Advice needed/ Vetsulin related

[ida01]

Greetings to all!! I'm new to this forum so I feel overwhelmed with all the new information that I have learned and I would like to expand the knowledge about the condition that my beloved cat was diagnosed with. My baby had been diagnosed with pre-diabetes in May 21, 2020 and the Vet recommended that I feed him RC Glycobalance dry food (which I now know is terrible for diabetes). After several months my cat began to drink a lot of water and eat too much so I decided to take him to the Vet and his sugar was at 625!! I still can't understand how it is that apart from showing the symptoms that I explained, he was still playing and jumping normally. He was hospitalized for 3 days and only with prescribed food (glycobalance canned food). Obviously his symptoms did not improve and I had to take him to the hospital with is sugar in 629, after another 3 days they decided to treat him with Vetsulin 1x a day which ended up being useless and they increased to twice a day. Since then the doctor has been increasing the units. Currently it is in 2 units and even so it still has his sugar very unstable. At his last appointment at the Vet his bg was 375 after I injected him with 1.5 units before going to the vet. They did a fructosamine test and the results came out at 500 so they increased to 2 units. It has been 3 months since his diagnosis and I am very worried about his health by not getting his sugar to stabilize, I feel that I am doing everything in my power but still it is not enough. Last week I started home testing and I have realized how out of control his bg is. Please if someone could help me I would be more than grateful, I already managed to create his SS and signature. Any extra information you need let me know, Thanks in advance! PD: After being hospitalized 3 times the vets never managed to get his bg below the 300, so he's never been close to get a good number even with the vets taking care of him probably due to the stress, and he tested negative for ketones 3 months ago when he was diagnosed.

 

[Librarianista]

Welcome! This is a great place to learn about FD and get support.

Great job starting home testing and switching your cat’s diet! Those are 2 of the best things you can do for them.

Another thing to consider (depending on your situation) would be switching your insulin to a more cat-friendly type like Lantus, Levemir, or ProZinc. I think they’re all more expensive than Vetsulin, but cats tend to do sooo much better on them. Vetsulin was initially made for dogs, and is metabolized way before the second daily shot is given.

The first week or two on this forum is 110% overwhelming, so give yourself grace to ask TONS of questions, reread the same posts 40 times, and ask more questions. It gets easier!

 

[Librarianista]

I should also mention that while running high BG is not good for cats in the long term (months and years), it is MUCH safer for your baby than running too low and having hypo events because of too much insulin.

When did you switch from the prescription to the low carb (LC) food? After I switched my Chloe, I started seeing BIG differences in her numbers within a week.

 

[ida01]

Welcome! This is a great place to learn about FD and get support.

Great job starting home testing and switching your cat’s diet! Those are 2 of the best things you can do for them.

Another thing to consider (depending on your situation) would be switching your insulin to a more cat-friendly type like Lantus, Levemir, or ProZinc. I think they’re all more expensive than Vetsulin, but cats tend to do sooo much better on them. Vetsulin was initially made for dogs, and is metabolized way before the second daily shot is given.

The first week or two on this forum is 110% overwhelming, so give yourself grace to ask TONS of questions, reread the same posts 40 times, and ask more questions. It gets easier!

I wish I could change his insulin, but the Vet who's treating him claims that this is the best insulin for cats and dogs... clearly he's not well informed about that insulin. I wish I could change him to another vet for a second opinion but those I have contacted think the same about that insulin and they insist on feeding him the RC prescribed food.

 

[ida01]

I should also mention that while running high BG is not good for cats in the long term (months and years), it is MUCH safer for your baby than running too low and having hypo events because of too much insulin.

When did you switch from the prescription to the low carb (LC) food? After I switched my Chloe, I started seeing BIG differences in her numbers within a week.

I switched foods about two weeks ago, but I think it hasn't help too much. I notice that your kitten showed improvement when changing insulin, perhaps that is the problem with my baby, I think it is very harsh for him since by injecting he quickly goes to sleep throughout the day and is rarely active.

 

[Christie & Maverick]

Hi there, and welcome! I have a couple of suggestions. Home testing is the best way to get a feel for how the insulin is working, so I'm glad to see you've been able to set up your SS and get some tests going. Here is the Beginner's Guide to Caninsulin/Vetsulin

You've been getting some great tests during the morning cycle, so I'd like to suggest you also get in the habit of testing also before bed, at the moment you only have half of the picture, and some spot checks at night if you can will fill in some of the blanks. We've often found that kitties like to go lower at night, so getting some spot checks there is always helpful. I'd also suggest following the dosing guide and not increasing too quickly. You want to be able to determine how low the dose is taking the kitty, and then make adjustments by 0.25u after a week. At the moment, you've been increasing perhaps a little too quickly, by too much, without much data. Since Vetsulin can often drop BG quickly, I'd also try getting some spot checks in around +2 or +3 to get an idea of patterns.

 

[ida01]

Hi there, and welcome! I have a couple of suggestions. Home testing is the best way to get a feel for how the insulin is working, so I'm glad to see you've been able to set up your SS and get some tests going. Here is the Beginner's Guide to Caninsulin/Vetsulin

You've been getting some great tests during the morning cycle, so I'd like to suggest you also get in the habit of testing also before bed, at the moment you only have half of the picture, and some spot checks at night if you can will fill in some of the blanks. We've often found that kitties like to go lower at night, so getting some spot checks there is always helpful. I'd also suggest following the dosing guide and not increasing too quickly. You want to be able to determine how low the dose is taking the kitty, and then make adjustments by 0.25u after a week. At the moment, you've been increasing perhaps a little too quickly, by too much, without much data. Since Vetsulin can often drop BG quickly, I'd also try getting some spot checks in around +2 or +3 to get an idea of patterns.

You are right, I've been changing the dose based on the results of the moment without waiting a few days... I think I get very nervous when I see that his blood glucose appears high and other days it improves, that makes me get confused and nervous. Also, I will definitely check his bg at night. Do you think I should stay at 2 units for now? In case I have to change the dose, how much would 0.25u be in a U40 syringe?

 

[Librarianista]

In case I have to change the dose, how much would 0.25u be in a U40 syringe?

Do your syringes have 1/2 unit markings? .25 units would be halfway between the 1/2 unit and the full unit.

Also bummer about the vet not giving you what you actually want. That seems real dumb. Are there any mobile vets around you or anything where you could just get a script? I’m sure you’ve tried everything you can think of. Here’s a link to the most recent guidelines from the AAHA regarding feline diabetes. Maybe sharing this would help?
https://www.aaha.org/globalassets/02-guidelines/diabetes/diabetes-guidelines_final.pdf

 

[Christie & Maverick]

Based on the data you have currently on 2U, I'd suggest it is fine to hold the dose, and see what you can do about getting some night time tests. I'll also tag Janet @JanetNJ since she has previous experience with Vetsulin to see what she thinks.

 

[JanetNJ]

Hi. You probably have some insulin resistance going on there. It’s ok, we will get that number down. 2 unit’s is nota large dose. My cat didn’t see a preshots under 300 until I got to 3 units. They need what they need. My cat was also in Vetsulin in the beginning and did good on it. Even went into remission after 4 months. (When she came out of remission I eventually switched to ProZinc). Since you have it we will work with it. If it isn't working for your cat them you'll want to push for something else.

if it were my cat I’d hold it another day or two then up it to 2.5. I want to see some blue numbers.

im glad you got him off that awful glycobalance food.

 

[ida01]

Hi. You probably have some insulin resistance going on there. It’s ok, we will get that number down. 2 unit’s is nota large dose. My cat didn’t see a preshots under 300 until I got to 3 units. They need what they need. My cat was also in Vetsulin in the beginning and did good on it. Even went into remission after 4 months. (When she came out of remission I eventually switched to ProZinc). Since you have it we will work with it. If it isn't working for your cat them you'll want to push for something else.

if it were my cat I’d hold it another day or two then up it to 2.5. I want to see some blue numbers.

im glad you got him off that awful glycobalance food.

I am very grateful for all the responses I have received, I definitely feel more hopeful that my kitten will improve thanks to this forum. As for insulin resistance, should I be concerned? Or could it be remedied with the correct dose? I think I will wait at least two more days before changing the dose since I've been changing it too quickly these past few days. Today he has been sleeping all day and when he gets up he walks very little and lies down, his hind legs look a bit stiff when he walks, I wish I could make him feel better.

 

[Librarianista]

I am very grateful for all the responses I have received, I definitely feel more hopeful that my kitten will improve thanks to this forum. As for insulin resistance, should I be concerned? Or could it be remedied with the correct dose? I think I will wait at least two more days before changing the dose since I've been changing it too quickly these past few days. Today he has been sleeping all day and when he gets up he walks very little and lies down, his hind legs look a bit stiff when he walks, I wish I could make him feel better.

Insulin resistance sounds worse than it is. It just means that the insulin is currently having a tough time regulating the BG levels. But once they do, they can start to come down pretty quick. If you look at the beginning of my spreadsheet (only when I started tracking - she was dx-ed before this), you’ll see that her numbers are pretty high for the first 14 days or so and the insulin broke through (with a combo of diet change) and we started seeing numbers that were no long black or red.

Regulating his BG will very likely help him feel better. I watched my creaky old lady trying to lie down or climb up to her favorite sleeping place, wondering if she had arthritis. But after a few weeks of a good dose for her, she’s back to moving mostly normally.

 

[ida01]

Insulin resistance sounds worse than it is. It just means that the insulin is currently having a tough time regulating the BG levels. But once they do, they can start to come down pretty quick. If you look at the beginning of my spreadsheet (only when I started tracking - she was dx-ed before this), you’ll see that her numbers are pretty high for the first 14 days or so and the insulin broke through (with a combo of diet change) and we started seeing numbers that were no long black or red.

Regulating his BG will very likely help him feel better. I watched my creaky old lady trying to lie down or climb up to her favorite sleeping place, wondering if she had arthritis. But after a few weeks of a good dose for her, she’s back to moving mostly normally.

It definitely sounds scary, but I am hopeful that I will manage to lower his numbers with the help of this amazing forum, I followed your advice in checking his bg at night, right now his bg is at 268, is that okay? Considering that his pmps was 424.

 

[Librarianista]

Yes, that is an okay number. Not sure about Vetsulin curves, but generally BG numbers will be lowest (nadirs) between +5-+7. Then they’ll tick back up. You want to see lower numbers

I definitely freaked a bit the first time I saw Chloe’s BG drop much lower than I had been used to seeing. But it’s a good thing! Means it’s working.

 

[Sienne and Gabby (GA)]

I really hate to suggest this but your vet does not seem to be up to date when it comes to treating feline diabetes and you may want to consider consulting with a different vet. The vet suggested food that is high in carbs and is recommending that you stick with an insulin that is not recommended for cats by the American Animal Hospital Assn -- one of your vet's professional associations. (See the link that Alex & Shane included in post #8.) What Tabby's spreadsheet reads is that you're not getting sufficient duration from Vetsulin -- which is no surprise given that it has a short duration that is inappropriate for a cat's metabolism. (FWIW, the other name for Vetsulin is Caninsulin -- it was developed for dogs.) You're seeing better numbers earlier in the cycle and the numbers jump back up at pre-shot times. At the very least, I would discuss the guidelines with your vet and ask to have Tabby prescribed an insulin that is more appropriate for cats. Lantus is expensive. People either order through Canada (Mark's Marine Pharmacy in Vancouver) or buy a biosimilar (aka generic) form of glargine -- either Basaglar or Semglee. Prozinc can be sold either by your vet or on Chewy's.

Just a quick correction. You're not seeing insulin resistance. That's an entirely different issue than glucose toxicity (which sounds worse). If your cat sits in higher numbers, the cat begins to react to the higher numbers as the new "normal." It gets a bit harder to get the numbers to move and it can create a greater likelihood for bounces.

 

[Librarianista]

I really hate to suggest this but your vet does not seem to be up to date when it comes to treating feline diabetes and you may want to consider consulting with a different vet. The vet suggested food that is high in carbs and is recommending that you stick with an insulin that is not recommended for cats by the American Animal Hospital Assn -- one of your vet's professional associations. (See the link that Alex & Shane included in post #8.) What Tabby's spreadsheet reads is that you're not getting sufficient duration from Vetsulin -- which is no surprise given that it has a short duration that is inappropriate for a cat's metabolism. (FWIW, the other name for Vetsulin is Caninsulin -- it was developed for dogs.) You're seeing better numbers earlier in the cycle and the numbers jump back up at pre-shot times. At the very least, I would discuss the guidelines with your vet and ask to have Tabby prescribed an insulin that is more appropriate for cats. Lantus is expensive. People either order through Canada (Mark's Marine Pharmacy in Vancouver) or buy a biosimilar (aka generic) form of glargine -- either Basaglar or Semglee. Prozinc can be sold either by your vet or on Chewy's.

Just a quick correction. You're not seeing insulin resistance. That's an entirely different issue than glucose toxicity (which sounds worse). If your cat sits in higher numbers, the cat begins to react to the higher numbers as the new "normal." It gets a bit harder to get the numbers to move and it can create a greater likelihood for bounces.

Thank you for the correction on glucose toxicity!

 

[JanetNJ]

I am very grateful for all the responses I have received, I definitely feel more hopeful that my kitten will improve thanks to this forum. As for insulin resistance, should I be concerned? Or could it be remedied with the correct dose? I think I will wait at least two more days before changing the dose since I've been changing it too quickly these past few days. Today he has been sleeping all day and when he gets up he walks very little and lies down, his hind legs look a bit stiff when he walks, I wish I could make him feel better.

Eventually we will find the "breakthrough dose" and then you'll see the numbers drop and then hopefully the dose as well.

 

[JanetNJ]

It definitely sounds scary, but I am hopeful that I will manage to lower his numbers with the help of this amazing forum, I followed your advice in checking his bg at night, right now his bg is at 268, is that okay? Considering that his pmps was 424.

that's a good drop... I wanna see blue but yellow is a start.

 

[ida01]

I really hate to suggest this but your vet does not seem to be up to date when it comes to treating feline diabetes and you may want to consider consulting with a different vet. The vet suggested food that is high in carbs and is recommending that you stick with an insulin that is not recommended for cats by the American Animal Hospital Assn -- one of your vet's professional associations. (See the link that Alex & Shane included in post #8.) What Tabby's spreadsheet reads is that you're not getting sufficient duration from Vetsulin -- which is no surprise given that it has a short duration that is inappropriate for a cat's metabolism. (FWIW, the other name for Vetsulin is Caninsulin -- it was developed for dogs.) You're seeing better numbers earlier in the cycle and the numbers jump back up at pre-shot times. At the very least, I would discuss the guidelines with your vet and ask to have Tabby prescribed an insulin that is more appropriate for cats. Lantus is expensive. People either order through Canada (Mark's Marine Pharmacy in Vancouver) or buy a biosimilar (aka generic) form of glargine -- either Basaglar or Semglee. Prozinc can be sold either by your vet or on Chewy's.

Just a quick correction. You're not seeing insulin resistance. That's an entirely different issue than glucose toxicity (which sounds worse). If your cat sits in higher numbers, the cat begins to react to the higher numbers as the new "normal." It gets a bit harder to get the numbers to move and it can create a greater likelihood for bounces.

I think I will give the vet a chance and I will try to explain all this information to him, I just hope he does not take it the wrong way, it is disappointing to see that those who are supposed to know more about this condition do not know how to treat it correctly... I should clarify that I'm not in the United States, I live in Puerto Rico and from what I've seen the vets here promote RC's food as one of the best and I suppose it's the same with Vetsulin. There aren't really many options, but I will try to discuss it with the current vet. I really hope I can find a solution to this ):

 

[ida01]

that's a good drop... I wanna see blue but yellow is a start.

Today his AMPS were high as usual but he has been in a better mood compared to yesterday, in the afternoon his bg was quite good compared to other days

 

[ida01]

I just verified the pharmacy in Canada and they ship to Puerto Rico! Lantus insulin is much cheaper there and delivery is not that expensive considering the distance, I would just have to wait to consult it with the vet and hopefully he gives me the prescription.

 

[Sienne and Gabby (GA)]

Vets do not get much more than a few lectures on diabetes during their training. Even with those lectures, they have to cover diabetes across a number of species. All we do here is focus on feline diabetes. We also have a diverse membership and have access to both medical and veterinary journals.

It may be useful to print out the AAHA guidelines and bring them along to share with your vet. Ask what he thinks. (The guidelines are freely available on the internet. You don't need library access.) Maybe if your vet will be accepting if you try to convince him that this is a partnership wherein your are both working to keep Tabby as health as possible he will be less defensive.

I work with lots of medical professionals. I've found asking questions from the, "Help me to understand..." perspective seems to help. For example, "I'm a bit confused. The RC Glycobalance canned food contains powered cellulose. Do you know what that is? Isn't that sawdust? Why would a diabetic food contain corn starch and flour?" (Royal Canin Glycobalance is 14% carbs which is not a low carb food.)

 

[BellaBlue82]

Hi Ida! I'm fairly new myself, and my Nico was just recently diagnosed in mid April this year. After three hypo attacks at 2u then 1.5, then severely rebounding up into the 600-700 range, and the final draw being an ER vet visit in the 4th if July, I was adamant with my vet I would no longer let him suffer through the Vetsulin. He went so low this past weekend we thought he had a stroke... No, just insane hypo attack and severe rebound that caused his neuropathy to exacerbate. He couldn't even walk, I was in tears.
We just switched Nico to Prozinc, and these past few days is the first ever I've seen his AMPS be BELOW 300!!! I'm still holding my breath though, as we have to wait until after this week to do a successful curve. I just want to share my story to give hope -- I refused to give up on Nico, and pushed back (in a polite way) when I knew it was right.

Wishing you luck, hang in there!!!
Bella