DOSING ADVICE FOR SHADOW

Can I please ask if Shadow's spreadsheet can be looked at please.

This morning at 10.40AM UK time he was as low as 2.

We've been gradually lowering his dose down for some time since we changed his diet to a high meat, low carb wet food only.

He has only been on 1 Unit of Caninsulin since the 2th March, and it looks like I'll need to drop the dose again to 0.5.

Is this okay!?

 

I don't know how to upload n up to date spreadsheet as it would take me forever to do this one currently showing.

 

Claire, here's the link to the current SS...
https://docs.google.com/spreadsheet...scPzlt714Pn8Wh4f8YG8movS8wz_7E73U7KLW78#gid=5

 

Yes thats the link I'm using, does his numbers look okay to miss a dose this evening!?

 

https://docs.google.com/spreadsheet...scPzlt714Pn8Wh4f8YG8movS8wz_7E73U7KLW78#gid=5

Can I miss Shadow's insulin this evening dose!?

 

Claire, as you know a hypo warrants an immediate dose reduction. So yes, I would agree with dropping the dose to half a unit.
And I would also strongly suggest raising the number at which you give insulin shots.

Shadow has had a lot of hypos, and this is very likely taking a toll on his body. So it is super important to try to keep him safe. ...And if there are repeated hypo episodes then the body can cease to recognise hypo as the dangerous event that it is (hypoglycemic unawareness), and may not raise the blood glucose in a crisis.
If this were my cat I'd reduce the dose to half a unit, and I'd also raise the number that I give insulin to at least 10 (on a human glucose meter). Then I'd keep to that for a week and then reassess the situation.
If the blood glucose drops too low in that time then another reduction would need to be made immediately. If the numbers start trending higher over the course of the week then it may be that a dose increase will be required. As we say here, 'better too high for a day than too low for a minute'....

Cats can be more sensitive to insulin after a hypo, so it is important to monitor closely following a hypo episode. It is clear that you are very good at testing Shadow's blood glucose. That's great! So you are very able to monitor the effect of the reduced dose.

Edited to add: Regarding missing this evening's dose. You haven't done this in the past following a hypo. Why exactly are you considering it on this occasion?

 

Thank you for your advice. I'll reduce his insulin down to 0.5 tonight.

 

Shadow is still low at 2pm UK time, ie he still only 4.9.

He gets checked again at 3pm, then just before evening dose.

https://docs.google.com/spreadsheets/d/1l2SX8xaJvh6wOzdBW2ssxgSAg6NTagqb-v5iwsmgUVM/edit#gid=5

 

I agree with everything Elizabeth said. Please, please listen to us when we advise to reduce. You received that advice several times on Facebook and still haven't reduced.

@Elizabeth and Bertie are you thinking stick with the 5/90 as reduction point? I was originally thinking 70/3.8 as it seems to hold him in a slightly better numbers - but it is very dependent on sticking to the no-shoot threshold and taking reductions as soon as earned

 

He is currently 6.1 at 3pm.

Will retest at 6.15pm tonight.

Dose will be reduced down to 0.5.

Thank you for the advice xxxx

 

https://docs.google.com/spreadsheets/d/1l2SX8xaJvh6wOzdBW2ssxgSAg6NTagqb-v5iwsmgUVM/edit#gid=5

Shadow is now 6.2 before evening dose.

I have lowered this down to 0.5 as advised.

Does this mean he is going into remission!?

 

Did you shoot? Elizabeth advised to skip shots if he's under 10 for now

He's definitely doing well!

 

Not had any insulin as he was 6.2 on his evening test.

Is this okay!?

 

Claire, please keep a very close eye this evening. Shadow will be very sensitive to insulin after his hypo this morning and we don’t want another one - it’s possible even on that reduced dose, at a pmps of 6.2.

 

Claire I thought you just said you had lowered the dose to 0.5u? So you have dosed? Which is it?

 

I havent given a dose this evening as advised.

 

Ok good. So your post above saying you were lowering the dose down to 0.5u was incorrect.

 

Defo no insulin tonight, I'm very anxious, please see spreadsheet. I'm scared, please bear with me.

He will be tested throughout as normal until I go to bed after 11.40 pm

https://docs.google.com/spreadsheets/d/1l2SX8xaJvh6wOzdBW2ssxgSAg6NTagqb-v5iwsmgUVM/edit#gid=5

 

Claire, if you haven’t given insulin there’s no need to be scared or anxious. This morning’s dose will have worn off now and with no insulin tonight, he can’t hypo. It’s much more scary giving insulin on low bg numbers. Remember, from tomorrow, no insulin if bg is 10 or lower.

 

Yes I was confused because you have 0.5U in the dose column for this evening. That indicates to us you shot. If you skip, please put NS. Thanks!

But you are correct in that your new dose is 0.5U - if he's 10 or higher.

 

It would still be good to test because it will give us a clue how well his pancreas may be working. But as Diana said there is no risk of hypo tonight so do not worry

 

Its 9pm.

Shadow is 9.8 with no insulin since this morning.

Is this okay!?

 

It's very possible he's bouncing from those lows earlier today (if they drop lower/faster/too low their liver panics and dumps stored glycogen and counterregulatory hormones in order to spike BG back up). It's very likely he's been doing that for awhile, but because dose was too high you didn't see these higher numbers often.

Nothing to be done right now, just wait til morning shot time

 

I was advised not to give insulin tonight.

So far, 9pm he's 9.8, 10.40pm 8.9, another test at 11.40pm.

He's okay.

Will test around 3am.

Then again at 6.15am tomorrow morning.

 

There's no reason you need to stay up (or wake up) at 3am to get another test tonight. Since you didn't give insulin tonight, there's no risk of him dropping too low. Take this opportunity to get some extra sleep!!!

If your usual shot time is 6:15am, maybe you could test at 5:45 (don't feed) so IF he's still under 10, you'll have some time to ask for advice.

This Caninsulin forum doesn't get a lot of activity so I'd recommend instead of posting here, you post in the Main Health forum which has a lot more active people. Once you post there, you can also post the link to that post in the Feline Diabetes group on Facebook too which will also help get attention on your post.

 

Its just gone midnight, and he's now 9.8

If he goes above 10 by 6.15am, what dose should I give him!?

 

You would give 0.5U if he's 10 or higher. Under that, skip for now. That advice may change but first we need to see where he's at without the overdose

 

Morning everyone.

Shadow had no insulin last night.

By midnight he was 9.8.

This morning at 6.15am 8.6, so again no insulin.

Does this mean he us in remission now!?

 

His numbers are still higher than we'd like to call it remission, we want him mostly under 120 (6.7). But he's not leaving a lot of room to give insulin. You said you have a vetpen correct? And smallest dose is 0.5U?

I am pretty sure you can withdraw insulin from the vetpens using regular syringes, that may end up being what you need to do. Because you'll need to do something more like a drop dose to 0.25U. In these numbers, "remission" won't last long. Wait to see if one of the other ladies know if you can use regular syringes with it.

 

I've just checked him at 9am, he is now 7.

I'll test him throughout the day.

 

Shadow's blood sugars this morning are now very good.

I've been testing him regularly.

Its now 10.40AM UK time and his blood sugar level is now 6.6 compared to 8.6 at 6.15AM

https://docs.google.com/spreadsheets/d/1l2SX8xaJvh6wOzdBW2ssxgSAg6NTagqb-v5iwsmgUVM/edit#gid=5

 

That is looking good...
I'm not sure what your feeding schedule is for Shadow, but feeding mini meals (rather than a couple of larger meals) can help to stimulate the recovering pancreas to produce insulin, without overwhelming it with too much to do all at once.

 

Afternoon.

He is currently 7.8 just gone 3pm.

I'm hoping fingers crossed he should be around 8.6 like last night.

I feed him Nature's Variety, and Lilly's, both are 0 carb.

He usually gets fed around 6.15am, and same time in the evening.

He usually gets 2 pouches at meal times only.

Now he's not on any insulin, what feeding small meals do you recommend!?

Can I reduce him down to 1 pouch and a half!?

He weighs around 5.68kg.

 

I was thinking of doing the following for Shadow:-

1 pouch at 6.15am, half a pouch around midday, 1 pouch at 6.15pm, and a half pouch around 10pm.

Does that sound okay for smaller meals!?

 

I answered on Facebook as well, I would continue to feed however many calories he needs to get to or maintain his ideal weight.

How big is a pouch (weight, volume)?

 

Nature's Variety are 70g and Lilly's either 70g for the tins or 85g for the Pate's.

 

Ok then I would just split it up into relatively even amounts throughout the day/night. My cat just grazes all day, but a lot of people tend to do about 2-3 small meals each cycle, or 4-6 total per day.

 

Okies, so I'll feed the 4 pouches throughtout the day, the last one being around 10pm in the evening.

 

I would still do some during the night if you can, it helps keep them lower. You can always freeze it beforehand so it thaws throughout the night for him.

 

Shadow was 10.1 the cut off for insulin at 6pm.

Do I give a dose of half a unit!?

 

Yes, if you can monitor.

 

He's only had 85g food. Is that okay!?

 

How much does he normally eat before his shot? I'd say that should be ok, that's a decent amount of food

 

He usually has 2 pouches, but as it was only 0.5 units he had 1 pouch at 85g, plus a little more after.

By 9pm his levels had dropped down nicely to 7.4.

This morning at 6.15 am he was 9.3 so no insulin was given and only 1 pouch of food.

He will be fed again at midday another pouch and so on.

 

https://docs.google.com/spreadsheets/d/1l2SX8xaJvh6wOzdBW2ssxgSAg6NTagqb-v5iwsmgUVM/edit#gid=5

So Shadow's levels so far this morning.

Currently its nearly midday UK time.

I gave Shadow half a tin of Lily's Kitchen at 11AM UK time.

Lily's Kitchen is low carb wet food.

By 11.40 +4 his blood sugar is now 7.6

Is that normal after food, will it drop down again!?

 

Replied on Facebook, yes, "normal". His pancreas is working a little bit, but he's still higher overall than we'd like.

Can you send a picture of the top of an unused cartridge please? The little vial with the insulin. At this point you are going to need to buy regular syringes to withdraw the insulin from the cartridge, and not even use the pen because it cannot do small enough doses. But I'd like to see it before having you go buy stuff.

 

I don't think Shadow might not need any more insulin.

Its currently 2pm UK time and he has dropped down to 6.5 and has been 6.5 since 1pm too.

Looks like the smaller meals are working for him xx

 

So remember that with a human meter a nondiabetic cat is 50-100 (2.8 to 5.6), that is usually what we aim for with remission. Vetsulin is a little different because it's usually not safe to bring them that low.

What we DO want is to see him below 120 (6.7) most of the time, and he's not quite there. He really does need twice a day dosing, so at this point I would shoot the 0.5U if he's above 9. You shot the 0.5U over 10 and he didn't stayed on the higher side. We need to start lowering the no shoot number slowly.

 

That's looking very nice indeed...


Claire, I 'think' you said in a previous post you said you'd ordered syringes from VetUK? Is that the case? And have you tried using them yet at all? It 'may' be that Shadow needs very small doses on an 'as needed' basis at the moment, if his numbers are high enough for a shot. And the syringes would enable you to draw up extremely small amounts. If you have them but haven't tried using them yet then it may be good practice to just draw some water into them to get a feeling for how they work, and for experimenting with measuring very small doses.
..The syringes should have half unit markings. But it's quite easy to draw up a 0.25, for example, by drawing water/insulin half way between the zero line and the 0.5 line. And it's also possible to draw up much smaller doses than that with just a little bit of practice.. Shadow 'may' not need the insulin, but it may also be that his pancreas still needs a little bit of support from time to time...

 

Remission is essentially a fully healed pancreas. We know the healing takes place in the green range on the spreadsheet, so the more time they can safely spend there, the better.

For reference - here is a cat in remission on Vetsulin/Caninsulin. https://docs.google.com/spreadsheet...Wpm6anpTlKn8LfeOnQpksaFUNZkuWIHgWWFCA/pubhtml

You can see he's mostly in the 50-120 range on his own, and we tapered the dose down to very fine amounts to give his pancreas insulin support and time to heal. It got to the point that even the smaller doses brought him too low, so the only choice was to try an OTJ (off the juice) trial or switch to an insulin like Lantus.

 

Thats why he had half a unit a couple of nights ago, so far at 1pm, and 2pm he's holding steady at 6.5.

I've just been sorting out his food marking on packets one the carbs are, some of his food is 0 carb, so will purchase some more of that today.

 

Note for anyone lurking, there are parallel conversations on Facebook group and this forum, so there will be some missing pieces of the puzzle, will try to keep it straight here -

It appears Shadow's current food is a mix of low carb up to 8%, Claire is going to reduce that to up to 5%.

Claire - at this point hold the shoot/no shoot number as 10, and keep the 0.5U dose. Please note food change in Remarks column. After 3 days of the 5% and under let me know so we can reevaluate

 

https://docs.google.com/spreadsheets/d/1l2SX8xaJvh6wOzdBW2ssxgSAg6NTagqb-v5iwsmgUVM/edit#gid=5

Shadow currently 6.8 at +8 or 3PM UK time.

This new feeding regime is amazing for him.

I will aim to feed him between 0 and 4.8 of carbs a day.

I have to say he seems totally fine, and he's not drinking loads of peeing for Britain, in fact he's only used the litter tray once since early this morning.

 

I gave him a food at 3pm which is only 2.14 in carbs, half of it as recommended.

He will be fed a more at his 6.30pm evening feed.

Fingers crossed, no insulin tonight.

 

Hi Claire, can you just clarify regarding the syringes? Do you have these and are you using them? Or are you still just using the Vetpen?
If you are using the syringes that will make more options available to you when it comes to measuring/using small doses at lower pre-shot numbers.

 

*updated advice on Facebook, shoot if 9 or higher and can monitor

 

Shadow seems to be doing really well, Claire.
Don't be concerned if he needs insulin on an 'as needed' basis at this point. That happens sometimes. Just think of it as giving the pancreas a bit of extra help while it's getting stronger.

Eliz

 

https://docs.google.com/spreadsheets/d/1l2SX8xaJvh6wOzdBW2ssxgSAg6NTagqb-v5iwsmgUVM/edit#gid=5

Morning everyone.

Shadow is doing really well.

8 days now without insulin.