Newbie with first low numbers - and questions

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kateliz

kateliz

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Hi all,

I'm reposting now that I'm out of the low number panic mode.

My cat is a 9 year old male tabby who was diagnosed with diabetes on May 22. We've started Lantus twice a day (1.5 U) and I've been reading lots on here to help get better informed about caring for a cat with diabetes. Luckily, James is a really laid back cat who doesn't mind injections or BG testing (using a Relion Confirm), so I've had great success with making a spreadsheet and tracking his numbers. He didn't even mind switching to an all-wet food diet (Royal Canin, with some Fancy Feast and Friskies)!

Today I tested the first really low numbers, a 49 and 42 6 hours after his morning shot! I've gotten his numbers back up out of the danger zone and will be around all day to check on him, so I'm not too panicked. He's feeling fine, has a great appetite, and is taking his usual post-meal bath/nap.

My questions now are:
1. Should I even give him a shot this evening? Should I give him a shot but reduce the dose way down? My only syringes don't have half-unit marks (I just ordered some!) so I'm not being super accurate at this point.

2. How much of the high carb food (his favorite Friskies Prime Filets in gravy from before the diabetes diagnosis) should I be giving him today, and how long will I be seeing the effects of that?

The FMDB has been really helpful to me so far, and I really appreciate any advice/insight!
 
You want to test him about 30 minutes after that test where you got the 91 but not feed again till you see what that number is.
Carl
 
Hello and welcome! That is great that you have been testing so much and already have your ss up and going. Congratulations on switching to all wet food as well. You are way ahead of the curve.

My questions now are:
1. Should I even give him a shot this evening? Should I give him a shot but reduce the dose way down? My only syringes don't have half-unit marks (I just ordered some!) so I'm not being super accurate at this point.

2. How much of the high carb food (his favorite Friskies Prime Filets in gravy from before the diabetes diagnosis) should I be giving him today, and how long will I be seeing the effects of that?
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1. Let's wait and see what his numbers look like at +11 and at PMPS. I imagine that James's numbers will jump up quite a bit as his liver over reacts. You will want to reduce him to 1.25U because of the number below 50. If he is still fairly low at PMPS, you may reduce even more for that one shot.

2. ECID (Every Cat Is Different) on the high carb food. While you are bringing up his numbers, you want to give it a tsp at a time so he doesn't get too filled up all at once. That way, if you are having a hard time getting his numbers up, he is still hungry enough to eat. It may take 12 hours to clear out or may take only a few. ECID.

Welcome again! You have definitely been doing your homework and handled it really really well. Please don't be shy and post any questions you might have. Also, since you already have your ss up, I think it would be great for you to post over on the Lantus board so their eyes can see you. I will post a link over there now and see if i can get them to stop over.
 
Great job on catching to low number. Though at 6 hours, he may not have dropped any lower, but every cat is different. (ECID)

He is probably going to be very high this evening due to the extra food. Don't worry, that is normal. If you give insulin, I agree with lowering the dose to either 1/2 or 1 unit.

What is your "don't shoot" BG number? For newbies, we recommend not giving insulin if the BG reading is less than 200. If you want to post back with the reading at his normal dose time, we can advise you then. If you decide to skip the dose until the morning, you will be fine. Skipping a dose is usually ok, you just may end up with a higher BG reading during normal at the next shot. But usually within a day, the pattern returns back to normal.
 
Below is a great link to "How to handle low numbers with Lantus"

http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=147

It’s important to recognize that just because your cat may be experiencing low BG numbers doesn’t mean that your kitty is critically hypoglycemic. Many cats will have low numbers and never have symptoms. It’s important, though, to bring those numbers up into a safe range. ALWAYS make sure you have a stock of test strips, high carb (HC) canned food that contains gravy and is over 15% carb such as Fancy Feast grilled, marinated, or Gravy Lovers varieties (see Janet & Binky's Food Chart for a full list of options), and/or a simple sugar solution such as Karo/corn syrup, honey, maple syrup, etc.

If your cat is experiencing symptoms, especially if those symptoms are severe, you need to rub Karo syrup, honey, or maple syrup on the gums or, if symptoms are very severe, administer rectally and get your cat to the nearest 24-hour emergency facility. Take the bottle of syrup with you to administer on the way if necessary. (Note that it is rare that we see episodes of symptomatic hypoglycemia with Lantus and even rarer to see severe symptoms. But, you need to know what to do should they occur.)

The symptoms to be concerned about include but are not limited to:

staggering, uncoordinated movements, 'drunken' walk, wobbling, balance problems
ataxia - usually lack of muscular coordination, but maybe changes in head and neck movements
disorientation (yowling, walking in circles, etc.)
twitching
stupor
convulsions or seizures
coma
If your cat is testing in low numbers and you are not getting a quick response to your post, there are several things you need to do. (Low numbers are under 50mg/dL or 2.8 mmol/L.)


Depending on how carbohydrate sensitive your cat is, feed approximately a teaspoon or less of food with high carb (HC) gravy or HC food only. (If you have a cat with GI issues, using syrup plus LC food is an alternative.)
Test again in 15 – 20 min. Depending on the numbers, give more HC food.
Repeat the above steps every 15 – 20 min. until your cat tests in the 50 mg/dL (2.8 mmol/L) or above range for 2 consecutive tests. Continue to feed in small amounts to keep numbers in a safe range.
Test in 30 - 40 min. and repeat the test and feed process until there are 2 consecutive tests where numbers are stable or rising.
Test in an hour and follow the same steps.
DO NOT become complacent. If number have risen after one or two tests, it’s important to continue testing. Numbers may bobble up and down as the HC food and/or Karo wear off. DO NOT get one test where your cat has risen from low numbers into the 50s and go to sleep or leave the house. You are putting your cat in a risky situation. When in doubt, leave HC food out.
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Hi all,

Wow! This is all so helpful!

@Carl
Carl & Bob in SC said:
You want to test him about 30 minutes after that test where you got the 91 but not feed again till you see what that number is.
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Thanks for your quick reply, Carl. I just tested him again after I stopped feeding and he's still low-ish, by our relatively new standards (77). Do I feed until he goes "high"? Or just keep watching to make sure it's not back below 50 again?

Melissa & Tarragon said:
1. Let's wait and see what his numbers look like at +11 and at PMPS.
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Thanks, Melissa! I thought of this right after I posted! I guess it would depend on his numbers at night! I've been trying to follow the post you listed as closely as possible, and numbers so far are steady or rising. I'm at about 2 hours after I caught his low numbers, and I plan to keep checking him at least every 30 minutes. He's pretty disappointed I took the food bowl away to feed him from a spoon, so I guess that's a good sign for his appetite!

Lisa and Witn (GA) said:
What is your "don't shoot" BG number? F
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Lisa, I got 180 the other night and skipped his shot completely. The next day was all in the 300s. :( That makes me hesitant to skip a dose completely again, but at this point, I'm definitely not comfortable giving insulin anywhere below 200.



Thanks again! I will keep checking him and be back with more questions, I'm sure.
 
THis is from the "How to handle low numbers" sticky in the Lantus forum:
If your cat is testing in low numbers and you are not getting a quick response to your post, there are several things you need to do. (Low numbers are under 50mg/dL or 2.8 mmol/L.)

Depending on how carbohydrate sensitive your cat is, feed approximately a teaspoon or less of food with high carb (HC) gravy or HC food only. (If you have a cat with GI issues, using syrup plus LC food is an alternative.)
Test again in 15 – 20 min. Depending on the numbers, give more HC food.
Repeat the above steps every 15 – 20 min. until your cat tests in the 50 mg/dL (2.8 mmol/L) or above range for 2 consecutive tests. Continue to feed in small amounts to keep numbers in a safe range.
Test in 30 - 40 min. and repeat the test and feed process until there are 2 consecutive tests where numbers are stable or rising.
Test in an hour and follow the same steps.
DO NOT become complacent. If number have risen after one or two tests, it’s important to continue testing. Numbers may bobble up and down as the HC food and/or Karo wear off. DO NOT get one test where your cat has risen from low numbers into the 50s and go to sleep or leave the house. You are putting your cat in a risky situation. When in doubt, leave HC food out.
Click to expand...

So yes, if you just got a 77, go ahead and give him another tsp of gravy or high carb w/gravy, and test in another 15-20 minutes.
Carl
 
I would keep testing every 1/2 hour so you can make sure James is coming up on his own and not just from the food. The gravy can wear off pretty quick. Also, you will definitely reduce his dose by .25 U tonight. However, depending on his numbers, you may want to give a reduced dose or no shot at all. I don't recommend skipping a shot since you don't want the shed to drain, but depending on his numbers you might have to. What time is +11?
 
You don't want to have him skyrocketing up into the 300s, but the important thing is to dole out the food in small portions so that if you need a boost from high carb gravy food, there's still room in his tummy for more food. There's nothing wrong with him hanging out in the double digit numbers for a while. You just don't want to see him drop lower again while you wait this out. Stressful for you, but good news for him!

Carl
 
Melissa & Tarragon said:
I don't recommend skipping a shot since you don't want the shed to drain, but depending on his numbers you might have to. What time is +11
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@Melissa,
+11 is 7 pm EDT for me. I'm just at +8 as of 15 or so minutes ago, so I have a while to go.

@Carl,
You are definitely right; I will try to portion things out so that we can ride this out as evenly as possible. He's still down in the double digits, but has gotten a little annoyed with all the attention and ear poking so I am also trying to space out the tests!
 
LOL, try to keep in mind....you and I know he's diabetic, but he's clueless. All he knows is that Mom suddenly has developed a fondness for chasing him around the house with sharp pokey things. ;-) That, and he's getting an awful lot of extra snacks. :smile:
Carl
 
Have you been giving food? He is holding pretty steady in the upper greens. Let's see how his +11 and PMPS is but you may want to skip tonight or give a very small dose like .5U.
 
I've given him about a tablespoon, maybe more every half hour from +6 to +8.5 He wasn't interested in coming to the bowl for food at +9 or +9.5 (when his numbers were higher) so I didn't force the issue. I finally brought the bowl to HIM at +10 and he wolfed down about 2 generous tablespoons. At this point, he's eaten almost 3/4 can of Friskies Prime Filets (turkey in gravy) and 1/4 can Royal Canin calorie control since +6!

I usually don't feed him between +10 and his evening shot, but should I in this case? Or should I wait and see what his numbers do on their own?
 
I would hold off on food now. Let's see which way he is headed on his own. If he doesn't come up much more I would probably skip the shot. You need to do what you are comfortable with. However, he might be getting full and not eat well if you need him to. He will probably be high tomorrow in that case but then you can give his ears some rest and start with 1.25u tomorrow.
 
Gosh, Melissa, thank you SO much for following up and sticking with me through this! Everyone's advice has helped so much.

+11 BG is up to 131, and he hasn't had any food for an hour! If he's up above 200 by PMPS, I would like to give him at least some insulin...
 
No problem. We have all been there. I'm glad he is coming up on his own.

Let's see where he is at at PMPS. You might check out the Lantus board tomorrow and start posting there if you can. It will get more eyes on James and there are a lot of Lantus knowledgable people there. You can check it out under Insulin Support Groups - Lantus Tight Regulation. There are a lot of stickies in that board that will be invaluable to you. We can talk about it later. Let's get through tonight. See ya in 1/2 an hour! :-D
 
Re: Newbie with first low numbers. Advice on PM dosing?

Okay, this latest test at +12 was only up to 139! James is taking his sweet time recovering from those low numbers.

I've never given him insulin below 250, so any dosing advice for me?

Kate
 
It all depends on what you are comfortable with. His +11 and PMPS are virtually the same number with meter variance. You have never shot this low. You can skip or give a small token dose. If you skip, he will probably be high tomorrow. He may be high anyway from the greens today. So, you could give .25U or .5U if you are determined to get insulin in him. I would be tempted to skip. Tomorrow go with 1.25U and start anew. What are your thoughts?
 
I think I'll skip tonight's dose. I know I won't be able to watch him as closely tonight or tomorrow, so I think high numbers is the least risky route. He's also tired after me chasing him around for tests all afternoon, so I'm not sure I'd be able to get him to eat enough if he did drop again!


Thanks again :smile:
 
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