? "Caninsulin dosing advice needed"

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Diana&Tom said:
Hmmmm! It does seem logical that a consistent dose might be better, but when you are monitoring BGs regularly and can see that a certain dose isn't working (either too much or too little) there is an obvious argument to change the dose to get the desired result. I do feel for you, Anthony, as you have tried various options and are really giving this your all.

I think what I would do in your shoes is say ok, let's try a consistent dose for a week - go for 0.5u to start with, as she seems to be doing ok with this - and keep a note of her numbers as usual. If she jumps up to the 20s again, that dose is clearly not enough for her, so maybe try a week at 0.75u and see how that goes... etc etc.

That's just my personal way of looking at it. Others may say no, go with a sliding scale... Shelley should have as much insulin as she needs, when she needs it...

Tagging @Elizabeth and Bertie and @JanetNJ who are two experienced Caninsulin users and may have some other thoughts to add.
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Hello Diana,
Thank you very much. Unfortunately her numbers do seem to be creeping up. She is eating and urinating more and her pre shot this morning is 19.1. I am thinking of shooting 0.75u?
 
Yes try 0.75u Anthony... it is such a hard call, I know, but sometimes you have to go with your instinct.
Eliz asked you about foods and I do wonder if the sheer variety you are feeding Shelley may be a factor in her fluctuating numbers... some foods, AGAIL among them, do spike BGs in some cats. But she has to eat what she likes so I know it probably isn't easy to stick to one or two varieties!
Anyway try that dose now and let's see what that does.
 
Thanks Diana, very helpful to get another opinion so promptly!
Shelley does like a variety and sometimes will not eat a certain food. I often try up to 3 to get her to eat before her shot but she does seem to lap up the jelly in that Aldi food well. It is cheap but that's not why I bought it, I just happened to take a relative shopping there.
Thank you for being so understanding, I really appreciate it!
 
We all understand, Anthony... FD can be very frustrating to treat and it can and does take over our lives... all we can do is the best we can in any given circumstances. Hang in there!
 
Hi everyone,
I am having difficulty dosing Shelley at the moment as her numbers are varying a lot. Last night her PS was 23.2, this morning it is 12.2!
I had a vet appointment yesterday as Shelley had been limping badly. I thought it was neuropathy as it improves when her numbers are lower. The vet thinks it is arthritis.
I asked him when I get a low pre-shot number should I reduce the dose or wait until the number rises. He said the latter as it was better to try and maintain the 1.0 u dose.
I would be grateful to see if other members agree with this advice.

I have been delaying shots and that means injecting at midnight and getting up about 4 am to check her at the nadir at the moment.

Thanks for reading!
 
It is very tricky for you, Anthony, I do sympathise. You've tried many combinations of dosing according to numbers, but not seen any real consistency. It may be that Shelley is in pain - that can certainly cause BGs to rise. Did he give Shelley anything for pain relief? I have often wondered and still do wonder if some of her BG fluctuations are due to dietary changes - some foods are known to spike BGs in some cats, and I know Shelley has a lovely varied diet!

I'm really not sure what to say... we do need some experienced eyes on Shelley's ss. I think if it were me I might start a new thread now with a very specific header to try to get more people reading amd answering... sometimes a fresh pair of eyes can see something we've missed. Do keep going - FD is rarely easy to treat but you are certainly giving it your best shot and you deserve some better numbers soon!
 
Hi Diana,
Thank you for your comments.
I have been wondering about pain. She started to limp again at the weekend, I thought it was neuropathy due to her numbers rising. Once I increased the dose she gradually improved.
I asked the vet about pain relief but he wants to check her kidneys before starting her on some.
I have been trying to be more consistent with food but that may still be part of it.
I can certainly try a new thread.
Thanks again for your support!
 
Just to bring you the latest on Shelley.
She has had a BP check and that is OK on Amodip. She had a urine test which showed the presence of protein, specific gravity of 1.014 and protein creatinine ratio 1.2.
My vet has devoted some time to studying Shelley's BG results and has discussed with colleagues.
He says the constant fluctuations are occurring because I keep changing the dose. The BG normalises in response to 1.0 u but then rises when I reduced the dose because of the lower pre shot numbers.
He insists that this is not good for Shelley and that I should consistently dose 1.0 u, even at low pre shot numbers.
He said the urine test was inconclusive because she has so much glucose going through her kidneys.
Shelley is her usual self but has never been as well since before the hypo when she was on the higher dose.
Thanks for reading!
 
Anthony Morgan said:
Just to bring you the latest on Shelley.
She has had a BP check and that is OK on Amodip. She had a urine test which showed the presence of protein, specific gravity of 1.014 and protein creatinine ratio 1.2.
My vet has devoted some time to studying Shelley's BG results and has discussed with colleagues.
He says the constant fluctuations are occurring because I keep changing the dose. The BG normalises in response to 1.0 u but then rises when I reduced the dose because of the lower pre shot numbers.
He insists that this is not good for Shelley and that I should consistently dose 1.0 u, even at low pre shot numbers.
He said the urine test was inconclusive because she has so much glucose going through her kidneys.
Shelley is her usual self but has never been as well since before the hypo when she was on the higher dose.
Thanks for reading!
Click to expand...
Ask about adding Benazapril for the protienuria. My cat was on Booth Benazapril and amlodipine.
 
Actually Anthony, I had a look at Shelley's ss a few days ago and thought she was doing ok... not necessarily consistent, but that's hard to achieve because cats are living creatures and not robots! As for fluctuations being caused by different doses and the need to keep to one dose - we may have discussed this before, there is a school of thought that says that's correct, and there is another school of thought that says sliding scale dosing is more appropriate. See Elizabeth's comments at No 148 above.

I can't remember if you have tried following what the vet says? - the problem with that is when you get a low pre-shot number it is tempting to reduce the dose for safety, and no-one would disagree with that. The problem is that 1u may be too much sometimes and drop Shelley too low. Hard to know what else to say. Are you going to follow the vet's advice and report back to them in x weeks? It's worth a try - if you try it and it doesn't work it might give you ammunition to ask about a different insulin which may be gentler on Shelley's system.

Let us know what you decide!
 
Hello Diana,
Good to hear from you, thanks for keeping an eye on things. I know its been discussed before and I tried to stick with 1.0u until I felt it was unsafe.. I think this is the third time I have been told this, so I plan to give it a try and will just have to be very vigilant.
Kind regards!
 
I'd do the same, Anthony, I wouldn't give any dose I felt was unsafe. But the vet seems insistent.... tbh I still doubt if he is as knowledgeable as he could be, but give it a shot and see what happens... if you end up with very low pre-shot numbers you can show the vet your ss and see what he says then!
Good luck!
 
Diana&Tom said:
I'd do the same, Anthony, I wouldn't give any dose I felt was unsafe. But the vet seems insistent.... tbh I still doubt if he is as knowledgeable as he could be, but give it a shot and see what happens... if you end up with very low pre-shot numbers you can show the vet your ss and see what he says then!
Good luck!
Click to expand...

Thank you!
 
Shelley's BG numbers today.
0953. 11.8
1444. 12.4
1812. 11.2

I think this is borderline whether to give insulin or not? I would just welcome any thoughts.
 
Anthony Morgan said:
Shelley's BG numbers today.
0953. 11.8
1444. 12.4
1812. 11.2

I think this is borderline whether to give insulin or not? I would just welcome any thoughts.
Click to expand...
Shootable pre-shot number, Anthony, if only a small dose, but I understand your hesitation, especially as she has come down a little... maybe test again in an hour and make a decision then?
 
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