? New member. Need help with dosing. Low numbers

[Heather & Hwy 99]

edit: changed thread title as suggested

AM reading was 61, 1 hour later after feeding was 107 and am withholding insulin until more experienced/knowledgeable recommendations
I'm still so overwhelmed and trying to process/read all the "if this, then that" and I do have karo syrup on hand, I am feeding his some of his ff pate and kibble and plan to retest in about 30 minutes is that right? Do I give him his insulin or wait?? He has been on Lantus every 12 hours for only 2 full days (spreadsheet is updated)
He doesn't "appear to have any hypo symptoms

He did have a low number (50) mid day yesterday as well but I was out of strips and amazon was late (they delivered last night thankfully)

also please note that due to his continued weight loss, and other cat in house who is used to free feeding I do have w/d kibble out always,-I am not sure how much food affects numbers as it is one of the many things I am trying to understand but just thought this might be a factor...

 

[Judy and Freckles]

Can you repost this thread over in the Lantus forum? Put a question mark ? in your title and it will draw more eyes. Have you tested him again recently?

 

[Heather & Hwy 99]

Can you repost this thread over in the Lantus forum? Put a question mark ? in your title and it will draw more eyes. Have you tested him again recently?

I am so overwhelmed by everything, including this forum-how do I find that thread? I JUST did right now, after eating and 1 hour after the initial 61, it is 107 and I am not giving insulin until I can figure this out...thank you for your response!

 

[Nan & Amber (GA)]

Yes, please don't give insulin right now. That 61 on an AT2 requires a dose reduction as well.

If there's no history of ketones/DKA, I would skip this dose entirely and regroup. So glad you are testing and caught that!

 

[Heather & Hwy 99]

Yes, please don't give insulin right now. That 61 on an AT2 requires a dose reduction as well.

If there's no history of ketones/DKA, I would skip this dose entirely and regroup. So glad you are testing and caught that!

I dont know what what that is is, DKA? So I am not sure about history...-I am really truly so overwhelmed by the amount of things I am trying to figure out to take care of my baby, while also struggling with impaired cognitive function due to my own health issues/medication...I just updated 1 hour later his bg is 107, Im still holding off insulin until/unless some more knowledgable/experienced people suggest otherwise! thank you

 

[Nan & Amber (GA)]

If you don't know what DKA is, rest assured Hwy 99 didn't have it! I ask because it's a very serious condition for diabetic kitties, and one of the triggers is not enough insulin. So, for a cat that has a history of DKA, we want to be careful about skipping shots.

Luckily, that is not the case here! Even though he's come up a little bit, I think I'd still skip today. We generally don't like new people to shoot numbers that low. It might be possible later once you have gathered a lot of data, but for right now, I would not recommend shooting any number below 200.

By the way, I don't see a shot for last night on your spreadsheet. Did you shoot, and if so, how many units? That 51 definitely requires a reduction in dose.

 

[Judy and Freckles]

Hi Heather,

Yes, there is a LOT of information to learn in a short amount of time, but there are a lot of people on this forum who can help you out. You aren't expected to learn everything all at once, and take heart in knowing that all of us were beginners at one point.

DKA (Diabetic ketoacidosis) is a condition that some diabetic kitties get and if they have DKA it's very important for them to have insulin and food. If Hwy doesn't have DKA then that is good. Nan is an experienced member and she recommended to skip the morning shot and reduce the amount of insulin for the PM shot.

 

[Heather & Hwy 99]

If you don't know what DKA is, rest assured Hwy 99 didn't have it! I ask because it's a very serious condition for diabetic kitties, and one of the triggers is not enough insulin. So, for a cat that has a history of DKA, we want to be careful about skipping shots.

Luckily, that is not the case here! Even though he's come up a little bit, I think I'd still skip today. We generally don't like new people to shoot numbers that low. It might be possible later once you have gathered a lot of data, but for right now, I would not recommend shooting any number below 200.

By the way, I don't see a shot for last night on your spreadsheet. Did you shoot, and if so, how many units? That 51 definitely requires a reduction in dose.

yes, 2 (i just updated, thanks for pointing out!) I switched from vetsulin once a day, to lantus twice a day at the recommendations on here but my vet hasnt responded to my email questions about what numbers I should/shouldnt shoot so thank you!

 

[Red & Rover (GA)]

From: http://www.felinediabetes.com/FDMB/...-low-go-slow-slgs-tight-regulation-tr.210110/

Until you collect enough data to know how your cat will react, we suggest following the guidelines in the FDMB's FAQ Q4.4:
Q4.4. My cat's pre-shot level was way below the usual value. Should I give the injection?
A4.4. There's no hard and fast rule, but if you don't have data on how your cat responds to insulin, here are some general guidelines.​

• • Below 150 mg/dl (8.3 mmol/L), don't give insulin.
  • Between 150 and 200 (8.3-11.1 mmol/L), you have three options:
    • a.) give nothing
    • b.) give a token dose (10-25% of the usual dose)
    • c.) feed as usual, test in a couple of hours, and make a decision based on that value
• Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise.
• In all cases, if you are reducing or eliminating insulin, it's wise to check for ketones in the urine.
• Above the normal pre-shot value, give the usual dose, but if the pre-shot value is consistently elevated, it's a good idea to schedule a full glucose curve to see whether a change in dose or insulin is appropriate. In most cases, the target "peak" value should not be below 100 mg/dl (5.6 mmol/L), and for some cats it might be higher.

 

[jt and trouble (GA)]

Hey Heather? Its ok. and its going to be ok. All the tricks of message boards can really overwhelm a person. I remember when I was just a newbie with a computer much less trying to figure out diabetes and a message board. NO WORRIES we will help you anyway we can ok? I remember in the early days how I paced the floor in front of this computer WAITING waiting for a reply. I thought I'd lose my mind. But answers always came. I was just too impatient.
its going to be ok.

jeanne

 

[Judy and Freckles]

When you get close to your pm shot time (like +10 or +11) ask for help as to what you should shoot. Be sure to have your spreadsheet up to date with any tests that you take today.

 

[Red & Rover (GA)]

FYI:

The dry Hills w/d is over 40% carbs. I checked with 2 different carb calculators. The goal is to keep carbs under 10%.

How much w/d does he eat? That is what could be driving his numbers up and why you are seeing low greens (I'm wondering if he did not snack on the w/d overnight).

Do not give insulin, remove the w/d, and get a couple of tests in today to see what his numbers are like. You might see some very high numbers. That would be his body's natural reaction to the low greens. It takes a bit of time for a cat's body to get used to lower numbers.

It would also be good to start getting a few tests in during the nighttime cycle. How low did he actually go last night? A test 2 hours after the PM shot would help you see which way the wind is blowing. You don't have to stay up half the night or set an alarm if the numbers are good, but if you get up to use the bathroom, get a test.

It does get easier, I promise.

Give me a minute or two and I'll find the slang dictionary for you.

 

[Red & Rover (GA)]

Confused about our jargon? Don't let it scare you off! You'll catch on in no time.
Until then, here's some help:

• The Official Lantus, Basaglar, & Levemir ISG Slang Dictionary - Created by lynn and bear (ga) with a little help from her friends, circa 2008; updated & edited numerous times over the years by members of the Lantus & Levemir ISG
• FDMB Glossary - common abbreviations & definitions used throughout the Feline Diabetes Message Board

 

[Dusty & Roe]

yes, 2 (i just updated, thanks for pointing out!) I switched from vetsulin once a day, to lantus twice a day at the recommendations on here but my vet hasnt responded to my email questions about what numbers I should/shouldnt shoot so thank you!

Heather you are doing a good job ! You are on here asking for advice when you are not sure . You are trying your best . Just keep asking questions even if you think you shouldn’t just ask that’s what this forum is for to help you . It’s ok you are learning Heather You Can Do This . It is Overwhelming

 

[Heather & Hwy 99]

From: http://www.felinediabetes.com/FDMB/...-low-go-slow-slgs-tight-regulation-tr.210110/

Until you collect enough data to know how your cat will react, we suggest following the guidelines in the FDMB's FAQ Q4.4:
Q4.4. My cat's pre-shot level was way below the usual value. Should I give the injection?
A4.4. There's no hard and fast rule, but if you don't have data on how your cat responds to insulin, here are some general guidelines.​

• • Below 150 mg/dl (8.3 mmol/L), don't give insulin.
  • Between 150 and 200 (8.3-11.1 mmol/L), you have three options:
    • a.) give nothing
    • b.) give a token dose (10-25% of the usual dose)
    • c.) feed as usual, test in a couple of hours, and make a decision based on that value
• Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise.
• In all cases, if you are reducing or eliminating insulin, it's wise to check for ketones in the urine.
• Above the normal pre-shot value, give the usual dose, but if the pre-shot value is consistently elevated, it's a good idea to schedule a full glucose curve to see whether a change in dose or insulin is appropriate. In most cases, the target "peak" value should not be below 100 mg/dl (5.6 mmol/L), and for some cats it might be higher.

thank you-its embarrassing but I currently have 45 pages bookmarked trying to read and process, my brain is like a colander and I cant retain much of this...Do I have enough data to know how he responds? I just dont get it...and I recently switched insulins so does that factor in?thank you...

 

[Heather & Hwy 99]

FYI:

The dry Hills w/d is over 40% carbs. I checked with 2 different carb calculators. The goal is to keep carbs under 10%.

How much w/d does he eat? That is what could be driving his numbers up and why you are seeing low greens (I'm wondering if he did not snack on the w/d overnight).

Do not give insulin, remove the w/d, and get a couple of tests in today to see what his numbers are like. You might see some very high numbers. That would be his body's natural reaction to the low greens. It takes a bit of time for a cat's body to get used to lower numbers.

It would also be good to start getting a few tests in during the nighttime cycle. How low did he actually go last night? A test 2 hours after the PM shot would help you see which way the wind is blowing. You don't have to stay up half the night or set an alarm if the numbers are good, but if you get up to use the bathroom, get a test.

It does get easier, I promise.

Give me a minute or two and I'll find the slang dictionary for you.

yes, I have been transitioning him to mostly fancy feast pate, but he has IBS and has had the prescription w/d for years, and my other cat is overweight so that has been their primary for years and is one of the many changes I am making! He DID get kibble at 6am and I tested at 9am (I am really trying to understand how all these things affect each other but have severe cognitive challenges) would the w/d cause him to have that low number? does it change anything as far as me holding of on his insulin?

 

[Red & Rover (GA)]

thank you-its embarrassing but I currently have 45 pages bookmarked trying to read and process, my brain is like a colander and I cant retain much of this...Do I have enough data to know how he responds? I just dont get it...and I recently switched insulins so does that factor in?thank you...

We have all been where you are now, and we will help you as much as we can. Feline diabetes is a steep learning curve but soon it will be second nature. As I said earlier, it does get easier. And no, you don't enough data yet. It takes time.

 

[Judy and Freckles]

thank you-its embarrassing but I currently have 45 pages bookmarked trying to read and process, my brain is like a colander

Hahaha... I know this feeling all too well. lol I read, reread, and reread again. I've got pages bookmarked, printed out and highlighted so you are definitely not alone! lol

Do I have enough data to know how he responds?

I would say you don't have enough data yet. You definitely need more pm test numbers as kitties tend to go lower at night. If you can at least get in a test before you go to bed, that will help to know what Hwy is up to.

recently switched insulins so does that factor in?

Yes, changing insulin can be a factor. Lantus is a 'depot' insulin which means it can take about 6 cycles to see what the dose will really do for the cat. Some other kinds of insulin are a kind of 'in and out' meaning you shoot it and the effects of the insulin are done in a few hours. Lantus has a lingering effect and that is why it is longer lasting and usually get flatter (more simiiar) numbers.

 

[Dusty & Roe]

thank you-its embarrassing but I currently have 45 pages bookmarked trying to read and process, my brain is like a colander and I cant retain much of this...Do I have enough data to know how he responds? I just dont get it...and I recently switched insulins so does that factor in?thank you...

Heather you are testing which is not easy in the beginning so that is impressive right there . It also gives the more experienced members a way to see how Hwy s BG numbers are reacting . Do you test him after he eats at night ? For right now I would focus on the major things like no food 2 hours before testing . Then testing and shot time , feeding time , keeping an eye on Hwy s behavior than the same thing 12 hours later . If you try to remember everything you will process so much you can forget . Don’t ever be embarrassed. Remember the most experienced on here had to be a beginner at one time . You just ask whatever you are thinking . It will help and also help your peace of mind

 

[Judy and Freckles]

would the w/d cause him to have that low number?

The higher the carbohydrate levels in the food, the higher the cats glucose numbers tend to go. Dry kibble tends to have higher carbohydrates but there are some wet foods that have high carbs too. Here is another link to the information about carbohydrates in food. I don't know anything about IBD and the kind of food he needs for IBD. Can you edit your signature so it says that Hwy has IBD?

Link to catfood data base:
https://catinfo.org/chart/index.php

 

[Red & Rover (GA)]

He DID get kibble at 6am and I tested at 9am (I am really trying to understand how all these things affect each other but have severe cognitive challenges) would the w/d cause him to have that low number? does it change anything as far as me holding of on his insulin?

Yes to both.

Yes, the w/d would have raised his numbers. It makes me doubly wonder how low he went during the night.

Yes, you should immediately lower his dose to 1.75 units. Maybe even lower than that. Let's see what more experienced members than myself suggest. If you go up to the top of of this thread, in the right hand top corner you will see "Thread Tools." Click on the blue "Edit Title."

This will take you to

Click on the question mark. Then change the test of your thread to "New member. Need help with dosing. Low numbers" so that anyone reading your thread can immediately see what is needed.

I've got a batch of bread on the go and will be offline and in the kitchen for the next while.

 

[Heather & Hwy 99]

Heather you are testing which is not easy in the beginning so that is impressive right there . It also gives the more experienced members a way to see how Hwy s BG numbers are reacting . Do you test him after he eats at night ? For right now I would focus on the major things like no food 2 hours before testing . Then testing and shot time , feeding time , keeping an eye on Hwy s behavior than the same thing 12 hours later . If you try to remember everything you will process so much you can forget . Don’t ever be embarrassed. Remember the most experienced on here had to be a beginner at one time . You just ask whatever you are thinking . It will help and also help your peace of mind

thank you! I havent done much pm testing mostly because of financial limitations and trying to prioritize when to use $1 strips but if you think its important, I will do that! Do you think the small amount of squeeze cheese I am giving him WHILE I am getting his bg is affecting the reading? Its been the only way I can keep him still...

 

[Heather & Hwy 99]

The higher the carbohydrate levels in the food, the higher the cats glucose numbers tend to go. Dry kibble tends to have higher carbohydrates but there are some wet foods that have high carbs too. Here is another link to the information about carbohydrates in food. I don't know anything about IBD and the kind of food he needs for IBD. Can you edit your signature so it says that Hwy has IBD?

Link to catfood data base:
https://catinfo.org/chart/index.php

thank you-it is in my signature but maybe not as clear-Initially he was diagnosed with IBS (less severe than IBD) and the w/d is a high fiber food that is often prescribed for overweight or ravenous (as he always was) pets to help them feel more full, it was also the only food that would control his severe diarrhea and worked for years but with the development of his diabetes he is no longer overweight, and I am trying to get him on only canned food but it is not entirely possible at this point for controlling diarrhea... Oddly w/d is labeled safe for diabetic pets despite high carb factor...he did have w/d kibble at 6am which makes it all the more confusing that he has such low numbers today right?

 

[Judy and Freckles]

WHILE I am getting his bg is affecting the reading? Its been the only way I can keep him still...

It usually takes 15-20 minutes for food to affect bg readings. I use freeze dried chicken treats that I get from the dollar store. I crumble 1 up and put in Freckles' dish while I test her. She loves them and they have no carbs in them.

When I test Freckles, I put the strip in the meter, but not all of the way in. I put a little vaseline on her ear, poke it and then scoop the blood droplet on my fingernail. Then I push the strip all the way in the meter and let the strip 'suck' up the blood droplet. By doing it this way, I'm not trying to hold Freckles' ear the whole time while the meter is doing it's thing. You can also use a plastic credit card to scoop up the blood droplet.

What kind of meter are you using?

 

[Judy and Freckles]

which makes it all the more confusing that he has such low numbers today right?

He may have gone even lower if he hadn't had the dry food. There are some dry food that have low carbs, but I'm not sure if any of the prescription foods are. I've found that the prescription foods are sometimes not that great for diabetic cats. When I first started, the vet wanted me to give Royal Canin dry for diabetics. Well the only thing good about it was it had an ingredient in it that made Freckles want to drink more. The Royal Canin had way too high of carbs and would have kept Freckles in very high numbers had I not switched to lower carb wet. I add water to her meals, so she's getting plenty of water.

 

[Judy and Freckles]

it is in my signature but maybe not as clear

right. Sorry, I missed that.

 

[Judy and Freckles]

I have to go and do some income tax stuff so I will check in later. Ask lots of questions... there are a lot of people on this forum who are very experienced and very willing to give of their experience and time to help others out. That's one thing I've noticed about the people on this forum is how much they want to try and help others.

 

[Heather & Hwy 99]

now I am really a mess! seeing all the thoughts on how his food is affecting his insulin I feel even more confused by his low numbers and reading that low numbers are more concerning than high numbers?? I am getting alot of low numbers it seems-I've been transitioning to mostly the 3% carb fancy feast but if his numbers are so low this often does that mean I am making him worse??

 

[Judy and Freckles]

I've been transitioning to mostly the 3% carb fancy feast but if his numbers are so low this often does that mean I am making him worse??

No, not at all - but you don't want him to go too low which can be life threatening. With some kitties, all that's needed is to transition to low carb food and they need very little, if any, insulin. It just makes things a little bit tricky when you first start giving insulin and switch to low carb food at the same time.

The following is very important to understand. Here is the link if you want to read the complete article. https://catinfo.org/feline-diabetes/

"For diabetic patients, it is very important to decrease their carbohydrate consumption (to less than 7-10% of their daily caloric intake) while keeping in mind that as dietary carbohydrates are lowered so will the insulin needs for nearly all cats. If this fact is not considered – with the insulin lowered accordingly - a dangerous hypoglycemic (low blood sugar) state may occur. This issue is discussed in more detail at catinfo.org – Feline Diabetes – under the ‘STOP sign’ section and should also be discussed with your veterinarian."

Very Critical Points
If you do not read any further on this webpage, please understand the following principles. Your cat’s life literally depends on your understanding of these issues.

Many cats that are in a diabetic state no longer need any insulin when they are finally fed an appropriate low-carbohydrate diet.

Others will always need some insulin but the amount necessary to maintain proper blood glucose levels is nearly always significantly reduced once the patient is on a low carbohydrate diet.

Please re-read the previous two paragraphs carefully.

If you change your diabetic cat’s diet to one with lower carbohydrates, he will, in all probability, IMMEDIATELY (not days or weeks later) require a reduction in his insulin dosage. He may also immediately go into ‘remission’ and not need any insulin at all.

If this warning is ignored, you may very well end up with a cat in a hypoglycemic crisis (dangerously low blood sugar) which can result in death, or brain damage.

If you take only one point away from this page, it needs to be the understanding that if you stop pouring carbs into your cat by switching to a low-carb canned food diet (or even a dry food diet with lower carbs than you have been feeding), you MUST be aware of the probable immediate and significant impact on your cat’s insulin needs.

If I could shout this from the rooftops, I would.

Frequently, I hear of reports of cats that ended up near-death – or actually did die – from insulin overdoses because lay caregivers and veterinarians did not understand this basic concept.

I often hear my colleagues support the change to a low carbohydrate diet but then recommend “re-testing in a week or two” while the caregiver continues to administer the same amount of insulin. This very common lack of recognition of the immediate effects of low carb diets on the blood glucose level of the diabetic patient often results in a dangerous hypoglycemic state.

 

[Nan & Amber (GA)]

No, long term you're making him better! The more time he spends in the normal range (68-mid 100's on an AlphaTrak meter), the more opportunity there is for his pancreas to heal. One of the big advantages to using Lantus is that it's very good at holding safe low numbers like that-- you don't get the huge swings in BG that you do with Vetsulin.

Here's the problem: just below that range is the danger zone, where you risk hypoglycemia. We have to be very very careful there, because a severe hypo can kill. High numbers over a long period of time can cause damage, but low numbers can kill very quickly. That's why, especially in the beginning, we are more cautious about shooting below 200 until we know that doing so is unlikely to result in a hypo.

We are cautious about food changes too because they can reduce insulin needs greatly, as @Judy and Freckles describes above. That's a good thing! It's just, again, we don't want it to happen too quickly or unexpectedly.

You are doing it correctly , monitoring blood glucose during the transition to help keep your boy safe. We just want to be aware of the food changes that are happening. Knowing that the dry is being removed now, we might want to be more aggressive about reducing the dose. So, we're all kind of "thinking out loud" here in this thread, so that when the next shot time comes around, we can give sensible advice.

 

[Red & Rover (GA)]

You might want to think about using a human meter. A lot of us do. The strips are much, much cheaper.
Don't talk to the vet about it. Tell him after the fact. Just say you cannot afford the strip cost of the AlphaTrak.

 

[Red & Rover (GA)]

Also, when you are coming near the end of your current vial of Lantus. Ordering from Canada will save you a fortune.
Many people use Mark's. It is a reputable business. It has a storefront and everything.

• Ordering Lantus, Basaglar, or Levemir from Canadian pharmacies

Also check out our Supply Closet from time to time.
http://www.felinediabetes.com/FDMB/forums/supply-closet-for-sale-or-free.15/

 

[Judy and Freckles]

Just say you cannot afford the strip cost of the AlphaTrak.

I started with Alphatrak because I thought it was 'better' - but what most of the vets don't realize is the cost of the strip is not sustainable. For me in Canada a strip was almost $2.00 ea. The thing that I kept in mind beside cost when choosing a monitor was the blood droplet size that the strip required. I didn't want to HAVE to have a big blood droplet. Here is some info on different monitors and the blood droplet size.

http://main.diabetes.org/dforg/pdfs/2017/2017-cg-blood-glucose-meters.pdf

There are some monitors that you can get free when you purchase the strips. You can look online for coupons once you decide which one you want to use. There is one meter that some members use that have an unlimited amount of strips/month - but you order them online so you always want to be prepared and have extra on hand (which you want to do anyways regardless of the meter you use.)

 

[Heather & Hwy 99]

I DID just post the following in the LANTUS board but it seems like not many people go there...? and since this is a continuation of yesterdays same problem I am hoping this is ok because I need help... I am shooting low again this morning after having skipped yesterday AM shot entirely, and reducing PM shot-this morning he is 72 low again, and I already messed up and out of habit I started feeding him (normally I would use that time to get his shot ready but came here instead) so where I should have apparently stalled and tried again, I fed him and now I dont know (again) whether to give insulin...? Please advise if you can!
He did have a small amount of w/d kibble at 630am, I tested at 9am and fed so does that mean I wont get accurate next reading for 2 more hours?

Also, my life long voraciously hungry cat is hardly interested in food the last two days, I can get him to eat "enough" like 1/4 pate, or 1/8 cup w/d kibble (for his IBS and yes I have been trying to transition off) but I am not sure if this behavior is reflective of anything to do with his insulin-specifically his reduced dose maybe?

6am feed w/d kibble (not ideal but due to my health limitations, I basically roll over and pour their breakfast until I can get up)
9am test (using small amount of squeeze cheese to keep him still)
Feed pate, give insulin (when numbers indicate I should)
1-2 pm attempt test
feed combo wet/dry
9pm test
Feed pate, give insulin
I have attempted many tests thru out day to try to get data/patterns which are reflected in my spreadsheet but its been a challenge

THANK YOU

 

[jt and trouble (GA)]

@Nan & Amber (GA)

Lets see if Nan is around.