newby and hypo type reaction

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Jessica Martonik

Member Since 2017
my 12yr old baby boy lucian just startus 3u bid lantus. this morning. hes been running 308-346 last few days @+6 hrs post am injection. this morning at breakfast dose he was 223. acting slow n just plain off. agraid of the world n walking slow. although numbers arent low he was acting like hypo symptoms. he also has lung cancer for 7 months and is on prednisolone 2.5mg each am. hes acting better now but im worried about him. too new to this and wantimg to know if anyone out there has gone thru something like this. seems a bit better now after eating but concerned he'll drop again. any suggestions? i left a message for his vet already too.
 
not able to get bg yet. watching him closely. he is still improving. resting now. but alert and ok. hubby coming home as early as he can. when he gets home we'll test right away. what is a caturrito and how do you do that?
 
Ok so make sure I have this right from previous post :bookworm:.
Lucian just started insulin today and also has lung cancer.
AMPS: 223 at 06:15 EST
Given 3.0U of Lantus insulin at 06:00 EST
Around +0.75 you stated possibly hypo symptoms even though number wasn't low. Do we have another BG test at this time to know number wasn't low?
Around +1.5 was given 1T of DM wet with karo in it
It's now +3.5 and Lucian seems ok.

How long til DH gets home? Are you up for trying the caturrito to get a BG test?
Try to breathe :bighug::bighug::bighug:
 
Lucian start 3u lantus on sunday (5 days ago)
no amps- dr said not to
given 3u of lantus at 5:15am after 1/2 can wet dm. (did not give 4u as vet directed)
was a bit slow to come out today and walked like he was scared of something so did a bg at +.75
+.75 bg 223
around +1.5 was given 1t of dm w/karo in it
its now about +4-4.5 and he's still walking slow but more responsive. cried for food. gave a small amount dry kibble just now.
he struggles and won't let me hold him. could be hours before dh is home. I don't know
trying to breathe. just want him to be ok
 
Jessica Martonik said:
Lucian start 3u lantus on sunday (5 days ago)
no amps- dr said not to
given 3u of lantus at 5:15am after 1/2 can wet dm. (did not give 4u as vet directed)
was a bit slow to come out today and walked like he was scared of something so did a bg at +.75
+.75 bg 223
around +1.5 was given 1t of dm w/karo in it
its now about +4-4.5 and he's still walking slow but more responsive. cried for food. gave a small amount dry kibble just now.
he struggles and won't let me hold him. could be hours before dh is home. I don't know
trying to breathe. just want him to be ok
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He'll be ok. Just keep watching. Do glad you didn't do 4
 
trying to see if anyone is around to help to test him. he came out for a bit and is doing better still. a wee bit slow but getting there. spoke with his dr and she said to do pm pre shot test and call her and she'll tell us what to do. says he it could be a reaction from his sugar dropping from being high to a more "normal" level but it shouldn't really happen. if it does again she has to see him because it could be something else entirely. i'm not so sure about that. until the insulin he's never ever been like this. soooo glad I didn't listen to her and do 4. going to keep an eye on him. hubby probably can't get home before 4pm eastern time so I'll have to manage until then. If I can get anyone to help I'll check his bg again and post. If not I'll try caturrito and see if he'll do that. worst case keep eyes on him and wait. one step at a time, just try to stay calm so he stays calm. does it ever get any easier?
 
Jessica Martonik said:
trying to see if anyone is around to help to test him. he came out for a bit and is doing better still. a wee bit slow but getting there. spoke with his dr and she said to do pm pre shot test and call her and she'll tell us what to do. says he it could be a reaction from his sugar dropping from being high to a more "normal" level but it shouldn't really happen. if it does again she has to see him because it could be something else entirely. i'm not so sure about that. until the insulin he's never ever been like this. soooo glad I didn't listen to her and do 4. going to keep an eye on him. hubby probably can't get home before 4pm eastern time so I'll have to manage until then. If I can get anyone to help I'll check his bg again and post. If not I'll try caturrito and see if he'll do that. worst case keep eyes on him and wait. one step at a time, just try to stay calm so he stays calm. does it ever get any easier?
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Gets a lot easier... But remember she has you doing TRIPLE THE RECOMMENDED STARTING DOSE. I still STRONGLY suggest you guys only do 1 unit until you gave a couple weeks of data and see if it needs to be adjusted... And then you raise it by 0.25-0.5 units at a time. This vet is way too aggressive with dosing a newly diagnosed cat.
 
Jessica Martonik said:
does it ever get any easier
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There is a lot to learn with feline diabetes and the use of insulin but it does get easier. Unfortunately there are many vets who really don't know how to treat it safely and effectively but fortunately there are lots of people with experience on this board who will guide you!
 
i'm seeing that. I was nervous about the starting dose- vet said because he was 346 and on pred so that could make him insulin resistant she had to start him higher- or would've done 2u bid. who knows. but I feel much better talking it out with others who have been in this position and have the experience with their own babes. worth its wait in gold! going to see his pmps tonight and what the other dr has to say about dosing and go from there but I am leaning toward start low and take it from there for him. the bg testing I need to improve at because right now he cries every time I do it and I really think maybe i'm hitting the wrong spot and its actually hurting him. this could be why he's so resistant with me. I watched the video so I think i'll have a better idea of where to do it from now on. will post later with update. thanks again!
 
Lantus is a depot insulin. The body will store some of the first few doses which means that sometimes it takes a few cycles for a dose to have it's full affect on the kitty's BG. So we start with a small amount of insulin and then work our way up the dosing scale usually by .25 after a few cycles.
Given that Lucian is having hypo symptoms (even though the BG does not suggest it) I might be tempted to skip tonight's dose to let the depot drain and then start with 1 u tomorrow morning after testing. @JanetNJ what do you think?
 
Jessica Martonik said:
i'm seeing that. I was nervous about the starting dose- vet said because he was 346 and on pred so that could make him insulin resistant she had to start him higher- or would've done 2u bid. who knows. but I feel much better talking it out with others who have been in this position and have the experience with their own babes. worth its wait in gold! going to see his pmps tonight and what the other dr has to say about dosing and go from there but I am leaning toward start low and take it from there for him. the bg testing I need to improve at because right now he cries every time I do it and I really think maybe i'm hitting the wrong spot and its actually hurting him. this could be why he's so resistant with me. I watched the video so I think i'll have a better idea of where to do it from now on. will post later with update. thanks again!
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Try the warm sock method I suggested above, it will help him bleed and may actually numb the ear a bit. Also you can use neosporin on his ear afterwards. His ear will get used to it, I promise!
 
Jessica Martonik said:
i'm seeing that. I was nervous about the starting dose- vet said because he was 346 and on pred so that could make him insulin resistant she had to start him higher- or would've done 2u bid. who knows. but I feel much better talking it out with others who have been in this position and have the experience with their own babes. worth its wait in gold! going to see his pmps tonight and what the other dr has to say about dosing and go from there but I am leaning toward start low and take it from there for him. the bg testing I need to improve at because right now he cries every time I do it and I really think maybe i'm hitting the wrong spot and its actually hurting him. this could be why he's so resistant with me. I watched the video so I think i'll have a better idea of where to do it from now on. will post later with update. thanks again!
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Just aim right on the edge. Try freehand poking without the Lancet device.... Most find they can be more accurate that way.
 
Judy and Boomer said:
Lantus is a depot insulin. The body will store some of the first few doses which means that sometimes it takes a few cycles for a dose to have it's full affect on the kitty's BG. So we start with a small amount of insulin and then work our way up the dosing scale usually by .25 after a few cycles.
Given that Lucian is having hypo symptoms (even though the BG does not suggest it) I might be tempted to skip tonight's dose to let the depot drain and then start with 1 u tomorrow morning after testing. @JanetNJ what do you think?
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I'm not a lantus user so I'm no expert in this department. Let's see what the pmps is and take it from there. Would be super helpful if she could get the spreadsheet going today though.

@Jessica Martonik
If you need help setting it up, @Yong
Is very good at this sort of thing.
 
JanetNJ said:
I really should keep a notebook. What do you have on me? Lol

Eta Nevermind I probably don't wanna know. Lol
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laughing02.gif
Nothing bad :)
 
I didn't realize the deposit thing with the lantus and that it could take time for the full effect to show. That could possibly be whats happening with him. I totally need to read more on this and on cycles to be more informed. I'll see what the pmps is and post tonight. I'll work on getting the spreadsheet up.
 
We have had many kitties here on pred. @Tricia Cinco(GA) & Harvey is another. It's ECID (each cat is different) in how much the pred impacts their blood sugar. My civie was on pred for lymphoma and I tested him because I was paranoid. The amount it impact his BG depended on the pred dose, but he was always in normal numbers - thankfully. 2.5 mg is a relatively small dose.

What is Lucian's normal diet? Does he eat dry food all the time? If so, which brand? Lower carb food is better for both diabetics and kitties with cancer, though I wouldn't change things just yet.
 
he was eating max cat wet (small cans 1/2 am, 1/2 pm), dry max cat for treats, positive reinforcement things, etc. last week when he was first diagnosed dr said to switch food. we now have him on purin dm (large can 1/2 am, 1/2 pm) same purina dm dry for treats and reinforcement. he's very very good with food and switched beautifully. we have a few cans of his max cat and also fancy feast classics on hand as well just in case he starts to not like what he's on now or we have to stop for some other reason. i'm glad to know about the deposit with the lantus. we didn't know that before coming on here and now that I do it makes it that much more important to monitor him. if I went by his md blindly I could've really hurt him.
 
Jessica Martonik said:
vet said because he was 346 and on pred so that could make him insulin resistant she had to start him higher
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Hi there Jessica,

I am glad you are here, glad you are learning to home test and I hope you have many good days with your kitty.


Prednisolone can complicate things a bit, as I am going through right now, but you can do this with help from some great people here. My vet started me on 2u, then went to 3u Lantus and he was on 5mg of prednisolone BID and didn't say to test outside of the AMPS an PMPS for first 3 days. MISTAKE! Once I came here and started testing and having someone help guide me - things got a lot better.

Testing is going to be really important as you need to know when and how much does the prednisolone affect kitty's BG's. Jones did really well on the 2.5mg - 1.25 mg twice per day. I was able to get his BG's back down and drop his insulin dose again after his last pred dose increase. Watch when you do any dose changes or food changes, as that can really change things fast.

The only other thing I found is that giving the pred dose at shot time, timed the BG increase from the pred to the timing of onset of the Lantus - hopefully. I am trying to get the timing right so the two offset. Still a work in progress and then things change!

I also found with Jones that the higher the pred dose it seems he bounces more.

Jessica Martonik said:
although numbers arent low he was acting like hypo symptoms.
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Jones had an episode like that on the evening of June 7th. I, like you, thought hypo but he tested 124 @ +3. He jumped up from his bed when I got home and his back legs didn't seem to work. I tested, then gave some food and he ate a bit. Walked 5 feet and did a face plant. We rushed to the ER to wait 2 hours. He ate, become more alert and he seemed fine by then except for some dog legging in his hind end. Next day he was fine. Nothing since. Here is the link if you want some details. And in the end I didn't do any further testing as he visited his IM vet 3 weeks later and he didn't find anything wrong either for heart rate or blood pressure. So I don't know what it was. He never showed any symptoms of hypo before even when he was low. It was a very stressful time at our house and I wonder if that was a factor too. Sometimes you just need to deal with what is in front of you.
 
Hey Tracey. We've been giving him the pred dose just a little while after he eats since we started it and it works for him so we've been keeping it the same. Eat, halfway thru we dose, then 20-30 min later we give pred. He's only been on insulin for 5 days and until this morning he's done seriously amazingly well. Started at 346, then 308 (tested the "nadir" +6 twice- sun b4 starting and yesterday). every morning by 4am he's screaming for breakfast but today he didn't. when we woke up we looked for him because he wasn't right out to get his food and he was just soooo off. we definitely thought hypo but he was 223. scary stuff. he's never like that. he's been steady on 2.5mg pred once in the am for 7 months. thinking more and more that the drop to a "more normal" level caused the hypo feeling in his body. hopefully we can get this under control and he can feel better. thanks for sharing.
 
Jessica Martonik said:
he's been steady on 2.5mg pred once in the am for 7 months
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You may find it easier to get the FD in better numbers if you split the dose, I did. Then my insulin and pred were consistent. When he was on it just once a day - I gave it at night - as the BG's can drop lower at night and I figured if it was going to bump his numbers up at least I could sleep.;)

ECID

Best of Luck to you Jessica.
 
Tracey&Jones said:
You may find it easier to get the FD in better numbers if you split the dose, I did. Then my insulin and pred were consistent. When he was on it just once a day - I gave it at night - as the BG's can drop lower at night and I figured if it was going to bump his numbers up at least I could sleep.;)

ECID

Best of Luck to you Jessica.
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great info.
 
Jessica Martonik said:
maybe starting pred at night tomorrow is good to do. especially if numbers go lower at night. thanks
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ECID - Every Cat is Different.

If you do tests +3 +6, or a +2,+4+6 - mini curve- you may see if you are getting a spike in the BG numbers. You will see the pred affect when you see the numbers go down then back up again before the usual nadir. Jones was like +3-+4 - it would go back up before the usual +7-+9 uptick during the day.

I think you are going to learn a lot over the next little while with some mid-cycle tests. ;)
 
ok well . update. spoke with his vet just now who said I did the totally wrong thing in giving him any extra food at all today besides his breakfast because I made his sugar rise to 448 pmps. she says that amps 223 is totally fine and his reaction today of not being right in the morning was something else entirely and all this was not his sugar or because of a sugar drop from 308 nadir (+6 amps) to 223 (amps this morning). she said after the shot his sugar will rise anyway and he should not be fed. she told us to give 3u tonight and keep that for the next few days and keep checking his bg amps and pmps. i'm so lost now. I don't want to hurt him and hope that nothing else is wrong. we fed him 1/2 can wet for dinner and gave the 3units at 5:05pm EST. We'll monitor him over the next few days to see where he's at and go from there. to say the least they were not super nice about it and made me feel horrible like a bad parent. I know i'm not. just nervous and afraid for my babe. one day at a time.
 
I'm sorry you're in this situation with your vet and that she has made you feel bad when you were only trying to keep your baby safe. :bighug::bighug::bighug::bighug:
You did nothing wrong today! You couldn't test and your kitty was showing some behaviours that were not normal. It is always better to be safe than sorry.
In your situation, and based on the PMPS of 448, I would have given 1 unit and, in 4-6 cycles if he showed no response, increased it by .25.
This should be repeated until his numbers improve. But testing during key points like +3 +6 and maybe +9 is necessary to find out how low he goes. The decision to increase a dose should not be made unless you know how low he is going.

It's a very difficult situation when you're in conflict with your vet. Lots of us have been there! But please consider changing to 1 unit tomorrow morning. :bighug::bighug::bighug:
 
Jessica Martonik said:
his vet just now who said I did the totally wrong thing in giving him any extra food at all today besides his breakfast because I made his sugar rise to 448 pmps. she says that amps 223 is totally fine and his reaction today of not being right in the morning was something else entirely and all this was not his sugar or because of a sugar drop from 308 nadir (+6 amps) to 223 (amps this morning). she said after the shot his sugar will rise anyway and he should not be fed.
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A cat's sugar will rise after feeding, but not by the amount he did today. What you saw was an example of "bouncing". From the New to the Group Sticky Note:
Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

Diabetic cats do better with several small meals. Speaking of which, wet food is better. The DM has no magic properties that make it a better food. Ideally you want to feed a low carb wet food (or raw) that is under 10% carbs. This list here, lists many of the commercially available foods, with lots of options.

I am glad you are continuing to monitor the next few days with such a high starting dose. Make sure he always has food to eat in case he gets low. Getting mid cycle tests will be valuable. We can help you learn how to do dosing, if you enter your test data in a spreadsheet format we use. Here are the instructions on how to create the spreadsheet.
 
587amps. had to give cerenia w 1/4 tsp food 3 hrs before for cough. but hes perky and back to normal. we'll see what pmps brings. thankful my babe is ok! thank you all for your advice and kind words...helped me thru a rough day yesterday. heres to goping his bg levels go to a more normal level soon.
 
Jessica Martonik said:
587amps. had to give cerenia w 1/4 tsp food 3 hrs before for cough. but hes perky and back to normal. we'll see what pmps brings. thankful my babe is ok! thank you all for your advice and kind words...helped me thru a rough day yesterday. heres to goping his bg levels go to a more normal level soon.
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If your husband is home this weekend it would be really helpful to get a curve in (test every 2 hours for 12 hours) to see what the curve is. I think 3 units is bringing him more than 50% of the preshot down causing a high bounce for the next cycle.
 
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