NEED ADVICE!

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DiegoBones

DiegoBones

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Okay, so my Diego has been on insulin for only three days now. Before eating this morning he was at 19.8 mmol/l (356.4) that was at 8:30. I tested him again now, thinking I would do it every 6 hours, and do it before I give him his lunch. (He's on wet food) Well my most recent blood glucose reading was only 8 mmol/l (144). I'm not overly familiar with what all this means, only that my vet had said that 4 - 8 is the normal non-diabetic range and he should not be in it. My vet's office is closed on Sundays or I would just call her. He is on 3 units of Lantus every 12 hours. I'm just wondering if I should be concerned, and then if he is still so low at his next scheduled injection than should I skip it? There is an emergency number to call, but I figure once he has something to eat it might change..? He's seems happy enough, he's having a bath, but when I asked the vet what I was looking for in the numbers she said 4-8 is normal for non-diabetics but quite low for a kitty like Diego that has had numbers as high as 26 mmol/l (468). Any thoughts? (Thank goodness for this message board and all of you who take the time out of you day to respond!)
Laura and Diego
 
Hi, Laura. I'm still learning, too.
My cat dropped to a normal reading within a few days, too. If that low reading is near the nadir of the cycle (the point where the insulin is at its peak, usually around 6 hours after the shot), then it will probably go back up. I would check again in a couple hours.
Have you read the sticky at the top of the forum page that talks about what to do about hypos?
Make sure you have, and make sure you have hypo supplies (syrup, honey) around in case he goes too low.
 
Thanks for your prompt response. It is good to know that other kitties go into the "normal range"... I guess I don't have to freak out. (There is so much to get used to with this!) I have read a lot about hypo attacks and it may be why I was so panicked to see the low reading - his lowest so far. He is a sleepy, lazy guy on good days so I worry about missing any signs. :)
 
You can quit freaking out right now - 144 is NOT a hypo number or anywhere near a hypo number! It's a GOOD thing so BREATHE!!!

Once more...breathe...

NOW - DANCE!!! NICE!!!

That was a fairly significant drop so he'll probably 'bounce' so don't panic when the numbers go way back up. A 'bounce' is caused by the liver 'sensing' that the bg level is lower than it's been used to lately. As a safety measure, it dumps lots of glucose back into the bloodstream.

HUGS!
 
Yeah, 144 (8) at six hours out is niiiiiiice. That was my Pearl's favorite BG level. She was always most active around 145. I would check again in two hours, to see if he had reached his nadir (low point in cycle) or is going up again. Or maybe holding steady (particularly once we were on Levemir, she often leveled off for a while.) This is just information that is good to know. It helps you get a feel for what the whole 12 hour cycle looks like. That is the beauty of hometesting. On top of saving lives (if they go too low) it arms you with information about how YOUR cat is doing on a dose of insulin. It's outstanding!!!
 
Looking at your first post, Diego is on 3 units twice a day (3u BID). That is a fairly high dose, you caught this early, before noticing symptoms, and seem to be changing foods. I do not know what foods he is actually eating, could you clarify that? I wanted to say, you may really need to test frequently because of those factors, particularly catching it early before noticeable symptoms, being on lantus and the dose size. Lantus and food change in an early diabetic can cause remission quite quickly. I would not even be surprised to see you post him low at shot time. So I think right now you need to be particularly vigilant about testing. This is not meant to be scary, it's just a heads up that you have a lot of factors going that you may not have a cat that is on insulin very long, and you need to watch numbers to see what is going on. You are doing a great job for such a new diabetic cat parent!
 
Hi Laura,

Racci is on Lantus also and sometimes she drops to a 61! That's when I panic but so far no hypo. I just give her something sweet that she likes. So as you were told by, it's not unusual at all and actually good if he's normal at his nadir. Great number!

I would test a little more often in the beginning, every 3 hours. So you know where his high and low points are because every cat is different and it's helpful to know how high and how low he is going.

You also might want to post on the Lantus board where the Lantus experts are.

Melanie & Racci
 
What kind of meter are you using? You, and your vet, should be aware that the meters designed for humans on average give lower numbers than the lab tests or the cat calibrated AlphaTrak. The 4-8 number is the normal range for the lab test/AlphaTrak, with a human meter the normal range is more in the 2.8-6.5 area.

You might want to give this paper a read http://jfm.sagepub.com/content/11/8/668.abstract (full pdf is available at this link) and give it to your vet if he/she is not up to date on the latest diabetes treatment. Things have changed pretty dramatically (for the better!) in the past few years, and with home testing so readily available it's now possible to safely aim to keep a cats BG levels in the normal range. Even if you don't aim to follow the tight protocol in this paper (or the modified version on this board), this article contains some very useful info about the numbers that are safe when read from a human blood glucose meter.
 
chiming in here, you have been given great advice. Please do test more frequently after this "lower than usual" reading. Another piece of info that will help in understanding Diego's insulin use is how much he weighs.

3u BID is a lot to start a cat out on and you could see a sudden drop in overall BG levels. Lantus is an insulin that builds up a slowly dispersing reserve in the body. When you start it takes up to a week for this reserve to get filled. With a large dose you can get a corresponding big drop once it reaches full effectiveness.

Lantus is dosed by the lowest number in the cycle, not the preshot BG because of this carry over. We test preshot to be sure that BG levels are not too low to give insulin, knowing that when we have onset they will go lower still. If you have fed in the 2 hours before preshot testing, that can make the levels look higher than the actually are, you are testing before the insulin still in the body has a chance to use it up. Then you can get a sudden drop.

As for you vet saying normal levels are too low for a cat on insulin, I think he is used to owners who do not monitor closely and aren't prepared to deal w/ low numbers. for new members we recommend not shooting if preshot BG levels are in the normal range. Post here and we can walk you through it. You will see those of us who have been here for a while shoot in the normal range all the time. But we have experience on how our cats react and know how to get them up from dangerous numbers. Don't try it on you own at first! Read the info above on being prepared to handle low numbers and have your kit ready and waiting.
 
Thank you all (again and again) very much for the responses. I just tested Diego again and he is up to 12.3mmol/l (221.4). He is supposed to have dinner (Wellness canned wet food) and then his insulin injection at 9p.m (3 units). I've heard it mentioned many times that it is a high dose... Should I be worried about giving him this injection?
 
144 is a nice HEALTHY low reading. If you're concerned keep an eye on itty and test again in an hour or so. But 144 is NOT Hypo. It means you're right on track for finding the "sweet spot" or optimum dose.
 
DiegoBones said:
Thank you all (again and again) very much for the responses. I just tested Diego again and he is up to 12.3mmol/l (221.4). He is supposed to have dinner (Wellness canned wet food) and then his insulin injection at 9p.m (3 units). I've heard it mentioned many times that it is a high dose... Should I be worried about giving him this injection?
Click to expand...

If he has not gone lower than that 144 and you are feeding the same, you are probably ok. This is where getting tests between shot tests really comes in handy. Gives you a feel for what is going on. If his preshot is near what he has been all along and the lowest you have seen him go is 144 and you haven't changed his food, you are probably good for now. Just try and get some more spot tests. (I always found +4 and +8 - that is four and eight hours after the shot- to be very helpful. Or +3 and +6 and +9 for a mini curve.)
 
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