After advice

We have been feeding Rupert Fancy Feast for two weeks now. Last week when we tested his glucose levels they were 25.4 (keep in mind I'm in Australia). It took ages to get blood so by the time we got some he was all worked up and it would have been high from stress. Tonight we tested and got blood a lot quicker. Levels are 3.4

What do we do now? It's Sunday night so our vet is closed until tomorrow morning. I called an emergency vet to ask for some advice and they said to not give him any insulin tonight and just leave food and water out for him overnight.

What's the best thing to do?

 

Hi. Are you using a human or animal meter? I think that is an international number and I only know the U.S. ones. Do you know what it would convert to by any chance? I do know that my cat has been in the low 50's for a couple of hours and I am feeding and testing and haven't gone to bed.

It would help if you could set up a spreadsheet when you have time through google. You just need an account to do it and then dosing advisors will be able to help you. Have a look at the stickies on the lantus forums too. That might help as well. I'd also like to invite you to join one of the lantus forums. Most of us post daily and there are really helpful people to advise you. I post to the tight regulation forum as it is very active except for the middle of the night in the US.
Here is the link to the forum.
viewforum.php

 

Hi Laura and rupert

If you are using a human meter (not the alpha track) then you need to steer your cat with food if it goes below 2.8. So that a low number but not quite where you need to feed a little high carb food just yet. Remi will go that low during his cycle but always comes up before his next shot is due. Can you clarify what time you got that number. Was it preshot? +6/+7 in the cycle, etc??

To get the US number you times the number by 18 (unless it is the alphatrak ) so 3.4 x 18= 61.

Either way I think you are right not give to insulin tonight, especially as this is the first time this has happened. As the saying goes better too high than too low for a minute. I am sure you will get some advice from more experienced members either in this thread or if you start a new one in tight regulation.

How to handle low test readings viewtopic.php?f=32&t=61798


I think what you are saying is that the change to wet food has dramatically altered the amount of insulin Rupert needs. Could you perhaps list out all the blood glucose readings you have taken recently and this will help others to give you advice? Or set up the spreadsheet.

Finally for future reference if you need advice quickly you can add a 911 icon to your posts or whatever one is most relevant. It is also best to really get the title to quickly indicate the exact advice you are after. For example -urgent advice needed, low blood glucose reading pre shot.

Best wishes

Sarah

 

Thanks, sorry I don't come here much so I'm not very familiar with the best way to do things

Rupert has been on hills m/d since he was diagnosed in February this year. We test him in the evenings before food and insulin, about 6:30pm. We've only been testing him weekly because he hates it and I have a really hard time getting blood from him. I think we're going to try him again in the morning to see how he went overnight.

Oh and we use a human meter. That's what was recommended to us.

Other than that though he's acting normal and not showing any signs of being hypo. I am hoping very quietly this is the start of remission but not getting my hopes up.

 

Hi Laura,

We recommend that you test before every shot. Changing the food to a lower carb type can dramatically drop the glucose levels and insulin needs. This is one reason why testing more frequently is suggested.

Your insulin dose is a very high dose unless there are other health issues going on. Most cats only need between 1-2 units twice a day. Now that you have changed Rupert's food, you should also lower his insulin. My suggestion is to start back over at 1 unit and gradually increasing it until you find his optimal dose. To do this you start over at 1 unit and keep that dose for at least 1 week and test before every shot. After a week you would increase it by 1/2 unit and keep that dose for another week before you determine if you need to increase it again.

You said that Rupert does not like to be tested. One suggestion is to find a low carb treat that he likes and only give it when testing. Many cats like freeze dried chicken & fish. Even if you are not successful, reward him anyway. Soon he will associate his getting his treat with testing and that will be a good thing.

Also, if you are nervous or not comfortable with hometesting, Rupert will pick up on it also. If you are having problems with testing, let us know and we can give you some hints that will make it easier.

 

I am glad that Lisa has given you dosing advice

Re the ear testing a treat definitely helps. The other thing that made a great difference to me was heating the ear before trying to get some blood. I made a little rice sock that I hear for about 15 seconds in the microwave. I get all the testing stuff together and let me cat sniff he treat. Then I Gently hold the heated sock against both the inside and outside of the ear. This encourages blood into the area. Once I have poked the ear I put my fingers either side of the area and gently squeeze. Usually the blood comes quickly. Get he reading and then give the treat. Funnily enough my cat remi comes running not if I show him the treats but when I show him the rice sock :lol: .

 

In addition to the other info about home testing, I'd just like to add that, as you test more frequently, new capillaries grow at the test site and it quickly becomes much, much easier and quicker to produce a droplet for testing.

I echo the recommendation for diabetic-friendly treats. Making the testing time a one-on-one fuss fest (lots of praise, stroking or grooming - whatever he really enjoys) could possibly help Rupert begin to actually like test time because he'll associate it with nice things.

 

Ok a bg of 3.4 = 61 in us terms....the way to calculate this is to multiply the bg by 18

3.4 x 18 = 61.2

That being said, that is a very normal - non diabetic level number. I see that you are giving 5 units of lantus at a time. With a number at this level, 5 units is most likely too much insulin.

Since you are so new to this process you have some options:

1) skip the shot - as I am assuming you probably did
2) wait 30 minutes and test again to see if the number rises (without giving any food)
3) give a token dose - meaning less than the normal dose of 5 units

In your situation, since you may not have too many BG tests and 5 units is a very high starting dose, I think your best option for tonight is to skip the shot.

Keep testing and let's see what the morning brings.

Here are some other things to keep in mind when starting out:

1) for safety reasons we usually recommend a shoot/no shoot BG level if the cat is 200 or lower (11 or lower in your terms) do not give insulin.

2) as you are able to test more easily, you can lower this shoot/no shoot threshold to 150 (8) then to 100 (5), etc....

3) if you get a BG level 50 or under (3 or less) that means the cat earned a dose reduction.

As I don't know your story, I have to ask how you arrived at 5 units of lantus. I ask this because that is a very high starting dose. For safety reasons, we recommend a starting dose of 1 unit or even 1/2 unit at a time. If the vet recommended 5 units, it is usually based on one test done at the vet's office and can be influenced by vet stress and other factors, so it's really a false reading and potentially dangerous one, especially as you are feeding low carb canned food.

My general recommendation would be to start over at 1 unit or even 1/2 unit and to give insulin only if the bg reading is 11 or higher.

I hope this makes sense. When you have the time, please be sure to visit the Lantus forum so you can read up on how Lantus works, when to shoot and not shoot and the protocols.

Please continue to ask questions and if there is anything I wrote that you don't understand, please let me know. I tagged this post, so I will get notification of all replies.

 

Lets get you started using our grid to record your glucose tests. It will help us give you better feedback. Instructions are here.

Understanding the spreadsheet/grid:

The colored headings at the top are the ranges of glucose values. They are color-coded to clue you in as to meaning.

Each day is 1 row. Each column stores different data for the day.

From left to right, you enter
the Date in the first column
the AMPS (morning pre-shot test) in the 2nd column
the Units given (turquoise column)

Then, there are 11 columns labeled +1 through +11
If you test at +5 (5 hours after the shot), you enter the test number in the +5 column
If you test at +7 (7 hours after the shot), you enter the test number in the +7 column
and so on.

Halfway across the page is the column for PMPS (evening pre-shot)
To the right is another turquoise column for Units given at the evening shot.

There is second set of columns labeled +1 through +11
If you snag a before bed test at +3, you enter the test number in the +3 column.

We separate day and night numbers like that because many cats go lower at night.

It is merely a grid for storing the info; no math required.

After you've set that up, you can put it in your signature, along with other details that may help us give you feedback.

Go to the top left of the screen.
Click on User Control Panel.
Click on Profile
Click on Edit Signature
A text box displays.
This is where you paste the link for your spreadsheet, once it is set up.
Add any other text, such as
your name, cat's name,
city and state,
date of Dx (diagnosis)
insulin
meter
any other pertinent issues like food issues, allergies, IBD, etc.

 

Hi Laura,

How many hours after the shot did you get that 3.4?

Regarding blood glucose numbers, generally, as long as the number is within a safe range, it's not so much 'what the number is' but rather 'where it's heading'.
So, to see a 3.4 at the peak of the insulin cycle (the lowest number of the cycle) could be a really good thing. If a 3.4 is seen earlier on in the insulin cycle then that would probably indicate that steps need to be taken to raise the blood glucose level as the insulin is still working in the system and the blood glucose could drop further.
If the 3.4 is seen prior to giving insulin then that indicates that no insulin is needed at that time. 3.4 is a beautiful normal blood glucose number.

Given that you're using Alphatrak however we'd interpret that number as being something around maybe 2.4 (most of us are used to 'human meter' numbers, and the Alpatrak reads differently). But that number can be fine too [Struck through because Laura isn't using A'trak]

The normal blood glucose range is approximately 2.6 to 7.2, but some cats can be lower or a smidge higher than that.

As others have suggested, the switch to lower carb food will almost certainly have reduced Rupert's blood glucose levels. And it seems a reduction in dosage is needed....

Eliz

Edited to strike though A'trak info.

 

Tested him again this morning (12 hours after the last one) and they were 18.4 so I gave him 2 units of insulin.

We didn't start out at 5 units. We started out more and gradually increased after his levels were staying high. We were originally getting them done at the vet and after having consistently high levels made the decision to try testing him at home and started getting lower levels (as in he would be in the 20s at the vet and high teens at home).

I'll look into the spreadsheet at home tonight, about to start work now. Should I call my vet or just keep doing what I'm doing? I'm worried they'll tell me off for feeding him fancy feast instead of md.

 

I wouldn't bother telling him ... until after you've collected the data that shows how much better he is doing!

Or, you might share the Cat Info web site with him.

 

Oh also thought I should mention we don't use an alphatrack, just a human meter.

 

Ok - if you are using a human meter (which most of us use too), then the numbers I listed earlier are good guidelines to follow....and yes setting up the spreadsheet will be a huge help. and it's something you will be able share with your vet too.

 

If I start using the spread sheet, will people help me with it, like how much insulin to give for certain levels and such?

I'm winging it at the moment and don't feel comfortable guessing.

 

Sorry Laura, my mistake (Duh!)

 

Yes, Laura, rest assured you can get help here. There are some very experienced Lantus users who will be very happy to assist.

 

One problem with only relying on test at the vet's office is that stress can easily cause the glucose levels to jump significantly. Most cats are stressed when they go to the vet. By testing at home you will get more accurate levels.

One of the other reasons I suggested starting over at a low dose is because of the food change, your optimal dose has changed. There is a condition called Somogyi rebound that is caused when the insulin dose is too high. In order to protect itself from becoming hypoglycemic when too much insulin is given, a cat's body will produce extra glucose. So instead of seeing his BG levels drop as you increase the dose, they seem to get higher. By starting over at 1 unit twice a day and increasing by only 1/2 units over several weeks, you will be able to determine the dose that works best.

You can call your vet. It is a partnership between you and your vet to keep Rupert healthy. But also do not be surprised if he discourages taking advice from the internet. Many vets are not familiar with this site and you can also encourage him to come check us out. Just remember, you are the person who is responsible for Rupert's health and your vet works for you. As you are seeing positive results, share them with your vet. You would not be the first person on this board that have converted their vet. :mrgreen:

 

Ok I've got the spreadsheet going now. Hopefully I'm filling it out right!

 

Looks OK from here, Laura. :smile: