AMPS (503) No morning dose given as to fix schedule, PMPS (382) - Decrease Vetsulin to 1 unit?

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Erica & Carter

Erica & Carter

Member Since 2016
Hi all,

Went ahead and skipped this morning dose from advise from others to get him back on a better schedule that works better with my work schedule. 7:15am/7:15pm.

His BG has dropped from 503 this morning, to 382 about 11 hours later WITHOUT any insulin. Ate twice at 7am + noon. Given that is a pretty big drop to have not had a dose, I'm opting to give him only 1 unit of insulin in about an hour.

Does that sound okay?

Given that I probably should have given 2 to air on the side of safety last night when he was in the 400s, 1 unit seems more appropriate now that he's in the upper levels of the 300s. Then I was going to test again at +3 to make sure all is ok.

Definitely switching to the canned food diet is creating some sort of control in the diabetes, perhaps even more than the Vetsulin... happy I'll be able to switch to Lantus here in the next week or two.

He's just about to eat (which usually takes around 30ish minutes) so I'm about to shoot here in an hour if anyone can confirm/deny my if my intuition is correct in the next hour for peace of mind that would be awesome.

**Separately: which brand of Nature's Variety (Instinct) free dried are the low carb ones/good for treat use?
 
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Here's your previous post...we like to have the previous post link in the new one so it's easy to go back and see what's been going on

1 unit sounds like a good idea considering you're starting lower and have also lowered the carbs in his diet

Hopefully you'll have a good night and not end up staying up all night
 
Chris & China said:
Here's your previous post...we like to have the previous post link in the new one so it's easy to go back and see what's been going on

1 unit sounds like a good idea considering you're starting lower and have also lowered the carbs in his diet

Hopefully you'll have a good night and not end up staying up all night
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How do I link posts? The same way I would put a link in my signature?

I post a lot from my phone so I'm not sure if I just can't see the "link" option.

And okay I'm about to shoot with 1 unit then! :)
 
Update: +3 @331

Didn't drop as much as I'd still expected but I'm glad I did 1 unit o be safe, it could still drop a little more in the next 3 hours but hopefully at least into the mid 200s. He is eating 1/4 can of food before bed too because I've decided to do the 4x daily feedings to the best of my ability unless my schedule says otherwise.

If it's back in the 500s in the morning should I do the 3 units? or 2 units to be safe? I do have to work but I'll be back 4 hours after first shot.
If it's around the 300s should I do the 1 unit again?
 
Since I've never used Vetsulin, I'm not really comfortable giving you dosing advice

I do know that a lot of times you can develop a "sliding scale" using Vetsulin (which we don't do with longer insulins) so if the Pre-shot is X, you give Y but without knowing more about your insulin, I'm not the one to guide you

Let's tag @Squalliesmom , @Critter Mom , @BJM , @Sue and Oliver (GA) ....I think they'd be better suited to help you with dosing as long as you're using Vetsulin

One thing I'm never afraid to admit...and that's when I'm out of my league. I'd never want to be responsible for giving bad advice that might hurt your sweet Carter. I can advise you on what to do if he's too low, and probably how much NOT to give, but as for this, let's see if we can get some other eyes watching you
 
Will check in tomorrow (in UK - need to try for some sleep). Hopefully Lucy might have posted as well by then.

You've not got any potential carryover from a previous dose influencing tonight's cycle. I'll be very interested to see whether the AM preshot is out of the black range. Re dosing, I always suggest erring on the side of caution (doubly so with Vetsulin).

Later,


Mogs
.
 
Like Chris, I am never comfortable giving dosing advice. I would never want to put somebody's precious kitty at risk! I am doubly reluctant in this case, as there isn't much information in Carter's spreadsheet for me to draw on. Having said that, though, I think you would probably be safe to give 2 units in the morning if Carter's AMPS is still in the 400-500s. What was his biggest drop, on how many units, and at what part of the cycle?
 
Critter Mom said:
Will check in tomorrow (in UK - need to try for some sleep). Hopefully Lucy might have posted as well by then.

You've not got any potential carryover from a previous dose influencing tonight's cycle. I'll be very interested to see whether the AM preshot is out of the black range. Re dosing, I always suggest erring on the side of caution (doubly so with Vetsulin).

Later,


Mogs
.
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Nope, still in the blackrange at 580. :(
 
Squalliesmom said:
Like Chris, I am never comfortable giving dosing advice. I would never want to put somebody's precious kitty at risk! I am doubly reluctant in this case, as there isn't much information in Carter's spreadsheet for me to draw on. Having said that, though, I think you would probably be safe to give 2 units in the morning if Carter's AMPS is still in the 400-500s. What was his biggest drop, on how many units, and at what part of the cycle?
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It was 580 this morning. I will give the 2 units. No vets around here are open on the weekend so it's hard to get confirmation otherwise.

I'll be back from work in 5 hour so I'll test him again, see what that two units gave me.

If it's not the much of a drop, maybe the food change has done it's job in dropping his BG and now it's up to the insulin again?

His highest drop was from his AMPS at 580 to +5 127 mid-day. That was right after his food change though and 4 units.
 
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Erica & Carter said:
It was 580 this morning. I will give the 2 units. No vets around here are open on the weekend so it's hard to get confirmation otherwise.

I'll be back from work in 5 hour so I'll test him again, see what that two units gave me.

If it's not the much of a drop, maybe the food change has done it's job in dropping his BG and now it's up to the insulin again?

His highest drop was from his AMPS at 580 to +5 127 mid-day. That was right after his food change though and 4 units.
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You should be okay with two units today. You may have to further adjust his dose, or tweak it a bit, but he should be safe at 2 today. If in doubt, always go with a lower number! You can always give him 1 unit again!

Maybe someone else will weigh in here, too?
 
One thing to note is that Vetsulin often hits its nadir in the +3 to +4 range for the shorter acting portion (it is 2 duration insulins combined). That means +5 may not be his lowest value; it could be earlier.

At some point, if you could do a curve - serial tests every 2 hours - you could get a rough sense of how Vetsulin works in him. Nadirs can fluctuate some, too, so a nadir time one day may be somewhat different the next

That drop of 453 mg/dL on 4 units is pretty large and may not have been his nadir. I'm glad you backed off some while you are adjusting his food. You mentioned adjusting his food, and meal timing and both of those play into how the Vetsulin works. The guide suggests feeding, then waiting before you shoot to help buffer the steep drop. Feeding a touch more about +2 may further buffer the steep drop. Then, as the Vetsulin action begins to reduce, you want to avoid feeding (or feeding as close to straight protein as possible) so the glucose doesn't shoot way up by the next pre-shot test.
 
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BJM said:
One thing to note is that Vetsulin often hits its nadir in the +3 to +4 range for the shorter acting portion (it is 2 duration insulins combined). That means +5 may not be his lowest value; it could be earlier.
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This is my worry also. Indeed, Saoirse occasionally had nadirs as early as +1.5 or +2.


Mogs
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Thank you all for the information.

I will do a curve on him on Monday as I'm home all day tomorrow.

I have a general idea on how to proceed with the curve but if anyone could provide some brief instructions, from start to finish, that would be great.

Also my current schedule right now is as follows, please let me know if I need to tweak it especially regarding my feeding.

6:30am: AMPS
6:35: breakfast food
7:15am: insulin
12:15pm: +5 test
12:30pm: lunch food
6:30pm: PMPS
6:35pm: dinner food
7:15pm: insulin
10:15pm: +3 test
10:30: late dinner
Then if all being well I usually go to bed around 11:00pm.

I've tried to space out the meals to 4x a day but The reason there is about a 6 hour gap in the day is the time where I usually go run errands, walk my dog, sometimes I'm called into work during those hours, etc.

I'd ideally like to get him settled on one brand of food but right now we're still trying 3-4 to see which he likes best. He has eaten all of his food the past two meals without any water being added or me sitting with him, so I'm happy about that.

Also I am going to buy a Relion Confirm today +strips. How do I make an additional page with a human meter? And should I start testing using that right away?
 
Squalliesmom said:
Hi Erica, how is Carter doing t his evening?
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Hi,

His +5 today was 127, and his PMPS is 205.

I'm about to feed him dinner.

With it being at 205 I'm assuming I shouldn't shoot correct? He would be due for insulin in about 45 minutes but I'm leaning towards holding off because he dropped from 500s to 127 in 5 hours already today on 2 units.
 
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Erica & Carter said:
Hi,

His +5 today was 127, and his PMPS is 205.

I'm about to feed him dinner.

With it being at 205 I'm assuming I shouldn't shoot correct? He would be due for insulin in about 45 minutes but I'm leaning towards holding off because he dropped from 500s to 127 in 5 hours already today on 2 units.
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I would give it a miss tonight, if he was my kitty. That's just my opinion, but someone else may weigh in with a different suggestion. :)
 
Squalliesmom said:
I would give it a miss tonight, if he was my kitty. That's just my opinion, but someone else may weigh in with a different suggestion. :)
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I'd feel more comfortable missing too. He dropped so much with only 2 units this morning that I think even 1 unit would put him below close or below 100 at +3.

I can't wait to switch to Lantus. The more I've learned about Vetsulin the more nervous it makes me and he has constantly gone from lows to back up in the 500s every morning.
 
I would not risk him dropping even on 1 unit, especially at night when you are unable to monitor constantly. Also, many cats have a tendency to drop lower at night just as a matter of course.

I think you will be happier with Lantus. It has it's scary moments, too, but not like Vetsulin. :)
 
Maybe stall another 30 minutes and re-test. If he starts rising up to a safe to shoot number well over 200 mg/dL, may give just 0.5 units. Some of the high numbers you're seeing could be bouncing.
Bouncing happens when the glucose drops quickly, and/or drops to an unfamiliar number, and/or drops too low. Compensatory hormones release stored glucose (glycogen) and boost the glucose back up.
 
BJM said:
Maybe stall another 30 minutes and re-test. If he starts rising up to a safe to shoot number well over 200 mg/dL, may give just 0.5 units. Some of the high numbers you're seeing could be bouncing.
Bouncing happens when the glucose drops quickly, and/or drops to an unfamiliar number, and/or drops too low. Compensatory hormones release stored glucose (glycogen) and boost the glucose back up.
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I had already fed him though after his PMPS so will that not give a false number sort of in regards to his BG?
 
Squalliesmom said:
I would not risk him dropping even on 1 unit, especially at night when you are unable to monitor constantly. Also, many cats have a tendency to drop lower at night just as a matter of course.

I think you will be happier with Lantus. It has it's scary moments, too, but not like Vetsulin. :)
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Yeah and I work a difficult shift tomorrow so I have to get some sleep or I'll crash. I'm anemic so I'm constantly tired anyways but I don't want to be super tired AND worried if I can avoid it.

I'm curious to how much he is dropping at night because he is always back in the 500s by the AM.

If he does not get insulin in the PM should I not feed him before bed but due one more BG test?
 
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You've decided to skip, so go ahead and feed him.
In the morning, when he may be really high, if he is, you might drop the dose by 0.5 units.

(And, there are several kinds of anemia. Does your doc have you on anything? I lived with anemia for years and it sucks to be so tired all the time.)
 
BJM said:
You've decided to skip, so go ahead and feed him.
In the morning, when he may be really high, if he is, you might drop the dose by 0.5 units.

(And, there are several kinds of anemia. Does your doc have you on anything? I lived with anemia for years and it sucks to be so tired all the time.)
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Technically the dose he's on is 3 per the vet but I've been living on the side of caution of 1-2 units this weekend because of his drops and lower PMPS. So when you say drop the dose should I give 2.5? 1.5 units? Or .5 units? Do I just eyeball it since my syringes don't have half units?

I fed him is regular dinner but I usually feed him a small amount before bed too after the last BG. I'm about to do his BG once more but he isn't super interested in eating right now more interested in playing with my other cats.

I'm not sure. I don't have insurance in America only in Canada. I just general iron supplements right now but I probably need something else tbh. I was hospitalized several times when I was a baby/toddler/child from bottoming out during an anemic spell. I'm not the epidemy of health lol
 
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I think you might go down to 1.5 units with monitoring for ketones (see my signature link Secondary Monitoring Tools for tips). Either he'll show he needs to go back up (increased appetite, thirst, and urination), or perhaps he will bounce less and not swing so high. Either way, you get to sleep tonight. Most of us just eyeball quarter units. Alternatively, some use calipers, or firm ruler with tiny increments to line up the dose.

For anemia, some of the most common causes for women are nutritional deficiencies such as iron, Vitamin C, and B vitamin complex. You really need good intakes of all 3 of those nutrients to make blood cells. One of the more absorbable iron types is ferrous gluconate (ex Fergon).
 
If you want to give a dose like 1.5, take an old syringe and pull up a "sample" dose of whatever you're going to call 1.5u....what's important is that the dose is consistent, not that it's exactly 1.5

A lot of us will use colored liquid of some sort, like coffee, tea, koolaid or water with food dye and then we have a sample to compare to when we're dealing with the real thing
 
BJM said:
I think you might go down to 1.5 units with monitoring for ketones (see my signature link Secondary Monitoring Tools for tips). Either he'll show he needs to go back up (increased appetite, thirst, and urination), or perhaps he will bounce less and not swing so high. Either way, you get to sleep tonight. Most of us just eyeball quarter units. Alternatively, some use calipers, or firm ruler with tiny increments to line up the dose.

For anemia, some of the most common causes for women are nutritional deficiencies such as iron, Vitamin C, and B vitamin complex. You really need good intakes of all 3 of those nutrients to make blood cells. One of the more absorbable iron types is ferrous gluconate (ex Fergon).
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He was 168 this morning with no dose last night and no late food. Should I shoot this morning? I have to shoot him in 35 minutes if I do, or else I have to go to work. My spouse will be home so should I give her alternate instructions?

Thanks for the vitamin tips!
 
Definitely do not give Carter his shot if he is under 200. If he comes up over 200 and you plan to shoot, please make sure it is a very-reduced, small dose!
 
Much better AMPS. Bounce-free by the look of it. What do you think, Lucy? (@Squalliesmom) Previous doses too high and causing bounces into black, perhaps?

@Erica & Carter - good to see improvement in the PU/PD symptoms with the better numbers you're getting now. :) I hope you can get some mid-cycle tests today to see how Carter does.


Mogs
.
 
Okay so to recap he was 168 at AMPS. I went to work so I told my wife to wait 30 more minutes after he already ate and do a BG again to see if he went up significantly. He went up to the 400s so I told her to give him 1unit.

She kept an eye on him and just did an+5 and he was 148. She the fed him 1/4 can.

I'll be home to do his PMPS.
 
Erica & Carter said:
Okay so to recap he was 168 at AMPS. I went to work so I told my wife to wait 30 more minutes after he already ate and do a BG again to see if he went up significantly. He went up to the 400s so I told her to give him 1unit.

She kept an eye on him and just did an+5 and he was 148. She the fed him 1/4 can.

I'll be home to do his PMPS.
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Next time please wait to feed him until you have that next test result. You don't want to be operating under a false sense of security because of a food-influenced rise in BG! He will probably be okay with the 1 unit today, just remember for future reference: test, stall if need be and re-test, feed, shoot. :):):)

I would recommend checking his BG a time or two between now and his PMPS, just to get an idea of how he's handling the insulin. :cat:
 
Critter Mom said:
Much better AMPS. Bounce-free by the look of it. What do you think, Lucy? (@Squalliesmom) Previous doses too high and causing bounces into black, perhaps?

@Erica & Carter - good to see improvement in the PU/PD symptoms with the better numbers you're getting now. :) I hope you can get some mid-cycle tests today to see how Carter does.


Mogs
.
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@Critter Mom Yes, Moggy, I definitely agree. His final BG this AM was food influenced, so it's hard to try and estimate what will be a safe dose for him, but he seems to be fairly insulin-sensitive so I would suggest keeping it low for the time being. Easier to increase his dose than deal with a hypo! :cat:
 
Squalliesmom said:
@Critter Mom Yes, Moggy, I definitely agree. His final BG this AM was food influenced, so it's hard to try and estimate what will be a safe dose for him, but he seems to be fairly insulin-sensitive so I would suggest keeping it low for the time being. Easier to increase his dose than deal with a hypo! :cat:
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Ohhh okay I gotcha.

So if I ever have to stall should 30 minute be enough time? Or should it be like an hour?

Also if he stays where he has been at today, safe to skip PM dose? I think even .5 of a unit would be too much with how low he has been today.

Also I have been getting a +5 usually and then giving him a bit of lunch and then the test isn't usually until his PMPS. Mainly because I'm often out of the house between like 1-5. Is it okay to feed him after the +5 or am I feeing him right when the insulin is doing it's thing?

If my wife just did his +5 when would be an appropriate time to test again? Maybe +8?

Anddd finally I wanted to do a curve on him but the only day I know Ill be home all day is Wednesday. I just got the Relion Confirm so I will be using that. Is there a way to make an spreadsheet for this new meter but where you could still see the data from the AT2?

Sorry for all the questions!!
 
Erica & Carter said:
Is there a way to make an spreadsheet for this new meter but where you could still see the data from the AT2?
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You can either just put a distinct line on the current one and have it say something like HUMAN METER or start a new spreadsheet with the human numbers and put the few numbers you have now onto it with a line saying "Alpha Trak"....if you started a new one, it would be formatted correctly for human meters

If you look at China's spreadsheet for 3/24, you'll see what I mean by a "line" (where she had her dental)...you'd just want that to go all the way across the spreadsheet

Glad to see you shot tonight....looks like he's bouncing pretty well from his visit to the blues today!
cat1.gif


Have you ordered the Lantus? I think he'll do much better on that
 
Chris & China said:
You can either just put a distinct line on the current one and have it say something like HUMAN METER or start a new spreadsheet with the human numbers and put the few numbers you have now onto it with a line saying "Alpha Trak"....if you started a new one, it would be formatted correctly for human meters

If you look at China's spreadsheet for 3/24, you'll see what I mean by a "line" (where she had her dental)...you'd just want that to go all the way across the spreadsheet

Glad to see you shot tonight....looks like he's bouncing pretty well from his visit to the blues today!
cat1.gif


Have you ordered the Lantus? I think he'll do much better on that
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Would you advise feeding after his +3 tonight or not? I'm afraid my feeding schedule is interfering with allowing the insulin to do it's thing at key points of time but I'm trying to fit 4x feedings a day successfully...

I think so too. Vetsulin is making me so nervous, I don't even want to think about what would have happened if I hadn't found this site. Probably still on dry food, just blindly shooting him with his starting dose. Ugh, no good. Vet said it was good to home test and encouraged me to buy the AT2 but she never mentioned how many times a day, what time a day, before/after shot etc, all stuff I would have been without knowledge of if I hadn't done my own research.

I start using my Relion tomorrow, yay! I even bought a big kit so I can keep all of Carter's stuff organized where we do his shots next to our sharps bin.

I have not ordered yet. I am calling my vet tomorrow to get her to write the prescription and then picking it up on Tuesday so I can purchase the Lantus.
 
BJM said:
If you get Lantus from Mark's Marine, it will be much less costly than here in the US. Your vet can fax the Rx to them.
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Yeah that's where I was going to order it from. :)

If I submit a request to Mark's will they just fax them a request for a RX or do they need the vet to fax them first?

I was worried about my vet being skeptical about ordering from a Canadian pharmacy so I was just going to tell her I'm ordering the Lantus solostar pens online and need the perscription and then just email it to them lol

I could probably also say I'm familiar with the pharmacy since it's located in my home city.
 
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Erica & Carter said:
If I submit a request to Mark's will they just fax them a request for a RX or do they need the vet to fax them first?
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You can email the script directly to Marks...or if you have a fax machine, you can fax it to them....what I did was just call my vet and say "I need to get China's lantus refilled...will you please fax a script to the pharmacy at 800-xxx-xxxx"....and they did!

I never mentioned that they were in Canada
 
Erica & Carter said:
Would you advise feeding after his +3 tonight or not? I'm afraid my feeding schedule is interfering with allowing the insulin to do it's thing at key points of time but I'm trying to fit 4x feedings a day successfully...
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It should be fine to feed at +3.....it's actually easier on the pancreas to deal with small meals than big ones anyway, so it'll be better on Carter if you can feed several times per day

The only time it's really important that they don't have food is for the 2 hours immediately prior to Pre-shot tests so that test isn't influenced by food....after that, it's one of those ECID things...some cats do better if they get all their food before nadir so that as the insulin is starting to naturally wear off, you're not adding carbs, but some cats can eat all the way up to +10 without any problem
 
Erica & Carter said:
Yeah that's where I was going to order it from. :)

If I submit a request to Mark's will they just fax them a request for a RX or do they need the vet to fax them first?

I was worried about my vet being skeptical about ordering from a Canadian pharmacy so I was just going to tell her I'm ordering the Lantus solostar pens online and need the perscription and then just email it to them lol

I could probably also say I'm familiar with the pharmacy since it's located in my home city.
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If you get the written script from your vet, you can scan it and email it to them...it was a super easy process when I did it last year.
 
Chris & China said:
You can email the script directly to Marks...or if you have a fax machine, you can fax it to them....what I did was just call my vet and say "I need to get China's lantus refilled...will you please fax a script to the pharmacy at 800-xxx-xxxx"....and they did!

I never mentioned that they were in Canada
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Gotcha.

Do you submit the order and then they just hold it until they recieve the perscription?

Do I need to specify to my vet I want the 5 pack solostar pens?
 
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Chris & China said:
It should be fine to feed at +3.....it's actually easier on the pancreas to deal with small meals than big ones anyway, so it'll be better on Carter if you can feed several times per day

The only time it's really important that they don't have food is for the 2 hours immediately prior to Pre-shot tests so that test isn't influenced by food....after that, it's one of those ECID things...some cats do better if they get all their food before nadir so that as the insulin is starting to naturally wear off, you're not adding carbs, but some cats can eat all the way up to +10 without any problem
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Okay good.

I always feed after AMPS around 6:30amish, then at noonish (after +5) and then dinner after PMPS, and then that small meal at +3. My main concern was feeding around noonish after the +5, if by feeding around then I am bringing his BG up when the Vetsulin is trying to work.
 
Erica & Carter said:
Do you submit the order and then they just hold it until they recieve the perscription?

Do I need to specify to my vet I want the 5 pack solostar pens?
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They can't dispense it until they receive the script....just email or have your vet call/fax it in and then contact them to make arrangements for payment

It doesn't matter with Marks since insulin is OTC in Canada...if he writes it for the vial, just tell them you're rather have the pens and the pharmacist can change it for you. I've heard of others that had the script for a vial and asked for pens instead and had no trouble from Marks....they really are great people there!!
 
Chris & China said:
They can't dispense it until they receive the script....just email or have your vet call/fax it in and then contact them to make arrangements for payment

It doesn't matter with Marks since insulin is OTC in Canada...if he writes it for the vial, just tell them you're rather have the pens and the pharmacist can change it for you. I've heard of others that had the script for a vial and asked for pens instead and had no trouble from Marks....they really are great people there!!
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Oh okay, I just didn't know if it's like other online order sites where you submit the order, and then they hold the order, wait for the prescription, then send it. Or if I had to have the prescription sent in before I submitted the order and then they just put two and two together.

I'll probably just call my vet and give them the number to fax it and go that route instead of explaining it's in Canada etc.
 
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