Newly diagnosed. Goofy numbers!

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Marilyn and Sheldon

Marilyn and Sheldon

Member Since 2014
Hi all. Great forum. Been reading lots for a month now. Thanks.

Polly's a shy girl. Rescued 10 years ago, she's always been my elusive girl. No touching for a year, no appearances when other people are in the house. Sort of a Garbo-esk girl.

Excessive drinking mid March took us to the vet at the end of the month. UTI, gum infection (she's been toothless for 7 years but a tooth pocket had been badly infected). Blood work showed 398 glucose and urinalysis indicated +3 glucose in urine.

No more free-feeding on dry food. (I have three other cats; never knew who was the crunch muncher) Had been feeding Friskies pates, now added some Fancy Feast Classic pate to the menu.

10 days of Clavamox. Home testing. Numbers consistently 170-180 with just a few easily explained outliers. She stresses badly with little provocation. For almost 3 weeks seemed that she was pretty controlled.

Back to the vet mid April for a check on infections and to compare our meters. Infections appeared cleared, meters measured where a Relion and an AlphaTrack would expect to differ.

Vet thought the numbers were high, but not insulin worthy. I agreed. Monitored by observation. (She was becoming more and more elusive and I wanted to regain her trust w/o all the snatching and grabbing and poking and prodding.)

Two weeks later, weight loss and lack of appetite took us back to the vet. I give sub q fluids at home. Her home testing numbers remained mostly in the 170s. Vet is perplexed. Thinks she's throwing keotones but no evidence in the testing. Says 3 types can develop and lab only measures two. He admits, though, that Polly's a conundrum.

Two days at the vet, but home each night, for iv drip (she's badly dehydrated) and fast acting insulin. Take her home and start Lantus. First night (171), one unit. Next morning (162) one unit. Off for her second day of iv drip and monitoring. Back home, PMPS = 90. No shot. She eats well. Three hours later, 60. She eats some more. I keep careful watch all night. This morning, AMPS, 312. I give .75 units thinking we may have some bounce happening and I'm nervous about hypo while I'm at work.

Any insight?

Sorry for the long post. I'm just baffled. Had a super-sweet kitty six years ago and I don't remember such goofy up and down numbers with him.
 
Since Lantus builds up over several days, you may want to go with 0.5 units. One unit got you too low to shoot (for new folks, that is 200 mg/dL) without lots of data showing it was going to be safe to do so. Once you've collected a good couple of weeks data, you may shoot at progressively lower numbers so long as the nadir lowest glucose between shots) remains above 50 mg/dL on a human glucometer.

The most important tests you can get are pre-shots, nadir, and before bed in case she's dropping fast and you need to intervene.
 
Are they getting any dry at all? Treats? Any dry can spike or keep the blood glucose high for over 24 hours.

Friskies pâtés can be a little higher in carbs than some cats can handle. I would try more fancy feast pâtés, you want her BG in the 40-130 range on your relion.

Definately try a lower dose. Lantus takes a week initially to build up in the cats system. We usually hold the initial dose that long to let it settle, then slowly increase. Since her numbers aren't high to start with a lower dose is safer, and especially if you change food as suggested. I wouldn't shoot under 130 for now until we get more data.

Do you test her urine for ketones? Might be worth doing if you think she is prone to them

Maybe ask the vet about Prozac? It's good for cat stress, or you could try feliway.

Wendy
 
Thanks for your replies.

Polly was 141 pmps tonight. Probably a little stressed since we played the "get the kitty out of the cupboard" game before testing! I didn't have the courage to shoot her. I suspect she'll be in the mid 300s amps.

Will go to 0.5 units in the morning. Weekend means I can keep closer watch and test mid cycle.

I find it hard to believe with her numbers consistently in the 170-180 range before we started Lantus that she's throwing keotones, but I'll pick up some strips for checking. No evidence of keotones in her lab work. Vet just thinks that accounts for her earlier lack of appetite and weight loss. Normal appetite and steady weight these last four days.

We're working out a system for testing, feeding and shooting that's working so far. A little Kabuki and a lot of seduction and some cat-herding, but we manage to get her cajoled into the master bath where she jumps on a vanity, gets tested and then gets her meal. In time I hope this routine just becomes the norm. I'll stick to the FF Classics, too. For treats everyone (four cats and big ol' black lab) get freeze dried chicken or boiled chicken breast pieces. Hope that's o.k.

Again, thanks for your help. I'm sure I'll be needing more as we start this sugar dance.

Marilyn
Polly's companion "bean."
 
Thanks for the replies and suggestions.

We've got a system for testing, food and shots that's working pretty well. Low stress. Now if only I could get her numbers to settle down!

Couple questions:

1. Looks like I should maybe up her dose to .75. Don't want to jump around with dosing, though. Is it ok if I wait through another two cycles or should I wait longer...or change now? Of course, if her numbers go down (or up) I'll be back with a different question!

2. Before we started insulin (Lantus) she was pretty flat in the 170's. Now, on insulin her numbers have been much higher 'cept when we had the low riders at 1.0 units. Any guesses why she'd be higher on insulin that she was before we started? I'm baffled.

I appreciate your help. Miss Pollydoodle does, too.

Polly and da'Bean, Marilyn
 
If the glucose goes too low (or to an unaccustomed low) or drops too fast, compensatory hormones kick in and release stored glucose. We call that a bounce. Its a survival mechanism to make sure there is enough glucose for everything to keep functioning. Also, bounces can take around 3 days to resolve.

Just hang in there and continue with the 0.5 units for 5-7 full days, unless she drops below 50 mg/dL around +5 to +7 hours after the shot, which earns a dose reduction.
 
Something else you need to watch for. When my cats were on subq's I always noticed a significant drop in their BG readings. Not every cat responds that way, but it may be something you want to watch out for.
 
Lisa and Witn (GA) said:
Something else you need to watch for. When my cats were on subq's I always noticed a significant drop in their BG readings. Not every cat responds that way, but it may be something you want to watch out for.
Click to expand...

Be sure to give the Lantus in a different location from the fluids. Lantus is supposed to crystallize when if is injected and excess fluid in that area may alter the rate at which the crystals dissolve and take effect.
 
THANK YOU!!!

I'll stick to .5 and keep checking her levels.

I didn't know the impact fluiding could have. So glad to have that information.

Any preferred spots for the Lantus injections? I've been shooting a tad back of the shoulders. 'Course that's also where I do her sub q fluids although she hasn't needed fluiding since Thursday. Will definitely be aware of moving the spot for one of her "sticks."

Again, thanks for all your help. I'd be a wreck without your input and the confidence it gives me to stay the course.

Pollydoodle and Marilyn
 
Try shooting in some loose skin/fur back near the hips, just a tad down from the spine.
 
Looks like she might be bouncing. I would try and get a few tests in later in the cycle.. Maybe even every two hours when you see a blue like the other night, you need to know how low she is going.
 
Guess I need more testing. I know I do. She's just so skittish.

Good thing my cell phone lets me set five alarms! Going to be a "restless" night, but I really want to find out what's going on. Now if only the little girl will cooperate!

341 at pmps. Sort of scaring me.

Thanks for all the help.

Polly and Marilyn
 
Start with a +3, she probably won't come down that fast. If that number is the same or higher then you can ignore the alarm and sleep till morning. But if it's blue or low yellow I would test again in two Hours.
 
ok. +3 is easy. Near bedtime. I'll follow your advice. Thanks.

I have been waking every couple of hours spontaneously since we started Lantus. Since she sleeps up by my pillow (I guess I'm not such a scarey creature when I'm sleeping!), I've been calling her name softly to see if she responds....she wiggles over for chin scritches. Sort of figure if she's dropping too low, she won't be that responsive.

I understand the importance of testing, though. And we'll both do what we need to do to get this thing figured out.

Question. If she's not bouncing (and it's been three days since her 60) am I looking at a dose increase in a few days? Could three days of intense stress (Tues., Weds, Thurs) at the vet cause a longer bounce time?

Mega thanks.

Polly and Marilyn
 
Thats so cute she sleeps by your pillow. Nice and easy to poke and go back to sleep. However don't assume because she is responsive that she isn't dropping low. Sometimes there are no symptoms until they are seizing.

Good job on the tests! she dropped last night but not too low. One protocol many of us follow is tight regulation (http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581) which bases changes on the nadir. Since her nadir was under 200 last night I would wait 5 days (10 cycles) to see how she does i.e.

ncreasing the dose:
Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.
After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.
Click to expand...

read the protocol carefully and let us know if you have questions!
Wendy

PS dont shoot for now if she is under 200 until you have more data.
 
Thanks Wendy. She's holding pretty steady today, albeit higher than I like. But I am sticking to the .5 through at least 5 days, maybe 7. Want more data! (See, I'm learning something).

We'll do a +3 in a little while. If that's mid 200's I'll test when I wake naturally during the middle of the night. She follows me to the master bathroom jumps up on the vanity and we test. Takes less than a minute. It's routine now. Whew.

If she's lower, I'll test at +7 +9 again. We'll play it as it goes.

Tight Regulation sounds terrific. I just don't know if I can commit to it. Keotones? Hypo? Intimidating. I don't know if I'm ready for that level of responsibility. I'll give it more thought though. Right now my goal is regulate and then work to down the numbers.

Thanks for your counsel. Thanks for your encouragement. Polly and I will keep on dancing!

Polly
Marilyn
 
Ketones are a by-product of fat breakdown for energy.

Too many may indicate diabetic ketoacidosis (DKA), a potentially fatal, expensive to treat complication of diabetes which may happen with infection and/or not enough insulin and/or not enough food.

Testing the urine for ketones may alert you early enough to save your cat; more than a trace level warrants a vet visit.

Two of the 3 ketones the body makes have a distinctive odor - fruity or like nail polish remover. If you ever smell that on your cat's breath, get to a vet asap.

See my signature link Secondary Monitoring Tools for a few tips on urine testing, plus other useful assessments you may wish to make.
 
Darn! We seemed to have leveled off, albit high, for a brief bit. Then WHAM this amps comes in at 437. (first try was 441; I waited ten minutes, tried again and got the 437.) Took a reading of my own glucose and came in at an expected number.

Any guesses. Should I think about upping dose to .75?

We're still dancing, but I think we may be off-beat!

Thanks,

Polly and Marilyn
 
5 days @ 0.5 with nadirs over 200 mg/dL?
Yes, an increase of o.25 units may be done.

Also, what is your current no shot limit? You're doing enough testing and have the data for it to be 150 mg/dL. With spreadsheet, low carb diet, and home-testing in place, you may want to move over to one of the Lantus forums.
 
Thanks. The little girl dropped to 185 at nadir last night. Gave a fat .5 this am after a 408 ampm.

Will see what happens today and tonight.

Am jumping over to Lantus TR for the rest of the dance.

Thanks to everyone who has been so kind, so encouraging.

Polly and Marilyn
 
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