Vetsulin dosage help

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MrWorfMen's Mom said:
Petrina, it's clear your vet doesn't have a clue what she is doing. You can't regulate a cat overnight no matter how much insulin you give them. She seems to think insulin is like a pain killer.....if one aspirin doesn't help, take two next time. Problem is you can't keep taking more and more aspirins or eventually the aspirin will make you sicker not better. That is what is happening here. The high dose of insulin is causing the high readings.

You need to ask yourself what you and Smudge have to lose by trying the lower dose for a few days. Your vet doesn't need to know you are doing it. Are you afraid the vet will get upset with you or are you afraid the lower dose is going to hurt Smudge?

If you lower the dose starting tonight and through the weekend, by Monday it should be clear whether the lower dose is working better or not and you'll know whether to trust the vet or not. If our theory that the current dose is too high is correct, you will have your proof for the vet.

If you follow the vet's advice and Smudge goes too low overnight or over the weekend, you are going to have to deal with the consequences should they occur (and I personally think they are VERY likely to occur) and those consequences could lead to a major vet bill for emergency treatment or worse, be fatal, if not caught on time.

I understand you wanting to believe/trust the vet but please don't let blind faith because she has a few letters behind her name make you trust her implicitly. She is after all just another imperfect human being.
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Doing the 1 unit, do I still test at 20 min and 1 1/2 hours?
 
In going to be frank here. Your vet is ignorant in dosing and putting your cat at great risk. If you blindly follow his advice your cat will be facing a life and death situation. I'm sure of it. You don't raise insulin like that. 4.5 dose is ridiculous after 2.5 weeks. I suggest finding a new vet. Seriously.
 
smidge&smudge said:
Doing the 1 unit, do I still test at 20 min and 1 1/2 hours?
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Please take a test before you give the shot so you know what the starting point is. Then you could test at +1 hour after shot and post the readings you get. Good luck with the testing!! :bighug:


ETA You may or may not see much movement at +1 hour after shot. Each kitty is different in how long it takes for the Vetsulin to start working (onset) If you don't see much movement at +1 then you could do another test at +2 hours after shot.
 
I have so much to figure out, just came back from store to get more lancets, I have been giving her the shot after eating, I hadn't waited long before, should I wait a bit after? Will start the one unit this evening, will test pre shot.
 
The routine should be take pre-shot test, feed, wait 20-30 minutes, inject insulin. You should also make sure Smudge has not eaten for 2 hours or more before taking the pre-shot test. Then test 2 hours post shot and depending on how much and how fast Smudge's BG is dropping, you decide if another test at 4 hours post shot is ok or if you need to test sooner if the BG has dropped substantially at the 2 hour test.
 
smidge&smudge said:
I have so much to figure out, just came back from store to get more lancets, I have been giving her the shot after eating, I hadn't waited long before, should I wait a bit after? Will start the one unit this evening, will test pre shot.
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The reason for the wait is that Vetsulin is fast acting insulin and you want food on board before shooting. So your sequence tonight will be test/feed/wait 20-30 min/inject insulin/ test again at +2 (2 hours after injection).
 
smidge&smudge said:
I think I may have gotten the spreadsheet worked out, will need to retest about 830
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Great job getting the spreadsheet up. You can add the numbers and dose from earlier today to give a good comparison on how the lower dose is working.

I see you have done a +2 test and Smudge is showing a decent drop already. Vetsulin "usually" will have an onset between +1 and +2 after shot so this is looking good so far. If possible a +4 test will give a good idea how this dose is working. The nadir (lowest number) "usually" runs between +4 - +6 so she should still be dropping more

:bighug: :bighug:
 
Well done Petrina, you're all set up now so if you can just get a few more readings throughout the cycle we will be able to see at a glance how the insulin is working. Starting on a low dose means you can increase in small increments as necessary - working down from the high dose the vet prescribed would have been much more difficult. The more data you can add to your spreadsheet the easier this will become. It's all falling into place so keep going!
 
Petrina

Were you able to get a test at +4 last night? That test should have shown how the 1 unit dose was working.

If you are able home this weekend it would be useful to do some extra testing to see what sort of pattern Smudge is getting from this dose. A prehot test and then more tests at +2 and +4 hours after the shot will fill in some of the pieces of the puzzle.

Please do post after you have tested today.:bighug:
 
Great to see you got the spreadsheet working! :D That +2 reading last night was a good drop in BG despite the lower dose. It's really important to get those early cycle tests at +2 and +4 to see how low the 1u is taking Smudge. Looking forward to seeing how Smudge does this weekend.
 
Hi Petrina
I see you got a +2 reading today, well done. That's not such a steep drop as on the 4 units so Smudge will be feeling better for that. Can you do a +4 test as well? That will be interesting, to see if he drops further on the 1u you gave him.

These are still high readings and we want to get them down, but if the 1u proves not quite enough we can slowly work upwards until we find a dose that's right.

I hope you're beginning to see how this all works? Treating feline diabetes is an ongoing commitment, but once you've got your head round the theory and get into a routine, you will find it manageable - and Smudge will thank you for it!
 
Thank you once again, since my cat is so challenging to regulate I so appreciate the support, I got the 4hr reading, seems like I should bump up the insulin just a bit?
 
smidge&smudge said:
Thank you once again, since my cat is so challenging to regulate I so appreciate the support, I got the 4hr reading, seems like I should bump up the insulin just a bit?
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I can't see the +4 reading, what was it? Would be good if you could update your soreadsheet as you go along, and mention the latest numbers here for easy reference.
 
Good job on getting the readings. It is possible that Smudge may need to get a slightly increased dose but I would prefer to have some experienced vetsulin users weigh in on the dosing.

To get more attention on your post could you change the title to "Need dosing advice for Vetsulin" If you go up to the top right corner of this page just under the title there is a box "thread tools" if you hold your mouse over it it will give you the option of "edit title" Then you can change the title to the new one and chose the "?" icon from the left side of the title box where you are editing


@Kris & Teasel @JanetNJ
 
Also if you can manage to get a test at +6 that will help to show whether Smudge goes lower in the middle of the cycle or if she is just "surfing" or starting to go up. This helps to determine the duration of the insulin as far as how Smudge is reacting to it.
 
Tuxedo Mom said:
Also if you can manage to get a test at +6 that will help to show whether Smudge goes lower in the middle of the cycle or if she is just "surfing" or starting to go up. This helps to determine the duration of the insulin as far as how Smudge is reacting to it.
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Exactly! And well done for changing the heading of the thread, Petrina. These little things do help us and other people reading the forum to see exactly what help is needed.
 
a 300 point drop is good... lets see what happens tonight. can you add info to your signature? Put date diagnosed, type of insulin and the food you are feeding.
 
Smudge had a good drop so far today. A +6 reading will provide some clue as to when her lowest point was today. Obviously she is getting a decent and a more controlled drop from 1u. If she really needed the 4u you were giving her, chances are you would have seen much less drop in her numbers today.
I am sure she is still in a bounce and would not advice changing the dose yet. You need to find out what her numbers look like without any influence from that huge drop yesterday and that can take up to 6 cycles to totally clear so changing the dose now would just make things worse.

I know you want to see the numbers come down but you cannot force them down because that will just make Smudge bounce more. You need to find the right dose using a controlled process not a knee jerk reaction. Slow and steady wins the race.
 
MrWorfMen's Mom said:
Smudge had a good drop so far today. A +6 reading will provide some clue as to when her lowest point was today. Obviously she is getting a decent and a more controlled drop from 1u. If she really needed the 4u you were giving her, chances are you would have seen much less drop in her numbers today.
I am sure she is still in a bounce and would not advice changing the dose yet. You need to find out what her numbers look like without any influence from that huge drop yesterday and that can take up to 6 cycles to totally clear so changing the dose now would just make things worse.

I know you want to see the numbers come down but you cannot force them down because that will just make Smudge bounce more. You need to find the right dose using a controlled process not a knee jerk reaction. Slow and steady wins the race.
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Agreed. We don't know how Smudge would respond to 1u if she wasn't bouncing so we need to determine that before we think about a dose change.
Petrina, are you with us so far?
 
I think you've been given good advice about waiting to see what BGs look like without a bounce complicating things. I'm so relieved you're doing this slowly and methodically. :)
 
@smidge&smudge well done for trusting people on here and having the bravery to go against what your vet says. I've been there and I know it is so difficult to do - we are supposed to be able to trust our vets but the way I see it is that they have a lot of knowledge about lots of conditions without necessarily being experts in all of them. The people on here have a wealth of experience geared towards diabetic cats and that can't be reproduced in books or courses.

My girl was started on a 5 unit dose of the same insulin - it was way too much for her to cope with and she had a hypo within the first week. The emergency vet was horrifed that she was on such a high dose and said she should have been started on a 1 unit and increased if needed. Even so my vet still wanted her on a 3 unit dose which I refused. Since then I've taken control of her dosing and tell them what I'm doing - at first they were shocked that I would change her dose but when I explained that I was hometesting (which again they don't recommend) they were happier for me to adjust. Now they leave me to it :) She is anywhere from a 0.75 to a 1.25 which is a world away from her starting dose!

My personal view is it is better to start low and build up as/when needed. I've seen hypo and I've seen how being on so much insulin changed Sky. Fortunately she got through it but she shouldn't have been put in that position.

Hopefully Smudge will start feeling better on a lower dose - and I'm sure a more gradual drop and curve will be better for him than such a massive drop.

Karen
x
 
One thing too, she is still drinking a lot of water, but I noticed her pee is more yellow and smells more like urine than before, sorry tmi, maybe this means her body is working better? I am very familiar with her pee since she doesn't go in the box since she got sick. Hopefully this will get better too.
 
smidge&smudge said:
Should I stick with same dose this evening, last test was 501?
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It has been suggested by some experienced vetsulin users that you continue with the 1 unit tonight. Since Smudge dropped a lot yesterday that would have caused a "bounce" where stored glucose is released by the body because of the big drop in glucose numbers. This can cause higher readings for a day or a few days. As the bounce clears then the numbers will start to come down. This morning there was a decent drop in numbers but not so much as to cause bouncing. It can take a few days to see the full extent of a dose. Please do test before the shot, then again at +2 and +4 hours after the shot to see how the insulin and the dose are working.
 
I would stick with the 1u just for now... it is quite possible that a higher dose may be needed but we have to see first what the 1u is doing. It is no surprise to see the higher number later in the cycle because the insulin had been pretty much used up...if you has got a +6 it would probably have been a better number as the insulin was still working. After +6 it's no real surprise that she was rising again.

Take heart, Petrina - the good news is that Smudge does respond to insulin so it's a matter of you doing the work now to dose appropriately.... I know you said she was getting irritated with the ear prick but this is for her own good so persevere and do more mid-cycle tests today if you can so we can see a bigger picture. Have we told you about giving her little treats at test time - freeze-dried chicken or small pieces of fresh chicken or ham? - she will come to associate test time with these and be much more amenable!

The early stages of FD treatment aren't always straightforward but you're not alone. Hang in there. Read up some more - maybe look at some other members' threads on this forum - it all starts to come together quite soon but there is no "quick fix" - you have to go through the process to work out what works for YOUR cat.
 
Personally I think one unit at a starting number over 450 may not cut it. 4 however was insane. I would go with 2 for a while until we see those numbers come down.
 
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JanetNJ said:
Personally I think one unit at a starting number over 450 is never going to cut it. 4 however was insane. I would go with 2 for a while until we see those numbers come down.
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It does look as if 1u isn't doing enough... it's a difficult one, stick with 1u for another day and get more data to make sure any bounce is cleared, or up the dose a little - 1.5 or 2u - and see if that makes a difference to drop AND duration... either way it's all about more testing!
 
A bit of a dose increase may be a good idea, but it would be very useful to get some tests around +4 or +5 hours after the shot. That is the "usual" time when the insulin has the largest effect and gives the nadir (lowest reading). Part of adjusting the dose with Vetsulin is to know just how low a dose takes your kitty.
 
I agree Smudge may need a bit more insulin but she has a UTI and I believe is still on antibiotic so if she is still in a bounce, which I think is very likely, upping the dose right now is only going to muddy the waters more. If the 1u dose was that much too low, I don't think we would have seen a drop of almost 300 points yesterday. The drop we know about on Feb.3 was over 300 points only 2 hours after insulin so it's quite possible/likely Smudge dropped lower that day but we have no idea by how much. We have no idea how many times prior to Feb 3rd Smudge dropped by huge amounts so I think bouncing right now is a logical assumption. The drop on the 3rd alone might have made her temporarily more sensitive to insulin so her defences may be clicking in sooner than they normally would and upping the dose right now is just going to set off more bouncing which won't help find the right dose.

The caveat to this situation is that Smudge has high BG plus an infection which hopefully is clearing up now. I would strongly recommend checking her urine for ketones which can be done using ketone test sticks available at the pharmacy and shouldn't be too hard to do if Smudge is still peeing on the floor outside the litter box.

Petrina, how is Smudge acting? Is she lethargic or sleeping a lot? Is she eating well? Is she still having diarrhea or are her stools back to normal? Are you feeding her meals only at shot time or are you feeding her some snacks in between? Are you keeping her on wet food only or still offering some of the dry food?
You mentioned Smudge's pee is more yellow and smells like pee now. That's not TMI around here......it's good info! :D Diabetic pee can smell sweet. Was that the odor you noticed before?

If she was my cat, provided there are no other signs of her condition worsening, I'd hold the 1u dose at least for both shots today and get pre-shot tests as well as tests at +2, +4 , +6 and +8 today to see what her entire day cycle looks like.

The key here is testing and without more data it's impossible to be sure what the best course of action is. I would keep any insulin increases to 0.5u because we don't know if the 2u initially prescribed didn't work because of the diabetes or if the lack of improvement was also influenced by the UTI.
 
I will agree with the other members here.

Scooter was diagnosed in late August 2016 and had a wild ride on Vetsulin. His dose was to high and the vet kept increasing rather than decreasing. He kept bouncing because of somogyi effect. This is when either your furbaby drops too fast or goes hypo. A failsafe in the cats body will realize its bs is too low or dropping too fast and release glucagon and hormones which will spike the next am or pm shot to be HI or 600+.

This forum helped Scooter cause when I reduced his insulin he became better regulated.
 
Thanks, can't wait to get her to normal. She read as high for preshot. Last night was last dose of antibiotic. Her poop is good now and she poops in litter box but still will not pee in it. She is down now to only two spots she pees in and those two are right next to the boxes, I put puppy pads down, I changed litter to dr. Elsy cat attract on friday but that hasn't made a difference. Before her pee was more diluted and didn't have much of a smell. She is still drinking lots of water, she is acting okay, still not back to normal, she is usually a very vocal, assertive kitty, she is still too laid back for her normal personality. Loves the wet food and is eating well. No ketones which os a relief I get nervous with these hi readings since I don't know how high she is. Going to test at the 2hr mark in just a little bit. Ugh, I have to drive my kiddos around today so may not get to test again until later afternoon. ☺☺☺☺
 
With Scooter it took a good 3 days or 6 12 hour cycles for numbers to start to stabilize. This was on a fancy feast classic only diet. The md kibble the vet recommended kept his numbers high also.
Scooter only peed outside his box when his ketones were high. When his bs is somewhat regulated the ketones will lower. This had to be his way of telling me something was wrong cause he never goes in the house ever.

It's critical to check nadir as stated in the above posts. With Scooter this was +4 or 5 hours after shot. Every kitty is different.
 
Reading through the posts, got a bit confused and panicked when I got the hi reading and increased to 1.5 this morning and brought her down to 234 at 2hrs. Hope this is good news, maybe if all is okay this may be a good dose? This is amazing how this low dose is working! I mean per vet I would have had her up to 4.5!!!! And this is working!
 
smidge&smudge said:
Reading through the posts, got a bit confused and panicked when I got the hi reading and increased to 1.5 this morning and brought her down to 234 at 2hrs. Hope this is good news, maybe if all is okay this may be a good dose? This is amazing how this low dose is working! I mean per vet I would have had her up to 4.5!!!! And this is working!
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That is a big drop in only 2 hours. Since it is still early in the cycle, I would suggest testing again in about 30 minutes. "Usually" the biggest drops will occur from +1-+5 hours after shot depending on the kitty.


ETA The people on this forum live and breathe feline diabetes 24/7. There is a big difference between a vet giving advice according to what he has read and a person who deals with this every day. That is why so many people made the suggestion to drop the dose...from their own experiences.
 
Keep the same dose for at least 3 days to stabilize and administrator at the same time every day +-15 min.

1 unit would bring Scooter down from HI. 600+
Kept him on that for 3-5 days and when his nadir (lowest reading) was 250 after 5 days increased to 1.5 which is perfect for him bringing him to 90-100. His pancreas is kicking back in so I hope remission is in our future.
 
I know it's amazing how much this lower dose has an effect on her, 1.5 may have made too big of a drop, god only knows what 4.5 would have done to her!
 
Obviously the lower dose was the best way to go. However as I said in my other comment that is a big drop in only 2 hours so another test at +2.5 hours would be prudent. There is still 2 or more hours that the glucose levels can fall and we don;t know when the nadir (lowest number) is with Smudge yet

Also you can change your title to add "AMPS 600 +2 234" in order to get more eye on this
 
Petrina, I hope you will see now that the vet's dosing suggestion was far too high - so well done for trusting a bunch of strangers on a message board! The thing is, we do know what we're talking about because we have lived with diabetic cats on a daily basis, and vets too often have not.

OK so you decided on a 1.5u dose this morning which has dropped Smudge A LOT after two hours... the 234 in itself is better of course than the much higher readings you've been getting but do heed what Linda and others have said about not muddying the water with a higher dose all the while we're not sure if Smudge is bouncing and/or recovering from an infection. Please try to get a +4 and +6 today so we can be sure that the 1.5 is ok... I would urge caution at continuing until you have more readings taken DURING THE CYCLE - we really do need to see just how low Smudge is dropping on any dose before making tweaks to dosage. The other thing to remember is that Smudge will be feeling a little odd with these fluctuations in her BGs so the more you can avoid too high or too low readings, the better... eventually you will get there but for now you are still working on this...
 
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