Repost here suggested from Main Forum post; help?

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MissLuna

Member Since 2018
Hello All! I posted the following over on the Main board, but it was suggested that I post here, and as Miss LunaMae's numbers are so wonky, and she is newly on Lantus, and I've just read all about the "Depot" and longevity of Lantus - I understand that doses a couple of days prior may affect today's numbers. I'm hoping that some of you might have had similar experience and can give me some insight. Here's the post:
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Hello All! I just joined, our kitty, Miss LunaMae, having been diagnosed 9 days ago. I just posted an introduction, downloaded the spreadsheet and added the numbers. I am now requesting your wonderful advice!!!

LunaMae was at the doctors for 5 days last week - (she had an "all clear" annual check up 2 months ago) - she took a dive over the weekend, and the next day, a week-ago Monday, had a number of tests. She has a kidney infection and diabetes. Her BG numbers numbers have been all over the place - the vet agrees with this. He also agrees that during her check up there were no signs in her tests, which is unusual. I like this vet a lot. I went to bring her in for a curve, and hadn't been yet trained on how to test her, and she was acting really out of it. I decided to give her some corn syrup. He wasn't happy with this, as it did not help the curve, but agreed based on her symptoms that it was the right thing to do. I was trained on how to use the lances, but have been much happier using the lancing device. I am using the Alphatrak 2, and just ran out of strips, but should receive more this afternoon (so very expensive!)

She has had a few "scary low" numbers since, and is receiving low doses of insulin. She is on a very high protein diet now, only wet food. If some of you could take a peek at her spreadsheet, I would be grateful! Her vet has already changed her "1 in the morning and 1 in the evening" to 1 unit in the morning and .5 in the evening. She is eating more food now, and feeling a whole lot better (it was scary for a few days there) - it was scary when I gave her 1 unit in the morning on the 25th and her BG dropped from 426 to 36 in 5 hours. So I gave her .5 the next morning, but honestly I couldn't feel the plunger move at all (it is so little!) and her numbers did not go down much at all. So for the evening dose, when she was at 301, I gave her .75 This morning her BG was even lower, so I gave her no insulin.

I've been force feeding her using two large syringes (no needles of course) fairly successfully every morning and evening. Yesterday and today she lapped a little as well. She is happy, looking so much better, jumping up on our bed, coming out to see how everyone is. Regarding the insulin: .5 seems to be too little. .75 too much. I know that it takes a while to regulate, but her BG numbers just are getting way too low.

Or is this because her kidney infection is being treated, and she is getting high quality wet food? Maybe she won't need insulin? Do I just keep poking her poor ears multiple times a day?
She is on Lantus 100. The needles are correctly sized, with "half" markings as well. I am being VERY careful, and am the only one to feed/prick/test/administer medication to, so that we can avoid any issues (no double dosing, in other words.)

With her numbers so low today, I don't want to give her insulin until my new testing supplies get here later today. Has anyone else seen such dramatic swings with such a small amount of insulin? (She had lost some weight, and is about 6 lbs.) Your expert advice is so very welcome!

ps, as she was at the doctor's 5 times last week, and Winky twice (I found an unusual lump on her that we had biopsied) we have already spent over $3,000. I would rather not have to take her in to see what the vet had to say yet - he will want to do another curve, and I feel as if I can do that successfully at home, with less stress effecting the results, once my supplies get here. She will already be going in late next week. Thank you!
 
Welcome. So very glad you are home testing. Great job getting up and running with the spreadsheet. With this wide range in numbers you have kept her safe!

Can you say anything more about her food? I suspect she was eating high carb / dry? If you have made a significant change in diet (i.e. low carb wet), it is possible she may be diet controlled. I would like for others to weigh in because she has other issues (infection etc), but while we wait for others to comment, please say a bit more about her diet and any recent changes.
 
Welcome. So very glad you are home testing. Great job getting up and running with the spreadsheet. With this wide range in numbers you have kept her safe!

Can you say anything more about her food? I suspect she was eating high carb / dry? If you have made a significant change in diet (i.e. low carb wet), it is possible she may be diet controlled. I would like for others to weigh in because she has other issues (infection etc), but while we wait for others to comment, please say a bit more about her diet and any recent changes.
Thank you so much for your quick reply!

Miss LunaMae has food allergies (she gets bumps all over/crusty eyes/crusty nose/sneezes), and was on a prescription diet for the past year - she ate freely. With the diet she appeared much healthier than prior to this food. She had been on a "selected protein" diet, which she did well on, however Royal Canin had an issue with supply, so we were told to transition to the Hydrolyzed Protein.

Royal Canin Hydrolyzed Protein (only comes dry)
Crude Protein (min) 23.0%
Crude Fat (min) 18.0%
Crude Fiber (max) 5.6%
Moisture (max) 8.0%
With her being so ill, her dr. now has her on

Hill's Prescription Diet a/d Canine/Feline
He also advised feeding her baby food with just chicken and chicken broth. She was pretty sick, so quickly, so anything we could get her to eat was fine. I've been adding some water to the Hills and force-feeding her, though she has begun to eat on her own, albeit just a little.​

I've just ordered some Tiki Cat, which I've read it good for high-protein/very low carb diets. We've also purchased water fountains for the front and back of the house.

Again, thank you!
 
Most here use this food chart to understand carbs etc. However, it doesn't cover dry foods. I did a quick look and found an estimate of the carb content for RC Hydrolyzed protein, and it looks high at 37.5%. An abrupt change to a quality canned food can be expected to have significant impact to blood sugar, but more time / stability would be required to understand if she can be diet controlled.

I think right now, we need to be aware that there was a significant change in diet to low carb food and therefore, be conservative with insulin dose.

Hope others will weigh in with their views, but at this point, I'm thinking you should go back to a very small dose and try to stabilize on that. Lantus needs time to build the depot and consistency is important. Of course, safety is more important, so I totally agree that with such low numbers you had to reduce. :cat:

I'd like others to please comment on a new lower dose given the diet change and other issues such as AB / infection.
 
Hello and welcome :cool:

Those lime green numbers indicate the dose is too high. So glad you didn’t give insulin.

Are you monitoring her urine for the presence of ketones?

Is she eating well?




I didn't know yet about monitoring for ketones. I've done a bit of searching, but cannot seem to find the right link(s) on how to collect urine from a cat to test for ketones. If you have advice/a link it would be appreciated! Also, do the human strips work for cats?

Yes, Miss LunaMae is eating well, and even came out today to ask for food (a first!) She gobbled up her dinner!!!!! Yay!!! (high protein, low carb - first time I didn't need to assist her in days!) She also had her oral antibiotic. Her blood glucose was up to 357 today, then within two hours of having 0.5 Lantus, she registered 168. I will do the "2 hour record dance" twice more tonight.
 
she took a dive over the weekend,
In what way?

He also agrees that during her check up there were no signs in her tests, which is unusual.
No signs of what?? What was she tested for?
She is on a very high protein diet now, only wet food.
This can be a huge game changer.
Do I just keep poking her poor ears multiple times a day?
Yes, there is a lot going on with your kitty right now and it would be prudent to monotor as closely as possible
I didn't know yet about monitoring for ketones. I've done a bit of searching, but cannot seem to find the right link(s) on how to collect urine from a cat to test for ketones. If you have advice/a link it would be appreciated! Also, do the human strips work for cats?
Yes, strips for humans work for kitties. They are available at most pharmacies.
How you collect urine for testing depends on Miss Luna. Try the easiest method first-try and get the test strip into the urine stream. That worked for my boy. If that doesn't work post for other suggestions- there are quite a few tricks to try.
Yes, Miss LunaMae is eating well, and even came out today to ask for food (a first!) She gobbled up her dinner!!!!! Yay!!! (high protein, low carb - first time I didn't need to assist her in days!) She also had her oral antibiotic.
That's great news!
Her blood glucose was up to 357 today, then within two hours of having 0.5 Lantus, she registered 168.
I'm concerned that 0.5u may be too much - keep an eye on this cycle. As I mentioned above, changing to a proper high protein all wet diet can be a huge game changer.


Regarding monitoring for ketones in the urine, high BG, an active infection and not eating can invite the formation of ketones. If ketones are present, the first order of business is to do all possible to derail their formation. Once you have a few random ketone tests under your belt we can better advise you as to what path to follow.

In any case you will need to find a consistent dose you can safely give every 12 hours. Changing doses each cycle can cause wonky numbers and muddy the picture. Lantus dosing is based on the nadir value (how low a dose takes your kittys BG during the cycle) rather than the AMPS or PMPS value. This is because Lantus is slow to onset - generally 2-3 hours, so along with determining nadir figuring out when onset takes place for your kitty is very important.
 
In what way?


No signs of what?? What was she tested for?

She had her annual checkup, which included blood tests for older kitties. There were no signs of diabetes - I had mentioned that she was drinking more water, and they looked for diabetes, but the numbers did not indicate it.



I'm concerned that 0.5u may be too much - keep an eye on this cycle. As I mentioned above, changing to a proper high protein all wet diet can be a huge game changer.



In any case you will need to find a consistent dose you can safely give every 12 hours. Changing doses each cycle can cause wonky numbers and muddy the picture. Lantus dosing is based on the nadir value (how low a dose takes your kittys BG during the cycle) rather than the AMPS or PMPS value. This is because Lantus is slow to onset - generally 2-3 hours, so along with determining nadir figuring out when onset takes place for your kitty is very important.

I'm a little confused by the acronyms. I understand that Lantus is slow to onset - what I would love to be able to do based on LunaMae's numbers is give her 0.25 of a dose, but it is so very hard measuring even just 0.5 of a dose!

I just tested her again, and it is so worrisome! She ate well at dinner, when I gave her the 0.5 dose. She had not had any other insulin today, because of her low numbers this morning.

She started at 357, when she was also eating her dinner (she ate a full amount, on her own - the first time I didn't have to help her!)
2 hours later she was at 168
2 hours later than that she was at 37!!! - I brought out "second dinners" - a delicious meal, and she is eating voraciously.
1 hour past that (5 hours after the 0.5 insulin) she was back up to 103. Whew.
 
I'm a little confused by the acronyms
Here you will find our glossary
The sooner you become familiar with it the better.
She started at 357, when she was also eating her dinner (she ate a full amount, on her own - the first time I didn't have to help her!)
2 hours later she was at 168
2 hours later than that she was at 37!!! - I brought out "second dinners" - a delicious meal, and she is eating voraciously.
1 hour past that (5 hours after the 0.5 insulin) she was back up to 103. Whew.
I'll restate this in the common language used here:

PMPS =357
PM+2 =168
PM+4 = 37 :eek:
PM+5 = 103

One of the many time honored maxims here is:
"Better a day too high than an hour too low"

That 37 indicates 0.5u is too much insulin and a reduction is in order. Next dose to try is 0.25u.

Its important to know that those numbers under 50 trigger a protective over-reaction in your kittys body in the form of counter-regulatory hormones released in to the bloodstream to bring BG back up. We refer to this as a ''bounce" as it is usually quite high. A bounce can take up to 72 hours to clear the system. So you may see a red number for AMPS. If so resist the temptation to shoot more than 0.25u. The bounce will eventually clear. You just have to wait it out.


what I would love to be able to do based on LunaMae's numbers is give her 0.25 of a dose, but it is so very hard measuring even just 0.5 of a dose!
.Below is a picture to help you draw a 0.25u dose (click to expand)
0.25u.jpg

Grab a magnifying glass if needed and practice with some tea or other colored liquid. When you think you have it, save the syringe to use as a guide to compare against when you draw actual insulin. Don't worry about whether it is a 100% accurate 0.25u; it will be your 0.25u however do focus on being consistent with
each 0.25u dose.

Please start a new thread for 6/28 and start your thread with the date, kitty's name, and AMPS BG number. use one thread for all your comments and questions you have that day since this forum is so busy. This will keep all pertaining to your cat together everyday.

What time zone are you in and what times do you shoot?
 
That 37 indicates 0.5u is too much insulin and a reduction is in order. Next dose to try is 0.25u.
Good morning. I see you gave .5u again this morning and Luna is already dropping. Please keep checking her BG and have some high carb/ karo/ honey ready should she drop below 68 on your AT meter it's time to intervene.

So you may see a red number for AMPS. If so resist the temptation to shoot more than 0.25u.
Numbers below 68 on an AT meter warrant a reduction. Numbers in the 30's on an AT meter are way too low. Please reduce her dose at next shot time.
 
Yikes! See Luna hit 30’s again. Hopefully you’ve give high carb wet food and karo. I don’t think she’ll need insulin much longer but certainly needs less. I’d skip the PM shot today even if she’s high and try .25 tomorrow morning.
 
Yikes! See Luna hit 30’s again. Hopefully you’ve give high carb wet food and karo. I don’t think she’ll need insulin much longer but certainly needs less. I’d skip the PM shot today even if she’s high and try .25 tomorrow morning.
Thanks for the support! I skipped her dose last night, and her BG was 222. This morning it was 244. I'm trying a 1/4th dose. Yikes, that is hard to "see". I practiced yesterday with tea, but I think I need to get different types of needles.
 
Ugh, see she’s at it again. I might try skipping insulin for a day or two. She’ll likely be high at PM because of bouncing but do wonder if you don’t give insulin for a day or two if she’ll go to normal numbers on her own and be diet controlled. Let me tag a few to take a look. @Jill & Alex (GA) and @Sandy and Black Kitty or @Wendy&Neko
Thanks for posting again! I just posted a new post for today, as Sandy & Black Kitty suggested. I am leaning towards no dose tonight, but her dr. did want me to dose this morning and keep track for the day. Her poor ears!
 
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