New Member! Cat’s BG seems normal without insulin?

[Mellya]

Hello,
My boy, Lucius (14 y/o), was just diagnosed on 12/12/21. I had to rush him to the emergency vet that afternoon because he had collapsed. Long story short he was admitted to the hospital for three days and diagnosed with diabetes, a minor heart murmur, and was very dehydrated. His BG was 469 when admitted and was likely brought on by the steroids he was taking for severe skin allergies. No ketones were detected. He was prescribed 2 units of Lantus 2x/day and put on a low carb canned diet.
Cut to today and he seems to be doing so well that I’m suspicious. I’ve been monitoring his BG with an Alphatrak pet meter. The past four days his BG has only ranged from 87mg/dL to 186mg/dL and that’s with only 1 unit of insulin administered the entire time! I’ve been skipping the insulin dose for any BG reading under 180mg/dL and only give 1 unit for readings between 180-250mg/dL. Anything above that and I give 2 units, but I have to be careful because I find that can drop his BG by over 200mg/dL.
I’m not sure I’m doing the right thing by skipping doses, but I’m scarred of hypoglycemia as I’m not able to be with him 24/7 most days. The syringes I was given only have whole unit measurements, so I’m not able to give a half or quarter unit of insulin. Lucius still has some increased thirst/urination, but not nearly as bad as it was. His appetite has also decreased. Previously he was ravenous, but now he does not eat his meal in one sitting, although he eventually finishes. We will go back to the vet in 2 weeks for a fructosamine test.
In the meantime, do I seems to be on the right track? Is there anything else I could be doing?

 

[Chris and Checkers]

Hi welcome to the site. Switching to a low carb diet does drop a cats blood glucose. Is he still on steroids, if he is no longer on steroids that would effect his blood glucose too. So what you are experiencing is not surprising.
Though I don't have have enough experience to give you dosing advice. I am sure someone will be along to better help you.

We here use syringes with half unit markings so that we can give half and quarter unit dose. You can get these syringes at Walmart. When the kitties bg are more consistently in the normal range we gradually reduce from 1 unit to .75 to .5 to .25 to .1 and then to a drop (following a protocol). Rather than 1unit to nothing. This works better for retaining remission.

Are you testing only before you give him insulin or in-between as well. Are you using a human meter or pet meter?

To get the most out of this site check out this link:
https://www.felinediabetes.com/FDMB/threads/new-how-you-can-help-us-help-you.216696/

Also here is some really good information on hypoglycemia
https://www.felinediabetes.com/FDMB/threads/how-to-treat-hypos-they-can-kill-print-this-out.15887/

 

[Mellya]

Thanks so much for your response. I didn’t realize you can just buy syringes. I thought they were prescription only, so I’ll definitely look into that.
Lucius is no longer on steroids. I haven’t had too many opportunities to test his BG between doses because of my holiday work schedule, but now that things have settled down, I’ll try to test more often (I’m using a pet meter BTW). The times I have tested mid cycle, the numbers have been around 80-90mg/dL. When we go back to the vet, I’m going ask him for better dosing guidelines. When we went the first time, he just said to aim to keep his BG the 100-200mg/dL range.

 

[Larry and Kitties]

I didn’t realize you can just buy syringes. I thought they were prescription only, so I’ll definitely look into that.

Some states and localities require a script for syringes. It all depends upon where you live. Here is one listing:
https://childrenwithdiabetes.com/insulin/prescription-laws-and-resources/

 

[Sienne and Gabby (GA)]

Welcome to FDMB!

Some cats develop steroid induced diabetes and it sounds like the steroid played a major role in elevating Lucius' numbers.

I'm going to provide some background. Apologies since this is probably more than you want to know and may be adding to your feeling overwhelmed.

A bit of information about Lantus. Lantus is a depot type of insulin. (This is compared to shorter acting insulins that are "in and out" in less than 12-hours.) What is meant by a depot insulin is that the insulin is deposited in fat tissue in the form of microcrystals that slowly dissolve over at least a 12-hour period. However, not all of the crystals dissolve over that period so there is overlap between doses. This is what give Lantus it's long duration and gentle action (vs slamming numbers into submission like the shorter acting insulins do).

The reason this information is important is that if you skip shots, the depot never has a chance to stabilize. Likewise, if you are basing your dose on the pre-shot numbers and keep changing the dose, the depot never has a chance to stabilize. In all likelihood, the 2.0u dose is too large. You want to find a dose that you can routinely shoot twice a day. Depending on the dosing method you (or your vet) may suggest, the starting dose may be based on weight or on a fixed amount. The Tight Regulation (TR) protocol for Lantus uses a weight based formula (initial dose = 0.25 x ideal weight in kilograms) and is generally close to 1.0u. The other method that was developed here, Start Low Go Slow (SLGS) starts cats at 0.5u providing your cat is eating a low carbohydrate canned food diet or 1.0u if your cat is on dry food or a high carb diet. With TR, your cat must be on a low carb, canned food diet.

The other issue with dosing is that Lantus dosing is based on the lowest number in the cycle, not the pre-shot number. The pre-shot number tells you if it's safe to give a shot. However, there are other option besides skipping a dose since skipping has a negative effect on the depot.

So, to summarize:

• It would be helpful to find a dose that will allow you to give a shot safely twice a day
• We need to know what you're feeding Lucius so we know what your choices are with respect to dosing methods
• There are syringes with half unit markings. That's the smallest increments. We change doses in 0.25u amounts (and you can either eyeball the dose or get digital calipers that will help with measuring.)
• If you're getting dosing guidelines from your vet, a sliding scale for dosing doesn't work well for Lantus since the dose is based on the lowest number in the cycle (i.e., the "nadir")

If you want to get started, this post on helping us to help you will give you instructions for setting up a spreadsheet to track Lucius' progress and will allow us to follow along. The post also includes how to set up a signature so we don't keep asking the same questions.

Please let us know how we can help. The members here are very generous with their time and knowledge.