? Low sugar in the evenings with only one insulin shot

Hi everybody, thank you for contributing so much info to the forum! It was really helpful! My 12yo cat got diagnosed with diabetes in August and the last two weeks were quite adventurous for us.

His blood sugar was over 400 when diagnosed and he weights 5.2kg, so the vet prescribed 2IU injections twice a day (Lantus by Sanofi, our remote region doesn't have pet insulin available). I did it dutifully for 3 days (starting Sep 1) but he crashed quite hard after the 6th injection in the evening, showing all the "moderate hypoglycemia" symptoms from this thread. I applied honey onto his gums and rushed to a hospital where they tried to do glucose curves along with calibrating insulin injections for two days, but his blood sugar was all over the place, almost random. Plus he started getting aggressive, so we decided to take him home for a rest.

We started again slowly this Monday (Sep 7), injecting just a hub diluted with NaCl (i.e. less than 1IU). It reduced the blood sugar from 400+ in the mornings to ≈350 in the afternoon. The vet gave a permission to switch to 1IU and just in day something strange started happening: his sugar is 350–380 in the morning before an injection (and feeding), 6 hours after injection it gets to 230–250, but 12 hours later it gets to roughly 150! (We are currently using Accu-Check Instant but AlphaTrak 2 is also on the way from the US.)


(He eats three times a day: 15g of Hill's m/d in the morning, half a can of Nutrience in the evening and 15g of Hill's m/d before sleeping. This is a schedule that we adjusted through the last year when he started vomiting in the morning from bile accumulation on empty stomach. Previously it was Hill's for seniors 11+.)

We talked with the vet and decided to not inject him in the evening at all out of fear of having one more episode of hypoglycemia. She is going to to contact some vets who may have more experience with cats reacting to insulin this way. And I am here, wondering if anybody has seen something like that..? (I've tried searching the forum but no results so far.)

Thanks a lot in advance!

 

My cat seems to be responding in a similar manner but we are WAY too new to be offering much insight to this. She was diagnosed last week and I am only 9 days into insulin and how my girl responds to it. I am, however, very interested to see what the seasoned veterans have to say about it. I have got a pretty nice curve going since last night too. I'm starting to get consistent on these ear pokes - THANKFULLY! Good luck!

 

Hi. With Lantus, who is a sour 4 pH depot insulin. And with that bg drops you should Start Low dose, and Go slow.
Try split that 1 U into 1/2 U BID, equals twice a day, am, pm.
@Deb & Wink

 

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jeanne

 

Thank you! Oh wow, I've just checked some members' spreadsheets – I should raise our tracking to this level of detail.

 

Can you get U-100 syringes there with 1/2 unit markings? If not, what brand are you using? I'm wondering if we can find a smaller dose for you to give. It looks like you gave 0. 5units once, maybe stick with that dose and see what happens. We determine how to change the Lantus dose based on how low the dose takes the cat, not the preshots, so ignore the higher numbers if you see them at preshot time.

Is the Hills m/d you are feeding wet food or dry food?

You might want to head over the Lantus forum, and read the yellow starred Sticky Notes at the top of the forum. Lots of good information there.

Here's where you can find instructions on how to create a spreadsheet:
FDMB Spreadsheet Instructions:

• Please set up a Google Spreadsheet as soon as possible. Always keep spreadsheets up-to-date! Valuable time may be lost looking for information when a spreadsheet is not up to the minute.
• If you have not been able to transition your kitty off of DRY food yet, please note it on your spreadsheet and in your signature. A dry food diet will often require higher doses of insulin to bring numbers down. Having this information plainly visible will help us help you.

Understanding the Spreadsheet/Grid

 

Lantus is a depot insulin. It puts aside a little of each shot to develop a depot. Lantus craves, demands consistency to work properly. Finding a dose that you could give twice a day would benefit your cat greatly.

Did your cat have any other health conditions prior to becoming a diabetic?

 

The current ones are BD Ultra-Fine 30IU with a 6mm/0.25mm needle, I just realized they have 0.5 unit markings on another side (I thought it was some other unit and was measuring half the gap visually, ugh). We'll probably try 0.5 for a while.

What's the best time to measure? Now I wait 6 hours from the shot time but maybe it's too much.

Dry, Nutrience is wet and both of them have roughly the same carb %% (10-13%). The last time we checked, wet Hill's m/d wasn't available in our country.

Thank you, will do! Will also try to migrate to the official spreadsheet format when AT2 arrives.

Nope, super healthy aside from losing his molars about 5 years ago, but that that was a genetical issue as far as I know (they basically started to dissolve while fangs and front teeth weren't affected).

 

@don_gato When choosing Spreadsheet - As Chilean, Chose The World Template on her
https://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
International bg numbers are in mmol, you punch your bg numbers in then in mmol,
and it translates directly over to U.S mg ....
So chose the right spreadsheet template

 

The vast majority of us use human blood glucose meters. The test strips are so much cheaper. Plus our dosing methods were developed before the AT2 came out - human meters is what vets used to use too. You can start entering numbers now. We will all understand them.

We have a list of some cat foods available in Argentina and Mexico, maybe some are available in Chile too? MEXICO AND ARGENTINA FOOD CHARTS data complied by Veronica & Babuchiri (Jan 25, 2020)

 

Hmm, my meter is in mg/dL and there's no switch. We occasionally use US units here (like inches in plumbing) because of the historical imports from there.

I've seen the pricing discussion on the forum but decided to try the compatible FreeStyle strips (they are sold here). The human meter was actually given me by my vet and I probably over-reacted ordering AT2 too. But now I have two glucometers to compare.

 

So, after reading it on this forum, CatInfo.org, and also getting the same advice from an endocrinologist we quit dry food completely and in 3-5 days our cat was diabetic no more! His sugar is in 75-110 range with Accu-Chek and in 90-125 range with AlphaTrak 2 at whatever time of the day, before or after feeding.

This is just incredible! If only we knew it before because in the last years we totally could afford feeding him with quality wet food all the time... Well, I've sent the link to the guide from CatInfo to all cat-owners I knew.

Thanks again for the advice and keeping the community alive!

 

Congratulations and thanks for posting an update. It’s always worth celebrating when one of our kitties goes “off the juice” (no longer needs insulin injections).

My first diabetic also became “diet controlled” quite quickly after removing high-carb food. Just remember that diet can play a huge role in maintaining normal BG and that it’s important not to become complacent. I’ve seen more than a few people add dry food back in “for convenience” over the years, only to have their cat’s BG skyrocket and have to go back on insulin again. And it’s often harder to get them off insulin the second time. Once diabetic, always diabetic.

It’s also a good idea to keep doing periodic BG tests for awhile to confirm that the BG is holding in normal ranges.

Good job!

 

Same here

 

So happy for ya! Yes every once in a while check his BG levels ...Not only for sugar but its a good way to see if an infection is brewing.

 

Chloe has been like that lately and she's only on 0.5 units. If you look at my SS, you can see. I've only been giving her one dose in the mornings. She's on Lantus, too, which is a depot drug (go to the Lantus board to get more information about that). My vet says that she may be going into remission. Sometimes, she vomits up a clear liquid (bile?) in the night, but I never really thought about that. I'll note it on my SS from now on. Please start a spreadsheet. It's very helpful to see numbers at a glance and it's color coded. Oh, I see that the switch to wet food has done the trick. Congratulations!

 

Congrats!