109 glucose right before night feed, no insulin?

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picklesmom

picklesmom

Member Since 2020
Pickles was diagnosed about a month and a half ago and we’ve been doing 3 units vetsulin 2x a day. I don’t take his glucose frequently bc the vet said it wasn’t necessary since his numbers were so high (500s) but today I did right before his dinner and it was 109. I’m assuming I shouldn’t give him insulin tonight. I’m going to test tomorrow before breakfast again. If it’s under 200 again to I skip insulin again? I completely switched his food from typical dry to low carb when he was diagnosed. Is it possible he’s going into remission?
 
Don't have an answer for you about remission since you're not testing regularly, sorry. There's no way to tell if you're not testing daily.
I disagree with your vet, numbers can be inflated at the vet, and as you can see they fluctuate. Glad you got a test in this time, please skip tonight.
He may have earned a reduction as well but I can't tell without data. Would you consider testing daily for us to help you with Pickles? 3 units is a very high dose for a new diabetic.
 
Its a good thing you are testing. I dont know what it is with vets and home testing smh

I cannot give dosing advice but this post will put your thread to the top of the page.
 
Panic said:
Don't have an answer for you about remission since you're not testing regularly, sorry. There's no way to tell if you're not testing daily.
I disagree with your vet, numbers can be inflated at the vet, and as you can see they fluctuate. Glad you got a test in this time, please skip tonight.
He may have earned a reduction as well but I can't tell without data. Would you consider testing daily for us to help you with Pickles? 3 units is a very high dose for a new diabetic.
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Thanks for the reply. Yes I will try to test more frequently. I couldn’t get him to stay for the ear so my husband and I do his paw (he holds and I do the rest) so it’s dependent on him being home and he works shift. I’m sure I can get at least one test in a day but 2 might not be possible.
 
Do try to get him used to working with his ears, I'm sure the paw pad is difficult for one person. Food as a reward goes a long way to get them to do what you want. :) It takes a bit of time for kitty to get used to having their ears messed with and also waiting for the capillaries to form to make poking easier, but it will help you to prevent hypos and ER visits AND help you to see when Pickles needs a reduction. Very few cats need to stay on the same dose for longer than a week. I worry about the high dose he's on.

As for tomorrow, if he is under 200 yes, continue to skip until you're able to test regularly. He'll probably be high tomorrow because you're skipping though. Shooting lower numbers means you're prepared to monitor and intervene if numbers dip lower than they should. Since you're not able to test on your own right now, it'd be risky to shoot low.
 
Panic said:
Do try to get him used to working with his ears, I'm sure the paw pad is difficult for one person. Food as a reward goes a long way to get them to do what you want. :) It takes a bit of time for kitty to get used to having their ears messed with and also waiting for the capillaries to form to make poking easier, but it will help you to prevent hypos and ER visits AND help you to see when Pickles needs a reduction. Very few cats need to stay on the same dose for longer than a week. I worry about the high dose he's on.

As for tomorrow, if he is under 200 yes, continue to skip until you're able to test regularly. He'll probably be high tomorrow because you're skipping though. Shooting lower numbers means you're prepared to monitor and intervene if numbers dip lower than they should. Since you're not able to test on your own right now, it'd be risky to shoot low.
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Thank you! Yes I will try eat again. It sounds like 3 units is high... what should I do tomorrow based on whatever number I get? Let’s say I get 300.. is 2 units ok? 400, 3 units??
 
Here's something I wrote up for others for testing...maybe it'll help you too!

It can be really helpful to establish a routine with testing. Pick one spot that you want your "testing spot" to be (I like the kitchen counter because it's got good light and it's at a good height....it also already blocked 2 escape routes due to the wall and the backsplash) It can be anywhere though...a rug on the floor, a table, a particular spot on the couch...wherever is good for you.

Take him there as many times a day as you can and just give his ears a quick rub and then he gets a yummy (low carb) treat. Most cats aren't objecting so much with the poking..it's the fooling with their ears they don't like, but once they're desensitized to it and learn to associate a certain place with the treats, they usually start to come when they're called! Or even when they hear us opening the test kit!

You also have to remember...you're not poking him to hurt him...you're testing him to keep him safe and understand what's going on inside his body. There's just nothing better than truly understanding what's going on inside your kitty's body and with this disease, the more knowledge you have, the more power you have against it. The edges of the ears have very few pain receptors, so it really doesn't hurt them. Also, if you're nervous and tense, it's going to make your kitty nervous and tense too. As silly as it might seem, try singing! It forces you to use a different part of your brain!

It's also important to make sure his ear is warm. A small sock filled with a little rice and microwaved or a small pill bottle filled with warm water (check temp against your wrist like you would a baby bottle) works well

For new kitties, using a heavier gauge lancet is also really helpful. A 25-28 gauge lancet pokes a bigger "hole" than a 31-33 gauge lancet does, so look for "Alternate Site testing" lancets that are usually a lower number

Finding the right "treat" will be a great help too! Freeze dried chicken, bonito flakes, little pieces of baked chicken...whatever low carb treat you can find that he really enjoys will help him to associate the testing with the treat! China's Achilles heel was baked chicken, so I'd bake a piece, chop it into bite sized pieces, put some in the refrigerator and freeze the rest to use as needed. It didn't take long for her to come any time I picked up the meter!

There are more testing tips here:

http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/
 
Dosage is based on how low insulin takes blood sugar, not by how high. A pre-shot test is (generally) going to be the highest number in the cycle, because the insulin has worn off by then.

Here's a hypothetical for you:

Let's say you gave 3 units of insulin and that brought kitty down to 40. 40 is very very low, lower than we want a kitty to be. The body is not used to this number, and bounces - bouncing is a phenomenon in which the body thinks the blood sugar is too low, and in an attempt to protect itself, dumps excess glucose in the bloodstream, increasing the blood sugar sky high. When we check blood sugar later, we see that the 40 has gone up to 500! Well that's a high reading, maybe we should give more insulin? Answer: No, we need less insulin, because that dose of 3u brought kitty way lower than they needed to be.

Sometimes (a lot of times) a cat is experiencing bouncing numbers and the vet checks the blood sugar, sees that high number, and goes "oh we need more insulin, let's up the dose" when in reality they're making judgments with very little data, and making things worse by increasing insulin. I'm really not sure why veterinarians aren't fully aware of how blood sugar works, they often make remission more difficult (ie unachievable) this way.

So in answer to your question - I almost think Pickles needs an reduction from that 109 this evening. But I'm also suggesting that based on almost no data, so it's a little hard to recommend anything. No matter how high he is, never increase the dose unless you have proof that the insulin is not bringing him low enough - and you'll only find out that number usually between 3 and 7 hours after injecting, what with how Vetsulin works. Definitely no more than 3u though, no matter what the number is tomorrow morning OR evening. @Chris & China (GA) thoughts on this?

Do you need help getting your spreadsheet and signature set up? That will allow you to keep track of Pickles' tests and allow us to see all the numbers you've ever gotten from him, rather than having to remember and tell us each time. :)

Spreadsheet Instructions
Signature Instructions
 
I don't have anything to add that hasn't already been said. But like the others, I want to encourage to get comfortable with using his ear for regular home-testing on your own. He will get used to it. I used the rice in the sock trick as suggested above to help warm up Franklin's ear sometimes. He gets tested on the kitchen floor in the same spot so he knows when I put him there, it's time for a test. He handles it just fine because he knows food is coming afterward. The diagram of where to poke him on his ear that is on that resources page posted by @Chris & China (GA) was very helpful for me.

Also, please set up the spreadsheet suggested by @Panic . This will be very helpful for you to monitor his results, for the people on this forum to help you (after you link to it in your signature file) and for when you go to the vet. I just had to take my Franklin in for something and I brought a weight log, his home-glucose tests for the year and his lab results from when he was originally diagnosed about three years ago. (I added a tab on the spreadsheet for a weight log for all of my cats and for Franklin's labs.) The vet tech was impressed with the information I had.

Good luck with your kitty.
 
Hi PicklesMom,

picklesmom said:
Pickles was diagnosed about a month and a half ago and we’ve been doing 3 units vetsulin 2x a day.
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That's a large starting dose. According to the manufacturer's protocol, starting dose should be 2 units or less, twice a day (2IU BID).

picklesmom said:
I did right before his dinner and it was 109.
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I've used Vetsulin (aka Caninsulin). Under no circumstances would I give even a small dose of Vetsulin to a cat this low at preshot. I would certainly not give 3 units.

picklesmom said:
I completely switched his food from typical dry to low carb when he was diagnosed. Is it possible he’s going into remission?
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Assuming the diet change was from a fairly high carb dry food to low carb wet then that is highly likely to have reduced Pickles' insulin needs. Your starting dose was already set too high for a newly diagnosed diabetic. The reduction in carb load means that the 3IU BID dose could now be way, way too high - to the point of being dangerous.

We just don't know what's happening with Pickles BG levels at the moment. You might have got a duff test result and he could be running higher. There's no way to tell without testing, either at home or at your vets. For safety's sake, you need to find out urgently.

Working on the assumption that the 109 was a valid reading, that's at preshot time when the Vetsulin dose is pretty much out of the system. Pickles could have been a lot lower earlier on when the insulin was working at maximum effect.

I strongly recommend you contact your vet as soon as possible - tomorrow morning first thing at the very latest - to tell them how low your test result was tonight. I think you need to determine Pickles' current blood glucose levels urgently. If the vet doesn't already know you've transitioned Pickles to a low carb diet be sure to inform them of this important change. I recommend that you tell the vet that you need urgent dosing advice, that you skipped this evening's dose and that you're stalling on the morning dose because you don't know how much insulin you can give safely now without speaking to them first.

I'd also recommend you do a spot check of Pickles' BG a couple of times tonight to see where his BG is without any Caninsulin in hs system. These aren't nice-to-have tests; you really need to find out what's happening with Pickles to make sure he stays safe and tonight's tests will at least give you some bit of information to share with your vet in the morning.

Given that you have very little data I would suggest you agree a 'no-shoot' number with your vet. (For information only, FDMB sets a guideline of 200 for cats with very little data - ETA: the 200 limit is as measured on a human glucometer; a higher no-shoot limit should be used if measuring BG levels using a pet meter. Please seek veterinary advice on a suitable no-shoot limit for the Alphatrak.)

Because Pickles' numbers might be high when he has had no insulin, as an important safety precaution you need to be testing Pickles' urine for ketones daily while his status is being determined (especially if you have skipped giving insulin). You can pick up ketone test strips at Walmart or any pharmacy. Here is relevant information:

Testing Your Cat for Ketones

Tips for Collecting Urine Samples


As Elizabeth (Panic) rightly says above, without data it is not possible to determine whether or not Pickles might be going into remission.

I'm sorry if this post sounds a little terse. I'm in the UK and I'm incredibly tired and a bit punchy. Sorry about that.


Mogs
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@Critter Mom I glanced at Pickles' mom's posting history and it looks like he started on 2u and the food change happened then.

Picklesmom (didn't catch your name!), if you had given Pickles his full shot tonight without testing and him having been at 109, he could have hypo'd and died. That's why we encourage getting a handle on testing asap. We don't want any kitties losing their lives because a vet said it's not necessary to test. It has happened many times and breaks my heart to even think about. :( We're here to help though and understand the learning curve you deal with when first starting!

Am I understanding right you're using the Alphatrak? In that case I would definitely reduce, no more 3u ... 1u maybe, unless someone else has a recommendation.
 
Panic said:
Definitely no more than 3u though, no matter what the number is tomorrow morning OR evening. @Chris & China (GA) thoughts on this?
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Definitely no more 3U doses. As others have said, without testing data, we're in the dark as far as giving much in the way of helpful advice but since it's obvious something is causing the blood glucose to be lower, whether it's due to the high dose, the food change or he's trying to head into remission, his need for insulin has changed.

I wouldn't give more than 1U tomorrow morning and only if you can test and he's above 250 (if you're using the AlphaTrak)....it's better that he runs too high for a day than too low for a moment.

If you'd like some help with setting up our spreadsheet, feel free to send me a private message by clicking on my name and choosing "start a conversation". It's no trouble at all!
 
Thank you all so much!! Reading your replies makes me very annoyed with my vet. First he tried to tell me not to switch his food to low carb and got mad at me when I did it anyway, but still recommended 3 units. Anyway... just took his glucose this am with the alpha trak and it’s 151. I’m assuming still no insulin this am. I’m going to call the vet once I get a response here so I have some info to back myself up. Thanks!
 
Good call!

I don't know why on earth he wouldn't want you to switch to low carb food, that's pretty basic diabetes 101, even for vets.

https://www.aaha.org/aaha-guidelines/diabetes-management/diabetes-management-home/

Please click the downloadable PDF link, this has ALL the information you need to back yourself up. It's the 2018 American Animal Hospital Association's Diabetes Management Guidelines for Dogs and Cats. It clearly states to use low-carb food, start between 0.5-1 units of insulin, and use Prozinc or Lantus for felines, NOT Vetsulin, which is designed for dogs.
 
Panic said:
Good call!

I don't know why on earth he wouldn't want you to switch to low carb food, that's pretty basic diabetes 101, even for vets.

https://www.aaha.org/aaha-guidelines/diabetes-management/diabetes-management-home/

Please click the downloadable PDF link, this has ALL the information you need to back yourself up. It's the 2018 American Animal Hospital Association's Diabetes Management Guidelines for Dogs and Cats. It clearly states to use low-carb food, start between 0.5-1 units of insulin, and use Prozinc or Lantus for felines, NOT Vetsulin, which is designed for dogs.
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Thanks! He seems to know more about dogs... before I realized his numbers are low I was planning to switch him from vetsulin to prozinc based on advice on this forum. I’m wondering if that still makes sense.
 
picklesmom said:
Thanks! He seems to know more about dogs... before I realized his numbers are low I was planning to switch him from vetsulin to prozinc based on advice on this forum. I’m wondering if that still makes sense.
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Yes it absolutely would. Highly encourage it. :)
It would still be beneficial to see what his numbers look like. For all we know he's trying to get off the juice.
 
Chris & China (GA) said:
Definitely no more 3U doses. As others have said, without testing data, we're in the dark as far as giving much in the way of helpful advice but since it's obvious something is causing the blood glucose to be lower, whether it's due to the high dose, the food change or he's trying to head into remission, his need for insulin has changed.

I wouldn't give more than 1U tomorrow morning and only if you can test and he's above 250 (if you're using the AlphaTrak)....it's better that he runs too high for a day than too low for a moment.

If you'd like some help with setting up our spreadsheet, feel free to send me a private message by clicking on my name and choosing "start a conversation". It's no trouble at all!
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Thanks for the help! I've set up my spreadsheet - you'll see he tested 151 this am before breakfast. I didn't give him the insulin. My husband isn't here so I've asked my brother to stop by for the +4 test (still can't get him to stay for the ear). I'm planning to call the vet after that reading. Regardless of what happens, I plan to switch him to prozinc.
 
picklesmom said:
Update! Just tested at +5 (wasn't able to do +3/4) and it was 111. About to call the vet and see what he says.
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The 151 and 111 are in the normal BG reference range for a cat not on insulin as measured on a veterinary meter.

Sending best wishes for a successful and satisfactory discussion with the vet.


Mogs
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Panic said:
Those are really good numbers for a cat skipping two shots. :eek:

Let us know what the vet says!
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Oof just talked to the vet... told them all of the numbers I've received and he just says those are good numbers, don't stop the insulin... When I pushed back he said "The numbers are good bc of the insulin".. Which I followed up with the insulin is only in his system for 12 hrs max and he hasn't had any in over 30 yet his numbers are still low and im worried about hypoglycemia... Finally he said if you're more comfortable stop the insulin and let us know if you notice him drinking a lot again... so not really the most helpful vet, but luckily I have you guys. My plan is to test right before breakfast and dinner and make a decision based on that.
 
picklesmom said:
not really the most helpful vet,
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Putting it mildly! :eek:

Well done for arguing your case so well and backing it up with solid evidence. You are perfectly correct to be worried about Pickles being at risk of having a hypo. In your situation I would be too. Very much so.

Did your vet even suggest a dose reduction when he advised you to carry on with the insulin?



picklesmom said:
My plan is to test right before breakfast and dinner
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Also test at +1 hour and +2 hours after Pickles has eaten. Sometimes when the pancreas is recovering it starts producing larger pulses after meals and sometimes BG can actually drop a little while after the food was eaten.

Also, in any given 24-hour period what is the longest time Pickles goes between feeds?


Mogs
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Critter Mom said:
Putting it mildly! :eek:

Well done for arguing your case so well and backing it up with solid evidence. You are perfectly correct to be worried about Pickles being at risk of having a hypo. In your situation I would be too. Very much so.

Did your vet even suggest a dose reduction when he advised you to carry on with the insulin?




Also test at +1 hour and +2 hours after Pickles has eaten. Sometimes when the pancreas is recovering it starts producing larger pulses after meals and sometimes BG can actually drop a little while after the food was eaten.

Also, in any given 24-hour period what is the longest time Pickles goes between feeds?


Mogs
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Nope, didn't even suggest a dosage decrease. He also made me switch from 2 to 3 very abruptly. And yes, I'll try to do more tests like that. Right now he gets his dry food (young again) around 9am, then he gets half a can of FF pate at 12pm and he kinda eats that throughout the day. Then I feed him around 9pm the dry food and leave out another half of the FF for overnight. Do you think a couple more meals a day would help keep his blood sugar more stable? I also give him freeze dried chicken a couple times a day as a treat.
 
picklesmom said:
Do you think a couple more meals a day would help keep his blood sugar more stable?
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Smaller, more frequent meals can help.

For general info, I think you'd be more likely to see a postprandial drop in BG numbers if the diet was all low carb wet food.
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picklesmom said:
Nope, didn't even suggest a dosage decrease.
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That's really not good.

Are there any other vet practices local to you that might have practitioners with better feline diabetes knowledge and experience? Or another, more FD-savvy vet at your current practice?


Mogs
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Uhhh....I don't even know how to respond to your vet's ignorance. The board has filters that don't allow such words

While the Young Again is low enough in carbs, if Pickles will eat the canned food, it's much better for him. The kidneys are the weakest organ in cats....even more delicate in a diabetic since they're under more strain. Almost all cats, as they get older, have some degree of kidney disease and it is a very common cause of death. Keeping those kidneys as healthy as possible is the best way to help Pickles live as long as possible.

Having as much water flowing through the kidneys is the best way to keep them healthy. That's why a lot of us add extra water to the canned food. Cats have a naturally low thirst drive so any way to get water into them helps! It also helps flush out any crystals that might be forming that could possibly cause an obstruction.

Dr. Lisa (from the famous food chart) posts here occasionally and even posted a thread about the use of the newer "low carb" kibbles. It's a good read.
 
Thank you all for your help! I’m going to start transitioning him a bit more towards the wet food and also add extra water to it. I’m also going to try to find a new vet. I’m thinking I’ll call come local ones up and tell them I’m looking for a new vet bc my current one isn’t knowledgeable in feline diabetes and ask them how they usually try to manage it.

finally, tonight I didn’t get a chance to test pre-shot but i skipped the insulin and tested him at +1 and it was 113. At this point he hasn’t had insulin in 36 hrs and his numbers seem okay. I plan to test tomorrow am before breakfast.
 
Good luck vet-hunting! Here's a thread about questions you can ask to help screen vets, if you find it useful. If you have an AAHA accredited vet nearby they may be useful, seeing as they have to stick to a higher standard of care to stay accredited, and I would assume they would already be aware of the AAHA Diabetes Guidelines.

Pickles is ready to impress us, wow! Keep it up!
 
Panic said:
Good luck vet-hunting! Here's a thread about questions you can ask to help screen vets, if you find it useful. If you have an AAHA accredited vet nearby they may be useful, seeing as they have to stick to a higher standard of care to stay accredited, and I would assume they would already be aware of the AAHA Diabetes Guidelines.

Pickles is ready to impress us, wow! Keep it up!
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Thank you! Found a new vet today! One of their vet techs even has a diabetic cat at home so I’m feeling good about it. There was another vet I would have preferred but they weren’t accepting new patients :/

I also just took his BG about 2 hrs after a mini meal and it was 106 and he hasn’t had insulin in over 2 days. We had a bit of a rough day testing today though. Tried two paw pokes with very little blood this morning, then tried two ear pokes (first time ever) and couldn’t get any blood but it did leave a bruise :( finally got a big drop today after eating the paw with a warm rice sock!
 
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