Amek

From a private message sent to several of us, so I've copied it here and linked it for the user.
"Hi,
My cat was initially diagnosed with diabetes a few years ago. After a couple of weeks of insulin therapy and a strict change to a low carb diet, she went into remission. About a year later, she relapsed. That was about two years ago. I was able to stabilize her blood sugar with Lantus every 12 hours and maintaining a low carb diet. Recently, she's been experiencing highs and lows. Going from 200's to 30's. The other night, she woke me - I knew something was wrong by her meows (although otherwise she wasn't exhibiting any other alarming behavior or characteristics). I checked her sugar and it was 30. I've tried different types of low carb canned food (she isn't terribly fond of the high end, gourmet brands..but I tried) and got a new insulin pen, but we're still experiencing unstable blood sugar. I'm frustrated and very worried. The only other thing that's different, are the syringes. As I'm out of town often for work, I thought it would be best for the pet-sitter to use a syringe that's easier to read, since she gets 1 unit, so I bought syringes with 3/10mL cc capacity rather than the 1/2mL cc capacity that I previously used. I'm not sure that would have made a difference with the highs and lows, but I'll be trying the 1/2mL syringes the next couple of days.

I would greatly appreciate any thoughts. I'm anxious about her health in general, but also due to the fact that while I'm gone for work, the pet-sitter is only here for 15 minutes twice/day to give her a shot and food. I'm sure you can imagine how nervous that makes me.

Thank you!
User: Amek

 

Welcome to FDMB.

Lets get you started using our grid to record your glucose tests. It will help us give you better feedback as we'll be able to see color coded patterns. Instructions are here. Put in as much data as you already have. If you use mmol/L, be sure to enter the data on the World side. The US side has formulas which will automatically update to mg/dL.

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.

 

Welcome to the board. I can certainly understand your concern.

The one thing that jumped out at me in your message is the syringes. The 3/10ml syringes with half unit markings are the ones I think you should be using. The markings on the 1/2ml are so close together that I think dosing issues would be more likely to occur. If you are worried about whether the sitter is giving the proper dose, you could draw up some coloured water in a syringe for her use as a guide or mark a syringe with a sharpie at the 1 unit line as a sample.

My next questions would be
1. Who the sitter is (professional or a friend),
2. Did you train her or are you relying on her word that she know what to do
3. What experience does she have
4. Does she test before shots. This is important to keep your cat safe.

Perhaps it would help if you supervised the sitter giving the shot at least a couple of time to ensure she is following your instructions and giving the right dose.

It doesn't matter whether your kitty eats expensive food or inexpensive food as long as it is low carb. Information about what food she is eating, how often she is fed and amounts, would be helpful. Have you changed her food recently?

I'm no expert here and hopefully one of them will chime in. From your description it sounds like your cat may be bouncing. That could be a sign she needs a dose reduction or perhaps she is trying to get off the insulin again.
IF a dose reduction turns out to be the solution, you will definitely want to be using the 3/10ml syringes as they have 1/2 unit markings. The 1/2ml do not.

As BJM mentioned, it would be helpful to see your BG readings so if you could provide those, we'll be able to brain storm with you to help get kitty stabilized and you less worried.

 

I hired a professional pet-sitting company for Booboo. I showed the manager how I check her sugar and administer her shot. I do have issues with the sitters (timing, not always being able to check her sugar, etc) with which I am trying to deal, as I have no one else to rely on - however, the highs and lows have been occurring under only my care lately. I haven't been out of town in about a month. .

Booboo is fed throughout the day, especially because she likes to eat and begs often, so I find it easier if I give spoonfuls of the one can throughout the day and evening. I haven't changed her food (usually give her Friskies special diet turkey and giblets), except to experiment a couple of times to try to determine if the food was the issue - which didn't make a difference.

I'll post the BG readings, but to give a quick idea of what's been happening lately: AMPS=61, PMPS=193, +4=37....AMPS=134, +3=28 (very scarry!!), +4=35 (still scarred, but she was acting fine and I was treating the hypo with food and treats), then by PMPS it was 122 and +4=76. That was yesterday and today.
I have never seen these lows with her previously. I didn't rush her to the vet, because she didn't have symptoms other than begging for food, so as I mentioned I thought it best to treat her myself with food (fed her some rice and treats with carbs) and monitor her at home. I also had been under the impression that I should add about 30 points to the reading on the Bayer Contour I use - in order to get a more accurate idea of her blood sugar. I realize from some of the posts I've read here how incorrect that is, especially with the lows (I feel sick about that). I wish I had discovered this forum earlier...but, thankfully throughout the last couple of years her blood sugar had been fairly well regulated.

I know that she gets stressed when I'm gone - sometimes when the pet-sitter checks her sugar it's a bit high (200's), but these fluctuations as of late and the extreme lows the last few days, are not due to any changes or disturbances at home. Did I do the right thing by treating her at home, or should I rush her to the vet next time (without symptoms, that is)?

 

Again I am no expert and if you can provide more complete information re: Booboo's BG readings including when the sitter vs. you has taken the reading, I'm sure other's with more experience will chime in with some ideas. It's really helpful to be able to look at the spreadsheet (BJM provided instructions above) to look for trends in the readings vs when insulin was given.

In my humble opinion though, if the readings in the 200's are happening only when the sitter tests, those could be stress elevation of Booboo's BG. Cats who are stressed can have a very substantial increase in their BG levels. Also, it sounds like Booboo is getting food spread out throughout the day when you are home but is only being fed twice a day when you are out of town. That too will affect her BG readings. She could be getting stressed out wondering when her next meal is going to be served.

Booboo is going really low and you are handling this as you should with some carbs etc. but the goal right now is to keep Booboo safe and stop those hypo episodes because they are dangerous.

From your notes it appears you did not give Booboo insulin when her AMPS was 61, but you did when her AMPS was 134. Is that correct? If that is correct, did you give her the usual 1u. dose? This is the type of detailed info needed to be able to help you figure out how to get Booboo stabilized.

For now, personally, I would NOT give Booboo any insulin at any pre-shot reading of 200 or less. If you get a low reading under 200, I'd feed Booboo and retest her BG an hour later to see if her numbers are rising and by how much. While no insulin isn't necessarily the right call, it's better to have Booboo's BG too high for a short time than too low for any amount of time. I am not experienced enough to offer specific dosing suggestions but m y inexperienced gut feeling is that Booboo is telling you she wants off the insulin.

Once you have more information posted (spreadsheet) the experts here will be better able to offer their suggestions to help you and Booboo.

 

Is Boo eating the same amount and kind of food with the sitter and when yo are home? It is not unusual for a cat to each less when other than the owner is caring fro the cat.

 

When you have a moment, could you add a few tidbits to your signature? It will help us give you feedback.

Editing your Signature

In the upper right corner of the screen, within the dark blue bar, you will see ID, Inbox, and Alerts

Click on your ID.

On the left, under Settings, Click on Signature.
This is where you will put information that helps us give you feedback.
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,
date of Dx (diagnosis)
insulin
meter
general location
any other pertinent issues like if there are any food issues, history of DKA, hepatic lipidosis, pancreatitis, allergies, IBD, etc.
Click the Save Changes button at the bottom.

Always click the Save Changes button at the bottom when you have changed anything.

 

Yes, she eats the same kind and amount of food (eating well has never been an issue with Boo). She has experienced highs when I'm gone - I know that's due to stress. However, the highs and lows (especially lows) in the last few weeks have not been a result of my absence. I've been home, thankfully! For instance, after the low of 28 yesterday afternoon and the 76 PMPS reading last night..her BG was 246 this morning. I gave her 1 unit, as usual. This seems to be the pattern...high, I give her 1 unit of insulin and either it goes down to normal range or falls way down. For such a long time I was able to maintain her BG in the normal range (70's to low 100's). I just can't figure out what's going on lately. I'm going out of town next week and it makes me terribly nervous to leave her.

 

When you are gone I would specify a reduced dose to help ensure the BG does not go too low. When you get back you can then try to determine what is happening.

 

I don't know what type of insulin you're using. If it is lantus or levemir you should have reduced the dose after getting numbers that low (which will require drawing the dose from the pen cartridge with an insulin syringe rather than using the pen). If the dose is too high you could get the results you describe - going down too low and then bouncing (the body tries to protect itself from low sugar levels by releasing stored sugar) over and over. It would be most helpful if you could attend to the signature data and spreadsheet per BJMs earlier post. It will help us to help you so much better.

Welcome aboard and kudos to you for home testing.

 

Hi everyone,
I populated the spreadsheet with Boo's BG and insulin info - I hope I saved the sheet correctly.
As you can tell, I have been giving her 1/2 unit of Lantus lately, to avoid the lows. However, I'm concerned about the highs now. Ugh!
Any thoughts? How do I regulate her blood sugar as it once was?

 

I can see your spreadsheet so good job! I am relatively new at this myself so I am going to leave it up the "experts" to give you their opinions but from my untrained eye it looks like you might need to bump up the dose just a smidge. That of course is just a guess on my part.

Can I suggest you start a new thread with a "?" mark in front of a title like "dosing advice needed". That way folks will realize you need some assistance and you'll get more eyes on it. If you need help to do this just ask.

Also can you add some info about exactly what food Booboo is on. Diet plays a big role in all of this. I know it's low carb but some low carb are lower than others.

 

Thank you. I should probably start a new thread...how do I go about doing so?

I generally give her Friskies Special Diet Turkey and Giblets. She likes it and it has (as far as is listed on charts I've seen online) the right amount of calories - although she hasn't lost weight. I've tried Tiki Cat, for the ultra low carbs, but she really doesn't like it. I've also given her Merrick Grain Free and other higher quality brands, but she doesn't like them much and the calories are generally quite a bit higher. I have considered trying a raw food diet, although her vet doesn't recommend it - not that I always agree with her, but I've read various opinions on that topic.

 

Looks like the diet is ideal so no worries there. Thankfully Booboo doesn't have champagne taste!

Since you are using Lantus, I am going to suggest you post in that forum.
Go back to the forum menu and scroll down to the one named Lantus (Glargine)/Levemir (Detemir) and click on it.
Now up in right hand area of the screen you will see a button "Post new thread". Click on that.
On the top of the screen you get, is a box for the title of your thread and to the left of that box there is a little arrow with the words "No prefix " beside it. Click on the arrow and find the "?" then type your title. Your message goes below and works just like in this thread.

Hope that helps. If not just holler.

 

I don't think you have enough data there to suggest raising the dose at this point. If possible you need to get, as well as your preshots, a least one additional test per cycle. Lantus dosing is based on how low the dose is taking the kitty with very little attention paid to the PreShot numbers (you test those to make sure it's safe to shoot). In particular a lot of kitties like to go lower at night than they do in the day so a before bed test is very helpful.

With that 28 on a non full depot (with lantus it takes about 6 cycles at a dose for the depot to fill) I would be very hesitant to raise the dose without additional data - particularly night data.

Worfmens Mom gives a very good suggestion for you to move over to the lantus/levemir insulin support group forum as that's where the lantus experts hang out. There is also some great information there in the stickies (posts stuck to the top of the forum) about the different protocols we use, how to handle your lantus etc. in particular I would like to draw your attention to the shooting and handling low numbers sticky. That information saves lives.

 

@Vyktors Mum Amek has started another thread in the Lantus forum and she may not check back here to see your note if she doesn't have notifications set up.

 

And that post is here.

Oops! Sorry - the correct link is below in another post.

 

Thanks guys @BJM the link is to a different kitty?? I have trawled through health and lantus land but I can't find another post from amek

 

It['s here http://www.felinediabetes.com/FDMB/threads/lantus-dosing-advice-needed-please.140376/

 

Thank you @MrWorfMen's Mom

 

A shorter way to find someone's other posts:
Click on the user name on the left and go to the person's profile page. Select the tab for postings and you'll see a list in reverse chronological order.