Newly diagnosed - AMPS 320, +5 = 180

[Jennifer & Linus]

Hi - I'm a cat mom to a newly diagnosed cat and I was lucky to be working from home this morning - and just tested my newly diagnosed cat a blood sugar of 180, 5 hours after his breakfast. Unfortunately, I have to leave for work now - but gave my cat a snack, hoping his BG doesn't dip too much lower...I gave him a small scoop of raw food to tie him over until I come back home this evening.

This is all very new and very confusing - since I will not be home for another 6 hours, I am hoping my cat will be ok. Was it ok for me to give him a snack? I normally don't....he's on Lantus 2 units, twice a day -although I did give him 2.5 units this morning, per his vet's instructions.

Let me know your thoughts - my newly started spreadsheet is below.

Thank you!

 

[Wendy&Neko]

Hello and welcome. A snack was perfectly fine to give. Many of us invest in automated feeders, such as the Petsafe 5, so that snacks can be available at times of the day when we are gone. Food is what helps keep our kitties safe.

Is today your first day of testing? Your spreadsheet is a different document type than I am used to, but only shows today’s numbers. If you have any data from earlier, that would be helpful to enter. Most blood meters keep a couple weeks history.

What was the reason for the dose increase today? Typically we increase by 0.25 units at once. Cats react to very small changes in dose.

 

[Jennifer & Linus]

Hello and welcome. A snack was perfectly fine to give. Many of us invest in automated feeders, such as the Petsafe 5, so that snacks can be available at times of the day when we are gone. Food is what helps keep our kitties safe.

Is today your first day of testing? Your spreadsheet is a different document type than I am used to, but only shows today’s numbers. If you have any data from earlier, that would be helpful to enter. Most blood meters keep a couple weeks history.

What was the reason for the dose increase today? Typically we increase by 0.25 units at once. Cats react to very small changes in dose.

Hi! Yes, today was my first day of testing - I tried blood testing a little bit yesterday but didn't record all of the numbers accurately.

I came home from work and did my darndest to get a pre-meal evening BG but couldn't get enough blood for a test...after struggling for a few minutes, I gave up - and gave Linus his dinner. Do I give him the usual 2 unit dose of insulin and try testing again 2 hours later? Thoughts?

 

[Jennifer & Linus]

Hello and welcome. A snack was perfectly fine to give. Many of us invest in automated feeders, such as the Petsafe 5, so that snacks can be available at times of the day when we are gone. Food is what helps keep our kitties safe.

Is today your first day of testing? Your spreadsheet is a different document type than I am used to, but only shows today’s numbers. If you have any data from earlier, that would be helpful to enter. Most blood meters keep a couple weeks history.

What was the reason for the dose increase today? Typically we increase by 0.25 units at once. Cats react to very small changes in dose.

And just to answer your last question - I thought his AMPS BG test was a little high so I gave him the 2.5 unit dose of Lantus this morning - as my vet directed. But I kind of regret it now because I read a little more about how Lantus works...so I think I'm back down to 2 units tonight....

 

[Wendy&Neko]

On this forum, we determine how to dose the cat based on how low the dose takes the cat. That is typically somewhere in the middle of the cycle. We don't make decisions based on a single preshot. We find that giving consistent doses is better, given that Lantus is a depot insulin. Unless he goes low, I would stick with 2.0 units for a few days and gather data so you know what to do next. Has he been on 2.0 units since you first started giving insulin?

Here are some Testing and Shooting Tips that might help you. We strongly recommend getting a test before you shoot, so you know it's safe to shoot.

 

[Jennifer & Linus]

On this forum, we determine how to dose the cat based on how low the dose takes the cat. That is typically somewhere in the middle of the cycle. We don't make decisions based on a single preshot. We find that giving consistent doses is better, given that Lantus is a depot insulin. Unless he goes low, I would stick with 2.0 units for a few days and gather data so you know what to do next. Has he been on 2.0 units since you first started giving insulin?

Here are some Testing and Shooting Tips that might help you. We strongly recommend getting a test before you shoot, so you know it's safe to shoot.

yes, he has been on 2 units, twice a day generally consistently. I just tested him 2+ after his dinner and shot (2 units) - and his bg was 116. Is this worrisome?

 

[Bron and Sheba (GA)]

yes, he has been on 2 units, twice a day generally consistently. I just tested him 2+ after his dinner and shot (2 units) - and his bg was 116. Is this worrisome?

116 is quite low for +2, but still a safe number. I would get another test at +3 to see if Linus is still dropping. If he is lower than the 116 at +3 I would give him a tablespoon of his normal food and post the result.

Did you get a Preshot BSL test before giving the evening insulin dose? It is really important to always get a Preshot test to see if it is safe to give the insulin.
@Jennifer & Linus

 

[Jennifer & Linus]

116 is quite low for +2, but still a safe number. I would get another test at +3 to see if Linus is still dropping. If he is lower than the 116 at +3 I would give him a tablespoon of his normal food and post the result.

Did you get a Preshot BSL test before giving the evening insulin dose? It is really important to always get a Preshot test to see if it is safe to give the insulin.
@Jennifer & Linus

Hi - I tried to get a pre shot BG but after struggling for several minutes (sweating profusely - me, not my cat!) I had to give up. I'm still new to all of this - I wasn't sure what his BG was before his dinner - but I was able to get one afterwards, when his stomach is full and he's more relaxed.

I got a AMPS this morning - and his BG measured at 351. I just gave him his breakfast, gave him 2 units - then will take a BG +2....should I go down in dose, do you think? I'm wondering if 2 units might be too high for my sweet kitty...

 

[Mandy & Rex (GA)]

Hi and welcome! I think 2u is fine for now.

I am wondering if we can get you to download our spreadsheet. It's hard to read your version and the cells aren't being automatically painted according to the numbers you input.

What kind of trouble are you having when you try to get the PS numbers and it doesn't work? Is it not bleeding enough? Have you tried to warm up the ear first before poking?

 

[Jennifer & Linus]

Hi and welcome! I think 2u is fine for now.

I am wondering if we can get you to download our spreadsheet. It's hard to read your version and the cells aren't being automatically painted according to the numbers you input.

What kind of trouble are you having when you try to get the PS numbers and it doesn't work? Is it not bleeding enough? Have you tried to warm up the ear first before poking?

My cat is really wriggly before meals because he wants his food NOW.... and my inexperience and nervousness about poking his ear don't really help I am trying the rice in a sock and it worked well for me this morning, so I have it on hand as well now.

I thought I downloaded the right spreadsheet, what am I doing wrong? I will investigate it further....

 

[Mandy & Rex (GA)]

I thought I downloaded the right spreadsheet, what am I doing wrong?

I don't know how you downloaded yours. You can look at any of our spreadsheets and see how it fills up the full screen and all the cells are colored if there are numbers typed in. Click on your link and compare.

 

[Crista & Ming]

Hi Jennifer Hopefully someone with more experience drops by but typically, you want to hold the dose for at least 6 cycles for Lantus to take full effect. Check out the different methods of dosing in the stickies and you’ll have a better idea of how increases and decreases are earned. Of course, every cat is different and depending on the situation, they might get increases and decreases faster or slower.

As well, you want to get as many tests as you can in the beginning. You want to catch Linus’ nadir or lowest BG reading in a cycle so we know how well the dose is working. That usually happens around +6 to +10. But again, some cats nadir early, some later. So that’s why testing more frequently in different points of the cycle in the beginning is important. You need to gather as much data as possible.

 

[Jennifer & Linus]

Hi Jennifer Hopefully someone with more experience drops by but typically, you want to hold the dose for at least 6 cycles for Lantus to take full effect. Check out the different methods of dosing in the stickies and you’ll have a better idea of how increases and decreases are earned. Of course, every cat is different and depending on the situation, they might get increases and decreases faster or slower.

As well, you want to get as many tests as you can in the beginning. You want to catch Linus’ nadir or lowest BG reading in a cycle so we know how well the dose is working. That usually happens around +6 to +10. But again, some cats nadir early, some later. So that’s why testing more frequently in different points of the cycle in the beginning is important. You need to gather as much data as possible.

Thank you for your response! I just tested his BG +6 after breakfast and he was still pretty high...351...so confusing!! He was 180 yesterday, at +5 after breakfast....the numbers seem all over the place. I will try to test again, either at +7 or +8....

 

[Bron and Sheba (GA)]

He could be bouncing. He was 116 at +2 last cycle so probably dropped lower during that cycle which could be why he might thrybe bouncing. You need to get some tests mid cycle to see how low the insulin is taking him. We don’t change the dose based on the Preshot but on the nadir which is the lowest point in the cycle. So even though you are seeing Higher numbers at the moment it could be because he is bouncing.

 

[Jennifer & Linus]

He could be bouncing. He was 116 at +2 last cycle so probably dropped lower during that cycle which could be why he might thrybe bouncing. You need to get some tests mid cycle to see how low the insulin is taking him. We don’t change the dose based on the Preshot but on the nadir which is the lowest point in the cycle. So even though you are seeing Higher numbers at the moment it could be because he is bouncing.

So at +9 hours - he's at 280. If he's undergoing an insulin "bounce" - what to do? Skip a dose or consider a reduced dose of Lantus?

 

[Bron and Sheba (GA)]

So at +9 hours - he's at 280. If he's undergoing an insulin "bounce" - what to do? Skip a dose or consider a reduced dose of Lantus?

You don't do anything. You just have to wait til Linus comes off the bounce which could take up to 6 cycles.
Bouncing happens when
1. kitty drops too low.
2. Kitty drops too fast.
3. Kitty drops lower than he has been used to,because he has been in higher than normal numbers for some time ...even though he is in safe numbers his body thinks he is too low. When any of these happen, many kitty release hormones and glucose into their system to "save themselves" and this is called bouncing. You just have to patiently wait for it to stop and the BSLcome back to what they normally are for that kitty.

What you need to do it to get tests during the cycles to see how low the insulin is taking Linus. If you get a +2 which is lower than the preshot or much the same, it is important to get a test around +5 for example. If you get a test of 116 like last night you need to get another test at +4 or +5 to check he is not dropping too low.
Keep asking questions. It is a steep learning curve in the beginning.

 

[Jennifer & Linus]

You don't do anything. You just have to wait til Linus comes off the bounce which could take up to 6 cycles.
Bouncing happens when
1. kitty drops too low.
2. Kitty drops too fast.
3. Kitty drops lower than he has been used to,because he has been in higher than normal numbers for some time ...even though he is in safe numbers his body thinks he is too low. When any of these happen, many kitty release hormones and glucose into their system to "save themselves" and this is called bouncing. You just have to patiently wait for it to stop and the BSLcome back to what they normally are for that kitty.

What you need to do it to get tests during the cycles to see how low the insulin is taking Linus. If you get a +2 which is lower than the preshot or much the same, it is important to get a test around +5 for example. If you get a test of 116 like last night you need to get another test at +4 or +5 to check he is not dropping too low.
Keep asking questions. It is a steep learning curve in the beginning.

OK - thank you. This is all so complicated so I will keep on going.... between me trying to learn how to take BG - and failing sometimes - and trying to get as many readings as possible, this is quite challenging. My cat also had a dental cleaning on Oct 24 - from "moderately severe gingivitis" (he had five extractions) so I'm wondering if that may have elevated his BG when the vet took his blood test right before the dental cleaning, and diagnosed him with diabetes.

I just have this weird feeling that 2 units of Lantus, twice a day - is too much for my cat but I'll keep on going and measuring his BG as closely as I can....thanks again for all your advice.

 

[Bron and Sheba (GA)]

OK - thank you. This is all so complicated so I will keep on going.... between me trying to learn how to take BG - and failing sometimes - and trying to get as many readings as possible, this is quite challenging. My cat also had a dental cleaning on Oct 24 - from "moderately severe gingivitis" (he had five extractions) so I'm wondering if that may have elevated his BG when the vet took his blood test right before the dental cleaning, and diagnosed him with diabetes.

I just have this weird feeling that 2 units of Lantus, twice a day - is too much for my cat but I'll keep on going and measuring his BG as closely as I can....thanks again for all your advice.

The best way to find if it is too much insulin is to test during the cycles to see how low the insulin is taking Linus.
If you find that the BSL drops too low, post and ask for help. Do you have some higher carb food and honey or Karo to use if the numbers drop too low?
Have you read this link on how to deal with low numbers and hypos. Print this off and put on your Frig.
http://www.felinediabetes.com/FDMB/threads/how-to-treat-hypos-they-can-kill-print-this-out.15887/
It is stressful in the beginning but you are doing really well. Linus is lucky to have you

 

[Jennifer & Linus]

I'm working from home today but for the rest of this week, I'll be away from my cat for 9-10 hours a day which worries me...

I'm wondering if I should lower the dose to 1 unit / twice a day - following the SLGS protocol, starting over. Is there harm in lowering the dose so I can get a better 'baseline' for my cat's diabetes? At 2 units / twice a day - he seems to be all over the place...low yesterday, and now high today...everyone so far has told me "don't change the dose" but thought I'd ask again in case I get a different answer! I won't be able to be home monitoring him at 2 units / twice a day until Saturday.

and thank you for telling me Linus is lucky to have me, I really appreciate it!!

The best way to find if it is too much insulin is to test during the cycles to see how low the insulin is taking Linus.
If you find that the BSL drops too low, post and ask for help. Do you have some higher carb food and honey or Karo to use if the numbers drop too low?
Have you read this link on how to deal with low numbers and hypos. Print this off and put on your Frig.
http://www.felinediabetes.com/FDMB/threads/how-to-treat-hypos-they-can-kill-print-this-out.15887/
It is stressful in the beginning but you are doing really well. Linus is lucky to have you

 

[Bron and Sheba (GA)]

Have you decided what you are following. The SLGS or the TR protocol?

 

[Jennifer & Linus]

Have you decided what you are following. The SLGS or the TR protocol?

Shoot - I am really worried now.

I was following the protocol my vet prescribed - about a week before my cat's dental cleaning - he was having trouble eating and not eating his usual raw food (that has no carbs). I relented and started to give him Wellness canned chicken food, which he had an easier time eating, so I thought - once his dental cleaning is done - I will switch him back to raw food when he has less teeth pain.

His urine levels were getting larger and he was drinking more water, once he was eating Wellness but it wasn't too alarming to me.

The vet took his blood test before the dental cleaning and noticed his high blood glucose, and diagnosed my cat with diabetes. From reading the posts on this board - cats can have higher levels of blood glucose with moderate-to-severe gingivitis, and the Wellness canned chicken food may have also contributed to his high glucose level (measured by the vet at 368). The vet immediately prescribed my cat 2.5 units of Lantus, twice a day. When I asked my vet about the dose - he said it was based on my cat's weight, not his blood glucose level. He also advised me not to do home glucose testing, which I promptly ignored.

Once my cat came home from his dental cleaning - I switched him to raw food only, his usual diet. So with no carbs in his diet - I worried about giving my cat 2.5 units of Lantus, twice a day - so I started with two units, twice a day. Once I received my BG meter two days ago - his levels have been really all over the place, and I wonder if my cat really has diabetes? Is there a way I can start over, safely - to measure his BG while he's on a raw food diet, without the icky gingivitis in his teeth? I am wondering if the insulin depot and the bouncing is caused by the insulin I am giving him - when he might not even need insulin at all?

Poor kitty....

 

[Bron and Sheba (GA)]

If you work during the day and can’t test, you might be better going with the SLGS protocol.
It would be a good idea to buy a bottle of ketostix from the chemist to test for ketones. They are not expensive and you test the urine so not hard.
I am going to tag a couple of more experienced people to see what they think of your idea of starting over with a lower dose and the SLGS protocol if you are worried about leaving Linus during the day
@Wendy&Neko @Chris & China

 

[Jennifer & Linus]

If you work during the day and can’t test, you might be better going with the SLGS protocol.
It would be a good idea to buy a bottle of ketostix from the chemist to test for ketones. They are not expensive and you test the urine so not hard.
I am going to tag a couple of more experienced people to see what they think of your idea of starting over with a lower dose and the SLGS protocol if you are worried about leaving Linus during the day
@Wendy&Neko @Chris & China

thank you Bron & Sheba, I really appreciate your help here. This is all so confusing....

 

[Chris & China (GA)]

Have you read the sticky on "Is TR possible with a full time job--Yes!" ?

Even if you don't do TR and choose SLGS, there are some good ideas there for keeping Linus safe.

Is there any chance you could shoot earlier so you could get a +2 before you have to leave for work? The +2 can act almost like a crystal ball to let you know what might happen later in the cycle.

How much does Linus weigh?

 

[Jennifer & Linus]

Two weeks before Linus' dental - when he was on raw food only - he weight 11.5 pounds. Two weeks later, after going on Wellness canned food - he was down to 10.5 pounds. He had been peeing a lot too in the past two weeks before his dental. I was shocked in the period of two weeks, he lost a pound. I thought it was because he had trouble eating with his infected teeth but now I'm wondering if the rapid weight loss had to do with the canned food and the introduction of carbs to his diet...

Is there a danger if I lower his insulin dose?

 

[Chris & China (GA)]

I'm wondering if the rapid weight loss had to do with the canned food and the introduction of carbs to his diet...

Adding carbs wouldn't cause a weight loss....reducing calories would though. You might want to check how many calories are in the canned food versus the raw but I doubt if that's the problem. Diabetic's can eat a huge amount of food and still lose weight because without insulin, the food (which breaks down into glucose) can't get into the cells. Think of insulin like it's a key....and on every cell in the body there's a lock. Without the right number of keys, no matter how much glucose is in the bloodstream, the cells can't get it and they starve.

There's a standard starting formula for using Lantus with Tight Regulation....it's weight in kgs x .25...so a 10.5lb cat would be started at 1U

What dose was he started on? If less than 2U, how were doses increased? In whole or half unit increments?

 

[Jennifer & Linus]

Adding carbs wouldn't cause a weight loss....reducing calories would though. You might want to check how many calories are in the canned food versus the raw but I doubt if that's the problem. Diabetic's can eat a huge amount of food and still lose weight because without insulin, the food (which breaks down into glucose) can't get into the cells. Think of insulin like it's a key....and on every cell in the body there's a lock. Without the right number of keys, no matter how much glucose is in the bloodstream, the cells can't get it and they starve.

There's a standard starting formula for using Lantus with Tight Regulation....it's weight in kgs x .25...so a 10.5lb cat would be started at 1U

What dose was he started on? If less than 2U, how were doses increased? In whole or half unit increments?

Aren't newly diabetic cats usually ravenous but lose weight? That's how I felt Linus was, when he was switched to the canned food with carbs... my vet wanted me to give him 2.5 units of Lantus twice a day but I felt in my bones that was too high since I was going to switch him to raw food (which I did immediately after his dental extractions / dental cleaning). So I started him at 2 units of Lantus, twice a day...haven't really moved from 2 units except for one morning he was kinda high in his BG AMPS so I went to 2.5 units for that one time but a lot of FDMB users told me to not move him up dosing-wise (which was super insightful) so I've kept him at 2 units.

His BG is high but not incredibly high right now so I didn't give him his insulin after dinner because I didn't want him to dip low like he did last night...i will do my darnest to get his AMPS tomorrow morning (he's super wriggly in the morning bc he is hungry and wants food)... I have to leave for work early so unfortunately, I will not be able to get a +2 tomorrow AM.

 

[Chris & China (GA)]

Aren't newly diabetic cats usually ravenous but lose weight?

Yes, but that's because no matter how much they eat, without insulin, they're basically starving to death.

ALL food, including protein, eventually breaks down into glucose. Glucose is "food for the cells" ….but without insulin, that glucose stays in the bloodstream (which is why they have high blood glucose numbers)

In an attempt to "dilute" the glucose from the bloodstream, they drink copious amounts of water....which leads to copious amounts of urine. (doesn't have anything to do with food but just explaining more about diabetes....why they drink so much water and pee so much)

I have to leave for work early so unfortunately, I will not be able to get a +2 tomorrow AM.

I don't know your schedule, but could you get up earlier so you could get a +2 before you have to leave for work? ….and still get home by +12?

I think you'd be totally OK to reduce him down to 1U and start gathering data ….As long as he's never had any problems with ketones or DKA

 

[Chris & China (GA)]

@Jennifer & Linus

How's Linus doing? Haven't heard from you in awhile and we worry!