Help. stalling but gb still going down.

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bbwyo

Member Since 2017
Kitty has had no insulin since 2:30 pm yesterday when Vet reduced 1x daily dose to .5 cu. This morning getting ready to give new dose. Tested during night at 4 am roughly +14 and she was at 83. I fed her since she seemed hungry and went back to bed. Tested at 6:30 she was 75 held food tested just now almost hour later and she's even lower 65. I don't know what to think? Help.

She does seem ravenous but is otherwise very active and looking great. More normal than for some time.

Or I could just wait until 2:30 this afternoon and give her the .5 cu
 
that's what I'm going to do. I'll plan to give next dose at 2:30 and see where we are at that time. That's about 6 hrs. from now and would be somewhat on a schedule. This will all settle down. I think it's going to work great just have to ride it out for now.
 
Is 2:30 your normal shot time for Kitty? Since you don't seem to have any information on how low she will go if you give her 0.05U at this low BG, I would be cautious. If you cannot be home to monitor, I would skip the shot.

ETA: If 2:30 is not your normal shot time, I would wait till your regular
PMPS and see how her numbers look then.
 
THX all. the problem is that we are only on day 4+ with Lantus and coming down from initial dose of 1 u 1x day. Skipped yesterday's am shot because of low #'s. Vet said go ahead and give the new dose .5 cu 1x day when I got home which was 2:30 pm and I (long story) forgot to do PT but then tested +1 and on. I have to leave at 11 am this morning so will test and shoot if heading up but otherwise will wait until I get home around 3pm. Im so new to Lantus and have been on Vetsulin so I'm having to adjust my thinking. I am glad I didn't give shot this am since an hour later she was even lower with no insulin. She's just so much better in the few days on Lantus I really want to keep things as steady as possible. Thanks for watching.
 
Here is the link from yesterday. There was discussion yesterday that Lantus is best administered 2x / day on a consistent schedule 12 hours apart. I know you are just getting started with Lantus and struggling with some low numbers, but please don't forget about the guidance to establish consistent doses 12 hours apart. I hope some more experienced eyes will guide you regarding a safe dose based on what you are seeing so far.

It is great to hear you are already seeing improvements and she is doing well!
 
Could you update your spreadsheet with the words Skip or NS (no shot) where you deliberately did not shoot. That way we know it wasn't just a missed entry.

I think maybe you should try practicing drawing a 0.25 unit dose, so you can shoot more often. Rosie really likes Lantus.:D
 
025unit-1.jpg
 
yes, this afternoon I gave a skinny .5 cu.(possibly even .25 but hard to tell for sure) The vet started us on a 1x daily shot. I am working toward the 2x daily Vet still thinks 1x daily will work but for now I'm letting things settle down a bit. I tried to clean up my SS so it would be more easy to read. It was hard to show that I skipped the AM shot but gave reduced dose in afternoon. Then today "skipped" AM shot because low #'s but was still consistent with yesterday's dose at 2:30 pm. So basically gave skinny dose 24 hours after the last dose. Will see what #'s are in the morning and decide how to go forward. She seems so much better. I don't know how much the earlier 1 cu doses accumulated and loaded her "depot" but I'm still watching closely and trying to understand the Lantus. Any observations are appreciated.
 
Sorry, but what does the "S" mean in the units column? Is that a skip? Since you are trying once a day dosing, it might be worth a comment in the Remarks column as to when you started it. And so people keep asking why you are missing shots. You could put 0 (zero) in the units column. I don't understand why there are three rows for today - it looks like 3 separate days. I would put last night's 83 in the +2 column this morning (+14), with a zero in the units AMPS column. Then the 75 would go in the +4 (+ 16.5) and the 65 in the +5 (+17.5). When you finally shot, that 70 would be listed in the PMPS column as 70 @+x, however many hours after the previous shot. If it's once a day, it would be +24.
 
I'm sorry I have redone this about 3 times and never get it quite right. Will try to get it fixed. I wasn't sure about how to go out +20... or to show stalling numbers.. but maybe it's not necessary to show those. Only use the one used for the PS. It's going to be another long day since I went ahead and shot the .5 on the 109 AMPS. Watching closely and in contact with Vet so ready for a long day. Sure appreciate the assistance and will work on SS today.
 
I wasn't sure about how to go out +20... or to show stalling numbers.. but maybe it's not necessary to show those.
yes, those are very good to know. For example, if you skip at AMPS (+12) put Skip in the units columns, the in the +8 cell, you can put the dose and bloodtest value. For example, in that cell you could put "70 0.5U@+20".

I hope Kitty stays safe for you today. I still think 0.5 units is a bit too much insulin.
 
thanks Wendy, Kitty has done amazingly well. I was able to monitor and watch closely but have not had time to sit down with the SS. I had about 3 other crisis today that all hit at once. I tested Kitty at +3 and she was at 38 but no abnormal behavior at all. I contacted the Vet and filled her in on what I dosed and previous readings so she was aware if anything went south. She said give her a little to eat every couple of hours. I wasn't able to test again until +6 and by that time she was back up to 46 and still no issues. +10 she was 54 and outside doing her normal routine. Will test again at +16 but think we have made it through this day. Have to follow through with this a couple more days and then will talk to Vet about 2x daily at reduced dose. I agree the .5 cu may be high for 2x daily so I guess the next step down would be .25 cu 2x daily. More info is definitely needed. All in all I'm very pleased. If I hadn't been watching the numbers there would have been nothing to clue me in to the lows.

So appreciate the care and concern for keeping us safe
 
I am glad you caught that low number! In future, if you see a below 50 number, it's best to give them a couple tsps of high carb food. Below 40, I used to add a drop of karo to the food. You don't want them lingering down there long. And yes, 0.25 units would be the next step. Kitty is reponding really well to insulin!
 
I am glad you caught that low number! In future, if you see a below 50 number, it's best to give them a couple tsps of high carb food. Below 40, I used to add a drop of karo to the food. You don't want them lingering down there long. And yes, 0.25 units would be the next step. Kitty is reponding really well to insulin!
Wendy I was going to reduce to .25 this morning but had a 126 bg. I am going to be able to test more often today I think. I know you said it wasn't good to stay in such low numbers...I'm concerned about this also. Can you explain this a little more? It's a little hard to get used to the difference in Lantus and Vetsulin. She doesn't move through those lows as fast but these numbers aren't so bad for "normal" cats and she doesn't seem to be in any discomfort and is out moving around. Also do you know if numbers are low is exercise a good thing or not so good? It would seem like she would need more glucose if active?
 
Hi. I'm not Wendy, but if you need to shoot do 0.25u 0.5u is too high because you have had to skip night shots. Give 0.25u and monitor.

You do want to have the cat be in greens longer so the pancreas can heal.
 
@Wendy&Neko
I think that Wendy was refering to the lime green numbers. Those are too low, the dark green is where you would want you kitty to stay within. What those lime green numbers are telling you is that your kitty is getting too much insulin.

Here is a copy from within the stickies that explains how Lantus works, take a look at insulin depot links. The biggest difference is that Lantus is a long acting insulin while vest I believe is an in and out insulin.

A full understanding of the following concepts will go a long way in helping you regulate your kitty's blood glucose when using Lantus or Levemir:
  • Carryover - insulin effects lasting past the insulin's official duration
  • Overlap - the period of time when the effect of one insulin shot is diminishing and the next insulin shot is taking effect
  • Insulin Depot - a "spare tank" of insulin, which has yet to be used by the body
  • LANTUS & LEVEMIR: WHAT IS THE INSULIN DEPOT?
  • Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).
 
Thanks. I will re-read the above. I am wishing I would have reduced the dose this morning but thought the 126 was higher, actually it probably just because the previous days I had tested an hour earlier. I have been staying in touch with Vet who said these numbers were good. Vet is good with 1x daily dosing which is what I have been doing. SS looks like skipping but I will try to fix that. It's Saturday so will not talk with Vet until Monday unless something major happens. I will test more frequently today and lighten dose tomorrow. This morning she was actually more playful and "normal" when she was in the 126 range...but we had been out walking/exercising too.

I am kind of not getting the "depot" thing. If dosing on Lantus is best 2x daily 12 hrs...when I only give one dose a day does that deplete the "depot"? So that in a 24 hr period there is less depot to help carry over doses?
 
Please reduce the dose. You kitty just spent too much time today in dangerously low numbers. We primarily decide on dose based on how low it takes the kitty, not how high. This morning could have been a bounce. You need to keep feeding high carb/karo until Kitty gets above and stays above 50. Testing once every few hours is not enough.

One dose a day will mean the depot does not get established for that dose, meaning you could get some odd higher numbers, much like you got first thing this morning, as the insulin wears off.
 
Wendy, Thank you so much for checking on this. when you say this morning could have been a bounce. Are you talking about the AMPS/126 or the +3/54? I am sure the 54 was a response to me feeding HC gravy. Tested just now +11/ 55

Would appreciate your opinion.
RE: reducing the dose. I know the numbers are too low and I am uncomfortable with it...but if you look back at my SS when first starting insulin. The Vetusulin caused low numbers and we (me and FD) started trying to change things around too early and Kitty was all over the place. Then when the Vet tests (she doses on fructosamine levels) and all the switching around presented some not representative #'s but looked like bg's had been in 600's we had to start over. There are some things that I am not sure of and really want the Vet on board with. If I have the data I can talk to her about specifics. In our conversations I know that she is not completely on board with all the testing etc etc. so I am educating her along with myself and she is coming along. She is happy with the low numbers...BUT she does not know how low the numbers have been today (34). She has instructed dosing 1x daily at this point. Also she thinks the error factor in the glucose monitors needs to be taken into account and likes to use them more for trending.

My dilemma this weekend is just getting through it, collecting as much data (safely) as I can and consulting with her on Monday am. After the low number this morning I have been contemplating texting her to see what she thinks about reducing to .25 2x daily which I believe will be the trick in leveling things out. My cat is an indoor outdoor rural cat so its hard to tell day to day what new stresses she's going to have and if she catches a bird/mouse ??? or who knows what.

After the past experience I don't want to be changing things around too quickly or dramatically. Yes the lower dose .25 cu will most likely be more beneficial but if I only give it 1x a day she may end up with another fructosamine test that shows false results. What I am trying to do is to be steady and as gradual as safely possible. The 38 is not safe and bumping her up with food is helpful but not a long term solution.

I'm thinking a skinny .5 in the morning is a good idea but then I'm guessing on the 1x daily dose by her next AMPS the bg #'s will be even higher. We have about 2 more weeks until the next Fructosamine test... I'm sure once we get this settled down the F test will go away but for now I feel I have to deal with it.

Thanks for taking the time to plow through this.
 
Also, I appreciate your concern about testing but believe me I am testing her constantly...just not with glucose meter. I watch her eyes, her interaction or lack of, her breathing if she's sleeping, how interested she is in food. I realize none of these replace a glucose meter but I read her pretty intensely...and always if something isn't right I do a bg test. I am so glad that FDMB has given me all these tools to work with .
 
@Wendy&Neko

The low numbers this morning, could have caused hypo if you didn't catch it and bring her number back over 50. Especially if she is goes out doors, you wouldn't want him that low and alone. The .5 is just way too high for her. I know you like you vet and that she also want the best for you kitty, I am just concerned with the fact that she does not know about the 2x day dosing for Lantus as that is the standard for cats. I have yet to see anyone on here doing once a day. I know it's not easy getting suggestions that differ from what your vet maybe saying, I had a hard time too. My vet is now on board with everything due to his progress. She's even checked out this site :)

If it was my cat I would reduce as too risky at the moment.
 
The 126 could have been part bounce, but was more likely just the insulin wearing off cause it had been 24 hours and cats metabolize Lantus faster than that.

I knew a vet that had a diabetic cat that passed from a hypo. I was not willing to take that risk. Most vet clients do not test like we do, so vet's don't really know what the cycles look like. I loved my vet for everything else but the insulin dosing, where I had more experience than she did. I was her first client to home test. Starting a kitty on Vetsulin says enough about experience. Neko was started on Caninsulin/Vetsulin and it wasn't until a locum vet with more experience saw her did we switch.

The meter knows the truth that the eyes cannot see. I once caught Neko in the 20's with no symptoms. Thankfully she couldn't have been there long.

Please reduce to 0.25 units instead of skinning the dose. 0.5 is too much insulin. Especially if she is outside and you cannot see her and she is seeing the 30's. I have seen too many stories of cats with hypos.
 
So if I do reduce to .25 and at +10 she's at 63 like she is tonight, what do I do? Give her another .25 cu? I just reread Dr. Hodgkins info on Tight Regulations:

"As long as you are feeding your cat ONLY low-carbohydrate foods, you do not need to be fearful of clinical hypoglycemia. In fact, those blood glucose numbers in the 60-120 range are the objective of the protocol. Even if the blood glucose drops to 30-50, do not feed sugar syrup or dry food. A small, high protein wet food meal is all you need for a cat at these numbers and that is more for the owner than the cat."

Please do not feel like I am arguing with you. I'm not and I agree that a smaller dose seems better and I am no where near ready to go on a TR regime but the above sounds like my Vet? What is the difference in ProZinc and Lantus? My Vet used Lantus regularly until prices went so high so I know she is familiar with it.

I just want things to settle down not get balled up like last time with the Vetsulin. This same exact thing happened. Her numbers dropped into 40's and I went through the whole "hypo" drill. She was fine except her bg went high because of all the HC stuff I fed her. I do not like her spending the day in such low numbers but maybe this is just something that takes time for her body to adjust to? I need to re-read the start slow protocol.

If you are still out there I would appreciate your comments. I will look in the morning before I dose and hopefully you will have had a chance to respond. It's getting kind of late here. Thank you again for caring enough to persist.
 
Ok. So I reduced to .25 and looks like she had a nadir at somewhere before +6/69? Guessing that by +12 she will be much higher. Give the other .25 cu?
 
Did you keep testing? You need to give her some higher carb food and test again to make sure she is above 50. The TR we practice here is way different than what you quoted above.
 
I've been on this board for over 7 years. I've seen the other feline diabetes message boards crop up and the one that follows Hodgkins' recommendations is hugely problematic. FWIW, the Hodgkins method of tight regulation (i.e, not feeding your cat high carb when numbers are low) has literally killed cats. No one wants to see your cat die from hypoglycemia. I would forget anything and everything you've learned from Hodgkins. Her dosing recommendations were developed based on the original formulation of Prozinc and therefore cannot be generalized to a long-acting, depot type of insulin. It's apples and oranges.

Cats are notorious for hiding how they are feeling whether it's illness, pain, or low blood glucose. I would not trust observation over the readings on a glucometer. Gabby's numbers would drop into the 20s or 30s and she would look fine. The good thing was I would test diligently and she never spent any length of time in dangerously low numbers. We do not know how long it takes for a cat to be in those kind of low numbers for organ damage to occur. Once you start seeing symptoms of hypoglycemia, it could be well beyond a margin of safety and you are looking at a very expensive stay at the emergency vet to get numbers back into a safe range. Your glucometer is your cat's best friend and the only way to keep your kitty safe. It's your choice how much you test but with the kind of numbers you're seeing, basing your cat's BG level on your observation, IMHO, is playing with fire.

All of that said, at the very least, I would skip a day or two of shots. It may empty the depot a bit and give you a chance to evaluate whether insulin is even needed.

 
I am kind of not getting the "depot" thing. If dosing on Lantus is best 2x daily 12 hrs...when I only give one dose a day does that deplete the "depot"? So that in a 24 hr period there is less depot to help carry over doses?
Please read this sticky about the depot: http://www.felinediabetes.com/FDMB/threads/lantus-levemir-what-is-the-insulin-depot.150/

Bev, both of my boys tested in the 20s more than once with absolutely NO sign that they were low. If I hadn't caught it and fed HC, I shudder to think what might have have happened. High numbers can cause kidney damage over time, but low numbers can kill very quickly. We just had a very experienced, long time member here lose her beloved kitty following a hypo. They gave him his regular dose and went out for several hours, then came home to find him unresponsive. We don't want that to happen to Kitty, or anyone's precious baby.

I'm sorry, but your vet does not understand Lantus, and Dr. Hodgkins is a menace. We aren't vets, but we have years and years of experience with Lantus amongst us (look at the dates under Wendy's, Sienne's and my avatars), and we have seen what happens when a cat gets too much insulin and isn't closely monitored. It's heartbreaking. You have been lucky so far, but playing Russian Roulette with your cat's life isn't ever a good idea. Sorry so be so harsh, but you have us all worried. We truly care.

Please try the .25 twice a day, and keep testing. We want this to have a happy outcome.
 
Thanks for your candor. I do get it and I'm not saying that observation is better than testing, I was just trying to make the point that I wasn't just leaving her on her own.
Also I am not giving a dose tonight and I did give the .25 as shown in the examples ( I was very careful to do exactly as shown) I do not quite understand what's up with her. Her PMPS was even lower than she had been all day except for early this morning. I'm sorry I have read and re read the sticky about the depot. I have googled Lantus and the "depot" and I do not find information to help me understand enough to figure out what is going on here.

Maybe Lantus is going to be a miracle drug for her?? Look at the SS and compare her #'s on Vetsulin and what's been going on the past week with the Lantus? It's been 8 days since our first dose. 1 cu. 1x daily for 2 days, 5 days on the .5 cu 1x daily, and then today? Any ideas?
 
I am not in any way suggesting that you don't care and aren't paying close attention. I was just trying to illustrate the importance of testing. I am glad you took what I said in the spirit in which it was intended. :)

I agree that with that 48 you should not shoot tonight. I like Sienne's idea of stopping insulin for a couple of days to drain the depot and re-evaluate. You are not endangering her in any way by skipping, and I suspect the picture will be a lot clearer once you do that. Not being able to shoot consistently is only clouding things up.
 
Here is a link to more information on Depo: http://www.felinediabetes.com/FDMB/threads/lantus-levemir-what-is-the-insulin-depot.150/

The weird numbers you are getting is because the dose is too high, and she is bouncing and clearing the bounces. She is not stable at the moment, and since only giving once a day the depo isn't as optimal as it should be. Feeding MC or HC is not causing those high numbers, it is the cat body reacting to too low a number, the goal of feeding MC or HC (couple spoonfuls) when numbers are too low is get her out of dangerous number, it also helps sometime to prevent a bounce making her number a bit flatter and allowing her body to get used to good numbers.
 
BTW, I suggest you get a few tests in over the next couple of hours, since 48 is pretty low for 12 hours after the shot. You need to be sure kitty is coming up and stays up. If you haven't already, feed her!
 
I was looking at your profile, do I read correctly that her diet was changed to all wet July 22 at the same time you started Lantus?

- Sorry to confuse but NO she has been all wet LC since mid May.
- Yes I have fed evening +tsp. small HC gravy.
-How long does it take to "drain depot"?
Here is a link to more information on Depo: http://www.felinediabetes.com/FDMB/threads/lantus-levemir-what-is-the-insulin-depot.150/

The weird numbers you are getting is because the dose is too high, and she is bouncing and clearing the bounces. She is not stable at the moment, and since only giving once a day the depo isn't as optimal as it should be. Feeding MC or HC is not causing those high numbers, it is the cat body reacting to too low a number, the goal of feeding MC or HC (couple spoonfuls) when numbers are too low is get her out of dangerous number, it also helps sometime to prevent a bounce making her number a bit flatter and allowing her body to get used to good numbers.

What do you mean "clearing the bounces"? Doesn't the depot even some of that out?
 
I am sorry, for now the bouncing and clearing is less important.

There are two types of insulin, the in/out and long lasting like Lantus with depo

In/out insulin from my understanding start working immediately when you give you kitty a shot, it keeps working until it is used up by the cat's system (few hours). So this means you will see your cat's numbers go down almost immediately after the shot. Basically it is short acting - More experience folks please correct me if I am not explaining correctly.

Depo type insulin like Lantus, is long lasting. How it works is that for the first 6 cycles (3days) give or take, each time you give insulin to your cat, his body stores a portion of the insulin for future use. The depo when full is the same size as the dose you give you cat. This type of insulin is slowly release in your cats system through out the 12 hour cycle. That why you don't see an immediate change in BG when you give the shot, the peak performance of the insulin is typically at + 7 give or take. When you change a dose up or down the depo has to adjust, so the first few cycles it may take time to see the true effect of the dose as the depo is not the same size as the new dosage yet. To build up or drain the depo, can take up to 6 cycles. The best description of depo I have seen is thinking about it as a spare tank.

I know it's a lot to take in, I didn't get it until I ran into situation like you are in right now that affected my own cat. I still ask questions as every cat is different, and little things seem to impact them easily.
 
A little encouragement, I think you need it. The good thing is that you are home testing. That is a big plus. Yes we do want a bit more monitoring when your kitty is really low, which you are starting to do so that is fantastic. You cat is reacting very well to the insulin, maybe too well. Since you is at such a low dose already maybe letting the depo clear may help. With such low BGs and dose, it is sure that the dose is too high and it's possible that maybe she doesn't need it any more and can be managed by food only. It's hard to tell right now, but it won't take long to figure that out. :cat:
 
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