Bub's BG was 55 this AM, vet told us to NOT administer insulin today, but...

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Kelley & Bender "Bub"

Kelley & Bender "Bub"

Member Since 2020
We just started Bender ("Bub") on insulin (Lantus) on Monday at 1 unit 2x/day. Throughout the week, his BG ranged from 175-364. This morning, his BG was 55. We immediately called the vet, who told us to skip insulin today. HOWEVER, we tested his BG again about 45 minutes later after feeding him and he was at 185. At 1:30pm he was at 179 and at 7pm he was at 317 (he had not eaten since the morning). We're thinking we should give him 1 unit of insulin at his regular time (9pm), but the vet is now closed, and we don't want to do the wrong thing. Has anyone experienced big swings like this? What would you do? Please help!
 
Kelley & Bender "Bub" said:
We just started Bender ("Bub") on insulin (Lantus) on Monday at 1 unit 2x/day. Throughout the week, his BG ranged from 175-364. This morning, his BG was 55. We immediately called the vet, who told us to skip insulin today. HOWEVER, we tested his BG again about 45 minutes later after feeding him and he was at 185. At 1:30pm he was at 179 and at 7pm he was at 317 (he had not eaten since the morning). We're thinking we should give him 1 unit of insulin at his regular time (9pm), but the vet is now closed, and we don't want to do the wrong thing. Has anyone experienced big swings like this? What would you do? Please help!
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Tagging @tiffmaxee for you
Sounds like 1 unit is too high a dose. Wait for a more experienced helper. I cannot give dosing advice.
I see you dont have a spread sheet would you like to set one up? you can do that here:
FDMB SPREADSHEET INSTRUCTIONS

Bubs sure is a handsome fellow :bighug:
A spreadsheet will help you help Bubs. It also will help us help you!
 
I dont know if youve had a proper welcome so I will say
WELCOME TO OUR FAMILY:bighug:

Another tool we have to benefit both you AND bubs is a signature. This gives everyone at a glance information about Bubs.

Complete your profile. This is where you can put your location if you wish. Please do not put in personal information such as work schedules as it is a security risk.

Make sure your signature is up-to-date.
  • On the left, under Settings, Click on Signature. This is where you will put information that helps us give you feedback.
    • There is a limit of two lines which may include two links; you may separate pieces with commas, dashes, | etc. This is where you paste the link for your spreadsheet, once it is set up.
    • Add any other text, such as
    • Caregiver & kitty's name (optional)
    • DX: Date
    • Name of Insulin
    • Name of your meter
    • Diet: "LC wet" or "dry food" or "combo"
    • Dosing: TR or SLGS or Custom (if applicable)
    • DKA or other recent health issue (if applicable)
    • Acro, IAA, or Cushings (if applicable)
    • Spreadsheet link. Please put the signature link on the bottom line of your signature information, on its own, so it is easy to find.
    • Please do not put any information about your location in the signature for security reasons. If you wish to add your country location, please add it to your profile.
Be sure to click the 'Save Changes' button at the bottom. If you need help urgently it is important we know these things at a glance. We don’t want to waste valuable time finding out information.

We look forward to helping you navigate Bub's journey.
jeanne
 
Hi Kelley,

Bub is so cute! :)

It's great that you're already home testing.

Please can you let us know the type of meter you're using to check Bub's blood glucose levels (human meter or pet meter) so that we can interpret the numbers correctly.

Also, could you let us know whether Bub got both AM and PM doses of Lantus on Monday? I ask because Lantus builds up a sort of chemical 'tank' in the body (the 'depot') so we need a proper idea of how many doses Bub has had to date so as to get a handle on the depot status.


Mogs
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Critter Mom said:
Hi Kelley,

Bub is so cute! :)

It's great that you're already home testing.

Please can you let us know the type of meter you're using to check Bub's blood glucose levels (human meter or pet meter)so that we can interpret the numbers correctly.

Also, could you let us know whether Bub got both AM and PM doses of Lantus on Monday? I ask because Lantus builds up a sort of chemical 'tank' in the body (the 'depot') so we need a proper idea of how many doses Bub has had to date so as to get a handle on the depot status.


Mogs
.
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Thank you for the reply! We use an AlphaTrak 2. Bub started Lantus in the PM on Monday. I updated my signature with his spreadsheet, although I'm not sure I'm filling out the spreadsheet right. Particularly, I'm not sure how to enter "1 unit of Lantus" -- like, what the numerical value would be. I sense it is not "1". I thought it might be ".01," and that's what I put. Please excuse my ignorance!

Thank you jt and trouble (GA) and tiffmaxee for the welcome and info!
 
Hi again, Kelley.

Great job getting your signature up and your spreadsheet going. You're flying it! :)

First, the business end of things: the 1.0 unit dose of Lantus is too high, so when you next give insulin you will need to reduce the dose (both AM and PM doses).

The 55 reading today is below the lower bound of the feline blood glucose (BG) reference range as measured on an Alphatrak meter (i.e. in they hypoglycaemic range). Anything below 68 on your Alphatrak means that you need to take action to bring BG levels back up into safe numbers.

Just going to have another look at your spreadsheet readings. BRB...


Mogs
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Kelley & Bender "Bub" said:
We're in the process of decreasing the pred.
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That will hopefully make a world of difference. Some steroid-induced cats race down the dosing scale and can even go into remission.

Has there been a change in diet as well? Switching to a low carb diet can drop overall numbers by up to 100 points.

Sorry about all the questions. The clearer the picture, the better we can help you.
 
While I'm looking at the spreadsheet, Kelley, could you please let us know whether you changed Bub to a low carb diet after he was diagnosed with diabetes. If this is the case, when was the first day he got to 100% low carb food only?


Mogs
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Red & Rover (GA) said:
That will hopefully make a world of difference. Some steroid-induced cats race down the dosing scale and can even go into remission.

Has there been a change in diet as well? Switching to a low carb diet can drop overall numbers by up to 100 points.

Sorry about all the questions. The clearer the picture, the better we can help you.
Click to expand...

We changed his diet as soon as he was diagnosed--no more dry food and, to Bub's dismay, no more Temptations. We had been feeding him Fancy Feast Classics and are keeping him on that (2 3oz cans a day). He weighs about 11lbs right now.
 
Critter Mom said:
While I'm looking at the spreadsheet, Kelley, could you please let us know whether you changed Bub to a low carb diet after he was diagnosed with diabetes. If this is the case, when was the first day he got to 100% low carb food only?


Mogs
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We switched to LC wet food ONLY on 9/17/20 when he was diagnosed. He gets 2 3oz cans a day, plus 1-2 pieces of dehydrated chicken treats.
 
Kelley & Bender "Bub" said:
We switched to LC wet food ONLY on 9/17/20 when he was diagnosed. He gets 2 3oz cans a day, plus 1-2 pieces of dehydrated chicken treats.
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Kelley, what’s his ideal weight? Is he over or under? I ask because 2 3oz cans a day only is at the most 200 calories so just want to make sure he’s getting enough food especially since diabetic cats can’t process the nutrients in food efficiently and end up eating but always starving and losing weight.

Minnie has IBD and she’s on budesonide. It’s a localized GI tract steroid only designed not to work on the entire body thus not affecting bg levels. Amazing to me how many vets don’t know about it :arghh:
 
A few more questions for you, Kelley (just some standard 'pre-flight' checks):

1. Do you have any higher carb foods in the house (e.g. Fancy Feast Gravy Lovers, Temptations treats)?

2. Do you have honey or karo?

3. Have any of Bub's blood or urine tests ever come back positive for blood ketones?

4. How long till Bub's next dose is due? (HH:MM) ETA: Time interval between now and then, please, not the local time when the dose is due (we're all in different time zones).

5. How many test strips do you have for the Alphatrak?

6. Should the need arise, are you in a position to test for several hours tonight?


Mogs
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Aleluia Grugru & Minnie said:
Kelley, what’s his ideal weight? Is he over or under? I ask because 2 3oz cans a day only is at the most 200 calories so just want to make sure he’s getting enough food especially since diabetic cats can’t process the nutrients in food efficiently and end up eating but always starving and losing weight.

Minnie has IBD and she’s on budesonide. It’s a localized GI tract steroid only designed not to work on the entire body thus not affecting bg levels. Amazing to me how many vets don’t know about it :arghh:
Click to expand...

This is good insight, thanks! Currently Bub is underweight - we had him at a good weight about 2 months ago, so I definitely would like to get him to gain some weight. We're still adjusting Bub's feeding schedule, trying to figure out what's best. Before the diabetes diagnosis, he would graze on dry food (Fussie Cat) throughout the day in addition to half a 3oz can 4x a day (spread out because Bub used to throw up if he ate too much food at once even out of a slow feeder). Now that we've cut out the dry food and have switched to feeding every 12 hours we're having trouble encouraging him to eat his meal all at once again. Ideally we would give him some food between the 12 hour injections but the vet recommended we stick with feeding as close to 12 hours as possible. The vet said 2 3oz cans is fine but also mentioned we could increase to 3 cans a day. The problem now is getting him to actually eat that much at the 12 hour marks.
 
Critter Mom said:
1. Do you have any higher carb foods in the house (e.g. Fancy Feast Gravy Lovers, Temptations treats)?
Click to expand...
Yes, we have Temptations.
Critter Mom said:
2. Do you have honey or karo?
Click to expand...
Yes, we have honey.
Critter Mom said:
3. Have any of Bub's blood or urine tests ever come back positive for blood ketones?
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I'm not sure. The vet did a blood test two weeks ago, but didn't give us info about ketones.
Critter Mom said:
4. How long till Bub's next dose is due? (HH:MM) ETA: Time interval between now and then, please, not the local time when the dose is due (we're all in different time zones).
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We were supposed to give him a shot about 45 minutes ago. Per vet's advice, we did not give him any insulin today. However, he seems okay and his numbers have been much higher since the AM 55 reading.
Critter Mom said:
5. How many test strips do you have for the Alphatrak?
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We just ordered some more test strips, so we should have about 45-ish?
Critter Mom said:
6. Should the need arise, are you in a position to test for several hours tonight?
Click to expand...
Yes, we could test for several hours tonight.
 
Kelley & Bender "Bub" said:
Ideally we would give him some food between the 12 hour injections but the vet recommended we stick with feeding as close to 12 hours as possible.
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This type of feeding schedule would be more appropriate when treating a cat with one of the intermediate-acting insulins. They tend to drop BG levels very hard and fast early in the cycle, so the cat needs to be 'primed' with food, ready for the insulin to go to work on. [ETA: The intermediate insulins also tend to poop out several hours before the next dose is due, another reason for the common vet recommendation to get all the feeding done at the beginning of the cycle, but longer-acting insulins don't require such constraints - see below.]

Kelley & Bender "Bub" said:
We're still adjusting Bub's feeding schedule, trying to figure out what's best.
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Because Lantus is long-acting and typically has a gentler mode of action, feeding schedules can be more flexible. Normally, the preferred schedule is to feed the majority of the grub in the first six hours after the insulin dose is administered. That said, the only time that you need to withhold food is for the two hours before each preshot check (as explained above). In particular, when a cat needs to gain weight it's fine to feed several small meals at all other times in the cycle. Many members use a timed feeder (e.g. Petsafe 5). The feeder can dispense food at regular points in the cycle, and you can also set it up to rotate to an empty compartment 2 hours before the preshot test is due (should give you a little extra shut-eye in the mornings!). From what you describe above, it might suit Bub well.

Kelley & Bender "Bub" said:
The problem now is getting him to actually eat that much at the 12 hour marks.
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It might be an idea to look for low carb kitten foods for Bub. They're more calorie-dense and could help him to regain weight a little faster.

As Bub's regulation improves, he will start being able to utilise his grub better and begin regaining weight.


Mogs
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If you can monitor tonight, I'd suggest 0.5 units.
Reasons: 1. reducing the pred dosage, 2. switching to low carb food

However, if you shoot 1 hour late tonight, you will have to roll slowly back to your shot time for a couple of days by shooting 15 minutes earlier each cycle OR 30 minutes early on one of the shots per day. Anything faster than this can act like double dosing or an increase.

If you decide to shoot, start off by getting a test at +2.

Kelley & Bender "Bub" said:
Ideally we would give him some food between the 12 hour injections but the vet recommended we stick with feeding as close to 12 hours as possible.
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Old school. It is best to give a main meal at shot time, then a couple of snacks throughout the cycle picking up any food at +10 (two hours before the next shot is due) so that the test number at shot time is not carb influenced. Feeding snacks means that the insulin dips are not as great and it helps the pancreas heal.
Feed Bub some snacks.
 
Some btw's.
The strips for the AlphaTrak are crazy expensive. At some point, you might want to consider moving to a human meter.

And because you saw low numbers this morning, please read and print out for your reference:

Make sure you have plenty of strips on hand and some karo or honey and some high carb food. Take a look at this spreadsheet of a steroid-induced cat that went into remission.
https://docs.google.com/spreadsheet...guC-KcIp7p6wVPlSB6ICZ51pGTXzbAtUgJEZ0/pubhtml
 
Kelley & Bender "Bub" said:
This is good insight, thanks! Currently Bub is underweight - we had him at a good weight about 2 months ago, so I definitely would like to get him to gain some weight. We're still adjusting Bub's feeding schedule, trying to figure out what's best. Before the diabetes diagnosis, he would graze on dry food (Fussie Cat) throughout the day in addition to half a 3oz can 4x a day (spread out because Bub used to throw up if he ate too much food at once even out of a slow feeder). Now that we've cut out the dry food and have switched to feeding every 12 hours we're having trouble encouraging him to eat his meal all at once again. Ideally we would give him some food between the 12 hour injections but the vet recommended we stick with feeding as close to 12 hours as possible. The vet said 2 3oz cans is fine but also mentioned we could increase to 3 cans a day. The problem now is getting him to actually eat that much at the 12 hour marks.
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I think that’s very old school. A diabetic cat does not have to eat twice a day only. That works for dogs who have a slower metabolism than cats. Most of us feed smaller meals throughout the day with the bulk of the meals being around shot times. It’s also easier on their already compromised pancreas to eat less each time but more times a day. I suggest you let him graze and if he needs to gain, let him eat. Diabetic cats also burn calories just by peeing since there’s sugar in their urine. A good rule of thumb is 20 times ideal weight to get the daily calorie intake. So if he should be 15 pounds, he should be eating 300 calories a day at least, I’d add at least another 25% to that to get him to gain. A lot of us also use timed feeders overnight so they can eat while we’re sleeping. It’s important for diabetic cats not to lose too much weight because of the risk of ketones. I think you need to feed him more and more times a day too. Just try smaller meals or snacks. After +6, we suggest snacks and no heavy meals.
 
Thank you all for the advice on a range of subjects. We have learned a lot just from this thread! Bub and I are grateful for the support. There's so much to learn and it's overwhelming right now, but hoping to get the swing of things soon.

We gave Bub 1 unit of insulin at his regular time this AM. His AMPS was 296.

We're going to look into the automatic feeder for overnight feeding and switch back to smaller meals throughout the day, plus treats! I forgot to mention that we give Bub his prednisolone and cerenia with cheese whiz, so that adds a little to his caloric intake, but also a small amount of carbs there.
 
The test yesterday morning showed that 1 unit is too much insulin for Bub. Lantus is dosed based upon how low it takes a cat and not on the pretest. The pretest let’s you know if it’s safe to give insulin. Please get a +1 and +2. Future tests today will depend on those bg results.
 
Kelley & Bender "Bub" said:
Thank you all for the advice on a range of subjects. We have learned a lot just from this thread! Bub and I are grateful for the support. There's so much to learn and it's overwhelming right now, but hoping to get the swing of things soon.

We gave Bub 1 unit of insulin at his regular time this AM. His AMPS was 296.

We're going to look into the automatic feeder for overnight feeding and switch back to smaller meals throughout the day, plus treats! I forgot to mention that we give Bub his prednisolone and cerenia with cheese whiz, so that adds a little to his caloric intake, but also a small amount of carbs there.
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Do you have 1/2 unit marked syringes? It seems you need to go down to .75 and it’s easier to measure those quarter amounts on 1/2 unit marked syringes.
Also, can you add the other meds and conditions he has to your signature please? :cat:
 
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@Kelley & Bender "Bub" i recommend you read all the yellow sticky notes on the Lantus forum so you can learn about the dosing protocols we go by here. Mainly this:

https://www.felinediabetes.com/FDMB...-low-go-slow-slgs-tight-regulation-tr.210110/

the reason you don’t want to dose by the preshot numbers is that you don’t know how low it will take your cat during the cycle. For example, Minnie can have an amps in the mid 300’s and go all the way down to 60 or 50 at her nadir. That’s close to a take action number for a hypo. Vets will tell you to do a scaling dose based on pre shot numbers, but we really don’t believe in that and we’re advising you based on the low numbers you’ve already seen. Does that make sense?

Btw, what you experienced yesterday with your vet not calling you back in time, it’s one of the main reasons I rely in this forum and don’t run dosing by my vet anymore. I test at home and I follow a protocol and ask for help here when I need it. Vets are not always there, but this forum is :)
 
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When a cat’s bg goes so low that they might become hypo, their body releases insulin which causes the bg to elevate, a bounce. There is a potential for a symptomatic hypo when you get a reading under 68 on an AT meter. That would require a trip to the ER for a glucose drip. That is why we suggested you drop the dose. Once the bounce clears you are likely to see another drop under 68. The bounce can take up to 3 days to clear or it could clear quickly. Lantus onset is generally at +2 but can happen earlier or a later. It reaches its lowest,the nadir, usually around +6 but can happen earlier or later. Some cats nadir at +10 or even preshot. Stay safe.
 
Hi Kelley,

Aleluia Grugru & Minnie said:
For example, Minnie can have an amps in the mid 300’s and go all the way down to 60 or 50 at her nadir. That’s close to a take action number for a hypo.
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I need to give you a clarification. Aleliua is referring to the 'take action' hypo number for HUMAN meters here (50mg/dL).

Alphatrak meters read higher than human meters do for cat blood. Because you are using an Alphatrak meter, your 'take action' number is 68mg/dL.

If at any time Bub's BG were to get to 68 - or even below - 68, you need to intervene straight away with higher carb wet food (e.g. Fancy Feast Gravy Lovers) and, if numbers are any significant amount less than 68, with honey/karo to bring BG back up to a safe level ASAP. See the Hypo Guide that Red linked for you above.

If a kitty goes below the hypoglycaemia threshold (the 'take action' number) you need to:

1. Feed a few teaspoons of higher carb food (possibly with honey/karo).
2. Test BG again no later than 30 minutes.
3. If BG comfortably above hypo threshold, don't feed, test again in 30 mins. If close to or below hypo threshold, go back to step 1.
4. Rinse and repeat until the cat goes above and STAYS above the hypo threshold without any food for a period of two hours.

Note that if a low number occurs early in the 12-hour cycle, it may take several hours of feeding/testing before the cat is safe.


Mogs
.
 
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Critter Mom said:
Hi Kelley,


I need to give you a clarification. Aleliua is referring to the 'take action' hypo number for HUMAN meters here (50mg/dL).

Alphatrak meters read higher than human meters do for cat blood. Because you are using an Alphatrak meter, your 'take action' number is 68mg/dL.

If at any time Bub's BG were to get to 68 - or even below - 68, you need to intervene straight away with higher carb wet food (e.g. Fancy Feast Gravy Lovers) and, if numbers are any significant amount less than 68, with honey/karo to bring BG back up to a safe level ASAP. See the Hypo Guide that Red linked for you above.

If a kitty goes below the hypoglycaemia threshold (the 'take action' number) you need to:

1. Feed a few teaspoons of higher carb food (possibly with honey/karo).
2. Test BG again no later than 30 minutes.
3. If BG comfortably above hypo threshold, don't feed, test again in 30 mins. If at or below hypo threshold, go back to step 1.
4. Rinse and repeat until the cat goes above and STAYS above the hypo threshold without any food for a period of two hours.

Note that if a low number occurs early in the 12-hour cycle, it may take several hours of feeding/testing before the cat is safe.


Mogs
.
Click to expand...
You’re absolutely right, sorry. I’m too used to the human numbers :rolleyes:
 
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