8/22 River AMPS=293 +3=202 +5=160 +6=204 +9=542 ???

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Picknickchick

Picknickchick

Member Since 2013
I am concerned that River might be dropping too fast for what his body can handle. He was recently diagnosed with pancreatitis, and had uncontrollable high diabetes until an episode of ketosis landed him in the hospital for 6 days. He was released a month ago, and has been doing better. As he's been improving, his numbers have shot way down, and he had a hypo on Tuesday, which was the scariest thing I've ever experienced.

I will link a spreadsheet with his numbers, after I post this.
He is a 14 y.o. male cat, weighs 5.52 kilos (12 lbs.), eats low carbs raw, Wellness no-grain canned, and (infrequently) Orijen dry.

Here's how his numbers have gone:

Sunday August 11
7 AM preshot 19.8
8 AM 2.5 units glargine
11 AM 16.5
2 PM 11.5
5 PM 12.4
8 PM preshot 27.9
8:20 PM 26.2
8:30 2.5 units glargine
9 PM 28.9
4 AM 22.7
8 AM preshot 22.3
8 AM 2.5 units
11 AM 18.7
2 PM 16.6


When we spoke, the vet recommended increasing the dose to 3 units. She said to not be upset about the high 8 PM readings, as I could "expect flareups from a cat with pancreatitis".

Sunday August 18
- Sunday I was worried that he might be going into the hypo range, as he's not used to low numbers.
8 AM 2.5 units
10 AM 8.4
12 PM 4.7 - at this point I gave River 2 pieces of sweet potato with Karo and called the clinic
2 PM 6.6
5 PM 10.2
7 PM 18.9
7:15 PM 2.5 units - clinic said to reduce insulin to 2.5 units

Monday August 19
- Monday he had a checkup and ultrasound of his pancreas, which is healing well. About the hypo, the vet dismissed this concern and wrote in the report that he is "well controlled".
8 AM 2.5 units
10 AM 22.7
Went for checkup and ultrasound and vet recommended increasing back to 3 units for AM and 2.5 for PM shot. She said he was "well controlled" but I didn't think so.
7 PM 27.3
7:15 3 units - I gave 3 units because he was so high. Phoned clinic and they said this was correct. However later I emailed vet and said that ongoing, I am anxious about giving 3 units in the day because he's going into hypo range, and would prefer to do 2.5 units twice a day. Would this be ok? She did not respond.

Tuesday August 20
- Tuesday he had a hypo.
7 AM 15.6
8 AM 3 units
10 AM 13.1
12 PM 9.7
2 PM 5.4
3 PM 4.8 - Because his numbers continued to go down, I gave him some kibble and two small pieces of sweet potato with honey.
5 PM 7.1
8 PM - Just before his preshot reading, he had what I am guessing is a seizure! He was lying beside where I was writing on the table, and his eyes looked all wrong: tiny pupils and third eyelid partly covering. I called him, and shook him gently, and he was completely limp and didn't seem to be breathing. I started giving him mouth to mouth, and he suddenly came awake, and stood up. I picked him up in my arms and he shook himself so that he almost jumped out of my arms. I put him down on the deck, and he walked a bit. We went inside, and when I touched him he jumped and shook a bit; super-sensitive to touch. I thought he might be hypo so I got the Karo and stuck some in his mouth, and then got some rabbit/turkey raw food, which he was happy to eat. I was freaked out, and called vet to see if I should give him his 8PM shot, and what to do. They said to reduce the shot to 2.5 units.

Wednesday August 21
- Wednesday he was high, bouncing.
6:20 preshot 24.4
8 AM 2.5 units
10 AM 20.4
12 PM 19.7
2 PM 20.2
4 PM 19.9
Vet called and advised:
- no insulin tonight at 8
- tomorrow don't check BG because it'll be all over the place
- no insulin at 8 am or pm tomorrow
- insulin Friday am 2u and then 2u BID
- do BG next Friday unless weirdness

However, I did not follow this advice, posted on FDMB, and gave 2.5.


Thursday, August 22 (today)
- Today he is lower, but I'm worried that his body might not be able to take this low yet and he'll hypo again.
AMPS 16.3
8 AM 2.5 units
11 AM 11.2 Worried that he is dropping too fast, I gave him 1 mg B12 wrapped in liverwurst and 1/4 c Orijen. Posted message to FDMB asking if he's dropping too quickly.
1 PM 8.9 Fed small pieces of sweet potato with Karo.
2 PM 11.4

My concern is whether I should lower the insulin dosage. Although he was lively early in the day before his 8 AM shot, grooming and walking around quite well, he's now very quiet and has been mostly sleeping all week. I'm afraid of stressing his body too much. Should I go lower with the insulin? I am assuming that he would have gone even lower without the feedings I gave him.
 
Re: 8/22 River AMPS=293 +3=202 +5=160 +6=204 dropping too fa

5 PM reading: 30.1
Please some advice if possible.
I was just about to give him dinner. Should I hold off?
 
Are you following any particular protocol?

At this point I would hold the dose for 3-6 days (unless he drops under 50) to see how he does. That blue was a nice number today!
 
Hello, and welcome to Lantus Land. First a question for you - what is your name?

Thanks for getting your SS up and running. Most people here speak mg/dl (US numbers) so the SS helps them. I'm from Canada so "speak" mmol/L. For your latest question, feel free to go ahead and feed if it's normal dinner time. However, most people do a test, feed, and shoot insulin all within 15 minutes or so. You only want to feed a small amount of food after nadir.

Try not to worry about the numbers at PS. Lantus is dosed based on the low point or nadir. Those 4.7 and 4.8 numbers you got are not hypos, they are all in the normal blood glucose range for a cat. I tested my non diabetic cat last week, and he tested at 3.0. :-D The more time River can spend in those numbers, the more healing his pancreas can do.

I'll give more info in the next post, just wanted to get this one to you first.
 
It's OK to take the 911 off now. You are getting answers to your questions and we like to reserve the 911 for medical emergencies.

People posting here follow the Tight Regulation Protocol listed in the sticky at the top of this forum. According to it, you are supposed to hold the original dose for 5-7 days, to allow the Lantus depot for form, unless the cat goes below 50 (2.8). I would stick to the 2.5 units for now. Lantus works best with consistent dosing and as I said before, is not based on the preshot, but rather the nadir.

That high number you just got is likely the result of a bounce. River saw a lower number than he's seen for a while and is reacting to it. It's a normal thing, most cats do it when they first start on insulin. Try to ignore it - he will get over it. And stick to the same dosing.
Bounces - what are they and is my cat doing them?
When a cat is first diagnosed, the blood glucose has probably been high for a while. As the insulin starts to take effect and numbers start to come down, the liver has to learn to adjust to the lower numbers. We call this "liver training school". But before it relearns that low numbers are ok, when the BG drops to a number lower than the liver is accustomed, or if BGs drop low, or if the BG drops suddenly, the liver”panics” and reacts by releasing counterregulatory hormones and glucagon. This drives the BG back up. This is what we call a "bounce". Bounces can take up to 72 hours to clear so we are generally careful about increasing doses during the bounce. Once the bounce clears, then you can see the "real" numbers and determine if the dose needs to go up or down.
Click to expand...

A couple other things. Please ditch the Orijen dry food. It's too high in carbs and can play havoc with the numbers. Rather than sweet potato and karo, you might want to invest in some of the Fancy Feast or other brands with gravy. The gravy from the Fancy Feast Gravy Lovers line is a great way to boost numbers when they are low. The numbers he had today did not need to be boosted. Normally we reserve high carb food (HC) or karo for numbers under 50 (2.8). That 542 might also be the result of the high carbs you gave him earlier.
 
Thanks for the info and advice, Wendy&Neko!

Why I was reacting so strongly to the low numbers of the last few days is because River had a seizure on Tuesday, which was probably a hypo, and he wasn't in really low numbers. It might have been just because his body is not used to low numbers yet, so today I was afraid he was going to have another seizure today if he went too low (for him). The hypo was the most frightening thing that I think I've ever encountered, and I still have a sore stomach from it. So I'm a bit jittery about what's going on.

I'm wondering if it be better to ease him into lower numbers, what do you think?

Thanks again,

Lara

Edited to add: I am on vacation all this week so I've been watching him closely. However on Monday I return to work, and I am so very worried about him going too low while I am not here.
I'm quite stressed about this.
 
Hi Lara. We have many members here who work. One strategy some of the use is to shoot early enough in the morning, that they can get a +2 before leaving for work. That will give a good indication of what the cycle will be like. A +2 number similar to the PS means you are likely to have a normal Lantus cycle. A number less than PS means an active cycle where he might get low numbers.

Is River a grazer or does he eat all his food at once? If he eats all at once, you could buy an autofeeder and have it set to go off mid cycle with medium or high carb food if that +2 test tells you River might be going low while you are gone. An alternative to the autofeeder is to freeze portions of food combined with water, in an ice cube tray and leave one or two out before you go. It will thaw later when he needs the food. If he's a grazer, just leave the appropriate food out with extra water in it to keep it from drying out. Any chance you live close enough to work that you can occasionally come home and test mid day?
 
Hi Lara

Welcome to you and River. We're glad you found us!

I agree with Wendy that his numbers the other day were not hypo numbers. Cats do feel off when they've been in high numbers and then start to get Into lower numbers.

I'm also going to encourage you to lose the dry food no matter how little you give currently. Dry food can take a while to
raise low numbers up and then it hangs around.

Please let us know how we can help.
 
Nikki's Mom, Wendy&Neko, Marje and Grace,

Thank you for your thoughtful and helpful messages! I'm glad I found you too! dancing_cat Today is a new day, I'm less stressed out, and your advice helps a lot.

I love the idea of changing the shot time and getting a +2 in before going to work. Sometimes, but rarely, it's possible to come home at lunch, or better yet work from home, but I'm in a new job role that allows less of that. So how do I change the injection times? I have been giving shots at 8, and would like to move that to 6 or 6:30. Can I shoot 30 minutes earlier each day until I reached the new time?

This is so helpful to know that " Cats do feel off when they've been in high numbers and then start to get Into lower numbers." Thank you for that, Marje and Gracie. Knowing what's going on changes it from scary to just how it's going to be for a little while. And I see you also have a cat who is of the feline aristocracy. Small world!

I'll lose the dry food for River. I have six other cats, and a couple of them get it at the most 1 or 2 meals per week. I can't afford to do raw for all of them, so they get the Fancy Feast classic pates.

To answer your question, Wendy&Neko, I have never free-fed. Right now, what I've been doing is giving River 4 small meals per day: two breakfasts, one either before or at shot time, one 1 or 2 hours after, and two dinners, one when I get home, say 6ish, and one with the shot at 8 PM. And I give one small piece of freeze dried duck liver or pork heart at 10ish. Let me know if this is okay for a diabetic cat.

Nikki's Mom, thanks for the encouraging word about the blue number yesterday. I should have just held off with the sugar yesterday and discovered where he went, rather than interfering. After all, he had 2.5 units last night, and is very much alive and well today. In fact, he has been great, acting like the alpha cat again, chasing another cat and play-boxing him.

I have a question. Let me know if I should make this a separate posting, but it's about B12. I have read Jasper's story, and "The Importance of B12" on IBDKitties http://ibdkitties.net/B12.html. My vet won't prescribe injectible B12, but I have the tablets. It's the right kind, methyl-B12 with no additives. But I have read that it's better to give the injections because the pill is poorly absorbed. Do you have any experience or insight into this? From what I read on Jasper's story, it seems like he got the tabs. If the pills are all I can get, I'd still rather give them than not.

Thank you again ~so much~ for your help,

Lara
 
Lara

On the B-12, it depends on why you are giving it. Methylcobalamin is the better form of B-12 for neuropathy and for IBD. For neuropathy, most of the members who use it give Zobaline.

For IBD, it seems most vets give cyanocobalamin injectable. I do know methylcobalamin injections exist and so it's possibly a question of absorption. I'd check with the vet on that if you are asking for IBD or the other reliable Internet sources you have found.

We do one condo per cat per day so, for future questions, you can put all of them in your daily condo. :-D
 
Hi Marje and Grace,

Zobaline - aren't you sweet to include the link! I'm wanting to give him B12 for neuropathy, as he has had stiffness and weakness in his back legs. He isn't walking on his hocks, and I don't want it to get to that point. I am giving him B12 from Sisu right now, but can switch to Zobaline when the bottle is done.
This may be a silly question, but what's a condo? I checked the glossary and it's not there.
 
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