First day of treating Hugo's diabetes

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Tiina and Hugo

Tiina and Hugo

Member Since 2016
So my cat Hugo is newly diagnosed, on Friday 5th Feb, and tonight two hours ago I attempted the first Lantus shot with two units. But I'm not sure if the insulin actually made it into his system. His fur smelled of insulin afterwards. His reading was 19.4 before I gave him the shot. He ate only a bit of wet food and has eaten a few freeze dried chicken bits after that. He was at the vet today and his blood glucose was 20 there. When he was diagnosed it was 24.2. I changed his diet "cold turkey" after the diagnosis, from high carb to a low one. He used to love his dry food and gravy wet foods. He also always got high carb treats as an reward after he got his inhaled asthma medication with the Aerokat chamber, but now I only give him the freeze dried Cosma Snackies. Should I set an alarm to check his blood glucose during the night? At what time would it be best? The vet told me to continue giving him wet food that is a bit higher in carbs for a week, do you think that's okay? Shouldn't I just stick to using the low carb foods I started on Friday? And how do I make sure the insulin actually goes under the skin and not to the fur...:/ Thank you.
 
Oh and we are in Finland, and I gave him the insulin at 9pm and now it's 11.22 pm. What time should I measure the BG again?
 
Onset can be anywhere from 1-4 hours.

Almost forgot to say Welcome! :)

How much does Hugo weigh? We recommend a starting dose for Lantus of .25u/kg
 
Thank you! I'm glad this forum exists. Feel more than a little alone with this. Hugo weighs about 4,6 kg, he is 8-years-old and very tall and slim Oriental Shorthair.
 
Tiina and Hugo said:
Why already now?
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We often use a reading at +2 to give us an idea of whether or not the Lantus cycle is likely to be active. Of course as this is Hugo's first shot, you won't have enough data to know that yet, but getting into the habit of getting a test at 2 hours after your shot time will definitely help you in the future to know how often you're likely to have to test on any particular cycle. If Hugo conforms to the most usual pattern, you'll find that if his +2 number is higher than his pre-shot number, it's likely to be a fairly quiet cycle. If it's close to the same as his pre-shot number it will probably be an active cycle. And if it's significantly lower, then it's likely to be a very active cycle where you will probably have to test more frequently. Starting to gather that information early will really help you as time goes on. :)
 
Can we get you to start using our spreadsheet to track blood glucose readings? It's a valuable tool for the members here to help you pick out patterns in Hugo's sugar.

Some reading to get you started:

LANTUS & LEVEMIR - THE BASICS: NEW TO THE GROUP? START HERE!
LANTUS & LEVEMIR - SYRINGE & INSULIN INFO: HANDLING, DRAWING, & FINE DOSES
LANTUS & LEVEMIR - WHAT IS THE INSULIN DEPOT?

These three pages cover the basics of what you will need to know to successfully treat your cat with Lantus. They're the first three "stickies" at the top of the Lantus/Levemir Group. Also in the stickies are the two "methods" of using Lantus, the "Start Low, Go Slow Method" and the "Tight Regulation Protocol". Take a look at them, see what you think, and please come join us in Lantus&Levemir Land. Welcome to the best place you never wanted to be:)
 
Tiina and Hugo said:
Thank you! I'm glad this forum exists. Feel more than a little alone with this. Hugo weighs about 4,6 kg, he is 8-years-old and very tall and slim Oriental Shorthair.
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You're not alone at all! There are so many wonderful people here to help you and pick you up when you're feeling down, or just need to vent your frustrations.
 
Andy & Pimp said:
Can we get you to start using our spreadsheet to track blood glucose readings? It's a valuable tool for the members here to help you pick out patterns in Hugo's sugar.
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That looks a bit intimidating, but I could definately try making one. :) Thank you for the tip. I'm really really new with everything about diabetes, though my mom has had it for 20 years, but now trying to understand and accept everything that is happening to Hugo feels overwhelming.
 
Tiina and Hugo said:
That looks a bit intimidating, but I could definately try making one. :) Thank you for the tip. I'm really really new with everything about diabetes, though my mom has had it for 20 years, but now trying to understand and accept everything that is happening to Hugo feels overwhelming.
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Regarding the spreadsheet, its actually quite simple though looks daunting. All the instructions should be easy to follow, and someone can help you if you get stuck with it. Once you have it set up all you have to do is enter your BG readings:)

Feline Diabetes is an unusual beast- the kittie's pancreas is capable of healing while a human's is generally not, which makes treatment an ongoing dance. I'm glad you made it here so we can teach you the steps;)
 
We just gave Hugo's morning insulin 3 hours ago, BG was 19 then and now is 3.2! I double checked. What now? I gave high carb food and some treats, is it enough?
 
How long since you checked? You need to check him again 15-30 minutes after he ate the HC food. No longer. Post the number here when you get it.
 
I had to do the conversion after I posted...possible hypo gets first priority and I'm not used to world units. 3.2mmol=58mg/dl. He's not at a dangerous level right now, but you need to make sure he doesn't continue to go lower. In the Lantus group we feed HC food when they go under 50.

Edit to add: since you gave him crunchy treats he's probably fine for the rest of the cycle.
 
What type of meter are you using a human meter or a pet specific meter. That is a HUGE drop in only 3 hours. As Andy said you need to continue testing. At this point you do not have much data as to how Hugo is going to react to the insulin and when the full effect of the Lantus will take place. The nadir...or lowest point...with Lantus can be between 4-7 hours depending on your kitty, so you want to continue testing. It is good to have syrup on hand...karo, maple syrup, honey etc.. IF Hugo should go too low using syrup or a high carb food, such as Friskies with gravy can help bring the numbers up faster than hard food. Please repost your next test.

You are not in a worrisome place right now, but you do need to continue testing. The information will be very useful as well for the future.

With a big drop like that it is likely that Hugo's numbers will go up much higher later. This is normal and is called "bouncing". Don't worry if that happens either.
 
Okay. He hasn't been eating his low carb foods that well but I was shocked that it was so low. Isn't this dose too big for him? If it drops from 19 to 3.2 in 3 hours.
 
I use a human meter called Care Sens but have ordered a pet meter called Wellion Vet Gluco Calea. It's a new one in my country and the vet said it will be more accurate.
 
Tiina and Hugo said:
Okay. He hasn't been eating his low carb foods that well but I was shocked that it was so low. Isn't this dose too big for him? If it drops from 19 to 3.2 in 3 hours.
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For just starting insulin this is a big drop. It could be that the dose may need to be changed, but you need to document the information. If he is eating a higher carb food on a regular basis that could be part of what has been giving him higher numbers. However you don't want to change his normal food until you see how the insulin affects him

OK..you are using a human meter right now. That is good to know.

Do not panic ...you are home testing and that is the most important thing right now,
 
Tiina please post your newest test result. I use the mmol/L numbering system so I can follow just fine
 
Now BG is 4.4. What if I overdid it with the treats? Is he safe now? Sorry to be pestering you with questions :( thanks for helping me Andy. Everything just so new to me and I don't know how much food and treats to give when needed.
 
Tiina and Hugo said:
Now BG is 4.4. What if I overdid it with the treats? Is he safe now? Sorry to be pestering you with questions :( thanks for helping me Andy. Everything just so new to me and I don't know how much food and treats to give when needed.
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That is good...it means he is not dropping any more right now. You could give him a Tbsp of his low carb food and retest again in about 20-30 minutes. Hugo is definitely responding to the Lantus so the more information you have on his responses the better prepared you will be for any dose changes.

Please retest and post his numbers again in 20-30 minutes. Hugo is at safe numbers so do not panic. It is just a big drop for the first shot and may need to be adjusted in the future when you have more information.

You are doing great!! :bighug:
 
You're welcome. You did the right thing posting for help.

Please continue testing until you know he's either flat or going up without eating for 2 hours. If that's before +8 I would continue to test every 2 hours if he's not gone to the moon yet (see bounce below). Nadir on Lantus can be anywhere from +2 to +12.

I highly recommend getting a spreadsheet set up and reducing to a proper starting dose of 1 unit for the next shot. That is assuming that he's high enough to shoot. He will probably bounce.
Please go back and read my earlier post Hopefully we'll see you in Lantus Land.

6am, yay. I'm off to bed. Thanks for popping in Mary Ann:)
 
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As Andy said you need to continue testing. Even though his numbers have gone up a bit, that could be from the food. Since this is all new to Hugo you don't know when his nadir (lowest number of the cycle) will be.

As mentioned it would be a good idea to post the information you get on the Lantus/Levemir forum:

http://www.felinediabetes.com/FDMB/forums/lantus-glargine-levemir-detemir.9/

There are many long term, experienced members that can give you some advise as to what dose would be best for Hugo, since 2 units is bringing him down very fast.
 
Tiina

Using a human meter you want to keep Hugo above 2.8 mmol/l (50 mg/l US numbers) . Hugo will most likely have much higher numbers later today because of the big drop but no worry about that..it is normal to bounce when there has been a big or fast drop.
 
I need to learn more about the terminology you use. I feel so stupid trying to understand what you are saying. Foreign language AND foreign terminology! o_O I tried to do the spreadsheet last night but got stuck not finding where to change to the numbers we use. Should I post to the Lantus group in the future? Hugo has not been eating high carb foods since Friday at all. Only those under 10% carbs and some raw. He doesn't like the low carb meals and only tastes his food.
 
This is all new to you and can be very overwhelming but you are doing great. The most important thing is that you are testing at home. Learning the ins and outs of treating diabetes is a new and frightening experience but you will get the hang of it. You are testing and you are posting for help so right now that is most important.

The spreadsheet is invaluable. I was lost with it as well and had to ask for help to get it started, but now I wouldn't do without it. One of the spreadsheets has the world numbers mmol/l which is what you are using (and myself) and it automatically converts to the US numbers on another tab, so you don't have to worry about learning a new system.

You should post on the Lantus group, since there are always more members on there. Just ask for help to get your spreadsheet started and ask for dosing advise. When you post there is an option in the title when you start your post with a drop down box to the left of the title, If you have a question you can choose the "?" icon and if there is an emergency you can choose the "911" icon. This will get attention much quicker.

Sorry if I am rambling with my responses but after only 4 hours of sleep I am still in a bit of a fog :)
 
Thank you so much Tuxedo Mom for your help.:bighug: All the numbers in the Lantus group message titles, I don't understand them yet. I bet you're all like :banghead: with my questions. I tested him now and 5.4. I think I'll be fine now, you go get some sleep. It's afternoon here and I'm glad to be able to stay home with Hugo. Should I continue testing now, next food then low carb after two hours? I forgot to mention, last night I tested his urine for ketones and the strip was faint pink. So only a little ketones.
 
Tiina and Hugo said:
Thank you so much Tuxedo Mom for your help.:bighug: All the numbers in the Lantus group message titles, I don't understand them yet. I bet you're all like :banghead: with my questions. I tested him now and 5.4. I think I'll be fine now, you go get some sleep. It's afternoon here and I'm glad to be able to stay home with Hugo. Should I continue testing now, next food then low carb after two hours? I forgot to mention, last night I tested his urine for ketones and the strip was faint pink. So only a little ketones.
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The numbers in the titles people are posting are in US measurement which is a different system than what you use. If you multiply your number by 18 it will give the US system equivalent. Or if you divide the US number by 18 it will give the numbers in the system you use.

NEVER feel bad about questions. It is a very steep learning curve when you first start treating a diabetic cat. I must have driven everyone here crazy with all my questions in the beginning. Just keep reading and asking questions and it will start to make more sense.

Hugo is holding his numbers fine right now, so you should be fine to wait another hour to retest. You do not need to give any more food at this time, unless his numbers drop again on the next test. When you get a chance post on the Lantus forum to get some help setting up your spreadsheet. This will be very helpful to aid in figuring out what dose Hugo should be on tight now.

Has Hugo ever been diagnosed with ketones before? I use the ketodiastix and sometimes it is hard to tell whether the strip has changed a bit pinkish or whether it is just from being wet. I used one to test myself to get a comparison. Trace of ketones are not a worry but if they go higher then it could mean a quick trip to the ER.

When you post on the Lantus forum start a new thread using the "?" icon and include a link to this posting (you can just copy the link from the browser bar) so that all the information is in one spot.

I actually just got up when you posted earlier so I am not going to bed, just trying to wake up :) Please continue to post if you need more help or informaton
 
Hi Tiina,
Gosh! Well done for catching that low number! :woot:

This must have been pretty stressful for you, but you're doing a truly fantastic job. (I see that you had some great folks helping you too. :) )

Eliz
 
At the vet on Friday 5th Feb when he was diagnosed, they took a urine sample from his bladder with a needle and checked for ketones. None were present at the time. Last night I smelled his breath and it smelled a bit like sweet and I had just bought the Ketostix so decided to test. With him peeing so much and for so long, I was able to run with a cup from the other side of the apartment to catch some of it until he was done. I waited for the 15 seconds like they told to do in the package and the strip was definately pinkish. I haven't checked today but his number was so low, so there can't be any right? If he had some in his system they clear on their own when the BG drops, or not? He's pretty spooked right now, just hiding. And until I finished that last sentence he got an astma attack and I had to drag him from his den to give him his inhalator. I also checked the BG and now it is 7.6.
 
OK Hugo's numbers are good and he should be fine now.

As far as ketones, they can occur at any time, usually when the glucose numbers are high, there is an infection and he is not eating. It is less likely to have them at lower numbers, but it is always a good idea to check on a regular basis. A trace is not a concern, but if it goes higher then would need to be seen by a vet quickly. The results on a ketodiastix show what was in his system and can change. It takes a while for ketones to show up in the urine.

If Hugo has asthma that can cause stress and raise his numbers as well. I am not familiar with the inhalers used for feline asthma, but some of the human ones have steroids in them, which can also cause the glucose levels to rise.

You say he is spooked...do you think that is from the testing?? Is his asthma brought on when he gets upset?? Other than that does he seem to be "normal"?
 
I think he is frightened of the constant poking and testing. I'm not sure why the asthma attack happened just now, but before he was diagnosed with the diabetes he was coughing daily. During the weekend it was better and no coughing. Maybe stress or dry air, in wintertime his asthma is worse. Hugo's astma medications are called Flixotide and Ventoline and he gets both twice a day. First he inhales the Ventoline that clear his lungs and opens the airways, then after ten minutes I give him the Flixotide that prevents the attacks. I think he seems normal...but very scared. I can check the ketones later today when he goes to his box, but right now he's just too scared to come out. Poor guy. This is so hard.

A question about the spreadsheet, I now use the human meter but today should arrive the pet meter. Which spreadsheet should I set up? I think I will sometimes use both meters, to compare results and because pet meter strips are expensive. Or should I use the human meter for this first week, then change to the new one? The Care Sens meter is my mum's old one.
 
The fluticasone may affect the levels of glucose in the blood, but if he needs to use it then do not stop. You should also notate on your spreadsheet that he is getting the fluticasone and the times of day he gets it.

If you are going to be using a pet specific meter as your usual testing meter, then there is a spreadsheet for pet meters with both world and US numbers. The only difference is the lower end number is higher than on a human meter, since pet meters tend to read higher than human meters. I use an AlphaTrak2 pet meter and the lowest you want your kitty to get using it as a reference is 3.8 mmol/l (68 US) although when first starting on insulin some people use 5 mmol/l (90 US) as a number to start giving higher carb food to keep the numbers up. This also depends on how early in the cycle lower numbers occur. If the low number comes at 2-4 hours after giving the shot, then it is more important to watch than if the low number comes at 6-8 hours after shot.

I am not familiar with the Wellion Vet Gluco Calea meter, but if it is pet specific then it should be fine. You could do a couple of comparisons using both the Wellion Vet Gluco Calea and the human meter on the same drop of blood so that you can see the difference in readings. As long as you use one type of meter all the time for your spreadsheet, and inform people if you are using a pet meter, then watching the trends in readings is more important. You could also put the readings you already have in the sheet and put a line with a notation that you have changed to a pet meter before you record results from the Wellion Vet Gluco Calea
 
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Also I am sure poor Hugo is totally confused as to what is happening, with Mom poking his ears and all. If you try to remain calm and set up a regular routine for testing...including his favourite low carb treat as a reward :)... hopefully he will not be as stressed as time goes along. My first few days of home testing were a nightmare for me and my Tuxie...he was squirming and howling and I was crying. Now he willingly walks to his test spot and lays down, since he knows he will get a treat afterward ;)
 
Wow that sounds amazing with your Tuxie! I hope Hugo will understand too that this is to help him, not to torture him. At least with the asthma medication, now going on for seventh year, he comes running when he hears the Aerokat chamber being taken out. He gets treats afterwards, and luckily he likes the freeze-dried ones. Will now try to master the spreadsheet, I think I will go with the pet meter one. Good to know that he should not get a lower reading than 3.8 mmol/l with the new meter. Thank you again for giving me advice :)
 
Tiina and Hugo said:
Wow that sounds amazing with your Tuxie! I hope Hugo will understand too that this is to help him, not to torture him. At least with the asthma medication, now going on for seventh year, he comes running when he hears the Aerokat chamber being taken out. He gets treats afterwards, and luckily he likes the freeze-dried ones. Will now try to master the spreadsheet, I think I will go with the pet meter one. Good to know that he should not get a lower reading than 3.8 mmol/l with the new meter. Thank you again for giving me advice :)
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See if Hugo has associated the inhaler with treats he will soon learn to do the same with the testing, I have a brighter light by Tuxie's testing area and if I turn it on he comes running....even if I don't plan on testing him. Kitties are VERY smart critters :)

I am totally useless at helping with spreadsheets so if you need help go to the Lantus forum and post a request for some help. There are some real spreadsheet wizards there. I will be away for a few hours but if you need any help or have more questions there are lots of helpful people on the Lantus forum and they can explain things better and more fully than I can.

I will check back later when I get home.

PS....I never did welcome you to the group :bighug: welcome to FDMB you are in the best place possible for help and information and YOU are doing a fantastic job for just starting treatment.
 
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