Insulin lasting too long?

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Natasha2001

Member Since 2020
My cat is on caninsulin, started at 3iu, is down to 2.2iu over the past few weeks.

His nadir is stable around 5 at 2.2iu.

The problem I'm starting to have is that his insulin is lasting too long. Right into hour 13 he is still only at 10. Hour 14 it only goes up to 12.

Really unsure whether I should shoot or not? I know it's an in and out insulin, but I'm worried about it potentially bring him too low if I do it 12 hourly? Should I just be lowering the dose more? Giving a smaller dose when this happens?

Sorry no spreadsheet I'll try to get it fixed today. Overall he has a nice slow decline to his nadir that hits at +7 hours.

Thank you!
 
Well, nadirs at +7 is rare on Caninsulin.
Insulin can carryover, so one dose effects the next, even if its not depot.

I'll tag @Critter Mom for you, she has experience with this insulin.
Do you need help setting up a spreadsheet? :D
 
SashaV said:
Insulin can carryover, so one dose effects the next, even if its not depot.
Click to expand...
Sasha is correct here that it is possible for there to be some carryover of effect into the next cycle when using an in-out insulin, but it's very unusual with Caninsulin. Normally the dose starts to peter out around the +7/+8 mark, but every cat is dfferent.

I'm really sorry, Natasha, but it's just not possible to suggest anything on dosing without seeing a cat's data. It wouldn't be safe for Meowmeows to do so. I'm going to tag Bhooma (@Bandit's Mom) to see whether she can help you sort out your spreadsheet problem. In the meantime, please can you contact your vet to get guidance on dosing.


Mogs
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SashaV said:
Well, nadirs at +7 is rare on Caninsulin.
Insulin can carryover, so one dose effects the next, even if its not depot.

I'll tag @Critter Mom for you, she has experience with this insulin.
Do you need help setting up a spreadsheet? :D
Click to expand...
Thank you! Just in the process of copying data from my BG reader into a new spreadsheet, mine became read only.

Here is some recent curve data

+0 17.9 then given 2.5iu
+2hr 19.5
+4hr 16
+6hr 9
+7hr 4.2
+8hr 3.9
+9hr 4.6
+10 7.1
+12 14

I then reduced his dose down to 2.2iu after a week because nadir still too low


+0 19.3
+2 20.3
+4 16.2
+6 12
+7 4.4
+8 6.8
+10 7.1
+12 18.9

Only this week has he been having these normal numbers right until +14. Thank you for confirming that they can still be affected despite it being an in and out insulin!
 
Critter Mom said:
Sasha is correct here that it is possible for there to be some carryover of effect into the next cycle when using an in-out insulin, but it's very unusual with Caninsulin. Normally the dose starts to peter out around the +7/+8 mark, but every cat is dfferent.

I'm really sorry, Natasha, but it's just not possible to suggest anything on dosing without seeing a cat's data. It wouldn't be safe for Meowmeows to do so. I'm going to tag Bhooma (@Bandit's Mom) to see whether she can help you sort out your spreadsheet problem. In the meantime, please can you contact your vet to get guidance on dosing.


Mogs
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Click to expand...
Thank you! Just called and left a message for my vet so hopefully he phones me soon too advise. If it's ok I'll tag you once I've got my spreadsheet filled in! He definitely didn't start off this way, at the beginning he had a sharp drop from 30 down to 10 within the first few hours, and it was wearing off by +6 hours. His nadir had shifted to +6-7 hours after six weeks on insulin and was stable there until recently.

He is otherwise doing well, very lively and regained the lost weight.
 
Natasha2001 said:
I then reduced his dose down to 2.2iu after a week because nadir still too low
+0 19.3
+2 20.3
+4 16.2
+6 12
+7 4.4 <<<<<<< ** DOSE IS TOO HIGH **
+8 6.8
Click to expand...
[Emphasis and commentary mine]

A nadir of 4.4 is too low for a Caninsulin cat, so the 2.2IU dose is too high, Natasha. According to the FDMB guide to Caninsulin/Vetsulin any time BG drops below 5.0mmol/L | 90mg/dL (human meter*) the dose should be reduced immediately. The normal dose reduction is 0.25IU, but a 0.5IU dose may be considered too (especially if it's not clear how the cat is responding overall).

I hope you can get the spreadsheet issue sorted out, Natasha. You're doing a good job with the BG testing and we'd be able to help you more if you could get the data you're gathering into a shareable format.

In the meantime hopefully your vet will be able to give you a steer. Also, the dose adjustment section of the FDMB Caninsulin guide is quite helpful.

When you get a moment, Natasha, it would be great if you could add the type of meter you're using to your forum signature. :)


Mogs
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Critter Mom said:
@Natasha2001 -

Hi Natasha,

Did Bhooma contact you about the spreadsheet yet?


Mogs
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Click to expand...
https://docs.google.com/spreadsheet...uSMFoma9hbTsMZ-eZz5RAfv_qvE/edit?usp=drivesdk

This link should work I hope. I have copied everything I have. Some data is missing sorry!
I use a caresens Pro human meter.

When I say "didn't shoot until now" it starts on the line below. When I say gave dry I mean hills glucose support. Cat is strictly on raw/ff/friskies pates.

Thanks so much!
 
****extra info I feed on demand except for overnight. I suspect the numbers were MUCH lower over night due to no food, which is really scary given his daily lows... The other vet at the clinic said the numbers were OK and I didn't need to be testing. My vet had said keep doing what I'm doing. I think I had a false sense of security due to the other vets attitude about it (other very apparently very familiar with feline diabetes) :(
 
My spreadsheet went to view only straight away, tried all the fixes :(. His numbers today are OK, the same sort of curve, he's at 13 at +5 hours, which is about where he usually is with nadir still to come. It looks like dropping to 2iu wasn't too low for him at all
 
Hi Natasha,

I've only just come online. Did you skip the dose this morning?

I hate having to say this after all your hard work but your spreadsheet is very confusing. There are dates missing, doses missing, and you seem in places to be using more than one line if you shot late. It's also not clear whether you allowed 12 hours before the next shot when you did shoot late. You need to record all of these actions in the Remarks column so that members replying to your posts understand properly what you're doing and, where necessary, to give you pointers on what to do and what not to do if preshots and/or nadirs are lower.

I can't tell if whether you're giving insulin once or twice a day. If you are giving insulin on the PM cycles then you need to get tests at +2 or +3 in the PM cycles to know what's going on better.

I really want to try to help you but I can't do that without reliable, understandable info. Have a look at this spreadsheet to get a better understanding of the appropriate way to record Meowmeow's info:

https://docs.google.com/spreadsheet...E9ig5TCMoLJ8mQtliWfi8BndEGsbVSbSpNENg/pubhtml

The reds and blacks that you've seen lately look like bouncing from the lower nadirs and the 2.20IU dose was too high. That's about all I can tell you with the information available.

For future reference, if preshot BG is below 200:

- do not feed, wait for 20-30 minutes and test again to see if BG has risen over 200.

- if PS BG rises over 200 then proceed as normal. Remember to adjust the time of the next dose to be 12 hours after the time the dose was given.

- if PS BG does not go above 200 then, provided Meowmeows has no history of testing positive for ketones or episodes of DKA then I suggest you skip the dose and wait till the next preshot BG. If he does have history of ketones/DKA then post for help.

I think it would help you a lot to familiarise yourself with the FDMB Caninsulin/Vetsulin guide. It has a great deal of practical guidance for what to do when it comes to handling lower preshot BGs and also when the nadir BG is too low and the dose needs to be reduced.


Mogs
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Critter Mom said:
@Bandit's Mom -

Hi Bhooma,

Is there anything you might be able to do to help Natasha access her spreadsheet consistently? Also, would you be able to help her get the information into a more understandable presentation?


Mogs
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Hi Mogs, I was tagged in another condo of hers and have offered to set-up a new SS for her. I think she's in NZ? So waiting for revert when she wakes up :-)

Thanks!
 
Bandit's Mom said:
Hi Mogs, I was tagged in another condo of hers and have offered to set-up a new SS for her. I think she's in NZ? So waiting for revert when she wakes up :)
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Thanks for replying, Bhooma. :)

Per my comments above, if there's anything you could do to liaise with Natasha to get dates/doses/remarks into a more intelligible state it would help a great deal. There's very little members replying to Natasha's posts can do without understandable data.


Mogs
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Thanks mogs.

I do have all of that info, it's just the 4th time I've had to copy my Google sheet and it's frustrating. All of his BG info is stored in his meter. There is a good amount of data missing here. I was just rushing to try to get it all in so someone could help.

I have been shooting 12 hourly. I agree that it's more than likely a result of too high of a dose the bounces that I see.

Aaanyway, thank you for your help. That makes sense and I'll stick to that, and keep skipping if I notice he's too low (he's rising too slowly). Unfortunately at the moment I work part time and am I'm working full time on my masters, so I'm really stretched. I think I'll switch him for him to have curves at the vets and let them advise

Thanks for trying, I appreciate it!
 
Bandit's Mom said:
Hi Mogs, I was tagged in another condo of hers and have offered to set-up a new SS for her. I think she's in NZ? So waiting for revert when she wakes up :-)

Thanks!
Click to expand...
Hello! I know how to set up the spreadsheets, I've tried the fixes, clearing cache, and sticking to only android or only desktop. I still have the able issue where after recording data my sheets revert to read only. Occasionally it fixes, but always to revert to read only following that. I googled to troubleshoot, seems to be a known bug?

*** the problem with this particular sheet is I accidentally used a template I edited for my vet, not the full original.

Is there any other spreadsheet platform that is acceptable on this forum?
 
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