4 days on caninsulin-please review as vet visit tomorrow

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phlika29

phlika29

Member Since 2014
Hi all

I have been measuring BG levels and injecting canninsulin into my cat remi for the last four days. I have created a spreadsheet and linked it my signature (as an aside how do i make it so the whole link isnt displayed as it is taking up my allotted characters). I will be taking remi to the vets tomorrow for a blood glucose curve and it would be nice to have some points to discuss.

When i have reviewed the limited figures that I have collected and I can see that:
a) 1 unit sends remi into too hard a drop
b) the day and night curves appear differently
c) during the day remi's lunchtime meal sends remi back up the numbers yet the evening meals not so much so
d) the curve is quite sharp down and then back up

With his new wet food all of his meals are about the same size just spread over a number of times a day. He eats at dosing time and then about + 2/3 and +4/5
Remi is stil on a steroid EOD-1.25

So whilst I would really like remi to switch over to lantus -sp? for now I just want to get the best out of the caninsulin and try to get a dose that works for him. Does anyone have any observations and ideas of questions to ask the vet. He is very open

My main concerns are that on caninsulin remi will remain out of regulation for much of the time but if we up the dose we risk the deep lows we had on friday night. Is it better to hold on the lower dose and see how things settle?

Whilst I am able to monitors remi's BG in the evening neither me or my partner are here during the day (except quickly at lunchtime). I am the only one who is able to take the BG reading at the moment and so most lunchtimes it will just be a visual check.

Re the feeding to confirm if possible remi should have a larger meal when dosing and a relatively smaller snacks at lunctime and later on in the evening? today fall died away when he ate his lunchtime meal so maybe we gave him too much?

Sorry so many questions

Sarah and remi
 
I've added some more figures to his sheet. To my movie eye it looks like the 0.60 dose isn't getting us quite where we need to be with the figures today not quite so good as yesterday.

If anyone could have a peek and comment that would be great :-D
 
If you can test, the .8 looks like a better dose. But little scary to be more agressive if you won't be there. Yes, the pm dose seems to have a bigger wallop than during the day. You could give .8 during the day and .6 at night? Sometimes feeding small mini meals can flatten out the curve. If you can't be there, an automatic feeder could help. (set it to go off when you want to feed, every few hours and then move to an empty slot 2 hours before the preshot test.). I love my PetSafe 5 - easy, flexible setting, hard for a cat to break into.

It's hard when the insulin only lasts a few hours. You want him below the renal threshold (under 250-270)'as much as possible so his pancreas can heal. I'd push the vet to change the insulin.



To make it just say Remi's SS,

Put Remi's SS
 
HI Sara,

You're doing brilliantly with the home testing! Not experienced enough to give you advice about dosing. My vets did say that it takes a few days for a dose to settle on Caninsulin, and BJM advised that if Remi bounced after that low the other evening it could take several days to clear. I'm sure some experienced members will be able to give you more and better info.

WRT testing, you're already getting some info on Remi's pattern. The lowest values on the PM cycle are at +4. I'd be inclined to get a +3 and a +4 on some evening cycles to see whether the +3 might be lower than the +4.
 
Thanks for the advise. Remi is having a BG curve done today at the vets and because I already have info on the 0.6 dose I wonder whether I should dose him with 0.8 this morning so they can test that curve?

My only worry is as BJM mentioned that it can take a few days for remi to settle so we perhaps we might not be seeing quite how good he could get on 0.6. It just seems like a missed opportunity to test the 0.8.....
 
Hi Sarah, sorry I haven't followed anything here over the weekend but it looks as if you're making progress and certainly beginning to understand how insulin, in particular Caninsulin, works. I know you're anxious to see an improvement and get Remi into better numbers but I agree with others that you may need to give Caninsulin a bit longer to see more of what it is really able to to. Different feeding times, different food etc can impact on bg readings as well as different doses and other things too, so until you can see a definite pattern emerging it may be a little early to think about switching insulin.

What I would do is have a good chat with the vet about all you've learned here and see if you can come up with a plan between you. Vets do not often have specialist FD knowledge beyond what they are taught at college; in other words they are taught to do things by the book and may not have had access to the kind of collective experiences that people on this board can offer. Similarly, we are not vets here (although some members are medical types and very experienced and knowledgeable. So you need to combine both what you are learning here with what the vet is able to do (prescribe). Maybe refer your vet to this site - he/she will probably learn things. In any case, a good vet will listen to your concerns and what independent research you have done, and everyone can work together to get the very best result.

Good luck
Diana
 
Yes I am going to try to get the best out of the caninsulin. I think I will give a 0.8 dose this morning and let the vets monitor how remi doses.
 
Do remember that cats can run up to 100 points higher at the vet than at home. (noise, other animals, people who are not the mommy :mrgreen: ). I don't know if the vet curve will show you much and I'd be very cautious about changing the dose based on vet numbers. You'll probably find your curves at home are much more accurate.
 
How odd I did an update but it doesn't seem to have appeared. I seem to be having problems with the Internet. Writing this on my phone. Try to get the Internet going again but guess I have lost my post.
 
Great I didn't lose my post

Hi everyone

Remi survived the vet visit although I think he hurt his leg trying to escape for the cage before we left the house. He seems a little lame on one front leg.

Anyway the 0.6 dose that I gave on Saturday and Sunday didn't seem to bring the curve down low enough and so as suggested by sue I gave remi a 0.8 dose. When I saw the vet we discussed all the readings I had taken so far. He made a note of them and I had also sent my spreadsheet. We agreed to continue to work with the caninsulin with the aim of getting remi into remission. He explained why remi might have had such a large drop to begin with but hopefully as time goes on this won't happen as much.

I haven't got all the figures that the vet took today yet but basically his preshot was 24.4 and at the vets dropped to 21.4 and then down to 16.2 at +4 and then gradually increasing back to 24.1. My vet felt that this was a smooth response to the insulin but that the dose was not high enough.

He is aware of my desire to avoid the hypo range like the plague and therefore we agreed to continue with the 0.8 dose for the next few days and drop remi's steroid dose to 0.5 eod from 1.25. I will monitor remi at +4 to spot the nadir (and of course I will do the +2 and a variety of others).

How does that all sound?
 
The vet's suggestion sounds sensible. No-one wants to see that steep drop and ensuing anxiety again from the higher dose, and the curve in 0.8 units is certainly much gentler so it makes sense to stick with that in conjunction to lowering the steroid dose.
It really is a matter of trial and error until you start to see better results - there's no hurrying these things, they take as long as they take, but this is the way to do it.
 
Thankyou Diana . It is always reassuring to get feedback from people who are living through it.

I will try to update the spread sheet tonight and will continue to do so but I can already see that remi is perking up a little.

I do keep getting tiny air bubbles in my steroid dose and I read the various instructions and think I am doing it right but I can't be. I have tried tapping the syringe but that doesn't get rid of them. Should I be tapping the bottle? I push the plunger down the syringe before I put it in the bottle so no air is left in the syringe beforehand. Any thoughts?
 
Well, there are many more here more experienced than me, I'm just chipping in with some moral support because I know what a hard and lonely road this is. Hopefully others will be along soon with their thoughts, including what to do about air bubbles.
Keep smiling, you really are doing ok you know!
 
Thanks:).

I thought I was feeling more confident but have just taken a BG measurement off remi at +2 and it lower than I thought it would be at 13.1 (235.8). I have just given him so more of his wet food. Anything else I should do? Worried how much further it will drop yet the 0.6 didn't get him near where he needed to be.

Have updated the spreadsheet

Perhaps I shouldn't panic just yet...
 
What was his pre-shot number? 24? If so (or thereabouts) yes it is quite a drop but try not to panic. Some more wet food would be good, yes, it might delay a further drop too soon. If you are worried, test again in an hour but as you say, the 0.6 dose didn't do enough so hopefully the 0.8 will be a compromise between that and the 1 unit. Again, hopefully the 'technical team' will be along here soon...
 
Sorry just updated sheet further. His preshot number was 22.6 (406.8) . I was really hoping it was going to be around 15 again.

It amazes me the difference between such tiny shots.

Will test again at +4 so in about an hour. He has eaten quite a big bowl of food so hopefully that will help.
 
Try not to worry. There have been situations like this (on this board) before, where tiny differences in tiny doses make a surprising difference. Trial and error, as I said before. See what the others say...
 
I'd strongly suggest grabbing a +3, Sara, followed by a +4. He may get an earlier nadir. Also, if you don't feed him between now and just after the +4 (if that suits his schedule) you'll get a better idea of the significance of any rise you see in the +4 reading.

Will post more in a few mins.

ETA:

Just reread your earlier post. It didn't register with me on first read that Remi had eaten. (Danged PTSD :roll: )
 
PS just looked at your spreadsheet and seen that you're feeding all wet as of today (sorry if I missed that from another post). So the all-wet diet is making a difference, probably.
 
A few things could be influencing the lower +2 number from tonight's home test:

1. Absence of vet stress.
2. All wet low-carb food.
3. Remi's numbers look like his BG may run lower on the PM cycle. (I've read here many times that this is not uncommon).
4. Reduction of steroid dose.
 
Thanks you guys you are the best.

He was nearly on the all wet diet yesterday with literally just a couple of dry biscuits added to each meal but yes it could make a difference.

His +3 is 8.9 (160.2) . Not sure what this implies. I will retest again at +4 and not feed in between. What am I looking for at +4?

Many many thanks

Got to pop out to pick up my partner but will be back in 30 minutes
 
You're looking to see if Remi goes higher or lower. If higher, it could be a food spike. If lower, it starts to give you a stronger indication of when his typical nadir is likely - though not guaranteed - to be.
 
Oh dear I was so worried at warding off to low a reading I gave him a big bowl if food. The vet thought that + 4 would be his nadir. So say the nadir is at +4 and I gave him a food spike that you would see over this period his BG wouldn't drop again afterwards would it as it had already reached his nadar??

Sat in car waiting for my partner. The joy of smart phones :)
 
Yes, his nadir has been +4. The little bigger dose might push that a little later but he still has room to drop. We don't worry about any hypo possibilities till he is in the 50s. It is scary to see those first blues, but they are what you are aiming for. The food could give him a rise and it could drop a little again. Thrilled you are testing and can stay right on top of this.

If he drops lower than you are comfortable with, you can always feed a little of the gravy off gravied foods if you have some.
 
Sue

It is scary, especially when it's at night!

Anyway I've taken a +4 (and a bit) and it's come up 10.2 (183.6). So it seems the food might have affected it.I feel happy to go on to bed as even if it drops some more. Remi does always have a couple of smaller meals in the late evening but perhaps tomorrow I will hold my nerve and not give him a big meal if I see it dropping. Or maybe not...

I am a little concerned about tomorrow as I go to work soon after his dose. My partner is home all day but can't yet take BG readings. I guess we will have to go on observations alone. He will make sure he has enough food but it's a bit of a step into the dark :shock:

Many thanks to everyone yet again. Will update the spreadsheet.
 
Good job sneaking in the +4, Sara!

Tell your partner to keep an eye out for appetite upticks and maybe give Remi some food if he sees one.

Hope that by the time you read this you'll have had a good sleep. :smile:
 
Just to update. Remi seemed fine overnight and curled up under the covers with me.

He was back up to 22.5 mmol/l this morning so he got his 0.8 of caninsulin. My partner was left with a whole list of things to do and check.

Will carry on with the 0.8 dose for now. Remi has a lot of bruising on his ears from the BG measurements. The vet thinks this is because he is on steroids and bruises more easily. His ears are obviously tender. So for the next day I would like to really only so the most important BG readings to allow his ears to recover. If I want to make sure I catch a dangerously low nadir what time is it best to get a reading? The + 2 is confirming you have the shot. So maybe I could leave that one now? Is it risky to just do a +4? Or maybe a +3 might be an earlier catch but then how do you don't how much it falls afterwards.

Cheers

Sarah
 
Thanks for the suggestion. I had seen it mentioned before but this is not a product I am aware of. I guess you can probably get it in the uk. Is it the cream or ointment? I am hyper vigilant that remi doesn't like or eat anything that might be fatty or greasy and flair his pancreas so wouldn't want something he might lick and ingest. I guess I could rub it in well.
 
hi Sarah,

I checked a while ago and neosporin doesn't seem to be available in the UK. I believe vaseline helps with helping the blood to pool, but it doesn't contain pain relief. Hope things went well today when you were at work. x
 
SweetAngel said:
hi Sarah,

I checked a while ago and neosporin doesn't seem to be available in the UK. I believe vaseline helps with helping the blood to pool, but it doesn't contain pain relief. Hope things went well today when you were at work. x
Click to expand...
Hi

I kept phoning my partner and getting to to go check. He would just say yes Remi's asleep so I would then go and make him wake remi up. But he was fine. I have a feeling that the dose isn't high enough but going to hold steady and then reduce the steroid.

Re the Vaseline. I am just a little worried that remi might lick off the Vaseline! I a sure that the accu chek aviva BG monitor requires a lot of blood. Maybe I should have gone for something else but I was in a panick after the alpha trak didn't arrive. Do you know if some monitors require less blood.

I spoke to the royal veterinary college remission clinic and they sent me an email all about the trial. Trouble is remi is still on steroids and that excludes him. I am hoping to have him weaned off by the end of next week. It is making me anxious knowing that there maybe a better drug out there for him. I am still hoping that the caninsulin can get him there but i have my doubts.

Hope your angel still doing well. I looked her up on Facebook. She's a real cutie.
 
The accu chek aviva BG monitor requires 0.6 ul of blood while the AlphaTrak requires 0.3.
In the past I have used meters that required 3 ul and 1 ul.
 
phlika29 said:
Remi has a lot of bruising on his ears from the BG measurements. The vet thinks this is because he is on steroids and bruises more easily. His ears are obviously tender.
Click to expand...

This is actually normal when you're first learning how to test. Usually within the first month or so, the ears clear up as they "learn to bleed" and pretty soon, you won't even be able to tell that you test him.

I also haven't seen if anyone has share this Caninsulin Primer with you yet. It goes into some pretty great detail about using food to manipulate the cycle that you might find helpful.
 
Thanks Kpassa

Each day I learn more from this forum. I have updated my spreadsheet if anyone wants to take another peak. I don't think the level is quite high enough yet but as per guidance from here I am trying to find my patience pants and wait a few more days before increasing. Will be starting the lower steroid from now on.

Finally I am away from home Thursday evening. My mum can do the insulin shot but can't check his BG before. I will be home for a + 4 test. That should be okay shouldn't it? I will make sure she feeds him before the dose.
 
hi Sarah,

If Remi is definitely coming off steroids it's worth booking him in for the trial assessment, as you will have to wait a while for an appointment. re Thursday night if you're going to be back less than 3 hours after Remi's shot time, you could safely delay his pm shot.

Thanks for the comments about Angel, he is still doing great, fingers crossed. He is the sweetest boy, within a year he's lost his sister and his 2 companions, been diagnosed with diabetes, had his territory changed (I've had the garden re done) and now got a new baby brother and sister, kittens arrived a month ago. And he's still so loving.

x
 
Wow poor angel. She did go through a lot of change. I spoke to the trial co ordinator and unfortunately even if remi will be off the steroid he still won't be suitable because he has inhaled steroids for his asthma and thus this creates a difference with the other trial candidates :sad: It is very disappointing as she explained how well lantus worked.

I will be back just after the three hour window so I have decided to go ahead and get my mum to do it without a pre shot reading. Going on previous preshot reading he is back up into the 20 s. I will be home between the +3 and +4 and mum will check back in on him again in between. I was going yo measure out the syringe in the morning and put it in the fridge. This is okay to do isn't it? It makes me nervous but I have a hospital appointment in London and can't afford to lose the train fair.
 
I am not sure about Canninsulin, but most insulins are not supposed to be left in the syringe. Could you mark the syringe with a marker so your Mom could draw up to that amount? If not, then I am sure one time won't be a catastrophe.

Other UK users were able to get Lantus or PZI when they could "prove" that Canninsulin did not work well for their cat and produced sharp onsets and low nadirs and didn't last long enough. (Seems like a ridiculous system but guess it is how it works there.) So your spreadsheet over time should help your vet get you a milder, longer lasting insulin.
 
It is OK to pre fill syringes for a day or so with true insulins but not the insulin analogs like Lantus and Levemir (an Humalog which is not used in cats).
 
Sue and Oliver (GA) said:
I am not sure about Canninsulin, but most insulins are not supposed to be left in the syringe. Could you mark the syringe with a marker so your Mom could draw up to that amount? If not, then I am sure one time won't be a catastrophe.

Other UK users were able to get Lantus or PZI when they could "prove" that Canninsulin did not work well for their cat and produced sharp onsets and low nadirs and didn't last long enough. (Seems like a ridiculous system but guess it is how it works there.) So your spreadsheet over time should help your vet get you a milder, longer lasting insulin.
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Hi sue

As good as my mum is the measurements are so small I would be more worried if she did it herself. I am not leaving till gone 11am so I think will just do it at the last moment and put it back in the fridge.

Yes I think my spreadsheet will demonstrate that it doesn't keep him under control for long enough. Of course he is still at quite a low dose but still seems to respond quite dramatically to the insulin but come up quite quickly.
 
Larry and Kitties said:
It is OK to pre fill syringes for a day or so with true insulins but not the insulin analogs like Lantus and Levemir (an Humalog which is not used in cats).
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Thankyou. I have told my mum to gently roll the syringe in her fingers before she injects him. To only inject if he eats and not to rush if he isn't settled.
 
Hi Sara,

I'm sure you've done this already, but just in case it'd be a good idea to have the forum how-to for hypos printed out and all the stuff from your hypo kit laid out so your mum can find it easily.

I know this probably sounds like overkill, but it might be a good idea to show your mum how to post on the forum in case anyone here might be able to help if she's not sure about anything and she can't get hold of you (mobile signal problem, for example).

This is all belt 'n' braces stuff. I'm just a died-in-the-wool paranoiac. (Too many years as a project manager ...) :roll: :oops: :-D
 
Hi Aine

I've got the hypo info printed out on the fridge and have left my poor mum with a long list of things to do at specific times.

Looking at remi's spreadsheet I don't think the dose if quite up to where it needs to be but at the moment I am happy getting into a pattern with remi and understanding more about treating this condition before we go near the scary numbers again :shock:

As of tonight remi's steroid will be cut down in half to 0.5 eod.

As an aside does anyone know how it works if the steroid tipped him into being diabetic. Does that mean when it is stopped he will recover? Or is it not as easy as that :?
 
Hi Sara,

phlika29 said:
... at the moment I am happy getting into a pattern with Remi and understanding more about treating this condition before we go near the scary numbers again :shock:
Click to expand...

Know that feeling very well. Saoirse's numbers are better but I bottle almost as many doses as I administer now, especially on PM cycles because Saoirse runs low at night. Because I can't regulate my sleep I'm afraid I wouldn't be able to stay awake if she were to have a strong active PM cycle where the curve needed feeding. nailbite_smile That said, if she were still on Caninsulin, I would not be able to give her any insulin at all on her current numbers because the BG drops were so big compared to Lantus.
 
hi Sarah,

Such a shame Remi is not suitable for the trial. Try to persuade your vet to change him to Lantus. (more data you get from home testing the more ammunition you have).
I still have my hypo form pinned to the freezer even though Angel hasn't had insulin for a while, must put it in the 'cat drawer' and hope I will never need it again! Angel's insulin is Prozinc which isn't even available in uk yet apart from this trial. It's nice to know he's doing something that will help other diabetic cats in the future.
x
 
Critter Mom said:
Hi Sara,

Just checking in to see how things went for your mum and Remi last night.
Click to expand...

Mum did really well. She fed him, left it for 20 minutes and then injected him. She decided to stay around my house for the evening so he came and sat on her lap most of the time she was there. She was then able to give him the small amount of food about an hour and a half later. She only left him when I got home. I tested his BG and it showed she had injected him fine. Really pleased how it went overall. Remi's levels still aren't going low enough and I think I am going to have to bite the bullet son and up the dose :o
 
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