? Need insulin advice

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Mshaas75

Mshaas75

Member Since 2016
Paris is currently on vetsulin. Monday we started 3 units 2x a day. Her preshot numbers are always HI over 600. I'm doing a curve today please look at my spreadsheet. It appears her number drops until hour 5 and then starts to go back up after that. I am going to talk to the vet on Monday but am looking for suggestions and advice since I don't think this is my vets area of expertise. I have been watching her all day and the only thing she has eaten has been boiled chicken no carbs.
So my question is will increasing the dose make it last longer or maybe vetsulin just isn't working for her. Any thoughts and suggestions before I talk to the vet are appreciated. Thank you
 
She drops 50% or more but is still high overall. She might be bouncing, but her preshot numbers are really high, even for bounces. Is she eating low enough carb (under8-10%). If not, that may be part of the issue. No chance she has any kind of infection? It may also be that she needs another insulin. She might have a high dose condition. See if any of these symptoms sound familiar:
http://www.felinediabetes.com/FDMB/...-other-high-dose-conditions-what-we-know.375/
Sorry I have no conclusive ideas. Unfortunately there may be a number of different reasons she is running high.
 
Hi Heather, I can understand your frustration. Unfortunately, increasing Paris' dose will not make it last any longer. Many Vetsulin users find that it does not have a full 12-hour duration. My kitty did fairly well on Vetsulin, but it is definitely not for everyone! After looking over your spreadsheet, I would suggest talking to your vet about prescribing Paris a longer-acting insulin such as Lantus or Levemir. Also double-check her foods and make sure she is eating only foods with 10% carbs, or less! You may already have this, but if not, here is a link to a really good list of foods/carbs:

http://catinfo.org/docs/FoodChartPublic9-22-12.pdf
 
Hi Heather, Paris has given you a typical vetsulin curve with the low point at +5 and down into the yellows so she is responding to the insulin with a nice drop from AMPS. The 600+ numbers are frustrating, firstly because you don't know the actual number, and secondly because they are 600+. Has anything changed other than the insulin dose in the time you have been giving it - food, activity levels, general state of health? Looking at her other numbers she does drop by the +5 mark so it is doing something for her.

It is difficult to say if she is bouncing but she was giving you some ok numbers on a lower dose.
 
She seems as normal has she can be with bad liver and kidneys she still drinks and urinates a lot. I have been monitoring her food purina savory selects dm but I try to give her boiled chicken because it's no carbs.
It appears the insulin works just not long enough. The vet last visit mentioned if numbers stay high that there could be a tumor but like I said it works just not long enough. I will suggest switching to Lantus and she what she says. Last time I mentioned it was the cost. At this point cost does not matter it's getting her better.
 
If you can get a script (or your vet will fax one) you can get Lantus a lot cheaper in Canada. A LOT of us are doing that now since it's so insanely expensive here in the states

Here's all the information on Getting Insulin from Canada

I've used Marks three times since I found them and between the message board and the Facebook Feline Diabetes group, everyone has been pleased with their customer service...and the price of course!!!!

You should get the pens too. They're like having 5 "mini-vials" of 3ml each (300 units) instead of one big 10ml vial so you're able to use every drop instead of worrying about the vial losing it's efficacy before you can use 1000 units.

If your vet orders the vial, all you have to do is call Marks and ask...they can switch you to the pens if you ask them to!
 
I would ask your vet about testing for acromegaly and other high dose conditions as well. Acromegaly appears to be surprisingly common in diabetic cats. Vetsulin typically gives a smile shaped curve with sometimes a small drop at +10 so what you are seeing is normal for vetsulin. What we don't know is how steep the drop is but you may get better control with a longer acting insulin.

If you are worried about the cost of Lantus (or even if you are not) check out the supply closet or look into obtaining supplies from Canada as many members do, you will need the pens rather than the vials.
 
I hate to say this, but Purina Savory Selects DM is not considered to be low carb. Purina DM pate is only 3% carb. Ther'e are a lot of low carb foods that you can buy in stores or online. Just be sure it has no corn,wheat, soy, rice, potatoes ot fruits and vegetables. Also, dont buy any food with gravy in it.
 
Do you know any pharmacies in the US that will sell a single pen? My stepdad in Florida takes lantus and I could probably have them send me a pen but if the vet agrees I would like to get 1 pen and start it soon. Apparently she wants to throw up now have to go clean up
 
Mshaas75 said:
Do you know any pharmacies in the US that will sell a single pen?
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You just have to start calling and ask....The reason I ended up finding Marks in the first place was no pharmacy within 150 miles of me would sell just one pen! (and yes, I called them all!!)

Try Target or Costco....they tend to be the ones I hear about occasionally being willing....also small local pharmacies or hospital pharmacies are sometimes more willing
 
Oh my I don't know what happened but her am preshot was 480. Now 4 hours in 185. I have never seen anything below 200
 
Yes I can't believe it. It almost scares me. Could it be it just took 3 weeks for her body to get used to the insulin. Keeping fingers crossed this is some kind of break through. I know it's a roller coaster
 
Missed hour 6 but hour 7 back to 324 hopefully it doesn't go up to much in the next few hours. I gave her a small snack of boiled chicken but she only ate half.
 
First blues appearing is good - this is what you want to see, as well as a 'proper' pre shot number so it looks as though her nadir is around +5 and she drops around 300 points from pre shot levels. Is she getting consistent food now both in type and timings?
 
Yes. Check sugar at 5:30 then food shot by 6:00
Food is either fancy feast or cooked chicken.
Weekday husband comes home for lunch and feeds at 11:45 and then usually a snack of chicken before bedtime around 10pm. When we go to bed all food is picked up until the 5:30 am feeding. Her fancy feast isn't the best it's the gravy lovers I try to sneak in the dm savory selects when I can. Waiting on sample of young again zero carb food
 
Back over 600 at 10 hours. She really had only eaten boiled chicken today no carbs so I don't understand
 
Some days are just like that, I don't know why either. Let's see what she does for PMPS, this is the point where you just have to be patient but you do have some good and useful information from yesterday and today which will help you when making decisions in the future. We now know a 3 unit dose produces a nice typical curve without taking her too low from a red number, which is just what you need to know at this stage.
 
I second the recommendation to try a longer acting insulin like Lantus--with time, patience, and careful monitoring these insulins are very good at keeping cats in healthy blood sugar levels all the time. I don't know if it is an option for you, but our vet sells me smaller vials of Lantus quite affordably (I know that re-packaged lantus is recommended against, but we've had nothing but good experiences--it probably depends on the vet and how careful they are).
 
Mshaas75 said:
She really had only eaten boiled chicken today no carbs so I don't understand
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She's "bouncing"

Her body isn't used to being in those lower numbers, so it thinks they're "too low". The liver panics and sends out stored hormones and sugars to bring the blood glucose back up to where it's "used to" being at.

Bouncing is a frustrating but normal part of the sugardance and can take up to 6 cycles to clear
 
I have her the shot at 5 instead of 6 since she was so high already. Going to send spreadsheet to the vet tomorrow and discuss our options
 
Talked to the vet today and she has agreed to let me switch to Lantus. My mom is going to send me a Lantus pen overnight on cold packs and I will pick up some u-100 needles. I won't start her til the weekend so I can be home with her. So vet says over 360 give .5 unit and under 360 give .25 units does that sound right for starting dose?
 
Mshaas75 said:
So vet says over 360 give .5 unit and under 360 give .25 units does that sound right for starting dose?
Click to expand...

No.....You don't use a "sliding scale" with Lantus....it does best when given consistently.....same dose, every 12 hours

How much does Paris weigh? Is this a good weight for her or is she underweight or overweight?

How much you start at also will depend on which dosing method you choose.....the Tight Regulation Protocol or the Start Low, Go Slow method

It makes a difference on dosing advice we'd give you. TR is the only protocol that's been published in a veterinary journal so it has a lot of science behind it, but it requires you be able to test a little more often than SLGS. It also gives the best chance at remission. We've had cats go OTJ (Off The Juice) on SLGS, but it's much more common on TR because you adjust the dose more often in response to the numbers you're getting.

Some of the basic differences are:

TR...dose adjustments can be made as often as every 3 days (6 cycles)...this is most effective because if they're staying in numbers we don't like, we can increase more often
SLGS...dose adjustments are made once a week....this can be hard on the caretaker IF the cat is "stuck" in high numbers very long

TR...reductions in dose are given if they drop below 50 on a human meter, 68 on a pet meter
SLGS...reductions are given if they drop below 90 on either meter

TR...You'll want to get the 2 PS tests and at least one other test....preferably at least 2 other tests.....One somewhere between +4 and +7 on the AM cycle and a "before bed" test on the PM cycle...if you can only get 1, the "before bed" test is most important since most cats go lower at night
SLGS...You still must get the 2 PS tests in, and then do a curve once a week (testing every 2 hours for 12 hours or every 3 hours for 18 hours)
 
Paris weighs under 10lbs. I would have to weigh her to get exact. I guess I want the TR. I usually do curve on Saturdays. On weekdays I can only test preshot and then leave for work. As soon as I get home from work at 5 I do my pm preshot and usually test again before bed.
Amazingly I am finally getting good numbers at 5 hours on the vetsulin but it doesn't last long.
I would not start her on the Lantus til Saturday when I am home all day.
 
You might want to read some of the suggestions in this "Is TR possible with a full time job"? thread. You might find something that works for you!!

You can do TR as long as you can do the Pre-shot tests and at least a "before bed" test. If you can't get any other tests on the AM cycle, it's even more important to get them on the PM cycle, but you may need to hold a dose a little longer if none of the ideas will work for you....Of course you'd want to get more tests on any days off you have too

I'd also go over to the Lantus Forum and start reading. You can learn a lot by reading other people's posts too
 
It would be helpful to get a weight on her because if you're doing TR, the starting dose is based on weight

From the TR Protocol:

STARTING DOSE: The weight based formula for determining a starting dose of Lantus or Levemir when following the Tight Regulation Protocol:
  • the formula is 0.25 unit per kg of the cat's ideal weight
  • if kitty is underweight, the formula frequently used is 0.25 unit per kg of kitty's actual weight
  • if the cat was previously on another insulin, the starting dose should be increased or decreased by taking prior data into consideration
 
Hi Heather. Chris gave you suggestions for determining a starting dose when a cat is new to receiving exogenous insulin. However, since Paris has been on insulin for a month now, coming up with a starting dose for Lantus is a bit more complex. Much consideration is given to kitty's response to the doses given while on the previous insulin. Prior to starting Lantus, it would be a good idea to get more eyes on your situation by asking for advice about a starting dose in the Lantus and Levemir Insulin Support Group.

Good luck with the switch! :)

 
thanks i will do more reading and research and then post over on that page. also i will get an accurate weight. I think I am going to wait until the 20th to actually do the lantus switch only because I have a concert on the 19th. her shots are at 6 am and 6pm, that friday we will have to leave by 4 pm and I will have to shoot early and I know I am comfortable doing that with the vetsulin. her numbers are usually elevated pretty good by then. thanks everyone
 
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