New to this, cat regularly showing lower numbers after three weeks on insulin, curious what to do

[Finn & Murray]

Hi! Been a lurker on here so far, but decided to make an account and post to ask a couple questions. My apologies, I have a feeling a lot of these will have already been asked elsewhere, but hopefully you'll be able to bear with my new-to-this-ness.

A bit of background information: My 8 year old rescue cat, Murray, was diagnosed with diabetes just under a month ago. I had brought him in due to something else, but the vet suggested that, due to his weight, doing a blood sugar test was likely a good idea. She came back with the diagnosis, and within the week I started Murray on Lantus.

As suggested on here, I purchased a meter, and have been tracking Murray's levels since I started his shots. Immediately, I had switched him over completely to wet food (it's always been his favourite anyways, so the dry wasn't missed), and worked through the supply of Purina DM I had (stupidly) bought from the vet. For the first couple weeks, his levels didn't seem to change much, staying mostly in the 12-18 range. That is, until the vet-prescribed food ran out, and I switched him over to President's Choice pates on a suggestion from someone here for a good low carb food in Canada. Almost immediately after starting him on that, his levels dropped - the highest they've been on the PC food has been 12, I believe, and the lowest has been 5.3.

That's where my question comes in. The vet had told me that when it comes to blood sugar levels, they would prefer it be a little high rather than too low. I've seen elsewhere on here that, at a certain level, giving a shot isn't necessary or advised, and I also believe I've read that at certain levels, if a cat stays in that range for long enough they're considered in remission. The thing I'm wondering is how to go about dealing with his new recent levels. On Thursday morning, Murray's level was at 6.1, which is the lowest it had been since I started testing. I was so surprised by it that I tested again, sure that the meter must've been on the fritz, but nope. Unsure about what to do, and not wanting to bring him too low while I was at work, I followed the advice I read in a different thread and skipped his dose for that morning. When I tested in the evening, he was back up to a 12, and I gave him his shot like normal. Same thing happened on Friday - in the morning, he was at a 5.3 (that lowest level I mentioned before), and again I skipped, and again that evening he was higher, albeit only at a 10 that time. Today (Saturday), I tested him in the morning - my dad had fed him about half an hour prior to his test so I think that skewed the results, but - he was at a 7 and I only gave a half dose, and this evening I tested and he was at a 6 again. So, a bit all over the place, but recently evening out at what seems to be a lower, more "normal" blood sugar range. So, I guess my main questions are... what do results like this seem to indicate about how his diabetes is being managed or how it's going in general, and what do I do when I test him and he's in the 5-7 range?

Sorry for all of the rambling - again, I'm quite new to this, and I haven't really gotten much advice about what to do in situations like that. I really want to be hands on with Murray's treatment and do everything right to give him the best chances of managing this well and potentially going into remission, and I think being active on here is the best way to go about doing that. As well, one last bit of information I feel is pertinent in this situation - I know dental problems can cause blood sugar levels to be a bit all over the place, and Murray currently needs to have a few teeth pulled, I'm just in the process of doing a bit of research to find the best vet in town for the best rate. So... I think that's it! Thank you in advance for the advice and help, and I hope my babbling wasn't too much.

 

[Chris/China (GA)/Garfield]

How much Lantus are you giving?

The quick, easy answer to your questions is that if you keep getting Pre-shot numbers that are too low to shoot, the dose is probably too high and you should decrease the dose

Are you getting any tests in between the shots? Lantus dosing is always based on how low it takes them, not the Pre-shot numbers, so it's really important to get tests mid-cycle on the AM cycle and "before bed" on the PM cycle.

As for what to do with lower Pre-shot numbers, until you have enough data to know for sure, we suggest that if you get a Pre-shot under 200 (11) that you stall, DON'T feed and test again in 20-30 minutes to see if the number is coming up without the influence of food. Use that time to post and ask for help. The first few times you shoot a lower number, someone here will agree to stay and watch out for you until you're sure everything is OK....that's one of the promises we make here.

It will also help if you'll start to record your test results in our spreadsheet. We are very data driven here and before we can give much in the way of advice, we'll want to see your spreadsheet.

Here are the Instructions on getting the FDMB spreadsheet ....if you have any problems getting it going, let us know!

 

[Finn & Murray]

As of right now, he's getting 1U at 7:30 in the morning and at night. I was told by the vet that that's already a relatively low dose, was that correct?

I haven't been doing any testing in between yet, no. I was planning on doing a curve tomorrow, given that I haven't been able to do one since I started his insulin and the vet told me I would be able to do one at home with the meter I have, so I'm assuming information like that will be helpful in regards to regulating his dose and knowing where he's at?

I think what I'll do now is start testing him earlier in the day - I've been doing 7:30 simply because that's when I get up for work, but now that I'm seeing these odd numbers, testing that late doesn't give me much time to stall and wait to see where his levels get to. I don't know if that's what you would advise, but if it is, I'll likely start testing earlier just to give myself some wiggle room time-wise.

As well, I've saved the spreadsheet to my Google drive now, so I'll make sure to use that! Might take a bit of getting used to it, but I'm sure I'll get the hang of it soon. Thank you so much for your help - I could tell from my lurking that this is a pretty supportive place, and I'm so glad there's such a wonderful community for this sort of thing!

 

[rhiannon and shadow (GA)]

I'm glad you've got the spreadsheet.... there should have been instructions on how to add it to your signature....
you want a signature at the bottom to tell us stuff so you won't have to repeat it constantly.

There are sticky's at the top of this forum that you will want to spend some time reading that give you a lot of information,
we'll still answer the questions as they come but even old timers have to go back and read sometimes to refresh, it's a lot of info.

It would be wonderful if you could do something like every 3 hours or 4.... depending on your day tomorrow for that curve.

I hope you will post daily like everyone here.

 

[Chris/China (GA)/Garfield]

I was told by the vet that that's already a relatively low dose, was that correct?

That's pretty much a normal starting dose, but you can reduce the dose down all the way to 1 drop! It's important to have syringes with half unit markings so it's easier to do shots like .75, .5, .25

We want to get our cats into a strong remission, not necessarily a fast one, so we keep them on insulin as long as it's safely possible to give the pancreas the most time to fully heal......rushing it usually just leads to them falling out of remission fairly quickly and it's REALLY hard to get a 2nd remission.

I don't know if that's what you would advise, but if it is, I'll likely start testing earlier just to give myself some wiggle room time-wise.

That's exactly what I'd suggest....except it's important to keep the doses as close to every 12 hours as possible, so I'd slowly work your way back in 15 minute per cycle increments until you're at the time you want to be testing/feeding/shooting.

As well, I've saved the spreadsheet to my Google drive now, so I'll make sure to use that!

There's a "shareable link" you can put into your signature here so we can see your spreadsheet any time we need to. If you look below our comments, you'll see the information we like to have in our signatures as well as our spreadsheet link.

To fill out your signature, just go to the top right and find your sign on name....there's a drop down menu and you'd choose "Signature"....a new box will pop up for you to enter information in like :

Your name/Cats name, age, sex, date of diagnosis, type of insulin, type of meter, type of food, any other health issues?, any other meds?, and general location.....then you'd get the link to your spreadsheet and paste it in and "save"

 

[Finn & Murray]

Alright, so, I've got the spreadsheet set up, I have the link and other info in my signature... I realized I'd goofed with putting it in my Google drive at first, but it's all fixed now!

It would be wonderful if you could do something like every 3 hours or 4.... depending on your day tomorrow for that curve.

I should be able to do testing today every two or three hours, so we should be good on that front. I'm not sure if more testing (two hours as opposed to three) is better or not? Also, that's very true - there's so much information out there, and I can imagine needing to have a bit of a refresher every once in a while!

That's pretty much a normal starting dose, but you can reduce the dose down all the way to 1 drop! It's important to have syringes with half unit markings so it's easier to do shots like .75, .5, .25

We want to get our cats into a strong remission, not necessarily a fast one, so we keep them on insulin as long as it's safely possible to give the pancreas the most time to fully heal......rushing it usually just leads to them falling out of remission fairly quickly and it's REALLY hard to get a 2nd remission.

Oh, good! I had seen people talking about half doses and things like that, but I wasn't sure if that was just a once in a while thing, or a regular amount you could give your cat if they seemed to need that. The syringes I bought do have half unit markings, so we're good on that front!

So, obviously rushing remission isn't the goal here... when a cat has lower levels, though, what sort of dose do you end up giving them? This morning he was at a 9, and because I'll be home all day doing his curve and it wasn't as low as the 5 or 6 he got the other day, I gave a full dose of 1U. And then realized after the fact that I should've stalled, and started worrying. Was that too much? Should I have done a half dose? The last thing I want to do is give too much and put him in danger of being too low, but I also don't want to give too little and hurt his chances of getting better. There really is a lot to know, and hopefully I'll get the hang of it soon...

That's exactly what I'd suggest....except it's important to keep the doses as close to every 12 hours as possible, so I'd slowly work your way back in 15 minute per cycle increments until you're at the time you want to be testing/feeding/shooting.

Oh, of course - I did his shot around the same time this morning, but I'm hoping to bring it back 15 minutes tonight and do the same for the rest of the week until I get him closer to 6:30-7 am. That would give me more time, which would be best, really! In the meantime, though, is it possible to test his blood sugar levels earlier and shoot later? Just so that, if his levels are at a point where I need to stall and retest, I have the time to do so? If that makes sense, I hope it does...

Again, thank you both for your help and advice, I appreciate it so much! There's so much information, so many things to remember, so I hope I'm not screwing it up too badly just yet.

 

[Sienne and Gabby (GA)]

Welcome to the Board (as a non-lurker)!

First, regarding the spreadsheet (SS), if you are using the "Canadian" numbers, enter them on the tab for the "World" version of the SS not on the US tab. If you enter on the World tab, your numbers will automatically be converted to the US version on the US tab. That will allow the US member to read the numbers since we're mostly conversant with mg/dL vs mmol/L.

I suspect you're seeing a change in Murray's numbers for 2 reasons. It takes Lantus about a week for the depot to form. It's at this point that Lantus starts to really work. The food change has likely also contributed. (The Purina DM canned food isn't horrible in terms of carbs. It's just lousy food -- mostly animal by-products.)

Just to clarify regarding the need for syringes that have half unit increments -- We typically change doses in 0.25u amounts. Given the size of the syringe barrel, using syringes that are in 1.0u increments makes it very hard to measure a dose consistently. Even with the half unit increments, consistent measuring is hard to gauge. (Many of us buy digital calipers to help be more accurate when drawing up a dose.)

In the meantime, though, is it possible to test his blood sugar levels earlier and shoot later? Just so that, if his levels are at a point where I need to stall and retest, I have the time to do so? If that makes sense, I hope it does...

It depends on what you mean by "earlier." If you mean 15 min, it's probably OK. If you mean an hour or more, probably not. While it may seem inconceivable, a lot can change in an hour. Most of us test, feed, and shoot within minutes. I would give Gabby her shot when her head was in her food bowl.

So, obviously rushing remission isn't the goal here... when a cat has lower levels, though, what sort of dose do you end up giving them? This morning he was at a 9, and because I'll be home all day doing his curve and it wasn't as low as the 5 or 6 he got the other day, I gave a full dose of 1U. And then realized after the fact that I should've stalled, and started worrying. Was that too much? Should I have done a half dose? The last thing I want to do is give too much and put him in danger of being too low, but I also don't want to give too little and hurt his chances of getting better. There really is a lot to know, and hopefully I'll get the hang of it soon...

In part, how low you shoot depends on whether you are planning on following either Start Low Go Slow or Tight Regulation as your approach to dosing. For someone new to FD, both approaches suggest that if your pre-shot is in the 150 range (8.3 mmol/L), you post and ask for help. As you become more comfortable with lower numbers, you begin lowering your threshold for where you want to shoot. With TR, most of us would shoot anything above 50 (2.8 mmol/L). We don't expect that anyone who is new will do this. For those of us who would shoot low, we have experience with managing low numbers. With SLGS, 90 (5.0 mmol/L) is the point where you consider whether to shoot. Ultimately, you want to get comfortable shooting "green" numbers rather than skipping shots if your goal is your cat going into remission. Also, you need to remember that Lantus dosing is based on where the lowest point in the cycle (nadir) is and not on the pre-shot number.

You are absolutely correct that the front end of the learning curve is overwhelming. Please let us know how we can help.

 

[Finn & Murray]

Hi! Thank you for the welcome!

I was wondering how to go about doing the conversion... didn't realize just how simple it was, whoops! Should be fixed now, hopefully I've entered it right this time!

That makes sense as well - it doesn't seem like something that gives overnight changes, so I wasn't super surprised that his numbers started changing, especially with the change in food.

Are there any digital calipers you'd suggest investing in? I can only imagine how tough a .25 measurement would be to get - it's already difficult enough to get the dose right on the line as is, so going without any reference to get a dose seems a little daunting!

I was wondering if that might be the case, too. It seems like a lot can change quite quickly with this, so testing earlier than the shot probably isn't worth it. I'll just work on slowly bringing the time earlier, so I can give myself that wiggle room to be able to stall if needed.

As well, I'm not entirely sure which approach I should follow... it sounds like Tight Regulation is a lot more accurate, but I'm not sure if it's easier to start with the other and move on to a more close watch of what's going on? I do want to get to the point where I'm able to shoot lower "green" numbers because I'd definitely like to get Murray into remission. I mean, I'm sure that's most people's goal, but I feel like he has a good chance of getting to that point once he loses some weight and has his teeth fixed. But, I might also be mistaken, so who knows for sure?

I'll definitely let you know if there's anything I need help with, and I'll make sure to do whatever I can on my end to give Murray the best chance at having success no matter which approach I take. I'm going to be testing him again soon here, two hours after his morning shot, so hopefully the information I get will help with all of this too!

 

[Wendy&Neko]

Hello and welcome from the finally smoke free west coast. I hope your air is clearing up there too.

Regarding calipers, my hubby bought me a pair at KMS tools. If you don't have one in Kelowna, you can get them at most metal or woodworking tool stores such as Busy Bee, or even Canadian Tire, though pricier there.

Love your profile doc. Crazy cat people are very welcome here. You may find multiple small meals easier on a healing pancreas that large meals at shot time. Just try to feed most food in the first half of the cycle when the insulin is strongest.

 

[Finn & Murray]

Ahhh, another west coast Canadian! Hello! The smoke does seem to be clearing somewhat here... more than it is where the rest of my family lives at least, apparently it was pitch black out by 6pm last night there

I know we definitely have a KMS Tools around here, so I can definitely take a look there! I'm... gonna be honest, I'm not entirely sure what I should be looking for there, but I'll take a look anyways

And, thank you! Yours is wonderful too! I try to surround myself with crazy cat people, they're the best kind of people in my opinion I think that's what I'm going to aim for - I do give him a little more with his shots because he usually hasn't had any for a while at that point (being at work between morning and night shot times), but I miiiight have to invest in some sort of automatic feeder if smaller meals spread throughout the day are better. That way, I can feed him in the hours after the shot without being at home!

Also, update on where he's at - I've done his third BG test since his shot this morning, and the results so far have been... 7.4 two hours after, 4.5 five hours after, and 5.4 eight hours after. Not sure if that shows much yet, but it's something!

 

[Wendy&Neko]

Digital calipers, I have the EZCal brand, gray box. You want at least two decimal places on the mm setting and a locking screw on top so you can set your dose and leave it. There are two sets of measuring arms, big ones for measuring the outsides of things and little ones for measuring the insides. I presume you are using the BD syringes? The arms for measuring the inside are useful for getting inside the ring on the outside of the BDs. You want this inside arms to be fairly skinny, which they are on mine. Google digital calipers, and you will see what they look like.

Lovely numbers today! That 4.5/81 may be significant, depending what dosing method you decide to use.

I got the Petsafe 5 automatic pet feeder. You can get them in Petsmart or at Amazon. It gave me piece of mind that she would be safe while I was gone.

I have family in Kamloops, scary last week when the air quality reading said don't go outside at all.

 

[Finn & Murray]

Oh, okay! Yeah, that makes a little bit more sense! I do have the BD syringes, they were the ones they supplied at the vet, are those ones usually quite common for people to use?

And ahhhh, yay! I'm glad to hear those numbers sound good! Significant in what way? And, is there a dosing method that I should be considering more than the other with these sorts of numbers? My ultimate goal is to get him into remission (as I said above, that's something I'm sure most people would like to have happen) so if there's a method that lends itself more to that happening, I'd probably go with that

I just looked at that one on Amazon, that looks like quite the feeder! I assume it must work with wet food as well as the dry food it shows in the product image?

Right? I know a few people there, and when I heard that I was just shocked - it was smoky enough here, but not quite that bad, I don't think!

 

[Wendy&Neko]

The BDs are available at any people pharmacy, maybe even cheaper than what the vet charges. My Save On Foods pharmacists has many cat clients. Oddly enough, Safeway pharmacy is cheapest for syringes and lancets around here.

Read this he sticky notes on TR and SLGS, and decide what suits you best. TR has better odds of remission, but cats using SLGS also can go into remission. TR is more aggressive, and not for everyone. It's a tradeoff. SLGS would have you reduce because he went under 90. TR uses 50 as the reduction point.

And yes on the feeder working with wet. There is a spot under the feeder you can fit a tiny ice pack or ice cubes, or you can add water or an ice cube on the wet to keep it fresh.

 

[Finn & Murray]

Yeah, I had almost bought some BDs when I got the prescription filled at Costco, but I hadn't known whether those were the right ones or not so I waited. And then I didn't wanna go all the way back there once I had the vet show me what to do, so I was like... I'll buy these here for now, but in the future I'm getting them elsewhere I'll have to check Safeway out, though!

I think, from the sounds of it... I'd like to try TR, though I know it's a little more... involved, is that the right word? I just bought myself a bike this weekend, though, and I'm about a five minute bike ride from work, so... I'm thinking I can swing by my house in the afternoon to do a test if needed. Is that how TR works? I know it involves more testing, but I'm not sure if that means you can't leave it for eight hours at all or if it's pretty flexible when you test. Either way, I'll make it work! I really want to give Murray the best chances to go into remission - he's still relatively young, and he's got a few other things (weight, dental problems) that, once they're fixed, I think should help him go back into remission, so... whatever I have to do to help him get there, I'll do it! And, if he never goes into remission, that's totally alright too! But, you know, I'd like to give it a chance at least

Ahhh, perfect! Well, I might just have to buy myself one of those soon... I think Murray would be pretty happy getting food during the day while I'm gone, too, so it's good for both of us!

Oh! Also, edited because I forgot to add: I did Murray's evening shot, and when I tested he was at a 7.1. Not knowing quite how he reacts when at that level, I just gave him a half a shot - that should be okay, I would think?

 

[Wendy&Neko]

Due to the nature of the Lantus depot, the cycle with a reduced shot can still be active and require monitoring. If you can get a before bed test, that'll let you know if he's safe or needs some extra food left out. Over time, and as you gather more data about how Murray handles Lantus, you will be able to shoot full dose on lower numbers. Just not yet.

Do you have high carb wet food on hand, just in case?

TR does require more tests, in order to keep them safe. It's good to learn Murray's onset and nadir to start. That will help you learn when you need to test.

 

[Chris/China (GA)/Garfield]

There's all kinds of good tips and info in this "Is TR possible with a full time job? Yes!! thread

 

[Finn & Murray]

I should be up for another couple of hours, and I did his shot an hour and a half ago, so... Right before I go to bed, I'll do another test and see where he's at. But yeah, I know that for the time being it's going to be a little uncertain, not knowing exactly how he reacts to the medication, but once I get a bit more information it should go a little bit easier!

I have some Friskies pate, the stuff that Murray would eat before his diagnosis, but I don't know if it's exactly high carb? Is that in case of a hypo episode, or?

More tests are fine, I'm alright with doing that! I basically just want to make sure I'm doing enough of them, at the right times, and also really understanding the terms and what everything means and all of htat. Onset and nadir, that's... I know nadir is the lowest point, right? I feel like I know so little, oop!

Also, thank you for the TR and full time jobs thread! I'll have to take a peek at that!

 

[Wendy&Neko]

Usually the high carb food are the ones with gravy. The ingredients will include wheat, corn, rice, or potatoes. The Fancy Feast Gravy Lovers have lots of carbs in a small can, so you don't waste much. Pates are usually low carb. But you can make something high carb with a drop of corn syrup, maple syrup or honey.

 

[Finn & Murray]

That's good to know! I'll pick up a few cans of food that are more like that, just to have on hand in case they're needed. But, I always have honey and syrup around the house, so I was quite pleased when I heard those can be useful for diabetic cats

I placed an order yesterday night for that automatic feeder mentioned above - it looks perfect for what I need, so I caved and just bought it. It'll be good to have in the long run anyways, so! As well, when I tested Murray this morning he was at a 6, and then when I tested half an hour later he was at a 5.8. Because I knew I'd be home checking up on him in four or so hours anyways, I did another half dose, just to be on the safe side, and I'll hopefully be able to get away from work around lunchtime to bike home and retest then. If that's needed, of course?