Vetsulin Dosing??

Tomlin

Tomlin

Very Active Member
Hi. I just joined the group. My cat is 12 years old & was diagnosed with chronic pancreatitis Fall 2014. He only had 2 issues with it (a year apart) but has been stable with no problems since his last issue in August 2015. He has been on Prednisolone & attempts to decrease it beyond 3.75mgs daily result in issues with his illness, so its not an option to change it. He's also eating mainly prescription Royal Canin Gastrointestinal Moderate Calorie wet food & occasionally snacks on the dry formula. He went in for his yearly exam on June 14 & his glucose was high so a frucotsamine test was done & that was also high. He was not symptomatic at all. He was started on 3 units of Vetsulin on June 17, but a Cornell U vet that specializes in pancreatitis was consulted & he suggested lowering the dose to 2 units, so he's been on the 2 units 2x/day since evening of June 19. We were asked to do some glucose measurements:

5/26 6+ it was 266 (he did eat some dry food 2h30mins before)
5/28 6+ it was 288
5/30 Pre Injection A.M. & Before Pred given it was 253 (ate some dry food 2h45mins before)
5/20 6+ it was 250 (ate some dry food 3h20min before)

The suggestion is to increase the dose to 3 IU. I've read quite a bit on this forum & it looks like people aren't fans of increasing the dose by 1 unit vs .25 or .50.

Would love thoughts. Obviously it also concerned me to see the advice not to shoot when BG is 200 or below & we aren't that far from that. Note: the readings were done using AlphaTrax AND my cat was definitely stressed for the last 3 readings because of multiple pricks to get the blood :(!!
 
Welcome to FDMB. My apologies that you've had no response till now.

Mr. T. is a very handsome fella and a lucky one to have you as his pet parent. Sounds like you're managing the chronic pancreatitis very well at this point in time. Given the pancreatitis, the prednisolone and the dry food, all of which can serve to raise BG, Mr. T's BG isn't too bad at all. And kudos to you for testing. That is the best tool we have for keeping our kitties safe and getting them regulated.

You are correct that we don't usually recommend raising doses by more than 0.25 to 0.5u at a time. This is to ensure you don't skip over the best dose for your kitty. You are also correct that we don't recommend giving insulin at any pre-shot BG reading of 200 or less using a human meter. With your pet meter, we'd generally suggest raising that limit a bit as pet meters read higher than human meters. Those recommendations are meant for use in the early days until you get a bit more data to see how Mr. T is responding and once you have more data, you can lower your no shoot number.

You started off at a dose of 2u which is higher than we would normally recommend, however, with pancreatitis and the steroids in the picture, I can understand why. I would suggest though, that any increases be done slowly and systematically as you seem to be doing (raising to 2.5u instead of 3u).

A few suggestions for you.
Get a pre-shot test before every shot and withhold food for at least 2 hours prior to the pre-shot tests. You've been grabbing mid cycle tests at +6 which is fine except that Vetsulin kicks in early and you could be missing the lowest part of the cycle. I'd suggest you stagger the testing a bit and get tests randomly between +2 and +7 in the cycle. All test data is helpful but you want to see how low the current dose is taking Mr. T's BG and that may be occurring before +6. Also, try to get at least one test in every night. Many, if not most kitties, go lower overnight so we strongly recommend always getting a test in before bed.

One last thing to consider would be Mr. T's diet. Obviously with the chronic pancreatitis you don't want to be messing with his food but if you could replace the dry food with the wet for snacking, it might help get him better regulated as that dry food is really high in carbs. If you do want to try to stop the dry food, monitor Mr. T's BG a little more closely as removing even a small amount of that high carb food can make a significant difference to BG.
 
Thank you for your thoughts. I've been cautioned about over testing my man so I'm following the instructions I've been given from our team with regard to that :). I'll try to stagger the checks though. I actually have amazing guidance from a specialist at Cornell University Feline Clinic, a specialist from another top U.S. University vet clinic as well as my local vet so fortunately, all is being monitored VERY closely as we figure out the strategy...thank goodness! I'm blessed with a great team with a TON of knowledge. Fortunately, he's not eaten for 2+ hours before any tests we've done so far (yay).

He is also now pretty much all wet food (like around 98% of the time, 100% most days) :)!
 
I'm happy to hear you have a good support network. I do wonder though where vets get the impression testing before every shot and once a cycle is over testing. It's really the only way to keep a kitty safe and get them regulated. In my view, my cat is like a baby and I certainly wouldn't give a baby insulin without knowing it was safe to do so and then I'd want to know how low the dose of insulin was taking the baby's BG. Vet curves are fine but often lead to overdosing because most cats get stressed out at the vet which leads to elevated BG while they are there. That of course leads the vet to think the cat needs more insulin and too much insulin can look just like too little. It's a complicated disease that is very much hands on which is why we recommend more home testing than many vets seem to think is necessary.:)
 
What a beautiful boy you have. I too am a newbie and have been figuring out the dosage for 2 1/2 weeks now. He started with 2 units of Vetsulin and I increased .5 unit until we got to 3 units. On testing his best numbers were when he was on 2 unit so I am headed back to the 2 units and see where we are at. His BS starts in the 400's and had gone down into the 200's. We have had one reading in the 100's. I was told that with Vetsulin the starting dose is 1 unit. Our vet started him out what 2 units told me to raise it to 3 if the numbers are still high and he went on vacation for 3 weeks so we have been on our own. Thank goodness I found this message board. Education is priceless. I test four times a day at 4 or 6 or 7 before each meal and before bed time. I did test every two hours for the twelve hour cycle one day. It is overwhelming and stressful and I know in time it will become second nature. Right now it's hasn't become a part of our normal life. So welcome to this wonderful board and good luck with this new journey we both are now on.
 
Thank you! I love your Mango as well! I'm holding at 2.5 until we do some tests tomorrow & until we also speak with the Cornell vet again. Once we get him very regulated we will not be testing more than 3-4x/week as per the various experts recommendations for my particular boy. My boy is my baby but thankfully he is a feline baby vs a human baby. The science shows that cats are a bit different than us when it comes to managing glucose....in a good way! Obviously if a cat is unregulated, or like our situation, in the beginning of treatment, more testing may be recommended/required. Every situation & feline is different & while glucose is important so are clinical symptoms etc..For example, if a cat is obese, like a human, they are more likely to have more issues regulating than a feline that isn't obese. It really is SO dependent on the feline & what exactly is going on! With that being said, I always ask questions, read published, peer reviewed scientific data from PubMed & of course try to consult with a few of the top specialists from University settings where they live & breathe, lecture & study this stuff! Our boys BS has been in the mid to higher 200's, never above that or in the 100s with the 2 units so we definitely had to make a move, bumping it up. He's never been clinically symptomatic. We lucked out & found it early during one of his routine exams. My boys got chronic pancreatitis so we keep an eye on his labs. The enzymes from the pancreas that are for digestion actually leak--VERY painful in all species. Imagine acid leaking :(. It can cause extreme pain for him after eating, so keeping him eating is key!! My boys issue is more than likely due to some pancreas damage from the pancreatitis . Only time will tell. In the meantime, hang in there & I'm glad to meet you! We will persevere! As strange as it sounds, this has been much easier for me than what I've been through with his pancreatitis. This is still stressful, but one of the fastest ways to lose a cat is by them refusing to eat & thats exactly what happened a couple of times in the past with his pancreatitis. It was a bad scene & SO scary for awhile!!
 
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