Advice needed - give dose or not

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davidscat

davidscat

Member Since 2022
Snowy, my 11 year old, has been doing well on 2.5 U Vetsulin every 12 hours. Unfortunately, I have difficulties injecting which I thought were resolved but have returned. Between a tremor and anxiety, sometimes I can't do the injection despite trying for 30 minutes or more. Today I missed his morning's dose.

Today Snowy hasn't eaten much, he didn't get the AM injection, and so far as I can tell he hasn't been drinking much water. I'd guess he has eaten 3 to 4 oz of food in the last 12 hours, although he did eat over 6 oz of food in the prior 12 hours. I don't do BG testing as with my tremor I'm lucky to even be doing injections.

I know I'm flying blind WRT his BG, but based upon what I've described would someone suggest a course of action? I could go ahead and give his PM injection and I can apply an appetite stimulant if need be, or I can do nothing. FWIW, the closest ER vet is over 30 miles away. He is scheduled for an insulin curve tomorrow.
 
Hi David unfortunately I don't think any member would feel comfortable giving you any advice on a dose, I read your previous posts and know that you have a lot of anxiety and that your hand tremors .
I see other members have commented on your previous posts trying to give you some tips
I know it's hard but you need to be testing Snowy's BG both AM and PM and at least twice a day after the AM test and PM test.
Snowy could be dropping dangerously low.
With Vetsulin you need to feed first then wait 30 minutes before you give insulin
because vetsulin hits hard and fast

I also read Snowy doesn't get both doses sometimes
I can tag a few members for you but I don't think they can give you any advice

@FrostD

@tiffmaxee



@Suzanne & Darcy
 
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Meantime
If you can set up your signature that would be greatTo set up your signature which you will see is at the end of everyone's post in gray, click on your name up top and then tap on the word signature and add this information
  • Add info we need to help you:
    • Caregiver & kitty's name
    • DX: Date
    • Name of Insulin (do not include dose or frequency)
    • Name of your meter
    • Diet: "LC wet" or "dry food" or "combo"
    • Dosing: TR or SLGS or Custom (if applicable)
    • DKA or other recent health issue (if applicable)
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Be sure to click the 'Save Changes' button at the bottom. If you need help urgently it is important we know these things at a glance. We don’t want to waste valuable time finding out information.
 
Are you able to test for ketones? When I start seeing things that add up to ketones, I get nervous (missed doses, not home testing, not eating much - not a criticism, meant to be informational if you weren't aware of the factors that contribute to ketones/DKA).

Diane is right that I can't comment on dose at the moment.

But a few thoughts for you:
A Libre, even just for a two week span (if it lasts that long), would be immensely helpful to give you a clue what his BG is doing.

WRT to missing doses, with Vetsulin that can be very rough. The insulin itself can already be very harsh, but adding in missed/off-time doses does make it worse. My suggestion, if you can swing it, would be to switch to a depot insulin like Lantus. It is much more gentle, and a little more forgiving with missed/late doses. Most people are able to find its generics for the same cost/cheaper than Vetsulin. It is a U100 insulin though, so you'd need new syringes.

Do you have any curve results from the past you can share? The downside to curves at the vet is they are often higher due to stress, but also you run the chance of them bouncing. Bouncing happens when they drop lower and/or faster than they're used to (possibly because dose is too high), then the liver panics and dumps stored glycogen and counterregulatory hormones in order to spike BG back up. So they are high and flat for a few cycles, which can make it look like they need an increase (when in fact the dose may be too high). Again I realize youre limited in what you can do, but this is where the Libre would help you.
 
The only way we can help with dosing is to see a spreadsheet and tests. I wish I could but it’s impossible to predict without testing. Maybe you could get a friend or a vet tech to help you?
 
I appreciate all the advise. Let me state unequivocally that with my tremor there is no way I can perform home BG testing. To do so requires fine motor skills that I no longer possess. The Freestyle Libre is an option I suppose, my vet has mentioned it, but I don't think that the vet's practice has much experience with the Libre. I'd hate to have to reapply one every 14 days but I'll discuss it further with the vet.
 
Unfortunately the longest the Libre seem to work is 15 days. Maybe a high school student would want to earn a little money helping you out? We have even had an 8 and 13 year old brother and sister take care of their diabetic cat. You are in a tough situation. :bighug:
 
I wonder if the 14 days was established by the manufacturer for medical reasons; i.e., skin irritation and/or infections, rather than because of battery life.

FWIW, I ran into a gentleman at the vet's office who self-applied Libres to his ancient little dog and checked the dog's BG every hour. He said that he had encountered a number of units that didn't work.

The technology has come so far that hopefully, in the not too distant future, it'll be good for 30 days or more. I know of a girl , now a young teen, who was diagnosed as Type 1 as an infant, and for years it was finger sticks. Wearable BG measurement and insulin pumps have been life changing for her.
 
Even if the Libre isn’t perfect, it might be a great option for your cat so you can at least have a clue how the insulin is working. At least you wouldn’t be completely “shooting blind” and you could collect some valuable data.

You don’t have to keep a Libre applied non-stop — even just an experimenting with one once or twice might let you know whether it’s a good option for you given your inability to test with a handheld meter (which I completely understand).

Won’t hurt to try, and might help? Just something to consider…
 
davidscat said:
I wonder if the 14 days was established by the manufacturer for medical reasons; i.e., skin irritation and/or infections, rather than because of battery life.
Click to expand...
Besides battery life, the sensor is limited to how low the actual glucose sensing element will provide sufficiently accurate values.
https://www.diabetes.co.uk/forum/threads/freestyle-libre-why-does-it-last-14-days.157552/
The other major CGM is the DexcomG6. That sensor only lasts 10 days and uses a separate transmitter that is good for 3 months because of battery life. There are ways to restart the DexcomG6 sensor though
https://www.diabetesdaily.com/blog/...sor-goes-beyond-the-ten-day-hard-stop-580510/

Sems the actual sensing element is what control life.
 
I use libre 2. Sometimes mine last 14 days, some don't. I do a combination of blood and libre. I like the libre when I'm doing a curve or wanting to check in the middle of the night. Much easier. I find if you scan too much they stop working sooner. I do think it's a good option for him to try. A lot of vets aren't familiar with them. They are a newer technology for pets and the libre company will actually tell you that they are not approved for pets. I have talked to two vets and neither were familiar with them but they were willing to try and learn about them. You can get a discount on them if you sign up online, again don't say it's for a pet. I get mine at walmart under that program with no problems. Talk to your vet and see if they are willing to give it a try. I think it's worth a try in your case. If it doesn't work for you, it doesn't work but you never know unless you try. The libre 3 is now coming out and it looks great.
 
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