New member from Brazil - Seeking advice on BG control on the mornings

Calvin

Calvin

Member Since 2026
Hi everyone! I'm joining from Brazil with my 12-year-old boy, Calvin (we call him Careca). He was diagnosed in February 2026. He is a very large cat (90cm from nose to tail) but currently underweight at 3.9kg with severe muscle loss and plantigrade stance.

Our biggest challenge is taming his BG (Blood Glucose). He often hits high numbers in the morning (around 400) and we are trying to manage his 'bounces'.

Diet: We are following a strict high-protein, low-carb homemade/raw diet to help him regain mass.

  • Main meals: ~50g of lean beef (ossobuco) and raw chicken breast, mixed with pumpkin and supplements (Nutro Plus).
  • Schedule: We feed small portions every 3-4 hours to keep a steady 'protein ballast' for the Lantus.
  • Total daily intake: ~150g of meat (~34g of pure protein).
He is currently on 1U of Lantus twice a day. I’m working on his spreadsheet and will share it soon. Happy to be here and learn from you all!
 
Hello and welcome to the board!

I’m just passing by and don’t have time for a detailed post right now, but I’m sure others will be around soon. In the meantime, you might want to head on over to the Lantus forum and read some of the Info posts. Good job at setting up a signature and spreadsheet already.

The early days of diabetes can feel hopeless but you’ve come to the right place. We like to say that Feline diabetes is a marathon, not a sprint. One step at a time. The blood glucose data you collect will help point you in the right direction and guide dosing decisions.
 
Hi there, and welcome! What should we call you? Agreed with JL though, nice job so far! Sounds like you’re doing a lot of the right things. You’ve got a good insulin, good food, home testing.

Couple quick comments while you wait for some more experienced help:
  • Is the On Call Plus II a pet or human meter? You have the pet-meter spreadsheet right now. It uses a slightly different color code than the human version of the sheet does.
  • Here’s the sticky post for the dosing methods. Might be good to read up about managing the dose.
  • I think the experienced folks will tell you that the evening cycle is just as important as the day cycle. Right now we only have half of the picture. I know it’s impossible to be up 24/7, but even a +2 in the evening cycle could be worthwhile to see where he’s trending.
But again, good work so far. There’s a lot of wisdom here. These folks live FD every day.
 
Hi Tim & Pookey!

Thank you so much for the warm welcome and for the eagle eyes!

You can call me Fabiano

Regarding the meter: the On Call Plus II is indeed a human meter. I didn't realize I had grabbed the wrong spreadsheet template! I will fix that right away and move my data to the Human Meter template so the color-coding reflects his situation correctly.

I also take your point about the evening cycle. I’m still adjusting our routine, but since Careca is sleeping peacefully in his new cave, I decided not to wake him up for a +2 test tonight to avoid unnecessary stress. After a few months of home testing, I’ve noticed that his night nadir is usually very similar to his day nadir, with very little variation.

To give you some background, we decided to manage Calvin's diabetes ourselves because we had a very scary experience with our previous vet. He was treating Calvin's BG like a fever—constantly raising and lowering the dose based on a sliding scale. This 'number-chasing' led to two severe hypoglycemic crises that almost killed Calvin. That’s when we drew the line, did extensive research, and decided to take the reins of his treatment.

Because of this, we also developed a very strict feeding protocol to keep him safe:

  1. Pre-Lantus Main Meal (Split in two rounds):
    • Round 1: Lean beef (ossobuco) + warm bone broth (fat strictly removed) + Nutro Plus (a supplement with vitamins and minerals, especially calcium to balance the phosphorus in his raw diet).
    • We wait 15 to 20 minutes to make sure his stomach is settled.
    • Round 2: Raw chicken breast.
  2. The Shot: We wait another 15 to 20 minutes after he finishes the chicken before giving the Lantus shot.
We started doing this because we cannot risk him eating, getting an insulin shot, and then vomiting. That would put us in a highly dangerous situation with active insulin and no food in his system. This split-feeding method has been a lifesaver for stabilizing his stomach.

Sorry for the wall of text, but I wanted to make sure you have the full picture! Thank you again for the guidance. This community is a breath of fresh air for us!
 
That’s great! About what you’ve been doing, not so much about your previous experience :confused:. Glad you landed here.

Once you’ve decided on a dosing method (SLGS or TR) and get a couple later tests, maybe you could consider a small increase. See what feedback you get from the others.
 
When are you taking the pre-shot blood glucose (BG) reading? Is it before any food is given, between rounds of food, immediately before the shot, or something else?

We typically recommend fasting at least 2 hours before the shot and that the PS be taken before any food is given so that the number isn’t food-influenced. (It’s important to understand the timing in order to best interpret the data).
 
Hi everyone! Thank you for the detailed feedback.

JL and Chip, to answer your question about the PS reading: we always make sure he has fasted for at least 2 hours before we take the reading.

Previously, our routine was:1. AMPS/PMPS test -> 2. Feed (in two rounds) -> 3. Wait 15-20 min -> 4. Insulin shot.We were doing this 'food ballast' first to ensure he wouldn't vomit after the insulin was already in his system, which was a big fear of ours.

However, after reading your suggestions, we decided to try a different order this morning:1. AMPS/PMPS test -> 2. Insulin shot -> 3. Immediate feeding.

I would love to hear your thoughts on this! Is the 'Insulin then Food' sequence safer for Lantus users, or should we stick to the 'Food then Insulin' method to prevent issues if he happens to have a sensitive stomach?

Also, Tim & Pookey, I've officially moved my data to the Human Meter (World) spreadsheet as you suggested. It's much clearer now with the correct color-coding for the On Call Plus II.

Looking forward to hearing your opinions on the feeding/shooting sequence!
 
Update: (5:48 PM here in Brazil) - PMPS is 374. Feeling a bit frustrated because he reached 212 at +6 today, but bounced right back. I'm considering an increase to 1.25U, but I'm waiting for the 0.5U syringes to arrive for better precision. I'll do a +6 check tonight to see if 1.0U is at least holding the nadir below the renal threshold.
 
With Lantus, you can shoot and feed at the same time. That’s what most of us here do.

Some of the older and “harsher” insulins (such as “N” for example) had a more rapid onset and could drop the BG precipitously. Those insulins *did* require food on board at least 30 minutes before the shot in order to blunt the initial impact of the insulin. With the introduction of Lantus and Prozinc, those older-use insulins are no longer recommended for cats, although they are sometimes still prescribed.

With Lantus, there’s a delayed onset and you don’t typically need to have food on board before the shot. Unless your cat has some sort of stomach or inappetance issue that changes the calculus, I would t worry about it.

If you haven’t done so already, I encourage you to go to the Lantus/Levemir/Biosimilars forum and read the “Sticky” notes at the top of the forum. There is a lot of information there that is extraordinarily helpful. I still find myself re-reading them occasionally even after all of these years on the board. Lantus / Levemir / Biosimilars
 
+6 check: 203 mg/dL.Very happy to see him staying below the renal threshold during the night cycle. It seems the 1.0U dose is finding a good floor around 200, even though we are still seeing some bounces at PS. Moving to the midnight snack now (beef and broth) to keep him stable until morning.
 
Nice PM +6. That’s very good data to have.

I’d suggest also getting some tests at different times during the cycles (AM cycle for sure, PM cycle as you can). The +6 is considered a common nadir for Lantus but that’s not always the case. It’s a good starting point though. Collecting data at other times as well can help fill in the picture. And know that nadirs can and do move around a bit. Every cat is different, so the more data you collect, the better you will know your cat’s response.
 
6:00 hs AM in Brazil | AMPS is 402. He had a small snack at +8 (6g beef + broth) because he was very hungry. It seems 1.0U is not holding him long enough, as he went from 203 (+6) to 402 (+12).

I am feeling exhausted and a bit lost. To be honest, I am currently unemployed at 50, which is a complicated situation. While it allows me to give 100% of my time to Careca’s care, the lack of resources is a huge burden when it comes to supplies. These 0.5U syringes are quite expensive here in Brazil, but I am doing my best to source them so I can safely increase the dose to 1.25U. I really need to get him stable.
Edit / Update:
I've just decided to start him on a 'Fat 1.0U' dose. I'm using smartphone camera to ensure the plunger is just a hair below the 1.0 line consistently.

I'm entrusting this cycle to Bastet! He just had his breakfast and I'll keep monitoring his numbers closely today to see how this slightly increased dose handles the mid-day nadir and the potential bounce. Thank you all for the support during this tough time.
 
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I’ve read here that the fat and skinny doses are usually for when you really dialing in on a dose. I think most of the time the 0.25 increments are fine. Maybe your 1.0 fat is close to 1.25 anyways…
 
+6 Update: 89 mg/dL! >I was a bit panicked as he came from a 402 AMPS, so this is a huge drop. I immediately fed him a reinforced meal: 16g ossobuco + 15ml broth + 4 small kibbles of Whiskas wet food (just for a tiny carb bump to keep him safe).

He licked the bowl clean and seems perfectly fine, very alert and hungry. I'm worried about a potential bounce later, but happy to see a 'green' number. Will test again at +8 to see the trend.
 
PMPS: 349 (A bounce from today's green numbers, as expected).

Thank you, Tim, for the explanation. After seeing the 85 at +7, I've decided to follow the SLGS approach. That drop was a bit too fast and too low for my peace of mind, especially with my past trauma regarding hypos.

For tonight's dose, I'm going back to a strict 1.0U (no 'fat' dose this time) and I'll keep it there to see if he stabilizes. I need to prioritize safety and a good night's sleep to keep up with his care. He is alert now and ready for his dinner. Thanks to everyone for the support!
 
Hi Fabiano, Welcome to the forum! You've gotten some good advice already from Tim and JL. Now that you've decided upon a dosing method, when you get a chance, please update both your spreadsheet and signature with SLGS.

As Tim mentioned, you definitely want to start filling in some of the gaps on his spreadsheet so that you can get an idea of how Calvin is managing the insulin through each cycle. When following SLGS, you'll perform a curve after Calvin has remained at a dose one week (unless he falls below 90--and if this happens, please check back here). The information for the curve is on the sticky Tim posted earlier about dosing methods.

One important note: with each cycle, if possible you want to grab a +2, +3 and/or +4 test (around the insulin's onset, which is TYPICALLY when Lantus begins to work in Calvin's system). These tests can sometimes help predict how active a cycle might be--and by active, I mean how low the insulin might take Calvin. A general rule is that if you see a drop that is significantly larger ( greater than ~20%) from the preshot test at +2 - +4, this can signal that Calvin's numbers might drop lower as he goes through the cycle. This is important knowledge because 1) you know that you'll need to test Calvin more frequently to monitor his numbers to keep him safe, and 2) when you see that drop, you can begin using food to bump his numbers up to keep him from diving so sharply in the cycle. Sharp dives in his numbers can lead to bouncing (I'll post the definition of bouncing below), which can sometimes take a few cycles to clear (he's very likely bouncing right now from those lower numbers today).

FD is a challenging disease for caregivers; it's overwhelming for the caregiver for a variety of reasons, the least of which is the learning curve. You're doing a great job so far. Keep asking questions and checking in with us. Calvin is fortunate to have you taking such good care of him.

Definition of bouncing: “Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is 'too low'. 'Too low' is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a 'bounce'. Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of 'sugar' into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as 'liver panic or 'panicky liver'. *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).”
 
One other thought, without a clearer picture of his p.m. cycle bg numbers, you're not really sure how low the insulin is taking him at night, which could be causing the morning bounces.
 
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