Newbie. Withholding insulin. Am I wrong?

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Kiera

Kiera

Member Since 2021
Dx was a month ago. 2 units lantus (2x daily). I wasn’t home testing. Didn’t know I was supposed to be.

A few days ago my cat became very lethargic and seemed “off”. Vet was closed so I did my own research, found this site and learned about home testing.

Purchased One Touch meter immediately that night (I had a feeling something was wrong)


BG READINGS / DOSAGE

9/3/2021
• AM 2 units lantus given - purchased meter that night
• *** IMPORTANT!!! ***
Very FIRST time testing BG at +9 was 65 mg/dL
*skipped PM dose


9/4/2021
• AMPS 140
• AM 0.25u given (almost nothing)
• skipped PM dose


9/5/2021
• AMPS 139
• AM 0.25u (almost nothing)
• skipped PM dose


9/6/2021
• AMPS 124
• skipped both doses


9/7/2021
• AMPS 121
• skipped AM dose
Do I skip PM again??



MISC. OBSERVATIONS

•still peeing large amounts even though BG numbers are lower and urine strips are negative for glucose (glucose is on the same strips for testing ketones, which I was told to do)

•9/1 — 9/4/2021 seemed to have VERY noticeable increase in appetite (due to possible hypo?), lethargic, looked “off”

•decrease in appetite 9/6/2021 — present

QUESTIONS
Should I keep withholding insulin or am I making a mistake?

What does this all mean? Besides the fact that I got incredibly lucky. This could have been very tragic had I not tested when I did
 
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Not sure if it matters, but I do not take food away prior to testing. My cat grazes and goes to the bowl many times throughout the day. USUALLY he eats small amounts at a time, many times a day/night. In general I let him eat whenever he wants. I leave food out overnight.

feeding: fancy feast and friskies pates. No dry food anymore. the diet change was probably the only thing my vet got right. I made the change right after dx. My other cat had to get on board too.

My vet obviously didn’t consider how big of an impact the diet change would make. Unless diet isn’t the reason for his hypo scare. Or was that not hypo? Maybe the dose was just too high. I’m confused and have no clue what my numbers mean.

regardless, I’m not sure what I do from here.
 
Hi Kiera! So 65 was the lowest reading you got? And on a human meter, correct? If so, that number is not technically a hypo number (we say under 50 on a human meter is the “take action” number here), but it is quite low for being new to insulin and can certainly be scary!

I will tag @tiffmaxee for you, who is a lantus user and is on right now.

It would be helpful if you could set up a spreadsheet when you get a chance. This will help people see Bailey’s BG readings more easily and make it easier to help you :cat: Here’s the link to the directions. If you need help let us know and we can help you!

https://felinediabetes.com/FDMB/threads/how-to-use-the-spreadsheet.241653/
 
Wanted you to see that right away. Cats can become diet controlled. Your cat was started on too big a dose with a diet change. Unless really large most start with 1.0. With a switch from dry even .50. Because the test might have been food influenced you should not give insulin tonight. Did your vet say whether your cat had dka? What is the pmps?
 
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Sarah&Soph said:
Hi Kiera! So 65 was the lowest reading you got? And on a human meter, correct? If so, that number is not technically a hypo number (we say under 50 on a human meter is the “take action” number here), but it is quite low for being new to insulin and can certainly be scary!

I will tag @tiffmaxee for you, who is a lantus user and is on right now.

It would be helpful if you could set up a spreadsheet when you get a chance. This will help people see Bailey’s BG readings more easily and make it easier to help you :cat: Here’s the link to the directions. If you need help let us know and we can help you!

https://felinediabetes.com/FDMB/threads/how-to-use-the-spreadsheet.241653/
Click to expand...
tiffmaxee said:
Wanted you to see that right away. Cats can become diet controlled. Your cat was started on too big a dose with a diet change. Unless really large most start with 1.0. With a switch from dry even .50. Because the test might have been food influenced you should not give insulin tonight. Did your vet say whether your cat had dka? What is the pmps?
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I guess I’m bad at explaining things because I don’t think anyone is understanding me.

The BG of 65 was days ago (9/3/21). It was my first time testing. I was trying to say the reading was 9 hours after insulin that morning. That’s what I thought +9 meant.

So 65 at 9 hours after isn’t hypo? I thought it was supposed to be lowest mid-cycle? So closer to 6 hours.

I haven’t been giving insulin (except for the 2 tiny morning doses). I’ve been too afraid after getting the 65.

Can you please tell me what was confusing with my first message so I can fix it? I don’t quite know where I messed up.

I have only been doing 1 test a day. Up until a week ago, I didn’t know about home testing. Since I haven’t been giving insulin, I haven’t been doing additional tests. I just need advice on what to do next.
 
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tiffmaxee said:
Wanted you to see that right away. Cats can become diet controlled. Your cat was started on too big a dose with a diet change. Unless really large most start with 1.0. With a switch from dry even .50. Because the test might have been food influenced you should not give insulin tonight. Did your vet say whether your cat had dka? What is the pmps?
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What is dka? If I was giving insulin tonight, it wouldn’t be for 2 more hours. Doesn’t PMPS mean PM pre-shot? Right before insulin?

The only reading I have for today is at 11am. For the past month, I have been giving insulin at 11am/11pm (with the exception of the past few days where I gave only 0.25 or skipped).

I skipped the dose again this morning. Was that wrong?
 
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In order to help you we need you to set up a spreadsheet and a signature. You need to test before you shoot every time. Yes that’s amps and pmps. You test to make sure it’s a safe number to shoot. You feed next to make sure they will eat and then shoot. When no to insulin you should not shoot under 200 without someone helping you.

DKA is diabetic keto acidosis. I would hope your vet would have told you if that happened as it’s very dangerous. Did your vet mention if he had ketones?

We talk in terms of + numbers because we come from all over the world. I’m going to guess you are in the USA. Is that right? Lantus is dosed based upon how low it takes your cat. That generally happens between +4-+7. We have two dosing methods we use here.

You can read about them on the lantus forum. I will provide the links. Why did you pick 11 as shot time if I may ask?
 
In order to help you we need you to set up a spreadsheet and a signature. You need to test before you shoot every time. Yes that’s amps and pmps. You test to make sure it’s a safe number to shoot. You feed next to make sure they will eat and then shoot. When no to insulin you should not shoot under 200 without someone helping you.

DKA is diabetic keto acidosis. I would hope your vet would have told you if that happened as it’s very dangerous. Did your vet mention if he had ketones?

We talk in terms of + numbers because we come from all over the world. I’m going to guess you are in the USA. Is that right? Lantus is dosed based upon how low it takes your cat. That generally happens between +4-+7. We have two dosing methods we use here.

You can read about them on the lantus forum.
https://felinediabetes.com/FDMB/thr...-low-go-slow-slgs-tight-regulation-tr.210110/

Why are you giving insulin at 11 if you don’t mind me asking? Will you able to get mid cycle tests?
 
You are doing nothing wrong. Just finding your feet, is all. Caution is good at the beginning. We've all been where you are now. Feline Diabetes is a steep learning curve. We can help you with that every step of the way.

Is Bailey on any other medications? I ask because some cats become diabetic after a course of steroids.

Kiera said:
So 65 at 9 hours after isn’t hypo? I thought it was supposed to be lowest mid-cycle? So closer to 6 hours.
Click to expand...
Not every cat's nadir is mid-cycle. Some cats nadir early. Some late. 6 hours is the average.

Kiera said:
AM 0.25 units lantus given (almost nothing)
Click to expand...
Yes, it looks like almost nothing but it can be effective.

Breathe. We can help you keep Bailey safe.
 
If under 200 at shot time you will stall, DON’T feed and ask for dosing advice. Without data and a spreadsheet we can’t tell your cat’s insulin dose. You were absolutely right not to shoot low numbers and to skip. That test before insulin needs to be without food 2 hours before. Other than that he can graze.
I think you need to reduce your dose. I would probably go all the way back to 1.0.
 
It took me awhile to give him his first shot (because I was scared). It ended up being 11:00pm. So I just went with it. Works fine for me because I’m a night person and I work a lot from home. So the time is good for me. Does it matter?

I’ve been injecting for close to a month and didn’t know about pre-shot tests. I can’t go back and undo that now. He started acting lethargic and off in general. Prior to that, he seemed perfectly fine.

When I saw symptoms (on September 3rd), I found this site, got a meter and tested. Since I got the meter, I really haven’t been giving insulin. I’m just not sure if that’s the right thing to do or not. That was the point of my message but it got lost in all the info I guess.

I test for ketones with urine strips - always negative
 
tiffmaxee said:
What kind of meter are you using, pet or human?
Click to expand...
Human One Touch.
Giving 1u would actually be a huge increase from the past few days of no insulin. I listed my numbers and dosage in the first message. Can you please look again? If you have time
 
Breathe. We will help you. I think it best to see how he does without insulin for a few cycles. He might need just .25 or .50. How long has he been eating wet food? Any dry?
 
Red & Rover (GA) said:
You are doing nothing wrong. Just finding your feet, is all. Caution is good at the beginning. We've all been where you are now. Feline Diabetes is a steep learning curve. We can help you with that every step of the way.

Is Bailey on any other medications? I ask because some cats become diabetic after a course of steroids.


Not every cat's nadir is mid-cycle. Some cats nadir early. Some late. 6 hours is the average.


Yes, it looks like almost nothing but it can be effective.

Breathe. We can help you keep Bailey safe.
Click to expand...
No other medicine. Should I go back to 0.25 or continue to withhold insulin based on his numbers?
 
Kiera said:
Human One Touch.
Giving 1u would actually be a huge increase from the past few days of no insulin. I listed my numbers and dosage in the first message. Can you please look again? If you have time
Click to expand...
Yes. I agree. He might be becoming diet controlled. How about testing at 11 and recording the number. Then test 3 hours later.
 
tiffmaxee said:
Breathe. We will help you. I think it best to see how he does without insulin for a few cycles. He might need just .25 or .50. How long has he been eating wet food? Any dry?
Click to expand...
I answered these questions in my first 2 messages I think. We changed his wet food to LC and removed the dry food when he was diagnosed. He’s been without insulin for 4 cycles right now. How many more should I skip?
 
If he is diet controlled his bg will come down 3-4 hours after eating. Will you set up a spreadsheet? I can link you to the directions. If you need help we have someone that can do it for you.
I thought you were giving 2 units which is why I originally said 1.0. We need to get a few days of tests in to know what dose to give.
 
tiffmaxee said:
Yes. I agree. He might be becoming diet controlled. How about testing at 11 and recording the number. Then test 3 hours later.
Click to expand...
Ok. And skip insulin again? I didn’t realize how late it was. 11pm is 30min away. He didn’t have any insulin this morning. None the day before or the night before that.
 
Kiera said:
I answered these questions in my first 2 messages I think. We changed his wet food to LC and removed the dry food when he was diagnosed. He’s been without insulin for 4 cycles right now. How many more should I skip?
Click to expand...
Set up the spreadsheet. Test every 3 hours. See what happens. I can’t tell you how long to withhold insulin until I see the numbers. Normal on a human meter without insulin is 50-100.
 
tiffmaxee said:
If he is diet controlled his bg will come down 3-4 hours after eating. Will you set up a spreadsheet? I can link you to the directions. If you need help we have someone that can do it for you.
I thought you were giving 2 units which is why I originally said 1.0. We need to get a few days of tests in to know what dose to give.
Click to expand...
I was giving 2 units, twice a day before he was showing symptoms. Before I found the site. And before I started home testing. This all happened recently but he’s been on insulin for about a month.
 
Would you get a test at 11 and let me know what it is please? Unless it’s high no insulin tonight. Do you need help with the spreadsheet?
 
tiffmaxee said:
Would you get a test at 11 and let me know what it is please? Unless it’s high no insulin tonight. Do you need help with the spreadsheet?
Click to expand...
I just downloaded the app for excel but I don’t know how you get the template that everybody uses. How do I do that?
 
I’ll give you a link. Don’t do excellent. Our spreadsheet is coded. It colors everything. All you supply is the date, bg and dose. Be right back.
 
tiffmaxee said:
I’ll give you a link. Don’t do excellent. Our spreadsheet is coded. It colors everything. All you supply is the date, bg and dose. Be right back.
Click to expand...
PMPS is 129.

What’s weird is before this I almost started thinking he needed more insulin because none of his diabetic symptoms had improved. And then recently it was like a complete 180 flip and I was no longer seeing the constant drinking (which was the biggest indicator leading to dx). Although strangely when he pees… it still in such LARGE amounts. I don’t know when he could possibly be drinking all this water because I’m not noticing it like I used to. He’s peeing more than he’s drinking… LOL. I know it’s not possible but it seems like it

Then on the 2nd and 3rd of September I saw signs of hypo out of the blue. I didn’t even know that was a possibility until googling his symptoms. My vet never discussed that with me or told me there was a risk

I have no way to know what was going on over the past month. I didn’t know I supposed to be testing or that I was doing anything wrong. I had no idea I was potentially putting Bailey at risk. My vet didn’t even tell me home testing was a thing. I had never heard of it before (never known anyone with diabetes). Vet made it seem so simple. Insulin, twice a day. End of story.

And then I come here and my head is spinning…
 
tiffmaxee said:
Don’t go back. Just fill in the last week.
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Ok I’ll fill it out.
The strips I use to test ketones test glucose as well. It used to be the highest color glucose. Now it’s always negative. The complete opposite. Never had any color change for ketones. Not even trace. The vet told me to ignore the glucose part. So that’s what I did. But I still saw the results.
 
Skip. Your story is too common. You are smart snd had the sense to skip. Others come here with cats with symptomatic hypos. My sister and a friend had diabetic cats. They shot blindly and occasionally took cats in for curves. I was shocked to learn I needed to test. Their cats peed all over the house. Clearly not controlled yet they were on and off insulin based on curves at the vet. They thought I was crazy the way I tested. Let’s keep track of the numbers tomorrow and go from there. Get the spreadsheet up and running There’s a chance as Kel said that a tiny amount of insight he needed or he could be food controlled. It’s good the symptoms are going away. Time will tell. Let us know if you need help with the spreadsheet. @Bandit's Mom can help.
Get a test in 3 hours after eating. Don’t let him eat two hours before amps
 
Kiera said:
Ok I’ll fill it out.
The strips I use to test ketones test glucose as well. It used to be the highest color glucose. Now it’s always negative. The complete opposite. Never had any color change for ketones. Not even trace. The vet told me to ignore the glucose part. So that’s what I did. But I still saw the results.
Click to expand...
Great you tested for ketones and negative. That would be the only problem with skipping if that was positive.
 
tiffmaxee said:
Great you tested for ketones and negative. That would be the only problem with skipping if that was positive.
Click to expand...
I don’t understand what ketones are? Or what causes them? I thought I read it’s when glucose is high so I likely won’t see them with these numbers. Or is that wrong? I tested for them about 2 hours ago and it was still negative
 
Kiera said:
I just downloaded the app for excel but I don’t know how you get the template that everybody uses. How do I do that?
Click to expand...
tiffmaxee said:
I’ll give you a link. Don’t do excellent. Our spreadsheet is coded. It colors everything. All you supply is the date, bg and dose. Be right back.
Click to expand...
I can help you set-up your spreadsheet. I need a few details. Will send you a PM. Look for it in the Inbox.
 
Bandit's Mom said:
I can help you set-up your spreadsheet. I need a few details. Will send you a PM. Look for it in the Inbox.
Click to expand...
I think I have it figured out. There’s not much info to enter. I just don’t know what to put when I didn’t give insulin. 0 or just leave it blank?
 
Kiera said:
Ok. I’ll figure that out next
Click to expand...
No rush. Let me know if you need help. Are you using your phone to set-up the SS?

To share the SS and paste the link in your Signature:
Tap the three vertical lines in the upper right. Tap "Share and export" again, tap on "share". You will see "Link Sharing is Off". Tap on this. You will see a green link that states "Anyone with the Link" ; tap on "can view" and make sure it has a checkmark next to it. Tap the back arrow. It should now state "Link sharing is on" and "anyone with the link can view". Right below that, tap on "copy link to clipboard".

Then paste this link in your Signature on FDMB
 
tiffmaxee said:
Great you tested for ketones and negative. That would be the only problem with skipping if that was positive.
Click to expand...
Bandit's Mom said:
No rush. Let me know if you need help. Are you using your phone to set-up the SS?

To share the SS and paste the link in your Signature:
Tap the three vertical lines in the upper right. Tap "Share and export" again, tap on "share". You will see "Link Sharing is Off". Tap on this. You will see a green link that states "Anyone with the Link" ; tap on "can view" and make sure it has a checkmark next to it. Tap the back arrow. It should now state "Link sharing is on" and "anyone with the link can view". Right below that, tap on "copy link to clipboard".

Then paste this link in your Signature on FDMB
Click to expand...

Did I do it right? I think I filled it out correctly. But I am using a phone so it’s hard to see what I’m doing.
 
Bandit's Mom said:
No rush. Let me know if you need help. Are you using your phone to set-up the SS?

To share the SS and paste the link in your Signature:
Tap the three vertical lines in the upper right. Tap "Share and export" again, tap on "share". You will see "Link Sharing is Off". Tap on this. You will see a green link that states "Anyone with the Link" ; tap on "can view" and make sure it has a checkmark next to it. Tap the back arrow. It should now state "Link sharing is on" and "anyone with the link can view". Right below that, tap on "copy link to clipboard".

Then paste this link in your Signature on FDMB
Click to expand...
Should I give a small dose? Like 0.25 and monitor? Or should I just continue to skip? I’m not sure if these numbers are still too high or not and I don’t want his chance at remission to be compromised because I stopped insulin too early but I was just too scared to give anything after seeing that 65 at +9 for my first test ever. The only reason I gave 0.25 the first two mornings was because I wasn’t sure if I could just stop cold turkey like that. But I ended up doing it anyway
 
Kiera said:
Did I do it right? I think I filled it out correctly. But I am using a phone so it’s hard to see what I’m doing.
Click to expand...
Perfect!

Kiera said:
Should I give a small dose? Like 0.25 and monitor? Or should I just continue to skip?
Click to expand...
I think you can try giving 0.25U twice a day and see how she responds to it. The 2 shots should be 12 hours apart.
It's pretty late tonight. Why not start 0.25U tomorrow morning and see?

@tiffmaxee
 
Bandit's Mom said:
No rush. Let me know if you need help. Are you using your phone to set-up the SS?

To share the SS and paste the link in your Signature:
Tap the three vertical lines in the upper right. Tap "Share and export" again, tap on "share". You will see "Link Sharing is Off". Tap on this. You will see a green link that states "Anyone with the Link" ; tap on "can view" and make sure it has a checkmark next to it. Tap the back arrow. It should now state "Link sharing is on" and "anyone with the link can view". Right below that, tap on "copy link to clipboard".

Then paste this link in your Signature on FDMB
Click to expand...
I’m so glad I trusted my gut that night. I just knew something was wrong but couldn’t put my finger on it. I can’t even imagine what would’ve happened if I didn’t test that night and continued with insulin. Who knows if this was an issue for days prior. Can cats stay in a hypo for days? That’s how long I was seeing symptoms. Are there any complications that can result after the fact from hypo (especially if it was a longer period of time, like days or who knows)?
 
Bandit's Mom said:
Perfect!


I think you can try giving 0.25U twice a day and see how she responds to it. The 2 shots should be 12 hours apart.
It's pretty late tonight. Why not start 0.25U tomorrow morning and see?

@tiffmaxee
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Actually, midnight is OK. And then I could slowly get back to 11 by doing 15 min early each time. Right?. He won’t eat now. He had a few bites a half hour ago. He’s always eaten within an hour or two after insulin since this started. He’s just a grazer. I would never be able to get him to eat on demand no matter how hard I tried. I don’t know if that changes things but I would never be able to get on a schedule it he had to eat right at insulin. It’s not an option honestly
 
Bandit's Mom said:
Perfect!


I think you can try giving 0.25U twice a day and see how she responds to it. The 2 shots should be 12 hours apart.
It's pretty late tonight. Why not start 0.25U tomorrow morning and see?

@tiffmaxee
Click to expand...
But tomorrow might be better since I’m not staying up all night to monitor him. What do you think?
 
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