blood sugar 45!!!!

I do not normally home test, but all that is gonna change today! Checked Lyla's sugar at 4:30 9 hours after getting 3 units of insulin and her blood glucose was 45!!! She has never been this low before. I knew it would go down because she is on Purina DM, but I didnt know it would go this low. Obviously shes not getting insulin tonight. and right away I gave her a tablespoon of her wet food. Is there anything else I should be doing? My vet is closed. She is acting normal. Thank you!

 

Retest to confirm
Feed 1- 2 teaspoon of high carb
Recheck in 15-30 min

What insulin?

 

she is on lantus, 3 units in the morning and 2.5 at night

 

Since Lantus is long acting, you will need to continue with
1-2 teaspoons high carb
Wait 15-30 min
Test

And repeat until out of the woods.

I posted a call out in Lantus so folks should start responding here.

How many test strips do you have?
Do you have Karo syrup/honey/etc?
Do you have high carb food?
Got an oral syringe?

 

thank you! Im trying to stay calm but I am worried. I have plenty of test strips, and I dont have karo but I do have honey and syrup. I just gave her a small amount of Iams (what my other cats eat) opposed to the Purina DM. & yes I have an oral syringe

 

OK. Good.

So you tested at about
+9 - 45
How about a retest.

Do you normally leave food out?

 

You say her blood sugar was 45 at 4:30pm. Isn't it 5:45pm there now? Have you gotten any other tests?
With a 45, I would test every 30 minutes until she's up over 70.

 

Honey and syrup is good. Stay calm and it will be fine. Now you see why we strongly recommend testing. Keep checking here as there will be people to help you soon.

Tonite lets handle this, tomorrow lets discuss dosing and setting up a spreadsheet.

Wendy

 

Yes it 550 here now. I figured to wait 2 or 3 hours before i tested again but decided to post on here for help. Im gonna retest at 6.

 

No i was told not to leave food out since her diagnosis in october 2012. She gets a tablespoon of wet purina dm in the am and mid afternoon i give her 1/4 cup of dry purina dm, then in evening i give her a tablespoon of purina dm wet

 

Please retest now

We need to know if she is rising.

 

Just retested its 87

 

What kind of numbers do you have now?

 

Summary:

+9 (4:30) - 45
+10.5 (6:00) - 87

Rising, good.

 

What should i do now?

 

He's over 70, heading upwards. Offer another teaspoon of food. Check again in 30 minutes.

I'd like to see the 2nd number rising too.

 

She actually had insulin at 730 am this morning i counted wrong!

 

So, the 45 was 10 hours after the insulin, is that correct?

 

So how many hours post insulin did you test and get the 45? The 87?

 

9 hours

 

Are ya'll aware she tests with an Alpha Trak 2? It is in her profile.

 

45 was at 4:30 9 hours after insulin and the 87 was 10.5 hours after insulin

 

Yes i use an alpha trak!! Thats good right?!

 

What's her total intake of the wet DM per day? Is it a can, more than a can, less that a whole can?
How much does your girl weigh?

Carl

EDIT - the 45 was on an ALPHA TRAK?

 

AM PS ?? (7:30)
+9 ~ 45 (4:30)
+10.5 ~ 87 (6:00)

Alphatrak numbers.
Human glucometer would read about 30 points lower in low numbers.

 

I believe the Alpha Traks don't have the big difference compared to human glucometers when in the lower number range.

 

Carl - she is getting wet and dry Purina DM.. thats a low BG for a cat getting dry

Wendy

 

Are you seeing dilated eyes?

Any difficulty standing or walking?

Any purring or meowing?

Does anything seem off at all?

 

yes all my numbers are from the alpha trak, and she weighs 15.5 pounds. She is a big girl!

 

KDD - The others will be good advice for today. In the future you might stick around for some changes in treating your cat's diabetes. Most of us use human glucometers...the test strips are MUCH cheaper which allows you to test frequently without going broke. That will help keep surprises like today from happening.

Also - even though it is DM food, the dry food you're feeding is much higher in carbs than wet food. Additionally, for the cost of the DM you could be feeding a good quality 'regular' food that is still appropriate for diabetics. =)

 

No dilated eyes. She is her normal self. Before I even noticed all this she was purring and cuddling on my lap. She did urinate on the carpet today we figured out- and she never does that, it could be because we have a problem with our other cats spraying, or could that be because of her sugar? Her pupils are a little smaller than normal but she is sleeping right now, which is normal for her this time. But I have noticed this past week she has been very grumpy and irritable! So I am guessing that was a sign of her blood sugar being off.

 

I can afford the test strips and the food. I understand it is higher in cost but I want to feed her the best she can have, and I was told by my vet that is was the DM. And now that I have switched to the DM her sugar obv is lower, so im hoping she won't have any need for insulin after feeding her this food for awhile. My vet told me that eventually the diabetes could go into remission with the DM, and thats what I am hoping for. I really appreciate everyone's advice and I am taking it all into consideration. I am still new at all of this stuff!

 

Whenever you get a chance sometime: We'd love to see a picture of her. Lyla is an absolutely darling name. BTW, what's your first name?

 

Were you trying to reduce her weight?

The amount being fed was pretty low for a 15 lb cat. She may have been burning fat for calories.This can result in ketones. If you have any urine ketone test strips, you should test for those too. Too many ketones may result in diabetic ketoacidosis, an expensive and potentially fatal complication of diabetes.

 

Vets often receive any nutrition education from the pet food manufacturer, who has a vested interest in having their product sold. Beyond that, they don't really get much education on it, so they may be uninformed of what is supported by current research, ie DM is not "the best"

 

Please get another test; like to see her above 100.

 

Please start testing Lyla before every shot, and getting mid-cycle tests every opportunity you have even if it's setting an alarm for the middle of the night. Most likely you will be advised to skip the shot tonight and to start over again, tomorrow.
In the mean time, can you get a spreadsheet started and link it to your signature?
Someone will provide you with the link for that.

 

The reason her sugar is lower....
The DM wet food is low carb, like 3%, so that is a valid reason. HOWEVER, there's flavors like Fancy Feast Turkey, chicken, and dozens of other brands and flavors that are just as low as the DM canned.

The DM dry is NOT low in carbs. It ranks up there with gravy style higher carb canned food.

And while your vet might believe that the DM is high quality as far as ingredients....well it really isn't. You can buy higher quality food at Petsmart, Petco, or the local grocery store for much less per can. DM is expensive because it's "prescription", not because it's "good". If money really isn't an issue, you can buy much higher quality diabetes appropriate food off the shelf.

And she can go into remission on grocery store food too. Hundreds of our cats have.


To Dyana's point about the spreadsheet.....here are the instructions for setting one up and attaching it to your signature. Please let us know if you need any help with it:
http://felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207
Carl

 

You mentioned that you are dosing 3u for am and 2.5u for pm; Lantus does not do well with dose changing frequently. Lantus works much better with a stable dose. The dose you are giving is pretty high but I can't say much without knowing how you reached this dose.... regular home testing and a gradual rise from a low starting dose is a good idea so that you know you are not giving too much insulin.

Dry food is best eliminated from all diabetic cats' diets as it causes higher numbers. Many cats need no insulin at all, or very little, once all of the dry food and treats are removed from the cats' diet.

http://www.catinfo.org/

 

Really need another test to make sure the glucose is staying up and not dropping again.

 

I am definately going to test her from now on, and I got those dosing numbers from my vet.

 

Oh my! Look at that beautiful Lyla! She's so pretty!!! Does she plop herself in front of your computer screen? Looks like it!!!

 

Great that you'll be testing before shots from now on! I'm guessing your vet just doesn't realize that the best way to dose Lantus is to shoot the same amount day and night?


How long ago was the last test you got?
Like BJ said, it's a good idea to see if she's come up some, and not dropped back down.

Carl

 

Can you do another test now to see where she is? And her shot is due in 30 minutes?

 

A lot of us trusted our vets ... at first. And then did some research and discovered that vets are human. They can't possibly know about contemporary treatment for every disease for every animal. The best they can manage is to review when they get a patient with a condition they haven't treated in a while.

Here are the American Animal Hospital Association guidelines.

And here is a proven protocol for using Lantus to share with your vet and then discuss.
Roomp and Rand Lantus Protocol

 

he actually suggested to do the 3 but I told him her numbers and her behavior after getting that much and he said to try 2.5 and I have been giving her that since then. Her insulin was due about an hour ago. But I did not give it to her. So in the morning.... depending on her number what should I be giving her?

 

& I trust him, his specialty is diabetic cats

 

Please can you get a test now?

 

One of our sayings is "Each cat is different"

Like right now - please test so we can see if she's still rising.

 

Ok homework. Please set up a spreadsheet tonite or tomorrow morning (or send me the numbers and I will build it for you). Plug in any numbers and doses.

Then tomorrow morning about an hour before the shot is due take a measurement. Go onto the lantus tight regulation board and ask for help http://felinediabetes.com/FDMB/viewforum.php?f=9.

Really need that test now - she could be dropping again as the high carb wears off and you need to know this!!!!.

Guys - any dose recommendations for tomorrow morning if she is over 200'

Wendy

 

Because she dropped to 45 tonight, her next dose should be reduced by either .25u or .5u.

If your vet's specialty is feline diabetes, and he prescribes Lantus, then he should be familiar with the protocols that are followed here, especially the Roomp/Rand tight regulation protocol. He should also understand that no dry food of any kind is ever appropriate for a diabetic cat.

You can give him these links, but he should already know about these vets:

http://www.catinfo.org/?link=felinediabetes Dr. Pierson is an expert on feline nutrition and feline diabetes.

http://felinediabetes.com/Roomp_Rand_2008 dosing_testing protocol.pdf That's a link to the study that resulted in the "tight regulation protocol" for Lantus that gives cats the best chance at remission. It indicates that her dose should be reduced by .25u going forward.

This is a link to another protocol used here, called the "start low, go slow" method.
http://binkyspage.tripod.com/SLGS.html That protocol indicates she should have her dose reduced by .5u going forward, although with Lantus you could elect to take a .25u reduction instead.

Carl

 

The initial Lantus dose formula: 15 lbs / 2.2 * 0.25 = 1.7 units

We don't know if the 45 was her nadir or not.

And after today/this week, she may be much more sensitive to insulin, so I'd round down to 1.5 or even to 1 unit.

 

G is on Lev, but if we saw this low a number on the current dose, I'd be inclined to cut it in half, let her settle in, and then gradually increase as you try to find the right dose per TR (tight regulation) guidelines. But the folks on Lantus TR will be able to offer much more wisdom.

As a side note, my vet treats a number of cats with FD. All of them are on ProZinc, where we started. But by taking info, and discussing, (after having researched and read), I was her first client to switch insulin. I still consult with her regularly, but I also get wisdom from those in the same boat, day in/ day out.

Wishing you luck in finding the right dose for your baby.

Lu-Ann

 

I missed the posts on page 2 before I posted my last message. BJ (2 posts back) has given you great advice. She's very experienced and you would be wise to heed her suggestion.

 

BJ posted on the Lantus board asking for some of us to stop by. I'm in Illinois, as well (Chicago). As far as I know, there really isn't a vet in the area who's a "specialist" in feline diabetes. There may be someone at the U of I vet school but there's no one in the metro Chicago area or suburbs that's a specialist.

I'd encourage you to take a look at the starred, sticky notes at the top of the Lantus board. There's a huge amount of information there that will help you to better understand Lantus and to maximize your use of this insulin. The links to the notes and a brief description is below:

• Tight Regulation Protocol: This sticky contains the dosing protocol that we use here. There are also links to the more formal version -- the “Tilly” Protocol developed by the counterpart of this group in Germany, which was also published by Kirsten Roomp & Jacqui Rand, DVM in one of the top vet journals.
• New to the Group: Everything you wanted to know about this forum and more. Info on our slang, FAQs, links to sites on feline nutrition and to food charts containing carb counts, how to do a curve and the components to look for, important aspects of diabetes such as ketones, DKA, and neuropathy, and most important, info on hypoglycemia.
• Handling Lantus: how to get the maximum use from your insulin and what to not do with it!
• Lantus depot: This is an important concept for understanding how Lantus works.
• Lantus & Levemir: Shooting & Handling Low Numbers: What data you need in order to be able to work toward remission or tight regulation as well as information if you have a low pre-shot number or a drop into low numbers during the cycle.

Most of the prescription foods that are available do not contain high quality ingredients. If you look at what the composition of DM is, it is primarily meat by-products. There is very little muscle meat. For less than what it's costing you for DM, you can be feeding your cat a premium, human grade cat food (e.g., Wellness, EVO). if you want more information on feline nutrition, Lisa Pierson, DVM has an excellent website on this topic. She also has a food list that will give you a great number of choices when it comes to low carb (i.e., below 10% carb) food. (Most of us feed around 5%.) FWIW, most of us leave food out for our cats and/or feed several small meals throughout the day.

I'm glad you've decided to home test. It gives you a great deal of control over your cat's numbers and allows you to manage Lyla's diabetes effectively. Most of the people here keep their test data in a spreadsheet. The spreadsheet will allow you to keep track of Lyla's progress and see trends. It will also allow us to help you and provide input, if you feel that would be of use.

With Lyla's numbers dropping into the lower ranges, you should reduce her dose in the morning. Personally, I would suggest sticking with 2.5u twice a day.

Please let us know how we can help.

 

I know i should have but i didnt want to test her anymore tonight. We prick her paw and eAch time we tested we had to prick her almost 5 times or more each time. Im gonna take it again in the morning and i will post what it is. Again thank you to everyone!

 

My cat is officially in remission starting today - she's now a diet controlled diabetic. :mrgreen:
My vet told me to use DM wet and dry but based on the recommendations here, I only fed her Fancy Feast classics pates and Friskies pates.
DM is definitely not a magic bullet - other foods are just as good if not better.

 

Did you have difficulty testing on the ear? We've got lots of tips to help with that.

Meanwhile, you might check my signature link on Secondary Monitoring Tools for some additional ways to assess your cat.

 

Hi there

I know it was pretty crazy for you and Lyla the other day but I hope she is doing well now. In case you missed any of the advise people gave I am summarizing it for you below but especially, please let us know what issues you were having with home testing.

Heres a summary of what people said

1. You aren't feeding her enough so increase her wet food to at least 1 1/2 cans a day. Or two cans if you think she needs to regain weight. Then stop dry food altogether. To save money you could switch to the Fancy feast classic pates (~3 cans).
2. Change the dose to 2.5IU twice a day
3. Keep home testing and work with us to see if we can resolve the issues. Try these ear testing tips
4. Set up a spreadsheet so we can track results together
5. Buy urine testing ketone strips ( walmart Relion are $7)

Does that sound good?
Wendy

 

Thank you everyone again for all of your advice & input. Lyla is doing great. I took her to the vet today and they said to watch her glucose for the next three days & if its normal it means she doesn't need insulin anymore !! I took her to the vet because this afternoon a day and a half with no insulin her sugar was 69.

 

Actually we don't classify a cat as in remission and completely off insulin until they have stayed in normal numbers for 14 days with most of those in the double digits. Plus remember that just because Lyla may be now a diet controlled diabetic she is still diabetic, so she will never be able to go back to eating a high carb diet again.

Mel, Maxwell, Autumn & The Fur Gang

 

Whatever you do Don't give her any dry.. The dry will spike her blood glucose and the diabetes will recur. Give her two cans of the purina canned a day.

 

2 cans of 5.5 oz food a day? thats a crazy amount of food for one cat

 

Actually two 5.5oz cans a day for a cat isn't unheard of, I have one guy here that maintains a nice lean body weight on 2 (5.5oz) cans per day, but his lean body ideal weight is also 17lbs, he is a very long and tall fellow and very active for a 14 year old diet controlled diabetic.

Mel, Maxwell, Autumn & The Fur Gang

 

Keep in mind that canned food is generally 70+% water, so the volume will be greater than the amount of dry that would have been fed previously.

You note that she is about 15.5 lbs from a high off 25 lbs, so 1 can of 5.5 oz per meal is probably accurate or even underfeeding.

Cat Info has more details on calorie requirements and weight management, as well as a PDF file you can print with nutritional information for a number of foods.

 

I used this calculation from Dr Lisa:

Required calories per day = [13.6 X ideal weight in lbs] + 70

based on 15.5lbs = 280cals. (assuming she wants to maintain this weight)

One 5.5oz can of Purina DM = 191 calories.

 

Hey there,How is Lyla doing? Do you want help setting up your spreadsheet?

Wendy

 

Sorry i havent posted been so busy lately. Lyla is doing really well. She is so
much happier And rarely ever grumpy anymore. Simce taking her to the vet on feb 18 I have been keeping up with checking her. My mom holds her and pricks her while i have a handful of treats feeding her and I get the blood on the strip. She doesnt even mind anymore having it checked. Yedterday her bs was 75. This was 2 hours after eating and she has been on no insulin. The vet says she is still overweight and I think that is why she isn't getting a lot of food. When i took her to the. vet last she was still 15.5lbs. With how nasty she was I would have never thought I would ever be able to home test her with no struggle!!

 

That's great that Lyla is doing so well. ;-) YAY!

 

I'm glad to see that Lyla is doing so great! Zoni is a big cat too, and he eats a lot too. I think Zoni eats about two cans per day with a little bit of waste. I mix bottled water into it to get more water into him and keep it fresher longer, and he seems to like it that way. I have taken all the dry food completely away since his BG is down in a good range. Hoping they are both OTJ for good!!

 

Yay, sounds like another kitty OTJ.

To prevent any future problems, be careful never to give dry again, weigh her once a month, test weekly, keep an eye on her teeth for infection and dental issues, watch the litter box pee spots sizes, never give her steroids, and hopefully if there is an issue you will catch it early!

 

Yes i hope Zoni can stay off the insulin! & im always looking at the litter box spots but its hard to determine because i have three other cats now and sometimes they pee in the same spot so it makes a bigger spot. I still give her dry but only 1/4 cup a day. I never have to worry about her not drinking she loved to drink at her water bowl. But she isnt drinking all the time like she used to before i knew she was diabetic.

 

Also I will be testing weekly. She just had dental surgery 2 months ago and had most of her teeth removed & all her infections went away! She had multiple broken teeth in the back and abseces. I have no idea what the people she was with before but she obviously never had any dental care in her life before me. Could the reason for her not needing insulin anymore because all the infections are gone? Does that have anything to do with it?

 

Absolutely!
Infection raises glucose levels: removing infection, generally reduces glucose levels.

 

Lets just say, I have heard of kittys going OTJ soon after getting a dental. All those infections do raise the BGs.