? Magic BG 137 @ PMPS (Vetsulin) - Help needed

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Denver & Magic (GA)

Denver & Magic (GA)

Member Since 2021
Met with my vet yesterday and they changed Magic's dosage to 5u/x2. Numbers last night and today have been better than they've ever been. Spreadsheet is up to date.

His Nadir (up until this point) has ALWAYS been at +6. However, today we continued to drop through +8 and now at +9.

I'm thrilled to see him in more 'normal' numbers. But I'm starting to get a little worried since he's scheduled for his next shot in three more hours and we're this low now.

I realize that there is a comfort issue with the lower numbers since the closer he gets to being normal the less of a cushion that will exist. I plan on checking him again at +10 to see if - hopefully - we start going up.

I'm a little panicky here because he's NEVER been this low and his glucose has never dropped any past +6 before.

UPDATE: At +10 looks like we're headed back up with a 104 mg/dl. +11 is 109 mg/dl.

Any ideas what I should do for his evening shot? He didn't drop below the 90 but I'm concerned that his PMPS will be way too low for the new dose - unless it shoots up like it has before but doesn't seem to be doing today.
 
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Ended up giving him 3u since he usually shoots super high. He decided NOT to eat the FF Turkey and Giblets he’s been going nuts over and had to throw out. He’s finally eating a can of Friskies Chicken shreds.

Something tells me this is going to be a very Looooong night :-(
 
Hi Denver and Magic.
Magic is on a large amount of insulin for a newly diagnosed cat.
Going up in1 unit increments is not ideal. We recommend going up in 1/4 unit increments.
Have you thought at all about swapping to a more suitable insulin for cats?
Vetsulin was made for dogs. It is a faster acting and harsher insulin than Lantus and has a shorter duration.
You would be much better swapping to something like Lantus which is a gentler, longer lasting insulin and is great for cats.

Are you testing foe ketones in the urine?
 
Bron and Sheba (GA) said:
Hi Denver and Magic.
Magic is on a large amount of insulin for a newly diagnosed cat.
Going up in1 unit increments is not ideal. We recommend going up in 1/4 unit increments.
Have you thought at all about swapping to a more suitable insulin for cats?
Vetsulin was made for dogs. It is a faster acting and harsher insulin than Lantus and has a shorter duration.
You would be much better swapping to something like Lantus which is a gentler, longer lasting insulin and is great for cats.

Are you testing foe ketones in the urine?
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Vet and I had a very lengthy discussion… They wanted to get his numbers to something more reasonable before attempting a switch. They felt letting him potentially shoot back up to where he had previously been would do more harm than trying to get at least some control first.

I’ve been testing for ketones as so have they. He’s been negative, even when we’ll over 800.

Based on his numbers today/tonight I’m at a loss to exactly what is going on.
 
Denver said:
wanted to get his numbers to something more reasonable before attempting a switch. They felt letting him potentially shoot back up to where he had previously been would do more harm than trying to get at least some control first.
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I disagree with your vet.
The whole point is that the vetsulin is not going to get Magic into better numbers. He is up to 5 units.
You need to get him onto an insulin that will get away from those constant black BGs. The duration is not there with vetsulin so even if he comes down during the cycle, he goes back up towards the end of each cycle into black BGs.
If you did a swap to Lantus you don’t start all over again with the dose. You do a swap to somewhere close to where you last were with the vetsulin.
For example if you swapped now, you would most likely start the Lantus around 4 units.

I’m very glad you are testing for ketones.
 
I do agree that the vetsulin isn't a good fit for your cat. ProZinc or lantus would be better because they last longer in their system. The insulin he's on now is for dogs who have a slower metabolism. Some cats do ok on it.... My cat did good on it in the beginning... But many find it doesn't last long enough or that it makes their numbers very bouncy.


Also I see you're raising in whole doses. It's better to raise in 0.25-0.5 increments so you don't skip the ideal dose. I like this 4.5 dose... 5 may have been just a little too much.
 
Looks like Magic had a great day yesterday! Why did you take him down to 4.5 units this morning?

My husband and I are playing around with Mocha's Vetsulin because we see that his nadir is around +4 and by +8 he's right back up. As annoying as it would be, we are gonna try a few days of 3x/day dosing. My husband leaves for work at 6am so it's easy to take his sugar and give a shot then. But by 2pm he's already back up. So we're seeing if we can give a little dose midday then a full dose at 10pm when we go to bed.

I'm sure that's probably not the ideal thing for Magic either. It's hard enough to give insulin twice a day let alone 3 times a day. Looks like his nadir is around +6. But he goes up from there. If possible might be worth an experiment to see if a frequency change might help. He certainly doesn't seem to be in danger of going hypo (except for those good numbers yesterday). Do you think his numbers were good yesterday because he ate less food? I see your note that he refused his usual food.
 
Mocha's_mom said:
My husband and I are playing around with Mocha's Vetsulin because we see that his nadir is around +4 and by +8 he's right back up. As annoying as it would be, we are gonna try a few days of 3x/day dosing. My husband leaves for work at 6am so it's easy to take his sugar and give a shot then. But by 2pm he's already back up. So we're seeing if we can give a little dose midday then a full dose at 10pm when we go to bed.
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@Mocha's_mom have you been given some advice about dosing three times a day? You are having to deal with three nadirs and unless you are experienced, you could run into trouble.

Mocha's_mom said:
sure that's probably not the ideal thing for Magic either. It's hard enough to give insulin twice a day let alone 3 times a day. Looks like his nadir is around +6. But he goes up from there. If possible might be worth an experiment to see if a frequency change might help. He certainly doesn't seem to be in danger of going hypo (except for those good numbers yesterday).
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Please don’t encourage other new members who are just finding their feet to try something like dosing three times a day.
 
Hey Denver,
I'm fairly new here too, and Nico had a similar experience with Vetsulin. He would come down into the 160's but his body would react by bouncing back up into the 600's. I went through a few months of this, and I felt so bad for him. At first my vet said give it time to work, and increased his dose, but after a pretty scary episode and an ER vet visit I TOLD (lol did not ask this time) that we were switching insulins. She was a little bit miffed but she got over it. A little hiccup here and there (mostly on me, whoops) but for the most part he's doing great now.

Maybe if Magic is still bouncing a lot, your vet will see that too and you can talk with them about trying another type.

Wishing you luck, hang in there!
 
Actually yes I was given advice from a trusted vet who has used Vetsulin for many years successfully. And since there aren't many people on here who like Vetsulin I thought I'd share my experience with Denver who I know is using it too. Not everyone wants to change their cats over to Lantus right away as recommended on here.

Bron and Sheba (GA) said:
Janet who is an experienced Prozinc user said she liked the 4.5 dose…..post 10:)
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He's using Vetsulin not Prozinc.
 
Mocha's_mom said:
Looks like Magic had a great day yesterday! Why did you take him down to 4.5 units this morning?

My husband and I are playing around with Mocha's Vetsulin because we see that his nadir is around +4 and by +8 he's right back up. As annoying as it would be, we are gonna try a few days of 3x/day dosing. My husband leaves for work at 6am so it's easy to take his sugar and give a shot then. But by 2pm he's already back up. So we're seeing if we can give a little dose midday then a full dose at 10pm when we go to bed.

I'm sure that's probably not the ideal thing for Magic either. It's hard enough to give insulin twice a day let alone 3 times a day. Looks like his nadir is around +6. But he goes up from there. If possible might be worth an experiment to see if a frequency change might help. He certainly doesn't seem to be in danger of going hypo (except for those good numbers yesterday). Do you think his numbers were good yesterday because he ate less food? I see your note that he refused his usual food.
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Until the unexpected bizarre shift of his nadir from +6 to +9 yesterday, Magic was having a fantastic day at the new dose. Everything was going fine until we hit his PMPS @ 137. After seeing how his trends work I was seriously concerned that around 8pm we’d be hypo but I also know that unmedicated he shoots up like a bottle rocket…. That’s why I posted seeking advise since my vet was already closed for the day. Since the board was low traffic I decided to use what knowledge I had from dealing with my Mom’s diabetes to try and safely navigate until this morning.

Since 4u wasn’t enough and 5u caused chaos I decided to try and split the difference and see if we can keep the same trend but at slightly higher/safer number - fingers crossed it works.

Yesterday morning Magic ate fine. I think Magic’s uncooperativeness last night was that he was ‘over’ having his blood checked, tired from not getting his nap in, and it was also storming here. He ate the Shreds but took longer to do so than he usually does. This morning he ate the Fancy Feast Turkey without complaint.

I know Vetsulin isn’t perfect and I know everyone here is truly trying to help. However, I’ve spoken now with all three vets in my area - different practices - and they’ve made it clear they want him to remain on Vetsulin for now at least. I made that my mission Thursday. So I’m effectively stuck until someone will relent and write an Rx for him so I have to work with what I have.

The reason for the full unit dose increase was because the vet and the technical folks at Merck both felt that was warranted. The needles I have do not have half marking but I can eyeball it until his next appointment in two weeks.
 
Bron and Sheba (GA) said:
@Mocha's_mom have you been given some advice about dosing three times a day? You are having to deal with three nadirs and unless you are experienced, you could run into trouble.


Please don’t encourage other new members who are just finding their feet to try something like dosing three times a day.
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Christina and I actually chat a lot via email and share discoveries from our respective vets and food ideas. I know she has been working with her vet on additional options for Mocha so I know in what context her statement was intended. We both have temperamental fur babies.
 
JanetNJ said:
I think

4.5 may give a shootable am/pm that's the same. I think the jump from 4 right to 5 may be too big of a jump all at once.
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THIS is exactly what I’m hoping for. If so, that may be a solution that actually works.

Only thing that concerns me is the bizarre shift in his nadir for no apparent reason - that’s NEVER happened before.
 
Do not get hung up on when the nadir is. They can and do shift around.

I am donning my Moderator's hat and climbing on a soapbox. @Mocha's_mom - the advice you are dispensing about using Vetsulin three times a day is flat out dangerous. Vetsulin can drop numbers hard and fast. In a blink of an eye, a cat's BG could be in the 20s and if you weren't paying attention, this could cause a severe, symptomatic episode of hypoglycemia or worse. And this would be based on your recommendation. I frankly don't care that your vet has a lot of experience with Vetsulin. When a cat is crashing in the middle of the night or on a holiday, there's no one home at the vet's office and it can be the members here who are attempting to rescue someone's cat or the caregiver is rushing to an emergency clinic. There is a reason the American Animal Hospital Assn does NOT recommend Vetsulin (or Humulin N). There is also a huge difference between the dose you're giving Mocha and the dose that Magic needs. I would also suggest your read this post of giving advice.

@Denver and anyone who is lurking and others following this thread, dosing insulin three times a day is an advanced technique. It means you are awake around the clock in order to shoot every 8 hours and to check BG numbers. For most caregivers, this is impossible and exhausting. It takes guidance from a highly experienced member. In my 12 years here, I've seen this approach used only rarely and after other strategies were tried and not found to be successful. I have never seen this approach used with a faster acting insulin. If someone wants to try this with their own cat, you do so at your own risk. I would not endorse advising someone else to do so unless you clearly articulated the risks and were going to be providing the around the clock back-up that the caregiver would need. I would also be very circumspect about providing this kind of advice when both caregivers are new to FD management.
 
Sienne and Gabby (GA) said:
I frankly don't care that your vet has a lot of experience with Vetsulin.
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Well I do care. And I will continue to do what I think is right for MY cat. I wasn't "giving advice" as you say. I was sharing my experience with my cat just as a lot of people on here do.
Sienne and Gabby (GA) said:
For most caregivers, this is impossible and exhausting. It takes guidance from a highly experienced member.
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I'm not most caregivers and it's not impossible for me. I take my guidance from experienced veterinarians not just members of a message board. Maybe you don't like Vetsulin but my vet does. Who's right?

I come here to see what other people are going through and share my lived experiences too. Because we can all learn from other people.
I take everything I read here with a grain of salt because who really knows who is on the other side of the keyboard. I'm pretty sure most people can agree with that. Sharing my experience is not the same as giving advice. I'm sorry that you took it that way as it was not my intention. But thank you for letting me know.
 
Denver said:
THIS is exactly what I’m hoping for. If so, that may be a solution that actually works.

Only thing that concerns me is the bizarre shift in his nadir for no apparent reason - that’s NEVER happened before.
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I see magic earned a bit of a reduction. I'd suggest going down to 4.25
 
Denver said:
We’re actually going back to 4u and will be having a discussion tomorrow about where we go from here. After today this obviously isn’t working.
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I would suggest a longer acting insulin. ProZinc or lantus.

Don't be discouraged by the black pmps. That's just a bounce from going lower than she's used to.
 
Mocha's_mom said:
Well I do care. And I will continue to do what I think is right for MY cat. I wasn't "giving advice" as you say. I was sharing my experience with my cat just as a lot of people on here do.

I'm not most caregivers and it's not impossible for me. I take my guidance from experienced veterinarians not just members of a message board. Maybe you don't like Vetsulin but my vet does. Who's right?

I come here to see what other people are going through and share my lived experiences too. Because we can all learn from other people.
I take everything I read here with a grain of salt because who really knows who is on the other side of the keyboard. I'm pretty sure most people can agree with that. Sharing my experience is not the same as giving advice. I'm sorry that you took it that way as it was not my intention. But thank you for letting me know.
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What you fail to understand, because you haven’t been here long enough to know, is there are a lot of people here who join and just read. They don’t post or ask questions. And when they read something like you’ve written, regardless of whether you deem it to be “sharing your experience” or we see it as giving advice, inexperienced members will try it. Some people are desperate enough to get their kitty’s BG under control that they will try anything they read about.

Just as in the medical profession, we also here have the adage “first do no harm”. While it is obviously not intentional by any member here who makes a less than ideal suggestion or gives poor advice, it’s still very crucial that we all think about what we write before we write it.

As Sienne said, TID dosing is not for the inexperienced and, really, none of us here would suggest it for someone so new. Your point is well taken that we don’t know who is on the other side of the keyboard but perhaps you should look at it as we do. We don’t know who will test the cat often enough, if they understand how and what to feed when, if they can test the cat when they need to, if the cat is indoors or outdoors and if they have to catch it, if they will shoot and think they will stay awake but then don’t, on and on. We’ve seen it so very many times over the years and that’s why we are more conservative even in what we discuss.

If you like Vetsulin, fine. For those of us here who are very experienced, and, yes, I’d say more experienced than your vet, we recommend against using it unless cost is a factor. It is a harsh insulin and more cats experience hypoglycemia from it than the longer lasting insulins.

And while you might like your vet, and that is great, using Vetsulin in cats is old school and most up- to-date vets only suggest it if cost is an issue. I am just a bit curious since you did mention wanting to switch to Lantus in this post and your first post seemed to indicate you didn’t have that much faith in your vet. Did you switch vets?

Bottom line….moral support by new members for newer members is great but sharing the use of advanced techniques with someone who has little data and doesn’t understand how the insulin works or onset, nadir, and duration, etc, is unwise and unsafe.
 
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Marje and Gracie said:
And while you might like your vet, and that is great, using Vetsulin in cats is old school and most up- to-date vets only suggest it if cost is an issue. I am just a bit curious since you did mention wanting to switch to Lantus in this post and your first post seemed to indicate you didn’t have that much faith in your vet. Did you switch vets?

Bottom line….moral support by new members for newer members is great but sharing the use of advanced techniques with someone who has little data and doesn’t understand how the insulin works or onset, nadir, and duration, etc, is unwise and unsafe.
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Again, point taken. What I deemed as "sharing my experience" appeared to be "advice" from your point of view. That was not my intention.

Yes I actually sought out the advice of 2 additional vets since Mocha's diagnosis. All 3 have agreed that this is working for him and there's no need to change insulins right now as he's responding quite well to our sliding scale approach & dietary changes. If and when that stops working then we agreed to trying a different approach.
 
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