Repost: Severe drop in blood numbers after 1.5 weeks

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ekoren

Member Since 2011
Hello Lantus group,

I'm reposting from the main board in case there are Lantus experts who might know more about this issue.

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I am writing to draw on the collective wisdom here. I'm trying to see if anyone else here has experience with severe drop in blood glucose after 1.5 weeks on insulin, and get your perspective on next steps to discuss with my vet.

Brief review: I have 2 brother cats, Sander and Tree age 10.5 years, diagnosed diabetic in January 2010. I was about to leave the state for 6 weeks when they were diagnosed, and, in coordination with my vet, decided to just change their diet to low-carb canned food until I returned from my trip. When I returned, 1.5 weeks ago, their blood glucose levels were still relatively high, so we put them both on insulin. They are now on 2.0 units of Lantus twice a day. (Sander, who weighs more, started at 2.7 units twice a day, but he had a hypo on day 2, so we lowered his dose to 2.0.). This morning, their twelfth day since starting insulin, I tested blood glucose levels at 48 for Sander and 59 for Tree. I called the vet, and we agreed that I would not give them insulin this morning, and I'd check Blood glucose tonight and only give insulin if it had risen above 180. My vet was surprised at the low numbers. She wasn't sure what the next steps would be but surmised that maybe they are not true diabetics, and that we'll have to check blood numbers over the next day or two and see where we are.

My questions to you all are: Have you seen this before? If so, what is the best course to take next? What are my options: lowering insulin dose or frequency, eliminating insulin? Is it possible that 1.5 weeks of insulin was all the cats needed?

My charts are linked in my signature. Please note, that my cats (and, thus, I) HATE doing blood tests, and that I decided, in coordination with the vet and to preserve my sanity, that I would commit to testing once a week and more when necessary. I understand that it would be better to test regularly, but it's just not what I can do.

Thanks for all your help,

Elisa
 
i'll bump you up for someone else to comment on your dosage question - but i'll also add that there aren't any cats or people that like doing blood testing at the beginning, but all of us get used to it. i felt the same way as you - had to wrap my cat in a towel for the first 2 weeks to manage the testing, but we both got used to it and now it's not a big deal. we've been doing it for about 6 weeks now and instead of taking 1/2 hour for a test it takes less than a minute now.

when you're testing him once a week are you doing it, or taking him to the vet?

the thing i'd be really worried about is a blood glucose level of 49 is getting close to dangerous for the cat's survival. when my cat has dipped below 50 i've given him carbs to bring it up.

i know someone more expert will be along to help you.
 
Frankly, I don't see how testing only once a week is really going to help either of your cats. I don't know how it would be possible to adjust dosing with only that one test. I know it sucks to do at first, but they really DO get used to it, and so will you. The hardest part is keeping yourself calm about it--if you're stressed/anxious, then they can sense that and will become anxious too. And don't forget to give them lots of treats after a test, and give yourself a treat too!

It IS possible for a cat to only need insulin for a week or two, tho I don't think it's all that likely. I know I have seen cats on here that went OTJ in a week or two...but usually it's more like 4 weeks or more. It took us 6 weeks, and somewhere in the 2-3 month range is what I seem to remember happening more often when I was here frequently.

The fact that you've already had hypo or near hypo episodes speaks volumes to the initial dosing being too high. The normally prescribed protocol around here is to start at 1 unit (regardless of the cat's weight or BG readings), then gradually work your way up if/as needed. Some cats never need an increase. We started at 2U (per vet), and after 2 weeks Max's numbers stabilized, and then went down a crazy roller-coaster ride over the next 4 weeks. Normally dosage is decreased by .25U...we went down by .5U at a time, and sometimes had to decrease again within a day or two. It all depends on the cat. Some do it fast, others do it slow, but you'll never know if you aren't testing at least twice a day at shot times. Dosing for Lantus is done based on their lowest number during a shot cycle though, so even just testing at shot times isn't enough.
 
We are very data-oriented here. We need a great deal more information in order to provide input regarding dose and/or progress. Please read the starred, sticky notes at the top of the Board. In particular, please look at the Tight Regulation Protocol sticky.

My first thought is that your cats were started on far too high of a dose. Most cats here start on a dose in the 1.0u range. There is a formula for initial dose (initial dose = 0.25 x ideal weight in kilograms).

Further, Lantus dosing is based on the nadir, not on pre-shot blood glucose values. I am very concerned based on your not testing, these numbers, and having your cats on relatively high doses that you are risking hypoglycemia.
 
Elisa, I was also going to add that my cat was diagnosed Dec 4 and we did weekly testing at the vet's and 2x day shots of ProZinc insulin at home. On Jan 4 his BG was 158 at the vet's office and the vet declared him over the diabetes. We stopped the shots and checked back in on Jan 27, when his BG was 428.

He was never not diabetic, probably what we saw was just a particular BG reading on that particular day at that particular time. By itself, it was almost useless information.

I took him to the vet's at different times of the day - including within 2 hours after his morning shot. Now i know that testing at different times of day gives different information but it doesn't give you a good picture of what is overall happening with your cat, or what the lowest blood sugar is.

i don't want to hammer the point, but you are obviously devoted to your cats or you wouldn't be here. I could've written your post - really. i hear myself in all that you wrote. I hated doing it, my cat acted like a little wild thing at first, and i wanted anything except to be doing this. It's just that as i read and read on here, i realized that in fact, for my cat's best chances of survival, this is what i needed to do. Because I learned that giving them the same magic dose and continuing to feed the same food doesn't guarantee that the dose won't become too much and the cat won't go hypoglycemic. They respond differently from day to day, even without changing the insulin or diet. I didn't know that - I guess i thought it was like a neat math equation "punkin +3u insulin = good health." If i'd continued giving him insulin at home and testing him only once a week at the vet's and he'd gone hypoglycemic, i would've felt terrible.

Everyone here will help you with all kinds of ideas and suggestions to make it as easy as possible. Best wishes to you as you plow ahead and make your decisions! We all get it - it's not easy, but you'll get lots of help to make your kitters as healthy as possible.
 
Thanks, guys, for your detailed feedback and encouragement. It is very helpful to hear your experiences. I'll lower the insulin dose, and try and test more frequently to get the data I need to keep the cats healthy. I have to admit, though, that two cats freaking out over blood tests one after another is really enough to make a person want to hire a personal cat nurse (if only it were possible!).

Elisa
 
:lol: i hear ya, elise! i'm sure we'll see more of you - make yourself at home and poke around. welcome on board!

you might take a look at some of the spreadsheets to see how other cats react to their insulin.
 
I have to agree with Sienne. This is a data driven forum. Minimum of at least 4 checks a day and always a before bed check. You have no idea where your cat is going in between shots. Have you tried giving treats when you test? Do you have a spreadsheet to track the numbers. We arrived here on 10 units - vet prescribed. 28 months later through the guidance received here my kitty is OTJ (off insulin). You are in a great place here in LL but you need to provide information in order to receive opinions. It is difficult at first but you will master the testing and kitty will become agreeable to it. Good luck. Hope you post often and read condos.
 
I also hear ya on the testing Elise! Max was okay with it at first, and then his ears got sore, and he'd run. I took me a while to figure out where to test him (it worked better for us to always test in the same spot, with him sitting on the half-wall by my stairs--he gets fed there, so it is a 'good' place), how to tuck him under my arm, how to keep him calm when I had a screaming baby near by, or a rambunctious toddler pulling on my leg...or when I had to pull him out from under my bed to get a test before leaving for work just to make sure his numbers were going up by then and I wouldn't come home to a crashed kitty. When Max was diagnosed I had a 6mo baby and a 2.5yo toddler (and was working full-time)...it was probably just about the worst time for his diagnosis to come in. I know there are people here to think I'm awful because I did consider putting him down. At the time, life was already overwhelming--dealing with a diabetic cat was just a little too far beyond what I thought I could handle. But with all the help of the wonderful people here, we made it through--and so will you!

And really, don't forget to reward yourself for testing as much as you reward your cats! ;-) Had I not been nursing at the time, I'm pretty sure there would have been a lot more whiskey going down my throat. :lol: But chocolate worked almost as well, and we made it through!
 
Hey y'all,

Thanks again for your support. It's especially good to hear from you, julie220 and mindy and max, to know that it's always hard to test at first, and that there are always a ton of other things going on that make diabetes a pain in the you know what.

I lowered the cats doses down to 1.5 units last night, after skipping yesterday morning's shot. This morning, same situation: both cats are testing in the 40s. I'm going to skip this morning's dose, and try 1.0 tonight. Does that sound like the right approach?

FYI: I have read all the stickies on the Lantus page, and they are very helpful. But it's a lot of information at once! I hope that, soon enough, I'll be able to understand all of this so I can figure it all out myself.

Cheers,

Elisa
 
You really don't need to do this solo. Please consider posting regularly. We're happy to lend a hand so you can better understand the process because you're right -- it's an overwhelming amount of information to absorb.
 
ekoren said:
It's especially good to hear from you, julie220 and mindy and max, to know that it's always hard to test at first, and that there are always a ton of other things going on that make diabetes a pain in the you know what.
Click to expand...

I can't tell you how hard it was to test Bandit at first...he would fight and run and I would end up in tears thinking "If I can't test my cat he's going to die because I won't be able to tell if he's had too much insulin!!!"

I just had to get my technique down. I calmed down and resolved myself, bought a basket and fleece blankets, and bundled him up so he couldn't escape. I did the tests (it was hard to get enough blood at first) , and then gave him a freeze-dried salmon treat after each one. A little neosporin + pain relief on the spot I poked reduced his struggling, too.

After a few weeks, he resigned himself to the tests cause he knew he wasn't getting out of that basket 'til I was done. I can now do a test one-handed, regardless of where he's sitting, and he doesn't even flinch. Just runs to his basket or cat tree afterwards for a treat.

It gets sooo much easier! And the advice I got here was so valuable to us. I hope you do become a regular poster, because this is a great place if you need dosing advice, or to rant, or just someone to tell you that it will get easier.
 
i think Sienne's right on - there's no reason to struggle through it alone. i must've posted 50 times asking for more ideas on stabbing my poor pincushion's ears! but last week, I tested him while holding a phone and chatting with my sis-in-law. i've been hometesting since Feb 25th, i think. so . . . one month. give it a little longer and really, it does get easier.

Like Julia, i also steeled my resolve and decided punkin was going to have to endure it til i got it down. and he and i both did.

my guess is that everyone here probably went through that awful beginning part. now i'm kinda hooked on the testing because of the info it gives, and the poor guy is still getting poked a lot. The difference is that he now will purr through it.

go ahead and plan to post here every day. Then you are all set to ask for help when you need it and others can see what's going on and offer advice if you want.

hang in there!!!!!!
 
Elisa: just want to welcome you, Sander, and Tree to Lantus Land where you will get lots of help, information, and support. I agree with Julie wholeheartedly. Unless you are doing frequent testing and can see the patterns, it's difficult to really know where they are and what they are doing. Especially if they might be bouncy cats; there are times when my girl is in the 30s and if I'd only checked her then, I would have thought she did not need insulin. But she is bouncy like Julie's Punkin and Sienne's Gabby and many others so that by the next day, she might be in the high 200s.

I would update my subject line to "dose question" and ask about a good "re"starting dose instead of just arbitrarily taking them down by .5 unit. We typically recommend increases/decreases in .25u increments so you don't miss the fitting dose but seeing that they hit 40 today......it may be that some of our people more knowledgable about dosing might suggest that you "re-start" somewhere else or they might think the 1.0u is a good place to restart. At any rate, whichever they recommend to you, it's important to have consistency in shot time and to test, test, test.

As you test more, you'll get better at it...quicker. We often recommend newbies start with a little thicker gauge lancet (29) so you get a good draw the first time and then you go eventually go to a thinner one. The other thing is to put the neosporin for pain ointment on their ears...it will help with the soreness and will also help to bead the blood up for you. And lastly....alot of newbies come in trying to hit the vein...you don't want to hit the vein..you are aiming for the outside part of the ear.
 
i didn't realize for several weeks that i wasn't supposed to hit the vein, and honestly, sometimes that was the only way i thought i could get blood. if i tried several times and couldn't get enough, sometimes i hit the vein on purpose just to be done with it. with the lancet device i'm using (freestyle) you can't see exactly where you're going to hit. I suspect, however, that having hit the vein in his left ear a lot at the beginning, because i could get blood on that ear more easily, has resulted in some scar tissue forming there and now i can't easily get blood from the left ear at all.

so i've tried to make sure i'm not hitting the vein anymore, and i make certain to apply pressure for 30 sec or so afterwards so it doesn't bruise and hopefully, doesn't scar. i also think the neosporin cream with pain relief helps. i don't use it every time, but a couple of times a day.

oh yeah, and in case you don't know, to edit your subject line go to your first post of today, click edit, change it then click "save post" Changing the subject line will get more experienced eyes on your question.
 
Like the others have said - testing once a week, or even just once a day doesn't help you. I know poking them isn't fun (for either of you) but it really does get easier as it becomes routine. In the beginning it took me several tries to get blood, Kazi was squirming and wanting up and giving me the stink eye when I tried to give her insulin. These days? She runs to the bed where we always test and circles meowing...she knows BG testing means mealtime, snuggles or treats so she is all about it! ;-)

There are plenty of diabetic friendly treats out there to make the process more tolerable for your kitties. Mine especially likes boiled chicken breast or freeze dried sirloin steak.
 
The first weekend that Enana spent with me after being diagnosed, I cried the whole time I was so stressed out about testing her so many times (11 on Saturday...I dont remember Sunday). I thought I could not do that for the rest of Enana's life...here we are, two months later after she was diagnosed, and as everyone has told you here, and now me, things get easier for you and the cats. Hang on.
 
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