Vetsulin dosing advice

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Squalliesmom said:
I went ahead and made an executive decision: I gave Squallie 2.5 units (really closer to 2, my syringes don't have markings for .5 units so I had to estimate). I figured higher BG numbers are safer than numbers that are too low and, since he has been showing such a huge drop shortly after his morning shot, I thought it would be best to err on the side of caution. I hope I made the right decision.
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Here's my probably terrible explanation at a bounce. These #'s are from Luna's SS the last few days. On the top column where there's a 115 as the low at +10 she hit 319 at +9 during the PM cycle (off to the right of the SS). This is a bounce.

You see it again in the middle column where her AMPS was 275. At +7 she started dipping towards 57, her low of the day. She instantly sky rockets to 424 at PMPS, and stayed red all night. You will notice too that Luna takes about 24 hours to clear a bounce, when she goes below blue/green #'s, she immediately goes red/pink for about 12 hours, and slowly back to yellow by about +18, and then by +24 she's back into low #'s.

If you look at Squallie's SS, try and notice any patterns like this. I personally would not be worried about duration and would just try and train your eye looking for the 'bounces'.

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Critter Mom said:
Getting data at the lower dose may help you to identify bounces better if at some stage you might need to ease the dose upwards.

How is the food change going, Lucy? What percentage low carb wet to kibble is Squallie getting now?

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He gets about 1/2 - 3/4 cup of dry Evo (8% carbs) throughout the day, he really just nibbles at it when he gets hungry (very frequently those times coincide exactly with drops in his BG), and he gets 1/2 can of FF low carb pate or Tiki Cat no-carb wet food for breakfast and again for dinner. It doesn't sound like he eats very much but I have trouble getting him to eat just that small amount because he isn't thrilled with any of these foods. He is chubby and has even gained weight since his last vet visit last week; he weighs 14 lbs. We are managing to keep all carbs below the 10% mark, even if he doesn't like it, lol.
 
pevsfreedom said:
Here's my probably terrible explanation at a bounce. These #'s are from Luna's SS the last few days. On the top column where there's a 115 as the low at +10 she hit 319 at +9 during the PM cycle (off to the right of the SS). This is a bounce.

You see it again in the middle column where her AMPS was 275. At +7 she started dipping towards 57, her low of the day. She instantly sky rockets to 424 at PMPS, and stayed red all night. You will notice too that Luna takes about 24 hours to clear a bounce, when she goes below blue/green #'s, she immediately goes red/pink for about 12 hours, and slowly back to yellow by about +18, and then by +24 she's back into low #'s.

If you look at Squallie's SS, try and notice any patterns like this. I personally would not be worried about duration and would just try and train your eye looking for the 'bounces'.

p8dqtQs.png
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Okay, I kind of think maybe I see what you're talking about. I don't know that I would have identified it as a bounce, though. Let me see if I can put it in words and you can tell me if I'm on the right track - When a kitty hits a very low point in a cycle the body starts trying to compensate and the numbers climb higher than they would, had that low not occurred. Is that a bounce? I still don't know that I wouldn't just have viewed it as just a low point that started to come up higher as the insulin reached the end of the cycle - except that it seems out of line with other average high numbers.
 
Thanks for the food info, Lucy. I wasn't sure if the kibbles you're feeding were low or high carb.

Squalliesmom said:
He is chubby and has even gained weight since his last vet visit last week ...
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That may well be due to the insulin helping Squallie to make better use of his nutrients? Some diabetic cats are underweight at Dx, and start regaining weight when they start insulin therapy.
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Critter Mom said:
Thanks for the food info, Lucy. I wasn't sure if the kibbles you're feeding were low or high carb.


That may well be due to the insulin helping Squallie to make better use of his nutrients? Some diabetic cats are underweight at Dx, and start regaining weight when they start insulin therapy.
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Squallie was pretty chunky when he was diagnosed, too. He hasn't been even close to underweight in years, if ever, lol. Until recently, he'd never met a cat food or treat that he didn't like!
 
Squalliesmom said:
... he really just nibbles at it when he gets hungry (very frequently those times coincide exactly with drops in his BG) ...
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It's great that you've noticed this correlation. Saoirse used to start asking for food when the Caninsulin started to really kick in (onset). I used to use it as a signal to start monitoring her more closely. I also recorded the time of onset in her spreadsheet notes. As the Caninsulin became progressively too potent for her I noticed that she got her 'appetite uptick' earlier and earlier after the injection was given (e.g. moving from +2 back to +1.5 and eventually to +1 after the injection) and her nadirs started coming earlier followed by a rise in BG as her system started to compensate for the Caninsulin threatening to take her BG levels too low. (She also started showing similar behaviours and BG responses toward the end of her treatment with Lantus.)
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Critter Mom said:
It's great that you've noticed this correlation. Saoirse used to start asking for food when the Caninsulin started to really kick in (onset). I used to use it as a signal to start monitoring her more closely. I also recorded the time of onset in her spreadsheet notes. As the Caninsulin became progressively too potent for her I noticed that she got her 'appetite uptick' earlier and earlier after the injection was given (e.g. moving from +2 back to +1.5 and eventually to +1 after the injection) and her nadirs started coming earlier followed by a rise in BG as her system started to compensate for the Caninsulin threatening to take her BG levels too low. (She also started showing similar behaviours and BG responses toward the end of her treatment with Lantus.)
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Squallie' s appetite uptick seemed pretty consistent at around +2 until I started the transition to the new, low carb food. He doesn't come looking for it now because he doesn't like it, and he's discovered that I'm not going to give him the junk food that he loves so much. But that's also about the same time he started having these hypo episodes, just after we finished the transition onto the new diet.
 
That is very valuable information, Lucy. Food, feeding habits and insulin dose are all so intertwined. Recording and sharing information like this can help enormously in working out a safe treatment plan for Squallie.
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Critter Mom said:
That is very valuable information, Lucy. Food, feeding habits and insulin dose are all so intertwined. Recording and sharing information like this can help enormously in working out a safe treatment plan for Squallie.
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I really think that's why his BG started going so low when he was still getting 7 units of insulin; that was okay when he was eating all the high carb food but once his system adjusted to a much lower-carb diet the 7 units became deadly over-kill.
 
Squalliesmom said:
Okay, I kind of think maybe I see what you're talking about. I don't know that I would have identified it as a bounce, though. Let me see if I can put it in words and you can tell me if I'm on the right track - When a kitty hits a very low point in a cycle the body starts trying to compensate and the numbers climb higher than they would, had that low not occurred. Is that a bounce? I still don't know that I wouldn't just have viewed it as just a low point that started to come up higher as the insulin reached the end of the cycle - except that it seems out of line with other average high numbers.
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Yes that's basically a bounce. The liver effectively gets used to being at high numbers. When you introduce a sufficient amount of insulin to make the #'s drop drastically to (healthier) levels, the liver reacts by releasing stored glucose as a kind of 'defense' mechanism, thus the system gets flooded with glucose and BG level's effectively skyrocket. On 8/5 Squallie had quite a bounce from his 22 at +4 to 419 at +9, though that was probably food influenced as well. On 8/4 your PMPS was 524, I can almost guarantee you had a low # that day somewhere in the cycle, probably around 50-75. It's a little tougher to tell with vetsulin I think, but hopefully you get the idea. Low # followed by super high # = typically a bounce.
 
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pevsfreedom said:
Yes that's basically a bounce. The pancreas effectively gets used to being at high numbers. When you introduce a sufficient amount of insulin to make the #'s drop drastically to (healthier) levels, the pancreas reacts by releasing stored glucose as a kind of 'defense' mechanism, thus the system gets flooded with glucose and BG level's effectively skyrocket. On 8/5 Squallie had quite a bounce from his 22 at +4 to 419 at +9, though that was probably food influenced as well. On 8/4 your PMPS was 524, I can almost guarantee you had a low # that day somewhere in the cycle, probably around 50-75. It's a little tougher to tell with vetsulin I think, but hopefully you get the idea. Low # followed by super high # = typically a bounce.
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Okay, that makes sense. Thank you for explaining it. So much to learn with a diabetic cat!
 
Just tested Squallie at +8 and his BG was 357. I think maybe the 2 units this morning wasn't enough? Or maybe it IS a duration issue and he does need a shot 3x daily, just lower than 4 units TID?
 
Squalliesmom said:
Just tested Squallie at +8 and his BG was 357. I think maybe the 2 units this morning wasn't enough? Or maybe it IS a duration issue and he does need a shot 3x daily, just lower than 4 units TID?
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Lucy: please, please be guided by Carl and Sue. I really don't think TID dosing is right for Squallie.

Regulation is a marathon; not a sprint. It takes time to first find a good dose that will keep Squallie in better - SAFE - numbers for a good part of the day. As his treatment progresses all that time spent in lower numbers will allow his pancreas to rest and, hopefully, heal enough to not need insulin some day.

You cannot rush the body to accept lower numbers. Squallie's body's current idea of 'normal' is to run at high blood glucose levels. When it sees numbers lower than it's used to, it thinks, "Yikes! I'm gonna run out of energy! MORE GLUCOSE!!!"

It's not possible to 'force' the body into good numbers. Squallie's body needs to relearn what it feels like to be in healthier numbers. It needs to recognise that safe lower numbers are OK so that the liver will stop overreacting and producing bounces. It needs to go through 'rehab'. He'll first get used to the yellows, then the blues, and then the greens. We stock patience pants here for a reason! :)
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Critter Mom said:
Lucy: please, please be guided by Carl and Sue. I really don't think TID dosing is right for Squallie.

Regulation is a marathon; not a sprint. It takes time to first find a good dose that will keep Squallie in better - SAFE - numbers for a good part of the day. As his treatment progresses all that time spent in lower numbers will allow his pancreas to rest and, hopefully, heal enough to not need insulin some day.

You cannot rush the body to accept lower numbers. Squallie's body's current idea of 'normal' is to run at high blood glucose levels. When it sees numbers lower than it's used to, it thinks, "Yikes! I'm gonna run out of energy! MORE GLUCOSE!!!"

It's not possible to 'force' the body into good numbers. Squallie's body needs to relearn what it feels like to be in healthier numbers. It needs to recognise that safe lower numbers are OK so that the liver will stop overreacting and producing bounces. It needs to go through 'rehab'. He'll first get used to the yellows, then the blues, and then the greens. We stock patience pants here for a reason! :)
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I bow to your greater knowledge, Mogs! I wasn't really suggesting it was a good idea to go to TID dosing, just throwing it out there to get opinions. He hasn't had any sharp drops today, thankfully, but he has stayed in higher numbers, overall. Thank you for reminding me to put on my patience pants, I need that every once in a while :-).

I just tested him at +10 and it read 343. When I test his BG I've been basing my +times on when I administered his shot, not on the time I do the pre-shot test. Is this right, or should I switch it the other way around?
 
I know you want this fixed fast, Lucy. It may be that 2 units isn't enough, but I would give it three full cycles before you increase. He has been bouncing all over and gone from 7U to 4 to 2. He dropped at least 50% today.

And if he is still in higher ranges tomorrow morning, then I would increase to 2.5 and hold that dose three cycles.

My thinking is to give his body time to adjust to all these changes, get a picture of how he does on 2 units and then raise 0.5 units at a time, if needed.
 
Squalliesmom said:
Thank you for reminding me to put on my patience pants, I need that every once in a while :)
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We all do, Lucy. We all do! :D

Squalliesmom said:
When I test his BG I've been basing my +times on when I administered his shot, not on the time I do the pre-shot test. Is this right, or should I switch it the other way around?
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That's absolutely spot on, Lucy. The clock starts running from the time of the injection.
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Sue and Oliver (GA) said:
I know you want this fixed fast, Lucy. It may be that 2 units isn't enough, but I would give it three full cycles before you increase. He has been bouncing all over and gone from 7U to 4 to 2. He dropped at least 50% today.

And if he is still in higher ranges tomorrow morning, then I would increase to 2.5 and hold that dose three cycles.

My thinking is to give his body time to adjust to all these changes, get a picture of how he does on 2 units and then raise 0.5 units at a time, if needed.
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That makes good sense to me. I want it fixed, yes, but not to Squallie's detriment, that would kind of negate the whole reason we're doing this in the first place. :-)
 
Squalliesmom said:
I bow to your greater knowledge, Mogs! I wasn't really suggesting it was a good idea to go to TID dosing, just throwing it out there to get opinions. He hasn't had any sharp drops today, thankfully, but he has stayed in higher numbers, overall. Thank you for reminding me to put on my patience pants, I need that every once in a while :).

I just tested him at +10 and it read 343. When I test his BG I've been basing my +times on when I administered his shot, not on the time I do the pre-shot test. Is this right, or should I switch it the other way around?
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You're doing it right. It's + from when the shot was given.
 
Critter Mom said:
And letting him settle for a little while at a safe dose might mean Squallie won't feel so crummy.
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He actually purred a little for me this evening, something he doesn't do much of these days. He slept all day today, only got up once or twice earlier in the day. I know I'm exhausted from lack of sleep and stress, so I know it's got to be even worse for him!
 
Squalliesmom said:
He actually purred a little for me this evening, something he doesn't do much of these days. He slept all day today, only got up once or twice earlier in the day. I know I'm exhausted from lack of sleep and stress, so I know it's got to be even worse for him!
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Lol. Glad he's purring again. You guys will figure it all out soon (ok maybe not ALL out)! It's not easy!
 
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