At what supper time glucose level should I not give insulin?

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SamanthaLily

Member Since 2020
Lily is on 3 units bid of caninsulin. She was diagnosed as diabetic at the end of Feb 2020. She is very uncooperative when I or any one else tries to prick her ear (including vets) to get a blood glucose reading so most times I don't try but that scares me. I was trying a lot of the tricks people suggested (blanket burrito, treats, sensitization) but they do not work with her. I do monitor her urine glucose level with test strips, etc. It is hard enough getting insulin into her. The times that I have taken her to the vet for a blood glucose curve, the vet says she is ECID and that she definitely is. We tried 3 units once a day but that produced excessive drinking and peeing which I had gotten under control by giving twice a day. I have looked at the curves for caninsulin and the blood glucose level starts the downward fall right away (but away from hypoglycemic levels) and then at around 12 pm the glucose level starts to climb the upward slope. Not my child. Her glucose level will drop right away (around 8 am) and very low, close to hypoglycemic level and sometimes over (she has had hypoglycemic symptoms a couple of times) and she will not start the uphill glucose climb until around 5 pm. If I give her insulin again at 8 pm it is just going to drop her back down again possibly causing hypoglycemia during the night. I am wondering at what glucose level at supper time should I not give her insulin to prevent hypoglycemia. Some of the readings I have from one of her typical blood glucose curves in mmol/l are: 8 am - 14.2, 10:17 - 9.2, 11:20 - 3.7, 1:26 - 2.7, 2:24 - 2.3, 3:14 - 2.2, 4:10 - 2.2, 5:10 - 3.3, the vet clinic closes at 5 but they wanted to keep her overnight to make sure she was continuing to rise and see how the curve would take shape past 12 hours, 8:26 pm - 6.8 Thanks for helping.
 
Hi Samantha! I'm going to be a little limited to what I can help you with since you're not testing regularly (testing is data!) but I will make due.

Caninsulin ... I don't like this insulin in cats. It hits hard and fast and poor Lily is getting the brunt of it. 3 units is a lot as well. Consider switching to Lantus or Prozinc, it's much gentler in kitties.
Are you feeding 30 minutes prior to giving insulin? Food must be on-board first. Are you giving food snacks during the first few hours? If you already know that great, if not that will help prevent hypoglycemia.

I don't like to see cats dropping below 5 mmol/l on Caninsulin ... and no insulin if BG is below 11 mmol/l.

Some kitties are very stubborn in the beginning. Does Lily like cuddles or treats? It takes a lot of bribery in the beginning, and personally I find "less is more" when restraining a cat. Ideally you want them to sit there on their own without being pinned down in any way. Could you tell us what part Lily really doesn't like? We can work on desensitizing her.
 
PLEASE consider setting up one of these. It will help us help you. Once you do get some tests in.
FDMB SPREADSHEET INSTRUCTIONS

I cant remember if I welcomed you so just in case, WELCOME TO FDMB! We are here to help anyone who needs help with their diabetic kitty.:bighug:
It would also be beneficial for everyone including extra sweet Lilly to set up your signature:
  • On the left, under Settings, Click on Signature. This is where you will put information that helps us give you feedback.
    • There is a limit of two lines which may include two links; you may separate pieces with commas, dashes, | etc. This is where you paste the link for your spreadsheet, once it is set up.
    • Add any other text, such as
    • Caregiver & kitty's name (optional)
    • DX: Date
    • Name of Insulin
    • Name of your meter
    • Diet: "LC wet" or "dry food" or "combo"
    • Dosing: TR or SLGS or Custom (if applicable)
    • DKA or other recent health issue (if applicable)
    • Acro, IAA, or Cushings (if applicable)
    • Spreadsheet link. Please put the signature link on the bottom line of your signature information, on its own, so it is easy to find.
    • Please do not put any information about your location in the signature for security reasons. If you wish to add your country location, please add it to your profile.
Be sure to click the 'Save Changes' button at the bottom. If you need help urgently it is important we know these things at a glance. We don’t want to waste valuable time finding out information.

I dont want to overwhelm you. Do this when you feel comfortable. We all want the same for you and Lilly. A safe comfortable life.

IF you have problems with setting up anything just let us know . We are here to help you!
jeanne
 
Hi Samantha,

I agree with Red: with numbers like that, Lily's insulin dose is much too high and needs to be reduced immediately. I haven't a clue by how much but if it were my cat getting numbers like that I would look to adopt a very conservative approach and for safety try to find a viable workaround re the home testing difficulties you're currently experiencing.


SamanthaLily said:
Some of the readings I have from one of her typical blood glucose curves in mmol/l are: 8 am - 14.2, 10:17 - 9.2, 11:20 - 3.7, 1:26 - 2.7, 2:24 - 2.3, 3:14 - 2.2, 4:10 - 2.2, 5:10 - 3.3, the vet clinic closes at 5 but they wanted to keep her overnight to make sure she was continuing to rise and see how the curve would take shape past 12 hours, 8:26 pm - 6.8.
Click to expand...

If those readings were taken on a human meter they're too low. (Ref. Range: 2.8-6.7mmol/L, as used at FDMB.)

If those readings were taken on a veterinary meter they're WAY TOO LOW! (Ref. Range: 3.9-8.3, as advised by my vet.)

* If your cat was at 6.8 at preshot I would consider that too low to give any Caninsulin, not even a small dose (and certainly not 3IU). *

For the example curve you posted, the AMPS blood glucose level


Some Questions:

1. Am I correct in understanding that, with the exception of the time when the vet tried her on 3IU SID, has Lily's dose remained 3IU BID since she was diagnosed?

2. Was that curve run by the vets?

3. If it was a vet-run curve, and assuming they were using a veterinary meter, do you know what actions they took during the period when Lily's BG was below 3.9 (11:20 to at least 17:10 - c. 6 hours minimum)?

4. How many other curves do you have with numbers like that? Were they also run by the vets?

5. What did the vets say/do when you told them about Lily's hypo episodes?

6. Has Lily ever tested positive for ketones, or has she any history of diabetic ketoacidosis (DKA) episodes?


Mogs
.
 
Red & Rover (GA) said:
I do hope that the dose will be lowered. It is obvious from the glucose curve you listed that the dose is far too high.

Tagging @Panic @JanetNJ @Deb & Wink

Keep trying with the testing. Have you tried using the paw pad instead of the ear?

Click to expand...
When Lily was first diagnosed she was always hyperglycemic most of the time beyond what the meter would register at so she was always at a very high dose and now she has been lowered during one of her vet blood glucose curves. If I remember during that curve they told me she was not feeling well therefore the very low numbers and the wanting to keep her overnight. I have not tried the paw but I have read that infections are easier that way due to using the litterbox. I do want to continue with the testing as yes low numbers are scary but yes I know what to do in a hypoglycemic emergency.
 
Panic said:
Hi Samantha! I'm going to be a little limited to what I can help you with since you're not testing regularly (testing is data!) but I will make due.

Caninsulin ... I don't like this insulin in cats. It hits hard and fast and poor Lily is getting the brunt of it. 3 units is a lot as well. Consider switching to Lantus or Prozinc, it's much gentler in kitties.
Are you feeding 30 minutes prior to giving insulin? Food must be on-board first. Are you giving food snacks during the first few hours? If you already know that great, if not that will help prevent hypoglycemia.

I don't like to see cats dropping below 5 mmol/l on Caninsulin ... and no insulin if BG is below 11 mmol/l.

Some kitties are very stubborn in the beginning. Does Lily like cuddles or treats? It takes a lot of bribery in the beginning, and personally I find "less is more" when restraining a cat. Ideally you want them to sit there on their own without being pinned down in any way. Could you tell us what part Lily really doesn't like? We can work on desensitizing her.
Click to expand...

When Lily was first diagnosed she was always very hyperglycemic, had muscle wasting, and a plantigrade stance so she was on a higher dose.
Yes I am feeding Lily 30 minutes before giving her insulin and then when I get home for lunch I give her some more. She has had 4 or 5 vet blood glucose curves and the dose has been lowered. I think during this curve the vet said that Lily was not feeling well representing the numbers and the wanting to keep Lily overnight. Lily does not like anything. She even hates it when I put vaseline on her ear. I do want to continue testing. She is very picky in what she eats also but I bought her cheese so hopefully that will help. She likes cuddling up to a point. I usually sit beside her, sometimes she will half sit on my lap, even putting the gauze against her ear she freaks out. Growls, hisses, swipes, bites, scratches is what I get for trying to keep her safe.
 
jt and trouble (GA) said:
PLEASE consider setting up one of these. It will help us help you. Once you do get some tests in.
FDMB SPREADSHEET INSTRUCTIONS

I cant remember if I welcomed you so just in case, WELCOME TO FDMB! We are here to help anyone who needs help with their diabetic kitty.:bighug:
It would also be beneficial for everyone including extra sweet Lilly to set up your signature:
  • On the left, under Settings, Click on Signature. This is where you will put information that helps us give you feedback.
    • There is a limit of two lines which may include two links; you may separate pieces with commas, dashes, | etc. This is where you paste the link for your spreadsheet, once it is set up.
    • Add any other text, such as
    • Caregiver & kitty's name (optional)
    • DX: Date
    • Name of Insulin
    • Name of your meter
    • Diet: "LC wet" or "dry food" or "combo"
    • Dosing: TR or SLGS or Custom (if applicable)
    • DKA or other recent health issue (if applicable)
    • Acro, IAA, or Cushings (if applicable)
    • Spreadsheet link. Please put the signature link on the bottom line of your signature information, on its own, so it is easy to find.
    • Please do not put any information about your location in the signature for security reasons. If you wish to add your country location, please add it to your profile.
Be sure to click the 'Save Changes' button at the bottom. If you need help urgently it is important we know these things at a glance. We don’t want to waste valuable time finding out information.

I dont want to overwhelm you. Do this when you feel comfortable. We all want the same for you and Lilly. A safe comfortable life.

IF you have problems with setting up anything just let us know . We are here to help you!
jeanne
Click to expand...

I set up my signature but not a spreadsheet and yes you welcomed us a long time ago. I asked about comprehensive feline diabetes books and advise on how to prick the ear of an aggressive cat.
 
Excellent. I would recommend a Petsafe 5 autofeeder ... the thing about Caninsulin is it drops very early, so for most cats by lunchtime they've already dipped and are heading back up. We want to slow the drop as much as possible to make it more gentle. Some cats feel a little cruddy on Caninsulin because of how it sharply manipulates the BG.

I think the link Deb posted above is a great way to start. We obviously don't want to stress Lilly by testing but we also don't want her to go hypo because she doesn't know to hold still for you haha. She sounds like she needs a lot of desensitizing so if she likes cheese by all means! Does she like meat too? Lots of kitties like freeze-dried PureBites chicken. I cooked up some turkey yesterday and turned them into small treats and my cats about plowed me over for them. Cats really like how smelly turkey is. Anything that she considers high-value should be used. I would start slow, scratching her ears or giving them a quick rub then a treat - or letting her see the treat while you do it so she's focused on the goodies - and work your way from there. :)
 
Critter Mom said:
Hi Samantha,

I agree with Red: with numbers like that, Lily's insulin dose is much too high and needs to be reduced immediately. I haven't a clue by how much but if it were my cat getting numbers like that I would look to adopt a very conservative approach and for safety try to find a viable workaround re the home testing difficulties you're currently experiencing.




If those readings were taken on a human meter they're too low. (Ref. Range: 2.8-6.7mmol/L, as used at FDMB.)

If those readings were taken on a veterinary meter they're WAY TOO LOW! (Ref. Range: 3.9-8.3, as advised by my vet.)

* If your cat was at 6.8 at preshot I would consider that too low to give any Caninsulin, not even a small dose (and certainly not 3IU). *

For the example curve you posted, the AMPS blood glucose level


Some Questions:

1. Am I correct in understanding that, with the exception of the time when the vet tried her on 3IU SID, has Lily's dose remained 3IU BID since she was diagnosed?

2. Was that curve run by the vets?

3. If it was a vet-run curve, and assuming they were using a veterinary meter, do you know what actions they took during the period when Lily's BG was below 3.9 (11:20 to at least 17:10 - c. 6 hours minimum)?

4. How many other curves do you have with numbers like that? Were they also run by the vets?

5. What did the vets say/do when you told them about Lily's hypo episodes?

6. Has Lily ever tested positive for ketones, or has she any history of diabetic ketoacidosis (DKA) episodes?


Mogs
.
Click to expand...

I just remember the first time Lily got her ear pricked it was a purple meter and the reading was 28 mmol/l. When I talked to the tech about my meter (one touch ultra 2) I think she said that was the meter they used but she has a diabetic cat so that might have been what she used at home. When Lily was first diagnosed she was always very hyperglycemic (most times my meter would not even read it). She started at a very high dose and through 4 or 5 vet blood glucose curves the dose was decreased to 3 units BID. I think those vet blood glucose curve numbers the tech said that Lily was not feeling well and therefore the low numbers and the wanting to keep Lily overnight - the 6.8 mmol/l at 8:26 pm she was not given insulin.

1) Since Lily was very hyperglycemic at the beginning (muscle wasting over her back, plantigrade stance, low energy, very high numbers such as 33.3, HI, 28, etc) she was on a high dose then decreased over the months. When she was on the 3 units once a day it was for two weeks and I noticed the difference right away because I was monitoring food consumption, urine output, water consumption, weight, etc on a daily basis. She has been on 3 units BID for months - every time I worry about the dose and decrease it slightly it seems her urine output and water consumption increases.

2) All curves (4 or 5) have been done by the vet. I can barely get her to allow me to do one test. She had been so good whenever she went to the vet until the last time then she freaked out and getting very upset and started biting, growling, and scratching etc so it was pointless to continue. That was 2 people working on her. Now they won't take her for another one but expect me to be able to do one by myself.

3) 4) The numbers from that curve was using my meter, the one touch ultra 2, I don't know what action that they took as they phoned me in the middle of it and asked if they could keep her overnight. She has always taken a long time to start the upward climb of the curve. When I went to pick her up the next day they told me she had not been feeling well during the curve. It was not until I looked at my meter that I saw the results.

5) The vets have instructed me on what to do for a hypoglycemic event.

6) Since I don't have much luck with blood glucose testing and because I monitor her urine output I also test for ketones using ketostix and Vet 10 sticks. She has never tested positive for ketones or DKA.
 
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