Insuline dose decrease

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Marina & Chico

Marina & Chico

Member Since 2021
Chico male 8.5 years old, british shorthair, started on Caninsulin 10 days ago, removed dry food over a week ago, changed wet food from Purina DM (which gave him diarrhea) 2 days ago to cosma for one day and animonda the second day (transition period to a stable diet). Today in the morning we measured 198 AMPS. Vet recommended to measure in 1 hour after food and then decide. What should we do?

Thank you in advance for your help

Update: after 1 hour after food we measured 315, our vet recommended to go with 1 unit of insulin instead of 2.
 
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Marina & Chico said:
Chico male 8.5 years old, british shorthair, started on Caninsulin 10 days ago, removed dry food over a week ago, changed wet food from Purina DM (which gave him diarrhea) 2 days ago to cosma for one day and animonda the second day (transition period to a stable diet). Today in the morning we measured 198 AMPS. Vet recommended to measure in 1 hour after food and then decide. What should we do?

Thank you in advance for your help

Update: after 1 hour after food we measured 315, our vet recommended to go with 1 unit of insulin instead of 2.
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I am not a caninsulin user but 1 unit sounds reasonable to me. I will tag @JanetNJ and @Critter Mom as they use caninsulin.
I would get a +1 and a +2 to start with to see how he is going. And give him a small snack at +2.

Always make sure you have a good meal on board before you give caninsulin as it can hit hard and fast.
Are you giving snacks during the cycle as well as before the dose?

I am going to attach the caninsulin guide in case you don’t have it
Click on this link https://www.felinediabetes.com/FDMB/threads/beginners-guide-to-caninsulin-vetsulin.231587/
 
Bron and Sheba (GA) said:
I am not a caninsulin user but 1 unit sounds reasonable to me. I will tag @JanetNJ and @Critter Mom as they use caninsulin.
I would get a +1 and a +2 to start with to see how he is going. And give him a small snack at +2.

Always make sure you have a good meal on board before you give caninsulin as it can hit hard and fast.
Are you giving snacks during the cycle as well as before the dose?

I am going to attach the caninsulin guide in case you don’t have it
Click on this link https://www.felinediabetes.com/FDMB/threads/beginners-guide-to-caninsulin-vetsulin.231587/
Click to expand...
We keep on going back and forth about eating rules, my husband thinks it is best to feed him 2x day before shots and if needed we can give him additional food to increase blood sugar, i would feel more comfortable to give him 2 big meals with the shots but then other smaller meals as well. We still didn't really get a clear compromise on this one. Is there a consensus on this topic?

We were completely taken by surprise today, we saw 299 @ +4 after PMPS and we were certain nadir would be max +5 so wouldn't go too low, so we stopped measuring. now we are terrified at what values he had in the night :(:(

We were already discussing with the vet to switch to lantus but with this change probably would be better to wait and see how will he react further to caninsulin. Thanks for the link, i will have to take a better look at that.
 
With the meals we recommend feeding a good meal before the dose of insulin and then 2 or 3 snacks during the first half of the cycle when the insulin is strongest. So preshot meal +2, +4 and +6, or +2 and +5 for example. It is better for the cats to get some snacks during the day as well as preshot meal

If you get a lower BG during the cycle, always test again until you see that the BG is rising again.
Cats often drop lower at night.

Personally if I were you, if you have talked to the vet about swapping to Lantus and he has agreed, I would swap to Lantus now.
It is a longer lasting, more gentle insulin that is more suited to cats. You will find Chico will have better numbers I am sure.
The sooner you can get Chico into normal or better numbers the better for him.
 
Bron and Sheba (GA) said:
With the meals we recommend feeding a good meal before the dose of insulin and then 2 or 3 snacks during the first half of the cycle when the insulin is strongest. So preshot meal +2, +4 and +6, or +2 and +5 for example. It is better for the cats to get some snacks during the day as well as preshot meal
Click to expand...

Thanks for the confirmation

Bron and Sheba (GA) said:
If you get a lower BG during the cycle, always test again until you see that the BG is rising again.
Cats often drop lower at night.
Click to expand...

We thought we knew that, after tonight we clearly got cocky too early in the process.

Bron and Sheba (GA) said:
Personally if I were you, if you have talked to the vet about swapping to Lantus and he has agreed, I would swap to Lantus now.
It is a longer lasting, more gentle insulin that is more suited to cats. You will find Chico will have better numbers I am sure.
The sooner you can get Chico into normal or better numbers the better for him.
Click to expand...

This morning value gave me a lot of hope that maybe he will get better soon so i was thinking if it is not better not to bother his body with the transition to lantus. There is the big unknown regarding the transition period...
 
Marina & Chico said:
This morning value gave me a lot of hope that maybe he will get better soon so i was thinking if it is not better not to bother his body with the transition to lantus. There is the big unknown regarding the transition period...
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You should have no trouble swapping from caninsulin to Lantus. It is simply giving caninsulin in one cycle and swapping to Lantus at the next cycle. Because Lantus lasts longer than caninsulin you should start to see better AMPS and PMPS numbers.
At the moment he starts off high, drops down during the cycle and is back up in mostly black and red numbers at the next preshot.
With Lantus you should not see such big swings.
It is your choice.
 
Bron and Sheba (GA) said:
You should have no trouble swapping from caninsulin to Lantus. It is simply giving caninsulin in one cycle and swapping to Lantus at the next cycle. Because Lantus lasts longer than caninsulin you should start to see better AMPS and PMPS numbers.
At the moment he starts off high, drops down during the cycle and is back up in mostly black and red numbers at the next preshot.
It is your choice.
Click to expand...

Thanks, we want to, and what you say doesn't make it seem too difficult. There is still the question of dosing. Until today we knew that we need to give him an equivalent of 2 units of caninsulin. Now we have to see how his body will manage 1 unit and what BG will he have before PMPS. And if we have to go back to 2 units then we know that the equivalent of this won't bee too much for him in Lantus as well.

We never saw a 198 before AMPS, what if it his his body reacting to excluding the dry food and the wet food that bothered him?
 
When you are ready to swap over, post and ask for help and we can tell you an appropriate dose of Lantus.

If you have very recently got rid of dry food that will certainly help to lower the BGs.
 
Marina & Chico said:
Chico male 8.5 years old, british shorthair, started on Caninsulin 10 days ago, removed dry food over a week ago, changed wet food from Purina DM (which gave him diarrhea) 2 days ago to cosma for one day and animonda the second day (transition period to a stable diet). Today in the morning we measured 198 AMPS. Vet recommended to measure in 1 hour after food and then decide. What should we do?

Thank you in advance for your help

Update: after 1 hour after food we measured 315, our vet recommended to go with 1 unit of insulin instead of 2.
Click to expand...
Next time stall the shot without food. The reason is the food will make it rise but will eventually wear off and then you might have given too much based on a false number. No food at least 2 hours prior to the preshot test... But you can feed meals in between.

So if you get a lower than expected number, stall without feeding for an hour. If it's going up, shoot the regular amount.
 
JanetNJ said:
Next time stall the shot without food. The reason is the food will make it rise but will eventually wear off and then you might have given too much based on a false number. No food at least 2 hours prior to the preshot test... But you can feed meals in between.

So if you get a lower than expected number, stall without feeding for an hour. If it's going up, shoot the regular amount.
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In the mornings he is usually extremely hungry, he is even meaner with us while measuring his sugar :(
 
Bron and Sheba (GA) said:
That is a big drop from +2 to +3.
I would give a good sized low carb snack. And test at +4
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thank you for your quick aswer,i gave him 50g, should i do more?

P.S. i realized it is impossible for someone else to advise us on the amount of food for our cat, i didn't share all the needed information...
I really appreciate your quick answer and I will have to hope that my decision regarding the amount was correct.
 
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These are perfectly safe numbers. we WANT to see the numbers lower then they have been. You WANT to aim for those high double digits. Numbers around 80-100 are GREAT safe nadir numbers. I think that steep drop is partially the food wearing off.
 
JanetNJ said:
These are perfectly safe numbers. we WANT to see the numbers lower then they have been. You WANT to aim for those high double digits. Numbers around 80-100 are GREAT safe nadir numbers.
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Thank you, it is incredible what is happening today, we gave him 1 unit of insulin instead of 2 which he used to receive and even like this he is decreasing. These are the numbers that we want to see and we are extremely happy to see but it was a huge drop at only +3 after AMPS so i got worried it is decreasing too fast. At +4 he is 162, still decreasing but slower :) we really hope for a general improvement of his condition, it is awful to see those black numbers ...
 
The improvements in BG numbers may be a consequence of reducing the carb load in the diet.

Even after a cat's transition to a low carb diet has been completed sometimes numbers may continue to improve significantly in the days that follow so keeping a very close eye on BG levels and dose is very wise. Case in point:

Harrison's Spreadsheet

Harrison was treated with Vetsulin (brand name for Caninsulin in the US). He was was transitioned to a low carb food immediately following his FD diagnosis. After less than than two weeks his numbers started rapidly improving and his dose had to be slashed and within days he was on an OTJ trial (now in remission!).

There's no guarantee that Chico's response will be the same as Harrison's. I've just posted his sheet and potted history to give you a real-world example of why extra-close monitoring of BG and dosing is advisable when the carb load has been reduced.

Chico's responded well to the 1.0IU dose today. If he were my cat, I would not go back to the 2.0IU dose because I think there's a risk it is too high. Note that it may prove that 1.0IU is too low but the dose can always be increased again if required (in 0.25IU increments).

On feeding, I'd suggest the latest time in the cycle for a mini meal should be +5, since the effect of the dose typically starts to wane around that time.


Mogs
.
 
Critter Mom said:
The improvements in BG numbers may be a consequence of reducing the carb load in the diet.

Even after a cat's transition to a low carb diet has been completed sometimes numbers may continue to improve significantly in the days that follow so keeping a very close eye on BG levels and dose is very wise. Case in point:

Harrison's Spreadsheet

Harrison was treated with Vetsulin (brand name for Caninsulin in the US). He was was transitioned to a low carb food immediately following his FD diagnosis. After less than than two weeks his numbers started rapidly improving and his dose had to be slashed and within days he was on an OTJ trial (now in remission!).

There's no guarantee that Chico's response will be the same as Harrison's. I've just posted his sheet and potted history to give you a real-world example of why extra-close monitoring of BG and dosing is advisable when the carb load has been reduced.

Chico's responded well to the 1.0IU dose today. If he were my cat, I would not go back to the 2.0IU dose because I think there's a risk it is too high. Note that it may prove that 1.0IU is too low but the dose can always be increased again if required (in 0.25IU increments).

On feeding, I'd suggest the latest time in the cycle for a mini meal should be +5, since the effect of the dose typically starts to wane around that time.


Mogs
.
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Thank you for your response, we are seriously contemplating giving him 1unit tonight (unless all this shoots into the red/black numbers by the evening).

We see here very often that increase in dose should be by 0.25 units, we have a pen syringe that only allows us 0.5 increments, how do people increase by 0.25?
 
Marina & Chico said:
We see here very often that increase in dose should be by 0.25 units, we have a pen syringe that only allows us 0.5 increments, how do people increase by 0.25?
Click to expand...
By using the appropriate syringe for the insulin - ideally ones with half-unit markings - instead of a pen.

Marina & Chico said:
are seriously contemplating giving him 1unit tonight (unless all this shoots into the red/black numbers by the evening).
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It's possible that if you hadn't fed Chico after the 198 at the end of the last cycle you might have seen preshot in the yellows. The blacks he's getting are likely in response to the steep drops typical of Caninsulin in the early part of a cycle.

Today's 1.0IU AM dose is giving a smoother cycle thus far today. I'd suggest sticking with the 1.0IU dose tonight to see whether it might level Chico out a bit. His nadirs might be slightly higher but there is a possibility that his preshots might come down a bit. As I said above, you can always raise the dose again if needed.


Mogs
.
 
Critter Mom said:
By using the appropriate syringe for the insulin - ideally ones with half-unit markings - instead of a pen.


It's possible that if you hadn't fed Chico after the 198 at the end of the last cycle you might have seen preshot in the yellows. The blacks he's getting are likely in response to the steep drops typical of Caninsulin in the early part of a cycle.

Today's 1.0IU AM dose is giving a smoother cycle thus far today. I'd suggest sticking with the 1.0IU dose tonight to see whether it might level Chico out a bit. His nadirs might be slightly higher but there is a possibility that his preshots might come down a bit. As I said above, you can always raise the dose again if needed.


Mogs
.
Click to expand...
So you mean that if we waited 20-30 min in the morning we would have seen an increase without giving him food?
 
Per my earlier post - and based on your having got a reading of the 198 at the very end of the previous cycle - it is possible that if you hadn't fed Chico you might have seen BG rise to a preshot level in the yellows. It is also possible that he might have dropped further. (While uncommon with Caninsulin, it is sometimes possible to see a bit of carryover of effect into the next cycle.)

The whole purpose of the stalling technique is to see whether the BG will rise high enough without any food to safely give a dose. The intent is to give a better picture of how BGs are trending at that point in time - rising or dropping - and therefore should provide better information upon which to base your dosing decision.

There's no way of knowing for certain what would have happened had you stalled.


Mogs
.
 
Critter Mom said:
Per my earlier post - and based on your having got a reading of the 198 at the very end of the previous cycle - it is possible that if you hadn't fed Chico you might have seen BG rise to a preshot level in the yellows. It is also possible that he might have dropped further. (While uncommon with Caninsulin, it is sometimes possible to see a bit of carryover of effect into the next cycle.)

The whole purpose of the stalling technique is to see whether the BG will rise high enough without any food to safely give a dose. The intent is to give a better picture of how BGs are trending at that point in time - rising or dropping - and therefore should provide better information upon which to base your dosing decision.

There's no way of knowing for certain what would have happened had you stalled.


Mogs
.
Click to expand...
We read a lot about stalling today, actually we read before as well but we thought it is applicable for Lantus only. Now that is what we would do in case this repeats.

Thank you a lot for your help
 
Marina & Chico said:
We read a lot about stalling today, actually we read before as well but we thought it is applicable for Lantus only.
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For future reference, here's the relevant section from the FDMB Caninsulin guide:

Q: It’s time for my cat’s shot, but the BG is a little too low. What now?

  • If your cat’s BG is a bit below 200 mg/dL [11 mmol/L] on a human meter, consider ‘stalling’.
    • Stalling is waiting - without feeding your cat - for 20+ minutes, then retesting to see if the BG has risen to a suitable level.
    • You are looking for a number that is rising, not falling, and is high enough to give insulin.
    • If you have time, you can repeat the stalling process to see if the cat’s BG reaches a number you can shoot.
  • If you cannot stall do to time constraints, if numbers are continuing to drop or if you do not have a supply of strips and high carb food on hand, it will be safer if you skip the shot.
  • Note: As you gain experience with home testing and have gathered data to show how your cat responds to insulin, you will become more confident and better able to shoot progressively lower numbers.
  • Ask for help on the forum before giving insulin if you are unsure, as you can never ‘un-shoot’ insulin.
  • If your cat has history of ketones or DKA, or other health issues, or you are concerned, DO post on the Main Health forum for further advice.

Mogs
.
 
Please help!!
Chico was doing very well all day with 1unit of insul, our usual dose is 2 units. PMPS is 484. Should we shoot 1 or 2?
 
Critter Mom said:
By using the appropriate syringe for the insulin - ideally ones with half-unit markings - instead of a pen.


It's possible that if you hadn't fed Chico after the 198 at the end of the last cycle you might have seen preshot in the yellows. The blacks he's getting are likely in response to the steep drops typical of Caninsulin in the early part of a cycle.

Today's 1.0IU AM dose is giving a smoother cycle thus far today. I'd suggest sticking with the 1.0IU dose tonight to see whether it might level Chico out a bit. His nadirs might be slightly higher but there is a possibility that his preshots might come down a bit. As I said above, you can always raise the dose again if needed.


Mogs
.
Click to expand...
@Critter Mom you still think we should shoot 1 unit even if PMPS is 484?
 
Hi Marina,

I've only just seen this. Sorry I missed you at preshot and that no other members with Caninsulin experience were around at that time to help. :(

I see from Chico's spreadsheet that you went with the 1.0IU dose and that the latest mid-cycle is also in the reds. Might be a bounce, might be he needs more insulin. If still high in the AM, I'd suggest going up to 1.5IU and getting early tests in to make sure he's in an OK range.

If you need urgent help with a dose decision in the future:

1. Change the thread title to let members know you need dosing advice for Caninsulin quickly. (Click on Thread Tools at the top of the very first post in the thread to edit the title.)

2. Try tagging members with good experience in using Caninsulin/Vetsulin (janetnj, panic, Elizabeth and Bertie, myself, or any other members who've already helped you with the dosing side of things).


Mogs
.
 
Critter Mom said:
Hi Marina,

I've only just seen this. Sorry I missed you at preshot and that no other members with Caninsulin experience were around at that time to help. :(

I see from Chico's spreadsheet that you went with the 1.0IU dose and that the latest mid-cycle is also in the reds. Might be a bounce, might be he needs more insulin. If still high in the AM, I'd suggest going up to 1.5IU and getting early tests in to make sure he's in an OK range.

If you need urgent help with a dose decision in the future:

1. Change the thread title to let members know you need dosing advice for Caninsulin quickly. (Click on Thread Tools at the top of the very first post in the thread to edit the title.)

2. Try tagging members with good experience in using Caninsulin/Vetsulin (janetnj, panic, Elizabeth and Bertie, myself, or any other members who've already helped you with the dosing side of things).


Mogs
.
Click to expand...
Thank you for your answer. We will probably increase tomorrow to 1.5 units
 
Hi Marina,

Checked on Chico's spreadsheet. Per the FDMB Vetsulin guidelines, the 2.0IU dose is too high (nadir BG below 90). It is good that you carried on testing and caught that much lower nadir. After a drop of nearly 500 points in four hours to nadir, there is a chance that Chico may bounce sky high again by AMPS.

What you've seen in action today is one of the reasons why I don't advocate dosing on a sliding scale with Caninsulin. It can be very good at dragging down high numbers. Increasing the dose in response to a 'bouncy' preshot increases the risk of BG going too low at nadir.


Mogs
.
 
Etc
Critter Mom said:
Hi Marina,

Checked on Chico's spreadsheet. Per the FDMB Vetsulin guidelines, the 2.0IU dose is too high (nadir BG below 90). It is good that you carried on testing and caught that much lower nadir. After a drop of nearly 500 points in four hours to nadir, there is a chance that Chico may bounce sky high again by AMPS.

What you've seen in action today is one of the reasons why I don't advocate dosing on a sliding scale with Caninsulin. It can be very good at dragging down high numbers. Increasing the dose in response to a 'bouncy' preshot increases the risk of BG going too low at nadir.


Mogs
.
Click to expand...
We learned our lesson the hard way, we were pretty nervous around nadir. The 500 at PMPS just got us too worried that the decreased dose is not enough and we are going back. Yesterday he was nervously hungry all day and he started drinking more water again, we just felt that we made a step backwards... taking care of a diabetic cat is a constant decision making process and we clearly took a wrong one yesterday... today we want to give him 1.5IU but i understand we should expect high numbers anyway...
 
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