New Member, our First Curve and Dosing Advice Needed

Status
Not open for further replies.
Diane Engoron

Diane Engoron

Member Since 2020
Hi everyone - my name is Diane. I live in Upstate NY. My 15 1/2 year old girl, Wenchie, was diagnosed a month ago with diabetes. It has been a roller coaster. I will post what I posted today on the Facebook site as I'm still very unfamiliar with how this site works and where I need to post questions, etc. I hope this is the place to post this as we need some dosing advice for tonight.

"Doing a curve today. Wenchie is on 1/2 unit of Lantus twice a day (depending on her test numbers).

First test number was 353 - which has crept up over time despite complete change of diet. Fed her, gave her insulin. Fasted her for two hours, next reading was 232.

Fed her, then fasted her for two hours and her reading was 35!!!!! No obvious change in behavior. She ate once again (a pate snack mixed with some Young Again Zero Mature) and we did a small amount of Karo Syrup on her gums. She seems fine, no obvious signs of hypoglycemia.

We tested the Alphatrak 2 and it was fine.

She is now fasting again for two hours for her next reading.

My question is WHY? Why so low all of a sudden? We are keeping a close eye on her of course and she is acting her “new normal”."

Follow-up:
" I have rechecked twice. The first recheck her number was so low it didn’t register. Karo Syrup and Beef with Gravy. She didn’t want to eat and seemed disoriented. More Karo both on her gums as well as my husband giving her a bit in a syringe. Second recheck was still too low to register. More Karo and Beef with gravy - she began eating with her usual gusto, climbed up on her fave wicker chest - recheck and 145.

I’ll be damned if I can figure out what the heck is going on. She is back to her “old diabetic” self but will be rechecked in another 15 mins. I’m sure she feels like a pin cushion by now."

So, my question is - if her number is high tonight (which it probably will be), should I even shoot her? She was on a half unit and my husband and I were thinking a 1/4 unit but I'm VERY nervous about doing even that much.

Any help will be so appreciated.

Diane
 
Hello Diane and welcome! I'm not the most experienced member, but I can help until you get more replies. With that low a low, I would absolutely be wary of giving insulin, even if her number climbs. And it will likely be higher, from bounce from the very low BGL. There are things you can do though. Often, when the nadir reading is so low, the dose gets adjusted down. For example, you might try .25 of a unit twice a day for a few days. Make sure you are able to get some mid-cycle tests, not even a full curve, maybe a +2 and a +4 hours after injection. Of course, if her BGL is too low at injection time, skip the dose altogether.

It sounds like Wenchie is getting ready to make her own insulin, and may be headed for remission. She still may need small doses of insulin to let her pancreas continue to heal. People often change to a .25 dose, or even down to just a drop dose during this time. Sometimes we get lucky, and a diet change to low carb is all a cat needs.

Fasting time before injection is important, but I don't think you have to do it before every test on a curve day. Maybe some other members can clarify this for us.

For members to give you the best advice, it would really help if you got Wenchie a spreadsheet set up, and put some information in your signature. There's great information on how to do that here: New? How you can help us help you!

I would also mention that if you skip doses, that is a time you should test for ketones. Many members here use inexpensive Ketostix you can but at a pharmacy, and test urine.

You did great today dealing with that low. Take some deep breaths, get yourself some of the good chocolate, and keep taking such good care of Wenchie!
 
Thank you so much. It’s been difficult but we’re determined to get her stabilized. I never imagined how difficult a disease this was! But we will all keep on keeping on!

I will be doing a spreadsheet within the next couple of days. All this is so new to me and a bit confusing until I learn my way around.

Thank you for your kind response and very needed help!
 
We all get overwhelmed at first. Remind yourself that you are a rock star for taking such good care of Wenchie. There's tons of good information here on the board. I especially recommend the sticky posts at the top of the Feline Health and FAQs section. The more you know, the better you will be. And click on Billy's spreadsheet in my signature to see an example of a kitty who went into remission fairly quickly. He was so sick at first, he wasn't even eating. Now, thanks to the good information and folks here at FDMB, he is in remission and doing awesomely. Of course, not all kitties reach remission, but all diabetic cats can have a long healthy life with proper treatment.
 
Remember that no two curves will be the same, sometimes it depends on which way the wind blows. They are important; my first sugar cat had textbook curves, the second looked like your kids took a pack of crayons to the wall. Whatever the case knowing what goes on in those 12 hours is so important.
 
Wenchie was our first kitten adoption (we usually adopt older animals) but I saw her on Petfinder 15 years ago and fell in love. Of my 5, she is the absolute best cat of all - easy going, never an ounce of trouble. She is the diva!

Thank you for the links - I just updated my profile page and will look at Billy's spreadsheet next! I so appreciate your help and your words of encouragement. I'm usually the type of person who can handle anything but this has really thrown us!
 
Thank you so much! When she was diagnosed, I was so relieved it wasn't cancer, not realizing how awful this disease is and how hard it could be to get her stabilized. We're not giving up - we love our girl!!!
 
Wenchie's spreadsheet link in your signature won't open for me. Chris may not have created the SS for you yet.

For now, you can directly enter the blood glucose test results in your post. Like this.
2/17/2020
AMPS 353 0.5U lantus
+2 232
+ 4 35

Fed high carb food and syrup.

Syrup wears off quickly. Please do not wait another 2 hours to test. Please test again ASAP.

That 35 BG reading you got for Wenchie is an automatic dose reduction. No matter how high the BG's have been in the past.

"Feed the 40's"

"Yell for help with the 911 prefix icon on your post, if your cat falls into the 30's and you need help to bring up the BG levels." BG readings in the 30's are nothing to fool around with. Put the low BG number in your title post, the word HELP and that 911 prefix will have people come to help. Just like if you called the police, fire, ambulance in your town.



Lantus insulin has a "depot" of stored insulin underneath the skin. That "depot" or storage area can take several 12 hour dosing cycles to drain.

Juls and Billy said:
Fasting time before injection is important, but I don't think you have to do it before every test on a curve day. Maybe some other members can clarify this for us.
Click to expand...
No, fasting before every test on a curve day is not needed.
 
Deb & Wink said:
Wenchie's spreadsheet link in your signature won't open for me. Chris may not have created the SS for you yet.

For now, you can directly enter the blood glucose test results in your post. Like this.
2/17/2020
AMPS 353 0.5U lantus
+2 232
+ 4 35

Fed high carb food and syrup.

Syrup wears off quickly. Please do not wait another 2 hours to test. Please test again ASAP.

That 35 BG reading you got for Wenchie is an automatic dose reduction. No matter how high the BG's have been in the past.

"Feed the 40's"

"Yell for help with the 911 prefix icon on your post, if your cat falls into the 30's and you need help to bring up the BG levels." BG readings in the 30's are nothing to fool around with. Put the low BG number in your title post, the word HELP and that 911 prefix will have people come to help. Just like if you called the police, fire, ambulance in your town.



Lantus insulin has a "depot" of stored insulin underneath the skin. That "depot" or storage area can take several 12 hour dosing cycles to drain.

No, fasting before every test on a curve day is not needed.
Click to expand...


Thanks, Deb! Weird, the spreadsheet link works for me. Not sure what I'm doing wrong or you hit it at a time when I was working on it? I made several mistakes while doing it so who knows! Can you give it another try and let me know?

Tested Wenchie at 4:00 and she was at 87. We usually shoot her at 6:30/6:30 so she's fasting before her next test, at 6pm. I'm leaning towards not shooting her tonight.

What......a......day.....
 
Deb & Wink said:
It wants me to try signing on to your google account.
That means the link was not set up correctly.

Reviewing the setup steps may help you to resolve the issue.
I think the "Share the Link" step was where you went wrong.
Steps are here for you.FDMB Spreadsheet Instructions
Click to expand...

Just deleted the first one and started from scratch - could you give it a go? I honestly don't remember seeing a "Share the Link" step!

Thank you so, so much!
 
5. Click on "File" again, scroll down the list and click on "Publish to the web":



6. In the box that opens, be sure that "link" is underscored. If not, click on "link" to underscore it. Next, be sure the box below states "Entire Document". Then click "publish".



7. Google will ask if you are sure you want to "Publish this selection". Click "ok". A link will be provided; before you copy this link, scroll down and click on "published content and settings". Be sure the box next to "Automatically republish when changes are made" is checked.



8. Copy the link and close the text box.

9. Follow the instructions below to paste the Spreadsheet link into your FDMB Signature block.
 
Deb & Wink said:
We are replying at exactly the same time. So repeating what I said to you. SS is fine.
Now please enter the BG tests from today.

Do you understand the + hour system we use?
Click to expand...

LOL!!! OK - I'm on it! I found the page explaining the +hour system So I test at 6am, she eats, then shoot at 6:30 am, then retest at 6pm, eats, then shoot at 6:30 pm so that's 11 1/2 hours after the shot - how do I indicate that?
 
+ hours are counted from the time you dose the insulin.

Not from the time you did the pre-test.

Pre-test still goes in the AMPS or PMPS column.
Notes in the Remarks column for anything special going on.
 
Deb & Wink said:
Understanding the Spreadsheet/Grid What the columns on the SS mean.
For future reference or for other people "lurking" before they sign up and start posting in Feline Health (Welcome & Main ) forum.

How long have you been home testing? Anything more than this mornings BG cycle tests to share with us?
Click to expand...

I have been home testing since February 1st and will share those numbers either tomorrow or day after. I'm exhausted and on edge, getting ready to retest her at her regular 6pm time. She seems fine, she fasted from 4pm (as usual before her shot) so fingers and paws crossed it's good. I will be entering those numbers as soon as I'm done!
 
Your choice on dosing tonight or not.

That LO and 35 reading on the Alphatrak meter is an automatic dose reduction, by at least 0.25U.

SS says 0.75U given this AM, 2/17/2020.
Options if the BG is not high enough at PMPS for you to feel comfortable about dosing the insulin.
Stall. Wait 20 minutes without feeding, retest. Rinse and repeat until you get a rising BG. With Lantus, you do not want to stall for more than about 1 hour. Next dosing cycle needs to be adjusted back in small 15 minute increments. Maximum adjustment of 30 minutes per 24 hour period.
Skip. No dose of insulin. Lantus insulin "Depot" will drain a bit.
Reduced dose. Like 0.1U of insulin. To get some insulin into Wenchie.
Are you able to monitor this evening?

Please check for ketones if skipping or giving a reduced dose of insulin.

Very little data with only the curve numbers today to base a dosing decision on.
Are you using SLGS (Start Low, Go Slow) dosing protocol or TR (Tight Regulation) with the Lantus insulin you are using?

Sticky: Dosing Methods: Start Low, Go Slow (SLGS) & Tight Regulation (TR)
 
Quick question - Wenchie's pre-dinner number is 81 - should I test again before bed or leave her be? She is happily eating her dinner right now!
 
I think I'd skip since you got that 81 at PMPS tonight.
With SLGS, you don't want to give insulin if the BG is <90 mg/dL.

Yes, I'd retest Wenchie later tonight. To see how far up Wenchie's BG levels "bounce."
 
Deb & Wink said:
Your choice on dosing tonight or not.

That LO and 35 reading on the Alphatrak meter is an automatic dose reduction, by at least 0.25U.

SS says 0.75U given this AM, 2/17/2020.
Options if the BG is not high enough at PMPS for you to feel comfortable about dosing the insulin.
Stall. Wait 20 minutes without feeding, retest. Rinse and repeat until you get a rising BG. With Lantus, you do not want to stall for more than about 1 hour. Next dosing cycle needs to be adjusted back in small 15 minute increments. Maximum adjustment of 30 minutes per 24 hour period.
Skip. No dose of insulin. Lantus insulin "Depot" will drain a bit.
Reduced dose. Like 0.1U of insulin. To get some insulin into Wenchie.
Are you able to monitor this evening?

Please check for ketones if skipping or giving a reduced dose of insulin.

Very little data with only the curve numbers today to base a dosing decision on.
Are you using SLGS (Start Low, Go Slow) dosing protocol or TR (Tight Regulation) with the Lantus insulin you are using?

Sticky: Dosing Methods: Start Low, Go Slow (SLGS) & Tight Regulation (TR)
Click to expand...

First, I have no idea how to test for Ketones - I don't even know what they are. At 81 I don't want to give her any Lantus. No idea which method I'm using as my veterinarian is not much help in this matter. She tells me if she's 100 or over, give her insulin. That's well within the normal range so I don't think she is well versed on Feline Diabetes!
 
Deb & Wink said:
I think I'd skip since you got that 81 at PMPS tonight.
With SLGS, you don't want to give insulin if the BG is <90 mg/dL.

Yes, I'd retest Wenchie later tonight. To see how far up Wenchie's BG levels "bounce."
Click to expand...

Excellent. I will retest her before bedtime (around 8:00-8:30). I'm an early bird!

Thank you so, so much, Deb!!! You have no idea how much I appreciate all your help. I hope I can eventually pay it forward!
 
Diane Engoron said:
So I test at 6am, she eats, then shoot at 6:30 am, then retest at 6pm, eats, then shoot at 6:30 pm so that's 11 1/2 hours after the shot - how do I indicate that?
Click to expand...

Actually if you test at 6am, you can feed to make sure she'll eat and shoot immediately. With Lantus, you usually have 2-3 hours before the shot you're giving will start to "kick in".

I'd Test/Feed/Shoot all in about 5 minutes. As long as I saw China was willing to eat, I'd shoot.

That way, if you T/F/S at 6am and you get a test at 8am, that's 2 hours since the shot so the number goes in the +2 cell....if you test again at 11am, that's 5 hours, so goes in the +5 cell....all the way up to +11 and then it's time for the PM cycle!
 
Oh boy! We can help you learn more about treating Feline Diabetes. Sometimes, I do think we know a lot more than many vets do. Not about everything. But certainly a lot about feline diabetes.

Skip the dose for sure tonight.
Then some homework for you.
Read that link I gave you on the Lantus Dosing protocols, back in post #25.
Print a hard copy if you can.

Ketones are byproducts of fat breakdown and if too little insulin, too little food, infection or inflammation, can be life threatening. To people as well as cats.

Buy some ketone test strips at your local pharmacy or drug store and test the urine. Link here explaining more of what ketones are and how to test the urine.
Ketones/Diabetic Ketoacidosis (DKA): Ketones, Diabetic Ketoacidosis (DKA), and Blood Ketone Meters

That is your second piece of homework.

p.s. Early to bed myself. You won't find me here much after 8 pm EST.
 
Diane Engoron said:
Thank you so, so much, Deb!!! You have no idea how much I appreciate all your help. I hope I can eventually pay it forward!
Click to expand...
Encourage all those folks over in the facebook sister site to get their FDMB user id, signature and SS setup and learn to navigate around the FDMB before a low numbers crisis. That is one way you can "pay it forward."

You probably don't realize how quickly that LO could have led to seizures and coma.

Do you have a printed copy of the Hypo Instructions? To look for symptoms. I kept a printed copy in my hypo tool kit.
Agitation or restlessness like you described is a classic hypoglycemia symptom.
Good thing you had some higher carb food and syrup ready.
 
Deb & Wink said:
Oh boy! We can help you learn more about treating Feline Diabetes. Sometimes, I do think we know a lot more than many vets do. Not about everything. But certainly a lot about feline diabetes.

Skip the dose for sure tonight.
Then some homework for you.
Read that link I gave you on the Lantus Dosing protocols, back in post #25.
Print a hard copy if you can.

Ketones are byproducts of fat breakdown and if too little insulin, too little food, infection or inflammation, can be life threatening. To people as well as cats.

Buy some ketone test strips at your local pharmacy or drug store and test the urine. Link here explaining more of what ketones are and how to test the urine.
Ketones/Diabetic Ketoacidosis (DKA): Ketones, Diabetic Ketoacidosis (DKA), and Blood Ketone Meters

That is your second piece of homework.

p.s. Early to bed myself. You won't find me here much after 8 pm EST.
Click to expand...

I promise to read both links completely tomorrow as well as getting some ketone test strips. I'm too exhausted to read anything more tonight! I feel like I've gone back to college!! LOL!

I cannot thank you enough for all your help. Our Wenchie is our favorite (don't tell my other 4) but we are realistic that she is 15 1/2. We want her to have quality time in the time she has left. Per her bloodwork, THIS is the only thing wrong with her - her kidneys are great, everything else is great so we're hoping once we get this under control, we'll have many more years of quality time with her.
 
Diane Engoron said:
My husband feels bad for Wenchie and doesn't want to test her again. I told him would you rather find her gone overnight? So, we're testing before bedtime!
Click to expand...
Good for you on insisting on more tests this PM!

There is still the insulin "depot" to account for, so that will still be releasing some insulin you gave Wenchie for several more cycles. Including this PM cycle, even without giving more lantus insulin.

Tell him that please.
 
Deb & Wink said:
Encourage all those folks over in the facebook sister site to get their FDMB user id, signature and SS setup and learn to navigate around the FDMB before a low numbers crisis. That is one way you can "pay it forward."

You probably don't realize how quickly that LO could have led to seizures and coma.

Do you have a printed copy of the Hypo Instructions? To look for symptoms. I kept a printed copy in my hypo tool kit.
Agitation or restlessness like you described is a classic hypoglycemia symptom.
Good thing you had some higher carb food and syrup ready.
Click to expand...

I know! And I absolutely will post my whole story tomorrow and how important it is to get on FDMB. It wasn't that I was lazy, I was so damn busy (I have a very demanding disabled cat - he doesn't walk so he requires a lot of hands on care) I couldn't focus on this site.
 
Deb & Wink said:
Good for you on insisting on more tests this PM!

There is still the insulin "depot" to account for, so that will still be releasing some insulin you gave Wenchie for several more cycles. Including this PM cycle, even without giving more lantus insulin.

Tell him that please.
Click to expand...

I am telling him that right now!!!!
 
Diane Engoron said:
My husband feels bad for Wenchie and doesn't want to test her again. I told him would you rather find her gone overnight? So, we're testing before bedtime!
Click to expand...
I swear it's easier on the kitties than it is on us. Tell your husband I would have lost my sweet Billy on day five, if I had been following his vet's instructions and not tested. Those mid-cycle tests are what keep your baby safe, and what help you know when to reduce dose. A little neosporin on the ear after each test can help it heal. And putting pressure on the ear right after test can help keep it from getting bruised.
 
Juls and Billy said:
I swear it's easier on the kitties than it is on us. Tell your husband I would have lost my sweet Billy on day five, if I had been following his vet's instructions and not tested. Those mid-cycle tests are what keep your baby safe, and what help you know when to reduce dose. A little neosporin on the ear after each test can help it heal. And putting pressure on the ear right after test can help keep it from getting bruised.
Click to expand...

It sure is! We just did one more test before I go to bed (I'm an early bird) and she was at 262 but I'm not giving her any insulin after what happened today. Hopefully tomorrow morning she'll still be at or around this level and she will get a 1/4 dose. Also sending all my notes to the vet tonight.

What a day - I'm glad it's over, I'm glad Wenchie is happily eating and purring and still with us. Hard lesson learned!

Night night, everyone - thank you so, so much for being here for my girl.
 
Noah & me (GA) said:
It's not necessarily awful. There are things to watch for but other than HYPO's cat's don't die solely of diabetes. It's all the related medical conditions that may come with it. Wenchie is in good hands and may yet live a long life. Think positive and be vigilant, we will always be here to help you.
Click to expand...

Thank you for your kind words! She’s eating like a champ today, affectionate, and pooping like a horse - all good! Yesterday was draining but so thankful I found this group!
 
Hi Diane, when you skip a shot, Please put 0 in the units column.

What other BG tests are you able to get today?

Laughed to read how Wenchie is doing today. Was able to picture exactly how the poop looked.
You are doing great. Keep posting, here and over in the facebook group if you prefer. Try to keep us "in the loop" so to speak. Not all of us are members of the sister facebook group.

p.s. Lots of beautiful country in Upstate NY.
 
Deb & Wink said:
Hi Diane, when you skip a shot, Please put 0 in the units column.

What other BG tests are you able to get today?

Laughed to read how Wenchie is doing today. Was able to picture exactly how the poop looked.
You are doing great. Keep posting, here and over in the facebook group if you prefer. Try to keep us "in the loop" so to speak. Not all of us are members of the sister facebook group.

p.s. Lots of beautiful country in Upstate NY.
Click to expand...

This morning, her BG was 390 - high but expected from what I've read. She looks good today - purring, very affectionate. After yesterday, I was terrified to wake up this morning but my husband got up in the middle of the night twice to check on her and she was fine, sleeping on his wicker chest (new favorite spot). I'm absolutely relieved!

Upstate NY - meh.... If this gives you any perspective, we lived in San Diego for 10 years and I desperately want to go back. If I never see snow again, I will be a happy woman! But, all kidding aside, there really is some pretty country up here. We have a nice neighborhood, great neighbors, life is easy here. But I miss SoCal.

I've made that change to the SS. I will absolutely keep everyone in the loop here and on FB, but here especially!
 
Noah & me (GA) said:
But like a pony, not a Clydesdale right? That would qualify as one of those "awful things" you spoke of. Like the 28 pound cat we had, litter box was replaced by an enormous Tupperware with a door cut into it. The things we do for our cats!
Click to expand...

LOL! I ride and muck stalls so, no, not quite like a Clydesdale but like a stinky pony for sure!!!!

28 pound cat!!! Wow - I love big cats - big cats, big dogs, big horses. But that Tupperware litter box is hilarious! Yup, the things we do for our cats. I pretty much would do anything to keep them happy and healthy. Thankfully my husband feels the same way.
 
He was bigger than big. A big orange head, unpredictable behavior, intimidating, lost the popular vote, blames his problems on everyone else.
Wait, I was thinking of another mammal. When his arthritis got bad we moved his litter box on to a shelf I built two steps down the basement stairs. Unfortunately the other eight cats found that very convenient, easier to clean with a snow shovel.
It's always a dead giveaway spotting first time cat owners scratching their heads and eventually picking litter rakes the size of spatulas and a box big enough for a ferret. And that "one more box than the number of cats" rule sometimes doesn't apply.
 
Noah & me (GA) said:
He was bigger than big. A big orange head, unpredictable behavior, intimidating, lost the popular vote, blames his problems on everyone else.
Wait, I was thinking of another mammal. When his arthritis got bad we moved his litter box on to a shelf I built two steps down the basement stairs. Unfortunately the other eight cats found that very convenient, easier to clean with a snow shovel.
It's always a dead giveaway spotting first time cat owners scratching their heads and eventually picking litter rakes the size of spatulas and a box big enough for a ferret. And that "one more box than the number of cats" rule sometimes doesn't apply.
Click to expand...

A big orange boy - usually they are sweethearts but there's one in every crowd!

Yeah, we have had cats forever now and I know what you mean about newbie cat owners. It's a lot of trial and error!
 
You caught what Chris? Not contagious is it, like hope for a better future?
nixon01.JPG
Fool me once shame on you....
 

Attachments

  • nixon01.JPG
    nixon01.JPG
    10.5 KB · Views: 292
Last edited:
Status
Not open for further replies.
Back
Top