Caninsulin PMPS 23.7 +4 6.4 +4.25 6.9 wobbly cat - advice and support please

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Alexi

Alexi

Member Since 2016
Did a PMPS +3 and was a lot lower than I have had before, she started looking stunned and a bit wobbly before I did +3 so I have gave 1/2 pouch normal wet food, +4 was worse so have given cat biscuits and more wet food. Have rechecked at 15 mins and slightly better reading although she is still not right. Have syrup standing by and checking every 15 mins (much to her disgust). Anyone around who can hold my hand?
 
How is Cappuccino doing now?? The glucose numbers are not too low even with a pet meter, but the numbers are lower than she is used to, Have you done another reading?
 
just now +4.75 9.7, I have just stuck her head in the food bowl again and she is eating but not very much, she was very quiet and slightly floppy for about 15min but taking notice ok.
 
Alexi said:
just now +4.75 9.7, I have just stuck her head in the food bowl again and she is eating but not very much, she was very quiet and slightly floppy for about 15min but taking notice ok.
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OK Then she is holding her numbers okay. It is possible that because of the big drop, this is what is making her a bit wobbly. Caninsulin is a harsher quicker acting insulin that can bring the numbers down quite a bit in the early part of the cycle. A bigger drop can be very draining on Cappuccino. From what I can see from your spreadsheet she should be past the point where she will drop any further for now.
 
I know that in the UK all vets start kitties on Caninsulin (Vetsulin) as per the guidelines. When a kitty drops too fast or too low the body produces counter-regulatory hormones that increase the glucose levels back up higher, which seems to be what is happening with Cappuccino. It might be worth asking your vet whether they might suggest a longer acting, gentler insulin such as Lantus, Levemir or Prozinc. Those insulin will not cause the big drops and big bounces that you are seeing now. Going from highs to lows and back again can be very draining.
 
+5, 12.4, has livened up a bit. I have asked about ProZinc and they are investigating as they have no experience of it but would be happy to give it a go. It has only just been licensed in the UK. Should I drop her dose? I am at work tomorrow so won't be able to monitor her. She has had extra food since she dropped tonight. It is now 1.30am here.
 
I do not use Caninsulin myself but I would suggest that because of how quickly and how much the Caninsulin drops Cappuccino that you cut back the dose since you will not be able to monitor tomorrow during the day. I am not really proficient in offering dosing information for Caninsulin but I might suggest cutting back to 1.5 units. I will see if I can find some other members that use Caninsulin to offer their advice.

@Critter Mom @Sue and Oliver (GA) @BJM
 
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If you do not get any more replies tonight you can go ahead and reduce back to 1.5 units for the morning. I imagine you are pretty exhausted by now, so you need to get some sleep. Just check back here in the morning and see if any other members have posted some advice on dosing. :bighug:
 
+5.25, 17.9, she has access to food all night and appears normal now. It is now 2 am so I'm off to bed but will check back in the morning. Thanks for being there, I am on my own here so was dreading an early morning rush to the out of hours vet with a flat cat!
 
Alexi said:
+5.25, 17.9, she has access to food all night and appears normal now. It is now 2 am so I'm off to bed but will check back in the morning. Thanks for being there, I am on my own here so was dreading an early morning rush to the out of hours vet with a flat cat!
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She should be fine for the night. Caninsulin can bring the numbers down fast and hard, but usually does not last the full 12 hours. Just check in the morning before you shoot and see if anyone else has weighed in with advice. Have a good sleep...what little is left of the night.;)

:bighug:
 
Alexi said:
Should I drop her dose?
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I would if it were my cat - absolutely.

Sounds like Cappuccino has had an incident similar to one Saoirse had after a very precipitous drop when on Caninsulin. Saoirse's incident also happened in normal numbers (though she went down to 4.3 - Alphatrak). It's the only symptomatic hypo Saoirse has had. Saoirse became more sensitized to insulin afterwards.


Mogs
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Critter Mom said:
I would if it were my cat - absolutely.

Sounds like Cappuccino has had an incident similar to one Saoirse had after a very precipitous drop when on Caninsulin. Saoirse's incident also happened in normal numbers (though she went down to 4.3 - Alphatrak). It's the only symptomatic hypo Saoirse has had. Saoirse became more sensitized to insulin afterwards.


Mogs
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Mogs

What might you suggest as a dose for the morning. She will be at work and not able to monitor. I had suggested going to 1.5 units from the current 2.5 units. What do you think?
 
There is every possibility that Cappuccino may have gone lower at +2 (can happen when the dose is too strong) and her liver may already have been starting to release glucose to compensate. Granted, without actual test data this is mere speculation but it is a possibility. That lethargy and floppiness you describe is exactly the same as Saoirse experienced. It put the heart crossways in me so I can imagine you must be quite unnerved, Alexi. :bighug: Thank goodness you did the before-bed check!

If Cappuccino were mine and I couldn't monitor her through the day I would speak to the vet first thing about giving a token dose (c. 0.5 IU Caninsulin) - or I might bottle out altogether if she wasn't ketone-prone and had no history of DKA. Even if she's sky-high in the morning - a likelihood because of the high carb and also a possible bounce - her numbers could tank again as soon as she receives the next dose of insulin.

If it were my cat, over the next few days I would be extremely cautious WRT dose size and I'd monitor BG closely.


Mogs
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AMPS 27.8, despite all the extra food, she has never had ketones so I'm bottling out, omitting her dose, and will ring the vet later. I have to leave for work before they open and although there is an emergency service I'd prefer to speak to my own practice. I have emailed them her spreadsheet with an explanation of what happened.
 
Yes - when in doubt, play safe. Better to be high for a bit until you can get BGs under control again than too low and not be there to do anything about it.
Let us know how today goes.

Diana
 
Oh, (((Alexi))), and poor Cappuccino; that's quite a trampoline act she's got going there.....

It may be that a lower dose would help to even out those highs and lows.

Or, perhaps this data is sufficient to persuade a vet to let you try Prozinc......? They'll probably say that they don't have experience of using it (as it's new here); but, unless the vets are extremely young, they may well have experience of the veterinary PZI (Insuvet PZI) that was in use here until a few years ago: Prozinc shouldn't be so very different to that, in principle... And, someone has to be the first in their clinic to try it..... :rolleyes:

Of course, there's no guarantee that Prozinc would work better than Caninsulin, but, given it's (usually) longer duration and gentler action, there is every possibility that it will....

Eliz
 
So after a normal day of food (and no extras given by well meaning cat minders) and no insulin her PMPS is lower than her APMS. Long discussion with the vet, they think I did a good curve and the caninsulin is working as it should, I did say I thought that might actually be be the issue. She was surprised that Cappuccino showed hypo symptoms when in a normal BG range as cats shouldn't do that apparently. I did say maybe she has adjusted her regulation because of running on high sugars for a period of time as humans do. So, outcome of today's discussion is to reduce her dose to 2 iu bid but to give a 2.5 iu dose on Wednesday morning then take her to the vet so they can monitor and see if she does it again. Just given her PM dose and will do a +2 and +3 and give up on the expectation of a reasonable bedtime. She has had no insulin for just over 24 hours so I wonder if her pancreas might be starting to recover. They thought I handled the situation well. I will write another update on progress for them when I go in on Wednesday.

Thank you everyone for the support - it is a worrying time. Tomorrow she will have a minder all day who knows her well and can spot if all is not well.
 
Alexi said:
So, outcome of today's discussion is to reduce her dose to 2 iu bid but to give a 2.5 iu dose on Wednesday morning then take her to the vet so they can monitor and see if she does it again.
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If it was my cat, vet or no vet, I would not give 2.5IU Caninsulin again. I think all those blacks could well be bounces from too hefty a dose. (My two penn'orth; other members may have a different take.)

Alexi said:
They thought I handled the situation well
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I agree! :)


Mogs
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Numbers are already looking better on 2 iu, I think they wanted to see what actually happens as my description was good but they wanted to see for themselves as it was not what they expected to happen. She seemed better today again and I was surprised she was not higher at PMPS as it was more than 13 hours between readings. I am not going to go higher than 2 now at home. I have handled many diabetic emergencies in my time so know what needs to be done and what to watch out for, I also know Cappuccino's typical behaviours and when she is not right. It is continuing to worry me though.
 
Alexi said:
I have handled many diabetic emergencies in my time so know what needs to be done and what to watch out for, I also know Cappuccino's typical behaviours and when she is not right. It is continuing to worry me though.
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Whenever I give Saoirse a dose of insulin I worry. I'm nervous when giving her a dose of Lantus. I was absolutely petrified when she was being treated with Caninsulin.


Mogs
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Pleased to report that today she has been full of beans and doing her normal stuff. Woke up this morning to find her back in her favourite place to spend the night - my pillow. She did have an episode of blood in her urine overnight - I have meloxicam for her as she gets stress induced cystitis, and purring away as I checked her glucose level. Better than she has been for the last couple of weeks!
 
Returning to favourite spots is a great sign, Alexi! What a very encouraging update!! :)

I hope that the cystitis clears up quickly; Saoirse is prone to stress-induced urinary tract issues as well.


Mogs
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Curve done at the vet today on 2.5 iu, displaying no symptoms at lowest which was 8.6, but stressed by the look of the numbers and the large present she left me in the litter box immediately on return home. If it happens again they want me to film it but staying at 2 iu bid dosing now. Lower dose tonight to get her back on track with timings, agreed that Cappuccino hadn't read the manual! They have sent an email to the diabetes specialist to see what they think. Another home curve to be done this weekend. Cystitis has cleared up after her dose of meloxicam. They will monitor her spreadsheet as well. So slightly disappointing as I had a feeling she would behave perfectly normally!
 
Hmmm.... That '8.6' looks completely incongruous to me.... It just doesn't 'fit' with the other numbers. I wonder if it was a wonky test. Or if it was meant to be '18.6'...?

Eliz
 
It was 8.6 at +4.25, they specifically commented on it as it 'should' have been what was expected. I suspect the higher numbers before were stress effect, and the lower numbers towards the end was when she was more relaxed. She was starved all day. I really don't want to have them do another one as it is really disruptive, not to say costly. They have asked for another curve on her lower dose to be done at home.
 
Alexi said:
It was 8.6 at +4.25, they specifically commented on it as it 'should' have been what was expected
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The SS says that it was 23 at 12.15, and 8.6 at 1.15. Are those timings not correct? (Sorry if I've misunderstood...) Just checking, as that would've meant she'd dropped 14.4 mmols in an hour....? :confused:
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Yes, timings are correct. This was after the larger dose that gave her a hypo and normally I give a snack 1-2 hours after her shot which she didn't have today at the vet (mornings I usually leave food in the bowl so she can help herself later).
 
Hell's bells! I've never seen a blood glucose drop like that in all the time I've been here - not even close....
If that wasn't a test error then I think you must surely have sufficient data to entitle you to use a different insulin now, Alexi....?

I would expect to see a huge bounce after that kind of drop. Anything over roughly 5.5 mmol can (typically) cause a bounce, but 14.4 mmol.....? Yikes! :eek:
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I expect it is because she had no food at the vets. I have been deliberately giving her something within an hour or two of her dose to prevent a big drop after seeing what happened on her first curve, so the second one I did at home was with adjusting her food timings and quite controlled.
 
Elizabeth and Bertie said:
Hell's bells! I've never seen a blood glucose drop like that in all the time I've been here - not even close....
If that wasn't a test error then I think you must surely have sufficient data to entitle you to use a different insulin now, Alexi....?

I would expect to see a huge bounce after that kind of drop. Anything over roughly 5.5 mmol can (typically) cause a bounce, but 14.4 mmol.....? Yikes! :eek:
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Saoirse had some 16+ point drops when she was on Caninsulin. I wonder whether the first few readings on Cappuccino's curve today didn't show much movement because of vet stress? That plus the different feeding pattern could have produced a curve like what we're seeing. (Speculating here.)


Mogs
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The full data's on an old PC (Excel - I hadn't set up my Google spreadsheet at that stage). She'd get dose onset at +1.5 - +2. By +3 her BG would have tanked.
 
Critter Mom said:
Saoirse had some 16+ point drops when she was on Caninsulin. I wonder whether the first few readings on Cappuccino's curve today didn't show much movement because of vet stress? That plus the different feeding pattern could have produced a curve like what we're seeing. (Speculating here.)


Mogs
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That's my view as well. The first curve she had done at the vets she was showing in the 30's for the first few hours as well and seemed to follow a similar pattern. She was disturbed by a yapping dog, when I arrived with her this morning the same thing happened. I will add it to the start of the spreadsheet.
 
Alexi said:
That's my view as well. The first curve she had done at the vets she was showing in the 30's for the first few hours as well and seemed to follow a similar pattern. She was disturbed by a yapping dog, when I arrived with her this morning the same thing happened. I will add it to the start of the spreadsheet.
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It would be much more helpful, data wise, for you to do a full curve at home. The numbers I also suspect, are most likely stress influenced. The first (and only) vet curve I did on Tuxie showed no change at all the first 6 hours. They stopped the curve at that point. Tuxie had spent the whole time cowered in the litter box and had not eaten nor drank since he arrived there. I wasn't home testing at that point, but I started right after and although his numbers were too high, the readings at home were MUCH different than the ones at the vets.

That +5 test stuns me when you look at all the other readings :woot:
 
Tuxedo Mom said:
It would be much more helpful, data wise, for you to do a full curve at home.
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Line 8 on the SS was the first home curve - done under the same conditions as at the vets (starved). Line 15 on the SS was a home curve with some snacks at the beginning of the cycle - followed by the 'incident' after her PM shot. Just done her P+3 and she may do it again. Another late night for me!
 
Alexi said:
Line 8 on the SS was the first home curve - done under the same conditions as at the vets (starved). Line 15 on the SS was a home curve with some snacks at the beginning of the cycle
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Alexi, can I ask why you are not feeding Cappuccino 'normally' during the home curves? (I'm sure there's a reason, but I've somehow missed it, sorry...)

And don't worry about the high number this morning. That was to be expected after yesterday. :bighug:
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I have a multicat household and they all eat at different rates so she doesn't finish all her breakfast (2 pouches) so I generally leave some for her to eat later, also at dinnertime. She is no longer starving hungry so in order to get the food into her I split her meals, she has a habit of walking away so she can finish off later. Her weight is static and she still has a little more to gain. The first curve showed a bounce so to try to avoid this I tried some food early in the cycle to mitigate this, this was agreed with the vet to try to even out her numbers somewhat. The result was a normal curve the second time as I wanted to avoid the huge drop she seems to get if not fed between meals. I will try another with the no food between meals approach on the 2 iu dose. So normal for her is to split her meals, abnormal is to not eat for 12 hours.
 
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