JoJo’s new diabetic journey

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Alicia & JoJo

Alicia & JoJo

Member Since 2018
Hi there! My kitty, Jojo, was recently diagnosed diabetic (about 3 weeks ago) and I am in need of some advice. Pre-dx, he was a dry food/free feed kitty who would enjoy a small amount of fancy feast wet in the AM and PM. I have slowly transitioned to ONLY fancy feast classics; splitting majority of calories pre-insulin in the AM and PM; then a few small amounts throughout the day. The vet started him on 1u of Lantas 2x daily then after 1 week and a glucose curve, bumped him up to 2u 2x daily. During this time, I was transitioning from dry food to wet. His last curve was completed last Wednesday (8/8/18) where the vet dropped him back down to 1u 2x daily. I began home testing back on 8/2 with numbers all over the place but never within normal range. As of 8/11/18 evening, he is now solely on ff wet food, here are the numbers since:
8/11-7:00pm pre shot-607 (1u)
8/12-7:00am pre shot-338 (1u)
8/12-6:15pm pre shot-214 (gave dinner)
8/12-7:00pm pre shot/retest-226 (have not given insulin)

My question is that now he is officially on solely wet/low carb; it seems that his bg has lowered significantly in the last 24 hours. I know this last number is still higher than we would like to see, but I’m worried about him dropping too low over night. I called my vet but it’s nearly impossible to actually get the vet on the phone; currently waiting for a call back (still waiting after 2 hours). He is almost 2 hours past his injection time, should I hold off with no shot tonight, retest in the AM and see if he is continuing to drop with the diet alone? Any help is appreciated! :)
 
Sorry that I can't write more at this time (very late here and I have to leave the house early tomorrow), but wanted to say welcome and just to make a few remarks. First, and most important, Lantus dosing is based on the lowest number in the 12-hour cycle: the nadir (usually occurs around the middle of the cycle). Not on pre-shots. Jo Jo may well be going low in the middle of the cycle and you would not know it if you don't test at times other than pre shot time. Try to get in at least one test around the middle of each cycle and a test before bedtime.
Second: when raising or lowering dose follow the protocol (see the discussion in the "Stickies"--the informational posts at the top of the Lantus/Levemir forum). We make dosing changes in 1/4 units--not whole units. This is to insure that we don't go past a good dose. Raising dose in whole units in too short a time will wreak havoc on blood glucose readings. Lantus needs time to get established. It is a "depot" insulin, which means that it builds on itself. Every time a change in dose is made the "depot" has to recalibrate itself.
I know that you will get lots of good advice tonight, so I will have to stop here. Welcome!
I think that I would skip tonight's shot!
 
Thanks so much for the warm welcome! After all the research I’ve done on this disease, I was most definitely in disagreement with my vet over the whole unit increase, then whole unit decrease a week later. I unfortunately have a vet who is not open to input (time to look elsewhere) so that is why I turned here. I did decide to skip tonight’s dosage. I will test in the AM, then again about 5-6 hours in, then again in the PM and report jojo’s numbers. If he has a lower number tomorrow morning (below his last reading of 206 taken at 9:00pm) should I skip another dosage?
 
I agree....it's too late to shoot tonight without changing your shot times quite a bit.

I'd just plan on testing at AMPS and then getting at least 1 mid-cycle test on the AM cycle (if at all possible) and then get at least a "before bed" test on the PM cycle.

Lantus dosing is based on how low it takes them, not the Pre-shot numbers, so it's really important to get those "in between shot" tests in

If it's impossible to get mid-cycle tests on the AM cycle due to work, it's even more important to make sure to get some tests on the PM cycle and then do a curve (test every 2 hours for 12 hours) on a day off

Until you get some data on how he's responding, we usually will say that if you get a Pre-shot under 200, that for now, you stall, don't feed and post for help. Test again in 20-30 minutes to see if the number has gone up without the influence of food. Usually if the number goes up without food, it's going to be safe to go ahead and shoot, but whether you shoot or not will depend on your ability to test later in the cycle. We also like to have someone with experience that's willing and able to stay online with you as long as necessary to make sure everyone is safe and sane.

As you get more experience, that "no shot" number will come down. Those of us with enough experience will shoot anything over 50 (on a human meter), 68 on a pet meter
 
You know, I am actually off work this entire week so doing mid cycle testing will not be an issue at all. I am comfortable doing a curve as well! So, what would be the best plan of action for tomorrow morning?
 
Alicia & JoJo said:
So, what would be the best plan of action for tomorrow morning?
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If he's below 200, stall, don't feed and post for help. Make sure your subject line says something like "STALLING, NEED HELP!" so you'll get someone's attention ASAP. Plan on testing again in 20-30 minutes.

If above 200, go ahead and feed and shoot the scheduled dose. I like getting a +2 because it can act a lot like a crystal ball for a lot of cats and give you early warning if they're going to go a lot lower later in the cycle. (that's a test 2 hours after the shot)

Then plan on getting another test somewhere around +5 to +7 (5 to 7 hours after the shot)….unless the +2 is lower than the PS....then you might need to test sooner (more than just a few points)

It's also help if you start to keep track of your test numbers on our spreadsheet. Here are Instructions on setting up the FDMB spreadsheet

Will you also go ahead and fill out your signature? You'll see below our comments there's some basic information about each of our cats like:

Your name/Cats name, age, sex, date of diagnosis, type of insulin, type of meter, type of food, any other health issues or medications? and a general location.

That keeps us from having to ask the same questions over and over again.

To fill out your signature, find your sign on name (top right of the page) and click ….there's a drop down menu....Choose "Signature" and a new box will pop up. Add the information and then "Save". Your spreadsheet link will go there too when you get it set up
 
Good morning! Mr. Jo came in at 256 this morning so he is eating up his breakfast and I’ll be giving the 1u. as instructed. I will test at the 2h mark and repost our progress. I’ll also get my signature and start the spreadsheet today. Thank you again for your help!
 
What is the best action to take as far as testing for the rest of today and tomorrow? I am running low on test strips; only 6 left. I have another order coming but won’t be here until Wednesday!
 
That's another reason we're so big on human meters....you can run to the store and get strips when you need them!

Can you run to WalMart and pick up a Relion Confirm or Micro meter and some strips?
 
Yes, I can do that tomorrow. I have 6 test strips left for the alpha track; can you please tell me the best way to proceed for this evening and tomorrow?
 
Test at PMPS and maybe +3 tonight.....hopefully he won't decide to make it exciting

Use 1 at AMPS and about +2 and if the +2 is about the same or higher than the AMPS, you can run to WalMart

That's 4 of the 6....as long as he doesn't decide to go diving tonight, you should be OK
 
Update: today jojo stayed pretty steady, and has come down this evening. Here is a recap:

AMPS-256 (gave 1u lantus at 7:00am)
+2 202
+4 222
PMPS- 220 (gave 1u lantus at 7:00pm)
+4.5 156

Should I be concerned about what will happen overnight or is this looking pretty good? What is the ideal range that he should be in at the low point after the shot? I feel like I am getting conflicting information. Advise appreciated, thank you!
 
That's a nice gentle drop

I think you'll be fine tonight.

It takes 5-7 days before you're going to see how well the 1U dose is really going to do, but so far, he's having a good response.

Normal blood glucose levels are 50-120 on a human meter, 68- about 150 on the AlphaTrak
 
Alicia & JoJo said:
After all the research I’ve done on this disease, I was most definitely in disagreement with my vet over the whole unit increase, then whole unit decrease a week later.
Click to expand...

WELCOME to the forum! Best advice you'll find anywhere! :D:D

Your comment about your disagreement with your vet is very, very common - some people feel odd disagreeing with the 'expert aka the vet' with years of training - however - unless they've studied feline endocrinology or have their own diabetic cats on insulin they cannot possibly know as much as the veterans here in this group. Many here have been doing this for well over a decade and you can benefit from all that expertise for no charge! It's a wonderful life saving group of people who are giving/volunteering their time to help you and your kitteh ... try to look at all the stickies, figure out your protocol and hang on for the ride.:bighug::bighug::bighug:
 
Good morning! Here’s a quick update, JoJo’s BG was at 117 this morning :) I opted to skip the AM dose because I will not be able to test mid cycle today. Will re-test this evening and see where we are at. This morning’s numbers are considered within normal range, yes? Am I doing right by skipping the AM dose? Tried to get the vet on the phone but was promised another call back.....arg!
 
Yes, that is fine that you skipped this morning. Because you skipped, you can shoot at his regular time tonight or, if you wanted to change his shot time, you can do so with his PM shot after you get a test. His SS is not updated with today’s info but I would suggest you get a test as soon as you get home so you see where he’s headed.

Yes, 117 is a normal number but my cat was that and below the majority of her 5-1/2 years as a diabetic. There is a process and first the kitty needs to become regulated and then well regulated.

Could you please start a new condo (thread) each day? All the questions, etc for that day go in one condo. Our forum guidelines can be found in Making the Most of your Lantus/Balsagar/Levemir ISG Experience.

Chris & China said:
If he's below 200, stall, don't feed and post for help. Make sure your subject line says something like "STALLING, NEED HELP!" so you'll get someone's attention ASAP. Plan on testing again in 20-30 minutes.
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Just as a reminder to new members who might be reading, the actual “no shoot” PS number in this forum for cats following the TR protocol is 50; however for new members with little to no data, the “stall, don’t feed, and ask for help” number is 150, not 200. Generally, i don’t like to copy and paste guidlinesbut I will this time so you can see it in writing :)

From Tight Regulation Shooting and Handling Low Numbers:

New members without much data collected, but are following the TR Protocol in the Lantus, Basaglar, and Levemir Insulin Support Group should ask for guidance when presented with a preshot number less than 150 mg/dL. Once you've collected data to support your decisions, the TR "no shoot" number is 50 mg/dL.
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For members following SLGS, there is a “no shoot” PS of 150 or below. Above 150, stall, don’t feed, and ask for help.
 
Hello, I will start a new thread tomorrow but will stay on this thread for today since I already initiated conversation here today. I have updated my spreadsheet with todays numbers and also added some of the older info that I was able to get from the vet (he had to be boarded a few days due to a work obligation that took me away). As you can see, he has consistently come down in his numbers, tested at 117 this morning (skipped dose), retested 4 hours later; 144, then tested an hour prior to shot time and is at 158. He has dropped so consistently and drastically over the past few days that I am so worried about him dropping to a dangerously low number. Help please?
 
I do, however, I just got off the phone with my vet and they are instructing to not give the insulin this evening, retest in the AM and call with his number prior to shooting. The thing that I am most confused by is that according to them (my vet office) his numbers within the past two days have been in or close to "normal" range for a feline. But here, we are wanting to get him closer to the 50-80 range? Those numbers just terrify me! but I am a newbie to all of this and still learning....just seems confusing.
 
Vets usually like their clients to run higher than we'd like because they're more concerned about hypo's than they are about getting cats into remission.

If you're home testing and have all the supplies you need, there's no reason to fear the lower numbers. YOU are in control of the blood glucose numbers!!

It's people that don't test that run into problems with hypos
 
Just a reminder that Alicia is at present using the AlphaTrak meter, not a human meter. Most of us have the human meter as our frame of reference.
And just a comment that JoJo has not been on Lantus long enough to get a clear picture of how, or what, he is doing.
The range for a "normal" (non-diabetic) cat is, as I recall, between 50 and 120 on a human meter. Our goal is to keep our diabetic kitties (on insulin) in "normal" numbers as much as possible, because this allows the pancreas to heal. The trick is to arrive at a dose that we can shoot safely without having continuously to skip shots, and the best way to do this is to follow the protocols (as set forth in the "Stickies").
Feline diabetes is complex, and every cat is different.
Hang in there, Alicia! It's a steep learning curve, but it works.
 
Alicia & JoJo said:
But here, we are wanting to get him closer to the 50-80 range? Those numbers just terrify me!
Click to expand...
Since you are using the AlphaTrak, kitty earns a reduction below 68 if you are following Tight Regulation, so you don't want him below that. If you find yourself skipping a lot, it may be better to reduce the dose a bit so you can shoot the same dose twice a day.
 
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