Need help regulating insulin levels, newly diagnosed

[Marvin's Mama]

Hi,
My 13 year old cat Marvin was diagnosed with Diabetes in November. I have started home testing his blood levels (we're not very good at this yet, and I've only done a few readings).

-At the end of December we were at 3 units twice a day. Home tests of his glucose were 38 (at 4.5 hours after an insulin injection), and the following day another reading of 135 at the same time as an injection. Though Marvin wasn't acting strange, the numbers scared me and I dropped him down to 2-2.5 units. On the lower dosage, his thirst was a lot bigger than it had been, and I brought him back up to 3 units, and recently had a visit to the vet.
-At 6 hours after an insulin injection, the vet's readings were 57 (my glucometer gave a reading of 42 and 49 while were were there).
-Following the visit, we dropped Marvin down to 2 units. During the week his readings were 95 (5 hours post injection), and 175 (time of injection). The vet was very happy with these numbers, and told us to drop down to 1 unit. (I thought the numbers were high...)
-Marvin's been at 1 unit, twice a day, for 2 and a half days now. His glucose level this afternoon was 59 (6 hours post injection). I am very surprised by this number - his thirst is really high!

Even though this last reading was low, I am still concerned about him being on too low a dose of insulin. I thought he should stay at 2 units longer, I felt like his blood readings were high at 2 units.

I'm also concerned with my glucometer and readings being off. Sometimes the strip sits out for 10 minutes before a reading - Marvin gets up right before I'm about to poke him, and I need to re-comfort and calm him. It's the sound of the strips jiggling in the container that scares him, so I need to get them out well in advance! At the vet, I let a strip sit for just a few minutes and also used a fresh strip to see if there was much difference. There was a slight difference, but it was only out for 3 or 4 minutes.
For the last reading, I had a strip out and ready in the meter, got blood, touched the strip to the drop, and then realized that the strip must have been in the meter too long and was no longer accepted. With the blood drop still on his ear, I put a new strip in the meter and used the same blood drop. Should I have wiped the drop away and massaged his ear for a fresher drop? The existing drop was sitting there for maybe 30 seconds max, but had been touched by the non-working strip. Is this going to affect the reading?

Any thoughts regarding the insulin dosage would be great! Thank you!

 

[Sue and Oliver (GA)]

What kind of insulin? (it makes a difference in dosing)

. One thing that might help is to get the blood on your fingernail, then operate the meter away from the cat and test the sample.

For reference, we consider a cat regulated when they are in the mid 200s at preshot and in double digits at nadir (but above 50 ). So your cat seems to be in very good numbers. You can shoot lower numbers once you have some data to help you figure out how low your cat might drop on a given dose. Since you have very little data, we'd probably urge you not to shoot under 200.

As you get better with testing and have more data, you could shoot safely at lower numbers.

 

[Larry and Kitties]

Welcome and good for home testing.
you said "the vet's readings were 57 (my glucometer gave a reading of 42 and 49 while were were there)" That is good agreement between the different meters and taking different masuremnts. The accuracty of the home devices is +/- 20%.
As Sue said, the BGs at 1 unit is good.

 

[Marvin's Mama]

Thank you! I use Lantus. I'll keep him at 1 unit now, thank you both.

One thing that might help is to get the blood on your fingernail, then operate the meter away from the cat and test the sample.

This sounds like really helpful advice, Sue! I assume that I need to put vaseline on my nail to keep the drop as a droplet?
I think we'll be much more successful this way, and I will plan on charting Marvin's curves soon.

 

[Wendy&Tiggy(GA)]

I would try and get some more tests in - if he drops below 50 then thats indicate the dose is too high. He might be doing that and you are missing it. he could be heading to remission.

By the way, not all cats drop low at +6 ( 6 hours after shot). It varies quite a bit and many drop lower at night than during the day.

Also if he stays 50-130 for a week thats another indication dose is too high. Dose decreases are usually done in 0.25 unit increments.

 

[Deb & Wink]

-At 6 hours after an insulin injection, the vet's readings were 57 (my glucometer gave a reading of 42 and 49 while were were there).

What kind and brand of meter are you using? Human glucometer or vet specific?

It makes a big difference in the interpretation of the numbers.

 

[Marvin's Mama]

What kind and brand of meter are you using? Human glucometer or vet specific?

It makes a big difference in the interpretation of the numbers.

I'm using a human glucometer - the One Touch Ultra 2.

I would try and get some more tests in - if he drops below 50 then thats indicate the dose is too high. He might be doing that and you are missing it. he could be heading to remission.

By the way, not all cats drop low at +6 ( 6 hours after shot). It varies quite a bit and many drop lower at night than during the day.

Also if he stays 50-130 for a week thats another indication dose is too high. Dose decreases are usually done in 0.25 unit increments.

I would definitely bet that he is dropping much lower at night based on his actions. We've been increasing and decreasing by 1 whole unit, as the vet has told us. I thought that seemed a little extreme, and asked if we should use smaller increments....
Since we're at 1 unit now, I will decrease by .25 next week assuming his levels stay relatively low.

 

[Deb & Wink]

Hi Marvin's mom! Would you share your first name with us please?

I'm also concerned with my glucometer and readings being off. Sometimes the strip sits out for 10 minutes before a reading

It's ok. The strips will be fine for quite some time after you take them out of the container. What will affect them is moisture and high temperatures. So make sure your hands are dry before you take them out of the container. There is a bit of desiccant in a closed off part of the test strip container. This helps to keep things dry. Just remember to tightly close the lid after you get the test strips out, so the desiccant can help to keep things dry.

I often take two strips out of the container. This gives me one on 'standby' in case I get an error with the first test strip. If I don't need it, I pop it back into the container when I'm putting away my testing supplies.

For the last reading, I had a strip out and ready in the meter, got blood, touched the strip to the drop, and then realized that the strip must have been in the meter too long and was no longer accepted. With the blood drop still on his ear, I put a new strip in the meter and used the same blood drop. Should I have wiped the drop away and massaged his ear for a fresher drop? The existing drop was sitting there for maybe 30 seconds max, but had been touched by the non-working strip. Is this going to affect the reading?

Meters time out after a couple of minutes. You might try only pushing the strip part way in, have everything ready including Marvin, then poke, get blood drop formed and then push the strip the rest of the way into the meter and then test. No need to wipe the drop away and get a fresh drop, at least if the remaining drop is big enough. Having the drop touched by the non-working strip will not affect the reading.

By the way, would you be willing to put some information into your signature? (User control panel, profile tab, edit signature) It would help us to help you better. Something like this:

your name & Marvin (13 yr old, male)
dx date 11/xx/2013
Lantus and One Touch Ultra 2
food being fed
any complicating medical conditions (DKA, steroids, pancreatitis, CRF, etc)

 

[Marvin's Mama]

Ahh, Sorry! I'm Marisa!
Thanks so much, this is so helpful and really calms my nerves!

 

[BJM]

[Glucose reference ranges are unsubstantiated and have been removed by Moderator]

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How to use the glucose reference values chart:

When you get a test, look for the number on the chart that either equals, or contains, the test value you have. Read the information. As needed, make a decision and act.

Ex. You are a new insulin user and you test your cat before giving insulin. The test is 300. It probably is safe to give insulin.

Ex. You are an established user of Lantus, following the Tight Regulation protocol. You've tested around +5 to +7 to spot the nadir. It is 200 mg/dL. You probably need to increase the dose, following the instructions for the protocol.

Ex. Your cat is acting funny. The eyes are a bit dilated. You are concerned and test the glucose. The number is 35 mg/dL. ACK! The cat may be in a hypoglycemic state. You quickly follow the HYPO protocol linked in the glucose reference values chart. (which we really, really, suggest you print out and post on your refrigerator.)