? "Caninsulin dosing advice needed"

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Anthony Morgan

Anthony Morgan

Member Since 2017
My cat Shelley is in her teens and has had diabetes for 6 years which has been controlled with Caninsulin with no problems and a most recent dose of 1.8 units. On February 9th she had a hypo and her blood sugar fell to 1.1. She was in hospital for 2 days when she had another hypo after the vet injected 1.5 Caninsulin units. The hypos happened about 4 hours after the injection. Her insulin was stopped in the hospital and her glucose curves were normal over 24 hours, the Vet thought she was in remission and no glucose was present in her urine.
As soon as she came home though the blood glucose numbers were above normal and Caninsulin was restarted on very small dose but this was not bringing the diabetes under control.
On the advice of my Vet her dose was increased to 1.0u and I started to see a more consistent pattern.
However on the 9th March her amps was lower and the pmps so much so that I delayed injectiong and in the end gave no insulin.
The numbers remained in a narrow range in the early hours and then rose this morning. I was just concerned that the numbers might fall too low but I probably should have injected something last night. But she seems to have stayed fairly low on that one shot for 22 hours?
On the 10th I gave a reduced dose of 0.75u but at +4/+5 I got 6.3 and 6.7 . Although not really low these numbers do make me worry because of the previous Hypos.
So any advice on the way forward would be greatly appreciated.
Thank you for reading!
This is the limk to the previous thread:
http://www.felinediabetes.com/FDMB/...aninsulin-hoping-for-views-on-doseage.174006/
Shelleys Spreadsheet:
 
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I would try 1/2 unit and see what BGs result.
Next would be to try an insulin like Lantus or Levemir in order to try t get a flatter curve
 
Thank you Larry, I think I will. My Vet wasn't keen on changing insulin before but I will have to speak to him about it again.
Regards, Anthony
 
So 20.02 hrs PS = 24.5, not eaten for 2 hours.
Fed Shelley
Decided to re-check prior to shot 20.50=21.8
Not easy to know what to shoot?
 
Anthony

The 0.75 unit dose today brought Shelley down into nice blue numbers. I don't know if you fed her any higher carb after the +5 reading that could have caused the jump by +6. The numbers are still safe, but some of it will depend on your comfort levels. I know the previous hypo is still weighing in on your mind. My thought would be to keep the 0.75 dose if you are able to do some more testings up until +4 or +5 after the shot, but if you are not comfortable with the drop you could try the 0.50 unit as Larry suggested. This will give you an idea of whether a reduced shot will still get Shelley into good numbers.

I would really prefer if a few more people weighed in with their opinions. I will tag a couple of people but they may not be on for awhile.
@JanetNJ @Kris & Teasel @Elizabeth and Bertie @Squalliesmom
 
Thank you Mary Ann for coming back so quickly. Due to the big jump pre shot I went for the 0.75u. I will have to check in the night that all is OK. She did have a little Gourmet Soup. I actually got it for Herbie, it does have derivatives of a vegetable origin but I don't know if that did it?
 
Shelley seems to react much the same way that Sky does. The 1 unit will bring her nice numbers for AM and PM and then she will suddenly throw unexpected lower numbers into the mix to worry and confuse me. I'm sure she somehow manages to store it in her system! I then manage her on a lower dosage (depending on her numbers this will vary) until she shows signs of increasing again when she will then get more. It's just a merry go round - take a look at her spreadsheet, she was lower on an AM dose than on the PM and had no insulin the previous evening as I forgot!

The Caninsulin does work for her, it's clear from the spreadsheet, but the dosing is obviously tricky for her. I would have given her probably a half unit yesterday evening when she hit the yellow as she was still in a safe range - certainly wouldn't have given her a 1 unit but from your earlier figures a half until would have probably taken her down a little in the blues.

If you did feed her before the PM shot this evening it could easily be food influenced. Has she had the gourmet soup before and if so did it have similar effect? I don't think we ever know fully what causes spikes - usually just a best guess!

Hope Herbie is okay :)

Karen
 
Anthony Morgan said:
Thank you Mary Ann for coming back so quickly. Due to the big jump pre shot I went for the 0.75u. I will have to check in the night that all is OK. She did have a little Gourmet Soup. I actually got it for Herbie, it does have derivatives of a vegetable origin but I don't know if that did it?
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I am not familiar with the Gourmet Soup but that could have been what caused that bit of a food spike at +6. This is all good information to have as to which foods raise glucose levels. It may be useful if you want to bring the numbers up a bit but not over carb her, or if you want to avoid certain foods when she is higher. One of my kitties is VERY carb sensitive and the other one is much less so. All good information for knowing how Shelley reacts. I will check back at +2 and see what her numbers are doing.
 
Sootyca said:
Shelley seems to react much the same way that Sky does. The 1 unit will bring her nice numbers for AM and PM and then she will suddenly throw unexpected lower numbers into the mix to worry and confuse me. I'm sure she somehow manages to store it in her system! I then manage her on a lower dosage (depending on her numbers this will vary) until she shows signs of increasing again when she will then get more. It's just a merry go round - take a look at her spreadsheet, she was lower on an AM dose than on the PM and had no insulin the previous evening as I forgot!

The Caninsulin does work for her, it's clear from the spreadsheet, but the dosing is obviously tricky for her. I would have given her probably a half unit yesterday evening when she hit the yellow as she was still in a safe range - certainly wouldn't have given her a 1 unit but from your earlier figures a half until would have probably taken her down a little in the blues.

If you did feed her before the PM shot this evening it could easily be food influenced. Has she had the gourmet soup before and if so did it have similar effect? I don't think we ever know fully what causes spikes - usually just a best guess!

Hope Herbie is okay :)

Karen
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Hello Karen,
Thanks for your comments. I haven't had the soup before. I thought it might tempt Herbie but he wasn't keen. He has had a few small meals today, seems to lose interest after a few mouthfuls. But he has been very bright, playing in the garden this morning. So that's good.
I will have to get use to Shelley's fluctuations. It just throws me when it seemed I was getting a steady pattern!
 
Tuxedo Mom said:
I am not familiar with the Gourmet Soup but that could have been what caused that bit of a food spike at +6. This is all good information to have as to which foods raise glucose levels. It may be useful if you want to bring the numbers up a bit but not over carb her, or if you want to avoid certain foods when she is higher. One of my kitties is VERY carb sensitive and the other one is much less so. All good information for knowing how Shelley reacts. I will check back at +2 and see what her numbers are doing.
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That's very good of you, thank you!
 
Thanks Shelley did a pretty good drop from prehot to +2. Are you giving a bit of food after the testings? It might be a good idea to give her a nice snack at this point to slow down the drop a bit. Could you test again at +3 to make sure the drop is not going too fast. Her nadir is +4 to +5 so she still has more time to drop. This is not a worrisome number, but you don't want the drop to be too steep
 
Also do you have foods on hand sorted by carb content? Low carb, medium carb and high carb. Having a good cross section can be useful if you are trying to slow a drop or just keep her surfing.
 
Tuxedo Mom said:
Also do you have foods on hand sorted by carb content? Low carb, medium carb and high carb. Having a good cross section can be useful if you are trying to slow a drop or just keep her surfing.
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Not exactly but broadly. I probably need to be more specific about that.
 
Hello,
Last night at +4, Shelley's blood sugar was 22.1, hardly any change from when she was injected 1.0 u, when it was 21.7.
I am very careful when preparing and injecting the insulin and I wasn't aware of any problem.
Is this likely to be a bounce from her having to deal with too much insulin?
Some thing similar happend on 6.3.17 when at +2 the blood glucose had risen form 21.9 t0 25.0.
Thank you for reading, I would be grateful for any thoughts on this please?
 
Your SS shows that you had nice blues at a dose of 1.0 u. I see that you dropped the dose this AM because you started a new vial of insulin. That's always a safe move. If the numbers are high today and tonight, I'd try working up to 1.0 u again, maybe giving 0.75 u as an interim dose for 2 cycles or so.
 
Kris & Teasel said:
Your SS shows that you had nice blues at a dose of 1.0 u. I see that you dropped the dose this AM because you started a new vial of insulin. That's always a safe move. If the numbers are high today and tonight, I'd try working up to 1.0 u again, maybe giving 0.75 u as an interim dose for 2 cycles or so.
Click to expand...

Thank you, that sounds like a good plan. I am I right to think that I needn't worry about the occasional unexpected out of pattern high number?
JanetNJ said:
How old was the other vial?


Go back to 1 u.
Click to expand...
 
Anthony Morgan said:
Thank you, that sounds like a good plan. I am I right to think that I needn't worry about the occasional unexpected out of pattern high number?
Click to expand...
Hi, it was new on 30/1/17. They usually only last a month but ofcourse I didn't use any for a week or so after the hypo. When this occurred to me I ordered a new vial.
Thank you!
 
Anthony Morgan said:
Thank you, that sounds like a good plan. I am I right to think that I needn't worry about the occasional unexpected out of pattern high number?
Click to expand...
The only single numbers you should react to immediately are very low ones. Other than that, (over)reacting to individual numbers can lead to less than ideal dosing decisions. It's the trend in numbers over time that tells the story.

I see that Janet has suggested you go back to 1 u without an in between dose. That is certainly possible. My recommendation was based on your preference for caution.
 
Kris & Teasel said:
The only single numbers you should react to immediately are very low ones. Other than that, (over)reacting to individual numbers can lead to less than ideal dosing decisions. It's the trend in numbers over time that tells the story.

I see that Janet has suggested you go back to 1 u without an in between dose. That is certainly possible. My recommendation was based on your preference for caution.
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Thank you, I will have to decide looking at the pre-shot numbers but I certainly prefer to be cautious. Also, Shelley's blood glucose does sometimes fall quite quickly and I think I will have to speak to the Vet as to whether she would benefit from a change of insulin.
 
Anthony Morgan said:
Thank you, I will have to decide looking at the pre-shot numbers but I certainly prefer to be cautious. Also, Shelley's blood glucose does sometimes fall quite quickly and I think I will have to speak to the Vet as to whether she would benefit from a change of insulin.
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You may be right in thinking that a different insulin would work better for Shelley, Anthony... maybe keep trying with the Caninsulin for another week and if you're still getting these fluctuations ask the vet about a gentler option.
 
Diana&Tom said:
You may be right in thinking that a different insulin would work better for Shelley, Anthony... maybe keep trying with the Caninsulin for another week and if you're still getting these fluctuations ask the vet about a gentler option.
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Thank you Diana, I will do that. Kind regards!
 
I see you have got some good input from others. The only thing I would add is that it is important to get some tests between shots. Yesterday morning you did not show any in between tests so it is hard to tell how low Shelley went on that dose. If you look back at some of the other days you will see that the preshots were higher but she did hit some nice blues during the cycle.


ETA Shelley "seems" to have a nadir around +4 to +5 so having tests before and around these times will tell whether she is hitting lower numbers during the cycle.
 
Tuxedo Mom said:
I see you have got some good input from others. The only thing I would add is that it is important to get some tests between shots. Yesterday morning you did not show any in between tests so it is hard to tell how low Shelley went on that dose. If you look back at some of the other days you will see that the preshots were higher but she did hit some nice blues during the cycle.
ETA Shelley "seems" to have a nadir around +4 to +5 so having tests before and around these times will tell whether she is hitting lower numbers during the cycle.
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Hello Mary Ann,
Shelley was sleeping a lot yesterday and she had quite a few test the previous day, so I decided not to disturb her so much and only do a minimum. I know that is not ideal but just trying to get a balance as she is an elderly cat.
Thank you!
 
Anthony

I understand where you are coming from. Getting the preshot tests is so important to make sure the numbers are safe to shoot, but getting a nadir (lowest number) reading is also important, both to make sure the numbers are not dropping too fast or too low and to see how low a specific dose is taking Shelley. However if she hit low enough numbers it could even cause her preshot readings to be higher which you would not be aware of if you hadn't got mid cycle tests. If Shelley were to be at higher numbers at preshot and you didn't know if she had hit lower numbers during the cycle the natural inclination would be to increase the dose. Even trying to get at least one test around her nadir time...approximately +4 to +5 will let you know whether a certain dose is working well or if it needed to be increased or decreased for maximum effect. You are doing a great job and gathering all the data you have definitely gives a much better picture on how the insulin is working with Shelley. :bighug: :bighug:
 
Tuxedo Mom said:
Anthony

I understand where you are coming from. Getting the preshot tests is so important to make sure the numbers are safe to shoot, but getting a nadir (lowest number) reading is also important, both to make sure the numbers are not dropping too fast or too low and to see how low a specific dose is taking Shelley. However if she hit low enough numbers it could even cause her preshot readings to be higher which you would not be aware of if you hadn't got mid cycle tests. If Shelley were to be at higher numbers at preshot and you didn't know if she had hit lower numbers during the cycle the natural inclination would be to increase the dose. Even trying to get at least one test around her nadir time...approximately +4 to +5 will let you know whether a certain dose is working well or if it needed to be increased or decreased for maximum effect. You are doing a great job and gathering all the data you have definitely gives a much better picture on how the insulin is working with Shelley. :bighug: :bighug:
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Thank you, Mary Ann, I will keep trying! Kind regards!
 
You're doing really well with her Anthony. I'm not as cautious and would be back up to 1 unit whilst she is still in the purples at preshoot time. When she was on that dose her numbers were gradually dropping and got to nice blues in the middle.

Did you try and see if there is any correlation between food and high numbers? I only ask as Sky yesterday has shown a fantastic example of how food has a real impact on her numbers. Sky is always on Sheba fine flakes, gets nice consistent numbers most of the time. For lunch yesterday she had Appaws senior. Her evening PM shot showed a massive increase. I increased her dose by a small amount to bring her back and a day on Sheba and she is getting back down but it does show clearly that I have to stick to one food if I want to keep her low.

Maybe it is time to try a different insulin - beware though if you get Prozinc it is expensive so be sure on the Caninsulin first. The Prozinc was £90 for a vial - was supposed to last 3 months but as Sky didn't react well do it it was wasted money. Before you can go onto the other insulins you have to show you have used the "proper" animal insulins first. I could have switched to one of the others but gave the caninsulin another go.
 
I agree with Karen. The 0.50 unit dose is not moving the numbers much at all so it is just not enough to get Shelley into good numbers. I know you were being cautious with starting a new vial of insulin, but the numbers are barely moving on this dose.
 
I do sympathise, Anthony... you're on a new vial and you're very conscious of hypo, but I'm sure you'll agree that 0.5u isn't enough at the moment. So difficult. I don't have anything to add to what others have said but I do echo the comments about how well you're doing. Give yourself a big pat on the back! Keep going... you will get there.
 
BTW vetsulin lasts longer than a month when refrigerated. My vet said it's good for up to three months.
 
Sootyca said:
You're doing really well with her Anthony. I'm not as cautious and would be back up to 1 unit whilst she is still in the purples at preshoot time. When she was on that dose her numbers were gradually dropping and got to nice blues in the middle.

Did you try and see if there is any correlation between food and high numbers? I only ask as Sky yesterday has shown a fantastic example of how food has a real impact on her numbers. Sky is always on Sheba fine flakes, gets nice consistent numbers most of the time. For lunch yesterday she had Appaws senior. Her evening PM shot showed a massive increase. I increased her dose by a small amount to bring her back and a day on Sheba and she is getting back down but it does show clearly that I have to stick to one food if I want to keep her low.

Maybe it is time to try a different insulin - beware though if you get Prozinc it is expensive so be sure on the Caninsulin first. The Prozinc was £90 for a vial - was supposed to last 3 months but as Sky didn't react well do it it was wasted money. Before you can go onto the other insulins you have to show you have used the "proper" animal insulins first. I could have switched to one of the others but gave the caninsulin another go.
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Hello Karen,
Good to hear from you. I did intend to stick at 1u until that drop to 14.4 pmps on the 9th and then did get some blues on the 10th with 0.75. I probably am being too cautious and not necessarily helping Shelley.
I did try sticking with Felix for a few days but with changing doses didn't come to a conclusion. I tried the Sheba flakes but Shelley only ate the jelly. She seems to be able to eat pates best and they tend to be Gourmet. I did read somewhere that Gourmet Gold is the same as Fancy Feast. She has been eating mainly Gourmet, so I will try and see if there is a pattern.
I didn't know Prozinc was so much more expensive, switching may complicate things from what you say.

Thanks for your comments and encouragement. I will keep trying to get it right!
 
Tuxedo Mom said:
I agree with Karen. The 0.50 unit dose is not moving the numbers much at all so it is just not enough to get Shelley into good numbers. I know you were being cautious with starting a new vial of insulin, but the numbers are barely moving on this dose.
Click to expand...

Thank you for keeping an eye on things. I certainly need to increase to 0.75u at least.
 
Diana&Tom said:
I do sympathise, Anthony... you're on a new vial and you're very conscious of hypo, but I'm sure you'll agree that 0.5u isn't enough at the moment. So difficult. I don't have anything to add to what others have said but I do echo the comments about how well you're doing. Give yourself a big pat on the back! Keep going... you will get there.
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Thank you Diana, I appreciate that and yes I do agree. Thinking about tonight's shot shortly.
 
just out of being cautious I changed vials after 10 weeks instead of 12, but I could clearly see the numbers were pretty much the same with the new vial... so it's probably fine to even wait until 3 months as long as it's refrigerated.
 
Last nights 0.75u took Shelley as low as 4.4. Gave some Dreamies and food and her level rose to 9.3 after 20 minutes.
She had been eating before hand as well, so quite worrying.
 
Hmm that is quite a big drop, although the 4.4 is actually a nice number, just scary I know when you're used to so much higher ones. It is looking as if Shelley somehow uses insulin in an unpredictable way... I'd say you're not far off the time now when it would be worth showing your vet your spreadsheet and asking if another insulin might be in order... it does seem difficult to determine a dose or doses that follow the pattern you'd expect on Caninsulin. It is a tricky call though, when there are various factors to take into account - the different foods she eats being perhaps the main one, and the cost of other insulins which are dearer (not that that's insurmountable when it comes to our kitties!)

This whole issue of unpredictability is probably why Shelley hypo'd in February - the dose at the time was consistent, I think (?) and maybe she did have a little bit of build-up in her system.

It may be that if you hadn't given her Dreamies she would have stayed in the greens a while longer and ended up at pre-shot this morning slightly lower than her usual... that's the situation we're aiming for but it is certainly easier said than done. See what others say, and perhaps consider callling the vet to ask if you can email a link to your ss and ask his opinion.. I know he's not the most experienced in FD but this is just the sort of thing he should be able to address if he wants to become more knowledgeable in his profession, so he might take it upon himself to do some research.

Sorry I can't actually say anything useful but I do sympathise and I do wish you the best of luck!
 
That was a big drop, but still in the safe zone although with the recent hypo I am sure it was a scary drop for you. There is a good chance that the numbers will be higher for the next preshot because of the big drop.

It is hard to say whether changing insulins is the best approach. Even on the long lasting insulins some kitties are prone to having big spreads between the nadir and the preshot.

I am going to tag a couple of people and see if they can offer some more insights.

@Kris & Teasel @JanetNJ @Squalliesmom
 
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