Fear of Hypoglycemia (again)...to give insulin or to not give insulin?

[Moose (GA) & Rae]

Hello all! I'm going to try to compose my thoughts as best that I can...so forgive me if I'm all over the place.

Last week, my sweet Moose showed signs of hypoglycemia. He was walking in circles, bumping into things, etc. I checked his blood sugar and it was very low (47 mg/dl). I gave him some honey, and his numbers started to increase but I was still worried. I called my regular vet, who advised that I rush him to the emergency vet.

Long story short, he is fine (thank goodness!) The emergency vet advised that I decrease his insulin from 2 1/2 units twice a day to 2 units twice a day.

I have been diligently checking his blood sugar every time before I administer the insulin...but am a bit confused/scared whether or not I should give him insulin depending on his numbers. I ran a full curve this past Saturday (and will be running another full curve this coming Saturday) and his nadir was 65 mg/dl...still very low.

I called my vet and she advised that if his blood sugar is 120 - 150, do not give insulin. If it's > 150 but < 200, give half of a dose (1 unit). If it's > 200, give the full dose (2 units). Does that sound like a good rule of thumb? I read the FAQ here and the rule of thumb was the same. I'm just so scared to give him his insulin, go to work, and then come home to...well...I don't even want to say. More times than not, I have been skipping the insulin altogether if his blood sugar is < 250.

I just downloaded the spreadsheet for tracking his blood sugar and will be filling it out tonight and posting it. For now, here is his most recent curve:

Saturday, 1/22
8:43am (pre-shot): 329 mg/dl
9:00am - Gave 2 units of insulin
11:58am - 212 mg/dl
2:01pm - 98 mg/dl
4:01pm - 65 mg/dl
6:09pm - 90 mg/dl
7:57pm - 157 mg/dl

Lately though (in the past week) his pre shot levels have been between 230 - 280, so not quite as high as they were on Saturday.

Edit: I want to note that he was diagnosed in 2011, was on 1 unit of insulin (Lantus) twice a day until he went into remission in 2015...in 2016 his diabetes "returned" and the new vet started him off at 2 1/2 units twice a day of Glargine.

 

[Nan & Amber (GA)]

Wow, how scary!!!!

So glad you are hometesting, and that Moose was OK after that episode.

What kind of insulin do you use? That's a pretty good response you are getting right now, but where you go from here will depend in part on the insulin.

 

[Tracey&Jones (GA)]

I think you are on Lantus right?

The lantus depot does not work well with constant changes in dosing. The guidelines for not shooting below 150 are far new CG getting used to testing and recording numbers. Once ready, you would start to shoot lower numbers and letting Moose earn his reductions. Members here would stay with you and guide your through that until you are comfortable.

Have you had a chance to review the TR protocol or the SLGS approach for using Lantus? Each has their own method of increasing and decreasing the dosage. It is methodical to keep kitty safe and help with getting a right consistent dose.

 

[Moose (GA) & Rae]

Wow, how scary!!!!

So glad you are hometesting, and that Moose was OK after that episode.

What kind of insulin do you use? That's a pretty good response you are getting right now, but where you go from here will depend in part on the insulin.

Hi there!

I use Glargine Insulin.

 

[Moose (GA) & Rae]

I think you are on Lantus right?

The lantus depot does not work well with constant changes in dosing. The guidelines for not shooting below 150 are far new CG getting used to testing and recording numbers. Once ready, you would start to shoot lower numbers and letting Moose earn is reductions. Members here would stay with you and guide your through that until you are comfortable.

Have you had a chance to review the TR protocol or the SLGS approach for using Lantus? Each has their own method of increasing and decreasing the dosage. It is methodically to keep kitty safe and help with getting a right consistent dose.

Yes, well Glargine but same thing!

Oh goodness, I was not aware of that. I am going to read the protocal and SLGS approach now. I feel so guilty that I have been so uninformed up until this point I have been doing my best to inform myself. There is so much information!

 

[Nan & Amber (GA)]

You're doing great! There really is a huge amount of information here.

Lantus is a great insulin for cats, but as Tracy says, it works best when you can find a dose that can be safely used twice a day, consistently. I'm glad your vet had you reduce the dose after the hypo, it's exactly the right thing to do then, but changing the dose based on the pre-shot is really more appropriate for a fast-acting insulin like Vetsulin. With a depot insulin like Lantus, you want to change doses gradually (not day-to-day ups and downs) based on the nadir (lowest point), not the pre-shot. The spreadsheet is really helpful here, because it gives you a quick way to look at patterns over days and see where the nadir is falling and how low it goes.

 

[Tracey&Jones (GA)]

I have been so uninformed

It happens to all of us and unfortunately the veterinary world is not that up on feline diabetes and the different insulin.

Once you are ready to choose and have your spreadsheet up and ready...put a post over into the Lantus forum. Large forum with plenty of helpful members to assist with getting a good dose for Moose.

 

[Moose (GA) & Rae]

You're doing great! There really is a huge amount of information here.

Lantus is a great insulin for cats, but as Tracy says, it works best when you can find a dose that can be safely used twice a day, consistently. I'm glad your vet had you reduce the dose after the hypo, it's exactly the right thing to do then, but changing the dose based on the pre-shot is really more appropriate for a fast-acting insulin like Vetsulin. With a depot insulin like Lantus, you want to change doses gradually (not day-to-day ups and downs) based on the nadir (lowest point), not the pre-shot. The spreadsheet is really helpful here, because it gives you a quick way to look at patterns over days and see where the nadir is falling and how low it goes.

Thank you so much! I will definitely be doing the SLGS method as my schedule does not allow for the TR protocol. I really do appreciate bringing my attention to it. I have been on this message board a few times before and was trying to take in a much useful information as possible, but obviously missed a few things (or wasn't really sure what I was looking at.) I will stop changing doses day to day.

I relied a little too heavily on my vet to give me the right answers as I would always report the glucose curve to her... I'm excited to have the information where I can interpret and adjust the insulin myself without waiting for her to call back (however long that may take.)

She had also advised that I do a glucose curve every few weeks after I had switched him to a wet food diet (he was previously only on dry food as he could not handle wet food). After reading the information here, I realize that I absolutely should have been checking his blood sugar a lot more often after the switch and not every few weeks!

 

[Moose (GA) & Rae]

It happens to all of us and unfortunately the veterinary world is not that up on feline diabetes and the different insulin.

Once you are ready to chose and have your spreadsheet up and ready...put a post over into the Lantus forum. Large forum with plenty of helpful members to assist with getting a good dose for Moose.

My eyes have definitely been opened to that...I really counted on my vet and while I know she did not purposefully give me wrong information...it's still disheartening.

Thank you, I absolutely will! Thank you for your advice and support.