New to the forum, Vetsulin dosing advice

[bloodbellschime]

Hi there. A moderator is going to be helping me fix my spreadsheet, it is not color coded at the moment, but I have it in my signature. I use a ReliOn Prime meter. Gary has been displaying numbers below 200 fairly regularly lately so I have skipped several doses. Last night he was a bit higher (183) so I gave him his normal dose with 3u of Vetsulin, Gary went down to 44 which I know is too low. I realize I should not have given him such a high dose, or maybe any dose. I brought him back up during the night, to 94, with food over the course of a few hours. This morning pre-food he was 325. Unsure of how much to give, and since I had to leave for work so could not monitor him, I did not give him a dose this morning. So, his last dose was 3u last night after dinner.

Just now, before dinner, still with no dose, he was at 251. He is eating dinner now. I have not given him any dose yet, because I would like advice on how much Vetsulin to give. Thank you!

 

[Marje and Gracie]

Hi there. A moderator is going to be helping me fix my spreadsheet, it is not color coded at the moment, but I have it in my signature. I use a ReliOn Prime meter. Gary has been displaying numbers below 200 fairly regularly lately so I have skipped several doses. Last night he was a bit higher (183) so I gave him his normal dose with 3u of Vetsulin, Gary went down to 44 which I know is too low. I realize I should not have given him such a high dose, or maybe any dose. I brought him back up during the night, to 94, with food over the course of a few hours. This morning pre-food he was 325. Unsure of how much to give, and since I had to leave for work so could not monitor him, I did not give him a dose this morning. So, his last dose was 3u last night after dinner.

Just now, before dinner, still with no dose, he was at 251. He is eating dinner now. I have not given him any dose yet, because I would like advice on how much Vetsulin to give. Thank you!

While I get the SS fixed for you, I would suggest you give him 1u of insulin. You’ve been bouncing around on the dose too much even with Vetsulin. Yes, it has more flexibility than the longer duration insulins like Lantus or Levemir but you still want to be relatively consistent. Because 3u dropped him too low and we need to be able to see what a consistent dose will do for him, let’s try 1u for a few cycles. Please be sure you get a +1 and +2 test after you give the insulin (and you did say you fed already which is really important with Vetsulin; he must eat before you shoot).

 

[bloodbellschime]

Okay, thank you so much for your help! I will give him his 1u in just a few moments.

 

[Marje and Gracie]

Okay, thank you so much for your help! I will give him his 1u in just a few moments.

Can you be there to test him? If not, I would be cautious about giving any insulin. He’s bouncing off the low numbers. I’ll be back to explain that in a minute but I want you to see this.

 

[bloodbellschime]

Can you be there to test him? If not, I would be cautious about giving any insulin. He’s bouncing off the low numbers. I’ll be back to explain that in a minute but I want you to see this.

Yes, I will be testing him in 1 hour and after 2 hours. If I need to stay home after that, I will.

 

[Marje and Gracie]

Yes, I will be testing him in 1 hour and after 2 hours. If I need to stay home after that, I will.

Yes, you might very well need to do so.

Here’s what I want to explain now that you’ve answered the question. Gary’s liver got used to some high numbers and so now, when he gets insulin and his numbers come down, his body reacts by trying to bring the BG back up to what has become the “new normal” which is higher numbers. It does this by releasing counterregulatory hormones and glucagon driving the BG up. This is called “bouncing”. Almost all diabetic cats do it at first and it is totally normal. Gary’s BG looks like a roller coaster because the 3u is way too much for him so he drops, bounces up, clears the bounce and drops. We need to get that stopped.

It’s possible Gary needs very little, if any insulin, but I read on your Welcome post that he had an episode of diabetic ketoacidosis. If this is correct, please be sure and put it in your signature block because with post-DKA cats, you want to avoid skipping shots as they are prone to developing DKA again if they don’t get the right amount of insulin.

We need your help in figuring out what is the right amount for Gary. In order for us to do that, we need you to please be sure and test every single time before you give him any insulin. Please do not shoot blind or you risk causing hypoglycemia. It’s also important to try and get a couple tests every single cycle. If you work, if you can get a test before you leave for work and one when you get home, that helps (these are in addition to the preshot tests). At night, a +2 or +3 and a before bed test will help.

Possible?

 

[bloodbellschime]

Yes, you might very well need to do so.

Here’s what I want to explain now that you’ve answered the question. Gary’s liver got used to some high numbers and so now, when he gets insulin and his numbers come down, his body reacts by trying to bring the BG back up to what has become the “new normal” which is higher numbers. It does this by releasing counterregulatory hormones and glucagon driving the BG up. This is called “bouncing”. Almost all diabetic cats do it at first and it is totally normal. Gary’s BG looks like a roller coaster because the 3u is way too much for him so he drops, bounces up, clears the bounce and drops. We need to get that stopped.

It’s possible Gary needs very little, if any insulin, but I read on your Welcome post that he had an episode of diabetic ketoacidosis. If this is correct, please be sure and put it in your signature block because with post-DKA cats, you want to avoid skipping shots as they are prone to developing DKA again if they don’t get the right amount of insulin.

We need your help in figuring out what is the right amount for Gary. In order for us to do that, we need you to please be sure and test every single time before you give him any insulin. Please do not shoot blind or you risk causing hypoglycemia. It’s also important to try and get a couple tests every single cycle. If you work, if you can get a test before you leave for work and one when you get home, that helps (these are in addition to the preshot tests). At night, a +2 or +3 and a before bed test will help.

Possible?

Yes, my plan is to test him as much as possible and ALWAYS before a dose.

I did not think he had ketoacidosis... but reading the symptoms, I think that is what he had when I initially took him to the vet where he got diagnosed. Drinking and peeing a ton, lethargic, he smelled overly sweet at times. I did not realize that is ketoacidosis, but before he got on insulin that is what he was dealing with. I noticed today with his higher numbers, he was drinking more water again. This information from you is so incredibly helpful. My vet did not mention ANY of this (I am sure you hear that a lot).

 

[bloodbellschime]

Yes, you might very well need to do so.

Here’s what I want to explain now that you’ve answered the question. Gary’s liver got used to some high numbers and so now, when he gets insulin and his numbers come down, his body reacts by trying to bring the BG back up to what has become the “new normal” which is higher numbers. It does this by releasing counterregulatory hormones and glucagon driving the BG up. This is called “bouncing”. Almost all diabetic cats do it at first and it is totally normal. Gary’s BG looks like a roller coaster because the 3u is way too much for him so he drops, bounces up, clears the bounce and drops. We need to get that stopped.

It’s possible Gary needs very little, if any insulin, but I read on your Welcome post that he had an episode of diabetic ketoacidosis. If this is correct, please be sure and put it in your signature block because with post-DKA cats, you want to avoid skipping shots as they are prone to developing DKA again if they don’t get the right amount of insulin.

We need your help in figuring out what is the right amount for Gary. In order for us to do that, we need you to please be sure and test every single time before you give him any insulin. Please do not shoot blind or you risk causing hypoglycemia. It’s also important to try and get a couple tests every single cycle. If you work, if you can get a test before you leave for work and one when you get home, that helps (these are in addition to the preshot tests). At night, a +2 or +3 and a before bed test will help.

Possible?

After 1u and 1 hour, he is at 138. He is drinking thirstily again. I will test again in 1 hour.

 

[Marje and Gracie]

After 1u and 1 hour, he is at 138. He is drinking thirstily again. I will test again in 1 hour.

You should give him some medium carb food to slow him down and so you aren’t up all night with him. That’s too fast of a drop. I’d feed him and retest in 30 mins after he eats. That way we can try and stop the drops.

Looks like we might need to back the dose down a bit more. Let’s see how he does.

 

[bloodbellschime]

Eek, okay. I have friskies pate, some purina dry food, and I have temptations treats.. sorry, I am new at this. Will any of these work?

 

[bloodbellschime]

You should give him some medium carb food to slow him down and so you aren’t up all night with him. That’s too fast of a drop. I’d feed him and retest in 30 mins after he eats. That way we can try and stop the drops.

Looks like we might need to back the dose down a bit more. Let’s see how he does.

Sorry I am reposting because I am not sure if my comment went though as a "reply" and therefore created a notification - I have Friskies pate, some Purina dry food, and Temptations treats. Which one of those should I give him?

 

[Marje and Gracie]

Eek, okay. I have friskies pate, some purina dry food, and I have temptations treats.. sorry, I am new at this. Will any of these work?

Try a Temptations or two. It might skyrocket him but will work faster than dry.

EDITED TO ADD: And when you have a break, please read this post on a HYPO Toolbox which you need to have ASAP.

 

[bloodbellschime]

Try a Temptations or two. It might skyrocket him but will work faster than dry.

EDITED TO ADD: And when you have a break, please read this post on a HYPO Toolbox which you need to have ASAP.

I had given him a few treats when I tested him last, then he ate some wet food and a few more treats. I just tested him and he is 59 so I gave him two more treats. I was going to go out tonight but now I am scared. What should I do?

 

[Marje and Gracie]

I had given him a few treats when I tested him last, then he ate some wet food and a few more treats. I just tested him and he is 59 so I gave him two more treats. I was going to go out tonight but now I am scared. What should I do?

I would not leave him. Do you have any karo, syrup, or honey?

I would feed him a good couple of tsp of food and add a drop of hard, syrup, or honey. Retest in 30.

 

[MrWorfMen's Mom]

Just noticed that 59 and am watching too.

 

[Marje and Gracie]

I would not leave him. Do you have any karo, syrup, or honey?

I would feed him a good couple of tsp of food and add a drop of hard, syrup, or honey. Retest in 30.

You are using U40 syringes, yes? Do they have 0.5u markings? His dose needs to come down especially with your schedule. I want to see how he does but it’s probably smart to reduce to 0.25u or 0.5u. Thoughts @MrWorfMen's Mom?

If he was never diagnosed with DKA, I am leaning towards you not shooting any BG under 200 if you aren’t going to be there to test. I’ve not yet seen a cat in DKA resolve without vet assistance although he could have just had ketones.

Have you had full labs done on him lately to check his kidneys? The copious water drinking and sweet smell can also be kidney related.

 

[MrWorfMen's Mom]

I'm thinking it would be best to take him down to 0.25u and see what he does. Expect he may bounce after that 59 and don't want too much insulin in his system when that clears. He could be just a bit more sensitive right now given the low of 44 the other night too so better to be extra cautious for the moment. Dose can be increased to 0.5u later if need be.

 

[Marje and Gracie]

I'm thinking it would be best to take him down to 0.25u and see what he does. Expect he may bounce after that 59 and don't want too much insulin in his system when that clears. He could be just a bit more sensitive right now given the low of 44 the other night too so better to be extra cautious for the moment. Dose can be increased to 0.5u later if need be.

I’m leaning towards 0.25u as well but he’s not showing any insulin sensitivity as we see, for example, after a symptomatic hypo.

Letitia...hows he doing? Do you have another test number for us?

 

[Marje and Gracie]

I just saw the 64. I’m glad he stopped dropping.

just a note: if we suggest a dose and that you shoot, we “hang out” to be sure everything is ok. That means we keep checking back and stay online in case you need anything. It’s very important if members are helping you, that you respond so we know everything is ok.

I wouldn’t stop testing until he’s up quite a bit and it’s been at least two hours since any high carb food. We would suggest you lower the dose to 0.25u in the morning and here’s an illustration in this post.

In addition, if he’s below 200 in the morning, skip the shot.

 

[MrWorfMen's Mom]

@bloodbellschime Letitia, do your U40 syringes have half unit markings?

 

[bloodbellschime]

@MrWorfMen's Mom - No, they don't have half marks unfortunately. @Marje and Gracie - Update: this morning before breakfast, Gary was at 109. This is pre-food, but well below 200, so I will skip the dose.

 

[MrWorfMen's Mom]

Good that you skipped today. Let's see what Gary's BG is tonight before feeding him. If Gary needs insulin at all, it will be less than 1u as he dropped lower than ideal with the 1u last night and would have earned a dose reduction for dropping below 90.

 

[bloodbellschime]

Hello, wanted to provide an update on Gary. I have updated his spreadsheet for all his numbers as of just a few minutes ago. I have not given him any insulin in 3 days due to his good numbers. He is eating and drinking normally. I'd like to get some thoughts on these numbers, so am tagging @Marje and Gracie - I am hopeful that these numbers continue to stay level, but will not become complacent - I will be vigilant with the testing.

I did have one question that has been bugging me. I know the general rule is not to shoot over 200. But what if he's just a little over 200, like say somewhere between 201-250?

 

[Marje and Gracie]

Hello, wanted to provide an update on Gary. I have updated his spreadsheet for all his numbers as of just a few minutes ago. I have not given him any insulin in 3 days due to his good numbers. He is eating and drinking normally. I'd like to get some thoughts on these numbers, so am tagging @Marje and Gracie - I am hopeful that these numbers continue to stay level, but will not become complacent - I will be vigilant with the testing.

I did have one question that has been bugging me. I know the general rule is not to shoot over 200. But what if he's just a little over 200, like say somewhere between 201-250?

He is really looking good. One thing we do to see if the pancreas is working is feed three hours before testing and then test at the three hour point. If the pancreas is working, the BG will be down. If you have an auto feeder, you could set it up at night with LC food to feed him three hours before you test at what would be his normal “AMPS” time; same with his normal “PMPS” time.....feed at what would normally be +9 and then test at what would normally be +12. Let’s see what his pancreas is doing.

Considering where he is, if he goes over 200, I would try giving him a drop of insulin and see what that does. That might be way too conservative but with Vetsulin and the way he’s reacted before and his numbers without insulin, I’d rather be safe. It’s easy to adjust the dose up with Vetsulin if he doesn’t respond to a drop.

You draw a drop by pushing the plunger in all the way and then inserting it into the vial and then letting go. The pressure will pull up one drop. If he goes higher than 225 or so, tag one of us to help with dosing advice.