Stabilizing our Batman

Alfred Spitzer

Alfred Spitzer

Member
Our vet suggested we only give our Batman (12 years old) two 3 oz low carb meals a day, with one unit insulin at each meal time. The problem is that Batman’s BG can either go up or usually goes down, way down as low as 58 using a human glucose meter (CVS Health). He has gone down to the mid fifty’s within two hours of eating. When we see this, we give him more food for fear he will crash completely. Are we doing the wrong thing by giving him additional food when his numbers go low? Please any suggestions would be appreciated.
 
Alfred Spitzer said:
Our vet suggested we only give our Batman (12 years old) two 3 oz low carb meals a day, with one unit insulin at each meal time. The problem is that Batman’s BG can either go up or usually goes down, way down as low as 58 using a human glucose meter (CVS Health). He has gone down to the mid fifty’s within two hours of eating. When we see this, we give him more food for fear he will crash completely. Are we doing the wrong thing by giving him additional food when his numbers go low? Please any suggestions would be appreciated.
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No you're doing the right thing feeding when he drops too low. I think he's likely on too high a dose if you're having this problem frequently. Could you tell us more about your kitty?
  • when he was diagnosed
  • what your testing routine is
  • how the 1 unit dose was decided on (it's a typical starting dose but some kitties need less).
Many cats do better with several small meals a day even though vets usually tell you to feed only twice a day. Most cats feel more satisfied with more meals and it can help to stabilize blood glucose.
 
Wow! That's a pretty crazy drop. No feeding is ABSOLUTELY the right thing to do in those situations. The questions Kris has above will help us to help you figure out what's going on there. It's possible your kitty just needs a lower dose.
 
Batman was diagnosed Oct 29 after having severe constipation and having his urine tested for glucose, which came back high. Batman weighs 14.2 pounds and our vet started him off with two units twice a day. It was immediately apparent that, that was too much insulin and cut it down to one unit twice a day. We test him in the morning(fasting for six hours) and about two hours after eating. We discovered that Batman is metabolizing the insulin in from between 4-6 hours. I am self employed, and have been able to test him hourly for a few days. As an example Friday 5:27am he BG tested at 278 (fasting), ate 3.25oz wet food, was given 1 unit insulin, ate another 1oz by 7am, and BG tested at 10:25am with a BG of 56.
 
Djamila said:
Here is your spreadsheet:

https://docs.google.com/spreadsheets/d/1zUp11sLztAWiM48ZLUk2OazQfcLYwCYth02a8fo6cos/edit?usp=sharing

The link you shared appears to only have AMPS and PMPS numbers. You said you've done a lot more testing, and it's those mid-cycle numbers that we really need to see. If you click on this link you can enter the other data you have.

Can you also check and see if what I entered is how I should be reading the data on the PDF?
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What you entered is correct. Do you have a legend for this spreadsheet? What do the +numbers mean
 
The + numbers are the number of hours since the shot was given. Since we all live in different time zones, we tell time by the hours since the shot instead of the time on the clock. :)

So if you gave the shot at 6:30am (for example), then 8:30am would be +2. 12:30pm would be +6.

Here is the link that explains it all: http://www.felinediabetes.com/FDMB/threads/understanding-the-spreadsheet-grid.156606/

You can also click on some of our spreadsheets (the blue text in our signatures) to get a sense of how to format things that get tricky. I like to keep my spreadsheet clean so I can see patterns and trends without distractions. So I add extra information in notes (Right click on a cell and choose "insert note" from the drop down menu that appears). Other people like to type right into a cell so that their notes are always visible. It's up to you how you prefer to do it.
 
Thank you. Today is Tuesday Nov 27,2018, last night 7:15pm at dinner Batman’s BG was 90, he ate 3oz of wet food. I did not give him his usual 1 unit. We checked him every 1-1/2 hours, his BG readings were 95,98,101.
This morning 5:24am his BG was 102. We fed him at 6:45am 2-7/8 oz wet food. Still no insulin shots. Now at 9:53am his BG is still 102.

Does this mean he is stabilized?
 
Alfred Spitzer said:
Thank you. Today is Tuesday Nov 27,2018, last night 7:15pm at dinner Batman’s BG was 90, he ate 3oz of wet food. I did not give him his usual 1 unit. We checked him every 1-1/2 hours, his BG readings were 95,98,101.
This morning 5:24am his BG was 102. We fed him at 6:45am 2-7/8 oz wet food. Still no insulin shots. Now at 9:53am his BG is still 102.

Does this mean he is stabilized?
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This means he's doing well and *might* be heading toward remission. People who have eased their kitties into remission would say he probably needs a tiny dose of insulin to nudge him down into the 50 to 80 range (as measured on a human meter). So far you've only given 1 unit. There are a number of fractions below that to try from 0.75 u all the way down to 0.1 u (basically a hair over the zero marks).

We look at patterns on the spreadsheet used here to decide on the dosing needed and when it's reasonable to stop insulin for what's called an "off the juice" trial.
 
Kris & Teasel said:
This means he's doing well and *might* be heading toward remission. People who have eased their kitties into remission would say he probably needs a tiny dose of insulin to nudge him down into the 50 to 80 range (as measured on a human meter). So far you've only given 1 unit. There are a number of fractions below that to try from 0.75 u all the way down to 0.1 u (basically a hair over the zero marks).

We look at patterns on the spreadsheet used here to decide on the dosing needed and when it's reasonable to stop insulin for what's called an "off the juice" trial.
Click to expand...
These are the last curves we did.

Today


Nov. 26


Nov. 25



Nov.24
 

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Good numbers but I don't think he's quite there yet. It's hard to know what to suggest. I think in your position I might try 0.25 unit to see how he does. You'd have to eyeball that. The higher numbers on your curves indicate that his pancreas still can't keep his BG within normal range (50 - 80).
 
Kris & Teasel said:
Good numbers but I don't think he's quite there yet. It's hard to know what to suggest. I think in your position I might try 0.25 unit to see how he does. You'd have to eyeball that. The higher numbers on your curves indicate that his pancreas still can't keep his BG within normal range (50 - 80).
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You are suggesting 50-80, but our vet says 80-120 on a human glucose monitor. How do I know what to follow ( I’m not trying to pressure anyone here, I just want to understand)
 
Alfred Spitzer said:
You are suggesting 50-80, but our vet says 80-120 on a human glucose monitor. How do I know what to follow ( I’m not trying to pressure anyone here, I just want to understand)
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The range I cited is normal range. Vets likely aim for a slightly higher range and are more likely to stop insulin "cold turkey" whereas the methodology here is to gently "ease" off insulin. You could try skipping insulin for today and tomorrow to see how he does.

Interesting thread for you: http://www.felinediabetes.com/FDMB/threads/protocol-for-going-off-insulin.206403/

More from elsewhere on FDMB - OTJ TRIALS:

Prior to starting an OTJ trial, one wants to see kitty mostly in the range of a healthy cat (50 - 80 mg/dL), but under 100 overall... with only occasional readings in the 100 - 120 range.

Remission is achieved when kitty can go 14 days without insulin while maintaining normal blood glucose values under 100 overall. Most will stay in the 50 - 80mg/dL range. Although, some will occasionally experience BG numbers up to 120 mg/dL.
 
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