New to Testing and Insulin-First Reading Concern

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HeatherVan

Member Since 2013
Hi,
My cat was just diagnosed with Diabetes and she is now on 2 units of Lantus twice daily. Today we just tested her for the first time using the ReliOn Confirm. We did the reading at 5pm right before we fed her dinner and the reading was 78. I'm very concerned since everything I've read on here says not to give her the insulin if the reading is below 150. I'm afraid of not giving it to her because she has just been so sick and my vet told me that at home tests were more important for tracking spikes than paying attention to the actual number.

I'm sure I can find more information if I keep reading but after reading about this all week and starting her on 5 new medications this week I'm overwhelmed right now. My current plan is to retest her in 1 hour and see what she at then. Does anyone have any suggestions what I should if the reading is still around 78? I won't be able to do a curve test until next weekend so should I just go with her before food tests and make a decision from that for now?

In case this matters she is also sick with an allergic reaction to something and I think something is also wrong with her throat but the vet can't find anything yet.

Thanks for your help!!!
 
Hello
great job on the testing - its the best way to keep her safe. At 78 you should not be shooting, since you dont have the data to know how low she is going to drop. Skip it for tonite but get a reading in 2 hours to see what she does as a result. This will start to give you data you need if this low preshot happens again. As a newbie you dont want to shoot under 200.

Have you changed her food recently?

Definately test before every shot and if you cant be around during the week to test, then try and get a before bed test too ( ideally a few hours after her nighttime shot). That will give you some data at least.
Wendy
 
Hi Heather!
First if all welcome to FDMB...
I am still a newbie so I won't give you advice, I'm just going to tell you what happened to me. Charlie's numbers were in the 200s and the vet shot him with 2u and he went hypo that first night! I had many people on here telling me what to do to help him and I am so grateful for them. They are very knowledgeable and you are in great hands. I am now a frequent tester and I am not afraid to challenge my vet with questions. Charlie is on Lantus as well. I asked the vet at what number should I not shoot and he told me 186. If its below that, don't shoot...like I said, I am still a newbie but I would no way shoot if fur baby is in the 70s...I would monitor closely...
I'm sure you'll get the help you need in here.
 
What other medications is your kitty taking? Are the medical problems related only to allergy? Is there any history of diabetic ketoacidosis? By any chance did the vet put your cat on steroids for the allergies?

Without any data, it's just not safe to shoot that low of a number. Stalling is a good option providing you are able to shoot 12-hours from whenever you give a shot this evening.

Getting pre-shot numbers is important. However, with Lantus, dosing decisions are made based on the lowest number in the cycle. So, it's important to be able to get some tests. It doesn't have to be a curve. Getting tests at random times can be at least as good as a curve. I also have to respectfully disagree with your vet. You need to get a pre-shot test in order to determine if it's safe to give a shot -- like tonight. Tests during the cycle tell you if you need to lower or raise your cat's dose. Many vets treat Lantus like other insulin where dosing is based on the pre-shot number. That's not how Lantus works.

I'm guessing you're going to need to reduce your cat's dose. The initial dose of Lantus can be based on a weight-related formula:
initial dose = 0.25 x ideal weight in kilograms​
A starting dose of 2.0u is a large dose. (Your cat would need to weigh 17 lbs if you were using this formula.)

I'd suggest you read the post I've linked on shooting and handling low numbers. If your cat does not have a history of ketones, it's likely that the safest route is going to be to skip tonight's shot and lower the dose to 1.0u tomorrow -- or to contact your vet to see how he'd like you to proceed.
 
The threshold here in the Feline Health forum is don't shoot if BG under 200 for newbies like yourself.

Once you have collected more data and are ready to move over to the lantus forum, the threshold is don't shoot if BG under 150.

Unlike your vet, we recommend testing before every shot. That reading you get is called the pre-shot value. If taken in the morning, it is the AMPS. If taken in the evening, it is the PMPS.

Since you did that test, you now know your cats BG is too low to shoot at our recommended threshold of 200.

We have seen many starting doses of insulin being set too high by the vet, based on stress induced BG readings taken at the vet. You can often expect a 100-180 point rise in the BG values taken at the vet.

Starting does for lantus should be weight divided by kilos times 0.25 units, rounded down for safety.

So if your cat weighs 12 pounds, the starting dose of lantus should be 12 divided by 2.2(# of pounds in a kilo) = 5.4 times .25 units = 1.36 rounded down = 1 unit to start. This is based on the Roomp and Rand protocol for lantus. Don't know what protocol your vet used to arrive at this starting dose but you might want to ask.

Here is the link to the Roomp and Rand dosing protocol I mentioned. http://www.felinediabetes.com/Roomp_Rand_2008 dosing_testing protocol.pdf

Unless you want a "trial by fire", I would not advise giving any insulin at that low BG reading. That is a normal value. Range for a non-diabetic cat on a human glucometer is 60-130. Your cat is in the normal range. This makes me wonder if your cat actually has diabetes.

Was a fructosamine test run as part of the blood work? This gives an average of the BG levels over the past 2-3 weeks and is a better indicator than a single number done at the vets.

Infections can also raise BG numbers.
 
Thank you everyone for your input.

Isabella has been sick for over a year and until now nothing has ever been conclusive. We've seen our normal vet, holistic vets, even pet communicators. She has always had respiratory illnesses and seems to be very bad lately so she is on holistic immunity improving pill for that and a detox homeopathic liquid. She is also on a probiotic because she has an upset stomach a lot which started when she ate an entire foam ball last year. She also seems to be having some issues with her throat hurting and swallowing. Overall I think we are just at the beginning of finding out what all is wrong with her but she's always been a little borderline diabetic and they finally decided from a urine glucose test that she must be because it was reading so high, she was at home and we took the sample right from home as soon as she peed. We can never get an accurate reading for anything at the vet which is partially why it's been hard to diagnose her with anything. She HATES the vet because she was very ill when we got her 10 years ago and she had to spend many weeks in nebulizer treatments.

I will say that she does seem to be doing a little better with the insulin, she is eating a little slower and not trying to eat every bit in 10 seconds. She currently weighs 12 lbs so I'll lower her dose to 1 unit for now and keep testing as much as I can to see how that goes.

The regular vet of course keeps pushing a steroid for her respiratory issues but for now I've told them no, my husband and I don't use traditional medicines on ourselves and I'm not happy about having to use any traditional medicines on Isabella either. She has been eating Weruva and BFF wet food for a few years so her food is good. Because of her constant need for food the vet thought it was behavioral so we had started leaving out some Lotus dry food for her which she did eat. Our holistic vet told us to stop that as soon as possible so we have slowly stopped that but that is the only food change we've made.

Again, thanks for all the advice! This is such an overwhelming thing and I just want her to feel better and it's nice to hear from others that have been through similar situations!
 
Using an inhaled steroid vs. a steroid injection is actually ok to do for breathing (asthma) issues. And the use of inhaled steroids (ie. Flovent) does not increase the BG like the injection.

Is your vet suggesting you go with inhaled steroids?
 
Deb & Wink said:
Starting does for lantus should be weight divided by kilos times 0.25 units, rounded down for safety.

So if your cat weighs 12 pounds, the starting dose of lantus should be 12 divided by 2.2(# of pounds in a kilo) = 5.4 times .25 units = 1.36 rounded down = 1 unit to start. This is based on the Roomp and Rand protocol for lantus. Don't know what protocol your vet used to arrive at this starting dose but you might want to ask.

Here is the link to the Roomp and Rand dosing protocol I mentioned. http://www.felinediabetes.com/Roomp_Rand_2008 dosing_testing protocol.pdf
Click to expand...
i think what deb meant to say is the initial starting dose of lantus is based on 0.25u per kg of a cat's ideal weight unless kitty is underweight. if kitty is underweight, we've found an initial starting dose of 0.25u per kg of actual weight works well. the American Hospital Association (AAHA) Diabetes Guidelines suggests the same: an initial starting dose of 0.25u per kg of lean body weight.

since many of our diabetic kitties tend to be overweight or what i like to call "fluffy" using "lean" or "ideal" insures a newly diagnosed kitty won't be starting out with a dose that's too high... and the same for an underweight kitty.

welcome to the FDMB, heather... isabella is lucky to have you in her corner!
 
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