? Assistance with Vetsulin Needed - ? too high a dose

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Jennie, before your bed time I'd like your advice. How much insulin do you recommended? In case Yellow, Pink, or Black.
Nederland said:
Kako, maybe if you could test again soon, and see if he rises, he could have his little meal? I feel so sorry for him, he must be hungry ...

But he's doing great, really, I'm very happy he is showing such good numbers.
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OK, will do! :) And before your bed time, I'd like your advice in insulin dose for tonight.
In case PMPS is Black, Red, Pink, Yellow, or Blue.
 
+7 is 274! Maybe should shoot for +8 but Tux is hungry. I fed him.
I end test here (until PMPS).
 
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You can give him his little meal now. Otherwise it will be too close to his important meal at the next shot and he will not be hungry enough.

In these cases we advise to test the pre shot level for the time being. You are already doing that, so please continue to do that.
I still seems that the second peak is working well, I don't think the low point is at +7 (that would be strange with caninsulin), it could be that the second peak is a little wobbly. Another good possibility is that the pancreas started to help out, which would be wonderful, but it also complicates the decision what the dose should be. So I'm going to think.

An additional problem is that you use the Alphatrak, which gives other numbers than the human meters. I'm used to reading 'human' numbers and acting upon them. I will have to be extra careful, because Alfatrak numbers are higher than human meter numbers and there is no formula to calculate an alphatrak number to a human meter number.... I have sheets of a cat named menace (on this forum) whose owner has both meters and the differences are enormous, it's really scary for me ... So I really have to be very very careful. Maybe too careful, but I won't take any risks.

Greens: no insulin (that's the easy one)
Blue: one drop (that's insulin up to the zero-line on the syringe, not more)
Yellow 200-250: two drops (just a little more than 1 drop)
Yellow 250-300: 0.25 unit
Pink: 0.5 unit
Red: 1 unit
Black: 1.5 unit

And now I'm going to beg you to buy a human meter, e.g. the Relion at Walmart .... I have sweaty palms now. You see, the sheet of Menace that I used to guess what the levels on a human meter would say, has 419 on the Alphatrak and at the same time 272 on the human meter .... or 325 on Alphatrak and 227 on a human meter. Those are huge differences and I'm used to the lower human meter levels ... If I see a 419 I think 'far too high, it requires a high dose'. But if that is in fact a 272 that I'm used to, I would advise a far lower dose ...

So this was really scary, making the list for this meter. If you feel the advised dose is too high, shoot less. Better safe than sorry. Really, I wouldn't mind. But whatever you do, don't shoot more.
 
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Thank you Jennie. I now know that I can give insulin starting with one drop.
I am not changing meter because it would be confusing. I am sorry... if you are scared, I will try to do my own following knowledge I am given on this board.
Again, Thank you Jennie for everything you've done for me and Tux. :)
 
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I can fully understand that you wouldn't want to change the meter, considering I'll be online for only 4 more days now ... I hope the people on this forum have more experience with reading Alphatrak levels. Confusing, yes, it could be, surely in het beginning, but you would get used to it. But anyhow, it's not necessary to change if the people here can understand those levels and can work with them.

I'll check your topic every day, the coming days, to see if I can assist in anything else.

What I would like to say is what we aim for. Of course remission, but if that won't be the case: we aim at a level between 108 and 145 at the low point on a human meter. That is a safe low point, because you need a safety margin in case the insulin works really well suddenly. There is some room then before we start to take action to prevent a hypo. We start feeding the cat to prevent a hypo at a level of 72 or lower on a human meter.
If the low point is anywhere between 72 and 108 on a human meter, we lower the dose a bit. Is it close to 72, mostly the next dose will be 0.25 lower. Is it close to 108 and the cat is usually very stable around the low point, we'll check a next low point and then make an adjustment or not (depending on the level of the next test).
It is also a matter of 'know your cat' and you get to know your cat by testing.
I hope someone can convert those numbers to pet meter numbers ....

We still haven't found the timing of the low point, but another series of tests you could do is a day curve. Since he stays low for such a long time it is interesting to know what pattern his levels during 12 hours show. You would have to test preshots and every 2 hours in between. He will probably show a prolonged low point because of the second fraction of caninsulin actually doing its job. That would be great.
 
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AMPS today is 555. I don't know how accurate the number is since Tux really is tired of testing, he moved a lot and I had to poke his ear 4 times. :(
Both Tux and I are stressed. Since it's a marathon, we'll take easy and find BG lowest time when time comes. :)
 
Don't worry, morning pre shot levels are usually higher than evening pre shot levels: start up hormones.
He's doing well, you just started. And this kind of stress is normal in the beginning ....

The body can take up to two weeks to get used to the new food in combination with the insulin. If you find his low point by then, and keep him in safe numbers until then, it should be okay. After two weeks of the new food, he will possibly have a stable reaction to vetsulin, and maybe you can find a fixed dose for him (fixed until it needs to be adjusted, of course).
The aim is to keep him low for as long as possible every day. Feeding him when at +3 will make his levels rise too soon. Looking at his spreadsheet, I would feed him between +5 and +6, as he seems to be lowest by then (appr). If he is really really begging for food before that time, nervously looking around for something to eat, test him to check if he isn't too low. If he is, let him eat immediately.
 
Nederland said:
Maybe we don't see them because we seldom test pre shot levels with caninsulin cats? If the level of the low point remains stable, we continue the dose. If the level of the low point goes up, we don't adjust the dose immediately, because tomorrow or the day after tomorrow the level can be normal again.
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I know I'm a bit late, and this is anecdotal, but I would be cautious about not doing pre shot tests once you have figured out your dosage. My cat was at a dose of 3.5 units and had a usual pre shot level of around 19 to 22 at the time. One time, I did a pre shot and it came back at 13! I thought it must have been a test error so tried again, and got a 14, and to me that would be the same. I am very glad I knew this and was able to reduce the dose way down for that cycle. I also reduced the regular dose to 2 units at that time.
 
Nederland said:
Did you notice a dropping low point in the period before?
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No, and I've never had such a low pre shot test since. I don't have my log book with me, but I believe I gave only 1 unit that cycle and tested a few times after. That particular cycle had the same low point as the previous cycles at 3.5 units (low point of roughly 7 at +4.5).

I wish I knew what happened to cause such a low pre-shot test so I could duplicate it, but I think it would involve ritual sacrifice and a particular alignment of the stars. ;)
 
My husband took me out to give me a break. We just left Costco, and we are stopping by a pet shop.
I want to get a treat for Tux for after testing. Someone was saying... frozen meat? be good? Or something else?
I cooked chicken breast. Didn't put any salt or any flavors but it's salty! I can't give to Tux.
 
Freeze-dried meat with no other ingredients is the perfect treat for diabetic kitties. There are a few brands, but one that most of the pet stores seem to stock is Pure Bites. You can buy the chicken flavor in a large size bag (which works out much cheaper overall) that's labeled for dogs, but they still only have chicken in them - you just break up the bigger treats to make them cat-size. :)
 
manxcat419 said:
Freeze-dried meat with no other ingredients is the perfect treat for diabetic kitties. There are a few brands, but one that most of the pet stores seem to stock is Pure Bites. You can buy the chicken flavor in a large size bag (which works out much cheaper overall) that's labeled for dogs, but they still only have chicken in them - you just break up the bigger treats to make them cat-size. :)
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Thank you! Got a bag of Pure Bites freeze dried Duck for dog. Oh I felt like duck.:rolleyes:
 
We give Thrive treats or Cosma snackies, also freeze dried meat and fish. I don't know if it's for sale in the US. Perfect and they like it very much. Also non-diabetic cats ....
 
Tux loves his new treats. :)

And... what do you give your kitty to keep his/her teeth healthy?
Mom of kitty who is newly diagnosed with diabetes has a lot to learn!
 
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I like to look at the rate of drop when there are both pre-shot tests and then checks when you'd expect to see some drop, or around the expected nadir period. You can calculate the drop per hour, and based on the insulin, project where the glucose is going. This was helpful for a recent ProZinc poster when the dose was plunging the glucose quite rapidly; the poster intervened and was able to prevent the cat from getting into trouble. Had she not checked, the cat would likely have had a full blown hypoglycemic attack.

For example, 555-309 over 6 hours is a drop of 246 and about 41 mg/dL drop per hour. Given the usual action of Vetsulin/Caninsulin, it should start going up by this point. What we've seen in ProZinc, is that if a dose is too high, the glucose will continue dropping - have you seen that with Vetsulin/Caninsulin?
 
manxcat419 said:
I'm so glad he likes them. :) They were an instant hit with our cats too. :)


Low carb wet food. It's actually the carbs in food that cause dental issues rather than the texture of the food. So, fortunately, that's a nice, easy fix.
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How about gum health?
 
Again, the best diet for teeth and gums is a species-appropriate diet. And the closest we can get to that is low carb wet food (or raw if your cat will eat it - mine won't).
 
[QUOTE="BJM, post: 1669084, member: 2941"Had she not checked, the cat would likely have had a full blown hypoglycemic attack.[/QUOTE]
Tux saw two vets since 4/22 when he may had hypoglycemic attack. Neither vet made big issue about it. "Boncing happens". One vet told me to raise Vetsulin to 5 units, another one vet we saw later said go back to 3 units. No tests.
 
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Bouncing does happen, but hypoglycemia shouldn't - or at least should be corrected very quickly. A cat can only bring it's own glucose back up as long as it has sufficient glycogen stores. Once those are exhausted, the cat has nothing left with which to counter the next hypo and then they're in trouble. And that's assuming that the individual cat's body can react fast enough and strongly enough to bring their level back up in time to avoid problems in the first place. If any vet told me to ignore a hypo attack, I'd be looking for a new vet immediately! As for the advice to raise the dose following a hypo...I can't say words fail me, but the ones I want to use aren't suitable for a public forum!!
 
I think the 3 units was too much, seeing how he does on 1.5 units, so 5 .... well, I can't even say what I think about that advice. I think you casn also give him 1.5 in the evening, seeing his level (and he was black yesterday). But you have to feel co0mfortable with it.
As far as I can see, he's having a normal caninsulin curve with a second peak, which keeps the level down for a prolonged period, which is great.
For the moment keep him on 1.5 as it can take up to two weeks for the influence of the new food to become completely clear.
When it's clear that he really is too high during his low point, increase with 0.25 and keep that dose for at least 3 days. It also takes some time for a new dose to show its effect: the low point can become lower every day with the same new dose. When he's still relatively high on that point, an increase after 3 days can be done. But if he is near the good numbers, wait 5 days before increasing. Just give the insulin some time to show what it can do. When increasing too soon when the cat is near a good number, you could get him into trouble.

Unfortunately, you can not say: he gets 1.5 unit and drops 300 points, so if he gets 2 units he will drop 400 points. That would be really easy, but it doesn't work that way. The influence of 0.25 unit extra can be enormous or tiny. And the first 0.25 extra can have a tiny influence, the next 0.25 can have a big influence. So always be careful.

BJM said:
What we've seen in ProZinc, is that if a dose is too high, the glucose will continue dropping - have you seen that with Vetsulin/Caninsulin?
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What we often see with an overdose is a very fast drop and a very fast rise of the levels if the cat produces stress hormones to counteract the insulin with glucose dumping. In fact, they prevent a hypo this way or turn the hypo: survival mode. They will stay in survival mode for at least 3 days, often longer. Not all cats go into that survival mode: the levels will drop to hypo and beyond ..... It will happen fast. If the low point is normally on +4, it will happen before that moment (how soon is depending on how much overdose it was).
The numbers in the stress period can go anywhere, from very high to very low. So it's necessary to test pre shot levels, because the level could be 'healthy' at that moment and you don't want to give insulin to a cat with a healthy glucose level. But if the cat is very high preshot after a hypo, even higher than he usually was, the dose of caninsulin still must be lowered by at least 1/3. The body is oversensitive to insulin for a period of time.
 
Thank you again Jennie for your advice. :) I am glad to know that his curve is good. I'm trying to find his lowest time by testing different times from the past.
This morning Tux is looking/acting just as he was in the past (1.5 months ago). His fur is shiny, he purrs non stop, he follows me all over the house begging food. :) He was with me until I started vacuuming carpet.
I gave 1.25 units last night after thinking between 1.25 and 1.5. Yes, I will go for 1.5 if it tested in Black tonight. :) I will read over all advises and follow.

I can't afford to see another Dr. nor trash Vetsulin and purchase different insulun right this moment, but we will go see another Dr. (it will be the third Dr!) as soon as I can afford and go with insulin the new Dr. would recommend.

It's good to know that cats would take 2 weeks to adjust their new food. I will stay with 1.5 for awhile and will keep testing preshot BG and increase or lower dose as needed (by 0.25 or so) later. :) The best I can hope is for him go into remission before we use up Vetsulin. :p
Thank you again for all those detailed advice. :)
 
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Jennie, maybe I will hear from you tomorrow but in case I won't....
Have a wonderful trip! :cat:
Where US are you coming?
Hope Tux's numbers be much better when you are back to FDMB. :)

Kako
 
We'll go to the south-west. Landing in Phoenix, see lots of Parks, then to Las Vegas, some other Parks, and then San Francisco, Los Angeles and flying back home from San Diego. 4 weeks of driving around to see that beautiful country. I will be exhausted when I'm back.

I will write some extra notes for you later today or tomorrow. How much vetsulin did you buy, by the way?
And you can also have a look at my topic in the think tank. There is more on vetsulin/caninsulin there.
 
Nederland said:
We'll go to the south-west. Landing in Phoenix, see lots of Parks, then to Las Vegas, some other Parks, and then San Francisco, Los Angeles and flying back home from San Diego. 4 weeks of driving around to see that beautiful country. I will be exhausted when I'm back.

I will write some extra notes for you later today or tomorrow. How much vetsulin did you buy, by the way?
And you can also have a look at my topic in the think tank. There is more on vetsulin/caninsulin there.
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Hi Jennie! Sound like fun plans you have on your trip! :)
I got one 10ml bottle of vetsulin. 2/3 left.
It's almost 2am. I will come read first thing in the morning. Good night! :)
 
@Nederland -

Just a quick note to wish you bon voyage, Jennie! Have a marvellous time and travel safely. Look forward to hearing from you when you get back. :)


Mogs
.
 
Kako said:
I got one 10ml bottle of vetsulin
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We always buy 2,5 ml bottles, as the quality of the insulin gets bad after three weeks. So we don't have to throw away that much .... 10 ml bottles are meant for dogs (they use more insulin, they are bigger).
That's something to keep in mind ... if you see his numbers rising on the same dose, when the insulin is older than 3 weeks, you will probably increase the dose to see better numbers. Be very careful when you start a new bottle! The same dose or a higher dose of a new bottle may be far too much for Tux. To be safe, you have to lower the dose when you start a new bottle and first see what the new bottle does.
But maybe you won't buy a new bottle, maybe you will start on another insulin. We usually see the ones with a long second peak (low numbers) do very well on lantus. I'll say it again, if I had another diabetic cat, I would start with lantus immediately.
 
Nederland said:
We always buy 2,5 ml bottles, as the quality of the insulin gets bad after three weeks. So we don't have to throw away that much .... 10 ml bottles are meant for dogs (they use more insulin, they are bigger).
That's something to keep in mind ... if you see his numbers rising on the same dose, when the insulin is older than 3 weeks, you will probably increase the dose to see better numbers. Be very careful when you start a new bottle! The same dose or a higher dose of a new bottle may be far too much for Tux. To be safe, you have to lower the dose when you start a new bottle and first see what the new bottle does.
But maybe you won't buy a new bottle, maybe you will start on another insulin. We usually see the ones with a long second peak (low numbers) do very well on lantus. I'll say it again, if I had another diabetic cat, I would start with lantus immediately.
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How about Prozinc? Is Prozinc similar to Lantus? A hospital I am thinking to try next has Prozinc on hand. A vet may give prescription if I want go with Lantus, though.
AMPS 543 this morning. I decided to go for 1.75 units.
 
When I adopted Badger he was on Lantus and his BGs were erratic. I then changed to Levemir since Another cats was using that already. That was the same. N was a little better. I then changed to BCP PZI which was a little better but when I ran out I started ProZinc. That worked better but still not really good. He was on about 5 units. When I adopted Badger he has ear polyps which continuously oozed. Antibiotics would resolve it for awhile. last July I had the polyps surgically removed. Since then his BGs improved and his dose lowered to 1-2 units. Since I had two cats on Levemir I decided to use Levemir instead when the proZinc ran out. Badger is no on about 1/2 unit Levemir and I can maintain his BG below about 110 all day.
 
Before I go on my holiday, just one more message.

If I were you I would choose Lantus, not Prozinc. And then follow the advice given by the lantuspeople of this forum. With lantus and Tight Regulation, you can get his numbers in the healthy range all day, and most cats feel very well in that insulin. I gave my cat caninsulin first, and only at 5 PM did he wake up and become a little bit active. When at lantus, he woke up at 2 PM. He was very ill, so I was happy with everything that made him feel better. But the cats on our forum that go from caninsulin to lantus, very quickly feel better and become more active.

You increased the dose to 1.75 because of the AMPS. I had given you a list of doses based on preshot numbers, because we didn't know what was happening that day, it looked as if he kept dropping slowly and I was concerned that he would not stop dropping. In that case the dose should be based on the pre shot level. By now he is rather stabel in his preshot levels, so nothing funny/strange is going on.

The dose of vetsulin, and I must stress this, is based on the level of the low point, not only on the pre shot level. This is very important. The pre shot level is only important if it happens to be very low.
The pre shot level was rather high however, but really, you should try to find his low point first, before deciding to increase the dose. I think the low point was still too high, but I need to say this in case next time his low point happens to be really good (and his pre shot very high) .... you cannot increase the dose if in future his low point is okay, no matter how high the preshot level.

After an increase of the dose, you should stick to that higher dose for at least 3 full days, but better still is 5 full days, and test the low point daily. We aim for the blue numbers with vetsulin: they are safe and low enough.
If his low point starts dropping to better numbers, his pre shot numbers may also start slowly dropping to better numbers. That is also why the number at the low point is most important for the dose.

I know Tux doesn't like to be tested, but it's for his own safety and health that you need to find his low point. That is also the moment that he should have his little meal.

I hope that next time I check this topicb(after my holiday), I will see that you switched to lantus. Or another insulin. But what I have seen of Prozinc up to now .... I would choose Lantus if it were my cat, and ask for advice on the forum.

I wish you and Tux good luck! And I'm very glad that he is already feeling better and that he looks good. And I'm also really happy that he's enjoying his wet food, and his snacks.
 
Hi Jennie! Thank you for the last minute (before your departure) advice. I decided on Lantus last night. :) As soon as I can afford Tux will be with Lantus. :)
Thank you for caring us.

You enjoy your vacation! :)
 
No more wait, I am switching to Lantus anytime now! (Wish I could give this news to Jennie before her departure!)
This evening my husband brought me a news that we will be on a trip (business trip, kind of) on 6/3-6/11.
I have a friend (neighbor) who come feed and give insulin for Tux mornings and nights during that time. I feel BG testing is too much to ask her.
It means Tux may need receive insulin without testing same units safely 6/3-6/11.
In this situation when is ideal time to switch from Vetsulin to Lantus?
 
If you can switch in the next couple of days, you'll have almost a month of Lantus data to work with to figure out a safe dose for while you're away. I would have thought the gentler action of Lantus is probably safer for the sort of situation where you have to have a cat receive shots without testing for a few days. Most people reduce the dose slightly for the time they're going to be away to make sure there's no risk of a hypo - I'm sure people who have done that will be able to help you figure out a safe dose nearer the time you leave for your trip.
 
manxcat419 said:
If you can switch in the next couple of days, you'll have almost a month of Lantus data to work with to figure out a safe dose for while you're away. I would have thought the gentler action of Lantus is probably safer for the sort of situation where you have to have a cat receive shots without testing for a few days. Most people reduce the dose slightly for the time they're going to be away to make sure there's no risk of a hypo - I'm sure people who have done that will be able to help you figure out a safe dose nearer the time you leave for your trip.
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Thank you for the quick response! OK, I will go get Lantus tomorrow! Good thing, the second vet we saw uses Lantus and she said she has it on hand! :)
 
Kako, you might want to check out the supply closet. There are a couple people on there selling single lantus pens so it wouldn't be so much up front. You also need u100 syringes.
 
billysmom (GA) said:
Kako, you might want to check out the supply closet. There are a couple people on there selling single lantus pens so it wouldn't be so much up front. You also need u100 syringes.
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What is "the supply closet"? Yes, different type of syringes. I will get them too. I won't use u-40.
 
You should be able to find U-100 syringes in your local Walmart (or of course any regular pharmacy). Walmart sell them for around $13 for a box of 100 so they're not a major part of your switching costs. :)
 
manxcat419 said:
You should be able to find U-100 syringes in your local Walmart (or of course any regular pharmacy). Walmart sell them for around $13 for a box of 100 so they're not a major part of your switching costs. :)
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Wonderful! $13 sounds really inexpensive after spending $1000 the last 30 days! :)
 
manxcat419 said:
It adds up quickly - it really does. I try not to total up how much I've spent on vet bills over the last year and a half - I have a feeling the total would be frightening!
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I can understand!!!!!!!! But now I am very happy that Tux is saved, also I am finding ways to save costs here! :) I was filled fear the night I came here asking help.
How often are you taking your kitty to a vet for health check ups? I think the first vet (that I will never go back) said a diabetic cat needs to see a vet once in two months for testings... something like that. Oh I can't afford that for sure!
 
Rosa really didn't get check-ups specifically for her diabetes at the vet. I spent my money on testing supplies so I could get accurate numbers at home instead of having them run curves. What I did was email them the link to Rosa's spreadsheet so they could see the numbers I was getting and what I was doing with her dose. The real costs of diabetes were around the time of her diagnosis. But now she has CKD, so she has to have very regular blood work while we try and find a way of getting the best control of that we can...and some of the meds she's on now are actually more expensive on a daily basis than Lantus too!
 
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