Please help!

Status
Not open for further replies.
Elizabeth and Bertie said:
@Kako,

I am one of those who has used Vetsulin/Caninsulin, and I've followed a lot of Vetsulin/Caninsulin cases on this forum over the last 9 years.

Kako, I rarely beg, but I honestly do beg you now NOT to raise the insulin dose to 5 units Vetsulin.
There is a distinct possibility that the current dose is already too high. (Others have explained about rebound, 'bouncing', above.)

I would suggest doing some more tests at different times; earlier than 6 hours later. It may well be that your kitty's blood glucose is dropping lower than you think....


Does your kitty have any history of ketones?

.
Click to expand...
Ketones...I have no idea. The receipt says: The vet did:
- FeLV/FIV snap ELISA test
- CBC, Chem, T4, UA (senior Pr.)
I have no idea what is what.
She said Tux's kidney is a bit dehydrated but fine. Never been mentioned about ketones.
 
Elizabeth and Bertie said:
With Vetsulin it's quite possible that you'll see the lowest number of the cycle between 4 - 5.5 hours after the insulin shot (but 'your mileage may vary' ;) )
Click to expand...
With Vetsulin you may see the lowest number in the cycle as early as +2 - highly likely at +3.

Vetsulin typically drops BG levels really hard within the first 3 hours (it's engineered that way). You need to test earlier in the cycle - both AM AND PM (many cats go lower at night so you need to establish response pattern for both day and night). Those tests are necessary in order to better determine how your kitty is responding to the Vetsulin so that you might better judge a suitable dose.

I'm really glad that you have not followed your vet's recommendation to jump the dose up to 5IU Vetsulin BID; that would be madness. As it is, I think it was wrong of your vet to increase the dose from 1IU BID to 3IU BID; it's too big a jump and increases the likelihood of skipping over a 'good dose'. In your situation I would want to talk with my vet about stepping back the dose to less than 3IU BID. If the vet wasn't prepared to discuss this option I would look for a second opinion from another vet (preferably one with a lot of success in treating feline diabetics).

Whatever you do, DON'T CHANGE YOUR CAT'S FOOD to low carb. You need to get the Vetsulin dose sorted out and establish exactly how your cat responds to it before even contemplating a food transition.


Mogs
.
 
In the Netherlands we have lots of experience with caninsulin. I've been moderating a forum for diabetic cats for 18 months now, and have learned quite a bit (not yet all, though).

The lowest point with vetsulin (if it is the same as caninsulin) is between +3 and (sometimes) +6, but mostly around +4 or +4.5. Caninsulin is designed tot act fast and has a first peak around the mentioned +4, and after that a second peak at +6/+7. The numbers tend not to rise back quickly, but stay in the 'low' numbers for a couple of hours. Not all cats do that second peak (peak as in peak of the working of the insulin).
Dogs have the lowest point around +6, and some vets think cats are dogs. They are not. A test of a cat 6 hours after the shot is NOT a good base to make decisions on about the dose.

But first needs to be determined whether the dose is too high or too low. If there is a Somogyi effect, the drop will be very fast, and the rising again will also be very fast, to very high numbers. If the 3 units was too much for a longer time, the numbers will hardly or not drop at all (insulin resistance).
You home test apparently. Could you please test the preshot value, a +2, +3 and a +4?

Kako said:
When insulin unit was raised, blood glucose dropped but then jumped to over 700!
Click to expand...
This is a sure sign of Somogyi, a reaction to an overdose (survival mode). I strongly suggest lowering the dose to 2 units twice a day, to start with.

The dose should never have been increased with 2 units at a time. Increasing should be done wit 0.25 or 0.5 units max.
 
Nederland said:
In the Netherlands we have lots of experience with caninsulin. I've been moderating a forum for diabetic cats for 18 months now, and have learned quite a bit (not yet all, though).

The lowest point with vetsulin (if it is the same as caninsulin) is between +3 and (sometimes) +6, but mostly around +4 or +4.5. Caninsulin is designed tot act fast and has a first peak around the mentioned +4, and after that a second peak at +6/+7. The numbers tend not to rise back quickly, but stay in the 'low' numbers for a couple of hours. Not all cats do that second peak (peak as in peak of the working of the insulin).
Dogs have the lowest point around +6, and some vets think cats are dogs. They are not. A test of a cat 6 hours after the shot is NOT a good base to make decisions on about the dose.

But first needs to be determined whether the dose is too high or too low. If there is a Somogyi effect, the drop will be very fast, and the rising again will also be very fast, to very high numbers. If the 3 units was too much for a longer time, the numbers will hardly or not drop at all (insulin resistance).
You home test apparently. Could you please test the preshot value, a +2, +3 and a +4?

This is a sure sign of Somogyi, a reaction to an overdose (survival mode). I strongly suggest lowering the dose to 2 units twice a day, to start with.

The dose should never have been increased with 2 units at a time. Increasing should be done wit 0.25 or 0.5 units max.
Click to expand...

Thank you for helpful information! I've given Tux 2 units last night and this morning. And I will test +2, +3, and +4. :)
 
Hi Kako,

Glad to hear you've got your test strips now. Good news on the ketones, too. Be sure to keep monitoring Tux's urine for ketones (with Keto-diastix or similar). How is he feeling/acting today?

:bighug:


Mogs
.
 
Critter Mom said:
Hi Kako,

Glad to hear you've got your test strips now. Good news on the ketones, too. Be sure to keep monitoring Tux's urine for ketones (with Keto-diastix or similar). How is he feeling/acting today?

:bighug:


Mogs
.
Click to expand...
Thank you kindly, Mogs! Keto-diastix... do we need prescription for that?
Tux seems better. :) He's never looked bad but today he seems stronger. Hope his BG test shows good. 45 min. to go.... It will be the first reading since we lowered to 2 units. :)
 
31mMVNE0DkL.jpg




These are the ketodiastix. They measure ketones and glucose in the urine. You do not need a prescription for them.
 
I've had a look at the sheet. I'm worried that the level goes up again at +4. With the time difference I don't know what time it is now for you. Here it's 12 o'clock in the afternoon at this moment.... How long ago was your +4 or are you sleeping now?
 
If you test your cat, don't test at +6, test at +4 in the future. That the level you need.

I think at April 22 he was too low at +4 (probably even at April 21), the body needed to take counter measures and released stress hormones (glucose), and the level went up and up. It may have happened again, and the body may have decided to realease those stress hormones continually, so the curve became high and reasonably flat (flatter every day).
After such an episode, the dose must be lowered by at least 1/3 (which you have done). During the following 5 days (max) the body recuperates, but in that period you can see all kind of levels, from very high, to even very low preshot values. This could also explain the relatively low preshot level in the morning of April 22, so probably the 3 units of April 21 did their job far too well .... It's probably that day when everything went wrong. And April 22 did not help. The bouncing levels could also still cause the level to go up at +4 this evening.

I advise you to test preshot levels, and +4's. Do not increase the dose for at least 5 days, because high levels can still be caused by stress hormones and you don't want to shoot against stress levels, only against diabetes levels.

If your preshot level is low, don't shoot the normal dose, because you will bring back the survival mode in that case.
I will think about a safe sliding scale for the next days, although I have little experience in making them (just reading them in the posts on our dutch forum). But maybe it's better than nothing.
 
Nederland said:
If you test your cat, don't test at +6, test at +4 in the future. That the level you need.

I think at April 22 he was too low at +4 (probably even at April 21), the body needed to take counter measures and released stress hormones (glucose), and the level went up and up. It may have happened again, and the body may have decided to realease those stress hormones continually, so the curve became high and reasonably flat (flatter every day).
After such an episode, the dose must be lowered by at least 1/3 (which you have done). During the following 5 days (max) the body recuperates, but in that period you can see all kind of levels, from very high, to even very low preshot values. This could also explain the relatively low preshot level in the morning of April 22, so probably the 3 units of April 21 did their job far too well .... It's probably that day when everything went wrong. And April 22 did not help. The bouncing levels could also still cause the level to go up at +4 this evening.

I advise you to test preshot levels, and +4's. Do not increase the dose for at least 5 days, because high levels can still be caused by stress hormones and you don't want to shoot against stress levels, only against diabetes levels.

If your preshot level is low, don't shoot the normal dose, because you will bring back the survival mode in that case.
I will think about a safe sliding scale for the next days, although I have little experience in making them (just reading them in the posts on our dutch forum). But maybe it's better than nothing.
Click to expand...

@Nederland


I copied your post to the other thread in the Health forum. I have suggested that all future postings be done there,. I think to keep all information in one spot that continued posting should be done on the Health thread.

http://www.felinediabetes.com/FDMB/...vetsulin-needed-too-high-a-dose.156816/page-2



That way all the information is available without going back and forth between two different postings. :)
 
Status
Not open for further replies.
Back
Top