PSBG 30.1 on AT2

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Sarah and Muffin

Sarah and Muffin

Member Since 2021
Hi everybody. This is my first post.

I took my 16 yo cat Muffin to the vet last week because she's been drinking heaps lately and I thought she looked like she'd been losing weight. The vet took bloods and glucose and lipids were very high. Subsequent fructosamine test result of 600 confirmed diabetes. This was last Friday. Muffin was booked to go in to the vet for the day the following Monday to start insulin and record a bg curve. As soon as I found out the diagnosis on the Friday I changed her food to Fancy Feast classic pate. So she had been eating this diet for 2 days by the time the vet started insulin and did the first curve. Muffin weighs 4.5kg and was started on 1 unit if lantus twice a day. All muffin's bg readings on day 1 at the vet were above 20. The vet sent Muffin home that night and lent me her glucometer so that I could take a couple of readings at home. I was successful once and got a reading of 13.4. (I returned the glucometer to the vet the next day). During the next few days I gave muffin her insulin as prescribed and then today (Friday, so 4 days since the first bgc) I borrowed the vets glucometer again to do an at home bgc. Firstly, muffin hates me now, and runs away as soon as I come near her. I've been giving her lots of cuddles and treats but she now seems to associate treats with something nasty, which is not helpful. But I did manage to get the first 3 readings at 8.30am, 11.30am and 2.30pm. They were 41.1, 15.2 and by 2.30pm the reading was 2.2. at which point we went straight back to the vet who treated Muffin's hypo and then sent her home. Muffin is back home now, but won't let me near her at all. So I haven't given any insulin tonight, just food. I guess I have 3 main questions. 1: how to deal with the fact that muffin isn't letting me near her to inject or check bg; 2: I am presuming I need to reduce the insulin dose to 0.5u or less (although my vet hasn't actually said anything to me about reducing the dose), but my disposable syringes will not allow me to measure such a small dose very easily. I can try do it by eye but it won't be exact and after today's hypo I'm kinda scared to give any at all; 3: is the morning reading that I got of 41.1 likey to be a rebound from her having had another hypo the previous night?

Any advice people have (anything at all) would be most appreciated.

Thanks, Sarah
 
Are you Canadian?

Can you afford to buy a human bg meter? They are the cheapest and most use.

Yes, lower the insulin to 0,5 BID since it is Lantus.
 
Ann & Scatcats said:
Are you Canadian?

Can you afford to buy a human bg meter? They are the cheapest and most use.

Yes, lower the insulin to 0,5 BID since it is Lantus.
Click to expand...

Hi. I'm in New Zealand. I already have a human glucometer as my son is type 1. The vet took synchronous readings on Monday to check that it gave similar readings to her one, but it was apparently all over the place so she advised me not to use it.
 
Do use the bg meter you have.

Muffin hypoed fast in 6 hours from 41 to 2. So you have to use the bg meter you already have. And shop around there for half-unit marked insulin 100 U syringes. I use BD's myself.

@Bron and Sheba (GA) in Australia might be able to know were to shop for you in NZ.
 
Hi Sarah and Muffin and welcome. I live in Australia. I don’t think you have 1/2 unit syringes there...we don’t. But you can buy them from the aiK if you want to.
First of all, I’m really glad you were able to get that 2.2. That is really low.
Can you tell me what type of insulin you are giving please? And the dose?
 
The glucose meter you use for your son is perfectly OK. Your vet was probably trying to compare it with a pet meter which will give different readings.

We recommend using the human meter here and our dosing methods are based on the human meter.
The pet meter has only been around for a few years. Before that all vets used the human meters.. .

You will definitely need to reduce the dose of the insulin. It is most likely he dropped lower earlier and that is why you got the earlier high preshot.
Here is a link to home testing. Are you giving Muffin a treat every time you test?
https://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/

Do you have a hypo kit set up with some honey and high carb food i. It. If it make sue you get it set up ASAP. If he drops low like he did again, rub honey on his gums and feed him some high carb food and test again 20 mins later.
Link to hypo information within this link
https://www.felinediabetes.com/FDMB/threads/new-how-you-can-help-us-help-you.216696/
 
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Bron and Sheba (GA) said:
The glucose meter you use for your son is perfectly OK. Your vet was probably trying to compare it with a let meter which will give different readings.

We recommend using the human meter here and our dosing methods are based on the human meter.
The pet meter has only been around for a few years. Before that all vets used the human meters.. .

You will definitely need to reduce the dose of the insulin. It is most likely he dropped lower earlier and that is why you got the earlier high preshot.
Here is a link to home testing. Are you giving Muffin a treat every time you test?
https://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/

Do you have a hypo kit set up with some honey and high carb food i. It. If it make sue you get it set up ASAP. If he drops low like he did again, rub honey on his gums and feed him some high carb food and test again 20 mins later.
Link to hypo information within this link
https://www.felinediabetes.com/FDMB/threads/new-how-you-can-help-us-help-you.216696/
Click to expand...

Thanks for all this info. The video on home testing difficult cats is really helpful.
 
Bron and Sheba (GA) said:
The glucose meter you use for your son is perfectly OK. Your vet was probably trying to compare it with a let meter which will give different readings.

We recommend using the human meter here and our dosing methods are based on the human meter.
The pet meter has only been around for a few years. Before that all vets used the human meters.. .

You will definitely need to reduce the dose of the insulin. It is most likely he dropped lower earlier and that is why you got the earlier high preshot.
Here is a link to home testing. Are you giving Muffin a treat every time you test?
https://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/

Do you have a hypo kit set up with some honey and high carb food i. It. If it make sue you get it set up ASAP. If he drops low like he did again, rub honey on his gums and feed him some high carb food and test again 20 mins later.
Link to hypo information within this link
https://www.felinediabetes.com/FDMB/threads/new-how-you-can-help-us-help-you.216696/
Click to expand...

The vet's meter is an AlphaTrak. What is a LET metre and how does it differ? I was using the vet's meter when I got today's readings.
 
Sarah Hartley said:
The vet's meter is an AlphaTrak. What is a LET metre and how does it differ? I was using the vet's meter when I got today's readings.
Click to expand...
I don’t know what a LET meter is....oh I have just seen I wrote let meter instead of let meter. It was a typo sorry. I will correct it.
The difference between a pet meter and a human meter is that the pet meter reads a bit higher so you can’t compare them. They are both right but can’t be compared, if that makes sense.
We know that under 3.7 (68 in US numbers) is when you need to give high carb food to bring the numbers higher. And always test again in 20 minutes if you get low numbers.
With a human meter the number you need to give high carb food to up is under 2.8 (50)

If the reading of 2.2 was on the alphatrak meter that is extremely low. It’s a wonder Muffin didn’t have hypo symptoms.
Are you able to test before giving any more insulin?I wouldn’t give any more insulin unless I was testing him closely.
You need to test first, then feed, then give the insulin in that order.
I think before we can recommend a dose, we really need to see what the AMPS .....am preshot BG is.
Are you able to post that in the morning and ask for help. I probably won’t be here but I can ask a couple of others to keep an eye out for you.
I think you will need to reduce to at least 1/2 unit but we need to see blood glucose numbers first.
Have you taken any more tests this evening.?
He will probably bounce really high again but that doesn’t mean he needs more insulin.

Also were ketones mentioned at all at diagnosis?
If you are skipping doses it is a good idea to test the urine for ketones.
You will need a bottle of Ketostix from the pharmacy, collect a urine sample and dip a test strip into the urine and read the result exactly15 seconds later against the colours on the side of the bottle. Tell the vet if there is more than a trace of ketones. If there is a trace you will need to keep monitoring closely.
Can you tell me what time you will be testing the BG in the morning in preparation to give the insulin please?
 
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Hi. I didn't give any insulin last night and didn't manage to get another bg reading as muffin has been hiding under the bed all night.

Thank you for the advice on the order in which to do things.

I will take a reading this morning at 8.30am NZ time before feeding. That's in about an hour and a half. And I will post the reading on here and wait for advice before giving insulin.

Thanks heaps.
 
Hi. I didn't give any insulin last night and didn't manage to get another bg reading as muffin has been hiding under the bed all night.

Thank you for the advice on the order in which to do things.

I will take a reading this morning at 8.30am NZ time before feeding. That's in about an hour and a half. And I will post the reading on here and wait for advice before giving insulin.

Thanks heaps.
 
Bron and Sheba (GA) said:
I don’t know what a LET meter is....oh I have just seen I wrote let meter instead of let meter. It was a typo sorry. I will correct it.
The difference between a pet meter and a human meter is that the pet meter reads a bit higher so you can’t compare them. They are both right but can’t be compared, if that makes sense.
We know that under 3.7 (68 in US numbers) is when you need to give high carb food to bring the numbers higher. And always test again in 20 minutes if you get low numbers.
With a human meter the number you need to give high carb food to up is under 2.8 (50)

If the reading of 2.2 was on the alphatrak meter that is extremely low. It’s a wonder Muffin didn’t have hypo symptoms.
Are you able to test before giving any more insulin?I wouldn’t give any more insulin unless I was testing him closely.
You need to test first, then feed, then give the insulin in that order.
I think before we can recommend a dose, we really need to see what the AMPS .....am preshot BG is.
Are you able to post that in the morning and ask for help. I probably won’t be here but I can ask a couple of others to keep an eye out for you.
I think you will need to reduce to at least 1/2 unit but we need to see blood glucose numbers first.
Have you taken any more tests this evening.?
He will probably bounce really high again but that doesn’t mean he needs more insulin.

Also were ketones mentioned at all at diagnosis?
If you are skipping doses it is a good idea to test the urine for ketones.
You will need a bottle of Ketostix from the pharmacy, collect a urine sample and dip a test strip into the urine and read the result exactly15 seconds later against the colours on the side of the bottle. Tell the vet if there is more than a trace of ketones. If there is a trace you will need to keep monitoring closely.
Can you tell me what time you will be testing the BG in the morning in preparation to give the insulin please?
Click to expand...

The vet tested Muffin's urine for ketones yesterday (when muffin had her hypo) and at the time of diagnosis and on both occasions there were no ketones. Muffin won't use a litter tray so it will be difficult to get a urine sample at home. I do however have ketone strips for use in my son's human glucometer. So I can try and get a ketone reading after the glucose reading. Does anyone know if the human ketone blood strips work for cats?
 
Bron has given you excellent advice, please do post the preshot number so we can be sure it is safe to give insulin. Seeing such low numbers on AT2 would make me extra cautious. Yes, the human ketone strips work just fine for cats. Sorry to hear Muffin has been hiding.
 
Christie & Maverick said:
Bron has given you excellent advice, please do post the preshot number so we can be sure it is safe to give insulin. Seeing such low numbers on AT2 would make me extra cautious. Yes, the human ketone strips work just fine for cats. Sorry to hear Muffin has been hiding.
Click to expand...

Just done the PSBG and it was 30.1
 
Is it possible to set up a spreadsheet? Do you need help? I use US numbers but know enough to know that is high enough to shoot. I would shoot the .5 Bron suggested. Please add your ca’s name to the title and change PMBG to PMPS.
 
If not a +1 then try for +2. Are you giving a treat after you poke him? Freeze dried 100% protein treats are loved by most and many learn to come running for a test to get the treats.
 
Yes, giving treats every time. But she's gone from loving them to running and hiding the second she hears me pick up the bag. Haven't tried freeze dried protein treats yet. Will buy some today.
 
How are you going with everything Sarah. Did you manage to get the spreadsheet working?
I will tag @Bandit's Mom to come by and help if needed as we need to get it up and running so we can see the data.
Have you managed to get any more tests in yet?
 
Hi. I'm just setting up the spreadsheet now. I've managed the following readings today:
8.30am 30.1 gave 0.5units lantus (eyeballed the half unit measure)
10.30am 28.2
1.30pm 23.2
4.30pm 20.1
6.30pm unsuccesful
8.30pm 16.2 gave 0.5units lantus (eyeballed the half unit measure).

I am conscious of the fact that the bg has been on a slow, steady downward trajectory all day. So am expecting the trajectory to continue throughout the night, so with this in mind, (given that Muffin grazes on her food all day and all night) I've added a dozen biscuits to her wet food tonight.

Muffin still hates me for doing her readings and injecting the insulin, and refuses any treats, freeze dried protein, even temptations!. But I've found if I put her bowl of food (from that morning that she's been grazing on consistently), under the bed (which is where she runs as soon as the ordeal is over), she's been eating some straight after each test. And although she's still really pissed, she seems to be EXPECTING the food now each time, so I am hopeful that this maybe a small step in the right direction.

If it turns out that 0.5units is still too high, but no insulin at all is not sufficient, what are my options? Is it to give 0.5units and increase her carb consumption slightly?
 
Hi. Spreadsheet has been successfully setup. I am going to setup 2. One for when I've got the Vet's Alphatrak (which she has currently lent me) and another for inbetween times when I will be using my son's Caresens human meter.
 
There are a few doses below 0.5 if needed. 0.25, 0.2 and a drop.
I think you will drive yourself crazy if you use 2 meters and 2 spreadsheets
It is hard to see trends if you are chopping and changing from one meter and SS to the other.

It looks as if Muffin could be coming off the bounce so be vigilant and test in case he drops low.
If you see him dropping low, feed him to slow any drop and if he drops under 100 please post and tell us.
If he drops under 68 on the alphatrak meter, you need to feed him high carb and / or honey to bring him up higher and test again 20 minutes later to see he is on the wat back up. And keep testing.
68 is the take action number ion the alphatrak meter.

Well done getting the SS up and running with data!
 
What do you mean when you say "it looks as if muffin could be coming off the bounce"? Are you thinking she's dropped low today between readings?

Also, how do you measure 0.25units? My syringe is in 1 unit increments and it's pretty tricky doing 0.5units. I'm not even sure I'm getting the 0.5 particularly accurate.
 
Sarah Hartley said:
What do you mean when you say "it looks as if muffin could be coming off the bounce"? Are you thinking she's dropped low today between readings?

Also, how do you measure 0.25units? My syringe is in 1 unit increments and it's pretty tricky doing 0.5units. I'm not even sure I'm getting the 0.5 particularly accurate.
Click to expand...
When I say she could be coming off the bounce I mean she could be going to drop lower as the hours go by over the next cycle or maybe a bit longer. I don’t mean she is dropping low in-between the tests. It doesn’t happen like that.

We can show you hap the measure smaller doses. It can be done so don’t be concerned.
 
Bron and Sheba (GA) said:
When I say she could be coming off the bounce I mean she could be going to drop lower as the hours go by over the next cycle or maybe a bit longer. I don’t mean she is dropping low in-between the tests. It doesn’t happen like that.

We can show you hap the measure smaller doses. It can be done so don’t be concerned.
Click to expand...


So we woke up at 7am and took Muffin's reading, it was 12.6. Now I've been finding it to be a 2 person job (muffin being as feisty as she is) and my husband is at work all day today and overnight (won't be home til tomorrow), so this morning's reading is the only reading I think I'll be able to get.

Last night, because Muffin's BG steadily declined all day with 0.5units of Lantus, when I gave her the evening 0.5units I decided to put a dozen temptations in with her fancy feast wet food. Now, this morning's reading is 12.6, so not a drop to the extent seen during the day yesterday, but still a drop. The diabetes nurses and doctors when I take my son to 3 monthly diabetic clinic (he's a type 1 diabetic) always advise us that if you've got your Lantus dosing correct, you should wake up with the same glucose reading that you went to bed on. If the BG in the morning is always significantly lower than the night before, then you've got the dose too high. I take it, this same logic applies to cats? With all this in mind, and especially since I've got no-one here today to help me do the BG readings, do you think I should lower the dose to 0.25 units? And if so, have you got any advise on techniques for measuring such a small amount with 1 unit increment syringes? I've been reading the post on fine dosing using a 0.5unit increment syringe, and I think it makes sense, although I've been finding it tricky to move the plunger in the syringe such a small amount, as the plunger tends to slip and move too much when I try...grrr!

Thanks heaps for all the advice, you guys are amazing :)
 
Sarah Hartley said:
So we woke up at 7am and took Muffin's reading, it was 12.6. Now I've been finding it to be a 2 person job (muffin being as feisty as she is) and my husband is at work all day today and overnight (won't be home til tomorrow), so this morning's reading is the only reading I think I'll be able to get.

Last night, because Muffin's BG steadily declined all day with 0.5units of Lantus, when I gave her the evening 0.5units I decided to put a dozen temptations in with her fancy feast wet food. Now, this morning's reading is 12.6, so not a drop to the extent seen during the day yesterday, but still a drop. The diabetes nurses and doctors when I take my son to 3 monthly diabetic clinic (he's a type 1 diabetic) always advise us that if you've got your Lantus dosing correct, you should wake up with the same glucose reading that you went to bed on. If the BG in the morning is always significantly lower than the night before, then you've got the dose too high. I take it, this same logic applies to cats? With all this in mind, and especially since I've got no-one here today to help me do the BG readings, do you think I should lower the dose to 0.25 units? And if so, have you got any advise on techniques for measuring such a small amount with 1 unit increment syringes? I've been reading the post on fine dosing using a 0.5unit increment syringe, and I think it makes sense, although I've been finding it tricky to move the plunger in the syringe such a small amount, as the plunger tends to slip and move too much when I try...grrr!

Thanks heaps for all the advice, you guys are amazing :)
Click to expand...
Hi Sarah,
Sorry no one got back to you sooner.
What the doctors say about humans doesn’t really mean the same thing with cats.
Lantus dosing is based on the nadir not the preshot. We look at the preshot BG to see it is safe to give the dose but we look at the nadir to decide the dose.
What Muffin is doing is bouncing after that very low number of 40 on the alphatrak meter.
Bouncing happens when a cat drops to low, too fast or lower than they are used to. The cats body panics and thinks it has to save itself and dumps stored glucose and regulatory hormones into the system which sends the BGs high.
Bouncing can last from 1 to 6 cycles. This is what you are seeing now.
It is a shame you didn’t test at least once during the pm cycle last night to see what is happening.
He could be coming off the bounce now and that is why you are seeing a lower am preshot.
I would not have reduced the dose. I would have stayed with the same dose,but seeing you had no advice you did what you thought was best.
Regarding testing........have you tried kneeling behind him, with him between your knees and you sitting on your heels.
That has him tucked in but not held. Just put a hand on his chest to steady him.
Have all the testing stuff ready and give him something low carb to eat and try testing as he eats. That may help
It is a shame you can’t get any tests in during the am cycle as he could be dropping.
 
Bron and Sheba (GA) said:
Hi Sarah,
Sorry no one got back to you sooner.
What the doctors say about humans doesn’t really mean the same thing with cats.
Lantus dosing is based on the nadir not the preshot. We look at the preshot BG to see it is safe to give the dose but we look at the nadir to decide the dose.
What Muffin is doing is bouncing after that very low number of 40 on the alphatrak meter.
Bouncing happens when a cat drops to low, too fast or lower than they are used to. The cats body panics and thinks it has to save itself and dumps stored glucose and regulatory hormones into the system which sends the BGs high.
Bouncing can last from 1 to 6 cycles. This is what you are seeing now.
It is a shame you didn’t test at least once during the pm cycle last night to see what is happening.
He could be coming off the bounce now and that is why you are seeing a lower am preshot.
I would not have reduced the dose. I would have stayed with the same dose,but seeing you had no advice you did what you thought was best.
Regarding testing........have you tried kneeling behind him, with him between your knees and you sitting on your heels.
That has him tucked in but not held. Just put a hand on his chest to steady him.
Have all the testing stuff ready and give him something low carb to eat and try testing as he eats. That may help
It is a shame you can’t get any tests in during the am cycle as he could be dropping.
Click to expand...

Hi Bron.

I got one :) It was 9.2 (166). She wouldn't take my treats, but I gave a few to her under the bed as soon as we were done, which she ate. They're not very healthy treats though, they're Temptations (they're high carb (35%), but per treat, it's negligable. I gave her 3, which weigh 2g altogether, which equates to 0.7g of carbohydrate). I bought some freeze dried protein treats yesterday in a couple of different flavours, but she just looks at them and walks away. I tried putting them in her food as well, just to see if she would eat them at a time when I'm not bothering her, but she still ignored them (She's a stubborn one)
 
WELL DONE getting that test!
She is on the way down off the bounce so I would keep testing if you can. Maybe in a couple of hours
Have you given her any food? If not, I would offer her a snack to slow down any drop. Ordinary low carb food.
 
Hi Bron

I just tried to get another reading but it was a failed mission. I just couldn't seem to get her ear to bleed. I warmed it with the rice sock, and ended up pricking 4 times (on the edge right next to the vein) but for some reason it just wouldn't bleed. Poor old Muffin had well and truly had enough by the fourth prick :-(

I will give it an hour an try again.
 
Sarah Hartley said:
Hi Bron

I just tried to get another reading but it was a failed mission. I just couldn't seem to get her ear to bleed. I warmed it with the rice sock, and ended up pricking 4 times (on the edge right next to the vein) but for some reason it just wouldn't bleed. Poor old Muffin had well and truly had enough by the fourth prick :-(

I will give it an hour an try again.
Click to expand...
Good try. It will get easier. I wasn’t always successful in the beginning......most people aren’t.
 
Sarah Hartley said:
Hi Bron

Managed to get a reading this time. 19.8 (356).

What do you think that means? Keep the evening dose at 0.25 or go back to 0.5?
Click to expand...
Well done getting another reading!! Progress!!
She could be bouncing again from the blue BG or maybe not enough insulin.
I would go back to the 0.5 dose and stay there unless Muffin drops low. Have you had a look and decided if you want to follow the ‘tight regulation’ or the ‘start low go slow’ method? It will make a difference as to when you need to reduce and how often you can increase. If you are feeding any dry food you can’t do the TR.

Could you also do your signature please so we can see all Muffins details without having to scroll back all the time...thanks.

Dosing methods https://www.felinediabetes.com/FDMB...-low-go-slow-slgs-tight-regulation-tr.210110/

How to do a signature is within this linkhttps://www.felinediabetes.com/FDMB/threads/new-how-you-can-help-us-help-you.216696/
 
Bron and Sheba (GA) said:
Well done getting another reading!! Progress!!
She could be bouncing again from the blue BG or maybe not enough insulin.
I would go back to the 0.5 dose and stay there unless Muffin drops low. Have you had a look and decided if you want to follow the ‘tight regulation’ or the ‘start low go slow’ method? It will make a difference as to when you need to reduce and how often you can increase. If you are feeding any dry food you can’t do the TR.

Could you also do your signature please so we can see all Muffins details without having to scroll back all the time...thanks.

Dosing methods https://www.felinediabetes.com/FDMB...-low-go-slow-slgs-tight-regulation-tr.210110/

How to do a signature is within this linkhttps://www.felinediabetes.com/FDMB/threads/new-how-you-can-help-us-help-you.216696/
Click to expand...

Thanks Bron. I will give 0.5units tonight and try and get more regular readings tomorrow.
I've done my signature properly now too. As for choosing between TR and SLGS I think SLGS sounds like a good option for us.
 
Sarah Hartley said:
Thanks Bron. I will give 0.5units tonight and try and get more regular readings tomorrow.
I've done my signature properly now too. As for choosing between TR and SLGS I think SLGS sounds like a good option for us.
Click to expand...
Thanks for setting up the signature. That is very helpful as we always look at the signature and the SS when we help you.
So with the SLGS method you reduce the dose if Muffin falls under 90.
You hold the dose for 7 days and do a curve before increasing the dose if needed. try and always get a before bed test in as the pm cycle is just as important as the am cycle and cats often drop lower at night. If the before bed test is lower than the preshot, that is your warning that the cycle could be an active one and the BGs could drop lower. So if that happens set the alarm and get up a few hours later to check the BG
 
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