Need advice on insulin dosage adjustment for my precious Chomel

[Ana R.]

Hi all,

I’m Ana from Malaysia. My bff for 12 years has just been diagnosed with diabetes last month. Her initial reading was ceiling high- 551mg (~31mmol/L). I did went thru the struggle and finally able to do BG home testing in week 3.

Her BG is now in the range of 16-23mmol/L with 2x/day 3IU Lantus insulin, however recently it is showing low reading in the morning, as low as 2.9mmol/L after breakfast. This BG will rise to 13-16 mmol/L in the afternoon. My vet told me this is normal and mentioned it is safe, since accucheck glycometer is not calibrated for animals, hence giving lower reading than actual.

My question is, do i continue to give my Chomel insulin shot although her reading is below 4? Not much help from my vet. All he said, if I am in doubt, just skip. Really looking forward for your help and guidance here.

She’s my best friend, the one I come home to for the past 12 years. We are nowhere ready to say goodbye.. she’s fighting it and so am I!

 

[Idjit's mom]

Ana, welcome to FDMB and I must say Chomel is a very lovely kitty girl! We will help you and Chomel all we can, and you are already doing well with insulin therapy and home testing.

I am providing some links that will walk you through creating the signature, adding profile information (in which you can tell us more about yourself and Jack, if you wish), and then setting up the spreadsheet we use here. The spreadsheet is for recording the insulin dose and testing data you will be getting and is very helpful to you and other members to see how the insulin is working.

• Editing your Signature, Profile, and Preferences

• FDMB Spreadsheet Instructions
• Understanding the Spreadsheet/Grid

If you need help with the spreadsheet set up, please let us know. There are members who can assist or set it up for you.

Seeing the blood sugar testing data on the spreadsheet in graphic form is going to help advising members make recommendations on Chomel's insulin dose.

You can read information about using Lantus HERE, beginning with The Basics: New to the Group? Start here!

The insulin dose of 3 Units twice a day is very high for a starting dose and sometimes vets recommend a dose that is actually too high and a kitty's blood sugar drops quite low after injection, sometimes too low.

From information in the Lantus files:

Until you collect enough data to know how your cat will react, we suggest following the guidelines in the FDMB's FAQ Q4.4:
Q4.4. My cat's pre-shot level was way below the usual value. Should I give the injection?
A4.4. There's no hard and fast rule, but if you don't have data on how your cat responds to insulin, here are some general guidelines.

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  • Below 150 mg/dl (8.3 mmol/L), don't give insulin.
  • Between 150 and 200 (8.3-11.1 mmol/L), you have three options:
    • a.) give nothing
    • b.) give a token dose (10-25% of the usual dose)
    • c.) feed as usual, test in a couple of hours, and make a decision based on that value
  • Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise.
  • In all cases, if you are reducing or eliminating insulin, it's wise to check for ketones in the urine.

I am tagging some of the experienced members to advise further

@Wendy&Neko
@Lisa and Witn (GA)
@MrWorfMen's Mom

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[MrWorfMen's Mom]

Welcome to you, Ana and Chomel. Chomel is indeed a beautiful girl. Such unique markings!
We are very data oriented here and without seeing what has been going on over the period of at least a week or 2 it's impossible to give you advice on how to best help your little one. I will say however that knowing you are getting BG readings of 2.9mmol in the mornings makes me seriously wonder if she needs a dose reduction. Lantus works best when dosed consistently so if you are having to skip shots, that too is impacting the readings you are seeing.

Please set up a spreadsheet as suggested in post #2 above and plot in the readings you have taken for the last couple of weeks and we can then offer you some opinions. If you need help setting up the spreadsheet, just holler. We can set it up for you if need be.

 

[Wendy&Neko]

Hello and welcome. Good for you on home testing. Are you giving insulin with syringes or pens? If syringes, do they have half unit markings? We usually suggest changes by 1/2 or 1/4 unit at a time. We eyeball the 1/4 unit from the half unit marks on the syringes. We would ideally like to find a dose you can safely shoot twice a day, instead of skipping or reducing a dose because the numbers are too low,

 

[Lisa and Witn (GA)]

You have already received great advice. I agree that your starting dose is probably too high. Generally unless there are other known health issues that affect glucose levels, a starting dose is 1-2 units. One if the purposes of home testing is to find the optimal dose that works best for your cat. Every cat is different (ECID) and responds differently to the type of insulin and the dose. This is why we always recommend home testing. Since you just started this journey of caring for a diabetic cat, my suggestion is to start over at 1 or 1 1/2 units twice a day. Before deciding an increase is needed, stay at that dose for at least a week and test before feeding for every shot. Also if possible test again several hours later. By getting all of these readings we can help you determine if you need to increase the dose. If an increase is needed, you only want to raise it by 1/4 to 1/2 units. We recommend using syringes with 1/2 unit marks even if you are using the pens. The pens are mini vials so you can use syringes with them.

If an increase is needed, you want to stay at that dose for another week and again testing before every shot. If another increase is needed you will repeat the same process. This method is called "start low and go slow" (SLGS). Later on once you are more comfortable about changing doses you may want to follow the tight regulation protocol instead. But don't worry about it right now.

Another thing you also should do is set your "don't shoot" number. This means if you get a reading below this number you skip the dose or delay it to later. For new members we recommend using 200 as this number. I believe this would convert to around 11.1 on your meter. By skipping the dose you lower the risk of hypoglycemia. If you do skip the dose, most likely you next reading for the next dose will be high than normal, but that is expected.

 

[Ana R.]

Thank you very much for your replies! These are really helpful. I have completed the spreadsheet here: https://drive.google.com/open?id=10svzIYvYXrrsYeZU_ceZSpIj8hFLFIVU
The readings are incomplete though, as my first few weeks trying to draw blood has caused my Chomel's ears to be swollen badly. My vet told me to give it a rest and only check BG as necessary and use urine strip as rough estimation to know if it is safe to give a shot.

@Wendy&Neko: I am using Lantus pen, which only the minimal unit=1IU, hence 1/4 or 1/2 adjustment is not possible with this pen.
@Lisa and Witn (GA), @MrWorfMen's Mom: My vet started with 2IU and actually advised to increase to 4IU in the 2nd week, which I refused to do so as that's contradicting from what I've read. I did increased the dosage in week 4 to 3 IU (since Lantus pen's minimal unit is 1IU). And I think both of you are right, her BG is more stable when I reduce the insulin back to 2IU.

There are other few things which I hope to get your advice on;

1. Is RC Diabetic dry food good for her? I did introduced this for 2 days, but her BG shoot-up rapidly. I stopped this after 2 days.
2. Chomel is mostly on home-cooked meals now brown rice+baked fish (small size, half portion) (her favorite), twice a day + Fancy feast-0.5can/day as snack. (She has been a nibbler all her life, she has gastric and will vomit all out if she's left too hungry). My question is, would the home-cooked meals here deprived her from other vitamins? If yes, what types of supplement should i gave to her?

Thanks again all for being very kind and supportive. This means the world to me!

Ana.

 

[Wendy&Neko]

Is RC Diabetic dry food good for her?

No, it is not. It is too high in carbs. Dry food in general is bad for her.

If yes, what types of supplement should i gave to her?

Home cooked meals may not have all the essential nutrients, such as taurine, that a cat nees. Dr. Lisa has a formula for home made here. I have used both FoodFurLife's EZComplete andpremixes. You just add the premix to the meat to get a complete meal. With TCFeline you also add egg, and for some formulas you add liver.

I am using Lantus pen, which only the minimal unit=1IU, hence 1/4 or 1/2 adjustment is not possible with this pen.

Then you need to get syringes. I am not sure about Malaysia and whether you can buy some there that have half unit markings. If you can get the BD Ultrafine syringes, there is a paper ruler you can use to help you find the in between doses. Check with your local pharmacy (chemist) to see what is available. Ask what people would use for diabetic children. You may also be able to get syringes with 1/2 unit markings on line.