Wild fluctuations

Discussion in 'Caninsulin / Vetsulin and N / NPH' started by Milo T Cat, Aug 20, 2020.

  1. Milo T Cat

    Milo T Cat New Member

    Jul 29, 2020
    Hello All,
    My Milo was diagnosed this summer with diabetes. At first we tried just the DM food to see if his glucose #s would go down. that didn't work, so the vet had me start to give Milo 1/2 unit of insulin, twice a day. The numbers kept going up, so I was told to give him 1 unit, twice a day. I've uploaded the times i've given him his insulin, and his glucose # as well as time of reading.


    Could somebody please help me? Are these wild fluctuations "normal"? His day to day diet has not changed at all. Nothing has actually changed. I did try a control test MANY times with his glucose reader, the strips and reader seem to be working. Is it just me? Am I not testing him right (I test his ear). I'm so new to all of this, and though I'm trying my best to educate myself, all of this is quite overwhelming and I just want to make sure Milo is healthy and ok!!
    Thank you so much for reading this

    Attached Files:

  2. Panic

    Panic Well-Known Member

    Apr 10, 2019
    Hello to you and Milo!

    Am I understanding right that you're just getting one test in randomly in the day each time? Which insulin are you using, NPH or Caninsulin/Vetsulin?
    There's nothing particularly strange about the tests - however consider the question of them being "wild fluctuations". Let's say you have a tv with a movie on. You walk by briefly and see a scene of a boy riding a bike. You come back an hour later and now there's a woman eating dinner. Another hour passes and you walk by and now see a fire being put out by an old man. By the end of the movie, you have no idea what was going on. None of the scenes matched, nothing made sense. Why? Because you didn't sit down and watch the whole thing. This is what you're doing with Milo's tests right now - you're testing just once a day, not aware of what the dose is actually doing. There's no way to know what his insulin is doing if you just get one random test in a day. That's why it looks confusing, there's nothing wrong with your meter or the way you're testing. :)

    Have you seen our spreadsheet file? It's an easy way for all of us to understand a cat's insulin reaction. The photo you sent has times on it but they're really not relevant to most of us since we all live in different time zones. Would you be willing to set up a spreadsheet and input Milo's times so we can form a game-plan and actually see what he's doing? If it is too confusing to set up we have mods that are happy to do it for you.

    Are you testing before giving insulin at all? Typically (if your schedule allows it) we get at MINIMUM pre-shot tests to make sure it's even safe to give insulin, and then a couple during the day and at least one before bed-time. Then we'll be able to see Milo's "big picture"! ;)
  3. Milo T Cat

    Milo T Cat New Member

    Jul 29, 2020
    Thank you, I will def start to work with this spreadsheet!! Milo is on vetsulin. I was honestly just doing what the vet told me to do... 1 shot after he eats breakfast, test midday, one shot after dinner. I'm not blaming his vet, but I think a lot gets lost when you get a massive amount of info dumped in your lap. Especially during a pandemic where your conversation is happening in the parking lot! Maybe she did say to test more than that? I can't remember at this point... but I did email her today with this new reading (exactly 6 hrs after his AM insulin shot - 536!). and she told me to up his dose to 2 units, twice a day. Milo has always been healthy and perfect until this summer... that's almost 13 years of "great" check ups.

    What you're saying about having a fuller picture makes total sense though. I can begin tomorrow with the testing more frequently so that there can be a full days picture.

    Dumb question, but if you're testing multiple times a day, I guess you could alternate ears, but do you basically prick the same general "sweet spot" to get the blood? Milo's fine with the needles, it's me who HATES them! I did try the rice sock trick though, and wow that makes a world of difference!

    Thank you again for your input! It's GREATLY appreciated!!!

  4. Panic

    Panic Well-Known Member

    Apr 10, 2019
    That's okay! My vet didn't tell me ANYTHING except my girl needed new food and shots twice a day. Nothing else. :rolleyes:

    Please don't up the dose to 2 units though! That is way too big a jump for cats. We increase by 0.25 units at a time, with Vetsulin only after a week on a dose and proof that more insulin is needed. We have no information that Milo needs more yet. I'm willing to bet that that high 536 was likely a bounce, meaning more insulin will make it worse.

    Bouncing is a phenomenon that occurs when the body experiences (or at least thinks it does) hypoglycemia. Luckily the body uses bouncing as a defense mechanism against this where it attempts to compensate the low blood sugar by dumping excess glucose provided by the liver in an attempt to raise blood sugar back to “normal” numbers. Unfortunately, “normal” is a relative term according to the body. For a diabetic whose body has been untreated for so long that it considered very high numbers to be the new normal, lower numbers can often make the body overreact in attempt to save itself, even if it’s not in danger.

    A cat who has been suffering from diabetes for some time may at the point of diagnosis have a new “normal” of 400. When insulin is introduced and brings it down, even to 200 (still diabetic levels), the body thinks it is in danger, dumps excess glucose, and thus the blood sugar skyrockets up to the 400-600s. After enough time has passed, the body will eventually realize that 200 isn’t such a bad number, and bouncing will happen less often. Note some cats are extremely bounce-prone and a switch to Lantus/Levemir is needed.

    There are three main causes of bouncing: when blood sugar drops too low (hypoglycemia), drops lower than the body is used too, or by dropping too much too quickly. Typically if a cat drops more than 50% of their blood sugar a bounce is likely to happen, or if they drop 100 points within an hour.

    While bouncing can be considered as a safety net in the instances of hypoglycemia, it can look very confusing on paper.

    It's very possible (and likely, what with how Vetsulin functions in cats) that Milo is experiencing bouncing and the only numbers you are seeing by midday is result of a bounce number. You never want to base a dose off of bounce numbers.

    Some notes on Vetsulin: I don't recommend it (LOL). It's a very harsh insulin in cats. You are in the US (Vetsulin is called Caninsulin everywhere else) so there is the 2018 AAHA Diabetes Management Guidelines that recommends using only Prozinc or Lantus for cats. Vetsulin is best used in dogs who have a slower metabolism. You can show this file (which is by the American Animal Hospital Association) to your veterinarian, rather than just saying some rando on the internet told you about it. I highly recommend Lantus. In cats, Vetsulin hits hard and fast early in the cycle, causing lots of bouncing and dangerous potential for hypoglycemia. Vetsulin often drops the blood glucose within 1-2 hours so hard and fast that the numbers skyrocket back up the next hour, and then kitty is stuck in high numbers the rest of the day until the bounce clears their system (which can take up to three days!).

    When using Vetsulin, you need to test, feed (if BG is high enough), wait 20-30 minutes and THEN give insulin. The reason for this is food already has to be on-board due to how fast it hits the system. Slower, longer-acting insulins such as Prozinc and Lantus are gentler on cats and don't cause these dramatic drops.

    Here is my recommendation for you and Milo specifically:

    Test before shooting EVERY time. Any test below 200, please stall feeding 20 minutes and retest. If he is still not at 200, skip insulin.
    If your schedule allows, get a +1 (possibly +2) to see how fast the BG is dropping. That way you'll find out how fast Vetsulin reacts in Milo's system. I recommend feeding at +1 to slow the drop.
    (+1 just means 1 hour AFTER administering insulin)

    Get another test at +3 or +4. Basically we want to find out when the Vetsulin starts wearing off. Unfortunately it usually doesn't last very long (another reason we don't recommend it). Once it starts heading up expect higher numbers. It won't be unusual for pre-shots to be high; the insulin will be used up long before then.

    Please make sure Milo is also getting food around +1 and a couple more times before +6. Just use his regular low-carb food as snacks. The bulk of his food should be for breakfast/dinner, but a spoonful or two during the day at each snack time is needed. (this also applies at night, where they drop even more! Most of us use Petsafe 5 feeders to achieve this). Also please get a nightly test in before bed to make sure he's safe.

    It's a lot, I apologize, but that is the general basis to get you started I hope! Please ask questions if needed and please please don't up the dose just yet until we find out what is happening to Milo's blood sugar. It's very common for vets to not understand the full gravity of certain insulin and how it works; unfortunately they don't have much education on feline diabetes in school. There's a million stories here of vets not knowing much about FD and putting cats in danger. My own vet had my girl on 5 units of NPH (slightly worse insulin for cats than Vetsulin) and wanted me to start giving her insulin THREE times a day because she kept running high!
    Last edited: Aug 20, 2020
  5. Panic

    Panic Well-Known Member

    Apr 10, 2019
    You can! Some people like to alternate to give the ears a break, but you'll eventually figure out that one of Milo's ears bleeds a little easier than the other, so you may be partial to that ear. For me it was sooo difficult to get blood from my girl's other ear that I just stuck with the same ear. You also don't have to stick to JUST the sweet spot - anywhere along the edge of the ear will suffice!

    The rice sock trick is the best, isn't it? :D

    Happy to have you here, Maggie! Keep up updated on Milo! He is a CUTIE.
  6. Milo T Cat

    Milo T Cat New Member

    Jul 29, 2020
    Wow, thank you SOOO much, I really appreciate all this info!!!!

    I didn't up his dose. I tested before he had breakfast (636), and then +3 (402) I'm gettin' the lingo down ;). I would have done more but this morning has been a touch chaotic with work. Fridays should be nice and easy, but for some reason I have a ton of meetings so I think doing every 3 hrs is the best I'll be able to do today. I love this spreadsheet so that's a help :) But I do see what you're saying with the rapid drop

    He ate some of his breakfast (he's not wild about the DM food to be honest). I made him chicken bone broth (thew it into the blender with the chicken meat) and made this slurry he seems to like! If he doesn't eat more than half his breakfast, I'll give him that slurry. His treats are all those PureBites treats or those whole filet packs that look better than what I eat for dinner sometimes. (For the record, I often tell Milo that he needs to get better quickly because I need to pimp him out to a cat modeling agency so he can start earning his keep! :p)

    I saw on a few other posts that Fancy Feast Classic Pate is what a lot of folks like to give their cats.... Instead of mixing the DM with this Organix pate he seems to just tolerate, I'm thinking of mixing it in with the FF. Hopefully this way he eats a little more and I can stop slaving over a hot stove. Milo unfortunately doesn't get kibble... it seems to mess with him. He used to eat this Wuruva food that I now know is high in carbs!

    I'm going to speak to the vet next week, so I'll ask about switching his insulin! Thank you for that link, that's incredibly valuable info!!! Sometimes I'm so trusting of others that I don't think to question if what the vet says is what's best for him!

    Thank you again for all your knowledge!!!! I really really appreciate it!!!!
  7. Panic

    Panic Well-Known Member

    Apr 10, 2019
    You got it! ;)
    Every 3 hours is better than none! Not everyone has the luxury of being home all day with the sugar kitties!

    Really common actually, DM food is mostly liver and cats tire of it rather quickly. That slurry sounds like kitty heaven haha!
    Honestly a switch to pure FF Classics would be a smart move for him (another popular choice is Friskies Pate). The DM is "fine" but as you're seeing, they don't care for it and there's cheaper options anyway. You'll want to do it over the course of a few days and not cold-turkey, with BG monitoring while you do it in case the food change earns Milo an insulin reduction. And actually, Weruva makes low-carb food too! It looks like Cats In The Kitchen and (most of) Truluxe varieties are perfectly suitable. This is the chart we use from Dr. Pierson. Anything under 10% is acceptable - preferably under 5%.

    It's a good thing Milo doesn't get kibble - it makes controlling BG nearly impossible. :rolleyes: Even the two low-carb kibble brands that are acceptable carb-wise still cause difficulties, and wet is healthier anyway.

    Hope everything goes well with your vet! Some get a little defensive, hopefully not yours, but just focus on the Guidelines I sent and remember that you're the boss of Milo and you decide how to care for him. :cat:

    Do keep us updated!

    One last thing I forgot to show you: this link here will show you how to set up a signature! You can put all Milo's info (diagnosis date, insulin, age, spreadsheet) in it so it's all in one place. c:

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