05/05 Lucy AMPS 283, +5 34 then 52 then 70! 1st day on insulin

Susan and Lucy

Susan and Lucy

Member Since 2021
Lucy was diagnosed almost 4 weeks ago for her annual blood tests, but vet couldn't fit her until this week for an actual physical where I learned how to inject insulin. In the 3 weeks between Dx and vet appt, I changed her food from dry kibble to wet low carb. I started testing with ReliOn meter 2x daily at meal times. I noticed that
1. her blood test numbers were definitely trending lower than at her 584 diagnosis (spreadsheet below).
2. She had previously losing a lot of weight, but she regained 9 ounces in this 3 weeks
3. Her water consumption went from 16-20 oz per day to about 9 oz. She currently weighs 7 lbs 13.5 oz and is 16.5 yrs old.

I thought she was getting better.

I created a spreadsheet in the forum, but didn't use it as she wasn't on insulin yet. I kept a separate spreadsheet however and tested her at each of her two daily meals of canned Friskies pate.

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I received the Lantus insulin yesterday and since my vet was uncomfortable with me home testing with a human meter when he uses the Alphatrak, I ordered an Alphatrak which hasn't arrived yet. In the meantime, I continue to use the ReliOn.

This morning, Lucy couldn't walk. She was falling with every step. She can't get into the litter box by herself and when I lifted her in there and held her up, she peed like mad! The poor thing was just holding it! I called the vet to talk about the neuropathy. She also wasn't eating or drinking this morning. Her morning glucose was 283. The vet told me to dose her immediately with 1U of Lantus at 11:18am, which I did. I have filled in the forum spreadsheet ever since then and have tested her every hour. But the last test came back as 34! Before panicking, I tested again a few minutes later and got 52 and then a few minutes later I got 70. Is that because it's moving back up? Or are the test strips just that inconsistent and do I need to give her honey or gravy or something anyway?

I'm sorry for my newbie questions, but this first day of insulin in a roller coaster!
-- Susan
 

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Hi Susan, welcome! That's quite a drop! I can't give dosing advice but I'll tag a couple of people who might be around to assist there. @Wendy&Neko @tiffmaxee @Chris & China (GA) It's good that she's coming back up a bit but I would continue to test every 20-30 min until she's in safer numbers. Do you have honey or high carb wet food on hand if you need it?
 
Good job getting started on the spreadsheet, home testing and switching to wet food. That's made a huge difference. As a result, that 1 unit of insulin was waaay too much insulin. Can you tell me what type of syringes you are using? Did the vet show you how to measure the 1 unit?
 
Also, when you get a minute could you update the spreadsheet with the current numbers? The most recent one I see is the 34. (Long-term you could consider adding in your older data as well, just so you have it all in one place. But that's definitely lower priority right now.) When was the last time she was tested?
 
Good to know on the syringes - we've had the odd person dispense 10 instead of 1 unit, so I like to double check that.
 
Yes, she has eaten a Fancy Feast pate and some bites of a Friskies pate (I was trying anything to tempt her). That was about 4 hours ago though.
 
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How about a couple tsps of that gravy food, and test again in 30 minutes. She's safe, but just barely.
 
Lisa, how do you enter multiple tests on the spreadsheet if they are in between the hours. I tested 3 three times in a row at +5 because the first one was 34 and I wanted to make sure that it was accurate.
 
You can just enter it all in the same cell, noting the times (for example, in the +5 cell: "34; 53@5.5; 70@5.75"). You then have to manually do the color coding, but that's not a big deal. Check out Oberon's SS for some examples today.
 
Wendy&Neko said:
How about a couple tsps of that gravy food, and test again in 30 minutes. She's safe, but just barely.
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She wouldn't touch the gravy food so I tapped her mouth lightly with a tiny bit of honey on my finger. This is stressful! And she's been tested about 10 times today so she doesn't trust me much at the moment. She's avoiding me as much as she can.
 
I tested her again at +6.5. She is now at 49. I gave her a tiny bit more honey on her mouth and will test her again in at +7. She is supposed to have another insulin dose (1 unit) tonight at 11:00pm Pacific time. (Her first dose was at 11am when she was stumbling around and unable to walk). I'm really nervous about giving her ANY insulin tonight. Can I wait until I talk to her vet in the morning?
 
See what Wendy advises, but if it were me I think I would skip. 1 U is clearly too much, and right now I think we need to focus on keeping her safe overnight while this dose washes out. That's exactly what I did when Oberon got his first dose- he dropped a lot, so I skipped the next dose, and we started over with a lower dose.
 
Lisa & Oberon said:
See what Wendy advises, but if it were me I think I would skip. 1 U is clearly too much, and right now I think we need to focus on keeping her safe overnight while this dose washes out. That's exactly what I did when Oberon got his first dose- he dropped a lot, so I skipped the next dose, and we started over with a lower dose.
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Thank you so much Lisa. I am emotionally exhausted and distraught over this day. I'm very data-driven. I love spreadsheets more than chocolate. I keep daily Excel spreadsheets of my own glucose and ketones (I'm not diabetic, but eat Low carb so I pay attention), blood pressure results, lab tests across the years so I can see trends. BUT the constant hurting of my cat for over a dozen times today where she is screaming at me and avoiding me when not testing, is really hard. She's normally a cuddle bug. I know I'm new at this, but I'm overwhelmed. Thank you for your help. I can't begin to say how much I appreciate you and the other volunteers here.

I just tested her +7 is 53. She won't eat or drink anything right now. It might be because she is so agitated. Or perhaps it's just because she doesn't feel good. I put honey on her mouth twice already. Maybe I was too tentative and didn't give her enough? I just touched her mouth so she would like it off of her own mouth.
 
It's really tough, especially when you're just getting started. It does get easier as you get more experience. If you're able to give some sort of reward along with the blood testing, that will help over time. (Oberon's favorite right now is actually just watching the Cornell FeederWatch livestream! Keeps him occupied while I poke him.)

Right now, though, let's focus on getting through today. If she isn't interested in the gravy, would she eat some of the pate with some honey on it? If not, then definitely get some more onto her gums. She's still in the safe zone, but at the lower end. Lantus nadir is usually around +6 or so, so with luck we're past the low point, but I'll be happier if we can get her up some more.
 
Lisa & Oberon said:
It's really tough, especially when you're just getting started. It does get easier as you get more experience. If you're able to give some sort of reward along with the blood testing, that will help over time. (Oberon's favorite right now is actually just watching the Cornell FeederWatch livestream! Keeps him occupied while I poke him.)

Right now, though, let's focus on getting through today. If she isn't interested in the gravy, would she eat some of the pate with some honey on it? If not, then definitely get some more onto her gums. She's still in the safe zone, but at the lower end. Lantus nadir is usually around +6 or so, so with luck we're past the low point, but I'll be happier if we can get her up some more.
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My husband just went to get some more test strips and some other varieties of gravy food just in case that will help. I tried the honey again for a 3rd time and she fought me so much that now both of us are all sticky. Ugh. I would laugh under other circumstances. I'm really glad to hear that Lantus nadir might be past us now. I hope so. I will test a few more times in the next couple of hours and then I think I need to leave her alone for the night if she isn't below 50 at that point. I am understanding this process more now - thank you for your kindness and patience.
P.S. Oberon is a little love. What a beautiful baby you have. I will have to get a photo of Lucy up. She's a brown tabby.
 
Hang in there Susan - you are not the first to be overwhelmed (we alllll have been) and you are doing amazing home testing and helping Lucy :bighug::bighug::bighug: So many of us (me included!) came home from the vet and just injected insulin without any testing - so you are way ahead of the game in that respect. And, I promise Lucy will forgive you for today and you all will figure out a groove (and dose!).

Speaking of dose, I'm sure Wendy will swing back by or @tiffmaxee is also west coast and may be online later.

BTW, if you skip tonight, you can not only rest and give yourself and Lucy a break but you can also adjust your shot time if you wanted; a lot of us try to shoot at a time where we can get a "before bed" test (so PMPS +2 or +3). Perhaps your current time works for you but if not then a skip is a great way to reset your shot schedule.

Hang in there :bighug::bighug::bighug:
 
Susan Smith said:
My husband just went to get some more test strips and some other varieties of gravy food just in case that will help. I tried the honey again for a 3rd time and she fought me so much that now both of us are all sticky. Ugh. I would laugh under other circumstances. I'm really glad to hear that Lantus nadir might be past us now. I hope so. I will test a few more times in the next couple of hours and then I think I need to leave her alone for the night if she isn't below 50 at that point. I am understanding this process more now - thank you for your kindness and patience.
P.S. Oberon is a little love. What a beautiful baby you have. I will have to get a photo of Lucy up. She's a brown tabby.
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Oh, ugh. Hopefully you'll look back and laugh later, but I completely understand... I've been at the "frustrated to the point of tears" point at times. If you can get a few more tests that would be good; I'd love to see her up over 100 or so. Once things settle down a little, we can help you with advice about testing strategies and stuff that will make it go easier on both of you. Suzanne just made a good point about using this as an opportunity to adjust your shot time if you want to.

Oberon looks like a sweetheart, but he's a total jerk. But also a Very Good Boy; he actually jumps right onto the table for testing now. Oh, and I'm also a spreadsheet geek... when you have some downtime check out the various tabs on Oberon's SS. I graph the heck out of everything.

I'll be around for a while longer this evening; I'm on the east coast, but it looks like Oberon may be keeping me up late. Hang in there!
 
Hi. What an introduction to giving insulin! Do you think she didn’t like the gravy food or is just full? Lucy is being stubborn about coming back up. Honey doesn’t last long so it will be better if she will eat. Will she eat the pate with a little honey mixed in it?

I would skip insulin tonight and in the morning give her .50. It’s usually a .25 reduction but she went so low on one shot and I think the diet change has made a big difference in the starting dose. Don’t be surprised if she’s real high tonight or tomorrow. Cats bounce high when the bg goes low and it can take up to 6 cycles (3 days) to clear. You will still stick with the .50 even if she shows up high. Once the bounce clears her dose might need to be adjusted. Does this make sense?
 
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Something else to be aware of: very often after dropping low, cats will "overcompensate" and bounce very high for a day or so. So don't be alarmed if Lucy hits some very high numbers tomorrow. Her body wasn't used to these low numbers!

ETA: OK, I didn't read Elise's post closely enough... she already covered this!
 
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What an introduction to the forum! Now that the dust has settled, I'd still like to see what you consider to be 1u on your syringe. It is quite small, this post has a pic of insulin syringes, https://www.felinediabetes.com/FDMB...info-proper-handling-drawing-fine-dosing.151/

I understand you had been guided at the vet's but I have also seen in recent history someone guided by the vet's office give the wrong dose on the correct syringes. It is possible to have such a dramatic reaction to the first dose, but I haven't seen that many. Most have been incorrect doses. Just my 2 cents. I'd suggest skipping tonight.
 
The most recent number on the spreadsheet is the 53 at +7... have you been able to get another check done? I'm hoping she's starting to come back up now.
 
tiffmaxee said:
Hi. What an introduction to giving insulin! Do you think she didn’t like the gravy food or is just full? Lucy is being stubborn about coming back up. Honey doesn’t last long so it will be better if she will eat. Will she eat the pate with a little honey mixed in it?
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Sorry for the delayed response. It was crazy town around here. I got Lucy tested for +8 and she's at 70 now! She ate a little bit of her pate food (no honey). So at least she's eating now. But we got some new varieties of gravy food that she might like in case this happens again. Another victory: She even used the makeshift litter box I made today. Since her neuropathy was pretty bad today, she couldn't climb over the edge of her regular box. So I took a cardboard box and cut it way down in the front with a trash bag taped around it as a liner. I will buy a permanent low-access litter box, but I had to be creative in the meantime.

Question: do I have to keep testing her for the rest of the night, or now that she's at 70 and apparently on the way back up, can we hold off testing til the morning? (It's 8:22pm Pacific time right now.) Thank you!
 
Oh good! Really glad she's eating and on the way up. I think I would try to get at least one more test in an hour or so if you can. We want to make sure this isn't just a food bump that's going to wear off.
 
Christie & Maverick said:
What an introduction to the forum! Now that the dust has settled, I'd still like to see what you consider to be 1u on your syringe. It is quite small, this post has a pic of insulin syringes, https://www.felinediabetes.com/FDMB...info-proper-handling-drawing-fine-dosing.151/

I understand you had been guided at the vet's but I have also seen in recent history someone guided by the vet's office give the wrong dose on the correct syringes. It is possible to have such a dramatic reaction to the first dose, but I haven't seen that many. Most have been incorrect doses. Just my 2 cents. I'd suggest skipping tonight.
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Lisa & Oberon said:
Oh good! Really glad she's eating and on the way up. I think I would try to get at least one more test in an hour or so if you can. We want to make sure this isn't just a food bump that's going to wear off.
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Okay. I'll do that.
 
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Christie & Maverick said:
What an introduction to the forum! Now that the dust has settled, I'd still like to see what you consider to be 1u on your syringe. It is quite small, this post has a pic of insulin syringes, https://www.felinediabetes.com/FDMB...info-proper-handling-drawing-fine-dosing.151/

I understand you had been guided at the vet's but I have also seen in recent history someone guided by the vet's office give the wrong dose on the correct syringes. It is possible to have such a dramatic reaction to the first dose, but I haven't seen that many. Most have been incorrect doses. Just my 2 cents. I'd suggest skipping tonight.
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The syringes that I have are U100 syringes. They clearly say 10,15,20 on them and in the area between the top line and the "10", there are 10 lines. I used the very first line after the top line.

In this photo, I believe the plunger to be at the 2 unit line. I used the line ABOVE the 2 unit line.
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Susan Smith said:
The syringes that I have are U100 syringes. They clearly say 10,15,20 on them and in the area between the top line and the "10", there are 10 lines. I used the very first line after the top line.

In this photo, I believe the plunger to be at the 2 unit line. I used the line ABOVE the 2 unit line.View attachment 60799

View attachment 60799
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Yep, that's correct. So she just responded really dramatically to this dose.

By the way, has anyone discussed using Zobaline (a B12 supplement) to help with the neuropathy? Might be worth looking into. It's a tablet but you can crush it and sprinkle it on the food instead of giving it like a pill.
 
I’d just want to make sure she stays up without food for 2 hours and then you can let her eat a little and stop testing.

I am on the west coast as well. Since you are skipping tonight you can shoot at whatever time you want to be shot time. Shooting at 11 is kind of late. Think about what time would work best to shoot every 12 hours and also that you could test again 2 hours later and again around +4-7 if needed.
 
tiffmaxee said:
Hi. What an introduction to giving insulin! Do you think she didn’t like the gravy food or is just full? Lucy is being stubborn about coming back up. Honey doesn’t last long so it will be better if she will eat. Will she eat the pate with a little honey mixed in it?
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So far, she won't eat anything at all with or without honey. She is just too upset (I think) from all of the testing. My husband went to get some other varieties of gravy food to tempt her. If she doesn't eat that, I will try the honey and pate. The last time she ate anything was about 3.75 hours ago. She does most of her eating overnight, so maybe I will just sleep out on the couch and keep an eye on her.
tiffmaxee said:
Hi. What an introduction to giving insulin! Do you think she didn’t like the gravy food or is just full? Lucy is being stubborn about coming back up. Honey doesn’t last long so it will be better if she will eat. Will she eat the pate with a little honey mixed in it?

I would skip insulin tonight and in the morning give her .50. It’s usually a .25 reduction but she went so low on one shot and I think the diet change has made a big difference in the starting dose. Don’t be surprised if she’s real high tonight or tomorrow. Cats bounce high when the bg goes low and it can take up to 6 cycles (3 days) to clear. You will still stick with the .50 even if she shows up high. Once the bounce clears her dose might need to be adjusted. Does this make sense?
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Yes, thanks! I just got her last read of the night (+9). It was 108. Whew. I think I'll be able to sleep tonight.
 
So glad to see that blue in the spreadsheet! Yeah, I think you can both take a break for the rest of the night. Maybe give her treats and cuddles if she'll let you.

From the picture, it looks like your syringes are marked off in whole units, not half units, right? You'll have to eyeball a 0.5 U dose, but that's manageable for now.
 
Lisa & Oberon said:
So glad to see that blue in the spreadsheet! Yeah, I think you can both take a break for the rest of the night. Maybe give her treats and cuddles if she'll let you.

From the picture, it looks like your syringes are marked off in whole units, not half units, right? You'll have to eyeball a 0.5 U dose, but that's manageable for now.
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Yeah, the syringes are whole units only, but I'll make them work. Next time, I will order my syringes online with half units. The ones I have came from the vet. As for treats and cuddles...Lucy isn't much of a treat girl. Don't laugh (well, okay if you want to), but although she dislikes cat treats and any kind of people food, she IS highly motivated by butter and bacon grease. If I fry an egg, leaving the pan on the stove to cool, and walk out of the room, Lucy is up there (before the neuropathy anyway), licking the pan! I had to start putting lids on the pans that were cooling. LOL.
 
Susan Smith said:
Yeah, the syringes are whole units only, but I'll make them work. Next time, I will order my syringes online with half units. The ones I have came from the vet. As for treats and cuddles...Lucy isn't much of a treat girl. Don't laugh (well, okay if you want to), but although she dislikes cat treats and any kind of people food, she IS highly motivated by butter and bacon grease. If I fry an egg, leaving the pan on the stove to cool, and walk out of the room, Lucy is up there (before the neuropathy anyway), licking the pan! I had to start putting lids on the pans that were cooling. LOL.
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LOL! Oberon likes Pringles. Can't let him have them any more, of course. I had another cat once who loved the smell of Thin Mints. She'd literally try to stick her face in my mouth after I'd eaten them.
 
Oh Susan, what an ordeal by fire for you and Lucy. I am soooo impressed at how well you handled things today. You will not be the only one to sleep on the couch to keep an eye on their kitty! I hope you all get a good rest tonight and start again fresh tomorrow.
 
How is Lucy doing today? I saw that you posted a couple of BG numbers on her SS this morning. Any news since then?
 
Lisa & Oberon said:
Yep, that's correct. So she just responded really dramatically to this dose.

By the way, has anyone discussed using Zobaline (a B12 supplement) to help with the neuropathy? Might be worth looking into. It's a tablet but you can crush it and sprinkle it on the food instead of giving it like a pill.
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No one has discussed it, but I read it elsewhere on the forum, so I already ordered the Vitacost version (and folate too). Waiting for it to arrive.
Lisa & Oberon said:
How is Lucy doing today? I saw that you posted a couple of BG numbers on her SS this morning. Any news since then?
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Hi Lisa. How nice of you to follow up. Lucy had a rough day. She wasn't eating or drinking and she only drank about 2 oz of water in the past 24 hours. She seemed to be in some pain as she would bite me if I petted her in certain places (along her spine and sides).

I had a call into the vet at 8am to explain what happened last night with Lucy's hypo event after her very first dose of Lantus. Even though I called two more times, the vet didn't get back to me until 10 hours after my first call. I was pretty upset because I had been waiting to see if I should decrease the insulin dose for this morning. When the vet finally called back, he told me to stop insulin altogether and to use the Alphatrak and not the ReliOn meter from now on and test her twice a day - 4 hours after each meal. I guess he didn't hear me when I said that she wasn't eating or drinking today. He doesn't trust anything but a pet meter.

I asked about Methyl B12 since Lucy has severe neuropathy and can hardly walk (falling over constantly), but he said that the neuropathy would go away when the glucose was normal.

A short time ago, I WAS able to get her to take a few licks of Friskies Pate, which she generally likes (normally eating 2 cans per day), and about 1/2 oz of water. But I would hardly call that a meal so I don't know if I should test her 4 hours after that or not.

I don't feel very confident with that vet phone call. And earlier today, I thought that Lucy had stopped breathing for a bit, but it was my imagination. She is in slow motion now and very unengaged with her surroundings. I hope that she will eat and drink more over night but I'm very concerned about this issue. I slept on the couch last night to be near her, but it killed my back, so I'm going back to the bedroom tonight. It's possible that Lucy just feels awful. But how do I tell? Thanks for listening. I think I'm just venting my frustration and feelings of helplessness. I wish I could tell if this is the end for her or just something that has to be gotten under control. She is 16 but seemed so young and active until the diabetes diagnosis last month.
 
It sounds like she could be nauseous. You mentioned pain. I’m wondering if she has pancreatitis. If nauseous ondansetron, a human medication or cerenia, a vet med might help get her eating.
 
I'm so sorry that Lucy isn't feeling well, and that you had a bad experience with the vet. I know they're probably all swamped, but it's very frustrating when they don't reply quickly to an urgent matter. (I've had it happen.) And one common theme you'll hear on this board is that unfortunately many vets aren't especially knowledgable about feline diabetes. They have so many different things to know that it's hard for them to be an expert on any one of them. That's where the board really helps- the accumulated knowledge here is really impressive. I'm hoping some of the long-time members may be able to chime in and give you some good advice about ways you might proceed. [I see that Elise just posted while I was typing!]

So far as I know, it doesn't really matter much which meter you use so long as you're aware of the differences. Most of us here use human meters but some use the AlphaTrak because of vet preference or other reasons. I'd suggest that you continue to test periodically, maybe both before and after meals, so you can get a sense of what her BG is doing in the absence of insulin but on a low carb diet.

I think the methyl B12 will help with recovery from neuropathy (along with bringing BG down, of course). There certainly shouldn't be any harm in using it.
 
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tiffmaxee said:
It sounds like she could be nauseous. You mentioned pain. I’m wondering if she has pancreatitis. If nauseous ondansetron, a human medication or cerenia, a vet med might help get her eating.
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Thank you Elise. This gives me a direction to turn if things don't change soon. I appreciate it! In fact, I read up on pancreatitis after you mentioned it, and Lucy definitely has some of the symptoms. She even threw up several times over the past few days. I will follow up.
 
Oh Susan, I'm so sorry to hear of your day and the unresponsiveness of your vet. I think if it were me, and she wasn't showing any signs of improvement tomorrow, I would be getting an appointment tomorrow with the vet. I am far from an expert, but I've had some recent stressful times with Minnie in and out of the hospital and not eating when she came home so I am very sensitive to this! Also I am convinced that things always seem to take a turn on a Friday night when the vets are shut! But you know Lucy best.

Susan Smith said:
I wish I could tell if this is the end for her or just something that has to be gotten under control.
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I completely relate to this, I was feeling exactly the same last month. It surely doesn't help with the vet not being particularly responsive. I'm so sorry you're going through this. I hope Lucy is feeling better and eating in the morning. I can't believe Lucy is 16, she looks so young and perky in that photo!

:bighug::bighug::bighug:

PS I see you're on the west coast - whereabouts are you?
 
Liz & Minnie said:
Oh Susan, I'm so sorry to hear of your day and the unresponsiveness of your vet. I think if it were me, and she wasn't showing any signs of improvement tomorrow, I would be getting an appointment tomorrow with the vet. I am far from an expert, but I've had some recent stressful times with Minnie in and out of the hospital and not eating when she came home so I am very sensitive to this! Also I am convinced that things always seem to take a turn on a Friday night when the vets are shut! But you know Lucy best.


I completely relate to this, I was feeling exactly the same last month. It surely doesn't help with the vet not being particularly responsive. I'm so sorry you're going through this. I hope Lucy is feeling better and eating in the morning. I can't believe Lucy is 16, she looks so young and perky in that photo!

:bighug::bighug::bighug:

PS I see you're on the west coast - whereabouts are you?
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Hi Liz, I'm in Southern California.
 
Susan Smith said:
Hi Liz, I'm in Southern California.
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Maybe I saw that somewhere?! A bit too far for me to recommend a vet, in any case!

Though you remind me...I read someone post in the last day or two in California they had found a visiting vet who sounded great. @tiffmaxee might remember who it was, I think she asked for the name. Though I realize California is a pretty big place!!
 
Elise has a good point about pancreatitis; definitely worth getting that checked out. Even if that's not it, it really does sound like there's something going on besides the diabetes that should probably get checked sooner rather than later. As a backup plan, do you have access to an after hours/emergency/weekend vet?

I'm in NJ now, but lived in SoCal (Pasadena/Azusa/Van Nuys) for about 10 years while I was in grad school/postdoc. No vet contacts in the area, unfortunately, but maybe someone here will have some ideas!
 
Susan Smith said:
Thank you Elise. This gives me a direction to turn if things don't change soon. I appreciate it! In fact, I read up on pancreatitis after you mentioned it, and Lucy definitely has some of the symptoms. She even threw up several times over the past few days. I will follow up.
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I’d see if you vet will give you one of the two medications for nausea tomorrow if she’s not eating by morning as cats can get fatty liver pretty quickly if not eating. Pancreatitis is very common in cats and seems to occur a lot with diabetes in cats. Max had chronic pancreatitis for a few years before becoming diabetic. I hope things are much better in the morning.
 
I'm heading to bed in a minute, but I hope Lucy starts to feel better soon, and that you have better luck with vet care tomorrow! :bighug::bighug::bighug:
 
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