? Safer not to treat? BG 210 - 265 without insulin, history of hypo

My kitty, Pants, was recently diagnosed and we had three hypo incidents in a week, including two that occurred at .5 units of Lantus every 12 hours. She's now totally off insulin and has a BG between 210 - 265. I know most people target lower numbers, but I'm wondering if running the risk of hypo to try to get the numbers down is worth it.

I work full time and cannot monitor her as closely as I would like and I'm very scared that she will crash again and die while I'm at work. We've had an awful lot of bad advice from vets so far and while we've got a new vet who seems better, I'd really value opinions of folks who have weighed similar choices or dealt with managing a cat who seems oversensitive to insulin.

Here's her history (sorry this is long):

She was diagnosed on June 27 and her BG at the vet was 300. We switched from dry to low-carb canned food before starting on 2 units of Lantus every 12 hours on July 1. The vet didn't get a baseline BG after the food change and told me not to home test. On July 4, Pants had a very scary hypo incident and her BG was so low the emergency vet couldn't get a reading. She was hospitalized for two days, and came home with her BG at 476 on July 6. Given what I now know, that was clearly bouncing and/or stress.

After that, I used the emergency vet for primary care while waiting to get into a new primary care vet. The emergency vet dropped the dose to .5 every 12 hours, and got me started started testing. I saw drops of 200+ points at home, but the emergency vet said hypo was virtually impossible at this dose.

On July 10, the emergency vet told me to shoot when Pants's pre-shot BG was 270, which led to a BG of 60 at +2. We don't have much history, but that was likely not the peak, so they had me put Karo on her gums and rush her in again. She bottomed out at 50 and then started going back up, but they held her to monitor her.

The emergency vet was sure I'd messed up the dose, since half a unit of Lantus shouldn't produce drops of 200+. But the same "impossible" thing happened to them while she was hospitalized -- Pants fell from 300 to 30 from a .5 shot on July 11.

On July 12, I took Pants directly from the animal hospital to our first appointment with the new vet, who said we should start over and see what Pants's real BG numbers were on low carb wet food without insulin. After two days at home, Pants settled in to numbers consistently between 210 and 265 for the past couple of days.

We haven't been back in for the follow up yet, so I don't know what the new vet will advise, but I'm very nervous about giving her any amount of insulin if I'm not home 24/7 and testing around the clock. Obviously, I can't do that, at least not for long enough to be assured she won't crash again.

Thoughts?

 

It was wise to try her off all insulin to see how she'd do. It looks as though she needs a tiny dose of insulin. There are many people who have to give less than 0.5 u of Lantus. Doses of 0.25 u and even 0.1 u are seen here. I suggest you post on the Lantus forum and ask for advice about your situation and tips on micro dosing.

 

I'm not sure she'd continue on Lantus. The emergency vet seemed to think she should be switched to a different insulin if she was going to continue receiving insulin at all because she's too sensitive to Lantus. The emergency vet also also thought .5 was the minimum dose of Lantus I could give and said it's impossible to measure less accurately.

Then again, the emergency vet thought a lot of silly things and I don't know yet what the new primary care vet thinks.

 

It's possible that one of the non-depot insulins might be better for her. ProZinc is a good one. It's what is called a U40 insulin and is less concentrated than Lantus so you measure out larger volumes of insulin liquid. Without explaining the details here, you can use U100 syringes (like those for Lantus) to dose the ProZinc and then you can easily measure tiny doses like 0.2 u and 0.4 u as well as eyeball 0.1 u and 0.3 u fairly easily.

 

How often do you feed her?
Have you tried testing, feeding, and testing again 2 hours later, without insulin? Sometimes small meals throughout the day will help simulate the pancreas to keep the BG in better numbers when off insulin.
Do you ever get lower than 200s?
I agree with what Kris said. Prozinc could be better and with the conversion chart you can measure very small doses.

 

I also like the idea of trying Prozinc, should she need insulin. Could you update her SS too? Sorry, we ask questions on top of questions sometimes . I'm also interested in the answers to previous questions

 

I'm feeding her twice a day, but not pulling the food until about 2 hours before the next meal is due. Now that she's not ravenous from very high/very low BGs, she's gone back to grazing. She eats most of the meal before I pull it.

As to the spreadsheet, that's all I've got on insulin. I was told not to home test by the first vet, so I have no data from the 4 days she was on 2 units of Lantus, and then she only made it 4 days on 1/2 unit. I stopped entering the numbers when I stopped using insulin -- it doesn't seem to make sense on the spreadsheet, since it's just times of day, not hours after shots. And there's no curve, just noise between 210- 265.

 

Might still allow us to see something you're not, is all . Since you're still taking up food 2 hours before next meal, you can use her meal times for what would be AMPS or PMPS and enter tests accordingly for +hours after meal.

 

It's updated now. I added a time row instead of the +hours, I couldn't keep it straight otherwise. 8PM/AM is mealtime, except for Wednesday. I gave her dinner at 7, since she got breakfast at the vet at 6AM. In addition to Wednesday/Thursday likely reflecting bouncing and stress, they fed DM kibbles at the emergency vet because she refuses to eat DM or wet MD. (She gets wet Spot's Pate Chicken at home, but they won't feed my food there.)

The only time she's been below 200 off insulin was a single instance of 195 before dinner Thursday.

She seems to feel really good off insulin, despite the numbers. She's playing more than she has been recently. And she's peeing a lot less. I hadn't realized how much more than normal she was peeing before -- it must have climbed very gradually.

 

Pants is beautiful.
I hope you can get it figured out. I would ask the vet about trying a different insulin. See what they have to say.

 

Thanks!

 

So the vet says no insulin, switch her to Hill's M/D or Purina D/M. Which she won't eat, or at least, wouldn't eat at the emergency vet once she realized a hunger strike would get her kibbles. Also, the Hill's is three times the carbs of what I'm feeding now, so that seems like an obvious no go. The Purina is significantly higher protein and lower fat than the Spot's Pate, so maybe that would help if she'd actually eat it?

 

As long as it's under 10% carbs, you can feed her anything she'll eat!!

I disagree with your vet....her numbers are still running a little too high and possibly above renal threshold which is straining her kidneys. I think it's worth trying a smaller dose like .25 or .1 and seeing how she does

 

I don't like leaving her at these numbers, but I'm very uncomfortable with continuing to try insulin at this point, and I'm particularly reluctant to do so against the advice of a vet and without any vet support for getting it right. I don't trust that I can accurately microdose, especially since I'm so new at this. I'm also not sure a tiny dose wouldn't put her back in the hospital or kill her, even if I can get it right. It took several days for the hypo to develop and if I hadn't been home to catch it both times, she'd likely be dead. After the first episode, I barely slept and kept skipping out of work to check on her. I just can't do that for days or weeks at a time.

And we've had a couple of outlier numbers (195, 187) that particularly worry me about putting her back on insulin -- what if I'd dosed her a few hours before she would have hit those numbers naturally? We're also only on Day 5 of wet food, no insulin, so there may yet be at least a little bit more of a downward trend from diet alone. She was 187 - 249 today.

She seems to be doing really well off the insulin in terms of other indicators. Her energy is up, she's climbing better and playing more, and she's peeing a lot less. Her appetite is normal -- she's eating consistently, but is not ravenous. It's in part because of these signs that the vet doesn't think she's at/above her renal threshold.

There's no risk free path here. And for now, no insulin is the risk I'm more comfortable with.