Shoot Insulin or Not?

[Louellen]

I am stumped and caught between vet orders and this forum's protocols and beliefs.

Morrigan has been throwing me some oddball numbers here and there at night, pre-shot every once in awhile. Our vet said to "not test so much" but,...well....I haven't been so good at doing that since I came in here so, I test when I feel it's necessary, even if she ate ok during the day. I've had a couple of "blue numbers" lately. They just come in for no foreseeable reason now.

Tonight, she gave me a 7.7 AFTER EATING. (She's on m/d kibble and Natures Valley mixed in).
I re-tested and got a 7.8 within 5 minutes.
Still NOT believing that number, I thought the meter was wrong so, used another meter. 7.7 on that meter...which is approx. 138 mg/dl in American standards.

So, after 3 pokes, I gave up, gave her a treat and decided "no insulin tonight" as the vets (yes, 3 of them and an internal medicine vet that my vet consulted over Morrigan's every hour curves at home) said NO insulin at 10 (180) or below.

She is difficult to test at the best of times but, I'm going to try one more time before going to bed.

Anyone think that I need to be worried (besides a likely higher number for the morning shot)? She won't eat anymore right now so, I don't want to keep on prodding and poking more. Safe or not? BTW... ETA.... she's eaten her usual amount of calories today and urine output is normal amounts for her now that she's being treated...as a matter of fact, one less than usual.

 

[Elizabeth and Bertie]

Hi Louellen,
That 7.7 is a nice safe number.
But, since there are no other test results for today (and we don't know if Morrigan is still dropping) I agree it would be good to get another test to see if she is dropping, rising, or staying the same; maybe in an hour?
In all likelihood Morrigan is absolutely fine, but occasionally there have been cats on Lantus that continue to drop after 12 hours.

Eliz

 

[Chris & China (GA)]

If you made the decision to skip tonight, then she should be safe since there's no "extra" insulin on board

 

[Elizabeth and Bertie]

Tonight, she gave me a 7.7 AFTER EATING. (She's on m/d kibble and Natures Valley mixed in).

Hi again, Louellen,
What we don't know, of course, is how low she dropped earlier in the cycle, prior to eating.
Given this evening's surprise number, it would be super-duper if you could start to get some mid-cycle tests to see how low Morrigan is dropping. Those tests (along with the preshot tests) would give you some valuable and important information.
It may be that Morrigan is beginning to need less insulin, but without knowing how low she is dropping on this dose it's not really possible to say.

Hugs,

Eliz

 

[Louellen]

Thank you both so much @Elizabeth and Bertie and @Chris & China.

I just did a test solution test on both meters and both are within range.

Now to get one more test in as it's nearly 2:30 a.m. here.

As for the mid-cycle tests, I totally agree. My vet insists on every hour curves being done so, I've done 2 or 3 of those now (2 back in 2015 I believe and one a few weeks ago now). The +4 is when she is at her lowest in each case. The vet then runs her numbers past an internal med vet who says to stay where she is on insulin for now????

I need to run this past the vet again tomorrow but, I am going to try now to get another test in to see where she's at. She ate a tiny bit more....but, this is her "sleepy time" so, I don't expect her to want to eat much more at this point anyway.

I think since we're already a couple of hours past her shoot time, I will skip tonight's shot to be on the safe side and touch base with her vet in the morning/early afternoon. He may want me to do another curve or get some more numbers...but HE is the one who INSISTED that I "not test so much", meaning "not at all). HA! Good thing I tested as I did test anyways.

 

[Louellen]

Just an update....at the + 2.5 hr post "no-shot" test....9.7 (174/175) so, I will leave it for tonight since she's gone up and has no more insulin shot and give her vet a call in the A.M.

Thank you both so much!

 

[Critter Mom]

Hi Louellen,

Is there any chance you'd be able to do a PM+2.5 (or preferably PM+3) test each evening? It could provide you with very valuable information about where each cycle might be heading and it could help you to build up some bit better of a picture of what Morrigan's BG levels might be doing mid-cycle on a given dose. (Backing this up with a weekly curve would also help a lot.)

From Morrigan's spreadsheet remarks:

Only gave 1 U at other vet's in the practise instructions. 8 to 10- 1U, 10-12- 2U, above 12- 3U's

Based on the advice your vets have give you, I'm a bit concerned about how they think Lantus works. Sliding scale dosing is more suited to in-out insulins like Prozinc. To the best of my understanding of how Lantus works, varying doses as suggested above would really muck up the insulin depot and therefore make Morrigan's response to Lantus much more unpredictable; it can take several cycles for the effect of a dose change (increase or decrease) to fully manifest in a cat's blood glucose levels. Indeed, if a cat following such a dosing guide who was regularly receiving, say, 1 IU Lantus BID were to bounce and be over 12mmol/L at the next preshot following those dosing guidelines and giving a dose of 3IU Lantus could be very dangerous since there could be too much insulin in the depot when the bounce clears. Finally, dose changes of 1 unit are far too big. If you post on L&L I suggest you ask for input from experienced members there about the advice your vets have given to you about Lantus dosing.

That said, there are times when it may be necessary to give a reduced - even token - dose of Lantus, but in general terms it works better - and safer - when dosed consistently.

For general reference, with sufficient testing it can be safe to give Lantus at BG levels lower than 10mmol/L (following Tight Regulation).

(@Chris & China - I'd appreciate it if you could review what I've written here for accuracy.)

(more active, playing??? BUT...not eating as much, gaining weight, sleeping more due to not being able to go outside with cold/snow??? Unsure what's going on. Good or bad???

If Morrigan's more active, eating a little less (but still enough for her daily needs), and gaining weight that may be because she's in better numbers and the insulin is helping her body to make better use of her nutrients. Increased activity can also enhance the effect of the insulin.

Here's a body condition chart to help you monitor how well Morrigan's doing weight-wise.

Body Condition Chart


Mogs
.

 

[Louellen]

Hi Louellen,

Is there any chance you'd be able to do a PM+2.5 (or preferably PM+3) test each evening? It could provide you with very valuable information about where each cycle might be heading and it could help you to build up some bit better of a picture of what Morrigan's BG levels might be doing mid-cycle on a given dose. (Backing this up with a weekly curve would also help a lot.)

From Morrigan's spreadsheet remarks:


Based on the advice your vets have give you, I'm a bit concerned about how they think Lantus works. Sliding scale dosing is more suited to in-out insulins like Prozinc. To the best of my understanding of how Lantus works, varying doses as suggested above would really muck up the insulin depot and therefore make Morrigan's response to Lantus much more unpredictable; it can take several cycles for the effect of a dose change (increase or decrease) to fully manifest in a cat's blood glucose levels. Indeed, if a cat following such a dosing guide who was regularly receiving, say, 1 IU Lantus BID were to bounce and be over 12mmol/L at the next preshot following those dosing guidelines and giving a dose of 3IU Lantus could be very dangerous since there could be too much insulin in the depot when the bounce clears. Finally, dose changes of 1 unit are far too big. If you post on L&L I suggest you ask for input from experienced members there about the advice your vets have given to you about Lantus dosing.

That said, there are times when it may be necessary to give a reduced - even token - dose of Lantus, but in general terms it works better - and safer - when dosed consistently.

For general reference, with sufficient testing it can be safe to give Lantus at BG levels lower than 10mmol/L (following Tight Regulation).

(@Chris & China - I'd appreciate it if you could review what I've written here for accuracy.)


If Morrigan's more active, eating a little less (but still enough for her daily needs), and gaining weight that may be because she's in better numbers and the insulin is helping her body to make better use of her nutrients. Increased activity can also enhance the effect of the insulin.

Here's a body condition chart to help you monitor how well Morrigan's doing weight-wise.

Body Condition Chart


Mogs
.

Hey Mogs:

First off, how is Saoise doing? I hope you and she got some rest and things are going better. I haven't had a chance to check the past day or 2 (medical stuff for myself).

I totally agree with you about that scale that the OTHER (fill-in) clinic vet gave me, being whacky. I don't generally follow that. I had no clue why she gave me those guidelines. My regular vet just says, "under 10...no shot and DO NOT test so much"....then, orders me to do an "EVERY hour curve". So, the night that I gave her only 1U, it was one of those nights of wondering...do I not shoot or shoot or do I give her some? I chose to play it safe for that night and give only the 1U and see what happened after that before I called the vet. She had a high number the next morning as expected....but, went back to her normal values after that so, I let it go.

Then, a couple of nights ago, she was at a 10.7 (having already eaten about an hour prior) so, I chose to swallow my tongue and stomach back down and shoot the full 3U's as usual. I pretty much know from her every hour curves and (if you go back to the 2015 charts where I was testing more often to see I was getting other numbers too), I knew that her +4 is her lowest number then, it hovers at the same values for the next several hours. Kind of a "flat curve" as expected with Lantus. Figuring the lowest the 3U has dropped her...was 3 to 4 points, I figured shooting at the 10.7 mark, the lowest she would go would be a 7 or at the very worst, a 5....which were all perfectly safe and good numbers. HOWEVER, having shot the full 3U's anyways, the next morning, she was STILL up at a 17! YIKES! Why? It was like her body fought back and raised that glucose! A bit of insulin resistance going on here?

Now, last night, I didn't give her the shot at a 7.7 because it could have been going down too far/ a little too close for comfort for me AND....even when I shot the full 3U dose at a 10.4....her numbers the next morning were atrocious at a 17!. I'm at that point today too. It didn't matter whether I shot the full dose or not....she was still up at 17.2 this morning. At least I slept after getting a 9.7 at the +2.5 last night.

I would do a curve at night but, we had to choose noon to 1 p.m. and midnight to 1 a.m. for the shots and tests as that is the ONLY time both hubby and I are home to test and shoot. With Morrigan, it takes 2 of us to TEST. One can shoot ok but, NOT TEST! She's shredded both of us in the past even with 2 of us there. So, last night, I stayed up until nearly 4 a.m. to check her, test her again and make sure she was ok. I had an appointment this morning so, needless to say, I am zonked today.

Anyways, I'm being long-winded in saying that I'm waiting for the vet to call back and talk about this. He wanted "NO testing". I said "NO way!" He has been consulting with an internal med vet on Morrigan's case so, they wanted to try to reduce the stress of the testings (for HER...it IS stressful...) and see what she did while trying a lower carb kibble (Morrigan has colitis so, she cannot tolerate canned foods at all...after 5 attempts and 5 rounds of Metrodinazole (sp?)) I cannot do the TR as she's a kibble cat. So, of course, I did things my way and compromised with only pre-shots and if I KNEW she wasn't too low, I'd forego the test for that one or 2 times....but, I cannot NOT test. Thankfully, I DID test because of that 7.7 last night (gotten 3 times on 2 different meters).

Honestly, Mogs (and anyone else reading this)...I am trying SO hard with her and her personality, my schedule, hubby's schedule and I'm really confused between what is practised here and what 3 vets are telling me, on top of an internal med vet. I get wrist slapped too by the vets. I actually got (from 2 vets now)...."who is treating her....us or the group?" Ok, I swore under my breath and walked out but, that has left me so confused. I've stayed off of these boards for the most part for awhile now...because I am far too confused between 2 very different points of view and methods. I know that I cannot test Morrigan the way that a lot of people here test their cats. I wish I could! I just can't. Sadly, when I run into trouble at 1 and 2 a.m. and have nowhere to turn, I come here for help/advice and try to weigh out everyone's opinions and balance those with what the vet has said and go the route of the most safety (from my own reading up on this on other sites as well), knowing what she's done in the past and my experiences as well as a very thorough charting (which vets all laugh at and call me "obsessed") of her eating, peeing, caloric intake, weight, general mood and, overall picture which helps me see where she's been and is going. Then, I take everyone's advice, my own records (which even ER vets have said are as thorough, if not more thorough than their own charting LOL and look at me as though I have 3 heads or am a psych patient ) and I decide what to do, based on her overall picture as well as what's said in here and what her vets and an internal med vet is saying. (Yeah, I consult a LOT and am about ready to BE in a psych ward LOL ) Very unfortunately, though I know WHY everyone in here is saying it...the most common answer is..."you haven't tested enough". I then, work my way through a total panic attack, try to stop hyperventilating and think straight enough to do what I feel is best for Morrigan, based on everything, all put together.

ETA: I had a hypoglycemic event myself yesterday. I am not diabetic or pre-diabetic but, have been diagnosed as hypogylcemic. I went down to a 3.1 and was "out of it". I had ignored earlier signs as I was out and didn't grab a snack. Oh boy! Horrid feeling! I can only imagine how even a drop from a higher number that a cat's body is used to, down to a more "close to normal" number would feel for them. Even a drop to a low "normal" makes you feel really cruddy.

Ok, I've ranted on enough here. I am going to wring my vet's neck if he's not called me back and left for the day (as he's sometimes done). I'm going to try calling again to see what's going on and ensure he calls me back. I may have to switch vets but, I don't want to do that if I don't have to. I've formed a "bond" with him and he tries to get answers for me, even if it's consulting the internal med vet. He's been good but, he goes on a LOT of vacations! LOL Little wonder with how much I pay every year with a couple of pets.

HUGS MOGS!!!!!!!!

 

[Olive & Paula]

Louellen, it is difficult to keep everyone pleased and not make yourself crazy. For what it's worth. I've never heard of curves being done every hour. Every 2 hrs for 12 hrs or every 3 hrs for 18 hrs.

Since your doing them you can just tell the vet if they mention it that you just couldn't get a reading every hour and this was the best you could do.

On the daily tests, one before each shot. If you can, one before you go to bed so you know she is safe for the night and any other(s) you can get during the day.

Pretty sure my vet thinks I'm nuts lately with Smokey and his vomiting, gas issues and highly stinky you know what. But I lost a cat because of a previous vet boggling and not concerned enough. It turned out to be pancreatitis but because of the vet it went to long without treatment and then hepatic lipidosis, the ER said she was to far gone for treatment to help the lipidosis. So now I push them. Good luck you will figure it out.

 

[Louellen]

Louellen, it is difficult to keep everyone pleased and not make yourself crazy. For what it's worth. I've never heard of curves being done every hour. Every 2 hrs for 12 hrs or every 3 hrs for 18 hrs.

Since your doing them you can just tell the vet if they mention it that you just couldn't get a reading every hour and this was the best you could do.

On the daily tests, one before each shot. If you can, one before you go to bed so you know she is safe for the night and any other(s) you can get during the day.

Pretty sure my vet thinks I'm nuts lately with Smokey and his vomiting, gas issues and highly stinky you know what. But I lost a cat because of a previous vet boggling and not concerned enough. It turned out to be pancreatitis but because of the vet it went to long without treatment and then hepatic lipidosis, the ER said she was to far gone for treatment to help the lipidosis. So now I push them. Good luck you will figure it out.

Oh my Woodsywife! What a struggle and hair raising time you are having with Smokey and numbers. I don't know how you do it. Just hugs. It IS a worry and a total commitment, isn't it?

I totally agree with everything that you've said...as I agree with what others are saying as well. It's the "line" where we are becoming obsessed with numbers of all kinds (readings, testings, shots, urine output, ketones...blah, blah, blah) that really has to be drawn somewhere, according to each cat, their temperament, our lives and not turning our kitties into pincushions, nervous wrecks and turning our lives upside down, isn't it? That's the hard part. Where is that line?

I think the members in here (myself included) have become a tad the opposite to the diabetic pet owner (both cat and dog) who do very little, if any home testing. We tend to watch everything and test frequently. It's almost like a mini-curve daily for a lot of cats in here. I guess I question what kind of a life that is for them too??? But, being that we're here and we're loving them, we do what we think is best. As you've said though...it's in finding a compromise that suits everything and everyone that is the problem. It's so hard to find, isn't it?

As for the bowel/tummy issues...uhhhh....yeah....for me, I had to give up on the trying the canned foods after rounds and weeks of problems and nearly having an affair with the vet LOL I mean, I called the guy every single day almost with one issue or another. I think he labelled me as "neurotic" and still does! YIKES! But, like you....I've lost a few pets because vets didn't take things as seriously as I was trying to tell them it was. I had a dog that had pancreatitis twice. Thankfully, he didn't develop diabetes...believe it or not. He recovered from it both times and lived more than his full life span at nearly 15 when he passed away.

Obviously, if we didn't love them so much, we wouldn't be here, trying our best to figure things out. However, we do and we're all trying. I think that what is ok for several people and cats here, isn't ok for others. Like you, Morrigan can't be on TR because of the kibble (m/d for her and Natures Valley Instinct @ 12.5% carb). I'm like you and have to keep her on a SLGS program/method.

Nothing is easy, is it?

Oh well, I did get a +4 today and I will see where she is in a bit when I test yet again (the $$$ signs are rolling up through my head on the strip costs LOL) and then, see where to go with it tonight. I'm pretty sure after missing last night's dose and the +4 number today that she'll get her full dose tonight. But....hey...they throw us curve balls that send us into tizzys, huh? I need SLEEP tonight though.

Oh and by the way, I did get ahold of my vet today. He said that NOT shooting last night was the right thing to have done and even he wouldn't have shot any insulin at that point. I didn't get any other answers but, I'm to call him back tomorrow after another +4 number if I can get one. (Boy is she shifty for tests! LOL)

And, as for the every hour curve....no, I hadn't heard of it either and was angry because it means that I have to be home all day for 12 hours and by the end of the day, I'm ready to swallow a bottle of Advil. I can't imagine Morrigan's feelings. I did ask why the every hour curve and he said, "because the internal med vet he's consulting insists on it". The last one that I did a few weeks ago, I had read that some internal med vets WILL insist upon this type of testing but, they said that once we see the number at its lowest then, raises with the next test, shift to very 2 hours. That's what I did last time and told our vet why I did that. He was ok with it.

 

[Critter Mom]

@Louellen - Got your post. Will reply later. In the meantime here is a for you.


Mogs
.