Stalling- please help. Djoko's uncontrolled diabetes

Hello,

I am joining this forum because I am exhausted and desperate. I am putting all my heart into saving my diabetic cat with no great results so far. I truly need your help.


**


My cat Djoko (male, 13 yrs old , around 4k) has been diagnosed with DB in last September (high values (27 – 35 mmol/l). At the time, my mother was taking care of him in another city. He started to melt and was urinating a lot. It would have been better to go to the vet before given his symptoms but no point in blaming her. Prior to insulin, we tried to adjust his BG by changing his diet (was eating treats and anything he wanted basically while at my mother’s) and oral medication without success. He started eating M/D canned food and M/D dry food in November. Please note that it took everything for eat one canned food per day. In fact, feeding him one can per day was considered a success and although dry food is not good for his health, we needed to feed him with some to ensure he eats enough before shots. I have recently switched his diet as it will be explained later.


On January 18, I brought him to my house because my mother did not want to give him insulin shots and I wanted to save him. The move and transportation (3 hours in a snowstorm) did not go well. Djoko got very sick (could not move and vomiting) and got hospitalized for 24 hours to get rehydrated and receive other treatments. The diagnosis was a possible pancreatitis. I felt very bad because I had asked the vet prior to bringing him with me for recommendation and she said it would be fine.


history

I started giving Djoko Pro-Zinc insulin on January 17 (0.5U x2). After his hospitalisation, on January 20th, the vet advised to increase his dose to 1 U. We performed a BG curve on February 1 (he had a fare-up of pancreatitis again between the move and this BG curve so could not give him consistent treatment while vomiting, etc.).

SEE ATTACHMENT.


Note that the glucometer was calibrated to ensure reliable results.


Given these results, the vet recommended to increase the dose to 2U which we did. After 24 hours, the cat vomited bile. I called the vet and asked whether I should give him the shot. They said yes as long as he has eaten. I did give him the shot. Next day, 48 hours after starting to give him 2U, he vomited twice and I noticed him trembling. I was not comfortable knowing that hypoglycemia was a possible consequence of giving him insulin so I tested him. He was at 3.2. I retested him to make sure this result was adequate. He was at 3.1. I gave him maple syrup but now I know it would have been better just to feed him. I brought him to the vet as I was panicked and they wanted to hospitalize him again (3rd time in 3 weeks $$$). I said no because I felt I was able to monitor him. No one told us about the somogi effect. He did not receive insulin when he was at 3.1 of course, but we gave him his 2U dose at night because he was higher than The following day we found him at 1.9 at 4PM without any symptoms. It was a random test to ensure his values were fine. I started to be very paranoid about hypoglycemia after this 2-day episode. I also did not understand his reaction to 2U given his high values.


After that, we decreased his dose to 1U and he was still high. On February 13, Djoko got sick again (diarrhea) and seemed in pain (intense meowing). I rushed him to the vet. I was so scared of keto but he tested negative. They switched his insulin to Glargine (Lantus). They wanted to start him with 2U but I was still concerned about the hypo episode and we agreed to start with 1.5U. We also started giving him B12 (weekly injection).After a week on new insulin, we performed a BG curve (on th 7th day of new dosage).

SEE ATTACH.

We were unable to get the last value. Djoko could not stand being poked again and we knew that with these results, the vet would suggest increasing his dose to 2U. I did not share the values with the vet as the last result was missing and I was also thinking that it may have been premature to perform the BG curve that quick. The reason I did so is because I was scared he would develop Keto. I asked another vet (in my family) about his values and she said we should increase the dose to 2U. I did not run this information by my current vet but knew she would agree because giving him 2U was their first recommendation. It seems also in accordance with scientific literature: more than 20mmol/l – start at 2U for glargine. I told her what happened aftwerwards.


After giving him his firs 2U, I tested him three hours later to know how his body was reacting. He was at 25 mmol/l so felt he would not go into hypo. The following morning, I gave him his shot without doing a blood test. I tested him 15 minutes after the shot and he was at 10mmol/l. I panicked because I know his tendency to go very low. On that note, I need to inform you that my vet believes I am over testing the cat. From my perspective, his values are all over the place and it is the only way to understand what is going on and if he can indeed receive insulin (his poor ears though).


After realizing I had made a mistake, I started to feed him a lot (dry food) to counteract the effect of insulin. I did even put some maple syrup on his gums. It may have been better to not do anything and see how his body was reacting but did not know what to do within the moment. Please see his values from that day and following days in the chart below. You will also note that we performed a BG curve during the night of Feb 29 – March 1 as we were wondering what was going on due to too many variations. The vet (at emergency and not usual vet) recommended to decrease the dose to 1U (I still question this advice).

SEE ATTACH.


On Monday March 2, I had to switch his food because he did not want to eat canned m/d anymore. He is still addicted to dry food but decided to stop feeding him with dry food to increase his chance. I went to buy him quality food which has less than 10% carbs. I fed him the same amount of calories as recommended but with another type of can (240 per day). I know consistency matters so as of today, I am only feeding him with D/M dietetic in sauce which is supposed to have less than 10% in carbs as well. I give him maximum 4-5 dry food to reward him after his blood tests.


I am very sad and do not understand what is going on. He seems off this week. He has not vomited (knock on wood) but I can tell by his behaviour that his blood level is high. I am trying to understand the results, but I obviously don’t. Is it because of the possible pancreatitis? Because I switched his food? It seems like his pancreas has been completely off on March 4. On Glargine, we have never had results in the 30s at 1.5U. Insulin is refrigerated and fairly new.


On one hand, I am concerned with hypo, on the other hand, I am terrified about Keto. His results vary a lot. Please see the day he went from 27.1 to 5.7 without going back up at his time of shot.


I apologize for the length of this text and mistakes (first language is French). I hope someone will be able to shed some light so that I can help Djoko. It is painful to see him that way without being able to help him.


Thanks

Marj

 

Are you a member of the French language feline diabetes facebook group?

Diabète félin: apprendre à gérer son chat diabétique

 

Welcome. Waving from Ontario. Your written English is excellent and you are doing a great job looking after Djoko.
Given the maple syrup reference, I'm assuming you are Quebecois. We have a few French-Canadians here.
Tagging @Ti-Mousse and @Sonia & Leo

It would help tremendously if you could set up a spreadsheet. Instructions and basic feline diabetes information is here:
http://www.felinediabetes.com/FDMB/threads/new-how-you-can-help-us-help-you.216696/

Feline diabetes in a marathon, not a sprint. Unlike Prozinc which is an in-and-out insulin, Lantus needs time to develop a depot. More information on Lantus can be found in the yellow stickies at the top of the Lantus forum.
http://www.felinediabetes.com/FDMB/forums/lantus-basaglar-glargine-and-levemir-detemir.9/

Again, you are doing a great job so far. And no, you are not "overtesting." That is how you keep your little one safe. I'm sure more experienced members will pop by in the morning to offer help. You have come to the right place. We do like to help.

 

It will indeed be very useful if you could set up that spreadsheet. The biggest reason is that members here can more easily see patterns in the format that we are used to, and that will help you help your kitty more than anything.

I understand the worry and the frustration, especially with the issues you've has so far. Take a look at the link in my signature that says Billy's spreadsheet. Look at the first 10 days and see how crazy all over the place the numbers are. It's all part of it. It takes time for a cat to get more regulated. Time, knowledge, and good advice, which you will get here. And look how often I tested, once I knew I needed to. Testing is the only way to keep your baby safe.

Take a deep breath, you are taking great care of your baby and the more you learn here, the better off you will be. Start out reading the sticky posts at the top of Health Links/ FAQs as well as the stickies at the top of the Lantus section. It will help, I promise. Do get your spreadsheet set up and your signature when you can.

 

Bienvenue sur le Forum, Marj!
Vous faites un travail extraordinaire avec Djoko ! Vous êtes au bon endroit pour avoir tous les conseils et profiter de l'expertise des membres qui sont extrêmement dévoués. Je dois cependant quitter car Ti-Mousse a un rendez-vous très bientôt chez le vétérinaire pour des tests importants (acro et IAA)! Entretemps comme on l'a mentionné plus haut, si vous pouvez faire votre SS c'est notre outil pour analyser les données. De plus, il serait bien de faire votre "signature"!
À plus tard! Bonne journée, vous n'êtes plus toute seule !

 

Its a bit of a learning curve but you have found the best site to help your Dkojo! Theres a wealth of info here and floks that can help you decipher it! WELCOME TO FBMD!

 

Bonjour Marj et Djoko, je voulais également vous souhaiter la bienvenue au forum FDMB.

Comme d’autres ont mentionné, il y a plein de gens ici sur le forum qui seront heureux de vous aider avec la gestion de diabètes de votre précieux minou.

En espérant de vous revoir bientôt.

 

Hello, I am not on FB but will maybe join. It might be helpful!

 

Hi Marj your English is very good.

Can I clarify a few things please?
Is Djoko still on Lantus insulin? That is a very good insulin for cats.

I see you have set up a spreadsheet...great!.....no numbers in there yet though. Can you add the last week or 2 blood glucose numbers please? That would help us a lot.
It says on the spreadsheet (SS) that you are using an Alphatrak meter. Is that correct?

We recommend you go only up and down in increments of 1/4 unit (0.25units) of insulin. So if you are increasing the dose you only go up 1/4 unit each time. This is much safer for the cat. And you hold the dose for at least 6 cycles (3 days) unless the numbers drop below 3.7
A lot of cats will bounce up high after they drop into low numbers...just like Djoko did. This is because his body panics when he sees these low numbers and he dumps regulatory hormones and stored glucose into his system to save himself. This will shoot his numbers up high again. A bounce can last from 1 to 6 cycles (each cycle is 12 hour.).

Is Djoko vomiting or not eating still? If so he may be nauseated and may need some antinausea medication from the vet such as cerenia.

What are you feeding at the moment.?
Are you still feeding M/D?
Ordinary low carb canned food from the shops is OK to use.
If you are testing the blood glucose levels and are only increasing the dose by 0.25 units when needed, you will hopefully not see so many swings.


Always test before EVERY INSULIN DOSE and before you feed. This is important to check that the glucose level is high enough to give the insulin.
Then feed Djoko, then give the dose of insulin.
Then check the BG levels during the cycles as well.
It is also good to give some snacks during the cycles as well at around +2 (2 hours after the insulin dose) and +4 or +5 (4 or 5 hours after the insulin dose).

If you are using the Alphatrak meter, you do not want the blood glucose level to drop below 3.7 (68 in US numbers). If it drops below 3.7 you need to give some high carb food or honey to bring the numbers up a bit and check again in 20 minutes.
Do you have some high carb food at home if needed?
High carb food will have rice or potatoes or other carbohydrates in it..

I'm sure we can help you a lot. We need you to fill in the spreadsheet though and if you can answer the questions I asked that would be very helpful.
I know how anxious you must be about your Djoko.
Please ask lots of questions, we are happy to help you.

Pease post here on FDMB for any dosing advice. While our FB page is a good support, they don't give dosing advice.

Looking forward to hearing back from you.

 

Facebook group I was referring to is not our sister site. But a French language specific feline diabetes facebook group. For those fluent in written French and used to French colloquialisms and European cultural differences between there and North America.

https://www.facebook.com/groups/chatdiabetique
Private group. You have to ask to join.

 

Ok..got it.
Are they allowed to give dosing advice?
I think Marj would do well to keep posting here for specific advice as she does have several issues with Djoko that we can help her with. What do you think?

 

Yes, the French language facebook feline diabetes group was started about 2 years ago. Modeled off some of the other facebook groups, but improved to meet the needs of native French speakers.

Yes, they give dosing advice. They have spreadsheets to track the BG tests (but they are called "pictures" or "folios" when google translate gets done with changing it to English). My French comprehension skills are very low, so I need google translates help to understand.

They work with vets to help guide the vet helping a cat that is in diabetic ketoacidosis.
They have administrators and moderators, experienced with feline diabetes.
Mostly lantus users, but they have been getting more Prozinc and Caninsulin users.

Files section with many documents about feline diabetes. Dosing protocols for Lantus is basically TR. Not sure if they have a SLGS version.

Lots of videos to explain things.
More people there seem to use the Libre CGM.

They are in contact with people from the Diabetes Katzen German Language group.

 

I forgot to ask. Should I give him snacks in addition to his meals. He is supposed to eat 240 calories a day. I read different advice regarding the amount of time per day he should be fed: mutiple times versus twice a day before shots. Thanks!

 

This message was meant to respond to you. Sorry for the confusion.
Thank you for your encouragement.
I am now feeding him with Weruva and DM Savory Selects in sauce. The DM Purina contains soy flavor, wheat gluten and corn starch-modified. I am not sure if these ingredients are recommended for a cat with chronic pancreatitis. Weruva contains more natural ingredients but Djoko won't it enough of it to meet his daily meal requirements. I will look into Fancy Feast tomorrow.

He has been on Glargine since February 18 but although this is supposed to be a peak-less insuline, he has experienced big drops (see spreadsheet). His values are all over the place.
I am wondering if this could be explained by his pancreatitis: when his pancreas his more inflammed, his values are higher maybe?

We will perform a GB curve tomorrow because he has been on 1.5U for more than 7 days and it does not seem enough (values almost always above the renal threshold). It seems that 1.75U would be a good option because 2U was too much last time. However, it is difficult to accurately measure 1.75U on these U100 serynges 3/10. Any advice?

I am using alpha trak 2. The strips are sold here for $100+ taxes for 50 strips. I wish I could find them at a better price. Any suggestions?

I am concerned with Djoko because there is no consistency in his results. For example, this week, he was at 34.6 at 7PM 1 hr before AMPS and dropped to 9.8 at 5AM (+9 after PMPS).
Have you ever experienced any drops like this? Is it considered normal?

Also, I was wondering if his ears may develop scar tissues by testing him too much. His ears are not in the best shape right now. They twitch.

I forgot to mention he has neuropathy. I hope this will stop and improve when he (hopefully) gets stabilized.

Thank you very much.

Marj and Djoko.

 

Hello Marj! I see that you were responding to Bron and Sheba, but I'll answer what I can, and let others help with the things I don't know enough about. I'm not sure about where you live. I know French is your first language, and you speak English beautifully. Are you in Canada? You don't have to use the pet meter, I know the strips are expensive. Many folks here use human meters. I'm not sure what brand options you have where you live, but you can check out what human meters are available and strip cost.

I know that folks who feed the Purina DM avoid the one that's bits in sauce, as it is higher carbs. The pate style Purina DM is a safer choice.

The neuropathy should improve as Djoko gets better regulated. Some members have had success with a supplement for neuropathy called Zobaline.

There are things to do to help his ears. Use both ears. Put pressure on the stab site for a moment after the test, this helps the bleeding stop and helps avoid bruising. You can also put a bit of neosporin ointment on the ears after testing.

The curve will be awesome. He might be ready to go up .25 of a unit, but it depends on his low readings. Folks will be able to help you better with that decision after the curve. I'll let someone more familiar with Lantus give you pointers on measuring partial unit doses.

Personally, I think diabetic cats do better on many small meals a day, rather than the two big meals most vets suggest. You do need to take away any uneaten food 2 hours before pre-shot tests. This makes sure they will eat when it's insulin time, and gives you a more honest BGL when you test. I also wouldn't worry too much about how many calories Djoko is eating until he is better regulated. Diabetic cats don't utilize their food very well, so some of those calories are going straight into the littler box. Some diabetic cats need twice as much food as non-diabetic cats.

It's pretty normal for a cat on insulin for their BGL to dip lower after insulin and then come back up before the next shot, even on a depot insulin like Lantus. There's also something called bounce, which is super common. Look at Djoko's readings on 2/29. 488 pre-shot. Then down to a lovely 124 at +7. Then bounced back up to 490 at the end of the cycle. That's textbook bounce. The nadir (low reading) was less than 50% of the pre-test.

Here's a simplified explanation of bounce. The cat's body is used to running on high sugar. The insulin starts to bring the levels down. Even if these lower readings are still higher than normal, the cat's liver gets worried and freaks out. "Help!" it shouts. "Our blood sugar is crashing! Release all the stored sugar!" The liver and pancreas release stored sugar, and bam, the BGL goes high again.

The thing is, you want to raise or lower the insulin dose based on the low nadir readings, not the pre-shot test. That's why getting mid-cycle readings is so important, and why the curve you are planning will give you much needed information.

Hope that helps a little. You are taking excellent care of Djoko!

 

Hello,
I am adressing my messages to anyone who can help .
Thank you for your response. It helps understanding the swings.
As you know, I will be performing a BG curve shorlty. When I do the pre-shot blood test, do I do it before or after he`s eaten? I normally start feeding the cat at 8:00 and give him his shot at 8:30 (normally, 7 and 7h30 but dailight saving time) should I take the blood test at 8:00 just before feeding or around 8:30 just before the shot?

With Glargine, I read that it is recommended to do the test every 4 hours. I feel like you can miss the nadir. Would you recommend every 3 hours instead?
I am French Canadian yes .
Thank you again.
Marj and Djoko.

 

I am answering you now.

 

Hello again,
I forgot to ask: what is the best approach to handle a bounce?

Thanks,
Marjorie

 

The only thing you can do is wait for the bounce to clear. When a cat bounces, the liver releases stored sugar and hormones to bring the blood glucose up. It can take up to 6 cycles (3 days) for those hormones and sugars to clear.

Bounces happen when they 1. drop too low, 2. drop too quickly, 3. drop into numbers their body isn't used to anymore (or any combination of all 3)

Can you update your spreadsheet? We really are very data-driven here and depend on the numbers to give you the best advice possible.

 

I tried to look up the Purina DM savoury selects in sauce and couldn't find it. It just said that Purina DM was 6 carbs but I don't think that applies to the one you are feeding because of the wheat gluten and corn starch...both carbs.
Try and find some canned foods that are 10% or less carbs, preferably around 5% carbs. You also need some higher carb foods in case he drops low. Do you have some of those too?

Cats can experience big drops when on glargine. They say it is peakless, and it can be, when the numbers are low and the curve tends to be a flat curve but you have to get into more normal numbers first for that to happen.

Looking at your SS I see that you are not testing before every shot to see it is safe to give the insulin.
It is really important you test before every shot. It not only tells us if it is safe to shoot, we can also look back at that shot later in the cycle and see if the number has gone up or down.
Looking at the SS I see all the colours. I can see he is responding to the insulin as you have some blue numbers there. I also see some reds and blacks and they could be from bouncing. But unless you have some consistent testing .....preshot, during the cycle...preshot, during the cycle, I can't tell where the low numbers are happening to cause the bounces.
He is also used to being in higher numbers now so a drop into blue numbers could be enough for him to bounce up high. Does that make sense?

He is only newly diagnosed so you need to give him time to get used to the insulin which is a hormone and not a medicine like an antibiotic which can work straight away. Insulin takes time.
There is nothing you can do about a bounce but wait it out. We all buy patience pants!!!

If you are finding the Alphatrak meter too expensive to run, I would buy a human meter. They are much cheaper to run and our dosing methods are based on the human meter.

For neuropathy you can buy Zobaline from lifelink.com which will help with the neuropathy. Once the numbers start to return to normal that will help a lot as well.

His ears should be fine and not develop scars. I tested Sheba on the ears for years and they looked quite normal.

Are you feeding during the cycle as well as at preshot? I would suggest feeding say at +2 (2 hours after the insulin and again at +4 (4 hours after the insulin). Feed before the insulin and just a small snack At +2 and +4 which may help the blood sugars dropping too fast. Does that make sense.?
Please ask any questions if you don't understand what I am saying.

 

Test, feed, shoot. Always best to test before you feed. If you feed first, the number could be bumped up by the food, which can lead you to dose when you might need to skip or reduce dose. Always best to test before every time you give a dose. If the number is too low, you can do one of three things: stall (wait 20 minutes without feeding and test again) skip the dose, or shoot a small token dose. Until you have done this longer and better know how Djoko reacts to insulin, a good "no-shoot" number is anything under 200.

For a curve, test every 2- 3 hours. I did every two. Feed as normal, no need to withhold food before every curve test. Even on non-curve days, getting some mid-cycle tests is a good idea. You can stagger the times: for example, one day you might get a +4 and +6. The next day you might get a +5 and +7. And PM tests are just as important. Even if it's just a test before bed, getting a PM mid-cycle test really helps. Most cats drop lower in the PM cycle.

 

For the curve, test every 2 hours from AMPS to PMPS.
For Lantus the dosing is based on the nadir so it is important to get in tests during the cycles in as many cycles as you can.
With Lantus you don't need to wait 1/2 hour after feeding to give the insulin.
As mentioned by Juls it is test, feed and shoot in that order. Many people give the shot as the cat is eating the meal. You just need to make sure he will eat.
Then the first test after the preshot, for the curve, is at +2 then +4 etc

 

A good meter that people in Canada buy is the Contour Next One human glucometer and the matching test strips. It has a really nice feature. It lets you add more blood to the test strip within 60 seconds if your first blood drop was not big enough. So you have a second chance for a good test with only 1 test strip.

 

Hello,
I will start testing him before each shot from now on. The vet warned me that I was testing him too much and that I should only test him when presenting signs of hypo.
I start to disagree with this approach given that we cannot identify his nadir and because his values fluctuate a lot. As such, I will be adding more results to the SP in the coming days.

We were supposed to perfrom a BG curve today. I am disappointed because I was waiting for this day the entire week. Last night, I did not test him PMPS because he has been consistent in the last three days (around 26-27 mmol/l, around 480-490 mmol/l). I tested him +5.5 to see if he was close to nadir (I have absolutely no idea if his nadir is closer to +5 , +6 or +7 and have read that it can vary from one cat to another). His result was 14.3 : 257. I gave him a snack (1/6 of a can) as I did not want him to drop too low so that it compromises the BG curve. He is used to snacking during the night but more around +8). To my surprise, he went gone up to 28.9; 520. He was very stressed out by the blood test. I woke him up while he was peacefully sleeping and he growled at me. He is normally very easy going.

This morning, I felt like my shot was not the best. However, I did not feel any wetness on his coat. His numbers were pretty high as shown in SP. After three tests, I decided to stop and plan to conduct a curve on another day.
Questions to you:

(1) is it possible that the snack and the stress could have caused this increase?
(2) when should I perform another BG curve?
(3) should I give him 1.5U for PMPS?

I am getting worried about ketoacidosis because he is almost always in hyperglycemia. I know this is not a marathon but I do feel some emergency to get the right dose. I would like to buy strips at the pharmacy to test for ketones. I have never done it before.

Thank you very much for your help. It is well appreciated.

Marj and Djoko.

 

Please, please, please test Djoko before every insulin shot you give. It's important to know what that BG (blood glucose) number is, so you know "if the number is high enough" to give Djoko insulin.

1. yes. See below for more info. It also could have been what we call a "fur shot". Even though you did not feel wetness in the fur, some of the insulin could have gone in the fur anyway. Put a question mark after the dose in the U (Units) column on the spreadsheet, and make a note in the Remarks column that this was a possible fur shot.
2. A curve can be done whenever you have a 12 hour period available. You can also gather data at random times during the 12 hour dosing cycle. A +1 and a +2 are always good tests to get. The +2 BG (blood glucose) test can be predictive of where the numbers are headed during this cycle. Up, down, flat.
3. As far as the dose to give at the PMPS shot time tonight, some of that depends on the pre-shot blood glucose (BG) test number. So the answer is maybe. As long as his BG test/reading/level/number is above the decision threshold. (SEE below for an explanation of that).

For new members on the Feline Health (Welcome & Main) forum, we set that "is this blood glucose reading high enough to give insulin number", that "decision point", that "pre-shot threshold" number at 11.1 mmol/L (200 mg/dL). As you gather more data and move to one of the ISG groups (Insulin Support Groups), that threshold can and will be lowered. For the Lantus ISG forum, the threshold number is 150.

Do you think you will be able to do that pre-shot test each time before the insulin shot in the future?

1. Yes, the food at +5.5 could have caused Djoko's blood glucose to rise very fast like that.
Could you tell us specifically what you fed him at that time? Brand, flavor, style of food is what I'd like to know.

You can also make notes on your spreadsheet in the Remarks column on the far right hand side about what foods you feed each cycle. If you start the note in that Remarks column with AM and then indicate the time in the + hour format, we can see when you fed food and how that food intake may be affecting the 12 hour insulin cycle.
Do the same type of note for the PM cycle.

Please only make notes on the "world" tab of the spreadsheet. The US tab has some formatting behind the cells and will automatically copy over the data you put in the cells on the "world" tab. If you accidentally enter data on the US side, please ask for help and we'll see if someone can help you fix the spreadsheet.

 

Hello,
I do not think that the shot last night at 12.30 (+5.5) was a fur shot. For Djoko's values, 14.3 is considered low. I gave him 1/6 of a can of DM purina (in sauce) dietetic + 5 dry pieces of dry food (m/d glucose weight management)


Yes I will be able to do that pre-test shot. Djoko is however more on the high end. When he first got diagnosed, he was between 27 mmol/l and 35 mmol/l.

I will add info in the remarks box.

Marjorie

 

Thank you for including some additional notes on your spreadsheet. That will be helpful for us to look at.

While Djoko started off in very high numbers, he is much lower now, at times. Not today of course. Today his blood glucose levels are very high. I think he is "bouncing" from those low numbers yesterday evening.

A blood glucose reading of 14.3 mmol/L (257 mg/dL) is not particularly low. We have cats here that are in the <5.5 mmol/L range (<100 mg/dL) regularly at both pre-shot and during the insulin cycle.

Here is an example of a thread from today, in the Lantus ISG where the cat is in very low BG (blood glucose) readings normally. Still receiving insulin. The owner has tried a couple of times to stop the insulin, but the cat was not ready yet. So the insulin was restarted.
3/8 Zoot! AMPS=68;+3=64;+6=54;+10.5=60

Spreadsheet for that cat is here for you to look at. Cat's name is Zoot! with the exclamation point as part of the cats name.
Zoot!'s Spreadsheet

 

Hello,
I am aware 14.3 is not low. From my reading, a healthy cat is supposed to be between 4-9 mmol/l. For me, at this point, 14.3 is somehow encouraring.
I hope he will have better numbers tonight.
Marj

 

14.3 mmol/L is ABSOLUTELY encouraging. I thought you meant it was a dangerously low number.

Too low and needing some food and maybe some simple sugar like honey or corn syrup,to bring the numbers back up would be <3.7 mmol/L (68mg/dL) on a pet meter like an Alphatrak and < 2.7 mmol/L (50mg/dL) on a human meter.

Keeping all paws crossed for lower numbers for Djoko tonight.

 

Hi Marj, I’m just checking you are not giving any insulin inbetween the two doses at AMPS and PMPS? From what you said above, it sounds like you gave a dose at +5.5 last night. Maybe I’m misreading what you are saying?

 

Hello, I gave him insulin at 7h30PM and tested his BG level at 12h10 - testing was between +4.5 - 5. Sorry for the confusion with +5.5. I will get better at including info in the Chart.
Hope this helps.
Marj

 

Thanks. Please don’t apologise. I thought that was the case but just wanted to check.

 

Hello,
In terms of carbs food, I have weight and glucose management m/d dry food.I do not think the % of cabrs is higher than 18%. What would you recommend?
Thank you.

 

The M/D dry food is about 17 or 18% carbs so that is a high carb food and will raise the blood sugar levels.
Looking at your SS it looks like you are feeding weruva brand and BBF brand foods. A lot of them are low carb.
Have you seen their website? They have all the carb values online. Have a look at these and see if any are suitable for you. Look for carbs under 10%.
https://weruva.com/

 

Hello, I went on catinfo.org and looked at canned food that contained less than 10% (looking ideally at those that contain 5% and less). I bought many cans last week (B.F.F and Weruva) and I am trying them to see if he likes them. I would like to stop feeding him DM purina in sauce. I am keeping the dry food bad for emengency. I am trying to find classic fancy feast in stores but can't find them. I will try to do a BG curve on Friday and during the night betweem Friday and Saturday If I can take a day off.

M

 

While you are looking for food, it would be a good idea to get a few higher carb cans for when Djoko drops into low numbers. Put the number of carbs on the top of the can and put them at the back so you don’t use them for normal feeding.
It sounds as if you are getting well organised Marj.

 

You mentioned that it is good to provide cats with snack after +2, +4. I would like to give Djoko a % of the can but wondering if I am not over feeding him at snack time. What would be considered a snack in terms of the proportion of calories? (because cans contain different amount of calories). Thank you! Marj and Djoko.

 

The Fancy Feast classic pate foods have a different label in Canada.
The label will not have the word "classic" on the front.
Those Fancy Feast pate food labels will look like this.

A couple of teaspoons (1 teaspoon = 5 mL measuring spoon, like you would use for cooking measurements) would be a good amount to feed as a snack. That would be about 1/8 to 1/4 of that 85 gram small can.

I used a black permanent marker to mark top of the can, with the percentage of carbs, on the medium and high carb foods. That way, I could grab a can, look at the top and know quickly what the carbohydrate content was. You don't want to be scrambling to remember what the carb % is when your cat is in low BG numbers.

 

Hello, Djoko was sick today. He vomitted twice (see SS). I am surprised about his numbers and not sure what to do. Any advice? Last time I tested him at 20h23 (so basically 25 min after what would have been his sht time), he was at 10.3. He ate since then but I am waiting to feed him more but he is not very hungry today. Should I skip a dose? decrease the dose if above 13?
Thank you.
M

 

For future reference, if you are going to stall, it is best not to feed but wait 20 mins and test again.

So are you now 1 1/2 hours after what should be his shot time?

you said in the SS he ate 1/2 can of 129 calories, 1/2 can of 54 calories and a spoonful of DM.... was this after vomiting and after you tested and got 10.3?
Have you tested again to see what he’s at now?

 

Hello,
I am 3 hours after his shot time. We tested at 17h45 (9.7) and 20h25 (10.3). His shot time was at 20h00. Do you think 20 min would have made a difference?

The food he ate was after vomiting.He got fed because I was sure he was going to be at 25 and +. I was surprised he was still low.

I was waiting to hear from feeback and would like to test him now. I guess 1.5 U is too much at this time.

 

3 hours after shot time is a long way off schedule. Do you have to go to work tomorrow morning? If you shot now you would have to shot 3 hours late tomorrow? How would that effect you?

 

I ended up giving him 0.5 because he was at 16.7 +4 of his PMPS and he was at 30 this morning .

I just don't get it. How come he is always between 24-35 PS time and one day he is at 9.8. Am I supposed to shoot him at 9.7 even though I knew he was at 27 before, meaning he has the ability to drop from 27 to 9.7 in a day? Does it mean if I shoot him at 9.7, he would be at 9.7 - 20? Could someone explain me how it works?

 

It takes time to adjust the insulin amounts. It takes time to level out the blood glucose. Patience is required when treating a cat for diabetes. We know it is very difficult to do that, be patient. But it will take time to get Djoko's blood glucose regulated.

We know this is also very stressful and concerning for you. Some people do deep breathing exercises, or yoga, or take a walk to help them manage the stress. Please try whatever works for you. Personally, I find a small piece of chocolate to be helpful for myself.

Cats bodies have a self protection mechanism. If their blood glucose drops too low, the body releases hormones and sugars from the liver and other places to bring those blood glucose levels back up. That is to protect the brain and other organs which need that energy (from the sugars) to operate correctly.

The low does not have to be a dangerous hypoglycemic low, where the blood glucose level is <2.7 mmol/L(50 mg/dL) The low can simply be lower than their body is used to. We call it "bouncing" or "liver panic".

Here is an explanation of bouncing, from one of the "Sticky" or pinned posts from over in the Lantus forum. It's from the link I have pasted below. BG means Blood Glucose:
Sticky The Basics: New to the Group? Start here!

"Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucagon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles)."

I'm not sure what you are trying to say here. What do you mean by 9.7 - 20? What does the 20 represent?

Did you give Djoko any insulin on 3/9/20 PM cycle? 3/10/20 PM cycle? 3/11/20 AM cycle?
If you gave Djoko no insulin, please enter 0 (zero) in the U (units) column on the spreadsheet.
Otherwise, if you did give him some insulin on those dates and cycles, enter the amount of insulin you gave Djoko in the U (units) column. Thank you.

Please let us know how we may help you understand. Whenever you need us to explain something, please ask. If you still do not understand, we will try to explain with other words or have someone else explain. Sometimes, a different way of saying something makes it more understandable.

"The only bad question is the one you do not ask."

 

Hello,
I don't think it was a bounce because I did not give him his shot at 8PM (second shot at 1.5U). I gave him 0.5 at midnght (+4). It was there normal that his blood level would increase without 1.5U of insulin.
I was scared to give him 1.5U when he was at 9.7. In retrospect, I should have given his a shot because he woke up at 30 in hyperglycemia.

By 20, I meant the differece between 27 and 9.7. In other words, if he is at 9.7, should I assume that he will have the same drop e.g. 20? Or his body will somehow adjust?
I do not think that to not provide him with insulin was a good call.

Does it make sense?

 

Understandable. You have never given him insulin when Djoko's blood glucose was that low.

No, you can not assume that Djoko's blood glucose will vary by the difference between one test and another. The blood glucose levels will change all the time, and you do not know what they will be until you test.

No, the drop from one blood glucose test to another is not always the same. There is rarely a time when you will take 2 tests and the number will be exactly the same.

There is a factor, a variable, an allowable difference in the repeatable accuracy results for hand held blood glucose monitors. Such as the meter you use. Blood glucose test meters are allowed to process and provide results within the set government standards for accuracy. They must be within 15% (15 mg/dL 0.83mmol/L) of a laboratory test 95% of the time.

That allowable difference is called "meter variance." That is why we use the color coded blood glucose ranges on our standardized spreadsheet. It's the range of the blood glucose, that tells you how your cat is doing, not necessarily the exact blood glucose reading.

So even if you test Djoko's blood with one test strip, and then immediately test his blood with another test, there can be a difference in the blood glucose test results. So we look at the colors on the spreadsheet, and don't focus too closely on the exact blood glucose tests. Except in certain circumstances.

One of those circumstances is when you have a lower blood glucose reading (test result) at pre-shot time (AMPS or PMPS). If you have a pre-shot blood glucose test result that is lower than 200, then you should "stall", no food, wait 20 minutes, take another test.

It's always a good idea to post on the message board for advice, if you are stalling and need help in making a decision.

 

With time, his body will adjust. But you may have to change the insulin, increase or decrease the dose, as you are treating his diabetes.

Lantus is a long duration insulin. It is best given at 12 hour intervals.
And our dosing protocols here indicate that the same dose should be given for at least 6 cycles UNLESS the blood glucose number drops too low. That "too low" would be 3.7 mmol/L (68 mg/dL) on an Alphatrak test meter.

You gave Djoko insulin 4 hours later last night
How late did you give Djoko insulin this morning?
At his regular morning (AM) shot time? or later?

Have you been able to test his blood glucose levels this morning, since his insulin shot?

p.s. Black color ranges on the SS (spreadsheet) does indicate bouncing.

 

The thing is, diabetes simply isn't that predictable. You will never be able to say, Oh, if he's at this number pre-shot and I give him this much insulin, he's going to drop to this number. That's why BGL testing is so important, and that's why it's so useful to get mid-cycle tests every time you can. For example, if you don't know how low he drops mid-cycle, you don't know when to reduce the dose. If one doesn't know the mid-cycle numbers, an owner might not realize the high pre-shot numbers could be bounce. Then there's a danger that the cat's insulin will be increased when it needs to be decreased.

The reason reaction to insulin isn't predictable is that the pancreas itself isn't predictable. As it begins to heal, it starts making it's own insulin, but it's doesn't heal all at once. One day, It's all "Lets make ALL the insulin!" That insulin added to the insulin in the shot can make the BGL pretty low. The next day, the pancreas can be all "Whoo, I'm tired. I don't think I'll make all the insulin today." Injected insulin gives the pancreas a break so it can heal, but as it starts making it's own, readings can be all over the place and doses might need to change fairly frequently, based on the lowest mid-cycle tests.

 

The blood glucose levels are also unpredictable because insulin is a hormone. It's not predictable like taking an aspirin to make a headache go away. Hormones can be processed differently each cycle, depending on what else is happening with your cat that day.

Maybe your cat ate a bit more one day, or played more or less another day. Maybe he took a longer nap or ran from window to window to see the birds or squirrels outside where you live. Maybe he saw a strange cat wandering around outside, or a dog and got scared.

You might have a fire alarm go off and need to clear your building, and that could cause your cat to be afraid, which means he is stressed and stress can raise the blood glucose levels as a cat reacts to that stress.

We only have control over a few factors in this diabetes journey. Your cat is "leading this dance" and you have to learn to go along and follow the steps and turns he is taking. Like Ginger Rogers following Fred Astaire dancing.

 

And right as you're feeling confident in doing the waltz, Djoko will decide he wants to do the two-step.

 

Marj, if you look at Djoko spreadsheet for the 3/10 you will see that Djoko has two blue numbers at +10 and +12 in the am cycle. I think that was him coming off the bounce which he had been on for the previous 5 cycles. Sometimes when they come off the bounce they can drop lower and faster and that is what he has done when you are seeing the blue numbers at +10 and +12.
Once he bounces, there is nothing you can do about it but wait and see when he decides to come off the bounce. His body has to start getting used to lower numbers again. This is very common in newly diagnosed diabetic cats, so he is not doing anything we haven't seen before.

Next time you are unsure whether you should give the insulin or not.....stall, don't feed and test again in 20 minutes.
Post and ask for help. Change your subject line to something like stalling, please help....so that we are alerted that you need help.
The subject line is the line at the top of your thread.

It isn't a good idea to give insulin 4 hours into the cycle because it completely messes up the dosing schedule.

 

Djoko was given 0.5U 4 hours later (midnight) as opposed to 1.5U at 8AM.
He was tested the following morning pre-shot at 7H40AM. He was at 30.2. Was it really a bounce or the result of having received 1/3 of his normal insulin dose?
Please explain.
I gave him 1.5 at 8AM this morning.
Why?

 

So what would have been a good solution? Just give him his normal dose knowing that he will rise up anyway?

 

Could you please explain what you mean by he has been coming off the bounce form the previous 5 cycles?

 

I did not change his dose. I gave him 0.5 because I did not want him to get to high or skip a dose. Next time he is at 9.7 at time of the shot, I test 20 minutes later. But if he is at 10.5, what do I do?

 

This makes sense. I was planning on doing the BG curve Friday but by giving 0.5 last night 4 hours later as opposed to 1.5U, did I compromise the curve? Should I do it Saturday instead?

 

Unfotunately for this poor animal, I live at the 13th floor of an appartment building downtown. He has a big window in front of him but birds are not coming here too often...:S

 

Sometimes when a cat drops into low numbers, or drops fast, or drops into numbers that are lower than he is used to (they could be low yellow or blue numbers, not necessarily green number) his body thinks he has to save himself from the sudden drop in numbers or the 'low' BG. So his body dumps regulatory hormones and stored glucose into his system to 'save himself' from the perceived threat. This sends his BG up high and these regulatory hormones and glucose can stay in his system for up to 6 cycles..
Cats can bounce from 1 cycle up to 6 cycles. Once a cat bounces, there is nothing you can do but wait for the bounce to clear.
When the hormones and glucose start to disappear, the BG starts to return to normal and you will start seeing normal numbers again. This is when the cat is coming off the bounce. Sometimes as they are coming off the bounce they can drop quite quickly and you will see lower numbers and see them dropping quite quickly. There is nothing for you to do but test and see the numbers don't drop too low. If you are aware this can happen, you won't be surprised if the BG numbers at the end of the bounce are sometimes low.

Have a look at his spreadsheet. You didn't test either preshot on 3/7 or during the am cycle so it is very possible he dropped lower at that time as he had a yellow BG @+4 in the pm cycle and then at +7 he shot up to a black BG and had black BGs in the following am cycle which indicates the start of a bounce to me.

Does that make sense?

 

Yes, wait until Saturday to do the curve. That is because the insulin depot or storage area that lantus has, needs to build back up to full. That can take several cycles for that the happen, for the "insulin tank" to be at Full. A curve on Saturday or Sunday will have given that "depot" or storage area time to fill up again.

 

You make a judgement call. Based on how well you know your cat and how he reacts to the insulin.

Your decision depends on several factors. It depends on if that pre-shot test of 10.5 mmol/L was a rising number or a falling number. It depends on if you have enough test data to know how low your cat will go on a dose. It depends on if your cat is eating well or not.

Lantus has an onset for most cats of around +2. Two hours after the insulin shot. Food will raise the blood glucose levels, so the test you get at pre-shot should have risen by the time the insulin onsets or begins to have an effect.

So knowing if the pre-shot test number is rising, and by rising I mean by at least 0.55 to 0.83 mmol/L or more (10 to 15 mg/dL or more), then you know it's likely going to be ok to give the insulin. There are no guarantees. There are always times when a cats blood glucose does the unexpected and drops after the pre-shot test. When that happens, you need to monitor and test more, to see if the BG falls too low.

 

Lantus insulin can last between 12 and 16 hours or more in a cat. By giving the dose last night 4 hours late, there was some over lap in the doses, between last night and this morning. The insulin doses were only 8 hours apart. We don't know how much overlap in the doses may have occurred. We don't know how low his BG numbers fell during the rest of the cycle this morning, 3/11. We don't have enough test data yet to judge something like that.

You seem to be looking for exact precision in the BG test numbers and knowing what to do based on those exact numbers. That precision does not exist. There are only general guidelines that you can follow.

You can always post here on Feline Health or in the Lantus ISG for help. When you are not sure what you want to do for a particular pre-shot test number or other number during the testing cycle, then post and put the ? icon prefix on your post.

 

I am not looking for exact precision but some sort of pattern. My concern would be to perform a BG curve that is based on an unatypical day (without knowing it) and that the dosage be increased based on those results which would ultimately lead to hypo (see Sunday for instance). Each time his dose was increased to 2U, his numbers got very low. But maybe this is how you treat a DB cat?

Maybe I am too scared to shoot low (9.7 for example) and this is the only way to help him.

 

Yes given that we have no idea what happened on March 7. Who knows! he may have dropped "low" for his standards. Good news is that he enjoys fancy feast!

 

I agree. If you understand the pattern, you know that he may be on the rise, which means it would be ok to shoot at 10.5. My plan is to do a BG curve longer than 12 hours to try to understand the overlap. I read the information on Lantus and what would be a typical curve on this website. What do you think of performing a longer BG curve? Would it help to gather data?Thank you.

 

Some people do test longer when they are completing testing for a curve. There are 2 main options used here.

Option 1 is to test every 2 hours, from 1 pre-shot test to the next pre-shot test.
So that would be AMPS, +2, +4, +6, +8, +10, +12 (which is also your PMPS pre-shot test).

Option 2 is to test every 3 hours, from 1 pre-shot test to the next pre-shot test and several hours beyond that for a full 18 hours of testing.
So that would be AMPS, +3, +6, +9, +12 (which is also your PMPS pre-shot test), +3, +6.

There is also the option to complete a testing curve during the PMPS cycle. The choice is yours.

Many people that are using either the SLGS (Start Low, Go Slow) or the TR (Tight Regulation) protocols, obtain enough tests, with varying the test times they take, that a curve is not necessary.

Yes, there is always that possibility.

For one thing, we do not increase or decrease the insulin doses by full units. We only make insulin dose changes in 0.25U increments. We also have specific criteria for increasing or decreasing the dose, according to the protocols we use here. Protocols that were developed from helping hundreds of cats, and written with the years of experience of many different members here.

 

Hello,
It is 15 minutes to shot time and he is at 13.5. He was stressed out while I was testing him so it may also have increased his BGL.
Is it OK to give him his 1.5U or too low? He started the day at 28.7.
Thank you for your advice.
Marjorie

 

13.5 is 243....that's high enough to go ahead and shoot the 1.5

Get a +2 to see how he's doing.

Please update your spreadsheet ASAP

I see what you did....you got the date as 3/5/20

 

13.5 x 18 = 243 mg/dL
Are you able to monitor tonight?
Do you have test strips?
Could you test him at +2?
And then again before you go to sleep?

That 13.5 mmol/L B level is normally plenty high enough to give insulin.
As long as you can monitor tonight.
I will not be able to stay up with you tonight, to guide you.
Let me find someone else to help you.

 

Hi @Chris & China (GA)
Are you able to stay up a bit with her? Already past my normal bedtime.

 

Yeah I can keep an eye out

 

Yes. I will otherwise I won't be able to sleep. He is normally above 20 when I shoot him, even high 20s and sometimes 33 so this is all new territory.
I hurt him when I gave him the shot so I am scared it went into the muslce and hit him faster. Is it possible? Maybe my angle was too steep.
When should I test him? +2 and then?

 

I have test strips.

 

@Marj ...Probably a good idea to move you over to the Lantus forum soon too. You'll get the most experienced eyes there. You don't need to do it right now, but maybe tomorrow start a new post there.

The +2 will give us a better idea of when (or if) you need to test again later in the cycle.

 

I just changed it to avoid confusion. Thanks

 

European style dates.
dd/mm/yyyy

Or
dd.mm.yy

 

If I injected insulin in his muscle, would it put him at risk because it will act faster?

 

hers had 03/05/2020 after the 03/11/2020

I always look for the European way too but all her other ones were like the US so that one was a surprise

 

It could, but it's really not that easy to shoot into muscle if you're using the tiny little insulin syringes. They don't go very deep.

 

Yes, intramuscular injections of insulin can act faster.
You could test him at +1.

 

Oh no. This was not the good time to do a shot improperly.
I just khow that it was not as smooth as it could be.
For food high in carbs, I bought temptations. Is that enough? There is a drugstore downstairs, I believe they sell Friskies, would that be better?

 

I am using the U100 3/10 ml/cc

 

You can always add a bit of honey, maple syrup, corn syrup or another simple sugar to his regular wet food if needed. To increase/bring up the carb percentage on the food.

Yes, the Temptations usually have enough carbs in them. But, since they are dry food, they can take longer to break down in the stomach and digest and get glucose into the bloodstream.

What needle length do those syringes have?
If you tent the skin before injecting, it's difficult to inject the insulin into the muscle.

 

It's the needle length that matters....most are 6mm or 8mm

 

It says 29g X 1/2 (0.33mm X 13mm)
I hope I did not jeopardize his health/life.

 

I make a tent but I think the angle was too steep. I am worried now.

 

One thing to always remember....As long as you can test and have high carb food, corn syrup, honey, maple syrup around, YOU are in control of his blood glucose.

If you're concerned, get a +1!

 

Those are longer and "thicker" than we usually recommend. Just wondering....Do they have half unit marks or do they just have whole unit marks?

Where do you live?

 

Just did a test and he is at 19.8.

 

I live in Ottawa, Canada. They do have half unit. I am not a fan of these needles. I bought them at the vet. Would the drugstore sell needles of the same lenght?

 

Thank you for helping me btw. It is well appreciated. If Djoko could talk, he would say thank you.

 

@Wendy&Neko lives in Canada....there are a bunch more but right now my brain's hitting a blank.

But yes, you can get syringes at any pharmacy with diabetes supplies. Wendy is usually on a little later in the evening but hopefully she'll see the tag

 

Djoko started at 13.5, +1 is 19.8, do I test him ar +2 or I wait at +3?

 

I think you could wait until +3 now

 

I used the BD Ultrafine II (yellow and purple box), available at most human pharmacies. You can also buy a version with 6mm needles. It's personal preference which you use. I liked the 8mm with my long haired girl.

 

Hello,
He is at 9.6. This is very low for this time. What do I do?

 

He is at 9.6 at +3. What should I do? He drops quickly.

 

That is still a safe number. Give a couple tsps of his low carb food. Can you test again in an hour or two?

 

9.6 is a 173.....still a high number. He's in no danger at all

Give him a couple of teaspoons of low carb food and check again in an hour