When should I be concerned?

Status
Not open for further replies.
Spike's Mom

Spike's Mom

Member Since 2015
I started home testing with a AlphaTrak meter a few days ago since every time we visited the vet spike's glucose readings were increasing. When he was at 515 I was over taking him to be poked and prodded by strangers. Tonight I was concerned at home because we were up to 493. Finally after over 4 hours of not eating & insulin given he is down to 286. Yes I know this is still high but when we were testing outside the home he would never get under 400.
At this point I am starting to question everything my vet is doing.
We started Spike at 2 IU's of Vetsulin twice daily on Jan 29th. Then we increased it to 4 IU's on Feb 19th.
Everything seems to be a battle.
I had done some research on food for diabetic cats before I had taken Spike to the vet. My vet seemed to have little knowledge of anything sold outside of his office.
Only after 2 rounds of glucose curves and things were getting worse I convinced my vet that I needed a home testing kit.
I know it is advised that all changes should be approved by his vet and I may be that overprotective parent but I am not sure my current vet truly understands what is best for my cat. He will be 14 in May and I want to see him live a lot longer.
I have already ordered the supplements for changing his food thanks to the following link. http://www.catinfo.org/?link=makingcatfood
I truly do not want to harm my cat so opinions on this matter are greatly appreciated.
 
Hi Tammy!

First Intro Post. Here's a link to your first post which has some background info.

First, you're doing a great job! From the time of your first post to now, you've got home testing down, you're working on diet change, you've got your spreadsheet up and running properly, and you're starting to get some very helpful data! GOOD JOB!

Sadly, many vets don't have a good handle on treating feline diabetes, their knowledge about the condition is outdated, or they basically try to treat their feline patients like small dogs, which doesn't work. Along those lines, changing things like insulin dose, or diet, do NOT require your vet's approval. You are your kitty's best advocate, and if things don't seem to be making sense, you absolutely have the right to change how you're doing things. You do need a vet's cooperation to get insulin, but beyond that, here at FDMB, most folks make dosing decisions on their own based on the data they procure via hometesting.

You've probably discovered that vetsulin isn't typically one of the best insulins for cats, as cats tend to metabolize it too quickly, resulting in big, fast drops, and inadequate duration. However, there are some cats that seem to do just fine with it. Have you given consideration to seeing about a switch to one of the longer-lasting insulins for cats, such as ProZinc, BCP PZI, Lantus, or Levemir, or is there a reason for wanting to stick with the vetsulin for the time being?

Second thing. The Alphatrack works just fine and is calibrated specifically for pets. As you've probably seen though, the price for the meter and more importantly, the strips, is obscene. If you run out of strips on a night when you're running in low numbers, you can't just swing over to Wal-mart to pick up some more. Most of us use human meters, which read lower from the animal-calibrated Alphatrack. However, comparisons have been done between the two types of meters, and some general guidelines have been developed which allow us to use the human meters just fine for purposes of knowing what's going on with our kitties' BG numbers. For your reference, BJM's Glucometer notes document will give you an idea as to how the numbers compare between a human meter and an Alphatrack. Human meters, such as the Relion line from Wal-mart are substantially cheaper, and the strips are way, way less expensive. And, you don't have to rely on your vet or mail order to get strips.

It's hard to say based on the data collected thus far whether 4 units is too much or not. The jump from 2 to 4 units might have been too much. Was the increase based on a high flat in-office curve at the vets? Did they do a fructosamine by chance before increasing?

Next. Testing. Great job tonight! To get some more data to see what's going on with the 4 units, I'd recommend that you keep testing for a bit if you are able. Spike's numbers have started to budge down, and they may come down a bit more yet tonight which will provide a clue as to how the vetsulin is working for him. Generally, you're going to want to get a test prior to every shot so you know how high Spike's BG is before giving insulin. After that, for vetsulin, since it's got a fast onset, you may want to try to see how far and fast Spike's dropping by about +2 or so (2 hours post shot). It tends to peak or nadir around 4-6 hours after the shot, so you'll probably want to see a test in that general time frame to see how low the insulin is getting Spike's numbers. Vetsulin tends to peter out at around +8 to +10 or 8-10 hours after the shot, so BG will typically start to rise again after that.

I personally don't have experience with Vetsulin, but I'm suspicious that the dose may be too high. Does Spike have any history of DKA or ketones? I hope some other folks with some Vetsulin/Caninsulin experience might be along with suggestions, but you could try a "reset" at a lower dose. Unfortunately, too much insulin can look the same as not enough insulin (high flat curves). Cats tend to be very responsive to very small changes in dose. We typically increase in increments of 0.25u or 0.5u at a time at most, to avoid skipping over a good dose. If you were to try that lowering the dose, you'd want to make sure you were testing Spike's urine at least twice a day for ketones, and you'd want to post here immediately to report if you had a positive ketone test for guidance.

Again, I want to reiterate that you're doing fantastic! There's so much information to absorb when you're first getting started out, it can be terribly overwhelming. That of course is made worse when your vet isn't quite up to speed on how to deal with FD. I've thrown a lot of information at you in one shot here, so please ask away if you have any questions.
 
Last edited:
Hi

You are right that the stress of the vets can increase blood glucose by over 100 points and so it is great that you are testing at home and should continue to test before you give each shoot of insulin. The drop that you have seen tonight is great, you might find that he has abit of a bounce (high numbers again) from this low number today but I agree with Jen 4 units is probably too high overall and especially as you will be switching to a low carb wet food. Remi started on 1 unit of vetsulin and I think this is a typical starting dose. My advice would be to start dropping the dose now you are testing at home and are beginning to see better numbers.

You should test, then feed and then give insulin. You can then give more food during the cycle.

In fact most of us do not ask the vet for dosing advice. Once we have the insulin and test at home we alter the dose based on the readings we get. When I got going I never once asked my vet for dosing or advice on food.

Can I get you to amend your signature to add in the insulin spike is having and that you are using an alphatrak meter.
 
Thank you for your quick reply.
As far as if the Vetsulin is working properly I am still undecided. I am going to test Spike in the morning before breakfast. As I have seen in other posts this will not be easy since he is ready for breakfast. I am hoping to get a good day of testing in tomorrow as I do not have to work. I think with a few more days of testing I will have more information to make a better decision. The one thing I really like is the pen kit that the insulin comes with. Does the insulin you use have one?
As far as the fructosamine test we are scheduled for this Thursday evening. The vet tried to convince me to wait until the fructosamine test results were in to invest in a meter. I just do not understand why. No human would try to manage diabetes without a meter and my pet is no different.
By chance do you know if I change to a human meter will it require a prescription?
 
Honestly, if you're hometesting, a fructosamine is a waste of money. All it does is shows the average BG over the course of about 2 weeks. It doesn't show if there's low numbers sneaking in there.

I use Lantus, and it does come in a pen form. However, the pen allows only allows dose adjustments in increments of a whole unit, which is too much. Cats are so sensitive to small dose changes, that you really have to go up in increments of no more than a 1/2u. I'm guessing the vetsulin pen only adjusts in increments of whole units, so you're probably going to be out of luck on that count, until some enterprising cat lover develops a pen mechanism that doses in tiny increments. ;) We just use the regular syringes to draw the dose out of the pen. I'm guessing you can probably do that with the vetsulin pen as well, because adjustments in whole units is probably going to be an issue.

You absolutely DO NOT need a prescription for a human meter. You can grab one off the shelf with the matching strips at Walmart.

Spike's Mom said:
No human would try to manage diabetes without a meter and my pet is no different.
Click to expand...

Absolutely! :cat:
 
The vetsulin pen can be adjusted in 1/2 u. I just took another reading and we are down to 228. That is the lowest it has ever been. Can you tell me how long I should or can wait tomorrow morning when I feed him to medicate? Based on today's readings I am going to reduce the amount if insulin he gets. I am a little nervous about starting back down to 1 then going up. Depending on his reading I plan him back down to 2 iu's twice a day. I can always reduce from there if needed.
I just hope I can get this under control. He is so hungry all the time now. He is under my desk now trying to get in the garbage. This is a first for my picky eater.
 
Yay! Downward movement. :) I always have to adjust my thinking since I use a human meter, but that 228 is actually a half-way decent drop. Roughly somewhere around a 150 on a human meter, which isn't bad.

Here is a guide to using Vetsulin. There's a TON of info packed into this document, so just chew on it a piece at a time.

For now, until you get a feel for how much duration Spike is getting on vetsulin, I'd suggest, shooting 12 hours from your shot tonight. Since vetsulin onsets quickly, you'll want to test and feed Spike's breakfast, and then shoot insulin about 1/2 an hour after he's eaten. Very important: if Spike's pre-shot number in the morning is under 300 (ALPHATRACK) post a separate thread here on health with a topic header that says something along the lines of "Low Pre-shot Number - Vetsulin - Help." Shooting vetsulin with a pre-shot number lower than that can be a little sketchy as it could result in Spike going too low.

If you opt to try a lower dose in the morning, you'll want to pick up some ketone urine test strips at the pharmacy - same kind as humans use, and test Spike's urine twice a day for the presence of ketones, which is a by-product of fat breakdown. In short - the presence of ketones can turn into a major medical situation pretty quickly. Any time we suggest reducing a dose to "reset," - we almost always also recommend testing diligently for ketones. The reason being is we just don't know yet whether the dose is too high or too low. If we guess wrong, and the dose is too low, we want to stay on top of things and bring the dose back up quickly, but methodically and safely. If it's too high, and you don't reduce, you just keep seeing worse and worse numbers, or potentially run into a hypo. Kind of trial and error at first.

The ravenous hunger is because he's not able to process the nutrients in his food. As Spike gets better regulated, the excessive hunger will get better.

Hang in there! You're doing great!
 
Regarding dosage - we recommend the start low, go slow approach.

Meaning a recommended starting dose of 1 unit or even 1/2 unit. And with home testing, adjusting the dose accordingly in 1/2 unit increments.

why --

1) it's very easy to skip over the ideal dose if you adjust in higher increments
2) once insulin is injected, you can't remove it from the body, so you could potentially be giving way too much insulin and then have to deal with hypos, bouncing, etc

Starting at 2 units, then going to 4 is not recommended regardless of insulin type. And as a starting dose 4 units is considered high.

It's great that you are now home testing, I don't see where you indicate what kind of food he is eating. I do see that you are familiar with Dr. Lisa's site and hopefully her food recommendations. Whether you go raw or canned, the idea is to serve food that is less than 10% in carbs....doing this will usually decrease the amount of insulin required. Just something to be aware of.
 
Right now he is eating Hills Prescription MD. I am expecting the supplements recommended from Dr.Lisa's site tomorrow. I ordered them online since this will be my first time making his food. I am headed to whole foods today to get the meats required. I am so ready to get him off this food. I know it is not really any better than his cat food he has eaten his whole life. I want to see him regulated and maybe even off the insulin completely. Yes I know I am being a little over optimistic.
 
No you are not being overly optimistic. You are feeling like everyone here feels. Everyone wants to get the cat into remission and if that is not possible, then to have the cat as well regulated as possible so he/she can lead a very normal and happy life.

Keep in mind that not all cats take to raw diets. It may take work, lots of trial and error to get him to eat it. I have one that won't touch raw food like that. Yet, she loves the freeze dried raw food by Stella & Chewy's, served dry only of course.

Be ready to mix the canned food with a little raw to start and over time you can increase the amount.

If you want to test how well yours will like it, you can try giving some ground up chicken, raw chicken pieces, as well as buying commercially available frozen raw food - such as Nature's Variety. they sell starter (sample) bags, that you could try and see how they like it. It's a great way to test before investing in a grinder, etc.
 
My thoughts exactly. I bought the bonemeal for now. He loves chicken already. My main concern is the raw portion. Since he was a kitten when we eat chicken he comes to the dinner table. The entire family has been known to tear off small pieces and give it to him. For a cat he has a few dog qualities. As he will beg for chicken. We have always had to keep a close watch on the butter as we have found him several times licking butter straight from the bowl. Well I am off to do his 3 hour reading and then off to whole foods and a stop by a local butcher that is actually open on Sundays. I also have to get a food scale. I am thinking Wal-Mart for the scale.
 
I have a cat that likes butter too. And that's actually a good thing. If you ever have to pill your cat and can't get it to go down, if you coat the pill in butter, it slides down nice and easy and coats the pill so you aren't "dry pilling" the cat too.
 
I would go slow with the changes in food. You don't want to upset his tummy. As Hillary said just add in a little bit each day to gradually change over and this will also prevent any very sudden drops in blood Glucose.

You asked me about the insulin I used for my cat and whilst I initially used vetsulin I quickly changed over the lantus and found it gave much better and longer control over blood Glucose. It worked so well that remi's pancreas was able to heal and he was able to stop the insulin altogether and he is now diet controlled.
 
Yay! Spreadsheet's up and you're getting data. Great job! :D

Saoirse started on Caninsulin (aka Vetsulin). Given how hungry Spike is at the moment, it might be a bit tricky to do but watch his behaviour from about +1-1.5 after his insulin dose to see if he gets even more demanding about being fed. I found that was a very good signal that the Vetsulin is kicking in. While you're unsure about whether Spike's dose might be too high, tests at +2, +3 and +4 after injection time are very good ones to get a warning about any dose that is likely to take him too low. If he does drop a lot, where possible keep a very close eye on him from the time of the test until at least +8, monitoring clinical signs and, if necessary, getting extra tests. Getting extremely persistent about being fed or becoming withdrawn of a sudden are things to watch for.

When you're changing over food, the gradual approach is even more important now Spike's on insulin as there is a strong likelihood that his insulin dose may need adjustment as you go through the transition. Is it the canned or the dry m/d that he's on at the moment?
 
I will go slow on the food change. He is on the canned Hills m/d. Readings today seem quite high . I can see he is stressed because he has been hiding from me today. We had a rough morning giving his insulin today and I don't really know how much he got today.
 
I'd suggest keeping an eye on Spike's withdrawal behaviour, too. The big swings in BG really didn't agree with Saoirse and she spent a lot of her time hiding when she was on that insulin. (Lantus, being gentler in action, agreed with her much better.)
 
For sure I will. I know he is mad at me right now he is a little dehydrated and the testing is not easy.
 
Aw, poor fella. :( Once you get into a routine of testing with lots of good things like fusses and treats, hopefully Spike will learn to regard it as an overall positive experience in time, and hopefully you will, too. I'd far prefer to have never needed to test Saoirse, but when I thought about the alternatives it made it a lot easier for me.
 
Just thought I would give an update on Spike. Our new meter freaked out. I was surprised the vet replaced it for free(including new lancets & strips). Which was good because I was almost out of test strips. We are up and running again tonight though. Last night I made Spike's food for the first time. The only problem I am having right now with the new food is he prefers the homemade food and picks it out and is refusing to eat the Hills m/d wet food. I think it is too soon to switch him to only homemade.
 
Sometimes cats just won't go ate your pace. Could you put done a little md first and then once finished given him the new stuff so you are still switching slowly.
 
Status
Not open for further replies.
Back
Top