Second Day on Insulin

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miaomi

Member Since 2013
The first thing I'd like to say is that you must stop using the True/result meter if you still use it. Make a long store short, I got a True/Result from CVS and it gave me the way too low numbers. I have been used it for almost two month, our vet thought my cat was borderlined diabetes, and maybe have some other issue to deal with her illness. Without treatment I have changed her diet around. Last week she stopped eating for two days, we ran to emergency hospital; her tested presentation of being in a ketoacidotic crisis. She stayed in hospital for three days, the cost was very very expensive. I brought her home yesterday, and tested her using Relion confirm & prime Meter(just bought) also the True/Result. Her BG was 246 with Relion, and 152 with the True one. I should have read more on this forum.
Anyway, when my cat Mao got home, she struggled and straining to pee; I had to bring her back to recheck. I give her one pill of Clavamox (antibiotics) twice a day, she seems OK now.
Today is second day that I give her the insulin. I give her 1 unit twice a day. I have listed her BG numbers below including the ones she had in the hospital. After I gave her last evening shot, she had all the high numbers, I don't know if I fed her too much or what. This afternoon I tested her 7 hours after the morning shot, her BG was only 72, the number dropped from 449 to 72, how come? Then she ate, now by 7:20pm her BG was 310. I support to give her insulin by 8:00pm.
My other question is how many times a day should I feed her? She cries for food frequently. Thank you.

12/1/13 (in hospital)
8pm-369 1Unit Lantus
12am-274
4am-182

12/2/13 (in hospital)
8am-164 1Unit
12pm-74
4pm-38 ( fed food)
7pm-82
8pm-skipped shot,The Vet let me skip the 8pm shot, the Vet wasn't sure if Mao needs one unit a day, or one unit twice a day.
10:40pm-283 (back home)

12/3/13 (home)
8am-485 1Unit (ran to hospital for struggling pee)
3:20pm-246 (back home and gave her antibiotics)
7:10pm-378 (Mao ate few meals between 3:20pm-10pm)
8pm-400 1unit
11:45pm-474

12/4/13 (home)
3:15am-495
7:55am-449 1unit ( the vet decide to give her twice a day)
2:56pm-72 ( fed her, why the number dropped so low)
7:10pm-310
 
The reason Mao's numbers dropped to 72 may be that the insulin was working well. 72 is a good number, not too low and not high. Then due to the lower number that Mao's pancreas is not used to, she bounced back up in the 300's. I think the dose you have given Mao must be just about right if the nadir was 72 as that number is in normal territory. You will get more comfortable with the diabetes and all that it entails in time. Welcome to a great community. Ask any questions and someone with more knowledge than me will help you. Monitor your cat's blood sugar at home and you will see patterns emerging. Someone can help you create a spreadsheet to keep track (I am not technology savvy enough to help you or I would do it) of Mao's numbers. Best to you!
 
With Lantus, it's better to dose every 12 hours. Lantus is a depot insulin, and if you only dose once a day, the depot will be constantly draining and refilling. It would be better to find a dose that you could give to Mao twice a day. It's possible to give lower doses than in whole unit increments. There are 3/10 cc syringes available with 1/2 unit markings on the barrel. These make it easier to give doses of 0.5U or even 0.25u.

What size syringes are you using?
 
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}
- no shot limit 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 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 mg/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.
 
Thank you guys! I did created a spreadsheet but don't know how to attach it.
I use syringes 3/10ml.
I shot her 1unit two times a day. I'd like to know if I can feed her after the shot, she seems starving all the time, it's impassible to feed her only twice a day; she use to eat free even during the night; but I worry if I give her too much food she will have large numbers.
 
Many of us still free feed our sugar kitty. I do. My cat does much better with food than without and is currently OTJ and brings his numbers down with food. You do not have to feed only twice a day! Most cats do best when they eat small meals frequently.
 
You don't attach the spreadsheet; you give us the sharing link to it in Google Docs.
 
This post from over in the Tech Support forum, gives you the steps for putting the spreadsheet into your user profile, profile tab, edit signature. You want to go down to step B. Publishing your SS, aka Attaching to signature (directions by Squeem3) and follow those steps.

If you used the World version of the SS, just enter your data in the world tab and then us folks in the backwards US can click on the US tab and it will convert the numbers automatically to the format we are used to.

Of course you can feed more than twice a day. Don't understand why vets insist on this. I feed mine 4 times a day. If I did not have two civies that were absolute Hoovers, Eurekas, Dysons, Shop-vacs that inhale their food, ohmygod_smile I could free feed. The reason I meal feed is the food disappears too fast and the civies would gobble up everything in sight in a couple of minutes.

Please, go ahead and feed your kitty more often.
 
I am now confident to feed Mao whatever she wants to eat, I felt bad to see her cry. The SS was finally posted. Thanks!
 
She eats lot, seems hungry. She still has those high numbers even on 1unit insulin. I read about the Glucose Reference, and are those first numbers BG numbers? If so Mao's BG numbers are high.
 
miaomi said:
She eats lot, seems hungry. She still has those high numbers even on 1unit insulin. I read about the Glucose Reference, and are those first numbers BG numbers? If so Mao's BG numbers are high.
Click to expand...

She may need more insulin, but you want to adjust that by following the protocol for Lantus.


Yes, in the reference chart, the numbers are glucose in mg/dL then mmol/L, using human meters, and in mg/dL using an Alpha Track or other pet-specific meter.
 
Mao is on insulin for 6 days, the vet said it takes 7-10 days to see the real BG numbers, the vet didn't let me feed her between shots because the additional food may make her BG higher.
I don't feel safe for her numbers.
 
The STICKY: LANTUS & LEVEMIR - TIGHT REGULATION PROTOCOL can be found here, in the Lantus Tight Regulation Insulin Support Group forum.

Yes, insulin drops the BG numbers and food raises it up. On the other hand, you do not want Mao to not get enough food. Spreading out the food into mini-meals throughout the day, actually puts less stress on the pancreas to produce insulin. That is why we suggest feeding more than twice a day.

At the beginning, your cat will eat more, and need up to 50% more food. A cat can not properly process the food without the right amount of insulin, so is literally starving. It takes time to find the right amount and the right amount will change over time, sometimes needing an increase in the insulin dose, sometimes needing a decrease in the insulin dose.

Lantus dosing adjustments are based on the nadir, or lowest point in the cycle, not the pre-shot numbers. The pre-shots are important to make sure you do not shoot a number that is too low and to put the mid-cycle numbers into perspective.

Mao is getting some very low numbers at mid-cycle. I can see why you are scared. Mao has dramatic swings in BG numbers, so may be dropping really low.

When are you home to get another test?
 
Were you able to get the test in? If anything, I think Mao might need a lower dose. Anything under 50 and we usually decrease the dose by .25u. With the 38 you got a couple of days ago, her dose should have been dropped to .75u BID. These higher numbers are very likely from bouncing. Try to also get another test in at around 1-3 today (+5-+7 hours after the shot).
 
Really high! It was 490. Mao starts drinking more often. I just wrote to the vet, she said it's nothing to worry about since she just started insulin for 6 days. The vet doesn't want me to test her said she has anemic. She wanted me to stop testing her for a few days.
 
I wonder if she dropped lower than 72 on the 4th which triggered a bounce. However the lantus is still settling in. I would reduce the dose to 0.75 -especially if you can't test her - better safe than sorry.

Also please tell me you are testing her pee for ketones - it means you will catch the issue early if it happens again. Anything over trace is a vet visit. We recommend you test pee for ketones twice a week or whenever the cat is over 350. You can get the pee strips in most pharmacies and we have tips to tell you how to catch the urine.

Wendy

PS i know how you feel about the true meter - I had exactly the same issue with the freestyle lite.
 
miaomi said:
The vet doesn't want me to test her said she has anemic. She wanted me to stop testing her for a few days.
Click to expand...
Why? Testing doesn't affect anemia. If anything, the better regulated Mao becomes, the more likely the anemia will clear up. You won't be able to easily get Mao quickly regulated without testing.
 
If I'm not mistaken, anemia isn't the amount of blood but the quality of blood. When my grandma was hospitalized, one of the things she ended up with was anemia. They told us specifically that she needed blood transfusions not because she was low on blood but because her blood didn't have enough hemoglobin. (This was because my aunt asked why they kept taking blood from her for blood tests if they were trying to put it back in her through transfusions.

And I'm fairly certain that human diabetics with anemia still test their blood because how else will they know whether to give insulin or not and how much to give.
 
Yes, but the body quickly makes up for lost total liquid volume but not the cells in the blood. Thus, the % of red blood cells will be reduced (more anemia) after the liquid volume is restored.
 
Thank you for all your suggestions and concerns. The vet did said that we need to let Mao's body regenerate red blood cell. She will probably let me test her again next Wednesday. I think they took much blood from her when she's in the hospital. Without testing her I am sure I will watch her closely. I am going to get Ketone strips.
 
While you're reducing the amount of testing per vet recommendations, see my signature link Secondary Monitoring Tools for alternative assessments. While not as precise as blood glucose monitoring, they can be helpful.

In particular, do the urine testing for ketones and glucose using KetoDiaStix. Urine tests only tell you what has been happening since the previous void.
- glucose in the urine since the previous void generally means not enough insulin.
- ketones in the urine since the previous void may mean not enough insulin, PLUS possible infection and/or lack of food consumption. Anything more than a trace is a medical emergency, so it calls fro the blood glucose test asap and contacting your vet.
 
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