BG low prior to injection, worried about dose/hypoglycemia

Status
Not open for further replies.
A

Astasmum

Member Since 2013
Hi,

My cat (Asta) has been showing a pretty sudden drop in her BG prior to her twice-a-day insulin injection. She's newly diagnosed and the vet said it would take some time for her to stabilize. I've been slowly increasing her dose as per instruction but there has seemed to be a sort of tipping point and now I'm worried that if I give her the dose I gave her this morning that she'll get hypo during the night.

Asta has gone from being around 18 a couple of days ago on the glucometer to just now 6.1 (prior to injection). The lowest I've measured at nadir is 3.1. Since I've noticed the drop I've stopped increasing the dose and reduced from 2.8 iu to 2.6 iu of insulin. I've called vet tonight but not heard back. Any suggestions about whether I should reduce the dose or should I just set the alarm for the middle of the night?

Thanks,
Deb and Asta
 
Re: BG low prior to injection, worried about dose/hypoglycem

Hi,
What type of insulin are you using?
 
Re: BG low prior to injection, worried about dose/hypoglycem

I went back to your earlier posts, and you were using Caninsulin, but were going to find out if you could switch to Lantus?

If you're still using the caninsulin, then I think further reduction in dose might be a good plan.

It is somewhat easier to understand the "logic" of dosing with caninsulin, or even prozinc, compared to longer lasting types like Lantus. By that I mean you look at he preshot number, and the nadir number and see how big the difference was. (edit to add - that isn't how Lantus is dosed. It works differently, and the logic behind doses and dose adjustments is NOT the same).

On a dose of 2u, for instance, if the BG dropped from 15 (270) to 3.1(55) at nadir, then you know that 2u can drop the BG by over 200 points. Doesn't mean it will do so every time, but it can. So when faced with a 6.1 at shot time (110) a much lower dose would be suggested. Actually, on a BG of 110, we'd normally recommend not shooting at all. 40-120 is "normal blood glucose" for a cat. In a case like that, you would either skip the shot, or stall. Don't feed, and don't give a shot until the number comes up on its own to somewhere close to 200. If you saw a 200, and you knew that the last shot and dose dropped the blood glucose a certain amount, you can adjust the dose downward accordingly. There's nothing bad about a nadir of 3.1(55), but you don't want it going much if any lower than that. If you see a nadir lower than 50 (2.8 for you), that means the dose needs to be lowered.
 
Re: BG low prior to injection, worried about dose/hypoglycem

Thank you Carl.

I bought a vial of Lantus and brought the package to the vet and told him I wanted to switch. He told me he would have to read up on it to know what dosage would be appropriate. He dissuaded me from changing insulins while she was still "stabilizing".
I've been charting Asta's BG and you're right...the change in blood glucose over the day seems to vary a fair bit. I wish I had waited a bit longer, because I just gave Asta a large amount of food and her 2.6 unit dose of the canisulin. I read somewhere you should steer with food but not change dosage without consulting your vet. So I'm setting my alarm for a 1:30 or 2:00 am BG test. Hopefully I won't end up frantically massaging her gums with liquid honey. This is stressful. Calling vet again tomorrow.

Thanks for posting,
Deb and Asta.
 
Re: BG low prior to injection, worried about dose/hypoglycem

Just tested her BG and its 7.4 on the glucometer...she moved when I injected her so for the first time I'm not certain if all the dose went under her skin or if some went into her fur. I couldn't find any moisture in her fur. I don't really know what to think at this point. Her neuropathy seems to get a little better, then it gets worse. I just keep giving her B12 and fish oils.

Arg.

Deb and Asta
 
Re: BG low prior to injection, worried about dose/hypoglycem

On the neuropathy...

It seems to usually take a while for that to really go away completely. Definitely an "every cat is different" thing though. There was a member, Lori, who had a kitty with very bad neuropathy. He was the most difficult kitty I've seen in that regard, and she used Methyl B-12 for a year. But it did eventually completely disappear. He was hard to regulate at first, but he eventually got down to .2u of insulin twice a day. Unfortunately, he died recently when he was attacked by a dog, but Lori was able to get his diabetes under control and saw his neuropathy cured.

Lower and more regulated BGs will definitely help the condition along with the supplements you are using. But it's a gradual improvement you will see, not an all of a sudden thing. Just wondering if you know whether the vet has checked Asta's potassium levels? Sometimes the rear leg weakness is at least in part due to low potassium, which causes overall muscle weakness. That was my cat, Bob's problem.

The thing with your vet's logic about not wanting to change insulins while Asta is "still stabilizing" is that caninsulin is a hard insulin to deal with, and harder to stabilize things with. Encourage your vet to do some "speed reading" on the Lantus. ;-)

You can steer the numbers with food based on the numbers you see during the cycle. Caninsulin tends to reach onset fairly early, and the duration is normally only 8 hours or so in a cat. You can feed and delay the shot by 30 minutes or so, which gives the food a chance to push up the numbers a bit before the insulin kicks in and starts pushing them down. You can also feed early in the cycle, like 2 or 3 hours after the shot, if you see the numbers drop a good bit by then. That can slow things down, and avert a nadir that is lower than you might want it to be. Basically, if the numbers are dropping further, or faster, than you like, you can use food to slow or stop the drop. And try not to feed too much after nadir, when the insulin will start to wear off and her numbers will be coming up due to that.
 
Re: BG low prior to injection, worried about dose/hypoglycem

Deb,

Would you be willing to add some useful information to your user control panel, profile tab, edit signature. This would enable us to help you better.

Can we provide some vet journal research to share with your vet, on Lantus?
 
Re: BG low prior to injection, worried about dose/hypoglycem

I definitely would but I'm not sure how...I'm using my phone to navigate this site and everything is so tiny.

Please please send me some peer reviewed articles on Lantus used with cats. That would be very helpful. Thank you, Deb.

Deb and Asta
 
Re: BG low prior to injection, worried about dose/hypoglycem

Hope you have a bigger screen besides your phone for some of these articles. ;-)

Lantus is also called glargine, so look for that name in some of these articles.

Veterinary Clinics of North America, Small Animal Practice, special edition all about Feline Diabetes from March 2013

Understanding Feline Diabetes mellitus from 2009

Slideshow from University of Queensland from 2009

dosing of lantus/glargine

Use of glargine in cats

Roomp and Rand, full article.

Merck veterinary manual Recommends Lantus as first choice insulin for diabetic cats.

Hope these help you.
 
Re: BG low prior to injection, worried about dose/hypoglycem

The user control panel is in the upper left corner of the screen, or should be.

Click on user control panel.
Click on the Profile tab
select Edit Signature from the left hand menu.
Start typing in the free form text box and submit, just like you would for a post.
 
Re: BG low prior to injection, worried about dose/hypoglycem

Thanks...I get that done as soon as I have a moment. What info should I include?
 
Re: BG low prior to injection, worried about dose/hypoglycem

Your name and Kittie's name
Date of diagnosis
Type of insulin and meter

Sort of what Deb and Wink have in her Sig.

There's a 255 character limit, so abbreviate as needed.
 
Re: BG low prior to injection, worried about dose/hypoglycem

Your name, cats name age and sex. Meter used for testing and insulin used. Any complicating medical issues like pancreatitis or CKD (chronic kidney disease). Diagnosis date for the diabetes.
 
Re: BG low prior to injection, worried about dose/hypoglycem

Thanks, will do as soon as I have a moment. (I'm so freaking thankful for this message board.)
 
Re: BG low prior to injection, worried about dose/hypoglycem

Thanks SO MUCH to everyone for their useful information!!
 
Re: BG low prior to injection, worried about dose/hypoglycem

Thought you might find this helpful.

Here are some glucose reference ranges used for decision making using a human glucometer. Numbers in parentheses are for non-US meters.

< 40 mg/dL (2.2)
- Treat as if HYPO if on insulin
- At nadir (lowest point between shots) in a long term diabetic (more than a year), may earn a reduction.

< 50 mg/dL (2.8)
- If before nadir, steer with food, ie, give modest amounts of medium carb food to keep from going below 50.
- At nadir, often indicates dose reduction is earned.

50 - 130 mg/dL (2.8 - 7.2)
- On insulin - great control when following a tight regulation protocol.
- Off insulin - normal numbers. (May even go as low as the upper 30s (1.7); if not on insulin, this can be safe.

> 150 mg/dL (8.3)
- At nadir, indicates a dose increase may be needed when following a tight regulation protocol.

200 mg/dL (11.1)
- no shot level for beginners; may slowly reduce to 150 mg/dL ( 8.3) for long-acting insulins (Lantus, Levemir, and ProZinc) as data collection shows it is safe

180 - 280 mg/dL (10 - 15.6)
- Any time - The renal threshold (depending on data source and cat's renal function) where glucose spills into the urine.
- Test for ketones, glucose is too high.

>= 280 mg/dL (15.6), if for most of the cycle between shots
- Uncontrolled diabetes and thus at risk for diabetic ketoacidosis and hepatic lipidosis
- Follow your insulin protocol for dose adjustments
- Test for ketones; if more than a trace level of ketones, go to vet ASAP.
 
Re: BG low prior to injection, worried about dose/hypoglycem

Push your vet to read up ASAP as the sooner you get on lantus the better the chance of remission. The remission window is short and you want to give your cat the best chance..

Or since you already have the lantus, make the switch and we will help you with it..
 
Status
Not open for further replies.
Back
Top