New member Vetsulin dosing advice please

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Suzanne & Darcy said:
This is troubling to me as it is not the normal thing for a cat with kidney disease to do. I guess the vet assistant did not give you any of the other blood work from his file today. I wish we had some earlier results to compare to. I don’t even know what his hematocrit is and if he may be anemic. He probably needs some B-Complex and B-12 injections. If he’s anemic he may need some other medication. I can’t stop my mind from thinking about Marvin and what’s going on with him. But he seems better than his numbers (at least on April 11) would seem to indicate. I am concerned that he needs IV fluids. I’m hoping for better things for tomorrow.
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I just checked my email and she sent me a pdf, I will figure out how to attach it.
 
Ok that's not bad at all. Go ahead and wait an hour (can do 45 mins if you want but hour might allow a nap ha).

Meters are allowed up to 20% variance, so he's essentially pretty flat/a little up from the last test (the MC will have juuust started kicking in with that last test). If you tested the same drop of blood you'd get a range of readings.
 
FrostD said:
Ok that's not bad at all. Go ahead and wait an hour (can do 45 mins if you want but hour might allow a nap ha).

Meters are allowed up to 20% variance, so he's essentially pretty flat/a little up from the last test (the MC will have juuust started kicking in with that last test). If you tested the same drop of blood you'd get a range of readings.
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I will test in an hour.

Thank you so much for all that you have done for me I really appreciate your time, energy and advice!!
 
Kwyn said:
I will test in an hour.

Thank you so much for all that you have done for me I really appreciate your time, energy and advice!!
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No worries! I'm glad he's holding pretty flat for now.

When you get a chance please update the spreadsheet with all these tests. That way if someone else pops in they can see everything at a quick glance (and add the MC info to Remarks column - 2 tsp 12% @ +X").
 
Suzanne & Darcy said:
This is troubling to me as it is not the normal thing for a cat with kidney disease to do. I guess the vet assistant did not give you any of the other blood work from his file today. I wish we had some earlier results to compare to. I don’t even know what his hematocrit is and if he may be anemic. He probably needs some B-Complex and B-12 injections. If he’s anemic he may need some other medication. I can’t stop my mind from thinking about Marvin and what’s going on with him. But he seems better than his numbers (at least on April 11) would seem to indicate. I am concerned that he needs IV fluids. I’m hoping for better things for tomorrow.
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I had to take a screen shot because I couldn't figure out how to attach the pdf. This is what she sent me. Hope you can read it.

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FrostD said:
No worries! I'm glad he's holding pretty flat for now.

When you get a chance please update the spreadsheet with all these tests. That way if someone else pops in they can see everything at a quick glance (and add the MC info to Remarks column - 2 tsp 12% @ +X").
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Absolutely I will take care of that right away!
 
Naxcel...interesting choice. Has a lot of random uses...

So initial BG was definitely very elevated, but that can happen with infections and things like that - and I see they gave him Naxcel at that time too? Little hard to read.

Kidneys looked ok...I'm now wondering if it's not CKD, but acute kidney injury. https://felinecrf.org/acute_kidney_injury.htm
 
Very hard to read especially on my phone but this is what I wanted to know (I wish there had been a urinalysis though). I’ve been hoping it’s an acute kidney injury (which can be brought on by a kidney infection- as well as many other things) only because I am hoping that he can recover from this. The felinecrf.org site has a lot of information about AKI.
 
Hi, I’ve just read through the thread…took a while!
What a time you are having.
I’m just a little bit lost……..did you actually give the tiny dose of insulin?
If so when?
 
FrostD said:
Naxcel...interesting choice. Has a lot of random uses...

So initial BG was definitely very elevated, but that can happen with infections and things like that - and I see they gave him Naxcel at that time too? Little hard to read.

Kidneys looked ok...I'm now wondering if it's not CKD, but acute kidney injury. https://felinecrf.org/acute_kidney_injury.htm
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Thank you for the link, that's a lot to digest at the moment. Can definitely rule out plants and meds since he has been quarantined in one room.
 
Bron and Sheba (GA) said:
Hi, I’ve just read through the thread…took a while!
What a time you are having.
I’m just a little bit lost……..did you actually give the tiny dose of insulin?
If so when?
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Yes I did at 7:53pm CDT, so 3 hours ago. Now I am wondering if it was too tiny.
 
Kwyn said:
Yes I did at 7:53pm CDT, so 3 hours ago. Now I am wondering if it was too tiny.
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We will see. Better safe than sorry with Vetsulin, it can be harsh and unpredictable in some cats. Numbers are perfect actually for now, we don't *usually* want them below 90.
 
Kwyn said:
Yes I did at 7:53pm CDT, so 3 hours ago. Now I am wondering if it was too tiny.
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So looking at the SS was it the pm dose you gave? That cycle is up to +5
Would you mind updating the SS please as I’ve just come into the conversation and trying to see where it is all up to . Thanks!
 
Bron and Sheba (GA) said:
So looking at the SS was it the pm dose you gave? That cycle is up to +5
Would you mind updating the SS please as I’ve just come into the conversation and trying to see where it is all up to . Thanks!
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Hello,

He doesn't get a PM dose as he has been on a dose of 2u once a day since diagnosis in sept 2021. It was just a tiny dose added for possible ketone detection. It would be added close to the +15 mark. I can add it there if that makes more sense.
 
Ok I see - Kwyn what you'll want to do this this:

Any tests before the shot, out in the +11 column . So you would move the"113@+13" to the AM +11 column. The PMPS is the BG you actually shot at, so "111@14.5". The tests after that restart on a normal 12 hour cycle - so then I think you have "114@+0.75" and "91@+1.5" both in the +1 cell. Then "101@+2.25" in the +2 cell. My times might be a little off but should be within 15 mins I think
 
FrostD said:
Ok I see - Kwyn what you'll want to do this this:

Any tests before the shot, out in the +11 column . So you would move the"113@+13" to the AM +11 column. The PMPS is the BG you actually shot at, so "111@14.5". The tests after that restart on a normal 12 hour cycle - so then I think you have "114@+0.75" and "91@+1.5" both in the +1 cell. Then "101@+2.25" in the +2 cell. My times might be a little off but should be within 15 mins I think
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Ok, thank you I will get to work on this
 
Kwyn said:
Hello,

He doesn't get a PM dose as he has been on a dose of 2u once a day since diagnosis in sept 2021. It was just a tiny dose added for possible ketone detection. It would be added close to the +15 mark. I can add it there if that makes more sense.
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Ok. I get it now….yes please add it where you gave it, thanks! I see Melissa is telling you how to do it.
I would also swap to the twice a day dose but much smaller amounts (if they are needed). Insulin once a day doesn’t work.
You are much better giving a smaller amount twice a day….but for now we need to get you through this and worry about that later.
 
Kwyn said:
BG still 101 at 11pm
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Ok good, that MC kept him flat. I'd check again in an hour. If he's awake and/or hungry, try to get him to have his regular low carb food.

You're at roughly +3.25 I think? I have to get to bed as it's past midnight here but I don't think he's in any danger tonight. So long as he's flat (above 90) at your next test, just leave him some regular low carb and get to bed. Ketones test as soon as you can as well.

I would actually try this dose twice a day if you can be around to keep an eye on him. We know he did ok with it tonight, so it doesn't have to be as test-intensive next time (it's not a guarantee they'll respond the same way every time, but it's good he didn't tank). I would start with a +1.5 each cycle, and let the size of that drop guide you. Realistically he would have been ok with LC tonight I think...he'd be under reduction point but not near hypo.

Hopefully these ketones sort themselves out here...
 
FrostD said:
Ok I see - Kwyn what you'll want to do this this:

Any tests before the shot, out in the +11 column . So you would move the"113@+13" to the AM +11 column. The PMPS is the BG you actually shot at, so "111@14.5". The tests after that restart on a normal 12 hour cycle - so then I think you have "114@+0.75" and "91@+1.5" both in the +1 cell. Then "101@+2.25" in the +2 cell. My times might be a little off but should be within 15 mins I think
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Ok all fixed, thank you for your help!
 
I will hang around for a while Melissa. I agree with the twice a day dosing at that small amount…it can be adjusted if necessary and the carbs can be adjusted so that a tiny dose can be given. The most important thing is to make sure we get rid of the ketones. The sub Q fluids and extra fluids in the food will help with that.
Kwyn I would offer as much food as Marvin will eat at the moment. We fight ketones with insulin, food and fluids.
 
SS looks great thank you. I can see what has happened now.
How do you feel about giving that tiny dose of insulin twice a day? It’s actually much safer than giving the 2 units once a day.
 
FrostD said:
Ok good, that MC kept him flat. I'd check again in an hour. If he's awake and/or hungry, try to get him to have his regular low carb food.

You're at roughly +3.25 I think? I have to get to bed as it's past midnight here but I don't think he's in any danger tonight. So long as he's flat (above 90) at your next test, just leave him some regular low carb and get to bed. Ketones test as soon as you can as well.

I would actually try this dose twice a day if you can be around to keep an eye on him. We know he did ok with it tonight, so it doesn't have to be as test-intensive next time (it's not a guarantee they'll respond the same way every time, but it's good he didn't tank). I would start with a +1.5 each cycle, and let the size of that drop guide you. Realistically he would have been ok with LC tonight I think...he'd be under reduction point but not near hypo.

Hopefully these ketones sort themselves out here...
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I will see if he wants to eat and check him at midnight. Thank you so much again for all your help. Sleep well!!
 
Bron and Sheba (GA) said:
SS looks great thank you. I can see what has happened now.
How do you feel about giving that tiny dose of insulin twice a day? It’s actually much safer than giving the 2 units once a day.
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Great I am glad I have it correct now. I will see if he wants to eat. I am happy to dose twice a day. Just for clarification when FrostD says start with +1.5 each cycle does that mean test his BG and hour and a half after his dose?
 
Kwyn said:
Excellent, thank you so much!!
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Just to clarify….you still need to test before the dose as well. The +1.5 is the first test after the shot to see how low the dose is taking Marvin. When shooting low, we like to get tests in early in the cycle so we don’t get a nasty surprise when we test at say +5 and find a very low BG.
 
Bron and Sheba (GA) said:
Just to clarify….you still need to test before the dose as well. The +1.5 is the first test after the shot to see how low the dose is taking Marvin. When shooting low, we like to get tests in early in the cycle so we don’t get a nasty surprise when we test at say +5 and find a very low BG.
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Yes absolutely I will test first. Should I still wait 30 mins after food before giving that dose?
 
Kwyn said:
Yes absolutely I will test first. Should I still wait 30 mins after food before giving that dose?
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Definitely? Vetsulin needs to have food aboard and being digested before the insulin is given as it hits harder and faster than the more gentle insulins such as Lantus.
 
Bron and Sheba (GA) said:
Staying very flat. I think if you left some food out you could go to bed now. He’s been a good boy! and you have managed brilliantly.
Are you comfortable with doing that?
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Yes I am comfortable with that plus I think he is done having his ears poked for the night. I could not have managed this without the help and advice of all you wonderful people. I can't thank you enough for sharing your time and knowledge. You are all amazing!
 
FrostD said:
We will see. Better safe than sorry with Vetsulin, it can be harsh and unpredictable in some cats. Numbers are perfect actually for now, we don't *usually* want them below 90.
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Good Morning!

Very happy to report that Marvin tested negative for ketones on 3 separate test strips at 3am.

BG was 109 at AMPS

Thank you again for all your help!
 
Marvin is looking good so far this morning. How is he eating? Will you try to get him in with the other vet? We absolutely need to see if his infection is 100% cleared. Did you tell me (yesterday?) how many days ago that he stopped the antibiotics? I am thinking that they thought he had a UTI since they prescribed Naxcel. But I don't see any urine testing and no culture was sent out. If you are able to take him to the new vet, please ask for a CBC and a Chemistry Panel and a urinalysis.
 
Suzanne & Darcy said:
Marvin is looking good so far this morning. How is he eating? Will you try to get him in with the other vet? We absolutely need to see if his infection is 100% cleared. Did you tell me (yesterday?) how many days ago that he stopped the antibiotics? I am thinking that they thought he had a UTI since they prescribed Naxcel. But I don't see any urine testing and no culture was sent out. If you are able to take him to the new vet, please ask for a CBC and a Chemistry Panel and a urinalysis.
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Good Morning!

Yes, I am going to try to get him in to the other vet today. His last day of antibiotics was on April 16th. I will ask for those tests. He is almost like a different cat this morning. He ate almost his usual PS portion of food this morning, and just ate some more now. He had a good bowel movement and tried to walk out of the bedroom when I was coming back in. Took me by surprise.
 
Kwyn said:
Good Morning!

Yes, I am going to try to get him in to the other vet today. His last day of antibiotics was on April 16th. I will ask for those tests. He is almost like a different cat this morning. He ate almost his usual PS portion of food this morning, and just ate some more now. He had a good bowel movement and tried to walk out of the bedroom when I was coming back in. Took me by surprise.
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Hooray! I am so happy to hear this! I'm sitting here at my computer (with my orange cat Oliver in my lap) and smiling! I really think those sub-q fluids have helped him :-)
 
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