Blood glucose 64. ..25 Lantus 5 1/2 hours ago

third evening dose of .25 unit of Lantus
Bella’s appetite has been diminished
BG 295 at 6pm
5 hour check was 64
Gave her honey x2 and got her to eat half a can of gravy rich fancy feast.
Help!

 

Hi Janet,

Have you tested again since you last fed the honey and gravy food? If not, test again and post the result here along with the number of ours after insulin the test was taken.

FYI - Bella was safe at the 64 (as long as she was - and still is - acting normally. Monitor clinical signs closely.


Mogs
.

 

11m BG64 fed honey and she ate 1/2 Can fancy feast with cheese and gravy

11:30 BG 73 fed honey 1 tsp small amount same food

11:45 BG 73 2 tsp honey not interested in more food

12:15 BG 137 more honey no food. Seems more alert

 

She’s not interested in any more food. Wants me to leave her alone.
Should I make a visit to our emergency clinic or wait this out?

 

Bella's at an OK number for now so don't feed any more until you see what her next test at 12:45 is doing.

Back in better numbers. Just to confirm, the 11pm test of 64 (human meter) was at +5 hours after Lantus 0.25IU given. Is this correct?


Mogs
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Correct

 

SITREP:

• Just started Lantus. third evening dose of .25 unit of Lantus - NB. All AM DOSES SKIPPED DUE TO LOW AMPS BG VALUES SO NOT WORKING WITH A NORMALLY FILLING DEPOT

• Bella’s appetite has been diminished

HUMAN METER READINGS

PMPS - 295 (at 6pm local time) | Food eaten = ???????? | Dose: Lantus 0.25IU.
11:00 - +5.00 - 64 - Gave her honey x2 and got her to eat half a can of Fancy Feast with cheese and gravy.
11:30 - +5.50 - 73 - fed honey 1 tsp small amount same food.
11:45 - +5.75 - 73 - 2 tsp honey not interested in more food.
12:15 - +6.25 - 137 - more honey no food. Seems more alert.


Mogs
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Can you get the next BG test please, Janet. Then post the result here straight away.

If the BG is over 50 don't give any honey at this point.

.

 

Bella's in safe numbers right now, and you're doing a great job with the testing to help keep her safe.

(((Janet)))


.

 

Hi Mogs - I can monitor if needed. I don't remember if you are a night owl. The BG levels are in a fairly safe range, even at 64.

 

12:45 231
How often should I retest?

 

Jeff, that'd be brilliant. I've got a large dose of sleep meds on board right now and I need matchsticks to keep my eyes open. (Really struggling to even type ... )

Janet, I am going to leave you in Jeff's capable hands here. He will sit with you and walk you through this process and, should the need arise, he'll tell you if you do need to go to the vets. BTW, just so we have a full picture, how far away are you distance/time-wise from the nearest emergency clinic?

Sending vibes for all to go smoothly and safely over the next few hours.




Mogs
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I’m about 30 minutes from the emergency vet

 

SITREP:

• 30 minutes from Emergency VET.

• Just started Lantus. third evening dose of .25 unit of Lantus - NB. All AM DOSES SKIPPED DUE TO LOW AMPS BG VALUES SO NOT WORKING WITH A NORMALLY FILLING DEPOT.

• Bella’s appetite has been diminished since starting Lantus treatment.

HUMAN METER READINGS

PMPS - 295 (at 6pm local time) | Food eaten = ???????? | Dose: Lantus 0.25IU.
11:00 - +5.00 - 64 - Gave her honey x2 and got her to eat half a can of Fancy Feast with cheese and gravy.
11:30 - +5.50 - 73 - fed honey 1 tsp small amount same food.
11:45 - +5.75 - 73 - 2 tsp honey not interested in more food.
12:15 - +6.25 - 137 - more honey no food. Seems more alert.
12:45 - +6.75 - 231 - No food or honey at this time.


.

 

Current summary is:
PMPS - 295 (at 6pm local time) | Food eaten = ???????? | Dose: Lantus 0.25IU.
11:00 - +5.00 - 64 - Gave her honey x2 and got her to eat half a can of Fancy Feast with cheese and gravy.
11:30 - +5.50 - 73 - fed honey 1 tsp small amount same food.
11:45 - +5.75 - 73 - 2 tsp honey not interested in more food.
12:15 - +6.25 - 137 - more honey no food. Seems more alert.
12:45 - +6.75 - 231

I would do another test at 1:00am or 1:30am. Frankly with the last 3 readings you are in the safe zone. I would not give any more honey - unless you like to see Bella bouncing off the walls

 

Also kudos to you Janet for being ready for a hypo.

If the next test at 1:00am or 1:30am is 100 or above, I would call this hypo resolved.

 

Thanks for the support! She seems ok... perkier than earlier. Annoyed with me, so that’s good.
How will I know when I can stop testing?

 

@JanetMR - Handing off now to @JeffJ. Will check in on yourself and Bella tomorrow, Goddess willing.

@JeffJ - Thanks again for being here. Gonna pass out now ....



Mogs
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Thanks

Thanks. This has happened before.. on vetsulin. We ended up at the emergency clinic. Took her off insulin. She started spilling ketones in her urine. Vet suggested Lantus...

 

Do another test at 1:00am or 1:30am.
Post the result.
If the BG = 100 or more then you are done for tonight.

1:00am will be the 7 hour mark for you. If the test is in the safe range you are fine. The last reading was probably influenced from all the honey.

 

(Lantus, Levemir, and Prozinc) in my opinion are all much better than vetsulin because of their carry-over at the 12 hour marks.

 

Just read Bella's profile. Leo also gets Fancy Feast classics mixed with water.

 

This was a good general suggestion on the vet's part because it's easier to administer very small microdoses of Lantus more easily and safely than the likes of Vetsulin.

Can you remind us, is Bella currently underweight? (Body condition chart)


Mogs
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BTW, if the 0.25IU dose proves to be a little too high for Bella to manage safely at the moment, we can teach you how to give smaller doses and also how to 'steer the curve' with food to enable her to receive the insulin she needs safely. More on that another time. My eyes are supergluing themselves shut.


Mogs
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1:15 BG 304
???

 

She may be slightly underweight.

 

1:15 BG 304
Great! You are now both ready for bed. I would leave some food out in case she wants it. But not necessary.

They hypo is over. I would call it a mini hypo since she never got below 50.

She sure is a fluffy pretty kitteh. I bet there is fur all over everything! I wish I was slightly underweight
.

 

Thank you so much for the support!
Scary
She is very fluffy.. there IS hair everywhere.
Thanks again!!!!

 

Please modify the topic and remove the "911" so others don't get worried. Thanks.

 

I would love to. How do I do that?

 

Glad I could help. Mogs did most of the help. And you did all the real work.

At that level of 64 (for the low), that is almost hypo but not quite. Still it is truly better to be safe, than lose your kitteh.

 

I figured it out

 

Great. I was just about to post a picture with some text. Instead here is a sleepy picture of Leo and Little Dude to help you relax and get some good sleep.

 

Closeout summary:
PMPS - 295 (at 6pm local time) | Food eaten = ???????? | Dose: Lantus 0.25IU.
11:00 - +5.00 - 64 - Gave her honey x2 and got her to eat half a can of Fancy Feast with cheese and gravy.
11:30 - +5.50 - 73 - fed honey 1 tsp small amount same food.
11:45 - +5.75 - 73 - 2 tsp honey not interested in more food.
12:15 - +6.25 - 137 - more honey no food. Seems more alert.
12:45 - +6.75 - 231 - No food or honey at this time.
1:15 - +7.25 - 304

 

Great job Janet, Mogs and Jeff!

 

Whew! You had great help though.

 

Thanks for all the help!
Going to get Bella in to see a vet this morning.
Her regular vet only makes house calls and is off on Friday. Of course.
Her blood glucose was 281
I held off on the insulin. Not sure what to do now. She also vomited a small amount of bile prior to eating.
The Lantus has also given her lose stools.
Roller coaster. Just trying to do the right thing

Janet

 

You have a tricky kitty who seems to need only a nanodose of insulin. There are ways of eking out these teensy doses and I'm sure there are folks to help with that. I read about other kitties here who had diarrhea in response to an insulin change. I hope it resolves soon.

 

Of course I have an usual situation.
Thanks for the support

 

Hi Janet,

Glad all is well this morning BG-wise. Well done last night! (Sorry I couldn't stay; was literally passing out from the sleep meds.)

If you can get something from the vets to help with Bella's GI issues and appetite problems then that should help even Bella out on her Lantus. You could also look at the carb values of the food's you're offering (assuming that she'll be able to eat better). If you use a food closer to the 10% carbs mark (or possibly a little higher than that until Bella has stabilised) the carbs should help balance the insulin better than a very low carb food. I'd suggest asking the vet to do a body condition score for Bella to assess how underweight she is currently (always trickier with long-haired cats); kitties who need to regain weight can be a little trickier to treat with insulin in the early stages as they sometimes go on the low side at nadir even with a very tiny dose of insulin and then head back up to high-ish BGs afterwards. Again, tweaking the carb load can help with this so that Bella can get the insulin she needs to properly utilise the food she eats and remain ketone-free, and also to regain the weight she's lost.

Be sure to let us know how the vet visit goes. If he's running blood work, it might be an idea to order a Spec fPL test to check for any possible pancreatitis issues, if only to rule them out. (Suggested this because of the vomiting and diarrhoea.)

I know how very much you want to help Bella as quickly as possible and I'm sorry that the two of you have had a bit of a frustrating / rocky start to treatment but sometimes it can take a little while to iron out the kinks. Things will get better.




Mogs
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Thanks for the suggestions.
I am extremely leery of putting her back on insulin.
I love my Bella, but I don’t know how I can continue doing this. It’s not fair to her or to me.
I haven’t slept in many nights more than a couple of hours and all I do is stick her and run around with food, and worry. It has completely consumed my life... this is no life.

 

(((Janet)))



You're not alone in feeling like you do at the moment: many, many caregivers are totally and utterly overwhelmed after the initial diabetes Dx and during the early days of treatment but things will get better once you establish a good routine that works for you and Bella. It may take a little time but you will get there and things will get much easier. I know it probably doesn't feel like it at the moment but, in spite of the sleep deprivation, you're doing really well with your home testing and keeping Bella safe. When you start seeing Bella feeling better it will all be worth it. I promise.

My best advice to you for today - especially with the weekend upon us - is to ask your vet about prescribing some anti-nausea meds (ondansetron or Cerenia, not Reglan) and an appetite stimulant (cyproheptadine is mild and can be given up to 3x per day but is not suitable for cats with liver, high blood pressure, or glaucoma issues; mirtazapine is a stronger alternative but it can only be given every 48 hours at a dose of 1.8mg per cat.) If these treatments are suitable according to your vet then that could help both yourself and Bella on the food side of things. This in turn should make giving insulin more straightforward. It might also be worth asking the vet about giving Bella a vitamin B12 injection as this can help with digestive issues and appetite.

With regard to insulin dosing, the experienced members on the Lantus and Levemir board would be able to help you with microdosing the Lantus should that be required (doses smaller than 0.25IU).

You could also discuss food with the vet. Not all members will agree with this suggestion but perhaps temporarily using a diet with moderate carbs might make it more straightforward to get enough insulin into Bella to keep her ketone-free, safe, and regaining weight. Once she is well-stabilised you can then revisit diet choices for the longer term.

Another important thing is to check Bella's hydration levels at the vets today just in case she might need some fluids (they can make a huge difference to kitties that need them, and may help improve appetite a little).

I hope some of the above helps. In the meantime, here are some more .

Be sure to let us know how you get on at the vets.


Mogs
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Another thing to ponder:

While there are no guarantees, some cats only need a relatively short period of insulin treatment before achieving remission. You've got a really good, long-lasting insulin for Bella and you're already home testing. These factors may greatly increase her chance of becoming a diet-controlled diabetic.




Mogs
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Yes. You are not alone. We can continue to help. Mogs is also correct that some kittehs only need a short period of insulin to go "off the juice" OTJ. It is possible that Bella will be sugar controlled through food alone.

It is usually a delicate balancing act to get the right equation for your kitteh. And some kittehs bounce around. As an example for Leo:
- several days at AMPS 220, and BG = 80-180 most of the day
then
- several days at AMPS 450, and BG = 150-240 most of the day

I feel for your lack of sleep. It has happened here too. This is the low point of Bella's health. Sometimes it takes that extra energy you are giving, and you can make Bella healthy again. I know...because others have done it, and we have done it with Leo several times. Hang in there.

 

Vet visit went well. Bella has gained 3 ounces since her last weight a couple of weeks ago. She didn’t see her as underweight or compromised.
Gave her an injection of cerenia for nausea and sent her home with pills. Vet seems to think she is s cat that might be regulated by diet alone. Told us to “ let her be a cat”. Take her off insulin and will retest in two weeks, including s fructosamine level. They will re- evaluate her need for insulin then. I will continue to monitor her but in a more balanced way for both of us.
Other than the stress from the vet she seems more alert and is eating well. Yah!

 

Hi Janet,

Glad to hear the vet visit went well and that Bella is eating better!

Keeping fingers and paws crossed for all to go well over the next fortnight. Needless to say, keep an eye on ketone levels and maybe snag a BG check morning and evening each day. Shout if you need any help or support.




Mogs
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