Do these BG numbers suggest anything to you???

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colin72

Member Since 2014
I just started my cat on Lantus this past Friday night. He's to get 1 unit once a day. I was hoping people here could look at these Blood Glucose numbers and tell me if they suggest anything.

It's Sunday morning and I won't be able to talk to my vet until Monday. Do these numbers suggest he needs twice a day dosing instead of once a day?? Or does it suggest he needs a higher dose??

The BG numbers are from a Relion Micro (human glucometer).

Friday

7:45 pm - BG 335

(7:45 pm Gave first dose of Lantus, 1 unit)

Saturday

1:00 am - BG 193
(Fed at 1:00 am)
5:00 am - BG 272
7:45 am - BG 237
10:45 am - BG 174
(Fed at 11:00 am)
6:30 pm - BG 336
(7:45 pm - Gave 1 unit Lantus)
10:45 pm - BG 181
(Fed at 11:00 pm)


Sunday

1:45 am - BG 212
5:15 am - BG 292
8:00 am - BG 195
11:00 am - BG 161
(fed at 11:00 am)
1:00 pm - BG 350
 
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How come you are only dosing 1 time a day? Lantus is ment to be given every 12 hours in a cat.
 
It's 6:30 am right now. As I noted above, his previous dose of Lantus was at 7:45 pm last night. Would be any danger in giving him another dose of 1 unit around 7: 45 am??

He's just been laying around this weekend. He's lethargic. No energy. Drinking lots of water. He had some, not a lot, but some ketones Friday at the vet's office.
 
colin72 said:
He's to get 1 unit once a day.
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Hi Colin, there is no insulin that lasts 24 hours in the cat. Cats have fast metabolisms. So, insulin is almost always dosed twice a day.

Also, Lantus is what's known as a 'depot' insulin. After the shot, some of the insulin can become available to the body soon afterwards, but some is also stored in the body forming a kind of reservoir or 'depot', and is released over time. It is only when a depot insulin has been given for several days (and the depot has built to its optimal level for that dose) that you can see the full effect of the insulin dose.

There is a lot of info in our Lantus subforum, and I do recommend that you grab a cup of coffee (or tea!) and have a read through of the information 'Stickys' at the top of the list of list of threads on this page.
http://www.felinediabetes.com/FDMB/forums/lantus-glargine-levemir-detemir.9/
.
 
colin72 said:
It's 6:30 am right now. As I noted above, his previous dose of Lantus was at 7:45 pm last night. Would be any danger in giving him another dose of 1 unit around 7: 45 am??

He's just been laying around this weekend. He's lethargic. No energy. Drinking lots of water. He had some, not a lot, but some ketones Friday at the vet's office.
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This worries me. Are you testing for ketones at home? Is he eating well?

Ketones can develop rapidly into a life-threatening situation. Caught early, treatment with food, insulin, and fluids can be very successful, but more severe cases are difficult (and very expensive).

As others have said, Lantus is typically dosed twice a day, so a shot this morning would actually be recommended, but I'd really like to also see a ketones test as well (you can use the urine dipsticks for humans, sold in regular pharmacies with the other diabetic supplies). If there are substantial ketones, it's not something that should wait until tomorrow. Just for information, is there an emergency vet near you?
 
Nan & Amber said:
This worries me. Are you testing for ketones at home? Is he eating well?
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Gosh, yes. Nan is right, and I'm so glad she spotted that! @colin72 , it's extremely important that you test for ketones.

You can get Ketostix (or Ketodiastix) from most pharmacies. And the test strip is just dipped into a little drop of pee, and then timed. ..Crumpling plastic food wrap loosely over the cat litter tray is often an easy way to get a sample, the pee collects in the little creases. Or, some people use non-absorbent litter or washed aquarium gravel; and some folks hold a long handled spoon under the cat's bum while they pee...

You really want to see a 'negative' ketone result; ie. the little test square doesn't change colour. Anything above a 'trace' reading is a reason to contact your vet, ASAP.
Also, not all kinds of ketones are picked up on the test strips, so do also have an awareness of how your kitty's breath smells. It should smell like normal kitty breath (!). If it smells fruity like acetone then that could indicate ketones.

Is your kitty eating OK? It is very important that he does eat....
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I mentioned above, "He had some, not a lot, but some ketones Friday at the vet's office." I can't remember the term the vet used. He could have said "trace amounts".

It's a long story that I was trying not to go into. I'm not going to be able to tell you every single thing that's happened. I know my vet is very competent and always approaches something like this very systematically and is always thinking of doing things in a cost effective manner.

Leo has been to the vet 11 times over the past 9 weeks. He initially went because he stopped eating. He was in the hospital for 3 days for fluid therapy and IV fluids. They suspected diabetes, he's had a fructosamine test, blood glucose curve... he's shown as borderline diabetic. He's also had a urinary infection which has been difficult to get rid of. There have been multiple urine tests and until Friday there were no signs of ketones. Over the 9 weeks there have been periods where he won't eat. The vet even suspected some issues with his teeth that could be contributing to the problem. I've been feeding him with a syringe since last Monday. As I said, there have been periods throughout this ordeal where he won't eat on his own (but this has been the longest period).

So.... 9 weeks later and Leo just started Lantus on Friday. The vet was concerned that if anything, his BG might drop too low. But instead, I'm getting the BG numbers I posted above, he's very lethargic and still not eating on his own yet.
 
colin72 said:
I mentioned above, "He had some, not a lot, but some ketones Friday at the vet's office." I can't remember the term the vet used. He could have said "trace amounts".

It's a long story that I was trying not to go into. I'm not going to be able to tell you every single thing that's happened. I know my vet is very competent and always approaches something like this very systematically and is always thinking of doing things in a cost effective manner.

Leo has been to the vet 11 times over the past 9 weeks. He initially went because he stopped eating. He was in the hospital for 3 days for fluid therapy and IV fluids. They suspected diabetes, he's had a fructosamine test, blood glucose curve... he's shown as borderline diabetic. He's also had a urinary infection which has been difficult to get rid of. There have been multiple urine tests and until Friday there were no signs of ketones. Over the 9 weeks there have been periods where he won't eat. The vet even suspected some issues with his teeth that could be contributing to the problem. I've been feeding him with a syringe since last Monday. As I said, there have been periods throughout this ordeal where he won't eat on his own (but this has been the longest period).

So.... 9 weeks later and Leo just started Lantus on Friday. The vet was concerned that if anything, his BG might drop too low. But instead, I'm getting the BG numbers I posted above, he's very lethargic and still not eating on his own yet.
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Did they rule out pancratitis? There's a simple snap test for that.
 
colin72 said:
As I added to the first post above, his BG at 8 am is now 195
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That is a nice number.... Not that far above normal range.... Normal range is approx 50 - 130 on a human meter. (To give some perspective, newly diagnosed cats can often be in the 400's.)

....Regarding the UTI, occasionally folks come here with cats that are diagnosed as diabetic, but whose diabetes has been diagnosed while the cat has an infection. Infection often raises blood glucose. Sometimes when the infection subsides the blood glucose goes back to normal.

Colin, you mention that there may be issues with teeth, has your vet actually recommended dental treatment?
And I agree with Janet that it could well be worth testing for pancreatitis....
(There's a list of pancreatitis symptoms on this page: http://www.felinediabetes.com/FDMB/threads/a-primer-on-pancreatitis.83108/)
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Ketones can develop from "trace" to life-threateningly severe in 24 hours, so having been tested on Friday and showing low ketones doesn't mean there's no problem today.

The recipe is, not enough food, not enough insulin, plus some kind of infection/inflammation to get the ball rolling (pancreatitis can do it, as can dental problems). Once it gets rolling, though, the not enough food/insulin can accelerate the process. Since your kitty is being syringe-fed and underdosed on insulin, and is acting lethargic, I continue to worry. Please try to get a ketone test in today! If it's negative, you'll get some peace of mind on that and know to look for other causes. I agree that the diabetes itself may very well be transient, caused by some other physical stress.
 
Nan & Amber said:
Ketones can develop from "trace" to life-threateningly severe in 24 hours, so having been tested on Friday and showing low ketones doesn't mean there's no problem today.

The recipe is, not enough food, not enough insulin, plus some kind of infection/inflammation to get the ball rolling (pancreatitis can do it, as can dental problems). Once it gets rolling, though, the not enough food/insulin can accelerate the process. Since your kitty is being syringe-fed and underdosed on insulin, and is acting lethargic, I continue to worry. Please try to get a ketone test in today! If it's negative, you'll get some peace of mind on that and know to look for other causes. I agree that the diabetes itself may very well be transient, caused by some other physical stress.
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^^^This^^^
 
JanetNJ said:
Did they rule out pancratitis? There's a simple snap test for that.
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I can't remember at this point if they brought up pancreatitis or not. He had an ultrasound last week to rule out the presence of kidney stones and tumors.
 
Elizabeth and Bertie said:
....Regarding the UTI, occasionally folks come here with cats that are diagnosed as diabetic, but whose diabetes has been diagnosed while the cat has an infection. Infection often raises blood glucose. Sometimes when the infection subsides the blood glucose goes back to normal.
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Yes, this was one of the issues we've had with him. Because his BG numbers weren't that bad, they thought the cause could be the UTI as you said.


Elizabeth and Bertie said:
Colin, you mention that there may be issues with teeth, has your vet actually recommended dental treatment?
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The vet was going to clean Leo's teeth one of the times he was there last week but his BG number was very high. The vet said he didn't feel comfortable putting him under anesthesia. He was able to do some cleaning of Leo's teeth (I think he referred to it as "scaling") without anesthesia. He said there may be a couple problem teeth but he didn't see anything really bad.

Elizabeth and Bertie said:
And I agree with Janet that it could well be worth testing for pancreatitis....
(There's a list of pancreatitis symptoms on this page: http://www.felinediabetes.com/FDMB/threads/a-primer-on-pancreatitis.83108/)
.
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I'll ask about it but he doesn't have any of these symptoms...
• hypothermia (68%)
• vomiting (35%)
• abdominal pain (25%)
• a palpable abdominal mass (23%)
• shortness of breath (dyspnea) (20%)
• loss of muscle coordination (ataxia) (15%)
• diarrhea (15%)


Thanks for taking the time to comment
 
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As I added to the first post above, his BG at 11 am is now 161.

Still no interest in food. I'll be feeding him with the syringe again this morning.
 
I bought ketone strips and tested his urine at 12:45 pm (he was fed at 11 am). It reads as "small".

I just also tested his BG at 1 pm. It's now up to 350.

Should I give me a unit of insulin now???? Is that safe?
 
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colin72 said:
I bought ketone strips and tested his urine at 12:45 pm (he was fed at 11 am). It reads as "small".
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Hi Colin, I am sorry but anything above Trace amounts of ketones calls for vet visit right away. My cat had DKA - it is not fun to say the least. I'd go to ER if your vet is closed.
 
colin72 said:
I just also tested his BG at 1 pm. It's now up to 350.

@colin72
Should I give me a unit of insulin now???? Is that safe?
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The number itself is safe to give one unit of insulin only if you are confident you can feed him. He does need insulin and food.

If you take him to ER they will be able to flash out he ketones and give him fast acting insulin then once he is stabilized you can continue insulin therapy at home. If they get the ketones out his appetite will restore.
Please do consider the ER visit - DKA is extremely dangerous. The earlier it is caught the better the chances for successful treatment.
 
colin72 said:
??? That's not really what this site says....
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Colin, our site has a much higher membership and gets much more traffic, so we simply see many more cases. That is why, in the light of what we've seen, our general advice is to contact a vet if a reading is above 'trace' ketones.

What you choose to do is entirely your call. But in the years that I've been here I've seen, many times, just how quickly ketones can develop into DKA. ..DKA is very expensive to treat, and can all too easily be fatal. Early intervention saves money and lives....
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I read the information at the link, and it seems to me that this site would also recommend a vet trip at this point. It's the combination of the "small" reading plus the lethargic behavior that is most concerning. At this point, things could go either way, and while no one likes going to the 24-hr vet ($$$$, and they don't know your cat), it could mean the difference between heading off any further problems with a small amount of treatment now, or progression to full-blown DKA, which requires a lot of very expensive treatment (and, sadly, is not always successful).

Tanya has had some really harrowing experiences with DKA. Her cat Ducia pulled through, but it took a lot of vet care plus a long period of dedicated nursing at home.
 
Elizabeth and Bertie said:
Colin, our site has a much higher membership and gets much more traffic, so we simply see many more cases. That is why, in the light of what we've seen, our general advice is to contact a vet if a reading is above 'trace' ketones.

What you choose to do is entirely your call. But in the years that I've been here I've seen, many times, just how quickly ketones can develop into DKA. ..DKA is very expensive to treat, and can all too easily be fatal. Early intervention saves money and lives....
.
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What is the ER vet going to do?
 
colin72 said:
What is the ER vet going to do?
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When Ducia was in they had her on fast acting insulin to stabilize the BG level, she had SQ fluids for hydration and electrolyte balance and some liver support medication.She was force fed.
ETA: sorry I forgot to mention that she also had antibiotics.
 
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Nan & Amber said:
Any updates? How is he doing this morning?
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1 month later and a lot happened. The short version...

Made a trip to ER Vet the day I first posted above, he was in bad shape...dehydrated and showing signs of DKA

He was stable after 24 hours... ER Vet and my Vet thought he could be moved to my Vet for treatment

After 24 hours doing well at my Vet, his temperature dropped (to 95 I think). My vet does not have 24 hour monitoring so I rushed him back to the ER Vet (by the way, if his temp would have dropped 2 hours later than it did, my Vet would not have caught it because they would have been closed... he would have most likely died overnight)

He spent 3 more days at the ER Vet

The good news....
After 3 weeks on Lantus, a lot of sleepless nights... weeks of getting up multiple times during the night to check on him and his BG... and over $5,000.... he's doing great and has been in remission for 4 days.

Thanks for the advice
 
Wow!!! What an adventure. I'm so glad he pulled through and is doing great now. Kudos to you for taking such good care of him-- and congrats on the remission!

Thanks also for checking back in-- we do worry in situations like this, with a cat in apparent crisis and then no news for a while, so it is really nice to hear the happy ending!
 
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