A word of thanks

Hello,

My beloved Siamese cat Minnow, age 13, was diagnosed with diabetes February 7 and started on Lantus at 2 units AM and PM. While I don’t want to disparage my vet, I now realize different vets take different approaches, I was given no guidance on conducting at home glucose monitoring, nor information on hypoglycaemia. I found this forum and did A LOT of reading.

I learned which monitor to buy and how to conduct at home glucose checks, how to build a hypo kit, the need for a pre-shot measure, and I successfully conducted my own curve. Well, today you saved Minnow’s life. We just returned from the emergency vet.

Last week Minnow’s pre-shot values were around 108 and I skipped doses due to what I read here. I reached out to my vet and was advised to lower his dose to 1 unit AM and 2 units PM. I reduced those doses further based on pre-shot numbers. This morning’s pre-shot was 223 and I gave him .75 units. By +2 he was 158 and at +3 he was 50. If I didn’t have a hypo kit ready I don’t know if he would be here now. I gave him high carb food and honey and rushed him to emergency. He either has gone into remission or his starting dose was too high. He’s off insulin for a few days until I can reassess. Again, every cat is different, so I don’t want to frighten anyone with my story. I just want to express my sincere thanks. Thank you. Without this forum I wouldn’t have been checking his BG at pre-shot and I wouldn’t have been prepared for a hypo. Minnow thanks you as well.

 

Hi Lisa,
I am glad this forum was able to help you and Minnow.
If you are going to go off insulin for a few days, please test the urine for ketones. These can appear if a diabetic cat is not getting the insulin they need. To do this you will need a bottle of Ketostix from a pharmacy or walmart.

I doubt your kitty is going into remission with BGs of 223.
Lantus dosing is based on the nadir or lowest point in the cycle, not the preshot.
I would think that Minnow needs a reduction in dose. We increase and decrease the dose in 1/4 unit increments and go down to a drop of insulin before stopping insulin.
You need to ensure that Minnow has a strong remission otherwise he will fall out of remission and need insulin again, and it is much harder the second time around to get them off insulin again.

What type of meter are you using? A human or pet meter?

What I would suggest you do is set up one of our spreadsheets and add at least a few weeks data into it and let us have a look to see what is happening.
It is very possible he is bouncing and this is causing the drops and then the higher BGs. We can help you with this.
Definition of bouncing from The Basics

• Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

Here is a link to the spreadsheet and signature and more
HELP US HELP YOU

 

Thank you! I suspect he is bouncing as well. I will fill out the spreadsheet. I am using an Alpha Trak 2, that’s what these numbers are from. I also bought a One Touch Ultra 2 and can use that as well.

 

I just want to add that Lantus requires consistency so you want to give the same dose in the am and pm unless you’re reducing because of a low preshot test value. 1 unit in the am and 2 in the pm is not recommended. You could do 1.5 twice a day. Anyway, just for future reference

 

Also, if taking him to the er is what you’re most comfortable with, that’s totally fine and your call but we’d probably have recommended that you tested again 20 minutes after the honey and HC food and if the numbers were going up to just keep monitoring and giving him more HC food until he was out of the danger zone. Great job on keeping your cat safe!!!

 

Thank you. I found the recommendation for different AM/PM doses suspicious as well. As for the emergency visit, I’m too new to have any confidence yet! I saw the 50 and freaked out. The ER vet put Minnow on IV glucose and his numbers were up then down then up. They mentioned insulin depots may be contributing. A little beyond my current understanding.

 

You will find the alphatrak meter is vert expensive to run...the test strips are very expensive. If you have a human meter you might like to swap to that...our dosing methods are based on the human meters. But don't use both...if you do you will get totally confused as the results are slightly different and cant be compared. So choose one and stick to it.
As Ale said lantus likes consistency so best to give the same dose both cycles. As you were giving 1 U and 2U (3 units total for the day) and that caused a drop to 50 on the alphatrak, you would need to reduce that dose to say 1.25 U each cycle (total for the day 2.5 for the day). Does that make sense.
DO you have a hypo kit set up
HELP US HELP YOU has the hypo kit in it. please make sure you get one set up today.
Please post here anytime you need help with understanding something or need help

 

You did great! Seeing low numbers for the first time throws pretty much everyone into a panic attack. Most of us get pretty innoculated to seeing numbers in the 50s (although, with an AlphaTrack, that translates to lower than 50 on a human meter). Hopefully, you will build your confidence when it comes to seeing low numbers so you don't end up spending a fortune at the ER vet. Bottom line -- you felt better and your cat was safe and that's what really matters.

With Lantus, a cat may be sensitive to insulin after a big drop in numbers. If you're planning on skipping insulin, get a few tests so you can see where Minnow's numbers are falling.

I'd encourage you to take a look at the sticky notes at the top of the Lantus board. There's a great deal of basic information there about Lantus and how it works and there's a note specifically about the depot. We're happy to answer questions, too. We're pretty good about filling in the blanks that the vet may have left!

 

Thank you for the words of encouragement. I’ve spent all morning reading the sticky notes for Lantus again. It takes time to process! I can see now how the insulin depot works and how we ended up in trouble with a starting dose of 2 units and then skipping doses. The ER vet recommended 3 full days with no insulin to clear his system, ensure he still has diabetes, and then just start over. That is what I will do with some tests thrown in over the next three days. I am also going with the SLGS method this time which is very similar to what the ER vet suggested. Starting at 2 units was likely too much. Looking forward to sharing the results here. Thank you for the support!

 

If you are not giving insulin for 3 days I would recommend you test the urine for ketones as diabetic cats who are not getting insulin can develop ketones which must be addressed straight away to prevent them developing further.
To test, you need a bottle of ketostix which you can buy from Walmart or a pharmacy. Follow directions on the bottle.

 

You are correct -- there is an overwhelming amount of information to process! The good news is that after a bit of time, much of it becomes routine. I'd also note that I've been here for a lot of years. I still see things in the sticky notes that I find helpful and I go back to look them over frequently -- and I've written some of them!

There is also a weight based formula for the initial dose, although it was developed for the Tight Regulation Protocol. The formula is: initial dose = 0.25 x ideal weight in kilograms. Practically, this usually results in a starting dose in the neighborhood of 1.0u for an average sized cat. With SLGS, if your cat is already on a low carb diet, the starting dose is 0.5u.

If you've been using the pen for dosing, you will need to get syringes. You will want U-100 3/10cc syringes with half unit markings. The sticky note on Insulin Care & Syringes has the information you will need.

I also agree with Bron. Testing for ketones is a matter of prevention. Diabetic ketoacidosis can be a life threatening condition. If you catch it when the ketones are in the trace to small range, you can manage this at home. If they go beyond that level, it can be an expensive hospitalization. Keeping an eye on whether they are developing can save your cat and your bank account.