How low is too low BG pre-injection?

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Harley2023

Member Since 2023
Hi there,
My cat is newly diagnosed with diabetes...for the past week he's been on a combination of 2U lantus 2x daily 12 hours apart (max starting dose based on his size @17.4 lbs) and have been slowly trying to transition his diet to more wet based with still a little dry. He's a kibble junky and has been a grazer for most of his life so it's been challenging but we are slowly getting him to two meals a day at about 132 cals per meal (total 264 cals a day). We've tried so many types of wet foods as he is super picky but finally settled on Tiki cat grill pates or fancy feast classics, and I'm giving him a very small amount of Purina DM kibble (about 1 tablespoon worth) after he eats the wet food.
So I've been testing his blood glucose at home periodically. I usually test before giving him his injection. The numbers have slowly been coming down from his previous 24 mmol reading at the vet, to 10-15 mmol which is great. The other day though, his pre-injection one night was 10.3 mmol and I was nervous about giving him insulin when it's already closer to the normal range, so I didn't bother with the evening dosage. The next morning, I tested his glucose and it went back up to 22, so I resumed his insulin. My question is, how low is too low for a pre-injection reading? I'm super paranoid about hypoglycemia. Thanks!
 
I’m sorry I’m not familiar with pet meters so I really don’t know the range to tell you. Most of us here use human meters. On a human meter, we tell beginners to stall without food and retest 20 minutes later on anything less than 200. This is to see if the bg is going up on its own. But under 200 the choice is to give a token dose or skip, especially if you can’t monitor like overnight.

I do want to point out that starting at 2 units seems like too high a dose but tagging @Sienne and Gabby (GA) and @Bron and Sheba (GA) to weigh in as well.

lastly, just want to mention that you don’t need to feed twice a day only. Diabetic cats do better on smaller meals throughout the day. It’s easier on their pancreas and helps avoid big sugar spikes as well as slows down big drops.

it’s great that you’re home testing and transitioning away from the dry food. Lantus is also a great insulin for cats. The drop in bg can be a result of tampering off the dry food. If you would be willing to set up a spreadsheet, we’d be able to help you better.

With a diabetic cat you need
  • A low carb wet diet that is 10% carbs or under. Most of us use around 4-7% carbs
  • A suitable insulin such as Lantus or Prozinc which are long acting, more gentle insulins than the old insulins.
  • We recommend hometesting the blood glucose with a human meter…it is not necessary to use a pet meter which is expensive to run and is no better. It will keep your kitty safe and you will know how the dose is working for your kitty. Only testing every so often will not tell you what is happening in between those times and an awful lot can happen in even a day.
  • HELP US HELP YOU has information about the spreadsheet, signature and hypo box which you will need to be able to look after your beloved kitty properly
We are happy to help you with setting up the spreadsheet and much more. This is an excellent site for diabetic cats…it has been around for more than 25 years and has very experienced people to help you.

Keep asking lots of questions!
 
Welcome to FDMB!

It looks like Ale missed that you are using Lantus. It's a good insulin for treating feline diabetes. You may want to do a bit of reading. This is a link to the Lantus board. There are several sticky notes at the top of the board that you may want to familiarize yourself with.

It also sounds like you're outside of the US. (@Ale & Bobo & Minnie (GA) -- those are not necessarily numbers from a pet meter.) Most of us are in the US and the measurement on US meters is calibrated differently. We use mg/dL and outside of the US, the measurement is in mmol/L. You need to multiply your meter reading x18 to convert. The 10.3 mmol/L = 185 mg/dL and 22 mmol/L = 396 mg/dL. Once you have a spreadsheet set up, the World version of the template will automatically convert the numbers from your meter to US format on a separate page of the spreadsheet.

As for the dose, with Lantus, if you are following the Tight Regulation Protocol, the initial dose is based on weight. The 2.0u dose is fine based on the formula of initial dose = ideal weight in kilograms x 0.25. So, if your cat's current weight is close to his ideal weight, initial dose = (17.4 lbs = 7.9 kg) x 0.25 = approx 2). If you decide to follow the Start Low Go Slow method for dosing, the starting dose would be less. The snag is that with Tight Regulation, your cat cannot be eating dry food.

To answer your question about what's too low to shoot, the numbers will change over time. For someone who is new to managing their cat's diabetes, we typically suggest that if you get a pre-shot number that's below 200, you post and ask for help. In all honesty, 200 is perfectly safe to give a shot. In fact 150 is likely fine. However, without knowing how comfortable you are with home testing, if you'll be home to monitor and have the necessary supplies, and are comfortable/knowledgable about what to do if numbers drop, we suggest a greater margin for safety. The Health board is generally pretty busy so if you're worried, someone will be here to walk you through what to do and hang out with you to be certain your cat stays in safe numbers. Once you're more experienced, you'll be able to shoot progressively lower numbers.

You do not need to be feeding your cat only twice a day. We generally recommend that you give a good portion of your cat's food at shot time and then spread out the rest of the food over the first several hours of each cycle. The DM kibble is particularly high in carbohydrates. If your cat can't be transitioned to a completely canned food diet, Dr. Elsey's and Young Again Zero Carb are low in carbs. ZiwiPeak has a freeze dried variety that's low in carbs, as well.
 
Thanks for your insights! I'll be sure to check out those resources. I live in Canada, and my vet uses the mmol/L measurement, and I use the Aphatrak 3 (I actually work as a receptionist for the vet, so with my discount it ends up being not too expensive). Is there much variation with a human glucometer? I can always purchase an Accucheck and compare the two devices I guess.
I was concerned that 2 units sounded a little high as a starting dose, and I even asked my vet my concern is that if I cut my cat's carbs down along with adding insulin he might become hypoglycemic. The vet didn't seem concerned and said cats don't normally respond too quickly to insulin and he even thinks he may need up to 4 Units twice daily (this now seems wayyy to high). Today, I measured Harley's peak insulin (Nadir) about 6 hours post injection and it was 7.1. That's the lowest I've seen so far (and he ate DM dry this morning, with a little tiki wet), and I'm even thinking we may need to eventually taper down the dose as I reduce more carbs from his diet. The vet seems adamant about DM, and says many cats have gone into remission with that brand. I know it's still too high in carbs, although better than the old food, but I'll definitely check out some of those dry options you mentioned and see if my fussy guy will go for it.
I gave him a light snack (1/4 can) of Fancy Feast this afternoon and he finished the whole plate. I agree with the concept of smaller frequent meals throughout the day. For some reason my vet thinks 2 meals is better, I guess to make sure he eats well at insulin time? I'm thinking I'll try spreading the meals a little more and see how that goes. His current caloric intake is to help him lose weight and they hope he'll get down to ideally 13-14 lbs.
I do have a bottle of corn syrup ready in case of a hypo episode, and I've read up a lot on how to deal with them but hopefully with careful monitoring I'll never have to go through it.
I'm so glad I found this board because I was getting so many conflicting messages from people and vets, so it's great to hear from people who have actual experience with diabetic cats!
 
In addition to the syrup, I’d get a few cans of high carb food too. The honey or Karo are a good way to quickly bring up the bg but it also wears off fast. You don’t want to use that much unless he goes under 50 in a human meter. You could also mix a few drops of syrup to low carb food to get a medium to high carb food equivalent.

I commend you for being a receptionist at the vet and still knowing better than to blindly followed their advice. And about the DM food, your instincts are correct. Unfortunately most vets do not know a lot about feline diabetes….they have many animals to look after and they all have different diseases and treatments. Vets also get their information about nutrition from the big cat food manufacturers so they are biased in what they recommend. A dry high carb diet is not good for any cat, especially a diabetic cat. That’s like feeding your diabetic child a diet of chips, ice cream and sweets. The advice to feed x2 a day is something that works for dogs, not cats who have a much higher metabolism. And yet, vets tend to treat cats and dogs alike when in reality there are too many differences between the 2 species, which means that is not the best treatment approach.

I would not change the dose until you’re done transitioning him completely off the dry food. Unless he goes under 90 on a human meter. Then, according to the SLGS dosing method we use here, he’d have earned a 1/4 unit reduction in dose moving forward. If his ideal weight is 13 pounds, his daily calorie intake should be about 260 calories, x20 times ideal weight is a good rule of thumb, so the amount you’re feeding seems just right.

I believe the meter variance is about 20% but most of us here use human meters because in the US the test strips are way more affordable and also most members here are more experienced with human meters. If you setup your spreadsheet, it will automatically convert to it all on a difference tab so it would be easier for any of us to give you dosing advice should you need it.
 
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Adding that, most of us do feed the larger meals around shot time and then 3-4 smaller meals or snacks throughout the day.

Bobo actually went into remission in May and he was on the TR protocol which seems to have the higher remission rate out of the 2, but as Sienne said you can’t follow it if your cat is on any dry food.

last, I want to give you the link to the Lantus forum. I recommend reading all the yellow sticky notes which have a ton of super helpful info: https://www.felinediabetes.com/FDMB/forums/lantus-levemir-biosimilars.9/
 
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