Advice Needed - Cat's Glucose dropped over 250 points overnight - what to do?

Hello all, my cat Benny who is 12 has just been diagnosed with diabetes. I hope you can provide some insight, as I'm incredibly overwhelmed and confused with all the new information.

I have been giving him Vetsulin injections twice a day (around 7 am and 7 pm) since last Wednesday (Sept. 13). My vet started me with 1 unit every 12 hours. She told me to check his glucose levels twice a week. I bought the AlphaTrak monitor and checked a couple of times. It was 358 on Wednesday night (before the very first injection) and then 417 on Saturday morning. On Sunday morning I measured his glucose again before food and his insulin shot, and it was 480! I gave him 1 unit of insulin at 7 am. Then, around 3 pm on Sunday he threw up and I checked his glucose again - it was 450. I consulted my vet on what to do and she advised I increase his insulin dose to 1.5 units and administer it as usual that evening. So, I gave him 1.5 units on Sunday night (yesterday) at 7 pm.

This morning I woke up with this nagging feeling that I need to check his glucose before his morning shot. I am glad I did because his glucose in the morning was 193 (before food). My vet suggested I give him 1 unit of insulin after he eats. However, after reading some of the threads here, I was concerned about giving him any insulin since his glucose number was below 200 and had dropped 257 points overnight. I haven't done a glucose curve for him yet, so I was afraid there was a chance his glucose would go really low. There's no one at home with him during the day, and I'm terrified of him becoming hypoglycemic. I am so incredibly worried and I hope someone can offer insight on why his glucose might have dropped so suddenly. Since I didn't give him any insulin in the morning, is it likely to go up significantly during the day today? Should I continue giving him 1 unit of insulin or change it based on the glucose number I get tonight?

Thank you for any help in advance!

 

Hello and welcome!

Good instincts on not shooting this morning, since you wouldn't be able to monitor today. Skipping shots isn't ideal-- the goal is to find the right 2x/day dose for your cat-- but the prime concern is safety, so that was the right move today!

I don't want to try to give really specific advice on the dose, both because you don't have a ton of BG data yet and because I am not a Vetsulin expert, but I would guess that the 1.5 was a bit high for Benny right now. We often move doses in increments of 0.25U, because with an animal as small as a cat, even just that little bit can make a big difference (as you discovered!).

He may indeed go higher today, not just because of the skipped shot but also because he might "bounce" from the unfamiliar (to him) lower BG last night after the 1.5U. He may have gone even lower than the 193 (in fact, he almost certainly did-- Vetsulin is at peak action 4-6 hrs post-shot, I think). So don't be alarmed if you see a really high number. Hopefully some of the Vetsulin people will be around before then to help guide you on dosing.

Just in general terms, the best thing you can do for Benny going forward is to keep monitoring his BG and his response to the insulin. If you aren't home during the day, getting some tests during the nighttime cycle can be really helpful. Once you get a better idea of his patterns, it gets a lot easier (and less nerve-wracking!).

A couple of questions to help others who might have some advice: what kind of food does Benny eat, and have you changed his food recently? When he was diagnosed, did he have ketones or a DKA diagnosis? Has he recently gotten any kind of steroid treatment? Any other health issues (kidney disease, heart problems)?

Welcome again!

 

Welcome! Nan has given good feedback. Here's the testing schedule we recommend:

Here's how to approach finding the good dose range:

1. test every day AM and PM before feeding and injecting (no food at least 2 hours before) to see if the planned dose is safe
2. test at least once near mid cycle or at bedtime daily to see how low the BG goes
3. do extra tests on days off to fill in the response picture
4. if indicated by consistently high numbers, increase the dose by no more than 0.25 u at a time so you don't accidentally go right past a good dose
5. post here for advice whenever you're confused or unsure of what to do.

Many people who work away from home through the week get evening tests and extras on the weekends to fill in the gaps.

 

Hi Nan & Kris,

Thanks so much for your responses!

I'm using the VetPen that comes with Vetsulin which goes in increments of 0.5, so unfortunately I can't increase the dose by only .25 units. Benny is a bigger cat - close to 20 pounds, so I wonder if that makes a difference. It's just strange that 1U didn't make a difference and in fact his glucose kept increasing, but an addition of just 0.5U made such a huge difference.

I guess my vet's reasoning this morning was that his glucose would increase after I fed him, and it would be high enough for a 1U dose of insulin. This is one of the things that's confusing me. Should the insulin dose be based on his glucose reading BEFORE or AFTER he eats, as it's sure to increase after food consumption? I've been measuring his glucose before giving him any food. What's considered too low for insulin administration - 200 or below?

Also, this may be a dumb question, but when you say test "mid-cycle" does that mean 6 hours after giving insulin? I'm assuming if I'm giving insulin once every 12 hours, mid-cycle would be at the 6 hour mark, is that right?

To answer your questions:
1) Benny used to eat both dry and wet food. I've taken him completely off of his Science Diet dry food as soon as he got diagnosed and right now I'm giving him two 3-oz cans of Fancy Feast a day (regular, flaked or chunky). The vet also prescribed Purina DM dry food and recommended I give him no more than 1/4 of a cup a day. I actually just take a few kibbles (which are tiny), crush them and sprinkle on his food, as that makes him finish his meals. So, he gets practically no carbs now. So, yes the change in the diet is recent - about 2 weeks.

2) When he was diagnosed, the vet said he did have glucose in his urine. His lab results show trace amounts of urine ketones but don't give an actual value.

3) No steroid treatments.

4) The vet did a full exam and said there were no other issues. He's never had any health issues before.

Thanks,
Margarita

 

Hmm. The change in food can have a big impact on blood glucose and insulin needs, and it's possible that he may be getting different amounts of carbs each day depending on much of the DM he's nibbling on (it is higher in carbs than the Fancy Feast).

Very glad to hear that there are no other health issues-- that makes things much easier going forward!

To answer your questions: use the before-food test to make the decision about dose, but (especially with Vetsulin), don't shoot until Benny has eaten. When just starting out, 200 is a good no-shoot cutoff (as you get more information you can adjust downwards). Another thing you can do if you get a number like this mornings, if you have some flexibility in your schedule, is to stall-- don't shoot, don't feed, post for help and test again in 30 minutes.

"Mid-cycle" is any time between shots. Because we're all in different time zones around here, we use a shorthand of +1, +2, etc., meaning 1 hr post-shot, 2hrs post-shot, etc. Tonight, if you can, I'd recommend getting a test around +2 or +3, to start to "fill in the blanks" on what the insulin is doing for him.

How long until you are due to shoot tonight?

 

Thanks, Nan!
I was going to shoot around 7 pm, so about now, as soon as he finishes eating. I just checked his glucose, and as I suspected, it jumped to 427. My vet is suggesting that if he's eating well to give him 1.5 units. Since I'll be home, I can check his BG a couple of times during the nightsand I guess if it gets too low, I can give him some more food. Any thoughts on that?

 

With the AlphaTrak meter I would suggest raising the no shoot number to 225 to 250 until you get some more data. The 200 cut off is used with human meters which generally read lower than the AlphaTrak. Insulin dosing should be based on pre-shot numbers as well as how low a dose takes the BG. That is why it's important to get mid cycle tests. The lowest point in each 12 hour cycle is called the nadir and with Vetsulin, it generally occurs between +4 and +6 post shot. Nadirs are not the same every day so randomly testing during this period will give you an idea of when the nadir usually occurs. With Vetsulin, Benny's BG will probably start dropping some where around +2 or +3 post shot so testing at this time also helps to see what kitty's BG is doing.

 

@MrWorfMen's Mom , do you have any thoughts about the 1.5U?

It's a good plan to monitor tonight-- you can gather data, and keep him safe. Do you have some higher-carb food you can give him if he starts going low?

If you haven't yet seen this, here are some instructions on feeding higher-carb to bring numbers up and avoid hypoglycemia. It's a somewhat scary document to read, and hopefully you won't need it, but it's best to be prepared!

 

Thank you Linda and Nan so much for all of the information! The hypo instructions are extremely helpful, but terrifying to read, especially because I'm out of the house for 10 hours a day.

I gave him the 1.5 units and will test him during the night. I have the diabetic dry food, as well as the regular dry food on hand, as far as carbs. I also bought Karo corn syrup.

If his BG is lower again in the morning, would you suggest giving him a small amount of insulin - maybe 0.5U - to prevent it spiking later in the day, like it did today? Are spikes worse than consistent high or low numbers? My vet suggested consistently giving him 1.5U and not testing until Wednesday, but I don't really feel comfortable with that.

 

Without being able to see some data and the random testing so far, it's difficult to say but I think the 1.5u will probably be Ok tonight. he might be bouncing from that lower reading this morning which is why I tend to feel dosing based on pre-shot numbers without taking nadir into consideration can be misleading. Sliding scales work for some cats once you have some data but without data it's impossible to predict.

I would suggest checking his BG around +2 or at the latest +3 and if he has dropped a lot, give him some more food to slow down the drop. And recheck around +4 or +5 if you do have to feed him to slow him down.

As for tomorrow morning, if you test him before feeding and get a low number, post for assistance. Not sure if the vet advised this or not, but it's best to test, then feed and then wait for 20 to 30 minutes before giving the insulin so that the food has time to hit his system before the insulin starts working. So if you want to shoot at 7am, test him at 06:30am and post if you have any concerns using a "?" prefix to draw attention to your post.

In the meantime, it would be really helpful if you could set up one of our spreadsheet to track the BG readings you are taking., The instructions are HERE and THIS document explains how to use the spreadsheet. If you have any trouble setting it up, just let us know and we'll get you set up.

 

I don't have any dose recommendations.
While spikes aren't ideal, along with other data they can help you see if too much insulin or too little is being given. If kitty drops too low basically the body goes into panic mode and dumps glycogen and other things which can keep BG readings elevated for a few cycles. Those high cycles (bounces) can look like not enough insulin is being given so it's best to start low and go slow. If bouncing is suspected give it a few cycles to clear, and then if his BG readings, especially based on the nadir, are high then a possible increase is needed. I'm not familiar with vetsulin but here is the forum for that http://www.felinediabetes.com/FDMB/forums/caninsulin-vetsulin-and-n-nph.19/ and the user guide. http://www.felinediabetes.com/FDMB/threads/vetsulin-caninsulin-user-guide.302/