One month on with Vetsulin ...and we've switched to Lantus today!

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blcknwhitecat

blcknwhitecat

Member Since 2012
....and I am just so frustrated. Apologies to start if I haven't given updates on Neko recently. Here's a short summary of what's happened so far with Neko:
  • Diagnosed first week of March
  • Started on 1U Lantus - but vet took him off it after 2 days because Neko is very sensitive to insulin and the lows were a little too close for comfort. Instead of adjusting dosage we swapped to 0.75 /0.5u Vetsulin because it's short acting effect would be easier to manage (I'm having difficulty accepting this now)
  • Neko has been on a canned only diet..alternating between Ziwipeak and Wellness. There were a few days where my local store's stocks ran low so we had to switch to Addiction for a little bit. But the last few days he's back on Ziwipeak and Wellness.
  • First few weeks looked good with no reds (see spreadsheet here https://docs.google.com/spreadsheets/d/1lJ0OmJJMPvw6P2zZM5bYtAnbDQC9H1zH4pNVizb3bmU/edit?usp=sharing) and even a few healthy looking numbers (March 22, 23 and 29).
  • Last few days he's been seeing a lot more reds.... :(
It's just so sad to see his numbers go up like this. I also can't figure out Vetsulin's "action times" (lol is that what it's called?" ) it looks like the lowest point is anywhere between 3-6 hours? And in that case maybe Neko's been eating his meals right when the Vetsulin has worn off the most and it's causing his readings to be very high? Not surprisingly he's also been a little more constipated the last few days during this high streak...

I have a vet appointment on Monday and I might ask to switch us back to Lantus...hopefully it'll help sustain Neko's lower numbers until meal time.

Sorry this is rather vent-y...it's been a stressful month and a half what with all the vet fees and the seeming lack of progress.

Any insight or comments would be welcome. Also if any members are currently in Singapore, low carb food recommendations would be appreciated :) I've been running through common canned foods using the Scheyder carb calculator, but am finding there aren't a lot of options.

Oh and here's a photo of the old man (he's 16!) by the way for any curious soul out there :)
 

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Hi there,

The typical period of peak effect of Vetsulin is from around +3 to +6. Sometimes when the crystalline fraction kicks in you might get a second dip between +7 and +10. It's the nature of the beast: drop BG hard and fast in early part of cycle then peter out too soon.

I know there's not much Lantus data to go on (I'm assuming the first two rows on your spreadsheet are for Lantus) but the initial response was good. If the 3.4 was measured on a pet meter then that would have indicated Neko needed a dose reduction to 0.25IU Lantus. Can you let us know whether you're using a human or a pet meter, please? It's not possible to interpret Neko's data properly without knowing the meter type.

blcknwhitecat said:
Started on 1U Lantus - but vet took him off it after 2 days because Neko is very sensitive to insulin and the lows were a little too close for comfort. Instead of adjusting dosage we swapped to 0.75 /0.5u Vetsulin because it's short acting effect would be easier to manage (I'm having difficulty accepting this now)
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I could not disagree more with your vet: as you've seen Vetsulin can absolutely tank BG from very high levels to fairly low levels in the hours just after a dose only to have them rocket back up as the dose wears off. The mode of action of Lantus is much gentler: it typically produces relatively flat curves, not the BG roller coaster curves typical of Vetsulin (and that roller coaster can make a cat feel absolutely miserable). It is easier to make fine dosing adjustments with Lantus, too.

Here is a link to Saoirse's 2014 spreadsheet. Have a look at how up and down her numbers were during the first part of her treatment when she was put on Caninsulin (same as Vetsulin; different brand name) and then how much her BG levelled out when I managed to get her switched to Lantus. (And she was a much happier and healthier cat as a direct consequence.)

Saoirse's 2014 Spreadsheet (BG measured on Alphatrak 2 pet meter)

In the meantime it would be really helpful - and safer for Neko - if you could get a PM +3 before bed test each evening to determine whether he might be running lower during the night time cycles. (PM+2 if you can't get PM+3.)

I really like the picture of Neko. :)


Mogs
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I agree! I'm surprised your vet didn't even have you try out .5u 2x a day on the Lantus...some cats don't need a whole unit! But she was willing to do less than a unit on the Vetsulin? It's just odd. 2 days was not nearly enough time to give the Lantus time to settle in. It usually takes a cycle or two for the insulin depot to build where it even goes to work on lowering BG, so really, she took him off it based on one day of testing? What were his numbers on the Lantus for those two days?

Lantus will give you flatter, more gentle curves. And there's very little risk of dangerous hypoglycemic incidents, especially at lower/micro doses (.25u or less). It seems to me you've given the vetsulin plenty of time to work and it just hasn't--he's skyrocketing up and down, constantly. I usually tell people not to stay on vetsulin if you don't see good control in 4-6 weeks. If the cat doesn't go into remission on Vetsulin within a few weeks of the diet change, it's not likely to go into remission on it at all.
 
Critter Mom said:
Hi there,


I know there's not much Lantus data to go on (I'm assuming the first two rows on your spreadsheet are for Lantus) but the initial response was good. If the 3.4 was measured on a pet meter then that would have indicated Nemo needed a dose reduction to 0.25IU Lantus. Can you let us know whether you're using a human or a pet meter, please? It's not possible to interpret Nemo's data properly without knowing the meter type.

In the meantime it would be really helpful - and safer for Nemo - if you could get a PM +3 before bed test each evening to determine whether he might be running lower during the night time cycles. (PM+2 if you can't get PM+3.)

I really like the picture of Nemo. :)


Mogs
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Hi @Critter Mom ! Thanks for the response. Sorry to confuse! Actually the first 11 rows of my spreadsheet with the dates colored in green are from Neko's first bout of diabetes in 2012 . Back then it was a very short round of 0.5u of Lantus twice a day and within less than a month he was OTJ. Which makes his up and down response this time around especially confusing and frustrating....although I guess he is much older now so that's probably a big factor as well.
I don't have the actual glucose test numbers because those intial two days on Lantus were at the vet's..I do recall them saying he went as low as 1.6 mmo/l (28) with them though.

As when his first time in 2012 and now, I've been home testing on a human meter. Right now I'm using Freestyle's Freedom Lite meter because I read that its test strips need only the smallest amount of blood.

I'll get a PM+3 tonight and post back here!

Thank you - it's my favorite photo of him..all relaxed and happy :)
 
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Julia & Bandit said:
I agree! I'm surprised your vet didn't even have you try out .5u 2x a day on the Lantus...some cats don't need a whole unit! But she was willing to do less than a unit on the Vetsulin? It's just odd. 2 days was not nearly enough time to give the Lantus time to settle in. It usually takes a cycle or two for the insulin depot to build where it even goes to work on lowering BG, so really, she took him off it based on one day of testing? What were his numbers on the Lantus for those two days?

Lantus will give you flatter, more gentle curves. And there's very little risk of dangerous hypoglycemic incidents, especially at lower/micro doses (.25u or less). It seems to me you've given the vetsulin plenty of time to work and it just hasn't--he's skyrocketing up and down, constantly. I usually tell people not to stay on vetsulin if you don't see good control in 4-6 weeks. If the cat doesn't go into remission on Vetsulin within a few weeks of the diet change, it's not likely to go into remission on it at all.
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Hi @Julia & Bandit :) Yes, I was quite disappointed as well when we switched but I thought his insulin sensitivity had kicked up a notch since his first round of diabetes in 2012 and that Vetsulin was for the better. Sorry but I don't have the actual Lantus numbers as those two days were done at the vet's. I do know that at one point his low went down to 1.6 (28)...but I think this was on 1u of Lantus which historically has been too strong for Neko. So yes, odd that they didn't lower it to 0.5...but I guess they thought they would see similar results. I'm kinda kicking myself now for not asking to stay on Lantus a little longer.

Thank you. I'm glad you think I've given Vetsulin a good shot..when I mention switching to Lantus to my vet on Monday, I just want to make sure I've really given it a good try. I don't think he'd kick up a fuss about a switch, but I do want to make sure I've accounted for all the factors for the vetsulin not working so well with Neko.
 
Hi @Critter Mom

Neko's PMPS reading was 16 (288) today. I did a test/feed/shoot..so he has had something to eat and at +2 he was at 14.8 (266)...

Tomorrow I'll do a full curve every 3 hours as my vet requested one before our vet appointment. Would you know if every 3 hours is ok with Vetsulin?

Steph&Neko
 
Hi Steph.

Can you check at +3 or +4 today?

For the curve, I'd do every two hours with Vetsulin (and I'd sneak in a +3 test as well - sometimes it can be lower than the +4).


Mogs
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Hi @Critter Mom and to anyone else who might be online at the moment :)

Neko's AMPS today read at exactly 18 (324). At AMPS +3 (sorry I hadn't seen your post until just a few hours ago!) he was 12.6 (226.8) and at +6 he is back up at 17.2 (309). I didn't expect his reading to be so high at this halfway mark! I'm really surprised because his food hasn't changed and just a few days ago his +7 was much lower.

Should I give him another 0.75 unit shot this early or wait?

.... UPDATE
Vet got back to me an hour after this post and said to continue with the usual insulin cycle, so no early shot. He reckons the Vetsulin is neither strong enough or long acting enough...or if Neko is perhaps having UTI then he might have some insulin resistance . If he's clear for UTI then he'd like to switch us back to Lantus - a great outcome in a way because tomorrow's discussion at my appointment will be much easier! lol
 
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Hi Steph,

blcknwhitecat said:
He reckons the Vetsulin is neither strong enough or long acting enough...
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I mostly agree with your vet; I think that maybe the Vetsulin could be both too strong (dropping too hard in the early part of the cycle) and too short-acting (wearing off too soon) for Neko's needs. (Saoirse had a similar experience with Caninsulin.)

Good news that your vetty bean is on board for a switch to Lantus. I hope it helps Neko as much as it helped Saoirse. :)


Mogs
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blcknwhitecat said:
Should I give him another 0.75 unit shot this early or wait?
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Your vet's advice to wait till the next scheduled dose is due was spot on. You always wait until the next dose is due before giving any more insulin. (To do otherwise would be highly dangerous.)


Mogs
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Hi!

Just an update - we've switched to Lantus today! :D Maybe it's just wishful thinking but Neko also seemed quite happy about the switch too..chasing me around, wanting cuddles..showing a healthy appetite etc. We weighed Neko as well and he came in at 4.6kg, which was exactly the same a month ago after a few weeks on Vetsulin. So he hasn't gained weight, but he hasn't lost any either. I guess vetsulin was doing enough for him not to lose any further nutrients but not keeping it low for long enough to gain further...?

Neko's AMPS was 17.1 so our vet administered the 0.5u of Lantus at 9 am this morning and instructed me to check again around 6pm when he approximated it to be at it's lowest. Sure enough at 6pm it was around 3.5. He asked me to check again at 9pm and midnight and then around 3am.

His 9pm was up at 6.1 so I've skipped his shot and at 12:40am it was only up to 6.3 lol This shot of Lantus is really staying in there for a while!

Vet's idea is to wait til the reading is around 15+, which he expected to be about 2 or 3am and then give a half or 3/4 shot of Vetsulin...which will hopefully last til 9am at which point I give another 0.5 of Lantus. It's a little fiddly..so maybe it's a good thing that Neko's reading is still quite low? I highly doubt it will be 15+ at around 3am today.

Anyway, just wanted to share the good news about the switch and that Neko and I are both in good spirits :)
 
That's some drop for Lantus! Keep a close eye on things. (Might be a little bit of carryover from the last Vetsulin dose in the mix, but be careful.)

I'm a bit confused: is your vet advocating using both Lantus AND Vetsulin? If that's correct I'd strongly recommend you post a thread about that on the Lantus and Levemir board and ask for opinions on that from the very experienced members there. I've never heard of another cat being on such a treatment plan. (Personally speaking, it's not a treatment plan I'd be comfortable with for my cat.)

It's good to read that Neko is feeling happier. :)


Mogs
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blcknwhitecat said:
so our vet administered the 0.5u of Lantus at 9 am this morning and instructed me to check again around 6pm when he approximated it to be at it's lowest. Sure enough at 6pm it was around 3.5. He asked me to check again at 9pm and midnight and then around 3am.

His 9pm was up at 6.1 so I've skipped his shot and at 12:40am it was only up to 6.3 lol This shot of Lantus is really staying in there for a while!

Vet's idea is to wait til the reading is around 15+, which he expected to be about 2 or 3am and then give a half or 3/4 shot of Vetsulin...which will hopefully last til 9am at which point I give another 0.5 of Lantus. It's a little fiddly..so maybe it's a good thing that Neko's reading is still quite low? I highly doubt it will be 15+ at around 3am today.
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I might be reading this wrong, but what it sounds like your vet is telling you to do is not check BG until 9hr after Lantus? Lantus usually peeks at +5-+7 so waiting until +9 could complete miss how low he is getting.

And if (s)he is really telling you to not shoot Lantus 12/12, but to let the numbers rise, then shoot Vetsulin at his low point in a normal Lantus curve (2am-3am, would be your +6 on the Lantus shot), and then wait for Lantus 'til 24hrs. DO NOT LISTEN TO THE VET. What is being suggested is extremely dangerous. You never never never ever mix using Vetsulin and Lantus. Vetsulin is not a bolus insulin and bolus shots aren't given at the low point of the main insulin's cycle. You will get over lap with that and the Lantus and there will be little you can do to fight a drop with both of those on board. Only very experienced caretakers who test A LOT during the cycle will use a bolus, and that would not be Vetsulin. With Lantus taking him that low, If you had throw a dose of Vetsulin onto this morning's cycle, you would have dropped that 63 even lower. You just want to get consistently dosing 12/12 and watch for too low while you wait for the dose to settle and bouncing to stop. I am very concerned about your kitty if you try treating him with both Lantus and Vetsulin at the same time.

I think a switch to Lantus is great. It will give you a change to flatten out the curve and bring the numbers down. A second run at remission/regulation is always harder than the first. Donn't look at his dose or time it took the first time. This time will likely be more insulin and take longer.
 
Critter Mom said:
That's some drop for Lantus! Keep a close eye on things. (Might be a little bit of carryover from the last Vetsulin dose in the mix, but be careful.)

I'm a bit confused: is your vet advocating using both Lantus AND Vetsulin? If that's correct I'd strongly recommend you post a thread about that on the Lantus and Levemir board and ask for opinions on that from the very experienced members there. I've never heard of another cat being on such a treatment plan. (Personally speaking, it's not a treatment plan I'd be comfortable with for my cat.)

It's good to read that Neko is feeling happier. :)


Mogs
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Yup keeping a close eye on Neko, but he seems to be doing well. Will continue to monitor each time I give Lantus over the next few days.

And yes, my vet is indeed saying I should use both insulins...first time I've heard of it myself, but I will post on the Lantus board as you suggested for opinions on the matter. My vet seemed pretty casual about it...

Edit: Forgot to mention that the Vetsulin advice from my vet was only in the instance that he reads at 15+ in the middle of the night. I highly doubt it will go up at that high by 3am (nor do I really want to mix vetsulin into his system in the middle of the night...) but I'll check anyway.

It's 2am and Neko's having a good snooze :)
 
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Melanie and Smokey said:
I might be reading this wrong, but what it sounds like your vet is telling you to do is not check BG until 9hr after Lantus? Lantus usually peeks at +5-+7 so waiting until +9 could complete miss how low he is getting.

And if (s)he is really telling you to not shoot Lantus 12/12, but to let the numbers rise, then shoot Vetsulin at his low point in a normal Lantus curve (2am-3am, would be your +6 on the Lantus shot), and then wait for Lantus 'til 24hrs. DO NOT LISTEN TO THE VET. What is being suggested is extremely dangerous. You never never never ever mix using Vetsulin and Lantus. Vetsulin is not a bolus insulin and bolus shots aren't given at the low point of the main insulin's cycle. You will get over lap with that and the Lantus and there will be little you can do to fight a drop with both of those on board. Only very experienced caretakers who test A LOT during the cycle will use a bolus, and that would not be Vetsulin. With Lantus taking him that low, If you had throw a dose of Vetsulin onto this morning's cycle, you would have dropped that 63 even lower. You just want to get consistently dosing 12/12 and watch for too low while you wait for the dose to settle and bouncing to stop. I am very concerned about your kitty if you try treating him with both Lantus and Vetsulin at the same time.

I think a switch to Lantus is great. It will give you a change to flatten out the curve and bring the numbers down. A second run at remission/regulation is always harder than the first. Donn't look at his dose or time it took the first time. This time will likely be more insulin and take longer.
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Hi @Melanie and Smokey ,

So the vet only asked me to check at 6pm today after an AM shot at 9am because he figure Neko's ears looked a bit tender and 6pm was when he approximated the BG to be at it's lowest. So maybe if the cat's ears weren't so tender looking he might have suggested I check earlier rather than wait all the way til 6pm..not sure.

As for the second part...well it's not so much the vet telling me not to shoot every twelve hours, but rather, I couldn't give his 9pm shot anyway because it was at 6.1 (109). So the advice was to check every 3 hours and if it went up at +15 in the middle of this first night on Lantus THEN I should should give a 0.5 of Vetsulin. Although, yes the idea does make me uncomfortable. I think my vet's is assuming that my cat's bg would have gone up significantly by 2am/3am and therefore shooting Lantus in the middle of the night wouldn't make sense. At this rate though, Neko is unlikely to get up to 15 by 3am (I'll check anyway) and I'm pretty uncomfortable giving a vetsulin shot in the middle of the night coming off a Lantus shot.

So in a nutshell, I might just take a reading at 3am and again at 9am and give Neko his Lantus shot unless it's still quite low - does this sound ok? If this is how it plays out tonight I'll give the numbers to my vet and maybe he'll ask me to monitor a 0.5u of Lantus once a day for the next few days.

I wonder if it's worth lessening the dose to 0.25 twice a day..or is that just too difficult? Thank you for the comment on not comparing with his 1st round of diabetes..that was such a short round I often do look back and worry I'm not doing something right this time. Thanks for the reminder, I do feel a little better now especially that his number seem to go down and up a lot gentler and slower than Vetsulin.
 
blcknwhitecat said:
So in a nutshell, I might just take a reading at 3am and again at 9am and give Neko his Lantus shot unless it's still quite low - does this sound ok? If this is how it plays out tonight I'll give the numbers to my vet and maybe he'll ask me to monitor a 0.5u of Lantus once a day for the next few days.

I wonder if it's worth lessening the dose to 0.25 twice a day..or is that just too difficult
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If you haven't already, please visit the Lantus Forum and read some of the stickies about the different protocols we use here. Lantus is a picky insulin. It likes a pretty strict 12/12 dosing schedule. It is not a once a day insulin in cats, their metabolism is too fast and they need it twice a day. The way your vet is trying to dose it (giving insulin when numbers get high) works with an "in-and-out" insulin like Vetsulin. Lantus is what we call a depot insulin and you will have a really hard time regulating if you are trying to do that. In every shot, part of that shot goes to "fill the depot". This depot is crystals under the skin that release insulin over time and is what helps us get the longer flatter curves with Lantus. If you do not consistently dose on 12/12 schedule, then the depot is constantly draining and needing to be refilled. This results in difficulty regulating.

It looks like Neko is liking the switch back to Lantus. You might need to reduce to 0.25 if you need to in order to give 2 shots a day. On Tight Regulation for Lantus, you would eventually start to shoot those 100s. On the Start Low Go Slow method that 63 would have earned you a dose reduction to 0.25 already. The nice flat blues look very promising that this might just be another short spin around the sugar dance floor for Neko.
 
Hi @Melanie and Smokey

Thank you for the very clear explanation! Yes I'm reading through the Lantus forum at this very moment :) Thank you - I have a bit of studying to do it seems coming off Vetsulin.

Well yes the blues are looking good, but I'm a little concerned about the dip just now to 5.6 when 3 hours ago it was 6.3. A little odd. Either way, I'm getting the numbers I need to ask my vet tomorrow morning if I can perhaps try a 0.25 twice a day cycle instead.

Behaviourally Neko, I know is perkier now that he's on Lantus...he's been snuggling up to me and purring every time I sit down on the sofa, eats well and even jogged around the house for a little bit this evening :) For now, I'm just happy his numbers are spiking up to the 20s like it used to.
 
blcknwhitecat said:
And yes, my vet is indeed saying I should use both insulins ...
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So I did understand correctly.

Melanie has already replied here and confirmed my suspicion that your vet is advising you to do something dangerous. Thank goodness you posted here.

I agree with Melanie. DO NOT LISTEN TO YOUR VET! I've used both of those insulins to treat Saoirse - but not at the same time. I never would.

On a more positive note, it's great to see that Neko's responding so well to the Lantus! :D


Mogs
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Hi everyone! Thank you very much for the advice and cautions regarding mixing insulins - I'm also very glad I included that in my post earlier yesterday. When my vet mentioned the Vetsulin idea, my gut wasn't comfortable with it so I'm glad that correlates with everyone's advice here as well.

Just as an update his 9am reading today was 16.7 (300.6). I've given my vet the readings I took the previous night and early morning as well..and he was happy with the numbers. He initially wanted to keep Neko on 0.5u once daily, but agreed to try 0.25 of Lantus twice a day instead , so I've gone ahead and given him 0.25u of Lantus. He did ask me to give Neko's ears a break today though and they do look quite puffy and sore....so I think I'll take his word for it and forego a 3hourly check and just another one at +5 today. Thoughts?

I'll be keeping a close eye on Neko today to make sure he's not getting too lethargic. From here on, I think I might continue this thread and post updates in the Lantus forum :)

Thank you for all your help and for keeping me company through out the early morning lol I'm also feeling optimistic about Neko's condition :) See you in the Lantus forum!
 
Hello,

I would get a +3 and see where he is, if he has a significant drop, then I would test again an hour later.

That pink you got this morning might be a bounce of the low numbers yesterday, so you may see Neko remain high and flat if that's the case. But equally as you didn't shoot last night it could just be the lantus wearing of, in which case you might start to see his BG move at around +3 which is where we would expect to see onset, having the nadir around +6. ECID and the nadir and onset can move around.

Sorry to hear about Neko's ears, I have found that gently applying pressure to the test site with a cold cotton pad for 15 seconds or so helps keep bruising to a minimum.
 
blcknwhitecat said:
Thank you very much for the advice and cautions regarding mixing insulins - I'm also very glad I included that in my post earlier yesterday. When my vet mentioned the Vetsulin idea, my gut wasn't comfortable with it
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I'm really glad you posted about it, too. Your instincts were spot on, Steph. :)

Wishing Neko and yourself great results with the Lantus treatment. :cat:


Mogs
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Putting pressure on the poke spot for 20 seconds or more after the test does help reduce bruising a great deal (I always do so with a tissue or cotton pad at room temperature, but a cool pad sounds like a great idea if there is actual swelling). Also, where are you poking? Has anyone posted the picture of the "sweet spot" for you yet? Some people aim for the vein in the ear because it seems easiest, but you actually want to poke just above it, because poking the vein will cause bruising. (The picture of the sweet spot can be found at the top of this thread: http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/). If Neko seems a little uncomfortable, a tiny bit of neosporin + pain relief might help while his ears "learn" to adjust to the testing.
 
Julia & Bandit said:
Putting pressure on the poke spot for 20 seconds or more after the test does help reduce bruising a great deal (I always do so with a tissue or cotton pad at room temperature, but a cool pad sounds like a great idea if there is actual swelling). Also, where are you poking? Has anyone posted the picture of the "sweet spot" for you yet? Some people aim for the vein in the ear because it seems easiest, but you actually want to poke just above it, because poking the vein will cause bruising. (The picture of the sweet spot can be found at the top of this thread: http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/). If Neko seems a little uncomfortable, a tiny bit of neosporin + pain relief might help while his ears "learn" to adjust to the testing.
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Hi Julia!

Yup, I've seen the famous sweet spot photo before :) Thankfully Neko's ears are big and not furry that it's quite easy to get the lancing device there most of the time. I think it's just the repeated poking for the curve the other time and maybe I didn't apply as much pressure as I should've afterwards. What I was doing was just wetting a tissue with very cold water and running that over his ear..but not applying pressure.

He's been such a trooper about getting tested though...he'll still try to flick his ear away from me at the start, but generally if I rub his chin he'll just settle down soon enough. So I'm thinking it just looks worse than it really is and hopefully with a little bit of a break they'll be back to normal.
 
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