BG suddenly 3.4 ( at +5 since 0.5U Lantus)

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Mel & Monkey

Mel & Monkey

Member Since 2017
Sorry for so many questions everyone...

I never thought I'd be unhappy with this vet but I'm so stressed right now waiting for her to call back and I really want to know why it isn't two shots a day - the last few days she's been in the 20s and right now I just tested and she's suddenly 3.4 which I've never seen it so low. I'm giving her food and retesting in an hour as vet told me to do this initially, but does anyone have any other suggestions? I'm SO confused by how Monkey responds to the Lantus and if anyone could take a look at her SS I would be very grateful. I will tell the vet when she phones that I want to try 2 shots a day as well because I don't understand why it's just once a day. :(
 
How long ago was that 3.4 test done? How is she acting? I'd suggest immediately retesting, if it shows similar number, I wouldn't wait an hour to retest. Might just be a wonky strip that gave a reading but wasn't enough blood.

How much insulin did she get this morning?
 
Here's what I see:
  • a kitty who's very responsive to Lantus
  • might be on her way to not needing insulin but not there yet
  • might be able to handle a tiny dose of 0.25 u twice a day instead of a larger dose once a day
  • larger dose once a day seems to drop her low and then she rebounds high.
 
Yong said:
How long ago was that 3.4 test done? How is she acting? I'd suggest immediately retesting, if it shows similar number, I wouldn't wait an hour to retest. Might just be a wonky strip that gave a reading but wasn't enough blood.

How much insulin did she get this morning?
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She tested 2.4 [EDIT I meant 3.4, 2.4 was a typo] at 2pm pacific time (45 mins ago) and I fed her as much as she could eat and instead of waiting an hour I just did it (2:45pm pacific) and it's 6.8 - we're in the clear I hope?
 
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Kris & Teasel said:
Here's what I see:
  • a kitty who's very responsive to Lantus
  • might be on her way to not needing insulin but not there yet
  • might be able to handle a tiny dose of 0.25 u twice a day instead of a larger dose once a day
  • larger dose once a day seems to drop her low and then she rebounds high.
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Thank you :) I really hope we can figure this out soon for her sake (and mine! I'm anxious all the time about her)
 
nightglo said:
She tested 2.4 at 2pm pacific time (45 mins ago) and I fed her as much as she could eat and instead of waiting an hour I just did it (2:45pm pacific) and it's 6.8 - we're in the clear I hope?
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Where was that relative to her morning dose time? That 2.4 is awfully low. We usually recommend feeding very small amounts of HC food when they're this low, waiting 20 min or so and retesting. This would be repeated as many times as needed to get her to a BG above 50 that she can hold on her own without the prop of food.
 
Kris & Teasel said:
Where was that relative to her morning dose time? That 2.4 is awfully low. We usually recommend feeding very small amounts of HC food when they're this low, waiting 20 min or so and retesting. This would be repeated as many times as needed to get her to a BG above 50 that she can hold on her own without the prop of food.
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Sorry 2.4 was a typo, I meant 3.4. Her AMPS was 19.9, still giving her food
 
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Just give small amounts of food at a time and retest in 20 minute increments. Don't want to fill her up should she need to eat more. How much insulin this morning on the 19.9?
 
Yong said:
Just give small amounts of food at a time and retest in 20 minute increments. Don't want to fill her up should she need to eat more. How much insulin this morning on the 19.9?
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She got 0.5U Lantus and just now (+6:30 since am dose) she tested 10 and I'll keep giving her a bit of food every 20 min
 
I agree with Kris that it would be preferable to half the dose and give 0.25u of insulin 2 times a day instead of once. It looks like she is bouncing on the .5u dose and today it's finally shown that it can drop her too much. Monkey will likely feel much better with twice a day dosing at the lower dose and her numbers will probably come down too.
 
She tested at 13.4 (+7) after holding off on food since the 10.0 (+6:30) reading, is it safe to stop testing every 20 mins?
 
nightglo said:
is it safe to stop testing every 20 mins?
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Yes

3.4 really isn't terribly low.....that's 61 on our scale......On Tight Regulation, our "time to act" is when they drop below 50, but since you don't have a lot of data on Monkey yet, giving just a teaspoon or two of regular low carb food at 61 and then testing 30 minutes later is a good idea just to keep him safe.
 
Ty Chris, I just tested again and it was 17.6 --- are these numbers normal or should I try to get a new glucometer?
 
With Monkey dropping that low, it's normal for him to "bounce" high

It's probably been a long time since his blood glucose was in a "normal" range and his liver thought it was too low and panicked, releasing stored sugars and hormones to bring him back up to where it's gotten used to being.

Bounces happen....and they are a very frustrating but normal part of this disease!! It can take up to 3 days for those hormones and sugars to clear the body again, but (hopefully) as his body gets into those normal numbers more often, it will re-learn that it's OK to be there and he won't bounce as much or as high and will clear the bounces faster

I also agree that it might be a good idea to try .25 and do it twice a day...no matter what your vet says. You hold the syringe.
.25 unit.PNG
 
MrWorfMen's Mom said:
I agree with Kris that it would be preferable to half the dose and give 0.25u of insulin 2 times a day instead of once. It looks like she is bouncing on the .5u dose and today it's finally shown that it can drop her too much. Monkey will likely feel much better with twice a day dosing at the lower dose and her numbers will probably come down too.
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I also agree with this. :)
 
She just tested (+8:30) at 20.9. I would really like to switch to twice a day given everything I've been reading on here, I just don't know how to address it with my vet. When they called back today they just said leave it and if she tests under 15 for tomorrow's AMPS, don't give any.

I'm SO FRUSTRATED because I'm TERRIFIED of going against the vet's instructions. How do I call Monday with her numbers and say, "by the way, I started giving 0.25 twice a day even though you said not to" :( I know I'm having a hard time understanding what she was telling me about Monkey having a long effect from the Lantus and not to risk her going hypo with twice a day (yet). Does this make sense to anyone? Has anyone ever heard of this? :arghh:

I hate that they don't seem concerned by what's happening and she's gone so low that she's bounced basically twice in a row because she just got over the bounce from her first day (July 10).
 
Ok deep breathes. Your vet is NOT looking after Monkey 24/7 nor does your vet have to deal with any consequences of her suggestions for dosing. While we are just a group of cat people here, we have or currently do, live, breathe, eat and sleep feline diabetes with our own kitties. While Lantus is sometimes a once a day shot for humans, it is very rare indeed for a cat to get regulated on one shot per day. A cat's metabolism is much faster than a human's. If you need documentation to back up a choice of shooting a lower dose twice daily to show your vet, we can supply it from very reputable sources. Both the AAHA and ISFM recommend twice daily dosing. Not sure where your vet got the impression Monkey is having a long effect from the Lantus. It's not showing on your spreadsheet from what I can see although if she is judging by what happened on 1u of insulin, I suppose she could have taken a leap to that conclusion.

Many folks here have vets who don't necessarily initially agree with their dosing methods but usually once the vet sees the improvement, they are swayed. Unless your vet is willing to give you a 24/7 phone number to deal with any consequence of their dosing methods and promises to always be available, the decision is yours rather than theirs to make.

You need to do what you are comfortable with but from the massive amount of experience here, the consensus is that once a day dosing doesn't usually work. You can always try the twice daily dosing and if you don't see it helping to level out Monkey's numbers, then you can always go back to the vet's recommendations. Our goal here is to help you get Monkey regulated and keep her safe so we would not suggest twice daily dosing if we weren't confident that it's going to help Monkey.
 
nightglo said:
How do I call Monday with her numbers and say, "by the way, I started giving 0.25 twice a day even though you said not to" :(
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If you want to take the leap of faith that most of us have and listen to those of us that have been dealing with this disease for a long time, there's no reason you need to call your vet at all!....and well, if they call you, there's no law that says you have to answer the phone! (I love Caller ID)

If you want to take a stand, you could send him/her the links I posted in your previous post and ask why they think their advice is better than the rest of the feline diabetic community. You wouldn't have to be confrontational....just say something like "according to the studies I sent you, everything I read says it should be given twice a day. Can you explain again why you think Monkey only needs it once a day?....Maybe I'm not understanding something that you are thinking. I'd like to try a lower dose and twice a day dosing....would you be willing to let me at least try it and see how Monkey responds"?
 
Chris & China said:
If you want to take the leap of faith that most of us have and listen to those of us that have been dealing with this disease for a long time, there's no reason you need to call your vet at all!....and well, if they call you, there's no law that says you have to answer the phone! (I love Caller ID)

If you want to take a stand, you could send him/her the links I posted in your previous post and ask why they think their advice is better than the rest of the feline diabetic community. You wouldn't have to be confrontational....just say something like "according to the studies I sent you, everything I read says it should be given twice a day. Can you explain again why you think Monkey only needs it once a day?....Maybe I'm not understanding something that you are thinking. I'd like to try a lower dose and twice a day dosing....would you be willing to let me at least try it and see how Monkey responds"?
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Thanks for linking those :) Would it be safe to say that this quote from the diabetic mgmt of cats applies to Monkey's rebound given that she just started, so the best option would be to stay consistent with, say, 0.25 twice a day, even if her lowest reading is lower than 5 because her other numbers are still 20+? :

"The fluctuations of blood glucose concentration that were commonly observed in the first weeks, and more rarely months, following the initiation of treatment with glargine, and which might be mistaken for the Somogyi effect, generally resolved with time using consistent dosing. The dose of glargine or detemir should be reduced if the cat develops asymptomatic or clinical hypoglycemia but not when the blood glucose concentration is high and poorly responsive to insulin"
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I'm trying to get myself ready to just take care of this on my own with everyone's advice here - given how she went down to 3.4 today, would 0.25U be okay tomorrow morning as long as she's over 15? Would I then give 0.25U at night, or should I wait until the rebound clears?

Thanks so much to everyone for the advice and support, it really means a lot to Monkey and me :bighug:
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Argh!

I know exactly how you feel. I too had the war in my head between the advice given here and the advice my vet gave me. He too wanted me to shoot once a day, didn't like that I'd asked for a particular insulin, didn't think I needed to home test etc etc etc.

His words were 'if you home test your cat will start to hide from you'
My cat isn't a fan of it But she can be bribed! It took us a while to get the hang of it but we did get there.

If you look at the beginning of Tempests spreadsheet you will see what his advice caused after the first shot. Tempest was very sensitive to insulin. (Still wondering if they shouldn't have allowed me to see if it was diet controlled first).

All I can say is this. I listened and was guided by the wonderful, experienced people on this form. And as things progressed my vet couldn't say anything as the numbers didn't lie. I printed my SS out and showed him our progress. What could he say at that point? He had also suggested once a day dosing, I quietly explained to him that I had split the dose between am and pm and showed him the results.

Remember this, you are the paying customer, and paying for a service. While I don't think people should generally ignore their vets advice I think it's really important to realise the difference between what experienced people know, and how much vets are actually taught, and how much experience they have with particular issues.

He may not have appreciated my 'way with him at the time' but we still get on just fine and I'm happy with him.
 
TempestsMum said:
Argh!

I know exactly how you feel. I too had the war in my head between the advice given here and the advice my vet gave me. He too wanted me to shoot once a day, didn't like that I'd asked for a particular insulin, didn't think I needed to home test etc etc etc.

His words were 'if you home test your cat will start to hide from you'
My cat isn't a fan of it But she can be bribed! It took us a while to get the hang of it but we did get there.

If you look at the beginning of Tempests spreadsheet you will see what his advice caused after the first shot. Tempest was very sensitive to insulin. (Still wondering if they shouldn't have allowed me to see if it was diet controlled first).

All I can say is this. I listened and was guided by the wonderful, experienced people on this form. And as things progressed my vet couldn't say anything as the numbers didn't lie. I printed my SS out and showed him our progress. What could he say at that point? He had also suggested once a day dosing, I quietly explained to him that I had split the dose between am and pm and showed him the results.

Remember this, you are the paying customer, and paying for a service. While I don't think people should generally ignore their vets advice I think it's really important to realise the difference between what experienced people know, and how much vets are actually taught, and how much experience they have with particular issues.

He may not have appreciated my 'way with him at the time' but we still get on just fine and I'm happy with him.
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I'm glad to hear that even though your vet disagreed, they are now on board. I'll cross my fingers mine will too! I was looking at Tempest's SS and it looks like once you got down to 0.25U BID she stabilized?
 
nightglo said:
I'm glad to hear that even though your vet disagreed, they are now on board. I'll cross my fingers mine will too! I was looking at Tempest's SS and it looks like once you got down to 0.25U BID she stabilized?
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I wouldn't say they were thrilled lol but I wasn't there to look at their disapproving stare. And after the fact, there wasn't much they could do. We had a chat a month or so ago, I think he's starting to realise I'm not stupid and able to think for myself.

Her pancreas started spluttering so I did give a couple of .12 and a .10 but only if she went up over 10. If she was in lower numbers then it was a no shot. My safe number was a little higher than most because she liked to dive.

I think it's easy to see on your SS even though there's not many tests on it exactly what one shot a day does. It goes down and then high and then pm very high where if she had a pm shot it would allow it to be more stable so you get the drop in am and then the pm shot stops it rising right back to where you started.

It's programmed into us to follow those people who know more than we do, (or our perception of them knowing more than us) if they are in uniform it immediately puts us straight into a certain frame of mind and that is where we have such difficulties going against that even if our gut instinct says otherwise.
 
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