No insulin, Alpha Trak 2, BG falls after mini meals-advice?

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Tamiww

Member Since 2013
Update 10-21-13

We are a little stuck on what to do. There has been no insulin for 5 days (today is day 6). Her numbers are in the normal range for the alpha trak 2 tester almost always-but still seem high to me when looking at other spreadsheets. I'm a little nervous about giving her insulin at these numbers, but could try when I am home for a good part of the day?? She has dropped up to 100 points within an hour of eating with no insulin and seems to drop every time she eats. I'm feeding her small meals 4-5 times per day and putting frozen food in her dish at bedtime. She is eating canned wellness, no grain, 5% carbs. I just don't want to blow it if she is trying to go into remission and not sure what to do??"
Thanks in advance for any feedback.







Hi, I am a new member with a 13 year old cat diagnosed about 4 weeks ago. She was in dk and spent a week in ICU when diagnosed. They could not get her regulated at the vet and sent me home with a chart for how much insulin to give based on her blood sugar. Her insulin is lantus and I have switched her to very low (less than 5% carbs) carb canned food. I have been on a roller coaster since she has been home. I take her bg 5-10 times/day and it has ranged from high 100's to high 500's. She has had 2.5-6 units of insulin/day.

Over the past 5 days there has been a HUGE change. All of her readings have been below 250 and she has only had .5 units of insulin per day. Most readings are in the 120-170 range. One day she had no insulin. She is eating less b/c she is not crazy about the food she is eating, but still eating and seems to feel great. She is also overweight, so I "think" eating less is a good thing?

My question is this. I know her numbers are pretty good, but not great (yesterday 168, 189, 140, 136, 150 with .25units of insulin between the 189 and 140). From what I've read they should be a little lower, but I probably should not be giving any insulin with these numbers? Does this look like she is going into remission to anyone that has been there? Will the numbers come down more with time? Any input would be greatly appreciated.

***Please note the numbers in the far right column represent insulin given in addition to that on the chart as the vet recommended to dose her based on BG readings after being unable to regulate her during her one week stay.

***I'm using the Alpha Trak 2 glucometer. From what I am seeing here this meter might read higher? Does that make these numbers better than they look?

*** Over the last 3 days her BG has dropped 30-50 points after eating without insulin. Should I take this into consideration if she needs insulin?

Any suggestions/feedback would be greatly appreciated.

Thank you!!
 
Re: New Member and remission question

Good insulin; incorrect dosing advice.

Lantus is a depot insulin and the effects carry over shot to shot. You must hold a level for a minimum of 3 full days/ 6 shots, before evaluating its effectiveness.

So, stick with the 0.25 units, continue testing, and unless the glucose between +5 to +7 hours after a shot goes below 50 mg/dL (too low), do not adjust for the 3 days.

We track the insulin and glucose levels using a Google Docs Spreadsheet which may be viewed by others to give you feedback. Instructions are here.

AMPS = morning pre-shot glucose test
PMPS = evening pre-shot glucose test
U = units of insulin given; 0 if none
+1 = any test done 1 hour after shot , if done
+2 = any test done 2 hours after shot , if done
+# = any test done # hours after shot, if done
 
Re: New Member and remission question

Thanks for the quick response and the info. Still unsure though about giving insulin? Vet says no insulin under 150. Her last dose was .25 units at 8:30 am yesterday (189). This morning she was at 150 at 7 am. No insulin and 1/4 can food at 7 am. Now, at almost 9 she is at 122. ??
 
Re: New Member and remission question

Hello and welcome!

Wow, those are really super-duper numbers for this stage of the game. It took me a very long time to see any pretty numbers like those with my cat!

The general advice for newcomers to feline diabetes here is not to give a shot if the blood glucose level (at the time of the shot) is below 200. But this advice is very, well, 'general'. A lot depends on what insulin is being used, and how often the care-giver can test the blood glucose at home (and how much data there is about how the cat responds to insulin).

I don't use the same insulin as you. But my understanding from having read what other Lantus users here say about the dosing, is a) that it is better to hold to a certain dose for a period of time; and b) that insulin dosage for Lantus is based on the lowest number of the cycle (or 'nadir'). (This is unlike some other insulins whereby the dosage is calculated according to the blood glucose level at the time of the shot (although also, of course, takes the 'nadir' into account'). Lantus users - please correct me if I am wrong! nailbite_smile

There are a lot of Lantus users on this forum so you will get a lot of advice here. (And it may be worth editing your subject line to include 'Lantus' so as to attract more 'Lantus eyes' to your post).

Your cats blood glucose levels are coming down beautifully! And yes, it's does often happen that the numbers continue to drop. It could well be that your cat's pancreas is producing insulin of it's own and will heal enough to produce more. It is entirely possible that your cat may go into remission, but it's a little too early to know that for sure. Some cats need to remain on a low dose permanently. It's looking very good for your girl, though! :smile:

Eliz
 
Re: New Member and remission question

Tamiww said:
Thanks for the quick response and the info. Still unsure though about giving insulin? Vet says no insulin under 150. Her last dose was .25 units at 8:30 am yesterday (189). This morning she was at 150 at 7 am. No insulin and 1/4 can food at 7 am. Now, at almost 9 she is at 122. ??
Click to expand...

The reason it dropped with no insulin is that the pancreas responded some to the food! Yay! You can help it out by feeding mini-meals and spreading the food out across the day. Just pick it up 2 hours before you would give insulin, so that the pre-shot test or check is not influenced by food.
 
Re: New Member and remission question

Thank you so much Eliz and BJM. I'm feeling better about where we are. Stayed in the 100's all day today and did end up giving .25 units this afternoon. Will just keep fingers and paws crossed that we can drop down a little lower and stay there! So appreciate your responses and the information you shared. Thank you! Tami
 
Re: New Member and remission question

Hello and welcome to the board! You have a great insulin, good food and its great you are testing!

We dont recommend newbies shoot under 200 . Remember normal cat numbers are 50-130 and many cats can get there with a change to a low carb food so I would keep testing and see how she does and dont shoot for now unless she goes over 200.. you dont have enough data to shoot under that and deal with a hypo. she might already be in remission with those numbers. Keep testing her and let us know how she does.

Wendy
 
Re: Chart posted any feedback appreciated, Lantus, Alpha Tra

Thank you Wendy, I appreciate your feedback!
 
Re: Chart posted any feedback appreciated, Lantus, Alpha Tra

Ok cool - can you add "Lantus and alphatrak" to your signature?

Good job on the SS. She went to 78 today - on an alphatrak that is too low - anything under 80 merits a decrease! Do your syringes have half unit markings? I think it might be an idea to try 0.1 units next - heres how that looks.
http://s214.photobucket.com/user/jillsphotos2/media/Lantus Group/01unit-1.jpg.html


FYI
Here are some glucose reference ranges used for decision making using glucometers. Human glucometer numbers are given first. Numbers in parentheses are for non-US meters. Numbers in curly braces are estimates for an AlphaTrak.

< 40 mg/dL (2.2 mmol/L) {< 70 mg/dL for an AlphaTrak}
- Treat as if HYPO if on insulin
- At nadir (lowest point between shots) in a long term diabetic (more than a year), may earn a reduction.

< 50 mg/dL (2.8 mmol/L) {< 80 mg/dL for an AlphaTrak}
- If before nadir, steer with food, ie, give modest amounts of medium carb food to keep from going below 50 (2.8).
- At nadir, often indicates dose reduction is earned.

50 - 130 mg/dL (2.8 - 7.2 mmol/L) {80 - 160 mg/dL for an AlphaTrak}
- On insulin - great control when following a tight regulation protocol.
- Off insulin - normal numbers. (May even go as low as the upper 30s (1.7 mmol/L){60s for an AlphaTrak}; if not on insulin, this can be safe.

= 150 mg/dL (8.3 mmol/L) {> 180 mg/dL for an AlphaTrak}
- the lowest level pre-shot for ProZinc, PZI, or other non-depot insulins.

> 150 mg/dL (8.3 mmol/L) {> 180 mg/dL for an AlphaTrak}
- At nadir, indicates a dose increase may be needed when following a tight regulation protocol.

200 mg/dL (11.1 mmol/L) {230 mg/dL for an AlphaTrak}
- no shot level for beginners; may slowly reduce to 150 mg/dL (8.3 mmol/L) {180 mg/dL} for long-acting insulins (Lantus, Levemir, and ProZinc) as mid-cycle data collection shows it is safe

180 - 280 mg/dL (10 - 15.6 mmol/L) {may be 210 - 310 mg/dL for an AlphaTrak}
- Any time - The renal threshold (depending on data source and cat's renal function) where glucose spills into the urine.
- Test for ketones, glucose is too high.

>= 280 mg/dL (15.6 mmol/L) {may be >=310 mf/dL for an AlphaTrak}, if for most of the cycle between shots
- Uncontrolled diabetes and thus at risk for diabetic ketoacidosis and hepatic lipidosis
- Follow your insulin protocol for dose adjustments
- Test for ketones; if more than a trace level of ketones, go to vet ASAP.
Click to expand...
Wendy
 
Re: Chart posted any feedback appreciated, Lantus, Alpha Tra

Thanks again Wendy..that really helps. When she goes without eating for awhile, her BG rises to right around 200 (overnight and during the day if I'm not here). I feed her a spoonful of food and it drops 50+ points. Should I try the .1U or let the food bring her down? Any thoughts??
 
Re: Chart posted any feedback appreciated, Lantus, Alpha Tra

Maybe just answered my own question. She tested at 202 when I woke up. Fed her and now (1.5 hours later) she is at 104...that is a big drop, is this normal? Can anyone tell me why her BG goes up when she is not eating (where is the glucose coming from?) and am I doing the right thing by not giving insulin? -Thanks!
 
Re: Chart posted any feedback appreciated, Lantus, Alpha Tra

I think your cat's numbers look good and promising. If you could feed more mini meals throughout the day and night that may help her pancreas to heal. It looks like she is producing some of her own insulin.
With the recent DKA, I would keep up the testing as some cats are ketone prone and will get them again.
Do you have an timed automatic feeder that you could set up for the times when you are not home or sleeping?
 
Re: Chart posted any feedback appreciated, Lantus, Alpha Tra

I did not know there was an electronic feeder that would work with canned food - but I see that there is! I will get one of those set up for her and see if it works.

Thanks so much!! Tami
 
Re: Chart posted any feedback appreciated, Lantus, Alpha Tra

Tamiww said:
Maybe just answered my own question. She tested at 202 when I woke up. Fed her and now (1.5 hours later) she is at 104...that is a big drop, is this normal? Can anyone tell me why her BG goes up when she is not eating (where is the glucose coming from?) and am I doing the right thing by not giving insulin? -Thanks!
Click to expand...

If you gave insulin, that dropped the glucose level.
If you did not give insulin, that suggests the pancreas is starting to work again.

Fat and protein may be broken down to make glucose when there isn't enough.
Plus, food moves through the digestive tract over time, being absorbed over time, so it isn't an instantaneous process.

If the numbers stay in the normal range - 40-130 mg/dL in the US - no insulin is needed.
If the glucose is sustained at a higher levels, without sufficient insulin, organ damage may happen. Also, fat and muscle breakdown for energy may happen, leading to weight loss and possibly hepatic lipidosis.

With extreme fat breakdown, you risk hepatic lipidosis, where the fat overwhelms the liver, disrupts its functioning, and can result in the cat's death.
 
Re: No insulin, Alpha Trak 2, BG falls after mini meals-advi

Update 10-21-13

We are a little stuck on what to do. There has been no insulin for 5 days (today is day 6). Her numbers are in the normal range for the alpha trak 2 tester almost always-but still seem high to me when looking at other spreadsheets. I'm a little nervous about giving her insulin at these numbers, but could try when I am home for a good part of the day?? She has dropped up to 100 points within an hour of eating with no insulin and seems to drop every time she eats. I'm feeding her small meals 4-5 times per day and putting frozen food in her dish at bedtime. She is eating canned wellness, no grain, 5% carbs. I just don't want to blow it if she is trying to go into remission and not sure what to do??"
Thanks in advance for any feedback.
 
Re: No insulin, Alpha Trak 2, BG falls after mini meals-advi

The alphatrak runs higher than human meters. Normal cat levels on a human meter are 50-130. On an alphatrak its 80-160. most of us here are using human meters cos they are cheaper.


her numbers are looking good. Way to go day 6!

Wendy
 
Re: No insulin, Alpha Trak 2, BG falls after mini meals-advi

Here are some glucose reference ranges used for decision making using glucometers. Human glucometer numbers are given first. Numbers in parentheses are for non-US meters. Numbers in curly braces are estimates for an AlphaTrak.

< 40 mg/dL (2.2 mmol/L) {< 70 mg/dL for an AlphaTrak}
- Treat as if HYPO if on insulin
- At nadir (lowest point between shots) in a long term diabetic (more than a year), may earn a reduction.

< 50 mg/dL (2.8 mmol/L) {< 80 mg/dL for an AlphaTrak}
- If before nadir, steer with food, ie, give modest amounts of medium carb food to keep from going below 50 (2.8).
- At nadir, often indicates dose reduction is earned.

50 - 130 mg/dL (2.8 - 7.2 mmol/L) {80 - 160 mg/dL for an AlphaTrak}
- On insulin - great control when following a tight regulation protocol.
- Off insulin - normal numbers. (May even go as low as the upper 30s (1.7 mmol/L){60s for an AlphaTrak}; if not on insulin, this can be safe.

= 150 mg/dL (8.3 mmol/L) {> 180 mg/dL for an AlphaTrak}
- the lowest level pre-shot for ProZinc, PZI, or other non-depot insulins.

> 150 mg/dL (8.3 mmol/L) {> 180 mg/dL for an AlphaTrak}
- At nadir, indicates a dose increase may be needed when following a tight regulation protocol.

200 mg/dL (11.1 mmol/L) {230 mg/dL for an AlphaTrak}
- no shot level for beginners; may slowly reduce to 150 mg/dL (8.3 mmol/L) {180 mg/dL} for long-acting insulins (Lantus, Levemir, and ProZinc) as mid-cycle data collection shows it is safe

180 - 280 mg/dL (10 - 15.6 mmol/L) {may be 210 - 310 mg/dL for an AlphaTrak}
- Any time - The renal threshold (depending on data source and cat's renal function) where glucose spills into the urine.
- Test for ketones, glucose is too high.

>= 280 mg/dL (15.6 mmol/L) {may be >=310 mf/dL for an AlphaTrak}, if for most of the cycle between shots
- Uncontrolled diabetes and thus at risk for diabetic ketoacidosis and hepatic lipidosis
- Follow your insulin protocol for dose adjustments
- Test for ketones; if more than a trace level of ketones, go to vet ASAP.
 
Re: No insulin, Alpha Trak 2, BG falls after mini meals-advi

Thanks again for the feedback. There is so much info, it's hard to know if you are doing the right thing. The Alpha Trak came with her on discharge (and her $1200.00 bill) so I did not have any options at the time. I'm glad I had something to test her when she got home. They compared it to their labs and found to be accurate at the vet. I've since run out of test strips when the new ones took a week to arrive and had a very stressful few days trying to round some up at vet offices. Now I've purchased 100 test strips so that would not happen again. I will switch over to the WalMart version when I run out of these strips as I think the monitor and strips are less expensive than just the strips for the alpha trak. It will make it easier to compare her chart too.

You guys are the best thank you so much for your advice and support. I appreciate it so much.

Tami
 
Re: No insulin, Alpha Trak 2, BG falls after mini meals-advi

Day 7!

If she makes it to day 14 then testing will reduce but its probably a good idea to buy a cheaper meter anyway.

7 days to go

Wendy
 
Re: No insulin, Alpha Trak 2, BG falls after mini meals-advi

:mrgreen: :mrgreen: :mrgreen: CONGRATULATIONS!! :mrgreen: :mrgreen: :mrgreen:

Tips to stay OTJ

We say a cat is in remission if the cat can maintain BG levels for 14 days between 40-120 with most of that spent under 100. However, please keep in mind that once a diabetic always a diabetic.

1. Never feed dry - not even treats. If you change wet food types, be 100% sure the new food is also low carb and same low carb % as your current food. Some cats are very carb sensitive and an increase from 3-6% to 8-10% can spike the BG’s. Don’t feed if you aren’t sure!
2. Weigh every 2 weeks to 1 month to watch for weight changes. Too much of a weight gain can cause loss of remission.
3. Measure blood once a week, indefinitely. You want to catch a relapse quickly.
4. No steroids or oral meds with sugar - remind your vet whenever giving you any medication. Always double check.
5. Monitor food intake, peeing and drinking. If increasing, a sign of losing remission.
6. Regular vet checks for infection such as dental , ear or UTI. And get them treated quick!

If she does fall out of remission you need to be more aggressive and resolve issues/ back on insulin as soon as possible as the window for a second remission is tight if any.

Wendy
 
Re: No insulin, Alpha Trak 2, BG falls after mini meals-advi

Thank you so much for all of your help Wendy! I think it will take me awhile to only check her once a week, but we'll get there. This is such a great board! I will stick around and try to learn more, encourage where I can, and support as much as possible. Again, thank you for being so wonderful and easing so much of the stress that comes with a sick kitty. You are so very much appreciated :)

Tami and Yeti
 
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