Need advice- lower than normal numbers, not sure if I should dose

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Kathryn & Nugget

Kathryn & Nugget

Member Since 2018
Hi all,

Nugget and I have been home testing since Wednesday. For the last few tests she has been consistently in the normal range. Today she slept the ENTIRE day- 6:30 AM-4:30 PM. She ate most of her food, but is incredibly lethargic. I tested her BG as soon as I got home and it was 147.

I am supposed to give her 2 units 2x day of Lantus. I am worried that she will go too low and I do not need a hypo cat on my hands right now (my stress is off the charts).

How do I know when to adjust the dose, or do I give it at all? It has been exactly 12 hours since her last 2 unit shot. I don't want to wait too long and I am just a nervous nelly about all of this.
 
Can you stall 30 minutes? That means wait, do not feed, then test again in 1/2 hour to see if he's coming up to a number you feel comfortable shooting.

If he doesn't you might want to skip as you are new at this. Then I would shoot a lower dose tomorrow, maybe 1.5 units. 2.0 was a bit high as a starting dose.
 
I was thinking I would wait until 7:15, two hours after I put the food out. She did not eat much. I will test again at 7:15 and see how her BG is. If it is still low I might only give one unit. Many people have said 2 units is a very high starting dose. It seemed to keep her in the normal range the last few days so I am just unsure.
 
Kathryn & Nugget said:
I was thinking I would wait until 7:15, two hours after I put the food out. She did not eat much. I will test again at 7:15 and see how her BG is. If it is still low I might only give one unit. Many people have said 2 units is a very high starting dose. It seemed to keep her in the normal range the last few days so I am just unsure.
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The numbers on the ends look great, the only problem is, the numbers in the middle can be a lot lower. If you can do a curve (test every 2 hours for 12 hours or every 3 for 18) this weekend, it will tell you a lot more what is happening.

I don’t recall what her number was at diagnosis, but sometimes they can get very sleepy and out of sorts from being in lower numbers than they are used to.
 
Stacy & Asia said:
The numbers on the ends look great, the only problem is, the numbers in the middle can be a lot lower. If you can do a curve (test every 2 hours for 12 hours or every 3 for 18) this weekend, it will tell you a lot more what is happening.

I don’t recall what her number was at diagnosis, but sometimes they can get very sleepy and out of sorts from being in lower numbers than they are used to.
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I haven't done a full curve yet, I think this is part of the problem. I plan on doing a full curve tomorrow, 12 hours.

At diagnosis her labs were 356, in office glucose was 421, so we are clearly a lot lower than that. I am just worried about giving her the insulin and her dropping too low as I don't really know what her lowest point is. My mom suggested giving her a few pieces of dry food. Thoughts?
 
Hi Kathryn. I'm in the middle of making dinner, but wanted to pop in to bring others up to speed.
  • Nugget is just shy of 10 pounds
  • if Kathryn were following TR, Nugget's starting dose would calculate out to be 1.125u bid
  • if Kathryn is following SLGS, the starting dose would be 0.5u bid
  • Kathryn's vet set the initial starting dose at 2u bid
  • tonight is the 6th consecutive cycle at 2u bid
Kathryn, Lantus is a "depot" insulin. The reason the numbers haven't dropped too low on the 2u dose is because the effects of Lantus are cumulative... one dose builds upon the next. It takes around 6 cycles (3 days) to see how low a dose is capable of dropping kitty. Tonight will be the 6th consecutive cycle on this dose. It's no wonder numbers are down some. We're right at the point where we would expect to see how low 2u bid can drop her.

No matter what you shoot tonight, please monitor carefully.

Gotta finish making dinner. Will try to stop by later. :)
 
It looks like you skipped the shot tonight, looks like a good call since you’re just a week in. Lots of people don’t see numbers that low for weeks and ease in to dealing with lower numbers. Trial by fire isn’t very fun! ;)

Dry food isn’t recommended around here. A lot of cats come here having eaten a dry food diet, end up diabetic (for whatever reason), switch to lower carb wet food and go in to remission in short order, mostly due to diet change. Dry food is higher carb, bad for teeth, dehydrating, the list goes on. You can read up about it here, but the takeaway is, if at all possible you can keep your cat from eating kibble, it is a good thing for diabetes and beyond:

http://catinfo.org/
 
Stacy & Asia said:
It looks like you skipped the shot tonight, looks like a good call since you’re just a week in. Lots of people don’t see numbers that low for weeks and ease in to dealing with lower numbers. Trial by fire isn’t very fun! ;)

Dry food isn’t recommended around here. A lot of cats come here having eaten a dry food diet, end up diabetic (for whatever reason), switch to lower carb wet food and go in to remission in short order, mostly due to diet change. Dry food is higher carb, bad for teeth, dehydrating, the list goes on. You can read up about it here, but the takeaway is, if at all possible you can keep your cat from eating kibble, it is a good thing for diabetes and beyond:

http://catinfo.org/
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Yes we did skip the dose for tonight... I gave her 12 pieces of dry food, she only ate 8 of them... I just tested again, back up to 165 (which is just about what she was 1 hour PMPS). She did eat another few licks of her wet food, and even some water so I guess those are both good signs.

I will test again in an hour and see where we are. I figured out the lines on the syringe so now I can dose out 0.5, 1, 1.5, 2 etc. in case she climbs really high in the next hour!
 
Thanks for responding on her weight. I kind of thought she might have been started off too high. If it were me, I would do a reset of 1 unit and hold that dose for the required amount of time according to whether you are going to follow SLGS method or TR protocol ( both of the stickies on these are in the New to Lantus forum.)

ETA: Also remember that Saturday night we set the clocks ahead so you need to be mindful of how that impacts shot times. Here is a link to help you with the transition.

http://www.felinediabetes.com/FDMB/threads/daylight-savings-time-us-starts-march-11th.191994/
 
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Jill & Alex (GA) said:
Hi Kathryn. I'm in the middle of making dinner, but wanted to pop in to bring others up to speed.
  • Nugget is just shy of 10 pounds
  • if Kathryn were following TR, Nugget's starting dose would calculate out to be 1.125u bid
  • if Kathryn is following SLGS, the starting dose would be 0.5u bid
  • Kathryn's vet set the initial starting dose at 2u bid
  • tonight is the 6th consecutive cycle at 2u bid
Kathryn, Lantus is a "depot" insulin. The reason the numbers haven't dropped too low on the 2u dose is because the effects of Lantus are cumulative... one dose builds upon the next. It takes around 6 cycles (3 days) to see how low a dose is capable of dropping kitty. Tonight will be the 6th consecutive cycle on this dose. It's no wonder numbers are down some. We're right at the point where we would expect to see how low 2u bid can drop her.

No matter what you shoot tonight, please monitor carefully.

Gotta finish making dinner. Will try to stop by later. :)
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Yumm dinner. I am not cooking tonight, I do not have the energy... company over and I am being antisocial, sitting in the office (also known as the cat room lol), where I can research and figure things out while Nugget sleeps in her cat tree.

Understanding what this insulin does cumulatively is a big help. With that info I think that 2 units is probably too high a dose for her. Thank you for that incredibly helpful information.

She is eating again, so at 8:30 I will test again and if it is climbing I will shoot 1 unit and test again at 10:00 PM. I am drinking some coffee now to stay up!
 

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Kathryn & Nugget said:
Yumm dinner. I am not cooking tonight, I do not have the energy... company over and I am being antisocial, sitting in the office (also known as the cat room lol), where I can research and figure things out while Nugget sleeps in her cat tree.

Understanding what this insulin does cumulatively is a big help. With that info I think that 2 units is probably too high a dose for her. Thank you for that incredibly helpful information.

She is eating again, so at 8:30 I will test again and if it is climbing I will shoot 1 unit and test again at 10:00 PM. I am drinking some coffee now to stay up!
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Good plan and remember that the AM shot needs to be 12 hours after a potential shot tonight. Also see my previous post about DST.
 
Bobbie And Bubba said:
Good plan and remember that the AM shot needs to be 12 hours after a potential shot tonight. Also see my previous post about DST.
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Hmm. I am going to test again as soon as I can catch her- she seems to realize that tonight I am the bad guy and I am just going to keep sticking her ears- and if her numbers are rising, I am going to give one unit. To keep her spaced 12 hours apart means I can actually get some sleep tonight, and then adjust for daylight savings and eventually end up back at my 6AM/6PM insulin shot, which really works out well!

I like Bubba's eye patch! It gives him some serious character :)
I see you feed him a raw diet... what is that like? I think the low carb high protein diet is probably what I will stick to, but I am curious about feeding these furry love babies a raw diet!
 
Kathryn & Nugget said:
Hmm. I am going to test again as soon as I can catch her- she seems to realize that tonight I am the bad guy and I am just going to keep sticking her ears- and if her numbers are rising, I am going to give one unit. To keep her spaced 12 hours apart means I can actually get some sleep tonight, and then adjust for daylight savings and eventually end up back at my 6AM/6PM insulin shot, which really works out well!

I like Bubba's eye patch! It gives him some serious character :)
I see you feed him a raw diet... what is that like? I think the low carb high protein diet is probably what I will stick to, but I am curious about feeding these furry love babies a raw diet!
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The raw diet actually ends up cheaper than the higher quality low carb food I was feeding. And I don't have to worry about the cat food companies changing their formulas and then messing up the carb count. They do not have to give their new formula calculations for up to 6 months after they change them.

Bubba had some GI issues so I am finding the raw diet so much better! Check out www.foodfurlife.com as they have so much informative info on how to transition your cat to raw along with the supplements they offer that need to be added into the raw food to make it a complete protein that you kitty would get hunting in the wild.

So glad you found this website. So much knowledge and information here. And Welcome! Keep posting and peeps can help you with the dosing. Start a new thread each day and link the previous one to the thread. Most of us could tell you that our vets do the best they can with the 8 hours of instruction that they received in school, but the peeps here really know their stuff. We are here to help. :):cat::bighug:
 
I was just looking to try to find the carb count on the food I have been feeding her, and I can't find it. They are grain free formulas, so I can't imagine that they are terribly high in carbs, but I definitely have to look more into this. The dry food was so convenient, and the canned wet food is convenient too- I just want to feed her the best possible diet I can. I will look into that website for sure, thanks for posting it!

I've tested every two hours today, AMPS (185), 8:00 AM (170), and just now at 10:00 AM (122). I gave her one unit this morning after the AMPS because she was creeping higher. She's eaten almost all of the 3oz of food I gave her which I think is a good sign. Just gotta keep an eye! I do have a higher carb wet food (10% carbs) to give her if she continues to dip. I don't have any karo, just maple syrup. She's never gone so low to be staggering around, but I was just reading on some other threads and stickies that sometimes cats don't show signs of hypoglycemia. I suppose it is just easier to continue to test and be assured of what her levels actually are.
 
I actually just emailed the company to see if they will send it to me. I looked in the cat food spreadsheet that was in one of the stickies, and only two of the flavors she likes are on that spreadsheet. More research to be done!
 
Nugget is looking good on one unit and recovered beautifully from the skipped shot last night!

You’re right, they don’t always show symptoms in low numbers. Asia had a 41 just the other day on a human meter, purring, happy, just being her cat self, not any sign whatsoever. :rolleyes: Sometimes when she has gone low she is ravenously hungry, like she will chirp and yell at me for food and eat up what I give her and ask for more (not at all typical behavior for her). The weirdest symptom she ever displayed was laying down by her food bowl (not normal behavior for her), so I tested her and she was 32!

Maple syrup is fine to give, I use Karo syrup as I tried honey at first and it didn’t do as much as Karo. 10% carb is not really considered high carb, it’s more like the upper end of low carb. High carb is typically the foods with gravies.
 
Well now are down to 98... I just opened up the can of food with the gravy and she lapped all the gravy up. Its shredded chicken which she doesn't love, so I smushed the chicken down and added a little water to make more gravy. Just have to watch now. I think I will test every hour!
 
Kathryn & Nugget said:
Well now are down to 98... I just opened up the can of food with the gravy and she lapped all the gravy up. Its shredded chicken which she doesn't love, so I smushed the chicken down and added a little water to make more gravy. Just have to watch now. I think I will test every hour!
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Since she is in the middle of the cycle or somewhere near nadir ( don't really know when she nadirs yet but most cats are +4 -+7 ) I would have only given some low carb food. I get that seeing a green is a bit alarming but with using the Alpha Track meter, your "take action number is 68. 98 is still a nice safe number and the idea is to boost up about 20 points but not take them to the moon with a carb load. Usually a tsp of gravy is enough to do that, but Every Cat Is Different ( ECID) and as time goes on, you will learn what works best for her. Also, she could bounce on her own from just hitting a green and not being use to being in a normal number.

What I did to learn how higher carb (HC ) food works with Bubba was to put right in the cell with the BG what I fed and how it affected his BG's the next test.
 
Bobbie And Bubba said:
Since she is in the middle of the cycle or somewhere near nadir ( don't really know when she nadirs yet but most cats are +4 -+7 ) I would have only given some low carb food. I get that seeing a green is a bit alarming but with using the Alpha Track meter, your "take action number is 68. 98 is still a nice safe number and the idea is to boost up about 20 points but not take them to the moon with a carb load. Usually a tsp of gravy is enough to do that, but Every Cat Is Different ( ECID) and as time goes on, you will learn what works best for her. Also, she could bounce on her own from just hitting a green and not being use to being in a normal number.

What I did to learn how higher carb (HC ) food works with Bubba was to put right in the cell with the BG what I fed and how it affected his BG's the next test.
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I haven't done a full day curve before so I have no idea where her nadir is either. I am hoping this is it (12PM was +6). I think she is not used to being in normal ranges, after being high for 2-3 weeks. I am keeping a close eye. She is napping now. I do have her dry food still, if I had to give her a few pieces. She used to like the crunchy food mixed into the gravy. I will definitely keep a few cans of the higher carb food with gravy in the cabinet just in case. I've been taking lots of notes on the SS to keep track of what I am feeding her. I also have another spreadsheet with that info, which I should probably merge!
 
Back up to 154 :) one hour after giving her the food. I guess she hits her nadir about 6 hours post insulin. I will test her again at 3PM, then 6PM for her PMPS. She had no insulin last night, and only one unit this morning. The more I test the more I really think that 2 units was just too aggressive a dose to keep her on.
 
Kathryn & Nugget said:
Back up to 154 :) one hour after giving her the food. I guess she hits her nadir about 6 hours post insulin. I will test her again at 3PM, then 6PM for her PMPS. She had no insulin last night, and only one unit this morning. The more I test the more I really think that 2 units was just too aggressive a dose to keep her on.
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That is most likely a big high carb bump.
 
Holding steady at 154! I won't test again until 6:00 for her PMPS. Looks like she might not need another dose tonight. Is it possible that some cats only need insulin once a day?
 
Kathryn & Nugget said:
Holding steady at 154! I won't test again until 6:00 for her PMPS. Looks like she might not need another dose tonight. Is it possible that some cats only need insulin once a day?
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Lantus is best if dosed every 12 hours. Newbies usually don't shoot below 150. If she hangs where she is and you have plenty of test strips and some more higher carb food, you could shoot this PM. If you have any doubts or need assistance, change you title thread with a ? mark and say Dosing Help ASAP/

ETA : And you can monitor.
 
Kathryn & Nugget said:
Holding steady at 154! I won't test again until 6:00 for her PMPS. Looks like she might not need another dose tonight. Is it possible that some cats only need insulin once a day?
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It is possible for a cat to need insulin only once a day, but highly unusual. The number you didn't shoot last night is a number you would shoot with more experience. He did really well on the skipped shot, but you have to keep in mind the 5 doses of 2 units he had previously, there's some internal storage for that, and likely it carried him through without going too high.
 
Bobbie And Bubba said:
Lantus is best if dosed every 12 hours. Newbies usually don't shoot below 150. If she hangs where she is and you have plenty of test strips and some more higher carb food, you could shoot this PM. If you have any doubts or need assistance, change you title thread with a ? mark and say Dosing Help ASAP/

ETA : And you can monitor.
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I jinxed it. We ended up dosing 1.5 units at the 12 hour mark.. her blood sugar went up significantly to 247. I just tested her again and we are down to 216 one hour after the Lantus. I am going to toss the food she didn't eat in about an hour. I don't think she likes chicken at all! She lapped up the gravy and the pieces I smooshed. Left a good ounce and a half in the bowl.
 
Stacy & Asia said:
It is possible for a cat to need insulin only once a day, but highly unusual. The number you didn't shoot last night is a number you would shoot with more experience. He did really well on the skipped shot, but you have to keep in mind the 5 doses of 2 units he had previously, there's some internal storage for that, and likely it carried him through without going too high.
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This is such a puzzling mystery to me and I wish I could figure it out sooner rather than later, and I wish I didn't have to wait until April to see the specialist. I will keep testing tonight until I can't keep my eyes open anymore. She's mad at me too, giving me the stink eye from her tower (see if you can spot her in the picture). She bit my boyfriend's friend too, hard enough to draw blood. We told him to leave her alone and not pet her tonight, but no one listens. She clearly feels off because she very rarely bites hard enough to draw blood. She's only done it to me twice in the last 4+ years...

Photo on 3-10-18 at 7.14 PM.jpg
 
Kathryn & Nugget said:
I jinxed it. We ended up dosing 1.5 units at the 12 hour mark.. her blood sugar went up significantly to 247. I just tested her again and we are down to 216
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Remember, that Lantus dose is based on the nadir not the preshot number. I would have held the 1 unit to see what it could do based on her weight and the starting dose being too high AND you did not shoot last night and she still manage to have a decent cycle.

With her +1 being lower that her PMPS number, it could be an active cycle, so please monitor her tonight.


ETA: She has bounced up tonight for the PMPS as she is not used to being in green numbers.
 
I can barely keep my eyes open, but did one more check, back down to 124. I just fed her again as some time in between 8pm and now she gobbled the rest of the food that was in her bowl (guess when she is hungry she likes chicken). Will update in the morning.

Thanks for all the help and advice today... it is much appreciated. Grateful as always that I am here in this group.
 
Kathryn & Nugget said:
I jinxed it. We ended up dosing 1.5 units at the 12 hour mark.. her blood sugar went up significantly to 247.
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I agree with Bobbie, I would go back to 1.0 unit tomorrow morning. The skip last night will also have impacted the depot. The impacts of a skip or reduced dose can be seen in later cycles.
 
I was so tired this morning that I typed this, and never clicked to post. Oops. I was able to go back to sleep for about an hour and a half.

So my watch/alarm clock adjusted to DST, I am up and awake but wishing I was asleep. I tested her BG at 5:40AM, it is at 163. I fed her a new kind of food which I just realized is on the higher end of low carb. I am thinking 1.0 is a good plan too (thanks Bobbie and Wendy), gave that at 6:20.

Tested her again at 9:30 and BG is 162. I think the 150s-170s a good range for her because she is up, alert, jumping on the couch, knocking things around to get my attention... low 100s seem to make her very lethargic, as do the higher 250s. I've noticed this a few times.
 
Bobbie And Bubba said:
Remember, that Lantus dose is based on the nadir not the preshot number. I would have held the 1 unit to see what it could do based on her weight and the starting dose being too high AND you did not shoot last night and she still manage to have a decent cycle.

With her +1 being lower that her PMPS number, it could be an active cycle, so please monitor her tonight.


ETA: She has bounced up tonight for the PMPS as she is not used to being in green numbers.
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Bobbie, I've been trying to figure out my brain waves on this one... so if administering Lantus is based on the lowest BG reading in the curve (nadir), does that mean I should be giving her another dose when she hits that nadir? As in shooting every 12 hours is not the right way to give the insulin? My brain is flummoxed. I better have some coffee.
 
Kathryn & Nugget said:
Bobbie, I've been trying to figure out my brain waves on this one... so if administering Lantus is based on the lowest BG reading in the curve (nadir), does that mean I should be giving her another dose when she hits that nadir? As in shooting every 12 hours is not the right way to give the insulin? My brain is flummoxed. I better have some coffee.
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No, the Lantus is dosed every 12 hours . What it means is that we use the lowest number in the cycle or the nadir ( most kitties nadir around +4 - +7) as the guide to when to increase or decrease. Since she gave you that nice green 98 yesterday, you would hold the dose. I think what happened was you saw her jump back up and took her dose back up when you should have kept it the same.

Jill pointed out that her weight and starting dose would be about 1.125 and unless you are using calipers to measure that would be very hard. So 1 unit is good for her right now. She went into bounce mode from being in a lower numbers yesterday and the bounce can take 6 cycles or 3 days to clear. For now, I would hold the 1 unit for at least 6 cycles and see where she is after that. Of course if she goes lower than 68 on the Alpha Track her dose would get reduced to .75unit.

ETA : SEE highlighted
 
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Kathryn & Nugget said:
Tested her again at 9:30 and BG is 162. I think the 150s-170s a good range for her because she is up, alert, jumping on the couch, knocking things around to get my attention... low 100s seem to make her very lethargic, as do the higher 250s. I've noticed this a few times.
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Glad she is feeling better already! Feeling lethargic in the lower or higher range than what she is used to is typical. Asia was happy as a clam in the 300s when she was first diagnosed. :rolleyes: She was sleepy anything lower than that. Whatever numbers were typical for her in the time she's had diabetes until diagnosis is what she has decided is her new normal. A non diabetic, healthy cat has BGs in the range of 50-80, some cats, even lower (my civvie tested at 47). Ideally you want to keep her below renal threshold (the number, which is different for each cat, where is the tipping point and the glucose becomes too much and spills into the urine, thus putting a huge strain on the kidneys).
 
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