Blood Glucose at 81 - advice please

[Jamie and Simba]

Hi everyone,

I am new around here, although I have read a great deal that has helped me with my diabetic cat, Simba.

He was diagnosed in October 2009, with levels in the high 400's. He takes Glargine Insulin that had to be increased over a period of months until he was getting 4 units, twice a day. In January, his vet unexpectedly left her practice and I felt stranded. I then had a miscarriage of my own, and put everything else on the back burner for a few weeks. Of course I still did his shots twice a day, but I hadn't done a blood test in a few weeks. He has acting perfectly normal since he hit 4 units. Actually, he has been acting better than normal! He is perkier than he has been in a long time, so I thought that was a good sign. His water intake is normal, and his urine levels are good. He has been eating - everything seems to be perfect.

Today I did a blood glucose test at home, and his number was 81. I did it twice because I was sure that was wrong. The lowest I'd ever had a test result come up was in the 200's. His last curve ranged all around in the 200's. So this low was a shock to me, and scared me that he might be borderline hypoglycemic. I called a few different vets, and they all gave me different things to do. One said to continue giving him 4 units twice a day, and to do another curve. One said to only give him 2 of 4 units (is that safe to drop suddenly like that?). I tested again right before his shot was due (7 hours after his last glucose test), and the level only rose to 119. I am too scared to give him his shot tonight, so I decided to skip it. I don't know if that was the right thing to do.

Does anyone have any advice on what I should do? I'm in the process of picking a new permanent vet, which I know I need to do asap. If he has somehow regressed from diabetes in the past couple of months, how do I know this? Can I just stop giving him insulin and test him repeatedly to see if his levels stay normal, or could this harm him? I want to avoid causing hypoglycemia, and I want to avoid causing any damage to him at all. His diet is now completely diabetic wet food with a little diabetic dry food, and it's made a huge change. I am just at a loss, and I lost the only vet that knew Simba, and that we trusted. I know that people here are very knowledgeable, so I would appreciate any help. If I left out any important information, please let me know. Thank you everyone. =)

Jamie & Simba

 

[LynnLee + Mousie]

i'm gonna round up some experienced lantus users for you. i only recently started using it so i can't tell you exactly what you should or shouldn't do.

normally i would say not to give insulin because you don't have enough recent data to support giving insulin on such numbers (it is possible to shoot lantus on those numbers but only if you have the data and know how to support it). but let's see what they say.

 

[Vicky & Gandalf (GA) & Murrlin]

How many hours after you gave his shot did you get the 81 test? About 5 hours after if you are giving shot every 12 hours, right? Probably a bit earlier than it usually peaks, but an 81 at 5 hours after shot is a very good number! No harm done at skipping shot tonight. Perhaps you could test his BG now and see if it went down after eating?

He may have an awakening pancreas and you will need more BG tests to determine how much insulin would help the process.

It's very possible for diabetic cats to go in to remission, especially on the longer acting insulins glargine aka Lantus or detemir aka Levemir. They are able to hold the blood glucose level closer to normal range for longer periods of time, allowing the pancreas to heal and begin working again.

Used effectively Lantus should be able to hold the blood glucose within normal range for a long period, so you may be seeing the Lantus working as it should! And it's probably not a good idea to stop the insulin completely unless you can determine if he can maintain his blood glucose within normal range on his own.

Good for you that you are hometesting! You will need to do it more often to get a handle on his reaction. Keep posting and asking questions - there are many people who've gotten their cats in to remission on Lantus!

 

[Jamie and Simba]

Thank you both very much! It is really wonderful to hear from people who have experience with this.

I did test 5 hours after his first shot. My original vet said to test anywhere between 5-7 hours, so it is possible that it went even lower. I stayed with him for the following two hours after the shot to make sure he seemed okay. The emergency vet I spoke with said she wouldn't worry about hypoglycemia unless the level dropped to 60, and I didn't know if it would in the following 2 hours. Vicky, like you said, it could have peaked later.

I will keep testing, as Simba is very good about it. It's hard to say if it's remission he's going into, or if it's just the Lantus working. I am going to test again before his morning shot, and see what the levels are at. I'm expecting to do his morning shot, maybe at a decreased level, unless BG levels are still low. Hopefully I can start working on lowering his dosages, and possibly help him into remission. I am very glad to hear that others have been able to get their cats into remission!

 

[paige]

HI Jamie! 81 is very good for Simba :mrgreen:

It can however be quite scary to decide how to shoot the first time you see such a low BG. Definitely get the AMPS (AM Pre Shot BG) tomorrow morning to see where he is. Since you did not give a shot this evening it will be interesting to see where his numbers are in the morning. It sounds like Simba might have finally got the right dose!!! And yes most likely you can begin working on decreasing his dose---we all fear "hypoglycemia" :? . It would be very good to try and get more frequent spot checks to see when his nadir is and how his cycles go on the current dose.

You are correct that you do not want to just quit giving the lantus cold turkey. If his body is not ready to be off the insulin he could develop ketones if his BG started to rise to diabetic levels.

 

[Sienne and Gabby (GA)]

Hi Jamie.

You may want to take a look at the dosing protocol, Tight Regulation with Lantus or Levemir, that we use on the Lantus Insulin Support Group. The protocol will give you a guideline for reducing doses and hopefully, you will find it a useful resource. Just a word about dose reductions. According to the protocol, a dose reduction is earned when BG numbers in a newly diagnosed cat (i.e., diabetic for less than one year) drop below 50. Most of us have cats that will surf in numbers that are in the 50 - 70 range and there are no symptoms of hypoglycemia. Many vets seem uncomfortable with cats running low numbers but this is more than likely due to how so few people home test and don't know how to manage low numbers with food.

 

[Jamie and Simba]

Thank you everyone for your helpful responses! I'm learning so much here about how the insulin works. I thought I understood it, but hearing from people who actually have cats with diabetes makes so much more sense to me. I ended up testing his blood at 9:30 AM today, which is normally when he gets his AM shot. His blood was at 99, and I had expected it to be much higher. He hadn't had a shot in 24 hours, but again I was afraid to do 4 units with it being that low. I called the vet that I've been talking to that he has seen a few times in his life, I think I'm going to stick with her for now. She said to skip his shot again because that level was good. I'm going to test him periodically through the day, and before each shot. She gave me a chart to follow on how much insulin to give him, none - half - or full, based on where the blood level is at. Paige, thank you for the warning about ketones. I wasn't sure how those developed, so it might be something I will ask my vet to test for just in case - especially if his numbers rise back up. If I can test for them at home, I will do that too. I'm going to monitor his blood levels very closely, and try to match his insulin dosages with his blood levels. Does this sound like the right thing to do to all of you?

Sienne - that link is wonderful! I read it & bookmarked it to help me make future decisions. It's exactly what I was searching for yesterday and having a hard time finding. It's nice to know I'm not the only one in this situation.

-Jamie & Simba-