BG 425 to 73 in one day after starting Lantus don't know what to do?

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Sunny1031

Member Since 2015
Hey everyone I'm quite new to this but I am a fast learner and I've been reading as much as possible in the last week that I found out that my cat Sunny is diabetic. He is 11-12 years old and currently weighs in at about 14 lbs. He was about 20lbs only 6 months ago and then started getting all the symptoms, heavy drinking, urination, not walking good on his hind legs etc. In that short time he lost all that weight which I felt was good cause I knew he was overweight but I knew something was wrong because his diet was not changed at all. Unfortunately I was away for a few months for work and my parents were caring for him and started feeding him dry food twice a day as well as Wellness canned food unrestricted all day which I have had numerous arguments with them about free feeding him especially since he was overweight but they did not listen to me and I didn't even know about the dry food until he came back from the vet and his glucose was off the charts at 502 and then my dad decided to make a little confession to me (I'm sure you know how mad I was at this point) needless to say I immediately resumed control of his diet only feeding him wet food 2-3 times tops a day in between the week I had to wait for my vet to take him in and start him on insulin. In that week his fasting BG went down to about 370 and after eating 425. I've been testing him as often as I can. Yesterday was his first day on Lantus and I had to leave him at the vet all day for them to monitor him and make sure he was alright. He started him on 3 units twice a day and said that probably when I bring him back in 2 weeks to get checked again more then likely he would have to increase his dose. Well today one day later and 3 shots in at about 36 hours his fasting BG was 73 and after eating 98 at +12. My question is this normal to drop this low this fast? I'm afraid that maybe his dose is too high already if it dropped this fast or is this just the way that this insulin works? Keep in mind I did also alter his food in the last week to just straight wet Wellness canned and cut off all dry. I trust my Vet for the most part but he didn't even tell me to keep checking his levels like I have, I decided to do this all on my own but I don't know if I'm just freaking myself out for nothing or maybe my vet doesn't know as much as he thinks he does. According to the calculations I've read on here he should start on a dose of about 1.5 units if I go by his weight but is there something else I'm missing? He has no Ketones as of his blood test last week but his liver values are on the high side. Sorry to drag on but I want to make sure I have everything anyone might need to possibly help. At this point I'm afraid to give him his next dose I'm debating on skipping it and waiting till the morning to ask the vet or maybe just giving him a lower dose but I'm afraid to do that after all the stuff I've read on here about keeping the same dose for a few days before changing anything. Please help, any insight would be greatly appreciated. Thanks in advance!!!
 
I totally agree with you that 3 units is way too large a starting dose. There is no such thing as too much information around here BTW. Your calculation is correct on the starting dose. Lantus is a depot drug and builds up over time so glad you continued the three units he would go hypo almost certainly. We tell newbies not to shoot if the pre-shot number is under 200 and to post and ask for advice.nwhen are you due to give the next shot?

I would skip the shot and check the AMPS and post about half an hour before shot time for advice. Usually the nadir, lowest point in the cycle will be at 5-7 hours after insulin but some are early and some are late.

It's 1:11 a.m. in Californiawhere I am but my cat decided to throw me a low number so I'll be up for at least 45 minutes to make sure he stays safe. That reminds me. Do you have some high carb food and karo syrup or honey in case your cat drops under 50? What type of meter are you using and what is your name?
 
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I was supposed to give it to him 4 hours ago I just gave him 2 units right after writing this post I didn't think anyone was going to respond this quick and I was too afraid to wait any longer to call the vet in the morning. What should I do at this point just monitor and make sure he doesn't go too low and maybe just reduce the next dose as well? How could he tell me to give this dose I don't understand unless he's basing it on something else that's on his bloodwork that I just don't understand yet. I'm beside myself right now. Thanks for responding so quick!
 
Hi and welcome. Where do you live (as in city, state or country)? It helps to know what time zone you're in.

You're right that changing his diet to all canned low carb (is it Wellness Grain Free you're feeding?) could affect the BGs dramatically.

Many of us here had a similar experience with our vet when our kitty was diagnosed. What you need to keep in mind is that the typical vet has to know about alot of different conditions for several different species, and rarely do they know a lot about one specific disease. Vet students right now in the top teaching hospital in the country get exactly 5 hours of training on diabetes in cats and dogs! Most vets have little experience in treating it because, sadly, a great many people simply put their cat to sleep when they are diagnosed. Also, depending on your vet's age, he or she may not have much experience with Lantus, which is relatively new for cats, and may not completely understand how it works, which is quite differently than other insulins previously used.

What was his BG when you gave the shot?
 
I'm in NY so eastern time zone I should be sleeping right now instead I'm up doing my Vets job. His BG was 84 when I gave him the shot.
 
When I fed him 4 hours ago when I originally was supposed to give him the shot it was 73 and then spiked to 98 after eating if that helps.
 
I'm so sorry your vet gave you such bad advice. You need to get a test one hour after insulin and post. I'm hoping he won't drop. Meanwhile read the stickie in shooting low numbers. I asked Tricia to pop in and see that she has.
 
We cross posted again. I'm glad it's a human meter because that 84 would be about 30% higher in a pet one and is safe.
 
I'm thinking Sunny is going to need careful monitoring throughout this cycle. As Elise mentioned, having some high carb food and karo syrup or honey available is a good idea in case he goes low. By hi carb, I do NOT mean dry. Something with gravy is good. Do you have any of that? And plenty of test strips?
 
I have plenty of test strips in fact I have 2 different meters though I don't like the other one cause it requires more blood it's a onetouch ultra mini and a little older the freestyle lite is brand new I just bought it today when I went to go and pick up syringes thank god. Sometimes there readings differ anywhere from 10-20 so I'm not sure which one is off reading or if thats just how they are the freestyle tends to be a bit lower. I have Aunt Jemima syrup and I might have honey not sure I have to check. The only high carb food is some crappy 9lives that my dad feeds the stray cats outside sometimes but I don't even keep that stuff on the same level of the house. The wellness has some kind of yellowish gravy when I scoop it out though it kind of looks like maybe fat coagulated or something and yes I fed him again before I shot him. He's sleeping right now on the floor in front of me his breathing and everything sounds normal.
 
Okay. I don't want to scare you, but Sunny could go really low on that dose and you need to be prepared to keep a close eye on him, I'll stay with you until we're sure he's safe and/or someone else comes aboard. Some of our best experts live on the East Coast and will be getting online in a couple of hours.

Does it say Grain Free on the Wellness can?

May I know your name, please?
 
BTW, it's not at all unusual for two meters to read differently. In fact, the same meter, if you took one reading after another, could give you two different numbers. We just need to be in the ball park.
 
My name is Andrew.When is the peak of this insulin usually or is it different for every cat? It's prob been about an hour since I shot him cause it took me about a half hour to write the post and I didn't realize that it didn't post at first so I actually shot him before I posted it up then. Is there a different meter that I should be using or do I have just have to convert the numbers a little bit. I thought they were all the same the vet even said a human one is fine. The Wellness is grain free all natural the big can cost a little over $3 a can so it better be. I swear if something happens to Sunny you guys are gonna see me on the 5 0'clock news tonight strangling my vet after all the money I paid him and I still have to do his job for him you have no idea how mad I am.
 
Is he eating well? You will probably need to be feeding him some amounts more often right need to keep the BG in safe numbers. By peak do you mean low point which is called the nadir? That caries from cat to cat but is usually around 5 to 7 hours after injection. We will help you keep him safe. You have come to the right place. You will need to test hourly right now unless he drops lower.
 
Hi Andrew.

The peak is "normally" around 6 hours after you give the insulin - and by that I actually mean what we call the nadir, which is the lowest BG of the cycle. However, ECID - Every Cat is Different - and some nadir at +3 hours, some at +7. If you will test Sunny at about 1 hour after the shot and tell me what the reading is, we can maybe see if he's dropping. Keep in mind that some cats get a food spike, so if you test them at +1 or +2, you might get a higher number than the preshot, but then they'll start to go down.
 
Oh and not sure if I mentioned before but I did feed him again before I gave him the shot. He'll pretty much eat as much as I feed him whenever he'll eat anything he's kind of like Garfield only he's white with blue eyes. I never give him any human food but my dad has snuck it to him a bunch of times in the past and he always trys to jump on the table and eat whatever were trying to eat so feeding him won't be a problem I can wake him up right now and feed him if I want and he'll eat.
 
Elise and I posted at the same time.

Your meter is just fine. They are all pretty similar - some take more blood than others, some have less expensive test strips, etc.

I do know how mad you are. Unfortunately, yours is not an unusual story. Again, it isn't totally the vet's fault. They just don't have the experience. You have come to the right place. The people on this board are very knowledgeable and experienced, and they saved my cat's life when I joined.
 
Your vet gets points for telling you to home test, and for approving of a human meter. Many vets discourage testing and just tell you to shoot blind and come in once a week for a curve!
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He didnt tell me to test I asked him about it and then he said yeah thats good if I want to do it, he did just tell me to come back in 2 weeks and keep giving him the 3units twice a day that whole time.
 
I was shooting blindly for the first month but my vet had me come in a few times a week to check bi was chicken to test at first. Max hit a nadir of 60 in his office and we stopped insulin for three weeks. Not smart but at that point I was starting toniest but couldn't be home enough. As long as you follow the advice you get here you will be fine.
 
My vet did the same as Elise's, and kept raising the dose every time we went in for a test! She had us up to 3.5 units two weeks after diagnosis. I didn't start seeing results until I listened to the people here and lowered the dose.
 
It's possible because you are getting a food bump. Onset of the shot you just gave will likely be about 2 hours after giving it. Cats often bounce from normal numbers so Sunny might continue to rise. To be honest that would be a good thing right now.

Tricia and I cross posted. I set a phone alarm and try to nap on the sofa when having a pj party.
 
I read something that if they get stressed that it could spike him up a bit but that much? Idk I did delay giving him the dose by 4 hours and lowered it to 2 units like I said. I just tested one of my other cats thats younger and normal as far as I know and he was a 59 so what number am I shooting for here?
 
"Normal" numbers are generally around 60-120, I believe. Cats, like people, have fluctuations in the BG throughout the day, depending on what's going on. Eating and stress can affect it, as can illness. I've seen food spikes of over 100 pts.
 
Normal numbers are between 50-120 so that is where we strive for our cats to be as much of the time as possible. Lantus is dosed based upon the nadir and not pre-shots. Max hasn't gotten there in 1 1/2 years.
 
Hi Andrew, ladies

It's just heading into the evening for me so I can stay with Andrew if you'd like to get some zzzzzzzzz
 
Wow so how did sunny drop so low in only one day? Is this a miracle or something or maybe my prayers are pretty powerful I mean like I said I changed his diet and I also have been exercising him with the laser pointer though I haven't the past 2 days since he started the insulin cause I didn't want to do too much all at once but I'm pretty sure his body is producing his own insulin cause he went from 502 to 370 in only one day after cutting dry food and exercising him a little bit before I started him on the Lantus this week cause I heard that stimulates the cells to absorb insulin naturally. Haven't read any of that stuff yet. Usually I read every post on a forum and find the answer I'm looking for but tonight I couldn't read fast enough to find the answer that I was looking for and I read pretty fast that's why I decided to just post and see what happened but I didn't think that anyone was gonna respond that quick you guys are really great thanks a lot!
 
Changing from dry food is sometimes enough on its own for a kitty to go into remission. Here this has been combined with too high a starting dose which has resulted in what you're seeing now. It is a very encouraging sign that Sunny may be a candidate for remission though :)
 
Changing the diet alone is a big help. We had one cat that went from 5.5 units to 0 simply because he was switched to low carb moist. That's not the usual way it happens, but it's possible.

You really should read the stickies, though, so you understand how Lantus works and what you can expect. If Sunny's pancreas was just weak and maybe still functioning a little, giving too much insulin could really send him into dangerously low numbers. Giving the right amount (which is yet to be determined) will hold his blood sugar levels down and let the pancreas heal. That's how they go into remission. You also want to try to get the numbers below 250, as numbers that are above that for too long can cause the kidneys to suffer damage.
 
Some of my thoughts on issues raised in your thread:

Freestyle lite meter is known for reading lower in higher numbers (case in point is my Vyktor, I thought he was doing okay and next thing you know DKA :mad:), however it should be pretty close to your other meter in low numbers.

Free feeding low carb wet food is fine for diabetic cats provided they don't go too crazy on it and that you remove the food 2 hours before their shot time so that you know their preshot BG test isn't food influenced.

It's awesome that you're managing the home testing so quickly :) are you giving a low carb treat after each test? We find the treat to be a very important factor in the cat not only accepting home testing but, in the end, looking forward to test time.

I'm thinking it's about time for another test - +2 (hours after the insulin was given) I'm watching out for it...
 
Sorry, my ipad froze had to start up the computer

Give him a tsp of LC and we'll see if we can't get him 'on his surfboard'

It's a good that his +2 is similar to his preshot but still going to have to keep a close eye on him this cycle
 
Andrew, I'm gonna bail out on you now, but you are in excellent hands with Serryn. Good luck the rest of the night. I'll be checking in on you when I return to consciousness.
 
Hi, Andrew and welcome to you and Sunny. This is the best place you never wanted to be! A few of us put together some information for new members.

If you are like most of us, if this is your first few weeks of trying to wrap your head around the fact that your kitty has diabetes, you’ve no doubt been terrified, in tears, in a state of shock, and completely overwhelmed. Don’t worry. It gets easier. It really does.

None of us here are veterinary professionals but many of us have been working with our cat’s diabetes for a long time. Even those of us who have been here for a short time are here to help. This is a wonderfully supportive community.

There are a few first steps. We firmly believe that home testing is the best way to keep your cat safe. We keep a record of our cat’s blood glucose (BG) data on aa spreadsheet (SS) which you can create using these instructions in the link . If you’ve not mastered home testing, we’re happy to offer suggestions or you may want to spend some time on the Health board mastering the basics of testing, low carb diet, and getting your SS set up. We’re happy to help you with those things, but you should be aware that this is a busy board and if there’s an emergency, everyone’s attention goes to helping the caregiver and his/her kitty.

Once you’ve got a handle on the basics, you will have the option of following the Tight Regulation Protocol or the Start Low Go Slow (SLGS) method for managing your cat’s diabetes. You don’t have to stick with whichever approach you initially choose but it is helpful to give your choice a chance so you can evaluate the results fairly.

The Tight Regulation protocol was developed based upon the premise that a cat's pancreas may be able to heal and return to producing insulin if the cat's BG is kept in a normal range (i.e., 50-120}. Caregivers following this protocol adjust insulin doses following the protocol guidelines to aim for that range. Basic information on the TR is here: Tight Regulation Protocol. The advantage of this approach is that it is based on research published in a leading veterinary journal and has an admirable track record of getting cats who are within the first year since diagnosis into remission.

The Start Low Go Slow (SLGS) approach has caregivers start with an initial dose based upon the BG at diagnosis and whether kitty has been transitioned to a wet low carb diet, hold that dose for a week or two while testing for ketones regularly, being consistent with food and testing before shooting every 12 hours. Once a week a curve is done (test every 2 hours for one cycle) to check for the lowest point. the low number in that curve determines any dose change for the following week. This approach was the original method used in the FDMB prior to the TR protocol. It is an alternate approach if TR is not the right fit for you or your kitty. Basic information on the SLGS approach is here: SLGS.

Both approaches require that you test at pre-shot times and do your best to test at least once each 12-hour cycle. Lantus and Lev dosing is based on the lowest number in the cycle (i.e., the nadir) so getting at least one spot check is important to guide your dosing decisions.


Amy&Trixie, Dyana&(GA)J.D., Julie&(GA) Punkin, Marje&Gracie, Sandy&Black Kitty, Sienne&Gabby, Wendy&Neko



 
So let me see if I've got this right

at shot time (+12 from his last shot) he was 73, you didn't shoot but did feed and after the food he was 98. Then at +16 hours after his last shot (4 hours after he was due) he was 84 and you shot 2 units.

Then I'm a little confused, I have that his +1 was 114 and his last test (which I thought was +2) was 82. This is where the spreadsheet that Sienne just posted the link for would really help ;)

btw - you count as a potential emergency right now and you do have my full attention.

Did you give a little low carb to Sunny?
 
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