Hypo incidents need measurement advice

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Managed to test her again at 3 hrs after feeding with no shot and she read at 5.4. We'll do our best to get another test tomorrow morning but if we can't then maybe we shouldn't give the morning shot? I think the spreadsheet should be correct now. She's also running low on insulin so I'm wondering if we should ask to change type when we get the next prescription.
@Melsterwithcat

Tagged Bron , Bhooma and Christine for you
Hi ladies I know you are not a Caninsulin/ Vetsulin user , I tagged Janet yesterday who is familiar with Vetsulin but she really hasn't been on the board for a long time until yesterday.
I also tagged Suzanne.

Melanie cat Blackie was on 3 units in the AM and 2 in the PM.




I see Janet J said in her post above
I definitely recommend lowering the dose. no need to do different doses am and pm. Since you are monitoring now, I might just reset back to 1.5 am and pm (no need for different doses in a day) and lets track it for several days and see. Sometimes after a hypo they can be sensitive for several days

Melanie's first successful test was today PMPS
I'm wondering if she should lower the dose yet

Melanie said above
We chatted with the vet and he said under 7 not to give her anything.
Do you have any suggestions.
Blackie already had 2 hypos in Jan , it's on her signature

To bad we don't have more members that are familiar with Vetsulin.
She has no one to help her :(


@Bron and Sheba (GA)
@Bandit's Mom
@Christie & Maverick
@Suzanne & Darcy
 
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She's also running low on insulin so I'm wondering if we should ask to change type when we get the next prescription.
@Melsterwithcat

You live in Canada correct?
I would ask your vet for Lantus .
From what I know
Lantus is available at most people pharmacies, and typically without a prescription. Even the generic Lantus is fine to use
Ask your vet and tag me and let me know what your vet says
You can get 5 cartridges of Lantus and use them like a vial. The pharmacist might say that they are only good for 28 days but that's just for humans
One cartridge should last you about 6 months , they have the expiration dates on them. Put them in the middle shelf in the fridge.

You will need different syringes also
Let's see what the vet says
The member I want to tag that lives in Canada is in vacation or else I would tag her for you

You would take your syringe and push the plunger all the way in before you draw out the insulin then just insert the syringe how much you need , if you might over draw squeeze the rest out in the sink never the pen
Just take the cap off the pen and use a U100 syringes and pull the insulin out of the pen! You will see a small gray rubber stopper, insert the syringe there
syringe-in-pen-pic-jpg.45006
 
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I’ve just looked through your thread.
If the 1.5 dose is dropping your kitty down to 3.9 at +11 the dose is too high. I would reduce the dose to 0.75 unit twice a day and see if that helps. Can you measure that amount (0.75 u ok?) .
Do you think the breath smells sweet? Or like nail
Polish?
I would test for ketones in the urine. you will need a bottle of Ketostix from a pharmacy to do this. I’d like to be sure there are no ketones around.
What food are you feeding now? And are you giving snacks during the cycles?
 
with various diabetic wet food plus tuna/salmon/chicken and royal canin dry food.
What various diabetic wet food ,who makes it, whats the name of it. When you say plus are you just feeding like tuna from a can, pieces of cooked salmon and cooked chicken?

Have you seen Have you seen this list: CANADIAN Food Chart

By the way what are your shooting times for Caninsulin. They need to be the same time for the AM shot and the PM shot 12 hours apart.

If you're not home have you thought about getting an automatic feeder so you can set it to open when ever you want it to, ducts @+2, @+4 @+6
@Melsterwithcat
 
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She doesn't smell of anything usually, the fish smell was just a one off. She had 2* 0.75 today and measured about 45 mins after reading her evening meal at 4.7. I've updated the spreadsheet. She gets fed twice per day with no snacks, except for a couple of dry treats when we test her. Dry food is the royal canin which she always gets and today she had Royal canin wet food but yesterday she had chicken. I'm going to call the vet tomorrow and chat about options for insulin and food. We'll need more insulin and syringes in the next day or so so need to make a decision. I still think she is nauseous which is why she's bring so picky about eating so I'm going to ask about getting something for that. She hasn't thrown up for a few days though which is good. Is Lantus something the vet would prescribe? I'm not sure if the foster agency would be ok with off label use of human products unless I have some pretty solid info for them. It's a bit tricky because there is us, the vet, and the foster agency and with the three of us I feel like everyone is waiting for someone else to make decisions.
 
What various diabetic wet food ,who makes it, whats the name of it. When you say plus are you just feeding like tuna from a can, pieces of cooked salmon and cooked chicken?

Have you seen Have you seen this list: CANADIAN Food Chart

By the way what are your shooting times for Caninsulin. They need to be the same time for the AM shot and the PM shot 12 hours apart.

If you're not home have you thought about getting an automatic feeder so you can set it to open when ever you want it to, ducts @+2, @+4 @+6
@Melsterwithcat
The vet said to feed her twice per day and not in between, so she eats around 8am and 6pm. She's really hungry in the evenings so we offset it a bit. We feed a variety of diabetic wet food, tiki cat, Royal canin, and another one I forget. We try to change every day because she's really picky and will only eat a flavor for one or two meals. We also give her tuna, white fish, and chicken pretty regularly. I have no issue how we'd test her urine, how do you get it?
 
Please do feed your kitty more than twice a day. Twice a day feeding is old thinking with the old insulins. Cats do much better and are happier when given snacks as well.
To test the urine you need to collect a urine sample from her. You can either stick the test strip under her as she pees or put a spoon under her or a small container to catch the urine. And read the test strip exactly 15 seconds after the urine has hit the test strip
 
Spreadsheet seems to have something wrong with it. I can't edit. I've tried changing the share settings and making it editable by anyone but it hasn't helped. Any suggestions? Anyway, did another test at 3 hours after the shot and it was 4.1 (4.7 two hours earlier). That seemed a bit low so I've just given her some dry food which she's eating.
Eta fixed spreadsheet by making a copy.
 
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Please do feed your kitty more than twice a day. Twice a day feeding is old thinking with the old insulins. Cats do much better and are happier when given snacks as well.
To test the urine you need to collect a urine sample from her. You can either stick the test strip under her as she pees or put a spoon under her or a small container to catch the urine. And read the test strip exactly 15 seconds after the urine has hit the test strip
The vet was pretty adamant about not giving her anything in between the two feeds. I'm not very confident in them which is why the post in the first place about finding another one.
How do you catch the cat in the act of peeing? She just heads off to her litter box but other than hearing the scraping which is too late I'm not sure how we'd know.
 
Is Lantus something the vet would prescribe? I'm not sure if the foster agency would be ok with off label use of human products unless I have some pretty solid info for them. It's a bit tricky because there is us, the vet, and the foster agency and with the three of us I feel like everyone is waiting for someone else to make decisions.
I found this posted by some of our members to show the vet

Is Lantus something the vet would prescribe? I'm not sure if the foster agency would be ok with off label use of human products unless I have some pretty solid info for them. It's a bit tricky because there is us, the vet, and the foster agency and with the three of us I feel like everyone is waiting for someone else to make decisions.

Yes the vet prescribed Lantus

Also you need to be feeding snacks during each cycle , maybe 2 teaspoons of the wet food
@Melsterwithcat
 
Anyway, did another test at 3 hours after the shot and it was 4.1 (4.7 two hours earlier). That seemed a bit low so I've just given her some dry food which she's eating.
Looking at your spreadsheet Blackie dropped under 90 , you would reduce the dose again to 0.5 units
You need to be testing Blackie every AMPS and PMPS to be sure it's safe to give insulin and you need to be getting more tests in during each cycle
4.7 is 84 in US numbers
4.1 is 73 in US numbers
You times your numbers by 18 to get the US numbers
I'll tag a few members to confirm this
This is from the Vetsulin sticky
Changing the Dose

Hold the starting dose for at least a week UNLESS

  • your cat won’t eat or you suspect hypoglycemia
  • your kitty falls below 90 mg/dL (5 mmol/L). If kitty falls below 90 mg/dL (5 mmol/L) decrease the dose by 0.25 unit immediately.
After 1 week at a given dose perform a 12-hour curve (i.e., testing every 2 hours) OR perform an 18 hour curve (i.e., testing every 3 hours). Note: Random spot checks are essential in order to "fill in the blanks" on your kitty's spreadsheet. The goal is to learn how low the current dose is dropping kitty prior to making dose adjustments.

The general guidelines for making dose changes are:
  • If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
  • If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
  • If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit
  • HOWEVER, there are some situations which signal that a larger than usual dose reduction is needed. If you are unsure, please post on this forum or in the Health forum and ask for input about your dose.
@Bron and Sheba (GA)
@JanetNJ
@Suzanne & Darcy
@Bandit's Mom
 
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I found this posted by some of our members to show the vet

Is Lantus something the vet would prescribe? I'm not sure if the foster agency would be ok with off label use of human products unless I have some pretty solid info for them. It's a bit tricky because there is us, the vet, and the foster agency and with the three of us I feel like everyone is waiting for someone else to make decisions.

Yes the vet prescribed Lantus

Also you need to be feeding snacks during each cycle , maybe 2 teaspoons of the wet food
@Melsterwithcat
Was there a missing link?
 
Was there a missing link?
Sorry I forgot to post it, I found this posted by some of our members
I'm linking the diabetes treatment guidelines from the American Animal Hospital Assn for you and please feel free to discuss the information with your vet.

The AAHA points out that Vetsulin is not a good insulin for managing feline diabetes. It was developed to treat dogs. (Its name outside of the US is Caninsulin.) As a result, it is too short acting given a cat's fast metabolism. Since 2018, the AAHA has recommended either Prozinc or glargine (Lantus) for the treatment of feline diabetes. These are gentler, longer acting types of insulin. Unfortunately, if your vet is not familiar with using Vetsulin, it's likely that the vet won't be familiar with either Prozinc or Lantus.

Found this also

https://www.felinediabetes.com/FDMB/threads/aaha-guidelines-for-various-conditions.261508/
 
Checked with vet and Lantus is 2* the cost of caninsulin which may be why they recommended it. Will chat with vet tomorrow and follow up with the agency to see what they think about changing to Lantus.
Testing this morning was a complete gong show. Cat has ears like a pin cushion and tried to bite me, wasted more test strips, late to work. Did not give insulin this morning. Managed to test at lunchtime 1pm and she was 4.8. She's not eating well so I'm wondering if she is a) low because not eating or b) in remission or c) both. Either way seems like we maybe shouldn't be injecting her. I will attempt another test now, wish me luck.
 
Test before food was a complete failure. Didn't inject her and gave some fancy wet food to see if it would tempt her. She ate a bit. Measured at 5.4 a couple of hours after feeding. Seems to be easier to warm up the entire cat by lighting a fire she can sit in front of rather than warming up her ear. Not really scalable though.
 
@Bandit's Mom
I tagged Bhooma to help with your spreadsheet. You need to be using the World version of the spreadsheet so it converts your numbers to the system that's used in the US.

If you switched to Lantus, please make sure you have the appropriate syringes. You need U100 syringes and not the syringes you were using with Caninsulin.

Also, it sounded like you were using a 33 gauge lancet. That is way too thin of a lancet for the time being. It takes a while for the capillary bed in your cat's ear to more fully develop. Until it does, you need a wider gauge lancet -- usually a 26 or lower number. Once your cat's ear start bleeding more readily, you can switch to a thinner lancet. I typically used a 30 or 31 gauge.

I also agree with Bron. There is absolutely no need to feed your cat only twice a day. I fed my cat several small meals both in the morning and the evening. It's much easier on your cat's pancreas and it helps to gently offset any drop in numbers as the insulin begins to work.

And a housekeeping detail... We try to cap threads at 50 posts. It would be helpful if you could start a new thread.
 
A happy ending! We've spoken to the vet and it looks like Blackie is in remission. We'll keep testing her to track what is happening and will continue to investigate the nausea, but as of now she is off insulin and staying stable. Thank you everyone for your advice and helpful links!
 
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