Stalling, please help-- RESOLVED

Hello. I am a new member. My cat Dexter has been diabetic for over 5 years. I had been listening to the vets advice and feeding him the dry "prescription" food and testing his blood sugar every 12 hours. Administering lantus depending on what his blood sugar level was. Recently, his fructosamine level was too high, so I am just yesterday starting to switch him too high protein wet can food diet. I just checked his blood sugar on an alpha tracks and it is 86. Should I go ahead and give him his prescribed three units or wait? Also, how long do I wait? Until his number goes up or until his next dose time in 12 hours? Thank you so much and sorry I don't have my spreadsheet yet. I just joined today.

 

Hi and welcome to the forum.
NO. Don’t give any insulin at the moment. The BG is too low. You can stall, DONT FEED and test again in 20 minutes to see if the BG is rising.

Now that you have swapped to the low carb food you will find the BGs will drop dramatically.

I will wait for your reply with the BG in20 minutes

 

Hi Rena.....glad you posted over here. As I said on Facebook, stall without feeding him and re-test in 30 minutes.

With the food change, he probably is not going to need anywhere close to 3U anymore. Since we don't have any testing data on him and you've done the diet change, unless he were to go over 200, I'd probably just skip tonight and start over in the morning with a reduced dose.

We have a spreadsheet we all use to record our test data that's very important so we can give you the best advice. The instructions are HERE but if you'd like some help, I'd be happy to set it up for you. Just contact me on Facebook by private message.

Let's see where he's at after the stall before making any decisions on tonight though

 

Hi Chris… good to see you.

 

Thank you both. The little stinker did just take a couple bites of food. Sorry, I didn't know I couldn't let him eat while I was stalling. I will try to retest him maybe in an hour and not give him any insulin right now unless you have a different suggestion.

 

Hi Bron! Good to see you too!!

If Rena needs help setting up a spreadsheet and she'll contact me, I'll whip one up for her but I'm glad to see she's over here where she can get lots of experienced eyes helping out!

@Rena Bron's one of the best. I'd trust her with my cat anytime!

 

Great catch and deciding to stall!

I'll let Bron stay with you, but what food did he eat? Low carb wet? Do you know about how much?

 

Dexter took a couple bites of Friskies canned chicken pate.

 

Glad to see you made it here, Rena!

 

How long until you test again @Rena

 

Ok. I'll defer to Bron. The food will inflate the numbers a bit and take some time to wear off.

How far off schedule can you be? Your next shot will have to be 12 hrs from whenever you'd shoot. So for example, if you have to leave the house 14 hrs from now for work or something, you really only have about an hour to keep stalling.

Edit: I see Bron. I'll back out so as not to confuse anything

 

Just a reminder for anybody popping in...she is using the AlphaTrak

 

Happy to see around Melissa! Two heads are often better than one!

 

Thanks Chris. We need to get the signature set up

 

@Rena
In the link below you will find how to set up your signature… it’s easy and will tell us all about Dexter including the insulin and the meter. Could you get that set up soon please as it’s important everyone knows you are using an alphatrak meter. We always look at the signature and SS before helping people Thanks!
https://felinediabetes.com/FDMB/threads/new-how-you-can-help-us-help-you.216696/

 

With the re-test only at 71, that's close to the point where she'd earn a reduction in dose, so I'd just skip tonight. Go ahead and feed her and get a test in an hour.

If she drops below 68, that's where she "earns" a reduction in dose so she's too low to shoot tonight.

 

I just saw over on FB - he ate pizza a little bit ago? Just want to make sure Bron is aware

 

I agree with Chris. I’d skip too.
What do you think about moving forward Chris, if Rena is going to be feeding low carb?
Are you able to test during the cycles Rena?

 

Pizza! And he still dropped to 71!

 

Yeah I told her she'd have to watch that....these sugarcats will get carbs anywhere they can!

 

So funny

You are a saint, it's a lawless no-man's-land over there on FB some days

 

Well you know how I feel about "resets" but in this case, I'm thinking maybe 1-1.5?

Will have to ask @Rena if she has syringes with half unit marks

 

Tell me about it. We ask every single member to join here but it's like pulling teeth sometimes. I'm so thrilled that Rena did it right away and so glad she's here and learning what a supportive place this really is!

 

I hate resets too, but I don’t think I’d call this a reset……..it’s in response to a change of diet.

 

She's working on her spreadsheet (she got the human one so has to do it with the AT one) and will work on her Signature so she's not ignoring any of you. She's just busy! Told her tonight's a good time to get all that stuff out of the way since she's not shooting

 

I saw the SS link and looked like stuff was getting added when I opened it. She's quick!

FWIW, I too am leaning towards 1-1.25U. I'm just not sure if tonight's skip will drain the depot enough, but SS and AMPS will tell.

 

Sorry, I have been working on the spreadsheet and trying to keep Dexter away from the pizza we all had for dinner. LOL. I think I have the correct spreadsheet set up. Does it automatically save? I am scared to close it after entering all of his data. I'm glad I did... noticed some abnormal results from the Lab info I updated. Would appreciate any input you all have on those numbers. By @Chris & China (GA) 's suggestion I put the abnormally high lab results in red and abnormally low in green. I can keep a close eye on Dexter on the weekend, but I work during the week and have a busy week coming up, so I hope he does okay!! I will try to test again before tonight.

 

Oh, and my syringes DO have 1/2 marks!

 

Yes I can see the SS! Yes it should automatically save.

excellent!

can you leave food out for him when you are not there? Do you have an automatic timed feeder?

 

I always leave food out. I have two other kitties. Right now, I have the dry "RX" food that they have been eating still out because I was told to gradually transition to the canned. Is that the right approach? They honestly have not shown much interest in the dry stuff since I opened the can yesterday...

 

Yes it is better to transition slowly to stop any tummy upsets.
How are you going to manage moving forward if you are only using wet food and Dexter needs some snacks during the day?

 

So far, they do not eat all of the wet food that I have been putting out. They will come back and graze. I'm hoping maybe that will work.

 

How long since you started transitioning? Just yesterday?

 

Yes, just bought the canned food yesterday. It is now 4 hours after his original PM dose was supposed to have happened that I didn't give him. I just tested and he is at 65. I gave him some dry food treats. So glad I didn't give him insulin before.

 

Wow....that really makes me wonder just how low he went today!

By morning, he may "bounce" so don't freak out no matter how high he is. (plus, he didn't get insulin tonight).

Bounces happen when 1. they drop too low, 2. they drop too fast, 3. they drop into numbers their body isn't used to anymore (or any combination of all 3). The liver releases stored sugars and hormones to bring the glucose back up so they "bounce" high. It can take up to 6 cycles for the bounce to clear so we don't increase the dose until we know that it's truly over.

 

Thank you for that info! I will try to test as often as I can tomorrow.

 

A few of us are trying to figure out a good dose for you to start with tomorrow. We were thinking 1.5 if over 200 but with him dropping below 68 again with no insulin, 1U may be better, especially considering the high carb kibble is being removed from his diet completely.

I've asked Bron to chime in too.

ETA...great job on the Signature too. Don't forget to add the 65 from tonight to his spreadsheet!

 

I agree with Chris. I think 1 unit if over 200. The food has obviously made a big difference and we don’t know how low he went during the am cycle before he got the 86 at PMPS.
I would post and ask for assistance at AMPS. Tag @Chris & China (GA) and @FrostD. I will be asleep (in Australia) for your AMPS I think.
Change your subject line to say….need assistance with AMPS dose…new member…to get attention.

 

What did your vet have to say about the labs, namely the urine ones?

It's better to transition food slowly like Bron said...but honestly I did it in one or two days because he just would not touch the dry and I figured why argue with a cat (we were also on a much harsher insulin and I needed him to eat reliably). He was ok, no diarrhea or vomiting or anything.

 

Thank you all! Today one hour before his normal shot time, he was still down at 87. I just tested him 2 hours after his normal shot time and he's at 324, so perhaps he had some of his dry kibble. Just like yours, @FrostD they haven't shown much interest in dry since I popped open the can. I am going to give him 1 unit now.

 

Hold on don't shoot yet

 

@Rena can you please test again to make sure it wasn't a bad strip? Even if you shot, please test again.

@tiffmaxee thoughts here?

Quick summary - 86 on ATrak last night, previous dose 3U, food change in progress. Last night was skip because food influenced and still under 100 (including some pizza). Guidance was 1U if over 200 but this 87 to 324 is suspect

 

Well, this is turning into a wild ride! I just tested again, and he is at 422. So, so far today: 7am tested at 87, 10am tested at 324 and gave 1 unit Lantus, 12pm tested at 422. Also, I don't think the vet commented on any of his other abnormal test results from urine or blood, so would appreciate any explanation of what those are. Thanks again.

 

Also, I am wondering if the insulin has gone bad. I am going to purchase a new bottle today just in case.

 

how old is the one you have?

I seriously doubt if the high numbers today have anything to do with your insulin...he's "bouncing" from the lows yesterday as well as the skipped shot last night.

 

That makes sense. The insulin is a few months old and I did accidentally leave it out for a day, so I will go ahead and purchase a new vial just in case. Luckily, his pet insurance covers 90% so it is not a hit on my pocket book. I need to go buy more syringes today as well. Is it common for them to go so low suddenly after starting the canned food?

 

I agree with Chris, I just wanted to make sure it wasn't a bad strip.

Yes, some cats can see a very significant difference just from food alone (which is why your post on Facebook became such a hot topic lol)

 

We have had cats go from 500+ to OTJ (Off The Juice---aka remission) with just a diet change. Food makes a huge difference.

But I think in Dexter's case, it was a combination of the diet change and getting too much insulin since the carbs had been reduced and that's what caused the low numbers yesterday

 

If you have insurance that covers it, I'd get a 5 pack of Lantus Solostar pens if you can. Each pen holds 300 units and they come in a box of 5 (total 1500 units). You would be able to use pretty much every drop out of each pen because they don't start to "degrade" until you "open" them so you can use 1 pen and the other 4 stay pristine until you "pierce" them. You still use regular insulin syringes to pull the insulin out of the pen so you don't need the special "pen needles". (you may need a new script specifically for the pens though...don't know how it was written or how flexible your pharmacy is)

A vial holds 1000 units and usually lasts about 6 months but most cat's can't use that much before the insulin loses efficacy and you end up throwing a lot of it away.

 

@Marje and Gracie is our lab whiz. She may be on tonight and can take a look.

 

Rena if you need more assistance tonight, can you please start a new post, with a link to this one for continuity? And please change this thread title to "Stalling, Please Help -. RESOLVED" or something similar

 

Okay, will do. Fyi, just tested and he's at 401. Roller coaster kitty! I'm going to give him one and a half units Lantus. He is happily eating his canned food that would be amazing if @Marje and Gracie could shed light on the lab results.

 

Since you probably already gave it, that's OK but remember, you need to hold the dose for up to 6 cycles until you're sure the bounce has broken before you make a decision to increase. Right now, he's still probably bouncing from the lows yesterday. Those hormones take time to clear the body before you get a true picture of what that dose is doing.

Grab a +2 and let's see where he's going...and starting tomorrow, why don't you go ahead and move over to the Lantus forum. You'll get the most experienced eyes there to help you. We do post a little differently there though because there are so many cats on Lantus. Here's some info on "Making the most of your Lantus experience" to guide you.