Low preshoot BG, but normally he's much higher...

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Mike1979

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Our cat, Sherbert, is a 15 yr old orange neutered male. Here's some background before my question. He was diagnosed with diabetes about 3 months ago. Since his diagnosis, his BG has been uncontrolled. Typical BG readings for him are between 400 and >750 (with an Alphatrak 2). He's on 10 units of Lantus in the morning and 7 units at night. He also gets RenaPlus at each feeding, which is 2 cans of Hills k/d 2x a day. Yesterday was the first time I was successful in giving him subcutaneous ringers solution at home, which he is supposed to get 100 ml every day (after his last hospitalization, they sent us home with a bag of fluids and 18 gauge needles... have you ever tried getting an 18 gauge needle into a cat?? It proved impossible for me...). Also, at the direction of the internal medicine doctor he saw Friday for the first time, we stopped allowing him to free feed on the m/d dry food - he only gets the k/d wet now. His blood was sent to Michigan on Friday, so we are waiting for the IGH results. Since his diagnosis, he's had one hospitalization for DKA, and one for hyperosmolar non-ketotic diabetes being uncontrolled.

So here's my problem. His BG readings are typically in the 400-600's. We've become accustomed to seeing high numbers. But last night his preshoot reading was 230, and this morning he was 130. Two things have changed in the last 36 hours - no more free feeding, and he got his 100 mL of subcutaneous ringers solution. I was terrified of giving him his 10 units of Lantus this morning after seeing a BG of 130, which I'm sure sounds crazy since that is a normal number and we should be thrilled. But all we've known since his diagnosis is really high numbers and uncontrolled diabetes. Was I right to give him 10 units this morning, despite the lower (for him) preshoot BG? When should I check his BG again? I'm low on test strips, so I want to check it at the right time. Should I call his IM specialist? Unfortunately, his regular vet has completely checked out at this point and are no longer returning any calls from me (not that they are opened today anyway).

Thanks for any help/reassurance you can offer. He's napping right now (perfectly normal for this time of day) and showing no signs of hypoglycemia.
 
Hi,
I don't have a lot of experience but you may need to get to test more often today.
When did you feed him last and what kind of food was it?
If it were me I would test him 1 hour after the shot and definitely 2 hours after - the most revealing reading with my kitty.
 
a good test to get any time you can is a +2. It can indicate to you that you need to test more.
IF there is a significant drop from pre-shot to the +2, you will likely see an active cycle.


I would like to encourage you to set up a spreadsheet. Instructions.

this is a very useful tool and it helps us to help you. We can see the patterns to help you to figure out what's going on.

Without this, I suspect that you may have had other occasions with lower numbers and haven't caught it.... especially if you've only been testing at preshot
so he's been bouncing. That can often cause you to only see high numbers.

be sure and post your next test.

You've also made a food change and that can lower numbers when you get rid of the dry or high carb food.
Since you just made that change, don't increase that dose.
Not yet....

If you do have other tests,

you can list them ...

amps is am preshot
+2 ~
+5~

and so on....
 
Hi--

I agree with Tanya-- you are going to need to monitor closely today. I see you use an AT2, which is great, but you won't be able to get strips at short notice. If you are really low, it might be a good idea to have someone run out to Walmart or a pharmacy to get a cheap backup meter (human) and strips (Relion is the Walmart brand, other than that I'd go with the store brand at whatever pharmacy you have near you).

Now, as for that 130: that is in the "normal" cat range for an AT2. The 10 units you have been shooting is a large amount, and you just changed food to remove a major carb source. What that all means is: yes, the 10 units may have been more insulin than he needs today, and he may drop more than you are comfortable with.

The good news comes in three parts: 1) by home testing, you've given yourself the best tool to keep him safe through the day, 2) for all but the most severe drops ("hypos"), you should be able to bring him back up by giving some high-carb food or honey, and 3) he's a cat, and may ignore what I said above and cruise along in the 100's or even rise higher today ("bouncing", basically rebounding up from the unusual low this morning).

Lantus takes a couple of hours to onset, so take the time to get your supplies in order-- testing materials, high-carb food (if you have any "gravy" containing wet food, the gravy part is a favorite), karo syrup or honey-- and read this: http://www.felinediabetes.com/FDMB/threads/how-to-treat-hypos-they-can-kill-print-this-out.15887/

Be sure to post when you get the next reading-- weekends are inconsistent, but there's usually someone on the boards who can guide you through whatever situations arise.

Finally: welcome!
 
My vet was willing to supply me with a few alphatrak test strips when my delivery was late. Maybe you could plead for some from any vet open today.
 
Ask your vet for 20 or 21 gauge needles for the ringers.... I can't comment on the lantus dosage. That insulin is am enigma to me.
 
At this point, I'm guessing/hoping that they decided to just play it safe and take Sherbert to the vet to be monitored today, which would be a smart thing to do. I hope they come back, though-- among other things, I'm very curious as to how Sherbert got to such a high dose so fast.
 
Hope the kitty is ok and we hear about them soon,

Also I noticed he is getting k/d (I'm guessing Hills) they didn't mentioned why, but it's really HC (27%) and would explain at least partially for his high numbers
 
Maybe an online vet could say whether or not the fluids would affect the BG or even the absorption of the Lantus.
 
Hello, sorry I am late to the party. I am out of town watching one of our FDMB members run a marathon. Brings new meaning to the FD phrase "it's a marathon, not a sprint".

Anyway, my girl got up to 8.75 units of Lantus. Typically here we give the same dose in the AM and PM. With the depot insulins it seems to bring more consistent readings. I would strongly encourage you to do two things. First, create that spreadsheet Rhiannon mentioned so we can help you with dosing. There is quite a bit high dose cats knowledge here and we can help with dosing. Second, drop the dose of insulin, with a spreadsheet I might more confident in suggesting how much to lower it. At some point you may wish to consider going to a low carb wet food diet. If kitty has kidney issues, a high quality low carb protein diet is better than any dry food. But don't do the food switch yet. As you have seen, changing food can make a large difference in insulin requirements.

Side note, one in four diabetic cats have acromegaly, so I am glad to hear you are getting the IGF-1 testing done. I would have also recommended testing for IAA or insulin auto-Antibodies at the same time. The testing is done at the sMe place for a small coat add on.
 
Mike1979 said:
He's doing well, no issues during the day, preshoot BG was 150 before dinner. Will respond to all the questions later.
Click to expand...

Very glad he did so well yesterday!

That's still a low-ish number (on an AT2) to shoot without a lot of data about how he responds to the dose. With these newly-lower BG numbers, and the very high dose of insulin he is on, I would strongly urge you to start doing some tests in between shots to make sure he's not going dangerously low-- just because he didn't yesterday doesn't mean he won't in the future.

If I were you, I'd contact your IM vet today if you haven't already, to discuss the new BG numbers and what they could mean for his treatment. And, of course, there's always us, here-- there are several people on this board (such as Wendy, above), who are very experienced in dealing with high-dose kitties and we all love to help in any way we can!
 
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