Please help me...it's Sunday night, vet not available...

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solstice105

Member Since 2013
Hi. I have never posted on here, but have used the resources on here a great deal. Please be patient with me if I "do" something wrong.

My 12 year old, neutered male tabby was diagnosed with diabetes in early March. There were a handful of signs, but we had "perfectly good reasons" for each of them to be occurring. Then he suddenly started walking funny. We took him in immediately and his blood glucose level was 513. The vet put him on 1 1/2 units of Lantus immediately after each of his 2 feedings and we immediately switched him to a soft food only diet. Mostly a few different flavors of Wellness, as well a few flavors of Soulistic, and some of the Merrick Before Grains. All 5g of carbs or lower.

He responded fantastically. We ordered the Alphatrak 2 and monitored his blood pretty closely those first few weeks, and noticed some pretty low numbers. After talking to the vet, she recommended going down to 1 unit of Lantus after each feeding. After a month or a month and a half of this we did a mini curve at home. Tested him probably 6 times throughout the day. He had some great numbers and some that were borderline low. So I contacted the vet a week and a half ago and she recommended lowering it to 1/2 unit of Lantus with each feeding. We did so, taking random blood glucose readings as we went to make sure it wasn't getting too high. And just so anyone asks, I have been religious about coding the meter properly and using the control solution with each new batch of test strips. Sorry for so much back story but I wanted everyone to have all the info.

So the last several days y husband and I have both been under the weather. Looking back today, my husband and I think between the 2 of us our cat might have missed a dose or 2 over the last 3 or 4 days. We had planned to do a mini curve today anyway, but decided to monitor things especially because the possibility of missed doses. I tested my cats blood at 11:50 a.m. (he gets fed at 12 p.m. and 12 a.m.) and his reading was 95. I fed him some of the Soulistic Polynesian Picninc at 12 p.m. and he didn't seem interested. When it gets warmer outside our cats do seem to eat a little less so I didn't think much about it. However, the vet has always said if he doesn't eat much not to give him his shot, and with a reading of 95 I was pretty satisfied and skipped his shot. But I tested him again at 4:00 p.m. and his reading was 214. He seemed fine but I was getting pretty nervous. I tested him again at 5:00 p.m. and his reading was 237. I opened a new, different can of food and tried to get him to eat some. He wasn't super interested but he did eat some. So I decided at that point to give him 1/2 unit of his Lantus. I meant to test him a few hours later but time got away from me, and again, he has been acting fine. So I just tested him again at 9:45 and his blood glucose level was 49. I immediately gave him some hard food and a drop of honey. I plan on retesting in about 15 minutes.

What shout I do or think? We both had been so sick and sleeping so much, that we think that he might have missed his shot Saturday night, and then this morning since he wouldn't eat, I didn't give him one either. So then his glucose shoots up, but as soon as I give him 1/2 unit of his insulin, his blood sugar plummets. The 1/2 unit is the smallest possible marked dosage on his needle. I'm afraid to give it to him, and I'm afraid not to give it to him. And on top of things, I'm not really very happy with our vet. She seems like a very nice lady but she also doesn't seem very educated on feline diabetes other than the standard information. The first thing she did was try to push dry Hills Science Diet for diabetes on us. This board has been a godsend for information. Again, I'm sorry this has been so long, and I say thank you up front to anyone willing to read this and offer some help or information.
 
HI,
The first thing I'll say is that none of the numbers you have seen recently are alarming. The low 200 numbers are not "high". And the 49 is not critically low, but you did the right thing by feeding at that point.
I just want to be clear and ask how long after the shot you gave tonight was the reading of 49?

And testing again in 15-30 minutes is a good plan. I'll be here watching for the number.

EDIT TO ADD - If the numbers are from an AlphaTrak, then yes, the 49 is lower than you would want it to be, so feeding was the perfect choice. You don't want the number going much lower at all.
 
When the reading was 49, it was almost 5 hours after when I gave him his shot. I just retested and his number was 54. Gave him a tiny lick of honey again and a tiny bit of hard food. We've been trying to monitor pretty closely because the last time I talked to our vet she said there was the possibility that we were looking at a kitty who could go into "remission". She was really happy with his numbers and the way he was responding to his new diet. I guess anything other than his more "normal" reading we have been getting lately of 70 - 125 just shook me up a bit. 49 was the lowest reading we have ever had so far. Thanks so much for calming my nerves a bit.
 
We generally go by "the alphatrak meter will read 30 points higher than a human meter", but in the lower numbers, the difference is not that drastic. 54 is better, but you still want to see him come up above 70.

Do you have any higher carb canned food, something with gravy maybe? Soft food will digest and show up on the meter faster, like within 30 minutes. If you can mix the honey, just a few drops, with canned food, or give him some gravy from a higher carb canned food, that'll bring him up more quickly.

And another test in 15-20 minutes is a great idea.
 
We've been trying to monitor pretty closely because the last time I talked to our vet she said there was the possibility that we were looking at a kitty who could go into "remission".
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I think I'm agreeing with your vet's opinion regarding remission given the numbers you've been seeing, and the small doses you are giving. :smile:
 
With an Alphatrak, anything below 70 should be treated like a HYPO.

Dry food takes too long to bring up the glucose. And too much dry food may trigger vomiting as it swells in the stomach.

1) Test.
2) If below 70, take 1-2 teaspoons of wet food and add some of the honey and feed.
3) Re-test in 20 min.
4) repeat until over 100
 
What time did you get the 54? We definately want his BG higher so please follow Carls instructions and give a small amount of wet food with honey.

PMPS 237 1/2IU (5:00 p.m.)
+ 5 49 (9.45pm )
? time 54


Wendy
 
I got the reading of 54 at about 10:45.
I just took another reading at 11:15 and it was already up to 83. This is very close to a "normal" number for him.
His feeding schedule is at noon and midnight. I will test again between 11:30 and 11:45 and I will post his number. I will feed him at midnight and test again right after. Thinking it's probably not a good idea to give him a shot tonight. Last time I talked to the vet she said to try 1/2 a unit with each feeding but that "soon" we would probably be able to go to 1/2 a unit a day. She said that a few weeks after that, if his numbers were still good, we probably could try a week without insulin. I can't say thank you enough to all of you and this board for all of your help and information. If it wasn't for the amazing people and amount of information here, I would have gone crazy these last few months.
 
If 83 is a normal number for him, he doesn't need insulin.

And do not shoot less than 12 hours from a previous shot. Tomorrow noon is soon enough to determine if he will need a shot.
 
Good on the 83, but we want to make sure he stays up. Can you feed him some of his regular food, like a couple teaspoons? And test and post per your plan?
 
Carl & Bob said:
Good on the 83, but we want to make sure he stays up. Can you feed him some of his regular food, like a couple teaspoons? And test and post per your plan?
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Sure. :smile: Give me a few minutes.
 
Thinking it's probably not a good idea to give him a shot tonight.
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Definitely no shot tonight.

You gave the shot today 5 hours late, correct? You wouldn't consider shooting again until 12 hours after that time.

I think my suggestion would be to not give a shot until noon tomorrow (that is your normal schedule, right, noon and midnight?).

And because his number dropped that low tonight, you should also reduce the dose from .5u to .25u going forward. A drop under 70 on an AlphaTrak means an automatic reduction in dose by the protocols we follow for Lantus.
 
This is what .25u would look like in a syringe...
 

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Definitely what Carl said about dose reduction. If it is hard to measure 0.25, they make syringe magnifiers, plus clip on, visor, and freestanding magnifiers which may be helpful.

To help the pancreas, you might have read about feeding mini-meals, using a timed pet-feeder, and freezing part of the food. That will allow the food intake to be gradual and match with any insulin, plus keep the load on the pancreas more stable.
 
I must need to get different needles. The needles my vet had me get do not measure less than .5 so .25 will be kinda tricky. Just fed him and the rest of the crew a little early. He didn't eat a ton but I tested him after he had eaten a few tablespoons. Back down to 70 so I gave him another little bit of honey. 10-15 minutes and then I will test again. Boy is he a tolerant cat but not real happy with me tonight. :?
 
You eyeball 0.25 units as no commercial, disposable needles measure less than 0.5 units.

Some folks use calipers, so the amount < 0.5 is consistent, whatever it actually is.
 
Yes, unfortunately they don't make syringes with less than .5u markings, so that's why people came up with the pictures to show what smaller doses look like. It's not an "exact" science, but the drop in numbers tonight definitely indicates that less insulin is a good move.

I know you mentioned your vet said you could maybe go with ".5u a day". However, what we have found over the years is that insulin in cats works better if given twice a day instead of just once a day. They metabolize insulin twice as fast as humans or dogs do. So in order to keep insulin working in their systems around the clock, every 12 hours works better than just once per 24 hours.
 
We (my husband and I) have been talking lately about smaller and more frequent meals. I would be curious about the timed feeders but we are feeding 5 cats. Currently at each of the feedings (twice a day), Ernie, the diabetic cat, gets one can of food (he currently weighs 13.6 pounds and is holding at that weight. He was at 21 pounds before diagnosis). The other 4 each get 1/8 of a cup of Wellness Core Indoor formula hard food and 1/2 can of soft food. I wonder how that would work with timed feeders? We already have to monitor the situation pretty closely so everyone gets enough. There is usually a small amount of food left over right after the feeding but it is usually all gone by the time the next feeding comes around.
 
Carl & Bob said:
I know you mentioned your vet said you could maybe go with ".5u a day". However, what we have found over the years is that insulin in cats works better if given twice a day instead of just once a day. They metabolize insulin twice as fast as humans or dogs do. So in order to keep insulin working in their systems around the clock, every 12 hours works better than just once per 24 hours.
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See, it's info like this that makes me question my vets training in this area. She often seems to be winging it, as do the other doctors at the clinic. I'd love to find a new vet, but the only one I really trust in the area is not taking new patients currently. He is however great at answering most questions over the phone. Of course, with something like diabetes he is a bit hesitant since he hasn't seen the cat. So I just end up coming here for my info. I call the vet with the necessary questions, but I just don't know if I can trust what she says.
 
If it makes you feel any better...

I don't think, compared to other's testimony here, that your vet is all that "bad". She prescribed a very good insulin for cats. She's done a good job of getting you to reduce the dose based on the numbers you've been getting. She was off the mark with the Hill's food, but my vet prescribed the same thing for my cat, Bob, and I think my vet is the bomb outside of that. :smile: It's got to be hard for a vet to be up on everything. And although diabetes is on the increase in cats, it isn't like one out of ten gets it. They can't be experts on everything, but like I said, compared to some other stories I've seen here, your vet would be on the "better vet" list. :lol:
And we have a vet, Dr. Lisa, who posts here on occasion. She has said that most of her peers are very supportive of dose increments as little as half a unit at a time, and when she mentions .25u or smaller adjustments, she says they pretty much roll their eyes. And Dr. Lisa knows a heck of a lot about feline diabetes and about feline nutrition. So if her peers don't take her advice, I'm not shocked that other vets would think like her especially if they've never heard of her.
 
Would Dr. Lisa be Dr. Lisa Pierson? I love all the info on her website.
Ernie's most recent reading was 78. Still acting ok. Trying to feed food mixed with some honey intermittently then testing. Thought I would give him a 30-45 minute break since he is acting ok.
 
Yes, that Dr. Lisa!

Ernie's numbers are looking great. And you should be well past nadir. If he's up a good bit more in 30-45, you should be able to sleep peacefully. Which time zone are you in?
 
Central. Its 1 am here. But we are night people. Plus, having been sick, I slept 27.5 out of 42 hours! I will be up for awhile ! :lol: Thanks again for all your help. I know I must sound like a broken record but this website has gotten me through many an anxiuos night. Tonight was just the first time I actually posted.
 
Are you good with what to do tonight? Only asking because it's time for me to hit the hay. But I can find someone to take over if you would feel more comfortable with that.

And did you see my suggestions for tomorrow's shot schedule above?

I know I must sound like a broken record but this website has gotten me through many an anxiuos night.
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I know the feeling. This website has probably gotten every one of us through our share of anxious nights! I spent a few weeks reading before I ever posted too. :-D
 
Sorry. I went away for a bit. But yes, I am comfortable with what to do tonight and the shot schedule for tomorrow (today now). Last reading was 98 and I decided to let him sleep. He was very irritated at me by the end of it. :smile: Now that I am beginning to understand the differences reading an alphatrak vs a human glucometer I'm realizing his numbers have been even lower than i was thinking. No shots til noon and .25 every 12 hrs for now. I will try that for a week or so with random testing throughout. Then another curve next sunday. Thank you thank you to everyone.
 
Sounds like a plan. If you see a number that you feel is too low to give a shot, don't hesitate to ask here. And any time you need a quick response, and don't get one, go with your instincts, which were pretty good last night :-D

Keep us posted!
 
Just an update for everyone who was so incredibly helpful the other night...
tested Ernie off and on all day Monday as well, and his numbers were pretty spot on so I was nervous and did not give him any insulin. Spoke with the vet first thing Tuesday morning and gave her all the info from Sunday and Monday. She said she felt like, fingers crossed, we were looking at a kitty in remission. She advised me to stop the insulin and to monitor him with testing periodically. She also asked that I do another curve on this coming Sunday.

Since the shot on Sunday Ernie has had NO insulin and has had fantastic numbers, ranging from 95-130. The vet said to keep the insulin refrigerated because the high numbers could come back. But for now, Ernie is doing absolutely fantastic besides the fact that his Mom keeps poking him in the ear.

Thank you all again soooo much for all the amazing information you have gathered on this site and for all the support when I needed it. I will keep checking back to see how all the other kitties are doing.
 
We like to see a kitty in low numbers at both AM and PM for 14 days before we consider them in remission.

The numbers should be between 40-130 with most of those numbers below 100 in the double digits. This gives you a strong remission and hopefully will keep from needing insulin again.

Once a diabetic, always a diabetic. so remember to:
1. Always feed a low carb canned food diet with <10% carbs.
2. No high carb treats either or people food (except pure meat is ok)
3. Watch the size of the pee patches in the litter box. Getting bigger or more frequent means time to test
4. Test periodically to make sure the BG (blood glucose) numbers stay low, under 100 is best
5. Give him lots of loving and play time. Playing can help to keep the BG numbers low.
 
Since the shot on Sunday Ernie has had NO insulin and has had fantastic numbers, ranging from 95-130. The vet said to keep the insulin refrigerated because the high numbers could come back. But for now, Ernie is doing absolutely fantastic besides the fact that his Mom keeps poking him in the ear.
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Absolutely fantastic news! :-D
 
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