New Member with Questions

Hi all, I'm new here. My 11 year old male kitty, Sundance, was diagnosed with diabetes a few months ago.

Stats
- Diagnosed a few months ago but only started Lantus 2 units 2x a day a few days ago after he developed DKA and ended up in hospital.
- Using Auvon pet glucometer starting today
- The nadir so far has been 120.
- Was feeding wet food 2X a day but my vet said I can feed him whenever he wants since he is severely underweight. I know many on here recommend only 2X a day so I am not sure what is best. I do know that if he loses anymore weight it will not be good.
- Currently feeding Instinct Original pate duck and rabbit flavors which are about 5% carbs as well as freeze dried 0 carb chicken treats.
- Vet says to give him 2 units if his blood glucose is over 300 and 1 unit if his glucose is under 300 and above 100
- BIGGEST QUESTION: I have read on here that giving Lantus if glucose is 120 should not be done yet my vet said anything over 100 should be half a dose (1 unit). I did not give him his insuling this morning when his morning reading was 120 because I am afraid his will go too low and because I don't have a good picture of his actual nadir yet (wondering about the middle of the night numbers).
- SECOND BIGGEST QUESTION: Is dosing at shot time based on the nadir number or the number he was at before his pre-shot meal?

The vet I was going to at the time said I could try treating him with diet alone so I spent those months researching and lurking a lot on this forum. I put him on what I thought was a healthy, low carb diet mixing Halo wet food with Young Again dry kibble. I was, unfortunately, not testing his blood glucose because he seemed fine. But over the last month he started to drop weight and became emaciated. Last week, he developed DKA and ended up in the hospital for two days where they thankfully stablized him on fast acting insulin and then sent me home with instructions on giving him Lantus every 12 hours and a Freestyle sensor attached to his neck.

Two days ago, I removed the Young Again kibble from his diet and all seafood (because I read on here that seafood can raise blood sugar in some cats - I have not yet tested Sundance to see if seafood affects him). I also eliminated the medium carb treats he loves and am feedlilng Instinct Original pate duck and rabbit flavors which are about 5% carbs as well as freeze dried 0 carb chicken treats. Ever since I changed his diet his blood sugar has been 120-130 range even two hours after a meal.

Unfortunately, the Freestyle fell off and I replaced it and then it feel off again the same day. The vet wanted me to come in today to have a new one put on, but since I have an appt at the vet on Friday I decided to wait and try my hand at doing the ear prick testing with a home kit until he gets his replacement Freestyle. The vet told me not to give insulin last night because I was not able to test with the Freestyle. This morning, I was able to get a blood sample using my Auvon pet glucometer. Almost 24 hours after his last Lantus dose, which was a half dose because his last Freestyle test was 120) his blood sugar was still in the 120s. I did not test it overnight last night and don't know what it was.

I am going to test him in a moment. He hasn't had an insulin shot in 33 hours and I'm worried that that's really bad. But I'm also scared to give it to him if his pre-food glucose is under 150.

Should I give him 1 unit even if it's in the 100s or should I skip the shot again? I'm so scared that he's going to go back into DKA or backslide because he's doing so well! The vet said they rarely see cats bounce back from DKA so quickly. Any advice is welcome!

 

With DKA it’s dangerous not to shoot but without a spreadsheet I can’t give any dosing advice. Are you checking for ketones?

 

Yikes, okay. The vet told me not to shoot if I can't get the glucose reading. I just tested it and it was 345 so I'm going to give him his full dose once he has finished eating. Vet says to give insulin 20 mins after he's done eating. Is that what you all suggest?

I don't think he still has DKA. They didn't tell me to test for ketones but I just ordered the testing strips on Amazon. He has a habit of not covering his urine in the litter box so can I just dip the test strip into the puddle?

Now that I have the hang of getting blood from his ear I will try to test every two to four hours until his vet visit on Friday.

Is it a good sign that he was under 400 about 33 hours after a half dose? In the first couple of days he was consistely high 400s and even 500 and that was just a few hours after his insulin so it seems like his numbers are getting better? These lower numbers all since I took away the low carb kibble.

 

You can shoot right after eating. No need to wait at all.

 

Read the stickies here.

https://www.felinediabetes.com/FDMB/forums/lantus-basaglar-glargine-and-levemir-detemir.9/

That is right that you need to test every time before shooting and if the bg is under 200 until you have data it’s not safe to shoot. The diet change can decrease the amount of insulin needed and he could become diet controlled. With DKA you need to find a dose that is safe to give.

That is a large starting dose of insulin. Lantus is dosed upon how low it takes your cat, the nadir. For many cats that’s around 6 hours after insulin. Did your vet tell you to pick up food 2 hours before insulin so the pretest is not food influenced?

The bg coming down is a good sign but those are high numbers. You can check for ketones by dipping in the urine. The box will tell you how many seconds to wait to read it.

 

Dear Julie, i definitely recommend filling in the spreadsheet: https://www.felinediabetes.com/FDMB/threads/how-to-create-a-spreadsheet.241706/

It is difficult for people to tell their opinions if they don't see numbers. The spreadsheet is as well a very useful tool to track the progress. We have another tracking device but since they are different they both have their benefits.

Good luck and keep us posted

 

Thanks so much for your reply. The vet didn't say anything about withholding food 2 hours before insulin. They just told me to scan the Freestyle every two hours and base his shots on the last blood sugar before shooting. Nothing about testing before food or anything. Thank you for that. I read it just in time as I am due to give his shot in two hours.

I'm a little bit confused about something, probably because I've hardly slept in days trying to get my head around this situation! Ugh. So the Lantus dose is based on the nadir and not his pre-shot test two hours after eating? If his lowest recorded nadir is 120 do you think it's possible that 2U is too much? You mentioned that it's a high dose to start with. The vet office has given me a lot of conflicting info. One doctor in the office said to feed him carbs, the other doctor said low carb is best. One doctor said feed him whenever he wants because he's underweight, the other doctor said feed only 2X per day even if he's starving because it's more important that we stabilize his blood sugar than worry about gaining weight right now.

I should receive the keto stix tomorrow so I'll start testing that. Somehow I've figured out how to check his glucose via ear in a pretty reliable way. He and I came up with a good routine today and I was able to check him 5 times today every few hours to get an idea of today's range. I'm kind of worried that the Auvon glucometer isn't accurate because earlier today I tested him and he was 75 and I checked again a second later and it was 345. I didn't have much blood on the strip for the first test so I'm hoping that's why it was inaccurate. Second time was a good drop of blood. The range today has been 225-435. I'm thinking he got out of whack because we went 33 hours without a shot so hopefully he will stabilize now that I have the testing and food timing down thanks to you all.

Seriously trying not to lose my mind here and so worried about doing something wrong that could hurt him. . The good news is that he seems really happy and alert today. I can tell when he is feeling like crap because he spends a lot of time sleeping in another room by himself. The last two days he's been up and around the house all day, hanging out with me more and even played a little bit. He no longer minds the blood check at all and isn't mad at me, thank goodness. He actually just sits still and lets me do it whereas two days ago he was knocking my hand away and I had to put him in a cone to do it.

Tomorrow he gets a new Freestyle and hopefully it will stay on longer than 5 hours this time so I can get a really good curve for a few days.

 

Ah, okay! Thanks for letting me know. I will get that started.

 

Good to know! The reasoning they gave me for that was to make sure he doesn't throw it up before getting the shot but he hasn't been throwing up at all. Does it matter if the shot is 15 mins early or late when we are trying to get him regulated? I did the shot 15 mins early this morning at 10:15 and am wondering if I should keep that same time this evening or just do the normal 10:30 time.

 

I have another question. Can giving more insulin that is needed cause erratic numbers? I'm just wondering because during the 24 hours that he only had one dose of 1 unit he seemed to have much better numbers than after last night and this morning when I gave him 2 Units. Or perhaps it is just because of the change?

Edited to add yet another question: they tell me to give him 2U if he's over 300 and 1U if he's under 300. However, on this site I've read that one should only reduce by .25 U at a time. I'm wondering what the risks are with halving his dose suddenly anytime there's a number under 300?

 

You want him eventually to be in normal bg numbers 50-100. So a nadir of 120 does not mean he’s getting too much insulin. We don’t believe in the kind of dosing you were told. Lantus likes consistency so once you have enough data we would not give different doses. The methods we use are either SLGS or TR. You can read about them on the stickies on the Lantus forum.

We are very data based. Would you be willing to start a spreadsheet? That’s how we can help with dosing.

Since he is underweight you need to feed him as much as he wants and if you want him regulated we suggest feeding a low carb canned diet. You will need to have some middle carb and high carb food in case his bg falls too low and he needs carbs to get him into a safe range. You also will need karo syrup or honey on hand for the same reason.

How much does he weigh? The starting dose is based upon weight. My cat was 14 pounds at diagnosis and started on 1.0 units.

Most cats do best on several small meals each cycle. Some free feed except for the two hours before testing. Whatever your dose , even early on, with our methods you would shoot a full dose if around 200 at preshot. Lantus is a depot insulin and takes time to build. The initial depot takes about a week to build.

 

Hi, so his number this morning pre-meal was 146 and I gave him 1U per vet's instructions and because I'm worried that missing doses will mess him up. I just checked his BG again 2 hours post insulin and the reading is 89. I checked it a second time and the reading was 87. I think I've read that Lantus doesn't really kick in until 4 hours after injection so I'm a bit worried that he's already at 89 only two hours after meal/injection. I just gave him some treats that have 15% carbs after his shot. He has a vet appt in 2.5 hours for a follow up and I'm going to keep checking his BG until then. Is this reading of 89 good or bad so soon after his shot?

I will definitely get the spreadsheet going. I'm recording everything in my notes so I can just put it into the spreadsheet.

He weighs 10 pounds and his ideal weight is about 14 pounds. I'm thinking the 2U is too much based on the formula of .25 x body weight. Even if I do .25 x ideal body weight it says he should only get 1.5U.

 

Lantus kicks in around +2. The 2.0is likely too high but without a spreadsheet Icant say. The bg is likely to fall until +5-7. So I’d feed a little middle carb FD around 14% to keep him from dropping under 50. If there’s a drop under 50 feed some gravy and test every 20-30 until staying in the 60’s.

 

We would have started him on 1.0 or maybe 1.25 units.

https://felinediabetes.com/FDMB/thr...-low-go-slow-slgs-tight-regulation-tr.210110/

 

Thank you for your replies! Okay, so the BG keeps falling for 5-7 hours. I understand now. So I gave him some 15% carb treats which are his favorite treats in the whole world so he was thrilled. I checked BG 45 mins later and his sugar was 113 so the treats boosted it a little. I will check again in half an hour. I feel so lucky that he doesn't mind the blood testing. He's getting a new Freestyle put on today and I'm sure it will only last a day or two but I want to use it to compare numbers with my glycometer to see if they match up. It will also help me to get a better curve and I want to check him in the middle of the night. If his morning BG was 146 at the 12 hour mark I'm wondering how low it goes overnight.

I'm certain the vet is going to say to keep him on 2U but my gut and all of the info you've given me are telling me to put him on 1 U twice a day and watch it for a few days. I'll try to get the nadir in the middle of the night and middle of day.

And I will get that spreadsheet started.

Thank you so much! This forum is a godsend.

 

You dint want to boost his bg u less he falls under 50 if using a human meter which you are. Normal bg on a human meter is 50-100 roughly. The more time spent in those numbers the better. Save the hc treats for then. Get some 100% protein treats fir the rest of the time.

 

Ah, okay. I'm using an Auvon meter designed for pets - it doesn't say if they are human or pet numbers but they seem like human numbers. I tested myself after eating and got what seemed like a normal reading for me - 135. I gave him the treats because I was worried the BS would drop. Oops. So I will only do that if it goes under 50. I do have some 100% protein freeze dried treats - thank you!

 

Since you are using a pet meter, the take action number is 68. Would you add a signature with info we need? Look at mine . Things to include are food you feed, meter used, diagnosis date, and age.

 

Okay, will do! I'm running out the door to the vet for his one week checkup and will add a signature when I get home. Thanks!!