Do I or don't I (give a shot)...after near hypo

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Jennifer and Hannah

Jennifer and Hannah

Member Since 2014
Hello!

I'm new to the forum and have a question for those of you who have been doing this for a while. First, a little background...

My cat, Hannah, was diagnosed a few weeks ago and I was started on Vetsulin. My vet set the initial dose to 3 units twice a day based on the lab test showing a BG in the 500's (can't remember the exact number). I had some experience with feline diabetes because my mom lives with me and her cat has been on Vetsulin for over a year, but spent many hours that night reading everything I could find. Based on everything I read, a starting dose of 3 units seemed way too high for my 9.5lb kitty, so I delayed giving the first shot and instead went out the next day and got a ReliOn Micro meter and a case of Fancy Feast Classic wet food. Her initial BG reading before any insulin was 329 (this was with free-feeding dry Prescription DM food that I had switched her to as soon as I got the diagnosis a few days earlier). I stopped feeding the dry DM and began exclusively feeding the FF wet for 24 hours prior to her first insulin. Her first pre-shot BG was 324 but I was nervous about causing a hypo event so I started at just 1u of vetsulin and have been working up from there over the past 2.5 weeks.

On 1u, her pre-shot numbers were in the 325-385 range and her lows were 195-265. After 5 days of that, I bumped it to 1.25u for a couple of days, and got lows of 112 and 117, but then had a run of days where I wasn't going to be around to watch her consistently, so backed the dose just a hair to between 1u and 1.25u. During those 5 days, she had pre-shot numbers of everything from 288 to 417, but I was only home for one insulin peak reading which was still 197. I upped her dose again to 1.25u and maintained it for 5 days. I was expecting to get lows in the low 100's again, but despite running full or partial (around peak only at +3, +4, +5) curves for several days, the lowest I got was in the 150's. And, unexpectedly, the highs were HIGHER...308-466. So now, on to the fateful near hypo...

So Wednesday (PM shot, when I could do the curve), I upped the dose to 1.5u. At +3 she was 248 and at +4 she was still 210. I got sidetracked and forgot to do the +5 BG but didn't have high hopes since she was still 210 at the +4 reading. Her insulin usually peaks between +4 and +5 with the biggest drop occurring prior to +3 (which seems pretty typical for Vetsulin from what I've read). When I did the next BG, it was at +7 and I got a reading of 138, so I didn't know what to make of that...I'd never seen a drop that large after +4. By +8 she was at 200 and by her next pre-shot reading she was at 301. Unfortunately, what would have been the next dose of 1.5 ended up being my first ever fur shot, so yesterday AM she got no insulin (confirmed by her +4 BG of 364). Her pre-shot reading yesterday PM was 408 so I gave the 1.5u again. And that's when things went WAY CRAZY. When her +3 BG was already 134, I began to freak out...calmly, of course. I printed out Melissa and Popcorn's Hypo guide to have on hand, and readied the dry carb-heavy Cat Chow AND the Karo Syrup, just in case. At +4 her number was 84, and since I knew her peak was still coming, I fed her a full serving of wet food (because I didn't know if she'd actually still eat the dry stuff having been off it for 2 weeks) and watched her closely for symptoms. At +4.5 she had dropped to 64, but with no symptoms. She was still fully alert, playfully batting at her dangling toy mouse, and walking normally. Since I suspected her peak was still 30 minutes out and the last 30 minutes had yielded a 20 point drop, I immediately began counteractive measures following the guide's instruction for "Low Numbers Without Symptoms". I put down a bowl of the Cat Chow and she happily scarfed down a bunch. At +5 her BG was 59, but still with no symptoms (except that she was getting really vocal about all the ear pricks and wanted absolutely nothing to do with sitting on my lap). I tried giving her more Cat Chow, but I think she was full because she wouldn't eat any more. At +5.25, her number had risen to 73 and then at +5.5 to 77, so I knew we were out of the danger zone and I breathed a HUGE sigh of relief. By +7 she was 262.

This morning I came out here to the FDMB to see if I could figure out what type of dose to give her, if any. I found a very recent post from someone who had a kitty go hypo two doses in a row and the concensus on the reason was because cats can be more sensitive to insulin after a hypo event. So I had decided I probably wouldn't give her any insulin, but I tested anyway and got a BG of 518! She also has a few more clumps of pee in the litter box than has been typical for the past few weeks, which I'm sure is not a coincidence, so I don't know what I should do. So I figured I would register, post my question, and see if any of you who are online this morning have any opinions or experiences to share.

Oh, and sorry for all the numbers within the paragraphs. I have been running a spreadsheet, but it's not the one so many people here use (which I just found this morning) so I didn't upload it. Figured it would just be even more confusing than just putting the important numbers right here in my post.

Thank you in advance!!
Jennifer
 
I would go back to 1 unit. I do recommend that you do post your spreadsheet. It allows one to see all the BGs/doses together.

And welcome here. You seem to be on the right track
 
Welcome Larry to the best place to get your little sweetie back on track to healthy days!!! So glad to see you started to go slow with the insulin these guys here are sugarkitty angels so ...ask all kinds of questions and you are doing a great job Hugs and tons of healing green light to your beautiful girl for a quick and full recovery to a healthier life Kath
 
Hi Larry and Kath! Thanks for the replies!

Update...I tested Hannah again about an hour ago and she was at 418. (Realized that the 518 might have been so high because I had fed her at her normal time and tested 30 minutes after...400's isn't good, but it was pretty much what I expected after feeding dry carb food last night during the drop.) I also did some more reading, and since she didn't drop any lower than 59 and never showed any hypo symptoms, but now I am a few hours later than her normal shot time, I think I will go ahead and give her a small dose (1u or maybe a little less) to at least get her out of the 400's.

Here is a link to my spreadsheet. Green is her pre-shot BG, blue is her lowest BG between shots, and the last page has a few of the curves I charted.

https://drive.google.com/file/d/0Bx6MwSlqJQJjSmFZcnRiTTlYZUU/edit?usp=sharing

Thanks!
 
Was there anything yesterday when yo got the low BGs? Examples are did Hannah each here normal amount? Was the Vetsulin mixed properly?
 
I agree with Larry to reduce the dose to either 1u or 1.25 for the time-being. The 1.5u seems too much if you have to take corrective action to keep the numbers up during peak/nadir. You kept her above 40, which is a great job on your part and nice job on being vigilant! :thumbup

One other thing, dry food does not work well for bringing numbers up. It takes too long to hit and then it takes much too long to wear off. Stick with high carb, gravy foods and karo and ditch the dry.
 
Larry - Nothing weird yesterday at all. That's what I don't get. At 1.25u I couldn't get anything lower than 159 for 5 days straight, but 1.5u dropped her to 59...?

She gets fed 1/2 can of Fancy Feast at 0, +2, +4 and +6 during the 1st cycle and then 0, +2 and +4 of the 2nd cycle, and she pretty much always eats it all. The Vetsulin was mixed the same as I do every day: rolling and gentle shaking (not enough to cause foam), making sure the white powder is off the bottom and the liquid is uniformly cloudy, and I never let it rest after mixing it before drawing it up in the needle. The only difference was that she had that fur shot at the prior dosing, but I wouldn't expect that to make her react more strongly to the insulin. If anything, her PMPS was higher than normal at 408. I haven't started a new bottle of insulin, a new package of test strips, or a new package of needles...all are the same as the days prior. I'm completely baffled at what caused the drop.

KPassa - thanks for the tip on the dry food. I was following the guide posted here: http://www.felinediabetes.com/hypo-emergency.htm I didn't know how low it would go or how long it would last, so I planned on feeding the longer lasting dry food at 60 and pushing the fast/short acting syrup if the number got below 50, which thankfully I didn't have to do.

Jennifer
 
Sounds like you are doing a great job. I like going back to one unit and increasing slowly, by .25units at a time, as your testing suggests, if needed. (it is always safer to increase slowly than try to figure out how much to reduce if the dose is too high)

We should probably revise that sticky. We have found that low carb at first, in small amounts, can work to bring up a low number. If still dropping, we suggest the gravy off higher carb food and finally honey. It seems that the gravy and then honey, if needed, stays in the body a shorter time than dry food and doesn't affect the next few preshots as much as dry food might.
 
Thanks again everyone! Hannah made it through two low doses today with no issues so I'll start again at 1u for 3 days and then bump to 1.25u and chart, chart, chart to see if she produces consistent numbers. I'm sure I'll be back to ask for suggestions once I've gotten my data. The whole reason I went to 1.5u was because her highs and lows were still too high on 1.25u, but if 1.5u unexpectedly drops her to 60 it's not feasible either.

I'm so thankful to have found this group! :-D
 
If you get U-100 syringes with half unit markings, you can dose as finely as 0.2 units of Vetsulin.

Vetsulin is 40%, i.e. 0.4, of the concentration of a U-100 insulin.
This means that you can multiply the syringe marking by 0.4 to get the Vetsulin dose.

syringe
mark * 0.5 = Vetsulin dose
0.5 * 0.4 = 0.2
1.0 * 0.4 = 0.4
1.5 * 0.4 = 0.6
2.0 * 0.4 = 0.8
2.5 * 0.4 = 1.0

Alternatively, giving 0.25 or 0.5 units of Vetsulinis possible with a U-40 syringe. You can make a reference gauge by following these instructions.

[Glucose reference ranges are unsubstantiated and have been removed by Moderator]

* * * * * * * * * * * * * * *​
Examples of using the chart:

Ex. You are a new insulin user and you test your cat before giving insulin. The test is 300. It probably is safe to give insulin.

Ex. You are an established user of Lantus, following the Tight Regulation protocol. You've tested around +5 to +7 to spot the nadir. It is 200 mg/dL. You probably need to increase the dose, following the instructions for the protocol.

Ex. Your cat is acting funny. The eyes are a bit dilated. You are concerned and test the glucose. The number is 35 mg/dL. ACK! The cat may be in a hypoglycemic state. You quickly follow the HYPO protocol linked in the glucose reference values chart. (which we really, really, suggest you print out and post on your refrigerator.)
 
Hi Wendy - Hannah is doing fine, now - thanks for asking! After that one really low reading, I only gave her a 0.5u dose, just to be safe, and as I expected, her numbers stayed pretty high that cycle. The next couple of doses I did at 0.75u because I wasn't going to be home during her peak. Yesterday I started her back at 1u and her nadirs have been around 150. I think 1.25u should have been the right dose for her, but I had her at that dose for 5 days straight and didn't get a single nadir lower than 159 despite no changes in the other variables (type of food, timing of meals, etc.).

BJM - Good suggestion about using the U-100 needles and converting the dose. I guess it just seems so odd that Hannah's that sensitive to less than 0.25u, especially when I've read so many posts from newbie sugarcat owners saying that their vets were raising and lowering doses by full 1u increments...or more!! Can I say again that I'm so incredibly thankful I found this site! If I'd have given the 3u dose that my vet had initially prescribed, I am almost 100% positive there would be no more Hannah. It makes me so sad to think of how many people have likely lost their pets due to blind dosing. And they probably have no idea what went wrong (and possibly blame themselves)! Too sad...

So thank you again, everyone. I'll be charting for the next week or so as I slowly raise Hannah's dose again back towards 1.25u. I'll post again with all of her numbers when I get closer to an ideal range (unless something else unexpected comes up, of course). Thankfully, despite the difficulties with the numbers, I can definitely see her clinical signs improving. (No more crazy drinking or peeing, she is acting more playful again, and she's even gained back 0.8 lbs in the past three weeks since I started treatment!)
 
I know it's long, and yes, I do plan to convert. When I originally posted, I was short on time because I needed advice for the next dose to give Hannah and didn't have time to convert, and this week has just been too busy so far so I've continued to log on my old SS until I have time to move all of the data over.
 
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