Increase Vetsulin from 1 to 2 units?

[putus_human]

Hi all! I'm Victoria and my cat is Putu. We're new here and have a lot of questions, but have already found a lot of help and comfort with the resources so far. So thank you so much for your support But I have some questions I haven't been able to find an answer to yet...

My vet is recommending increasing Vetsulin from 1 unit to 2 units. I'm hesitant because I've seen 0.25 unit increases on the guidelines here: https://www.felinediabetes.com/FDMB/threads/beginners-guide-to-humulin-n-novolin-n-nph.231593/

• Is that very specific to N/NPH or is that for any intermediate-acting insulin?
• I don't even think I could dose 0.25 increments properly right now because I only have U-40 needles. Is that advisable to even try?

I've also read the AAHA guidelines to increase in 0.5 unit increments.

• Curious why the recommendation here differs from the AAHA guidelines?

I specifically asked my vet if a dose increase to 2 units was too big and if I should instead start at 1.5 units. She replied she had no concerns about increasing to 2 units.

I'm trying to figure out other reasons why an increase to 2 units would be justified. Some background on Putu:

Went DKA 9 days ago and was hospitalized for 3 days.
Was on prednisolone for about ~3 weeks (due to IBD) before DKA but this was discontinued immediately.
Is supposed to start budesonide tomorrow.
Is getting pre-shots in the 300-500's and nadirs in the 200's.​

• Would any of the above indicate that she needs to go to 2 units? Either because of a risk of DKA or to counteract the steroid? (Note: vet said it's not a steroid and won't have side effects but it looks like from my reading it is a steroid and may have side effects, just not as severe).

I did tell the vet I thought this insulin was not lasting long enough, but she said she wants to give it a month before switching to something longer lasting. My concerns are glucose going too low or dropping too quickly, but the vet says not to be concerned with that with where Putu's numbers are now.

• Can anyone advise whether going from 1 to 2 units of Vetsulin is safe given all the above?
• Conversely, is there harm/risk (e.g. DKA) with only going up to 1.5 units?

My personal opinion is what's the harm of being on the conservative side of 1.5 units, but I'm still too new at this to have well-formed opinions.

 

[Chris & China (GA)]

Can anyone advise whether going from 1 to 2 units of Vetsulin is safe given all the above?

In one word...NO! It doesn't sound like much going from 1U to 2U but it's a 100% increase in dose. That's like a human going from 30U to 60U...there's a whole lot of "in between" doses to try first!

Conversely, is there harm/risk (e.g. DKA) with only going up to 1.5 units?

What's important is that he get his insulin every 12 hours, gets extra calories, extra fluid (by mouth or sub-q) and is acting like he feels OK. You should also be testing for ketones at least once a day using either urine ketone test strips or by getting a blood ketone meter.

it is a steroid and may have side effects, just not as severe).

Yes, it's a steroid, but most of it's action is in the intestinal tract instead of throughout the entire body so it usually doesn't cause the problems that other steroids can. ECID though so all you can do is try it and see how your cat responds! Did your vet mention anything about trying a novel protein diet? A lot of IBD can be caused by a sensitivity to a particular protein source and can be improved a lot of times by feeding a diet with a protein source your cat has never eaten before like rabbit, venison, bison, kangaroo or lamb.

 

[putus_human]

Thanks for helping answer my questions! Yes, she is getting her insulin every 12 hours and is acting okay - just some mild lethargy and trouble jumping on/off the couch due to weak back legs. She's drinking but not eating enough (maybe due to the IBD). I will get some ketone test strips now too.

Also yes, we've tried all sorts of different diets for her IBD over the past year. I won't get too into the details because I know this isn't a forum for IBD, but I would have a lot say there haha...

 

[Diane Tyler's Mom GA]

Bump

 

[Bron and Sheba (GA)]

Food is really important when recovering from DKA so try and get Putu to eat as much as possible. Small frequent meals throughout the day and night.
Are you feeding 1/2 hour before giving the insulin?

It’s great you are home testing!
I’d also recommend getting a test in during the pm cycle as well as cats often drop lower at night.
What dose did you end up increasing to?

As. Chris said you need to be testing the urine for ketones at least once a day at the moment.
Keep posting every day and keep asking questions.

 

[Sienne and Gabby (GA)]

In addition to the blood glucose testing, it's important that with a cat that's recovering from DKA you test for ketones. In fact, it's critical that you test for ketones. You can pick up ketone test strips (aka Ketostix) at any pharmacy. This is a urine test so you have to stalk your cat to the litter box. There are also blood ketone meters. The strips are expensive but it may be easier for you to get a test with a meter.

The reason we recommend a 0.25u increase is that we try to find the smallest effective dose while keeping your cat safe. With the intermediated and short acting insulin, you don't have much time to intervene if the numbers are dropping hard and fast. This applies to Vetsulin and Novolin in particular. We've found it easier on your nerves if the increases are small and systematic versus large and causing a panic attack and you have no way to know what a good dose is for your cat.

In case your vet did not mention this, have you switched Putu to a novel protein diet? Proteins such as venison, rabbit, lamb, goat, and/or pork may help considerably with getting the IBD under control. This website discusses a raw diet but even if you don't opt to use a raw food diet, it has a great deal of information on IBD, supplements, etc.

 

[JanetNJ]

I’d try 1.25 or 1.5 u. 1 to 2 is a big jump.

 

[putus_human]

Just following up to let everyone know Putu is doing fine today and say thanks again for your help!

Are you feeding 1/2 hour before giving the insulin?

Yes, she's eating 1/2 hour before the insulin.

I’d also recommend getting a test in during the pm cycle as well as cats often drop lower at night.
What dose did you end up increasing to?

I will get some PM measurements in my spreadsheet, thanks for bringing that up.
I ended up giving her 1.75 today. This was the proper starting dose based on her weight and BG according to AAHA guidelines, so it looks like my vet was a bit conservative to begin with. I figure the guideline to increase in 0.5 increments should really only apply after she starts on the correct dose. I also knew I would be home to prompt her to eat at the right time and monitor her signs in case that was too big of a jump. Lastly, her pre-shots have been very high (500-600) and I'm not sure at what point DKA becomes more of a concern than hypo.

As. Chris said you need to be testing the urine for ketones at least once a day at the moment.

Thank you everyone for pointing this out. My vet didn't mention it all and I had no idea how important it was. I tested her this morning and she had no ketones.

In case your vet did not mention this, have you switched Putu to a novel protein diet? Proteins such as venison, rabbit, lamb, goat, and/or pork may help considerably with getting the IBD under control. This website discusses a raw diet but even if you don't opt to use a raw food diet, it has a great deal of information on IBD, supplements, etc.

Yes, we did food trials for a year before resorting to steroids, even tried the raw diet. I was very hopeful but it didn't work out. In fact, the vet even put Putu on the Hill's GI Biome diet for her IBD recently. I calculated today it has 40% carbs. It probably caused her diabetes as much as the steroids Luckily, we're no longer on that food.

 

[Bron and Sheba (GA)]

Here is a link to the guide to Vetsulin use
https://www.felinediabetes.com/FDMB/threads/beginners-guide-to-caninsulin-vetsulin.231587/

Vetsulin users are advised to feed 1/2 hour before the insulin is due. So you test, feed them then wait 30 mins then give the insulin. https://www.felinediabetes.com/FDMB/threads/beginners-guide-to-caninsulin-vetsulin.231587/

I would then give another snack at around 1 and a 1/2 to 2 hours after the shot.

The best way to monitor DKA after you have come home is to test for ketones.
Also to help prevent the ketones you need to feed as much as she will eat and not skip any doses.
Post if you are concerned at all and test at least once daily fir the ketones