New member... so confused

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shebasmom

Member Since 2013
Hi everyone,
I'm new here, but I've been dealing with a diabetic cat for a few years now. Sheba is about 10 years old and has been diabetic for about 3 years. We started at 1 unit (lantus) and stayed there for about 2 years. In the past year her vet has increased her to 3.5 units. Based on what I've read here, I've decided to start home testing her.
I'm so confused about the process... Drawing blood is no big deal to her, that isn't the issue. I'm not sure where to start with her insulin. Do I go back to the units suggested? Do I stay at the 3.5? I have another appointment with my vet next week, but she doesn't seem to be that familiar with diabetes. She is also showing signs or neuropathy, which is why the vet is increasing her dose.

Thanks so much in advance for any help! All this home testing and dosing is so overwhelming!
 
Welcome to FDMB.

First, it will help if you have some idea of what the glucose test numbers mean. We use human glucometers all the time to monitor our diabetics. The number scale is a little different from veterinary lab results, however we have reference numbers to use in cats. Think of it as the difference between reading temperature in Celsius or Fahrenheit. Both are correct.

Here are some glucose reference ranges used for decision making using a human glucometer. Divide by 18 if you are not in the US.

< 40 mg/dL
- Treat as if HYPO if on insulin
- At nadir (lowest point between shots) in a long term diabetic (more than a year), may earn a reduction.

< 50 mg/dL
- If before nadir, steer with food, ie, give modest amounts of medium carb food to keep from going below 50.
- At nadir, often indicates dose reduction is earned.

50 - 130 mg/dL
- On insulin - great control when following a tight regulation protocol.
- Off insulin - normal numbers. (May even go as low as the upper 30s; if not on insulin, this can be safe.

> 150 mg/dL
- At nadir, indicates a dose increase may be needed when following a tight regulation protocol.

200 mg/dL
- no shot level for beginners; may slowly reduce to 150 mg/dL for long-acting insulins (Lantus, Levemir, and ProZinc) as data collection shows it is safe

180 - 280 mg/dL
- Any time - The renal threshold (depending on data source and cat's renal function) where glucose spills into the urine.
- Test for ketones, glucose is too high.

>= 280 mg/dL, if for most of the cycle between shots
- Uncontrolled diabetes and thus at risk for diabetic ketoacidosis and hepatic lipidosis
- Follow your insulin protocol for dose adjustments
- Test for ketones; if more than a trace level of ketones, go to vet ASAP.
 
Second, some info on Lantus.

Lantus doses are adjusted based on the nadir, or lowest blood glucose level between 2 shots. This is usually between 5 to 7 hours after injecting it. So, you want to focus on getting some tests then.

If the nadir goes below 50 mg/dL on a human meter or below 80 mg/dL on a pet-specific meter, a dose reduction has been earned.
 
Hi and welcome!

What are you feeding Sheba? Is it Low Carb wet? If not, that could be the reason you're having to keep giving more Lantus.

I think the best thing you can do at this point is start home testing, and get a spreadsheet going so we can see how Sheba is doing before giving much advise on the dosage.

How much does she weigh? What's her ideal weight?

Sorry for not being able to give you more concrete advise, but there's just so much more information any of us would need before giving a lot of advise.

I know it seems to be a lot of work, but once you get going with testing, I know the members here will be so much more able to help you!

Here's the link to How to set up a spreadsheet

And if you could add as much information as possible in the signature, it will help too! We'd love to know what to call you too...other than Sheba's mom :-D
If you look at others posts, you'll see some of the information in our signatures...there's no such thing as too much information.
 
Once you get the hang of testing, you may find there are some food changes you can make to reduce the glucose levels.

Pop over to Cat Info and check out the web site and the food chart there. It provides the percent of calories from Protein, Fat, and Carbohydrates. After you are testing, it will be safe to change the food if you need to do that. The glucose may drop 100 mg/dL by changing to low carb canned or raw foods if you are not already feeding them.


Neuropathy may resolve a bit faster if you provide methylcobalamin, a specific form of B12 vitamin. Check out Jasper's Story to read more about it.
 
Thanks for the responses so far!
I'm Stephanie. Sheba weighs 14 pounds. She was eating hills w/d, but we switched her last week to purina dm. She refuses to eat that, so I did some research on low carb wet food and we seem to be doing good with the friskies and fancy feast pates so far.

I haven't actually started home testing her at any regular intervals yet, but she seems to tolerate the ear poking so far. So I do an AM test and then give her her regular dose? And then test her how often after? I can't do every 2 hours unless I'm off, but I could probably run home to do a 7 hour reading. Would the nadir be that number?

And on a side note, how do I update my signature? I'm sure it's pretty obvious, but I seem to be missing it :)
 
Test before every shot; for now, do not give insulin if the glucose is under 200 mg/dL.

Whenever you can get tests in the +5 to +7 hours after the shot to see how low the glucose is going. The nadir is not static; it moves around.

Snagging a test before bed will either reasure you that you can go to sleep or alert you to put on some coffe and keep an eye on him.

A curve - serial glucose tests every 2 hours from pre-shot test to pre-shot test - are helpful weekly. Alternatively, getting tests at different times on different days may help round out the picture (ex +2, +6, +10 one day; +3, +7, +11 another day, and so forth)
 
Hi Stephanie!!

To add information to your signature, look at the top of the page on the left side for "User Control Panel" and click there.

Then you'll see tabs titled: Overview, Profile, Board Preferences, Private Messages, Usergroups, and Friends & Foes.

Click on Profile...on the left you'll then have "Edit Profile" in red

Then you can add whatever information you want under "Edit Profile", like your Location, Birthdate, any Websites, Instant Messenger programs, etc....this is totally up to you

Then again along the left side, go to "Edit Signature"

In that box you can put your name, your cats name, age, male/female/fixed?, City/State you live in, the date of diagnosis, what kind of food you're feeding, what kind of Glucose Meter you use, What kind of insulin, etc.

Once you have your spreadsheet set up, you'd add the link to it into this same signature box

Click "Submit" and you're done!

Now if you'd like to add an avatar (like a picture of Sheba) you'd go back to that list on the left and choose "Edit Avatar"...If you have a picture of Sheba already saved in your computer, you can use that if you like, but the avatar pictures have to be pretty tiny.
If the picture you have is too big, you can go to Create Avatar to shrink it. If I remember right, it can't be bigger than 90 pixels, so you'll have to change the number in the box.
Then you'd just save the shrunken picture into your computer photo's, and go back to "Edit Avatar"
Where it says "Upload from your machine", click on Choose File and find the picture you just saved and that would be the "file" you choose

Then you just hit "Submit" to save your avatar picture
 
On your testing/shooting schedule, will your schedule allow you to get up, test, feed and shoot and then before you leave the house for work, get a +2?
A test 2 hours after he's eaten/gotten the shot? That can give you a good indication if it's going to be a quiet cycle or an active one. If the +2 is a much lower number than the AMPS time was, you might want to leave some food down for him so if he needs it, he can eat it. Most cats get hungry when their BG is dropping.

If you can get home about +7 to do a quick test, that's great too! The more "holes" we can get filled in, the faster some kind of pattern should start to show up!

Then when you get home for the evening, before your PM test (called PMPS Pm Pre-Shot) make sure Sheba hasn't eaten for the prior 2 hours so you can an accurate number at shot times. If it's 200 or higher, give his shot and feed him...then once again if you can get a +2 and another test right before you go to bed, that'll give a lot of data to help find out how it's working for your cat. Every cat is different (ECID)

Go ahead and get that started, start working on the spreadsheet and keep asking questions. None of us knew what we were doing when we first started, so you're in good company :razz:
 
Hi Stephanie and sugarkitty Sheba.

It did not take my sugardude Wink very long after stopping the Hill's W/D high carb (37%) dry food and transitioning him to Fancy Feast classic pates and some Friskies pates before his BG readings dropped dramatically. In fact, he went into remission.

Be careful with the food change and that 3.5U dose. You made need to drop the dose dramatically as the BG levels come down with the low carb food.

Good thing you have started home testing Sheba.
 
Thanks for all the responses! It really puts my mind at ease!

I did a pm check, it's been 11 hours since her last shot. She was at 174. So I don't give her a shot? I won't be home again for about 3-4 hours. Should I check her again and if she's high, give her a shot? If so, do I feed her again and if so, how much insulin?

Thanks so much again!
 
Would you be able to not feed her yet, but test her again in a half hour? What we would like to see is a rising number so we know it's safe to shoot. If she gives you a 196, for example, you'll be safe to give a shot.
 
Just in case you have been testing, here are some glucose reference ranges used for decision making using glucometers. Human glucometer numbers are given first. Numbers in parentheses are for non-US meters. Numbers in curly braces are estimates for an AlphaTrak.

< 40 mg/dL (2.2 mmol/L) {< 70 mg/dL for an AlphaTrak}
- Treat as if HYPO if on insulin
- At nadir (lowest point between shots) in a long term diabetic (more than a year), may earn a reduction.

< 50 mg/dL (2.8 mmol/L) {< 80 mg/dL for an AlphaTrak}
- If before nadir, steer with food, ie, give modest amounts of medium carb food to keep from going below 50 (2.8).
- At nadir, often indicates dose reduction is earned.

50 - 130 mg/dL (2.8 - 7.2 mmol/L) {80 - 160 mg/dL for an AlphaTrak}
- On insulin - great control when following a tight regulation protocol.
- Off insulin - normal numbers. (May even go as low as the upper 30s (1.7 mmol/L){60s for an AlphaTrak}; if not on insulin, this can be safe.

> 150 mg/dL (8.3 mmol/L) {> 180 mg/dL for an AlphaTrak}
- At nadir, indicates a dose increase may be needed when following a tight regulation protocol.

200 mg/dL (11.1 mmol/L) {230 mg/dL for an AlphaTrak}
- no shot level for beginners; may slowly reduce to 150 mg/dL (8.3 mmol/L) {180 mg/dL} for long-acting insulins (Lantus, Levemir, and ProZinc) as data collection shows it is safe

180 - 280 mg/dL (10 - 15.6 mmol/L) {may be 210 - 310 mg/dL for an AlphaTrak}
- Any time - The renal threshold (depending on data source and cat's renal function) where glucose spills into the urine.
- Test for ketones, glucose is too high.

>= 280 mg/dL (15.6 mmol/L) {may be >=310 mf/dL for an AlphaTrak}, if for most of the cycle between shots
- Uncontrolled diabetes and thus at risk for diabetic ketoacidosis and hepatic lipidosis
- Follow your insulin protocol for dose adjustments
- Test for ketones; if more than a trace level of ketones, go to vet ASAP.
 
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