Accidental Insulin Stoppage

B

Britty & Gingy

Member Since 2019
Hello all!

So we had an occurrence where I was going to work and my boyfriend was coming from work and we miscommunicated thinking the other had given insulin when neither of us had! As soon as we realized our mistake we checked him and decided to wait until morning to give his next shot as it was too late to give his pm shot. The next morning he was actually lower even without insulin so we decided to do a check to see what his levels were without insulin. He went up and down between 7.6 and 6.8 over the 3 day weekend. We thought this was good news and noticed that without the insulin he wasn't hiding under our bed all day.

So we had good numbers and Ginger was enjoying himself. I called my vet to ask him my next steps and he told me to go back on 2 units of insulin. I mentioned that I was informed to go on a lower dose by people on these message boards but he was adamant that 2 units should be used. He said though his numbers are good right now because Ginger has only been on insulin for less than 2 months that it could go back up into the red. It did lower his numbers into 4.7 and 5.3 with 2 units but he was going under the bed more again. We have been trying to get him back on a good schedule but he hates his shots and our schedules are so hectic right now. Should we see about lowering his dose to 1 unit, keeping him on 2 units or seeing a more long term no insulin range?

The numbers on the spreadsheet are calculated from a human glucose meter to a pet meter conversion and may be off a bit. We are also missing some numbers as our tracking has been poor lately. I want to do right by Ginger and my I just can't decide if I should trust Ginger to do well if he is feeling better or trust my vet and give him the 2 units of insulin.

Another quick question I have is in regards to food. We have recently been weaning him off the expensive hills diet to fancy feast and I cannot seem to be able to convert the kcal over? I feed 1 and a half (156 g) cans of hills DM per day as per my vets recommendation, can anyone help me convert this for the fancy feast pate (85 g) cans? TIA!
 
Welcome to Ginger and Britty!
I'm bumping your thread so it will be at the top of the list and be more visible!
It's nice to see that Ginger has nice numbers even though he didn't get insulin for many days. You should be able to have good dosing advice from an expert member! Good luck with your little friend!
 
Hey there and welcome. A few questions: when you say you converted your numbers from a human meter to a pet meter conversation, what exactly does that mean? Would it be possible for you to just give the human numbers as they were on the meter and post those? There isn't really a conversation from the human meter to a pet meter. Seeing the numbers as they were on the meter will be helpful.

About the calories from Hills to Fancy Feast ( it's the Classic FF that are the lowest in carbs) , it would be easier for you to figure out how many calories Ginger should be getting. Question: How much does she weigh? Is that a good weight for her?
To calculate calories need a formula that you can start with is the following:

The weight of cat X 13.5 +70 = the calories a day. Using the example of a 10 lb cat, it would be 10 X 13.5 =135 + 70= 205 calories a day. If you kitty needs to gain or lose weight, use that weight in the formula. This is a good starting place for you. The activity level of the cat needs to be considered and you might have to tweak it a bit.

The Fancy Feast Classics are approximately 95 -99 calories a can and you'd have to figure out how many cans you would need to get the calories you need.
 
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I'm running out the door, but won't be gone too long. I can come back to this shortly.

Just a few suggestions...
  • You'll generally get more input if you report BG numbers using the Imperial System rather than the Metric System since the board is based in the US: Blood Glucose Converter Calculator.
  • There are no accurate conversions between meters calibrated for human use and those calibrated for pet use. Please report the BG numbers as you see them on your meter.
  • Right now, we're missing too many pieces of the puzzle. Whatever mid-cycle spot checks you can get will go a long way to figuring out what is going on.
BBL...
 
On your pet meter numbers, he was way too low at times, even for a human meter. That 1.1 would have been serious intervention. Since you have those numbers on a human meter sheet, he had other low numbers that didn't flag lime green that should have been. He would have earned dose reductions on those days.

Your transition to fancy feast may have lowered his insulin requirements too.
That's all I can offer here, the experts will be by soon I bet.
 
Britty & Gingy said:
He went up and down between 7.6 and 6.8 over the 3 day weekend.
Click to expand...
7.6 mmol/L = 137 mg/dL
5.3 mmol/l = 95 mg/dL

Given the low numbers obtained with the pet meter, it looks like Ginger missed a couple of reductions. However, it's unclear what would constitute a "good" dose because of the subsequent 'conversions'. I do think 2u bid is too much. OTOH, I honestly don't know if 1u bid is too much or too little insulin.

Given the circumstances and without mid-cycle numbers, my suggestion is to pick a dose and stick with it while monitoring closely in order to catch any lows... if there are any. I hear you on being busy, but I don't see any way around close monitoring if you want to keep him safe. Perhaps the two of you could figure out some sort of schedule that would work? At this point it's really worth your while. It appears Ginger may be one of those kitties who will be OTJ sooner than later.

That said, you could start with a low dose of 0.5u or 1u and see how it goes if you're able to monitor closely.


Just my thoughts...
 
I forgot to comment on this:
Britty & Gingy said:
I called my vet to ask him my next steps and he told me to go back on 2 units of insulin. I mentioned that I was informed to go on a lower dose by people on these message boards but he was adamant that 2 units should be used. He said though his numbers are good right now because Ginger has only been on insulin for less than 2 months that it could go back up into the red.
Click to expand...
Years ago when cats started Lantus and immediately did well, vets were told to continue with the same dose for a minimum of two weeks before stopping insulin... almost regardless of the numbers. I haven't heard anything said about two months. Personally, I'd be concerned about kitty experiencing a hypo.

There's always the possibility of kitty falling out of remission for a multitude of reasons. It's why we suggest tapering the dose down to 0.1u prior to withholding insulin. Tapering gives those islet cells a bit more support... hopefully providing as strong a remission as possible.

We also suggest tapering testing down to once a month after kitty goes OTJ. Continued testing, even just once a month, will allow you to catch potential problems and address them before they become serious. If a kitty has to start back on insulin, the faster you catch the need and bring kitty's numbers back under 100 overall... the better your chances of kitty going OTJ again.
 
Bobbie And Bubba said:
when you say you converted your numbers from a human meter to a pet meter conversation, what exactly does that mean?
Click to expand...

I was using the pet glucose meter for about a month before I switched so just to get an idea of the difference I used both for about a week and got an average difference of 1.212 so I multiply my human meter numbers by that to get an estimate of his actual numbers. It's not perfect but helps me to get a better idea of where he is at.
 
Jill & Alex (GA) said:
I forgot to comment on this:

Years ago when cats started Lantus and immediately did well, vets were told to continue with the same dose for a minimum of two weeks before stopping insulin... almost regardless of the numbers. I haven't heard anything said about two months. Personally, I'd be concerned about kitty experiencing a hypo.

There's always the possibility of kitty falling out of remission for a multitude of reasons. It's why we suggest tapering the dose down to 0.1u prior to withholding insulin. Tapering gives those islet cells a bit more support... hopefully providing as strong a remission as possible.

We also suggest tapering testing down to once a month after kitty goes OTJ. Continued testing, even just once a month, will allow you to catch potential problems and address them before they become serious. If a kitty has to start back on insulin, the faster you catch the need and bring kitty's numbers back under 100 overall... the better your chances of kitty going OTJ again.
Click to expand...

I never knew about that but it definitely sounds about right.
I will give I unit for now and see where his.numbers go as I did get some hypo numbers from him unfortunately.
How will I know when he is actually in remission? Should I just tell my vet I am putting him on 1 unit. I don't want to undermine him but I also don't want Ginger to feel worse than he has to.
 
Britty & Gingy said:
How will I know when he is actually in remission?
Click to expand...

When he can maintain normal numbers for 14 days with NO insulin, he's officially in remission.

Britty & Gingy said:
Should I just tell my vet I am putting him on 1 unit. I don't want to undermine him but I also don't want Ginger to feel worse than he has to.
Click to expand...

A lot of us just keep it to ourselves until we have the proof that what we're doing is working ;)
 
Britty & Gingy said:
I will give I unit for now and see where his.numbers go as I did get some hypo numbers from him unfortunately.
Click to expand...
Please monitor closely because we have no idea how low 1u bid will take him.
Britty & Gingy said:
How will I know when he is actually in remission?
Click to expand...
Blood Glucose Converter Calculator
The conversion factor between the two systems is approximately 18. Using this factor, you can do your own conversions as follows:
  • Divide the decimal (USA) value by 18 to get the metric value: (mg/dl / 18 = mmol/L).
  • Multiply the metric value by 18 to get the decimal value: (mmol/L x 18 = mg/dl).
REDUCTIONS
First of all, depending on your dosing method/strategy, you'll want to follow the guidelines listed below for newly diagnosed diabetics when taking reductions:

Newly diagnosed diabetics - less than one year since diagnosis​
  • reduction *earned* after a single drop below 50 mg/dL and following TR, or
  • reduction *earned* after 3 drops between 40 - 50 mg/dL on three separate days for kitties who have shown they do not hold reductions well and following TR, or
  • reduction *earned* when the cat regularly has its lowest BGs in the normal range of a healthy cat (50 - 80 mg/dL) and stays under 100 mg/dl overall for at least one week and following TR.
  • reduction *earned* after a single drop below 90 mg/dL for those following SLGS ​

Long term diabetics - more than one year since diagnosis​
  • reduction *earned* after a single drop below 40 mg/dL for those following TR, or
  • reduction *earned* after 3 drops between 40 - 50 mg/dL on three separate days for kitties who have shown they do not hold reductions well and following TR, or
  • reduction *earned* when the cat regularly has its lowest BGs in the normal range of a healthy cat (50 - 80 mg/dL) and stays under 100 mg/dl overall for at least one week and following TR.
  • reduction *earned* after a single drop below 90 mg/dL for those following SLGS.
We highly suggest taking a reduction any time any kitty drops into the 30s or below. There are very few exceptions given for caregivers following TR who have collected years of data and KNOW their cat's response to the combination of insulin and food backwards, forwards, and inside out.


OTJ TRIALS
Prior to starting an OTJ trial, one wants to see kitty mostly in the range of a healthy cat (50 - 80 mg/dL), but under 100 overall... with only occasional readings in the 100 - 120 range.

Remission is achieved when kitty can go 14 days without insulin while maintaining normal blood glucose values under 100 overall. Most will stay in the 50 - 80mg/dL range. Although, some will occasionally experience BG numbers up to 120 mg/dL.
Britty & Gingy said:
Should I just tell my vet I am putting him on 1 unit. I don't want to undermine him but I also don't want Ginger to feel worse than he has to.
Click to expand...
I never wanted my vet to feel like I was undermining him either. I preferred us to be partners in Alex's treatment. I would just say something like: "I feel better reducing his dose to 'xx' right now. If it doesn't work out I can always 'increase/decrease' the dose." That way there was an open door between us and if something came up my vet knew what was going on and why. Your milage may vary depending on your relationship with your vet.


If you have questions, please post for help.
Good luck! :)​
 
Thank you all! This has helped a lot. I gave 1 unit last night an he was at 4.6 this morning before breakfast and his next dose. We will do a curve today to get an idea of how it is working for him. Thanks again! :)
 
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