Need help with Vetsulin dosing please

Looks like his lowest so far was at +4.5 so either a +4 or +5 would be my suggestion for testing today but as Kris says a curve would be the best way to catch it. I also agree it looks like time to bump the dose again. Nice start to this cycle!
 
Well he hasn't gotten to 1.5 yet, so would not want to bump it to 1.75. I'm actually going to hold on where I am for now for a few more days. I have to shift his cycle back to an earlier schedule. I freelance and so have a very flexible schedule and somehow got him on a very late shot schedule. But his mom works a normal job so she has to do an 8am/8pm schedule. So I'm going to shift him gradually back down to that and keep him on the same dose. Just in case there are any effects from circadian rhythms.

According to her, I'm the first visitor/friend that Chewy has every liked. And she said that when I leave he goes to the door and waits for me! Pretty funny. He also comes and sits with me and purrs and snuggles. She said he has never done that with anyone but her. I guess he is grateful that I saved his life!

Yes, you're right, I need to do a proper curve, but just wanted to give his poor ears a break and then I'll do it. Do you suggest every 2h or every 3h? I think I'll wait till I have him on the 8/8 shift which will be a few more days still. Today's shot was at 10:20am. That way I'll be able to hand him back over to mom at some point. I think she will do the home testing.

ONE QUESTION. I use the BD 31 gauge very fine needles with 1/2 markings. I had given her some initially and she brought them to her vet who told her that THESE NEEDLES DO NOT WORK FOR THIS INSULIN....

Huh???? Well clearly they do as they are working for me...but wondering if anyone has ever heard this? She THEN sold my friend a big box of Monoject 29 gauge (no 1/2 unit) needles....I'm thinking she only recs the ones she personally sells and had no interest in ordering another kind...? That 29 g needle is twice the length of the one I have and clearly that was also contributing to Chewy's not enjoying the experience.
 
Vetsulin is a U40 insulin and the syringes she got from the vet would be specifically for U40 insulin. Most of them (if not all) do come with a longer lower gauge needle which seems to be standard veterinary supply and most vets don't bother with or maybe don't know that 1/2 unit markings are available. The BD needles you have, if they are the ones you used with your kitty on Lantus, are for U100 insulin.

I'm a bit confused when you say you haven't got to 1.5u dose yet. That is the dose written on the log sheet in the picture you posted or does the "-" sign mean you've been giving a skinny 1.5u? If you have been using 100u syringes and drawing insulin almost to the 1.5u line, then you have only been administering approx. 0.5u (at the 1.5u line would be a dose of 0.6u) of insulin to Chewy since Saturday night. Is that why you are saying he's not a 1.5u yet? HERE is the conversion chart for using U100 syringes with U40 insulin. When stating dose, even when using the U100 syringes, we state the actual dose in U40 terms rather than where you measure to on the U100 syringe. Sounds like you have been using the U100 syringes but can you please confirm which syringes so we are all clear on dosing up to this point and going forward.

It's wonderful that Chewy has warmed up to you so quickly and so well. He obviously has good taste and knows who to trust! :D
 
Yikes, uh oh. Now I"m totally confused. I knew nothing about U40 vs U100. Yes, I"m using BD U100, what I used with Lantus.

And I've been giving a 1+ (which is a teeny space above 1...so I estimate like 1.25U) and then bumped it to a 1.5- ('minus' or skinny) and I estimate that to be about 1.35 or 1.4 U

So, YES< it appears I have been given the equivalent of 0.5U (or less) of Vetsulin if it were a U40 syringe, but I'm using the U100, so it's been 0.75- 1.5- (skinny) since I started.

Wow, he was getting 10x more than he is getting now!

I did not realize u100 units different than u40 units?

But is there a reason to use the U40 syringe? Does it matter? I don't understand why the difference. Do they make the U40s with 1/2 unit markers (my neighbor's box doesn't have them)

The U100 31 gauge is smaller and easier and he doesn't feel the needle going in.

SCARY to think what might happen if one did it in the other direction--and overdosed rather than underdosed like I did, because of not realizing that the needles differ in size...So I REALLY baby-stepped it for Chewy. Probably just as well cuz his body must have had to recover from those constant hypos...
 
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Martica and Fred said:
I did not realize u100 units different than u40 units?

But is there a reason to use the U40 syringe? Does it matter? I don't understand why the difference. Do they make the U40s with 1/2 unit markers (my neighbor's box doesn't have them)
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U100 syringes are for U100 insulins like Lantus. There are 100 units of insulin in each mL of liquid insulin. The syringes are constructed so that when you draw up insulin to the (for example) 1 u line, you have exactly 1 unit of Lantus in that little bit of liquid.

U40 syringes are for U40 insulins like Vetsulin. This insulin is less concentrated than U100 Lantus and there are only 40 units of Vetsulin in each mL of liquid insulin. The U40 syringes will look thicker in the barrel because they're built to hold a less concentrated (therefore larger volume) insulin. When you draw to the 1 u line (for example) on a U40 syringe you've actually drawn up more liquid but it contains only 1 unit of Vetsulin.

So: U100 Lantus is 2.5 X more concentrated than U40 Vetsulin (100 ÷ 40 = 2.5). You need the appropriate size of syringe to ensure you're drawing up an amount of liquid insulin that contains the number of units you want.

There are makers of U40 syringes with half unit marks. Many people also start using U100 syringes with a U40 insulin to be able to dose in smaller fractions. This requires a special conversion chart: http://www.felinediabetes.com/insulin-conversions. You'd want to hide the U40 syringes if you try this so no mistakes are made.

I hope this helps. Ask again if it wasn't clear. :)
 
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Thanks, Kris. that is pretty clear. But, the thing is, it's been fine using the U100...any reason to NOT continue using them? (Other than she has a big box of the U40s...) The U100 is certainly is a nicer needle I think and it's 'fine' so goes in easily I believe.

so I'm giving him a pretty teeny dose as it turns out (which I am thrilled about, actually.)
 
Martica and Fred said:
Thanks, Kris. that is pretty clear. But, the thing is, it's been fine using the U100...any reason to NOT continue using them? (Other than she has a big box of the U40s...) The U100 is certainly is a nicer needle I think and it's 'fine' so goes in easily I believe.

so I'm giving him a pretty teeny dose as it turns out (which I am thrilled about, actually.)
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Absolutely use the U100s. Do you have the conversion chart printed out so you can easily look up the volume you want in a U100 to correspond to a certain dose?

It's amazing that he's doing as well as he is on that tiny dose! :woot:
 
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Martica and Fred said:
Ok so today he was
AMPS +11 288
+4.25. 319
+ 11.75. 334

So i missed any dip. Still trying to inch his time schedule forward. Will hold steady
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Just so I'm clear on this - what was his exact insulin dose now that we've cleared up the syringe confusion? Are you using U100s now? Let us know what the dose was, not the level on the U100 syringe you drew to. I only mention that because it's been a point of confusion for others in the past. I'm so glad you're helping Chewy! :)
 
Thank you. So i have been using the U100 the entire week, since I took over on 11/21.

I started at 0.75U (0.5+) using U100. Then increased to where i am now ~1.35U (1.5- on the U100)

So it appears that using the conversion chart im giving what would be 0.5U if using a U40 syringe

Prior to 11/21 my neighbor was giving 5.0U BID using yhe U40 syringe

Is that what you mean by clarifying the dose?
 
Just to clarify dosing to date for anyone following:

11/21 - 0.3u am & pm
11/22 - 0.4u am & pm
11/23 - 0.5u am & pm
11/24 - 0.5u am & 0.6u pm
11/25 to present - 0.6u

I think Chewy needs an increase and you could safely take him up to 0.8u (2.0u mark on U100 syringes) for a couple of days. Don't want him losing momentum by sitting in high numbers for too long.
 
Hi Sorry, I missed your post earlier. Was giving it a few days and not doing nadirs to give his ear a rest, and me a rest with my schedule and shift him closer to the 8am/8pm time zone before I tweak further.

But he is getting better and better numbers on the same dose.
Yesterday

11/29 - 0.5U am & pm he was 261 and 301
11/30 - 0.5u am & pm he was 261 and 299
so I'm pretty sure during the last 3d he would have been staying in 200s if not dipping to 100s

12/1 - AMPS 259. 0.5u
12/1 + 4. 217
12/1 +12 PMPS 250 ! 0.5U


 
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Oh sorry, no, it was a screen shot of my excel sheet! This morning he was in the 200s again. Didn't write it down yet, will when I got back shortly for the PMPS shot. I will do a curve in the next few days and see about possibly bumping it up. I'm sick right now (a cold) so trying not to overburden myself cuz already so much other stuff to do as well as this!
 
I hope you start feeling better very soon. When you do, I think Chewy needs a dose increase to 0.75u+ or 0.8u (on 100u syringe 2.0u). Those yellows are a big improvement but you don't want to let him stay in those still high numbers too long.
 
Feeling like crap. Had fever last night. Just came to check Chewy and his AMPS was 208!

I would increase to 1.5 first. I need to start doing curves again to see how low he isgetting. As soon as i feelbetter i will.

What do you recommend the range should be ideally?

Im not afraid of higher numbers since the damage takes years to kick in. My Fred was consistently in the 300s and 400s for like 6y, occ 200s. Ironically, it wasnt till i lowered, rather than raised his dose that he got better numbers.

Ive regulated several cats on 0.25u lantus only once a day. I think their own insulin starts kicking in...chewy is def feeling good. He is being very affectionate. My neighbor saud shes never seen him be like that towards anyone but her. Once hes fully regulated i will go to her vet visit with her abdctryvto educate the vet
 
What a time of year to get sick.:( Hope you feel better very soon.

Loving that 208. Ideally you don't want Chewy going below about 80 and topping out at 150 or so. I'm not concerned about organ damage so much as him developing some glucose toxicity that makes getting the numbers down a bit more challenging but by all means you don't want to be increasing until you know you can monitor. You have to look after you first so you can look after Chewy.

Doesn't surprise me that lowering the dose improved Fred's numbers. We see that quite a bit around here. I myself ran into that a few times with my girl. Totally counter intuitive and hard to get novices to wrap their heads around. :rolleyes:

So nice to hear Chewy is feeling better and being affectionate. Their behaviour and demeanor is often just as good a gauge as their glucose numbers! He's definitely improving! Your neighbour and Chewy are so lucky you came to the rescue!:D
 
He was up a bit this morning at AMPS was 309. I'm still getting over this cold so not going to go whole hog into it again for a few more days.

getting below 100 makes me nervous. I'm a little bit unsure of his mom being as meticulous about this when she takes over. Although I guess if he survived 10U /day for a whole year maybe I'm being overly cautious.
 
Martica and Fred said:
any feedback from regular Vetsulin users would be helpful!
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I am not a regular Vetsulin user but a new one. My cat was put on a starting dose of .5 unit 2x/day. Are you sure it's 5 and not .5? Even as a newbie to this but as one who has done a fair amount of research on feline diabetes beforehand, 5 units per dose sounds scarily high, as other posters have said. Can you call the vet to confirm?
 
YES he was on a full 10U per day (5U BID) !! Crazy, I know. NOW he is on 1.5U (u-100 needle) which apparently is the equivalent of 0.6U on the u-40 needle.

Tonight he has ketones. 'Low to moderate' acc to the color picture. She is taking him to ER right now. Don't know if this is serious, have never dealt with ketones before, but today his BG was very high--higher than it's been. She gave him a new food yesterday (he has been on prescription M/D) I posted on main board for help, although now the ER will deal with it...worried that they are going to jack up his dose again..
 
They had to put Chewy to sleep yesterday. Hepatiic lipidosis. I'm shattered and in shock. My neighbor (his mom) is worse. I posted the details on the main FDMB forum under a 911 ketones thread...

thank you for all your help. At least the vet said that the dosing I had been doing was the right thing, thank god. She said his 5U BID that the other vet had put him on was 'crazy'.

But I should have known to watch out for hepatic lipidosis. Apparently he had pancreatitis..not sure my neighbor knew this, if so, she did not tell me. He had a UTI too. :(
 
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