New Member - 11/25 - Mimi - Questions about dosing

[Lena1]

Hello! I just joined this group despite my cat being diagnosed with diabetes for about 6 weeks. I am feeling behind on getting all of the info about cat diabetes and a little stressed about my situation. I am located in the US and am on Eastern time. My cat Mimi, 13yo female, was diagnosed with diabetes when her blood work came back with blood glucose level of 522 mg/dL. She got a urinalysis and did not have ketones. This was a new vet since I had to move for a job. Mimi went in for an in-vet blood glucose curve on 10/18/2022 and her BG was 375, 310, 436, and 322 throughout the day. They started testing at 8am and tested in 2 hour increments until 4pm. After this, they decided to put her on 2 units of Lantus twice a day every 12 hours. After 2 weeks on 11/2/2022 they did an in-vet BG curve again and her numbers were 270, 379, 445, and 318. They said to keep her on 2 units and bring her back in again in 2 weeks since her levels weren’t in the normal range. I wasn’t able to take her in for another curve because I was sick and then the Thanksgiving holiday came up, so I decided to start giving at home testing a shot. I went to my old vet today (since I’m visiting the area for Thanksgiving) to learn how to test BG in person, and on the Alpha Trak 2 monitor at 3 pm (7 hours post 2 units Lantus) her glucose was 46. The tech was concerned so she took her to the back to do a BG test from a vein. It was 76. The vet said that this is fine and told me me to cut her insulin in half to 1 unit and continue administering at the 12 hour mark. I tested her at 7pm and her BG on the AlphaTrak was 112. I thought this might be too low to give her insulin but since the vet today said she was fine, I did my best to estimate .5 units (rather than the 1 unit recommended). At 9:15pm, I tested again and it was 92. I’m nervous her levels will get too low. She doesn’t seem to have any symptoms of hypoglycemia and is acting normal. When is low BG considered too low on the pet monitor? How often should I be testing tonight? Should I have skipped the dose tonight based on these numbers? When is it better to skip vs give a small dose? I don’t have any high carb food besides treats so I gave those to her after I took the 9pm test. Also, for some further information, I have been giving her insulin at 8am and 8pm (previously was 7:30am and pm but I got behind). I switched Mimi to Young Again Zero about 3 weeks ago and she really likes it. I have tried to do wet food but she doesn’t really like it and only licks up a little bit. Other health conditions: Mimi also has bladder stones which we found out caused acute kidney disease (which we originally thought was chronic). Thank you everyone for your help.

 

[Red & Rover (GA)]

Welcome. Waving from Canada. I'll try to answer your questions one-by-one.

When is low BG considered too low on the pet monitor?

68 is the take action number on an AlphaTrak. It's a perfectly safe number but you don't want her going much lower.

How often should I be testing tonight?

Edited:
+11 (7pm EST) 112 (AlphaTrak)
8pm EST 0.5 units of Lantus. No test.
9:15pm (+1.25 = hours after shot) - 92
That's a nice slow drop.
Take a test now to check the drop.

You can post the numbers in the title of your thread. In the upper righthand corner of this thread, you should see Thread Tools. Click on Edit Title.
If the number is below 68 or darn close to it, you can add a red 911 to the thread title by Clicking on or just below No Prefix. I can't stay up much longer but someone will see it.

Now for the just-in-cases:
What treats do you have?
Do you have karo or honey or maple syrup?

Some essential reading.

• How to treat HYPOS - THEY CAN KILL! Print this Out!!
• jojo and bunny's HYPO TOOL BOX

• New? Seeing Low Numbers? How You Can Help Us Help You

Feline diabetes is a steep learning curve but it is one that is learned quickly and the people here can help you every step of the way.
When you get a chance, can you start a spreadsheet? That is the first place someone looking at your thread will look.

• How to Create a Spreadsheet
• How to Use the Spreadsheet

 

[Lena1]

Welcome. Waving from Canada. I'll try to answer your questions one-by-one.


68 is the take action number on an AlphaTrak. It's a perfectly safe number but you don't want her going much lower.


You shot 0.5 units of Lantus. AlphaTrak 112 7pm EST
9:15pm (+2.25 = hours after shot) - 92
That's a nice slow drop.
Take a test now to check the drop.

You can post the numbers in the title of your thread. In the upper righthand corner of this thread, you should see Thread Tools. Click on Edit Title.
If the number is below 68 or darn close to it, you can add a red 911 to the thread title by Clicking on or just below No Prefix. I can't stay up much longer but someone will see it.

Now for the just-in-cases:
What treats do you have?
Do you have karo or honey or maple syrup?

Some essential reading.

• How to treat HYPOS - THEY CAN KILL! Print this Out!!
• jojo and bunny's HYPO TOOL BOX

• New? Seeing Low Numbers? How You Can Help Us Help You

Feline diabetes is a steep learning curve but it is one that is learned quickly and the people here can help you every step of the way.
When you get a chance, can you start a spreadsheet? That is the first place someone looking at your thread will look.

• How to Create a Spreadsheet
• How to Use the Spreadsheet

Hello from across the border!

Thank you so much for your response! I’m sorry if my post was confusing. I shot .5 units of Lantus at 8pm EST. 1 hour before the shot at 7pm EST, BG was 112. I did not test right before the shot because she was being feisty. So +1.25 she was at 92 and I took another test at 10:30 PM EST. +2.5 hours she was at 91. I was planning on doing another test at midnight. I will add these numbers to the title and add 911 if her numbers go below 68.

For treats, I have Friskies Party Mix chicken flavor. I do have honey and maple syrup.

I’ll take a look at the essential readings and get started on a spreadsheet (although I may only get to the spreadsheet tomorrow). Thank you so so much for your help!!

 

[Red & Rover (GA)]

This is just a quick synopsis for anyone reading.

+11 (7pm EST) 112 (Alpha Trak)
8pm - 0.5 units Lantus (no test)
+1.25 92
+2.5 91

You are doing great.

 

[Lena1]

This is just a quick synopsis for anyone reading.

+11 (7pm EST) 112 (Alpha Trak)
8pm - 0.5 units Lantus (no test)
+1.25 92
+2.5 91

You are doing great.

Thank you! Also, to add to the synopsis prior to +11:
8am - 2 units Lantus (no test)
+7 46 (Alpha Trak), 75 (vein)

I will keep updating this thread with her numbers.

 

[Bron and Sheba (GA)]

Hi and welcome to the forum. I see @Red & Rover (GA) was around to help you.
How is it going? I will be around for the next several hours ( I’m in Australia) so will watch out for any posts from you.
When you get a chance I would go out and buy some higher carb food in case of lower numbers.
CANADIAN FOOD LIST
Look for foods 11%-16% for medium carb and 17%+ for high carb.
If the BG drops below 68 I would give some honey (about the size of your little finger nail) straight away and then post. Once you have the high carb food you can give that.
Because you are feeding dry food you will need to follow the Start Low Go Slow dosing method which you will find HERE.
With SLGS you reduce the dose if the BG drops below 90.
Are you giving snacks during the first half of all the cycles? If not I would recommend you do so .
Ask lots of questions
Bron

 

[Lena1]

Hi and welcome to the forum. I see @Red & Rover (GA) was around to help you.
How is it going? I will be around for the next several hours ( I’m in Australia) so will watch out for any posts from you.
When you get a chance I would go out and buy some higher carb food in case of lower numbers.
CANADIAN FOOD LIST
Look for foods 11%-16% for medium carb and 17%+ for high carb.
If the BG drops below 68 I would give some honey (about the size of your little finger nail) straight away and then post. Once you have the high carb food you can give that.
Because you are feeding dry food you will need to follow the Start Low Go Slow dosing method which you will find HERE.
With SLGS you reduce the dose if the BG drops below 90.
Are you giving snacks during the first half of all the cycles? If not I would recommend you do so .
Ask lots of questions
Bron

Thank you! Sorry for the confusion, I am located in the United States, Eastern time. Stores are closed now so I will go out tomorrow to get high carb food. No I am not giving snacks. What types of snacks? Diabetes friendly treats?

I just did another test at +4 and the result was 109. This seems off? She was not happy about the test and ran away so I’m not sure if I should try again or wait until +6.

 

[Bron and Sheba (GA)]

Thank you! Sorry for the confusion, I am located in the United States, Eastern time. Stores are closed now so I will go out tomorrow to get high carb food. No I am not giving snacks. What types of snacks? Diabetes friendly treats?

I just did another test at +4 and the result was 109. This seems off? She was not happy about the test and ran away so I’m not sure if I should try again or wait until +6.

No confusion. I know you are in The US and realised it would be tomorrow before you could get the higher carb food.
With diabetic cats, they do better with a main meal before the dose of insulin and then 2 or 3 low carb snacks during the first half of all the cycles. If you work, you might like to consider a timed automatic feeder to give the snacks
A snack would normally be a teaspoon or two of low carb food each time. As you feed dry food, you could give the equivalent amount of dry food each snack.
I just realised I gave you the Canadian food list . My only excuse is I was thinking of @Red & Rover (GA) who I know lives in the Canada!
Here is the US FOOD CHART
These are canned foods not dry foods. We don’t recommend using high carb dry foods. See if she will eat some of these. If she won’t, you will just have to stick with honey/Karo. That is effective. I used to use honey if I needed to raise She as BG levels.

Are you giving her a treat when you test her? Always give a treat and she will come to associate the tests with a test and be happy to have it done.

 

[Lena1]

No confusion. I know you are in The US and realised it would be tomorrow before you could get the higher carb food.
With diabetic cats, they do better with a main meal before the dose of insulin and then 2 or 3 low carb snacks during the first half of all the cycles. If you work, you might like to consider a timed automatic feeder to give the snacks
A snack would normally be a teaspoon or two of low carb food each time. As you feed dry food, you could give the equivalent amount of dry food each snack.
I just realised I gave you the Canadian food list . My only excuse is I was thinking of @Red & Rover (GA) who I know lives in the Canada!
Here is the US FOOD CHART
These are canned foods not dry foods. We don’t recommend using high carb dry foods. See if she will eat some of these. If she won’t, you will just have to stick with honey/Karo. That is effective. I used to use honey if I needed to raise She as BG levels.

Are you giving her a treat when you test her? Always give a treat and she will come to associate the tests with a test and be happy to have it done.

Thank you! No problem, thanks for the US list. I’ll test out the cans and if she doesn’t like them I’ll stick with honey.

Yes I do work, so I might have to invest in an automatic feeder. With Young Again, I usually give her the 1/3 cup once a day that is recommended and allow her to follow their “free choice eating” method. I do make sure she eats what look like good sized portions of this before she gets her insulin. So I guess she does snack throughout the day because she never finishes her food all at once. Should I change this to a more measured/clear cut method to know how much she’s eating before getting insulin?

I just gave her a treat after that last measurement and she still ran away after she ate the treat but I will keep up the positive association and see if that helps. Thank you so much!!

 

[Bron and Sheba (GA)]

So I guess she does snack throughout the day because she never finishes her food all at once. Should I change this to a more measured/clear cut method to know how much she’s eating before getting insulin?

Yes I would change it to make sure she does eat before every shot. It’s fine for her to graze after that as long as she is eating during the cycles.

just gave her a treat after that last measurement and she still ran away after she ate the treat but I will keep up the positive association and see if that helps. Thank you so much!!

It might take a little while for her to associate the treat with the test. I only had to touch the test strips and Sheba would come racing from wherever she was in the house as she knew it was treat time.

 

[Sienne and Gabby (GA)]

Welcome to FDMB!

It will help us enormously if you're able to create a signature and set up a spreadsheet. The signature provides some basic information about you and your kitty so we don't keep annoying you by repeatedly asking the same questions. The spreadsheet will allow you to track Mimi's progress and we can follow along and answer your questions based on Mimi-specific information. All of the information (and more) is in the helping us to help you post that Red linked.

I would encourage you to get your spreadsheet set up sooner rather than later and keep home testing. If you need a hand, @Bandit's Mom (Bhooma) can help. You're already seeing lower numbers and it's important to make sure that Mimi is staying in a safe blood glucose (BG) range. Many cats have a spike in their BG numbers when at the vet's office due to stress. They are stressed by being in a carrier, being in a car, the strange noises and smells at the vet's office, etc. Stress causes BG to rise. As a result, when the vet runs a curve (i.e., testing every 2 hours), the numbers are artificially elevated so the dose that the vet recommends can be too high. The numbers you get from home testing when your cat is in her normal environment may be much lower. It's why we're such advocates of testing at home.

There are a number of options for treats. One popular type is freeze dried proteins -- chicken is widely available. (It's a bit less expensive in the dog treat aisle or online.) Others use cooked chicken. We've had some members who will spoil their cat with cooked shrimp. Others use things their cat likes such as brushing. It all depends on how food motivated or non-food motivated your cat is and what your cat considers a "treat."

I'd also encourage you to take a look at the sticky notes at the top of the Lantus forum. The sticky notes contain a great deal of information about how Lantus works, dosing methods, etc. Regarding the latter, if you are feeding Young Again, this is considered dry food/kibble despite it being low in carbs. Feeding a dry food diet limits your choice of dosing method to Start Low Go Slow (SLGS).

Please let us know if you have questions. We're here to help.

 

[Lena1]

Welcome to FDMB!

It will help us enormously if you're able to create a signature and set up a spreadsheet. The signature provides some basic information about you and your kitty so we don't keep annoying you by repeatedly asking the same questions. The spreadsheet will allow you to track Mimi's progress and we can follow along and answer your questions based on Mimi-specific information. All of the information (and more) is in the helping us to help you post that Red linked.

I would encourage you to get your spreadsheet set up sooner rather than later and keep home testing. If you need a hand, @Bandit's Mom (Bhooma) can help. You're already seeing lower numbers and it's important to make sure that Mimi is staying in a safe blood glucose (BG) range. Many cats have a spike in their BG numbers when at the vet's office due to stress. They are stressed by being in a carrier, being in a car, the strange noises and smells at the vet's office, etc. Stress causes BG to rise. As a result, when the vet runs a curve (i.e., testing every 2 hours), the numbers are artificially elevated so the dose that the vet recommends can be too high. The numbers you get from home testing when your cat is in her normal environment may be much lower. It's why we're such advocates of testing at home.

There are a number of options for treats. One popular type is freeze dried proteins -- chicken is widely available. (It's a bit less expensive in the dog treat aisle or online.) Others use cooked chicken. We've had some members who will spoil their cat with cooked shrimp. Others use things their cat likes such as brushing. It all depends on how food motivated or non-food motivated your cat is and what your cat considers a "treat."

I'd also encourage you to take a look at the sticky notes at the top of the Lantus forum. The sticky notes contain a great deal of information about how Lantus works, dosing methods, etc. Regarding the latter, if you are feeding Young Again, this is considered dry food/kibble despite it being low in carbs. Feeding a dry food diet limits your choice of dosing method to Start Low Go Slow (SLGS).

Please let us know if you have questions. We're here to help.

Thank you! I will start a spreadsheet today and create a signature. I just did a pretest measurement and BG was 96 on Alpha Trak. I saw that people don’t recommend a shot if BG is below 200? Should I skip or do another small dose of .5 units?

 

[Sienne and Gabby (GA)]

I would stall for 20 - 30 min and see if numbers are heading up. You may need to repeat stalling if numbers are still a bit low. Also -- don't feed your cat while you're stalling! It will artificially inflate the numbers.

 

[Lena1]

I would stall for 20 - 30 min and see if numbers are heading up. You may need to repeat stalling if numbers are still a bit low. Also -- don't feed your cat while you're stalling! It will artificially inflate the numbers.

Thank you! I gave her 3 pieces of friskies treats and some dry food since I was trying to get her ready for insulin. I just took away her food. I don’t think she had a lot. Should I try at an hour or stick with 30 min intervals of stalling?

 

[Lena1]

Thank you! I gave her 3 pieces of friskies treats and some dry food since I was trying to get her ready for insulin. I just took away her food. I don’t think she had a lot. Should I try at an hour or stick with 30 min intervals of stalling?

Had trouble getting mimi out from under my bed but at the 40 minute mark her BG was 112. Not sure if this is artificial increase because of the treats and minimal food I gave her.

 

[Sienne and Gabby (GA)]

You did fine with skipping.

I'm curious. Did the vet do a complete work-up (blood work and urinalysis, fructosamine level) when Mimi was diagnosed? Had she been prescribed steroids for any reason? I'm asking because her numbers are rather good for a newly diagnosed diabetic.

Just so you're aware, Lantus does best if the dose is consistent. Given where Mimi's numbers are, you may want to drop the dose back to 0.5u. With SLGS, you would hold that dose for a week unless her numbers drop below 90, in which case. you reduce the dose.

 

[Lena1]

You did fine with skipping.

I'm curious. Did the vet do a complete work-up (blood work and urinalysis, fructosamine level) when Mimi was diagnosed? Had she been prescribed steroids for any reason? I'm asking because her numbers are rather good for a newly diagnosed diabetic.

Just so you're aware, Lantus does best if the dose is consistent. Given where Mimi's numbers are, you may want to drop the dose back to 0.5u. With SLGS, you would hold that dose for a week unless her numbers drop below 90, in which case. you reduce the dose.

Hi Sienne,

The vet did blood work and urinalysis, but did not test the fructosamine level. I asked about fructosamine and she said it would just confirm the diagnosis like the urinalysis, so it wasn't necessary to put Mimi through getting a blood draw again. Her glucose was 522 mg/dL (only other test that was almost out of range was Chloride - low/approaching low at 109 mmol/L). The urinalysis showed glucose in her urine - this number was 56. Mimi also had some symptoms - she was urinating often and drinking a lot. I originally thought this was due to her kidney disease (which we originally thought was chronic), but her kidney values came back normal on this blood panel when Mimi was diagnosed with diabetes so this new vet said her bladder stones and UTI probably caused the rise in kidney values. In May of this year, her glucose was 137.

You would recommend going back to .5 despite the 1 unit now recommended by my vet? I'm struggling to balance vet recommendations and the SLGS method because I think you're right and based on her number .5 would probably be better for Mimi. I shot 1 unit last night and based on her numbers, dropped the dose to .75 units this morning. Would it be too inconsistent to go down to .5 again tonight? Should I try to follow SLGS and see if her numbers drop past 90 and then drop to .5 or drop to .5 regardless?

Is it not normal for cats levels to go down this quickly? I also began feeding her Young Again Zero at the beginning of November. Could that be contributing to seeing lower BG sooner?

 

[Sienne and Gabby (GA)]

The lower carb food can cause diabetic numbers to drop, especially if Mimi was getting a diet significantly higher in carbs. There's a degree in variability with respect to how cats respond to insulin. At least to me, Mimi's spreadsheet looks like there could have been some other factor influencing the higher numbers. That's more of a guess given that your vet did the lab work. What I would suggest is that you take a look at other members spreadsheets. It will give you a sense of what cats' numbers look like. You may want to venture over to the Lantus forum to look at spreadsheets since most members once they are comfortable with the basics of diabetes management will move over to the Lantus board.

If you read through either of the dosing protocols, you'll notice that doses are held a minimum of 3 days/6 cycles barring a drop in numbers that necessitates a dose reduction. The reason for a holding doses is that Lantus is a "depot" insulin. Every time you give a shot, Lantus forms microcrystals that are deposited in the fat tissue. Over the course of the cycle, most of the crystals dissolve. However, a small amount do not dissolve during each cycle which is what gives Lantus its long duration and gentle action. Every time you change the dose, it has an effect on the depot. In order for the depot to stabilize, you need to hold the dose. If you make repeated back-to-back changes in the dose, you can end up with wonky numbers and in addition, it's next to impossible to know which dose is causing the change in numbers. This is my long winded way of suggesting that you need to pick a dose and stick with it. When following SLGS, you want to hold the dose for a week. Whether you pick 0.5u or 0.75u is entirely up to you.

 

[Lena1]

Thank you Sienne. What other factors could have been influencing the higher numbers? I will definitely take a look at others spreadsheets in the Lantus forum.

The depot concept makes sense. I've decided to stick with 0.5u and I will use that as my starting point for following the SLGS protocol. I feel like it's probably better to go back to a pretty low dose despite her recent high dose of 2 units since her BGs have been relatively low and the higher numbers today could be the rebound effect that I've been reading about from her BGs being lower than usual.

I appreciate your help very much!

 

[Sienne and Gabby (GA)]

Lena -

I want to make another suggestion re. housekeeping. Would you mind starting a new thread? The +7 from a couple of days ago quickly got my attention as I thought it was a more recent test number. If you'd prefer to keep this thread, I would change your subject line so it's more current with your needs or questions.

 

[Lena1]

Lena -

I want to make another suggestion re. housekeeping. Would you mind starting a new thread? The +7 from a couple of days ago quickly got my attention as I thought it was a more recent test number. If you'd prefer to keep this thread, I would change your subject line so it's more current with your needs or questions.

Thanks Sienne. Yes I've been posting in Lantus. My apologies about the misdirection. I just changed the title of this thread. Hopefully that helps. Thank you!