? Sudden diarrhea & high blood glucose, need advice.

[Critter Mom]

He's now home and +6 hours (since 1 unit Lantus this afternoon) and his BG = 50 (ReliOn).

The 50 BG reading* (human meter) is right at the limit where dose reductions are given on the Tight Regulation protocol.

My suggestion to you would be to look at the Start Low, Go Slow dosing method for Lantus. I also suggest you discuss the dosing method with your vet to make sure that they are happy it's a suitable treatment protocol for Oliver. Bearing in mind Oliver's recent heart scare your vet may recommend a different approach to his insulin treatment.

For the Start Low, Go Slow method, dose reductions are earned when BG drops below 90 (human meter), so Oliver ticked that box big time last night.

If you haven't already done so, regardless of the overall insulin treatment strategy they wish you to follow, I strongly recommend you agree a dose reduction with your vet before giving the next dose. Oliver's numbers dropped down to the very limit of the safe range last night. That was from the very first dose of 1.0 unit Lantus so there was no depot in play. If the 1.0 unit dose were to be maintained then as the depot started filling it is highly, highly probable that Oliver's BG would go too low.


Mogs


(* Did you mean 50 or 56 here? I ask because it's 56 in the spreadsheet.)

.

 

[Cat Caregiver]

Everything you said is sooo... helpful. Thanks Mogs.

Sorry, I failed to mention that the vet put a quick-acting insulin in Oliver's IV yesterday right away around noon which brought him out of the 500's (Alpha) into the 300's (Alpha). Then she gave him 1 unit Lantus at around 1:30 pm. So I'm thinking that today she will monitor his response to the Lantus without the added quick-acting IV insulin and make adjustments if needed. I have no idea what I'm talking about, just a wild guess! Maybe the 1 unit will not need to be reduced if his numbers were that low due to the quick acting insulin still having an effect.

There is a notable exception to the guideline not to administer any insulin to a cat with a preshot BG less than 200 (human meter) who doesn't yet have much data, and that is where the cat is prone to producing ketones or recovering from DKA. In such circumstances a token dose may need to be administered to prevent the cat from progressing - or relapsing - into DKA. In such circumstances dosing guidance should be sought from the vet.

Also, I forgot to say that the vet found ketones in Oliver so maybe I should have shot--or at least a token dose as you said--last night. I just didn't know. Sorry Oliver.

Note that there is no simple mathematical formula for converting Alphatrak meter reading values to human meter values.

Thanks. I do understand and appreciate this.

Unless your kitty falls below 90 mg/dL (5 mmol/L). If kitty falls below 90 mg/dL (5 mmol/L) decrease the dose by 0.25 unit immediately.

I will commit this to memory!

Thank you so much again. I am going to study hard before talking to the vet this afternoon and address all the great points y'all so generously gave.

 

[Cat Caregiver]

Oliver is home and happy. Since I skipped last night's dose she shot at 8 am this morning after I dropped him off (instead of yesterday's 1&1 time). Just before I picked him up there was a mix-up and he got his second dose for the day around 4:30 pm. So I asked the vet if tomorrow I could shoot at 6 am and establish a 6&6 dosing schedule and she said that would be fine.

Sometime today before 3 pm the vet measured (Alpha) BG@275. After the mistakenly timed 2nd dose at 4:30pm I measure, on my ReliOn, +2=208, and +4=233. I have no idea if I need to watch this tonight.

 

[tiffmaxee]

I honestly don’t know what to expect. So far it looks like the early shot is not acting like an increase. I’d get a +6 just to be safe but I think that it’s past that?

 

[JL and Chip]

I have no idea if I need to watch this tonight.

I agree with @tiffmaxee and would get an additional test or two if possible, even if you’re already past +6.

Shooting “early,” such as occurred today at +8.5, can act like a dose increase. You already saw a number in the 50s on 1u, although the variable of the fast-acting insulin might or might not have been at play. You also have a likely unstable depot and other potential health issues. So with that in mind, a few extra tests are probably a good idea. Better safe than sorry.

 

[Cat Caregiver]

Whatever happened because of the mistake of the early dose at 4:30 pm yesterday at the vet--and everything else that's going on--is probably making the last numbers UNUSUAL. It's 1 am and I got 366 Relion. Thanks for the input y'all. I really appreciate your help.

 

[Cat Caregiver]

Shooting “early,” such as occurred today at +8.5, can act like a dose increase. You already saw a number in the 50s on 1u, although the variable of the fast-acting insulin might or might not have been at play. You also have a likely unstable depot and other potential health issues.

I asked the vet if the fast-acting IV insulin that they gave him when admitted to hospital could have affected the later BG's and she said no; it would have lasted only an hour. So why the first day (but not the following days) on Lantus produced such nice BG's remains a mystery, at least to me because I'm a newbie!

What is "unstable" about the depot? Is it because it hasn't been established yet? Or because he's sick and his body is doing crazy things we can't know about. Probably all of the above?

He's very active today and asked for his walk (on harness, and I made sure he ate no grass. ) He even jumped on the kitchen counter (to get food) and I've never seen him do that before. He even hissed at me when I tried to prick his ear and was very non cooperative (probably from the hospital experience). However, his BG's make no sense to me, all yellow, and purple. No blue or green like the first day on Lantus.

 

[Cat Caregiver]

I'm a bit worried because today's +7=394 (which I also read on the Alpha as 500!!!)

 

[Ann & Scatcats]

@Cat Caregiver . Concerning 'depot', The Skin has the pH level 7,5, and the Lantus insulin is a sour insulin with pH 4 level. This very sour difference in pH level, is what makes the Lantus insulin to crystalize subcutan, inside in the skin layers where you give the insulin injection. Thus creates a crystalized depot, that releases a little insulin at a time, thoughout the 12 hour duration period.

See this Cornell University's Feline skin layers pic to understand better

And in the spreadsheet, the first day row of the green and blue bg numbers, they were most likely due to the xtra effect of the fast acting IV insulin.
Since on 1 U in the second day row of the bg numbers, the bg's are in the pinks and black.
Stick with 1 U for a week or so, and take bg's to build up more data.

 

[Cat Caregiver]

Ann & Scatcats, Thank you so much for sharing this. It makes so much more sense now .

 

[Ann & Scatcats]

@Cat Caregiver If you go back to Main Page www.felinediabetes.com, you have all research links there, for your vet.
AND, WHO Owns This SITE and All It's Content, since 1996.
And That Is Your American Physician Dr Rebecca Price.
And This It Was The Main Page www.felinediabetes.com bottom text says, By Owner, Your American Legally Litigation Liability Physician Rebecca Price:
"
Always consult your veterinarian about your pet's health and choice of pet supplies. This site is owned and administered by Rebecca Price MD, a *human* physician, and is not designed to take the place of regular veterinary care.
All content © 1996-2019."

I'm a Legal Citizen of U.S.A, Denmark, Sweden, and EU Myself

 

[Cat Caregiver]

Thanks again! I keep learning more and more about how much valuable information is available on the site.