Please help. What blood glucose is too low to give insulin?

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Giovanna1127

Giovanna1127

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Hello - My cat has been on insulin for a little over a week. We are on day 2.5 of his implanted freestyle libre monitor. The doctor implanted this thing and told me how to record blood glucose but said NOTHING about what to do when it gets too low, what is too low, or when it is too low for insulin.

his glucose has gone below 50 multiple times today and last night. After multiple calls to the vet a nurse told me to give him kero syrup if it goes under 50 but didn’t say what # is too low to give him insulin.

He just ate and his glucose is 85 which is in the low range (70-180) of good, but still good. Intuitively, I don’t want to give him insulin because I am afraid his glucose will crash but the doctor didn’t give me ANY scenarios in which not to give him insulin.

does anyone have a number where if below that # you don’t give insulin?

thanks!

gia
 
Thank you so much for your reply!!! Ok. No insulin give. Just checked again and he is at 90. He gets 2 units of lantis (the pen - not sure if this matters) 2x/day, 12 hrs apart, which I think is standard. Ladt insulin was 8:30 am.
 
Thank you so much for your reply!!! Ok. No insulin give. Just checked again and he is at 90. He gets 2 units of lantis (the pen - not sure if this matters) 2x/day, 12 hrs apart, which I think is standard. Last insulin was 8:30 am.
 
Giovanna1127 said:
He gets 2 units of lantus solostar. It is a 100 unit/ml pen.
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OK...2 units is a high starting dose and it's obviously too high for him right now. Most cats should be started at .5 to 1U and then that starting dose is held for 5-7 days to see what it can do.

It also sounds like you're using the pen with the special pen needles? We don't recommend that here because you can only give whole unit doses which is fine for humans, but our cats need much smaller dose changes! You can use regular insulin syringes that have half unit markings and pull the insulin out of the pen (under the cap is a rubber stopper just like a vial has...you just use the pen as a "mini-vial")

There are lots of other good reasons not to use the pens "as intended" too...besides being stuck with whole unit dose changes, you're also supposed to "prime" it each time you use it by wasting 2 units....that's a lot of insulin to shoot into the sink or the trash! Also you're supposed to hold the needle in for 10 seconds....a lot of cats aren't real cooperative about that.

The fact that you've already had some numbers that were too low (under 50) and now you're getting Pre-shot numbers too low to shoot is a very good indication that the dose is too high. If this were my cat, I'd probably drop down to 1.5 and see how it goes for several days.....but if he drops below 50 again, I'd drop down to 1U and start over.

It will really help us to help you if you'll start keeping track of your test results on our special spreadsheet. Here are the Instructions on getting the FDMB spreadsheet. If you have any problems getting it set up, feel free to send me a private message by clicking on my name and choosing "start a conversation".

Here's How to understand the spreadsheet once you have it set up.

Also, if you'll fill out your "Signature" it will save everybody time because we won't have to keep asking the same questions. (you'll see signatures under our comments). Things like:

Your name/Cat's name, age, sex, date of diagnosis, type of insulin, type of meter, type of food, any other health conditions or meds?.....and then the link to your spreadsheet goes in last.

To do the Signature just go to the top right and click on your sign on name...there's a drop down list ....just choose "Signature" and a new box will pop up. Enter the information and "save" and that's it!

P.S....what are you feeding?
 
Hi Chris,

thanks for all of the info. He’s over 15 lbs, so perhaps that is why the initial dose was so high, but agreed, it seems too high for him right now. He was also at 330-480 pre-insulin, so that may have been a factor. The needles I have do not have 1/2 markers on them, only full dose. I was also not instructed to prime or hold the needle in for 10seconds, so don’t do either!

I can try to hit 1.5, but it’s not an exact marker. Also, I am using the freestyle libre app, that auto uploads all of my data (while the “14 day” monitor is implanted anyway) To my vet (not that they have seemed to look at it yet). I’d rather post pics of the past 2.5 day graphs from the app, if that is ok, at least until he kicks the monitor off!
I have uploaded print screens of the past 2.5 days data. No pressure to review, just there if anyone wants it.

Re: food, that has been a changing variable as I was still weaning him off dry food (due to a fiasco I posted about 2weeks ago where my vet switched him overnight to 100% wet from 100% dry and he had diarrhea and vomiting for multiple days so we went back to the dry and started introducing the wet slower). Today was actually the first day of 100% wet food Today was actually the first day of 100% wet food. It has been a mix of Tiki cat after dark and meow mix pate toppers it has been a mix of Tiki cat after dark and meow mix pate toppers. The meow mix is a short term solution he handled it much better than the Tiki cat and Dave’s that I had given him which are better quality The meow mix is a short term solution he handled it much better than the Tiki cat and Dave’s that I had given him which are better quality.
 

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A diet change from high to low carb requires close monitoring as it greatly reduces insulin needs ... looks like this is the case for your kitty. Did you drop insulin dose any during this time?

Are you in the US? You can go to Walmart or Walgreens and pick up needles with half-units, 0.3 mL (not 0.5 mL). You'll have to eyeball it until then. :p
 
Giovanna1127 said:
The needles I have do not have 1/2 markers on them, only full dose. I was also not instructed to prime or hold the needle in for 10seconds, so don’t do either!
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The "priming" and holding for 10 seconds ONLY applies if you're using the special pen needles that are used with the pens. If you're using regular insulin syringes, you don't have to do anything special. Just insert into the pen, withdraw the correct dose and shoot the cat.

Giovanna1127 said:
The meow mix is a short term solution he handled it much better than the Tiki cat and Dave’s that I had given him which are better quality
Click to expand...

The important thing is feeding something the cat will eat! Most of us feed our own diabetic cats Fancy Feast Classics, Friskies pates or 9-Lives ground which aren't exactly "premium quality".

Giovanna1127 said:
He was also at 330-480 pre-insulin, so that may have been a factor.
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Starting dose has nothing to do with how high they were at diagnosis but can have something to do with the starting weight. On Tight Regulation, the starting dose is weight (in kgs) x .25 so would be 1.7U but we always start a little lower for safety (so 1.5 since you can't get syringes with .7 unit marks)

On SLGS, the starting dose is .5 if eating only low carb food and 1U if kitty is not on a wet/canned low carb diet

You can read more about TR and SLGS here

You can get syringes at WalMart that have half unit marks for $12.58/100. Their 3/10ml, 30 or 31 gauge insulin syringes all have half unit marks (no matter what they might tell you)
Relion syringes.jpg OR relion insulin syringes1.jpg
 

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Thank you panic. I did not drop the insulin dose because my vet didn’t tel me to. I did remind her about the feeding when she implanted the monitor 2.5 days ago and asked if changes were needed. She said no. I wasn’t testing sugar for 6 days between when he started insulin and getting the monitor 2.5 days ago. My vet said this was ok, but I’m concerned that his glucose may have been low during that period as well!!!! I have a lot to learn. Trying my best, tired, and frustrated. Also so appreciative and grateful for everyone’s kindness on this forum.

Yes, I will go to walmart tomorrow and get those needles. Didn’t know you can get without a prescription?! I needed a prescription for mine and my vet is closed tomorrow.
Regardless, will drop insulin to 1.5 tomorrow am. Monitoring him closely tonight.
 
Giovanna1127 said:
Yes, I will go to walmart tomorrow and get those needles. Didn’t know you can get without a prescription?! I needed a prescription for mine and my vet is closed tomorrow.
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I believe Walmart's pharmacy is closed on Sundays. Prescription depends on your state, a quick google search should tell you. I think you can still get up to 10 without a prescription if the law does require them.
 
Chris & China (GA) said:
The "priming" and holding for 10 seconds ONLY applies if you're using the special pen needles that are used with the pens. If you're using regular insulin syringes, you don't have to do anything special. Just insert into the pen, withdraw the correct dose and shoot the cat.



The important thing is feeding something the cat will eat! Most of us feed our own diabetic cats Fancy Feast Classics, Friskies pates or 9-Lives ground which aren't exactly "premium quality".



Starting dose has nothing to do with how high they were at diagnosis but can have something to do with the starting weight. On Tight Regulation, the starting dose is weight (in kgs) x .25 so would be 1.7U but we always start a little lower for safety (so 1.5 since you can't get syringes with .7 unit marks)

On SLGS, the starting dose is .5 if eating only low carb food and 1U if kitty is not on a wet/canned low carb diet

You can read more about TR and SLGS here

You can get syringes at WalMart that have half unit marks for $12.58/100. Their 3/10ml, 30 or 31 gauge insulin syringes all have half unit marks (no matter what they might tell you)
View attachment 56459 OR View attachment 56460
Click to expand...
Chris - thanks again. Good to know on priming and food. I paid $12 for 30 siringes So good to know I can get 100 for $12 from walmart!!!!! I’m teuly starting to question my vet.
What is SLGS?
 
Panic said:
A diet change from high to low carb requires close monitoring as it greatly reduces insulin needs ... looks like this is the case for your kitty. Did you drop insulin dose any during this time?

Are you in the US? You can go to Walmart or Walgreens and pick up needles with half-units, 0.3 mL (not 0.5 mL). You'll have to eyeball it until then. :p
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Yes I am in the US - Florida.
 
Giovanna1127 said:
Chris - thanks again. Good to know on priming and food. I paid $12 for 30 siringes So good to know I can get 100 for $12 from walmart!!!!! I’m teuly starting to question my vet.
What is SLGS?
Click to expand...
Looks like syringes can be purchased in FL w/o a script but many pharmacies have policies thAt don’t allow this. Apparently, my area (Tampa Bay) is notorious for this policy. Will give it a shot.
 
Giovanna1127 said:
He’s over 15 lbs, so perhaps that is why the initial dose was so high
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Last I knew, the recommended starting dose of Lantus was 0.25U per kg of the cat’s ideal weight, or 0.25U per kg if a cat is underweight.

The Internal Medicine vet and I discussed this specifically, including how often vets miss the “ideal” weight detail for cats who are overweight.

Some vets prefer to just start at a dose of 0.5u to 1u and work from there, regardless of weight.
 
Giovanna1127 said:
Looks like syringes can be purchased in FL w/o a script but many pharmacies have policies thAt don’t allow this. Apparently, my area (Tampa Bay) is notorious for this policy. Will give it a shot.
Click to expand...

If you are not able to buy syringes from Walmart of the local pharmacy without a script, you can order them online from here:
https://www.adwdiabetes.com/search....ch_return=all&sort_by_field=Price+Low+to+High

They are based in Florida and you should have them in 2-3 days. If you order before 3pm, they ship it the same day.
 
Thanks for the info on ordering syringes.

I’ve been sleeping for no more than an hr, at a time so I can keep testing, currently ranging from 60-100. Gave some food about 45 mins ago, which seemed to help.

i was planning on reducing dose from 2 to 1.5 units in the am but Chris suggested earlier than I not give insulin if under 200. Does the same apply in the am? Even at the reduced dose?

I will probably continue to use that 200 as a benchmark, unless someone says otherwise.
Thanks!
 
Giovanna1127 said:
Does the same apply in the am? Even at the reduced dose?
Click to expand...

Until you get a little more data, if you get a Pre-shot test that's under 200, try stalling, DON'T feed and test again in 20-30 minutes to see if the number goes up without food.

As you gain more experience and data, the Pre-shot you shoot starts to come down from that 200...down to 150....then slowly down to where you shoot anything over 90 (on SLGS)

I understand you're using the Libre, but we still need for you to convert your results to our spreadsheet. We're very data oriented here and people will need to see what's been going on using the format that we are used to using before they can give you much in the way of helpful advice.
 
Bandit's Mom said:
I have sent you a PM and if you will send me those details, I can set-up your spreadsheet for you.
Click to expand...
Thank you again!!!!! OMG his monitor is gone. He must have finally gotten it off. Now I have no way to test his blood. It has been less than 3 days, was supposed to last up to 14, and cost me $100 to implant.

how do all of you test glucose without one?!

My vet said the other way was to keep him in the vets office for a full day and test every 2 hrs but there was no test from home option.
 
What Jeanne said. As fantastic as the libres are (well, until they fall off or stop working), round here, most of us are testing the old fashioned way!

The meters require you to get a drop of blood for each reading. Where humans prick a finger, we use the edge of the cat's ear, which has very few nerve endings (they usually don't notice the poke at all, at least once they're used to the routine of sitting still and having the human mess with their ears).

The main things you want in a meter are: cheap and easily available strips, and taking a relatively small droplet of blood. If you have a Walmart near you, a favorite meter is the Relion Prime. You also will need some lancets to do the poke, and at least at first, you'll want them to be a larger size (26 or 28 gauge; smaller gauge = larger lancet size).

If you are able to get those supplies together quickly, we can help get you started!

I am guessing that you are not shooting insulin this morning, given that he went low and you can't take a reading this morning?
 
Nan & Amber (GA) said:
What Jeanne said. As fantastic as the libres are (well, until they fall off or stop working), round here, most of us are testing the old fashioned way!

The meters require you to get a drop of blood for each reading. Where humans prick a finger, we use the edge of the cat's ear, which has very few nerve endings (they usually don't notice the poke at all, at least once they're used to the routine of sitting still and having the human mess with their ears).

The main things you want in a meter are: cheap and easily available strips, and taking a relatively small droplet of blood. If you have a Walmart near you, a favorite meter is the Relion Prime. You also will need some lancets to do the poke, and at least at first, you'll want them to be a larger size (26 or 28 gauge; smaller gauge = larger lancet size).

If you are able to get those supplies together quickly, we can help get you started!

I am guessing that you are not shooting insulin this morning, given that he went low and you can't take a reading this morning?
Click to expand...
Thanks for offering to hep. Where do I get the lancets? Can I get without a prescription? I am in FL - Tampa Bay and may be difficult to get syringes w/o prescription, so may be same for “lancets”?

Its 8:45 now and I usually do insulin at 8:15.
It may be too late by the time I go out and get all the stuff I need and come back to test him I might have to wait until tonight?
I was also trying to research a new vet I’m just lost the trust in my current vet because she didn’t tell me really critical information about what to do when blood glucose was low if I followed her instructions I would’ve continued to give insulin twice a day regardless of what the blood” was and I don’t think I can get past that I was also trying to research a new vet I’m just lost the trust in my current vet because she didn’t tell me really critical information about what to do when blood glucose was low if I followed her instructions I would’ve continued to give insulin twice a day regardless of what the blood“ was and I don’t think I can get past that. Also dealing with my own medical issues and side effects from a new prescription so I am just a mess right now.
 
Its going to be ok. Sadly we hear the "mistrust" speech a lot.:(
You have landed in a safe place.
Everyone here is dedicated to helping and teaching everything you need to know to keep your cat safe.
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jeanne
 
Ah, that is frustrating. I will say, if you like your vet otherwise, a lot of us just quietly do our own thing with FD, and use the vet for other stuff.

Lancets are over the counter everywhere-- should be with the rest of the human diabetic supplies. While you're there, it's also a good idea to pick up some ketone testing strips, especially if you're skipping shots. That's a different test than blood glucose, it uses urine (which presents its own challenges with a cat-- we have tips for that, too!).
 
Thanks. I am going to walmart in about 10 minutes. Perhaps I can give 1/2 dose once I get back, if blood glucose is ok and I get info on how to test using the lancets and relion prime. Realistically, I won’t be back w/ the tools u til 10am est - 50 mins from now.

if someone could provide instructions in the meantime, it would be appreciated.
 
Some keys when starting out:

--- make sure her ear is warm. You can gently warm it by using a little sock with rice in it that you microwave briefly, or an empty pill bottle that you fill with warm water, or just by gently rubbing her ears a little.

-- treats are KEY for getting the cat to buy in to the testing process. Pretty soon, most of our cats go running to the testing spot just because they want the treats!

--- some cats are fine with all of it right from the start, but if you have a nervous or skittish cat, you may need to slowly build up to the testing process in stages, with treats at every stage. Bring her over to the testing spot, give a treat, let go. Bring her over, play with her ears a little, give a treat, let go, and so on.

--- if you're nervous, she'll be nervous. One way to make everything calm is to sing! Especially silly songs, it's really hard to be nervous while singing!

The whole process:

1) gather all your supplies (meter, strips, lancets, rice sock if you're using it, cotton round or piece of tissue to blot the blood afterwards, and treats) in the testing spot
2) bring your cat over, have her sitting on your lap or in front of you
3) get the meter ready with a new strip
4) poke on the outer edge of the ear (see pic below), avoiding the vein, and poking at a slight angle (we all have poked all the way through the ear, so don't worry if that happens!). A lot of us find that freehanding with the lancet is easier than the device, but do whatever works for you
5) get the test
6) hold the tissue or cotton round against the poke site to stop bleeding and minimize bruising
7) treat time!!!

Diagram of where you're aiming for (the "sweet spot"):

4395c545-36bf-4aba-bec7-4392fcdb191c-jpeg.48119
 
I’m failing miserably. Have been trying to get blood from the ear and it doesnt seem to be enough to register with the monitor. He’s being so patient but very visibly annoyed. I am almost in tears. I see the blood on his ear but its not beading so not registering.

ear is probBly not warm enough, I am trying my best and really pushing his limits. The pill bottle doesnt work. Am trying to warm up his ears w massage, that is “easiest” but hes not used to it so he only lets me do so much.
 
I tried to edit the above to add that He will not tolerate any in adamant object like a pill bottle by his ear he will let me touch him barely so I’m trying to little by little get him used to me touching his ears but also he never lays with his face anywhere near me he’s always got his back to me so it’s strange to be touching his ears and trying to get his face near me all at the same time these are things that he’s not used to and I’m doing it all at once. Typically I would take time to do this to get him used to it overtime so he trust me but this is all very sudden and I can’t just pin him down because that would be miserable twice a day I want to get him used to it gradually but I just don’t know what to do anymore Typically I would take time to do this to get him used to it overtime so he trust me but this is all very sudden and I can’t just pin him down because that would be miserable twice a day I want to get him used to it gradually but I just don’t know what to do.
 
Do you have any Vaseline? Just dab a small amount on the ear and then gently smooth off the excess. Sometimes that helps the blood bead up.

You can also scrape the blood off onto your fingernail and have the strip suck it off your fingernail. Not ideal, but worth a try in a pinch.
 
JL and Chip said:
Do you have any Vaseline? Just dab a small amount on the ear and then gently smooth off the excess. Sometimes that helps the blood bead up.

You can also scrape the blood off onto your fingernail and have the strip suck it off your fingernail. Not ideal, but worth a try in a pinch.
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Ok will try. Have poked the same ear like 4-5 times. I feel so bad. May move on to the other ear but need to warm that 1. I was soooo close w the blood on the strip but its just not enough. How long can I add to the same strip, before starting a new one? Ive been trying to get blood onto this one for a good 8-10 minutes now.
 
Bandit's Mom said:
I read here that Relion syringes all have half unit marks even though it may not say so on the box and Walmart staff are usually unaware of that.
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I don’t know. The pharmacist and I looked at an actual syringe together through the plastic and saw no half marks. He said those were the only ones he had, not sure of the brand.
 
Giovanna1127 said:
Ok will try. Have poked the same ear like 4-5 times. I feel so bad. May move on to the other ear but need to warm that 1. I was soooo close w the blood on the strip but its just not enough. How long can I add to the same strip, before starting a new one? Ive been trying to get blood onto this one for a good 8-10 minutes now.
Click to expand...
I also don’t own vasaline so would need to go buy some of that to try that
Method.
 
I am also doing this with one hand. Have to be petting him with the other, otherwise he won’t stay. He’s purring, so thats good but I live alone so don’t have anyone that I can tag team with!
 
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