Vetsulin dosage help

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smidge&smudge

smidge&smudge

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Thank you for your reply, I copied and pasted from my intro thread
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smidge&smudge

Hi,
I am so happy to find support and information on this site! My cat Smudge was diagnosed on January 16th her blood test was at 599 and started on 2 units 2x a day, one week later on follow up she was at 592 and increased to 3 units 2x a day, today was first time I successfully home tested and she was "Hi" which is off the meter. We go back to the vet on Monday. She is peeing everywhere except her litter box which is difficult to handle and I'm constantly cleaning her pee. She has switched to canned food which she likes much better anyway.

Sorry for the long post, I look forward to learning as much as I can and I hope she starts to get better soon.
 
smidge&smudge said:
2 units 2x a day, one week later on follow up she was at 592 and increased to 3 units 2x a day,
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Two units twice a day is higher than we'd recommend as a starting dose. One unit twice a day is better. Raising the dose to 3 u twice a day after only a week is a very large increase - 50%. We recommend increasing by only 0.25 u at a time so you don't pass right by a good dose. It's quite possible that the dose your kitty is on is too high.

smidge&smudge said:
She is peeing everywhere except her litter box which is difficult to handle and I'm constantly cleaning her pee.
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This usually settles down after a kitty is on insulin for a while and the blood glucose numbers start to come down.

smidge&smudge said:
She has switched to canned food which she likes much better anyway.
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Canned food is recommended. Are you feeding low carb canned food? That's important because carbs in food can raise BG significantly. There's no need to buy expensive prescription food. Grocery store brands like Friskies and Fancy Feast pates version are fine (no sauce or gravy types - too high in carbs).

Congratulations on home testing! What testing schedule do you follow and what meter are you using? We recommend that you set up a spreadsheet like the one we use here that's viewable by all members. It'sthe first thing we look at before giving advice.
http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
 
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Kris & Teasel said:
Two units twice a day is higher than we'd recommend as a starting dose. One unit twice a day is better. Raising the dose to 3 u twice a day after only a week is a very large increase - 50%. We recommend increasing by only 0.25 u at a time so you don't pass right by a good dose. It's quite possible that the dose your kitty is on is too high.


This usually settles down after a kitty is on insulin for a while and the blood glucose numbers start to come down.


Canned food is recommended. Are you feeding low carb canned food? That's important because carbs in food can raise BG significantly. there's no need to but expensive prescription food. Grocery store brands like Friskies and Fancy Feast pates version are fine (no sauce or gravy types - too high in carbs).

Congratulations on home testing! What testing schedule do you follow and what meter are you using? We recommend that you set up a spreadsheet like the one we use here that's viewable by all members. It'sthe first thing we look at before giving advice.
http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
Click to expand...
 
Kris & Teasel said:
Two units twice a day is higher than we'd recommend as a starting dose. One unit twice a day is better. Raising the dose to 3 u twice a day after only a week is a very large increase - 50%. We recommend increasing by only 0.25 u at a time so you don't pass right by a good dose. It's quite possible that the dose your kitty is on is too high.


This usually settles down after a kitty is on insulin for a while and the blood glucose numbers start to come down.


Canned food is recommended. Are you feeding low carb canned food? That's important because carbs in food can raise BG significantly. there's no need to but expensive prescription food. Grocery store brands like Friskies and Fancy Feast pates version are fine (no sauce or gravy types - too high in carbs).

Congratulations on home testing! What testing schedule do you follow and what meter are you using? We recommend that you set up a spreadsheet like the one we use here that's viewable by all members. It'sthe first thing we look at before giving advice.
http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
Click to expand...

Thank you for your reply, I am using the relion confirm and she is on fancy feast classic, when we go back on Monday I need to ask a bunch of questions, I just hope she starts peeing in the litter box again, I am constantly cleaning her pee! I will see if I can figure out the spreadsheet!
 
smidge&smudge said:
Thank you for your reply, I am using the relion confirm and she is on fancy feast classic, when we go back on Monday I need to ask a bunch of questions, I just hope she starts peeing in the litter box again, I am constantly cleaning her pee! I will see if I can figure out the spreadsheet!
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Is she peeing in the same spot each time? Is she just outside the box? Do you have more than one box in your house?
 
I agree with Kris. It appears very likely the dose of insulin prescribed is too high. While that sounds totally counter intuitive, too high a dose of insulin can look the same as too little and that is a mistake many vets make. It has to do with a natural defense mechanism that causes the cat to pump out hormones to get the liver to push glucagon into the bloodstream to bring blood glucose levels up to what the cat perceives as normal. The problem is that a diabetics defense mechanism is out of alignment and thinks "normal" blood glucose numbers are abnormal because they have become accustomed to high BG levels and therefore it works to increase them. The only way to get the cat past this problem is by starting the insulin at a reasonable dose of 0.5 to 1u and gradually increasing it by quarter units until you find the dose that keeps kitty in better numbers.

The urinating outside the box could be a sign of a urinary tract infection which diabetics are prone to or it could be that she is getting caught short. In all likelihood, getting the diabetes under control will help with the litter box problems but I would recommend getting your vet to take a urine sample to check for an infection.
 
JanetNJ said:
Is she peeing in the same spot each time? Is she just outside the box? Do you have more than one box in your house?
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She has several spots, one is right by her litter box, not sure why she just won't go in it, she poops in there, she has another favorite spot and I just recently got another box and put it in that spot, but she just pees near it too. She has other spots as well. Last weekend since I thought she would be getting better I deep cleaned all the floors, boy was I wrong!
 
MrWorfMen's Mom said:
I agree with Kris. It appears very likely the dose of insulin prescribed is too high. While that sounds totally counter intuitive, too high a dose of insulin can look the same as too little and that is a mistake many vets make. It has to do with a natural defense mechanism that causes the cat to pump out hormones to get the liver to push glucagon into the bloodstream to bring blood glucose levels up to what the cat perceives as normal. The problem is that a diabetics defense mechanism is out of alignment and thinks "normal" blood glucose numbers are abnormal because they have become accustomed to high BG levels and therefore it works to increase them. The only way to get the cat past this problem is by starting the insulin at a reasonable dose of 0.5 to 1u and gradually increasing it by quarter units until you find the dose that keeps kitty in better numbers.

The urinating outside the box could be a sign of a urinary tract infection which diabetics are prone to or it could be that she is getting caught short. In all likelihood, getting the diabetes under control will help with the litter box problems but I would recommend getting your vet to take a urine sample to check for an infection.
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I forgot to mention she has a uti and has been on amoxicilian, she has one more day left.
 
MrWorfMen's Mom said:
I agree with Kris. It appears very likely the dose of insulin prescribed is too high. While that sounds totally counter intuitive, too high a dose of insulin can look the same as too little and that is a mistake many vets make. It has to do with a natural defense mechanism that causes the cat to pump out hormones to get the liver to push glucagon into the bloodstream to bring blood glucose levels up to what the cat perceives as normal. The problem is that a diabetics defense mechanism is out of alignment and thinks "normal" blood glucose numbers are abnormal because they have become accustomed to high BG levels and therefore it works to increase them. The only way to get the cat past this problem is by starting the insulin at a reasonable dose of 0.5 to 1u and gradually increasing it by quarter units until you find the dose that keeps kitty in better numbers.

The urinating outside the box could be a sign of a urinary tract infection which diabetics are prone to or it could be that she is getting caught short. In all likelihood, getting the diabetes under control will help with the litter box problems but I would recommend getting your vet to take a urine sample to check for an infection.
Click to expand...
What a confusing disease, once I think I'm starting to under
MrWorfMen's Mom said:
I agree with Kris. It appears very likely the dose of insulin prescribed is too high. While that sounds totally counter intuitive, too high a dose of insulin can look the same as too little and that is a mistake many vets make. It has to do with a natural defense mechanism that causes the cat to pump out hormones to get the liver to push glucagon into the bloodstream to bring blood glucose levels up to what the cat perceives as normal. The problem is that a diabetics defense mechanism is out of alignment and thinks "normal" blood glucose numbers are abnormal because they have become accustomed to high BG levels and therefore it works to increase them. The only way to get the cat past this problem is by starting the insulin at a reasonable dose of 0.5 to 1u and gradually increasing it by quarter units until you find the dose that keeps kitty in better numbers.

The urinating outside the box could be a sign of a urinary tract infection which diabetics are prone to or it could be that she is getting caught short. In all likelihood, getting the diabetes under control will help with the litter box problems but I would recommend getting your vet to take a urine sample to check for an infection.
Click to expand...
Just when I think I'm starting to understand this disease......☺
 
smidge&smudge said:
I forgot to mention she has a uti and has been on amoxicilian, she has one more day left.
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That definitely explains some things. A combo of diabetes and UTI.


She's made a negative association between the box and the painful UTI. There's a litter called Dr. elsley's cat attract that could help.


If all else fails you can do what I did and put a puppy training pad down outside the box.
 
My favorite cat accident cleaner is called anti icky poo unscented.... Works great and had no scent at all.
 
Now she is constipated, off to get some pumpkin and a ton more paper towels, I am going to try and home test when I get back before I give her lunch.
 
Petrina

I jusy noticed that you posted on another FB group that you got a reading of HI on your meter. That means the glucose level is over 600 which is dangerously high. Do you have more readings?? Is Smudge eating properly?? With high readings like that there is much more of a possibility of ketones developing which can be very dangerous. Since you said he does not look well I am quite concerned about this possibility. Are you testing the urine for ketones?
 
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Petrina, are you still worried that Smudge looks "terrible"? You might like to put in a call to your vet to describe the symptoms and the HI reading - see what they say?

Keep us posted.

Diana
 
Just came back from vet, they tested like I would at home, and got the high 600 or over reading, was told to increase 4 units 2x a day, maybe I should start at 3 1/2? Still peeing anywhere besides her box, parked at water bowl , she didn't always keep her antibiotics down so now have some liquid amoxicilian. I was unable to download the spreadsheet on my phone, so I started a notebook. Hope she gets under control soon!
 
smidge&smudge said:
I was unable to download the spreadsheet on my phone, so I started a notebook
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To get it on a phone/tablet, you have to download Google Chrome, Google Drive and Google Sheets from the Play Store or App store (for Apple) first

You might want to check on that liquid amoxicillin .....most of the liquids contain sugar
 
4units of Vetsulin is a very large dose for a kitty that was just diagnosed 2 weeks ago and I am still very concerned the reason for the very high numbers is too high rather than too low a dose of insulin, Have you been giving 3 units? Have you been getting any tests during the cycle or just before the shot? Has the constipation problem been resolved? That too can cause some elevation of BG.

Vetsulin should be dosed based on both pre-shot and mid cycle tests. Testing done at the vets is known to be cause high BG due to stressBG elevation. I would strongly recommend you back off the insulin dose to perhaps 2u and get a test at 1.5 to 2 hours after the shot to see how much her BG has dropped. Any large drop in BG can set off the defense system that elevates BG so if you have not been testing mid cycle, it's quite possible what you are seeing is bouncing which happens when the BG drop to levels kitty has become unaccustomed to or steep sudden drops which can occur with Vetsulin.

It would also be most helpful if you could set up a spreadsheet. I see you tried and didn't have any success. You must have Chrome, Drive and Google Sheets installed on your phone in order to use the spreadsheet. If you still can't get it to work, we can have someone assist you.
 
Our vet said to wait a few days to test again after increasing to 4 units to see the effect, tested for first time today, unfortunately because of work I couldn't test until about an hour and half before her shot, had not eaten and again got that damned "hi" reading. This has to get better?
 
smidge&smudge said:
Our vet said to wait a few days to test again after increasing to 4 units to see the effect,
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Your vet is wrong.....especially with Vetsulin .....it's one of the harsher insulins and can bring the numbers down fast and far on the first shot.

smidge&smudge said:
had not eaten and again got that damned "hi" reading.
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Without testing, it's impossible to know what's going on, but it's entirely possible that that high a dose is taking Smudge too low and then her liver is trying to "save" her by releasing stored sugars and hormones to bring her back up quickly......we call it "bouncing". 4U is a really high dose for so early in the treatment. Most cats don't need more than 1.5-2 units

smidge&smudge said:
This has to get better?
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Yes, it will get better, especially once you're able to get more tests in and we can really see what's going on with Smudge! If what we suspect is true and she's getting too much insulin, it will show up in those numbers!!

Here's something I wrote up for others that needed help with testing...maybe it'll help you too! (substitute "her" for "him"...LOL)

It can be really helpful to establish a routine with testing. Pick one spot that you want your "testing spot" to be (I like the kitchen counter because it's got good light and it's at a good height....it also already blocked 2 escape routes due to the wall and the backsplash) It can be anywhere though...a rug on the floor, a table, a particular spot on the couch...wherever is good for you. Take him there as many times a day as you can and just give his ears a quick rub and then he gets a yummy (low carb) treat. Most cats aren't objecting so much with the poking..it's the fooling with their ears they don't like, but once they're desensitized to it and learn to associate a certain place with the treats, they usually start to come when they're called! Or even when they hear us opening the test kit!

You also have to remember...you're not poking him to hurt him...you're testing him to keep him safe and understand what's going on inside his body. There's just nothing better than truly understanding what's going on inside your kitty's body and with this disease, the more knowledge you have, the more power you have against it. The edges of the ears have very few pain receptors, so it really doesn't hurt them. Also, if you're nervous and tense, it's going to make your kitty nervous and tense too. As silly as it might seem, try singing! It forces you to use a different part of your brain!

It's also important to make sure his ear is warm. A small sock filled with a little rice and microwaved or a small pill bottle filled with warm water (check temp against your wrist like you would a baby bottle) works well.

When you're first starting, it's also important to use a lower gauge lancet, like 25-28 gauge. Most of the "lancet devices" come with 33 gauge lancets and they are just too tiny to start with. The bigger lancets (that are lower numbers) make a bigger "hole". As you poke more and more, the ears will grow new capillaries and will be easier and easier to get blood from...we call it "learning to bleed"

Finding the right "treat" will be a great help too! Freeze dried chicken, bonito flakes, little pieces of baked chicken...whatever low carb treat you can find that he really enjoys will help him to associate the testing with the treat! China's Achilles heel was baked chicken, so I'd bake a piece, chop it into bite sized pieces, put some in the refrigerator and freeze the rest to use as needed. It didn't take long for her to come any time I picked up the meter!
 
Thank you si much, is there a way to see if that is happening? Should I test after a shot? Sorry for so many questions I just want to get hee better.
 
You should always test before the shot....We call it the Pre-shot test....there's an AM Pre-shot (AMPS) and PM Pre-shot (PMPS)....and your cat shouldn't eat for the 2 hours immediately before the PS test.

That's the only way to know they're high enough for any insulin at all!!

With Vetsulin, you want to Test, Feed, wait 20-30 minutes and shoot (so there's food on board when the insulin "hits")

Then if you can get a test at +2 (2 hours after the shot) that can tell you a lot about how active that cycle is going to be....if the +2 is lower than the PS, that's a good indication that she might be going a lot lower later in the cycle and it's important to plan on getting more tests in

If it's impossible for you to get tests in on the AM cycle, it's even more important to get them on the PM cycle....most cats go lower at night so you should always get a "before bed" test in ....depending on your schedule, if it's possible, a +1 or +2 AND a "before bed" test will help to see what's going on with Smudge

We have a spreadsheet program that we all use that's very helpful in seeing what's going on. We depend on it quite heavily so I hope you'll get it started. Here are Instructions on getting the FDMB spreadsheet

You need a Google account to access it (and if you have any problems getting it set up, feel free to send me a private message and I'll be happy to set it up for you!!....just click on my name and choose "start conversation"

It will also help for you to go ahead and fill out your signature. If you go to the top right and click on your sign on name, there's a drop down menu where you'll choose "Signature".....a new box will pop up for you to put some information in. We like to see Your name/Cats name, age, sex, date of diagnosis, type of insulin, type of meter, type of food, any other health issues?, a general idea of where you live and then when you get it set up, the link to your spreadsheet. (you'll see all this information below our comments)

It keeps us from having to ask the same questions over and over again.
 
I
Chris & China said:
You should always test before the shot....We call it the Pre-shot test....there's an AM Pre-shot (AMPS) and PM Pre-shot (PMPS)....and your cat shouldn't eat for the 2 hours immediately before the PS test.

That's the only way to know they're high enough for any insulin at all!!

With Vetsulin, you want to Test, Feed, wait 20-30 minutes and shoot (so there's food on board when the insulin "hits")

Then if you can get a test at +2 (2 hours after the shot) that can tell you a lot about how active that cycle is going to be....if the +2 is lower than the PS, that's a good indication that she might be going a lot lower later in the cycle and it's important to plan on getting more tests in

If it's impossible for you to get tests in on the AM cycle, it's even more important to get them on the PM cycle....most cats go lower at night so you should always get a "before bed" test in ....depending on your schedule, if it's possible, a +1 or +2 AND a "before bed" test will help to see what's going on with Smudge

We have a spreadsheet program that we all use that's very helpful in seeing what's going on. We depend on it quite heavily so I hope you'll get it started. Here are Instructions on getting the FDMB spreadsheet

You need a Google account to access it (and if you have any problems getting it set up, feel free to send me a private message and I'll be happy to set it up for you!!....just click on my name and choose "start conversation"

It will also help for you to go ahead and fill out your signature. If you go to the top right and click on your sign on name, there's a drop down menu where you'll choose "Signature".....a new box will pop up for you to put some information in. We like to see Your name/Cats name, age, sex, date of diagnosis, type of insulin, type of meter, type of food, any other health issues?, a general idea of where you live and then when you get it set up, the linko to your spreadsheet. (you'll see all this information below our comments)

It keeps us from having to ask the same questions over and over again.
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I am going to work on her profile, thank you, was not sure how that was done ☺. I read your baby's, I am also in Missouri, St. Louis.
 
Sorry, still a noob, just need an opinion before I update vet today. Yesterday's Pre-shot was hi which is 600+ on my meter. Today I did the 20min after injection and she was 498, does this mean the insulin is at least doing some good?
 
That major drop of over 100 points in about 20 minutes is indicative that the dose of insulin is indeed dropping Smudge's BG very fast and substantially. This basically sets the cat up for a lot of bouncing and suggests very strongly that the dose of insulin is too high! Smudge's body will compensate and attempt to raise the BG when the insulin is pushing the BG down that much that quickly. Eventually, Smudge may not be able to compensate adequately and that could cause a hypoglycemic episode. While we all want our kitty's BG numbers down to more normal levels, they cannot be forced and taking the BG down more gradually allows the cat's body to get reacquainted with lower BG levels.

With a drop that large in such a short period of time, I would suggest you retest now and see where Smudge BG is. If you are unable to continue testing please leave lots of food down for her so she can eat as needed. A drop that fast and that early is worrisome.
 
Ok she is dropping extremely fast and you are going to have to monitor her very closely. How many hours ago did you give her insulin? What dose did you give her? Feed her something with high carbs now to try to slow down the drop in BG. Do you have any food with gravy in it? If so give her a tsp or two of gravy. If not mix a bit of honey or karo into a tsp of food.
.
 
Tuxedo Mom said:
It looks like that preshot reading was from yesterday.

" Yesterday's Pre-shot was hi which is 600+ on my meter"

We need to know the preshot reading today as well as how long after the shot the 187 was taken
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Good spot, Mary Ann. Petrina, to avoid confusion and make it easier for everyone to know how best to help you, do try to get a spreadsheet set up as soon as you can... I know it's one more thing to think about but it will be really helpful. There are people here who will help!
 
MrWorfMen's Mom said:
Good catch Mary Ann! I didn't notice that. Still a major drop between 498 and 187 in just over an hour!.
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Definitely.

Also need to know what dose of Vetsulin was given. The dose increases have been large and quick. Really need to have more data either on a spreadsheet or just listed from the last few days at this point
 
I wish I did but I didn't pretest today, the 187 was about an hour and half after shot this morning. She is on 4 units of vetsulin. The 498 was about 20 min after. I'm going to report to vet when they open, should another insulin work better?
 
smidge&smudge said:
I wish I did but I didn't pretest today, the 187 was about an hour and half after shot this morning. She is on 4 units of vetsulin. The 498 was about 20 min after. I'm going to report to vet when they open, should another insulin work better?
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I would say that you need to give this insulin a chance before looking at others... it's the DOSE especially that might need tweaking.
 
It's not whether another insulin would work better. It's about dosing appropriately with what you are using. Dose increases by 1 unit at a time and based on vet office readings all too often lead to too much insulin being prescribed. That is why we have been cautioning you. If you find the right dose for Smudge, the Vetsulin may work just fine for Smudge. Giving too much of any insulin is going to lead to problems.
 
smidge&smudge said:
I wish I did but I didn't pretest today, the 187 was about an hour and half after shot this morning. She is on 4 units of vetsulin. The 498 was about 20 min after. I'm going to report to vet when they open, should another insulin work better?
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It may be that Smudge is on too high a dose. That is a very big drop in 1 1/2 hours. It would be most useful to get preshots before every shot and a number of tests early in the cycle (time between shots) to see if the dose is dropping the numbers too fast. A fast drop or a drop into low numbers will cause Smudge's body to released stored glucose and that will cause numbers to be high afterwards. In that case giving less insulin would be the correct approach rather than more insulin, but until you have more data it is hard to make that call.

Can you test again and post the number. Do you have higher carb food, such as gravy types?
 
Petrina, we're all saying the same thing... it's possible that the dose is too high. Can you discuss this with your vet and ask why the current dose has been prescribed?
 
I know I don't know what is going on with her, makes sense because she really hasn't been back to normal self after starting the insulin on 1/16. I am going to try and get a spreadsheet going when I get to work since I can't get it going on my phone. And will be calling to vet when they open soon to report. I love her so much, hope I can get her regulated!
 
Diana&Tom said:
Petrina, we're all saying the same thing... it's possible that the dose is too high. Can you discuss this with your vet and ask why the current dose has been prescribed?
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If your vet is basing the dose increases on one number taken at the clinic, they do not have enough data to make that call. First a kitty at the vets can have a higher glucose reading from stress...much like the human "white coat syndrome" that causes some people to have elevated blood pressure at their doctors.

Also if Smudge is "bouncing" from lower numbers or too fast of a drop in glucose levels, the "emergency" glucose the body releases can cause numbers to be quite high for up to several days. If a test was done at this time it would be a wrong decision to increase. That is why consistent home testing shows a much clearer picture of what is actually happening.


ETA The drop today of at least 300 points in 1 1/2 hours will most probably cause a "bounce" into higher numbers. That is too big of a drop in such a short time.
 
smidge&smudge said:
I know I don't know what is going on with her, makes sense because she really hasn't been back to normal self after starting the insulin on 1/16. I am going to try and get a spreadsheet going when I get to work since I can't get it going on my phone. And will be calling to vet when they open soon to report. I love her so much, hope I can get her regulated!
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We want the best for her too! When you call the vet, ask if the dose was prescribed on the basis of one BG reading, as Mary Ann says above. If they say yes, you may have to be prepared for a discussion about re starting at a lower dose, probably 1u twice a day. Then if you are home testing as well, it will be much easier to see the true picture.
 
Petrina, there is no reason to think you cannot get Smudge regulated but right now you need to understand that Smudge's BG could drop too low today and she needs to be monitored to keep her safe.
 
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