9/16 (updated 9/19) 10 y/o newly diagnosed w/ BG below 10 for 108 hours after 7 days of Lantus

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Mandy Lai

Mandy Lai

Member Since 2017
Hello to all! This is Siu Bo and Mandy from Macau. Siu Bo is my feline brother, he turned 10 this August and has been newly diagnosed of diabetes last Friday 8 September. He's lost a kilo from 7kg early August to 6kg now. He's been on Lantus since then.

After fixing his low level of potassium which the vet said was the major cause of his refusing to eat, he's now eating, though just a little, and supplemented with syringe feeding home made clear chicken breast broth and babyfood. Will start to make him chicken/salmon paste today. His ALKP, which was another major worry, has moved back to within normal level of 98 U/L.

After 7 days of Lantus treatment, his BG seems to stabilise and has been maintained below 10 without Lantus for over 40 hours. However, the tricky part is, the "original vet" who's been seeing Siu Bo since he's a baby is currently on vacation and will be back only on the 22nd of September. Siu Bo has been diagnosed last Friday and he's been treated by the "visiting vet" since, the visiting vet's really helpful, as I brought Siu Bo to the clinic everyday since he's been diagnosed for blood test and check up. However the day before yesterday was the visiting vet's last day, and now I have no one to seek advice.

Just now I called the clinic again to confirm, the nurse advised that I should check Siu Bo's BG again at 08:00/20:00 everyday and follow the scale to decide on the dose, as the visiting vet has instructed that below 10, none, between 10 and 15, 1 unit, above 15, 1.5 units.

As advise by Kris (thank you again!), I've set up Siu Bo's spreadsheet. I've already made an appointment with the original vet, however it will be on 23rd and for the time being, I'm rather confused on what I should do aside from keep monitoring his BG and syringe feeding him with home cooked food. Would be much appreciated if you could kindly give me some advice. Thank you very much!
 
Hello and welcome. There is lots of information in the Sticky Notes on the top of this forum. They are good to read.

A few comments first about the spreadsheet, on those days or times when you deliberately do not give insulin, could you put NS (no shot) or Skip in the units column, so we know you did not give insulin, instead of just forgetting to enter something.

On this forum, we find that giving the same Lantus dose consistently is best instead of following a scale. We also determine the dose based on how low it takes the kitty. It looks like 1.5 units is too high a dose because he got down to 2.6 (47) two nights ago. Maybe try just 1 unit, no matter what the preshot value, except if he is below 11.1 (200) as you are new to testing, in which case you would skip the dose. If you find you have to skip doses a lot, that is also a sign that the dose is too high.

Have you tried any giving any low carb cat food? There are nutrients in cat food that he needs, like taurine, that are not in babyfood.
 
Hi and welcome. The protocols we use here do not dose on a sliding scale. I looked at your spreadsheet and see some dangerously low numbers. Lantus likes consistency and by jumping around the BG is bouncing around too. It's dosed not based upon tge preshot but rather the low point called the nadir. Preshot are important because if too low it's not safe to shoot. Please eread the yellow stickies starting with the basics and then SLGS and TR. when a cat tests 68 or lower on a pet meter it means too much insulin is being given. I think you will have more success and keep your cat safe dosing a lower dose every 12 hours. I'd consider a dose of no more than 1.0. See what others say.
 
Wendy&Neko said:
Hello and welcome. There is lots of information in the Sticky Notes on the top of this forum. They are good to read.

A few comments first about the spreadsheet, on those days or times when you deliberately do not give insulin, could you put NS (no shot) or Skip in the units column, so we know you did not give insulin, instead of just forgetting to enter something.

On this forum, we find that giving the same Lantus dose consistently is best instead of following a scale. We also determine the dose based on how low it takes the kitty. It looks like 1.5 units is too high a dose because he got down to 2.6 (47) two nights ago. Maybe try just 1 unit, no matter what the preshot value, except if he is below 11.1 (200) as you are new to testing, in which case you would skip the dose. If you find you have to skip doses a lot, that is also a sign that the dose is too high.

Have you tried any giving any low carb cat food? There are nutrients in cat food that he needs, like taurine, that are not in babyfood.
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tiffmaxee said:
Hi and welcome. The protocols we use here do not dose on a sliding scale. I looked at your spreadsheet and see some dangerously low numbers. Lantus likes consistency and by jumping around the BG is bouncing around too. It's dosed not based upon tge preshot but rather the low point called the nadir. Preshot are important because if too low it's not safe to shoot. Please eread the yellow stickies starting with the basics and then SLGS and TR. when a cat tests 68 or lower on a pet meter it means too much insulin is being given. I think you will have more success and keep your cat safe dosing a lower dose every 12 hours. I'd consider a dose of no more than 1.0. See what others say.
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Thank you both for your kind reply. I'll study the sticky notes. I've updated the spreadsheet with NS. He still isn't eating much on his own, so I want to syringe feed him to make up the energy he needs. Just now I tried to make him chicken and salmon puree, but he hates it. I think he's kind of sick of the fishy smell. I'll keep on with the chicken broth and make him some chicken puree.

Also thank you so much for the advice on Lantus dose. I'll check his BG again in two hours and if his reading is above 11.1 i'll start giving him 1 unit twice a day constantly (as long as his BG is not too low) until he sees his vet again on 23rd.

Thank you all again! I feel so much more at eased now, with all your support! Thank you!
 
Welcome to the group.

Not knowing what cat food is available in Macau, you may want to look over Lisa Pierson, DVM's website on feline nutrition. She does have a list of canned cat food on her website along with information on the amount of carbohydrates in the food. You want to be feeding Siu Bo low carb food -- which is sound like you are doing if you are feeding your kitty a raw diet. However, are you adding all of the necessary supplements to your cat's food to insure he's getting the proper nutrition? Supplements such as taurine are necessary for cat, for example. Dr. Lisa's site does have information on feeding a cat a raw diet along with what supplements are needed. This is the link to her website.

As Wendy was suggesting, Lantus does best if you give the same dose twice a day. It may mean lowering the dose so you can safely give your cat his injections rather than skipping doses. It may be that your starting dose was too large. The initial dose of Lantus is based on a cat's weight (initial dose = 0.25 x cat's ideal weight in kg) if your cat is not underweight if you opt to follow the Tight Regulation Protocol. If you follow Start Low Go Slow, the starting dose is 0.5u.

Please let us know if you have questions. The members here are very generous with their time and experience.
 
Hi Mandy, and welcome! :cat:

Some of those numbers on his spreadsheet are really low using an Alpha Trak meter. For future reference, we recommend giving a little bit of high carb food or some syrup or honey when the cat goes below 68 on an Alpha Trak and testing again every 20 minutes until they go above 68, and then every 30 to 60 minutes afterwards (because the high carbs can wear off quickly), until he is stable. Can you add the words using Alpha Trak meter to your signature line? The majority of us on this forum use a human meter which gives different readings, so it is important that we know you are using that meter.

I agree with trying the 1.00 dose consistently every 12 hours, as long as he stays above 200, for now. I also, am concerned that he is not getting the Taurine and other supplements needed. Are you adding any to his home cooked food? I had to syringe feed my kitty, and I used a canned wet cat food that was complete with the supplements.
 
Sienne and Gabby (GA) said:
Welcome to the group.

Not knowing what cat food is available in Macau, you may want to look over Lisa Pierson, DVM's website on feline nutrition. She does have a list of canned cat food on her website along with information on the amount of carbohydrates in the food. You want to be feeding Siu Bo low carb food -- which is sound like you are doing if you are feeding your kitty a raw diet. However, are you adding all of the necessary supplements to your cat's food to insure he's getting the proper nutrition? Supplements such as taurine are necessary for cat, for example. Dr. Lisa's site does have information on feeding a cat a raw diet along with what supplements are needed. This is the link to her website.

As Wendy was suggesting, Lantus does best if you give the same dose twice a day. It may mean lowering the dose so you can safely give your cat his injections rather than skipping doses. It may be that your starting dose was too large. The initial dose of Lantus is based on a cat's weight (initial dose = 0.25 x cat's ideal weight in kg) if your cat is not underweight if you opt to follow the Tight Regulation Protocol. If you follow Start Low Go Slow, the starting dose is 0.5u.

Please let us know if you have questions. The members here are very generous with their time and experience.
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Dyana said:
Hi Mandy, and welcome! :cat:

Some of those numbers on his spreadsheet are really low using an Alpha Trak meter. For future reference, we recommend giving a little bit of high carb food or some syrup or honey when the cat goes below 68 on an Alpha Trak and testing again every 20 minutes until they go above 68, and then every 30 to 60 minutes afterwards (because the high carbs can wear off quickly), until he is stable. Can you add the words using Alpha Trak meter to your signature line? The majority of us on this forum use a human meter which gives different readings, so it is important that we know you are using that meter.

I agree with trying the 1.00 dose consistently every 12 hours, as long as he stays above 200, for now. I also, am concerned that he is not getting the Taurine and other supplements needed. Are you adding any to his home cooked food? I had to syringe feed my kitty, and I used a canned wet cat food that was complete with the supplements.
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LizzieInTexas said:
Welcome :bighug:

Keep posting and asking questions. ;)
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Kris & Teasel said:
I'm glad you posted here, Mandy! Lots of experts to help you. :D
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Thank you all for your kind advices. My bad, I wasn't aware of the Alpha Trak note, actually Siu Bo has been tested with a human meter at home, but the vet has asked us to bring the meter to the clinic to do a comparison and the result is similar to the clinic blood test so it's sort of "approved" by the vet. I've deleted the Alpha Trak note from the spreadsheet. Thank you again.

The vet has initially prescribed Siu Bo with canned food from the clinic, but it seems Siu Bo is really reluctant to eat those, that's why the vet told us to first give him food he doesnt resist too much so as to coax him to eat more and get his liver index back to normal first. I have to confess that I have no knowledge on this and I've just been doing according to the vet's instructions (we've been visiting the clinic everyday), now the (visiting) vet's gone, I'm totally lost. Feeling lucky that I get so much support from you all. Thank you again.

I'll go over the information on the food, and I think I will either go back to the clinic tomorrow to get some other canned food for the syringe feeding, or the necessary supplement.

Siu Bo hasnt been eating (by himself) today, so we keep on feeding him home made chicken broth and babyfood (beef ternera) which he seems to like. He's actually quite energetic all day. The vet has commented that he's quite tough, since with BG as low as 1.9, he was still walking around far from collapsing.

It's been 48 hours since he last had his Lantus, but he's BG was just 5.3 so I dare not give him any dose.

Thank you all again.
 
You are absolutely right not to give insulin this morning. Does he gave other medical issues? I'm thinking he has to be nauseous if not eating in his own and needs medication for that. I've used both cerenia, a veterinary drug, and ondansetron. A human drug for that. AD if available where you live is easy to syringe by just adding a little water.
 
There are a couple of basics....

Your cat has to eat. At least for what may be a brief period, you can feed your kitty whatever he will eat especially if his liver values were off. Baby food, for example is fine but ultimately, you need a diet that contains all of the nutrients that a cat needs. It's fine to stick with a raw diet. You just need the additives. They may be available at a health food store, online, etc. There are companies that make pre-mixes -- dry ingredients to add to raw food that provide the nutrients needed. The problem is we don't know what's available in your part of the world.

Low carbohydrate food is good. Low carb canned food is best. Adding water to low carb canned food is even better. Most foods do not contain information regarding the "as fed" nutritional composition of the food. You have to get the "as fed" carbohydrate amount from the manufacturer. The guaranteed analysis values are only an estimate.

Many of the people here have run into vets that are not terribly experienced with either feline diabetes and/or the use of Lantus. You are likely to find that the people here have a wealth of experience with both. Frankly, my vet let me manage my cat's diabetes because she saw that I understood what I was doing and I learned from the people here. I didn't need to have her test my cat. In fact, many cats have higher blood glucose (BG) readings at the vet's office due to stress compared to what you see at home. If you adjust your cat's dose based on what you see at the vet's office, you could run the risk of overdosing your cat. This is among the reasons that home testing is so important. You obviously need a vet you feel like you can trust but your vet can't be available 24/7. There is usually someone on this board who can help regardless of the hour.

 
tiffmaxee said:
You are absolutely right not to give insulin this morning. Does he gave other medical issues? I'm thinking he has to be nauseous if not eating in his own and needs medication for that. I've used both cerenia, a veterinary drug, and ondansetron. A human drug for that. AD if available where you live is easy to syringe by just adding a little water.
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Sienne and Gabby (GA) said:
There are a couple of basics....

Your cat has to eat. At least for what may be a brief period, you can feed your kitty whatever he will eat especially if his liver values were off. Baby food, for example is fine but ultimately, you need a diet that contains all of the nutrients that a cat needs. It's fine to stick with a raw diet. You just need the additives. They may be available at a health food store, online, etc. There are companies that make pre-mixes -- dry ingredients to add to raw food that provide the nutrients needed. The problem is we don't know what's available in your part of the world.

Low carbohydrate food is good. Low carb canned food is best. Adding water to low carb canned food is even better. Most foods do not contain information regarding the "as fed" nutritional composition of the food. You have to get the "as fed" carbohydrate amount from the manufacturer. The guaranteed analysis values are only an estimate.

Many of the people here have run into vets that are not terribly experienced with either feline diabetes and/or the use of Lantus. You are likely to find that the people here have a wealth of experience with both. Frankly, my vet let me manage my cat's diabetes because she saw that I understood what I was doing and I learned from the people here. I didn't need to have her test my cat. In fact, many cats have higher blood glucose (BG) readings at the vet's office due to stress compared to what you see at home. If you adjust your cat's dose based on what you see at the vet's office, you could run the risk of overdosing your cat. This is among the reasons that home testing is so important. You obviously need a vet you feel like you can trust but your vet can't be available 24/7. There is usually someone on this board who can help regardless of the hour.
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Thank you very much. I'm finding so much support here and I'm really thankful.

Yes as you've said, his BG has been much more stable since Friday when he didnt need to visit the vet again for the time being. I'm now checking his BG at home and he's been very cooperative. This morning his BG was 5.9, and it's the 60th hour since his last Lantus dose. He's now mostly normal, maintaining his weight, and quite energetic when he's not sleeping, he did show interest in food, but he just sniffed and then walked away. I'll visit the vet later to buy some low carb cans to keep syringe feed him.

Thank you all again for sparing me your precious time and knowledge and experience. I'll keep studying about the food information. Wish you all a great Sunday ahead (it's now Sunday afternoon overhere in Macau), and I'll keep reporting whenever there is any update.
 
Hi Mandy.

I'd like to add my welcome to you and Siu Bo.

Mandy Lai said:
he did show interest in food, but he just sniffed and then walked away
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Did you happen to notice if he kind of licked his lips after he sniffed the food? Sniffing and walking away, especially if they are licking their lips, is an indication of nausea. When you talk to the vet, please ask about trying some medication for nausea to see if it helps get him to eat.

I didn't see this mentioned above (I might have missed it), but when feeding baby food, be certain the only ingredients are the meat and water and/or gravy. You don't want any vegetables, as some like onions and garlic are bad for cats.

Here is a post with some ideas that can help encourage cats to eat.

This thread has been going for several days now. To make them easier to follow, we ask each member to start a new one each day and put a link to the previous thread (or "condo", as we call it) in their first post of the day. Just ask if you aren't sure how to do that.

Here is a post we put together to help new members get comfortable with our forum.

We're glad you found us!
 
Hi Mandy,
I suggest you keep posting here for advice. Your kitty MUST eat. He's at risk for hepatic lipidosis if he doesn't. People here can help with many health issues, not just feline diabetes.
 
I'm confused as to why his BG is so low after 60 hours. Is he actually Diabetic or is it the other medical issues going on? Or is it that his normal food was causing the high BG levels and now the poor little furry isn't eating much, his levels have stayed low?
 
monty_dweezil said:
I'm confused as to why his BG is so low after 60 hours. Is he actually Diabetic or is it the other medical issues going on? Or is it that his normal food was causing the high BG levels and now the poor little furry isn't eating much, his levels have stayed low?
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I think any and all of what you are thinking might be true. I also strongly suspect pancreatitis. There's a blood test for it. Is he eating on his own now or are you syringing? If not eating on his own I strongly suspect nausea and he would not eat until it's controlled. Also he very well could develop food aversions to whatever you syringe. If not pancreatitis something else might be going on.
 
@monty_dweezil -- One possibility for the lower numbers is that with the switch to low carb food, the diabetes is getting under better control. Remember, even if a cat goes into remission, the cat is a diet controlled diabetic. Go back to feeding high carb food, illness or infection which can raise BG along with dental issues can all put a cat back on insulin. We've seen any number of cats that go into remission with a change to a low carb diet.

In response to Elise's observation above, is Siu Bo showing any changes in behavior other than not eating? Is he still active or is he sitting with his paws folded under his body and his head down ("meat loafing") or acting like his abdomen hurts?



 
Sienne, good questions. Max rarely meatloafed or showed pain. He always became inappetent though. Lots of other reasons for inappetence but nausea is almost always part of it.
 
Since you make chicken broth, have you thought of homemade cooked food? Try a little and see if he eats it, if so then you will need to add the nutrients but a few meals without them is okay. Spread his feedings out, smaller amount more often might help. This bone broth is good and healthy if your up to making it.

http://www.ibdkitties.net/bone-broth/
 
Thank you thank you all so much for your kind advises.

Last night Dad and I took Siu Bo to the clinic as he vomited (the second time since he's diagnosed on 8 September). There's another visiting vet, and after studying Siu Bo's medical record and multiple blood tests for the past week, he said it's unlikely pancreatitis, and the vomit was likely the result he's not eating enough and vomiting gastric juice. He prescribed Remeron and Zantac Oral Syrup. And the visiting vet strongly ordered that Siu Bo being syringe fed 3 packs of the prescribed Royal Canin Diabetic pouch. I got a new blender and was able to make it into porridge like texture and Siu Bo had one and a half pack in total last night, and another 2/3 pack this morning, and my parents will be feeding him again soon. He seemed okay with it and didnt struggle and ate everything we fed him.

However, I made a huge mistake this morning and I fed Siu Bo the entire 15mg Remeron this morning right before his breakfast. I have to come back to work after taking one week off. My parents are looking after him now. They said he's a bit too active, but aside from that nothing too wrong. I called the clinic this morning and they said I should keep monitoring him and call again at 10:00 when the vet would arrive.

I'm so scared now.

Sorry for being this careless. I'm really worried.
 
I would call your regular vet now (or an ER vet, if your regular vet is not available) and let them know what happened. I would ask for some (or a prescription for) another appetite stimulant often used called Cyproheptadine, as it is the antidote to serotonin syndrome which could happen with Mirtazapine. I hope everything works out, and your baby is fine.
 
I agree with Dyana and Elise. I hope Cyproheptadine is available there. You may have to get a prescription and have it filled at a human pharmacy if your vet doesn't carry it. We'll be watching for updates and hoping and praying that all is well.
 
Thank you all for your kind concern and advice!

My mom did say Siu Bo's a bit hyper and moved around this morning, after mom and dad fed him (the third pack of Royal Canin diabetic pouch since last night), he's calmed down and then he slept.

Just now during lunch i went home and brought him to the vet. After seeing him, the vet said he should be okay, and he actually gained 200 grams of weight (back to 6.1kg) overnight! He's been eating his syringe food properly, not struggling when feeding him, no vomitting. The vet said for the time being we should keep feeding him and will do blood test again in a few days. So I presume Siu Bo's stabilized for the time being.

But the vet did mention Siu Bo's a bit weird, cuz usually being diabetic will make the blood "acidic", but from Siu Bo's blood work he's actually towards slightly "alkaline". They are trying to figure out what that implies.

I'm a bit relieved now, and will keep going with the feeding. Hopefully he will be wanting to eat on his own in a few days time, and his appointment with his regular vet will be on 23rd September this saturday.

Thank you all again! I just rushed back to office and now i'll sneak to pantry to eat my lunch.
 
I'm glad he's okay.
What dose of mirtazapine did the vet say to give? I've read on this board that most people who use it, only give the teenyist sliver of the pill. I tried mirtz, but mostly used the cyproheptadine as it can be given every day.
 
Tricia Cinco(GA) & Harvey said:
Thank you for posting an update, Mandy, as we were concerned. I'm glad all is well and Siu Bo is getting a good amount of food.
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I should be the one to thank you all! Your concern and support are truly appreciated!

Dyana said:
I'm glad he's okay.
What dose of mirtazapine did the vet say to give? I've read on this board that most people who use it, only give the teenyist sliver of the pill. I tried mirtz, but mostly used the cyproheptadine as it can be given every day.
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The vet prescribed 1/4 of the 15mg tablet every 3 days, I was too nervous and i just got the "every 3 day" part but i missed the 1/4 of the tablet part. Lucky that Siu Bo is okay.

Just fed him another pack, he has eaten 3 packs (as prescribed by the vet) today, will feed him some more as supper before I go to bed. So far he hasnt vomitted or had any adverse effects. But I havent got time to check if he has any done any poop yet. Will do it now.

Thank you all again.
 
This is how Siu Bo is sleeping


https://imgur.com/aCoRs6O
MofN9
 
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That dosing for mirtazapine is the old way. Most give a much smaller dose once every day. I tried it several years ago for my cat and it only worked for about 1 1/2 days. It was new then. I still feel from too much experience that it's important to treat nausea before stimulating the appetite or food aversions can occur. So if she won't eat on her own ask about trying cerenia or ondansetron. I'm glad there wasn't a reaction to the large dose.
 
Kris & Teasel said:
He's very cute! :)
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Dyana said:
He looks so cute :)
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Thank you! I hope his sleeping position is not showing any sign of abnormality?

tiffmaxee said:
That dosing for mirtazapine is the old way. Most give a much smaller dose once every day. I tried it several years ago for my cat and it only worked for about 1 1/2 days. It was new then. I still feel from too much experience that it's important to treat nausea before stimulating the appetite or food aversions can occur. So if she won't eat on her own ask about trying cerenia or ondansetron. I'm glad there wasn't a reaction to the large dose.
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Tricia Cinco(GA) & Harvey said:
Awww, he hasn't a care in the world, has he? I'm so glad he is eating. Are you still having to syringe the food, or is he eating it on his own?
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He has had 600g of Royal Canin Diabetic (syringe fed) in 2 days, which is the amount prescribed by the vet. He hasnt vomited and so far no adverse effect. This morning he ate a few biscuits!!! On his own!!! But when I offered him his favorite canned food, he sniffed and walked away, so we syringe fed him. But he wasnt struggling much and he ate all we fed him. My parents also feel that he's starting to show interest in food, so we planned not to give him anymore those stimulating medication until we see his regular vet this Saturday :)

He BG has remained around 6 yesterday. But this morning his BG dropped to 5.1. Today is his fifth day without Lantus dose.

Thank you everyone!
 
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