? New member on very high starting dose of Vetsulin need watching

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Unfortuntely she is not on right now and her posts on the other thread were:

"I am using vetsulin . I have not given it yet I tested his bd st 1530 today and it was 61. I fed him 3oz of fancy feast wet low carb . I will recheck at 2330."

"He was given 5 units at the vets this morning it is his second day on insulin"

"I am so freaked out about him being diabetic . I gave another day and I fed him the same today threw the dry good away and feed chicken thighs but up for in between the am and pm meals"

So I am really lost for where in the cycle her kitty is, At least it sounds like she is home testing, but a 5 UNIT STARTING DOSE :eek: And with a diet change that could drive the numbers down much more.
 
Yeah, I put a post in that other thread; I agree, this is a pretty terrifying situation. The worst is not knowing what is going on-- I hope she comes back on, and if not, that her kitty stays safe tonight. :(
 
I have been seeing that 5U starting dose a lot lately. I don't understand why vets are suggesting such a high starting dose - 5U is extremely high!
 
Squalliesmom said:
Does anybody know if maybe she is on the FB FDMB group?
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I haven't seen any posts about someone just starting Vetsulin and it is hard to know what her FB name would be, but I will keep checking on FB. I am worried about that 5 unit dose and want to make sure she does not shoot again before getting more information from here and doing some heavy duty testing.
 
I checked 5 other FD groups on FB and can't see anyone that would fit into the description that Carolee posted. Hope she comes back soon. :nailbiting:
 
That's really scary :nailbiting:. Isn't Vetsulin one of the more fasting hitting insulins? And that after the 61 reading she couldn't retest for 8 hours.
 
Hi this is Carolee I did not give my cat any more insulin tonite . I did feed him 3ounces of fancy feast and I am rechecking his sugar at midnite.his schedule is 12noon And 12midmite
 
Carolee said:
Should I give him insulin ?
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As you've read several times, we think the 5 unit dose is far too high. I'm going to be the person to go out on a limb and suggest that you give only 1 unit of Vetsulin tonight. Test him again two hours after the dose to see what's happening.

Here's the sequence:
  1. test BG
  2. feed
  3. wait 30 minutes
  4. give insulin.
There must be food on board because Vetsulin hits hard and fast.
 
Carolee said:
So the 4units is to high I am going by the sliding scale?
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A sliding scale is one where the insulin dose AM and PM might change in response to the BG level. You're not there yet in your kitty's treatment. You're in the early stage of trying to figure out the approximate dose range that will be effective. Unfortunately, you've been thrown in at the deep end with the prescribed dose of 5 units BID. That's dangerously high. The Vetsulin manufacturer recommends a starting dose of 1 to 2 units BID per cat.

Please read the sequence I gave for testing, feeding and injecting.
 
Carolee said:
So fed him first then give 1Unit and retest in two hours
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Yes. This might well be too low a dose but it's likely a safe dose. The retest in two hours is to see if the Vetsulin is starting to kick in and, if so, how strongly. You said his BG was 380. That's high but not outlandish. If at 2 hours it's down a lot (100 points maybe) that's a sign that he might be heading lower than you'd like. The low BG point (called the "nadir") for Vetsulin usually happens around 4 to 6 hours after the injection. It wears off in 8 to 10 hours in many cats which is why the BG can be quite high just before the next dose is due.
 
http://www.vetsulin.com/vet/Cats_DosingOverview.aspx

The link above is to the Vetsulin manufacturer's info page on dosing in cats. Over time you'll have to learn more about this insulin's characteristics and how your kitty responds uniquely to it. Testing at home and gathering data on the spreadsheet we use here is a great way to build up a reference for dosing decisions down the line.

This is what we recommend in the early days:
  • start at 1 unit twice a day, dosed 12 hours apart
  • gather BG test data (just before each shot and near the middle of a cycle) to see how kitty responds to this starting dose for 3 or 4 days
  • if BG stays high, especially at nadir, raise the dose by 0.25 unit (eyeball on the syringe barrel)
  • continue that dose for 3 or 4 days and assess BG data to see if dose should be raised another 0.25 u.
This is how the good dose is found. Increasing by small fractions means you're not likely to pass by the good dose.
 
Here's the BG testing routine we recommend:
  1. test BG AM and PM before feeding and giving insulin (no food for at least 2 hours before these tests) to see if the planned dose is too high
  2. at least one other test near the middle part of a cycle (the 12 hours between doses) to see how low the dose takes him
  3. a test before your bedtime if you can't test mid day
  4. extra tests scattered through the cycle on weekends or days off.
 
Here's another tool you need in your diabetes kit - urine ketone test strips. You can buy them at any human pharmacy. The brand I use is Bayer Keto-Diastix but there are others. When a kitty is in high BG numbers, urine ketone testing is a good idea. Here are some ways to do it:
  1. put the testing end of the strip right in the urine stream when he's in the litter box OR
  2. put a shallow long handled spoon under his backside as he pees OR
  3. cover his favourite part of the litter box with a few layers of plastic food wrap and push little depressions into it to catch urine.
 
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I have to sign off now - long past my bed time. Your kitty should be OK for tonight on this low dose. Take some time to read the info stickies on the Caninsulin/Vetsulin forum and go over the other stuff I've posted to familiarize yourself with what you need to do going forward.
 
Carolee

I'm glad to see that Kris was here and able to give you some good information on Vetsulin.

This link:

http://www.caninsulin.ca/faq-answers-p.asp

has a lot of information on Vetsulin also called Caninsulin in countries outside of the US. If you read through you will see important points. This link is from the Canadian site but just remember that Caninsulin IS Vetsulin with a different name.

"
How does Caninsulin work in cats?

A lente (intermediate-acting) form of insulin, Caninsulin contains approximately 30 percent amorphous insulin for rapid onset of activity. The remaining approximately 70 percent of the formula is crystalline insulin which is absorbed more slowly. This formulation allows for a more continuous utilization of glucose to support the body's basic functions. In cats, the peak activity following subcutaneous administration of Caninsulin occurs between 1.5 and 8 hours (with an average of about 4 hours), and a duration of activity varies between 8 and 12 hours. Caninsulin should be administered subcutaneously twice a day in diabetic cats."

"In cats, the initial recommended dose is 1 to 2 IU per injection, and the injections should be given twice-daily (BID) at 12-hour intervals. Initial dosing is based on a per animal basis. The duration of activity of Caninsulin in the cat is between 8 to 12 hours – this is shorter than in the dog. Peak activity level occurs between 1.5 to 8 (average of about 4) hours in the cat."

When first starting any sort of insulin it is suggested to hold the initial dose for 5-7 days..unless the numbers drop too low...in order for the body to become acclimatized to using external insulin. Dose increases should only be done once adequate data (testing) has been done to see how your kitty is responding to a specific dose. Using a sliding scale with Vetsulin/Caninsulin is a more advanced approach and should only be done once there has been adequate data to show how your kitty responds.

Because Vetsulin has a faster onset time testing in the earlier hours after the shot is a good approach in order to catch any fast or low drops in the glucose levels. When a kitty drops too fast or too much the body produces counter-regulatory hormones which cause stored glucose to be released into the blood stream, since the body "thinks" that this is an emergency situation. When this happens the glucose levels can be elevated for up to 3 days, something referred to as "bouncing" This does not mean that more insulin is required since this will simply cause more bouncing. Recording regular glucose readings over the first week of treatment will show if there are any large ups or downs in the levels and make it easier to determine what dose changes are needed.

Also from your earlier post it appears that you are removing dry food from the diet. Dry food is high in carbs and once it is removed from the diet and out of your kitty's system ( which can take a few days) glucose numbers can drop sometimes quite a bit, depending on the kitty.

The one thing that this forum is always concerned with is keeping any kitty safe.

Please do continue testing and asking for advice. The people on here live and breathe feline diabetes daily and have lots of personal experience and understanding in treating feline diabetes. Not to be unkind, but if your vet gave a starting dose of 5 units, then they do not have a good understanding of how insulin for kitties should be approached. A serious hypo event that is not treated properly can cause neurological damage and even possibly death.
 
Hi Carolee,

How is your kitty this AM? How are you? That was a stressful evening but you got through it. I said that the 1 unit dose might be too low but it was at least a safe dose. Your kitty has only been on insulin a couple of days so your task right now is to read all about the insulin, set up a BG testing routine like I outlined in post #29 above and (hopefully) organize a spreadsheet like we use here. If you need help with the spreadsheet there are techie people here to do it for you.
http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

If you're off today and can manage it, testing every three hours or so between the 1 unit doses will give a much better picture of what you need to do next dose-wise.
 
So glad you stepped in last night, Kris! Lots of good information from you and Tuxedo Mom about Vetsulin here.

Quick question: was Clarance at the vet's for ketones or diabetic ketoacidosis (DKA)? Kris mentioned doing at-home testing for ketones-- it's important for any diabetic cat but especially one with any history of ketones. Also, if he does have a ketone/DKA history, that will change some of the advice we give, so it's important for us to know about that (or any other major health condition that needs to be managed simultaneously with the diabetes).

I do want to highlight one more thing that Tuxedo Mom mentioned: when a cat that has been diabetic for a while first starts to see low numbers again on insulin, often the body reacts to try to get the BG back up to where the cat has gotten used to being. We call this "bouncing", and I'm mentioning it because, while we don't have enough information to really know yet what is going on with Clarance, I think it's very likely that the high numbers you saw last night were (at least in part) a reaction to the 61 you got yesterday afternoon. You may also see some more high numbers this morning that are still part of the reaction to the 5U dose. Don't be alarmed-- it's perfectly normal.

It's also genuinely very confusing, especially at first, but don't worry, we can help you figure things out and get to the right dose to get Clarance feeling better. I just wanted to highlight the bouncing phenomenon for two reasons: 1) you are likely to see it, best to be prepared!, and 2) it illustrates why it's so tricky to dose on a sliding scale in the beginning-- the high number you see doesn't always mean more insulin is needed, sometimes it means less is needed! :confused:
 
So my cat bs this morning was 384 I did not give insulin because it not until 1230 I did give some wet food not much will test again at noon
 
Carolee said:
So my cat bs this morning was 384 I did not give insulin because it not until 1230 I did give some wet food not much will test again at noon
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That is not a bad reading for 9 hours after last night's shot. It is still high, but it does take some time for the body to adjust to having "outside" insulin. '

A few things that will make it much easier for members to offer information/advice. Since we are all in different times zones the timing for shots and tests is referred to as AMPS (morning preshot test) and PMPS (evening preshot test) The readings in between shots are referred to as "+" numbers. For example the 384 reading you just got was 9 hours after the shot so it would be "+9".

Also a valuable tool is setting up a spreadsheet to record all preshot tests and readings done between shots. This link:

http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

has directions on how to set one up. If you have trouble with the directions just ask and there are some people on here who are "spreadsheet gurus" and can help you get one set up. I had to have help when I first started...not too techie savy :)

Please do post with the preshot number when you get one. If it is possible and you are home today, it would be good to schedule some tests for +2, +4 and +6 hours after the shot to give a better picture how the Vetsulin is working,

It is rather overwhelming in the beginning but there are lots of people here to help you on this treatment journey. :bighug:


ETA Also putting information into your "signature" gives a snapshot of information that is important for anyone giving advice to know. This link has information on setting upyour signature:

http://www.felinediabetes.com/FDMB/threads/editing-your-signature-profile-and-preferences.130340/
 
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Sounds like a plan!

Can you say more about how the vet arrived at the 5U dosage? How long was Clarance at the vet being evaluated, and what did they do?
 
Nan & Amber said:
Sounds like a plan!

Can you say more about how the vet arrived at the 5U dosage? How long was Clarance at the vet being evaluated, and what did they do?
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He was there all day and nite on Thursday he did a curve of bs and started him out on 5 units
 
Carolee said:
Friday at 0800 am he was given 5inits and when I checked him at 1530!hebwas 61
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So the reading at the vets was 61 after 7 1/2 hours. This means the numbers could have been even lower earlier in the cycle (time between shots). Vetsulin "usually has a nadir ( lowest number) around +4-+6 hours after the shot. A drop into lower numbers and maybe even much lower numbers (hard to say without tests done earlier than the vet did) could very well have caused "bouncing" into higher numbers as I talked about in an earlier post. This could cause the numbers to stay higher for up to 3 days. I am very glad you decided to start with the 1 unit and monitor the readings.
 
So I feed him and rechecked at 2330'amd he was 380and then I feed him waitedhor gave 1 unit and I rechecked him at 2:30 am he was 400
 
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