? Do you give Insulin when BG is unusually LOW for that time of day?

EddieRufus

EddieRufus

New Member
Hello everyone,

I hope someone can help me with this.

My name is Wendy and I'm new here. I’ve been reading this board for about two weeks. I joined right when my cat, Eddie, was diagnosed with diabetes. This is my first post. Although I know I’ll eventually get used to Eddie having diabetes, right now I sometimes find it scary, like with what happened a couple of hours ago. If I could please get some advice, I’d really appreciate it.

It's Sunday evening. All Veterinarian offices are closed.

I don’t know what to do.

Eddie: 10 year old male, neutered, slightly overweight black cat. Healthy except for newly diagnosed diabetes (two weeks ago).

Treatment: Twice a day (7:00 AM & 7:00 PM), ½ can Friskies Pate followed immediately by 1 unit of ProZinc Insulin.

The Veterinarian said to keep Eddie at 1 unit of Insulin for a couple of weeks, then she’d adjust the dose. We’re expecting to hear from the Vet tomorrow (Monday) about his Insulin dose.

We’ve done quite a few days of BG curves. I write all BG readings down and make charts, so I’m now familiar with his BG pattern.

Below are typical average BG readings for the afternoon (until midnight, then it starts to go back up):

4:00 PM: 23 mmol/L (414 mg/dL)
6:00 PM: 24 mmol/L (432 mg/dL)
8:00 PM: 22 mmol/L (396 mg/dL)
10:00 PM: 14 mmol/L (252 mg/dL)
12:00 AM: 12 mmol/L (216 mg/dL) 5 hours after Insulin was given at 7PM.
Midnight is always the lowest reading of the 24hr day, then starts to go back up.

WHAT HAPPENED TONIGHT: Tonight, I sensed something was “off”, so I took a reading at 7PM and it was only 12 mmol/L (216 mg/dL)!! What? His BG is usually HIGHEST at that time of day. He doesn’t usually get to 12 (216) until 5 hours after his Insulin shot at 7pm.

I didn’t know what to do. My husband wanted to give Eddie the Insulin but I said “no” because I was afraid he’d go hypoglycemic. If Insulin makes him drop from 24 (432) down to 12 (216), then what happens if he gets Insulin when his BG is already at his normal “LOW”? Does he go hypoglycemic?

I took his reading at 8:00PM and it was 18 (324).

I’ll test again at 10:00PM.

Question #1: Did I do the right thing by not giving Eddie the Insulin or did I somehow make things worse for him? I’m so nervous right now. I’ll probably be up with Eddie half the night because I feel so unsure about this.

Question #2: If Eddie’s Blood Glucose goes really high during the night, should I feed him and give Insulin or just let his BG keep climbing until his regular meal/shot at 7:00AM? I’m afraid it will go really high because he didn’t get his insulin at 7PM. How high is dangerous?

Any advice would help. I hope somebody reads this. I’m going to make coffee now (9:20pm) so I don’t fall asleep. I want to keep an eye on Eddie tonight. I hope I get used to all of this soon. I think this has been harder on me than the cat, haha.
 
Short answers (to be followed by longer explanations)

1. Any number over 200 is safe to shoot. If you get a number below that, we recommend stalling without feeding and posting here for help. Any time sensitive stuff should go in the Feline Health forum since there's more traffic.

2. Since you skipped you can technically give the shot any time you want. BUT remember it has to be 12 hours apart, so you would be very off schedule. You can only move shots back half an hour (so if you shoot 10p, you'd do 930a, then 9p, then 830a, etc over the next few days).

Remember the normal range is 90-150 ish, those attempting to get as regulated as possible actually aim for 50-100 but that can be difficult/too much for some caregivers.

At a dose of 1U it's unlikely the dose is too high, which is why I say 200 is safe to shoot ( we say that to all new members, provided we don't suspect too high a dose). Remember that insulin action isn't linear, nor does it work the same way every time- so no, just because it brought him down 200 pts does not mean it would take him down to zero (or hypoglycemic).

When you say a "few days" of BG curves how many exactly? Part of what you may be seeing is what we call bouncing - it's when the liver dumps stored glycogen into his bloodstream in response to BG dropping lower or faster than he's used to, and can take 2-3 days to clear and come back down. Its different for every cat - he may very well bounce from that 200 pt bounce. There are things you can do to help alleviate it, like feeding at strategic times, but in some cases it will need a change to a more gentle insulin like Lantus.

If you skip and choose not to give any more insulin, no need to stay up with him. He's not in danger of hypoglycemia since this mornings shot has worn off, and there's nothing to be done about high numbers. High numbers in and of themselves aren't immediately dangerous, but over time can lead to neuropathy (often very treatable with B12), or if combined with infection and inappetence can lead to ketones (which is why we recommend testing for ketones weekly, and more often if they're ill/inappetent)
 
Now some housekeeping items:

How much does he weigh? Does he only eat twice a day? Is he at ideal weight, or over/under?

Are you testing before every shot? Preshot tests should be fasting for 2 hrs, for consistency. So if shot is 7am, you would pull all food at 5am. Then test him 7a, then feed and give his shot.

When you speak the vet, know that here we recommend increases of 0.25U. Many vets like to increase by whole units and many times that's counterproductive.

A spreadsheet and signature would be immensely helpful for us, more info here: https://www.felinediabetes.com/FDMB/threads/new-how-you-can-help-us-help-you.216696/

Also, another option whenever you're too nervous to shoot - half doses or quarter doses are also an option. It is often better to give some insulin vs none, unless of course the preshot test is too low
 
Super! Thanks FrostD. I feel much better now.
One more thing: Eddie had blood test at the vet 2 weeks ago. Diagnosed diabetes. Started Insulin immediately. Stayed at the vet 3 days (on Insulin). We have no idea what his BG levels were BEFORE he started Insulin. What I was worried about was the possibility that tonight (not on Insulin) his BG might go higher than his highest ever reading (26 or 468) while actually taking Insulin. So, the Insulin wears off completely? That means that the highest he can go would be 26 (468)? I didn't know that. We've only been able to talk to the vet ONCE and we can't go into the office because of the pandemic. It has been crazy. We've been talking to the receptionist at the office but not the actual vet (other than the one time) so, I'm still in the dark about a lot of things. Thanks again for your help. Much appreciated. PS: We've done about 7 days of BG curves (at home). The numbers I posted are the averages.
 
I posted this message below by mistake. I'll re-post as "reply" to your message. Sorry, I don't know how to use this board yet.
Original message:
Super! Thanks FrostD. I feel much better now.
One more thing: Eddie had blood test at the vet 2 weeks ago. Diagnosed diabetes. Started Insulin immediately. Stayed at the vet 3 days (on Insulin). We have no idea what his BG levels were BEFORE he started Insulin. What I was worried about was the possibility that tonight (not on Insulin) his BG might go higher than his highest ever reading (26 or 468) while actually taking Insulin. So, the Insulin wears off completely? That means that the highest he can go would be 26 (468)? I didn't know that. We've only been able to talk to the vet ONCE and we can't go into the office because of the pandemic. It has been crazy. We've been talking to the receptionist at the office but not the actual vet (other than the one time) so, I'm still in the dark about a lot of things. Thanks again for your help. Much appreciated. PS: We've done about 7 days of BG curves (at home). The numbers I posted are the averages.
 
It's a little unusual for them to stay at the vet just for insulin...was there something else happening? Ketones?

Different insulina work differently. In the case of ProZinc, it's duration is usually a maximum of 14 hours...meaning yes after 14 hrs it's worn off. Many cats don't get that 14 hrs, more like 9-12 hrs. BUT no that doesn't mean 468 is as high as he can go. I've seen cats here 600+, or higher than the meter can read. But since he's low carb diet, low dose, and these are the numbers you're seeing, no I wouldn't expect anything much higher than what you've seen
 
He stayed at the vet because we didn't have a BG tester at home and he needed Insulin right away, so needed to be monitored. We had to order the tester from the vet's office and it took forever because of Xmas holidays (distributor was closed). It cost us almost $2000 CAD ($1,500 USD) at the vet for Eddie (including the BG tester, a bag of diabetic dry food that he hates, the 3 day stay, tests, Vet, etc). If we had a tester, we could have done it at home instead of him staying there which cost a lot of money $$$.

I had typed out a response to your previous questions before I saw your last post:

Weight taken Dec 23rd was 7.9 KG (17.4 lbs) but he has definitely lost weight since then.

I was testing one hour before 7AM feeding and one hour after (but not every day). I think I’ll test every single day now, right before giving the shot. The vet didn’t tell us to test him at all, except for when she wanted the 'curve' after two weeks (sigh) which we submitted 2 days ago.

Eddie has no food at all during the night.

Before diagnosis, we left out Iams Chicken DRY food 24hrs a day (very high carbs), then fed ½ can wet food (Friskies flakes w/gravy) once per day. Treats on demand. Snacks on demand. Clearly, at the time I didn’t know that what I was feeding him was bad for him.

We have another cat (Rufus) who last week also needed to see a vet because he stopped eating. We decided to switch Rufus to a different vet because we were left in the dark for so long about Eddie after diagnosis (couldn’t talk to the vet). Rufus was given antibiotics and a cream we put on his ear to INCREASE his appetite. So, we’re trying to get one cat to eat MORE and the other cat to eat LESS (restricted diet), which he’s not used to. It has been challenging.

Dry food is no longer left out, because of Eddie (although now there’s the problem with Rufus needing more food). Diet now for Eddie is ½ can Pate twice per day and couple Tablespoons of dry (as per vet) but I’m not giving him any dry because of the carbs. I make him cooked chicken and give him a couple Tbsp chopped. I feed Rufus whatever he wants right now because he needs to eat (I put Eddie in a different room).

10:00PM his BG was 21.1 (378). It’s usually around 14 (252) at that time. It's higher because he didn't get Insulin. It usually drops again at midnight. I’ll test again then. I feel better now knowing there won’t be an “emergency” in the middle of the night but I’ll still keep my eyes on him. I’ll take your advice about the Insulin. That was very good information. You've been VERY helpful and I really appreciate it.
 
Certainly! We're here to help.

For what it's worth ...that feels like a money grab from the vet. I can see no reason why he had to be admitted immediately unless he had something else like ketones going on. I'd hazard a guess that 90% of the people on this site had to wait a day or two (or more!) to even get the supplies. It took mine a week to come in.

Great job on switching foods and snacks, and ignoring the advice about the dry. That doesn't sound like enough food for him though... Cats need about 20 calories per lb per day, if he needs to lose weight there's a formula for it but I don't think it would be just one can - especially being unregulated, they often don't utilize food as well. My cat is about 13.5 lbs and he eats about 1.5-1.75 5.5oz cans of the Friskies a day. I free feed him, but most members here feed several small meals throughout the day - larger ones at shot time, then another 1-2 smaller snacks throughout. Lot of us use 5-slot autofeeders.

As for testing - we usually recommend the two preshots, plus one other test each cycle. ProZinc often doesn't onset til 2-3 hours after the shot, so testing an hour after the shot (we call it +1) honestly won't tell you too much. Same with testing an hour before the shot (+11) - the insulin is almost worn off by then. Those are good tests to get occasionally just to see how the duration is, but the more important tests are near onset (when it starts to kick in) and nadir (the lowest reading).

Based on the data you have he appears to onset at +2/+3, and nadir around +5/+6. Know that it won't always be the same every cycle, but often stays around that window. The +2/+3 can give you a clue how fast he might be dropping, so if you see a big drop it's usually wise to feed a little low carb food to help slow it down. We call that the "before bed" test, as it helps you know if you're safe to sleep, or if it might be wise to set an alarm to check him again.

You'll also want to get some in the +4 to +7 range when you can, as dose should be based on nadir. Since his number was lower than usual tonight I suspect he probably was in the low to mid 100s at some point today (still perfectly safe!). So if the vet recommends an increase I personally would be a little hesitant, at least based on what I see here. Is Eddie home alone all day?
 
I just printed out your reply. I'll put it in Eddie's new "binder" with his BG charts and have my husband read it tomorrow. I'll need to read it a few times to figure it out but I will for sure (100%). My brain isn't functioning correctly at this late hour (although I am drinking coffee, to stay awake).

I learned about not giving dry, even the diabetic stuff (that I believe is still high carbs compared to wet) from reading this forum. I've learned more from this forum than anywhere else on the Internet. I had no one to ask in person (other than one call from the vet), so finding this site has been so valuable.

I agree with you about the food! It's not enough!! Not nearly enough. I know that because he's diabetic and not on the correct Insulin dose, that his body can't use the food he eats. That's one question that we did ask the vet because poor Eddie seems REALLY hungry sometimes and it breaks my heart! The vet said that it's because Eddie "needs to lose weight". Well, occasionally I'd sneak him an extra 2 Tbsp of cooked chicken because he'd literally be trying to lick crumbs off of the kitchen floor and/or licking his empty cat dish. I made sure it was time of day when his BG was "lower" and/or close enough to his usual dinner/shot. I felt like I was doing something wrong but I couldn't let him suffer like that. I was afraid that I'd mess up his BG level though (this is all still 'new' to me). Eddie never, ever, "asks" for food. Rufus will meow and literally follow me around and harass me until he gets his food, he's relentless (until last week when he stopped eating). Rufus is very loud and demanding but Eddie will just sit there and suffer and not say anything. You're right and I'm going to start feeding him more! When the vet calls tomorrow (IF she calls), I'll tell her that I'm going to feed him more so to help me figure it out or I'll figure it out on my own. I just need to make sure that I do it correctly. I'll study your replies and check that cat weight loss website you mentioned. I certainly don't want to make Eddie sick so I'll be VERY careful.

Midnight reading was 22 (396), usually it's around 12 (216) (always his lowest reading of the day). Well, 22 is a lot lower than I was worried it would be at midnight. I'm relieved. Although, now is the time it starts going up again and BG is 'high' by 6AM. Well, off I go to get more coffee. I'm going to stay up and keep testing him, just for my own records, so I have an idea how his BG is when he's NOT on insulin (and to make sure he's okay). Before today, I had no way of knowing because we only ever tested after he started taking Insulin and he's never gone 14hrs for it to wear off completely (and until you told me, I didn't even know 14hrs was how long it took to wear off).

PS: To answer your question, I'm home all day with the cats. Eddie is never alone. :)
 
It is a lot of info and the kicker is that we can't speak to anyone in real life to get his treatment plan adjusted and/or or ask questions about Eddie's treatment plan (after giving them $2,000.00 for initial diagnosis which included ONE call from the vet an no follow up!).
Vent: We didn't hear from the vet today (as we were supposed to) so we called the office right before it closed. The vet wasn't in today (surprise!) and tomorrow she's in surgery so once again, we're left hanging. Again, we could only speak to the receptionist who told us that 3.5-10 (63-180) is "normal" and anything over 3.5, we should give Eddie the Insulin shot. I said so if his reading is 4.0 (72), you want me to give him Insulin? She said "yes". I said "wouldn't that kill him???" & she said that she had asked and that's what she was told to tell me about Eddie's Insulin. So, clearly she got things confused, right?? That can't possibly be correct, right? I'm actually doubting myself right now because it was so surreal! I said "thank you", then I hung up the phone and immediately called a DIFFERENT vet clinic (the one we brought Rufus to last week), gave them all of Eddie's info and Eddie has an appointment with an actual VETERINARIAN at the new clinic in two days. I'm so upset right now but a part of me wonders if I'm overreacting. Can you please tell me what you think about what I just wrote. PS: Yes, I heard her right, and so did my husband. It was surreal.
 
I'd be changing vet too ha

So, the short answer is 63 or 72 is safe to shoot - provided you have the data that supports that and the insulin dose has been fine tuned.

That is NOT the case with Eddie. You likely would kill him (trust me, morbidly I've handled my share of emergency hypos here - from people in your exact situation - that have ended tragically).

What we recommend is slowly lowering the value you shoot over time. I always bring up Hilary @Hshray here, hopefully she'll be around and pop in. George's spreadsheet is a perfect example of learning to shoot lower over time.

In a nutshell, what you do is when you get a preshot that is maybe 10-30 points lower than you've shot before + you can be around to monitor + have hypo kit, you shoot full dose and see what happens. Over time, yes this can (and hopefully does!) lead to shooting full doses in green numbers. But for some people that is just too uncomfortable, so they only ever shoot if above say 120 ish. Shooting greens regularly usually only happens with cats near remission, but is much much more common with cats on Lantus insulin

What you do in the meantime with the lower than usual preshots is try the reduced/token doses I mentioned yesterday. You don't quite have enough data yet for me to make any solid recommendations (gonna need a spreadsheet!) but it's usually 10-50% of your normal dose depending on the BG. Those also give good data and reinforce whether or not you can shoot full dose at lower numbers
 
You’re doing so well getting everything organized and asking all of the right questions! Nice job on getting the blood tests too..it took George and I quite a while to get that little routine down.
FrostD said:
What we recommend is slowly lowering the value you shoot over time. I always bring up Hilary @Hshray here, hopefully she'll be around and pop in. George's spreadsheet is a perfect example of learning to shoot lower over time.
Click to expand...
If you look at the 2021 tab on George’s spreadsheet, he was on Prozinc starting at the beginning of April. At first I didn’t shoot full doses in or under 200s, but you can see on my spreadsheet where I gradually started shooting full doses at lower and lower numbers once I knew how he was reacting to various doses. Early June is when I finally started to shoot lower consistently, and he started seeing much better numbers then.

You’re in great hands here…Melissa and the others who advise are sooo helpful. George and I wouldn’t be where we are today without them :)
 
Wow, FrostD! I knew there was a lot more for me to learn but what you just wrote, blew me away. They should offer an actual course on this stuff. At times it seems overwhelming but I will try to learn as much as possible.

The good news is that Eddie’s highest BG reading of the entire night (from 7PM last night to 6AM this morning) was 23.4 (423). So, you were correct and my initial fear that his BG might “skyrocket” to some absurdly high number, was for nothing. Now I know.

Today at 7am he got his food & AM shot and tonight at 7:00PM his BG was 23.1 (414), which is ‘normal’ for him at that time (he then got his PM shot). I still have no idea why it was only 12 (216) last night at 7pm (when I didn’t give him his shot because I didn’t know what to do). I stayed up tonight until midnight to check his BG and it’s 14.7 (263?). Good stuff! Back to his “normal” range for midnight (on 1 unit Insulin). Yay!

You know, reading some other posts about kitties who are quite sick with what seem very serious medical issues, and some need special procedures and huge amounts of Insulin. Yet, these kitties parents seem quite calm and level headed and are doing a great job dealing with serious issues. I wondered if maybe these people have some kind of super-power. I mean, my cat missed 1 unit of Insulin and I nearly lost my mind & literally stayed up all night checking his BG every two hours. You guys must think that I’m such a paranoid “newbie”, haha.

Have a good night and thanks again for everything. You’ve been so, so helpful.
 
Thank you so much, HShray! I’ll check it out tomorrow, for sure. Much appreciated! :) I'd read it now but my eyes are closing so I better get to bed. Have a good night!
 
Ah, not much gets me riled up, that's just a personality trait lol (do you see my signature? Never a dull moment with Mr Kitty)

It is all very normal, it's because you care. And for me probably the biggest "slap in the face" was learning that no, the vet is not the expert in all things...and in the case of my first vet could have easily killed my cat. It's a bit of a shocker, perhaps naive. I had asked all these questions with human diabetes in mind - should I change diet, test at home, etc when first diagnosed and was told no, only if you want to, doesn't really matter. It was only after months of issues did I dig deeper and find this site...and a new vet.

But also, this is why we do give vets some grace here - because if every caregiver to a diagnosed cat got hit with all this, not all of them would choose to take it on. Speaking with my own vet some immediately want to put them down or send to shelter, and that's just from having to give two shots a day...no diet change or home testing mentioned.
 
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