Large swing in BG numbers in first few days - new user

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kkchmi

Member Since 2013
Hi All,

New user here. My kitty, Pishi, was just diagnosed with diabetes last weekend (7/20). He is about 9-10 years old and currently weights just under 15lbs. Just got my insulin from vet this Saturday (7/27).

I just started him on Lantus (glargine) on Saturday. The vet said to start out with 3 units twice a day. Side note - not sure I like the vet as she doesn't seem to think pre-shot testing is necessary and doesn't seem to want me to do it. Also had me buy Hills Prescription DM dry food, which, after doing research, I find is not the best thing at all. I switch to wet food, Fancy Feast Turkey and Giblets. He's eaten that since last Tuesday.

So BGs before any shots were like 450 when at the vet (on 7/20), so maybe high since he was stressed. I bought my glucose meter, reli-on micro, and tried it out. This last Friday first try with test at 9:15pm, got BG of 326, no shot yet. Saturday morning, I tried again to get the hang of it, and got BG of 334, no shot yet. Seemed accurate. (I tested my own blood too, just to make sure meter seemed accurate, and it did.)

So, first shot was Saturday evening. PMPS BG was 354. I gave him the 3 unit shot and he did fine. Next morning, I didn't do an AMPS test as the vet seems to think it unnecessary to test every time. I gave him the 3 unit shot again Sunday morning, no pre-shot test. So, Sunday evening, I just didn't feel right about giving shots and not testing, so I did a test. Sunday PMPS read 51!! I re-did the test, thinking something went wrong. Second test came in at 47. I tested my own blood to see if meter was off. While my own BG was low, it was within normal range for humans. I got scared that reading was so low. I fed him as usual, but did not give his evening shot. He seemed fine, no hypo symptoms. I checked his BG two hours later at 9pm, and it was still at 49. I checked again at 11:30pm, and it was getting better and back up to 81. Now I testing him this morning at 7am and AMPS all the way back up to 456! I ended up giving him a shot with 2 units instead of 3 since the BG shot back up again so high.

Is this usual to have such a large swing in BG when first starting out? Should I still give him a shot when his pre-shot reading is in the 50s??

I called my vet this morning telling her everything above. She just wants me to keep giving shots and said he will even out. She said I could lower to 2 units or even 1 if that made me feel better, but that would lengthen time for him to regulate. I just get the feeling she doesn't even want me to test his blood. But I feel like I could have made a huge mistake yesterday evening if I had not tested and given him a shot when his BG was ~50.

Can anyone give me any advice or counsel? Any additional sources you can provide would be greatly appreciated!

Thanks!!

Kristin
 
You started on 3 units, which were based on his previous diet ... then dropped the carb count considerably by changing the diet.

OOPS! You're lucky your cat is alive. Changing the diet drops the glucose at least 100 points.

We always test before giving insulin, for safety - thank goodness you did!

Please do not give insulin if a pre-shot test is below 200 mg/dL.

How much does he weigh?
How much should he weigh?
 
Thanks!

I told the vet this Saterday I switched to wet food, and these were his first shots, so 3 units was based on him eating the wet food.

He weights 15 lbs now. He's a pretty big cat, so I'd think his idea weight woudl be around 12lbs, but not sure as my vet didn't say anything abou that.
 
The starting dose for Lantus is estimated as
Lower of current or ideal weight
in kilograms
times 0.25

12/2.2*0.25=1.3 units, rounding down for safety, 1.25 units (you'll have to eyeball quarter units; no syringes mark them)
 
We find it really helpful to track the test numbers on a spreadsheet chart shared on Google Docs. It lets others review your data and give feedback.

Instructions are here

AMPS = morning preshot test
PMPS - evening preshot test
+1 = 1 hour after shot
+2 = 2 hours afte shot
etc.
We do the +# after shot approach so nobody has to convert for time zones.
 
Thanks for your help! I felt like 3 units was high to start since everything I read said like .5 to 1 units to start. But since my vet said 3, I trusted that was correct since she is supposed to be the expert on this.

I think I am going to go lower to start and keep track of BG before every shot.
 
As it turns out, there is a Tight Regulation Protocol which has about an 80+% chance of getting a cat off of insulin.
Read about it here

To find low carb, canned or raw foods, there's a great printable list at Cat Info. The site is written by Lisa Pierson, DVM. It explains more about feline nutrition than you ever though you'd need to know. :smile:
 
Three units is a big dose to start especially if you changed food to wet - so not surprised he dropped so low. Am glad you were testing!! Not every cat shows hypo symptoms until suddenly they start with seizures so dont just rely on the behaviour - numbers are just as (if not more) important! And say you did rely on watching him (and hoping that when the seizures or sleep turns to coma, that the brain damage is not too late.).. what happens at night?

You also discovered why its so important to test before every single shot - as you dont want to shoot when too low!

So reduce the dose and use the spreadsheet. We recommend 4 tests a day

- ALWAYS before every shot - AMPS and PMPS
- mid cycle if your schedule allows - 5-7hours after morning shot - because you need to know how low the dose is taking him and whether the dose needs changed. Also it keeps him safe
- before bed (2-3 hours after pm shot PMPS) to know what his nighttime plans are - if this number is lower than PMPS you might also want to set the alarm for a test at 5-7 hours out as it usually means an active cycle

Let us know if you need help with the spreadsheet.
Wendy
 
Welcome Kristin and your sugardude Pishi to the FDMB, the best little place in the universe to help you learn about how to manage the day-to-day care for your diabetic cat.

Lantus is a depot type insulin. Only part of the shot you give goes to work right away. The rest of the shot is stored in the cat's body for slow release over time Lantus has a cumulative effect. That means the initial dose takes 5-7 days to build up in your cat's body and start to have it's full effect.

Darn good thing you tested. You undoubtedly saved your cats life.

Sounds to me like your vet did not take into consideration your switch from high carb food to a low carb food in calculating the dose.

We like the "Start Low, Go Slow (SLGS) approach to doing insulin. Most cats don't need more than one unit to start unless there are extenuating circumstances such as ketones, DKA (diabetic ketoacidosis) or your cat is gigantic, like over 25 pounds.

What was the reason your vet prescribed such a high dose of 3 units for your cat Pishi? What protocol was that based on?

I suggest you put together a hypo toolkit, to be prepared for when your cat has low numbers again. We want you to be prepared, like the Boy Scouts. ;-) Here is what you will need:


IN CASE OF EMERGENCY - YOUR HYPO KIT

Put together NOW the following items and put in an easily accessible place!

● Phone number of your vet
● Phone number, address and map/directions to your nearest emergency vet (or phone number of the cab company and some cash/credit card)
● Karo syrup, honey or corn syrup
● High carb canned food with gravy – 2-3 cans
● Some favourite treats
● Spare pack of 25 blood glucose strips
● Coffee for you ;)
Click to expand...

AAHA Diabetes Management Guidelines for Dogs and Cats is a good resource for some recent info on diabetes management. Vet journal published in June 2010. I recommend you print a copy for you to read and a second copy to share with your vet.
 
Thanks for all the help! I'm not sure why my vet started on such a large dose. Everything I'm reading says 1-2 units max. I switched to 1.5 units the last 2 shots and his number are mid 200's, so much better to start off with. I'm planning on trying my first curve this weekend, and I think I'm going to look for a new vet. I've read so many article about insulin, how to test, nutrition, etc., so I feel a little better prepared.

Thanks for help everyone!
 
There is a link to Vet Interview Topics in my signature.

Lots of vets can be out of date because they treat multiple species for multiple conditions. We see specialists, they see everything, and it is difficult to be up to date on everything. If you think the vet is willing to become updated, Print out a copy of the 2010 AMerican Animal Hospital Association Feline Diabetes Treatment Guidelines. Read them over so you understand them as much as possible, then share them with the vet. Be tactful if you want to keep working with this vet; no one likes to be told negative feedback.
 
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