? Shelley - is back on Caninsulin, hoping for views on doseage ?

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Anthony

If you have a copy of all the labwork it would be useful if you could scan and post the entire report including the normal ranges. Some lab machines will use different normal ranges than others. Was this done at the vets or was it sent out? In Canada and the US, the SDMA is done at an outside lab such as IDEXX, but I am not sure how it works in the UK.
 
Hi, it was done by IDEXX.
I am having a few technical problems, struggling to update the spreadsheet as the laptop is running so slow. Thought I would be able to use the tablet. I can view the spreadsheet but if I try to update it I am referred to google sheets. When I try to download it says it is not compatible with my device.
I will see what I can do though.
Than you!
 
IDEXX.jpg
IDEXX.jpg
IDEXX.jpg
IDEXX.jpg

I don't know if this has worked properly but I seem to have uploaded the IDEXX report, hope it can be viewed OK.
Thank you!
 
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Herby has been sleeping a lot today. Bright when awake, eating only a little and drinking. He has lost some weight over the last few months, only about 300g. He does drink often but I put that down to the dry food, which he likes best.
Still haven't been able to get a urine sample.
 
Anthony Morgan said:
View attachment 26860 View attachment 26860 View attachment 26861 View attachment 26860
I don't know if this has worked properly but I seem to have uploaded the IDEXX report, hope it can be viewed OK.
Thank you!
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Adding in your previous information as well:


Unless stated the values were normal

Urea was high 12.7
SDMA. high 16
Potassium high 5.94
Total protein low 53.8
Albumin low 22.3
Calcium low 2.04
Lymphocytes absolute low 0.11

Perfect!!! I will retag @Marje and Gracie to have a look at this and see what she can make of it.
 
Thank you for the labs you attached but they are all the same.

Has Herbie had steroids recently or been running a fever? Just looking for reasons why his lymphocytes might be low. His hematocrit is good!

The other numbers you posted don't really tell me much without the entire picture. Surely the vet did not just run SDMA, potassium, urea, protein, albumin. There should be an entire superchem and it would be good to see the urinalysis. The SDMA does indicate that he has CKD. The false positives of that test are not really common. It would be very helpful to see the creatinine and the urine specific gravity.

Unfortunately, that's all I can tell you with what you've given as labs are best reviewed with the entire picture.

If you could please just send me a private message on the board when you have all of them, that will notify me quicker in case I don't get a tag.

Thank,you!!!
 
Thanks Marje!
I just noticed that all the labs were the same and was going to post to Anthony for the others with the SDMA electrolytes and the such.
 
I just checked on the vets in house urine analysis and was told;
Protein +++
PH 6.5
Specific gravity 1.043
I have posted the other page of the IDEXX report above.
The vets want a larger urine sample to send to the lab but I havent benn able to get one yet.
Herbie's temperature was normal and he hasn't had any steroids.
Thank you very much for your comments!
 
Thanks for posting the rest of the lab results. Marje wanted you to send her a private message with the full lab tests so that she can go over them and give her insight. If you click on her photo from her post above it will give you the option of starting a conversation and you can include the test results all in one place. Hope this makes sense?


How is Shelley doing today?
 
Thank you, I did send a private message but will include the results now.
Shelley has been bright but sleeping a lot. I have not disturbed her to test too much today but the numbers have been fairly stable. I will try and update them again shortly.
Thank you very much for your continued help and support! It is much appreciated!
 
Glad to see Shelley is doing okay today. When you are able to access your spreadsheet please update the data. Hopefully Marje will be able to help out with some interpretations on Herbie's lab work.

:bighug: :bighug:
 
Hi Anthony, I'm still following this thread but not commenting if there's nothing to say! Glad you are in touch with Marje about Herbie's bloodwork. Hopefully she will be able to explain it to you and add some detail to what the vet said... I can't recall exactly what that was exactly?

A suggestion - it might be an idea to start one, or two new threads now, ie one for each cat and their situation. For Shelley, you have a spreadsheet up and running now, and have been giving her 1u for a few days. You could start a new thread with a very specific heading, eg How can I get pre-shot numbers down? - you might get more responses from dosing experts here. The thing is, Shelley is responding well to the 1u and her mid-cycle numbers are looking fine..still some room for her to come down further but one step at a time. What we do need to do now though is work out how to stop her zooming up by pre-shot .. this is getting into trickier dosing territory so we need advice from people with experience of this scenario (not unusual on Caninsulin). It may be that you need to try another insulin that has a "gentler" effect and lasts longer... worth keeping your ss up to date so not only us but the vet can see how Shelley is responding too.

And your second new thread could be about Herbie, if you feel you will have ongoing questions that members here might be able to answer... just makes the picture more streamlined for members looking on Health.

Good luck anyway - you're doing great.
 
Diana&Tom said:
Hi Anthony, I'm still following this thread but not commenting if there's nothing to say! Glad you are in touch with Marje about Herbie's bloodwork. Hopefully she will be able to explain it to you and add some detail to what the vet said... I can't recall exactly what that was exactly?

A suggestion - it might be an idea to start one, or two new threads now, ie one for each cat and their situation. For Shelley, you have a spreadsheet up and running now, and have been giving her 1u for a few days. You could start a new thread with a very specific heading, eg How can I get pre-shot numbers down? - you might get more responses from dosing experts here. The thing is, Shelley is responding well to the 1u and her mid-cycle numbers are looking fine..still some room for her to come down further but one step at a time. What we do need to do now though is work out how to stop her zooming up by pre-shot .. this is getting into trickier dosing territory so we need advice from people with experience of this scenario (not unusual on Caninsulin). It may be that you need to try another insulin that has a "gentler" effect and lasts longer... worth keeping your ss up to date so not only us but the vet can see how Shelley is responding too.

And your second new thread could be about Herbie, if you feel you will have ongoing questions that members here might be able to answer... just makes the picture more streamlined for members looking on Health.

Good luck anyway - you're doing great.
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Hello Diana,
thank you for your message, very nice to hear from you. The vet isn't sure what is wrong with Herbie.

They have found protein in his urine which suggest CKD but he is able to concentrate his urine which is not consistent with that. There are also other values that are high such as SDMA which is apparently an accurate indicator of kidney disease.
I have been asked to provide another sample but so far have been unable to collect one.

Yes, it would present a clearer picture to have two separate threads, I will have to get that organised. That is an interesting point about the high pre-shot numbers, something I will have to think about and get further advice on.

Kind regards, Anthony
 
Larry and Kitties said:
That is a very good (not dilute) USG reading. That indicates little if any kidney degradation.
A low carb/high protein diet does frequently result in a high BUN/urea.
The creatinine value is still within range but on the high side.
Phosphorous vale is nice and low.
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Thank you for your comments. I hope so but some of the values are conflicting, high Urea and SDMA. Also protein in Herbie's urine?
Herbie has in fact mainly eaten dry food. He used to belong to a neighbour and I have tried to switch him to wet but it is the dry he really likes.
The vet want's a larger urine sample to send off to the lab but I am still trying to collect one.
Kind regards, Anthony
 
What dry food do you feed Herbie, Anthony? Could you at least try half and half with him perhaps and gradually wean him off dry?
 
Diana&Tom said:
What dry food do you feed Herbie, Anthony? Could you at least try half and half with him perhaps and gradually wean him off dry?
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He has been eating James Wellbeloved and he really did like it. But since he has been unwell he has hardly touched that. He has had some Orijen today and some Gourmet wet. He has been very bright and is drinking but his food intake is quite small at the moment.
 
Well, as long as he is actually eating, even in small quantities, that's ok, but maybe he should be eating more? I know you feed high-quality foods which is great but sometimes cats need to be tempted into eating more with something different. You could supplement his diet with fresh cooked chicken/turkey, or white fish... most cats like the fresh versions of what we give them in pouches and tins! I've recently found a new food that my six-year-old kitty loves - it's the Sainsburys Delicious range, comes in boxes of six pouches, either flaked chicken in jelly or ocean fish. It's a proper complete food and as near to fresh food as I've found. I personally like being able to buy cat food from supermarkets or pet superstores rather than online so this is ideal. She also likes the HiLife varieties - again, one of the best supermarket brands with high meat content and the proper vitamins and minerals added.

If Herbie insists on some dry, have you tried Thrive? It's a newish product and contains more protein than any other complete dry food I've come across. The website is www.thrivepetfoods.com if you want to look into it - ask for a free sample!
 
Thank you Diana, that is a few new ideas to try. I am usually in Pets at Home three of four times a week, I actually don't like going in because I stand and look at the shelves of food and think what on earth can I buy that they ( five cats in all ) will eat.
I do get them fresh chicken fairly often and it looks as if I will have to start tempting Herbie with something more paplatable to him.
I will cetainly try the Sainbury's range. I think I was put off the HiLife for some reason but I will have another look at that. And I haven't seen the Thrive dry food, I will look into that as well.
Herbie ususally eats quite keenly, so something is not right. He wouldn't use the litter try with the special litter so its looking like another visit to the vets shortly.
Thanks again!
 
Herbie is very cute!
Yes, see what the vet says about reduced appetite and meanwhile try sprinkling parmesan cheese or a little tuna on tip of his food, that might help. The vet might also prescribe an appetite stimulant if the situation goes on.
Do look at Thrive - the company has a great ethos and their products are great - the tins of wet are excellent quality as well as the dry which I think has the highest meat percentage of any dry food on the market.
Yes, try the Sainsburys food I mentioned if you have a store near you. They do single pouches as well as packs so you can try it. Interested to know why you discounted HiLife, my Sapphire likes it but I know sometimes there's a background issue that puts us off, not our cats!
 
Hi, just perplexed by Shelley's pre shot number tonight. Usually around 20.0.
At 21.30 with no food for 2 hours it was 14.4
She had some food then. Now 2 hours later,
At 23.17 = 14.6
So I am not sure what to inject if at all?
She did have a hypo in February but at that time I was not home testing.
Grateful for any comments, thank you.
 
I see you lowered your dose this morning. Was that because of the blue 9 last night? That's actually a nice number and you could have given a dose of 1 u. Why not give 1 u tonight? It's in the nature of Caninsulin to have high preshot numbers relative to nadir.
 
Thank you for your reply. The pre shot numbers have generally been around 19/20. Now they seem to running lower slightly. I just am concerned that something is going on I don't know about eg spluttering pancreas that could cause another hypo.
It has never been explained why it happened the first time and for a few days my vet thought she was in remission as they were getting normal curves without insulin.
 
Kris & Teasel said:
I see you lowered your dose this morning. Was that because of the blue 9 last night? That's actually a nice number and you could have given a dose of 1 u. Why not give 1 u tonight? It's in the nature of Caninsulin to have high preshot numbers relative to nadir.
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Anthony, as Kris says, it is the nature of Caninsulin to bave high pre-shot numbers relative to nadir (lowest point in the cycle) so this is not surprising to see at all. She may be running slightly lower because she is being given more insulin now with the recent 1u doses, which is keeping her in better numbers for longer - but sometimes the dose completely runs out and she zooms up to a kind of "default" number. I too think you could have given 1u and not the 0.75 you gave yesterday morning but I also completely understand your anxiety not to ovedose and risk another hypo. If the vet could offer an explanation as to why Shelley hypo'd and then got normal numbers for a while, that would go some way to helping... I don't know the answer to this other than it might just have been Shelley's system adjusting for a short while... FD is not an exact science unfortunately and surprises can and do happen.
I can't see any numbers on your ss since yesterday morning so if you could update those it would help us to see at a glance what the latest is.
It is frustrating I know but you're doing the best you can in the circumstances!
 
Thank you Diana, it was the fact that the pre shot numbers had not risen much that made me question injecting. Thee numbers have remained in a narrow range in the early hours and but have risen this morning. I was just concerned that they numbers might fall too low but I probably should have injected something last night. She seems to have stayed fairly low on that one shot 22 hours ago?
Unfortunately the vet I have been dealing with cannot offer any explanation for what happend in February.
I will just have to start again this morning and keep monitoring.
Sorry that the spreadsheet is not always up to date but my laptop is not very good and I still can't update the numbers on the tablet.
Thanks again!

I did have to go out yesterday afternoon for about 4 hours and I don't think Shelley eats when I am out, although food is available.
On the day of her Hypo I had been out for couple of hours. And also I don't think she ate much when in the vets. So I am thinking that her blood sugar is running significantly lower when she doesn't eat. I do try to observe the 2 hours without food prior to testing but this adds to my concern about dosing in relation to the times when I am not around to test.
 
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It is confusing I agree! It's all down to how Shelley is using the insulin... some days she is getting better duration than others and this variable may be due to various things... type of food (carb content) she has eaten, slight infection, stress... there are a lot of things that contribute to what we would see as inconsistency in how she responds to the same dose.. Caninsulin is an "in and out" insulin, ie when it is used up, BG numbers rise again, so it is doubtful that the lower numbers are because she still has any left as she approaches pre-shot time... it MAY just be that she sometimes produces a small amount of insulin herself but we don't know.
The fact is that most people on this board and the Facebook FD pages are resigned to the fact that unless/until their cat is in remission, they will be testing BGs at least twice a day (at pre-shot) if not more.
I sympathise with the laptop problem, not much you can do about that except to try to update it at whatever regular intervals you can... in an urgent situation when you might need to start a new post with a specific query, the first thing people will do is look at your spreadsheet.
Talking of Facebook FD pages, you might also like to post there ... there is some overlap of members but there are also people there who don't use this board. We would normally point FB users to FDMB, not the other way round, and I'm not suggesting you leave here... too much valuable information... but there is sometimes more traffic on the FD pages so people post there for quick answers, not relating to dosing but more general questions. There are several FD pages on FB, the busiest and most populated being the FDMB one. Have a look there maybe?
 
Thank you Diana, I did start on FB actually and was directed here but you are right, there is no reason not to look there as well.
Hope you have a good day and thank you as always for your contribution!!
 
Anthony

Sorry you did not get more responses last night. It might be a good idea to start a new thread (posting) and use a title such as "Vetsulin dosing advice needed" and use the "?" icon in the drop down box of the title. That will get more attention for your question. When a thread is older people may not be reading it to see if new help is needed. Using FB can be helpful, but people would need to see a completely updated spreadsheet to be able to give accurate advice and it is always good to have a number of experienced members give advice and their reasoning for that advice.

I know you are very concerned about the hypo that you had, but you also want to get Shelley into the "blue" numbers as much as possible. On a pet meter, these are the ranges that allow the pancreas to start healing and be able to function more on their own. When faced with a lower than usual preshot number you have a couple of options.

"Q4.4. My cat's pre-shot level was way below the usual value. Should I give the injection?
A4.4. There's no hard and fast rule, but if you don't have data on how your cat responds to insulin, here are some general guidelines. Below 150 mg/dl (8.3 mmol/L), don't give insulin. Between 150 and 200 (8.3-11.1 mmol/L), you have three options: a.) give nothing; b.) give a token dose (10-25% of the usual dose); c.) feed as usual, test in a couple of hours, and make a decision based on that value. Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise. "

http://www.felinediabetes.com/FDMB/threads/vetsulin-caninsulin-user-guide.302/

The numbers in this guideline are when using a human meter, which reads lower than a pet meter, so you could increase the suggestion numbers by a bit...maybe about 20-25% (not a hard and fast rule just an estimate) when using a pet meter. With your reading last night you could have given a smaller dose, even if only 0.25 unit because of your concern with the previous hypo. It is good to try to keep ahead of the rising numbers as much as is safely possible. However these are the situations where having input from a number of members is useful, which is why starting a new thread as I mentioned earlier is a good idea.

Also if you could add some information to your signature such as type of insulin used, type of food fed, when diagnosed, any health issues, previous problems (such as the hypo and date), type of meter ie: pet meter, location (UK) this will give valuable information to any member who wants to offer information/advice without them having to read through all your posts...sort of a snapshot of what Shelley's situation is. If you place your cursor over your name in the bar at the top of this page it will give you a drop down menu and select "Signature" and you can add this information to be included with your spreadsheet link.

:bighug::bighug:
 
Hi Mary Ann,
Thank you very much for that. I had to go out this morning, just got back, so will look at it in more detail later.
Kind regards,
Anthony
 
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