Dosing Advice/How are we doing?

[Elizabeth & Aiden]

https://docs.google.com/spreadsheets/d/1XCFRoDGK3u4XauZ9QloAChjTxvLkr4f0RKh4102e43s/edit?usp=sharing

Hey everyone! Here's a link to Aiden's chart...I'm worried because we're doing a curve today and his numbers are not varying much throughout the day as they typically would with a curve. The last time we did a partial curve (one week ago, the curve wasn't able to be completed due to some other factors), you can clearly see his numbers come down and start to go back up. This morning, he was totally fine, but around 10 he started to "throw up". I say "throw up" in quotes because one time it was a little liquid food, once it was a little clear/foamy, and the other times it was just gagging with nothing coming up. He did this probably a dozen times, then started seeking out plastic, knocking over the lamp, walking on the computer (basically all "troublemaker" things). Just now when I got him to check his BG, he sounded like he was coughing, and he ended up grabbing my hand pretty good (it feels kind of numb? But this isn't about me). Anyway, I guess the stress of "throwing up" could be throwing things off today.

Anyhow, how do you guys feel about his numbers? I really want to change insulins, but the last time I spoke to the vet she seemed insulted because "I give all my patients vetsulin and they've done well". I feel like he isn't doing as well as he could, considering he still continuously goes up into the 2 and 300s, even though he has gotten down pretty well some days in our curve.

If you have any tips for dealing with the random throwing up (it's a problem he's had long before...when I take him to the vet, they just check for blockage, say nothing's wrong, and give him an anti-nausea shot).

Thanks everyone. I just want to do what's best for my baby.

 

[Panic]

Hello Elizabeth!

First question comes to mind, how often are you feeding? Clear/foamy vomit is an indication of kitty bringing up stomach bile in anticipation of food. Aiden might be going too far in between meals.

You are holding the dose a really long time, combined with very few mid-cycle tests it's hard to know if he needs more or less right now. Any drop below 90 deems a reduction of 0.25 units which he has done a couple times now so he may be ready to go to 1.25 units.

Have you read the Vetsulin sticky on the forum page? Vetsulin does not last very long and you'll find most activity early in the cycle, within the first few hours before going back up. Pre-shots are the last numbers to go down, keep that in mind.

Your vet sounds like he doesn't appreciate that a client knows more than him. Show him the 2018 AAHA Diabetes Management Guidelines for Dogs and Cats. Vetsulin is for dogs, not cats. I would personally seek out a vet willing to write you a script for Lantus or Prozinc, vets seem to be more than happy to hinder a pet's progress than admit their knowledge is outdated. I would urge you to seek out someone new for Aiden's health.

 

[JanetNJ]

Can you get some +5-6 readings? Or before bed readings.

 

[Elizabeth & Aiden]

Hello Elizabeth!

First question comes to mind, how often are you feeding? Clear/foamy vomit is an indication of kitty bringing up stomach bile in anticipation of food. Aiden might be going too far in between meals.

You are holding the dose a really long time, combined with very few mid-cycle tests it's hard to know if he needs more or less right now. Any drop below 90 deems a reduction of 0.25 units which he has done a couple times now so he may be ready to go to 1.25 units.

Have you read the Vetsulin sticky on the forum page? Vetsulin does not last very long and you'll find most activity early in the cycle, within the first few hours before going back up. Pre-shots are the last numbers to go down, keep that in mind.

Your vet sounds like he doesn't appreciate that a client knows more than him. Show him the 2018 AAHA Diabetes Management Guidelines for Dogs and Cats. Vetsulin is for dogs, not cats. I would personally seek out a vet willing to write you a script for Lantus or Prozinc, vets seem to be more than happy to hinder a pet's progress than admit their knowledge is outdated. I would urge you to seek out someone new for Aiden's health.

He gets breakfast at 6:00am, snack between 11 and 2 (depending on when fiancée gets off work, I work until 4), meal at 6:00PM, snack at 9PM. Some days, he will not have food in his bowl...and I did notice him throwing up once because of this. However, when he was throwing up the other day, he had plenty of food in his bowl. So...not sure what's up with that.

I'm afraid I don't understand what you mean by 'holding the dose', could you explain please? As far as the curves go, it is impossible for me to get curves on Monday-Friday as I work, and Saturday/Sunday is always a tossup due to family things. I am trying my best to get them when I can. I'm just confused about dosing because he is consistently staying in the 200s/300s in the morning and evening...I know that going down mid cycle is important and helps know when to change the dose, but I feel like going down like that for only an hour or two isn't right. Like, he should be getting lower throughout the day, right? I feel like I'm not explaining that...basically, if his insulin was working well, he should not only be getting lower mid cycle, right?

I will read more on the forum page. I do know it doesn't last very long, which is what I don't like about it. I am looking into switching vets, as I have seen three different ones at this one place and that really irks me. If I go to the doctor, I want the same one each time so they know my history, you know? The one we saw today was at least semi okay with switching to glargine, which was a big yay, but there were other red flags that has me ready to switch...

 

[Elizabeth & Aiden]

Can you get some +5-6 readings? Or before bed readings.

I'm trying...I work Monday-Friday so it is not possible to get all those readings on those days. As far as the weekend goes, there are some days when we can possibly get readings, but I sometimes have family things to deal with or something else comes up (like last weekend, I didn't finish his curve because I noticed it was pretty stagnant and he wasn't feeling well...throwing up and very, very angry, so I just stopped so he could have some peace).

 

[JanetNJ]

I'm trying...I work Monday-Friday so it is not possible to get all those readings on those days. As far as the weekend goes, there are some days when we can possibly get readings, but I sometimes have family things to deal with or something else comes up (like last weekend, I didn't finish his curve because I noticed it was pretty stagnant and he wasn't feeling well...throwing up and very, very angry, so I just stopped so he could have some peace).

I hear you. When I'm working out of home I get a morning reading, a reading just before I leave if she was at a lower preshot, a pm reading, and a +4-5 before bed. I test more on days off.

 

[Panic]

He gets breakfast at 6:00am, snack between 11 and 2 (depending on when fiancée gets off work, I work until 4), meal at 6:00PM, snack at 9PM.

So Vetsulin drops the BG very early in the cycle before bouncing back up ... if you're doing shots at 6am and no snacks until 11-2, Vetsulin could already be in and out of the system. The idea of snacks (aside from small, frequent meals being easier on the pancreas) is to steer the drop of insulin. Vetsulin works sort of like a "V" - sudden drop, fast bounce back up. I would recommend on Vetsulin to feed every hour for at least 3 hours after injection - so meals at 7, 8, and 9. To do this you would want to use an autofeeder, Petsafe 5 is a popular one. You could set it for while you're gone and during the night.

When you can - and you may only be able to get them during the evening cycle and weekends - I would recommend testing 1 hour after injection, plus a couple more times before +6. That is usually where the most activity is. It's kind of a pain, I know, but that's just another reason why Vetsulin isn't a great choice of insulin.

I'm afraid I don't understand what you mean by 'holding the dose', could you explain please?

Holding the dose means you're keeping the dose the same ... he has been on 1.5u since July. Most cats are going to need a dose change every week, if not sooner. This is because the needs of the kitty's pancreas fluctuates - cats have the amazing ability to repair their beta cells, which is why keeping the dose the same all the time isn't beneficial. In fact, holding it for too long can cause glucose toxicity, which basically puts up a barrier to the insulin, making it ineffective. You then have to steadily increase the dose until the barrier "breaks", and then you often have to chase the dose back down again. We don't have enough data to know if this is the case for Amo, but that is why you don't want to hold the dose for too long.

As far as the curves go, it is impossible for me to get curves on Monday-Friday as I work, and Saturday/Sunday is always a tossup due to family things. I am trying my best to get them when I can.

Most of us actually do not do curves ... a spot check a couple times every day is usually enough to tell us what's going on, vs dedicating one entire day to a curve. It also paints a bigger picture of what happens daily, rather than just one day a week. Plus, if Amo got into food he shouldn't have, or his BG was running high from a bounce (if the BG drops too low, the body will dump excess glucose into the body in defense, making the BG "bounce" really high) the curve will be ruined. Best to get a couple tests a day instead.

I'm just confused about dosing because he is consistently staying in the 200s/300s in the morning and evening...I know that going down mid cycle is important and helps know when to change the dose, but I feel like going down like that for only an hour or two isn't right. Like, he should be getting lower throughout the day, right? I feel like I'm not explaining that...basically, if his insulin was working well, he should not only be getting lower mid cycle, right?

Yes ... but not in your case. On a GOOD insulin, one that reacts well in a feline body like Lantus and Prozinc, yes, the BG should drop closer toward the middle of the day, then go back up by shot-time. Amo's on Vetsulin though ... duration is usually 3-7 hours tops. We need it to last 12! Vetsulin is working as well as it can on Amo, but it has its limits, as you're seeing. It's not going to get any better.

I will read more on the forum page. I do know it doesn't last very long, which is what I don't like about it. I am looking into switching vets, as I have seen three different ones at this one place and that really irks me. If I go to the doctor, I want the same one each time so they know my history, you know? The one we saw today was at least semi okay with switching to glargine, which was a big yay, but there were other red flags that has me ready to switch...

One cat owner to another, just switch. You need a vet you can rely on in a crisis, one that's open to working with you and not against you. That's my biggest regret with my cat was not switching when I sensed they didn't know enough. I might recommend a AAHA-accredited vet, if you have one locally. You would assume they'd at least be up-to-date on proper insulin for felines.

Another thing, if your vet has not already told you - Vetsulin needs food already on board before giving insulin. The protocol is test - feed - wait 30 min - shoot.