Charlie dosing help please, the PM version..

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JaymiAndCharlie

JaymiAndCharlie

Member Since 2023
https://felinediabetes.com/FDMB/thr...help-tonight-on-vetsulin.279310/#post-3086281 This is my previous (first) post, I couldn't figure out how to edit.

Spreadsheet for Charlie https://docs.google.com/spreadsheets/d/1t-YPTxpi2o-J01pzD7vtjlP5nv1qifIZntJtDntpk0M/edit?usp=sharing

I don't get why we are so low. He doesn't eat much, maybe that's why? He's ready to eat now, but we're stalling. I did 0.5U last night and we dipped low, had to feed gravy. I have Hills M/D Glucose Support pate/kibble (he won't eat pate so that'd be syringed), I'm trying to semi-obey vet until she agrees to switch to Lantus.

What do I do? try to feed as much as I can? Stall?
 
You're posting in the right place.

Just to be sure, with Vetsulin, you feed, wait 20 - 30 min, then shoot providing numbers are safe to do so. Since it looks like Charlie has been recently diagnoses, we would typically not have you give a shot unless Charlie's numbers were appreciably higher. The only exception would be if Charlie has a recent experience with ketones or Diabetic ketoacidosis (DKA).

Every time Charlie's numbers have dropped below 90, you need to reduce the dose. He's getting too much insulin. His numbers have been in a safe range but Vetsulin is a harsh insulin that can drop numbers hard and fast. We generally encourage people to switch to a different insulin since Vetsulin is no longer recommended by the American Animal Hospital Assn. That said, if you opt to continue with Vetsulin, I'd encourage you to go slow. This is a link to our guide to Vetsulin. It may help you sort out dosing.
 
Sienne and Gabby (GA) said:
You're posting in the right place.

Just to be sure, with Vetsulin, you feed, wait 20 - 30 min, then shoot providing numbers are safe to do so. Since it looks like Charlie has been recently diagnoses, we would typically not have you give a shot unless Charlie's numbers were appreciably higher. The only exception would be if Charlie has a recent experience with ketones or Diabetic ketoacidosis (DKA).

Every time Charlie's numbers have dropped below 90, you need to reduce the dose. He's getting too much insulin. His numbers have been in a safe range but Vetsulin is a harsh insulin that can drop numbers hard and fast. We generally encourage people to switch to a different insulin since Vetsulin is no longer recommended by the American Animal Hospital Assn. That said, if you opt to continue with Vetsulin, I'd encourage you to go slow. This is a link to our guide to Vetsulin. It may help you sort out dosing.
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I don't have much room to reduce, we did 0.5U last night. Vet stressed the importance of needing to do insulin this weekend. She said "with the DKA you have to use insulin" to get things to settle down, but someone mentioned my lab work doesn't say DKA? just Pancreatitis? and the most recent labwork was done Thursday so I won't have results until Monday I think. I do NOT want to do Vetsulin, my Vet is making it very hard to switch to Lantus! I'm testing again now and then will syringe feed..
 
Labs generally don't say DKA. The diagnosis is made based on the results of lab tests and the vet has to interpret the results to make the diagnosis. Electrolyte values would be off -- phosphorus, potassium, etc. Basically, the kitty is in a state of metabolic acidosis as a result of fat being metabolized and throwing ketone bodies into the blood. This is a good summary about DKA.

If you give 0.5u, please test early and often. Are you going to be home to monitor? Do you have test strips and high carb food on hand? If no high carb food, do you have corn syrup (Karo or other) or honey or other type of syrup if needed?

Are you home testing for ketones?
 
Sienne and Gabby (GA) said:
Labs generally don't say DKA. The diagnosis is made based on the results of lab tests and the vet has to interpret the results to make the diagnosis. Electrolyte values would be off -- phosphorus, potassium, etc. Basically, the kitty is in a state of metabolic acidosis as a result of fat being metabolized and throwing ketone bodies into the blood. This is a good summary about DKA.

If you give 0.5u, please test early and often. Are you going to be home to monitor? Do you have test strips and high carb food on hand? If no high carb food, do you have corn syrup (Karo or other) or honey or other type of syrup if needed?

Are you home testing for ketones?
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I will be home and will be testing. I have plenty of supplies and gravy lovers. I have Karo (the dark one) and honey. I just got ketostix but haven't caught him peeing, I'm looking on Walmart's site to see if they have a Ketone monitor like the relion classic.

Vet had told me his numbers were good because he wasn't eating enough, and that he had muscle waste (1wk post-hospitalization), and that's why I need to be doing 2U vetsulin this weekend..
 
I don't believe Walmart has a house brand blood ketone monitor. You will likely need to order one. Check on ADW (American Diabetes Warehouse) or Chewy's may have them. You could also call around to local pharmacies, including Walmart, to see if they have blood ketone meters.

Your vet is sort of correct. One of the issues with getting a curve or even a test at the vet's office is that most cat's are scared when they're. The stress of travel to the vet's office, being some place that's unfamiliar, has loud dogs, weird smells, and people who your cat doesn't know (or like) handling him cause numbers to be artificially elevated. As a result, vets often recommend doses that are based on higher numbers than you see at home. Regardless of why Charlie's numbers are lower, those are Charlie's numbers. If you were to give 2 units, it could easily be an overdose. This is why I suggested you monitor closely.

Also, could you attach your spreadsheet to your signature? It will save you time and make it easier for us to locate. The instructions are here an I'm tagging Bhooma (@Bandit's Mom) in case you need help.
 
Bron and Sheba (GA) said:
How are things going now Jaymi.?
It looks like 0.5 U is a good dose.
Is Charlie eating for you.?
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We did well today on it. But too good. I'm just really confused by my numbers I'm getting. I double check most of them (Same blood drop). They are consistent. He's staying green all day. Not coming up to blues. I fed him about half a can of wet food (syringed) and 3 hours later he's lower? He went down from 92 to 84 after eating? Supposed to dose in 2 hours, but we're fasting for an accurate number. So I doubt it's going to go up. Today he grazed on the M/D Kibble, ate as many temptation treats as I'd offer (just trying to get him to eat something, and he did), and that half can this afternoon, and a good amount this morning. I'm at a loss. Again, she told me the numbers were good because he's losing muscle because he's not eating enough. I feel incredibly guilty. I don't know what to do tonight, or in general. On the upside I did sleep extra today so I feel a little more alive to face this.
 
@Bron and Sheba (GA) And I don't know how relevant this is but he's been sleepy slow today. Stayed in bed with me all morning which was nice, but he's been in his cat tree caves, sleeping in the walk in closet, just slow today. I'm taking him outside for some sunshine right now which always perks him up, I hope..
 
If his BGs are going down after eating, his pancreas could be starting to produce some insulin.
Keep feeding him all he will eat. If he likes the md dry and the temptation treats, then let him eat those. But keep offering the normal food as well. The most important thing is he eats….anything!
How long before the next preshot, so I can watch out for it.?
Is he lethargic?
Did the vet say they had corrected the electrolytes that were a bit out of normal range before he left hospital?
 
That would be a dream come true. Shot should be at 7:15pm PST and it is 6:11 PM now. I put down alllll the food, he grazes when he feels like it, he's been picking M/D with or without fortiflora.

He was being lazy a bit ago but I opened the front door to get ready to carry him out, he hopped down immediately and walked outside like he owns the place. Now I'm chasing his speed walking butt around to keep him from eating the grass. He is very alert and chipper outside with me right now.

No, I uploaded the labs in a previous post but those were taken pre hospitalization. We took labs and urinalysis this past Thursday but she had Friday off so I haven't received the results from those yet. Oh, we are doing SubQ at home with uh.. Idk, b12 in it? I'd have to look. I call it kitty mt dew. But we do.. 200mL a day of that, we started Friday.

Being outside with him right now, he's acting 100% normal and annoying (in the best way).
 
I don't know if I'll shoot tonight but I'm thinking I should get some wet food into him to make sure he's getting enough.. I have a huge variety (ff, weruva gravy's, m/d, etc) so could do whatever would benefit him the most until morning, if we don't shoot.
 
I would hesitate not to shoot if he has had DKA which you say he has had.
Let’s see what he is at Preshot.
Also 200 ml subQ fluids at one time is too much. I would not give more than 100 ml at a time. How long does it take for the sack of fluid to disappear ?
 
She said DKA several times. That was her explanation for wanting to do 2U this weekend. I'll test him now.

I might be wrong on the fluids, I have to look at the bag. Not sure on how long to dissipate, we only did it once so far and that was yesterday.
 
Okay, 95 preshot. I feel like I should feed him soon, just not sure what. Was thinking the M/D since it has carbs and I don't want him to dip too low and it's ready to go anyways.

They definitely told me 200mL a day, bag says Normosol- R, PH 7.4. Tech instructed me to do them all at once.
 
JaymiAndCharlie said:
She said DKA several times. That was her explanation for wanting to do 2U this weekend. I'll test him now.
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It is true that DKA needs insulin. But the BGs have to be tested as well so as not to send the cat into too low numbers. I think if we gave 2 units he would drop too low.
What we can do is feed some higher carb food than the low carb, to keep the BGs a bit higher.
Do you have any other higher carb food he will eat apart from the md dry? I'm thinking canned higher carb
Also are you giving an antinausea medication?
 
My ketone meter arrives tomorrow. I have ketostix but haven't caught him peeing yet. 2U is deffffinitely too much, I agree. I have uh.. I still have gravy lovers I could blend up ( chicken feast in gravy, chicken hearts/liver feast in grilled chicken flavor gravy, turkey feast in roasted turkey gravy), or beef feast in gravy. And various churus, and packets of FF Creamy broth, with chicken and veggies in a decadent creamy broth. They were his favorite, he'd lick up all the gravy and not touch the meat. Not sure if he'll still eat the gravy.

No meds, aside from mirataz or whatever on his ear in the morning. I might have sucralfate left, not sure if that's the same.
 
the beef feast in gravy is grilled, not gravy lovers, just to clarify. Shot is supposed to be soon.. should it be 0.5 or 0.25? i'm still trying to pick food, too
 
You need to ask the vet for some ondansetron or cerenia, preferably ondansetron for nausea. I’m surprised they didn’t send you home with some. An appetite stimulant is no good unless you give an anti nausea med first. Try and get some asap.

I would see if he will eat some of the gravy lovers on his own. Even licking the gravy is ok. That has the carbs in it.
Failing that I would give him as much md dry as he will eat.
Can you monitor this cycle?
See how much he will eat now and then we can decide on the dose.
You will have to wait 30 mins before the dose anyway after food.
How does that sound?
 
I have one cerenia pill left, it's supposed to be half a pill in the morning. I could give him that tomorrow?

He just ate a decent amount of M/D kibble, and some Temptation treats. Won't touch the broth packet or the gravy lovers. Going to blend it and give him some, but he did eat kibble.

I'm hoping to shoot by 8pm, I can't get too off kilter due to work schedule. I will be monitoring tonight.
 
Well done getting him to eat!
I think I would try the 0.25 U dose because he has been dropping under 90.
If his BG goes back up or we find ketones in the urine or blood, we will need to go back up in dose.
Try and get a urine ketones test overnight if you can. It’s important we know the ketones status.
 
Done feeding. Ok! Will do 0.25U at 8:00. He's not going to puke, or at least he has not been at all.

Any thoughts on the morning? I wouldn't be surprised if he's still low come morning, at least that's what he has been doing. I'm going to check his bg right before the shot just for curiosities sake, now that he ate. And Of course monitor tonight, and try to get the ketostix done.

Do I need to wait to do the Sub Q? I was going to do after insulin but realized it's the same area. Maybe wait an hour before the sub q.

Thank you for helping me through this.
 
R the sub Q fluids. I would wait until you half way through the cycle before giving the sub Q fluids as it can lower the BGs in some cats…but not all. And don’t give it in the same area as you give the insulin.
I am going to tag @Wendy&Neko re the amount of sub Q fluids to give at one time. I think 100 ml is enough at one time. (The vet tech told Jaymi 200ml Wendy.)

Re the morning dose…
are you going to be able to monitor the cycle?
Is he going to have access to food or will you be able to syringe feed him if needed?
If you can get a ketone test done before am dose that would be helpful
Let’s see how he goes with the 0.25 U dose overnight.
I may not be awake when the dose is due as it will be midnight or later for me and I have to get up early tomorrow morning but I can be around until about your +10.
 
I was only taught one place for the sub Q, make a tent between the shoulder blades, which is close to where we did the insulin. Halfway meaning wait 6hrs? I might have to miss it tonight, its 8pm already and I only have help (my mom is here for dinner) for like.. maybe an hour or two longer. But I don't want to mess up his insulin, it's being weird enough on it's own.

Yes I can monitor tonight. I'm supposed to curve tomorrow, probably will despite however the morning goes.
I'm keeping a watchful eye on him for going to the box, I will do my best. He hasn't drank much water today.
All good! Thank you for today/tonight. I'll likely make a new post in the morning and link to this one.
 
Can you give the insulin somewhere else?
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Morning! And good night Bron, haha. We are 133 AMPS, never caught him peeing last night unfortunately. But he ate a good amount of M/D kibble and I will get some wet food in him with extra water, and I think 0.5U for this morning. Ketone meter says arriving today, fingers crossed.
 
Bron and Sheba (GA) said:
He’s looking good on the 0.5 U dose today so far.
How is his appetite? Is he eating much on his own?
Let us know when you get a blood ketones result
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Oh Bron I could cry, I just did the blood ketone one and it came up 0.0, that's excellent right? I'm so happy for him. I want to test again but I only have 10 strips so I'm holding off unless you think I should. I don't mind using them.

We are at 73 +10. Food was picked up 90 mins ago. He eats when hungry, but I did syringe less than half a can of the M/D Into him around +7.5. Shot is about 2 hours away, was going to test in an hour and offer him as much kibble as he'll eat, then will syringe in more food. Numbers this low, I have no idea on dosage. He's been grazing like he usually does today. He will never be a wet food lover unfortunately.

Side note: I work mon-fri, so I'm off to work tomorrow early, shot should be around 715am and I'm at work by 8. I will be home on lunch (12:15pm) to check him. I'm scared of the work week since my lunch will be around or after nadir.
 
Bron and Sheba (GA) said:
He’s looking good on the 0.5 U dose today so far.
How is his appetite? Is he eating much on his own?
Let us know when you get a blood ketones result
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I messed up T_T PMPS was 74 and I got a good amount of food in him and he ate kibble before I did that, but I freaking measured wrong. I was certain I did 0.25U but then after I did it I looked at it again and I was off, I was on the line not between the line like I was supposed to. I checked it twice before I did it and still my brain didn't catch it. I'll be up tonight. I'm so upset with myself.
 
I’m sorry I have been out at an appointment and only just seeing this.
You will need to be monitor closely if you gave0.5u with a preshot of 74
I would get a +1 and a +2 to start with to see what he is doing and then we can go from there.
I would see if he will eat some md dry at +1 and a+2
Please keep in contact.
Great at no ketones!
Don’t bother wasting another strip to check. I’m sure it is correct. They are too expensive to waste
 
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Bron and Sheba (GA) said:
Greg at no ketones!
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Who's Greg?.....LOL

JaymiAndCharlie said:
I checked it twice before I did it and still my brain didn't catch it. I'll be up tonight. I'm so upset with myself.
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No reason to be upset with yourself. You've been run through the wringer in the past several days, you're tired (you're probably beyond tired) and might have made a mistake. Welcome to the human race....we all have times when our brain is in neutral. You are such a good mama for Charlie and I'm sure he appreciates it!
 
Bron and Sheba (GA) said:
I’m sorry I have been out at an appointment and only just seeing this.
You will need to be monitor closely if you gave0.5u with a preshot of 74
I would get a +1 and a +2 to start with to see what he is doing and then we can go from there.
I would see if he will eat some md dry at +1 and a+2
Please keep in contact.
Great at no ketones!
Don’t bother wasting another strip to check. I’m sure it is correct. They are too expensive to waste
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64 at +1, I syringed almost 10mL of just gravy because I don't wanna play this game
 
Chris & China (GA) said:
Who's Greg?.....LOL



No reason to be upset with yourself. You've been run through the wringer in the past several days, you're tired (you're probably beyond tired) and might have made a mistake. Welcome to the human race....we all have times when our brain is in neutral. You are such a good mama for Charlie and I'm sure he appreciates it!
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Hoping to survive this week, I slept almost all day yesterday and today between Charlie checks. My brain was SO SURE it was 0.25. Sigh. Triple checks it is. Thank you friend, he sure doesn't appreciate the pokes or the burrito life but I don't care :cat:
 
I'm sure you must be exhausted.
It is always harder in the beginning.
Don't worry if you made a mistake. We all have at some point.:bighug:
Get a +2 and I would get hourly tests for a few more hours to make sure he doesn't drop too low.
You can always rub some honey or karo on his gums if needed.
 
Bron and Sheba (GA) said:
Have you tested again Jaymi?
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I did not, I meant to come back and say that. I passed out at my computer. But he was good. He woke me up around then for cuddles.

This morning was weird/good. We were 110 AMPS, he ate a good amount of Kibble and then I syringed around half a can of wet food.. 40 mins later I tested right before shot and it was 84. I did a teeny dose because I had to go to work and I was nervous.
 
JaymiAndCharlie said:
Okay, 95 preshot. I feel like I should feed him soon, just not sure what. Was thinking the M/D since it has carbs and I don't want him to dip too low and it's ready to go anyways.

They definitely told me 200mL a day, bag says Normosol- R, PH 7.4. Tech instructed me to do them all at once.
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200 mL is too much for sub-q fluids and puts a tremendous strain on his heart. I would not do it. It's dangerous to give him that much fluid at one time. Has his heart even been checked. I would never give more than 100 mL at a time. There are a lot of authorities out there who say no more than 100 mL per day, but if you must to 200 then split it up at least to twice a day and don't ever give more fluid if the fluid "bump" where the fluids went in is still there or if the fluid has flowed down to the chest or down a leg or anything and is still there. You can feel around to see if he still has unabsorbed fluid.
 
Also, please check his resting respiratory rate. This is when he is resting and not purring. When he is sleeping is fine. It should be about 20 breaths per minute. Each rise and fall of the chest counts as one breath. Count for 30 seconds and then double it, that would be his resting respiratory rate. Or did you cut back to 100 mL already?
 
I agree with everything @Suzanne & Darcy has said about the subQ fluids and respiratory rate.
Suzanne what do you think about the dose moving forward?
History of DKA and poor appetite. Is syringe fed and eats a little dry. I’ve told Jaymi to feed whatever Charlie will eat for now.
No ketones showing at the last test, which is the first Jaymi has done at home.

Also Jaymi, did you ask the vet about ondansetron or some more cerenia? I think he still needs to be in some sort of antinausea medication. And I know you were using the last cerenia tablet.
Ondansetron is a better choice if you can get it. I think it is a priority that you get some more antinausea today.
 
Suzanne & Darcy said:
200 mL is too much for sub-q fluids and puts a tremendous strain on his heart. I would not do it. It's dangerous to give him that much fluid at one time. Has his heart even been checked. I would never give more than 100 mL at a time. There are a lot of authorities out there who say no more than 100 mL per day, but if you must to 200 then split it up at least to twice a day and don't ever give more fluid if the fluid "bump" where the fluids went in is still there or if the fluid has flowed down to the chest or down a leg or anything and is still there. You can feel around to see if he still has unabsorbed fluid.
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Thank you for the info. I did 100 in the afternoon yesterday and then the 100 later. I definitely don't want to give too much, he gets squirmy at 50.
 
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