Toki's blood sugar is coming down-what changes should we make

Hello,

This is my 3rd post with questions about our buddy Toki. In the last 2 weeks, we have started to see some drops in blood sugar. Background-he was diagnosed on 07/31/20-we started insulin the next evening when we got the prescription (Vetsulin). His vet recommended 2u every 12 hours. We have done that every day since then. We switched to FF and Friskies pate a couple days later after joining the facebook group.

In the last couple of weeks, he has had a couple readings (Relion) in the mid 100s; but mostly in the low 200s. Last night it dropped to the low 100s and has been there since. This morning was his lowest reading of 123. We decided to give him 1 u of Vetsulin. Unfortunately, I can't do all the midday readings but I did 2 today (4 hours after 1u; and just now 8 hours after). Thoughts on if we need to adjust his dose and skip a shot. I will test his blood before dinner in 4 hours. He ate this morning right after testing and before insulin. He also had a midday feeding 6 hours after insulin.

I appreciate all of your help. I think I have fixed my spreadsheet so it's done correctly-it was all messed up before.

Sincerely,
Naomi

 

Hello Naomi!

Could you do me a huge favor and enter in all the dosing data on your spreadsheet? It will help to know how much you're dosing.

We typically do not recommend giving insulin if BG is below 200. Vetsulin hits hard and fast so many times it plummets in the first couple hours before heading back up and staying there. We don't have hardly any mid-cycle data to work with so I can't really recommend whether a dose change is needed. I would be very curious to know what's going on early on in the cycle.
I don't know what your life schedule is but is it possible to start getting some mid-cycle data? Normally I'd ask for a +2 every cycle plus a "before bed" test but some people can only test and night or the weekends etc. We otherwise won't be able to determine when the dose needs to change. I WILL say that if you ever get a number under 90, reduce by 0.25 units.

Another thing, and I don't want to assume you've already been told this or not, but you want to have food available very early in the cycle. +1 you want to give a snack (both AM and PM since cats drop lower at night) and ideally every hour until around +4 or +5, kind of depends on the cat. This will slow the drop of BG to keep him safe.

 

Hello! I can't believe I didn't have the dosage in there. I'll add it-but he has received 2 u every 12 hours every day since 08/01/2020. This morning I have him 1 unit because I wasn't sure how much and I knew 2 would be too much. Our routine every 12 hours: (we have stuck to this very strictly since we found this group 2 months ago)

7AM/PM: Test with Relion. Give him breakfast/dinner. 30 minutes later give insulin. 30-45 minutes later give him the rest of the can of food. 6 hours later he has his next meal around 1:30 AM/PM with the autofeeder.

I will definitely be doing midcycle data on Saturday. Unfortunately we both work M-F; I'm a teacher and teaching from home right now for 2 more weeks. Even though I'm home, it's very hard to leave my computer whilst teaching. I was able to test during my lunch at +4 and at the end of the day at +8 (those are in the spreadsheet).

Thank you!

 

No worries at all, thank you for fixing it!

Okay excellent. I'm going to suggest having food available a little more in the morning. 6 hours after insulin is okay but I would suggest keeping food mainly in the early hours. If a cat nadirs at +6, feeding after that will "burn up" the insulin sooner, so it won't last the full 12 hours. We don't know when Toki nadirs yet though, you can only find that out with mid-cycle testing. With Vetsulin MOST cats barely get more than a few hours duration out of it before petering out, which is why we strongly recommend switching to a gentler, long-acting insulin such as Lantus or Prozinc. Lots of cats feel cruddy on Vetsulin due to its effect on the body.

Yep, I understand. If you can at least do those +4 at lunch time that will be a big help. Can you try to get a +1 and maybe a +3 (or whatever time it is before bed) each night? That will counter with the fact that you can't test during the day. Saturday testing is great as well but I imagine you won't always be available then.

Please let me know when you get some more tests in - those will help us see if Toki needs a dose change or not!

Onset = when insulin starts to take effect (for Vetsulin this is usually 1 hour after injection)
Nadir = lowest point in the cycle/insulin is at max effectiveness and BG is at its lowest (for Vetsulin it's usually between 3-5 hours)
Duration = how long insulin lasts - for Vetsulin this is usually 3-7 hours, give or take