Vetsulin dosage help

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MrWorfMen's Mom said:
right now you need to understand that Smudge's BG could drop too low today and she needs to be monitored to keep her safe.
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Linda is absolutely correct..you need to make sure Smudge is not dropping too low right now.

Can you do another test and post the number along with how long it has been since the shot
 
Petrina

I don't see you online right now, but if you see this post please continue testing Smidge's glucose levels. Vetsulin can continue dropping the glucose levels quickly for 4-6 hours depending on the kitty. With a big drop like you had earlier you need to make sure that Smidge is not dropping too low.
 
She had mentioned doing a spreadsheet when she got to work, so it may be that she has left for work. A bit scary since there is no further tests and it was never said whether there was any HC food given. :nailbiting:
 
Maybe she was going to work or to the vet? Not sure what time of day it would be for her.
I will back off from this for now as we are all saying much the same and I know what it's like trying to keep track of loads of messages on a phone!
 
Thanks for chiming in Diana. I think Petrina was putting her faith in her vet and not necessarily trusting us which is understandable but we all know that as much as we'd like to think that is the best MO, it often isn't. I wish there was some way to educate the vets!
 
MrWorfMen's Mom said:
Thanks for chiming in Diana. I think Petrina was putting her faith in her vet and not necessarily trusting us which is understandable but we all know that as much as we'd like to think that is the best MO, it often isn't. I wish there was some way to educate the vets!
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And if I recall, the kitty has/had a UTI so that could have elevated the BG reading as well... I wonder if the vet took that into account...
 
Diana&Tom said:
And if I recall, the kitty has/had a UTI so that could have elevated the BG reading as well... I wonder if the vet took that into account...
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You are correct Diana. It looks like she finished the last AB on January 28 PLUS she has switched to wet food...not sure what type. With clearing an infection and a switch to wet food those alone can cause glucose levels to drop.

Smudge was started on 2 units and in just over 2 weeks is already up to 4 units. Even without seeing a lot of data this is far too high a dose increase in such a short period of time...especially with clearing a UTI at the same time and a food switch. I really don't think the vet has weighed in all the other factors when he made such large dose increases.
 
Oh no, now so worried, had to take kids to school and stopped into work, just seeing all the messages and feel bad for leaving her. I didn't test her so often because I felt guilty for doing it to her, now I see with her numbers that she probably has been out of control like this for awhile, hopefully I can try to leave work early. I left a message for the vet with her numbers, do you think I should ask for a different insulin? Sorry if I'm a bit out of control today. Believe me I do trust all of you, in my short time with this I do not know what I would do without this board and the wonderful website. Worried!!!
 
smidge&smudge said:
Oh no, now so worried, had to take kids to school and stopped into work, just seeing all the messages and feel bad for leaving her. I didn't test her so often because I felt guilty for doing it to her, now I see with her numbers that she probably has been out of control like this for awhile, hopefully I can try to leave work early. I left a message for the vet with her numbers, do you think I should ask for a different insulin? Sorry if I'm a bit out of control today. Believe me I do trust all of you, in my short time with this I do not know what I would do without this board and the wonderful website. Worried!!!
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Testing is one of the most important things you can do to keep Smudge safe. It is the only way you can catch too low of a number and takes steps to make sure she doesn't get into a hypo range. Did you leave out any higher carb food before you left?
 
I have been doing wet food, but from reading one of the posts from this morning about eating I was worried if I left out the wet her sister would eat it all, so I left out dishes of the dry food, but it was the royal canin diabetic food, so hopefully that would be okay. Sorry one more question, do you think I should stick with the vetsulin and reduce the dose? Or try another insulin?
 
Stick with the insulin but reduce the dose. Take more BG readings,especially before dosing. Don't feel guilty about testing - it shouldn't hurt and you NEED to get this data.
 
smidge&smudge said:
I have been doing wet food, but from reading one of the posts from this morning about eating I was worried if I left out the wet her sister would eat it all, so I left out dishes of the dry food, but it was the royal canin diabetic food, so hopefully that would be okay. Sorry one more question, do you think I should stick with the vetsulin and reduce the dose? Or try another insulin?
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OK if you left out the dry food it is higher in carbs and will hopefully help keep the numbers from dropping too low.

Vetsulin can work well with some kitties. Right now you really don't know how it is working for Smudge since the dose has been increased too much in some a short time period. Without seeing more data it is hard to suggest what dose you should be using, but as was mentioned before if Smudge is getting over a UTI and is mainly eating a lower carb wet food that can cause the glucose levels to drop. Too high a dose will cause the numbers to drop too fast or too low which will cause a "bounce" and take her back into high numbers again. It might be worthwhile considering going back to perhaps 2 units and doing as much testing as possible. You would NEED to test before each shot and several times early on to see how fast or how low the numbers drop.

Hopefully some others will offer an opinion on what might be a good dose for right now.


ETA Smudge's numbers will most likely be quite high for her evening reading because of the big drop she had today. Dosing always takes into consideration how LOW the dose is taking your kitty and not just how high the preshot number is.
 
The normal starting dose for Vetsulin would be 1 unit twice a day which should be safe whilst the caregiver is getting the hang of testing and collecting regular data. Even with that "small" dose, Vetsulin can work fast and produce a steep drop. After a couple of weeks the data can be used to tell whether an increase is called for, maybe 1u or 0.5u.

It really is worth going back to the start in this situation but the sticking point looks like the vet... ideally he/she should be on board with this too.
 
I agree with Diana. I'd take Smudge down to 1u and numbers permitting, hold it for 3 days or so to ensure any bouncing from today has stopped. Then the dose can be gradually increased if necessary ideally by 0.25u but by no more than 0.5u and held again, numbers permitting. If you get any low numbers pre-shot or mid cycle with the 1u dose, then a decrease of dose might be in order. The only way to see if the dose is adequate, too low or too high is to consistently get pre-shot tests and get some mid cycle tests in whenever possible. With Vetsulin, the drop in numbers is generally most pronounced during the early part of the cycle so testing during the first 6 hours post shot will give you the most telling data.
Do not give insulin if Smudge's BG is 200 or less until you have a lot more data.

While it would be nice to have the vet on board, what you do at home is up to you and with that drop today, I'd dose on the conservative side even if the vet is not on board.
 
Thank you for all the information, I am going to present this once the vet calls me back, at initial diagnosis she was at 599 and was started on 2 units 2xday, would I slowly go down by 1/2? Will update once vet calls me back, I am going to test once I get home, she does pretty well with the ear stick it's the whole holding her down and trying to rub on her ear she gets irritated. I have had her since a kitten so she is my baby and I want to take care of her and hopefully nurse her back to health. Thank you once again, you are wonderful people.
 
Petrina when talking to your vet keep in mind what has been mentioned already:

1. Some kitties read higher at the vets because of stress

2. Smudge had a UTI which now (hopefully) is cleared up. Infections can cause glucose levels to run much higher

3. You are feeding Smudge a wet food diet...mainly...rather than dry food. Feeding lower carb food can drop glucose numbers quite dramatically with some kitties.

4. A test done at the vets when Smudge is "bouncing" does not give an accurate picture of what the glucose levels are doing within each cycle (time between shots). Only regular home testing can give the correct information on how Smudge is responding to the insulin and the dose.

Last but not least, try to relax and ask LOTS of questions. Everyone here cares so much for each and every kitty on this forum and will do their best to make Smudge and your journey as easy as possible.

:bighug: :bighug:
 
smidge&smudge said:
I am going to present this once the vet calls me back, at initial diagnosis she was at 599 and was started on 2 units 2xday, would I slowly go down by 1/2?
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That is precisely what is causing the problem Petrina. The 599 could be a very elevated number (by 100 points or even more) because it was taken at the vet's office. You appear to be getting similar numbers at home now because Smudge is bouncing. In all likelihood, her pre-shot numbers are going to come down when you decrease the dose but it may take a couple of days to see that happen. Treating diabetes is a marathon not a sprint and unlike a pain killer, you can't throw a bigger dose at it and expect to see the BG instantly drop. Dosing has to be done slowly and methodically so kitty gets used to being at more normal BG levels again.

Our advice is drop right back to 1u. Trying to slowly take the dose back is far more difficult and will still leave you scratching your head about what to do because she may continue to bounce.
 
Will update once the vet calls back and will retest when I get home. She is such as sweet girl and it breaks my heart, she has a sister, Smidge, who has hyperthyroidism, and that's what I thought Smudge had since it presented as the same symptom, but no....diabetes. I am more than happy to be adopted by you all, I am a mess :)
 
Petrina, if it's any consolation, ALL of us were upset and confused at the start of a feline diabetes diagnosis... it's not the easiest thing in the world to get your head round as a newbie... but if you relax and are willing to spend time learning the theory, you really will be well placed to manage things. This message board has talked countless numbers of people through the initial stages of treatment, continuing on with all sorts of questions as they come up from day to day....you are one of us now and we will look out for your posts and help you as much as we possibly can. This is a worldwide board so there is usually someone around at most times of day.

So remember - try to take on board what we've said about the need to start on a low dose of insulin... don't let the vet fob you off with a lot of waffle as to why the dose was prescribed because it is almost certainly too high. If necessary ask for a second opinion. The fact is that most vets do NOT have a huge amount of training in FD so it is up to us as caregivers to educate ourselves and work out the best plan for our kitties. Some vets are great - maybe once you've had a good chat with yours you can work together, and with us here, to get this under control.

Sending you hugs! You can do this!
 
I couldn't agree with Diana more. You can do this! It's not rocket science but there is a steep learning curve that we can help you navigate.

Your vet probably doesn't have many diabetic cats in their practice and probably hasn't treated that many during their career. This board is nothing but feline diabetes with a smattering of other kitty ailments thrown in just because everyone here is so involved in their cat's care. This community has helped thousands of diabetic cats and their caregivers and the amount of knowledge amassed here is more than any vet is ever going to know. While this community is made up of lay people, it's also a peer reviewed board which means you get a consensus of opinion rather than a singular view of what is happening with and what you should do to help your cat. The final decision about what you do is always yours and yours alone and should be with your vet too because you know your cat better than anyone else and you are the one who holds the needle.
 
Basically in tears, they want me to up her dose to 4 1/2 units and do a curve on Sunday with every two hours blood test on the 4 1/2. I asked a million questions and they thought it is too soon to change insulins, and I asked about her getting too much, etc.
 
smidge&smudge said:
Basically in tears, they want me to up her dose to 4 1/2 units and do a curve on Sunday with every two hours blood test on the 4 1/2. I asked a million questions and they thought it is too soon to change insulins, and I asked about her getting too much, etc.
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Oh dear... what did they say when you asked if the dose was too high? Did they give a reason?
I'm so sorry you have this dilemma... it is not easy to argue with the vets, but all our experience here suggests that 4.5u is not going to help matters. Let's see what others say about how you can handle this.
Tagging @Elizabeth and Bertie who always has a good take on thes things.
 
I asked about the drop and they said that is what the insulin is supposed to do. I asked about the dose and she just said that is what she needs, and that it is still early on with the diagnosis and it takes awhile to get regulated, she has an appointment on Monday.
 
Petrina, it is obvious you are dealing with a vet who is not willing to listen to what you are telling her and she doesn't have a good handle on the finer nuances of diabetes. :mad::banghead::arghh: It's not her fault an doesn't make her a bad vet but it's not fair to you to not be heard either. You HAVE to be comfortable with the treatment plan. Vets often let their egos get in the way of their advice and I am seriously afraid that is what is happening here if she was not willing to reconsider given the info you passed on to her.

My opinion is that the drop Smudge had in BG today is only going to get worse if you up the dose to 4.5u which is likely to seriously endanger Smudge's life. You hold the needle and have to decide what you are going to do. If she were my cat, I would NOT even consider increasing the dose despite the vet's advice.

Again what you do at home is entirely up to you. Something to think about......your vet is not going to be there with you if Smudge gets into trouble and she obviously isn't going to call you back immediately to help either! You are going to be the one dealing with the consequences of what the vet is recommending.

Take a deep breath and do what you feel is the right thing for you and Smudge. This is not about the vet's ego. It's about you and Smudge.
 
smidge&smudge said:
I asked about the drop and they said that is what the insulin is supposed to do. I asked about the dose and she just said that is what she needs, and that it is still early on with the diagnosis and it takes awhile to get regulated, she has an appointment on Monday.
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That's a very basic explanation of what insulin does. Yes, she does need to drop but not that steeply, and 4u was already a BIG dose... trust us... hoping that others will add their opinions here so we can work out what to do...
 
smidge&smudge said:
they said that is what the insulin is supposed to do
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Well dah! Obviously that is what insulin is supposed to do but it's not supposed to send Smudge nose diving off a cliff toward unsafe numbers either. That drop today was monumental and far too swift to be safe. Upping the dose is going to make the roller coaster steeper and steeper until Smudge has no reserve and can't get her BG back to safe numbers. The only way to figure out how much insulin Smudge needs is to do slow methodical increases starting at a REASONABLE starting dose which in your case was not done.
 
I have to disagree with the vet. As you saw today the current dose dropped Smudge's numbers A LOT. They may even have gone further down, but without more tests you don't know just how low she may have gone. If a kitty gets too low they can have a hypo episode which is a medical emergency and is also very costly to treat. Your vet does not seem to understand how insulin is used for feline diabetes. If you continue increasing the dose Smudge could end up in danger of a hypo. Here is some information on hypos:

http://www.felinediabetes.com/FDMB/threads/how-to-treat-hypos-they-can-kill-print-this-out.15887/

Until you are doing a lot more home testing and getting lots of data the safest approach would be to go back down to 1 unit and track how that works, It is easy to increase a dose if it is not doing what it should.
 
MrWorfMen's Mom said:
Well dah! Obviously that is what insulin is supposed to do but it's not supposed to send Smudge nose diving off a cliff toward unsafe numbers either. That drop today was monumental and far too swift to be safe. Upping the dose is going to make the roller coaster steeper and steeper until Smudge has no reserve and can't get her BG back to safe numbers. The only way to figure out how much insulin Smudge needs is to do slow methodical increases starting at a REASONABLE starting dose which in your case was not done.
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Absolutely. Start low, go slow is what we say here because we want our kitties to be SAFE. Vets seem to have an altogether different rule book.
 
Petrina, are there any other vets in your area who you could call and ask if they have experience dealing with FD? Quite often people have to switch vets to one who really understands this disease.
 
There are others on FDMB who would have killed the kitty if they'd listened to the vet's advice. There are also members who decided to do their own managing of kitty's FD with our help after the kitty had to be treated in the ER for a hypo. Please don't think we're pressuring you ... we're trying to help you avert a disaster.
 
Petrina, it's clear your vet doesn't have a clue what she is doing. You can't regulate a cat overnight no matter how much insulin you give them. She seems to think insulin is like a pain killer.....if one aspirin doesn't help, take two next time. Problem is you can't keep taking more and more aspirins or eventually the aspirin will make you sicker not better. That is what is happening here. The high dose of insulin is causing the high readings.

You need to ask yourself what you and Smudge have to lose by trying the lower dose for a few days. Your vet doesn't need to know you are doing it. Are you afraid the vet will get upset with you or are you afraid the lower dose is going to hurt Smudge?

If you lower the dose starting tonight and through the weekend, by Monday it should be clear whether the lower dose is working better or not and you'll know whether to trust the vet or not. If our theory that the current dose is too high is correct, you will have your proof for the vet.

If you follow the vet's advice and Smudge goes too low overnight or over the weekend, you are going to have to deal with the consequences should they occur (and I personally think they are VERY likely to occur) and those consequences could lead to a major vet bill for emergency treatment or worse, be fatal, if not caught on time.

I understand you wanting to believe/trust the vet but please don't let blind faith because she has a few letters behind her name make you trust her implicitly. She is after all just another imperfect human being.
 
If you go down to 1 u starting at her next dose (this evening) you might well have evidence one way or the other by tomorrow's PMPS. If you feel you need to explain to your vet why you didn't go up to 4.5 u, say you were afraid of a hypo. She might disagree but she can't argue about your feelings.
 
Petrina

A number of experienced people have suggested using 1 unit as a dose right now. If you can do some testing over the weekend you will see very quickly if 1 unit is a good dose or whether it may need to be a bit higher. When using insulins like Vetsulin which act fairly fast and sometimes quite "hard" you don't want to risk having the numbers drop too fast or worse too low. which could lead to a hypo episode, which is serious at the least. The idea of continuing to raise a dose based on a few tests at the vets office is certainly not the correct way to determine the right dosing. With Vetsulin you need to test before the shot and then again at +2 and +4 hours after the shot to see how it is working. Once you have more data the proper, safe dosing can be determined
 
Kris & Teasel said:
If you go down to 1 u starting at her next dose (this evening) you might well have evidence one way or the other by tomorrow's PMPS. If you feel you need to explain to your vet why you didn't go up to 4.5 u, say you were afraid of a hypo. She might disagree but she can't argue about your feelings.
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Yes - you could say you've been reading a lot about the danger of too much insulin and you were too scared to increase the dose. We DO understand that it's hard to contradict what the vet says but in this instance it is important to err on the side of caution... please read what Mary Ann has said above.
 
Thank you for the weight information. Smudge is not an overly large kitty at 11 lbs.

You could drop the dose down to one unit for tonight and do some extra tests after shooting. Ideally you would test before the shot, then feed and give the shot about 20-30 minutes later. Then at +2 hours after shot do another reading. "Usually" vetsulin will start acting around +1 or +2 hours after the shot.. although that can vary with each kitty. Then do another test at +4 hours after the shot. "Usually" the peak effect of vetsulin is around +4-+6 hours after shot. This will show how much 1 unit is bringing the numbers down. If you are home this weekend it is the perfect time to do some extra tests and get some good data.
 
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smidge&smudge said:
Is it okay to take her down to 1 unit starting tonight? Oh and she is 11 pounds, which is down a couple of pounds from before she got sick.
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Yes - test her BG first and let us know... it is likely she will still be quite high but it's always good to have a BG number before shooting any dose of insulin. If you can then test her two hours after the shot, that would be great - again let us know if you can so we can keep an eye.
 
You're getting there, Petrina! Give the 1u a go and we can see what happens to Smudge's BGs and go from there.
Try to relax and look after yourself - have some chocolate or a glass of wine and sit back and have a breather...
 
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