Henry's SS finally up and general glucose questions

[Henry’s Mom]

Hi there, Happy Holidays if you celebrate! Have not posted or come by the site in a couple weeks; we had changed Henry to a new vet so we've just been focusing on their instructions the past three weeks. His new vet applied the Freestyle Libre to monitor his sugar over the next 2 weeks. Today I finally got Henry's SS up in case anyone has time to take a look and provide any feedback. Anxious to see how the next two weeks goes and get a better idea on how his insulin is affecting him. Thanks for reading!

Brief history:

• Henry started to show symptoms of diabetes in August (drinking a lot, peeing a lot, lethargy, and walking on his hocks).
• In September we brought him to his then vet who thought he might have an infection and other things, put him on antibiotics.
• Weakness worsened, brought him back after one month and asked to have Henry's labs drawn. Bloodwork showed diabetes (I believe his glucose was in the high 400s).
• Vet started Henry on 2U Vetsulin twice a day, no instructions for testing or changing diet or anything like that.
• Found this site soon after (thankfully!)
• Changed Henry's vet in November, who lowered Henry's dose to 1U Vetsulin per day, monitor how he reacts x 2 weeks (became 3 weeks due to scheduling conflicts); I asked about Lantus and vet said it's definitely an option but to see how he reacts to 1U first.
• Over those 3 weeks Henry's energy increased and he became more alert, seemed more himself, and even was able to start hopping back onto the bed (albeit only once or twice a day), although he is still walking on his hocks. Henry's appetite also seems to have increased over the past 2 weeks (he actually lost his appetite over the summer).
• Followed up with new vet two days ago and she applied the Freestyle Libre, noted he gained 1 lb! (he is now 10.5 lbs), and maintained Henry on 1U Vetsulin twice a day for now. Next follow up is in 2 weeks for some updated bloodwork and at that point she would like us to start testing at home.

 

[Sienne and Gabby (GA)]

I admittedly have a bias. Vetsulin is just not a great insulin for cats. It is no longer recommended by the American Animal Hospital Assn. Looking at Henry's spreadsheet, you're seeing fast early drops in numbers and there is limited duration which is typical of a short acting insulin. Based on how we approach dosing, with Henry dropping to 65 on 12/22, his dose should have been reduced to 0.75u.

What I'm seeing are wide swings in Henry's numbers. Vetsulin typically drops numbers hard and fast. The insulin wears off well before 12-hours. Between the hard drops in numbers and the short duration, Henry's numbers swing back up into 300 - 400 range.

I'd suggest that it may be helpful for you to take a look at some other spreadsheets. You can compare Henry's spreadsheet to some Lantus spreadsheets. There will be variability but Lantus curves tend to be flatter and you get much greater duration.

 

[Henry’s Mom]

I admittedly have a bias. Vetsulin is just not a great insulin for cats. It is no longer recommended by the American Animal Hospital Assn. Looking at Henry's spreadsheet, you're seeing fast early drops in numbers and there is limited duration which is typical of a short acting insulin. Based on how we approach dosing, with Henry dropping to 65 on 12/22, his dose should have been reduced to 0.75u.

What I'm seeing are wide swings in Henry's numbers. Vetsulin typically drops numbers hard and fast. The insulin wears off well before 12-hours. Between the hard drops in numbers and the short duration, Henry's numbers swing back up into 300 - 400 range.

I'd suggest that it may be helpful for you to take a look at some other spreadsheets. You can compare Henry's spreadsheet to some Lantus spreadsheets. There will be variability but Lantus curves tend to be flatter and you get much greater duration.

Thank you so much. I agree; it is looking like a fast dip at about +2 hours and then back up in the 300-400s for the rest of the day. I hope after these two weeks I can again broach the subject of switching to Lantus. Thank you for the information about that 65 reading. Do you mean that, since the glucose went down to 65 at +2 hours in the PM, I could have given 0.75U the next AM? (Sorry, still learning!)

Thank you for reviewing and I am anxious to get his range more tightly controlled.

 

[Henry’s Mom]

I admittedly have a bias. Vetsulin is just not a great insulin for cats. It is no longer recommended by the American Animal Hospital Assn. Looking at Henry's spreadsheet, you're seeing fast early drops in numbers and there is limited duration which is typical of a short acting insulin. Based on how we approach dosing, with Henry dropping to 65 on 12/22, his dose should have been reduced to 0.75u.

What I'm seeing are wide swings in Henry's numbers. Vetsulin typically drops numbers hard and fast. The insulin wears off well before 12-hours. Between the hard drops in numbers and the short duration, Henry's numbers swing back up into 300 - 400 range.

I'd suggest that it may be helpful for you to take a look at some other spreadsheets. You can compare Henry's spreadsheet to some Lantus spreadsheets. There will be variability but Lantus curves tend to be flatter and you get much greater duration.

Oh and yes! Will definitely take a look at other Lantus SS. Thank you again.

 

[Diane Tyler's Mom GA]

Thank you so much. I agree; it is looking like a fast dip at about +2 hours and then back up in the 300-400s for the rest of the day. I hope after these two weeks I can again broach the subject of switching to Lantus. Thank you for the information about that 65 reading. Do you mean that, since the glucose went down to 65 at +2 hours in the PM, I could have given 0.75U the next AM? (Sorry, still learning!)

Thank you for reviewing and I am anxious to get his range more tightly controlled.

Anytime the BG drops below 90 you reduce the dose by 0.25 units
So yes after that 65 ,the next dose should have been 0.75 like Sienne said

I will give you the link to read about Vetsulin but here is what it says
Changing the Dose

Hold the starting dose for at least a week UNLESS

• your cat won’t eat or you suspect hypoglycemia
• your kitty falls below 90 mg/dL (5 mmol/L). If kitty falls below 90 mg/dL (5 mmol/L) decrease the dose by 0.25 unit immediately.

After 1 week at a given dose perform a 12-hour curve (i.e., testing every 2 hours) OR perform an 18 hour curve (i.e., testing every 3 hours). Note: Random spot checks are essential in order to "fill in the blanks" on your kitty's spreadsheet. The goal is to learn how low the current dose is dropping kitty prior to making dose adjustments.

The general guidelines for making dose changes are:

• If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
• If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
• If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit
• HOWEVER, there are some situations which signal that a larger than usual dose reduction is needed. If you are unsure, please post on this forum or in the Health forum and ask for input about your dose.

It is the link so you can read all about Vetsulin
https://felinediabetes.com/FDMB/forums/caninsulin-vetsulin-and-n-nph.19/

 

[Diane Tyler's Mom GA]

Just want to be sure you have your hypo kit in case you need to bring Henry's BG back up to safe numbers
Be sure to have these at home for your hypo kit



Such as
med and high carb wet food and some honey?


Fancy Feast Gravy Lovers Gourmet Beef Feast in Gravy 20% High Carbs

Fancy Feast Gravy Lovers Gourmet Chicken Feast in Gravy 15% Med Carbs

Fancy Feast Gravy Lovers Turkey Feast in Gravy 15% Med Carbs

Fancy Feast Gravy Lovers Chicken and Beef in Gravy 15% Med Carbs

Good idea to mark the cans with magic marker how many carbs

Or any on the food chart. Doesn't have to be Fancy Feast just an example about the med and high carb foods
And some honey in the house

https://felinediabetes.com/FDMB/threads/dr-pierson-new-food-

Between 11% and 17% is medium carbs.

18% and over is high carb.

 

[Sienne and Gabby (GA)]

Do you mean that, since the glucose went down to 65 at +2 hours in the PM, I could have given 0.75U the next AM? (Sorry, still learning!)

Yes! That's exactly what I meant. If you're following the basic information on Vetsulin, a drop in numbers below 90 signals the need for a dose reduction. We change doses in 0.25u increments. This may not be what your vet does, though.

Should your vet continue to give you a, "Let's wait and see." approach to changing insulin, this is the link to the guidelines published by the AAHA for the treatment of diabetes. It may be worth printing out and bringing along with you to your next vet appointment!

 

[Henry’s Mom]

Anytime the BG drops below 90 you reduce the dose by 0.25 units
So yes after that 65 ,the next dose should have been 0.75 like Sienne said

I will give you the link to read about Vetsulin but here is what it says
Changing the Dose

Hold the starting dose for at least a week UNLESS

• your cat won’t eat or you suspect hypoglycemia
• your kitty falls below 90 mg/dL (5 mmol/L). If kitty falls below 90 mg/dL (5 mmol/L) decrease the dose by 0.25 unit immediately.

After 1 week at a given dose perform a 12-hour curve (i.e., testing every 2 hours) OR perform an 18 hour curve (i.e., testing every 3 hours). Note: Random spot checks are essential in order to "fill in the blanks" on your kitty's spreadsheet. The goal is to learn how low the current dose is dropping kitty prior to making dose adjustments.

The general guidelines for making dose changes are:

• If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
• If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
• If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit
• HOWEVER, there are some situations which signal that a larger than usual dose reduction is needed. If you are unsure, please post on this forum or in the Health forum and ask for input about your dose.

It is the link so you can read all about Vetsulin
https://felinediabetes.com/FDMB/forums/caninsulin-vetsulin-and-n-nph.19/

Thank you! It’s looking like the nadirs have been above 150 except for that 65 reading on 12/22/22. I really appreciate this information.

 

[Henry’s Mom]

Just want to be sure you have your hypo kit in case you need to bring Henry's BG back up to safe numbers
Be sure to have these at home for your hypo kit



Such as
med and high carb wet food and some honey?


Fancy Feast Gravy Lovers Gourmet Beef Feast in Gravy 20% High Carbs

Fancy Feast Gravy Lovers Gourmet Chicken Feast in Gravy 15% Med Carbs

Fancy Feast Gravy Lovers Turkey Feast in Gravy 15% Med Carbs

Fancy Feast Gravy Lovers Chicken and Beef in Gravy 15% Med Carbs

Good idea to mark the cans with magic marker how many carbs

Or any on the food chart. Doesn't have to be Fancy Feast just an example about the med and high carb foods
And some honey in the house

https://felinediabetes.com/FDMB/threads/dr-pierson-new-food-

Between 11% and 17% is medium carbs.

18% and over is high carb.

Thank you! We have karo syrup and honey. Will purchase a couple cans of the fancy feast with some carbs.

 

[Henry’s Mom]

Yes! That's exactly what I meant. If you're following the basic information on Vetsulin, a drop in numbers below 90 signals the need for a dose reduction. We change doses in 0.25u increments. This may not be what your vet does, though.

Should your vet continue to give you a, "Let's wait and see." approach to changing insulin, this is the link to the guidelines published by the AAHA for the treatment of diabetes. It may be worth printing out and bringing along with you to your next vet appointment!

Thank you again. I will definitely bring the print out. I have to call the vet on Tuesday to let her know how Henry’s doing so I’m going to start mentioning the switch already.