Newly diagnosed, question about recently increased insulin dose

K

Kate and Bingo

Member Since 2025
Hi folks! Our 7yo Bingo was diagnosed last week after we rushed him to the ER and learned he was in DKA. Possibly the scariest night of my life.

Weirdly his glucose levels had been okay at previous vet appointments as recently as March (he goes a couple times a year for respiratory issues), but the hospital let us know it looks like he's been dealing with this a while, which was gut wrenching to hear. His visibly poor health and the ER visit seem to have been precipitated by an oral steroid prescription for a cough.

We are currently following doc's instructions on feeding and dosing, but learning here in the meantime so we can take control when the training wheels come off. Thank you everyone for the resources.

One question: Doc just increased his Lantus directly from one unit to two. He got his first 2u shot Wednesday PM (last night), and Thursday AM (this morning) at shot time his BG was still under 150 and dropping. Maybe this is dumb, but I was too scared of hypo to give him the AM 2u shot this morning. He did get 2u this evening on schedule. If his glucose is below 150 at shot time again tomorrow AM, is it really okay to give the full two units? (We were unable to reach doc directly today but we have a recheck Saturday.)
 
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Welcome to FDMB sorry to hear about what you are going thru we all have been there at one point or another you are right in thinking about hypo with such a high increase, the members recommendations increases/ decreases are done by 0.25 units at a time, I will tag a very knowledgeable member on DKA and Lantus that can assist you with these concerns
@Sienne and Gabby (GA)
 
I have noticed that vets tend to increase doses in whole units. 2u may well be the right dose for Bingo, but you also run the risk of overshooting that goldilocks dose when you increase by whole units. I know that isn't strictly what you're asking, but it raises some flags for me when we see folks post about big increases like that.

For Lantus we have two dosing protocols that we follow here, and both increase dosage at 0.25u for the most part. I recommend reading about our protocols here: Dosing Methods: Start Low, Go Slow (SLGS) & Tight Regulation (TR). You can even send the link to your vet and ask what they think. (Once I told my vet that we were using this site she's basically let us 'drive' our kitty's care.) If you're using a Libre at home, you shouldn't need to bring Bingo in just to adjust the dose, they should be able to handle it over phone or email. You can send a link to your spreadsheet or the vet can use LibreView to see all the data.

If you don't already, consider picking up some u100 syringes with half-unit markings so you can dose more precisely. I use these UltiCare ones but there are other brands that have them.
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I will let one of our more experienced members chime in on the specifics for shooting 2u under 150 BG. You did a great job setting up your signature and spreadsheet so they have all the info they need to help you.
 
Thank you both for the replies! We will definitely order the u100 syringes with the half unit markings.

Reading up on the dosing methods as well.

Bing is closer to 300 this morning so I’m a little less urgently worried, but still hesitant to give the full 2u and welcome thoughts going forward.
 
Welcome to FDMB!

Thank you for being so on top of getting your spreadsheet and signature set up. I was about to type that I couldn't really react to your question about dose without a spreadsheet and you were ahead of me!!

First and foremost, for kitties with a history of DKA we do whatever we can and whatever is safe to not skip a shot. Ketones can develop quickly and to make things more complicated, some cats are more prone to developing ketones than others. One quick questions -- are you testing for ketones? If not, please get urine ketone test strips. Ketostix is one brand but any brand is fine. There are also blood ketone meters. The strips give a color coded reading whereas the meters provide a number. Again, either is fine. The urine strips are much cheaper. This is a link to our primer on ketones/DKA.

You noted that Bingo was still dropping at shot time when you skipped the shot. It's helpful to remember that there is roughly a 20% variance in the actual value when you test. (That's on a hand held meter and I'm assuming there's also measurement error with the Libre since there's always measurement error on everything.) So, the 134 and 121 are really pretty much the same number.

I would not have encouraged increasing the dose by 1.0u. The most we typically will increase a dose is by 0.5u. Lantus/glargine is also not pharmacologically like other insulin. When you change a dose, it can take several cycles for the dose to stabilize. If you change the dose each cycle, the insulin dose doesn't have a chance to stabilize and you can end up with wonky numbers. It's the action of the depot that makes Lantus such a good insulin for cats. Basically, every time you give a shot, the insulin forms microcrystals that are deposited in the fat tissue. Over the course of the 12-hour cycle, most, but not all, of the crystals dissolve. The remaining crystals overlap with the next cycle which eventually will result in a "flat" curve and gives Lantus its long duration. If you've not had a chance to look over the sticky notes at the top of the Lantus board, there's a great deal of information about Lantus, the depot, etc.

Given Bingo's history of ketones, I'd think about giving a dose of 1.5u. If you're concerned about whether to give a shot, please post and ask for help. There's usually someone around who can lend a hand. We have members from all over the world along with some member in North America who are night owls.
 
Thank you so much! We are not testing for ketones— I’ll buy or order strips today. Really appreciate the linked reading on ketones because I don’t know anything about it. We will get up to speed.

It’s helpful to know those BG numbers are essentially the same. It sounds like we might be reacting too much to small changes like that. (Boy is it hard when you can see the data changing every minute of the day.)

Bingo has his check-in with the doctor today. Based on this info we haven’t handled his first six days perfectly. Hopefully we hear okay news.
 
Hi everyone! At Bingo's Saturday check-up Doc was generally positive about how things were going to far. We did get the news that he has "early" stage 2 kidney disease. She said the best treatment for now is to manage his diabetes.

Doc did reduce Bingo's insulin from 2 units to 1.5 earlier this week. He responded a little weirdly to the dose change-- yesterday he seemed high, today he is already trending quite low. Today it's also been hard to get him to eat, but we're at home so we've been offering food periodically.

We are honestly super stressed by the days and nights were he stays around 60 mid cycle. Trying to stay calm about it.
 
Just to add: Ketone strips came last night, so we are reading up and will use those.

We are also looking into a microchip feeder in case he would prefer to graze-- but he has never free fed and has always had set meals.
 
niltse said:
Just to add: Ketone strips came last night, so we are reading up and will use those.

We are also looking into a microchip feeder in case he would prefer to graze-- but he has never free fed and has always had set meals.
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We all stress, trust me, by FD is manageable, what insulin are you using? You should have a HYPO KIT hand that’s should include some medium carb foods and some high carb foods Karo syrup or honey, although if you get a reading of 60, which, if you are using ProZinc or Lantus that is ok, you worry when is 50 or lower, you can give a tsp of low carb at first, test 1/2 later if still low continue this process test feed tge same amount of lower than 50 then do the same but with medium carbs, tge Karo, syrup and high carbs are if you get a sudden lower BG is important to have a schedule like you do, but a programable wet feeder is also as good for when you are home, 3-4 meals between shots are advice to keep the BG in check.
 
CORKY said:
We all stress, trust me, by FD is manageable, what insulin are you using? You should have a HYPO KIT hand that’s should include some medium carb foods and some high carb foods Karo syrup or honey, although if you get a reading of 60, which, if you are using ProZinc or Lantus that is ok, you worry when is 50 or lower, you can give a tsp of low carb at first, test 1/2 later if still low continue this process test feed tge same amount of lower than 50 then do the same but with medium carbs, tge Karo, syrup and high carbs are if you get a sudden lower BG is important to have a schedule like you do, but a programable wet feeder is also as good for when you are home, 3-4 meals between shots are advice to keep the BG in check.
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Thanks for the reply! He is on Lantus. Sometimes we get intermittent Libre readings in the mid 50s in the +5-7 range (today he was briefly 53 around AMS+ 7) but never as low as 50 itself, and they sometimes disappear once the Libre graph smoothes its data, if that makes sense.

We offered food more than once today while he was low but we won’t always be home to do that.

The doc says not to worry as long as he is acting normally, which definitely he is— I guess this is because the Libre is known to exaggerate lows? I have definitely told her we are stressed out.

We do have a hypo kit with karo and some of the Fancy Feast grilled. If he goes below 60 we offer him some of his normal food which he sometimes nibbles at— but what scares me is that we can’t both be here all day every day (and awake all night every night) to do that when he dips low, especially if it’s happening nearly daily.

Is there a problem with his diet or dosage, or is this just a growing pain of week 2 and it will probably even out?

Thanks for listening.
 
Do you leave food out for snacking on? That helps keep blood glucose levels stable. Many people use a programmable timed feeder so their cat can have small snacks of canned food throughout the day (night too).
 
You can purchase it at WALMART OR chewy.com a cat wet a programmable feeder here,are between $$79.99-99.99
 
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squeem3 said:
Do you leave food out for snacking on? That helps keep blood glucose levels stable. Many people use a programmable timed feeder so their cat can have small snacks of canned food throughout the day (night too).
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We don’t leave food out because his sister would absolutely eat it all and leave none for him (and she is actually overweight and on a diet).

We did set up the microchip feeder yesterday in hopes that it facilitates grazing for Bingo. So far his sister failed to break into it overnight so that’s something!
 
There are tips here on how to help overweight cat lose weight safely: Feline Obesity: An Epidemic of Fat Cats The same low carb food you feed your diabetic cat is also good for the overweight cats. It's suggested to feed 20 t0 25 calories per pound of ideal body weight daily. A slow reduction from the current amount of calories to the more ideal calorie amount needs to be done slowly over weeks if not months 🐌 to avoid fatty liver disease.
 
squeem3 said:
There are tips here on how to help overweight cat lose weight safely: Feline Obesity: An Epidemic of Fat Cats The same low carb food you feed your diabetic cat is also good for the overweight cats. It's suggested to feed 20 t0 25 calories per pound of ideal body weight daily. A slow reduction from the current amount of calories to the more ideal calorie amount needs to be done slowly over weeks if not months 🐌 to avoid fatty liver disease.
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Great to know the foods that work for Bingo will also work for his sister! Yes, we've been reducing her calories slowly over many months. (Pretty sure she has been eating her current caloric amount with verrrry slow weight loss for most of a year. 😅) She has been getting a mix of wet and dry, but reading this article I'm realizing we should transition to all wet food for her too. Thanks for sharing!
 
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