Request for help - bg dropping fast. EDIT resolved

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Bedina

Bedina

Member Since 2023
337 pre-shot, +2 179, +3 118. I aimed for approximately 1.25U Vetsulin (vet advised 1.5U). I gave her a snack at +2.

Any advice very welcomed.
 
I'm not sure what's high carb. I just went to store and panic ought meow mix seafood favorites in gravy and Karo.

It's been 40 minutes. I can recheck now.
 
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I just spoke with a friend who has recently had two diabetic cats. She suggested a snack with a tiny bit of syrup (1/4 teaspoon) into a small amount of her regular food to try to regular any further drop. Is that good guidance?

She's up, asked for a snack, sitting by water bowl.
 
The gravy food is better than her regular food and save the Karo if she drops below 90. At that point you can rub some Karo in her gums, you don’t need to mix it with food. It acts faster that way. Don’t use dry food, it takes too long to work
 
I’ll check in with you here in about 20 minutes so keep me posted once you retest her but if it is below 90 even after she eats the gravy food, use the Karo and then you’ll have to retest in 20 minutes again. Also for future reference FF grilled flavors are typically medium carb so were around 10-15%. High carb would be 15-20% like FF tuscany.
 
Just so you know, if this was Lantus, the take action number would be anything below 50. That’s when you’d give the Karo or honey, but with Vetsulin I don’t want to chance it and I want to keep her at around 90 especially since this is likely her nadir at +4
 
OK, at 20 I tested but I had an issue with the strip. I flipped it to the other edge of the strip and it read 64. My diabetic friend said not to do that.

I pulled a new strip and did a fresh spot and I'm getting 113, which I think was a better test. Should I do a third time now or wait 20?
 
113 is the number you want to go by and it looks like the food brought her bg up. You can retest in 20 minutes if you’d like just to make sure. You can also give her a bit more food, but the regular low carb food now. This is all good data for you so now you know she reacts to the food and that’s a great thing. We could probably have given her regular food instead of the medium carb but I’m a bit scared of Vetsulin so wanted to be on the safe side.
 
I didn't get a number between +4 and evening pre-shot test for yesterday (our first proper full day), and she went from 179 at +4 to 156 at +11.5, with a low carb small snack at +6.

I'll test again at either +5 (which is 5 minutes from now and 20 minutes since the last test) or at +6. If good, I'll collect a +8.

Wow, this was scary. Thank you. I can't believe vets don't have everyone test.
 
Meow Mix Savoury Morsels in Gravy
Chicken and Shrimp 13%
Ocean Whitefish and Tuna 22%
Salmon & Ocean Fish 20%
Tuna & Crab 24%
Tuna & Salmon 24%
Seafood Entree 21%

Meow Mix Tender Favourites in Sauce:
Salmon and Crab 3%
Tuna and Shrimp 2%
Salmon and Red Snapper 19%
Salmon 19%
 
OK, bless you.

This was salmon and ocean fish. She had 15 grams of it out of 88, Before that I put down a little of her regular food where I had mixed a tiny bit of syrup (1/6 teaspoon) but I picked it up back up almost immediately when I saw your post. I'll add that to my notes.
 
So what you gave was probably high carb not medium carb and those are good to have in your hypo tool box kit!

97 is a safe number but with Vetsulin dropping the bg so fast, I wanted make sure she was going up and not down. If this happens again, let’s try low carb food instead to see how she reacts.
 
The amount doesn’t matter when it comes to carb content. It’s the same carb content whether you give a teaspoon or a cup. It’s not cumulative like calories. Save the Karo for anything super low and def anything under 50.
 
Also, some cats are really good about letting you know their bg is low and they need food. Kinda low humans. Whenever Minnie asked me for food at a different time than her usual times, I knew to test because she was likely going low. Babs may be too
 
I should not have used even the small amount of Karo. I panicked. I hope she's now not shooting in the other direction.

Should I plan for a +6?
 
And should I offer a small meal or her regular food?

I can't believe how much of this process is me kicking myself for screwing up.

I also need to figure out what to do about this evening's dose.

Will call tomorrow to ask about Lantus.
 
Bedina said:
And should I offer a small meal or her regular food?

I can't believe how much of this process is me kicking myself for screwing up.

I also need to figure out what to do about this evening's dose.

Will call tomorrow to ask about Lantus.
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you mean now or later? What’s the small meal versus regular?

Don’t beat yourself up. You did what your friend told you to. I think I panicked a little too because of how fast she was dropping and she’s not even my cat! Some people really panic and give dry food, which is the worst and doesn’t even work fast. You’re getting to know your cat and how she reacts. Next time let’s try just regular food unless she goes under 90 then we try the meow mix again. I would still hold off on Karo unless it’s a take action number.
 
It takes time to get used to those low numbers. It was hard for me at first too even on Lantus, but keep in mind that’s really where you want her to be in the 80-120 range. Over time I got so comfortable I was shooting Minnie’s regular dose even with a low amps of 76 because I knew I could monitor and keep her bg steady with food
 
You're very kind. I hope the small amount of Karo in her system doesn't play havoc with the rest of the day. I also wish I'd dropped to just 1u this am, but I didn't and I can't time travel.

As per my question, I meant both a small meal now to get better quality food in her, but perhaps that doesn't make sense. And she's actually sleeping now.

And for later, I have to figure out the dosage. I got between 1.25 and 1.5 in her this am, which is clearly too high. Clearly she's responding. I'm wondering if I should go for .5, depending on what her preshot number is.

(My "second" vet, who does in home acupuncture with Babs, is sounding more optimistic than when we had this diagnosis. I think the expectation all around may have been that the insulin wouldn't work. We at least know that she responds to it now!).

Thank you so much.
 
She def is responding to it and that’s great news!

As for the dosage, we do adjustments by 1/4 units so if you did decrease, you’d go down to 1 unit not 1/2. But she didn’t go under 90 so I’m not sure a reduction was earned. Id like more experienced Vetsulin users to chime in @Red & Rover (GA) do you know who they are? Is @Bandit's Mom one?
 
If you all see this thread and can offer any feedback, thank you. :)

A short summary:

We're just on day three of this. No shot last night as she was at 156 and I followed the guidance here. Two small meals yesterday, both prior to +6. This am at 337, then a fast fall to 97 at +3.75 at which point we gave her a higher carb snack and she correct back to 134 at +5.

Vet started us at 1.5u and gave me this guidance for Friday evening (my first evening at home of this). That said, vet was very upfront that this is new territory for her. Had I read here first, I believe I would have asked to start low and work our way up.

  • If BG is between 100-150 do not give next dose, and check BG in 12 hours.
  • IF BG is between 150-200 give approximately 1/2 unit
  • IF BG is between 200-300 give 1 unit.
  • If BG is between 300-400 give 1.5 units.
  • If BG is over 400 give 2 units.
  • If BG is less than 100, then recheck again in 1 hour. If falls below 60 she needs to eat or give her 1 tsp karo syrup.
 
I hope you’ll get more eyes on this. We def wouldn’t recommend changing the dose based on the preshot values. That’s what most vets do, but we adjust based on the nadir so I’d think we’d want to give the actual dose for anything above 200 regardless of the value. I think skipping with anything under 150 on Vetsulin is a smart call as a beginner. And we’d probably encourage you to give a token dose between 150-200 which is less that 1/2 the dose. Let’s see what others think!
 
Thank you. And of course, since I panicked, we don't know exactly what the nadir is (unless it is the +4, at which it was 179 yesterday and 97 and likely dropping before I intervened with carbs).
 
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Hello Bedina. I have a couple of observations. First, I think that the starting dose was too high. Second, I see from your spreadsheet that you are using a pet meter (AT2) so you should add that to your signature please.

The comment on take action number really applies more so to the longer acting insulins like Lantus and Levemir, and reference made to BG 50 is for a human meter, not a pet meter. In any case, with Vetsulin, you would decrease the dose if you got a number under 90, but since the dose was started too high and since you are using a pet meter, in the interest of safety, I would go down to 0.5u which is the starting dose for a cat who is on a low carb (under 10%) diet. Again, the guidelines were written with human meters in mind which say that you should stall under 200 (human meter) not feed, and test again in 20 minutes to see that the BG is rising to a suitable number and not falling and is high enough to give insulin. Considering you are using a pet meter, it’s even more important to be cautious with lower preshots, especially until you gather more data. In general, with this insulin and in the beginning, you are aiming for nadirs not lower than 90 on human meter. It might be worth looking into getting a human meter, the test strips are cheaper, and since the dosing guide is based on human meter numbers, it might make your life a little easier when trying to navigate around understanding the basics and assessing how the insulin is working.

this sticky on Beginner’s Guide to Vetsulin provides additional information.
 
Christie & Maverick said:
Hello Bedina. I have a couple of observations. First, I think that the starting dose was too high. Second, I see from your spreadsheet that you are using a pet meter (AT2) so you should add that to your signature please.

The comment on take action number really applies more so to the longer acting insulins like Lantus and Levemir, and reference made to BG 50 is for a human meter, not a pet meter. In any case, with Vetsulin, you would decrease the dose if you got a number under 90, but since the dose was started too high and since you are using a pet meter, in the interest of safety, I would go down to 0.5u which is the starting dose for a cat who is on a low carb (under 10%) diet. Again, the guidelines were written with human meters in mind which say that you should stall under 200 (human meter) not feed, and test again in 20 minutes to see that the BG is rising to a suitable number and not falling and is high enough to give insulin. Considering you are using a pet meter, it’s even more important to be cautious with lower preshots, especially until you gather more data. In general, with this insulin and in the beginning, you are aiming for nadirs not lower than 90 on human meter. It might be worth looking into getting a human meter, the test strips are cheaper, and since the dosing guide is based on human meter numbers, it might make your life a little easier when trying to navigate around understanding the basics and assessing how the insulin is working.

this sticky on Beginner’s Guide to Vetsulin provides additional information.
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Christi, thank you.

The vet said "this is an 18 hour insulin and recommended dose is between 1 and 2 units so I'm using 1. I don't know if that's right." As she appeared to think this was longer lasting and the first shot was at 3:30 Thursday (preshot at 372), without out a recheck until 10 am the following morning (non-fasting preshot at 300 because no one told me not to feed her), I suspect the vet thought the dosage wasn't high enough.

I think we should have started at .5u to begin with. I've been worried all afternoon about what to do tonight and that if gave her even 1 that she'd crash in the night and I wouldn't be awake for it.

My vet doesn't work on Mondays but I had plan to call regardless to see if I can get a prescription for Lantus as that seems to be the advice of most folks here. I can also look into a human meter (current replacement strips are on the way but those can go back to the vet to replace the ones they gave me).

I just missed getting a +8 reading. I can do a +9, unless it's not essential it be right on the mark.

Thank you again. This is hard. I feel like I'm being terribly selfish about making her go through this, but she's still engaging and purring and asking for food.
 
Ale & Minnie (GA) said:
Btw, is Babs still taking pred or have you completely transitioned her off of it? That could make a big difference on her bg
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She is still on it, but the vet who prescribed it advised that I start tapering it down and my vet friend has suggested looking into other options. The last two days she's been on 3.75mg of prednisolone, down from 5mg, so not a high dose to begin with. I had planned to research alternatives but this was all thrown at us Thursday afternoon when she was diagnosed, right as my vet friend was leaving town for the weekend.
 
You’re welcome, Bedina. If it is any consolation, it took us a lot longer (a month) before we saw a green ;). I think you are doing an amazing job, asking questions, and getting familiar with things very quickly, so don’t be so hard on yourself. Odd comment by your vet; FWIW in my 7 years here, I don’t think I’ve seen a cat get 18 hours duration on Vestulin, but I could be wrong.

Just take it one day at a time, and give that sweet girl some belly rubs for me.
 
Thank you all. I'll try to get meter to hopefully coincide with a transition to Lantus.
 
“This is hard. I feel like I'm being terribly selfish about making her go through this, but she's still engaging and purring and asking for food.” please don’t feel this way. Quite the contrary, you’re being selfless at your own detriment (because let’s be honest, none of this is easy on our nerves) and doing what’s best for her. What you’re making her go through is part of the treatment to get her well and she’ll feel so much better very very soon and it will all simply become part of her routine. She’s the lucky one, not all cats have humans who will do whatever it takes to give them the best quality of life possible. You are a hero and don’t you forget it Missy!!! :bighug::bighug::bighug:
 
Thank you so much. :)

I'm going to get a blood sugar at +9 shortly. Fingers crossed.

I'm also having U-40 syringe confusion on the box. I got from Amazon. I think this probably should be a separate thread, so I'll start one and link to it here.
 
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