Meika's spreadsheet...Questions!!

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elledean13

Member Since 2013
Hi Everyone,
I'm so sorry, I'm not sure if I should be posting on this board, or the Lantus board? I have just started trying to use this spreadsheet and I'm getting really frustrated by seeing the same levels. Meika's highest number has been 23 - she's never been above that (in all her years of being diabetic off and on). But it seems I can't really get her pre-shot numbers below 16 or so. Does anyone have any advice? Am I not giving her enough? Too much??

Also, with numbers in the 17-19 range, is it still normal to see her acting off? Drinking a lot and being tired/lethargic??

Any advice is greatly appreciated!!
xo
 

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I never used Lantus, but I believe you need to keep to a dose for awhile. You keep changing, not letting the dose "settle". What that dose should be I don't know. But I think you need to stick to one dose for about 5 days (unless the preshot is too low).
 
Thank you Maggies Mom Debby and Larry and Kitties!! I'm not home during the day, which is why there is a lack of in between shots. I worry about her going too low. This might be a stupid question but is there an approx number of units the glucose can go down? For example - if her BG is 17 in the morning - would it only drop so many levels- say to 11 or 12(6 hours in or so)?
I think you're right about letting it settle too - I will stick with the dose for at least a week and see if there are any changes.
 
this is a typical Lantus curve.

Example of a typical Lantus curve:
+0 - PreShot number.
+1 - Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number.
+3 - Lower than the PreShot number, onset has started.
+4 - Lower.
+5 - Lower.
+6 - Nadir/Peak (the lowest number of cycle).
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (may dip around +10 or +11).
+12 - PreShot number.
Click to expand...

Dose changes are based on the nadir or lowest point of the curve. Every cat is different but a lot of cats nadir around +6. Getting some more tests around that time would help us to help you better.

Yes, you may end up waiting until the weekend or a day off or setting the alarm for the middle of the night to get a test. We do think it is important to know what the lowest BG number is before changing dose.

I concur with Larry that the dose needs to be more stable also.

Here is a good link from the Lantus Tight Regulation forum on using lantus http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=18139

Keep asking questions and we will try to get you answers.

p.s. Welcome to the FDMB, the best place you never wanted to be. ;-)
 
Thank you Deb &Wink!! I will definitely check that out. Do you know if her BG numbers are high enough to be making her feel unwell? She really hasn't been herself in a few weeks and I'm just not sure how much of this is BG related. I don't live close to a vet (30 mins each way) and she gets very stressed on the drive (panting and sometimes she even poops). I'm trying to limit the vet visits if possible unless I really need to.

I'm so happy to have this board!! xo
 
There is a way to put the spreadsheet link permanently into your signature. In the user control panel, profile tab, select edit signature. In the free form text box is where the link to your google doc spreadsheet would go.

Haven't done it in a while but there are directions here http://felinediabetes.com/FDMB/viewtopic.php?f=6&t=50130 for both setting up the spreadsheet and putting a link in your signature. That way you will not have to keep adding it as an attachment each time you post. It will appear automatically as part of your signature at the end of every post.

I don't have a SS link in my signature anymore since Wink went OTJ. OTJ = off the juice, (no longer needs insulin, is diet controlled.)
 
Trying to answer some of your questions that you did not seem to get an answer on.

is there an approx number of units the glucose can go down? For example - if her BG is 17 in the morning - would it only drop so many levels- say to 11 or 12(6 hours in or so)?
Click to expand...
Nope, every cat is different (ECID) and even the same cat will drop different amounts from day to day and even between AM and PM of the same day. We simply do not have this much control over this disease to even predict the amount a cat will drop at any point in time. It's always changing. That's what makes this sugardance so challenging. One minute you are doing the salsa, then a slow tango, and then the hambo.

Every day is different, every caregiver is different, every cat is different. We simply have to adjust to all those changes on the fly.

Also, with numbers in the 17-19 range, is it still normal to see her acting off? Drinking a lot and being tired/lethargic??
Click to expand...

Unregulated blood glucose numbers, especially those above the renal threshold, will continue to cause excessive drinking (P/D or polydipsia) and excessive urination (P/U or polyuria)with huge pee patches in the litter boxes and frequent urination. Getting the BG numbers under control can help to control these symptoms.

Unregulated diabetic cats are also often ravenous, needed up to 50% more food intake than a normal cat. The diabetic can't not properly process food without sufficient insulin so their cells are starving for energy, hence the ravenous appetite.

Lethargy is understandable since the cat simply doesn't feel good with this much glucose floating around in the body.

Does your cat Meika also have problems with her hind legs? Diabetic neuropathy due to nerve damage from the excess glucose can make it difficult for the cat to walk comfortably because it is painful, take only a few steps and stop to rest, walk on their hocks, have problems jumping and climbing.

How long has your cat been diabetic this time? You mentioned she has been diabetic off and on for years.

Any recent steroid use? Change to a higher carb food to throw her out of remission and back into an unregulated state?

What are you feeding? canned, dry? What brand, how much, how often? All these can make a difference in the numbers which is why I am asking.

How much does your cat weigh? Is that a good weight, underweight or overweight?

All these are clues to help us help you figure out how to better treat your cat.
 
What time do you shoot at night? Can you get a before bed test a few hours later? Or maybe set the alarm for middle of the night occasionally? She could be dropping low and shooting back up again..
 
Wow you guys are honestly amazing!!! Thank you so much for all your help with this!! To try to give you some more info about Meika.... She does have some issues with het hind legs. She (and her sister from the same litter) both do. Not completely on her hocks but it is a noticeably different walk. She has been diabetic for about a month or so this time (so far). She typically only requires insulin for a few weeks and then reverts. I'm attributing this sporadic diabetes to her steroid use when she was younger. She has Eosinophillic Granuloma Complex and used to get depo injections to calm it down. She (thankfully) hasn't needed any in years (probably close to 6 or 7 years) touch wood! She is always on the same diet - hills m/d dry and Friskies wet. She grazes on the dry in the day and gets 1/4 can of Friskies in the am and again in the pm. She is 15.4 lbs (she was curvier when she was younger) I would say she is a little overweight but nothing major.

I can definitely set an alarm and check. I usually do the needles at 6am and 6pm.

I was an absolute mess last night and couldn't wait any longer. I brought her in to the vet and they are thinking she might have pancreatitis. She has some stomach meds to try (sulcrate) and I'm only giving her wet food now! No dry. She is also on 2 days of bupenepherine and no more metacam. I was thinking it might be best to wait a day or so to let her body adjust to the wet only diet before giving her insulin. What do you think? I've never had any experience with pancreatitis and I'm terrified :( I just want her to be okay!
 
Since you are home testing and she is above 13.3 (240), she is above the renal threshold and glucose is high enough to spill into her urine. I would suggest testing for urine ketones (strips from a human pharmacy; tips in my signature link Secondary Monitoring Tools).
 
Since you have stopped feeding her the dry food, and are only feeding her the wet food, her BG numbers will drop. Sometimes very quickly. You need to be home testing before every pre-shot at a minimum. Be very careful in changing from higher carb foods to lower carb foods because you will need to lower the insulin dose.

How much insulin is she getting right now?

The Hill's M/d Dry was 14-16% carbs and the Friskies wet is probably lower. Are you feeding the Friskies pates? or something else? It can make a big difference in control the BG levels to feed a low carb food, <10% carbs.

I transitioned my foster cat Wink from a high carb dry diet to a low carb canned diet. One day his numbers were fine, the next he hypoed. I had been slowly dropping the dose, but not quickly enough.
 
If its Friskies pate style wet food it is between 6-9% carbs but does contain a small amount of rice which some cats are very sensitive to...I know this because that is what my boy in remission eats. Fancy Feast Classics (if only feeding one cat as they are small cans 3oz) are between 3-5% carbs, slightly higher quality ingredients and no grains at all.

Mel, Maxwell, Autumn & The Fur Gang
 
She was getting 1.25 units of Lantus 2 x a day. I think I will wait until pm tomorrow before giving any insulin. She was at the vet most of today and is now only eating wet food diet. I'd rather her body adjust a little first.

She eats either the pâté or the gravy ones (they come in a mix box). I can definitely keep her on the pâté only thought - she loves those! I could try the fancy feast and she how she responds?
 
She eats either the pâté or the gravy ones (they come in a mix box).
Click to expand...

I would recommend that you set the gravy ones aside for now. You can add them to your hypo toolkit. If a cat's BG levels drop too low, the higher carb wet foods, like those gravy ones, can help to quickly raise the BG levels to a safe level. In a newly diagnosed cat, less than one year from diagnosis, any number under 50 is considered hypo territory and needs treatment.

In case you haven't already learned about how to manage low blood glucose or a hypoglycemic event, here is a good link. http://felinediabetes.com/FDMB/viewtopic.php?f=28&t=15887 I recommend printing this out and keeping a copy with your hypo tool kit. You do not want to be scrambling to find this document in the case of a hypo.

If you have internet access, and you think your cat's BG is too low, post on here with the subject of Possible Hypo and put the 911 icon on your post. Lots of people on here know how to treat a hypo and will help you through a hypo with testing and feeding advice. We've supported many people through this scary event.

Your other option is to get your cat to an emergency vet ASAP.

Items to include in your hypo tool kit:
1 .Several cans of high carb cat food such as the Fancy Feast gravy lovers food (several because you be squeezing out just the gravy to raise the numbers. Don't want to feed too much of the solid food because that could fill your cat up before the hypo event is over)
2. a simple sugar like karo syryp, honey or maple syrup
3. a blood glucose meter to test the blood
4. plenty of test strips at least 50 recommended.
5. And these instructions,printed out and nearby. http://felinediabetes.com/FDMB/viewtopic.php?f=28&t=15887
6. Phone number and directions to the nearest emergency 24 hour vet.
7. Credit card to pay for the vet.
8. Syringe for rectal administration of karo/other simple sugar of cat loses conciousness.
9. and last but not least A designated driver so you can keep rubbing the karo on the cats gums while you drive to the emergency vet


SYMPTOMS
Some cats may have NO symptoms whatsoever, but here are the most common ones:

MILD HYPOGLYCEMIA
Sudden ravenous hunger
Shivering
Weak or lethargic

MODERATE HYPOGLYCEMIA
Disorientation
Trouble with vision... bumps into furniture
Poor coordination, such as staggering, walking in circles or acting drunk
Changes in head or neck movements
Restlessness
Urgent meowing
Behavioral changes, such as aggressiveness

SEVERE HYPOGLYCEMIA
Convulsions or seizures
Unconsciousness
Click to expand...
To these list of symptoms, I would add extremely dilated pupils that do not respond to light. That is the only sympton my foster cat Wink exhibited. I knew he was low by doing home testing and was able to raise his BG numbers with a simple sugar like karo or honey and some high carb food. Dry food does not digest quickly enough to raise the BG numbers so having some wet food with gravy on hand is important.

The cat shelter neglected to mention hypoglycemia to me when I took Wink home to foster. I knew the switch from high to low carb food could impact the BG numbers but it happened very quickly, being ok one day and hypo the next.

We'd rather have you be able to keep your cat safe so be sure to blood test if anything ever looks funky or your cat just isn't acting right.
 
Thank you for your kind words and support :)

She is doing a lot better. She had a rough couple weeks with a really bad bout of pancreatitis. It was extremely frustrating trying to find a competent vet who took this seriously. As it stands right now, she is *thankfully* feeling a lot better.

Her BG is also starting to normalize. I was seeing numbers as high as 21 and 23 for her (that's high for her) and +4 after Lantus I even saw an increase in BG.
But, she's back down to the 14-16 range pre-shot (both pm and am). I will start putting together some more numbers for an updated spreadsheet. Hopefully your exerience will help me figure out if her dosage is correct still.

Also - thank you Deb & Wink for the Hypo info. I have a copy pretty much everywhere just in case!!!

xo
 
I'm glad to hear that Meika is feeling better. Pancreatitis is tough to deal with and the stress and pain seems to spike up the BG (blood glucose) numbers.

We'd like to get Meika lower than that 14-16 mmol(252-288 mg d/L) that she is in. That is still a bit over the renal threshold, where excess glucose is excreted by the kidneys and is dumped out in the urine.

I think we need our standard format spreadsheet to see what is going on and help you with the dose and suggestions.

Do you need help setting up a spreadsheet? There are folks here that specialize in doing that for members. Just ask.

Instructions here for spreadsheet setup if you want to try it on your own. ss setup
 
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