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dpaslean

dpaslean

Member Since 2014
On Feb 17, my 14 yr. old cat was diagnosed with diabetes at 437. I have always fed him wet food 2x/day and supplemented with dry food. When I started reading up on diabetes on Lisa Piersons site and read about the dangers of dry food, I stopped giving it on Feb 12. Anyway, my vet told me start him on Lantus at 2 units 2x per day. I started him the next morning. At the time I didn't have a meter to test and my vet wasn't too worried. I was able to borrow a Freestyle the next day and began testing not knowing that unit wasn't accurate. I kept testing and getting lower numbers. On Feb 23, I purchased a Relion Prime and found the readings to be 40 higher than the Freestyle. Eight days after diagnosis, my vet wanted me to bring him in for a urinalysis. I took in my meter to compare to theirs. I picked him up at the end of the day and she told me that she tested the BG at 9:00 and it was 119 with my Relion, 184 with her IPet and her blood machine was 198. At the time, I didn't know the reading difference between human meters and animal meters. She told me my meter was off and I should add 70 pts. to my readings. Since then, I learned to fill out your spreadsheet but I always added 70. It didn't make any sense that the unit could be so far off but why would I question the "expert"? I started reading this forum and the more I learned, the more I figured my readings were wrong. When I tested my own BG, I got readings 90-100. I then ordered the control solution from Relion but when I found it took over 2 weeks to get it, I ordered the Arkray Vital meter (with solution) from ADW. It came today. Comparing both meters with the solution I found they both read 108. Hopefully my SS will show here and you can see my readings. Up until today, I put in numbers with the 70 included. Today, I adjusted them to the real readings by subtracting the 70. I now see a lot of green and I realized that I had caused my cat to give some real low numbers. I was observing close and not one time did I see any hypo signs. I and he was probably lucky.
So now that I have been giving him 1.5 units 2x/day and today started reducing, what should be my future strategy? I believe I might have been overdosing so should I gradually reduce and see what happens.
Thanks for every ones help. I have been reading here for a couple of weeks and have learned a lot.

Dwight
 
Hi Dwight and Welcome to the FDMB! We'd love to know the name of your sugarcat too!!

First, good for you for switching to wet food. Hopefully you're also feeding low carb varieties! Just in case you haven't seen this already, here's the Food chart we use to make sure we're feeding under 10% carbs (column C)

You do need to go to your spreadsheet and change the permissions to "Anyone with the link" so we can see it. Just go to the top right corner and click on "Share", and then change it to "anyone with the link", and then save it. Right now we can't see it.

When you get that done, maybe we can see how your kitty has been doing and offer you some advice!
 
That's better, and WOW!!! Good thing you questioned it!! Looks like your kitty is responding REALLY well and you're very lucky you didn't have any problems with hypoglycemia since those are some really great, and even a little low at times, numbers!

It's possible that just the diet change may have been enough, but now that you're here, let's go "by the book" and make him/her "earn" the reductions.

My first thought would be you need to drop back to maybe .5 unit every 12 hours and see what numbers you get. It's important for you to try to get some mid-cycle numbers in the AM cycle, but we understand if work prevents that. If you can get tests on your way out the door or on your way in it'll help. On weekends maybe you can get more tests on the AM cycle.

Usually we tell new members not to shoot under 200 until they know how their cat reacts, but you've been routinely shooting lower numbers, so if you get a pre-shot over 100, and will drop back to .5, I think it might be OK, but hopefully some others will chime in soon too.

Is dropping back to .5 unit twice a day something you'd be willing to try? We'd hold that dose for at least 6 cycles unless they drop below 50, and then we'd want to go even lower.
 
OK. Hopefully you can read it now. His name is Boots. I might get a picture up tomorrow if I get some time.
There is a lot of green on the sheet so I think he is doing really good but as you can see there are some low numbers. Please let me know what you think as to whether I should be easing back or what.
As for food, he has some other issues like a BUN of 44 and creatinine of 2.4 so I have been watching for low phosphorous foods and have been sticking with the Friskies Spec. Turk & Gibs. My vet wants me to come back in 6 weeks for another check up.
It's late here so I'll be back to check in in 6 hours and update my chart with the AMPS number.
Thanks for setting me straight on the SS.
Dwight
 
I have no problem moving down to .5 unit. I will do his AMPS 6 hours from now so I can start then if you think it's time. Currently, I am gone M-F during the day but have been doing AM tests on Sat. and Sun. I will be testing this Sat and Sun also.

I will check back later.

I appreciate your input Chris so thanks again.
 
The Friskies is a good choice. It's both low carb and low phosphorus. We have a lot of cats eating it here with the same types of problems as Boots.

I think we probably cross posted, so in answer to your question, yes, I think you should probably drop back to .5 and then let's see what kinds of numbers you get.

Is there any chance you can get more tests in during the AM cycle? (I had to start getting up at 6 so I could get at least a +2 in..I hate mornings!!) Any tests you can get will be helpful.

Maybe as soon as you walk in the door? I'm just throwing out ideas since I don't know your work schedule.
 
His AM shot has always been at 6:30 est. and I leave for work an hour later so I can't do AM tests until tomorrow (Sat). Because of this I only reduced to about .75. I don't expect any numbers below 50 through the day so he will be OK. Tonight I will be able to test more often as well as Sat & Sun.

Thanks again.
 
OK, we'll figure it out!

Now that you've given the .75, you'll want to continue with that dose for at least 6-10 cycles (3-5 days) so we can really see how the dose is doing on Boots. Lantus needs to be consistently dosed to work it's best, so we want to give the same amount each time unless Boots drops below 50

Surf safely for your daddy, Boots!
 
Dwight

Chris asked me to pop over from the Lantus Tight Regulation forum and take a look at Boots' SS. First, you've done a great job by getting rid of the dry and finding a meter that was giving you an accurate reflection of his BG. Well done you!!!

I agree with Chris that it looks like he's actually earned enough reductions to be on the 0.5u dose. I could see trying him at 0.75u except you can't be there to test him during the day. While some cats' daytime cycles look like their nighttime cycles, many don't. I don't think I would have made the assumption that he would stay above 50 during the day.

Lantus is a depot insulin which means each shot builds cumulatively upon the previous one. At some point when the depot is full, the numbers drop...as you've seen. When a newly diagnosed cat drops below 50, a dose reduction is earned. Some of Boots' earned reductions were so close together that we probably wouldn't have dropped the dose back for every single below 50 he got. But I suspect he might go lower than 50 during the day.

Since it's Friday, and you shot 0.75u, and I'm assuming you'll be home to test him this evening and this weekend, I'd also just leave the dose for now and when he drops below 50, reduce the next shot to 0.5u. You might definitely want to get more spot checks during the day such as a +2 and a +6 at the very least. If the +2 is similar to or lower than the Preshot, you might want to grab a test before +6.

Last thing.....with Lantus and the other depot insulin, levemir, we dose for the nadir not the preshot. I don't know if seeing they blue PS this morning made you think he was trending higher and so he needed more than 0.5u. Seems logical but not if you know how the insulin works. Typically, the AMPS (the morning PS) would be the highest number of the day in a regulated cat like Boots.

Great job!!! Let us know how we can help.
 
Thanks to you both for the assistance. I knew I came to the right place.
Marje, I think the only reason that I dropped to .75 was that I had read where you shouldn't reduce so fast and reduce at .25 increments. Being that only a few days ago he was getting 1.5 and as of yesterday down to 1.0, I was thinking I should go slow in the reduction process. Because he got .75 this AM, you don't think he could move down to the .5 that you and Chris suggest as early as tonight? If not, I can keep the .75 and monitor closely until his Mon. AMPS before I need to go back to work. I would certainly like to be giving him only .5 instead and certainly like to be at 0 here shortly.
 
You can safely reduce the dose as much as you like. When increasing, we only go in .25 unit increments

At this point, it's kind of a guessing game since Boots is doing so well as to what dose to recommend. I think I'd still drop to .5 and see what kind of numbers that gives Boots.

If the .5 ends up not being enough, you could go back to .75, but whatever dose you decide on, you need to keep it the same for at least 6 cycles. If he dropped below 50, he'd "earn" a reduction, no matter what dose he was on. Otherwise you just hold the dose for at least 6 cycles and then we re-evaluate if it needs to be more.

If Boots can stay in "normal" numbers (50-120) for 7 days, we'd reduce him to .25 and start over. If he continued in normal numbers another 7 days, you'd drop to .1 unit, etc.. until he was (hopefully) off the juice (OTJ) completely.

Cats "earn" reductions one of two ways...either by dropping under 50 or by maintaining normal numbers for 7 days. The goal is to have them in normal numbers as much as possible on the lowest dose possible.

As much as I know it might be hard on you, you might also want to consider getting up early enough to get Boots tested/fed/shot and still be able to get a +2 before you have to leave for work. That +2 is a really important test, because if it's lower than the Pre-shot test, that's an "early warning" that he might be going lower during that cycle, and you'd either want to get more tests in, or make sure he has food available to him later in the cycle so he can eat if he drops too low. Most cats get really hungry if their blood glucose drops too low, so if it looks like he might be going too low later and you're unable to test, it's important he has access to food.

Of course if changing his schedule back means you can't be home in time to give the PM dose 12 hours later, we'll have to figure out something else.

Our main concern is keeping Boots safe. We sure don't want you to come home to a tragedy.

He's doing really great for so early in the process, so he may very well be one of the very lucky cats that can go OTJ quickly after only a short time on insulin and the change to low carb food :mrgreen:
 
Dwight
Marje, I think the only reason that I dropped to .75 was that I had read where you shouldn't reduce so fast and reduce at .25 increments. Being that only a few days ago he was getting 1.5 and as of yesterday down to 1.0, I was thinking I should go slow in the reduction process. Because he got .75 this AM, you don't think he could move down to the .5 that you and Chris suggest as early as tonight? If not, I can keep the .75 and monitor closely until his Mon. AMPS before I need to go back to work. I would certainly like to be giving him only .5 instead and certainly like to be at 0 here shortly.
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What you say is true provided the kitty was started at the correct dose and then went up the scale slowly according to the TR protocol and no major changes were made (like eliminating dry food). So we have different circumstances with Boots and it appears he was earning reductions pretty quickly. Our goal now is to keep him safe.

It's your decision whether to hold the dose or reduce it to .5u. IMHO, unless there is something that blatantly tells me a dose is too much, once it is reduced and if the caregiver can monitor, I would tend to hold the dose for consistency's sake until kitty earns another reduction by going below 50 or staying in normal numbers (50-120 but we like to see more time below 100) for a week.
 
At this point, it's kind of a guessing game since Boots is doing so well as to what dose to recommend. I think I'd still drop to .5 and see what kind of numbers that gives Boots.
If the .5 ends up not being enough, you could go back to .75, but whatever dose you decide on, you need to keep it the same for at least 6 cycles. If he dropped below 50, he'd "earn" a reduction, no matter what dose he was on. Otherwise you just hold the dose for at least 6 cycles and then we re-evaluate if it needs to be more.
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It's your decision whether to hold the dose or reduce it to .5u.
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OK. I will follow the recommendation you both give and reduce to .5 tonight and monitor for the next 6 hours.

As much as I know it might be hard on you, you might also want to consider getting up early enough to get Boots tested/fed/shot and still be able to get a +2 before you have to leave for work. That +2 is a really important test, because if it's lower than the Pre-shot test, that's an "early warning" that he might be going lower during that cycle, and you'd either want to get more tests in, or make sure he has food available to him later in the cycle so he can eat if he drops too low.
Of course if changing his schedule back means you can't be home in time to give the PM dose 12 hours later, we'll have to figure out something else
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At the moment, I could probably test, feed, and shoot an hour earlier at 5:30 AM and get a +2 in before I leave but my work schedule will be changing the week of 3/31. Then my hours increase to 9.5 hrs. with an hour drive each way. So that puts me at being away for about 12 hrs. So if you think it's worth it for 2 more weeks then I will do it. If not, I will leave it as it is (test, feed, shoot, 6:30 AM/PM EST)
 
As great as his numbers are, in 2 weeks he may be very close to being off the insulin completely

If his numbers stay in the normal range on .5 unit for 1 week, you'd be going to .25 for a week and at that point, it wouldn't be as important to get all those tests in.

We just want Boots to be safe, and getting a +2 is like a "crystal ball" into where he might go later in the cycle when you're at work.
 
OK. Sounds great. I will test tonight, tomorrow, and Sunday and we'll see how things progress.

Thanks again.
 
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. Please share this with your vet, too.

[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.)
 
I wasn't recommending dropping the dose down after reading you shot 0.75u this morning. ;-) I said it was your decision but IMHO since you can monitor, I'd hold the dose for now and get some tests and then reduce if he earns it. If you can't monitor then, yes, reducing is likely smart.
 
I'm glad I reduced to .5. His PMPS was 118, and after a .5 unit dose, +2 was 61 and +3 was 47. I was going to wait until +4 to test but with a 61 I decided to do a +3. Please advise.

Thanks BJM for that post. I have seen it before and have read it a few times to make sure I understand it.
 
When they drop below 50, you want to "Feed the 40's"

Give him a teaspoon of his regular food and retest in 15-20 minutes. If he drops or doesn't go above 50, you'd want to give him either a teaspoon of the "gravy" off of a Gravy Lovers food (or something higher carb) or add a couple of drops of honey, syrup or Karo into his regular food

you want to keep testing every 15-20 minutes until he's at least in the 60's and staying there without being fed more. You want to keep testing for at least 2 hours after the last food to make sure they're going to stay up
 
dpaslean said:
...Thanks BJM for that post. I have seen it before and have read it a few times to make sure I understand it.
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Your vet, however, has not. Might be worth sharing.
 
+3.5 still 47. Fed a couple of spoonfuls of his normal food. +4 up to 56. I'll continue to test for a couple more hours.
Hadn't heard of the term "feed the 40's".

Thanks Chris.

Your vet, however, has not. Might be worth sharing.
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True. When I got her list of recommended prescription diabetic foods to feed....I knew I'd better start learning this stuff on my own. And that is why I'm here.
 
Feed the 40's is one of the sayings you'll hear here. When it comes to those drops below 50, it's always good to know what to do, and it makes it easier to remember.

I think since Boots went below 50 on the .5, you could make a very good case for dropping it to .25 tomorrow, but since he's been on higher doses, it's also very possible that the reason he dropped was because of the "depot".

With lantus, only part of each shot goes to work quickly and the rest goes "in the depot"...that's why you always hold a dose for at least 6 cycles, so by the end of that 6 cycles, you're seeing the true effects of that dose.

Since you gave .75 this morning, plus even higher doses the last few cycles, his "depot" is overfull, and so it could very well be causing the low tonight, not the .5 you gave.

As long as you're going to be home tomorrow, have plenty of strips and high carb food, you could probably shoot the .5 again and just see how he does, BUT only if you have those things and can test!
Also, if you keep having to feed him tonight to keep him over 50 (have to "work hard to keep him up above 50) you'd probably be better to go ahead and reduce to .25 tomorrow morning.
 
Thanks for the thorough explanation. I'll see how the next hour or two plays out and then decide for tomorrow.
The +4.5 dropped back to 51 so I'll check again in a few minutes.

I've got plenty of strips and time and a couple cans of Friskies TT in Sauce so I'm set.
 
Just a quick note

If you need help, it's always best to go to your first post and "edit" the subject line. If you say something like "Under 50, help!" or "Advice needed please" it will help those that scan the forum see that you're needing help or advice.

If it's an emergency (and going below 50 is considered an emergency), use the 911 icon. It will get you the quickest help. Once someone is helping you, you can take it down again. We promise people that if we start with you, we won't leave you unless we find someone else who can stay with you until the "crisis" is over.

If you have a general question, using the ? icon on that first post will help show people that your post has a question in it.

Since you're testing, and have your spreadsheet set up, I think it'd be best for you to go over to the Lantus Tight Regulation Forum. There you'll get the most experienced Lantus users helping you. You can also continue here on the Health board if you like.

On the Lantus board, each day we start a new post (we call them condo's) with the date, cat's name and the AMPS number. As the day goes on and you get more tests, you can edit that first subject line and add the new test results. For example, today's condo for China has 3/14 China AMPS 216,+4 139,+8 71,PMPS 110,+3 153

In the body of the post, you'd give the WCR (Whole cat report). How Boots is feeling, how's his appetite, are the 5 "P's" in place? (Purring, playing, preening, peeing and pooping) along with anything else you feel might help people get to know Boots better. You can also ask questions here. When you have time, it's a big help to read other people's condo's too, since that may bring up questions you hadn't even thought of to ask.

You also want to put the link to the prior post in the body of the new one, so it's easy for people to go back and see what was said earlier. Just copy the link, click on the URL tab, and "paste" it.

I'll continue to watch for you here tonight if you don't want to move over tonight. If you decide to move, just say you're posting over in Lantus Land!
 
His +5 jumped up to 68 so if the +5.5 is this or higher do you think it will be fine to stop testing or continue awhile longer? Looking at his SS, his PM numbers seem to bottom out at +4 if not a little before and go up from there....or at least stabilize.

If it turns out that the danger has passed should I continue to post here tomorrow or move over to the TR forum?
 
When was the last time you gave him any food?

You want to test every 15-30 minutes for at least the first hour after they're in the 60's and then if he stays up, you can back it up to every 30 for the last hour...that way you've got 2 hours past the last food and he's still in at least the 60's or rising. As close as he likes to be to 50, I'd rather be safe than sorry. I'd like to see him into the 70's without being fed for 2 hours before I'd feel comfortable calling it a night (but I'd probably still set an alarm and get a later test just to be safe...but I can't sleep well if I'm concerned about China)

In the morning, I'd suggests you go ahead and move over to the Lantus board. Remember to put the link to this thread into the body of your condo for the day so people can quickly go back and see what you've already been through
 
Hi Dwight!

Chris sent me a message and asked if i'd check in on you. she's gotta be gone for a few minutes. i want to read up on your post and see what's going on.

are you doing ok?

julie
 
Thanks Julie. I was just getting ready to submit this when I seen you pop up.
Everything has been getting better and I was thinking about turning in since his AMPS are at 6:30 AM EST and it's been a long day. Chris had asked when I fed last so here it is.

I fed him 1 to 1.25 ounces at 10 PM (+3.5). At +5 he was at 68 and just now 2 hrs. later at +5.5 up to 80. I think we are good now.

I'll be up in 6 hours to get ready for his AMPS. What do you think for the AM? .5? a skinny .5? or drop to a .25?
 
i'm not sure on the dose. let me think out loud here.

first, are you around tomorrow and able to monitor?

because Lantus is a depot-insulin, meaning that it builds up in the body and slow releases, we can see the effects of a previous dose for as many as 6 cycles after the dose is reduced. so my gut feeling is that the numbers you've had tonight are from the previous doses.

i think i'd stick with the 0.5u because of that. however, if you're not going to be home to monitor, i'd reduce again to 0.25u or skip if you've got a low preshot number, say under 150. i have the feeling Boots doesn't want insulin for very long. ;-) :-D
 
oh, and for tonight, i do think you're good to call it a night.

if you're at all concerned, leave out low carb canned food so boots can have a snack. many cats will eat if they feel their blood sugar going lower.
 
Hey Dwight!!

I agree with Julie...Looks like you're past the hump tonight and it's fine for you to go to bed. Leaving a little food out won't hurt Boots either.

Since you're going to be home to test tomorrow, and have all the supplies you need, let's hold the .5 dose and see how he does. He may very well earn a reduction sooner rather than later!!

You've done great tonight, and I hope to see you over in Lantus Land tomorrow!
 
so my gut feeling is that the numbers you've had tonight are from the previous doses.
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I would agree since it has only been a couple of days since he was up at 1.5 units.

first, are you around tomorrow and able to monitor?
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Yes, I am home all day tomorrow and Sunday to further dial this in.

Anyway, thanks for your help.

Chris, I see your back. Thanks for devoting so much time today. I really appreciate it.
I'll be up in a few hours and we'll start it over again. I hope we're making progress.
 
Hi and welcome! Great job on getting everything set up and testing and steering his low numbers into a safer range. I just wanted to interject really quick that you might see much higher numbers tomorrow as a result of him going low today (we call it a "bounce"). If that's the case, resist the urge to give more insulin and stick with the .5 or .25u (whichever you decide to give). Bounces can also take a couple of days to clear, so don't worry too much if his numbers seem higher; just hold the dose steady and wait it out.
 
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