Date: 2/2. Cats name: TwoTwo. BG 438 at +3. Skipped AMPS b/c BG 225

[TabbyCatMom]

Hello everyone, we just started Lantus two days ago and it seems to have had a significant effect on TwoTwo's BG. She is also on <10% carb food. She was always "grain free" and was not a big dry food gal. So the diet changes (since 1/6/22) have not been too hige.

I have actually skipped her AMPS for the last two mornings but she was getting one unit every night of Lantus for the last two nights. When we wake up her blood glucose was either really low at 112 or just normal at 221 so I've been skipping it as per Vets suggestion.

My question is: I checked her BG at +3 today and her blood glucose was 438 on the alpha trax2 and 371 on the CVS glucometer because I was doing a comparison (I don't like the AlphaTrax strips - they don't such up the blood).

She has had, I believe, an E. coli infection since June 2021 and we are now on our third round of and antibiotic. I have a feeling the UTI/E. Coli has been making her blood glucose and creatinine levels wonky. We only now took a urine culture and found out that it's E. coli so we are on Veraflox for a two week course.

I would like to follow the "go slow" protocol but I'm so inexperienced and taking a blood sample really stresses out Two-Two. So I'm wondering if anyone has any tips. Should I just give her .25 or .50 Lantus every 12 hours? Should I just go down to one insulin? The vet advised me to skip yesterday and this morning's insulin so that's why I did.

Anyway thank you for your help and let me know if you have any questions. Her spreadsheet is updated and so is her signature.

 

[tiffmaxee]

I understand why you skipped yesterday but not this morning. Even with our less aggressive method we would tell you to shoot any BG over 200. Lantus likes consistency so you need a dose you will shoot every 12 hours. She was at a safe number to shoot today but it will take 5-7 days to see how she does on this dose as the depot builds. Why don’t you try .50 so you can get comfortable testing. Try singing when you test. I suspect she feels your apprehension and reacts.

Start using one meter and I strongly suggest that the human one. Many people have tried comparing and you just can’t. The pet meter will usually read higher but all meter are allowed 20% variance.

 

[TabbyCatMom]

Gotcha! Ok, I will do .5 morning and night unless she is below 125. Thanks for this - and I will ditch the pet meter and use human one. So appreciated!

 

[Ashleigh & Ares]

thats cute, the date was two two and cats name two two ..
also, u dont have to write "date" or "cats name" just fyi, makes it easier to write ur titles and gives more room to post +s.

 

[Sienne and Gabby (GA)]

I saw your post over on Health. I just want to be sure you are up to speed with some of the differences between Lantus and Vetsulin.

• I'm hoping you switched from U40 syringes the U100 syringes you need with Lantus.
• Lantus onset begins at around +2 for most (but not all) cats. You do not need to feed your cat well in advance of giving a shot. You can test, feed, and shoot all within a few minutes.
• The lowest point in the Lantus cycle (i.e., the nadir) is at around +6. Again, the time of the nadir varies -- some cats have an early or late nadir.

With any insulin, you need to get PM cycle tests. At the very least, you want to get a "before bed" test. Without any PM tests, you're missing half of your data and you're risking not seeing low numbers that would warrant a dose reduction.

 

[TabbyCatMom]

I saw your post over on Health. I just want to be sure you are up to speed with some of the differences between Lantus and Vetsulin.

• I'm hoping you switched from U40 syringes the U100 syringes you need with Lantus.
• Lantus onset begins at around +2 for most (but not all) cats. You do not need to feed your cat well in advance of giving a shot. You can test, feed, and shoot all within a few minutes.
• The lowest point in the Lantus cycle (i.e., the nadir) is at around +6. Again, the time of the nadir varies -- some cats have an early or late nadir.

With any insulin, you need to get PM cycle tests. At the very least, you want to get a "before bed" test. Without any PM tests, you're missing half of your data and you're risking not seeing low numbers that would warrant a dose reduction.

Hi Sienna and Gabby! THANK YOU!!! I was wondering about those night time tests and if she drops low at night. And yes I switched to Lantus and am using the U100. It's difficult to measure and not get bubbles in them though.

As far as food: She is RAVENOUS! She eats (all foods <10% carbs) at 8am, the at 9am I check her BG then if ok I give Insulin. Then at 1pm she is STARVING so I give a small wet snack same as above. Then 5pm MORE FOOD MOM 9same small low carb), then dinner 8pm then 9pm BG and Insulin.

Foods: Friskies, Fancy Feast and am waiting for Weruva Play line to come in mail. She is also on Veraflox for IUD and her Creatinine was 2.7/BUN 19, so they diagnosed her stage 3/4 and I later asked him and he corrected himself that it is CKD stage 3. I have the subQ fluid kit but am not sure if I need to give it to her. I just wanted to make it easier on her kidneys. But her phos levels were normal so not sure if I need to worry about low phos food? I am hoping her numbers get a little better when her UTI (e.coli) gets treated??

 

[Katherine&Ruby]

Even if her phosphorus levels are normal, you should feed low phosphorus food. She will like the PLAY pates. Phosphorus slowly deteriorates the kidneys, so even if it doesn't show up in high levels on the bloodwork you're better off avoiding it if you can, especially if she is stage 3. I would give fluids at stage 3, and it may even help her UTI as the extra water will help to flush out the bacteria from her bladder. I found that a teaspoonful of D. Mannose in food mixed with water several times a day works well against bladder infections.

 

[Bron and Sheba (GA)]

Hi @TabbyCatMom.
I see you have swapped over from vetsulin to Lantus which is a much better insulin for cats. Getting Two Two’s BGs down into more normal numbers will be much better for the kidneys, so that should be one of your goals.

If you are not wedded to the idea of only using a pet meter, I would swap to a human meter as both our dosing methods are based on the human meter and you know exactly where you are as far as the numbers go if you are unsure whether to shoot of not. You will need change the SS to a human meter SS but if you tag @Bandit's Mom she can do that for you if you can’t change it over yourself.

I would give some sub Q fluids. Did the vet give you any guidelines as to how much and how often?
Did the vet check her heart first to see that it is OK to give the subQ fluids?

I would also make sure you get the Ecoli treated successfully in the urine. Get another C&S test done after the treatment to see the urine is clear.

Have you looked at this site TANYA’s GUIDE TO CRD. I would highly recommend it. You will find a huge amount of information here and they also have an online support group where you can ask questions.

I am going to tag @Marje and Gracie as she is very knowledgeable about lab results and may be able to give you some suggestions to help you.
I would post every day so we can get to know you and can help if you are unsure whether to shoot or not.

If you get a lower than normal preshot stall, dont feed and test again in 20 minutes to see if the BG is rising. And post and ask for help.
Keep asking questions, we are very happy to help you and Two Two.

 

[Bron and Sheba (GA)]

far as food: She is RAVENOUS! She eats (all foods <10% carbs) at 8am, the at 9am I check her BG then if ok I give Insulin. Then at 1pm she is STARVING so I give a small wet snack same as above. Then 5pm MORE FOOD MOM 9same small low carb), then dinner 8pm then 9pm BG and Insulin.

The routine for Lantus is Test, feed the shoot. There is no need to wait any time between the food and the shot as Lantus doesn’t onset for a couple of hours, unlike vetsulin.
Also don’t feed for the 2 hours preshot as we don’t want the preshot BG to be food influenced.
It looks as if you were feeding, waiting an hour then testing the BG. Don’t do this.
Test, feed, shoot in that order.
I would also give several snacks during the cycles if he is starving. At the moment his body can’t absorb all the nutrients in the food so he will be hungry. Once he starts getting more insulin and the BG starts to come down his hunger should settle down. I would suggest a meal before the doses, then a snack at +2, +4 and +6 each cycle.
I can see he has dropped a lot at +3 so he is likely to bounce up high. By feeding these early in the cycle snacks you can hopefully slow down those drops.

 

[TabbyCatMom]

Ok, great thank you. I will test, feed, shoot. So she will get a test at 8am, then food, then insulin if her BG isn't too low, then snacks 10am, Noon, and 2pm. I think she will be hungry well before 8pm test, dinner then more insulin. Sorry I am so confused. Should I take her BG at certain intervals during the day?

 

[Bron and Sheba (GA)]

Ok, great thank you. I will test, feed, shoot. So she will get a test at 8am, then food, then insulin if her BG isn't too low, then snacks 10am, Noon, and 2pm. I think she will be hungry well before 8pm test, dinner then more insulin. Sorry I am so confused. Should I take her BG at certain intervals during the day?

Don’t apologise for being confused. That is perfectly normal in the beginning.

If you can get 2 or 3 in during the cycles, especially if he is dropping fast, that would be good. You could test when you give the snacks to start off with.
The nadir(lowest point) is somewhere between +4 and +7 normally but it can move around and can be earlier or later.
I would get another test in now with that drop to 177 @+3 and give a snack to try and slow the drop although it is a bit late today.

If you find she is very hungry and needs something between +6 and the next shot, give her a snack at around +8 or 9 but we try and keep the snacks in the first half of the cycles when the insulin is strongest.

 

[TabbyCatMom]

Thank you. I took it at 4pm and it was 167 then she got a snack b/c she is soooo hungry. I'll retake it now. It's 7 pm and she doesn't get insulin until 9pm. I feel for her!!! Poor baby. So I will keep the snacks closer to the nadir. of +4 or +7 depending on her. Thanks so much. Gonna also give her some sub Q - the vet recommended 1.0 ml every other day. She was not sitting still for me so she got .5ml every day for two days. So I'll get back on schedule and help that UTI and her kidneys. I would love for someone with Kidney knowledge to look at her labs. THANKS!

 

[Bron and Sheba (GA)]

Gonna also give her some sub Q - the vet recommended 1.0 ml every other day. She was not sitting still for me so she got .5ml every day for two days

Not sure I understand you here. 1 ml of subQ fluids is not the usual amount given. The usual amount is 50ml or 100 mls? Did you mean to write something else.

Looks looks like she is bouncing from the fast drop this morning.

 

[TabbyCatMom]

Yes, my mistake 100 ml every other day is recommended but she is getting more like 50 ml daily. Just tried to give her some and got scratched at about 50 ml. Also, her BG was 361. She ate at 8am, 1pm, 5pm and is ready for dinner in 1hr 45 mins. Wondering when I will know if I need to adjust her food...like if she is at 361 now, then perhaps I fed too much?

And when testing she gets freeze dried chicken and fish - do you know if this is high in Phos? When looking at % of phos do you know how to calculate if something has 481 mg/100 kcals. phos in a 5.5 oz can?

 

[Katherine&Ruby]

And when testing she gets freeze dried chicken and fish - do you know if this is high in Phos? When looking at % of phos do you know how to calculate if something has 481 mg/100 kcals. phos in a 5.5 oz can?

They don't publish phosphorus levels for treats because those aren't regulated for nutrition. I would stick to non fish treats as fish can be higher in phosphorus, but what you should really be looking at are the phos levels in the canned food. The website that Bron shared with you regarding feline CKD has a canned food list. That list sorts food with nutritional values on a dry matter basis (DMB). When looking at DMB values, you want foods that have less than 1% phosphorus. Friskies and Fancy Feast pates, while great for glycemic control, are not great in the phosphorus department. That list is confusing because of the dry matter basis values--hard to tell which ones are good for diabetics because they don't show the carb percentages the way we talk about them here, which is a percentage of total metabolizable energy. For CKD diabetic cats, we want them be on less than 10% carbs. Will PM you something you might find helpful.

 

[Bron and Sheba (GA)]

When looking at % of phos do you know how to calculate if something has 481 mg/100 kcals. phos in a 5.5 oz can?

If you are looking for low phosphorus, you need to look for food that is 250mg phosphorus or less/100kcals.

Yes, my mistake 100 ml every other day is recommended but she is getting more like 50 ml daily. Just tried to give her some and got scratched at about 50 ml.

50 ml a day is probably better and easier to give than 100ml every other day. Try giving her small pieces of food as you give the 50 ml.can someone help you? It doesn’t take long to run through.

Also, her BG was 361. She ate at 8am, 1pm, 5pm and is ready for dinner in 1hr 45 mins. Wondering when I will know if I need to adjust her food...like if she is at 361 now, then perhaps I fed too much?

I think you will find the 361 is from bouncing from the fast drop this morning, not the food.
Bounces happen when the BG drops too fast, too low or lower than the kitty has been used to. The body then panics and dumps stored glucose and regulatory hormones into the system and the BG goes up high. Bounces can last from 1 to 6 cycles and thee is nothing you can do but wait them out.

 

[TabbyCatMom]

If you are looking for low phosphorus, you need to look for food that is 250mg phosphorus or less/100kcals.


50 ml a day is probably better and easier to give than 100ml every other day. Try giving her small pieces of food as you give the 50 ml.can someone help you? It doesn’t take long to run through.



I think you will find the 361 is from bouncing from the fast drop this morning, not the food.
Bounces happen when the BG drops too fast, too low or lower than the kitty has been used to. The body then panics and dumps stored glucose and regulatory hormones into the system and the BG goes up high. Bounces can last from 1 to 6 cycles and thee is nothing you can do but wait them out.

Got it! Stay under 250mg phos.

Water: I was able to give her 50 ml. water. w/snacks and I sing to her - was that you who recommended that? - well it works!!

And lastly, the drop was because I fed, waited an hr then tested and shot. Now I will test, feed, insulin in the AM (all at the same time) then stick to usual snacks and we probably won't see the bounces? So tonight I will wait til 9pm, then test, then shoot. The only time I don't shoot is if BG is below 100? The food will help if it is 125 or something like that so I won't worry then?

 

[Bron and Sheba (GA)]

and I sing to her - was that you who recommended that? - well it works

Yes I suggested it. I think it calms the cat or makes them think ‘what on earth is going on here….mom is happy…she’s singing so everything must be OK!’

Now I will test, feed, insulin in the AM (all at the same time) then stick to usual snacks and we probably won't see the bounces? So tonight I will wait til 9pm, then test, then shoot. The only time I don't shoot is if BG is below 100? The food will help if it is 125 or something like that so I won't worry then?

If only bounces were that easy to fix. Unfortunately a lot of newly diagnosed diabetic cats bounce in the beginning. It is normal so don’t stress about it.
Feeding during the cycles help but some cats are stubborn and haven’t read the rule book about bouncing.

Because you are so new to Lantus and diabetes, I would not shoot a BG below 150 until you get some more data on how she reacts to the insulin.
If you are unsure you can stall, dont feed and post and ask for help. Adjust the subject line to alert us you need help, and make sure you post on the Lantus forum.
Retest in 20 minutes to see if the BG is rising.

 

[TabbyCatMom]

OMG I love you already! You've got a great sense of humor! Hope all is well in Sydney! I've been to the West Coast - Pert, then Queensland and also New Zealand North Island. I love your side of the world! No wonder you are so cool Thanks - this really means a lot. I apologize for messaging so much. It helps to have someone explain it. It can be difficult to to read so much info and digest it. So appreciated!!