more as potential bounces from numbers that were low in the middle of the cycle. Given how much he has dropped during the cycles where Lucy caught the scary green numbers during the middle of a cycle, I think it is safer to assume that they are happening during the cycles when she hasn't been able to "see them happen".

Yesterday, he dropped from 370 to 70 on 4 units. And Lucy had to carb him up to stop him from going lower, indicating that he wasn't at nadir (timing-wise) when she saw that 70. Last night, she gave him 2 units. Isn't it reasonable to believe that he again dropped down into green numbers when his PMPS was 100 points lower than his AMPS was? If he did drop to 70 or lower, then this morning could be due to that happening. I don't believe it was because the 2 units just didn't last long enough.
If I believed that, then I'd believe her vet's advice that Squallie needs three shots a day instead of two. And I see absolutely no data on the spreadsheet that supports that way of thinking.
In my mind, advising he needs shots closer than 12 hours apart puts him at risk, and is irresponsible advice.
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Thank you for the detailed reply, Carl. I'm sure glad you were here to catch that on my post and correct my thinking. I have puzzled over Genghis' sheet for only a little over a month - clearly there is an art to it that comes from experience. Essentially, to my untrained eye, all I saw was lower numbers bookended by higher ones. This is great info.

Thanks, @BJM for your explanation also!
 
Brashworks said:
Thank you for the detailed reply, Carl. I'm sure glad you were here to catch that on my post and correct my thinking. I have puzzled over Genghis' sheet for only a little over a month - clearly there is an art to it that comes from experience. Essentially, to my untrained eye, all I saw was lower numbers bookended by higher ones. This is great info.

Thanks, @BJM for your explanation also!
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You're welcome! I wasn't around much when you were using caninsulin so if you posted about the high numbers, I missed it. I hope things are going better with Lantus, but I can't be of much help with that.
I actually used compounded PZI which is also supposed to be an 8-10 hour duration, and a lot of times it was. But I still shot every 12 hours or so, and never went as far as shooting TID.
 
Brashworks said:
Thank you for the detailed reply, Carl. I'm sure glad you were here to catch that on my post and correct my thinking. I have puzzled over Genghis' sheet for only a little over a month - clearly there is an art to it that comes from experience. Essentially, to my untrained eye, all I saw was lower numbers bookended by higher ones. This is great info.

Thanks, @BJM for your explanation also!
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If you look at Luna's SS she bounces all over the place. Every time there's a low under 100 she flies up over 400. She's on Lantus, but same principle.
 
@Carl & Polly & Bob (GA) (and small thread hijack, sorry Lucy!) I understand you were out with the turtles and I loved all the photos (not just of the turtles). You have a gift! Genghis is doing wonderfully on Lantus - she has been pretty much under 250 since I started and I shot my first "green" tonight - if my data is any good (and the planets align) it won't be a long night...

I read up on the Caninsulin when I was using it and one site's "fix" for a cat's metabolism and duration issues was to suggest TID dosing.

If the peak time is less than five hours, a longer-acting insulin is given, or the current insulin is given more frequently, generally three times a day.

If the peak time is five to eight hours, the current insulin is continued on a twice-daily schedule.

If the peak time is greater than eight hours, the current insulin is continued, but is given once daily.
​
I never really bought into the TID or SID -- Genghis would peak at +4 through +10 - she just never seemed predictable (learning that nothing about FD ever is!) so I made the switch to Lantus.

Thanks again for the clarification - not sure I'll ever have a proper "eye" for reading the spreadsheets - this is an amazing place for help and information.
 
Carl & Polly & Bob (GA) said:
I view them more as potential bounces from numbers that were low in the middle of the cycle.
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I feel so stupid but I just don't understand bounces, or bounces vs duration. I don't know how to look at a spreadsheet and see a bounce rather than just a lack of insulin, or longer/shorter durations. :-(
 
Squalliesmom said:
But when I checked him at +5 hrs last night it seemed to me that his #s were rising again?
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Did you add that 201 recently? I don't recall seeing it last time I looked at the SS.

I am going to look for an old thread in PZI that Dr. Lisa participated in to see if I can help explain the whole "bounce" concept. It might not happen until tomorrow night though. I guess it comes from looking at thousands of spreadsheets, but for me (and for lots of others), differentiating between a bounce and short duration isn't impossible. Just takes practice. ;) And I am far from being always right!

edit to add - and Lucy, DON'T ever feel "stupid". You've only been at this for a couple of months. And feline diabetes is anything but easy to understand and deal with! You're doing great so far!
 
Carl & Polly & Bob (GA) said:
Did you add that 201 recently? I don't recall seeing it last time I looked at the SS.

I am going to look for an old thread in PZI that Dr. Lisa participated in to see if I can help explain the whole "bounce" concept. It might not happen until tomorrow night though. I guess it comes from looking at thousands of spreadsheets, but for me (and for lots of others), differentiating between a bounce and short duration isn't impossible. Just takes practice. ;) And I am far from being always right!

edit to add - and Lucy, DON'T ever feel "stupid". You've only been at this for a couple of months. And feline diabetes is anything but easy to understand and deal with! You're doing great so far!
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Yes, I was looking over his spreadsheet because I knew I remembered thinking his BG was coming back up, so I compared it to my meter's memory and saw that I hadn't entered that 201. Sorry if I screwed something up. I try to keep it all up to date but it's been so crazy here the past few days and I'm so short on sleep that I'm surprised I haven't missed more than that!
 
I monitored Squallie through the night and didn't see any of the incredibly steep drops he seems to show in the mornings. AMPS today he is back up to 421 and I don't know whether to give him 4 units, or maybe a little less? Anybody have any suggestions?
 
I went ahead and made an executive decision: I gave Squallie 2.5 units (really closer to 2, my syringes don't have markings for .5 units so I had to estimate). I figured higher BG numbers are safer than numbers that are too low and, since he has been showing such a huge drop shortly after his morning shot, I thought it would be best to err on the side of caution. I hope I made the right decision.
 
Sue and Oliver (GA) said:
I like your decision, Lucy. Glad you didn't go with 4. I'd rather see you slowly work your way up, if needed.
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Thanks. That's what I figured, too. Until I have a better grasp of what's going on with him, I think it's better to go with less and increase the dose if needed after I see where he's headed, BG number-wise. That sharp drop he's been experiencing for the past several days must be hard on him, I imagine, I wish I could get his numbers down a little more gently, if you know what I mean.
 
Squallie's BG at +2 hrs was 271; I know that's still fairly high but so far glad to not see that sharp plunge ha's been having the last few days! I hope it continues as a nice, slow downward slope!
 
Getting data at the lower dose may help you to identify bounces better if at some stage you might need to ease the dose upwards.

How is the food change going, Lucy? What percentage low carb wet to kibble is Squallie getting now?

.
 
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