Dropped below 200

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Suzanne & Cobb(GA)

Member Since 2013
Okay...sooooo...y'all told me to post here if a reading drops below 200.

His +8 reading...it is at 170. His +10 was 240. I take his PMPS in an hour...

Given his numbers dropped more than 200 over a 12 hour period today, I (nor my husband) am not comfortable shooting him tonight. I'll send an email to the vet after his PMPS and she's usually good at responding quickly, but given that its a holiday I'm not optimistic.

No insulin is better than too much...correct?
 
Until a Lantus user answers, our genral rule is to not shoot under 200 at preshot. He is over 200 but I agree he is in much lower ranges than he has been. And the food change may continue to bring him down. It is not ideal to skip with Lantus, as it drains the depot you have been building up. But I understand your hesitation, especially as it is the night cycle.

Go with your gut. You could shoot something less than your normal dose or skip.
 
cobbsmom said:
Okay...sooooo...y'all told me to post here if a reading drops below 200.

His +8 reading...it is at 170. His +10 was 240. I take his PMPS in an hour...

Given his numbers dropped more than 200 over a 12 hour period today, I (nor my husband) am not comfortable shooting him tonight. I'll send an email to the vet after his PMPS and she's usually good at responding quickly, but given that its a holiday I'm not optimistic.

No insulin is better than too much...correct?

At 10 units BID, you can't give none; he'll go sky high.
If his pre-shot test is below 200 mg/dL, we'd want you to be able to monitor, but his lowest point is still well above 100 mg/dL.
You could give a reduced dose if the concern is him going too low; maybe back off to 9.5 or 9 units.
If your spread sheet is up to date, I think you are OK.
 
I was just reading your "introduction" thread so I'll quote from that:
KPassa said:
If he drops below 200 overnight, that would be a great sign that the diet change is working its magic. What you don't want him to do is drop below 50. If it's his pre-shot you're worried about, at any time he's under 200, we always tell people to stall:
  • Don't feed
  • Don't give the shot
  • Create a new post in this forum and/or the Lantus forum for help with a subject something along the lines of "Under 200 pre-shot - what do I do?"
  • Test again in 15-30 minutes to see if it's a "rising" number and/or if he gets over 200 (depending how close to 200 his original pre-shot was)

As explained above, that "below 200" is talking about the number he's at when you give the shot ("pre-shot"). You definitely should ask for some help if, at shot time, he's below 200. It's not because shooting 200 is dangerous, it's just to help you get some extra guidance until you have lots of data on your cat. Being below 200 isn't a bad thing the rest of the time - in fact you want to work towards having him there all the time. Below 50 is the too-low point. Since you got 170 at +8 and 240 at +10, it's quite likely that it will be even higher when it's time for his shot anyways.

Whenever you give insulin at a lower BG level than you've done before, it's great to get some early tests in - like +2 - so you have can have lots of warning if you're going to need to keep him from going too low. He is at a really high dose so it's good to be vigilant.
 
Okay. Thanks all. It is both unsettling and encouraging when you see numbers lower than they ever have been!

His next shot is due at 8, so I could get a +2 at 10.
 
Because you have what appears to be a high dose kitty, I'm not sure if you should aim for the same levels as most cats. In general, though,the following are what we use.

Here are some glucose reference ranges used for decision making using glucometers. Human glucometer numbers are given first. Numbers in parentheses are for non-US meters. Numbers in curly braces are estimates for an AlphaTrak.

< 40 mg/dL (2.2 mmol/L) {< 70 mg/dL for an AlphaTrak}
- Treat as if HYPO if on insulin
- At nadir (lowest point between shots) in a long term diabetic (more than a year), may earn a reduction.

< 50 mg/dL (2.8 mmol/L) {< 80 mg/dL for an AlphaTrak}
- If before nadir, steer with food, ie, give modest amounts of medium carb food to keep from going below 50 (2.8).
- At nadir, often indicates dose reduction is earned.

50 - 130 mg/dL (2.8 - 7.2 mmol/L) {80 - 160 mg/dL for an AlphaTrak}
- On insulin - great control when following a tight regulation protocol.
- Off insulin - normal numbers.
(May even go as low as the upper 30s (1.7 mmol/L){60s for an AlphaTrak}; if not on insulin, this can be safe.

= 150 mg/dL (8.3 mmol/L) {> 180 mg/dL for an AlphaTrak}
- no shot limit for ProZinc, PZI, or other non-depot insulins

> 150 mg/dL (8.3 mmol/L) {> 180 mg/dL for an AlphaTrak}
- At nadir, indicates a dose increase may be needed when following a tight regulation protocol.

200 mg/dL (11.1 mmol/L) {230 mg/dL for an AlphaTrak}
- no shot level for beginners; may slowly reduce to 150 mg/dL (8.3 mmol/L) {180 mg/dL} for long-acting insulins (Lantus, Levemir, and ProZinc) as data collection shows it is safe

180 - 280 mg/dL (10 - 15.6 mmol/L) {may be 210 - 310 mg/dL for an AlphaTrak}- Any time - The renal threshold (depending on data source and cat's renal function) where glucose spills into the urine.
- Test for ketones, glucose is too high.

>= 280 mg/dL (15.6 mmol/L) {may be >=310 mg/dL for an AlphaTrak}, if for most of the cycle between shots
- Uncontrolled diabetes and thus at risk for diabetic ketoacidosis and hepatic lipidosis
- Follow your insulin protocol for dose adjustments
- Test for ketones; if more than a trace level of ketones, go to vet ASAP.
 
Ok. Thanks all!

His PMPS was 285, so I gave the 10 units. Last night it was 290 and it didn't drop into a danger zone. I'll take a before bed reading in two hours, and then periodically check him throughout the night when I have to get up with my human baby anyway. Then I can give the vet a good 24-hour picture of what is going on.

Looks like we are on our way to much better numbers, and we're going to switch to even lower carb wet food tomorrow...fingers crossed!
 
I popped over to Lantus Tight Reg and posted to ask if one goes for the same level of control with a high dose kitty. With some luck, we'll get a few responses here.

If the answer is yes, then the reference levels I posted above apply.
 
Great! Thank you so much.

We're thinking the high dose is directly linked to the dry "diabetic" food we have been giving him since his initial diagnosis back in April. Since we never introduced wet food (vet said since he wouldn't eat it to not worry), we don't think the Prozinc ever had any chance of success, especially because his numbers initially after diagnosis were much better than they have been since July. It's been a steady increase of insulin since then and the switch from Prozinc to Lantus.

On Sunday we took up his dry food because I got tired of seeing HI readings and figured something had to give! That's where you've seen the great decrease in his numbers since then.

I appreciate everyone's help!!!
 
cobbsmom said:
we're going to switch to even lower carb wet food tomorrow...fingers crossed!

What is the carb % of the wet food he's getting now? Please be SUPER vigilant with the change. There's a cat in the Lantus TR group right now who is very overweight and was free-feeding dry until he was adopted by someone here. He was on 11 units of insulin. Now that his diet has been changed he is down to only 0.5 unit!! That's MommaofMuse's Casey, if you want to take a look at his condos.

And that need to step down in dose happened very quickly. So if it is just your kitty's previous diet rather than another medical condition that is contributing to these high numbers, changing it could have a very dramatic effect.
 
We got a variety 5.5oz cans from the vet...some Hill's wet food, and then 3oz cans of Royal Canin diabetic. 5.5oz at 8am and 8pm, 3oz at 3:30am and 3:30pm.

Using the "calculating carb" post above, it looks like the Royal Canin wet diabetic has 4.5% carbs. No Ash is listed on the can.

It says:
Crude Protein - 9% MIN
Crude Fat - 1.5% MIN
Crude Fiber - 2.0% MAX
Moisture - 83% MAX

If I read the above post correctly, I subtract all of those amounts from 100%, correct?

Right now he is eating 2 of the RC wet a day, and 2 bigger cans. We're getting new food tomorrow.

The vet said eventually he should be eating 1/2 of a large can twice a day - but he seems to be starving on what we're feeding him now! He GOBBLES the food down so there's no "free-feeding" throughout the day. I assume that's due to the diabetes??
 
Most of the Hills foods are pretty high carb, and looking at our chart, the RC foods that are listed (there isn't one specifically called "Diabetic" are too high too. You don't need to pay a lot of money for fancy "prescription" foods....Here's our Food Chart that lists pretty much any food you can buy. It's important to stay under 10% carbs (Column C)

Friskies pate's, Fancy Feast Classics and Wellness are cheaper foods and low carb too!

Until his blood glucose is under better control, he'll eat a lot more than a "normal" cat because his body can't convert the food to provide the nutrition without enough insulin. China was easily eating twice as much as she is now, and was still losing a lot of weight.

At such a high dose, it's important to gradually reduce the carb percentage and test often. As you've already heard, lots of times just the diet change can make a big difference and we want to keep him safe. Now that you're off the dry and working on reducing carbs in his food, I'll bet he'll start coming down the dose ladder.
 
Hi Suzanne - I popped over to answer BJM's question about level of control for high dose kitties. And the answer is, it depends why the kitty is at a high dose. Some kitties are on the wrong food, and we get that fixed first. The other things we look for besides the appropriate diet, are signs of any infection or need for a dental. Those can also boost numbers. If Tommy had blood work and an exam when he was diagnosed, those causes should have been identified. And some cats are overdose - getting those nadir checks are very important. And lastly, there are medical conditions that an mean a cat needs a high dose.

My Neko has acromegaly, one of the high dose medical conditions, which is a benign tumor on the pituitary that sends out excess growth hormones and causes her diabetes. At one point we were up to 8.75 units eating low carb raw food. I followed the Lantus TR protocol all the way up. There are other high dose acrocats on the TR forum - one got up to 26 units, and we've all been following the protocol there.

There is some debate over the level of control one tries to get over the numbers, if the cat has acromegaly. Some people are happy to try to get the cat to spend the majority of time with numbers under renal threshold, which varies by cat but is roughly in the low 200's. I try to get Neko into slightly lower numbers, but that's because that's where she feels good and she doesn't bounce as much if I do. Acrocats have a working pancreas, so I'm not trying to heal it the same way as a cat with regular diabetes. I gave you information on getting the blood test for acromegaly in your first post. If you don't see any improvement once you've switched to low carb food and nadir checks are still showing high numbers, I'd recommend getting those tests done. There are some other effects of the growth hormones to be aware of - especially as it relates to the heart. It is treatable, but you have to know to look for it.

Cats with IAA you definitely want to get tighter control, because it's spending time in the good numbers which will help defeat it.
 
Hi Suzanne,

Just looked at Cobb's SS and think those red numbers could be a bounce from the blue number.
It may be that the blue number was a tad too low for Cobb's current comfort levels and his liver responded to that. It looks like the subsequent insulin dose managed to bring the high numbers down at the peak of the cycle (peak of the insulin's effectiveness), but then the numbers rose again after that.

Don't be discouraged. Some cats can get used to higher blood glucose levels and need to 're-learn' what is 'normal'.

Eliz
 
Elizabeth and Bertie said:
Just looked at Cobb's SS and think those red numbers could be a bounce from the blue number.

Eliz

So would you say to stick with the current dosage and see how today's numbers are? I did send info out to the vet this morning, and am waiting to hear back from her.
 
Although I can't say for sure what Elizabeth was thinking, I'd say yes, she would recommend staying at the current dose.

IF it's a bounce off the 170 on 11/28, then it can take up to 72 hours for the bounce to clear and to start seeing "real" numbers again.
 
Hi Suzanne,

I don't use the same insulin as you but it looks to me like Cobb has dropped steadily on that 10 unit dose (following his change to the lower carb food) and so if it were my cat I would continue for the moment. But do see what others say, and other Lantus users particularly.

It will probably be the case that Cobb gets used to the lower numbers and ceases to bounce (if that is indeed what happened). Sometimes that can happen quite quickly.

Eliz
 
Sorry to have to say this but you can't use the % on the can to work out the % of calories from carbs as fed. Cans numbers are just maximums and minimums. A min of 9% protein means the can could have anything from 9%-75% fat for example! You can't do an accurate calculation from that. The only way to find out is to contact the manufacturer and ask specifically for " % of calories from carbs as fed".

They may not provide it... As such many of us use the lists from Dr Pierson (food chart chris and china provided) as she worked with the food companies to get the correct amount.

Wendy
 
fancy feast classic pates and friskies pates are usually the cheapest. Wellness is a little more expensive but better quality I think
 
I would continue with the 10 and go higher if the relatively high BG continues. However, I would not increase when changing to the lower carb food. In fact you may have to reduce the dose.

My MurrFee is currently on about 11 units Levemir twice daily. He was on Lantus before but I could not get consistent BGs and the same and even higher does. Sometimes I reduce the dose a little like on the 27th when his PMPS was 73. I only gave him 10 and that was a mistake since the next morning PS was 216. His PS is typically about 140 PM and 160 AM.
 
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