DOSING ADVICE FOR SHADOW

C

CLAIRE MARSHALL

Member
Can I please ask if Shadow's spreadsheet can be looked at please.

This morning at 10.40AM UK time he was as low as 2.

We've been gradually lowering his dose down for some time since we changed his diet to a high meat, low carb wet food only.

He has only been on 1 Unit of Caninsulin since the 2th March, and it looks like I'll need to drop the dose again to 0.5.

Is this okay!?
 
Claire, as you know a hypo warrants an immediate dose reduction. So yes, I would agree with dropping the dose to half a unit.
And I would also strongly suggest raising the number at which you give insulin shots.

Shadow has had a lot of hypos, and this is very likely taking a toll on his body. So it is super important to try to keep him safe. ...And if there are repeated hypo episodes then the body can cease to recognise hypo as the dangerous event that it is (hypoglycemic unawareness), and may not raise the blood glucose in a crisis.
If this were my cat I'd reduce the dose to half a unit, and I'd also raise the number that I give insulin to at least 10 (on a human glucose meter). Then I'd keep to that for a week and then reassess the situation.
If the blood glucose drops too low in that time then another reduction would need to be made immediately. If the numbers start trending higher over the course of the week then it may be that a dose increase will be required. As we say here, 'better too high for a day than too low for a minute'....

Cats can be more sensitive to insulin after a hypo, so it is important to monitor closely following a hypo episode. It is clear that you are very good at testing Shadow's blood glucose. That's great! So you are very able to monitor the effect of the reduced dose.

Edited to add: Regarding missing this evening's dose. You haven't done this in the past following a hypo. Why exactly are you considering it on this occasion?
 
Elizabeth and Bertie said:
Claire, as you know a hypo warrants an immediate dose reduction. So yes, I would agree with dropping to the dose to half a unit.
And I would also strongly suggest raising the number at which you give insulin shots.

Shadow has had a lot of hypos, and this is very likely taking a toll on his body. So it is super important to try to keep him safe. ...And if there are repeated hypo episodes then the body can cease to recognise hypo as the dangerous event that it is (hypoglycemic unawareness), and may not raise the blood glucose in a crisis.
If this were my cat I'd reduce the dose to half a unit, and I'd also raise the number that I give insulin to at least 10 (on a human glucose meter). Then I'd keep to that for a week and then reassess the situation.
If the blood glucose drops too low in that time then another reduction would need to be made immediately. If the numbers start trending higher over the course of the week then it may be that a dose increase will be required. As we say here, 'better too high for a day than too low for a minute'....

Cats can be more sensitive to insulin after a hypo, so it is important to monitor closely following a hypo episode. It is clear that you are very good at testing Shadow's blood glucose. That's great! So you are very able to monitor the effect of the reduced dose.

Edited to add: Regarding missing this evening's dose. You haven't done this in the past following. Why exactly are you considering it on this occasion?
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I agree with everything Elizabeth said. Please, please listen to us when we advise to reduce. You received that advice several times on Facebook and still haven't reduced.

@Elizabeth and Bertie are you thinking stick with the 5/90 as reduction point? I was originally thinking 70/3.8 as it seems to hold him in a slightly better numbers - but it is very dependent on sticking to the no-shoot threshold and taking reductions as soon as earned
 
FrostD said:
I agree with everything Elizabeth said. Please, please listen to us when we advise to reduce. You received that advice several times on Facebook and still haven't reduced.

@Elizabeth and Bertie are you thinking stick with the 5/90 as reduction point? I was originally thinking 70/3.8 as it seems to hold him in a slightly better numbers - but it is very dependent on sticking to the no-shoot threshold and taking reductions as soon as earned
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He is currently 6.1 at 3pm.

Will retest at 6.15pm tonight.

Dose will be reduced down to 0.5.

Thank you for the advice xxxx
 
Did you shoot? Elizabeth advised to skip shots if he's under 10 for now

He's definitely doing well!
 
Claire, please keep a very close eye this evening. Shadow will be very sensitive to insulin after his hypo this morning and we don’t want another one - it’s possible even on that reduced dose, at a pmps of 6.2.
 
Claire, if you haven’t given insulin there’s no need to be scared or anxious. This morning’s dose will have worn off now and with no insulin tonight, he can’t hypo. It’s much more scary giving insulin on low bg numbers. Remember, from tomorrow, no insulin if bg is 10 or lower.
 
CLAIRE MARSHALL said:
Its 9pm.

Shadow is 9.8 with no insulin since this morning.

Is this okay!?
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It's very possible he's bouncing from those lows earlier today (if they drop lower/faster/too low their liver panics and dumps stored glycogen and counterregulatory hormones in order to spike BG back up). It's very likely he's been doing that for awhile, but because dose was too high you didn't see these higher numbers often.

Nothing to be done right now, just wait til morning shot time
 
I was advised not to give insulin tonight.

So far, 9pm he's 9.8, 10.40pm 8.9, another test at 11.40pm.

He's okay.

Will test around 3am.

Then again at 6.15am tomorrow morning.
 
CLAIRE MARSHALL said:
Will test around 3am.

Then again at 6.15am tomorrow morning.
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There's no reason you need to stay up (or wake up) at 3am to get another test tonight. Since you didn't give insulin tonight, there's no risk of him dropping too low. Take this opportunity to get some extra sleep!!!

If your usual shot time is 6:15am, maybe you could test at 5:45 (don't feed) so IF he's still under 10, you'll have some time to ask for advice.

This Caninsulin forum doesn't get a lot of activity so I'd recommend instead of posting here, you post in the Main Health forum which has a lot more active people. Once you post there, you can also post the link to that post in the Feline Diabetes group on Facebook too which will also help get attention on your post.
 
CLAIRE MARSHALL said:
Its just gone midnight, and he's now 9.8

If he goes above 10 by 6.15am, what dose should I give him!?
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You would give 0.5U if he's 10 or higher. Under that, skip for now. That advice may change but first we need to see where he's at without the overdose
 
Morning everyone.

Shadow had no insulin last night.

By midnight he was 9.8.

This morning at 6.15am 8.6, so again no insulin.

Does this mean he us in remission now!?
 
His numbers are still higher than we'd like to call it remission, we want him mostly under 120 (6.7). But he's not leaving a lot of room to give insulin. You said you have a vetpen correct? And smallest dose is 0.5U?

I am pretty sure you can withdraw insulin from the vetpens using regular syringes, that may end up being what you need to do. Because you'll need to do something more like a drop dose to 0.25U. In these numbers, "remission" won't last long. Wait to see if one of the other ladies know if you can use regular syringes with it.
 
CLAIRE MARSHALL said:
ts now 10.40AM UK time and his blood sugar level is now 6.6 compared to 8.6 at 6.15AM
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That is looking good...
I'm not sure what your feeding schedule is for Shadow, but feeding mini meals (rather than a couple of larger meals) can help to stimulate the recovering pancreas to produce insulin, without overwhelming it with too much to do all at once.
 
Elizabeth and Bertie said:
That is looking good...
I'm not sure what your feeding schedule is for Shadow, but feeding mini meals (rather than a couple of larger meals) can help to stimulate the recovering pancreas to produce insulin, without overwhelming it with too much to do all at once.
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Afternoon.

He is currently 7.8 just gone 3pm.

I'm hoping fingers crossed he should be around 8.6 like last night.

I feed him Nature's Variety, and Lilly's, both are 0 carb.

He usually gets fed around 6.15am, and same time in the evening.

He usually gets 2 pouches at meal times only.

Now he's not on any insulin, what feeding small meals do you recommend!?

Can I reduce him down to 1 pouch and a half!?

He weighs around 5.68kg.
 
I was thinking of doing the following for Shadow:-

1 pouch at 6.15am, half a pouch around midday, 1 pouch at 6.15pm, and a half pouch around 10pm.

Does that sound okay for smaller meals!?
 
I answered on Facebook as well, I would continue to feed however many calories he needs to get to or maintain his ideal weight.

How big is a pouch (weight, volume)?
 
FrostD said:
Ok then I would just split it up into relatively even amounts throughout the day/night. My cat just grazes all day, but a lot of people tend to do about 2-3 small meals each cycle, or 4-6 total per day.
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Okies, so I'll feed the 4 pouches throughtout the day, the last one being around 10pm in the evening.
 
CLAIRE MARSHALL said:
Okies, so I'll feed the 4 pouches throughtout the day, the last one being around 10pm in the evening.
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I would still do some during the night if you can, it helps keep them lower. You can always freeze it beforehand so it thaws throughout the night for him.
 
How much does he normally eat before his shot? I'd say that should be ok, that's a decent amount of food
 
FrostD said:
How much does he normally eat before his shot? I'd say that should be ok, that's a decent amount of food
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He usually has 2 pouches, but as it was only 0.5 units he had 1 pouch at 85g, plus a little more after.

By 9pm his levels had dropped down nicely to 7.4.

This morning at 6.15 am he was 9.3 so no insulin was given and only 1 pouch of food.

He will be fed again at midday another pouch and so on.
 
Replied on Facebook, yes, "normal". His pancreas is working a little bit, but he's still higher overall than we'd like.

Can you send a picture of the top of an unused cartridge please? The little vial with the insulin. At this point you are going to need to buy regular syringes to withdraw the insulin from the cartridge, and not even use the pen because it cannot do small enough doses. But I'd like to see it before having you go buy stuff.
 
CLAIRE MARSHALL said:
I don't think Shadow might not need any more insulin.

Its currently 2pm UK time and he has dropped down to 6.5 and has been 6.5 since 1pm too.

Looks like the smaller meals are working for him xx
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So remember that with a human meter a nondiabetic cat is 50-100 (2.8 to 5.6), that is usually what we aim for with remission. Vetsulin is a little different because it's usually not safe to bring them that low.

What we DO want is to see him below 120 (6.7) most of the time, and he's not quite there. He really does need twice a day dosing, so at this point I would shoot the 0.5U if he's above 9. You shot the 0.5U over 10 and he didn't stayed on the higher side. We need to start lowering the no shoot number slowly.
 
CLAIRE MARSHALL said:
Its currently 2pm UK time and he has dropped down to 6.5 and has been 6.5 since 1pm too.
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That's looking very nice indeed... :cat:


Claire, I 'think' you said in a previous post you said you'd ordered syringes from VetUK? Is that the case? And have you tried using them yet at all? It 'may' be that Shadow needs very small doses on an 'as needed' basis at the moment, if his numbers are high enough for a shot. And the syringes would enable you to draw up extremely small amounts. If you have them but haven't tried using them yet then it may be good practice to just draw some water into them to get a feeling for how they work, and for experimenting with measuring very small doses.
..The syringes should have half unit markings. But it's quite easy to draw up a 0.25, for example, by drawing water/insulin half way between the zero line and the 0.5 line. And it's also possible to draw up much smaller doses than that with just a little bit of practice.. Shadow 'may' not need the insulin, but it may also be that his pancreas still needs a little bit of support from time to time...
 
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