4/15 Toeby PMPS 369, +3 459 - Back after months OTJ, wonky numbers

Laurasboyz

Laurasboyz

Member Since 2020
Hi there, we last posted here on the FDMB last summer.

Toeby was diagnosed as diabetic in June 2020 and put on Lantus, SLGS.
He went off of insulin, with the approval of his vet, August 2020.
In November he was diagnosed as possibly having inflammatory bowel disease after bouts of vomiting and diarrhea. He was put on prednisolone, and I knew there was a chance it could cause recurrence of diabetes.
He did very well on the pred for several months - I would spot check his BG.
Last month he started drinking and peeing more and BG checks showed he needed insulin support again.
He started back on 0.5 units of Lantus on March 22 - I am testing with a One Touch meter and strips.
His vet agreed to try Budesonide instead of the prednisolone.
We tapered slowly off the prednisolone - his last dose was April 2.
He started on 1 mg Budesonide per day on April 5th.

Since being back on insulin he's thrown me low numbers a couple times.
April 8th I caught him at 23 mg/dL (1.3 mmol/L). I was able to get his BGs up, but it was a little scary.
His vet advised stopping insulin - she suspected Symogi effect.
After a few days with no insulin and quite high BG numbers, I decided to start him back, but the insulin does not seem to be having a positive influence on his BG's. Today I got a new vial of Lantus to be sure it is okay.
His vet is on vacation this week.
I am really unsure what direction to take with his insulin dose, and am wondering if it is just a matter of hanging in for a week after the bounce and being off insulin for a couple days?
The transition from prednisolone to budesonide might have complicated things.
If someone could look at his spreadsheet and give me a educated opinion, I'd really appreciate it.
Thank you, Laura for Toeby.
 
Sorry to hear Toeby is out of remission.:bighug: How was he diagnosed with possibly having IBD? Just seems odd to treat without having an actual diagnosis. Does he have any GI symptoms now? Inflammation can impact BG's too.

In your spreadsheet, you ask the question about whether Dr. Elsey's could cause the numbers go up. We have seen a few people now report that happening with Dr. Elseys.

The five cycles of no shot would have drained the depot - it can take 5-7 days to build it back up again. However, there isn't really enough mid cycle data to fill in the picture. If you are working during the day, could you try to get a before bed test each night?

Side note, there is no such thing as Symogyi. Post about it here, including the research article disproving it. It does look like Toeby is doing what we call bouncing.
 
Wendy&Neko said:
Sorry to hear Toeby is out of remission.:bighug: How was he diagnosed with possibly having IBD? Just seems odd to treat without having an actual diagnosis. Does he have any GI symptoms now? Inflammation can impact BG's too.
In your spreadsheet, you ask the question about whether Dr. Elsey's could cause the numbers go up. We have seen a few people now report that happening with Dr. Elseys.
The five cycles of no shot would have drained the depot - it can take 5-7 days to build it back up again. However, there isn't really enough mid cycle data to fill in the picture. If you are working during the day, could you try to get a before bed test each night?
Side note, there is no such thing as Symogyi. Post about it here, including the research article disproving it. It does look like Toeby is doing what we call bouncing.
Click to expand...

Hi again, Wendy,
Thanks for taking the time... I am so glad to have someone to "talk" to.
Toeby has been a chronic barfer for years, and last fall it became barfing with bouts of diarrhea... I was told the only way for a definitive diagnosis was to do a biopsy, and at his age, with his slightly enlarged heart, I didn't want to put him under.
We also discussed food sensitivity, and lots of things. Trying him on the prednisolone seemed like it was worth the risk.
His GI symptoms were good after November - has only thrown up a hair ball once in a long while, and no diarrhea, just big, normal BM's.

I wondered if going right off the insulin was right, but the 23 is SO low, and he'd given me 2 other sub 50 numbers, so I figured better safe than sorry while we were changing the steroids.
The vet supported me on stopping the insulin, but she is out of the office this week.

I read the link on Symogyi, but what's the protocol after a cat goes so low? Just be thankful you caught the hypo and saved the cat with syrup, etc, and either keep the dose the same or INCREASE the dose?
I really, truly do not understand.
I gave him a half unit this morning, more than last night, but I really feel like I have no idea what I am doing, and his numbers are now WAY higher than they were a week ago before he had the hypos.
Should I be substantially increasing his dose to say, 1 unit? Or is the half unit a good guess?
I had been using the bottom line on BD syringe, what I call .1 unit, the last couple cycles.

As far as Dr. Elseys goes, I suspect it because it's the only food that could possibly be higher carb - we like to leave it out because both he and his brother have been grazers all their lives, and the wet food will go crusty and unappealing to them during the day if they don't consume it all at once.

If I take him off the Budesonide, I am told I have to taper that off as well, so for now I am not messing with his 1 pill per day.

I have been doing most of my communication with his vet by email, which is great, I am thankful, but if he needs to get into the clinic in fur-son, it is almost impossible to get a same day appointment thanks to Covid restrictions.
So, I am hoping I can manage this at home.
Laura
PS Sorry if I sound frustrated, but I am... I am trying so hard and everything I do seems backwards.
 
@Laurasboyz
It is very frustrating and overwhelming in the beginning.
Can you take a photo of the syringes you are using and post please as I am concerned when you say the bottom line you are calling 0.1
Maybe take photo of where you draw the insulin up to when you give 0.5 units please.
Also tell us what type of syringe it is. Also post a photo of the plastic cover it is in that tells us what size of syringe please.
To post the photo you will have to copy and paste as the upload a file is not working at the moment.

It does sound as if you might be giving the wrong dose.
I see you gave 0.5 units this morning....... from your description I am concerned you might have given 5 units.
***Please test during this cycle

Lantus likes a consistent dose, not chopping and changing from dose to dose. Lantus is a depot insulin and if you keep changing the dose, the depot can’t settle and you will get wonky numbers. I think we need to establish that you are giving the dose you think you are before we talk about what dose to give.
I am heading off to bed now as I live in Australia but I am going to tag a couple of people to follow up and see if you are actually giving the dose you think you are giving
@Bandit's Mom
@tiffmaxee
@Christie & Maverick

See below picture of syringes and dose markings.


upload_2021-4-15_23-1-36.png
 

Attachments

  • upload_2021-4-15_23-1-36.png
    upload_2021-4-15_23-1-36.png
    167.6 KB · Views: 436
Last edited:
Bron and Sheba (GA) said:
@LaurasboyzI
Can you take a photo of the syringes you are using and post please as I am concerned when you say the bottom line you are calling 0.1
Maybe take photo of where you draw the insulin up to when you give 0.5 units please.
Also tell us what type of syringe it is. Also post a photo of the plastic cover it is in that tells us what size of syringe please.
View attachment 60596
Click to expand...

Hi, Thanks for your concern, I appreciate it.
Without a picture, I think this will put your mind at ease:
I am using BD U-100 Insulin syringes, 3/10 mL, with a 31 gauge Ultra-Fine needle, the 8 mm length (shorter length needle).
This syringe has half unit markings - the DIN number is 320440 if you want to Google for a picture of the box.
These syringes are marked at 5, 10, 15, 20, 25 and 30 units, with single unit markings AND half unit markings.

I am NOT giving him 5 units, please have no fear... This is my third go-round with feline diabetes, the first with a cat who passed in 2005 (I was a member of FDMB then), and again when Toeby was briefly diabetic last summer.

When I put in my notes 0.1, it is my way of telling myself I gave him just enough insulin to fill the syringe to the very bottom black mark, I have played around with a syringe and it is about 4 drops or so when you express it.
And I do appreciate that, like any mass produced item, the lines can be slightly off, or the size of the hub near the needle might slightly vary.
0.1 to me means I am giving him the least I can give without guessing, because I use the base line printed on the syringe, if the needle is pointing left, it's the black line closest to the needle.
Last summer I tried using a micrometer to measure smaller doses as well when I needed to

I hope the above reassures you that I am NOT giving him 5 units of insulin when I say 0.5, or one half unit.

I am not trying to change his insulin often, the changes I made were in response to hypos and low preshot readings:

April 5th I got a preshot reading of 2.3 (41) at +12 hours and only 5.3 (95) an hour later so I skipped his insulin that night.
This was after he was almost consistently on a half unit of insulin for twelve days, with one lower shot of a quarter unit the morning previous when his preshot was 5.7 (103).

April 6th he was 2.6 (47) at +5 hours
April 8th he was 1.3 (23) at +3 hours and I stopped giving him insulin for a couple days.
This may have not been the correct thing to do, but I was scared of killing him.
I still am.

I guess I am asking if anyone can, by looking at his spreadsheet, suggest what might have happened, and how to proceed.
It is counter-intuitive to me to increase the insulin dose of a cat who was 2.3, 2.6, and 1.3 (41,47, and 23 for American readers) but obviously Toeby's BG numbers the last couple days are crazy high.
If I give him a consistent dose of insulin to re-fill the depot, like a half unit, his numbers will start coming down?
IE have patience, keep going, and he will start to come down???
Does a half unit, the dose he was on before he started showing hypo numbers, sound like a good number to use given how high he is today, is was that too much insulin, and hence, the cause of the hypos?

Wendy is right, he might have inflammation somewhere - he has gingivitis but the vet is not fussy about putting him under for a dental.
Laura
 
Hi Laura, that’s good to know you are not mistakenly giving the wrong dose. And the syringes are the correct ones. So we can put that issue to bed.

As you are doingSLGS method, if a cat drops down under 90 (5) you need to reduce the dose.
0.4 unit dropped him to 1.3 (23) so I think I would give 0.25 units for both cycles and see how that goes. Stay with that dose unless he drops under 90 in which case you would reduce the dose to 0.1 units.
You need to be getting tests in consistently in both cycles so you can see what is happening. I suspect he is bouncing after the low numbers which send him up high.
When this happens you do not increase the dose. Bouncing happens when the BG drops too low, too fast or lower than the cat is used to. The cats body then panics and dumps stored glucose and regulatory hormones into the system and the BG goes sky high., bounces can last from 1 to 6 cycles and there is nothing you can do but wait it out. The BGs will return to the previous BG numbers when the bounce is over.
Give snacks during the cycles, especially in the first half of the cycle when the insulin is strongest.

The depot takes up to 6 cycles to fill.
Does all that make sense?
 
Bron and Sheba (GA) said:
Hi Laura, that’s good to know you are not mistakenly giving the wrong dose. And the syringes are the correct ones. So we can put that issue to bed.

As you are doingSLGS method, if a cat drops down under 90 (5) you need to reduce the dose.
0.4 unit dropped him to 1.3 (23) so I think I would give 0.25 units for both cycles and see how that goes. Stay with that dose unless he drops under 90 in which case you would reduce the dose to 0.1 units.
The depot takes up to 6 cycles to fill.
Does all that make sense?
Click to expand...

Hi again, and thank you very much for this.
Yes, it all made sense.
I will tell you that the 1.3 (23) hypo a week ago today scared me.
I put him back on insulin Sunday, so he's had 10 cycles including tonight, so his depot should be filled by now?
A problem I can see that I've done is that I re-started at 0.1 on Sunday, and increased it a bit with the high BG numbers I was seeing on Tuesday night, and increased it again today with the super high numbers yesterday.
He tested 10.4 (187) tonight, which was a surprise, but I thought I should not mess with the dose, so I gave him the same as this morning.

I will test him tonight, probably post the results under a new heading so it's obvious, because of the 10.4 (187) preshot.

I guess my biggest question is, would it be okay for me to reduce his dose tomorrow morning to 0.25?
That's making several dose changes in 6 days, but I'd like to do what is safest for him as I am not home 24/7.
Thanks for your help and support.
Laura
 
Hi Laura
With Lantus, you need to hold the dose for 6 cycles for the depot to fill. Lantus is dosed on the nadir or lowest point in the cycle.
That is why getting those tests in during the cycles is so important. Lantus is not dosed on the preshot number.

yes getting a number like 1.3 (23) is scary. It is very low and you were lucky he didn’t have hypo symptoms. Do you have honey or Karo in case of low numbers?
Also you need some high carb canned foods in case of low numbers.

Yes I would reduce down to 0.25 U in the morning because we know that a few days ago 0.4 U dropped him to 1.3
He is very likely coming off the bounce this evening and could drop quite a bit further so you need to keep testing him this cycle until he gets past the lowest point.
We don’t know what has been happening between the cycle during the last 10 days except for 1 test.

You will need to hold the dose of 0.25 U for 6 cycles unless he drops under 90 in which case you would reduce the dose to 0.1U
I know this will mean another dose change but the first thing we always need to do is keep the kitty safe.

I will watch for any tests you get in this cycle. I would get a +2 to start with
Bron
 
Bron,

He is 8.2 mmol/L (148) at +2.5 hours.

Not exactly sure what you meant by "we don't know what has been happening between the cycle during the last 10 days except for 1 test"
10 days takes us back to April 6th.
I've recorded quite a few mid cycle tests within the last 10 days, not just 1?
Do you mean a cycle where I test every couple hours for a full curve within the 12 hours?
If that is what you mean, no, I have not done a full curve within the last 10 days.
I've recorded tests at several points between shots on April 4th, 5th, 6th, 7th, 8th (lots), the 11th, 13th, and 14th.
But not a full "curve" in one cycle.

Yes, I have honey, karo, and even good old local maple syrup, for that matter.
I also have higher carb canned food.
I used both corn syrup and canned gravy food last Thursday when he went to 1.3 (23).

Thanks for support on reducing the dose tomorrow.
I will get checks tonight as I can...
I can do a full curve during the day soon.
Thanks
Laura
 
Hi Laura
I would get a +4
When you see a drop in the BGs at+2 that usually means it is going to be an active cycle and you need to keep testing.
Have you given him a snack? If not I would give him a snack now

Sorry I wasn’t clear about the testing during the cycles I mentioned. I was referring to the PM cycles when I said there were no testing except one test for the last 10 days overnight. Cats often drop lower at night and the pm cycle is just as important as the am cycle.
What we are needing to see is...is he dropping lower at night and bouncing during the following day.
Unless we can see some tests in the pm cycle we have no idea.
If possible you need to be getting at least one test in every cycle to see how the insulin is affecting his BGs. And if that test is showing quite a drop, you need to test further.
It is entirely possible for a cat to be in the 400s at preshot, drop to 40 during the cycle and then back up to the 400s at the next preshot. Unless we are testing we have no idea. And to increase the dose would be dangerous.
Does that make sense?
Bron
 
Hi Bron,

Thanks for the explanation re: getting evening tests - all good.
And yes, everything you are saying makes sense.

He is not very hungry today, which I can perhaps understand given his high blood sugar last night, he probably feels crappy today, but it's a problem tonight.
He did just eat some Weruva Cats in the Kitchen Slide n' Serve pate for me, which is low carb from what I read, and he actually likes it.
In order to test him I had to give him Temptations treats, which I KNOW are high carb, but tonight I don't really care.
He has been eating freeze dried turkey for testing treats but tonight he could not care less so Temptations it is.

I'll test him again soon...
You're 13 hours ahead of me... so I will aim for midnight my time, 1 pm yours.
One day I'll get to Sydney... it's on my bucket list, no matter how far.
Thanks
 
Do you have a bottle of Ketostix to test for ketones in the urine?
It’s a good idea to have them on hand and if Toeby is unwell or running high, you can test for ketones. Unregulated diabetic cats can be prone to ketones and they always need to be caught early and treated.

If you had to give him a HC rest to test him, so be it, but maybe put a note of it in the remarks column of the SS.
 
5.9 (106) at +3.75 hours

I changed the note on his spreadsheet to reflect high carb treats without using the brand name, although I suppose they are sold around the world.
Yes, I have Ketostix I bought last summer, I will check the best-by date and buy new tomorrow if they're outdated.

I will test his BG again soon; it's good to be a night owl.

I am feeding him the Temptations only to get him to test without a fight today, it is not a normal treat for him, but he likes them.

I am hoping high numbers will settle now that his depot is re-filled and with a dose reduction tomorrow?
Every day is another with the new budesonide settling in his system as well, and distance from the prednisolone.
 
Laurasboyz said:
I am hoping high numbers will settle now that his depot is re-filled and with a dose reduction tomorrow?
Click to expand...
The high numbers settling have nothing to do with the depot filling, either does a dose reduction.
When you give a dose of insulin (say 0.5 units) a little bit of that dose goes towards the depot. This happens each time you give the dose. And the depot is used each time insulin is given as well.
It can take up to 6 cycles for the effects of the 0.5 units depot to wear off, if you reduced the dose down to 0.25 U for example.
And it can take up to 6 cycles for the depot to build up if you increased to 0.75 U.
Here is a link to the depot which might explain it better.
https://www.felinediabetes.com/FDMB/threads/what-is-the-insulin-depot.150/

I will watch for the next test.
 
4.8 (86) at +5

So, still dropping.
I gave him a couple more Temptations, and some freeze dried chicken liver.
Will check back at +6.

Just read your last note - I guess what I meant was his high numbers be because he is bouncing high after receiving too much insulin, if I am understanding what could have caused the high BG's...
He hypo'd on a low dose of insulin, went off insulin, and then was showing really high numbers (yesterdays) on a higher dose than he hypo'd on...
I understand what can cause a bounce, I guess I am hoping I can figure out what the correct dose to avoid bouncing or hypos.
I suppose you're going to tell me that's the hard part... LOL....
 
Laurasboyz said:
4.8 (86) at +5

So, still dropping.
I gave him a couple more Temptations, and some freeze dried chicken liver.
Will check back at +6.

Just read your last note - I guess what I meant was his high numbers be because he is bouncing high after receiving too much insulin, if I am understanding what could have caused the high BG's...
He hypo'd on a low dose of insulin, went off insulin, and then was showing really high numbers (yesterdays) on a higher dose than he hypo'd on...
I understand what can cause a bounce, I guess I am hoping I can figure out what the correct dose to avoid bouncing or hypos.
I suppose you're going to tell me that's the hard part... LOL....
Click to expand...

He would have bounced high because he dropped too low. Bouncing doesn’t always mean that the dose is too high (although in this case it does).
Bouncing is always a response to the BG dropping too fast, too low or lower than the cat thinks is normal.

He dropped to 1.3 (23) when he was on 0.4 U which for him is obviously too high a dose of insulin. Then he bounced and you got the high numbers.

There is a saying here.....’feline diabetes is a marathon not a race’ and it’s so true. You can’t rush the cat into regulation. Insulin is a hormone and it takes time for the body to get used to it and respond the way it should. Although I have to say Toeby is responding a bit too well at times!
We have to hasten slowly to find the best dose.
Let’s get him safely through this cycle, reduce the dose to 0.25 U and see if that is a good dose. The only way we will be able to tell is by testing during the cycles.
Remember you can manage the drops in the cycles by feeding the curve as you are now and slowing any drop so it goes down gently and hopefully prevents a bounce.
 
[QUOTE="Bron and Sheba (GA), post:
Let’s get him safely through this cycle, reduce the dose to 0.25 U and see if that is a good dose. The only way we will be able to tell is by testing during the cycles.
Remember you can manage the drops in the cycles by feeding the curve as you are now and slowing any drop so it goes down gently and hopefully prevents a bounce.[/QUOTE]

4.8 (86) again at +6

I am still giving him a couple Temptations when I test him ( 2-4 treats).
 
Looks like a long night for you.
It’s actually a lovely cycle but we know what he is capable of with this dose so I would get another test in an hour
The temptations are probably helping him stop dropping too low.
 
Bron and Sheba (GA) said:
Looks like a long night for you.
It’s actually a lovely cycle but we know what he is capable of with this dose so I would get another test in an hour
The temptations are probably helping him stop dropping too low.
Click to expand...


I was afraid you'd say that... LOL
Well, like I said, after hearing someone with experience say I should probably not be at a half unit, I was okay giving him some treats despite the fact that it might push up his BG's.
It makes this evening's tests skewed, but I would rather do that, and stay up than have him go hypo tonight.
Seeing the 10.4 after the 23.4 this morning was odd, but I really do not think he ate much today - he was not feeling good.
So maybe the insulin had no food to buffer it.
I will test him again after 3 am

I really appreciate your help on this.
Truly.
 
5.3 (95) at +7

I gave him a couple more treats and got him to eat some low carb wet food by putting probiotics on it.
I think he's probably safe now?
 
There is always food in their dishes... they graze and we cannot get them to switch to eating defined meals.
We used to keep some dry Dr. Elseys out for him and his brother, but now I am starting to question if it's still a low carb option.
And I know that dry kibble is bad for a bunch of reasons, I know.
But it was something for them to eat if their wet food dried out while were were out of the house.
Anyway, it is almost 4 am and I think I will check on him (not test) and if he seems okay, I am going to bed.
Thanks again for all your help tonight.
Tomorrow I will test, and give him a quarter unit, unless he is under 5, in which case I will give him .1, as you suggested.
Laura
 
If he is under 5 stall don’t feed and test again in20 mins. Post and ask for help. Change the subject line to something like ‘stalling need help’ so we are alerted
It is fine to leave out the dr Elseys for them to snack on but try and not feed for the 2 hours Preshot.
It is fine to test again if you are still up
 
Good evening Bron!

Toeby was 12.4 (223) this morning and I gave him a quarter unit (0.25) of insulin.

Of course, this morning when I am tired and a little fumbly after only 3.5 hours sleep, the syringe had to be one of those miserable kinda sticky ones.
(yes, I move the plunger back and forth in the barrel to move the lubricant first)
But regardless, I think I measured a good quarter unit.

Again, thanks for all your help last night.
This morning was the first pre-shot in the yellow range I have had since last Friday, so that was great.
Last night was a pain in the a$$, but I am so glad he was/is lower.
You can tell he just plain feels better this morning too.

I try to only come here if I really need help - it always amazes me the generosity some people, like yourself, of their time and knowledge, for people and cats they do not know.
To be honest, I couldn't do what you do.

I will endeavour to get more evening checks going forward, but naturally, I hope not to have to spend a lot of sleepless nights like last night.

Double paws crossed that he has a good day today and doesn't dip too low.
Laura for Toeby
 
Hi Laura.
I’m sure you are feeling tired this morning!
But I’m glad Toeby is feeling better!
Hopefully the BGs will settle down now.

We are happy to help anytime. We care about all the kitties who come along...it’s a great community where you can get lots of support and help.
I would keep posting every day for a while until things settle down.
Are you able to start a new thread for today? On the L and L page a new thread is started each day....unlike the main health page.
Toeby looks such a sweet boy with his legs crossed.
Bron
 
You must log in or register to reply here.
Back
Top