Low blood sugar. Help please

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smilelari

smilelari

Member Since 2016
For the first time, tested before giving insulin this morning. Turner hasn't had food or insulin yet. Vet opens shortly. Blood sugar was 96 on an alpha track. What do I do?
 
At the BG with no fod do NOT shoot. Even with food I would not shoot since you do not have the experience of what happens. 96 is a non-diabetic number.
Have you recently changed diet? That can cause diarrhea and GI upset
 
We switched from dry to wet Hills md, but it's been a couple weeks and he hasn't had any stomach upset before

Should I go ahead and feed him?
 
I would not do a curve since if Turner ate normally yesterday the 3 units is too high based on this morning 96 BG. Since there seems to be no history I would be hesitant to even give 1 unit if he eats normally within an hour of normal eating time.
 
It looks like Turner was started on 2u of insulin, and then it was raised another 1u a week later? First, 2u is a large starting dose for a cat (starting dose is .25u per kg of ideal weight), so unless he is a very large Maine Coon type cat, then the starting dose was too big to begin with. Second, Lantus should be raised in .25u-.5u increments based off the daily nadir (lowest number of the cycle), and not raised in 1u increments. I think that 3u is probably way too much insulin for him--most cats only end up needing somewhere around 1-1.5u once the dry food has been removed.

I would check out some of the stickies in the Lantus forum when you get a chance, or once you get your spreadsheet up and running, you can post there for advice on the dose. When Bandit was first diagnosed back in 2009, his vet at the time was great with encouraging home testing, getting him on a low carb, canned commercial diet, and getting us on the right track with insulin, but her dosing advice was WAY off and very dangerous. She wasn't dosing him according to the recommended protocols, and instead was using her own protocol that she developed for her dogs. Because she didn't want to work with me using the recommended protocol, I ended up leaving and finding a new vet who would. She wasn't familiar with them either, but she was at least willing to read and learn about them and help work throught them with me.

I've attached an article for you to print out and bring to your vet regarding the treatment of cats with Lantus--it's very possible that your vet just hasn't seen it yet.
 

Attachments

Also, could you share a little information about Turner that might help us out with advice? I see that you're feeding Hills M/D, is it wet or dry food? Unfortunately, Hills M/D (even the the canned) is too high in carbs for diabetic cats and will likely present problems with getting his blood sugar under control. Purina DM canned is the only prescription food appropriate for a diabetic cat. But, you can feed any low carb, canned food--it doesn't have to be prescription! Bandit has never been on prescription food (except for the Hills W/D food that helped cause his diabetes). Just keep in mind that if you change the food, he will likely need less insulin (or even go into remission), so you need to be home testing daily and reducing the dose as needed. You can find a food chart here that listes the protein, fat, and carb content of many precription foods. Just pick any one that is less than 10% (but preferably less than 8%).

Does Turner have any history of Ketones? You'll want to be a bit more cautious in lowering the dose if that is the case. I see that he recently had a dental--a lot of times you'll see numbers level out and insulin need go down after bad teeth are taken care of. This was the case when Bandit had his extractions in 2010 and 2011.
 
Thanks! I'll have to go back and find the exact time lines, but yes, we started at 2u, went to 3u in the morning and 2u in the evening and then went up to 3u for both doses. We've done a curve at home with each increase and also a fructosamine at the vet.

I love this vet, so I'd be sad to switch (we lost a cat to cancer about a year ago, so they've been through some stuff with us). So, we'll see where this leads us. Starting with what she thinks of the number this morning.
 
I've been reading about the food situation already and want to switch. Not sure what to switch to yet. I don't thin he's had any history of ketones? And yes, he had some very serious dental problems that were recently taken care of
 
smilelari said:
Thanks! I'll have to go back and find the exact time lines, but yes, we started at 2u, went to 3u in the morning and 2u in the evening and then went up to 3u for both doses. We've done a curve at home with each increase and also a fructosamine at the vet.

I love this vet, so I'd be sad to switch (we lost a cat to cancer about a year ago, so they've been through some stuff with us). So, we'll see where this leads us. Starting with what she thinks of the number this morning.
Click to expand...

So, with Lantus, you want to test at least 3 times a day (but if you can manage to get a few more in, it certainly helps). You need to get a test before each shot, and then one (or more) in the middle of his cycle(s) to see how low his blood sugar is dropping on the dose. Dosing isn't based off a single weekly curve, but rather the lowest number of your daily cycle. This is because cats just starting on on insulin do what we call "bouncing". When their blood sugar drops too low (or their body thinks that it's too low because it's used to higher numbers), their livers dump glucose into their blood stream to compensate, and their blood sugar will go up. This high blood sugar can last up to 72 hours. The only way to determine if the dose is too high, too low, or where it needs to be is to get daily numbers to make sure he's not dropping too low. Given that you got a 96 12 hours after his last dose of insulin, and cats usually reach their lowest number somewhere around 6 hours after the shot, this would indicate the dose is very probably too high right now, possibly dangerously so.
 
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smilelari said:
I've been reading about the food situation already and want to switch. Not sure what to switch to yet. I don't thin he's had any history of ketones? And yes, he had some very serious dental problems that were recently taken care of
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There are so many options--the Fancy Feast "classic" pates are very popular here, and that's what I fed Bandit when he was first diagnosed. The Sheba "pate" (not the "cuts") are also all low carb and ok to feed. On the less expensive end of foods, Friskie's and Special Kitty (Walmart) brand pate foods are very popular for diabetics. For premium foods, Wellness, Weruva, EVO, and some others are good choices that are easy to find at a lot of pet food stores, and they all have storefinders on their websites. You just need to pick any low carb food that fits in your budget. Premium foods tend to be lower in phosphorus, which is good for older cats that may have kidney issues (that's why I switched foods a few years ago for Bandit), but Turner is only eight so I don't think i'd worry terribly about that with him.

It's also a good idea to limit fish flavors to once a week or so--cats get addicted to them, and they are the most common food intolerance that develops in cats.

Most vets are good vets--it's just that they need to know a lot about many different animals and diseases and sometimes aren't completely up to date or informed on very specific treatments. This is usually the case with feline diabetes, so you're certainly not alone! I would bring the information provided to your vet and ask them to work with you. If they read the information and then still continue to give dangerous dosing advice, well, that's when I would switch. But if they are willing to work with you (as most vets will), then there's no reason to switch.

With the right food, insulin, and dosing based on daily home tests, most cats (80+%) will go into remission, and their diabetes can be controlled with diet alone. Bandit has been diabetic for 7 years now, and he's only needed insulin for less than 2 of those years, total.
 
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smilelari said:
I'm pretty sure any of those foods, even the premium ones, are cheaper than the md :)
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They certainly are!!! I order my Wellness Core and Weruva on Amazon by the case, and it works out to be somewhere around $1.70 a can. I don't know how much the M/D is now, but back in 2009 the Purina DM was like $3 a can! And you get the added bonus of the premium food having much better ingredients than the prescription foods. Purina DM is nearly identical in composition to Fancy Feast or Purina One pates, and Hills M/D contains corn starch and cellulose (wood pulp) as fillers (which is likely why it's carb content is too high). Definitely cheaper! And you end up saving money in litter and vet bills, too. Cats can't really digest corn or wood pulp, so it all just gets pooped right back out, causing you to go through more litter, and getting them on the canned only diet also helps prevent kidney disease and urinary tract issues. :)
 
Special Kitty Mixed Grill at Walmart $1 for a 22 oz can. Same for the Turkey and Giblets pate.
 
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