Very high numbers to very low numbers - sick cat advice

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CharlieBoy&mama

CharlieBoy&mama

Member Since 2013
My Charlie has been on lantus for about a month and a half. All was going fairly well until last Thursday when I came home to find him wandering around in circles, tested him, and got a number of 29. I gave him honey and he seemed alright until Monday evening when he did not eat much food. Tuesday morning he was not posted up in his usual spot in the hall waiting to run into the kitchen, but laying beneath the table in the bedroom. I tested his blood sugar and it was high (I believe in the 400's). I gave him 2 units of Lantus and went to work. When I came home, he had thrown up a lot of bile in the bathroom and I found him wobbling his way to the litter box. He had hardly eaten any food during the day. Once again, his sugar was at 29. I rushed him to the vet out of fear yesterday and the vet advised that he may only need one 1.5 unit dose of Lantus in the morning and that his body did not require a second dose, and that his blood glucose is all out of whack and that is why he was feeling so bad. When we got home, Charlie went right under the bed, a place he had never visited before. This morning I tested his bg and it was "high". He did not want to eat any food and did not want to walk around. I took him to the vet again where they held him today for observation. They did testing and he has a uti so he got antibiotics. The vet said that this could be causing his bg to be all over the place, as well as his body reacting to low low low numbers and high high high numbers. He did not have any ketones in his urine. Tonight he did eat a some food and I took his bg and it said 25 so once again I gave him honey. He got his insulin today at about 11am at the vet and has not had any more. Has anybody else had experience with these bouncing numbers? If so, how long until it was somewhat regulated again? This is breaking my heart!!! THANK YOU!!!
 
Hi there:) I'm sorry you are having such a stressful time! The high numbers are something many members see, called a bounce, the liver reacting to the sudden low numbers and panicking by bouncing up. It sounds like your Charlie needs a much lower dose of Lantus, I think most members here start out at 1 unit or less depending on the cat's weight and glucose numbers. Cats should be dosed every 12 hours. Are you feeding all wet food, dry food? I'll post a note on the Lantus board to see if anyone can come take a look at your post.

Meanwhile, I'm not sure if you have it already but in case you want some links to read about Lantus and dosing, read the messages called "sticky" near the top of the page:) I've put the link for it here: http://www.felinediabetes.com/FDMB/viewforum.php?f=9

I know how heartbreaking it is, you are wonderful for doing this for your kitty!
 
once a cat has had a symptomatic hypo, they can become very sensitive to insulin.

good job on hometesting - that is the ticket to keeping him safe. Data is everything. The data will tell us what to do with his dose.

cats have a very fast metabolism and they need their insulin given twice a day - Lantus is dosed 12 hrs apart in cats. that evens out their blood sugar and helps them feel better.

can you give us some more info - what are you feeding and how big is Charlie (how much does he weigh)? Is he taking antibiotics for the infection?

can you start a spreadsheet so we can see the numbers laid out? it tells us the story of what's going on. here is the link - set it so that "anyone with the link" can look at it.

spreadsheet template

New to the Group sticky

Please get the spreadsheet going as best as you can, take a look at the New to the Group sticky, and then post in the Lantus Tight Regulation Forum http://www.felinediabetes.com/FDMB/viewforum.php?f=9. There are people on there nearly 24 hrs/day. Just post something like "new, need help with dose" in your subject line and someone will help you get started. With an infection going on, you don't want to let his BGs go untreated, but it's also important to not have another hypo.

Hang in there - you've found the right place. people here live & breathe Feline Diabetes and have the most experience possible. We'll teach you how to get Charlie back on his feet.
 
I agree with Julie. Cats can become super sensitive to insulin once they've had a symptomatic hypo.
If you could gather what data you have and make a spreadsheet, that will help us and you to make dosing decisions.
It may be that your kitty only needs 1 unit or even .5 units twice day.

I hope you will keep posting so that we can help you and your cat. Those twenties are scary.
 
Wow, you've been through the wringer!

When they become ill and the appetite is off, or there is vomiting or diarrhea, it can wreak havoc with the glucose levels.com If you're able to spot check in the +5 to +7 hours post-shot, that is when it is likely to be lowest. Since he's been having those issues, I'd definitely lower the dose to protect him from further hypo events.

For future reference, here is a protocol for handling hypos that we follow.
 
https://docs.google.com/spreadsheet/pub ... utput=html
There is my spread sheet, I tried to fill it in the best that I could as far at the dosage info. I will NOW start keeping track of this. Today he seems to be feeling better. His bg was 283!! I have never been so happy to have a high number that isn't "high". He is now on antibiotics for his UTI. I have been feeding him 9 lives super supper. The other day when I was at the vet I did get him some of the Purina diabetic wet food. He didn't seem to want to eat much since he hasn't been feeling well so I have been giving him the 9 lives. I woke up this morning to see that he had eaten some food through the night! I hope he pulls through! I started this whole mess, I fear, by giving him 2 units when he was in the 60's. I NOW KNOW DO NOT DO THIS!! Does anybody have any advice on giving injections? I have tried pulling the fur a little tight, doing the tent thing, and once again today I had a fur shot. It goes all the way through the skin. Thank you everybody for your advice and encouragement!
 
If you are using U-100 syringes, yes, they do.

Browse syringes at our shopping partner ADW at the link on the top of the page
 
Sorry to hear about Charlie but I am glad he pulled through

Heres my recommendations

1. testing - I usually recommend 3-4 tests a day

- always before the shot - this is mandatory as you don't want to shoot when too low. As a newbie this too low number is 200 but is reduced over time once you have the data to know if its safe.
- mid cycle - 5-7 hours after morning shot depending on your schedule. This is to see how low he is going. The low point "nadir" is what you base dose changes on since you don't want him dropping too low (under 50).
- before bed (2-3hours after Pm shot) to get an idea of what his overnight plans are. If this number is less than the pre shot test number you may want to set the alarm for a test a few hours later as this implies an active cycle.

2. I would reduce the dose for now to 1 unit. You want to find a dose right now you can give twice a day. Dont shoot under 200 for now.

and keep us updated every few days, that way we can see how the dose is doing.


Wendy
 
hi gina! great job on getting the spreadsheet together. it really helps to see the numbers laid out like that.

i think your 1.5u dose once a day is too high. here's why. lantus acts for about 12 hrs in a cat's body. it's lowpoint (or nadir) is somewhere 3-8 hrs after the shot, typically. not always, and one cat can be different from one cycle to the next. but when i see a HI on 9/25 after no insulin the night before, then a 25 15 hrs or so later - that is enough for me to stand up like this: :shock:

even that 104 tonight after a 307 this morning - each of these tells us that the dose is likely too high, and then it's wearing off by evening and the blood sugar is soaring again by morning.

our goal is to get a cat's blood sugar evened out as much as possible, and ideally, below 200ish so that their kidney's aren't being damaged by the high blood sugar. the path to that goal is to have 2 shots per day of a dose low enough that charlie's not dropping into 20's, which are literally life-threatening numbers.

now that you've got the spreadsheet, can i get you to post over in the Lantus Insulin support forum so people can give you help on the dose? as dyana & i said, a cat who has had a symptomatic hypo is more sensitive to insulin. we really want to keep your little guy safe! i'd probably drop to either .25units or .5 units twice a day - so significantly dropping the total amount of insulin. it is safer to work UP to a good dose while you are learning how to monitor him than to have the dose be in danger of being too large and trying to work DOWN. when you're more comfy with all of this, it's not hard to work down, but while learning it's much safer to not try to do that.

what i would not do is continue to give him the one dose of 1.5u once a day. it's too high. really. knowing what i know about diabetic cats, this makes me nervous. we don't want anything to happen to charlie!

Don't be intimidated by the subject lines or the lingo - i know i was - it's just a way for us to keep track of a large number of cats at a glance. we look at subject lines and can easily see who is in need of advice. go ahead and post - it's the busiest forum and the folks there know lantus inside and out. we'll teach you one step at a time so it's not overwhelming.

you can post on the Lantus forum and in the subject line, just put "new member needs help with dose." or anything like that. people will look for you right away.

oh yeah, and to shoot the insulin - grab a nice big hunk off the scruff area, lift it away from the spine. i can usually get quite a bit up away from the body. put the syringe near the head, facing the needle toward the tail and insert the needle straight back, parallel to the spine, into the area you lifted up.

as you get experienced, you can move the shots to different areas, but this is probably the easiest to start on. i always shot punkin while his face was in his bowl. i'm right handed, so i came along his right side facing him, lifted the scruff with my left and shot with my right.

here is a slide show from BD (syringe brand) that shows how to shoot. the link for it is located on the "new to the group" yellow starred sticky on the Lantus TR insulin support group.

How to shoot a cat with insulin
Lantus & Levemir - New to the Group?
Lantus (Glargine) Tight Regulation Insulin Support Group
 
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