need advice this morning soon - Niki

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nikkiaz

Member Since 2010
Newly adopted cat with diabetes. Readings were high in shelter (586 was the last one on the records from last week) so on 3 units of Lantus. Tested at vets on Monday, yesterday was told his BG was 537 so needed to increase to 4.5 units.

Have not done a full curve yet (was planning to this weekend). Gave dose of 4 (not 4.5) after dinner. Pretty much crazy hungry about 9pm (mildly hypo)? BG at 10pm was 255.

BG just now was 111. Ate well.

So what do we give him for his insulin this morning? We both work all day.

thank you.
 
Hi Niki,
I'm not one of the board experts--am still new--but I feel 99.9% sure that when one of our experts sees this, they are going to suggest that you skip your dose this morning and regroup tonight when y'all will be home to monitor. 111 is far below the "no shoot" advice number for those of us early in this journey. Good luck with Niki! You are awesome for adopting him!
 
That's great! Maybe your husband can grab a few tests today to see how things go--that will help our experienced folks help you!

PS--I think I was calling you your kitty's name. :)
 
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Do you happen to have any information about what your kitty's blood glucose numbers were when at the shelter? That was a huge increase in dose. It would be very helpful if they got some mid-cycle numbers while Nikki was at the shelter.

And thank your husband for staying home to keep an eye on your kitty.
 
Good job on helping out Niki's mom this morning!!!

Niki's mom, would you share your first name with us please? Maybe your husband's first name too?

Your husband really does need to get some BG (blood glucose ) tests today. With that 111 this morning and 3 Units of lantus, there is greater risk of hypoglycemia. So you want to monitor more today. We don't want to see a BG below 50. If there is one, more testing will be needed and supporting with food to bring the BG levels up and keep them up until your cat has passed nadir (usually around +5 to +7).

Could your husband get a BG test at +1 and +2 (1 hour after the insulin shot, 2 hours after the insulin shot)

What kind of food does your cat eat? Wet/canned? Dry? combo?
 
Thank you all.

The rest of the shelter results were not available (I tried). There was only one day that noted what time he got his insulin and the time of the test.

He has been free fed dry food and gets DM in the morning and at night. We want to switch him to Dr. Elsey’s dry (on order) and then gradually only to wet food. We kept up the free feeding that he had been getting in the shelter, but it’s not sustainable easily long term b3cause we have 9 other cats. (And a bunch of dogs).

My husband will try to test at +1 and +2 as you suggested, which will be soon for the first one. Niki is a small black squirmy cat so finding a vein has not been fun.

BTW, my name is Nancy and his name is Scott. (I also go by Nikki, which is pretty funny).

Thanks for all the help!
 
Hi Nancy and Scott. Your first names would be good info to see in your signature.

Tiny black cat. Black fur makes it harder to see where you need to poke. Recommend very lightly shaving the edge of the ear with a fresh safety razor, like women use to shave their legs. Be careful, you do not want to nick the ear.

You are not aiming for the vein, but the area of capillaries between the marginal ear vein and the edge of the ear. Here is a diagram for you and a couple of testing tips:
"Testing
We all know the basics:
  • Warm the ear with a rice sock or a warm washcloth wrapped in a plastic bag.
  • Either freehand or use a lancing device; new members usually start with a larger gauge lancet such as 28g or 29g until the ear learns to bleed; then progress to a 31g or 33g which are finer.
  • Be sure to poke in the "sweet spot" and not the major vein that runs along the length of the ear. Poking the vein will not only hurt, but will result in a lot of blood. The sweet spot is on the edge of the ear.
4395c545-36bf-4aba-bec7-4392fcdb191c-jpeg.48119

But did you also know there is a particular way for the lancet to be used? It has one side that is bevelled so the sharpest part goes in first, if used correctly. In the photo below, you can see the lancet is angled. When you poke the ear, it should be held in the position shown below so the longest side of it is on the bottom. Lancets should only be used once to ensure they are at their sharpest."

See more at Marje and Gracie's Testing and Shooting Tips to see the picture mentioned above.

This document on •Ear Testing Psychology• is a good one on home testing.
 
Looks like you had another diabetic cat back in 2010. I found a couple of old posts with your user name.

So, not your "first rodeo", some diabetic cat experience, but you could probably use some refreshers and memory jogs.

What would you like to/need to know?
Hypo kit ready?
Hypo symptoms to watch for?
Dosing protocols we use here for Lantus?
 
Thank you all for your help! Sorry for the slight delay in replying - I was driving to work.

Niki's BG test at +1 = 206. At +2 = 298

I have sent Scott the ear information that hopefully will make it easier on all involved. He is watching Niki closely and will try to get several BG throughout the day, including at +2 as requested.

Thank you for all the resources. I will fix the signature asap. Yes, this is not our first rodeo. This board was invaluable the first time with Anabel. Annie unfortunately was unable to be regulated at the end, so we perhaps are letting that traumatic experience really panic us when things seem to go wrong thus far.

We have tried to read all the posted information and the stickies, including the info on Lantus, and prepared the hypo kit, but I feel like so much information is just overwhelming - I have found myself in tears more often than not since we brought him home. He had an URI and possible pancreatitis also, and one of his liver enzymes is elevated (will get complete copy of bloodwork tomorrow), so he's been on doxy for that (last day today). But he seems really happy and is currently eating like a champ.

I think the questions that keep popping up that we can't seem to find an answer to easily are:
1. How much time should elapse between the meal and the insulin?
2. If we weren't supposed to give him a shot this morning because of the 111 on Lantus, when would he get his next shot? Dinner? Would he be ok until then? (we can't work at home usually).
3. If it continues (low number in am), what does that mean? (we need a lower dose overall, I guess?)

Thanks for all your patience and expertise!
 
Ann & Scatcats said:
Insulin shots are always 12 hour apart. A.m and P.m.
Click to expand...

Yes, thank you. I think I was asking if it was okay to just get one shot that day at dinner, if we could not give his morning show if his BG was low? We wouldn't give him one during the day before dinner; I was just worried about the physical effect on cats of only getting one shot/day if this happens again. :-)
 
Happy, eating food for Niki cat. I think those are good goals.
What to feed, lower carb food changes can come later.

nikkiaz said:
I think the questions that keep popping up that we can't seem to find an answer to easily are:
1. How much time should elapse between the meal and the insulin?
Click to expand...
1. With lantus, the sequence is test, feed, shoot. All in a short window of 15 minutes or less.
  • Basically no time elapsed between first meal of the cycle and the lantus insulin
  • If you are not sure if Niki will eat first, if his appetite is off, then you could hold off on the insulin shot until he has eaten some food. At least a small portion, 1 oz or 2 oz
  • Many cats are easier to give insulin when they are distracted, head in the food bowl as you shoot.
2. If we weren't supposed to give him a shot this morning because of the 111 on Lantus, when would he get his next shot? Dinner? Would he be ok until then? (we can't work at home usually).
Click to expand...

2. If you skip a shot, because the BG levels are too low at pre-shot test time, you pick up with the next scheduled 12 hour cycle. So yes, that would be the PM or evening cycle.
  • there are also options to stall
  • or give a reduced dose of insulin
As you gain experience on how Niki does on any particular insulin dose, then you can adjust the threshold for "shoot/ no shoot" lower. That threshold number is really a "stop and think" number, a "what decision to make" alert to your brain. Stop and think, ask here for suggestions, try to stall (no food, retest in 20 minutes for rising BG number).

If you can not stall than how would Niki do on a tiny dose 10-25% of his normal dose? or should you skip the shot of insulin entirely? ECID Every Cat is Different. Experience Crucial, need Data to know what decision is right.

Beginning threshold for new members here in Feline Health forum is 200, because of lack of experience with a diabetic cat and because people use other insulins, where a lower threshold could be more dangerous until they learn how "their" cat reacts. With lantus/levimir, the decision threshold is 150. Over time and with experience, that can be lowered.

You want a BG test at pre-shot test time that is not influenced by food, and may be inflated by that food getting into the bloodstream. We suggest 2 hours no food before the BG pre-shot tests. Not sure how you would accomplish that in your multi-pet household. Think about how you would be able to do that. Or even if it is possible in your loving home with all the pets you have. Might not be possible with 9 other cats + all those doggos. You may have to continue to free feed, but have all the cats on lower carb food. And put the dogs dishes out of reach of Niki. No free feeding for the dogs????

3. If it continues (low number in am), what does that mean? (we need a lower dose overall, I guess?)
Click to expand...

3. Many cats drop lower overnight. Lower dose is probably a good idea.
Sometimes, simply getting out of the shelter environment can cause a big change in the stress levels and therefore the need for insulin. There are also usually some "not so good for diabetic cats" foods in a shelter. Different food in your home could be making a difference.

Did Niki have ketones or ketoacidosis? at the shelter? at home?
Are you testing for ketones at home? Urine test strips are available for you to do this or there are special blood and ketone meters that some people here use.

@Juls and Billy uses one. maybe she will give you some ideas on a ketone meter to use.

Dose of 4.5 recently raised by the vet. you only gave 4 U last night. Only gave 3 U this morning.
The question is, what dose to give tonight?

Don't know, if >200 and you can monitor this evening, then maybe 1-2 units? I'd go with the littler amount since you have very little test data. Expect Niki to be very high at PMPS (evening pre-shot) PM = evening, PS = pre-shot test.
Sorry for the long reply. Trying to answer all your questions in one post.
 
Is it possible for your husband to get a test around mid-cycle today? That would be around +5, +6, +7 hours after the insulin shot this morning.


p.s. Welcome to the world of caring for a diabetic cat. I too fostered and then adopted a diabetic cat from my local shelter. You are a special person for doing that.
 
Deb & Wink said:
Is it possible for your husband to get a test around mid-cycle today? That would be around +5, +6, +7 hours after the insulin shot this morning.


p.s. Welcome to the world of caring for a diabetic cat. I too fostered and then adopted a diabetic cat from my local shelter. You are a special person for doing that.
Click to expand...


Sorry, I haven't gotten the hang of replying to these messages yet so I think my replies are all lumped together!

We try to adopt the more difficult-to-adopt medical cases from the shelter, but this is our first diabetic cat in 10 years.

Yes, he plans to test at those intervals to get more data, thank you!



Deb & Wink said:
Happy, eating food for Niki cat. I think those are good goals.
What to feed, lower carb food changes can come later.

Thank you - I've read your response over several times and am feeling more enlightened!

We can free feed Niki during the day like you suggested. The other cats with medical issues can eat the low carb food. Honestly, when we suspect that he eats most of the dry food that we leave him by lunch, so we would anticipate it would probably be close to 2 hours without food when we test pre-dinner.

(free feeding the dogs would be a disaster that might end up at the emergency vet!)

We have not tested ketones yet. No indication that they did so at the shelter either. We will purchase the strips and start that asap.

We can monitor this evening, and we will go with 1 unit as suggested. Do we then go back to 3 units tomorrow morning (provided he is over 150?)

I am so sorry for all my questions and confusion, and I appreciate your patience!


1. With lantus, the sequence is test, feed, shoot. All in a short window of 15 minutes or less.
  • Basically no time elapsed between first meal of the cycle and the lantus insulin
  • If you are not sure if Niki will eat first, if his appetite is off, then you could hold off on the insulin shot until he has eaten some food. At least a small portion, 1 oz or 2 oz
  • Many cats are easier to give insulin when they are distracted, head in the food bowl as you shoot.


2. If you skip a shot, because the BG levels are too low at pre-shot test time, you pick up with the next scheduled 12 hour cycle. So yes, that would be the PM or evening cycle.
  • there are also options to stall
  • or give a reduced dose of insulin
As you gain experience on how Niki does on any particular insulin dose, then you can adjust the threshold for "shoot/ no shoot" lower. That threshold number is really a "stop and think" number, a "what decision to make" alert to your brain. Stop and think, ask here for suggestions, try to stall (no food, retest in 20 minutes for rising BG number).

If you can not stall than how would Niki do on a tiny dose 10-25% of his normal dose? or should you skip the shot of insulin entirely? ECID Every Cat is Different. Experience Crucial, need Data to know what decision is right.

Beginning threshold for new members here in Feline Health forum is 200, because of lack of experience with a diabetic cat and because people use other insulins, where a lower threshold could be more dangerous until they learn how "their" cat reacts. With lantus/levimir, the decision threshold is 150. Over time and with experience, that can be lowered.

You want a BG test at pre-shot test time that is not influenced by food, and may be inflated by that food getting into the bloodstream. We suggest 2 hours no food before the BG pre-shot tests. Not sure how you would accomplish that in your multi-pet household. Think about how you would be able to do that. Or even if it is possible in your loving home with all the pets you have. Might not be possible with 9 other cats + all those doggos. You may have to continue to free feed, but have all the cats on lower carb food. And put the dogs dishes out of reach of Niki. No free feeding for the dogs????



3. Many cats drop lower overnight. Lower dose is probably a good idea.
Sometimes, simply getting out of the shelter environment can cause a big change in the stress levels and therefore the need for insulin. There are also usually some "not so good for diabetic cats" foods in a shelter. Different food in your home could be making a difference.

Did Niki have ketones or ketoacidosis? at the shelter? at home?
Are you testing for ketones at home? Urine test strips are available for you to do this or there are special blood and ketone meters that some people here use.

@Juls and Billy uses one. maybe she will give you some ideas on a ketone meter to use.

Dose of 4.5 recently raised by the vet. you only gave 4 U last night. Only gave 3 U this morning.
The question is, what dose to give tonight?

Don't know, if >200 and you can monitor this evening, then maybe 1-2 units? I'd go with the littler amount since you have very little test data. Expect Niki to be very high at PMPS (evening pre-shot) PM = evening, PS = pre-shot test.
Sorry for the long reply. Trying to answer all your questions in one post.
Click to expand...
 
Nancy Nikkiaz You said the following, but the way you did it, got buried in the orange text box.

Maybe try only writing in the text box, and not using the "Reply" function that you see in the lower right hand corner, next to the word "Like" for now. Simply start typing away in the text box at the end of the last post, and write what you want to say. Then click on the "Post Reply" button.

nikkiaz said:
Thank you - I've read your response over several times and am feeling more enlightened!

We can free feed Niki during the day like you suggested. The other cats with medical issues can eat the low carb food. Honestly, when we suspect that he eats most of the dry food that we leave him by lunch, so we would anticipate it would probably be close to 2 hours without food when we test pre-dinner.

(free feeding the dogs would be a disaster that might end up at the emergency vet!)

We have not tested ketones yet. No indication that they did so at the shelter either. We will purchase the strips and start that asap.

We can monitor this evening, and we will go with 1 unit as suggested. Do we then go back to 3 units tomorrow morning (provided he is over 150?)
Click to expand...

No, I think that Niki needs to stay at the lower 1U dose until his BG tests tell us otherwise. 3 units is likely to be way too much insulin for now. We only change doses in 0.25 increments, but many vets are unaware that can be done and only change the dose in full 1 unit increments.

Do you use an insulin vial or did you get the mini-vial, the Solostar Lantus pen?
If the pen, can the units only be changed in 0.5U? or 1U increments? dial-a-dose feature. Don't remember.

nikkiaz said:
Sorry, I haven't gotten the hang of replying to these messages yet so I think my replies are all lumped together!
I am so sorry for all my questions and confusion, and I appreciate your patience!

We try to adopt the more difficult-to-adopt medical cases from the shelter, but this is our first diabetic cat in 10 years.

Yes, he plans to test at those intervals to get more data, thank you!
Click to expand...
I separated out what you said, and got the BB code correct for you to see my answers easier.

No apologies necessary. It's a learning experience and you have not had a diabetic cat in 10 years. Memory refresher needed plus how to treat feline diabetes has progressed since the last diabetic cat you had years ago.

p.s. We're always afraid we are giving you TOO MUCH information and are overwhelming you. Life is busy and full and just got even busier and more stressful for your family with adopting a diabetic cat.

I highly recommend Mindfulness Breathing, yoga or Tai Chi to help you relax. Really helps.

PCC = Pima County Animal Shelter? It was on your SS. Love Tucson and all the hummingbirds you get there.
 
Thank you Deb for all the new info!

We will do 1 unit tonight and 1 unit tomorrow morning. I feel better about that. I am kicking myself for doing the 4 units last night (I refused to do 4.5...I thought 4 was too much of a jump) after it led to his mini episode of hypoglycemia. Have to balance my gut with my limited diabetes knowledge!

We received the Lantus vial. We need to find new syringes that can record in finer increments though. The .5 is barely discernible from the whole numbers, much less there are no .25 intervals!

What's a bit more stress? We already have a CKD cat, a (possible) liver cat, a tripod cat...along with a vestibular disease dog and a dog with MMM. It's just our calling, I suppose! :-) Can't sit still for meditation, etc., but we are both athletes so that's how we get (some) stress out!

Yes, we are in Tucson. (Pima Animal Care Center = PACC). We love the hummingbirds and other wildlife (except snakes). Was awoken the other night by javelinas fighting for bird food outside the window!

Thanks again! I may post new numbers this afternoon here (and of course on the SS), but we will go with 1 unit! We have a horseback riding lesson at 6 pm, so he will be alone for about 1.5 hours but that's it. I hope that's okay (shot will be at 5:45).

:-)
 
Syringes. You want to look for insulin syringes that are for U100 insulin. 3/10 cc (hold a maximum of 30 units or 30 ml) . Half unit markings on the syringe barrel if you can find them. Needle length is your choice. There are no insulin syringes that have markings as fine as the 0.25U dose we do. You will be "eyeballing" those small amounts and using your best judgment to draw a consistent dose.

You do not want insulin syringes that hold 100 units (1 cc or 1 ml).
You do not want insulin syringes that hold 50 units (1/2 cc, 0.5 ml).

Shelter gave me those large volume syringes to start, and it was impossible to measure the tiny insulin doses in those larger volume syringes.

You may need a prescription from your vet to buy syringes. Drug crisis so many states and cities restrict the sales.

ADW diabetes carries U100 3/10 cc with half unit markings syringes for mail order. https://www.adwdiabetes.com/categor...t-by-field=BESTMATCH,page=1,ppp=20,op=fs,ps=|

There are probably local pharmacies that have the 3/10cc syringes in stock. Call to find out before you drive.
Tucson is a big city and it takes a long time to drive from Tanque Verde, to N. Oracle or wherever you live, work and play. (And have horseback riding lessons! western style)

Marje and Gracie are from the Tucson area. But she is busy with a family crisis right now so we are trying not to bug her too much right now.

At 5:45 your time, I'm getting ready for bed on the east coast. I will tag @Wendy&Neko for you. She lives on the west coast of Canada and is up much later than I can ever be awake.
 
nikkiaz said:
I think I was asking if it was okay to just get one shot that day at dinner, if we could not give his morning show if his BG was low? We wouldn't give him one during the day before dinner; I was just worried about the physical effect on cats of only getting one shot/day if this happens again.
Click to expand...
If only 1 shot of insulin a day is possible because of whatever reason, like a skip for low BG numbers. Than numbers, BG tests or readings will be higher for that 12 hour cycle and a few subsequent cycles. Bouncing.
Depot storage area will drain or deplete a bit and you will see some of those effects in the insulin tests.

Lantus forms an extra little storage area, called the "depot". Lantus (and levemir) insulin forms little clusters of insulin (crystals) under the skin, for slow release later. It's why you don't want to rub the injection spot after dosing, because you can break up those clumps.

Cat will be more lethargic, sleep more, not want to play as much, appetite may be suppressed. More p/u (polyuria, pee clumps bigger than your litter scoop), p/d (polydypsis, drinking the water dish dry) may be seen. When you have a skipped shot or high BG numbers are being seen.

By going from 4 to 3 to 1 units of insulin, some of that "depot" effect" will be diminishing. Niki may need an increase in dose, but try to hold the 1U of insulin for at least 3 cycles, UNLESS she drops under 50 at any time.

Not sure if you want to use the TR or SLGS lantus protocols. Document for you here to peruse in your "copious free leisure time" explaining these 2 methods used here. :bookworm:
Dosing Methods: Start Low, Go Slow (SLGS) & Tight Regulation (TR)
 
Hello there from the west coast. Thanks for getting the spreadsheet up and running. A small request, some of the days or nights do not have doses in the Units cell. Could you either put skip or NS (no shot) in those cells if no shot was given? That way we know it wasn’t an omission in data entry. Data for the 12th is also missing. The Lantus depot takes some time to build, skips impact that timing. So those tests you have gotten mean something different if the 4 units last night was his first dose in 4 cycles.

Out of curiosity, how much does Niki weigh? Darn spell check wants to correct that name to Neko. :rolleyes:

Black ears, yup, I had those too. I had a small flashlight and I put the small piece of gauze I used on top of that and under the ear. That was my surface to poke on and did the trick in illuminating the veins, I also used a very tiny smear of Vaseline on top to bead up the blood, which just disappears into black fur.

Liver values are often elevated in the newly diabetic. Food hasn’t been getting into his cells properly. Should improve once the insulin starts working for him.
 
I just came home early, he missed +5, but +6 = 480 and +7 just now was 600.

Starting the panic again.. Are we still good to go with 1 unit tonight sand tomorrow?

I will fix the spreadsheet and order the "easier" syringes.

Thank you!
 
nikkiaz said:
I just came home early, he missed +5, but +6 = 480 and +7 just now was 600.

Starting the panic again.. Are we still good to go with 1 unit tonight sand tomorrow?

I will fix the spreadsheet and order the "easier" syringes.

Thank you!
Click to expand...

She has very high bg. So yes, she should have her 1 U insulin this P.m and tomorrows A.m and P.m too and onwards. twice a day then.
 
If Niki were brand new to insulin, our dosing methods would have him start at 1.0 unit due to the dry food in the picture. He is not totally brand new, but I don’t think we have enough data to say otherwise, as long as he remains negative for ketones,

Don’t feel bad, on the contrary, you knowingly adopted a diabetic. We love that! There is a learning curve. We have all been there, done that.

You can stop testing until preshot now. His body is reacting to the lower numbers than he is used to and dumping sugars, or what we call bouncing. Perfectly normal for new diabetic.
 
Thank you! I always want to be able to fix/cure my animals right away because I can't stand anyone being miserable/suffering. I know intellectually that's not possible in almost 100% of cases with chronic illnesses, but emotionally that's how I roll.

We will not test again until before dinner as suggested! It will give everyone (including all of you wonderful people) a break!

Thanks again! :-)
 
Deb & Wink said:
@Juls and Billy uses one. maybe she will give you some ideas on a ketone meter to use.
Click to expand...
We got a Precision Xtra for testing blood for ketones. Billy is a shy pee-er, and back when he got bladder crystals, we never could get a urine sample. The Precision Xtra worked great. We got it from Amazon. The test strips are pricey, you have to get the strips specifically for ketones, and they are about $1 a strip. But we just use this meter for ketone testing. We use an inexpensive RelyOn meter to test BGL.
 
Hi and welcome Nancy, Scott and Niki.
Just stopping by to say hi and I’m so glad you found us.
This is a wonderful, very supportive and knowledgeable community which I am sure you will enjoy being part of.
Thank you for adopting a diabetic kitty. Lucky Niki!

Ask lots of questions. We are all very happy to help.
Bron
 
Question of the moment (I can’t promise it will be the question of the day, hah)

When it has been suggested that we keep Niki on 1 unit doses for 3 cycles, what exactly is a cycle please? 3 days of AM and PM?

thank you!
 
A cycle is a 12 hour dosing period.
So 3 cycles would be 36 hours. Or 3 12 hour periods of time.
A day and a half.
But "days" can overlap from one physical day to the next.
3 full days would be 6 cycles.
Two 12 hour dosing cycles per 24 hour period.
A dosing cycle runs from pre-shot test until the next pre-shot test.

Next question please!:)
 
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