Blood sugar falling, what do I do?

Hello, today is 19-year-old newly diagnosed Gator's second day on Vetsulin. we were prescribed 1.5u, which I did last night, but he didn't eat so well last night so I did about .6u this morning.

He's due for his evening dose now (or half an hour ago), but his glucose is currently at 172, so I'm nervous about giving more insulin now, even a low dose. For comparison, he was at 400ish most of the time for several days before we started insulin, and he's been in the mid- to high 300s before his previous doses. I'm brand new to this and trying to figure out what I'm doing, and I'm worried about him getting low overnight while I'm asleep and can't catch it.

Thank you!

 

So is this correct?
Gator on vetsulin

3/3/20 PMPS no test 1.5U
3/4/20 AMPS no test 0.6U
3/4/20 PMPS 172 ???? U

 

No, I've been testing. He was somewhere around 360/370 before his previous insulin doses.

I just retested him at 249 and gave him about .4u. I'm just worried because he hasn't been eating very much and I worry about his glucose going low while I sleep and can't catch it.

 

I'm also brand new to all of this, so I don't know what information everyone needs. Let me know if there are other things that are standard to include.

 

Well, 2 things we like to have are some information in your signature and then have a spreadsheet set up to record the BG readings.

Directions on how to do those 2 things are in this link:
Sticky: New? How You Can Help Us Help You!

 

Thank you, I'll work on that tomorrow. Anything else relevant to tonight that you might be able to share with what I've shared so far, or am I maybe doing okay?

 

You're doing fine so far. If Gator's pre-shot test is below 200, skip the dose. As you have time to see how Gator reacts to the insulin, that "no-shoot" number might drop to closer to 150, but when we start out, a conservative "no-shoot" number is best. It's better to have a day with higher blood glucose than a dangerous hypo event. If the number is too low pre-shot, you can also stall. Wait 20 minutes without feeding and test again.

When your schedule allows, get some mid-cycle BGL tests in. For example, one day you might get a +3 and a +5 (3 hours after injection and 5 hours after injection) The next day you might try to grab a +5 and a +7. Even a +2 before you go to work, for example, can help us paint a picture of how Gator is doing on the insulin. Evening tests are good too, even if it's just a test before bed.

What diet are you feeding? Sugar cats do well on a canned, low carb diet. There's a great food chart here. Monitor closely if you change his diet. Switching to a wet, low carb diet can drop a cats BGL over 100 points. You could end up having to lower his dose.

A couple of things to keep in mind when starting out. Many vets suggest only feeding twice a day, but all diabetics, human and feline, do better on many small meals a day. Just pull any uneaten food 2 hours before test time. Ketones are something to worry about. You can get inexpensive Ketostix at any pharmacy and use them to check Gator's ketones. They test urine.

Hopefully Gator's appetite will pick up. My Billy was so sick when diagnosed, he didn't eat for 3 days. If it continues, speak to your vet about it.

Read the sticky posts, especially in the health links/ FAQs section, and the Vetsulin section. The more you know, the better you'll feel about this. It's overwhelming at first, we've all been there. Knowledge and practice is all it takes to help you help Gator have a happy healthy life.

 

Do you have a hypo tool kit and instructions printed out?
Sticky How to treat HYPOS - THEY CAN KILL! Print this Out!!
Sticky jojo and bunny's HYPO TOOL BOX

 

Why isn't he eating? Not liking a particular food?

 

Thank you so much, that's really helpful! I guess I basically did a stall last night, so I'm glad my instincts are reasonably good on this.

He's very picky on his food, for starters--he eats a widely rotating selection of wet foods and has for several years, so if he doesn't like it or gets the same thing too often, he just won't eat it. He also had his second B12 shot yesterday, so he's perked back up again (it seems to take about 8-12 hours to take effect, but it is HUGELY helpful for him once it does--we're doing them weekly for six weeks, then biweekly, since he's also got assumptive intestinal lymphoma--he ended up diabetic from steroids to control those symptoms). He is a grazer and always has wet food out. He's all about his breakfast this morning, so that's positive!

His highs are already dropping after three insulin doses--he was 311 this morning pre-breakfast. I'll be giving 1u soon, though I'll have to leave for work for a bit and it makes me nervous not to be able to monitor him closely. I work mostly from home with some outside appointments, so I have the freedom to test regularly, and plan to do his glucose curves at home to save him the stress of the all-day vets visits, with the support of our regular vet.

I haven't home tested for ketones yet but he was just officially diagnosed on Tuesday, and was not ketonic at that time, much to the internal medicine specialist's surprise.

 

Hoping this link works. for the new member shopping list.
https://www.facebook.com/notes/feline-diabetes/getting-started-shopping-list/10152642612690202/

 

Thank you so much! I really appreciate all your help.

 

Keep asking questions. It's how we all learn.

Did that shopping list link open ok for you? I think you have to be a member of our sister facebook group to access that link.
I'll go ahead and attach basically the same list, from my Google drive.
Here it is : New Member Shopping List.

 

Always a good idea to check for ketones. Especially with a picky eater new to insulin.

 

It did, thank you. I'll have to figure out how to test for ketones--can you do it in the litter box somehow? I'm sure there are instructions, I'll be wading through all this info over the next few days.

 

Urine Catching Tips document for you.
Fresh urine needed. Test a strip on the litter only first, to make sure the litter does not give a color change on the urine ketone test strip.
Better to catch the urine before it soaks into the litter.

 

If you could change the title on your post, that would be helpful.
Do you know that the editing tools for the thread are up near the top right corner of the screen, to the right of the title for your post?

Remove the ASAP and add anything appropriate you want to know about.

 

Gator's blood sugar has been falling--he had his insulin three hours ago, tested twice in the 80s, and just tested at 78 (AlphaTrak 2). He's had some Fancy Feast Gravies but isn't interested in eating more. What do I do? Syringe feed a bit? Something else? I've got honey if he drops another 10 points.

 

No spreadsheet Jenny, so we need you to list the BG tests in this format.

PMPS 80??? ? Units
+3 78

Could you please fix what I have above, so it has the correct +times and units and shows when you go those 80's

 

It is way past my bedtime and I don't have the spoons to figure that out tonight, but he's back up to 100, so immediate crisis averted.

 

What is PMPS? I can't find it in the stickies I've checked so far.

 

PMPS is PM pre-shot test
AMPS is AM pre-shot test

Explanations are here Understanding the Spreadsheet/Grid

It's some of the terminology we use for our spreadsheets.
Setup instructions for one of our color coded spreadsheets is here
FDMB Spreadsheet Instructions

There is a template you copy. Instructions include setup steps for pc, tablet, and smartphone.

 

Please test again as the numbers can drop.
What are you up to now.....+?
I'll watch for further results

 

I had to go to sleep. He was up to 130 when I did my final test before bed. Currently trying and failing to get him to eat enough to give him his morning insulin.

 

Jenny --

What is his BG number now?

 

267 about an hour ago, pre-insulin. I'll retest him shortly.

 

And he's finally eating a bit more! Maybe his cyproheptadine kicked in--I'm going to have to start giving it earlier, I think.

For background, Gator is 19 with probable intestinal lymphoma--possibly large cell, since the specialist we saw was fairly certain he felt a mass in his intestines--for which I'm seeking symptom control but not a definitive diagnosis and chemo. He developed diabetes as a result of steroids to try to control the IBD/lymphoma symptoms when we were truly unsure which it was, and now that I've backed his dose down, he's having more symptoms again and less excited about eating. I'm in discussions with my vet about whether we can just up his steroids again to keep him more comfortable since he's already diabetic and on insulin, and I'm monitoring him. My goal with him is to keep him as comfy as possible until he tells me he doesn't want to be here anymore, or his bad days outnumber the good. He is my heart, and I am sure this is the right decision for him. We saw the specialist this week, so it's been really hard and emotional, and we're also moving apartments in two weeks.

I'm going to run out for more carby food for him in case, and a bunch of other stuff so hopefully I can find more things he'll like, and I'll retest when I get back. I'm still not very good at sticking him and I'm doing terrible things to his ears, and he's holding his ears more closely to his head than he was a few days ago when I go to stick him. Our Neosporin ointment arrives today, so I'm hoping that will help. I'll start spreadsheeting today, too, and see what else I can figure out. This has all been exhausting (and on top of a major stomatitis flare of one of my permanent foster girls, though she's largely better now).

I truly appreciate everyone's help, I'm just trying to figure out what I'm doing while allowing Gator to feel as good as possible, with the minimum intervention I can manage (which I imagine will come with another couple weeks' experience as I start to get a better feel for it).

Thank you.

 

+2 104

I'm giving him a little Fancy Feast Gravies, and he's eaten a bit, but not a lot.

So
PMPS 267, .5 Units
+2 104

Did I do that right?

 

Jenny, please let us know how else we may help you and Gator.

 

He also drank a ton of water when his blood sugar was low last night, I'm not sure why. I'm able to get him to eat a little more by placing his food back in front of him when he gets up, and he does seem to be moving around okay.

 

Thank you, I'm trying. There's just so much that it's a little overwhelming, so I'm trying to figure out what to do, and what the plan is when his sugar is trending low (carby foods, retest, honey if he gets 68 or lower?).

 

Incidentally, Gator is also in kidney failure, probably still around stage 2. It's actually the least of our worries--he does super well with fluids and his phosphorus binder, and some calcitriol, but I don't know if or how that impacts his blood sugar.

 

Yes, that looks right.
Would you please update your signature so we can have some basic information at the end of your post?

Go to the upper right, click on your user name, select "Signature" from the drop down list, Start typing away in the text box.

Your first name, cats name, age & sex, Diagnosis date, insulin used, meter used for testing, any concurrent medical conditions (the lymphoma,CKD stage 2, phos binder).

Then click on Save Changes. Would you do that for us please?

 

Yes, thank you for breaking that down for me. It was one of the things I was going to work on today but that just made it easy, and I really appreciate that!

 

It wouldn't let me add all this, but in case it's relevant:

CKD, partial motor seizures, and arthritis are well controlled. GI symptoms are problematic.

Other meds: Calcitriol, aluminum hydroxide phosphorus binder, fluids (50 CCs twice a day), cyproheptadine, metronidazole, budesonide, ondanstron, Adequan, B12 injections.
Supplements: CBD, Miralax, Kidney Gold, probiotics, hyaluronic acid.

I'm also adding in some famotidine starting tonight.

 

Jenny & Gator,M,age 19, DX: 3/3/20, Vetsulin, AlphaTrak 2|diet wet, wide selection|CKD stage 2| suspected large cell lymphoma|arthritis, partial motor seizures|GI symptoms problematic; phos binder| SEE profile for more|Gator's SS

You could copy and paste the above to your signature. Getting close to the 250 character limit with what is above.

Condensed what you had, since you will need to leave room for the SS link. I put in the words for the SS link. When you get to that point, simply highlight the words Gator's SS with your cursor. Then click on the link edit icon (7 from left in post edit icons), and paste the link you copied back when you followed the setup directions for the SS template.

You could put some of the other meds and supplements in your user profile.

I'll give you some info on how to do that soon.

 

What is the BG level right now?

 

Done, thank you.

He's at 149, so he's coming up.

He is also deeply over these terrible things I'm doing to his poor ears.

 

What time in + hours was that 149 BG reading?

Was the 267 from today 3/7?

AMPS 267, .5 Units
+2 104
+? 149

It's early yet in the 12 hour dosing cycle, if it's before +6.

To add information to your user profile, click on your user name in the upper right hand corner.
Click on "your profile page" next to your avatar.
There are 4 tabs across the top.
Select the one that says "Information"
That is where you can list more medications and medical conditions and supplements.

 

+2.5 149

He hasn't been eating well, so it's harder to regulate him. I'm also super open to switching his insulin to a Lantus pen now that I've read more about it, but I don't know that it's a good idea to do that after only a few days on Vetsulin.

 

Sorry, what is SS? Is that his tracking sheet?

 

Sorry, that's +3.5 149

 

SS is shorthand for the spreadsheet. Where you would record the insulin doses, blood glucose tests, etc.

The Vetsulin usually has a duration of 8-10 hours in most cats.

AMPS 267, .5 Units
+2 104
+3.5 149

Are all these BG (blood glucose) readings from today, 3/7?

 

Yes, all from today.

AMPS 267, .5 Units
+2 104
+3 124
+3.5 149

 

Jenny,

Vetsulin usually has a 8-10 hour duration in most cats.
But it can last longer than that.
We don't know how long this insulin lasts for Gator.
That is why it's important to test for a few more hours this dosing cycle.
A cycle is a 12 hour period, from one pre-shot test, to the next pre-shot test.

Since you don't know when Gator has his nadir (lowest point in the cycle), it's going to be important to get a few more tests, to see when or if Gator goes lower.

That low or nadir is often around +5 with Vetsulin, but it can be later at +6 or +7. ECID Every Cat is Different.

Will you be able to test Gator more today?

I will not be able to stay for more than 30 minutes more. I have to leave to take care of someone else's cat, at 1:30 PM EST. I've sent a PM to a couple of people, to look out for you, but don't know if they have seen it.

If you have any numbers that are <100, please change your thread title to get more help.
Especially any numbers below 90 when using a pet meter, such as the Alphatrak you use, when using Vetsulin are of concern.

 

Jenny, could you review and see about getting the Spreadsheet set up?
http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

It's kinda challenging going thru all these posts and figuring out what's going on with Gator's numbers...

It would be a great place to get a good foundation for next steps...I hope this is helpful...

 

I'm one of the people Deb asked to lend a hand.

I'm not a big fan of Vetsulin. It's not a particularly good insulin for cats for 2 reasons. As Deb noted, it doesn't give you as much duration as either Lantus or Prozinc. It also tends to be harsh -- it can drop numbers hard and fast. The American Animal Hospital Assn no longer recommends Vetsulin for cats. (It was originally developed for dogs, which is why there are some of the issues with cats. Cats have a much faster metabolism.) This is my long way of saying if you have other options for insulin, you may want to consider them.

It will help us greatly if you can get a spreadsheet set up. It keeps all of your test data in one place and it's much easier for us to look at a spreadsheet versus scrolling through a thread to find the information, especially given how long this thread is getting.

With respect to both the cyproheptadine, you need to give an appetite stimulant at least 30 min prior to feeding Gator. An hour may even be better. You want to give it a chance to work before feeding your kitty. The ondansatron also needs to be dosed prior to the cypro -- you do not want to give a nauseated cat an appetite stimulant. If you do, and then present food, there's a good chance you'll create a food aversion. If nausea is continuing to be an issue, you can talk to your vet about getting a prescription for Cerenia. It works differently than ondansetron and may help to get any nausea/vomiting under control. It also has an anti-inflammatory property which may help with some of the GI issues.

It's also important to have food on board before giving Vetsuln. Ideally, you need to feed about 30 min. before a shot.

 

I am definitely open to switching insulin, and I may just cut to the chase and get a Lantus pen. If I just started Gator on insulin, is it better to get a sense of how it works for him generally, or should I see about switching sooner than later?

I will try to get the spreadsheet set up this evening. I've started using it, I'll figure out how to link it.

I'll start giving the cyproheptadine earlier. It doesn't always work for him, but it's our current best shot. Our current med regimen has been around 10am and pm, with insulin around 8 or 9, so I'll move his meds earlier. His ondansetron doesn't always work perfectly for him, but he actually reacts extremely poorly to Cerenia--stops eating, feels awful, lies around on the floor by the water fountain, etc. I know it's an atypical reaction, but it's an unworkable med for him, unfortunately-when I had him on it for a few weeks, I thought his kidney disease was progressing rapidly based on his behavior until we got more bloodwork and it became clear that that wasn't the problem.

I'm trying to feed before his shot but he isn't currently eating very well, but hopefully moving his meds earlier will help with this.

Gator and I ended up napping and I'm trying to give his poor ears a chance to heal a bit (and I'm afraid it may be becoming mildly traumatic for him), but I'll be home almost the whole day tomorrow and will plan to test him every hour to see if I can figure out where his high and low points are more definitively. I'll be doing his glucose curve at home instead of at the vet's office as well, with their input, to minimize his stress.

I really appreciate everyone's help with this, and thank you for your patience as I figure out how to get set up in ways that will help you help me better. I promise I'm working on it!

 

A small amount of Neosporin with Pain Relief ointment may help with Gator's ears. If you use a small amount, it can help the blood to bead up when you poke as well as numb his ear a bit.

At least you know the Cerenia is a no-go.

Be aware that Lantus is pricey. Getting one pen is a good way to cut the cost. You may need to call around to see if a pharmacy will sell a single pen. They come in a box of 5 and some places will not break up a box. Remember to try at Costco and Sam's Club, as well as other places. Many people here buy their Lantus from Canada due to the cost. (The price from a Canadian pharmacy is about 1/3 to 1/2 the price in the US.)

 

Hi I'm sorry I can't suggest much only that when my cat was on Vetsulin he did fairly well, when I saw he was dropping to fast I would try to feed him a small amount one hour after giving the insulin.

He has been on lantus for quite awhile now and is doing fantastic
As Sienna said it is expensive and buy from Canada

We also have a supply closet here where kitties that have passed their owners will sell the lantus pens they haven't used.
I myself have bought 5 pens in the past very cheap
I see someone has some for sale right now for 30.00 per pen expiration date 2-2022
I don't know where you live to see if they would ship, if you live in Canada you would be better off getting them there, so take a look at the supply closet,
Tap on forums and you will see Supply Closet,
Also the expiration date is good until what it says on them as long as you don't have to use it yet, just keep them in the fridge
With the pens they only have full units on them
So most all of us buy U-100 syringes with half unit markings
so you can be able to increase or decrease by 0.25 units or 0.5 units
But we can explain that to you if you decide to switch

 

Marks Marine Pharmacy, is used by hundreds of our members, both here and on our sister facebook site. Information about ordering is in this link>>>>>> Ordering Lantus, Basaglar, or Levemir from Canadian pharmacies

 

Thank you, I'll check all of that out. I'm in the US, and I'd prefer to buy one pen at a time if possible, but it also depends on the price.