Dose opinions welcome
- Thread starter JanetNJ
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Badtux
Member Since 2017
I don't think you're going to get good control with Vetsulin at this point. It looks like Vetsulin is just too fast-acting for your cat at her current stage. You might consider switching to Prozinc, which is slower acting and might be better suited for keeping her blood sugar under control without those disastrous dips that had you take her to the ER.
Critter Mom
Member Since 2014
Hi Janet,
Can't really offer anything concrete at the moment so I'm just chucking out ideas here:
1. Sometimes cats who have fallen out of their first remission may need treatment with a different insulin from the one used first time around in order to achieve a second remission.
2. Maybe even the small doses of Vetsulin are too much/too harsh and causing bouncing/protective rebounds? Some thoughts:
- 13 January - Drop from AMBG of 155 down to AM+7 of 72 with no insulin at for that cycle or for several cycles prior to that. (Pancreas is doing something.)
- 18 January - AM dose of 0.25 IU gave a better drop at +2 than the PM dose of 0.4IU.
- General trend: Early onset and significant drop by +2 can possibly be a sign that less Vetsulin is needed - OR - an insulin with a gentler action profile might suit better.
- 'Upside down' curves like today's AM cycle can sometimes be a sign that too much insulin is being given.
I'd like to grab numbers from later in the cycles to see if BG is going lower in the latter half.
3. Check for infections, etc. - e.g. PMBG on 17 January was high after no insulin at all for several cycles, plus general upward trend (hard to get any 'feel' for trends because of variations in dose/skipped doses).
4. Check for possible sources of contraband (e.g. new neighbour offering treats)?
I'm assuming based on your signature that you're still using an Alphatrak meter. So many of CC's recent readings have been within the normal range, albeit at the upper end. If you can't find any underlying cause that's producing a general upward drift in BG levels I'd suggest considering a switch to Levemir or Lantus. They typically tend to produce flatter curves than Vetsulin and are typically much safer insulins to use when aiming for tighter regulation/remission (easier to keep cat in a safe range when only microdoses are needed/possible).
My two penn'orth.
Mogs
.
Can't really offer anything concrete at the moment so I'm just chucking out ideas here:
1. Sometimes cats who have fallen out of their first remission may need treatment with a different insulin from the one used first time around in order to achieve a second remission.
2. Maybe even the small doses of Vetsulin are too much/too harsh and causing bouncing/protective rebounds? Some thoughts:
- 13 January - Drop from AMBG of 155 down to AM+7 of 72 with no insulin at for that cycle or for several cycles prior to that. (Pancreas is doing something.)
- 18 January - AM dose of 0.25 IU gave a better drop at +2 than the PM dose of 0.4IU.
- General trend: Early onset and significant drop by +2 can possibly be a sign that less Vetsulin is needed - OR - an insulin with a gentler action profile might suit better.
- 'Upside down' curves like today's AM cycle can sometimes be a sign that too much insulin is being given.
I'd like to grab numbers from later in the cycles to see if BG is going lower in the latter half.
3. Check for infections, etc. - e.g. PMBG on 17 January was high after no insulin at all for several cycles, plus general upward trend (hard to get any 'feel' for trends because of variations in dose/skipped doses).
4. Check for possible sources of contraband (e.g. new neighbour offering treats)?
I'm assuming based on your signature that you're still using an Alphatrak meter. So many of CC's recent readings have been within the normal range, albeit at the upper end. If you can't find any underlying cause that's producing a general upward drift in BG levels I'd suggest considering a switch to Levemir or Lantus. They typically tend to produce flatter curves than Vetsulin and are typically much safer insulins to use when aiming for tighter regulation/remission (easier to keep cat in a safe range when only microdoses are needed/possible).
My two penn'orth.
Mogs
.
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Critter Mom
Member Since 2014
PS:
Switching to an 'L' insulin might enable you to keep CC on insulin for a longer period, retrain her little body to feel comfortable in the lower part of the normal range and perhaps give her a better chance of achieving a strong second remission.
Mogs
.
Switching to an 'L' insulin might enable you to keep CC on insulin for a longer period, retrain her little body to feel comfortable in the lower part of the normal range and perhaps give her a better chance of achieving a strong second remission.
Mogs
.
Nan & Amber (GA)
Member Since 2016
I agree, I think this is one of the big advantages of the 'L' insulins in a case like this. They're really good at keeping a cat chugging along in pancreas-healing green numbers for a long time if necessary. It seems harder to acheive that with vetsulin, where, once the pre-shot numbers start getting low, it's tough to manage even with tiny doses. First time around, CC essentially just went straight to remission at that point
, but she may need a bit more support this time.
Critter Mom
Member Since 2014
@Nan & Amber -
I would never attempt to tightly regulate a cat with Caninsulin/Vetsulin; it's not an appropriate tool for the job.
Mogs
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I would never attempt to tightly regulate a cat with Caninsulin/Vetsulin; it's not an appropriate tool for the job.
Mogs
.
Critter Mom
Member Since 2014
This.
Been thinking more about CC. Another possible cause of an upward trend might be where a cat has recovered some beta cell function but the recovery is still quite 'fragile'. After insulin treatment is suspended the cat may hold in good numbers for a little while but then the strain of running without that little bit of support from exogenous insulin gets too much for the pancreas and numbers start drifting upwards again (hence the two-week wait before a cat can be officially classed as a feline diabetic in remission).
Some studies put the beta cell damage threshold at 7.8mmol/L (pet-calibrated equipment). I have seen another study which proposed an even lower level (was using another computer at the time and can't find the study now
). If this hypothesis is true then maintaining a cat for a sufficiently long period in the lower end of the normal BG range creates the optimum conditions to allow healing of damaged beta cells and, based on the huge volume of anecdotal evidence we see here on this board, this seems to hold true in the real world.I can imagine you're feeling very frustrated, Janet. CC has been sooooooo close ... (anti-jinx!)
Mogs
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JanetNJ
Member Since 2016
This has precisely been my thinking with what's happening. I think this past week her pancreas was trying trying trying and just kinda ran out of steam the last few days. I did want to start a small dose A few days earlier to give her even a tiny bit of insulin support, but my partner was even more trigger shy then I was and was adiment she was not ok with shooting under 200 just yet. Understandably so... I get it, and so I obliged her opinion. Again if we were home during the day we may have done a few drops. I will go back to the lower dose of 0.25 over the next few days and see if that little bit of support helps her come back down.This.
Been thinking more about CC. Another possible cause of an upward trend might be where a cat has recovered some beta cell function but the recovery is still quite 'fragile'. After insulin treatment is suspended the cat may hold in good numbers for a little while but then the strain of running without that little bit of support from exogenous insulin gets too much for the pancrease and numbers start drifting upwards again (hence the two-week wait before a cat can be officially classed as a feline diabetic in remission).
Some studies put the beta cell damage threshold at 7.8mmol/L (pet-calibrated equipment). I have seen another study which proposed an even lower level (was using another computer at the time and can't find the study now
I can imagine you're feeling very frustrated, Janet. CC has been sooooooo close ... (anti-jinx!)
Mogs
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I really feel like she will get there. It's just going to take a lot of patience.
In the meantime she's happy and purring and that's what really matters.
Another difference this time as opposed to a year and a half ago is her arthritis has progressed quite a bit in that time. Last year she would run and chase things. She still plays but mostly will lay down to swat at stuff. She's on adequan and it has helped a lot.... She's limping a lot less and grooming better, So I'm working on trying to get her back on her feet to play as I feel it will really help her numbers.
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Critter Mom
Member Since 2014
That won't be helping. Poor thing. ((CC)) I'm glad to hear the Adequan is helping her.
Mogs
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Critter Mom
Member Since 2014
Critter Mom
Member Since 2014
If it was me, I'd try the 0.25 and hold it for a few cycles (assuming no hypos or crazy high numbers) to try to get a handle on what CC's pancreas might be up to. (I'd also try to test daily for urine ketones, purely as as a precautionary measure.)
Mogs
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Mogs
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JanetNJ
Member Since 2016
Yeah that's what we are thinking. Always good to get a second or third opinion
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