New member / BG / insulin concerns

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Kristin Boel

Kristin Boel

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Hello everyone,

I'm new here my cat Dodge was diagnosed 5/8/24, I'm trying to wrap my arms around this journey but it's been interesting, as I'm sure all of you know! I have some specific questions (below) but first here's some background:

  • Tried Bexacat and didn't work
  • Vetsulin 1 unit AM and PM started 5/28/24
  • Hyperthyroidism controlled by Hills Y/D but also random pancreatitis flare ups so mix that w/ Hills I/D - wet and dry (on a timed feeder in between wet feeding sessions). Please don't come at me, I'm going off of the vet's guidance but I know these aren't low carb.
  • Last weekend he was overly lethargic, could hear his tummy gurgling/digesting (?), hiccups after eating, random licking of the chops/salivating, puked a few times.
  • Tuesday 8/13/24 vet visit = pancreatitis test negative, urine only had high glucose no ketones, blood came back ok.
  • Wednesday 8/14/24 Freestyle Libre 3 put finding consistent lows (sorry, I'm not up on the lingo yet) a few hours after each shoot, dropping down into 50's.
  • Friday 8/16/24 vet switched from Vetsulin to Glargine-yfgn (it doesn't say an actual name on it anywhere, maybe generic??) because of swings.
  • Saturday 8/17/24 AM shoot was the Glargine, dropped down and stayed down for most of the day (instead of coming up quicker w/ the Vetsulin), sometimes dangerously low, had to give him honey a few times and meals to keep him up, no physical signs of distress.
  • Did not administer PM shot because BG was 130 then stayed between 100-225 all night.
  • Today 8/18/24 did not administer AM shot because BG was 150.
  • BG holding between 140-175 this morning, now reading at 137.
QUESTIONS
  1. Are the consistent declines in BG normal after shooting? If so, how do I change that (adjust insulin / feed more)?
  2. Am I correct in not shooting because of the BG's at preshot (130 and 150)?
  3. If his levels hold stable like they are (140-200) should I be giving any insulin at all? It feels weird to not give him any...
  4. I read on here that I need to be feeding him 20-30 mins prior to administering the Vetsulin, if I do this, do I check his BG before the food or after the food?
I think I'll stick w/ the Vetsulin versus the Glargine because of how long the Glargine kept him low for. Any input/suggestions/experiences w/ that are welcomed.

Thank you all in advance, you know how stressful this can be. :(
 
Dodge is a cutie! Love how he is modeling his Libre for you!

What dosage of glargine/Lantus did you give on the day when he dropped low? Lantus and vetsulin use different syringes (U-100 vs. U-40), so it's also important to make sure you are using the correct syringe for each insulin.

Lantus is generally considered a better insulin for cats than vetsulin, in part because it tends to keep them steady rather than sharp declines and rebounds, but that one shot might have been too much.

We'll need more information before being able to specifically evaluate dosage and response to insulin, but here are some preliminary answers to some of your questions:

1. Both insulins will produce declines in BG over the course of hours, although they do differ in the expected pattern. In general, it is expected to have periods of time with consistent lower numbers, but things like the lows you saw probably require not only the in-the-moment reaction of feeding carbs/honey (which you did), but also an insulin dose reduction. Again, we'd need more information before making specific recommendations, though. We use a common spreadsheet format to record BG data over time. Instructions for making a spreadsheet: HOW TO CREATE A SPREADSHEET

2. Yes, it was a good instinct to hold the shots at those numbers! For vetsulin, we use 200 as a "no-shoot" number. For Lantus/glargine, when new caregivers get a number under 150 we recommend "holding" (don't shoot, don't feed) and asking for advice before giving a shot.

3. Those numbers are above normal range, but I agree that it's a little nerve-wracking to give insulin on those numbers to a beginning diabetic. Certainly, not vetsulin.

4. Before. The recommended order is: test, feed, wait [for Vetsulin; Lantus doesn't require this waiting period], shoot.

That's really great that you have the Freestyle Libre on him! Hopefully you will get good duration with it, it should be very helpful in figuring things out. If you create a spreadsheet, you can input some of the data you already have into it.

I wouldn't give up on the glargine/Lantus just yet. If you get a spreadsheet going and input some of your Libre data, we can look at the pattern of that day (and also other days where he got Vetsulin, or no shot) and try to interpret that strong reaction a little more closely. And definitely, check the type of syringes used and the dose.

Good luck, I hope this helps answer your questions. Let us know!
 
Nan & Amber (GA) said:
Dodge is a cutie! Love how he is modeling his Libre for you!
>>Thanks! He is quite the babe. Thank you for responding!!! Here's my responses below starting w/ ">>" and italics.

What dosage of glargine/Lantus did you give on the day when he dropped low? Lantus and vetsulin use different syringes (U-100 vs. U-40), so it's also important to make sure you are using the correct syringe for each insulin.
>>Vetsulin was 1 unit using U-40 and Lantus was 1/2 unit using U-100.

Lantus is generally considered a better insulin for cats than vetsulin, in part because it tends to keep them steady rather than sharp declines and rebounds, but that one shot might have been too much.

We'll need more information before being able to specifically evaluate dosage and response to insulin, but here are some preliminary answers to some of your questions:

1. Both insulins will produce declines in BG over the course of hours, although they do differ in the expected pattern. In general, it is expected to have periods of time with consistent lower numbers, but things like the lows you saw probably require not only the in-the-moment reaction of feeding carbs/honey (which you did), but also an insulin dose reduction. Again, we'd need more information before making specific recommendations, though. We use a common spreadsheet format to record BG data over time. Instructions for making a spreadsheet: HOW TO CREATE A SPREADSHEET
>>Ok good to know, I will work on creating a spreadsheet but have just been looking at the graphs from the Libre - I attached 3 pix from the last two days plus today for now.

2. Yes, it was a good instinct to hold the shots at those numbers! For vetsulin, we use 200 as a "no-shoot" number. For Lantus/glargine, when new caregivers get a number under 150 we recommend "holding" (don't shoot, don't feed) and asking for advice before giving a shot.
>>Ok good to know.

3. Those numbers are above normal range, but I agree that it's a little nerve-wracking to give insulin on those numbers to a beginning diabetic. Certainly, not vetsulin.
>>Ok good to know.

4. Before. The recommended order is: test, feed, wait [for Vetsulin; Lantus doesn't require this waiting period], shoot.
>>Again, good to know.

That's really great that you have the Freestyle Libre on him! Hopefully you will get good duration with it, it should be very helpful in figuring things out. If you create a spreadsheet, you can input some of the data you already have into it.

I wouldn't give up on the glargine/Lantus just yet. If you get a spreadsheet going and input some of your Libre data, we can look at the pattern of that day (and also other days where he got Vetsulin, or no shot) and try to interpret that strong reaction a little more closely. And definitely, check the type of syringes used and the dose.
>>I think what's scaring me is that the Lantus kept him lower for longer and I wasn't "used to" him staying that low. For Lantus, do I feed him first and then wait (a time period) and then shoot? I'm also a little freaked out because he's been under 150 today (no less than 100) back and forth. I'm nervous to shoot tonight if it's still back and forth until 7:30pm CST.

Good luck, I hope this helps answer your questions. Let us know!
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Great, thanks!

Clarification-- is this the sequence of shots corresponding to those graphs?

8/16: Vetsulin am, Vetsulin pm?
8/17: glargine/Lantus am, no shot pm
8/18: no shot

If that's the sequence, it looks like the vetsulin is dropping him hard and fast (as expected), while the Lantus also drops him but a little more gradually, and with a longer duration (also as expected). Also, I think I misunderstood your first post, I thought that you got the extra-low numbers on Saturday with Lantus, but it looks like they were Friday on Vetsulin?

Anyway, all of that looks pretty typical for those insulins, including the zooming back up after the lows (this happens in part because of the insulin wearing off, but also because the cat's body detects lows and fast drops and tries to counteract them).

Where it is starting to get interesting is today's data. If I understand the situation, you have not given a shot since yesterday morning, but he has been dropping for most of today. Is that correct?

These are still diabetic numbers (so far), but if he keeps doing this, I would not want to shoot, either. We can wait and see where he is at shot time-- definitely post again here with an update before making a decision about shot/no-shot and/or insulin. He earned a reduction of 0.25U, whichever insulin you use because (if I am reading the charts right) he went under 90 on both Friday (Vetsulin) and Saturday (Lantus). I understand why the Lantus makes you nervous, keeping him in those lower numbers for longer than you are used to, but as long as they aren't dangerous lows, it's actually easier on Dodge's body to have the steady numbers than the big swings that you get on Vetsulin.

Is this the first time you are trying the Libre? If so, were you able to do home-testing to see how he was reacting to the insulin before this or were you relying on vet numbers to assess treatment success?
 
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Nan & Amber (GA) said:
Great, thanks!
>>Hi again, and thanks again, you've been a tremendous help thus far. Please see below:
Clarification-- is this the sequence of shots corresponding to those graphs?

8/16: Vetsulin am, Vetsulin pm? - correct
8/17: glargine/Lantus am, no shot pm - correct
8/18: no shot - correct

If that's the sequence, it looks like the vetsulin is dropping him hard and fast (as expected), while the Lantus also drops him but a little more gradually, and with a longer duration (also as expected). Also, I think I misunderstood your first post, I thought that you got the extra-low numbers on Saturday with Lantus, but it looks like they were Friday on Vetsulin?
>>No misunderstanding, the graph doesn't show as low as it actually reported yesterday on Lantus for some reason. It had gotten down to a 53 (alarm goes off at 70). Friday on Vetsulin was also low though too. :(

Anyway, all of that looks pretty typical for those insulins, including the zooming back up after the lows (this happens in part because of the insulin wearing off, but also because the cat's body detects lows and fast drops and tries to counteract them).

Where it is starting to get interesting is today's data. If I understand the situation, you have not given a shot since yesterday morning, but he has been dropping for most of today. Is that correct?
>>He is all over the place today (see new image taken just now, 5:22pm CST) but between 100-200 and he HAS been snacking throughout the day, not a ton, but some.

These are still diabetic numbers (so far), but if he keeps doing this, I would not want to shoot, either. We can wait and see where he is at shot time-- definitely post again here with an update before making a decision about shot/no-shot and/or insulin. He earned a reduction of 0.25U, whichever insulin you use because (if I am reading the charts right) he went under 90 on both Friday (Vetsulin) and Saturday (Lantus). I understand why the Lantus makes you nervous, keeping him in those lower numbers for longer than you are used to, but as long as they aren't dangerous lows, it's actually easier on Dodge's body to have the steady numbers than the big swings that you get on Vetsulin.
>>I'm not overly excited about the Lantus syringes because the needle is so short...but if the numbers are there, I will try less than 1/2 unit of Lantus.

Is this the first time you are trying the Libre? If so, were you able to do home-testing to see how he was reacting to the insulin before this or were you relying on vet numbers to assess treatment success?
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>>This is the first home testing I've done. Relied on 2 glucose curves done at the vet until now.
 

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Ah, I jinxed it by saying he was dropping all day, he decided to make a liar out of me by nudging upwards for a little while!

We'll see where he goes from here. He's still not very far above normal BG, hmmm...
 
Nan & Amber (GA) said:
Ah, I jinxed it by saying he was dropping all day, he decided to make a liar out of me by nudging upwards for a little while!

We'll see where he goes from here. He's still not very far above normal BG, hmmm...
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>>Right?! LOL. I know, if we're shooting at 150 or higher w/ Lantus, I'm a little leary about doing so since it's been below that for almost half the day. Could there be times where I don't give him any insulin for a whole day?? I guess my brain wants to give it to him 2x day so this off and on is weirding me out.
 
Welcome to FDMB.

Nan has provided some great information. I would encourage you to set up a spreadsheet rather than use the graphs that the Libre provides. In part, pretty much all of us have been trained to read our spreadsheet which allows us to easily compare the day-to-day pattern of how your cat is responding to insulin. Looking at individual days based on the Libre graph doesn't allow us to do this. The pattern of response is the best way we can help you navigate how Dodge is responding.

One other observation regarding the Libre. We have had quite a few members use the Libre. It is a great option for a cat that is difficult to home test using a hand held glucometer. However, if your cat is in numbers around 100, the Libre often gives false low numbers when compared with a hand held meter.

This post on helping us to help you that also includes information on how to set up a spreadsheet as well as how to set up your signature. The signature gives us some basic information so we don't keep asking you the same questions.

Please let us know what dose of glargine (yes -- that's the generic/biosimilar name) you're giving. Also, as Nan suggested, please make sure that you are. using U100 syringes with the glargine. (Vetsulin requires a U40 syringe -- usually has a red cap vs U100 that usually has an orange cap). The syringes should be marked whether they are U100 or U40.

Just so you're aware, both of the varieties of the Hill's foods, even the canned food, are very high in carbohydrates. They are over 20% carb and we consider low carb as under 10%. Has Dodge has his thyroid levels checked if all you're doing is feeding him the Y/D? The other issue is that the pet food manufacturers lost a class action suit resulting from calling their foods "prescription" since there is nothing in the ingredients that requires a prescription. In fact, the diabetic foods are largely high in carbs which is not helpful for a diabetic cat.

>>Right?! LOL. I know, if we're shooting at 150 or higher w/ Lantus, I'm a little leary about doing so since it's been below that for almost half the day. Could there be times where I don't give him any insulin for a whole day?? I guess my brain wants to give it to him 2x day so this off and on is weirding me out.
Click to expand...
Part of why it would be helpful to know what the dose of insulin you're giving Dodge is that it may be helpful to reduce the dose so you can give a shot twice a day. Your kitty is still in diabetic numbers.
  • If you can get Dodge transitioned to a low carbohydrate diet, it could have a dramatic effect on his blood glucose levels.
  • Glargine is a very different type of insulin than Vetsulin. Glargine forms a "depot" -- every time you give a shot, the insulin forms microcrystals that are deposited in the fat tissue. Most, but not all of these crystals dissolve over the 12-hour cycle. Some take a bit longer and as a result, you are building up a bit of an insulin storage that overlaps the next cycle. This is what gives glargine its long duration. It also means that if you skip shots, you deplete the depot and you end up extending the period where you are giving a particular amount/dose of insulin.
  • There can be times when. you skip a dose (e.g., the numbers are too low to give a shot). Should you have a question about skipping, I'd encourage you to post and ask for help.
 
Hi Gabby,

Thanks for the info. I've been just "replying" to Nan's responses w/ my responses "inside" of hers...per question. So some of what you're asking has been answered above but is probably hidden in each orange response section. But I can start a fresh reply each time.

I gave 1/2 unit of glargine with a U100 syringe on Saturday morning.
Could it be possible that the glargine just "lasted this long" and kept his BG stabilzed???
I created a signature but I'm assuming it only showed on my initial post above?
I have had the thyroid levels checked this entire time and I'm currently mixing Y/D and I/D both wet and dry since the thyroid is staying in check w/ the Y/D.
Right now 6:22pm CST he's at a 155 and PM shot time is in 1 hour. I'm skeptical about shooting because of today's numbers.
I have not tried a handheld reader. Is there a different CGM that would be preferred over the Libre?

Thank you!!!!
 
I can see your signature :). If you're switching to Lantus, make sure to change/edit that part.

Home-testing: not another cgm system, testing blood glucose directly, poking the ear to get a drop of blood. Hometesting Links and Tips.

Usually it takes a few shots for the Lantus depot to build, but every cat is different, so you never know!

I think it should be safe to shoot 0.25U if he's still in this range at 7:30, as long as he's not dropping (rising would be best). As Sienne says, the food he's eating is pretty carb-y and will bump up his BG, so that will help keep him safe, too, if he has some of that available overnight. But let's see what he's doing at shot time (very soon, now, actually?).
 
I think I missed the drop down on your replies to Nan. I'd suggest handling the replies a bit differently so we can clearly see your response. You can quote someone's information by putting the material you want to quote inside the QUOTE brackets. Then, write your response to the right of the bracketed second QUOTE. It will look like what I did above.

BTW, I'm Sienne. Gabby was my kitty.

At least right now, the Libre is the CGM that has been used the most with cats (and dogs). Vets have jumped on the use. There's one other that has been popular for humans -- the Dexcom. I've not seen it mentioned for use with cats.

I agree with Nan. Dropping the dose back to 0.25u may help.

If Saturday was the first time you used Lantus, I'd be surprised if you got this much duration from one shot. It generally takes 5 - 7 days for the depot to form. As for tonight's shot, I think a great deal depends on your comfort level. We generally tell new members who are using Lantus to use either 150 or 200 as their "no shot" number. (The "no shot" number depends on which dosing method you opt to use.)
 
GAH thank you both. Sorry Sienne...both are beautiful names!

I think I'm going to stall and see how the numbers look. Once he just got up now and moved around it went to 160. It's barely been at 200 today.

I'll be back shortly...
 
Ok, I'm going to pass on the shot. He went up to 175 before eating but didn't eat a whole lot (he has snacked all day basically too) and now he's still at 150.

I know I need to consider switching his food - do either of you recommend anything specific? I still need to maintain the thyroid levels, so maybe replacing the I/D with low carb/high protein something or other?
 
For low-carb food: it gets tricky when you are balancing other health issues. I'm particularly concerned about the hyperthyroidism, which you are also controlling through diet. I don't have any experience with that, but from what I can tell the key thing is to limit iodine? so I'm a little nervous about recommending specific low-carb foods without knowing what their iodine content is.

I think what I would do is put up a new post in this forum asking about this, specifically. There may be someone here who has dealt with this same combination of issues, and maybe has some specific suggestions that worked for them?
 
Thanks Diane, yes, I will work on that over the next few days.

And Nan...right, it's definitely an added piece that's tricky. I will do that.

Thank you both for the help. Puts my mind at ease some, which is what I've needed this weekend.
 
I was Googling about diet and hyperthyroidism. You may already be familiar with this site. What I found interesting is that they linked the same site we use on feline nutrition. They also suggest what is a diabetes friendly diet. While I did see other sites that commented on limiting iodine as Nan noted, the site I linked mentioned avoiding both very high or very low iodine diets.

There is a chart on the feline nutrition site that provides information on the carbohydrate content of most of the canned foods available in the US.
 
Good morning and thank you for the info and sites. I didn't do his AM shot today because he was at a 114 to about a 130. Still confusing to me. I have no idea what cats going into remission looks like - could this be a step in that direction?
 
Oh, he's doing great!

I do suspect that his pancreas is working at least partially, but it is likely fighting a bit against the food. If we can find a low-carb food that works for his hyperthyroidism, that would be helpful. I'm really glad Sienne was able to find that site with trusted information, hopefully there is something there that will work for Dodge.

The standard we use for remission on this site is 14 days with no insulin and mostly below 100, with just the occasional pop up to the kind of numbers you are seeing here. So he's not necessarily there yet, he might still need a little insulin support for a while and/or the diet change.

But he's looking good so far! How is he feeling/acting?
 
He is down 3lbs since the beginning of this journey as well, so maybe that's making things inside work "better". I will definitely look around for some other food. Even if I can maintain the thyroid on the Y/D and incorporate low carb something else, it would be less carbs overall. I would love to avoid giving a pill for the thyroid but will if it means I need a completely LC diet.

Good to know on the remission information, thank you.

He's acting great today actually, his coat looks better, he was playing earlier, he's generally a happy cat but moreso this morning. Luckily I'm working from home for some days, so I can keep an eye on him (more like helicopter mom lately!).
 
Hello and good evening,
Dodges BG still hasn't been high enough to justify shooting. Last shot was given Saturday morning and he's still between 100-200 range, hovering around 150 during normal shooting times. Am I doing more harm than good by not shooting? I have yet to speak to the vet about this mainly because I'm not sure I'm confident in them so I'm asking here first.
Thanks again!
 
Well, the big danger in skipping insulin for a cat that needs it would be the possible development of ketones/ketoacidosis. It's a good idea to test any diabetic cat for ketones regularly (you can buy urine dipsticks at any pharmacy with other diabetic supplies). Especially, if he were to have any more episodes like the other weekend, if he stops eating, starts vomiting or just seems unwell, time to go on high alert.

Beyond that, the dangers of not treating diabetes are slow damage, not fast, and the numbers he's showing right now are not that high, so no, I don't think you are doing more harm than good.

I am very hopeful about figuring out a low-carb food that works with the hyperthyroidism. He just seems so close! In the meantime, I also think that a little bit of lantus (0.25U) would be safe to try when you and he are comfortable with that.

Good to hear that he is feeling well and playing today! I think he likes these numbers!
 
Thanks again for the information and peace of mind Nan.

I will definitely buy some dipsticks for the ketones - now to confirm that's only IF he gets high BG correct? How high is high?

I will be diving into the world of new food today to see what I can find. He does seem very close. I skipped out on the shot again today he was in the low 100's and I'm just not confident/comfortable.

Thank you!!!!!!!!
 
Kristin Boel said:
I will definitely buy some dipsticks for the ketones - now to confirm that's only IF he gets high BG correct? How high is high?
Click to expand...

Not necessarily, it's possible to develop ketones without high BG, although they do go usually go together. Physiologically, it's more about a lack of insulin than BG directly-- so the (usually) high BG would be downstream of the thing that is causing the high ketones, not the other way around. Usually, a cat that is developing ketones/going into ketoacidosis will also be showing signs of feeling unwell, whatever their BG, although some cats that are particularly prone to developing them may not show obvious signs in the beginning stages.

It's a little hard to talk safely about general rules with this stuff, because there are always exceptions. Here's a helpful primer that talks about ketones and ketoacidosis: Ketones, Ketoacidosis, and Diabetic Cats: A Primer on Ketones
 
Ok, thank you for that link. I got my spreadsheet going. The majority of the numbers input are taking off of the daily graph from the Libre, they don't give EXACT numbers on the graph, so I did the best I could at rounding. I did write some numbers down yesterday/today that I've put at the exact time of reading and going forward, will be doing that versus looking at the graph for estimates. Today I'm working from home, so I can update every hour. If you have a chance to review, let me know what you think.
 
Thanks for checking in. I got him some 0 carb food tonight to mix with the Y/D for thyroid and he ate well. He was 146 PMPS so didn't shoot. I'm trying to scan hourly but the rest of this week will be sporadic since I don't work from home as much (my schedule is a mess!). I'll stay on the spreadsheet thou. Hoping for some movement with the change in food.
 
@Nan & Amber (GA) Good afternoon,
I just got home from work and Dodge's alarm was going off once it synced to the sensor. He was at 69. I updated the spreadsheet - can you take a peek? I think it looks good, but, I'm paranoid. :) Help calm my nerves. Thanks.
 
Hi @Nan & Amber (GA) so it's been a hectic day. I got a new sensor put on him at the vet this morning (after his shot) and it didn't work. I finally got a replacement filled and put on and JUST NOW (5pm CST) was able to get readings going again. So basically I have no idea how his numbers looked today. I am a ball of stress. His appetite was up so I fed him some low carb food throughout the day, unfortunately I don't know about the numbers. I will continue to monitor and update the spreadsheet now that I can. Oy vey!
 
Hi @Nan & Amber (GA) thanks for checking in. I haven't gotten on my work computer to update the spreadsheet but numbers are staying about the same. I did shoot .25 this morning and it dropped him down low (60-70 for over an hour) which I didn't like. He was right around 150 AMPS. I'm heading out of town soon but have a vet tech coming by to pet sit. I will send get the spreadsheet updated Sunday. Hoping for a smooth and steady weekend. Fingers crossed.
 
Sienne and Gabby (GA) said:
There's one other that has been popular for humans -- the Dexcom. I've not seen it mentioned for use with cats.
Click to expand...
On the 10th of Aug I attached a Dexcom G7 to my Merles and Libre 3 to my Wiggles. Both lasted their design life, 10 1.2 days for Dexcom and 14 days for the Libre. After using many Libres I find at low BG the libre reads lower than and ear stick and human meter and at high BG the Libre reads higher.
 
Seconding Larry's post - my Libre decided to be extremely weird on me and was reading LO while the ReliOn said 99.

Also, when you mentioned that once he got up and walked around, his BG went up - this could possibly be because of a compression low (if he was laying on the libre, it can cause it to read lower than actual).

One option on diet is to consult with a vet nutritionist - they may be able to make you a homemade recipe that is suitable for Dodge's multiple medical issues, or help you confirm a good commercial diet / mix of commercial diets.
 
Thank you @Larry and Kitties and @Kara & Ember!! I am learning that this Libre might be giving me some wonky reads so instead of freaking out (like Kara said the compression low - which very well could be considering where it's on his body) I've been reacting better. I will talk to the vet about the Dexcom G7. Thank you for your input.
 
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