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Judy and Boomer

Judy and Boomer

Member Since 2014
Hi I am Judy and I have a 7 year old cat, Boomer, who was diagnosed as diabetic in Feb. He is receiving Lantus and I do home testing. Up to very recently we haven't had much luck getting his levels reduced; at 3 units we got readings in the 18-22 range (330-400) and some days they barely dropped at all. I have tried 3.5 and it seemed to drop him too low; I got nervous and went back to 3 units.
This week I tried 3.25 at his 6:00 pm dose on Wednesday. He had high readings for 24 hours then suddenly tested at 8.8 (157). Today his readings started at 6.0 (107) went as low as 3.9 (70) at +8 and were at 4.7 (85) at injection time. I waited half an hour after food and tested again, 5.4 (97). I backed off on the insulin and used 3 units again. Hopefully he doesn't jump back up to 18 (325) ! Should I have stayed at 3.25? It's so hard to monitor him at night.
I'm going to test him again in a few minutes at +2 to see where he's at and potentially give some food.
PS we use timed feeders and he gets 6 meals a day every 4 hours. We feed fancy feast and I choose the lowest in carbs that I can find.
 
ok he just tested at 4.3 (77) at +2. I've given him a bit of food. I plan to test at +4 when he would normally get his bedtime meal (my bedtime, his meal :-D ). May give him food a bit higher in carbs.
Any help/suggestions are appreciated!
 
You may have an active night. If you don't have a lot of test strips and some higher carb food or syrup, then I would go out and get it now. I hope Boomer surfs along in nice flat numbers all night for you.
 
It will help if we can see some numbers with respect to when you gave insulin.
You can just list them
AMPS (AM Pre-Shot), dose given
+# for any test done # hours after the shot
+5 would be 5 hours after a shot
+7 woulc be 7 hours after a shot, etc.
PMPS(PM Pre-Shot), dose given

We use a standard spreadsheet to display our numbers for others to review. We use Google Drive, so it is stored online and you choose how much you want to share it - view only, view and edit, or no access.

Instructions are here

Understanding the spreadsheet/grid:

The colored headings at the top are the ranges of glucose values. They are color-coded to clue you in as to meaning.

Each day is 1 row. Each column stores different data for the day.

From left to right, you enter
the Date in the first column
the AMPS (morning pre-shot test) in the 2nd column
the Units given (turquoise column)

Then, there are 11 columns labeled +1 through +11
If you test at +5 (5 hours after the shot), you enter the test number in the +5 column
If you test at +7 (7 hours after the shot), you enter the test number in the +7 column
and so on.

Halfway across the page is the column for PMPS (evening pre-shot)
To the right is another turquoise column for Units given at the evening shot.

There is second set of columns labeled +1 through +11
If you snag a before bed test at +3, you enter the test number in the +3 column.

We separate day and night numbers like that because many cats go lower at night.

It is merely a grid for storing the info; no math required.
 
Hi Judy,

Welcome to FDMB! I'm so sorry you have to be here, but I'm glad that you found this site. It's fantastic that you're testing at home! Dyana is right - you may be in for an active cycle tonight. What type of meter are you using?

What was your original starting dose for Boomer back in February? Sometimes, the vet starts the kitty on a dose that is too high. That could result in the high numbers you're seeing. Sometimes, the dose is "right," but the kitty bounces. With Lantus, we base the dose on the numbers we see at "nadir" - that's the lowest point in the cycle and is usually somewhere between 5 to 7 hours after the shot.

BJ mentioned the spreadsheet to you. If you could get one set up, that would help our experienced users figure out what the optimal dose might be for Boomer. If you'll stick with us here, those experienced members can really help you. They helped Jersey, my diabetic kitty, and I. We're now officially off of insulin and in remission!

Are there questions you have that we can help answer?
Shelly
 
Hi Judy!

Glad to see you made it over here. :-D You're in good hands and I'll be checking back here in case you need anything.
 
just saying hi - i posted on your facebook post about Boomer. i'm glad you found FDMB and have posted.

i'd give Boomer some food - is he a cat that will eat as much as you put out, or does he get full? if he'll eat endlessly, i'd give him a tablespoon or so of his regular food. if he's a delicate eater, you might want to give a teaspoon of the low carb and test again in a half hour.

When the +2 is much lower than the preshot number, that tells us to be extra vigilant because the cat's blood sugar is really moving. People will be glad to hold your hand through this - just post. if you don't get help here, you can also post on the Lantus/Lev Tight Reg support group - there is a lot of traffic there.

Here are the directions for handling low numbers:
DON'T PANIC! or HOW TO HANDLE LOW NUMBERS

First, try to not panic. Post to the Lantus Insulin Support Group or on the Health Board. Make sure your subject line indicates you are concerned about a possible hypo and/or add the 911 icon to the first post in your condo. People who are experienced in dealing with low numbers will be there to help. After posting, remember to refresh your browser periodically to see if people have replied.

It’s important to recognize that just because your cat may be experiencing low BG numbers doesn’t mean that your kitty is critically hypoglycemic. Many cats will have low numbers and never have symptoms. It’s important, though, to bring those numbers up into a safe range. ALWAYS make sure you have a stock of test strips, high carb (HC) canned food that contains gravy and is over 15% carb such as Fancy Feast grilled, marinated, or Gravy Lovers varieties (see Dr. Lisa's Cat Food Nutritional Composition List for a full list of options), and/or a simple sugar solution such as Karo/corn syrup, honey, maple syrup, etc.

If your cat is experiencing symptoms, especially if those symptoms are severe, you need to rub Karo syrup, honey, or maple syrup on the gums or, if symptoms are very severe, administer rectally and get your cat to the nearest 24-hour emergency facility. Take the bottle of syrup with you to administer on the way if necessary. (Note that it is rare that we see episodes of symptomatic hypoglycemia with Lantus and even rarer to see severe symptoms. But, you need to know what to do should they occur.)

The symptoms to be concerned about include but are not limited to:
staggering, uncoordinated movements, 'drunken' walk, wobbling, balance problems
ataxia - usually lack of muscular coordination, but maybe changes in head and neck movements
disorientation (yowling, walking in circles, etc.)
twitching
stupor
convulsions or seizures
coma
If your cat is testing in low numbers and you are not getting a quick response to your post, there are several things you need to do. (Low numbers are under 50mg/dL or 2.8 mmol/L.)

Depending on how carbohydrate sensitive your cat is, feed approximately a teaspoon or less of gravy from high carb food or high carb food only.
(If you have a cat with GI issues, using a couple of drops of syrup plus low carb food is an alternative.)
Test again in 15 – 20 min. Depending on the numbers, give more HC food.
Repeat the above steps every 15 – 20 min. until your cat tests in the 50 mg/dL (2.8 mmol/L) or above range for 2 consecutive tests. Continue to feed in small amounts to keep numbers in a safe range.
Test in 30 - 40 min. and repeat the test and feed process until there are 2 consecutive tests where numbers are stable or rising.
Test in an hour and follow the same steps.
DO NOT become complacent. If number have risen after one or two tests, it’s important to continue testing. Numbers may bobble up and down as the HC food and/or Karo wear off. DO NOT get one test where your cat has risen from low numbers into the 50s and go to sleep or leave the house. You are putting your cat in a risky situation. When in doubt, leave HC food out.

In the case of an accidental overdose or should there be symptoms of hypoglycemia, even if you have caught this in the early stages, you may need to monitor for literally 16 or more hours. Lantus and Levemir are long acting types of insulin. This means if your cat is over dose, you will need to stay alert for hours in order to closely monitor and to keep your cat safe.

Please post your numbers. Those people who are helping you will not abandon you. In fact, they are staying up with you. The experienced people will even work in shifts to make sure your cat is safe and you have the support you need. Remember to refresh your browser to see new posts and keep posting so we know all is well.

~ written by Sienne and Gabby
Click to expand...

Welcome to FDMB! The best place you never wanted to be. :-D
 
just did another BG 4.9 (87) gave him his dinner as per normal but I did add a wee bit of higher carb fancy feast into it. Have set up a snack for him in 2 hours; wee bit of normal ff and wee bit of higher carb ff
Also has his normal +8 meal set up
I probably wont sleep much tonight worrying about him so testing in a couple of hours probably won't be a problem.
 
Good morning everyone
So I tested Boomer twice last night. At +5.5 his BG was 5.4 (97) and at +7.5 it was 5.9 (107). I had mixed some high carb fancy feast into his low carb fancy feast and given him an extra snack during the night. He last ate at around +8.

Now at pre injection he's at 4.7 (85). This is exactly where he was at his last injection time. He's eating now and again I have mixed high card with low carb. Think I will test again in 30 minutes and as long as he isn't lower I will give 3 units. I know that it usually takes him 24 hours to respond to a change in insulin, both upwards and downwards, so I'm fully expecting numbers to jump drastically later today however I will be happy if they stay where they were overnight!

Any suggestions/advice?
 
That sounds like a good plan, Judy, as long as you have all the supplies you need and will be home (and awake) to monitor.
It's hard to help with your dosing question, without seeing a spreadsheet. Maybe you could set one, between tests today?
 
Half an hour after eating a medium fancy feast he is up to 6.9 (125) so I've given him 3 units and will monitor today. Historically 3 units didn't do much to lower BG levels but I'm hoping this time is different.

Question: What I don't get is how 3 units barely moved his BG levels down from 18 (330) yet 3.25 brings him down to such low numbers(65-85). I would have expected, when we started off with one unit of insulin, that gradually his numbers would come down as we gradually increased insulin dosages.
 
I would not give insulin at that BG reading.

I would have expected, when we started off with one unit of insulin, that gradually his numbers would come down as we gradually increased insulin dosages.
Click to expand...


You may have missed your optimal dose and he is rebounding. You may want to start back at 1 unit and wait at least one week between dose changes before you determine if you need to increase it. If an increase is needed, only increase it by 1/4 to 1/2 unit. Again, wait at least one week before increasing again. Rebounding means the dose is too high and in order to protect itself from becoming hypoglycemic, your cat is producing extra glucose. That is why the BG readings are high. By starting over and increasing slowly over a period of weeks, you are more likely to find the best dose that works to keep the BG levels under control. His pancreas may also be starting to work, so you may be able to eventually control his diabetes through diet.

For newbies, we recommend not giving insulin if the BG is below 200. If you have given insulin, please keep an eye on him. If the BG reading at the next time his dose is due is 100 or less, I suggest you skip the dose. His pancreas may be starting to work.
 
Back when he was first diagnosed we may have increased it too quickly. We had vacation planned and the timing was horrible. Boomer wouldn't let our pet sitter inject or test him so he went without insulin for two weeks. When we got back end of March we started all over at one unit and gradually got up to two. When he wasn't responding at all we did more blood work and a urine culture and found a urinary tract infection. Two weeks of antibiotics made no difference to his levels. We increased it to 2.5 then eventually to 3. Still not much of a response. Up to 3.5 and he responded but the low levels (not hypo but low enough to make me less than comfy) caused me to decrease it to 3.25. Levels still too low for my comfort so went down to 3 last night. Knowing that he doesn't usually react to a change for about 24 hours I'm waiting to see what happens this evening and meanwhile I'm managing his levels with food.
 
It'll help us help you if you post your numbers like this:
AM Pre-Shot, dose
+# for each test done between shots
Ex. to look for the Lantus nadir (lowest glucose) you might test at 1 or more of these 3 times over several days)*
+5
+6
+7
PM Pre-Shot, dose

(For Levemir, the nadir is later, so you would try testing between +7 to +9.)

When possible, putting your data in our spreadsheet grid will let us see patterns over several days. It is set up to color code the test numbers, which let's you see overall trends by shifts in
colors. Instructions are here.
 
Trying to start the spreadsheet now but here are today's numbers

pre shot 4.7 85 did not give insulin at this time, pending reading at +.5

.5 6.9 125 3 units given
+2 5.5 97 gave medium carb snack
+3.5 3.5 62 gave medium carb meal
+4.5 3.1 55 gave high carb snack
 
The reason people are encouraging you to get a spreadsheet going is that we know that individual numbers don't mean nearly as much as numbers in context. With Lantus and Lev both, it helps to see at least 2 weeks for the overall picture of what's going on, and the past 3 days to be able to suggest what is happening right now. Their longer-lasting action really makes a difference.

It is possible Boomer is overdosed, but i think if you can get a spreadsheet up for us it will become obvious if he is or not. I actually wouldn't drop back to 1u and start over at this point, but focus instead on getting us the data so we can help you assess if that's the case. I'm not disagreeing with Lisa in general, i'm just thinking that in your case, at this time, i'd give us the ss data so we can help you decide where to go next. It's absolutely true that a "good" dose can be missed with too big of increments, and the overall look of the spreadsheet can be high high high, with little change evident from dose increases. That could very well explain what has been happening. There are also cats that need more than the average amount of insulin and immediately decreasing without assessing that particular cat, can leave them in higher numbers than they need to be. I had one of those cats that arrived here on 3.5u and needed it, so i like to see people's data before assuming that you don't have that type of situation.

but now you're seeing good numbers - so since you're here where you can now get help from people who understand dosing and feline diabetes, if we could see the spreadsheet we could help you decide when/if he needs a reduction. He might be ready right now - it's a good sign to have flat numbers in the 50-120 range, because that allows the pancreas to heal and begin producing insulin on its own. However, when a person shoots a low number, it's very important to get a +1 and +2 to begin with to make sure the cat isn't diving, and then to monitor the cycle to see how low the cat is going.

Sounds like you've got a lot of this down already, but if you could get it so we can see it in context, we'll be able to help you.

You may have gotten to a point where things are "clicking" with Boomer and his pancreas is beginning to heal.
 
great - i'm just seeing your post above. Continue to test every 30 minutes and give a teaspoon of the gravy from high carb or a drop or so of karo syrup if he goes under 50.

Keep retesting until he stays over 50 for at least an hour without needing food to bump him up.

you're doing great, judy!!
 
I would test in 30 minutes. You want to try to get her up into the 60s. Hopefully, the high carb snack will get her up a little.
 
hold on, judy - you want the world template and it will convert the numbers for you. You enter in mmol on one page and we look at the US numbers page. let me grab the link for you.
 
Look on this page http://www.felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207&start=0 and go down to where it says "if you're posting in US numbers, use this link and if you're posting in mmol, use this world template." You want the world template.

Then when you link it to your signature, which YES WAHOO is working, link the page to the US numbers. That helps us who are trying to help you. The current page you've linked is super long (like over 15 pages) and full of zeros. i'd start again with the link above.

sorry for the confusion!
 
Not sure where my last post disappeared to!
Just tested at +5.5 and he's 2.6 so close to 50. Gave him some higher carb fancy feast and threw in a few pieces of purina DM for good measure since it's supposed to be between 14 and 18 percent carbs.
Must tell you though that he is acting perfectly normal....he's been playing a bit with our other cat and rolling around and he loves to play with his diabetic supplies (especially the tape roll that I hold at his ear when testing) and he's washing etc
 
just for a little perspective - the 50's are perfectly safe. The 40's are too, but in a cat getting insulin we use the 40's as our "take action" zone. It's the safety margin to keep him out of the 30's or lower. Those are the numbers to be concerned about. He's in absolutely no danger at this point, just keep monitoring every 30 minutes, as Dyana is saying.

Non-diabetic cats often test normally in the 40's.

the kibble may send him high for a day or so. it takes longer to get in the blood stream and longer to work out. We encourage people to get rid of every bit of dry pet food in the house, otherwise the kitters find it so irresistible that they inevitably get into it. you can stick with the gravy or karo. most of the carbs are in the gravy, so we use that instead of the food to bring up numbers. if you give food every half hour some cats will get full and refuse to eat more, which is why we squeeze the gravy out (put the lid back on the can and squeeze super hard) and give it. Or karo, honey, maple syrup are all good too. just a drop or two will bring up the numbers.

You've got the right spreadsheet now! woot! just fill in your numbers on the world page and it will magically be in US numbers for us on the other page. You'll also want to name the page something with Boomer's name in it.
 
2.6 again so same as last time maybe he's finally reached nadir and hopefully next reading will be higher.
dry food that was given before was only a few pieces, maybe 6 or 7 and I see there are 2 left on the plate

Should I do anything more right now? give gravy?
 
Just make sure to retest and see if the numbers are rising. The dry food takes longer to get into the system and will stay in longer as well. So dont give any more dry food. Just stick with gravies (HC) and feed a spoonful at a time. That way he isnt filling up to quick and he will want to eat more if need be.

So have you tested again?
 
Also, with the 47s Boomer gets a reduction! So you have a choice, you can shoot through the bounce tonight (shoot the same dose) and reduce tomorrow morning, or go ahead and reduce on his PM dose. Reduce to 2.75u (reductions are done .25u for each reduction). :mrgreen:
 
So you think maybe his pancreas is starting to work again? Well that would be awesome. I will continue to post numbers today and confirm in about 4 hrs that he should be reduced!
 
Good job, Today, Judy. You should reduce anyway, it's just a matter of whether you do it tonight or tomorrow morning.
If he bounces over 300 at PM shot time, then you can choose to shoot through the bounce (shoot the same 3.00 dose) tonight or do the reduction tonight.

I think there's hope ;-)

Good job getting the ss (spreadsheet) up too. Thanks it helps to see the numbers and the patterns.

If he just got a 43, then test again in a half hour.
 
I see the 41 on your spreadsheet. I don't see any indication of half hour testing on your spreadsheet, so am wondering if you are at 9 hours after the shot now. If you want to see how to add half hour testing results in your spreadsheet, you can look at mine. It's a good experience to look at other people's spreadsheets. When you type anything other than the one test number in a box, you will have to manually change the color of the box and manually change the other (U.S.) linked spreadsheet.
If you are at +9 now, and she is at 41, then I would still continue to feed her. We have a saying Feed The Forties, no matter where in the cycle they are. Otherwise, we try to hold off on feeding from two hours before the shot until shot time.
 
Okay, so that's fine. I see the 52 and that's good he's coming up a bit. You can hold off on the feeding and be sure to get a +11.

On the spreadsheet, the AMPS column is the test at the time of the shot, so if that was at 6:30am, then that's the number you put there. If you test again at 7:30am, then that's the +1 test and you put that number in the +1 column, etc.

If you test every 30 minutes or at the +.5 hour mark, you can make that note in the box, but you would need to add the color manually to the box. I guess I'm being confusing :-|
 
The tests have been hourly. Looks like nadir may be later than +6 based on the last two days curves. So I should give 2.75 tonight? What if he is still low then?
 
If he's still low then, then I would recommend skipping the dose and letting his depot drain a little.

How many hours or minutes until shot time? I need to run to the store, but want to be here for you.
 
You could also give an even bigger reduced dose tonight, depending upon his numbers. Let's see where he is at +12. Do you have lots of test strips still?
 
yes I just bought them yesterday.
He went down again to 2.6 so about 44.

He's not very hungry now because of course he's had several small meals earlier before I realized I should just give the gravy. Normal injection time would be less than an hour from now. I think I may be skipping it; partly because his levels are still so low and partly because I don't think he will eat much at that time.

Thanks so much for your help with Boomer!!!
 
Yes, you will be skipping tonight. Good job, today. Boomer's ears can rest a bit.
Since you're skipping, if you want to, you can easily adjust his shot time tomorrow morning to what ever would work best for you.

I would still get a few tests in at least for the first part of the night as he still has the depot of insulin in there.

I am asking for some more Lantus experienced eyes on your condo. Maybe we can adjust his dose even further back.

I would do a dose reduction tomorrow morning, no matter what, even if he's high.
 
I am really hoping he is up before I go to bed which is +6 from now lol.
He's been a very good boy for me today and very tolerant of the ear pokes.
I'll keep on testing and posting the results. And I look forward to hearing what the Lantus people say!
Tomorrow morning's test/shot will be early; it has to be early to work with my schedule when I have to go to work Monday-Friday. I can delay until about 7am (it's 5:45 pm here now) but that's it!

Thank you so much for your help today!
 
This is what I did. I figured out what would be the latest time that I normally get home from work and made that time my PM shot time, and that allows me the most amount of time (which isn't much :roll: ) to stall in the mornings or get some extra tests in before I leave for work.
 
Evenings aren't an issue for us; it's the mornings. I leave around 7:30 so I don't have much time to test or decide if/what to shoot.
 
You can try one drop of syrup. If he's not getting his shot, then it's really late in the cycle and the affect of this morning's dose anyway, should be wearing off.
 
I figured, the latest I normally get home from work is 6:00pm, so I made that my dose time. I leave the house at 7:30am, so I only get 1 and 1/2 hours in the morning for testing, but that's the best I can do.

+11 tests can be really helpful information.
If you get a +11 of say 100, and his next (pre shot) test is 125, then you know he is rising and it may be safe to shoot depending upon how comfortable you are with the number.
If the +11 test is 100, and his +12 test is 89, then you know he is dropping and you may want to stall the shot, without feeding, to see if he keeps dropping. You don't want to feed within 2 hours of shot time (unless below 50 like you did tonight) as the food will influence the BG numbers and you won't then know whether the rise in BGs was just the insulin wearing off or the food he just ate.

If he won't eat, take the food away and then try again in about 10 or 15 minutes, or try warming it slightly. If he seriously won't eat at all, then I would rub a drop of syrup on his gums. Test again in 30 minutes.

You're being such a good boy Boomer cat_pet_icon Give him some appreciative pets from me.
 
he didn't each much of the food with the syrop on it but I offered him some of his normal low carb food without the syrop and he ate some. Not as much as usual but then he's had several smaller meals today.
 
Judy

I'm going to send you a private message so check in the upper left corner of the page. You will see "User Control Panel" and then "__ new messages" with the _ being how many you have. I can get your SS linked in the correct place but let's sort that out by PM.

Great job today with Dyana. Super job, Dyana. I agree it's a good idea to skip and drain the depot a bit.
 
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