Moving into remission? Not comfortable shooting yesterday and this morning

Hey there! Rupert was 130 AMPS and 156 a half hour later. I’ve been dosing him on a sliding scale. He is mostly higher than a non-diabetic cat but so low I’m not apprehensive to shoot.

This the 3rd day of this being the case. I would appreciate someone taking a look at his SS for advice. Vet is closed and I can’t get him in for 2 weeks anyway. He is on Vetsulin. I’d like to try a new insulin but don’t want to completely stop shooting while we are waiting

Also I he’s been a little constipated the past week. Hard to gauge because I have 2 cats and can’t catch them in the act but sometimes only one poop and it’s pretty dry. Yesterday 1 dry and one normal. I doubt it’s dehydration. I give them almost as much water as food when I feed them. If you have time, I’d love an opinion.

 

It looks like he’s headed in that direction but your dosing needs to be more consistent. I’m not sure what is the sliding scale you’re using but when you had him at .5 units on 1/30 and he went under 90, you should have decreased the dose to .25. Instead, you upped it to .75. It also looks like most days you’re not giving insulin at night. Have you read the info on the dosing methods on the Vetsulin forum? We do dose adjustments by 1/4 units here and following ten SLGS method is the best way to get your cat safely into remission.

if he’s above 100 at preshot time, I’d recommend you give insulin. I wouldn’t go back to .75 I think that’s too much but tagging a few others to see what they think @Sienne and Gabby (GA) @Suzanne & Darcy @Bron and Sheba (GA)

 

thank you. I know I should shoot but I’m apprehensive because 0.25 looks impossible no matter what syringe I use. I have u40’s and was ready to buy u100. On a u100 the conversion is 0.2. This looks more tricky than eyeballing a u40 and eyeballing a u40 is scary.

If you look further back you can see how low he drops. I shot 0.75 on 1/30 because he was so high at AMPS. I did read the section and only learned about 2x a day from this forum.

He was prescribed 1x a day.

I’ve had a few scares and I’m terrified of overdosing him. I have guests in town this weekend and can’t be around to monitor but most days I’m available all day. I work from home

 

We see quite a few vets here prescribe insulin once a day only, but the issue is insulins don’t last more than 12 hours so then your cat is not protected the full 24 hours and their pancreas doesn’t get as much of a chance to heal. Vetsulin is also a short acting insulin that doesn’t even last the full 12 hours. Let’s see what others think. I understand the syringe issue can be tricky especially when you don’t have 1/2 units marked syringes.

 

Vetsulin is a bit trickier than other gentler, longer lasting insulin. However, what you're seeing is that without insulin, Rupert's numbers are not as good -- a lot the recent blue numbers are outside of normal range. In addition, vets who prescribe Vetsulin are likely more used to prescribing it for dogs. Cats have a faster metabolism and regardless of the insulin, need twice a day dosing -- even with Lantus which has a far longer duration than Vetsulin.

It's hard to get comfortable with shooting lower numbers. When you have company visiting is not the best time to start! What I typically suggest is think about what number you would be comfortable shooting. The more comfortable you become with shooting lower, progressively lower the number. Ideally, you're going to start seeing flat curves that are in the normal range.

 

Thank you. The only thing that makes me uncomfortable is my ability to measure such small doses and making decisions on the dose amounts on higher/lower days. I really don’t have the funds to be going back and forth to the vet right now especially when I don’t trust my vet. I’m new to my area also. I’ve made calls to numerous vets who won’t answer simple questions like “how experienced are you w feline diabetes and what is your basic strategy?”. Im just received with cold desk reception telling me to book and there’s no appointments available for a month. Super frustrating.

 

One option for small doses is to make up a sample syringe. Use colored water/juice, etc. it is generally easier to compare your insulin filled syringe with another syringe vs trying to eyeball the dose every time. We also have instructions for using digital calipers.

If there is a cat only practice in your area, I'd suggest that as an option.

 

I’m a bit confused by that last sentence, specifically how you arrived at “0.2” as the conversion.

It’s usually easier to measure small doses of a U-40 insulin in U-100 syringes. The important thing is to always have the conversion chart handy and to only have U-100 syringes available to use (so you don’t accidentally grab the wrong size syringe).

To use a U-40 insulin in a U-100 syringe, you’ll be giving the exact same amount of insulin you would have given had you used a U-40 syringe, you’ll just be drawing to a different line on the U-100 syringe.

To calculate where to draw to, you multiply by 2.5.
So, to give 0.1 unit of Vetsulin (a U-40 insulin), you draw to the 0.25 line of a U-100 syringe.

To give 0.2u of Vetsulin, you draw to the 0.5 line of a U-100 syringe.

To give 0.3u of Vetsulin, you draw to 0.75 on a U-100 syringe.

And so on.

On your spreadsheet, you always document the actual amount of insulin given, not the line you drew to. So, you’d document that you gave 0.1u, regardless of whether you drew to 0.1u on a U-40 syringe or the 0.25 line on a U-100 syringe.

Here’s the conversion chart for reference:
https://www.felinediabetes.com/insulin-conversions.htm

I know it’s confusing, but most folks get the hang of it pretty quickly. You can always post for confirmation that you’re drawing to the correct line before you shoot.

Note: if you’re going to try U-100 syringes, you’ll want 3/10cc with half-unit markings.

 

What I did when I was trying to find a new vet was to call and tell them I understand they are busy and the vet can't talk to me right now, but I have a newly diagnosed diabetic cat and I have some questions about treatment. It sure would be helpful if the vet could call me sometime after hours so I can get a few answers.

I wrote this list up when I was searching that has some basic ideas:

Finding a vet who’s willing to work with you is one of the most important factors in helping your diabetic cat. Here’s a list of some questions to ask if you’re looking for a new vet (or want to know where your current vet stands)
You can call and ask for the vet to call you back (this will usually happen after business hours)...If they don’t (or won't) call you back, that’s a telling sign too!!

Vet Interview Topics
1. Do they support home testing? Are they willing to use a human meter?
2. What type of food do they recommend? Do they support feeding an over the counter low carb canned or raw diet?
3. What is their "go to" insulin? Glargine (brand names Lantus, Basaglar, Semglee) Levemir or ProZinc are the most recommended. If you start with one insulin, are they willing to switch to another if you're not getting the best results? If so, how long would they expect you to try?
4. How many diabetic cats have they treated? What kind of results have they gotten? Any in remission? How long have the cats they have treated lived?
5. Do they have pricing you can live with? How often would they require you to come in and why?
6. How do they determine their starting dose of insulin?

They don't necessarily have to answer every question or give the exact answers we expect, but it gives you an idea of who's more open-minded and may be a good choice for you. Then you make an appointment.

 

Juts so you know what to expect, most vets will charge a visit to have this convo with you on the phone. They would not get on the phone with a new client otherwise. At least that was my experience when I called around in my area.

 

@Rupert — how is Rupert doing?

I see you started giving insulin again. Are the U-100 syringes working out?

 

@Rupert I hope you come back around and post an update. How are you two doing?

Your spreadsheet shows that Rupert went down to 55 today on 0.2u of Vetsulin. I believe that’s a bit lower than you want for safety.

Now that you’re using U-100 syringes, it should be easier for you to measure smaller doses. I’d strongly consider reducing to 0.1u Vetsulin (the 0.25 mark on a U-100 syringe). You’ll have to eyeball it because there’s no mark for that on the syringe.

 

Hi! I believe he’s in remission. No shots since 2/11 and he’s maintaining nice low numbers. I’m sorry I haven’t updated.

 

I’ll let others chime in as well, but I believe he could still benefit from a tiny amount of insulin. If you look at Bobo’s spreadsheet, you’ll see he was in greens when he went off insulin. If a cat is getting numbers in the blues, they’re still not fully in remission. There were a few days Bobo even got just 1 drop of insulin before going completely OTJ. It’s better to have a solid remission so it sticks!

 

I have to agree with Ale and start getting some night tests in