BG Elevated from stress of vet visit

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Laura Nels

Laura Nels

Member Since 2015
I've had my cat Vivian on a trial with no Lantus insulin for almost a week, as her numbers have been between 70 and 115, most around 100. She had been on .2U. This info is not on her spreadsheet, no current access to google drive, sorry. I know others would continue insulin at these numbers, I've made a choice not to unless she hit 120. She had been very inactive for a few days so I took her to the vet yesterday, she has a mild urinary infection, vet thinks pain from this could have made her not want to move around, that's reasonable.
She got some antibiotics and pain meds, has been more active this a.m. BUT of course the stress of the visit made her BG go up - it was 149 at the vet (it had been 108 before this visit) and this a.m. is 126. I still want to give it a chance to come down on its own but will probably resume insulin if it doesn't come down by...I don't know I guess today sometime? Any experience with increase in BG from stress and any indication of how long it would take to come back down? My guess is that it varies, just wondering...
thanks
Laura
 
My civie kitty Maxie had a UTI and I took her to the vet. She was VERY stressed and confirmed with UTI, Since I was there I had them run a senior's panel of BW etc. It showed a glucose reading of 260!!!! After 3 days on the AB and being back to normal her glucose was 72 an hour after eating. I have retested her a number of times and she is well within normal ranges. Both stress and infection can cause glucose levels to go quite high in some kitties.


EDITED TO ADD: I would continue testing the BG levels and see what happens once she is not stressed and the AB start to kick in and if there is no improvement you might want to think about restarting insulin. Good luck!
 
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I do not have experience with a kitty with cancer & on prednisone/ other meds while being treated for diabetes with Lantus.
(That said, I'm wondering why you would want to shoot if she hits 120, as that's a pretty low #.)
 
Ya, I thought I read that 120 was the top of the normal BG range, I guess maybe it was 130 - I remember the vet saying 150 is "high normal" when Vivian was first diagnosed at 342 BG back in late May. I know she has come a long way, which must be due to a switch to low carb diet, because she is still on pred, which is what put her into the diabetic state in the first place -
There are lots of perspectives on when to give and not give insulin - I just want her to stay in what is considered normal range for a cat who is not taking insulin. And I would really like to maintain her streak of no insulin until I get her on the alternative steroid, which with any luck will also help with BG.
I'm not certain that she has cancer, it is some sort of serious intestinal disease - inflammation and loss of layering - but cancer was not found in a needle biopsy and I won't put her through further diagnostics since it wouldn't change the treatment plan.
Anyway, I'm hoping for something lower than 126 this evening, but not sure how quickly cats recover from stress related BG elevation, or IF they recover if they are diabetic and maybe/maybe not in remission and not on insulin, like Vivian.
thank you
Laura
 
I totally understand, Laura, that you want to keep her BG within normal limits. But when your vet is referring to "normal/ high normal" #s, those are #s off-insulin. And yes you are on a mini-dose now (0.2), but please take a look at that +4 number on 6/28 @ 0.25U - that was @ hypo level.
PLEASE keep this in mind: Some cats are totally asymptomatic when they go hypo (actually, my cat tends toward that). I'm just encouraging you to err on the side of caution here, as your kitty has some other stuff she's trying to heal from, as well. I don't think she needs the additional stress on her body of a hypo event. (We generally do not advise shooting at under 200 here; and 200 is not a number that is above the glycemic threshold, i.e. the point at which glucose spills over into the urine.)

Try not to be in a rush: Diabetes doesn't happen overnight; it isn't resolved overnight, either.

All of that said, it's up to you to decide; this is your kitty. Just make certain you continue to monitor carefully during the cycle, regardless.
 
Forgot to mention: Bat-Bat is on a mini-dose (0.15U ProZinc), as needed. I am always home to monitor - but even so, I don't generally shoot her unless she goes above 165 @ AMPS/PMPS. (See her SS for July - surprisingly, she hypo'd twice.)
 
Thank you Robin, to clarify, I'm not giving Vivian any insulin right now, she's been off for almost a week and I'm trying to maintain that with normal #s.
That +4 number you are talking about is precisely why I lowered her to .15 and then took her off altogether. She has had a few hypo numbers in her short time on insulin and my vet is unconcerned because she's "clinically normal" - so I guess not seizing or comatose. She's been as low as 30, which completely freaked me out but did not disturb the vet. Anyway, I have taken those matters into my own hands, it is a priority with me that she not go that low again. But I find it really interesting that you say "we generally do not advise shooting at under 200 here" and there was a suggestion on the Lantus board that it would be okay to shoot at 100 or lower! "When you shoot low, BG surfs along in the normal range...take a look at many of our SS and you'll see this" So whew, don't shoot below 200 and go for it at 100 or lower, that's a big difference in perspective isn't it? And there is a lot of disagreement on these boards about what to give and not give insulin to. Just when I think I understand the reasoning and protocols there is major contradiction and I get super confused. So you're right the decision has to be mine - that's why I kind of chose the top # of normal range off insulin as a marker to keep in mind as we go through this trial off insulin.
thanks!
Laura
 
P.S. I am on vacation right now, but normally am not home all day to monitor Vivian's BG and can't stay up late at night monitoring, which makes it extra important that I don't do something to put her into super low numbers and then feed her a bunch of stuff to bring the numbers back up.
That just doesn't work or make sense to me.
thank you
Laura
 
You're welcome, Laura! Sounds like you've got your thinking cap on & are determined to be careful about when you shoot & when you don't.
Also sounds like you really know your kitty, too!:) I'm glad you're making sure you don't do anything to drop her too low when you're not around to monitor afterward; that was my chief concern, too. Best of luck to you & Vivian - we have fingers & paws crossed that she remains off the juice!:bighug:
 
Hi Laura,

Some clarifications:

1. 150mg/dL / 8.3mmol/L is the upper limit of the reference range for a healthy cat as measured on a pet-calibrated meter. FDMB uses 120 mg/dL / 6.7 mmol/L as the upper boundary for human meter users.

2. When a caregiver first starts giving insulin to their cat and home testing BG it takes time to accumulate enough data to get a picture of how the cat is responding in general to the insulin in use and also how it responds to different doses - even at different times of day. Until such time as sufficient BG data is gathered, for safety FDMB strongly advocates not administering insulin when the preshot BG test returns a value lower than 200 /11.1 (human meter). Once sufficient data has been gathered to establish the cat's pattern of response to the insulin in use it is then possible to gradually reduce the 'no shoot' number to a point that is safe for that particular cat on that particular insulin. Once a dose is gauged to be safe to administer at a lower number, if the cat is still not within the target zone for the evidence-based protocol in use, the dose may then be further increased. As the cat becomes better regulated and further data gathered the 'no shoot' cut-off for that cat may yet again be lowered if the accumulated data indicates that there is minimal risk of hypo. This approach is the essence of the Tight Regulation dosing protocol. The rest is a 'dance' of dose adjustments and decisions on 'no-shoot' limits, ideally tailored exactly to that particular cat's needs. There may be times when circumstances may dictate the use of a higher 'no shoot' cut-off; for example, when a pet sitter is caring for the cat; or when a caregiver cannot for some reason monitor mid-cycle to keep the cat safe. (An alternative to the raising of the 'no shoot' number might be to decrease the dose, but the size of the dose influences whether or not this is possible (it's a bit tricky to reduce microdoses), as does the cat's ketone status).

(Hope the above makes some sort of sense - PTSD's v. bad tonight.)
.
 
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That makes the most sense to me of anything I have read on this forum! It's very possible I'm just not a quick study, but I just have not been able to wrap my head around all the advice that seemed at odds with other advice. Spreadsheet doesn't show it b/c I don't have access to google drive right now, but I feel like we're headed for administration of some insulin after a week off. I took Vivian off insulin Wed 6/29 when she was at 69 BG before insulin. From experience I know that insulin as low as .2 or even .15 could have put her too low. So I decided to try her off insulin. Since then she has been at
7/30 82 and 105 BG
7/31 106 and 103 BG
8/1 116 BG
8/2 108 BG
8/3 113 BG and then 149 at the vet where she was diagnosed urinary infection
8/4 126 BG
8/5 this a.m. 142 BG
Unfortunately that doesn't look like remission to me, as I had hoped. If it was, seems like the vet visit and maybe infection and meds did her in.
I know I can give her .15U w/out tanking her BG, and thinking I probably should...
 
Laura Nels said:
Unfortunately that doesn't look like remission to me, as I had hoped. If it was, seems like the vet visit and maybe infection and meds did her in.
I know I can give her .15U w/out tanking her BG, and thinking I probably should...
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That 142 is a respectable #, but yes I agree she probably needs that little 0.15U mini-bump, since you can monitor, right?
 
Robin&BB said:
That 142 is a respectable #, but yes I agree she probably needs that little 0.15U mini-bump, since you can monitor, right?
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Also - just to clarify - you are using a human glucometer, right? NOT an alpha trak? (Appears that way on your SS, but just making sure I know which ranges we're looking at.
 
Using a human meter
I can monitor but Vivian is not a cat who will accept food pushed on her, we've been through this countless times, she'll just hide before she'll take food if I pester her. That said, she's a pretty good eater. So that's why I want to be sure that giving her some insulin is warranted and that she won't go too low.
.15U wouldn't push a 142 too low. Just looks to me like she's trending upward and not going to turn this around, especially since vet visit.
Is it better for her to give her a little insulin before she hits 200 if I know it's safe?
 
Laura Nels said:
Using a human meter
I can monitor but Vivian is not a cat who will accept food pushed on her, we've been through this countless times, she'll just hide before she'll take food if I pester her. That said, she's a pretty good eater. So that's why I want to be sure that giving her some insulin is warranted and that she won't go too low.
.15U wouldn't push a 142 too low. Just looks to me like she's trending upward and not going to turn this around, especially since vet visit.
Is it better for her to give her a little insulin before she hits 200 if I know it's safe?
Click to expand...
Well, that's what I do, Laura and we're coincidentally on the same mini dose as you & your kitty are! (You can go look at my SS; but please note: We are on Alpha Trak meter - just so you're aware that my "hypo zone" starts @ a higher value than on human meters, etc.)

As long as you are monitoring (and is clear you already know what to do in a "bottoming-out" situation), I would say it's up to you re: the dose; you know your kitty best!

It's frustrating when you feel like your cat is teetering on the brink of remission; Bat-Bat has been doing this for a while now, and she, too, is very sensitive (ck her SS) to even that 0.15U - she went super-low TWICE in July! Sometimes I want to say to her, "C'mon, Bat - just make up your mind!!!"
 
I gave her .1U, we'll see what that does. I think it is possible that 69 last week was because .2U was too high for her, but then maybe zero wasn't enough because she has been slowly trending upward. I don't want to chance having her go too high and possibly becoming symptomatic, for one because then I'm trying to figure out if she's peeing because of BG or peeing because she still has the urinary infection. She appears to feel better since antibiotic, she's up and about more, more social, but as expected has diarrhea from the med - this in a cat whose principal issue for a year has been diarrhea is not at all surprising, just one more curve ball.
 
Laura Nels said:
I gave her .1U, we'll see what that does. I'm trying to figure out if she's peeing because of BG or peeing because she still has the urinary infection. She appears to feel better since antibiotic, she's up and about more, more social, but as expected has diarrhea from the med - this in a cat whose principal issue for a year has been diarrhea is not at all surprising, just one more curve ball.
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Which antibiotic is she taking, btw?
 
She had a shot of convenia, which they gave her before I even knew what they were doing, so there's no adjusting that dose...
 
Laura Nels said:
She had a shot of convenia, which they gave her before I even knew what they were doing, so there's no adjusting that dose...
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Oh. Was just wondering ... A mild UTI will raise her BG somewhat until the antibiotic clears it up (and that's not an instantaneous fix, even in injectible form). And - again - that 142 is by no means a horrible #; in fact, that's pretty darned good considering the urinary tract infection! So ... yes, monitor her even on that 0.10U, since she's sensitive to even the mini-doses.

And be thankful that she's still peeing (as that's a good indicator that the UTI is not as severe as when a cat stops being able to pee). I would expect that she will be back on track for you once that UTI is gone! :) (And keep us posted on how she's doing, ok?)
 
Hi Laura,

A technique I used with Saoirse when I was worried about her going too low when she was nearing remission was to use once-a-day (SID) dosing. Saoirse naturally tends to run lower at night (both on and off insulin). I was able to monitor her during the day (I'm disabled so at home all the time) but my health was worse than usual and I could not guarantee being able to monitor my girl at night, so I gave Lantus microdoses on the AM cycle. The residual effect of the microdose plus my girl's tendency to run low at night kept her in the TR healing range for the full 24 hours. It's not orthodox but it did work for my Saoirse. Have a look at her spreadsheet numbers for October/November of last year if you'd like to see how the SID dosing worked for her.
.
 
Well that's great information and I think it could work for Vivian. Funny you should mention, just as I was thinking to myself she's only going to be getting one dose today anyway since I was very late deciding to give her insulin and I won't be dosing her at 10 pm
Thank you!
Laura
 
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