Injection keeps her bg low for a day or two?

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TheLadySeals

TheLadySeals

Member Since 2017
hello all im new here. Cecila is 9 and was diagnosised this past october when we took over her care. She also had a near full dental extraction at the same time. We switched her to all wet food and then started pretty steady at 1 unit vetsulin twice a day. Raised to 2 units but she was acting lethargic with it and i dropped her to 1.5. A curve on 1.5 seemed to be dropping her too low again. So back down to 1. For the last two or three weeks it has seemed that after a 1 unit dose she tests too low to shoot for nearly a day or two. Shell go up to the 300s, get a shot, and then stay in 100s for the next 24 hours or so.

after her last curve back on 1 unit (all done at home with alphatrak and hitting too low for comfort again) my vet was thinking possibly remission, but after a trial of no shots for a week shes spot testing again in the low 300s. So i feel like were just in this weird pattern of shoot, skip two shots for low numbers, repeat. Ive been in good contact with my vet but wanted to see if anyone else had any insight on to whats going on here. Thank you!
 
Hi welcome to you and Cecila! I don't have any experience with vetsulin, but it sounds like the dose may be too high. I'll bump you up and tag @JanetNJ as she knows more about that insulin.
 
as my cat approached remission I found it necessary to do LESS than 1 unit. sometimes .75, sometimes .5, sometimes as little as .25. click on the link to my spreadsheet in my signature below and you will see. any chance you could buy a meter and test at home? It's really easy to do, and that would be the best and SAFEST way to make sure shes getting exactly the dose she needs each day, and tweeking it until HOPEFULLY, she is in remission. The high 300 readings are almost positively a BOUNCE. that's what we call it when a cat's levels drop too low, so they compensate by releasing stored up insulin from their pancreas. You are on your way to remission but without home testing you will have a harder time of it.
 
Just wanted to pitch in here and say a couple of things, I see that you are and have been checking glucose levels at home, so you are definitely doing the right thing for Cecila. When getting Shaak into remission we eventually were giving less than one unit, in fact we were giving less than one drop eventually. It seems not possible to do this, but it is possible. You just hold the plunger down on syringe and insert into bottle, then turn bottle over to load syringe and then let go of plunger and pull syringe out of bottle, do not touch plunger at all when pulling syringe out of bottle. Don't touch plunger again until you inject shot, when you inject hold the plunger down for a few seconds while inserted. It gives a minute dose of insulin.
 
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Sky is similar - she seems to store up her insulin (she is also on Caninsulin/Vetinsulin). Her progress seems similar to yours - thought she was going into remission so stopped and then her BGs increased. Having monitored her a *lot* over the last month or so I have come to the conclusion that she has a slow metabolism for absorbing medication so it builds up in her - the vet said it was possible on the ebidence I gave him (3 different medications which mader her poorly, on each one when it was stopped she was better in 48 - 60 hours).

Whether I'm right or not, I'm getting by by adjusting her dose slightly and missing one ocasionally to try and give her a break from a build up.

So far we're doing okay.

Every cat is different :)
 
I agree with the previous posters that it's possible the dose of insulin is too high especially now that you have switched Cecilia to an all wet diet. Whether she is heading for remission or not is difficult to say when she has tested in the 300's after a week of no insulin but anything is possible. Without actually seeing the readings you've been getting on a daily basis though it's hard to say what's going on.

We have a spreadsheet here that most of us use to log the readings we take. It's a wonderful tool as it colour codes all the readings automatically and lets you see patterns which help you get a handle on what is happening. The spreadsheet is a shared document so members here with the link can view it and offer their opinions/suggestions based on actual data over time. If you would set up a spreadsheet, it would help us help you. The instructions for setting up the spreadsheet are HERE and THIS DOC provides information on how to use the spreadsheet. We don't deal with actual clock times here because we are an international group with members from around the world in different time zones.

If you can log the readings you have been getting and share your spreadsheet we'll be able to offer more opinions on how to help Cecilia. If you need any help setting up the spreadsheet, just holler and someone will help get you up and running. :)
 
A spreadsheet would definitely help us. We would be able to tell if she is bouncing and for how long. Typically, cats will come down in dose to 0.25u or 0.1u or...as Cathie said....even a drop before going off insulin.

But bounces can take six cycles to clear and so it is important we see a spreadsheet, see how low she gets with a shot, see if she bounces, and then see where she is when the bounce is over. Keep in mind that cats who have been diabetic a while can bounce from dropping to a BG that might not be that low but is lower than their body is used to. So, 1u may or may not be too much depending on how low her BG actually got.

The other thing that causes bouncing is a fast drop from a high number and vetsulin can certainly cause that to happen. So if she dropped rapidly one cycle fro, for example, 300 to 200 in 1.5 hours, she's probably going to bounce back up high.

If she's coming down to 100, that is a decent nadir for Vetsulin. What is your "no shot" number that you are using?
 
Hey all, thanks so much for the quick and informative replies! As im sure you all know, it can get a bit overwhelming when you feel like you don't have all the info and experience to know what's going with your fur baby! I'll get to filling out a spreadsheet with what tests i have in min!

The lowest ive seen her while doing a curve was 68 which did not thrill me and got some food in her even though she seemed ok behavior wise for such a low number. My vet called 70 a worry number, 60 a get some sugar in her now number.

My no shot number is 200. When she's hovering a bit over that i might give a small partial dose or judge how much she's eating, etc.
I only started spot testing after she seemed to be slightly hypo after moving her up to 2 units. After that, i started occasionally spot testing and can easily move into regular testing. She is very docile and takes well to being handled, getting shots. Though sometimes i could tell she would test low if she was actually trying to reject her shot. Like she knew it would make her feel bad! Ill get working on that sheet and im due to send an email to my vet tonight as well.

Here is the sheet with what information i had recorded. hopefully makes sense!
https://docs.google.com/spreadsheets/d/1PfqAqQPK9pHyO47xDzzljP3tGQO6cvNb9FQ4evV-r68/edit?usp=sharing
 
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Had a quick peak at Cecelia's spreadsheet and it looks to me like 1u is too high a dose given she dropped from 213 to 68 on the 15th. We all have a defense system against low BG numbers and when a cat's BG has been running high for awhile and their BG suddenly falls to normal numbers, they bounce back up to higher numbers because the defense system goes into action and spills glucagon into the bloodstream to try to get the BG level back up to what the body now wrongly assumes is normal. Bouncing can happen when lower than usual numbers occur, numbers go too low or the BG drops down to numbers they are not accustomed to.

I suggest you take Cecelia down to 0.5u, BG numbers permitting, and keep her on that dose for about 3 days (6 cycles) to see what she does. Holding the dose for a few days allows any bouncing to clear so you can see how the dose is working. It's important to get a test pre-shot without any food influence so make sure you withhold food for at least 2 hours before the pre-shot test. Then I would try to get some tests between 1.5 and 6 hours post shot to see how she is doing. A test early in the cycle when compared with the pre-shot test will give you a good idea how fast she is dropping and if she is dropping fast, you can steer her with food if need be. If her numbers are still a bit too high or if you have to skip a shot because of low pre-shot tests, it will tell you whether she needs more or less insulin. If you are not home all day, then test when you can. All data is helpful.

Curves work only if kitty is not bouncing and your dosing has been inconsistent for good reason so I'm not sure whether those curves are really giving you a good picture of what is going on. I see a curve as a snapshot where as random tests through each cycle over a period of time gives you a more detailed movie view of what's happening. :)
 
Thanks so much. I did give her evening shot at .5u and emailed my vet her updates along with wanting to reduce dose. It has felt very inconsistent! So many dose changes but she is newly diagnosed and i have been working with my vet on each change. Inbetween data sets she had been getting shots like clockwork unless she hadnt eaten much -and i was shooting pretty much blind in between curves. The idea of shooting blind now seems strange to me!

Ill keep updating the chart and let you all know how she is in a few days with the reduced dose. Thanks for the info on test before food too, i often test after but my cats are on a feeding schedule so thats easy to do. its crazy to navigate all this but its so awesome this resource exsists to help!
 
Thanks so much for the SS as that makes it a lot more clear.

I think the 300 numbers the last few days are definitely because she is not getting insulin and she hadn't had a shot for eleven cycles. That means all bouncing would have cleared.

I do think a reduction was warranted. I might have tried 0.75u but 0.5u is a place to start and you can always take her up if needed.
 
Its been over a week since the no insulin test and she's right back up high again. I still need to do a few more spot tests rather than just preshot tests but her pre-shot levels have been all in the high 300s Bumped her back up to 1u over the week and waiting on a response from the vet. Back to the sugar dance.
 
Mid cycle tests are really the only way to be sure those pre-shot numbers you're getting are not the result of bouncing. With Vetsulin, getting a test early in the cycle around +1.5 to +2 will often tell you just how fast the BG is dropping. Bouncing can happen if the drop is too fast, if the drop is down to lower numbers than kitty is now accustomed to or if numbers go dangerously low. The lowest readings with Vetsulin usually occur around +3 to +5 post shot but some cats nadir earlier and some later so until you get some mid cycle testing, it's impossible to say what is going on with Cecelia. Until you can get some mid cycle tests, I would be hesitant to raise the dose further.
 
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