? Assistance with Vetsulin Needed - ? too high a dose

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Um I know Im far away but I do have a great vet here. He could possibly give you advice over the phone given all info you have until you find a vet in your area. let me know if you want his number.
 
Did +2+3+4. Numbers are on the spreadsheet. Gave him snack (regular food) after +4. Now he is cleaning himself. :)
Good night!
 
Nederland posted her observations about last night's numbers in the original thread:

http://www.felinediabetes.com/FDMB/threads/please-help.156777/#post-1663515

This was her post:

If you test your cat, don't test at +6, test at +4 in the future. That the level you need.

I think at April 22 he was too low at +4 (probably even at April 21), the body needed to take counter measures and released stress hormones (glucose), and the level went up and up. It may have happened again, and the body may have decided to realease those stress hormones continually, so the curve became high and reasonably flat (flatter every day).
After such an episode, the dose must be lowered by at least 1/3 (which you have done). During the following 5 days (max) the body recuperates, but in that period you can see all kind of levels, from very high, to even very low preshot values. This could also explain the relatively low preshot level in the morning of April 22, so probably the 3 units of April 21 did their job far too well .... It's probably that day when everything went wrong. And April 22 did not help. The bouncing levels could also still cause the level to go up at +4 this evening.

I advise you to test preshot levels, and +4's. Do not increase the dose for at least 5 days, because high levels can still be caused by stress hormones and you don't want to shoot against stress levels, only against diabetes levels.

If your preshot level is low, don't shoot the normal dose, because you will bring back the survival mode in that case.
I will think about a safe sliding scale for the next days, although I have little experience in making them (just reading them in the posts on our dutch forum). But maybe it's better than nothing.



I think to keep all information in one spot that continued posting should be done here. That way all the informationis available in one place without going back and forth between two different postings.
 
Thank you for copying my post. I new here on the forum, so have to find out about such things. I will use this topic from now on.
I have here a link to our forum, to the topic with two graphs of the curve of a cat on caninsulin, when he is on the right dose. It may be informative.
You can see, that the average cat has the low point at +4, and basing a dose on the level at +6 can be dangerous, because you don't know what the low point was. Every cat is different, so it's an example, it's the average cat (most cats have the lowest point on +4 or +4.5, though). It's in Dutch (sorry), and in mmol. You can multiply the level with 18 to get mg/dL levels.
http://www.diabeteskatten.nl/forum/showthread.php?t=782
 
Nederland said:
Thank you for copying my post. I new here on the forum, so have to find out about such things. I will use this topic from now on.
I have here a link to our forum, to the topic with two graphs of the curve of a cat on caninsulin, when he is on the right dose. It may be informative.
You can see, that the average cat has the low point at +4, and basing a dose on the level at +6 can be dangerous, because you don't know what the low point was. Every cat is different, so it's an example, it's the average cat (most cats have the lowest point on +4 or +4.5, though). It's in Dutch (sorry), and in mmol. You can multiply the level with 18 to get mg/dL levels.
http://www.diabeteskatten.nl/forum/showthread.php?t=782
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Thank you. Often new members will post on the Introduction and then later on the Health forum and people will respond to both threads, Since this is becoming more involved with figuring out the data I thought it would be best for everyone to just post here.

Your input is very appreciated, since there are not a lot of experienced Vetsulin (Caninsulin) users here and the actions of Vetsulin is much different than the long acting insulins. It is very helpful to know the low point is usually at +4. This was what had been mentioned earlier to Kako about Tux's tests and the vet continuing to up the dose based on later cycle readings.

Thank you for your link to the forum. The more information that is available on these "less used" insulins the better. People could use a translator is they want to read more on the site. Some of use (such as myself) use the mmol/l system and those that don't can just multiply by 18 as you suggested.


ETA What does the second graph display. It is a 24 hour graph?
 
About food with the insulin caninsulin/vetsulin. The advised feeding pattern is different than with the long acting insulins.
The cat must have eaten before the shot: (test), eat, shoot. A preshot test is not always necessary, but for now, after the 'incident' please continue doing preshot tests.
The advised feeding pattern is: 35% of the total food per 24 hours to be given before the shot, 15% 4 hours later (to help against a too low point). Again in the evening, so it totals to 100%. Leave the food that is not eaten, but he should at least eat 75% of the preshot meal to feel safe to shoot the normal dose.
100 grams of wet food equals 25 grams of dry food. So you have to make a calculation if you give both types of food.

Every 12 hours should have the same kind of food on the same moments. So no wet food in the morning before the shot and dry food before the evening shot.
When the cat is out of the danger zone, the feeding could be a bit free-er. E.g. let the cat eat the 15% whenever he wants.

If you change the food to low carb, you have to adjust the dose of insulin immediately. I would not do that yet. First we have to find out if the dose of 2 units is okay or too high. Or too low, for that matter.

Please, ask questions, any of you, if you need clarification. I will be away on a long holiday from May 6, so I still have about 1 week to give information. I will be off line during my holiday (although I will be in the USA...)
 
Nederland said:
About food with the insulin caninsulin/vetsulin. The advised feeding pattern is different than with the long acting insulins.
The cat must have eaten before the shot: (test), eat, shoot. A preshot test is not always necessary, but for now, after the 'incident' please continue doing preshot tests.
The advised feeding pattern is: 35% of the total food per 24 hours to be given before the shot, 15% 4 hours later (to help against a too low point). Again in the evening, so it totals to 100%. Leave the food that is not eaten, but he should at least eat 75% of the preshot meal to feel safe to shoot the normal dose.
100 grams of wet food equals 25 grams of dry food. So you have to make a calculation if you give both types of food.

Every 12 hours should have the same kind of food on the same moments. So no wet food in the morning before the shot and dry food before the evening shot.
When the cat is out of the danger zone, the feeding could be a bit free-er. E.g. let the cat eat the 15% whenever he wants.

If you change the food to low carb, you have to adjust the dose of insulin immediately. I would not do that yet. First we have to find out if the dose of 2 units is okay or too high. Or too low, for that matter.

Please, ask questions, any of you, if you need clarification. I will be away on a long holiday from May 6, so I still have about 1 week to give information. I will be off line during my holiday (although I will be in the USA...)
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PERFECT!! This is the sort of information that we need to be able to give Caninsulin/Vetsulin users.
 
Both are 12 hour graphs. But the first counts from 1 tot 12, the second one from 8.00 to 20.00 hours.
The second one shows the working of the second peak of caninsulin (in some cats). The level rises very slowly and stays stable around 6 to 8 hours after the shot. The first one is how most cats respond.
 
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Nederland said:
Both are 12 hour graphs. But the first counts from 1 tot 12, the second one from 8.00 to 20.00 hours.
The second one shows the working of the second peak of caninsulin (in some cats). The level rises very slowly and stays stable around 6 to 8 hours adter the shot. The first one is how most cats respond.
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Thank you. It is good to know about the usual second peak with this insulin. I am assuming this is because of the two "types" of insulin in the mix...the faster acting and the intermediate acting? The fast acting would act first and drop the numbers a lot, then the intermediate would keep the numbers lower and perhaps drop them further?
 
Tuxedo Mom said:
Thank you. It is good to know about the usual second peak with this insulin. I am assuming this is because of the two "types" of insulin in the mix...the faster acting and the intermediate acting? The fast acting would act first and drop the numbers a lot, then the intermediate would keep the numbers lower and perhaps drop them further?
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Yes, correct. But few cats show an actual second peak. Some do, and that is really nice, they will stay below the renal threshold longer.

Edit: not completely correct. The second low point is never lower than the first low point.
 
Nederland said:
Yes, correct. But few cats show an actual second peak. Some do, and that is really nice, they will stay below the renal threshold longer.

Edit: not completely correct. The second low point is never lower than the first low point.
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We all know that ECID, but knowing the possible reactions that some kitties have is good information.
 
Tuxedo Mom said:
Often new members will post on the Introduction and then later on the Health forum and people will respond to both threads
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I did introduce myself on the Introduction forum, but I came here to get information on Prozinc, which is new in The Netherlands. The help is terrific, and I thought I could do something in return when it became clear to me that vetsulin is not well known here.

I have more info, e.g. on hypo treatment, which is definitely not the same as with the long acting insulins. Where should I post that kind of info? It's probably better to keep this topic for Kako and Tux. They must not drown in the info, they need actual instructions at this moment ....
 
Nederland said:
I did introduce myself on the Introduction forum, but I came here to get information on Prozinc, which is new in The Netherlands. The help is terrific, and I thought I could do something in return when it became clear to me that vetsulin is not well known here.

I have more info, e.g. on hypo treatment, which is definitely not the same as with the long acting insulins. Where should I post that kind of info? It's probably better to keep this topic for Kako and Tux. They must not drown in the info, they need actual instructions at this moment ....
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I would suggest that you do one combined post in the Vetsulin forum with all the main information that you have been supplying. That post could be regularly "bumped" up to keep it active and maybe eventually we could get a sticky note made out of it if the admins think it would be helpful. I won't discuss this any more on here so as not to get off topic for Kako and Tux :bighug:
 
Tuxedo Mom said:
I would suggest that you do one combined post in the Vetsulin forum with all the main information that you have been supplying. That post could be regularly "bumped" up to keep it active and maybe eventually we could get a sticky note made out of it if the admins think it would be helpful. I won't discuss this any more on here so as not to get off topic for Kako and Tux :bighug:
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I think it would be great to have the sticky in the Vetsulin forum but, as it has such low traffic, it would be really helpful to announce the addition of the sticky on Feline Health. That way regular contributors would know where to find it and then, through repeated posting of the link a greater number of members would learn to advertise the link to new members using Vetsulin/Caninsulin.


Mogs
.
 
Nederland said:
I have more info, e.g. on hypo treatment, which is definitely not the same as with the long acting insulins.
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Very true (I've used both Caninsulin and Lantus). It would be fantastic if you could post recommendations on managing hypos when Vetsulin/Caninsulin is in use. :)

I'm very glad you've joined FDMB! Thank you for your contributions thus far, and I look forward to reading more of your posts. :D


Mogs
.
 
Hi Kako,

Great job with the testing. :)

I see where @Nederland is coming from with the recommendation to test at +4 but, having looked at Tux's spreadsheet, I wonder whether he's a fast metaboliser of insulin; he was lower at +2 and +3 than +4. (My Saoirse metabolises insulin very quickly and Tux's data from last night looks similar to the the response Saoirse had a lot of the time when she was on Caninsulin - most notably when she was getting a little too much of it.) For the time being I would recommend you test at +2 and +3. If the +3 is lower than the +2, test at +4 as well.

To get an idea of the duration you're getting, throwing in the odd test at +7 would be helpful if you can manage it.


Mogs
.
 
Kako said:
Good morning ladies! It's 713 this morning.
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That's really high. But it's still the second full day after lowering the dose, and if the 3 units were too much and the body is in a reaction, the numbers still can go all over the place. Please, shoot no more than 2 units.
It may still be too high a dose, but we need more info and tests. A +4 and a +7 would indeed be informative today. Maybe, if you're up for it, a +2, too.
 
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Nederland said:
Ja! It's goedenavond, by the way, but I suppose that's a typo?
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Yep! :oops:

I only know a few Dutch phrases. I worked out of Amsterdam (Sloterdijk) for the best part of a year but I didn't get to learn much of the language because everyone spoke such wonderful English.


Mogs
.
 
Nederland said:
That's really high. But it's still the second full day after lowering the dose, and if the 3 units were too much and the body is in a reaction, the numbers still can go all over the place. Please, shoot no more than 2 units.
It may still be too high a dose, but we need more info and tests. A +4 and a +7 would indeed be informative today. Maybe, if you're up for it, a +2, too.
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Dear Jennie and ladies.
I gave 2. And I will do multiple readings today again.
Which should I follow strictly?
-No food for two hours before testing.
-Have Tux eat/munch as often as he wants. (no meaning of over feeding.) Let him stay with his eating habit.
Depends which is more important, times I can test be different.

Also right amount his regular food means? I am going with recommended cup measurement per weight of cat following the package of the food say. Is it correct?

By the way, I am Japanese. After living in the US for 20 years, it is still hard to communicate in English.
 
Kako said:
Which should I follow strictly?
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Today, if the cat ate enough before you gave the insulin (which should be about 35% of the quantity you give per day, see the package of the food) no food before the +4 test. But how much did he eat just before the shot? It's important he ate enough.
If he ate enough before the shot, you can feed him 15% of his daily quantity after the +4 test.

Mind, if he starts wobbling, having glazy eyes, falling over etc, TEST. Always test if his behavior is strange. And if he is too low, feed him, no matter what.
 
Hi, just wanted to pop in with a couple of additional thoughts. I am Kimmee, member since 2006 and mod since 2009, though absent in recent times due to life, you know how that happens ;)
Ps. Kako, you are doing great :)

The second drop happens as the body actually runs out of insulin, not because it is still working and dropping the sugar at +9 or so. It is a fast acting insulin,and tends to run out of steam by about +10.

The faq, written and posted in the vetsulin/caninsulin forum, make a couple of different suggestions for offering food.
For example... feeding 75% of meal about 20 minutes before shot, anf then offering that last 25% of the meal about 90- 120 minutes after the show, has been shown to really help slow the drop and get a more stable curve. It has also kept kitties out of dangerous lows, whena big drop happens, and know one is around.

Here is the faq, I realize it is need of an update, but the basics remain strong and the same http://www.felinediabetes.com/FDMB/threads/vetsulin-caninsulin-user-guide.302/
 
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Critter Mom said:
Quite a significant drop by +1. Good job getting that test in, Kako+
(BTW - I think your English is fine!)


Mogs
.
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It was actually +1.5, 2 hours after eating. I will try to test +1 by feeding Tux one hour before insulin injection tonight or tomorrow morning.
+3 was 672.
 
Nederland said:
Up again.... :(
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Yes. :(

Wonder if his system is a bit different because of his eating habit from the past. Tux was stray. He was 5-8 years old when he showed up my front door, asking for help. He weighted 4.8 Lbs., he was filled flea and flea poos, his fur was sticky and smelled like kitchen garbage.
He didn't know cat food nor toilet. He appears grew up eating or licking human food (or garbage). Since he got a home (here!), he just eat, sleep, go to toilet, eat, sleep.... he is very mellow. At first I thought he was in recovery from hard life. And he has been the same way for the 3.5 years.
 
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What I am seeing here, but anyone with a different opinion is welcome of course, is a curve of insuline resistance. I put a picture of that in my topic in the think tank.
I also see in the sheet, that he was responding correctly to the 1 unit he was on initially: a normal curve. Still too high, but as no +4 level was tested, we don't know how low he got. But he showed that he could do it, he can respond normally. But he doesn't at the moment.
It can normalise in a few days, but it can also mean that 2 units is still too much.
I think., if you keep on testing today (in my opinion you don't have to, but opinions can differ), the level will stay high. It will vary of course, as a cat is no machine, but I think it will stay high.
 
Jennie,
I am glad to hear that the curve was good when Tux was with 1 unit. :)
I feel so too.... BG would stay high today. I will take a break from testing until evening.
Hope, really hope he recovers from the bouncing shock on 4/22. It's been 5 days since...........
 
Was the fructosamine tested when he was diagnosed with diabetes? If yes, what was the level? And the glucose at the diagnosis was 596 as in your spreadsheet? Or was he diagnosed earlier?
How much is his weight now?

Considering the curve today, if he were my cat, I would start anew.

Kako said:
It's been 5 days since...........
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Yes it has been 5 days since the bounce, but it's only two days since you lowered the dose.
 
That's true... only two days since the dose is lowered. I feel like it's been two years. LOL
I need to learn patience. Thank you Jennie, and all ladies. I am blessed.
 
I'm going to bed now. Thinking it over, I would advise a fresh new start and to lower the dose to 1 unit. He needs to let go of the stress hormones quickly.
And test for ketones, please.

I will look again tomorrow.
 
Oh... Tux's weight has been 10.4 lbs (4.7 kg) last 7 days. He weighted 13.8 Lbs (6.26 kg) beginning of Feb. Then I strictly stopped him from stealing my food and sugar.
His weight started to drop... I was thinking diet's working. Then he started to drink more water. I thought he was hunger from human food so that drinking more water at first.
Hope his weight loss is from good reason.

I looked at the papers but fructosamine isn't mentioned.

Good night Jennie. :)
 
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Kako said:
OK... BG tested 668. :(
If it was your cat, how much dose do you give? Stay with 2, lower to 1.75, 1.5, 1.25, or 1?
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Jennie had suggested going back to the 1 unit and starting from there with proper testing during the early hours after shot to see how Tux responds. This might be a good idea if there is a suspicion that Tux is "bouncing" from what could have been lower numbers yesterday morning. Since you weren't able to test it is hard to see what might have happened.

If I remember correctly Tux has not had a problem with ketones? If not then trying the 1 unit and seeing if that settles the numbers down might be a good choice. You could shoot the 1 unit and do a +2 and +4 test tonite. Then in the morning a preshot test and post with the numbers. If the 1 unit does not seem to be working it is easy to go up higher.
 
I didn't answer all. So here are answers.
He was diagnosed on 4/5. Glucose was 582. He started insulin on 4/13. Glucose tested 596 before the first injection.
On 4/5, Ketones tested negative. Not tested since then. Tux goes outside for pee unless raining very hard. Haven't had a chance to test.

Jennie, how much dose are you giving to your kitty? What was BG when she/he was diagnosed?

PMPS was 668 tonight. Gave 1 unit. And I will test one or two more before bed. Good night.
 
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