Dosing advice for Manu

MsF & Manu

MsF & Manu

Member
Hi, my sweet 14-year-old Manu started on insulin on 3/19/22. He was put on 2 units Vetsulin, twice/day. Then after his first BG curve @ 2 weeks (done at the vet's office), he was increased to 3 units, twice/day. I am doing his BG curve at home today, now that I've gotten a bit better at it. I have been testing him sporadically as I could (sorry, I don't have a spreadsheet). Tests I was able to do had always been in the 300 - 400s at different times throughout the day. Two days ago, he had his first result under 300. He tested at 263 before his evening shot.

So, here's my current question! I started his BG curve this morning. Before his morning shot, he tested at 175! I was really hesitant to give him the entire 3 units, so I called the vet's office. I was told to give him his usual dose after encouraging him to eat more -- which I did. I will continue to do the curve today. But what would you have recommended? What if he tests under 200 tonight after dinner? The vet won't be available for consultation at that time. Thanks in advance!
 
Hi, sorry I don't have a spreadsheet. I have been struggling to get adept at testing and have only sporadically tested so far. But every time I did test, it was in the 300s & 400s. Those were also the numbers in the first BG curve which was done at the vet's office. Going forward, I should be able to test more often.

FrostD said:
Hi there,do you have a spreadsheet you could share with us?
Click to expand...
 
Ah sorry I see that now, was skimming while kids eat lunch.

A link for getting started with generic forum stuff (spreadsheet, signature, hypo kit, etc) - https://www.felinediabetes.com/FDMB/threads/new-how-you-can-help-us-help-you.216696/

Unfortunately it will be hard to give advice without a spreadsheet or more data.

Did you get a preshot before his shot last night?

Are you withholding food 2 hours before preshot test? The proper sequence is fast for 2 hours, do preshot test, feed, then give the shot 20-30 minutes later (if the preshot test indicates it's safe to do so).

Please post curve results here today. 3U is a pretty high dose for Vetsulin, and I get nervous when I see whole unit increases - especially on Vetsulin. I suspect you might have missed a good dose, and I suspect he needs a reduction as well
 
Thank you! Yes, I will post the results here. At 2 weeks, the vet wanted to increase from 2 units to 4. I told him I didn't want to increase that much, so he said 3 would be ok!

I am going to ask about switching to ProZinc or Lantus. Are there dosing adjustments when switching from one insulin to another?
 
At 4 hours after his insulin, he tested at 47! I gave him 4 greenies and 1/2 small can of wet food (that's all he wanted). Can a cat go into remission after a month? I hope that's enough. I'll test again in 2 hours. I'm wondering if his diabetes could have been induced by a horrible drug they put him on when they thought he was having cognitive problems (Selegeline). UGH.
 
Holy cow ok - if this is a human meter you need to reduce by 0.5U at your next shots and hold that dose.

If it is a pet meter please reduce by 0.75U.

Any time they are under 50 on human meter or 60 on pet meter you need high carb food (ideally wet) and honey
 
Oh sorry I replied in a mild panic trying to get you before shot time -

About the insulin, we need more data before recommending the starting dose for another insulin. It is often close to the same dose on another insulin, but in this case we would start more conservative. Once you can get a spreadsheet up and running I can also tell you whether ProZinc is even worth a try or just go to Lantus. Often, but not always, they respond similarly to ProZinc, just get longer duration. So if he's seeing big swings all the time once he's on a good Vetsulin dose, it's best to just go straight to Lantus
 
I think 2.25U will be ok but go with what you are comfortable with. Remember to withhold food 2 hrs before your preshot test.

If you get a number under 200 stall without feeding and ask for help on the main forum. I would not shoot anything below 150 at this point in time. With Vetsulin it is usually best to give a reduced or token dose when that happens, but you'll get solid advice if/when that happens.
 
He tested really high before his shot -- 395. It's not surprising since today he ate several greenies, Purina DM kibble and higher-carb wet food throughout the day in my attempt to get his BG up. He had his usual low-carb wet food for dinner.

I decided just to give him 2 units tonight and see what happens. I will make sure to just give him the low carb wet food during the night (a tsp. or so in a couple hours, and then once or twice in the night, as I have been doing). I will test him first thing in the morning. I updated his spreadsheet. Thanks for all your help today!
 
Posted on Facebook as well, that 68 is another reduction. That's lower than we want for Vetsulin on a pet meter, so perhaps another 0.5U reduction with your next shot. If you already shot please keep a close eye; if you will be gone please leave high carb food out
 
If he's under 150 I would skip. 150-174 try 0.25U if you can monitor, otherwise skip. 175-199 try 0.5U. Above that try 1.5U I'm hoping that's conservative enough
 
Well, it shot back up this morning (just tested at 7:30 am PST). It was 378. So I was thinking I should stick to the 2 units for now?
 
Hi, just to clarify, you would recommend an additional reduction to 1.5 (rather than stick to 2)? My syringes do not have 1/2 units, so I'd have to estimate with my bad eyesight!
 
MsF & Manu said:
Hi, just to clarify, you would recommend an additional reduction to 1.5 (rather than stick to 2)? My syringes do not have 1/2 units, so I'd have to estimate with my bad eyesight!
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Yes, 1.5U and just do your best! I know it's hard. Some people use their phone camera to zoom in
 
Ok... I gave him 1.5 units, and I'll keep him on the low-carb good stuff! I won't be home all day again today, but I will definitely test him again in 4 hours...which was when he was at the low point yesterday. Thank you!! I am leaving a small amount of "Young Again" kibble for him to snack on while I'm not here. I've been feeding him small meals approx. every 4 hours.
 
FrostD said:
Yes, 1.5U and just do your best! I know it's hard. Some people use their phone camera to zoom in
Click to expand...

I've just tested Manu at 10:30 am my time (2-1/2 hours from 1.5-unit injection) and he's back down to 101 again! Geesh! I fed him a tsp. of higher-carb wet food (his old kind with gravy), and 2 Greenies -- since yesterday he kept dropping for up to 4-1/2 hours after injection. Any advice? This is nerve-wracking!
 
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Wow. I know you said you can't be home all day, but if you're around a test in an hour would be good.

At this point I would go down to 1U tonight.

When was he diagnosed?

You are so unbelievably lucky you asked for help when you did, I can't believe it
 
Hi, I'm grateful I chose yesterday to do his BG Curve! I was going to do it earlier in the week. I'm staying around as much as I can today. I will test again in an hour. He was just diagnosed on 3/16/22, and insulin started on 3/19/22. He was first put on 2 units, twice/day; and after his first BG Curve at the vet's office on 3/29/22, the vet increased it to 3 units, twice/day as it was running almost exclusively in the 400s. Thank you!
 
Here is a link helping us to help you link. If you noticed, our members have some basic information about their cat's in their signature. This helps us to not pester you by asking the same questions (your cat's name, insulin type, date of diagnosis, etc.) repeatedly. We also have a link to our spreadsheet in our signature. We are very numbers driven. The spreadsheet is a record of your cat's progress. By linking it in your signature, we can follow along and provide feedback should you need the help
The signature is at the end of everyone's post in gray


I see you have your spreadsheet on your post above #9
Members will not see it there
After you fill out your signature you need to attach the spreadsheet to it
If you need help doing this just ask, we have a member who will help you
 
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MsF & Manu said:
My syringes do not have 1/2 units, so I'd have to estimate with my bad eyesight!
Click to expand...
Here are syringes U-40 with half unit markings for vetsulin
You can call them and they will contact your vet for a script, give your vet a heads up
https://www.adwdiabetes.com/product/16363/carepoint-vet-u-40-syringe-29g-half-unit
DIA10
adw-coupon-dia10.jpg

10% off your next order!
 
Diane Tyler's Mom said:
Here is a link helping us to help you link. If you noticed, our members have some basic information about their cat's in their signature. This helps us to not pester you by asking the same questions (your cat's name, insulin type, date of diagnosis, etc.) repeatedly. We also have a link to our spreadsheet in our signature. We are very numbers driven. The spreadsheet is a record of your cat's progress. By linking it in your signature, we can follow along and provide feedback should you need the help
The signature is at the end of everyone's post in gray


I see you have your spreadsheet on your post above #9
Members will not see it there
After you fill out your signature you need to attach the spreadsheet to it
If you need help doing this just ask, we have a member who will help you
Click to expand...


Hi, I tried to do that yesterday; but see it did not work. I posted under the "information" tab in my profile. I'll try to figure it out again! Thanks.
 
MsF & Manu said:
Hi, I tried to do that yesterday; but see it did not work. I posted under the "information" tab in my profile. I'll try to figure it out again! Thanks.
Click to expand...
Tap on your name up top and you will see the word signature , fill in the information. Then you have to attach your spreadsheet to it
Just ask if you need help, like I said we have a member who will be happy to do it for you
 
MsF & Manu said:
I've just tested Manu at 10:30 am my time (2-1/2 hours from 1.5-unit injection) and he's back down to 101 again! Geesh! I fed him a tsp. of higher-carb wet food (his old kind with gravy), and 2 Greenies -- since yesterday he kept dropping for up to 4-1/2 hours after injection. Any advice? This is nerve-wracking!
Click to expand...
What is the brand and flavor of food you gave him? Just trying to find specific carb % to pinpoint tonight's dose. The 1.5U is close, just not sure if 1U or 1.25U is better (I know that will be hard to measure but I have some ideas)
 
FrostD said:
What is the brand and flavor of food you gave him? Just trying to find specific carb % to pinpoint tonight's dose. The 1.5U is close, just not sure if 1U or 1.25U is better (I know that will be hard to measure but I have some ideas)
Click to expand...
Thank you for your advice! I posted this message on Facebook too. Your advice was right on. I am keeping him on 1.5 units (1/2 of what he had been on!) The vet is out of town this week, so I'm just doing it! You can check his spreadsheet, but he runs normal mid-day. I just tested him at 98 at noon AGAIN. It's high in the morning, but it seems like that's because the insulin wears off and he has two small snacks overnight (he demands one about 1-1/2 hours before breakfast). It was spiking late afternoon/evening I'm sure because I overcompensated with too many high-carb foods! I'm not doing that today. Just two small wet food, low-carb snacks during the day. Manu sends purrs.
1f63b.png
 
That is wonderful! Now we're not sure if that 98 was nadir, and remember reductions are by 0.25U any time he goes below 90. So, you may want to consider a 0.25U reduction. If he were my cat I'd probably hold the 1.5U a few days and try to test in the +3 to +6 range to see what he's doing. But if you won't be around with the holiday, work, etc the 0.25U reduction may be a good idea. Completely up to you and your comfort level
 
FrostD said:
That is wonderful! Now we're not sure if that 98 was nadir, and remember reductions are by 0.25U any time he goes below 90. So, you may want to consider a 0.25U reduction. If he were my cat I'd probably hold the 1.5U a few days and try to test in the +3 to +6 range to see what he's doing. But if you won't be around with the holiday, work, etc the 0.25U reduction may be a good idea. Completely up to you and your comfort level
Click to expand...

He's back up to 403 this morning! I only tested once during the day yesterday, but it was at the hour in which is was the lowest the previous 2 days. I'm feeling like 1.5 is too low. I think I may go up to 1.75 today (as best I can with my syringes). What do you think? You can see my spreadsheet. This insulin is clearly not working for him. I'm going to start a new post. Thanks!
 
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This very unfortunately is the problem with Vetsulin. It drops then hard and fast, which often in turn causes another bounce. Repeat forever. But also it does not have the appropriate duration for most cats

Nadir is the important part, hold the 1.5U for at least a week to see how he settles into it. Of course, take a reduction if he goes below 90.

We may end up needing a sliding scale (where you give a slightly different dose based on the preshot) but let's see how he does this week.

We usually say give any insulin about 2 months before making a decision, he's just past the 1 month mark. Give it a month of the regular testing and trying to keep nadir between 90-110 and see where he's at. He may come down overall, he may not. In which case you'd want to switch insulin
 
FrostD said:
This very unfortunately is the problem with Vetsulin. It drops then hard and fast, which often in turn causes another bounce. Repeat forever. But also it does not have the appropriate duration for most cats

Nadir is the important part, hold the 1.5U for at least a week to see how he settles into it. Of course, take a reduction if he goes below 90.

We may end up needing a sliding scale (where you give a slightly different dose based on the preshot) but let's see how he does this week.

We usually say give any insulin about 2 months before making a decision, he's just past the 1 month mark. Give it a month of the regular testing and trying to keep nadir between 90-110 and see where he's at. He may come down overall, he may not. In which case you'd want to switch insulin
Click to expand...

Thank you. That makes sense. Considering it's Easter and I was supposed to go out today, I will stay at 1.5 to be on the cautious side. I'll set up his automatic feeder and test him when I get home, probably late afternoon. I appreciate your reply! Thanks!! Happy Easter!
 
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