Sugar levels WAY up then, same day WAY down

[Mom-Mom]

I have a 9 year old Domestic Long Hair cat (Mom-mom). She has been recently diagnosed with diabetes. I originally took her to the vet because she didnt eat the night before or that morning and her breathing was very short breaths. She was there 6 days and the vet told me that she has diabetes. Faithfully every day that she was in there I would visit her for at least 2 hours every day. I dont have children so she is like my "child". She has always been VERY spoiled and always sheltered. I mean, if the weather was nice I would let her in the yard for grass but, ALWAYS stayed there with her (only 5 or 10 minutes) She has only seen a dog 1 time in her life and that was an English Bulldog that was a puppy at the time. Anyway, during a visit at the vet I noticed where they kept her. She was in a cage and there was dogs in all the cages around, barking CONSTANTLY. The vet told me that she didnt eat so they had to FORCE fed her every morning, now I could see why she didnt eat. She was traumatized. I took her home, and per advice from a guy on this feline diabetes site, went and bought all the necessary things for her. I have since been asked by him not to contact him because we didnt agree on the amount of insulin to give her, and the vet NEVER returns my calls, so I am going into this totally ignorant. I am reading a book on feline diabetes. I was using a meter called TRUEtrak until today, I got the Freestyle Lite. I test her in the a.m. 2 hours before breakfast, then again between 11-4, again 12 hours from the 1st shot, and once before bed. I test her keytones daily and they are good. Her readings are so off the wall. One day in the morning around 8am, it read high, then at 11am it was 34???? Then the 8pm was 114. Obviously, she didnt get insulin that night. She is on Lantus. When I get a reading over 300ish I usually give her a shot (same dose every time 1.5). I did nothing different and this morning was 439, at 11am it was still 439 but I did a spot check at 3pm and it was 504. Why am I getting these DRASTIC jumps? Can someone please help me. She is on wet food only. I feed her 6 small meals a day and NO TREATS. Her food is Fancy Feast classic, which is sapposed to be one of the better ones. (Chicken and Liver) and sometimes chunk light tuna in WATER ONLY. What am I doing wrong???? What else can I do that I am not doing?????? PLEASE HELP

 

[Elizabeth and Bertie]

...One day in the morning around 8am, it read high, then at 11am it was 34???? Then the 8pm was 114. Obviously, she didnt get insulin that night. She is on Lantus. When I get a reading over 300ish I usually give her a shot (same dose every time 1.5). I did nothing different and this morning was 439, at 11am it was still 439 but I did a spot check at 3pm and it was 504.

Hello to you and Mom-Mom, and welcome to FDMB.

I think it's possible that Mom-Mom's blood glucose is dropping too low and then 'bouncing' up high in response to that ('rebounding').

That 34 that you saw is a hypoglycemic number.

When the blood glucose drops too low (either 'hypo low', or, just too low for the cat's current comfort level) the body can respond by getting the liver to release glucose into the system. It can also release counter-regulatory hormones, the purpose of which is to try to keep the blood glucose level high for a time. When those counter-regulatory hormones wear off the cat can respond to insulin again, and the blood glucose will drop; and it may drop too low if the insulin dose is too high.

What dose of insulin are you giving Mom-Mom? (Sorry if I missed that).
Edited to add: Sorry, just saw that you are giving 1.5 units of Lantus.

Take heart, we are here to help.

Eliz

 

[Elizabeth and Bertie]

Hi again,

Have posted a link to your thread in the Lantus forum to try to get some 'Lantus eyes' over here.

 

[KPassa]

Welcome Mom-Mom and Mom-Mom's Caretaker! :YMHUG:

I was using a meter called TRUEtrak until today, I got the Freestyle Lite.

Other users have reported problems with both of these meters reporting feline BGs (Blood Glucose) accurately. If you're in the US, the Walmart ReliOn brand is a popular one around here, especially because the test strips are so cheap (which is where the cost adds up quickly).

I test her in the a.m. 2 hours before breakfast, then again between 11-4, again 12 hours from the 1st shot, and once before bed. I test her keytones daily and they are good.
...When I get a reading over 300ish I usually give her a shot (same dose every time 1.5).

It's great that you're already testing for ketones and that they've been negative. :thumbup What time do you normally give her the shot? Two hours before her breakfast? How often are you giving it? Lantus works best on a consistent dosing scale, twice a day (BID), every 12 hours. There is about a half hour a day of flexibility in shot times, but other than that, you want to remain as tightly to that 12-hour schedule as possible.

Her readings are so off the wall. One day in the morning around 8am, it read high, then at 11am it was 34???? Then the 8pm was 114. Obviously, she didnt get insulin that night. She is on Lantus. I did nothing different and this morning was 439, at 11am it was still 439 but I did a spot check at 3pm and it was 504. Why am I getting these DRASTIC jumps?

34 is considered hypoglycemic and that counts as an automatic dose reduction! You want her to remain above 50. Depending on how you're dosing her (every 12 hours or every time she's over 300??), these swings could either be because the dose is too high or because you're dosing too frequently/inconsistently.

My suggestion would be first to drop her dose down to 1u and, second, to start dosing only every 12 hours apart (if you're not already) as long as her pre-shot number is over 200. If it's under 200, post here first for further advice on what to do next.

ETA: Here is the other thread in the Lantus Forum

 

[Deb & Wink]

Hello and welcome to Mom-Mom and her caregiver. Would you please share your first name with us?

I have a few questions for you. Answers to these may help us to help you better.
1. How much does Mom-mom weigh?
2. What was her diagnosis date?
3. Has the dose of Lantus always been 1.5U (units)?
4. Where do you live?

We have a terrific way to track the BG (blood glucose) levels and units of insulin given. If you would set that up, we could follow along with what is happening with Mom-Mom and make better suggestions on what to do. Instructions for setting up the spreadsheet (SS) are here.

The spreadsheet is one of the best ways for us to see what is going on with your kitty. It only takes a few minutes to set up. Sure hope you will consider setting one up.

 

[BJM]

We suggest using an inexpensive human glucometer with pet-specific reference numbers. One many of us use is the WalMart Relion Confirm, or Confirm Micro, which is also sold at American Diabetes Wholesale as as the Arkray USA Glucocard 01 or 01 Mini (same manufacturer - Arkray USA). It uses a tiny blood droplet and the cost is significantly lower for test strips (like $0.36 each).

Comparing a human glucometer to a pet-specific glucometer is like reading temperature in Celsius vs Fahrenheit. Both are correct. You just need to know the reference ranges to interpret what the numbers mean.

[Glucose reference ranges are unsubstantiated and have been removed by Moderator]

* * * * * * * * * * * * * * *​

Examples of using the chart:

Ex. You are a new insulin user and you test your cat before giving insulin. The test is 300. It probably is safe to give insulin.

Ex. You are an established user of Lantus, following the Tight Regulation protocol. You've tested around +5 to +7 to spot the nadir. It is 200 mg/dL. You probably need to increase the dose, following the instructions for the protocol.

Ex. Your cat is acting funny. The eyes are a bit dilated. You are concerned and test the glucose. The number is 35 mg/dL. ACK! The cat may be in a hypoglycemic state. You quickly follow the HYPO protocol linked in the glucose reference values chart. (which we really, really, suggest you print out and post on your refrigerator.)

 

[Deb & Wink]

Laura sent this to me in a PM. Just wanted to share it with all you folks on the public forum. I removed some personal information.

Deb,
I am very new to this so I am not sure if this is the right way to reply but, to answer your questions. Mom-mom used to weigh 14 pounds about a year ago, the last 6 months she rapidly lost weight. She was probably about 2 pounds when I brang her to the vet. As I said, she had to be force fed there for 6 days,she absolutely refused to eat/drink, but that ended as soon as I got her home, I think, I know she was traumatized there. She has always been an inside cat, and only saw a dog 1 time, and that was a puppy. At the vet he had dogs in all the cages around her barking CONSTANTLY. I know this because I was there every single day to visit with her for about 2 hours or so.

The week I bought her home (3 weeks ago) she was like 2-3 pounds. Now she is approximately 7-8 pounds. She eats about 5 small meals a day and I give her Turkey slices for a treat and NO DRY FOOD anymore at all. She was diagnosed about a month ago.

When I brang her home, I was told by the vet, to only give her 1/2 unit, every 12 hours, and he NEVER mentioned a thing about testing her blood. I just happen to know this because my mom is diabetic but she takes pills. When I first brang her home I was so desperate that I started talking to this guy (name removed for privacy) on a feline diabetes website and he was DEMANDING this one day to give her 2.50U when she was only at 113. I said "No way" so he told me never to contact him again.

Anyway, I live in Radnor, Pennsylvania.

My name is Laura.
Thanks for your interest in my situation, it means the world to me

 

[Deb & Wink]

Laura has set up a SS (spreadsheet) for Mom-mom and entered some recent data.

It's looking to me like the dose may be too high for Mom-mom. You're having to skip too many shots, because the pre-shot readings are too low. That was a very good decision on your part by the way, skipping. For new members, we don't suggest you shoot if the BG (blood glucose) is below 200. As time goes on, and you gather data to see how your cat reacts to a dose, you can lower that shoot/no-shoot threshold. Over in the Lantus TR forum, the shoot/no-shoot threshold is 150.

I actually think you need to lower the dose. We want to find a dose that you can give consistently every 12 hours. With Lantus, it takes time for the full effects of the dose to be seen, 6-10 cycles, a cycle being 12 hours. We dose on the low point, the nadir. If that low ever drops below 50, we also automatically reduce the dose by 0.25U.

Looking at Mom-mom's SS, I see that you got 2 numbers in the 30's. That is too low and puts your cat at risk. We consider 50 to be low enough, leaving a margin of safety for your cat. If the BG's drop into the 40's, we say "feed the 40's", meaning get some food into your cat to get those blood glucose numbers up. Those 2 low's in the 30's also earned Mom-mom an automatic reduction according to the protocol we use.

I think 3 things are going on with Mom-mom.
1. Dose is too high. I'd suggest reducing it to 1.0U. It's easy to increase the dose if we need to. Once the insulin is in your cat, you can't take it back out again. "Better too high for a day than too low for a moment.
2. Bouncing. Mom-mom is having some wicked bouncing going on. When she drops too low, her body is compensating by dumping glucogen and compensatory hormones into her system to try and raise those BG levels back to a safe level. A bounce can take 6 cycles or 72 hours to clear. Patience here is key.
3. Inconsistency in dosing. You had to skip some doses because the pre-shot BG readings were just too low and it looks like you were changing the doses to try and compensate for the pre-shot numbers you were seeing. We don't dose Lantus based on the pre-shot numbers. I think if you can hold a lower insulin dose steady for at least 6 cycles, maybe longer, you'll see a big improvement in Mom-mom's BG readings.

Keep getting those pre-shot tests in. They are so important, as you have seen.

Please, make sure you have a hypo toolkit (some high carb gravy type wet food, syrup, lots of test strips) put together and print out these hypo instructions just in case. Whenever you get a really low number like that, you want to bring it up to keep your cat from having seizures. Most people on this board can help you in a situation like that, so if it happens again, post here and put that 911 icon on your post. That 911 icon needs to be on the very first post in the topic, so either start a new topic, or go back and edit your very first post in the topic and slap on that emergency 911 icon. If you are not getting a response here in the Feline Health forum, try posting over in the ISG (Insulin Support Group) for Lantus Tight Regulation ( affectionately known as Lantus TR). That is the other very active forum here and lots of experienced users there to help out in a sticky situation like a hypo.

ETA: Laura also has another post going over in Lantus TR forum, here.

 

[Mom-Mom]

She started out hi, went to 285 at 11:30, then 374 at 3:00, now shes 436 at 6pm. She doesn't get her shot until 8pm. Should I still go down to 0.25????

 

[BJM]

YES.

Lantus has a cumulative effect. It builds up over several doses. You have to be cautious and patient.