New and Confused, please help

Simba the ging

Simba the ging

Member Since 2018
Hi everyone, Simba was started on insulin (lantus) 1 unit twice a day, 2 weeks ago - I give him insulin at 8am and 8pm. He's been switched to a high protein, low carb wet food only diet and gets a snack around 5am, his breakfast at 7am, 4-5 snacks throughout the day, dinner at 7pm and 1-2 snacks before bed.

He had his first curve last night @ the vet( I work there and was there last night learning how to do a curve) and I brought my Bayer Contourglucometer to compare the alphatrak readings. Bayer was .5 lower difference in reading. His whole curve was overall low.. first one 4.8mmol at 9pm, 3.7mmol at 10pm offered him a snack, they missed the 11pm reading, 12am 4.3mmol, 1am 4.6mmol, 2am 4mmol, 3am 4.4mmol, 4am 4.4mmol, 5am 4.2mmol fed him at 5am after reading, 6am it was 3.4mmol on a different glucometer( can't remember name of it) 7am 3.9mmol. Dr told me to fed him once I got him home and give him 0.5 units and test again within the hour, I did and his reading was 2.3mmol - wasn't acting hypoglycemic at all but fed him right away and took another reading at 214pm after he had eaten at 1240 and the reading was 2.9mmol gave him food and tested 15 minutes after and it was 7.6mmol. I'm very very confused/concerned by the readings, something doesn't seem to make sense. He's 100% himself aside from being more tired then usual but he didn't really sleep last night with hourly pokes and dogs being loud etc and being angry at me for taking him to the vet and poking him this morning/afternoon when he got home.

Does anyone have any idea on what could cause the levels to be so low? Am I doing something wrong, can I do something to help? I'm trying not to freak out but I am very much so freaking out... :( :(
Please help,
Thank you ❤
 
Welcome! I'm in Canada so I can understand those numbers, but most folks here use the US mg/dl numbers (multiply by 18). Are those numbers you are showing the AT2 readings or your human meter? While the numbers get closer between human and AT2 at lower levels, I'm still worried for you seeing 2.3 (41) shortly after shot, not clear whether you had fed before insulin, but either way, that's too low on even a human meter. First thoughts, sometimes kitties can improve with just a switch from dry food, their pancreas can kick in and start producing insulin. Lower levels like you saw may mean too much insulin IMHO.

With Lantus, you ideally want to test before insulin shot, feed, then shoot all within around 10-15 minutes. The test you got 15mins after 2.9 (52) is likely food influenced, so if it were me, I'd keep monitoring...how many hours after insulin was that? Just a little tip also, we talk in hours after insulin, so PMPS number would be before shot (pm), and +1 is one hour after shot, +2 is two hours after shots and so on. People here are from around the world, so it helps us all understand what your numbers mean relative to when insulin was given, not our own times due to time zone differences. Lantus *usually* onsets (kicks in) around +2 or +3, and you'll *usually* see the lowest point in the cycle around +5 or 6. There is some more info in the stickies in this forum, see one here for general info http://www.felinediabetes.com/FDMB/...ntus-basaglar-levemir-group-start-here.18139/

That said, and I'm by no means super experienced, but seeing those numbers of your curve done at the vet, makes me wonder if Simba needs insulin. Can you please share what the basis for diagnosis of diabetes was? I'm glad you can test at home, that helps you immensely. Hope others will be along to offer some thoughts.

Oh...and I love the ginger tabbies :smuggrin:
 
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Hi and welcome to Lantus & Levemir Land, the nicest place you never wanted to be.

It's wonderful that you are home testing. That's the best way to keep Simba safe. Can you tell us when you switched him to a low carb food? What were you feeding before? As Christie said, sometimes just switching to low carb can make a huge difference in BG readings. How much does Simba weigh?

Have you read any of the "stickies" at the top of the L&L page? There's a ton of info there, so it can be overwhelming, but the more you know, the better. We are happy to answer questions, too. It will really help us, and you, if you can set up a spreadsheet and record all the BG readings you have for Simba in it. It really makes it easier to see what's going on.

Here are the instructions: http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/. Select the World Spreadsheet Template for Human Meters. You enter your readings in the World page, and it converts it to US numbers on the next page, which makes it easy for those of us in the US to understand. If you need any help setting it up, or understanding it, just ask.

One tip about testing: any time you get a reading that surprises you, test again immediately. Sometimes you get a wonky strip, too little or too much blood, etc. You want to make sure you are reacting to an accurate reading. Also, be sure to give a low carb treat (like freeze dried chicken) with every test. You want Simba to associate testing with good things.

There are some more good tips in this post we put together for new members. It's kind of like an FAQ.

It's okay to freak out a little. We were all new and scared once. We understand. You're in the right place to get help.
 
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There are instances where changing the diet to low carb, catching the disease early and starting treatment right away can have an early remission. We call this diet controlled. Keep monitoring and posting the numbers.... Having a spreadsheet for us to look at helps us to help you.
 
Thank you all - a little back story in his dx, I noticed he was losing wt/muscle mass and acting ravenous even after a meal. I thought he had hyperthyroidism so I took him in and we ran the T4 test and a CBC/ Chem 17 and the T4 came back normal but his CBC/Chem 17 came back with high glucose value of 18.42 mmol/L a high ALT value of 137u/l a high GGT value of 9u/l and a high value of chol 6.06u/l we also did a urine and the glucose in the urine was 54mmol/L he was very symptomatic for diabetes. He last weighed 7.7 kg in feb 2018 and when I took him in on Nov 18/18 he was down to 5.3kg. I switched the diet to low carb as soon as I found out dx. He was previously already on a low carb wet food with RC GI mod cal dry food.
 
UPDATE: after going over everything with Simba's vet, we've decided to stop giving insulin for 2 weeks I will be monitoring his behavior and symptoms very closely and in 2 weeks I'm going to curve him and see if he's actually controlled or not we'll also he running a fructosamine as well as rechecking liver values.

I'm just curious what are the actual odds of him going into remission or being diet controlled so early after dx?
 
We can't really give you odds, but if he was already on a mostly low carb diet, chances are that wasn't a huge factor. There have been cases where high BGs were a transitory thing, however, caused by some outside factor that, once resolved, left the cat in normal numbers. This is not common, by any means.

The thing with a fructosamine test is that it doesn't give you real time data. It's more of an cumulative test. That's why testing is so important. I wouldn't wait two weeks to test him, even though you are stopping insulin. Since we don't really know what caused his diabetes, we don't know if stopping insulin will result in normal or high numbers. You don't want to risk something like DKA, so I would test at least daily, ideally before feeding and 2-3 hours after he eats. In a healthy cat, the BG would be lower after he eats than it was before. This means the body is producing insulin. If you start seeing the numbers go up, don't wait too long to restart insulin.

It's still not a bad idea to set up that spreadsheet....
 
Tricia Cinco(GA) & Harvey said:
We can't really give you odds, but if he was already on a mostly low carb diet, chances are that wasn't a huge factor. There have been cases where high BGs were a transitory thing, however, caused by some outside factor that, once resolved, left the cat in normal numbers. This is not common, by any means.

The thing with a fructosamine test is that it doesn't give you real time data. It's more of an cumulative test. That's why testing is so important. I wouldn't wait two weeks to test him, even though you are stopping insulin. Since we don't really know what caused his diabetes, we don't know if stopping insulin will result in normal or high numbers. You don't want to risk something like DKA, so I would test at least daily, ideally before feeding and 2-3 hours after he eats. In a healthy cat, the BG would be lower after he eats than it was before. This means the body is producing insulin. If you start seeing the numbers go up, don't wait too long to restart insulin.

It's still not a bad idea to set up that spreadsheet....
Click to expand...
I'm going to continue to monitor his sugars and I will be posting my spreadsheet once I have some time. Thank you for all the help! I'm still very confused about this whole situation but I'll definitely keep updating stuff on here and reading all the info on here
 
Agree with Tricia ... daily testing is such an easy way to keep tabs on Simba . Removes the wondering and guess work :) Elmo is in remission and I still test him at least every other week and have for last two years. Really is great way to stay ahead of FD .
 
I suspect that the reason you were getting lower numbers is a combination of getting rid of the high carb food (less effort for the pancreas) and some beta cell healing going on. That means that the 1.0 unit dose was now too much insulin. When you shot the 0.5 unit dose the cycle after that, the depot from the 1.0 unit dose was still controlling the cycle. A larger depot can influence 4-6 cycles after a reduction. It doesn't mean that the 0.5 unit dose was too much.

I'm glad you are going to monitor closely the next few days. If his numbers start to creep up, you may have to start insulin again, though I'd start on something like 0.5 units. Here we find that if you can keep on safely giving insulin and gradually reduce the dose down to zero, you get a stronger remission than just stopping insulin suddenly. But who knows, here's hoping you are one of the lucky ones.
 
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