I guess what I am asking is how much accourding to bg numbers is the proper dose. If the bg is 250 what is the dose equal to? or if the bg is 400 what is the proper dose equal to? 2 units? more? what is the 5 - 6 mmol/L range in units? Maybe US mg conversion please. Here is one of my problems. I will make a spread sheet but when i do i need to know how to adjust the units. I understand by .25 up or down I just am not sure which way is up or down. Meaning if he is losing weight, still urinating alot, and always excessily hunger ( even being fed small meals as you recommended) but his BG is at 300-344 and he is getting 2units every 12 hours as prescribed, would i stay at 2units or increase it by .25 unit at that time? Im sorry to ask so many questions. Im probably explaining by myself the right way. Im not sure how other to word it. Im really bad at understanding numbers.
Thank you for your patience it is much appreciated.
I'm glad you're asking questions. I'll keep answering and try to be as clear as I can.
how much accourding to bg numbers is the proper dose. If the bg is 250 what is the dose equal to?
This is the reverse of the way we think about it. When kitty has BG numbers high enough to qualify as a diabetic - regardless of what those numbers are - we set a treatment dose to see what effect it will have. Most of us will use 1 unit twice a day to start with. Whether the BG is 250 (14) or 450 (25) we give that 1 unit dose and then track its effect by testing BG at key times. We keep that same dose AM and PM for 3 to 4 days or longer, test BG at key times and then look over the test data to assess how well that dose has been working. We DON'T change the dose because the BG is higher or lower. It's the pattern in 3 to 4 days' worth of data that tells us whether that dose of 1 unit twice a day needs to go up to 1.25 u or down to 0.75 u. The
most important data in deciding is how low that initial dose of 1 u caused the BG to drop within those 3 to 4 days of trying it.
what is the 5 - 6 mmol/L range in units? Maybe US mg conversion please. Here is one of my problems. I will make a spread sheet but when i do i need to know how to adjust the units.
If you mean what dose would you give if the BG before insulin is 5 or 6 (90 to 110) - you
would not give any insulin if this is the BG test result you get in the AM or PM pre shot tests.
I can summarize it as follows:
- start by choosing a reasonable dose (we would suggest 1 u twice a day but your vet has prescribed 2 u twice a day)
- test BG AM and PM (no food for two hours before) when it's time for a meal and then a shot. If BG is high enough for insulin (above 200 on a human meter or 250 on a pet meter) it does not matter if BG is in the 200s or the 400s (for example), give the planned dose .
- continue testing at important times over the next 3 or 4 days. Those times are before meals and at least once 4 to 6 hours after the shot. At least one test before bed is a good idea too. Do not change the dose, regardless of what the BG is in any of those tests UNLESS it drops too low (below 50 on a human meter or 68 on a pet meter).
I will make a spread sheet but when i do i need to know how to adjust the units.
All you have to do with the spreadsheet once you have one set up is enter the dose you gave AM and PM and any BG test results you have for the day - AM and PM before feeding, other times in the day. The spreadsheet we use will automatically colour code the BG numbers so that when we look at them before offering you our advice we assess the colour patterns over several days and decide if the dose is too low, working well or too high.
- WORKING WELL - pre shot BG might be high but it drops to some number in the 90 to 110 range in the middle part of the cycle (the 12 hours between shots). You would stay at this dose for now.
- TOO LOW - pre shot BG is under 200 on a human meter or 250 on a pet meter AND/OR the BG drops below 90 - 110 in the middle of the cycle. If pre shot BG is too low or the middle time BGs are too low a dose reduction of 0.25 u might be needed. Some knowledge is needed to make these decisions. Ask here for help.
- TOO HIGH - the pre shot BGs as well as the middle BGs stay in the 200s or higher over the 3 or 4 days you're trying that dose. A dose increase of 0.25 u would be tried to see if it can get the middle numbers down to the 90 - 110 range.
If you try different doses every time you test and get a certain BG number it will be extremely complicated, if not impossible, to "read" your kitty's patterns. The action of Vetsulin is such that a graph of BG over the 12 hours would look like a deep bowl-shape. The pre shot BGs will be high. It's related to the insulin's action and also depends on how your own kitty responds. Your goal is to get the BG down to a good range for as many hours in the 12 hour cycle as you can manage. Changing dose frequently will lead to very erratic BGs with lots of ups and down, some extreme.
This is taken directly from the Vetsulin user's guide in the yellow information sticky at the top of this forum's list:
STARTING DOSE - CANINSULIN (VETSULIN)
- Usually it’s best to start with a low dose of not more than one unit, twice a day.
- For those new to dealing with feline diabetes we recommend that no insulin is given if the BG is below 200 mg/dL [11 mmol/L] on a human glucose meter. (For more information on what these numbers mean see ‘Home Blood Glucose Testing’ information below.)
- If you’re using a pet meter, such as Alphatrak 2, be aware that these usually give slightly higher readings than human meters, so you may wish to have a slightly higher ‘no shot number’. Note: There is no general formula for converting human meter numbers into pet meter numbers (or vice versa). You are therefore encouraged to perform your own side-by-side comparisons with a human glucose meter, and/or to consult your vet for information about the specifics of your particular meter.
- If, after a week, and having reviewed your cat’s BG levels, the dose doesn’t seem sufficient, dose increases can be made in small increments of 0.25 or 0.5 of a unit. (If you use a VetPen the smallest increment that can be measured is 0.5 of a unit.)
- If you have reason to be concerned about hypoglycemia, or if your cat won't eat, decrease the dose immediately and contact your vet.
- Never inject insulin twice! Sometimes we may not be sure if we’ve given an insulin shot correctly. Perhaps we notice that the fur seems wet where we’ve injected (a 'fur shot'). If this happens, never repeat the shot/ injection. You may give too much insulin and your cat’s BG may drop too low.
- A note on measuring very small insulin doses. If you are having trouble measuring a small insulin dose in a U40 syringe, you may find it easier to use U100 syringes along with a special conversion chart that explains how to measure the correct dose. Before attempting this it is vital that you understand how the conversion works, otherwise you could give your cat the wrong dose of insulin. Don’t attempt this without first getting advice on the forum.
UNDERSTANDING 'ONSET', PEAK / NADIR and DURATION'
- Caninsulin (Vetsulin) can quite often start to have an effect quite quickly after it’s been injected. The point at which the insulin starts to drop the BG is called onset. After onset, BG will continue to drop for a time, and the process may speed up. Be aware that Caninsulin (Vetsulin) can sometimes drop the BG quite fast.
- The lowest BG level of the cycle is referred to either as peak (peak insulin activity) or nadir (lowest BG). With Caninsulin (Vetsulin) you may see the peak/nadir of the cycle at around 4 - 4.5 hours after the shot. But it may be earlier or later than this. It may occur as early as 3 hours after the shot, and as late as 7 hours after.
- The length of time that insulin remains active (lowers BG) in your cat’s system is called the duration. Caninsulin (Vetsulin) typically has a duration of 8 - 12 hours (depending on the individual cat).
- If you learn to ‘home test’ you should be able to identify when onset, peak /nadir, and duration typically occur on a given dose of insulin. Knowing these patterns can be extremely helpful.
