Need advice on dosing.New member UK

Ginger Leo

Ginger Leo

Member
Hello there, My name is Maria writing on behalf of Leo (He is not good with the laptop yet :) )He is 8 years old.Leo was diagnosed last May and started with Caninsulin first week of June.He was really good, just 1unit twice a day and almost in remission, eating high protein wet food and m/d Hills dry food.However last August he avoid eating, losing more weight and ending with DKA.He was really poor, 5 days in the pet hospital and survived. Now we are better but still worried about his diabetes. He needs 3.5 units twice a day but since I started to test at home is being a mess. He is now on high protein wet food only (Lillys Kitchen) following my former vet advice (She left uk now we have a new one)but his results are really strange.Leo's spreadsheet is below-signature. I don't know what to do. Any advice?Could be better to change the insulin.Prozinc? Thanks
 
Hi Maria and Leo. Welcome to FDMB. I'm so glad you are helping Leo with his computer skills! :D He's a handsome lad!

You have been changing the dose seemingly based on pre-shot testing and while that can work for some cats once they are regulated it more often muddles the picture and makes it hard to determine what dose works best for kitty.

The 3.5u dose is definitely too high. Your aim is to get BG to drop no lower than 5 mmol. and on 22nd of Oct., BG was down to 3.6 at pre-shot. This suggests that sometime the night before, Leo may have dropped to dangerously low BG and the high numbers you are now seeing may be from a phenomenon called bouncing. Bouncing is a defense system that causes the body to release stored glucose into the bloodstream to elevate what the cat perceives to be too low BG. What the cat thinks is too low is relative and sometime bouncing occurs simply because BG has dropped to safe levels but levels the cat is no longer familiar with. Bounces can take up to 3 days to clear. If you dose based on pre-shots and the bounce breaks the potential for a low BG event increases.

If I were you I would drop the dose to 2.5u and hold that dose for a period of 3 to 4 days as long as pre-shot tests are high enough to give insulin.....at least 11 mmol at pre-shot. The dose should be re-evaluated after the 3 or 4 day period.

In the meantime because there is a history of DKA, I would check ketones daily. You can use ketostix available at the local pharmacy. Any ketone reading above trace is cause for a call to the vet.

You're doing great with testing but until you get Leo sorted a bit more, I'd suggest you try to get a few tests in the earlier part of the night cycles as well as trying to get a mid cycle test every day cycle. Our kitties have a habit of going lower overnight so getting at minimum a test before bed every night can help provide clues as to what is happening overnight.

Vetsulin takes effect quickly and usually peaks between +3 and+6 hours post shot so if you can randomly test in that time frame, it will help you find his nadir (lowest BG in a cycle) and that is important information to determine dosing going forward.
 
MrWorfMen's Mom said:
Hi Maria and Leo. Welcome to FDMB. I'm so glad you are helping Leo with his computer skills! :D He's a handsome lad!

You have been changing the dose seemingly based on pre-shot testing and while that can work for some cats once they are regulated it more often muddles the picture and makes it hard to determine what dose works best for kitty.

The 3.5u dose is definitely too high. Your aim is to get BG to drop no lower than 5 mmol. and on 22nd of Oct., BG was down to 3.6 at pre-shot. This suggests that sometime the night before, Leo may have dropped to dangerously low BG and the high numbers you are now seeing may be from a phenomenon called bouncing. Bouncing is a defense system that causes the body to release stored glucose into the bloodstream to elevate what the cat perceives to be too low BG. What the cat thinks is too low is relative and sometime bouncing occurs simply because BG has dropped to safe levels but levels the cat is no longer familiar with. Bounces can take up to 3 days to clear. If you dose based on pre-shots and the bounce breaks the potential for a low BG event increases.

If I were you I would drop the dose to 2.5u and hold that dose for a period of 3 to 4 days as long as pre-shot tests are high enough to give insulin.....at least 11 mmol at pre-shot. The dose should be re-evaluated after the 3 or 4 day period.

In the meantime because there is a history of DKA, I would check ketones daily. You can use ketostix available at the local pharmacy. Any ketone reading above trace is cause for a call to the vet.

You're doing great with testing but until you get Leo sorted a bit more, I'd suggest you try to get a few tests in the earlier part of the night cycles as well as trying to get a mid cycle test every day cycle. Our kitties have a habit of going lower overnight so getting at minimum a test before bed every night can help provide clues as to what is happening overnight.

Vetsulin takes effect quickly and usually peaks between +3 and+6 hours post shot so if you can randomly test in that time frame, it will help you find his nadir (lowest BG in a cycle) and that is important information to determine dosing going forward.
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Thank you so much Linda, I felt bad that she didn't get a response. Thanks again @MrWorfMen's Mom
 
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Welcome, Maria!

Given that Leo has recently recovered from DKA, are you testing for ketones? There are urine test strips that most pharmacies in the US (and I'm presuming UK) have on the shelves. Alternatively, there are meters that test for blood ketones. The latter are expensive but in many ways easier to use since you don't need to stalk your kitty to the litter box.

In a post-DKA kitty, it's important to be vigilant for ketones returning. The basic recipe for ketones is not enough insulin + not enough calories + an infection or inflammation.

Hopefully, all of this information isn't essential since the episode of DKA was a few months ago. I'd still encourage you to test for ketones since it's a great preventative measure.
 
Hello Linda,Sienne and Diane, thanks a lot for your replies. I did reduce his insulin as advised to 2.5 or 2 depending on the numbers. I didn't know that the bouncing effect could last for 3 days. 3.5 Units with high protein diet it was too much.Yesterday we were at the vet and with the numbers in front of us we decided to change to Prozinc as we though that Caninsulin is not lasting enough for Leo.The vet also checked his tummy and apparently no more inflammation, so good news! it seems he is on his way to recover in full for his DKA. Still doing urine testing from time to time. The urine strips I use are from the pharmacy and just for ketones (Ketostix).We'll see how it goes with the new insulin.
Thanks again for all your help.
 
Ginger Leo said:
Hello Linda,Sienne and Diane, thanks a lot for your replies. I did reduce his insulin as advised to 2.5 or 2 depending on the numbers. I didn't know that the bouncing effect could last for 3 days. 3.5 Units with high protein diet it was too much.Yesterday we were at the vet and with the numbers in front of us we decided to change to Prozinc as we though that Caninsulin is not lasting enough for Leo.The vet also checked his tummy and apparently no more inflammation, so good news! it seems he is on his way to recover in full for his DKA. Still doing urine testing from time to time. The urine strips I use are from the pharmacy and just for ketones (Ketostix).We'll see how it goes with the new insulin.
Thanks again for all your help.
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Hey Maria that's great news no more inflammation. Hopefully switching to Prozinc will do the trick. You can post on the Prozinc forum also and in your signature say that you have switched to Prozinc, and on your spread sheet some where
If you ever want to tag anyone such as Linda or Sienna so they get an alert
to a questioin you might have this is how to do it
After you done with your last word of your post skip a space and hit the @ symbol and type the persons name like Linda's will be @MrWorfMen's Mom and Sienna will be @Sienne and Gabby (GA) As you are typing their names it will also come up to the left and you can just tap on that @Ginger Leo
 
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Diane Tyler's Mom said:
Hey Maria that's great news no more inflammation. Hopefully switching to Prozinc will do the trick. You can post on the Prozinc forum also and in your signature say that you have switched to Prozinc, and on your spread sheet some where
If you ever want to tag anyone such as Linda or Sienna so they get an alert
to a questioin you might have this is how to do it
After you done with your last word of your post skip a space and hit the @ symbol and type the persons name like Linda's will be @MrWorfMen's Mom and Sienna will be @Sienne and Gabby (GA) As you are typing their names it will also come up to the left and you can just tap on that @Ginger Leo
Click to expand...

Thanks for your advice Diane, never used a forum before. I will get better :) I will post on the prozinc group to see how it goes. So far I haven't received the insulin yet and still looking for syringes as apparently I can't use the ones I got for Caninsulin.They're expensive here in Uk.
 
Ginger Leo said:
Thanks for your advice Diane, never used a forum before. I will get better :) I will post on the prozinc group to see how it goes. So far I haven't received the insulin yet and still looking for syringes as apparently I can't use the ones I got for Caninsulin.They're expensive here in Uk.
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No problem I had to get used to using the forum also. I know there are some members from the UK. I will try to find out
 
Not sure who told you not to use the same syringes. Both Vetsulin and ProZinc are U40 insulins so the same syringes are fine although if your current syringes do not have 1/2 unit markings, that would be a reason to find alternate syringes. HERE is a doc with info on where to find syringes and other supplies in the UK.
 
MrWorfMen's Mom said:
Not sure who told you not to use the same syringes. Both Vetsulin and ProZinc are U40 insulins so the same syringes are fine although if your current syringes do not have 1/2 unit markings, that would be a reason to find alternate syringes. HERE is a doc with info on where to find syringes and other supplies in the UK.
Click to expand...
My vet wasn't sure about using the same syringes as Caninsulin's are 0.5 and Prozinc's are 0.3. I am sure those numbers are about volume as you can see that prozinc's are thinner than the others. Thanks for the link and your reply. This forum is amazing so helpful.
 
As you suspected, that 0.5 vs. 0.3 is strictly volume. The 0.5 syringe holds 1/2cc of insulin while the 0.3 holds 3/10cc. The only difference is that with the larger syringe the markings will make it harder to draw partial doses rather than full units. Some folks use their old syringes for full unit doses to use them up.
 
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