BG levels dropping without coming back up after 13 hours

Status
Not open for further replies.
Checkabunny

Checkabunny

Member
My 10 year old cat was diagnosed with diabetes two weeks ago with bg readings at 595. The vet started us with 1 unit of glargine 2x daily, but three days later my cat was still in the high 400s. We were bumped up to 2 units of glargine twice daily and that seemed to bring him down to 400. Today was his first glucose curve -- at the vets. He started out in the morning with gb of 401 before his shot, received his normal dosage of glargine at the normal time, but today his bg levels have been steadily dropping throughout the day without coming back up. It's 13 hours later, another meal later, and it's still dropping -- at 85 on the last test. Is this something to be concerned about? We're picking up a glucometer so we can continue testing into the night if we need to. Is it possible his pancreas as taken over and these are fine levels? What should we do?
 
so he was 85 at 13 hours post shot, and still at the vet's?

Insulin takes time to build up effectiveness, sometimes referred to as the storage shed. Doses shouldn't be increased too quickly, should be based on more data including nadir or lowest point data, and shouldn't be raised by more than 0.5 units at a time. Add to this the fact that stress at the clinic MAY increase blood glucose levels and..... well, luckily nothing bad happened :)

Please do test tonight just in case your cat gets uber duration. and please,seriously seriously seriously consider dropping that dose back to 1 unit and test prior to injection as well as in between when you can, so that you can get a better idea of how the insulin is working.

Jen
 
I'm not sure if your cat is still at the vet or at home. If he's at home, I would advise that you test in the morning before giving him a shot and come on here and ask for dose advice. You might want to post in the Lantus/glargine insulin support group and reference this post (just copy in the url).
 
We picked our cat up from the vet's just before their closing. They had arranged for me to take him to the emergency vet for another check 2 hours later because his numbers kept dropping throughout the day. As soon as I got home from the emergency clinic with the 85 reading, I fed him about 1 tsp of dry food that I suspect is high in sugar and which I had completely cut out of his diet two days ago. I had picked up a glucometer on the way back from the emergency clinic and tested him myself about 40 minutes ago. (It took a while to figure out what I was doing.) His number is now 111 from my home meter. Phew!
Thank you all for the support! Yes, I'll check one more time tonight, then again in the morning before considering another shot. Thank you for the weblink for support for his insulin. In my panic, I didn't realize until a few minutes ago that my vet had called and left me a message after she talked with the emergency room vet -- and she asked that I check in the morning with her before doing anything more with insulin.

A new development noticeable as of Friday and getting a little more pronounced each day is the neuropathy in his hind legs. Poor Checkers looks as if he's trying to skate when he's on the kitchen floor, and can only take a step or two on the carpet before needing to sit or plop over on his side.
 
Good job getting a meter and a test. I'm glad that your vet wants to check with you b4 you give more insulin. Maybe the diet change and a short course of insulin is all that your cat will need. But your meter will still be handy - but I'm getting ahead of things here. Be interested to see what his bg is in the morning.
 
Will post in the morning then Tony, thanks.

Yes, I'm wondering if the food is a big factor. A friend at work told me about a local pet food store where they grind meat with bones and organs. I knew better than to make too many changes at once, but I was worried with the neuropathy becoming so pronounced that Sunday I started switching him over to the cooked "whole" foods and quickly weaning him off any of the hard.
 
While you are out shopping, you might want to pick up a couple of cans of Fancy Feast grilled with gravy. This is higher carb food and can be used to bring his bg up and get less of a food spike. The dry works too, but is sometimes harder to get the cat to eat when he drops too low. Hopefully this won't happen again, but you know that the best way for it not to happen is to buy some hi-carb food!
 
Oh my! You still on Tony?
We just took another bg level and it's now 434! 85 at 8pm, 111 at a little after 10, 434 by midnight. Why such a high spike so fast?
 
The dry food is very high in carbs, and so will result in a high spike. When you check his bg in the morning this will probably be reflected. It will be important to include this info when considering the dose for the morning. Its ok - it will even out.

Edit to add: Have you read the modified regulation protocol in the Lantus stickies? The suggestion is to hold the same dose for a minimum of 3 days unless the numbers are dramatic and necessitate a change sooner. Raising the dose too quickly without adequate data can be dangerous.

Here is the basic dose info from the sticky:
Many Lantus and Levemir users in this forum have been successful following a somewhat modified version of this Tight Regulation Protocol for the last few years. These "general" guidelines are based on anecdotal evidence and personal experiences of laypersons frequenting the forum.

"General" Guidelines:

Hold the initial starting dose for 5 - 7 days (10 - 14 cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 cycles).
Each subsequent dose is held for a minimum of 3 days (6 cycles) unless kitty earns a reduction (See: Reducing the dose...).
Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.
 
often cats don't react the same at the vets as at home, because of vet stress. so the numbers can be deceiving. on top of that, i'd guess your cat didn't eat much if anything at the vet, which could be why the number dropped so much and stayed low. (plus that high a dose increase probably caused some overlap in dose (lantus tends to collect under the skin and often your number could reflect cumulative doses rather than just one shot)).

that 400-something number is probably a rebound reaction to the big drop earlier. i suspect the full unit increase in dose was a little too high. you might want to change your dose to 1.25u twice a day instead and see if that's better. no more dry, tho, unless necessary.

(my cat cleo did exactly the same thing at her first curve at the vet.)
 
Tony, his reading this morning (took awhile!!!) pre-breakfast was 417. No hard food for him at breakfast, ust a mix of high quality diet management food and "whole" ground meat.
Our vet says to give him the full 2 units this morning and to try only once a day. When he was moved to the 2 unit amount of glargine, it was about a little over a week ago, shortly after diagnosis. Checkers is a very large cat, 22 pounds. Trying to load a picture of him so you'll see he's overweight, but not nearly as much as you'd imagine. He's just a large kitty!
 
Hearing about Cleo was relieving too, thanks! We're waiting to hear back from our vet, but you're probably right, Checkers didn't eat at all at the vet.
 
I don't understand why the vet would want you to give 2 units again today after what transpired yesterday and once a day dosing is not going to do it. Why not start out at 1 unit, test during the day if you can, and give another 1 unit tonight. Start lower, go slower.
 
I know it is hard to hear advice here that conflicts with your vet. But we have been working with diabetic cats for 15 years or more and we get them into regulation or remission by working with the insulin requirements.

The likely reason you had such low numbers late is that your dose was too high. You got a high number this am because it had been 24 hours since the shot. I agree with Hope- repeating this pattern today makes no sense. Give one unit, test today and you will most likely have a shootable number tonight. That way your cat is protected the whole 24 hours.
 
Status
Not open for further replies.
Back
Top