BG Numbers all over the place

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Emilyskor

Emilyskor

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Hello All,

So my boy, Chibi has been on insulin now for just over a week. I started him on 1/2 unit for the first full week and it only brought his numbers down to the mid-high 200 range so I upped his dose on Saturday to a full unit of insulin, twice a day. Since then, his numbers have been all over the place and much higher than I've ever seen in him before. I have never tested him and have him be over 400, and since Saturday when he upped his dose, he has been over 400 twice.

What is going on here? I was expecting his numbers to go the opposite way - not higher! That, and I've noticed, the past couple days, hes been drinking a lot more water and urinating more frequently. His food has been low carb from the start so I don't think that is a big issue.

I know it has only been a few days... but is this normal?

Saturday am - Pre-shot: 295
Saturday pm - 3 hrs. later: 243
Saturday PM - Pre-shot: 408!
Saturday PM - 3 hrs later: 279

Sunday Am - Pre-shot: 358
Sunday Pm - 3 hrs later: 245
Sunday PM - Pre-shot: 344
Sunday PM - 3hrs later: 257

Monday Am - Pre-Shot: 233
Monday 1 hour later: 243
Monday Pm - Pre-shot: 447!
Monday PM - 3hrs later: 364


I am still very new to all of this so I am still in the stage of freaking out over every little thing! But really, any advice is very appreciated!

Thanks all!
 
First, the peak time of action for Lantus is about +5 to +7 hours after the shot; that's when you look for how low he is going. At +2, you may see a food spike if the cat eats a lot at feeding or reacts strongly to food.

It is possible you missed his optimal dose at 0.75 units twice a day, by increasing 0.5. Cats are much smaller than humans, so dose changes seem to work best in 0.25 unit increments. And syringes don't measure quarter units, so you have to eyeball these. The plunger edge will be between 0.5 and 1.0 units.

It is also possible he is bouncing. When a cat drops fast and/or drops a lot, the liver may release compensatory hormones to protect against hypoglycemia. These raises the glucose back up. It takes about 3 days on the same dose with consistent timing and feeding for a bounce to clear and the numbers to stabilize.
 
Thanks for the help. I've been tracking his numbers, in fact I just came home at lunch (6 hrs from shot) and his number is 361!! He was at 297 pre-shot this am! It seems like it's doing the opposit of what it should. Should I increase his dose?? Wait?? Lower the dose??? I really don't know what to do. I haven't been able to get a hold of my vet in the last two days either... Ugh
 
Hold the dose. You don't base dose changes on pre shot numbers- especially as the nadir could already be too low and you don't know. Set up the spreadsheet and track his nadir for the next few days and we will decide then.

I usually recommend 3-4 tests a day

- always before the shot - this is mandatory as you don't want to shoot when too low. As a newbie this too low number is 200 but is reduced over time once you have the data to know if its safe.
- mid cycle - 5-7 hours after morning shot depending on your schedule. This is to see how low he is going. The low point "nadir" is what you base dose changes on since you don't want him dropping too low (under 50).
- before bed (2-3hours after Pm shot) to get an idea of what his overnight plans are. If this number is less than the pre shot test number you may want to set the alarm for a test a few hours later as this implies an active cycle.

Wendy
 
You haven't shared your spreadsheet to anyone with the link.

Go to Google Docs.
Open your spreadsheet.
Click File, Share
Adjust the entry in the dialog box to anyone with the link.
Copy the resulting link.

Now go to FDMB.
Open the User Control Panel.
Click on Profile.
Click on edit Signature.
Replace the spreadsheet link with the newly copied link.
Optionally, Preview.
Submit.
 
Hey, thanks for the help! See spreadsheet attached!

The little guy had better numbers when he wasn't on insulin!!!!
 
Emilyskor said:
...The little guy had better numbers when he wasn't on insulin!!!!
Click to expand...

Well, the first 1 unit dose took him too low to shoot early on, and then you tried 0.5 units, then you increased to 1.0 units and started getting reds. To me, it suggests you could be going in the wrong direction.

Actually, I'm wondering if a drop back down to 0.5 units and hold it for 3-5 days would see if he stops the reds. And if he does, then maybe try a skinny , hair under 0.5, and continue shrinking the dose, etc. But that's me. Someone else may have different thoughts. If you test for urine ketones, you could see what that would do.

Mmm ... what are you feeding, how much, and on what time schedule? (Just checking)
 
Thanks for the advice. I kinda felt that he was doing ok on .5, but the vet originally prescribed him to 1.5, so I kinda thought if I increased him to 1, I'd see a bigger decrease in numbers. I was wrong, and thus am very confused! I think tomorrow, I'm gonna decrease back down to .5 and see where that gets us in a few days.

Food wise, he's been getting low carb stuff. I keep him mostly on Weruva, cats in the kitchen - chicken flick a zee and fawl ball; and Tiki cat-the chicken varieties. He also gets some B.F.F and raw... All pretty much under 6-7% carbs, so I'm not worried about that.

Should I test him before food? One thing I've noticed, is he normally eats around 5:30 am and pm.. And gets his shots at 6. I usually test him right before the shot, but should I be testing him before he eats??? It may make a small difference, but I don't see that really changing much.
 
To get a glucose that isn't food-impacted, we suggest you pick up the food 2 hours before shot time.

Then, we usually test, feed, and shoot in a 15 minute time frame for long acting insulins. Those pre-shot numbers can look much better without the food impact.

Also, there is a concern if the dose is too high - he could exhaust his stored glycogen, which breaks down into glucose, and hypo on you. Have you read our guidelines on how to handle low numbers?
Here they are

It is a good idea to be prepared for low glucose/hypo issues by having an extra container of test strips and some form of syrup, plus gravied high carb food on hand. Just be sure to mark them HC so you don't feed any by mistake !
 
Looks like some patience pants may be in order here. The vast and never ending patience pants lending closet is open and ready to provide patience pants as needed.


Everyone likes green patience pants. ;-)

Yes, you'll need to hold that 0.5u dose for a minimum of 3-5 days, unless the numbers drop below the 50 for a human meter threshold, then you reduce by 0.25U immediately.

BJM already gave you some great advice. I concur and would have said the same thing.

The timing of the feeding and testing and shot could definitely be tweaked to give us a better idea of what the BG numbers are without that food influence. Yes, please test first, then feed, and shoot in about a 15 minute timeframe.
 

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Patience is NOT my strong point :)


I've lowered his dose back down to .5 units and while his numbers are higher than I'd like them to be, they are moving in the right direction again. As for timing, I was feeding him with in 15 minutes of his shot before, but now I've changed the order in which I do. He now gets a test, food and shot - in that order, with in 15 minutes of one another. I'm not sure if it has made a difference, but only time will tell. Today, he has been back at the water dish numerous times thought the day, and is urinating a lot more than he has the past few days. I picked up some Ketone test strips but have yet to use them. I will probably try to get a test tomorrow.

Thanks for all of your help - and your patience with me!!! I'm still learning, but am making progress.
 
It takes from 3-5 days for the Lantus (or Levemir) level to stabilize when you change the dose.

Patience.

The urination is a clue, though, so keep an eye on that and appetite. See my signature link Secondary Monitoring Tools for other assessments you might make to monitor your cat.
 
His numbers are still pretty high and flat - I don't see much of a change. I would try and get an occasional test in the PMPS + 7 to +11 timeframe to see whats going on then.

If you don't see any blues and greens after 3 days of this dose i would increase to 0.75

Wendy
 
Would it be possible that my cat may only need one shot per day? I was jut taking a look at his numbers over the past month, and especially today - he seemed to be dropping low after the +7hr mark. I am wondering if maybe the second shot of the day may not be necessary - or less of a dose???

Does anyone do two differnt doses per day? Tomorrow, I am going to test him every two hours to see where he is at again... just curious!
 
We consider 'Low' to be below 50 mg/dL on a human glucometer and 80 mg/dL on a pet-specific glucometer.

He's nowhere near that.

Perhaps the following on what the test numbers from different meter types mean will be helpful.

Comparing a human glucometer to a pet-specific glucometer is like reading temperature in Celsius vs Fahrenheit. Both are correct. You just need to know the reference ranges to interpret what the numbers mean.

[Glucose reference ranges are unsubstantiated and have been removed by Moderator]


* * * * * * * * * * * * * * *​

How to use the glucose reference values chart:

When you get a test, look for the number on the chart that either equals, or contains, the test value you have. Read the information. As needed, make a decision and act.

Ex. You are a new insulin user and you test your cat before giving insulin. The test is 300. It probably is safe to give insulin.

Ex. You are an established user of Lantus, following the Tight Regulation protocol. You've tested around +5 to +7 to spot the nadir. It is 200 mg/dL. You probably need to increase the dose, following the instructions for the protocol.

Ex. Your cat is acting funny. The eyes are a bit dilated. You are concerned and test the glucose. The number is 35 mg/dL. ACK! The cat may be in a hypoglycemic state. You quickly follow the HYPO protocol linked in the glucose reference values chart. (which we really, really, suggest you print out and post on your refrigerator.)
 
Would you please add the insulin you are using and the meter you use for testing to your signature?

No, no insulin lasts 24 hours in a cat. Once a day dosing does not work. The numbers you are getting for Chibi are no where near being low.

I think you may want to increase.

We want to get Chibi out of those pink colors and down to the blues and greens.
 
I understand what the numbers indicate that I get when testing. The issue I am having, is every time I seem to increase dosage, his number go higher. Yesterday, was the first day I actually saw the insulin work as it was intended to - although the numbers were still pretty high, I thought I was making some progress.
He's been on 1.25 units for 7 days today, I am going to try increasing to 4.5 units tonight for his PMPS. The problem I had in the past, was I was increasing the dose to fast, and now I am tryin to hold each dose for at least a a week... Hopefully I will see some change soon.

Thanks for all the help!
 
Emilyskor said:
He's been on 1.25 units for 7 days today, I am going to try increasing to 4.5 units tonight for his PMPS. The problem I had in the past, was I was increasing the dose to fast, and now I am tryin to hold each dose for at least a a week... Hopefully I will see some change soon.
Click to expand...

I hope you meant 1.5u. ;-) If the increase doesn't work, you might want to think about doing a decrease instead. Something to keep in mind: when they're getting too much insulin, it can look like high, flat numbers that just keep going higher the more you increase. Sometimes you need to lower the dose to lower the numbers.
 
Those numbers are pretty flat. remember meters have a variance of 20%. So 310 could be the same as 370 or 250.

I don't know what protocol you are following but with tight regulation you would be increasing every 3-5 days with these numbers - see here http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581.

I do think the dose is too low if anything and you need to get a bit more aggressive.. plus try and get a mid cycle test every day as thats what you base the dose increase on .. if he was my cat I would be taking him to 1.5 if not 1.75 tomorrow.

Wendy
 
KPassa said:
Emilyskor said:
I hope you meant 1.5u. ;-)
Click to expand...
Click to expand...


Absolutely - 1.5!!

We'll see how that goes! I hope I can start seeing some change. The one thing that I really don't is, a lot of times when I do a mid-cycle test, I am not seeing a dip in numbers. They tend to remain constant. The little guy is such a trooper, I just hope I get him under control soon!
 
Hold this dose at least 3 days (6 cycles) and try to get mid-cycle and/or before-bed tests and let us know how he does with the increase. :smile:
 
Hi guys, I'm back!! I will update my spreadsheet here in little bit, but I wanted to check in with everyone really quick!
I am running into the issue where I give 3 units twice a day to my cat, and that seems to work, but every couple days - like 6-7 days, when it comes time for his shot, his BG number is under 100. This is where I get really confused... This am, he is as 89, and it was recommended to me to not give him his insulin if he is under 100... But here is the problem, if I don't give him insulin, he will bounce to like 500+ but mid-day!!! It happens every time. 89 isn't really that low of a number, so should I still give him his shot??
If you look at my spreadsheet for 2/22 he was at 69 at PMPS, so I skipped the shot, but by 4 hrs. later, he was 429!
This happened again on 3/08 – PMPS: 69 – went up to 318 3 hours later, then for the next AMPS, he was at 526!
Same thing again on 3/12 – 52 at PMPS – came up slightly, then for the next AMPS – 514!!!

This has happened one more time, but it is not on the spreadsheet yet, I have to update that, which I will do later today!!
Thanks for the help!
 
A pattern of high, high, high, high, high, high, low, repeat, could be a Lantus dose that is too high. Or, it could be bouncing for 3 days and clearing.
The only way to check that is to back off the dose and see if the numbers level out and if they are better or worse.

To shoot today, you can stall 30 minutes and re-test. If rising glucose and home to monitor, there is the option of shooting the regular amount and then testing at +2 and +4 to see if you might need to steer the numbers by feeding small amounts of higher carb food to keep the glucose levels safely above 50 mg/dL (human meter) or 80 mg/dL (pet meter)
Otherwise, you might give half the dose and check back in this evening for more feedback from Lantus users.
 
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