? Preshot numbers creeping into red...dose advice?

Panic

Panic

Very Active Member
Hey all! Panic has been doing fairly well but the past couple weeks her preshot tests just seem to be creeping back up into the reds. Due to my work schedule I can barely get in any late cycle tests but she is still occasionally pulling greens during the night, so I'm hesitant to up the dose. Could anyone please take a look at her spreadsheet and let me know if I need to make any changes?

Now that her weight is back to where it should be I'm attempting to cut back on her food (so far it's just giving her 3/4 can of FF for breakfast as opposed to a full can), then getting 1/2 can at +2, and 1/4 can at +5 and +6. Same for PM cycle.

@FurBabiesMama
@MrWorfMen's Mom

Hope you two don't mind the pings, you're always spot-on with advice!
 
No problem with the pings!

Panic was getting some nice mid cycles on the 1.6u but now seems to be kind of stuck. She's definitely a bouncy girl and right now it's hard to know exactly what's going on. My kingdom to know what Panic did mid cycle on the 27th of July and yesterday. She started out in yellow and zoomed up to black by the end of the cycle on the 27th which may have been due to the lowered dose that day given that yesterday she only went to red by PMPS.

I think I'd try increasing her to 1.8u when you can grab a mid cycle test or two. You don't want her staying in those high numbers too long and the more often you can get those mid cycles down to blues and greens the more Panic will get used to being there and you'll start to see the pre-shots drop too. Holding doses too long can lead to glucose toxicity and if that's the case here, you'll likely have to increase a bit to get her over the hump and then doses will need to be reduced again.
 
It is harder when you cannot always get a mid-cycle test, but you have quite a bit of data, and it looks to me like she needs more insulin. So, I agree with Linda. I would increase. You have been at 1.6 a long time, and she has rarely made it into the greens.
 
Thank you both so much! I suspected she may need an increase but wanted to be sure in case she just needed more time. I'll try the 1.8u tomorrow morning and get a couple tests in before work and see how she does. I also mentioned it to her vet this morning (was there for a different reason but she wanted to see Panic's latest SS numbers) and she mentioned it may also be the bottle getting old, something I forgot about too. I haven't had it quite two months yet though so I wouldn't think it'd be losing potency just yet.
 
I wouldn't expect the insulin to be losing it's efficacy in two months. Most folks can use their insulin for at least 3 to 4 months and sometimes more.
 
Panic said:
Thank you both so much! I suspected she may need an increase but wanted to be sure in case she just needed more time. I'll try the 1.8u tomorrow morning and get a couple tests in before work and see how she does. I also mentioned it to her vet this morning (was there for a different reason but she wanted to see Panic's latest SS numbers) and she mentioned it may also be the bottle getting old, something I forgot about too. I haven't had it quite two months yet though so I wouldn't think it'd be losing potency just yet.
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Normally, with ProZinc, if you have held the dose for a few days (with Mia, I found 4 days to be about right... it can vary for different cats), and the numbers are still too high, you can go ahead with a slight increase. If a dose is not achieving the desired impact, there is no reason to hang out at that dose a long time.

Assuming the insulin has been properly handled/stored, you should be able to get past the two month mark with it. With Mia, we got to maybe 2 1/2 months before I would start to feel like I was seeing a reduction in effectiveness, so I would get a new vial. I have seen people mention using their ProZinc for much longer than that, 3-4 months or even more, but I never had that experience. Maybe I could have increased the dose and stretched out the life of it a little longer, but I didn't want to play around with that. I did not want it to appear that she needed a higher dose than she did, nor did I want to have issues when we started a new vial that was fully effective.
 
@MrWorfMen's Mom hey Linda I was just looking at this about if insulin is getting old.
Now it got me thinking about Tyler's Vetsulin vial. On the bottle it says expiration date 03-2020 I picked it up at my vets office on 4-18-2019
I'm wondering if it's still good, I assume it is, it looks fine and as we can see Tyler's numbers have been very good @MrWorfMen's Mom
 
The expiration date on a vial of insulin applies if the vial is unopened. You want to make sure you use a vial prior to that date, but once the vial is opened and being used, the clock starts ticking on it's effectiveness. So, though the expiration date may be several months or even a year or two in the future, it becomes irrelevant once you start using the vial.

@Diane Tyler's Mom Here's an old post where they were discussing how long Vetsulin is good: http://www.felinediabetes.com/FDMB/threads/how-long-do-vetsulin-vials-usually-last.180083/
 
FurBabiesMama said:
The expiration date on a vial of insulin applies if the vial is unopened. You want to make sure you use a vial prior to that date, but once the vial is opened and being used, the clock starts ticking on it's effectiveness. So, though the expiration date may be several months or even a year or two in the future, it becomes irrelevant once you start using the vial.

@Diane Tyler's Mom Here's an old post where they were discussing how long Vetsulin is good: http://www.felinediabetes.com/FDMB/threads/how-long-do-vetsulin-vials-usually-last.180083/
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Ok thank you, I'm going to read it right now
 
FurBabiesMama said:
The expiration date on a vial of insulin applies if the vial is unopened. You want to make sure you use a vial prior to that date, but once the vial is opened and being used, the clock starts ticking on it's effectiveness. So, though the expiration date may be several months or even a year or two in the future, it becomes irrelevant once you start using the vial.

@Diane Tyler's Mom Here's an old post where they were discussing how long Vetsulin is good: http://www.felinediabetes.com/FDMB/threads/how-long-do-vetsulin-vials-usually-last.180083/
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This may be a dumb question , I guess when you say unopened, it means not inserting the syringe in it and drawing from it? So the first time I draw the insulin from it that is considered open? @FurBabiesMama I guess I should be writing down the date the first time I draw the insulin from the bottle
 
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Just wondering if you have access to the Vetsulin pens in the US. Here we can get the cartridges for the pen in packages of 10 X 2.5ml. So if the expiry was 2020 on the package, the only insulin that would expire/lose efficacy would be the cartridge that was in use. All the rest would stay good until first insulin draw from each cartridge. You'd be throwing out far less insulin.
 
MrWorfMen's Mom said:
Just wondering if you have access to the Vetsulin pens in the US. Here we can get the cartridges for the pen in packages of 10 X 2.5ml. So if the expiry was 2020 on the package, the only insulin that would expire/lose efficacy would be the cartridge that was in use. All the rest would stay good until first insulin draw from each cartridge. You'd be throwing out far less insulin.
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I will ask my vet or look on line, I hope mine is still good right now @MrWorfMen's Mom
 
Diane, your insulin may or may not be losing it's efficacy but it could be getting to the end of it's "life".

Just checked online and WOW I can't believe what they are charging for the Vetsulin pens. How much does the 10ml vial of Vetsulin cost you now?
 
MrWorfMen's Mom said:
Diane, your insulin may or may not be losing it's efficacy but it could be getting to the end of it's "life".

Just checked online and WOW I can't believe what they are charging for the Vetsulin pens. How much does the 10ml vial of Vetsulin cost you now?
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It costs 47.00 and also sorry @Panic that I posted my question on your thread, what was the price you saw when you checked
 
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Diane Tyler's Mom said:
This may be a dumb question , I guess when you say unopened, it means not inserting the syringe in it and drawing from it? So the first time I draw the insulin from it that is considered open? @FurBabiesMama I guess I should be writing down the date the first time I draw the insulin from the bottle
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Vials usually have a little plastic thing on top that is broken off before the first use (if you got it from your vet, they may have done that for you). You can start the countdown from the time you first insert a syringe into the vial. A lot of us indicate on our spreadsheet when we start a new vial so we will have that for easy reference. (If you look at Mia's, you will see a row between 5/15/2019 and 5/16/2019 that says new Levemir pen.) As long as your insulin still looks okay and is effective (based on your glucose test results), you are fine to keep using it!
 
FurBabiesMama said:
Vials usually have a little plastic thing on top that is broken off before the first use (if you got it from your vet, they may have done that for you). You can start the countdown from the time you first insert a syringe into the vial. A lot of us indicate on our spreadsheet when we start a new vial so we will have that for easy reference. (If you look at Mia's, you will see a row between 5/15/2019 and 5/16/2019 that says new Levemir pen.) As long as your insulin still looks okay and is effective (based on your glucose test results), you are fine to keep using it!
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Thank you , we moved this conversation over to my thread Tyler's Journey #7 I didn't mean to post this question on @Panic thread
 
@Diane Tyler's Mom No harm done! :D Actually that brings up an excellent point - @FurBabiesMama , how soon do you buy a new vial before the old one is ready to be replaced? Obviously as long as its unopened there's nothing wrong with having another vial on-hand, but I've yet to get to the end of a vial just yet (too busy switching insulin types). Do you purchase a month or so in advance or always have one on-hand?

FurBabiesMama said:
Normally, with ProZinc, if you have held the dose for a few days (with Mia, I found 4 days to be about right... it can vary for different cats), and the numbers are still too high, you can go ahead with a slight increase. If a dose is not achieving the desired impact, there is no reason to hang out at that dose a long time.
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Thank you for this too, I'll keep that in mind in the future! :)
 
Panic said:
how soon do you buy a new vial before the old one is ready to be replaced? Obviously as long as its unopened there's nothing wrong with having another vial on-hand, but I've yet to get to the end of a vial just yet (too busy switching insulin types). Do you purchase a month or so in advance or always have one on-hand?
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When we were using ProZinc, I ordered it online, so I would do so while I still had a few weeks worth of insulin left just in case there was some issue with the shipping. Now that we are using Levemir which I get at Costco, I wait a little longer since I can just go in and get it. Still, I overlap by at least a week 'just in case'.

Like you said, as long as it is unopened (and has a far enough out expiration date) it is okay to get another vial early, but I never wanted to get mine excessively early since I feel like that just creates additional, unnecessary risk. For example, if there were to be an extended power outage, you have to worry about keeping both vials at an appropriate temperature. We get the Levemir in pens; it comes in a 5 pen pack. Each is like a mini vial and lasts us around 3 months. So, by the time I am ready to open the last pen, that pen has been unopened in my refrigerator for a year. That is a perfect example of how the insulin is still good until the expiration date as long as it is unopened/unused. I purchased a Frio insulin cooling wallet to hold the pens in the event of an extended power outage... thank goodness, I have not needed to use it thus far.
 
that's all good to know -- I just donated my "leftover" Vetsulin vial, and also the partly used one from Mialia, to Little Red Waggin rescue group -- it's gone to the dogs :woot::woot::woot:

I warned the rescue coordinator that it may lose potency sooner than if it had never been used -- both had been kept in the fridge from Day One, both had been used more than a couple of months -- will keep in contact and see how it goes -- I put a label on each of them, showing the day it was first used, day it was last used, and the expiration date, in case they remove the label, they'll still know which is which, by the exp. dates on the labels

they were so happy to get it, they bought me a packet of raw pet food from the local (highly ethical) meat market -- was explained to me that if the meat is not "pretty" enough to put in showcase, they package it up and sell for pets -- this meat market has contracts with some of the local food-animal raisers, the meat market people go out and inspect and certify the quality and how the animals are being raised -- you can get ANY sort of meat there -- from alligator to bison to ostrich to rattlesnake -- they have a website and do online orders too -- my stepson gets smoked meat and jerky from them, shipped to Hawaii

not cheap, but quality rarely is
 
She's OK. Feed her some LC food and then retest 30 minutes or so after she's finished. She seems to usually nadir around +5 so the food should help her surf through.
 
I will post what she's at in a half hour. She's gone through a can of FF already and working on her second so at least she's got the appetite. Do I hold the dose?
 
Whoops xD Thanks for letting me know. Is there an ideal amount to feed? I've just let her have as much as she wants when she goes too low. :eek:
 
It's good to see some green! You're using a human meter so 64 is not too low. A little low carb food may be just enough to help prevent her from going too low between now and nadir. This may turn out to be a good cycle.
 
The usual routine would be to give her a tsp or 2 of LC and then retest 20 to 30 minutes later to see if she is holding, up or still dropping. If dropping, a little more LC and repeat the process, if holding no more food but retest again in 30 minutes to be sure she is holding. If rising, no more food and take a pokey break. You want her to surf in those healing numbers so she gets used to them and learns they are not cause for any panic (pardon the pun! :woot:) If she was in the fifties, you'd do the same but use a medium carb food instead.
 
Oooh okay, I'm going to write this down so I can reference it next time! Thanks! So just now she tested at 94, so no more food and pokey break? x3
I have a couple of HC cans (gravy lovers), is it true you can just mix LC and HC to make MC? Or should I pick up a couple MC cans next time I'm at the store? Is MC considered 10% ish?
And is it fine to keep her at 1.8 even though she dipped a little too low? I know anything under 50 is take-action but thought realistically you don't want to dip past 70 even with a human meter.

And that's 1-2 teaspoons correct?
 
Yes on the 1-2 tsps. Bare in mind though that these are basic guidelines. If Panic needs 3 tsps. of food to keep from dropping that's fine. The whole idea is to not overfeed because if you do have dropping numbers, you want kitty to be willing to eat. If you fill them up immediately with a lowish number and they continue to drop, you may have a harder time getting numbers up and have to resort to the big guns like syrup or honey.
And yes you can mix LC and HC together to make a MC. It might be easier though to just have a few cans of MC on hand. LC is up to 10%. 11 to about 15% would be MC. Anything over 15% would be HC.

64 is actually a wonderful number....not too low. Obviously you don't want her to drop too much more so some action is warranted but not enough to raise her BG or at least not by much. Goal is to get her surfing in that range and keep her there as long as possible.

I'd test her again in 2 hours to see if she is still surfing in the greens and catch any drop if she happened to still be on a mission today.
 
Well that makes perfect sense. Good to know, I've written it in her little log book so I'll have it on-hand. :) And thank you, I'll pick some up next time to make things easier haha.

Ah okay, my knee-jerk response is to get her back up into the 90s but I'll have to make myself hold out xD Really appreciate it! I expect probably a bounce tonight but I'll keep an extra eye on her and make sure she doesn't dip too much tonight ^-^ Really happy to see greens again!
 
Hey! I don't see you as much now that we've switched to Levemir. Glad to see Panic is having a good day so far!! :bighug:

edit: I just realized I was looking at yesterday. Oops! I hope you and Panic are still doing well today! :)
 
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Hiya! I've been thinking about you and Rocket too - saw you decided on SRT for him! I still need to do some reading on acro cats to fully understand everything but I really hope this helps him! <3

Thank you yes, we are have much better preshots and today we're a bit higher than yesterday at mid cycles XD
 
@MrWorfMen's Mom

Hey Linda, could I get you to take a peek at Panic's SS when you have time? She is giving me lovely PS tests in both AM and PM but it's almost like she's running a little flat during the cycle.
 
Looks to me like Panic is getting a bit stuck. Not bad numbers but she is flat and has lots of room to come down. I'd bump her up to 2u and hold for 3 days and then re-evaluate. Holding doses for 2 weeks when you are seeing hardly any blue and no green can lead to glucose toxicity so it may take one or more dose increases to get her moving down a bit again. :)
 
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