Switching insulin - Is my Vet doing it right?

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Correction - the time is flying by because I'm a bit panicky. Here are the specifics -
4.5U Vetsulin given at 9:30am Central time.
37 reading at 2:24pm (gave a FF Natural with Caro)
47 reading at 3:21pm (gave FF pate with Caro)

She is eating well, so that's positive. What do I do next?

My thoughts are to test hourly until her numbers are at least above 50. The Vetsulin should be leaving her system soon. Do I withhold insulin, make the switch to Lantus 2U, or lower the Vetsulin dose for her PM?
 
On Vetsulin you want numbers no lower than 90. Saff has to be able to go two hours without food propping her up at at least 90.

Check every 15-20 minutes until she's at 90. Give more high-carb food in small increments (don't want to fill her up yet) until she hits 90.
Hopefully since she's on Vetsulin it will wear off soon, like you said.

2u sounds appropriate for tonight if she's high enough. Depends on if she bounces or not.
 
Panic said:
On Vetsulin you want numbers no lower than 90. Saff has to be able to go two hours without food propping her up at at least 90.

Check every 15-20 minutes until she's at 90. Give more high-carb food in small increments (don't want to fill her up yet) until she hits 90.
Hopefully since she's on Vetsulin it will wear off soon, like you said.

2u sounds appropriate for tonight if she's high enough. Depends on if she bounces or not.
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So if
Critter Mom said:
Saff's on a low run so you need to keep monitoring. She's still low at +6. Can't rely on the Vetsulin dose to fade yet.

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I know my first job is to get her numbers over 90. That's what I will keep working on.

In terms of her 9:30pm dosing time, what numbers would be ideal to give her Lantus? Should I just test her and post around that time?
 
Panic said:
On Vetsulin you want numbers no lower than 90. Saff has to be able to go two hours without food propping her up at at least 90.

Check every 15-20 minutes until she's at 90. Give more high-carb food in small increments (don't want to fill her up yet) until she hits 90.
Hopefully since she's on Vetsulin it will wear off soon, like you said.

2u sounds appropriate for tonight if she's high enough. Depends on if she bounces or not.
Click to expand...

So if
Critter Mom said:
Saff's on a low run so you need to keep monitoring. She's still low at +6. Can't rely on the Vetsulin dose to fade yet.

.
Click to expand...



I know my first job is to get her numbers over 90. That's what I will keep working on.

In terms of her 9:30pm dosing time, what numbers would be ideal to give her Lantus? Should I just test her and post around that time?
 
Yep.

I suggest testing at +11.5 first to get an idea of where she's going. It'll give more time to get some feedback to you.

At least you've got concrete proof now that the current Vetsulin dose is too high (cold comfort, I know).

.
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Okay, we just clocked in at 91 at 4:14pm central. I went ahead and gave her a half can of Purina DM Savory which is 10% carb. Its the highest carb content of can food I have in the house (Only because I had some leftovers when we made the switch). I didn't add Caro this time, but still can if you think it's needed.
 
Critter Mom said:
URGENT:

If she hasn't eaten it all, don't let her finish it. You need to feed little and often in case you need to give more carbs before the end of the cycle. It's critical she can keep eating.

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I caught this late. She just finished it. However, it's why I only gave her half the can. I didn't want to give her the entire thing and she fill up too fast. I'll test her again in 30. Should I withhold food for a couple of hours to make sure she's holding her numbers on her own?
 
For information:

Vetsulin is made up of two fractions: crystalline and amorphous. The amorphous fraction does the lion's share of the work in the early part of the cycle. The crystalline fraction tries to extend BG lowering somewhat in the later part of the cycle.

The crystalline fraction is designed to kick in around the +7 mark and is supposed to last for the next three hours.

With numbers running low, the onset of this part of the Vetsulin dose may possibly have more of an impact than would normally be the case so we need to watch for that.

.
 
Critter Mom said:
For information:

Vetsulin is made up of two fractions: crystalline and amorphous. The amorphous fraction does the lion's share of the work in the early part of the cycle. The crystalline fraction tries to extend BG lowering somewhat in the later part of the cycle.

The crystalline fraction is designed to kick in around the +7 mark and is supposed to last for the next three hours.

With numbers running low, the onset of this part of the Vetsulin dose may possibly have more of an impact than would normally be the case so we need to watch for that.

.
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Thank you for this info. I'm keeping a close eye on her. She seems to be feeling better at the moment (she's yelling at me when she sees food, which is very much her normal personality). I'm glad I seem to have gotten better at testing.
 
Lacy said:
I caught this late. She just finished it. However, it's why I only gave her half the can. I didn't want to give her the entire thing and she fill up too fast.
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Oh, well. Chalk it down to experience.

You are spot on: you don't want her to get full.

-
Should I withhold food for a couple of hours to make sure she's holding her numbers on her own?
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Not quite.

Now she's at 91, don't feed, test again in 30 minutes.

If BG is at or above 90, don't feed, test again in 30 minutes.

If BG is less than 90, depending on how low she's dropped you might need to feed a small amount, poss with karo - the carb level would depend on how low the BG reading. Test again in 30 minutes.

Process is repeated until Saff remains in safe numbers for 2 hours without any food intervention.

.
 
Critter Mom said:
Process is repeated until Saff remains in safe numbers for 2 hours without any food intervention.

.
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Just to be clear, I want to make sure the numbers I've save in my note as a reference are accurate -

Not Treated - BG typically above 300 mg/dL. Poor clinical signs

Treated but not regulated - BG often above 300 mg/dL and rarely near 100 mg/dL. Good clinical signs. No hypoglycemia.

Regulated - BG generally below 300 mg/dL with nadir near 100 mg/dL. Good clinical signs. No hypoglycemia.

Well regulated - BG generally below 200-250 mg/dL and often near 100 mg/dL. No hypoglycemia.


So my safe numbers zone is between 100-300?
 
Lacy, when you get a moment please can you tell us whether Saff has ever tested positive for ketones, or had an episode of diabetic ketoacidosis (DKA).

We're getting ducks in a row for later.

.
 
Sorry to leave everyone hanging. I had a kid situation and the Vet finally called back.
Just tested her at 7:06pm and it is 280. (Nothing like a good prescription "diabetic" food to run those numbers up).
She's hungry so I just fed her again. Her normal evening Meow Mix can food 3% carbs.

So with those new numbers, are we all still in agreement that we skip tonight and start Lantus in the morning. The Vet heard what I had to say and gave me the green light to do whatever I want. She did however recommend starting her with 3U twice a day with Lantus after 24 hours of no insulin.

I'm more in favor of starting in the morning with 2U twice a day. Thoughts?
 
Lacy said:
I'm more in favor of starting in the morning with 2U twice a day.
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Agree.

Glad your vet is being supportive. I still think starting lower than 3IU is better. You don't want to risk skipping over a good dose and, by following TR, assuming a 'goldilocks' dose wasn't found first, you'd be up to that level in less than 2 weeks by following the 0.25IU doses advocated in the protocol.

Do first AM mid-cycle test at +2.

Glad you're OK. Nite, nite.


Mogs
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Critter Mom said:
Lacy, when you get a moment please can you tell us whether Saff has ever tested positive for ketones, or had an episode of diabetic ketoacidosis (DKA).

We're getting ducks in a row for later.

.
Click to expand...

And no. Saff has never tested positive for ketones that I'm aware of nor had an episode of diabetic ketoacidosis.
 
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