Stalling- please help. Djoko's uncontrolled diabetes

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Marj, if you look at Djoko spreadsheet for the 3/10 you will see that Djoko has two blue numbers at +10 and +12 in the am cycle. I think that was him coming off the bounce which he had been on for the previous 5 cycles. Sometimes when they come off the bounce they can drop lower and faster and that is what he has done when you are seeing the blue numbers at +10 and +12.
Once he bounces, there is nothing you can do about it but wait and see when he decides to come off the bounce. His body has to start getting used to lower numbers again. This is very common in newly diagnosed diabetic cats, so he is not doing anything we haven't seen before.

Next time you are unsure whether you should give the insulin or not.....stall, don't feed and test again in 20 minutes.
Post and ask for help. Change your subject line to something like stalling, please help....so that we are alerted that you need help.
The subject line is the line at the top of your thread.

It isn't a good idea to give insulin 4 hours into the cycle because it completely messes up the dosing schedule.
 
Deb & Wink said:
With time, his body will adjust. But you may have to change the insulin, increase or decrease the dose, as you are treating his diabetes.

Lantus is a long duration insulin. It is best given at 12 hour intervals.
And our dosing protocols here indicate that the same dose should be given for at least 6 cycles UNLESS the blood glucose number drops too low. That "too low" would be 3.7 mmol/L (68 mg/dL) on an Alphatrak test meter.

You gave Djoko insulin 4 hours later last night
How late did you give Djoko insulin this morning?
At his regular morning (AM) shot time? or later?

Have you been able to test his blood glucose levels this morning, since his insulin shot?

p.s. Black color ranges on the SS (spreadsheet) does indicate bouncing.
Click to expand...

Djoko was given 0.5U 4 hours later (midnight) as opposed to 1.5U at 8AM.
He was tested the following morning pre-shot at 7H40AM. He was at 30.2. Was it really a bounce or the result of having received 1/3 of his normal insulin dose?
Please explain.
I gave him 1.5 at 8AM this morning.
Why?
 
Bron and Sheba (GA) said:
Marj, if you look at Djoko spreadsheet for the 3/10 you will see that Djoko has two blue numbers at +10 and +12 in the am cycle. I think that was him coming off the bounce which he had been on for the previous 5 cycles. Sometimes when they come off the bounce they can drop lower and faster and that is what he has done when you are seeing the blue numbers at +10 and +12.
Once he bounces, there is nothing you can do about it but wait and see when he decides to come off the bounce. His body has to start getting used to lower numbers again. This is very common in newly diagnosed diabetic cats, so he is not doing anything we haven't seen before.

Next time you are unsure whether you should give the insulin or not.....stall, don't feed and test again in 20 minutes.
Post and ask for help. Change your subject line to something like stalling, please help....so that we are alerted that you need help.
The subject line is the line at the top of your thread.

It isn't a good idea to give insulin 4 hours into the cycle because it completely messes up the dosing schedule.
Click to expand...
So what would have been a good solution? Just give him his normal dose knowing that he will rise up anyway?
 
Bron and Sheba (GA) said:
Marj, if you look at Djoko spreadsheet for the 3/10 you will see that Djoko has two blue numbers at +10 and +12 in the am cycle. I think that was him coming off the bounce which he had been on for the previous 5 cycles. Sometimes when they come off the bounce they can drop lower and faster and that is what he has done when you are seeing the blue numbers at +10 and +12.
Once he bounces, there is nothing you can do about it but wait and see when he decides to come off the bounce. His body has to start getting used to lower numbers again. This is very common in newly diagnosed diabetic cats, so he is not doing anything we haven't seen before.

Next time you are unsure whether you should give the insulin or not.....stall, don't feed and test again in 20 minutes.
Post and ask for help. Change your subject line to something like stalling, please help....so that we are alerted that you need help.
The subject line is the line at the top of your thread.

It isn't a good idea to give insulin 4 hours into the cycle because it completely messes up the dosing schedule.
Click to expand...
Could you please explain what you mean by he has been coming off the bounce form the previous 5 cycles?
 
Deb & Wink said:
With time, his body will adjust. But you may have to change the insulin, increase or decrease the dose, as you are treating his diabetes.

Lantus is a long duration insulin. It is best given at 12 hour intervals.
And our dosing protocols here indicate that the same dose should be given for at least 6 cycles UNLESS the blood glucose number drops too low. That "too low" would be 3.7 mmol/L (68 mg/dL) on an Alphatrak test meter.

You gave Djoko insulin 4 hours later last night
How late did you give Djoko insulin this morning?
At his regular morning (AM) shot time? or later?

Have you been able to test his blood glucose levels this morning, since his insulin shot?

p.s. Black color ranges on the SS (spreadsheet) does indicate bouncing.
Click to expand...
I did not change his dose. I gave him 0.5 because I did not want him to get to high or skip a dose. Next time he is at 9.7 at time of the shot, I test 20 minutes later. But if he is at 10.5, what do I do?
 
Juls and Billy said:
The thing is, diabetes simply isn't that predictable. You will never be able to say, Oh, if he's at this number pre-shot and I give him this much insulin, he's going to drop to this number. That's why BGL testing is so important, and that's why it's so useful to get mid-cycle tests every time you can. For example, if you don't know how low he drops mid-cycle, you don't know when to reduce the dose. If one doesn't know the mid-cycle numbers, an owner might not realize the high pre-shot numbers could be bounce. Then there's a danger that the cat's insulin will be increased when it needs to be decreased.

The reason reaction to insulin isn't predictable is that the pancreas itself isn't predictable. As it begins to heal, it starts making it's own insulin, but it's doesn't heal all at once. One day, It's all "Lets make ALL the insulin!" That insulin added to the insulin in the shot can make the BGL pretty low. The next day, the pancreas can be all "Whoo, I'm tired. I don't think I'll make all the insulin today." Injected insulin gives the pancreas a break so it can heal, but as it starts making it's own, readings can be all over the place and doses might need to change fairly frequently, based on the lowest mid-cycle tests.
Click to expand...
This makes sense. I was planning on doing the BG curve Friday but by giving 0.5 last night 4 hours later as opposed to 1.5U, did I compromise the curve? Should I do it Saturday instead?
 
Deb & Wink said:
The blood glucose levels are also unpredictable because insulin is a hormone. It's not predictable like taking an aspirin to make a headache go away. Hormones can be processed differently each cycle, depending on what else is happening with your cat that day.

Maybe your cat ate a bit more one day, or played more or less another day. Maybe he took a longer nap or ran from window to window to see the birds or squirrels outside where you live. Maybe he saw a strange cat wandering around outside, or a dog and got scared.

You might have a fire alarm go off and need to clear your building, and that could cause your cat to be afraid, which means he is stressed and stress can raise the blood glucose levels as a cat reacts to that stress.

We only have control over a few factors in this diabetes journey. Your cat is "leading this dance" and you have to learn to go along and follow the steps and turns he is taking. Like Ginger Rogers following Fred Astaire dancing.
Click to expand...
Unfotunately for this poor animal, I live at the 13th floor of an appartment building downtown. He has a big window in front of him but birds are not coming here too often...:S
 
Marj said:
Could you please explain what you mean by he has been coming off the bounce form the previous 5 cycles?
Click to expand...
Sometimes when a cat drops into low numbers, or drops fast, or drops into numbers that are lower than he is used to (they could be low yellow or blue numbers, not necessarily green number) his body thinks he has to save himself from the sudden drop in numbers or the 'low' BG. So his body dumps regulatory hormones and stored glucose into his system to 'save himself' from the perceived threat. This sends his BG up high and these regulatory hormones and glucose can stay in his system for up to 6 cycles..
Cats can bounce from 1 cycle up to 6 cycles. Once a cat bounces, there is nothing you can do but wait for the bounce to clear.
When the hormones and glucose start to disappear, the BG starts to return to normal and you will start seeing normal numbers again. This is when the cat is coming off the bounce. Sometimes as they are coming off the bounce they can drop quite quickly and you will see lower numbers and see them dropping quite quickly. There is nothing for you to do but test and see the numbers don't drop too low. If you are aware this can happen, you won't be surprised if the BG numbers at the end of the bounce are sometimes low.

Have a look at his spreadsheet. You didn't test either preshot on 3/7 or during the am cycle so it is very possible he dropped lower at that time as he had a yellow BG @+4 in the pm cycle and then at +7 he shot up to a black BG and had black BGs in the following am cycle which indicates the start of a bounce to me.

Does that make sense?
 
Marj said:
This makes sense. I was planning on doing the BG curve Friday but by giving 0.5 last night 4 hours later as opposed to 1.5U, did I compromise the curve? Should I do it Saturday instead?
Click to expand...
Yes, wait until Saturday to do the curve. That is because the insulin depot or storage area that lantus has, needs to build back up to full. That can take several cycles for that the happen, for the "insulin tank" to be at Full. A curve on Saturday or Sunday will have given that "depot" or storage area time to fill up again.
 
Marj said:
Next time he is at 9.7 at time of the shot, I test 20 minutes later. But if he is at 10.5, what do I do?
Click to expand...
You make a judgement call. Based on how well you know your cat and how he reacts to the insulin.

Your decision depends on several factors. It depends on if that pre-shot test of 10.5 mmol/L was a rising number or a falling number. It depends on if you have enough test data to know how low your cat will go on a dose. It depends on if your cat is eating well or not.

Lantus has an onset for most cats of around +2. Two hours after the insulin shot. Food will raise the blood glucose levels, so the test you get at pre-shot should have risen by the time the insulin onsets or begins to have an effect.

So knowing if the pre-shot test number is rising, and by rising I mean by at least 0.55 to 0.83 mmol/L or more (10 to 15 mg/dL or more), then you know it's likely going to be ok to give the insulin. There are no guarantees. There are always times when a cats blood glucose does the unexpected and drops after the pre-shot test. When that happens, you need to monitor and test more, to see if the BG falls too low.
 
Marj said:
Djoko was given 0.5U 4 hours later (midnight) as opposed to 1.5U at 8AM.
He was tested the following morning pre-shot at 7H40AM. He was at 30.2. Was it really a bounce or the result of having received 1/3 of his normal insulin dose?
Please explain.
I gave him 1.5 at 8AM this morning.
Why?
Click to expand...

Lantus insulin can last between 12 and 16 hours or more in a cat. By giving the dose last night 4 hours late, there was some over lap in the doses, between last night and this morning. The insulin doses were only 8 hours apart. We don't know how much overlap in the doses may have occurred. We don't know how low his BG numbers fell during the rest of the cycle this morning, 3/11. We don't have enough test data yet to judge something like that.

You seem to be looking for exact precision in the BG test numbers and knowing what to do based on those exact numbers. That precision does not exist. There are only general guidelines that you can follow.

You can always post here on Feline Health or in the Lantus ISG for help. When you are not sure what you want to do for a particular pre-shot test number or other number during the testing cycle, then post and put the ? icon prefix on your post.
 
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I am not looking for exact precision but some sort of pattern. My concern would be to perform a BG curve that is based on an unatypical day (without knowing it) and that the dosage be increased based on those results which would ultimately lead to hypo (see Sunday for instance). Each time his dose was increased to 2U, his numbers got very low. But maybe this is how you treat a DB cat?

Maybe I am too scared to shoot low (9.7 for example) and this is the only way to help him.
 
Bron and Sheba (GA) said:
Sometimes when a cat drops into low numbers, or drops fast, or drops into numbers that are lower than he is used to (they could be low yellow or blue numbers, not necessarily green number) his body thinks he has to save himself from the sudden drop in numbers or the 'low' BG. So his body dumps regulatory hormones and stored glucose into his system to 'save himself' from the perceived threat. This sends his BG up high and these regulatory hormones and glucose can stay in his system for up to 6 cycles..
Cats can bounce from 1 cycle up to 6 cycles. Once a cat bounces, there is nothing you can do but wait for the bounce to clear.
When the hormones and glucose start to disappear, the BG starts to return to normal and you will start seeing normal numbers again. This is when the cat is coming off the bounce. Sometimes as they are coming off the bounce they can drop quite quickly and you will see lower numbers and see them dropping quite quickly. There is nothing for you to do but test and see the numbers don't drop too low. If you are aware this can happen, you won't be surprised if the BG numbers at the end of the bounce are sometimes low.

Have a look at his spreadsheet. You didn't test either preshot on 3/7 or during the am cycle so it is very possible he dropped lower at that time as he had a yellow BG @+4 in the pm cycle and then at +7 he shot up to a black BG and had black BGs in the following am cycle which indicates the start of a bounce to me.

Does that make sense?
Click to expand...
Yes given that we have no idea what happened on March 7. Who knows! he may have dropped "low" for his standards. Good news is that he enjoys fancy feast!
 
Deb & Wink said:
You make a judgement call. Based on how well you know your cat and how he reacts to the insulin.

Your decision depends on several factors. It depends on if that pre-shot test of 10.5 mmol/L was a rising number or a falling number. It depends on if you have enough test data to know how low your cat will go on a dose. It depends on if your cat is eating well or not.

Lantus has an onset for most cats of around +2. Two hours after the insulin shot. Food will raise the blood glucose levels, so the test you get at pre-shot should have risen by the time the insulin onsets or begins to have an effect.

So knowing if the pre-shot test number is rising, and by rising I mean by at least 0.55 to 0.83 mmol/L or more (10 to 15 mg/dL or more), then you know it's likely going to be ok to give the insulin. There are no guarantees. There are always times when a cats blood glucose does the unexpected and drops after the pre-shot test. When that happens, you need to monitor and test more, to see if the BG falls too low.
Click to expand...
I agree. If you understand the pattern, you know that he may be on the rise, which means it would be ok to shoot at 10.5. My plan is to do a BG curve longer than 12 hours to try to understand the overlap. I read the information on Lantus and what would be a typical curve on this website. What do you think of performing a longer BG curve? Would it help to gather data?Thank you.
 
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Marj said:
My plan is to do a BG curve longer than 12 hours to try to understand the overlap. I read the information on Lantus and what would be a typical curve on this website. What do you think of performing a longer BG curve? Would it help to gather data?
Click to expand...
Some people do test longer when they are completing testing for a curve. There are 2 main options used here.

Option 1 is to test every 2 hours, from 1 pre-shot test to the next pre-shot test.
So that would be AMPS, +2, +4, +6, +8, +10, +12 (which is also your PMPS pre-shot test).

Option 2 is to test every 3 hours, from 1 pre-shot test to the next pre-shot test and several hours beyond that for a full 18 hours of testing.
So that would be AMPS, +3, +6, +9, +12 (which is also your PMPS pre-shot test), +3, +6.

There is also the option to complete a testing curve during the PMPS cycle. The choice is yours.

Many people that are using either the SLGS (Start Low, Go Slow) or the TR (Tight Regulation) protocols, obtain enough tests, with varying the test times they take, that a curve is not necessary.

Marj said:
My concern would be to perform a BG curve that is based on an unatypical day (without knowing it) and that the dosage be increased based on those results which would ultimately lead to hypo (see Sunday for instance).
Click to expand...
Yes, there is always that possibility.

For one thing, we do not increase or decrease the insulin doses by full units. We only make insulin dose changes in 0.25U increments. We also have specific criteria for increasing or decreasing the dose, according to the protocols we use here. Protocols that were developed from helping hundreds of cats, and written with the years of experience of many different members here.
 
Hello,
It is 15 minutes to shot time and he is at 13.5. He was stressed out while I was testing him so it may also have increased his BGL.
Is it OK to give him his 1.5U or too low? He started the day at 28.7.
Thank you for your advice.
Marjorie
 
13.5 is 243....that's high enough to go ahead and shoot the 1.5

Get a +2 to see how he's doing.

Please update your spreadsheet ASAP

I see what you did....you got the date as 3/5/20
 
13.5 x 18 = 243 mg/dL
Are you able to monitor tonight?
Do you have test strips?
Could you test him at +2?
And then again before you go to sleep?

That 13.5 mmol/L B level is normally plenty high enough to give insulin.
As long as you can monitor tonight.
I will not be able to stay up with you tonight, to guide you.
Let me find someone else to help you.
 
Yes. I will otherwise I won't be able to sleep. He is normally above 20 when I shoot him, even high 20s and sometimes 33 so this is all new territory.
I hurt him when I gave him the shot so I am scared it went into the muslce and hit him faster. Is it possible? Maybe my angle was too steep.
When should I test him? +2 and then?
 
Deb & Wink said:
13.5 x 18 = 243 mg/dL
Are you able to monitor tonight?
Do you have test strips?
Could you test him at +2?
And then again before you go to sleep?

That 13.5 mmol/L B level is normally plenty high enough to give insulin.
As long as you can monitor tonight.
I will not be able to stay up with you tonight, to guide you.
Let me find someone else to help you.
Click to expand...

I have test strips.
 
Oh no. This was not the good time to do a shot improperly.
I just khow that it was not as smooth as it could be.
For food high in carbs, I bought temptations. Is that enough? There is a drugstore downstairs, I believe they sell Friskies, would that be better?
 
You can always add a bit of honey, maple syrup, corn syrup or another simple sugar to his regular wet food if needed. To increase/bring up the carb percentage on the food.

Yes, the Temptations usually have enough carbs in them. But, since they are dry food, they can take longer to break down in the stomach and digest and get glucose into the bloodstream.

What needle length do those syringes have?
If you tent the skin before injecting, it's difficult to inject the insulin into the muscle.
 
Deb & Wink said:
You can always add a bit of honey, maple syrup, corn syrup or another simple sugar to his regular wet food if needed. To increase/bring up the carb percentage on the food.

Yes, the Temptations usually have enough carbs in them. But, since they are dry food, they can take longer to break down in the stomach and digest and get glucose into the bloodstream.

What needle length do those syringes have?
If you tent the skin before injecting, it's difficult to inject the insulin into the muscle.
Click to expand...
I make a tent but I think the angle was too steep. I am worried now.
 
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Chris & China (GA) said:
Those are longer and "thicker" than we usually recommend. Just wondering....Do they have half unit marks or do they just have whole unit marks?

Where do you live?
Click to expand...
I live in Ottawa, Canada. They do have half unit. I am not a fan of these needles. I bought them at the vet. Would the drugstore sell needles of the same lenght?
 
@Wendy&Neko lives in Canada....there are a bunch more but right now my brain's hitting a blank.

But yes, you can get syringes at any pharmacy with diabetes supplies. Wendy is usually on a little later in the evening but hopefully she'll see the tag
 
I used the BD Ultrafine II (yellow and purple box), available at most human pharmacies. You can also buy a version with 6mm needles. It's personal preference which you use. I liked the 8mm with my long haired girl.
BD_320440.JPG
 
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