02/12 Riley AMPS 576

[Really Riley (GA)]

Riley and I were on this forum previously. A new vet said I must use Vetsulin because she had never had success with anything else and my use of a glargine insulin was why Riley's numbers were high. We switched to Vetsulin February 2, but by February 9 Riley's numbers had been too high for too long, and since he has kidney problems, I was really worried. I started using the glargine (Basaglar) again and his numbers dropped immediately. Right now it looks like it might be time for an increase. Can someone give me advice on this?

I corresponded with MrWorfMen's Mom on the Vetsulin forum and she was really helpful and supportive, but now that Riley is back on Basaglar she asked me to post questions here.

Thanks for any help you can give,
Cindy

 

[Kris & Teasel]

Glad you came here so quickly!

 

[Really Riley (GA)]

Should have also given you credit in my thread because you were there when MrWorfMen's Mom was busy. Did I include enough info? It takes a long time to get a response on this forum because it's so huge.

 

[Wendy&Neko]

Responses will be slower here if people have less information to work with. First question people will ask is what dosing method you would like to follow. Is Riley eating much of the Proplan? Is it wet or dry food? I think it’s fairly high carbs.

Next, we determine how to dose the depot insulins based on how low the dose takes the cat. Those low points are in the middle of the cycle. I see you have mid cycle checks most of the cycles, so that is good. Is there any reason you started back at 3.0 units? His numbers were better on a higher dose last time, but I don’t know if the food mix is the same as before.

 

[Really Riley (GA)]

I am so sorry that I had the name of the food wrong - it has been changed in the signature - Pro Plan Focus, not Plus. It is Turkey&Giblets flavor, canned. I found it on Dr. Pierson's chart when looking for something both lower in carbs and phosphorus. Carb percent is 4.

I am not sure what dosing method would be appropriate for his situation. I once thought SLGS was the best way to go and that if I found the proper dose he could some day be OTJ, but I moved too quickly through the dosing, not doing enough testing, and perhaps should not have ended up as high as 6 units.

I chose 3 units because I did not want to start him as low as .25 - did that once before. I didn't go back to 6 units because I have had two vets tell me that the dose he was on was too high, so I didn't want to jump right back to that dose. I have also had people tell me that I probably missed the correct dose for him by not doing enough testing and there is a possibility that 6 units is too high. 3 was a guess, and it did bring his BG down. Was it too high? Does it need to be increased .25 or .5?

Regarding his current diet, the items listed on the signature are the things he eats most often. Sometimes I give him Friskies pate Liver&Chicken because he will eat that when he is eating nothing else.. It is 5% carbs according to Dr. Pierson's chart.. For some reason though, it increases his BG.

 

[Wendy&Neko]

Ok, with all low carb, under 10%, you could choose either SLGS or TR for dosing. TR does require a bit more testing, but you are almost there. What you do next on dose depends on dosing method.

As for size of dose, there is no such thing as too high s dose. A cat needs however much insulin they need. My Neko had two secondary endocrine conditions that we call “high” dose conditions here, though not all cats with these conditions get to high dose. My girl maxed out at 8.75 units, but we have had kitties on over 80 units. No, that is not a typo. We usually suggest that when a cat gets to six units, they get tested for those conditions, called acromegaly and IAA or insulin auto antibodies. They are blood draws sent to Michigan State University. One in four diabetic cats has acromegaly.

His numbers did look better on 6 units in general, but you didn’t do enough testing around nadirs to say if it was too much insulin or too little. I am a little worried about the low numbers you got on lower doses of Vetsulin. Typically the insulin dose between different insulins isn’t that far apart. Did anything else change between the first time on Lantus and Vetsulin? For now, maybe hold the dose a couple more cycles and try to gather preshot and mid cycle tests so we can determine if it’s too much or too little insulin, then post again here for help.