Help please Jack is at 77 BG

Nicole and Jack

Nicole and Jack

Member Since 2022
Last edited:
Meanwhile Nicole, here is what the SGLS method says on the sticky

"How to handle a lower than normal preshot number:

Until you collect enough data to know how your cat will react, we suggest following the guidelines in the FDMB's FAQ Q4.4:
Q4.4. My cat's pre-shot level was way below the usual value. Should I give the injection?
A4.4. There's no hard and fast rule, but if you don't have data on how your cat responds to insulin, here are some general guidelines.
Below 150 mg/dl (8.3 mmol/L), don't give insulin.
Between 150 and 200 (8.3-11.1 mmol/L), you have three options:
a.) give nothing
b.) give a token dose (10-25% of the usual dose)
c.) feed as usual, test in a couple of hours, and make a decision based on that value
Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise.
In all cases, if you are reducing or eliminating insulin, it's wise to check for ketones in the urine.
Above the normal pre-shot value, give the usual dose, but if the pre-shot value is consistently elevated, it's a good idea to schedule a full glucose curve to see whether a change in dose or insulin is appropriate. In most cases, the target "peak" value should not be below 100 mg/dl (5.6 mmol/L), and for some cats it might be higher.
Keep in mind these are general guidelines, and they should be personalized to your own cat's response to insulin. If your experience is that your cat does not became hypoglycemic with a dose which is close to her usual, then personal experience should be your guide."
 
Hi Nicole, I see that Jack's dose has been increased from 1U to 3U very quickly and with very few mid-cycle test to see how low he is going. Without enough tests to see how low a dose is taking him, too much insulin can actually look like too little insulin! He is probably on too high a dose (given that he dropped to 131 on Day 3 of Lantus at 1U) and the higher numbers you are seeing are his body's response to dropping very low on insulin.

Have you fed him this morning? Can you get some tests if you give him insulin? How long after the 68 was the 77 and was it after food?

3U might be too high a dose for him, but it's anybody's guess what is a good dose for him. With so little data I am inclined to suggest either a skip or a token dose of 1U. Does he have any history of ketones?
 
Im not sure if you are doing SGLS but you will have to decide that soon.
According ro this, you may be skipping. Jack went from 700's to 60's...is that correct??
 
I have not fed him this morning. I have been stalling. Yes Jack when from 700s to 60s currently (I think his shot before he was most recently in the 700s was a fur shot, hence the high number). I just tested at 8am and he was 114.

77 was 20 minutes after the 68. The 114 was 25 minutes after the 77.


Bandit's Mom said:
Hi Nicole, I see that Jack's dose has been increased from 1U to 3U very quickly and with very few mid-cycle test to see how low he is going. Without enough tests to see how low a dose is taking him, too much insulin can actually look like too little insulin! He is probably on too high a dose (given that he dropped to 131 on Day 3 of Lantus at 1U) and the higher numbers you are seeing are his body's response to dropping very low on insulin.

Have you fed him this morning? Can you get some tests if you give him insulin? How long after the 68 was the 77 and was it after food?

3U might be too high a dose for him, but it's anybody's guess what is a good dose for him. With so little data I am inclined to suggest either a skip or a token dose of 1U. Does he have any history of ketones?
Click to expand...
 
Nicole Nicolaus said:
I have not fed him this morning. I have been stalling. Yes Jack when from 700s to 60s currently (I think his shot before he was most recently in the 700s was a fur shot, hence the high number). I just tested at 8am and he was 114.

77 was 20 minutes after the 68. The 114 was 25 minutes after the 77.
Click to expand...
I see from your FB post that he had ketones on diagnosis and that you can monitor if you shoot. A skip is therefore not advisable and he is rising without food. I would suggest a token dose of 1U.

ETA: Do not fill him up with the shot. You want him to be hungry enough to eat every hour, if necessary.
 
I would also strongly suggest that you get some mid-cycle tests every day to see how low he is going on a dose. Like I said earlier, too much insulin can look like too little insulin when you don't have enough data to know how low a dose is taking him. What happens when the dose is too high is the cat's body fights to stay alive. The insulin may be trying to drive the blood glucose down too low and the pancreas will release stored hormones and sugars to bring it back up fast so too much insulin can actually look like it's not enough! We call this reaction to lower numbers "bouncing".

"Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles)."

We like to suggest getting a +2 (a test 2 hours after the shot), because it can act a lot like a crystal ball in what the rest of the cycle is going to look like.
  • If the +2 is about the same as the PS, it's usually going to be a pretty normal cycle....gradually down to nadir and then gradually back up to the next PS.
  • If the +2 is a lot higher than the PS, that usually means there's a bounce starting and it's usually OK to take a little bit of a break on testing.
  • If the +2 is lower than the PS, that's your "early warning" that it could be an "active" cycle and numbers might go a lot lower later in the cycle and it's important to try to get more tests.
Weekly curves do not always give you an accurate idea of how a cat is doing on a dose. If he is bouncing on the day you do the curve, you will get flat high numbers which does not mean that the insulin is not enough. That is why we like to suggest as many "spot checks" as possible in addition to a curve.
 
Thank you to everyone for the help!

For this evening, since the 3U appears to be too high, should I lower his dose (depending on BG) to 2.25?


Bandit's Mom said:
I would also strongly suggest that you get some mid-cycle tests every day to see how low he is going on a dose. Like I said earlier, too much insulin can look like too little insulin when you don't have enough data to know how low a dose is taking him. What happens when the dose is too high is the cat's body fights to stay alive. The insulin may be trying to drive the blood glucose down too low and the pancreas will release stored hormones and sugars to bring it back up fast so too much insulin can actually look like it's not enough! We call this reaction to lower numbers "bouncing".

"Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles)."

We like to suggest getting a +2 (a test 2 hours after the shot), because it can act a lot like a crystal ball in what the rest of the cycle is going to look like.
  • If the +2 is about the same as the PS, it's usually going to be a pretty normal cycle....gradually down to nadir and then gradually back up to the next PS.
  • If the +2 is a lot higher than the PS, that usually means there's a bounce starting and it's usually OK to take a little bit of a break on testing.
  • If the +2 is lower than the PS, that's your "early warning" that it could be an "active" cycle and numbers might go a lot lower later in the cycle and it's important to try to get more tests.
Weekly curves do not always give you an accurate idea of how a cat is doing on a dose. If he is bouncing on the day you do the curve, you will get flat high numbers which does not mean that the insulin is not enough. That is why we like to suggest as many "spot checks" as possible in addition to a curve.
Click to expand...
 
Nicole Nicolaus said:
For this evening, since the 3U appears to be too high, should I lower his dose (depending on BG) to 2.25?
Click to expand...
I would go back down to 2U or 2.5U and get some mid-cycle tests for the next 3-4 days to see how low he is going. Don't hold the dose too long unless the numbers are where you want them to be. He will bounce from here and might stay high for as long as 3 days (bounces take up to 3 days to clear).

If you will post here we can help with dosing advice. :)

ETA:
Why is he on a kidney diet? What stage of CKD is he at? The only time a cat might need K/D is when they're in stage 4 or end stage CKD. Otherwise, you want to feed foods that are both low carb (for the diabetes) and low phosphorus (for the CKD). It used to be thought that a low protein diet is beneficial for cats with kidney disease but newer research shows that it's much more important to restrict phosphorus. That restricting protein at low levels of CKD just leads to muscle wasting. Look for foods with carbs under 10% and the dry matter for phosphorus under 250mg. Treating the diabetes will in turn help the kidney disease by reducing the strain on the kidneys that diabetes causes.
 
I hope you will set up a signature and spreadsheet so we can help you. We are very data oriented here.
 
I started switching Jack to half low carb/low phosphorus canned food August 13. He really likes the Weruva Truluxe glam and punk. He will also eat weruva steak frites and soulistic moist and tender chicken cans. The other half of his diet is science diet k/d tuna and chicken and vegetable, in addition to royal canin renal support D and T cans. I also ordered some BFF play chicken & turkey topsy turvy canned food to try with him.

As of February, he was stage 1 CKD. But when he was hospitalized 7/29/22 his creatinine was 4 and the emergency vet was concerned that his kidneys were failing. On 10/16/21 his creatinine was 1.4 and then on 12/11/21 it was 2.5. Once Jack left the hospital, his creatinine was 2.7.
 
Thanks Nicole for the update on food. You might want to put some notes in the Remarks column of the spreadsheet for August 13th, showing that you were switching to half low carb food. It would also be helpful if you put this morning's numbers on the spreadsheet. We are very data oriented here.

It looks like you switched to a lower carb diet on the 13th, the day after Jack gave you a 131 in the AM of the 12th. Lower carb diet probably means he needs less insulin, not more. If you do that token 1.0 dose today as Bhooma suggested, it would be interesting to get some more data on him.

With some high carb food in the diet, it means you have to follow the Start Low Go Slow method with Jack. That means no shots if he's under 90. Stalling like you did today was a good option. And anything under 90 means his dose needs to be reduced.
 
Nicole Nicolaus said:
I started switching Jack to half low carb/low phosphorus canned food August 13. He really likes the Weruva Truluxe glam and punk. He will also eat weruva steak frites and soulistic moist and tender chicken cans. The other half of his diet is science diet k/d tuna and chicken and vegetable, in addition to royal canin renal support D and T cans. I also ordered some BFF play chicken & turkey topsy turvy canned food to try with him.

As of February, he was stage 1 CKD. But when he was hospitalized 7/29/22 his creatinine was 4 and the emergency vet was concerned that his kidneys were failing. On 10/16/21 his creatinine was 1.4 and then on 12/11/21 it was 2.5. Once Jack left the hospital, his creatinine was 2.7.
Click to expand...
Tap on this post , there are a lot of weruva pates listed her in post # 18
https://felinediabetes.com/FDMB/thr...0-5-5-320-pmps-530-4-209.267718/#post-2994667
 
Thanks Wendy. I added the comment on his food to my spreadsheet. I also updated his spreadsheet and added it to my signature. As seems typical for him, he has lower numbers in the morning (this morning very low) and throughout the day his BG rises from eating high carb food. How does that affect the dose to give him tonight and after today? Is the idea that a lower dose (2.5U) would build up over time and keep him stable without the extreme highs and lows?



Wendy&Neko said:
Thanks Nicole for the update on food. You might want to put some notes in the Remarks column of the spreadsheet for August 13th, showing that you were switching to half low carb food. It would also be helpful if you put this morning's numbers on the spreadsheet. We are very data oriented here.

It looks like you switched to a lower carb diet on the 13th, the day after Jack gave you a 131 in the AM of the 12th. Lower carb diet probably means he needs less insulin, not more. If you do that token 1.0 dose today as Bhooma suggested, it would be interesting to get some more data on him.

With some high carb food in the diet, it means you have to follow the Start Low Go Slow method with Jack. That means no shots if he's under 90. Stalling like you did today was a good option. And anything under 90 means his dose needs to be reduced.
Click to expand...
 
Thanks for doing the updates on the SS and signature. Did you give insulin last night? The units cell is empty for PMPS.

Is it possible at all for you to get tests at night after PMPS? People circumstances, timing, and life style differs so just asking. Many cats go lower at night and we determine how to change doses based on how low the dose is taking the cat. Getting a before bed test if it's at least 2 hours after PMPS can be very helpful. I expect what's happening is Jack is going lower at night, perhaps even lower than what you are seeing at AMPS, then he's bouncing during the day. Not sure high carb food is the main reason you are seeing him go higher during the day. I've seen many cats with preshots above 500 at PS time, drop down really low during the day (or night) then bounce back to over 400/500 at the end of the cycle. That's why we really try to get people to get mid cycle tests if they can. Or at least +2 tests, which on Lantus can give clues as to what is happening during the cycle.

I'm hoping a lower dose would reduce the amount of bouncing and extreme high numbers. I also worry that, like last night, he might be going into hypo range at the 3 units dose. Not even sure if 2.5 units will be too much insulin, but it's a start. Do you have syringes with 1/2 unit markings on them?
 
Thank you for all your help Wendy!

I can do another test when I go to bed and test him first thing when I wake up. I hope that will help she’d some light with what is going on. I work from home luckily. I can continue with the mid cycle tests tomorrow.

I do have the U100 syringes with half unit markings! I have 3 different U100 syringes so I should be covered for every possibility.


Wendy&Neko said:
Thanks for doing the updates on the SS and signature. Did you give insulin last night? The units cell is empty for PMPS.

Is it possible at all for you to get tests at night after PMPS? People circumstances, timing, and life style differs so just asking. Many cats go lower at night and we determine how to change doses based on how low the dose is taking the cat. Getting a before bed test if it's at least 2 hours after PMPS can be very helpful. I expect what's happening is Jack is going lower at night, perhaps even lower than what you are seeing at AMPS, then he's bouncing during the day. Not sure high carb food is the main reason you are seeing him go higher during the day. I've seen many cats with preshots above 500 at PS time, drop down really low during the day (or night) then bounce back to over 400/500 at the end of the cycle. That's why we really try to get people to get mid cycle tests if they can. Or at least +2 tests, which on Lantus can give clues as to what is happening during the cycle.

I'm hoping a lower dose would reduce the amount of bouncing and extreme high numbers. I also worry that, like last night, he might be going into hypo range at the 3 units dose. Not even sure if 2.5 units will be too much insulin, but it's a start. Do you have syringes with 1/2 unit markings on them?
Click to expand...
 
Great, sounds like you are all set! :) Hopefully this little extra bit of testing will help us find a good dose for him quickly.
 
Hi Wendy,

I updated Jack’s spreadsheet with his test results from last night and this morning. I didn’t see a spot for it on the spreadsheet, but at 5:00am his result this morning was 567. I’m wondering if he is bouncing because his BG was so low yesterday? He seems better today and he is still eating well.

Thank you for your help!

Wendy&Neko said:
Great, sounds like you are all set! :) Hopefully this little extra bit of testing will help us find a good dose for him quickly.
Click to expand...
 
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Because this is a busy forum, we ask that people start a new post each day, with a link to the previous post.
POSTING GUIDELINES PLEASE READ

And yes, Jack is bouncing.
Nicole Nicolaus said:
I didn’t see a spot for it on the spreadsheet, but at 5:00am his result this morning was 567
Click to expand...
That 567 is put on the PM side of the spreadsheet, however many + hours after PMPS time it was. His numbers are going to wobble around the next few cycles due to that bounce.
 
Thank you Wendy! I’ll give it a few days and see how he does. Thank you for letting me know about starting a new thread. I will start a new thread with any additional issues with Jack.

Wendy&Neko said:
Because this is a busy forum, we ask that people start a new post each day, with a link to the previous post.
POSTING GUIDELINES PLEASE READ

And yes, Jack is bouncing.

That 567 is put on the PM side of the spreadsheet, however many + hours after PMPS time it was. His numbers are going to wobble around the next few cycles due to that bounce.
Click to expand...
 
@Nicole Nicolaus
Hi Nicole I think you should pick a dosing method and add it to your signature and spreadsheet so you know when an increase or decrease is needed

You don't have many test after AMPS and PMPS. Can you start getting some more tests in so we can see how the insulin is working and how low he's dropping . Most cats usually drop lower at night and we only adjust the dose by 0.25 units at a time

https://www.felinediabetes.com/FDMB...-low-go-slow-slgs-tight-regulation-tr.210110/
 
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When you start a new thread you would put the
Date Jack then his AMPS and any additional test after that and you can continue with the PMPS numbers
If you don't know how to add the additional texts to the right you will see Thread Tools, tap on that then tap on Edit Thread and add those tests and tap save
You always need to link your previous days post to the new one
@Nicole Nicolaus
 
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