? Coda having some issues with insulin, new to insulin, pls some advice?

[Coda (GA)]

Worried! Coda is having lots of up and downs with the insulin, highest BG I've seen was this morning (373). He didn't really want to eat and his (skinny) 1u was delayed 1 hour, managed to get him to eat about 1/4 of FF classic & fortunately he ate about 1/4c of Young Again ZERO mature (thinking he's either not feeling well or starting to protest the canned food lol). I've been trying to collect urine since yesterday to check for ketones but he's super not ok with me trying to catch it with a spoon or using a trash bag over the litter lol. (Going to get some aquarium gravel to see if he take to it today). I'm worried about him developing ketones, which is why I made sure he got insulin this morning, but now worried about hypo

I talked to the vet yesterday about his BG readings and she suggested that Coda might not be getting enough insulin (increased to 1u) OR having a weird version of somogyi effect, where Vetsulin is working too quickly in his system and his body is dumping more glucose in him to compensate for drop. Coda seems to be unhappy at the moment (especially since he hates ear pricks *sigh*)
I will be switching him to Lantus this weekend to see if it changes anything (unsure whether to Start Low Go Slow or start with TR, suggestions?)

 

[Coda (GA)]

Slight update: after a depressed looking nap for 1 hour since shot- coda decided to eat a little more, makes me feel a little better. Also checking the scruff of neck test for dehydration (but he's been drinking anyways)

 

[Kris & Teasel]

Yes, Coda is responding erratically right now but he's only been on Vetsulin for 6 days, far too early to see if it will work for him. It usually takes weeks of data gathering to be able to assess the insulin's appropriateness. It's possible that he needs fractions of a unit and I would say that for a low dose kitty like Coda, jumping from 0.5 u to 1 u is a huge leap. His good dose might be 0.25 u, 0.5 u or even 0.75 u. All of these are easily measurable or eyeballed if your U40 syringes have half unit marks on them.

Are you definite about starting Lantus this weekend? An insulin change might well need to happen down the line but I'd give this a bit more time.

 

[Coda (GA)]

Yes, Coda is responding erratically right now but he's only been on Vetsulin for 6 days, far too early to see if it will work for him. It usually takes weeks of data gathering to be able to assess the insulin's appropriateness. It's possible that he needs fractions of a unit and I would say that for a low dose kitty like Coda, jumping from 0.5 u to 1 u is a huge leap. His good dose might be 0.25 u, 0.5 u or even 0.75 u. All of these are easily measurable or eyeballed if your U40 syringes have half unit marks on them.

Are you definite about starting Lantus this weekend? An insulin change might well need to happen down the line but I'd give this a bit more time.

Ok, thinking of lowering to .25 if that was a "missed" good dose for tonight (unless going to .75 is more appropriate?). If I were to lower his dose to .25 for the next few days, if he needs increase, .5 is good? What should I do if he shows ketones?

I can wait a few weeks for insulin change (I'll just keep it in the refrigerator until possibly need it) Just concern of him not feeling well because of the shorter acting insulin and if I chose the wrong one (both insulins were recommended by vet at the beginning of diagnosis)

 

[Kris & Teasel]

Ok, thinking of lowering to .25 if that was a "missed" good dose for tonight (unless going to .75 is more appropriate?). If I were to lower his dose to .25 for the next few days, if he needs increase, .5 is good? What should I do if he shows ketones?

I can wait a few weeks for insulin change (I'll just keep it in the refrigerator until possibly need it) Just concern of him not feeling well because of the shorter acting insulin and if I chose the wrong one (both insulins were recommended by vet at the beginning of diagnosis)

It's true that kitties can feel better on one insulin versus another but at the beginning uncontrolled high BG can make them feel icky. too. Hard to separate these issues out.

It's hard to decide on a dose to try from your SS: on 02/12 a dose of 0.5 u gave a BG of 97 and then last night a dose of 1 u gave you a low of 115. It's important to try to pin down the action profile of the insulin at a dose: when is onset (typically), when is nadir (typically) and what is the duration (typically)? Vetsulin usually has a fair early onset, a nadir around +4 and often a duration of 8 to 10 hours in many cats.

Here's something to try if you're at home:

• aim for tests at +3, +5, +7 and +9 at the dose you gave this AM (skinny 1 u)
• try a full 1 u this PM, numbers permitting.

This should help you see how this dose is working and a dose change decision can be made accordingly.

 

[Nan & Amber (GA)]

I'm not sure if I agree about waiting on the insulin change. In general yes, absolutely-- 5 days is not nearly enough time to be able to tell if a particular insulin is the right one for a cat. In this case, though, there is a definite upside to switching to Lantus just because it has a better track record of working well with cat physiology and getting to regulation/remission than does the Vetsulin. And since you already have it in the fridge, there's no additional economic cost to switching.

You don't want to do a lot of hopping back and forth on insulins, but if you are willing to commit to giving the Lantus a solid trial of at least a month or two, I don't see any reason to stick with Vetsulin right now.

If you do go with the Lantus, you should use the SLGS method because of the presence of dry food-- not allowed on TR.

 

[Kris & Teasel]

I'm not sure if I agree about waiting on the insulin change. In general yes, absolutely-- 5 days is not nearly enough time to be able to tell if a particular insulin is the right one for a cat. In this case, though, there is a definite upside to switching to Lantus just because it has a better track record of working well with cat physiology and getting to regulation/remission than does the Vetsulin. And since you already have it in the fridge, there's no additional economic cost to switching.

You don't want to do a lot of hopping back and forth on insulins, but if you are willing to commit to giving the Lantus a solid trial of at least a month or two, I don't see any reason to stick with Vetsulin right now.

If you do go with the Lantus, you should use the SLGS method because of the presence of dry food-- not allowed on TR.

You make very good points, Nan.

 

[Coda (GA)]

Thank you both! I did a +2 and it's at 231 already- will check +3 and +5 (then I will be in class until PMPS +shot)
I see both sides of opinions for "to switch or not to switch"
I think the best thing I need to do is make a firm decision of either Vetsulin or Lantus and keep it at least for a month

I don't want him on dry either (working on transitioning, but he's stubborn and still needs to eat) (+ I think I'd rather to SLGS since I'm having trouble with frequent ear pricks)
this is the bit of dry food coda is on, less than 1% carbs

 

[Nan & Amber (GA)]

I haven't used the YA Zero Mature, but I have done the regular YA Zero, and I've never noticed any bump in BG numbers in my cat. I think it's a pretty good product to use as a supplement or when transitioning a kibble-lover to wet food.

 

[Coda (GA)]

I haven't used the YA Zero Mature, but I have done the regular YA Zero, and I've never noticed any bump in BG numbers in my cat. I think it's a pretty good product to use as a supplement or when transitioning a kibble-lover to wet food.

Yea I think it's doing well, it makes me feel better to have it for supplement if Coda decides he won't eat the wet for a meal or two (he'll eat it again eventually during the day, just sometimes refuses, just weird cat things lol)